Fathers Who Fail

Shame and Psychopathology in the Family System

Melvin R. Lansky

• Editorial: Routledge
• Año: 2013
• ISBN:
  9781134881376
• Edición: 1
• Categoría: Psychologie
• Categoría: Santé mentale en psychologie

Despite the burgeoning literature on the role of the father in child development and on fathering as a developmental stage, surprisingly little has been written about the psychiatrically impaired father. In Fathers Who Fail, Melvin Lansky remedies this glaring lacuna in the literature. Drawing on contemporary psychoanalysis, family systems theory, and the sociology of conflict, he delineates the spectrum of psychopathological predicaments that undermine the ability of the father to be a father. Out of his sensitive integration of the intrapsychic and intrafamilial contexts of paternal failure emerges a richly textured portrait of psychiatrically impaired fathers, of fathers who fail.

Lansky's probing discussion of narcissistic equilibrium in the family system enables him to chart the natural history common to the symptomatic impulsive actions of impaired fathers. He then considers specific manifestations of paternal dysfunction within this shared framework of heightened familial conflict and the failure of intrafamilial defenses to common shame. Domestic violence, suicide, the intensification of trauma, posttraumatic nightmares, catastrophic reactions in organic brain syndrome, and the murder of a spouse are among the major "symptoms" that he explores. In each instance, Lansky carefully sketches the progression of vulnerability and turbulence from the father's personality, to the family system, and thence to the symptomatic eruption in question. In his concluding chapter, he comments tellingly on the unconscious obstacles - on the part of both patients and therapists - to treating impaired fathers. The obstacles cut across different clinical modalities, underscoring the need for multimodal responses to fathers who fail.

IV
Shame and Symptom Formation

… Later, I think you’ll learn
That now as before you have done yourself no good
By gratifying your temper against your friends.
Anger has always been your greatest sin!

Sophocles
Oedipus at Colonus (852-855)

8
The Psychiatrically Hospitalized Father

The Problem

Within the past decade and a half there has been increased interest in the study of the father, both in the context of child development and in the life cycle of the father himself (Cath, Gurwitt, and Ross, 1982). Interest in and knowledge about fathers has, however, lagged behind interest in the individual child, the mother-child unit, or the mother alone (Howells, 1970). The reasons for this neglect are complex but in some part involve the difficulties in understanding the role of father and the sorts of activities that constitute fathering. These conceptual difficulties are greater with activities that constitute fathering than with activities that constitute mothering. Mothering is usually thought of as involving the experience-close caretaking, that is, feeding, cleaning, physical soothing, of the mother-child dyad. It is clear for purposes of observation and study what at least some of the activities are that constitute mothering and how they may be observed.

For fathering, though, there is seldom this sort of clarity. Fathering may involve parenting that is experience-close, but by and large the activities that fathers themselves consider to be appropriate fathering are experience-distant, and difficult to capture convincingly in observable terms: provision of support, protection, discipline, a sense of justice, and a sense of leadership. Few of those activities can be reduced to observable behaviors between father and child that are suitable for study. The problem of studying fathers, then, is inseparably linked to the problems of studying whole, or even extended, families. The data are complexly interactional, difficult to define with certainty, and contained in units of observation that may be both large and fluctuant.

How a father is evaluated by himself and by others—what kind of job he does, and in what kind of esteem he is held—is often as much of a measure of the marriage (i.e., of support or sabotage from mother) as it is of the father’s activities considered alone. Volatile, strife-ridden marriages may be taken as evidence of a father’s weakness, even if it is the mother who erodes the sense of stability with activities and commentaries that undercut the family’s sense of stability. In a better-bonded marriage, mother may compensate for a weak or even remote father. Hence, fathering has to be studied in the full family context, whereas significant aspects of mothering do not. To these complexities must be added the ubiquitous fantasies about what is wanted from parents: “I want my mother” is usually a regressive wish appealing for caretaking and exemption from responsibility; “I want my father” usually reflects a wish to master the world, not to avoid it. Some of these conceptual difficulties explain why until recently there was a dearth of academic and clinical interest in fathers and, in particular, why there has been a paucity of information on the psychiatrically disabled father in the role of father. As a matter of fact, a literature search failed to turn up a single source on the hospitalized patient as father. This communication is an attempt to approach the topic.

Obviously, any major illness will have a substantial effect on the father’s performance of his role, not only because of the consequent limitations on the father’s actual functions, but also because of the strength and power that the father gives to the family in the fantasies of family members and of the father himself. Thus, in addition to impairing the instrumental contributions of the father, illness also inflicts narcissistic injury on the father and on the family as a whole.

