The Incest Cycle Across Generations
by Carole Bennett, RN, MN
Using the theories of Murray Bowen and the teackings offoseph Campbell, the author presents a clinical case to demonstrate how generations ofsexual
abuse led to anxiety symptoms in the ofspring. Methods used to obtain and interpret the multigenerational family genogram, and the significance of family myths in sustaining dysfunctional patterns,
are reviewed.
T h e intergenerational transmission of mental illness occurs as patterns of physical and sexual abuse are repeated in generation after generation. The move from abused-to-abuser has been well-documented. Fraiberg, Adelson, and Shapiro (1975) claim: "A parent is condemned to repeat the tragedy of k s childhood with his own baby in terrible and exacting detail" (p. 388). Indeed, adults who have been physically or sexually abused as children are at risk for becoming abusing parents (Freeman-Longo, 1986). Or, a female child victim may marry an abusive man and fail to provide her children with needed protection. The devastating consequences of this cycle is thus transmitted from generation to generation. Assessing the family, using the genogram, provides a means by which the abuse cycle can be identified. Reviewing with a client and his or her family, the nurse therapist can use the information revealed in the multigenerational famdy genogram to provide an excellent context for treatment and the empowermentneeded for change.
Overview of Bowen's Family Systems Theory Murray Bowen (1978) views the family as a multigenerational system characterized by certain patterns of emotional interaction. Bowen has identified eight interrelated concepts, which together describe emotional family functioning (Cain, 1986). When an individual's dysfunction is understood as a symptom of anxiety within the family system, assessment and intervention will logically take place at the family system level (Bowen). Understanding these concepts provides the nurse with a framework for assessing the family system. Bowen's concepts relevant to a family assessment include:
Differentiation of self: This term refers to an individual's level of emotional independence or maturity. Low differentiation of self indicates a lack of distinction between thinking and feeling. This confusion results in poor decision making, which is based on emotional responses rather than cognitive appraisals. Within relationships, low differentiaPerspectivesin Psychiatric Care Vol. 28, No. 4, October-December,1992
19
~
~-
The Incest Cycle Across Generations
tion results in behavior that is guided primarily by perceptions of others in the family. Little distinction is made between self and others. Families with low differentiation are characterized by high levels of anxiety, high levels of depression, &d complex health problems (Bowen, 1978).
Multigenerational transmission: People tend to marry individuals with similar levels of differentiation of self; thus comparable levels of differentiation are passed on to the next generation unless interventions are made to increase emotional autonomy. For example, people who have been abused and people who are potential abusers will unknowingly attract each other. Both of them will have poorly differentiated selves. Triangle: Relationships between two individuals are potentially very unstable because of tension and intensity. Whenever anxiety develops in the relationshp, a thxd person or entity is drawn into the dyad to reduce the anxiety within and a triangle is formed. A common example of this scenario occurs when a couple decide to have a baby to avoid some conflict or disappointmentin the dyad relationship. Family projection:When a triangle has been formed, the thxd person who has been drawn in will become the f m s of intense affect.That is, the dyad wiU focus their anxiety on the third person, who often becomes dysfunctional and the ”identified patient.” The child who is having a normal developmental crisis might be described as extremely dysfunctional by overly anxious parents and become the ”sick or ’ b a d one within the system. Sibling position: Family position, or seniority, and gender distribution have important effects on role function within a family, as well as subsequent parent effectiveness(Toman, 1976). For instance, adults who grow up in female-only or male-only sibling groups are disadvantaged when parenting an 20
opposite sex child. Also, different sibling positions develop particular characteristics. Youngest children, for instance, have little leadership experience and may be poorly prepared to be a single parent.
