Family narratives and the intergenerational transmission of resilience

Carmen Bugan read her poems to her family. Her father had been imprisoned by Securitate, the Romanian secret police, for anticommunist rhetoric that he distributed on leaflets to people’s mailboxes. Securitate tracked him down by examining the leaflets for identifying typescript that they linked to one of his typewriters. He buried his other typewriter in the garden to escape detection. He would dig it up when he wanted to write serious anticommunist literature, then rebury it again in the garden.

"It is not important that the poem stays or goes," Carmen writes. "I discover a way to relieve our family’s suffering even though when I read the poems to Mom and my sister it seems that I create more pain at first.

"Mom loves the words, loves explanations of feelings to negotiate pain, and I can provide this for her. My sister says her feelings are exteriorized, articulated by the emotions in the poem and I can help bring things out" ("Burying the Typewriter," Minneapolis: Graywolf Press, 2012, p. 124).

Carmen created a poetic narrative to help her family manage their suffering. In this way, she helped her family become close and share a sense of belonging together. Carmen was able to transmute the family’s experience of trauma into a story that articulated their survival. Her poems became a written narrative of her family’s history. Resilience was created and passed along through the generations. This is the intergenerational transmission of resilience.

Intergenerational transmission has been shown in trauma; antisocial behavior; violence; religion; politics; substance abuse (J. Res. Adolesc. 1995;5:225-52); depression (J. Fam. Psychol. 2003;17:545-56); attachment (Psychol. Bull. 1995;117:387-403); perfectionism (J. Fam. Psychol. 2005;19:358-66); poverty; being on welfare; teenage pregnancy; education; and family life trajectories ("Intergenerational Transmission of Behavioral Patterns: Similarity of Parents’ and Children’s Family-Life Trajectories," Netherlands Interdisciplinary Demographical Institute, The Hague, 2006).

In short, there is evidence for the intergenerational transmission of everything bad. It is time to create evidence of the intergenerational transmission of resilience.

Researchers who study intergenerational legacies have discovered that children who know the most about their families have a strong sense of control over their lives, higher self-esteem, and the strongest "intergenerational self," compared with children who know less about their families. Marshall P. Duke, Ph.D., and his colleagues developed a measure called "Do You Know?" that asks children questions about their family. Examples of questions are "Do you know where your grandparents grew up? Do you know where your mom and dad went to high school?" (Psychotherapy 2008;45,268-72).

Dr. Duke identifies three common family narratives:

• The ascending family narrative: "Son, when we came to this country, we had nothing. Our family worked. We opened a store. Your grandfather went to high school. Your father went to college. And now you ... "

• The descending narrative: "Sweetheart, we used to have it all. Then we lost everything."

• The oscillating family narrative: "Dear, let me tell you, we’ve had ups and downs in our family. We built a family business. Your grandfather was a pillar of the community. Your mother was on the board of the hospital. But we also had setbacks. You had an uncle who was once arrested. We had a house burn down. Your father lost a job. But no matter what happened, we always stuck together as a family."

Healing narratives are prominent in American Indian and folk medicine traditions but also exist in modern medicine. In psychiatry, one of the tenets of the Recovery Movement is to focus on strengths and a positive sense of identity that is not linked to a psychiatric diagnosis. Communities such as Alcoholics Anonymous, Narcotics Anonymous, and Al-Anon foster resilience through communion and sharing. Narrative therapy, developed by Australian therapist Michael White and his collaborator David Epston of New Zealand in 1989 (Context 2009;105:57-58), is a type of psychotherapy that seeks and promotes a healthy, successful personal narrative to replace a dominant repressive illness narrative.

How can the psychiatrist, during a routine office visit, help patients develop a positive, resilient family narrative? Patients can benefit from an exploration of patterns of behavior or ways of relating that might have been passed down through the generations. Understanding the motivations, difficulties, and aspirations of their parents and grandparents provides patients with a historical perspective on their current difficulties. If patients can understand their difficulties in the context of the larger family system, they develop a more nuanced and less harsh understanding of the challenges they face.

When Sarah presented with depression, it became clear that her family dynamics were troubling. She felt happy and competent at work. In passing, she remarked that she felt intimidated by her teenage daughter, so I inquired about her family system to see what generational narratives might be at play. Over several sessions, we uncovered the covert negative messages she had received as a child. She had fought not to pass these on to her children, by being "more permissive and hands off." In response, her children chided her for being overly anxious, sensing that she was conflicted and troubled, although the source remained mysterious to everyone. Using a family systems approach to understand the intergenerational inheritance, the family came to understand the strong generational forces at work. This lessened her guilt and anguish, and increased the children’s understanding and empathy for their mother.