A study of family systems usually shows that predicaments or crises that present as clinical disruptions follow a change in family equilibrium. Disruption follows the sudden upsurgence of previously disowned infantile elements in the family system. This may happen, for example, when the family homeostasis changes after the birth of a first child. The combination of added demands on father, a decrease in attention from and caretaking by the new mother, and competition with the new arrival may change a previously well-compensated family system to one that is dysfunctional. The same may happen if physical illness in an older father necessitates his wife’s employment and occurs at a time when children are also becoming financially independent. The narcissistic issues often subsumed under the vague and overused term “self-esteem” are found to be intimately related to the parental role and are crushingly disturbed at such times of disequilibrium. Less well studied is the relation of psychiatric symptoms to the role of father. Such symptoms include psychotic episodes, suicidality, violence or intimidation, episodic substance abuse, and depression. I do not presume that difficulties with the role of father cause any of these symptoms, but only that the symptomatology itself is intimately bound up with the role of father in a way that is difficult to study yet is crucial to understand in any treatment strategy.

Because in the Family Treatment Program families are seen in every case and the index population is largely adult and male, the setting is optimal for observing the difficulties of the hospitalized father. Yet, for reasons not apparent on first glance, most fathers were loath to comment on their difficulties in functioning as fathers. Identifying their difficulties in other ways, they spoke of voices, drinking, violence, being suicidal, depression, anger at their wives, or anger at children. The staff on this program, highly sophisticated in the treatment of hospitalized patients and specialists in family psychiatry, also had difficulties focusing on the paternal role. Part of the staff’s difficulty arose from clinical apprehension that the issues were too threatening to the patients and could be brought up only with the risk of mortifying the patients. Staff had countertransference difficulties—emotional difficulties with men who were felt to be broken or defective; and they had unusual difficulties maintaining focus on these men on the paternal role. There was, then, a diffuseness of focus on difficulties in the paternal role, not only on the part of fathers, but also in their families and in the people who treated them.

This generalized diffusion of awareness to difficulties in the paternal role could not be attributed to mere ignorance or lack of focus on the problems of hospitalized fathers. Rather, it seemed to be a defensive process of overwhelming magnitude, one that came into focus only gradually. I use the term “defensive process” without any presumption that the origin of the patients’ basic difficulties was basically interpersonal or that the treatment was basically dynamic or interpretive. I am, rather, presuming that any approach or sensible treatment strategy must consider what sort of emotional struggles keep the areas of great difficulty so much in darkness that they cannot be examined, discussed straightforwardly, and diminished.

A view of the clinical picture is blurred by this diffusion of awareness. For that reason, it is important that we be mindful of the concrete particulars of the setting in which the issues faced by hospitalized fathers come into focus. Our treatment staff went through an unfolding awareness of the central role of shame and narcissistic mortification in these men and of the high cost of maneuvers to protect themselves from such mortification. These defensive maneuvers included the diffusion of awareness of difficulties in the paternal role. The more we understood these fathers’ struggles, the more their struggles seemed always to include one between concealing to avoid being seen and seeing oneself as defective and the opposite effort (with which we wished to ally our efforts)—revealing and clarifying the issues so they could be faced. Our knowledge of the plight of the hospitalized father grew with the deepening of our understanding of conflict and defense tied to shame.

As a general psychiatric inpatient unit with around-the-clock staffing, we at the Family Treatment Program were in a good position to observe the general disruptions that range from psychotic decompensation and its attendant symptoms to suicidal thoughts and actions, violence and intimidation, and episodic and continual substance abuse. We have come to see many of these symptoms, however chaotic they might seem, as the patient’s attempt to restore an optimal distance from supportive persons, both to keep them at a distance and to lock them into a relationship with the patient. We have a clear view of the impact of illness on the father’s role.

The intake meeting is used for examination of the circumstances leading to hospitalization and a workup of the family from an intergenerational perspective. Family sessions continue weekly and explore conditions under which the temporary containment by the hospital can be replaced by containment outside the hospital, by the patient himself, by the family, or by other support systems. These sessions may evolve into ongoing family psychotherapy sessions.

We have come to conceptualize the hospital as a temporary container for chaos when such containment cannot be provided by the patient’s personality system or external support systems, including the family. We have also come to focus on the benefits and difficulties of the symbiotic relationship created by a few months in the hospital. The temporary containment and relief from responsibility are often offset by the enormous shame the patient feels when he sees himself as needing the hospital for well-being, by the resultant envy and hatred, and by the controlling maneuvers (such as binge drinking, suicidal gestures, or violence) that forestall discharge and preserve the relationship with the hospital. They also divert attention away from the hospital dependency that so upsets the patient. Often the patient’s controlling maneuvers exhaust support systems. Family may become depleted and exhausted and may give up on the patient. We have come to see the absence of family (Lansky et al., 1983) as a source of data with major diagnostic and prognostic significance, never as a variant of normal.