Emotional cutoff: Family members may use emotional cutoff to distance themselves from emotional intensity in an undifferentiated family system. However, this coping method reduces the extended family support system, placing additional stress on the nuclear family to meet the emotional needs of its individuals. Nuclear family emotional system: This concept refers to the emotional system within one generation of a family. Three types of dysfunctional attempts to cope with high levels of anxiety within the nuclear family include marital conflict, dysfunction of a spouse, and projection to a child (Hall, 1981). Symptomatic children may be part of a family system in which the mother is functioning poorly or the marriage is stressed. Or, the family may appear to be completely calm and well-functioning, except for the symptomatic child. Societal regression: The concept of societal regression considers the complex network of organizations, such as schools, which families and individuals encounter over time. The larger network may replicate the family-of-origin dynamics, while changes in the family can effect change in the larger social system. Family Myths in the Abusive Family System Within all families, various myths operate that influence each member’s understanding of his or her life. Myths can be described as stories, part fact and part fiction, which reveal or explain some aspect of human behavior (Grolnick, 1983). Famihes create stories to explain behavior that might otherwise be difficult to understand. Thus, myths serve to validate nonns and behaviors of spec& groups of people. Perspectives in Psychiatric Care Vol. 28, No. 4, October-December,1992
In a dysfunctional family system, myths also function to maintain low differentiation of self among its members. In a family system where incest is present, members unconsciously accept the myth that it is OK for adults to violate children and for men to violate women. Acceptance of this myth leads individuals to join into a conspiracy of silence. In this way, myths generate unconscious assumptions about life, which influence the development of subsequent family relationships, particularly the mother/child relationship (Seltzer & Seltzer, 1983). The anxiety and undifferentiation within the parental generation are thus transmitted to the next generation (Kerr, 1988). Family myths are revealed as the nurse identifies dysfunctional patterns that have been repeated for generations. Once family myths that underlie dysfunctional assumptions and patterns are revealed and clarified, the myth is disempowered in its "hold on the family system. Myths can be discovered by skillfully constructing a multigenerational f d y genogram, which both documents significant events and describes intimate family relatiomhips.
Family Assessment and the Genogram The genogram is a graphic representation of at least several consecutive generations within a family system, and contains genetic, relational, and circumstantial information (Jolly, F r o m , & Rosen, 1986).The information is obtained in a highly structured interview, which usually can be sufficiently completed in a 90-minute session. When the identified client is a child, the interview is organized to identify the level of anxiety experienced by his or her parent during childhood. Such information helps to clarify how the parents' anxiety is currently being transmitted to his or her own child in the present. Throughout the interview, the nurse poses questions in such a way as to enable the parent to describe intimate family experiences perhaps never before revealed (Table 1).Textbook or sterile questioning does not elicit the needed information. Instead, the interview must be approached as though the nurse and parent are partners in a focused inquiry that will ultimately prove useful and Perspectives in Psychiatric Care Vol. 28, No. 4, October-December,1992
Table 1. Family Genogram Interview Introduction 1. Give explanation. 2. Determine time requirement. 3. Request cooperation. 4. Get agreement to begin.
First Generation: Grandparents 1. Names of grandparents ( b e p with mother's parents) 2. Living or deceased (causeof death and date of death) 3. Age and health status 4. History of psychiatricillness, arrests, sexual or physical abuse, alcohol or substance abuse 5. Health of relationship to the mother 6. Names and ages of children, starting with oldest: histories as in #4 above
Second Generation: Parents 1. Experience of being parented, experienceof childhood 2: Level of education 3. Employmenthistory 4. History of abuse/victimization 5. History of psychiatricillness, arrests, substance abuse 6. Way in which parents met 7. Health of relationship 8. Names and ages of children 9. Relationshipwith each child 10. Relationship with siblings 11. Divorces, remarriages, significant relationships 12. Other nodal events
Third Generation: Children 1. Pregnancy with index child 2. Birth of index child 3. Development of index child 4. Relationship with index child 5. Time of first concern 6. Schoolreports 7. Illnesses or hospitalizations,prior treatment 8. Relationshipsof index child with stepparents, other adults 9. Abuse history: physical or sexual 10. Circumstancesthat precipitated hospitalization
21
~~~~~~~
~
~
~
~
The Incest Cycle Across Generations
liberating. By the end of the interview, the nurse and the parent should have a clear perception of how the family dynamics over several generations have contributed to the child’s present dysfunction, or perceived dysfunction. Clinical Illustration
The following example illustrates how generations of abuse influenced one mother’s perceptions of her son. Sam, a 9-year-old boy, was referred for evaluation due to symptoms of anxiety, intrusiveness, and irritability. HIS teachers noted that he had poor concentration and displayed hyperactive behavior. The author interviewed his mother, Mrs. G., to obtain a multigenerational family genogram, which is summarized in Figure 1. The genogram graphically demonstrates how patterns of relationships are passed from one generation to the next. The repetition of sexual abuse across generations is very characteristic of undifferentiated families. From constructing the genogram, Mrs. G. gained insight about how the lives of women in her family were dominated by attracting,adapting to, and rejecting abusive men.