A family systems approach allows a family legacy to be revealed, reworked, and rewritten. A new family narrative that carries the family forward and allows the telling of a positive family narrative can be created. We can guide patients to find the positive aspects of their family stories and thus promote family resilience.

Here are a few questions we should ask our patients: "What did your parents teach you that you want to pass along? What values did your parents have? How have you lived or not lived those values? How has the relationship with your parents affected your relationship with your children? How did your parents resolve problems, and how do you resolve problems? How do your children resolve problems? What were the motivations that drove your parents? What countries do your relatives come from? What was it like for them growing up? Did they experience deprivation? War? How has that affected you and your siblings? Are there family secrets? What do you want to take away from this legacy? What do you want to pass along to the next generation?" Asking these questions allows the patient to see their current struggles and conflicts with a longer lens.

The novelist Laila Lalami, who did not know her mother, was surprised when her husband gave her a DNA test kit so that she could find out her genetic inheritance. When the results came in, Laila remarked: "So it was that, in just a few moments, I found myself returning to those childhood days when I used to dream up different families, and different fates, for my mother. What science gave me, in the end, was no different from what my own imagination had fed me for many years – stories. The search was not over. The search would never be over. And not even science could help fill out the abyss I grew up with. Only stories could." ("My Fictional Grandparents," The New York Times, July 26, 2013)

We are all part of our own family narrative that stretches back in time and forward into the future. We are creating a family story for ourselves in the present that our children will carry forward with them into their future. These narratives have many strands. Let’s help our patients pick out the strands that help them build family resilience.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).

Carmen Bugan read her poems to her family. Her father had been imprisoned by Securitate, the Romanian secret police, for anticommunist rhetoric that he distributed on leaflets to people’s mailboxes. Securitate tracked him down by examining the leaflets for identifying typescript that they linked to one of his typewriters. He buried his other typewriter in the garden to escape detection. He would dig it up when he wanted to write serious anticommunist literature, then rebury it again in the garden.

"It is not important that the poem stays or goes," Carmen writes. "I discover a way to relieve our family’s suffering even though when I read the poems to Mom and my sister it seems that I create more pain at first.

"Mom loves the words, loves explanations of feelings to negotiate pain, and I can provide this for her. My sister says her feelings are exteriorized, articulated by the emotions in the poem and I can help bring things out" ("Burying the Typewriter," Minneapolis: Graywolf Press, 2012, p. 124).

Carmen created a poetic narrative to help her family manage their suffering. In this way, she helped her family become close and share a sense of belonging together. Carmen was able to transmute the family’s experience of trauma into a story that articulated their survival. Her poems became a written narrative of her family’s history. Resilience was created and passed along through the generations. This is the intergenerational transmission of resilience.

Intergenerational transmission has been shown in trauma; antisocial behavior; violence; religion; politics; substance abuse (J. Res. Adolesc. 1995;5:225-52); depression (J. Fam. Psychol. 2003;17:545-56); attachment (Psychol. Bull. 1995;117:387-403); perfectionism (J. Fam. Psychol. 2005;19:358-66); poverty; being on welfare; teenage pregnancy; education; and family life trajectories ("Intergenerational Transmission of Behavioral Patterns: Similarity of Parents’ and Children’s Family-Life Trajectories," Netherlands Interdisciplinary Demographical Institute, The Hague, 2006).

In short, there is evidence for the intergenerational transmission of everything bad. It is time to create evidence of the intergenerational transmission of resilience.

Researchers who study intergenerational legacies have discovered that children who know the most about their families have a strong sense of control over their lives, higher self-esteem, and the strongest "intergenerational self," compared with children who know less about their families. Marshall P. Duke, Ph.D., and his colleagues developed a measure called "Do You Know?" that asks children questions about their family. Examples of questions are "Do you know where your grandparents grew up? Do you know where your mom and dad went to high school?" (Psychotherapy 2008;45,268-72).

Dr. Duke identifies three common family narratives:

• The ascending family narrative: "Son, when we came to this country, we had nothing. Our family worked. We opened a store. Your grandfather went to high school. Your father went to college. And now you ... "

• The descending narrative: "Sweetheart, we used to have it all. Then we lost everything."

• The oscillating family narrative: "Dear, let me tell you, we’ve had ups and downs in our family. We built a family business. Your grandfather was a pillar of the community. Your mother was on the board of the hospital. But we also had setbacks. You had an uncle who was once arrested. We had a house burn down. Your father lost a job. But no matter what happened, we always stuck together as a family."

