Managing family differences
What is it about families that makes our patients so upset? Why can our patients not just walk away from conflict? Why do they get so bent out of shape when family members do not say or do what they expect them to do? We all have families that are less than ideal and struggle with how to manage difference.
This column gives psychiatrists a framework for thinking with families about the universal dilemma of managing difference. This dilemma can be viewed from the perspectives of the individual, the family, and society: Identity is formed in the crucible of the family, where parental introjects become a model for the child’s development and can be rejected as an adolescent or adult as individuals shape their own identity. Processes within the family shape family members’ relationships and, therefore, their expectations of one another. Strong boundaries provide safety for those inside the family versus those outside the family.
Individual perspective
Family members’ perspective and expectations of others depend on their family position. Children or young adults want to please the parent, and to be accepted and recognized for who they are. They want their unique qualities to be valued, they want to be loved, and they want to feel that they belong.
Parents want their young adult to reach what they consider a successful life, and to be fulfilled and healthy. When their child strikes out on his or her own, the parent may not understand, and may feel let down or angry. The parent may say: “She married him to get back at me.” “Why is my son so rejecting of the business our family spent generations to build?” “How can my child reject our family values that we brought from the old country?” “How did it happen that my son is gay?”
Siblings have an idea of who their sibling should be, and this idea often is fixed and immutable. They may ask, “Why won’t my sister help me out?” “Why can’t she be a good sister?” “Why is my brother so jealous of me?”
Family elders may wonder why their adult children do not want to return home to care for them or why they want their parents to go into a nursing home.
These dilemmas are easy to understand as conscious expectations. More difficult to understand are the unconscious projections that tangle up families.
Unconscious psychological processes
The two main unconscious psychological processes that tangle up families are projection and projective identification. Projective identification is an unconscious process in which aspects of the self are split off and projected onto another person. In 1946, Melanie Klein introduced the term “projective identification” as follows: “Much of the hatred against parts of the self is now directed toward the mother. This leads to a particular form of identification which establishes the prototype of an aggressive object-relation. I suggest for these processes the term ‘projective identification’ ” (Int J Psychoanal. 1946;27[pt 3-4]:99-110).
Mutual projective processes can occur in committed relationships. The following scenario helps illustrate this: Ms. A. projects onto her husband her own feared and unwanted aggressive, dominating aspects of herself. The result is that she fears and respects him. He, in turn, comes to feel aggressive and dominating toward her, not only because of his own resources but because of her projections, which she forces onto him. He may, in turn, despise and disown timid and fearful aspects of his own personality and by a similar mechanism of projective identification force these unwanted aspects of himself onto his wife. Ms. A. is then composed of timid unaggressive parts of herself as well as his projections, and she carries these feelings as her part in the relationship. Some couples, like Mr. and Ms. A., live in such locked systems, dominated by mutual projections, with each not truly married to the other person but to the unwanted, split-off, and projected parts of themselves.
In this scenario, the husband becomes dominant and cruel, and the wife becomes stupidly timid and respectful. These marriages are stable, because each partner needs the other for narcissistic pathologic purposes (see “Some Psychodynamics of Large Groups” in “The Large Group: Dynamics and Therapy” [London: Karnac Books, 1975] and “The Ailment and Other Psychoanalytic Essays” [London: Free Association Books, 2015]).
Marriage offers an opportunity for individuals to work out these types of issues, or, in the case of Mr. and Ms. A, not work through them. Instead, they exist in tight mutual projections.