While the dyads within t h s family system with high anxiety are numerous, the two most highly charged ones are Mrs. G.’s relationship with her biological father, who reportedly sexually abused her sister, and with her exhusband, who abandoned her without providing any child support. Because Mrs. G. had been unable to confront her father and her ex-husband, she projected this anxiety onto her oldest son. Since Sam was drawn into a triangle in a family system where males constantly had been dyshctional, it is not surprising that he was ”chosen” to experience and express the family’s anxiety. Mrs. G. grew up in a family with two sibling subsets of an older sister and younger brother. Both older daughters were abused by stepfathers and were emotionally close to a dependent, younger brother. As adults, each chose abusive, emotionally dependent men as marital partners. The patterns of incest, husbands abusing stepdaughters, and a husband abusing and impregnatinghis wife’s younger sister, resulted in emotional distancing between the women in the family. Each woman then turned to her nuclear family for emotional support,placing more tension and dependency on the already dysfunctional nuclear family.
Figure 1. Multigenerational Family Genogram
A = person being interviewed identified patient or index person x deceased &= sexual abuse 24= emotional distance @= 2
22
+., = conflict/physical abuse -cc
a
.divorce = married relationship unmarried relationship
Perspectives in Psychiatric Care Vol. 28, No. 4, October-December, 1992
Mrs. G. began to contact extended family members to discuss the myth that had plagued her family for generations (that abuse is OK) and found support from these women. She was able to confront her father regarding his sexual abuse of her half-sister and to seek legal assistance for obtaining child support from her ex-husband. As this family discovered its myth and explored the generations of abuse and its consequences, Mrs. G. began to practice new methods of communicating with her son. As she gained insight into the various family relationships, the son’s behavior began to change. His school adjustment improved and he successfully completed the school year. Without the use of the multigenerational genogram, significant information might have been overlooked, leaving the myth an unspoken secret in the family history.
Assisting parents to explore the trauma of their childhood is essential in interrupting the intergenerational transmission of childhood abuse and its sequelae. Bowen’s genogram proves an effective tool for accessing and exploring these experiences, and for helping family members to free themselves from the devastation o f unchallenged family myths.
When therapy allows parents to remember
Freeman-Longo,R. (1986).The impact of sexual victimization on maies. Child Abuse and Neglect, 10,411414.
and reexperience their childhood anxiety
References Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson. Cain, A. (1986).Family therapy: One role of the clinical specialist in psychiatric nursing. Nursing Clinicsof North America, 2,48.3-392. Fraiberg, S., Adelson, E., & Shapiro, V. (1975).Ghosts in the nursery: A psychoanalytic approach to the problems of impaired infantmother relationships. Journal of the American Academy of Child Psychiatry, 14(3),387-421.
Grolnick, L. (1983). Ibsen’s truth, family secrets, and family therdpy. The Family Process, 22(9), 275-288.
and suffering, ”the ghosts depart, and the afflicted parents become the protectors of
Hall, C. (1981). The Bowen family theonj and its uses. New York: Jason Aronson.
their children against the repetition of their
Jolly, W., F r o m , J., & Rosen, M. (1986). The genogram. Tke Family Practice, 10(2),251-255.
own conflicted past” (Fraiberg et al., 1975,
Kerr, M. (1988). Family evaluation: An approach based on Bo7ot.n theory. New York Norton.
p. 420-421).
When therapy allows parents to remember and reexperience their childhood anxiety and suffering, ”the ghosts depart, and the afflicted parents become the protectors of their children against the repetition of their own conflicted past” (Fraiberg et al., 1975, p. 420-421). Perspectivesin Psychiatric Care Vol. 28, No. 4, October-December,1992
of
Seltzer, W., & Seltzer, M. (1983). Material, myth and magic: A culhu’al approach to family therapy. ??zeFamily Process, 22(1), 3-14, Toman, W. (1976).Family constellation. New York Springer.