Healing narratives are prominent in American Indian and folk medicine traditions but also exist in modern medicine. In psychiatry, one of the tenets of the Recovery Movement is to focus on strengths and a positive sense of identity that is not linked to a psychiatric diagnosis. Communities such as Alcoholics Anonymous, Narcotics Anonymous, and Al-Anon foster resilience through communion and sharing. Narrative therapy, developed by Australian therapist Michael White and his collaborator David Epston of New Zealand in 1989 (Context 2009;105:57-58), is a type of psychotherapy that seeks and promotes a healthy, successful personal narrative to replace a dominant repressive illness narrative.

How can the psychiatrist, during a routine office visit, help patients develop a positive, resilient family narrative? Patients can benefit from an exploration of patterns of behavior or ways of relating that might have been passed down through the generations. Understanding the motivations, difficulties, and aspirations of their parents and grandparents provides patients with a historical perspective on their current difficulties. If patients can understand their difficulties in the context of the larger family system, they develop a more nuanced and less harsh understanding of the challenges they face.

When Sarah presented with depression, it became clear that her family dynamics were troubling. She felt happy and competent at work. In passing, she remarked that she felt intimidated by her teenage daughter, so I inquired about her family system to see what generational narratives might be at play. Over several sessions, we uncovered the covert negative messages she had received as a child. She had fought not to pass these on to her children, by being "more permissive and hands off." In response, her children chided her for being overly anxious, sensing that she was conflicted and troubled, although the source remained mysterious to everyone. Using a family systems approach to understand the intergenerational inheritance, the family came to understand the strong generational forces at work. This lessened her guilt and anguish, and increased the children’s understanding and empathy for their mother.

A family systems approach allows a family legacy to be revealed, reworked, and rewritten. A new family narrative that carries the family forward and allows the telling of a positive family narrative can be created. We can guide patients to find the positive aspects of their family stories and thus promote family resilience.

Here are a few questions we should ask our patients: "What did your parents teach you that you want to pass along? What values did your parents have? How have you lived or not lived those values? How has the relationship with your parents affected your relationship with your children? How did your parents resolve problems, and how do you resolve problems? How do your children resolve problems? What were the motivations that drove your parents? What countries do your relatives come from? What was it like for them growing up? Did they experience deprivation? War? How has that affected you and your siblings? Are there family secrets? What do you want to take away from this legacy? What do you want to pass along to the next generation?" Asking these questions allows the patient to see their current struggles and conflicts with a longer lens.

The novelist Laila Lalami, who did not know her mother, was surprised when her husband gave her a DNA test kit so that she could find out her genetic inheritance. When the results came in, Laila remarked: "So it was that, in just a few moments, I found myself returning to those childhood days when I used to dream up different families, and different fates, for my mother. What science gave me, in the end, was no different from what my own imagination had fed me for many years – stories. The search was not over. The search would never be over. And not even science could help fill out the abyss I grew up with. Only stories could." ("My Fictional Grandparents," The New York Times, July 26, 2013)

We are all part of our own family narrative that stretches back in time and forward into the future. We are creating a family story for ourselves in the present that our children will carry forward with them into their future. These narratives have many strands. Let’s help our patients pick out the strands that help them build family resilience.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).

Carmen Bugan read her poems to her family. Her father had been imprisoned by Securitate, the Romanian secret police, for anticommunist rhetoric that he distributed on leaflets to people’s mailboxes. Securitate tracked him down by examining the leaflets for identifying typescript that they linked to one of his typewriters. He buried his other typewriter in the garden to escape detection. He would dig it up when he wanted to write serious anticommunist literature, then rebury it again in the garden.

"It is not important that the poem stays or goes," Carmen writes. "I discover a way to relieve our family’s suffering even though when I read the poems to Mom and my sister it seems that I create more pain at first.

"Mom loves the words, loves explanations of feelings to negotiate pain, and I can provide this for her. My sister says her feelings are exteriorized, articulated by the emotions in the poem and I can help bring things out" ("Burying the Typewriter," Minneapolis: Graywolf Press, 2012, p. 124).

Carmen created a poetic narrative to help her family manage their suffering. In this way, she helped her family become close and share a sense of belonging together. Carmen was able to transmute the family’s experience of trauma into a story that articulated their survival. Her poems became a written narrative of her family’s history. Resilience was created and passed along through the generations. This is the intergenerational transmission of resilience.

Intergenerational transmission has been shown in trauma; antisocial behavior; violence; religion; politics; substance abuse (J. Res. Adolesc. 1995;5:225-52); depression (J. Fam. Psychol. 2003;17:545-56); attachment (Psychol. Bull. 1995;117:387-403); perfectionism (J. Fam. Psychol. 2005;19:358-66); poverty; being on welfare; teenage pregnancy; education; and family life trajectories ("Intergenerational Transmission of Behavioral Patterns: Similarity of Parents’ and Children’s Family-Life Trajectories," Netherlands Interdisciplinary Demographical Institute, The Hague, 2006).

