UNDERSTANDING THE INDIAN MODERN FAMILY FROM A PSYCHOTHERAPEUTIC STANDPOINT - एक मनोचिकित्सा स्टैडपॉइंट से भारतीय आधुनिक परिवार को समझना

UNDERSTANDING THE INDIAN Modern FAMILY FROM A PSYCHOTHERAPEUTIC STANDPOINT

Role of culture and collectivism in shaping the family

Families do not exist in isolation and family dynamics are often best interpreted in the context of their societal and cultural background. Culture has been shown to determine the family structure by shaping the family type, size, and form[3,4] and the family functioning by delineating boundaries, rules for interaction, communication patterns, acceptable practices, discipline and hierarchy in the family.[4–6] The roles of family members are determined largely by cultural factors (as well as stages of the family life cycle),[4,7] and finally, culture also explains families’ ways of defining problems and solving them.[7]

Culture, however, is not an external passive influence on the families but families themselves serve as the primary agent for transferring these cultural values to their members.[8] Parents help children to learn, internalize, and develop understanding of culture through both covert and overt means.[9] Family members modify behaviors in themselves and others by principles of social learning. In this process, the general norms and beliefs may be modified to suit the needs of the family creating a set of “family values” – A subset of societal norms unique to the family.

It is imperative then, that therapists understand the impact of culture on family functioning as well as in conflict resolution and problem-solving skills of the family members.[10] One such important dimension of Asian and particularly Indian culture that affects family functioning is collectivism.[11–13] “Collectivism” refers to the philosophic, economic, or social outlook that emphasizes the interdependence amongst human beings. It is the basic cultural element for cohesion within social groups, which stresses on the priority of group goals over individual goals in contrast to “individualism”, which emphasizes on what makes the individual distinct, and promotes engagement in competitive tasks. “Horizontal collectivism” refers to the system of collective decision-making by relatively equal individuals, for example, by the intra-generational family member; while “vertical collectivism” refers to hierarchical structures of power in a collectivistic family, for example, inter-generational relations in a three generation family.

Classically, the cultures of Western Europe and North America with their complex, stratified societies, where independence and differences are emphasized, are said to be individualistic, whereas in Asia, Africa, parts of Europe and Latin America where agreeing on social norms is important and jobs are interdependent, collectivism is thought to be preponderant.[14,15] Studies comparing Caucasians or Americans with people from Asian cultures, such as Vietnamese or Filipino[13,16] do show that individualistic societies value self-reliance, independence, autonomy and personal achievement,[16] and a definition of self apart from the group.[13] On the other hand, collectivistic societies value family cohesion, cooperation, solidarity, and conformity.[16]

Such cultural differences mean that people in different cultures have fundamentally different constructs of the self and others. For more collectivistic societies like ours, the self is defined relative to others, is concerned with belongingness, dependency, empathy, and reciprocity, and is focused on small, selective in-groups at the expense of out-groups. Relationships with others are emphasized, while personal autonomy, space and privacy are considered secondary.[17] Application of western psychotherapy, primarily focused on dynamic models, ego structure and individuals, therefore, becomes difficult in the Indian collectivistic context. The point has been well discussed by Indian psychiatrists in the past. As early as in 1982, Varma expressed limitations to the applicability of the Western type of psychotherapy in India,[18] and cited dependence/interdependence (a marker of collectivism) in Indian patients with other family members as foremost of the seven difficulties in carrying out dynamic and individual oriented psychotherapy. Surya and Jayaram have also pointed out that the Indian patients are more dependent than their western counterparts.[19] Neki, while discussing the concepts of confidentiality and privacy in the Indian context opined that these terms do not even exist in Indian socio-cultural setting, as the privacy can isolate people in interdependent society.[20] Neki recommended a middle ground with family therapy or at least couple of sessions with the family members along with dyadic therapy in order to help the progress of the psychotherapy.[21] Family, therefore, forms an important focus for change in collectivistic societies, and understanding the Indian family becomes an essential prerequisite for involving them in therapy.

The traditional Indian family 

Any generalizations about the Indian family suffer from oversimplification, given the pluralistic nature of the Indian culture. However, in most sociological studies, Asian and Indian families are considered classically as large, patriarchal, collectivistic, joint families, harboring three or more generations vertically and kith and kin horizontally. Such traditional families form the oldest social institution that has survived through ages and functions as a dominant influence in the life of its individual members. Indian joint families are considered to be strong, stable, close, resilient and enduring with focus on family integrity, family loyalty, and family unity at expense of individuality, freedom of choice, privacy and personal space.[22]

Structurally, the Indian joint family includes three to four living generations, including grandparents, parents, uncles, aunts, nieces and nephews, all living together in the same household, utilizing a common kitchen and often spending from a common purse, contributed by all. Change in such family structure is slow, and loss of family units after the demise of elderly parents is counterbalanced by new members entering the family as children, and new members (wives) entering by matrimonial alliances, and their offsprings. The daughters of the family would leave following marriage. Functionally, majority of joint families adhere to a patriarchal ideology, follow the patrilineal rule of descent, and are patrilocal; although matrilocal and matriarchal families are quite prevalent in some southern parts of the country. The lines of hierarchy and authority are clearly drawn, with each hierarchical strata functioning within the principal of “collective responsibility”. Rules of conduct are aimed at creating and maintaining family harmony and for greater readiness to cooperate with family members on decisions affecting almost all aspects of life, including career choice, mate selection, and marriage. While women are expected to accept a position subservient to males, and to subordinate their personal preferences to the needs of other, males are expected to accept responsibility for meeting the needs of others. The earning males are expected to support the old; take care of widows, never-married adults and the disabled; assist members during periods of unemployment and illness; and provide security to women and children.[1,23] Psychologically, family members feel an intense emotional interdependence, empathy, closeness, and loyalty to each other.