To focus further on the problems of hospitalized fathers, we began brief (30 minute) intergenerational interviews for all fathers admitted to the ward who consented to have them. These interviews were tape-recorded sessions with a three-generation perspective. Each patient was asked first about his father: what the relationship was like, what was good, where it fell short, how any shortcomings were felt to have affected the patient’s subsequent life and his own ability to be a father. Next, they were asked about the women in their lives: wives, ex-wives, mothers of their children or step-children and whether they helped or hindered the paternal role. Lastly, they were asked about their own relationship with their children: good points, regrets, role of their illness, what they might need to help them.

A group was offered to hospitalized fathers. Patients had received the first offer of a group with much enthusiasm, but the group was very poorly attended. The few who came were very chronically ill men with years-long relationships to the hospital and damaged self-images. All were chronically suicidal. All were directly involved with their own children’s care, usually with some help from an ex-wife. A second group was formed from men who had had the intergenerational interview (40 fathers were offered the group). About 12 participated, but most of them attended for only a short while and then dropped out, most saying explicitly that they could not handle the upset that the material stirred up. The majority were divorced. Most felt rage, helplessness, and depression at the small or absent role they played with their children. Many had been ordered by courts to stay away either because of attempts to intimidate the family or actual violent episodes, or because they could not provide the support for the family mandated by law. All felt helpless, humiliated, and untenured. There were varying degrees of acceptance of responsibility. One man complained bitterly and vociferously of his ostracism from the family, but neglected to mention that in a fit of rage, he had beaten his infant son to death. The group was designed to be exploratory and supportive rather than confrontive, but all the men found it painful, anxiety provoking, and humiliating to talk about their difficulties and lack of status in the family. Those who were not directly involved with their children dropped out; several asked for (and were given) sessions conjointly with children to help with the issues raised.

The intergenerational interview and the father groups gave us considerable insight into the diffusion of awareness around problems of fathering. These hospitalized fathers were so overwhelmed with shame—the pain of seeing themselves, and of being seen, as defective in the fathering role and deprived of status—that most could not bear to address their difficulties. Over 90% of the hospitalized fathers agreed to be interviewed, and most of them showed interest in the fathers’ groups; however, less than one-third attended, and most of the fathers that did attend left, saying that the pain was too great and the hopes of improvement too dim to warrant further suffering.

Clinical Illustrations

Illness: Schizophrenia

Example 1. A 35-year-old Hispanic man had been transferred from another inpatient unit as an undesirable—a “manipulator,” a chronic schizophrenic beset with murderous rage and suicidal thoughts. His course in the Family Treatment Program was unlike that in the previous unit, and he profited immensely from a several months’ hospital stay. Despite the evidence of years of almost unremitting psychosis, and despite his describing his illness clearly, his family had refused to acknowledge that he was ill. His wife and adolescent son both treated him as contemptible and lazy and acted as though he could pull his life together simply by willpower and industry. His many suicide attempts could be seen both as precipitated by this lack of understanding and acceptance and as attempts to gain some control of his role in the family.

After he left the hospital, his suicidal ideation recurred intermittently, but he did not make further suicide attempts. He was readmitted, floridly psychotic, after a family quarrel in which his son had mocked perils he had undergone in military combat and his wife sided with the son. In the intergenerational interview, he expressed high regard for his father and some understanding of his wife’s inability to accept the fact that he was ill. He presented a consistent picture of himself and his struggles in all treatment settings: in ward meetings, family sessions, and in the fathers’ group. He had a persistently painful view of his broken, constantly fearful psychotic condition with very little surcease in awareness of the contempt in which he was held in his clinging, albeit hostile family. Conjoint family sessions were of great help in enabling his wife and son to comprehend the nature and extent of his illness and to respond more realistically to his limitations.

Illness: Alcoholism

Example 2. This 47-year-old man was admitted on a drinking binge after several months’ sobriety in a rehabilitation residence for alcoholics. He had been alcoholic since his teens. As is typical of alcoholic fathers, he described his own father as an alcoholic man, violent when drunk and absent emotionally (and usually physically) when sober. He said with bitterness that a better father would have provided the substance to his personality that he knew he had never had. He had been separated from his mother at birth, and told, for reasons not clear to him at the time, that she had died. He first met her whe...