In short, there is evidence for the intergenerational transmission of everything bad. It is time to create evidence of the intergenerational transmission of resilience.

Researchers who study intergenerational legacies have discovered that children who know the most about their families have a strong sense of control over their lives, higher self-esteem, and the strongest "intergenerational self," compared with children who know less about their families. Marshall P. Duke, Ph.D., and his colleagues developed a measure called "Do You Know?" that asks children questions about their family. Examples of questions are "Do you know where your grandparents grew up? Do you know where your mom and dad went to high school?" (Psychotherapy 2008;45,268-72).

Dr. Duke identifies three common family narratives:

• The ascending family narrative: "Son, when we came to this country, we had nothing. Our family worked. We opened a store. Your grandfather went to high school. Your father went to college. And now you ... "

• The descending narrative: "Sweetheart, we used to have it all. Then we lost everything."

• The oscillating family narrative: "Dear, let me tell you, we’ve had ups and downs in our family. We built a family business. Your grandfather was a pillar of the community. Your mother was on the board of the hospital. But we also had setbacks. You had an uncle who was once arrested. We had a house burn down. Your father lost a job. But no matter what happened, we always stuck together as a family."

Healing narratives are prominent in American Indian and folk medicine traditions but also exist in modern medicine. In psychiatry, one of the tenets of the Recovery Movement is to focus on strengths and a positive sense of identity that is not linked to a psychiatric diagnosis. Communities such as Alcoholics Anonymous, Narcotics Anonymous, and Al-Anon foster resilience through communion and sharing. Narrative therapy, developed by Australian therapist Michael White and his collaborator David Epston of New Zealand in 1989 (Context 2009;105:57-58), is a type of psychotherapy that seeks and promotes a healthy, successful personal narrative to replace a dominant repressive illness narrative.

How can the psychiatrist, during a routine office visit, help patients develop a positive, resilient family narrative? Patients can benefit from an exploration of patterns of behavior or ways of relating that might have been passed down through the generations. Understanding the motivations, difficulties, and aspirations of their parents and grandparents provides patients with a historical perspective on their current difficulties. If patients can understand their difficulties in the context of the larger family system, they develop a more nuanced and less harsh understanding of the challenges they face.

When Sarah presented with depression, it became clear that her family dynamics were troubling. She felt happy and competent at work. In passing, she remarked that she felt intimidated by her teenage daughter, so I inquired about her family system to see what generational narratives might be at play. Over several sessions, we uncovered the covert negative messages she had received as a child. She had fought not to pass these on to her children, by being "more permissive and hands off." In response, her children chided her for being overly anxious, sensing that she was conflicted and troubled, although the source remained mysterious to everyone. Using a family systems approach to understand the intergenerational inheritance, the family came to understand the strong generational forces at work. This lessened her guilt and anguish, and increased the children’s understanding and empathy for their mother.

A family systems approach allows a family legacy to be revealed, reworked, and rewritten. A new family narrative that carries the family forward and allows the telling of a positive family narrative can be created. We can guide patients to find the positive aspects of their family stories and thus promote family resilience.

Here are a few questions we should ask our patients: "What did your parents teach you that you want to pass along? What values did your parents have? How have you lived or not lived those values? How has the relationship with your parents affected your relationship with your children? How did your parents resolve problems, and how do you resolve problems? How do your children resolve problems? What were the motivations that drove your parents? What countries do your relatives come from? What was it like for them growing up? Did they experience deprivation? War? How has that affected you and your siblings? Are there family secrets? What do you want to take away from this legacy? What do you want to pass along to the next generation?" Asking these questions allows the patient to see their current struggles and conflicts with a longer lens.

The novelist Laila Lalami, who did not know her mother, was surprised when her husband gave her a DNA test kit so that she could find out her genetic inheritance. When the results came in, Laila remarked: "So it was that, in just a few moments, I found myself returning to those childhood days when I used to dream up different families, and different fates, for my mother. What science gave me, in the end, was no different from what my own imagination had fed me for many years – stories. The search was not over. The search would never be over. And not even science could help fill out the abyss I grew up with. Only stories could." ("My Fictional Grandparents," The New York Times, July 26, 2013)

We are all part of our own family narrative that stretches back in time and forward into the future. We are creating a family story for ourselves in the present that our children will carry forward with them into their future. These narratives have many strands. Let’s help our patients pick out the strands that help them build family resilience.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).