The changing Indian family 

The socio-cultural milieu of India is undergoing change at a tremendous pace, leaving fundamental alterations in family structure in its wake. The last decade has not only witnessed rapid and chaotic changes in social, economic, political, religious and occupational spheres; but also saw familial changes in power distribution, marital norms and role of women. A review of the national census data and the National Family Health Survey (NFHS) data suggests that, gradually, nuclear families are becoming the predominant form of Indian family institution, at least in urban areas. The 1991 census, for the first time reported household growth to be higher than the population growth, suggesting household fragmentation; a trend that gathered further momentum in the 2001 and the 2010 census. A comparison of the three NFHS data [Table 1] also shows that over the years there has been a progressive increase in nuclear families, more in urban areas, with an associated progressive decrease in the number of household members.[24–26] Other important trends include a decrease in age of the house-head, reflecting change in power structure and an increase in households headed by females, suggesting a change in traditional gender roles.

Table 1

Summary data from the National Family Health Survey

However, though traditional joint families have been significantly replaced by urban “new order” nuclear families, it would be wrong to look at present Indian families in such simple bimodal groups. The family systems presently have become highly differentiated and heterogeneous social entities in terms of structure, pattern, role relationships, obligations and values. Joint families that stay under same roof, but with separate kitchen, separate purse and with considerable autonomy and reduced responsibility for extended family members are common and represent “transitional families”.[27] Others may stay in separate households but cluster around in the same community. Such transitional families though structurally nuclear, may still continue to function as joint families. Sethi, back in 1989 pointed out the strong networks of kinship ties in Indian “extended families”, and observed that even when relatives cannot actually live in close proximity, they typically maintain strong bonds and attempt to provide each other with economic help and emotional support.[1]

Effects of societal and familial change on mental health 

Social and cultural changes have altered entire lifestyles, interpersonal relationship patterns, power structures and familial relationship arrangements in current times. These changes, which include a shift from joint/extended to nuclear family, along with problems of urbanization, changes of role, status and power with increased employment of women, migratory movements among the younger generation, and loss of the experience advantage of elderly members in the family, have increased the stress and pressure on such families, leading to an increased vulnerability to emotional problems and disorders. The families are frequently subject to these pressures.

Countries within the developing world are impatient and intend to achieve within a generation, what countries in the developed world took centuries. Hence societal changes here are not step by step or gradual, but rapid, the process inevitably involving “temporal compression”. Additionally, the sequences of these societal changes are haphazard or “Cacophonic”,[28] producing a condition that is highly unsettling and stressful. For example, in a household where a woman is the chief breadwinner but has minimal standing in decision making, the situation leads to role resentment and disorganized power structure in the family. Indeed, studies do show that nuclear family structure is more prone to mental disorders than joint families.[29] Fewer patients with mental illness from rural families have been reported to be hospitalized when compared to urban families because of the existing joint family structure, which apparently provides additional support.[30] Children from large families have been found to report significantly lower behavioral problems like eating and sleeping disorders, aggressiveness, dissocial behavior and delinquency than those from nuclear families.[31] Even the large scale international collaborative studies conducted by WHO – the International Pilot Study on Schizophrenia, the Determinants of Outcome of Severe Mental Disorders and the International Study of Schizophrenia – reported that persons with schizophrenia did better in India and other developing countries, when compared to their Western counterparts largely due to the increased family support and integration they received in the developing world.[32]

Although a bulk of Indian studies indicates that the traditional family is a better source for psychological support and is more resilient to stress, one should not, however, universalize. The “unchanging, nurturant and benevolent” family core is often a sentimentalization of an altruistic society.[33] In reality, arrangements in large traditional families are frequently unjust in its distribution of income and allocation of resources to different members. Exploitation of family resources by a coterie of members close to the “Karta” (the head of family) and subjugation of women are the common malaise of traditional Indian family. Indian ethos of maintaining “family harmony” and absolute “obedience to elderly” are often used to suppress the younger members. The resentment, however, passive and silent it may be, simmers, and in the absence of harmonious resolution often manifests as psychiatric disorders. Somatoform and dissociative disorders, which show a definite increased prevalence in our society compared to the west, may be viewed as manifestations of such unexpressed stress.

Therefore, rather than lamenting on the change in societal structure and loss of the joint family, the therapist should be aware of the unique dynamics of each family he treats, and should endeavor to find and utilize the strengths therein, while providing ways to cope with stress within the limits of the available resources