Conclusion
]inmid
by Carole Bennett, RN, MN
Using the theories of Murray Bowen and the teackings offoseph Campbell, the author presents a clinical case to demonstrate how generations ofsexual
abuse led to anxiety symptoms in the ofspring. Methods used to obtain and interpret the multigenerational family genogram, and the significance of family myths in sustaining dysfunctional patterns,
are reviewed.
T h e intergenerational transmission of mental illness occurs as patterns of physical and sexual abuse are repeated in generation after generation. The move from abused-to-abuser has been well-documented. Fraiberg, Adelson, and Shapiro (1975) claim: "A parent is condemned to repeat the tragedy of k s childhood with his own baby in terrible and exacting detail" (p. 388). Indeed, adults who have been physically or sexually abused as children are at risk for becoming abusing parents (Freeman-Longo, 1986). Or, a female child victim may marry an abusive man and fail to provide her children with needed protection. The devastating consequences of this cycle is thus transmitted from generation to generation. Assessing the family, using the genogram, provides a means by which the abuse cycle can be identified. Reviewing with a client and his or her family, the nurse therapist can use the information revealed in the multigenerational famdy genogram to provide an excellent context for treatment and the empowermentneeded for change.
Overview of Bowen's Family Systems Theory Murray Bowen (1978) views the family as a multigenerational system characterized by certain patterns of emotional interaction. Bowen has identified eight interrelated concepts, which together describe emotional family functioning (Cain, 1986). When an individual's dysfunction is understood as a symptom of anxiety within the family system, assessment and intervention will logically take place at the family system level (Bowen). Understanding these concepts provides the nurse with a framework for assessing the family system. Bowen's concepts relevant to a family assessment include:
Differentiation of self: This term refers to an individual's level of emotional independence or maturity. Low differentiation of self indicates a lack of distinction between thinking and feeling. This confusion results in poor decision making, which is based on emotional responses rather than cognitive appraisals. Within relationships, low differentiaPerspectivesin Psychiatric Care Vol. 28, No. 4, October-December,1992
19
~
~-
The Incest Cycle Across Generations
tion results in behavior that is guided primarily by perceptions of others in the family. Little distinction is made between self and others. Families with low differentiation are characterized by high levels of anxiety, high levels of depression, &d complex health problems (Bowen, 1978).
Multigenerational transmission: People tend to marry individuals with similar levels of differentiation of self; thus comparable levels of differentiation are passed on to the next generation unless interventions are made to increase emotional autonomy. For example, people who have been abused and people who are potential abusers will unknowingly attract each other. Both of them will have poorly differentiated selves. Triangle: Relationships between two individuals are potentially very unstable because of tension and intensity. Whenever anxiety develops in the relationshp, a thxd person or entity is drawn into the dyad to reduce the anxiety within and a triangle is formed. A common example of this scenario occurs when a couple decide to have a baby to avoid some conflict or disappointmentin the dyad relationship. Family projection:When a triangle has been formed, the thxd person who has been drawn in will become the f m s of intense affect.That is, the dyad wiU focus their anxiety on the third person, who often becomes dysfunctional and the ”identified patient.” The child who is having a normal developmental crisis might be described as extremely dysfunctional by overly anxious parents and become the ”sick or ’ b a d one within the system. Sibling position: Family position, or seniority, and gender distribution have important effects on role function within a family, as well as subsequent parent effectiveness(Toman, 1976). For instance, adults who grow up in female-only or male-only sibling groups are disadvantaged when parenting an 20
opposite sex child. Also, different sibling positions develop particular characteristics. Youngest children, for instance, have little leadership experience and may be poorly prepared to be a single parent.
Emotional cutoff: Family members may use emotional cutoff to distance themselves from emotional intensity in an undifferentiated family system. However, this coping method reduces the extended family support system, placing additional stress on the nuclear family to meet the emotional needs of its individuals. Nuclear family emotional system: This concept refers to the emotional system within one generation of a family. Three types of dysfunctional attempts to cope with high levels of anxiety within the nuclear family include marital conflict, dysfunction of a spouse, and projection to a child (Hall, 1981). Symptomatic children may be part of a family system in which the mother is functioning poorly or the marriage is stressed. Or, the family may appear to be completely calm and well-functioning, except for the symptomatic child. Societal regression: The concept of societal regression considers the complex network of organizations, such as schools, which families and individuals encounter over time. The larger network may replicate the family-of-origin dynamics, while changes in the family can effect change in the larger social system. Family Myths in the Abusive Family System Within all families, various myths operate that influence each member’s understanding of his or her life. Myths can be described as stories, part fact and part fiction, which reveal or explain some aspect of human behavior (Grolnick, 1983). Famihes create stories to explain behavior that might otherwise be difficult to understand. Thus, myths serve to validate nonns and behaviors of spec& groups of people. Perspectives in Psychiatric Care Vol. 28, No. 4, October-December,1992
In a dysfunctional family system, myths also function to maintain low differentiation of self among its members. In a family system where incest is present, members unconsciously accept the myth that it is OK for adults to violate children and for men to violate women. Acceptance of this myth leads individuals to join into a conspiracy of silence. In this way, myths generate unconscious assumptions about life, which influence the development of subsequent family relationships, particularly the mother/child relationship (Seltzer & Seltzer, 1983). The anxiety and undifferentiation within the parental generation are thus transmitted to the next generation (Kerr, 1988). Family myths are revealed as the nurse identifies dysfunctional patterns that have been repeated for generations. Once family myths that underlie dysfunctional assumptions and patterns are revealed and clarified, the myth is disempowered in its "hold on the family system. Myths can be discovered by skillfully constructing a multigenerational f d y genogram, which both documents significant events and describes intimate family relatiomhips.
Family Assessment and the Genogram The genogram is a graphic representation of at least several consecutive generations within a family system, and contains genetic, relational, and circumstantial information (Jolly, F r o m , & Rosen, 1986).The information is obtained in a highly structured interview, which usually can be sufficiently completed in a 90-minute session. When the identified client is a child, the interview is organized to identify the level of anxiety experienced by his or her parent during childhood. Such information helps to clarify how the parents' anxiety is currently being transmitted to his or her own child in the present. Throughout the interview, the nurse poses questions in such a way as to enable the parent to describe intimate family experiences perhaps never before revealed (Table 1).Textbook or sterile questioning does not elicit the needed information. Instead, the interview must be approached as though the nurse and parent are partners in a focused inquiry that will ultimately prove useful and Perspectives in Psychiatric Care Vol. 28, No. 4, October-December,1992
Table 1. Family Genogram Interview Introduction 1. Give explanation. 2. Determine time requirement. 3. Request cooperation. 4. Get agreement to begin.
First Generation: Grandparents 1. Names of grandparents ( b e p with mother's parents) 2. Living or deceased (causeof death and date of death) 3. Age and health status 4. History of psychiatricillness, arrests, sexual or physical abuse, alcohol or substance abuse 5. Health of relationship to the mother 6. Names and ages of children, starting with oldest: histories as in #4 above
Second Generation: Parents 1. Experience of being parented, experienceof childhood 2: Level of education 3. Employmenthistory 4. History of abuse/victimization 5. History of psychiatricillness, arrests, substance abuse 6. Way in which parents met 7. Health of relationship 8. Names and ages of children 9. Relationshipwith each child 10. Relationship with siblings 11. Divorces, remarriages, significant relationships 12. Other nodal events
Third Generation: Children 1. Pregnancy with index child 2. Birth of index child 3. Development of index child 4. Relationship with index child 5. Time of first concern 6. Schoolreports 7. Illnesses or hospitalizations,prior treatment 8. Relationshipsof index child with stepparents, other adults 9. Abuse history: physical or sexual 10. Circumstancesthat precipitated hospitalization
21
~~~~~~~
~
~
~
~
The Incest Cycle Across Generations
liberating. By the end of the interview, the nurse and the parent should have a clear perception of how the family dynamics over several generations have contributed to the child’s present dysfunction, or perceived dysfunction. Clinical Illustration
The following example illustrates how generations of abuse influenced one mother’s perceptions of her son. Sam, a 9-year-old boy, was referred for evaluation due to symptoms of anxiety, intrusiveness, and irritability. HIS teachers noted that he had poor concentration and displayed hyperactive behavior. The author interviewed his mother, Mrs. G., to obtain a multigenerational family genogram, which is summarized in Figure 1. The genogram graphically demonstrates how patterns of relationships are passed from one generation to the next. The repetition of sexual abuse across generations is very characteristic of undifferentiated families. From constructing the genogram, Mrs. G. gained insight about how the lives of women in her family were dominated by attracting,adapting to, and rejecting abusive men.
While the dyads within t h s family system with high anxiety are numerous, the two most highly charged ones are Mrs. G.’s relationship with her biological father, who reportedly sexually abused her sister, and with her exhusband, who abandoned her without providing any child support. Because Mrs. G. had been unable to confront her father and her ex-husband, she projected this anxiety onto her oldest son. Since Sam was drawn into a triangle in a family system where males constantly had been dyshctional, it is not surprising that he was ”chosen” to experience and express the family’s anxiety. Mrs. G. grew up in a family with two sibling subsets of an older sister and younger brother. Both older daughters were abused by stepfathers and were emotionally close to a dependent, younger brother. As adults, each chose abusive, emotionally dependent men as marital partners. The patterns of incest, husbands abusing stepdaughters, and a husband abusing and impregnatinghis wife’s younger sister, resulted in emotional distancing between the women in the family. Each woman then turned to her nuclear family for emotional support,placing more tension and dependency on the already dysfunctional nuclear family.
Figure 1. Multigenerational Family Genogram
A = person being interviewed identified patient or index person x deceased &= sexual abuse 24= emotional distance @= 2
22
+., = conflict/physical abuse -cc
a
.divorce = married relationship unmarried relationship
Perspectives in Psychiatric Care Vol. 28, No. 4, October-December, 1992
Mrs. G. began to contact extended family members to discuss the myth that had plagued her family for generations (that abuse is OK) and found support from these women. She was able to confront her father regarding his sexual abuse of her half-sister and to seek legal assistance for obtaining child support from her ex-husband. As this family discovered its myth and explored the generations of abuse and its consequences, Mrs. G. began to practice new methods of communicating with her son. As she gained insight into the various family relationships, the son’s behavior began to change. His school adjustment improved and he successfully completed the school year. Without the use of the multigenerational genogram, significant information might have been overlooked, leaving the myth an unspoken secret in the family history.
Assisting parents to explore the trauma of their childhood is essential in interrupting the intergenerational transmission of childhood abuse and its sequelae. Bowen’s genogram proves an effective tool for accessing and exploring these experiences, and for helping family members to free themselves from the devastation o f unchallenged family myths.
When therapy allows parents to remember
Freeman-Longo,R. (1986).The impact of sexual victimization on maies. Child Abuse and Neglect, 10,411414.
and reexperience their childhood anxiety
References Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson. Cain, A. (1986).Family therapy: One role of the clinical specialist in psychiatric nursing. Nursing Clinicsof North America, 2,48.3-392. Fraiberg, S., Adelson, E., & Shapiro, V. (1975).Ghosts in the nursery: A psychoanalytic approach to the problems of impaired infantmother relationships. Journal of the American Academy of Child Psychiatry, 14(3),387-421.
Grolnick, L. (1983). Ibsen’s truth, family secrets, and family therdpy. The Family Process, 22(9), 275-288.
and suffering, ”the ghosts depart, and the afflicted parents become the protectors of
Hall, C. (1981). The Bowen family theonj and its uses. New York: Jason Aronson.
their children against the repetition of their
Jolly, W., F r o m , J., & Rosen, M. (1986). The genogram. Tke Family Practice, 10(2),251-255.
own conflicted past” (Fraiberg et al., 1975,
Kerr, M. (1988). Family evaluation: An approach based on Bo7ot.n theory. New York Norton.
p. 420-421).
When therapy allows parents to remember and reexperience their childhood anxiety and suffering, ”the ghosts depart, and the afflicted parents become the protectors of their children against the repetition of their own conflicted past” (Fraiberg et al., 1975, p. 420-421). Perspectivesin Psychiatric Care Vol. 28, No. 4, October-December,1992
of
Seltzer, W., & Seltzer, M. (1983). Material, myth and magic: A culhu’al approach to family therapy. ??zeFamily Process, 22(1), 3-14, Toman, W. (1976).Family constellation. New York Springer.
Conclusion
]inmid
