Reconceptualizing Family

Bob is in the kitchen, settling down his family to preparing a celebration dinner with produce from the communal garden. He is a tall, wiry man with a gray beard and kind gentle eyes. His current family includes his wife, who is a therapist in a nearby town; a tall, blonde Scandinavian man who is spending time "finding himself"; a young, eager couple who tend the garden and teach the intricacies of organic farming; and a reclusive artist who works with metals and found objects.

Bob bought the dilapidated commune buildings several years ago, after retiring from his fast-paced, stressful life as an internist in California. He has meticulously restored the adobe buildings using the expertise of traditional builders. There are different types of adobe throughout the compound, sparkling mica walls in the bedrooms, and deep, rich brown in the large circular communal living room. Bob conceptualizes this historic setting as a retreat for meditation and a place to teach organic farming to the next generation. As I observed during my visit a few months ago, Bob is the elder and wise man of this communal family who gently quiets the demons in the spider-phobic Scandinavian.

This is a "family" in the best sense: a group of people who share a spiritual belief in their connection to the land, the goodness of the human spirit, and the importance of connection between people. Like the hippies before them who established New Buffalo in Arroyo Hondo, N.M., the residents reject many Western values, at least for a few years, and try out this alternative way of living. The community’s website says it is no longer a commune but that members are "connected by a common sense of ideals and a strong sense of place."

Communes have always existed in the United States. Native Americans live communally but are not recognized as communes. The largest recognized U.S. communal living group is the Hutterite community. About 42,000 people live in rural Hutterite communities across the United States. They are derived from the Anabaptists, a Christian sect dating back to 16th century Austria, which also spawned Amish and Mennonite communities.

Whatever type of family our patients live in, be it a religious sect, a down-to-earth commune, or a traditional family, to run well, that family needs to be organized, to communicate well and to have good boundaries (Fam. Process 2003;42:1-18).

Why is this important to psychiatry? Good family functioning is associated with good outcomes for patients with all kinds of illnesses from medical to psychiatric (Families, Health, and Behavior: A Section of the Commissioned Report by the Committee on Health and Behavior, Institute of Medicine [Families, Systems & Health 2002;20:7-46]). In addition, "a growing body of research finds that healthy family processes ... matter more than family form for effective functioning...," writes Froma Walsh, Ph.D., (Normal Family Process [N.Y.: Guilford Press, 2003]). To cope well with illness, families need to be able to problem solve, communicate, and stay connected. However, good family functioning looks different in different cultures, from the highly organized rigid religious sects to the looser counterculture New Buffalo community. So how do we describe families and their functioning?

One easy approach is to look at the Global Assessment of Relational Functioning, or the GARF Scale, found in Appendix B of the DSM IV-TR (Washington: American Psychiatric Association, 2000). It has three subscales: problem solving, organization, and emotional climate. The choices for rating families range from 1-20 "Relational unit has become too dysfunctional to retain continuity of contact and attachment," to the 81-100 range in which the "relational unit is functioning satisfactorily from self-report of participants and from the perspective of observers." This scale is easy to learn and use. Also, the scale is independent of culture and can be used for any group of people who call themselves a family. So yes, after observing the New Buffalo community for a few days, I would rank it a solid 88.

Bob is in the kitchen, settling down his family to preparing a celebration dinner with produce from the communal garden. He is a tall, wiry man with a gray beard and kind gentle eyes. His current family includes his wife, who is a therapist in a nearby town; a tall, blonde Scandinavian man who is spending time "finding himself"; a young, eager couple who tend the garden and teach the intricacies of organic farming; and a reclusive artist who works with metals and found objects.

Bob bought the dilapidated commune buildings several years ago, after retiring from his fast-paced, stressful life as an internist in California. He has meticulously restored the adobe buildings using the expertise of traditional builders. There are different types of adobe throughout the compound, sparkling mica walls in the bedrooms, and deep, rich brown in the large circular communal living room. Bob conceptualizes this historic setting as a retreat for meditation and a place to teach organic farming to the next generation. As I observed during my visit a few months ago, Bob is the elder and wise man of this communal family who gently quiets the demons in the spider-phobic Scandinavian.

This is a "family" in the best sense: a group of people who share a spiritual belief in their connection to the land, the goodness of the human spirit, and the importance of connection between people. Like the hippies before them who established New Buffalo in Arroyo Hondo, N.M., the residents reject many Western values, at least for a few years, and try out this alternative way of living. The community’s website says it is no longer a commune but that members are "connected by a common sense of ideals and a strong sense of place."

Communes have always existed in the United States. Native Americans live communally but are not recognized as communes. The largest recognized U.S. communal living group is the Hutterite community. About 42,000 people live in rural Hutterite communities across the United States. They are derived from the Anabaptists, a Christian sect dating back to 16th century Austria, which also spawned Amish and Mennonite communities.

Whatever type of family our patients live in, be it a religious sect, a down-to-earth commune, or a traditional family, to run well, that family needs to be organized, to communicate well and to have good boundaries (Fam. Process 2003;42:1-18).

Why is this important to psychiatry? Good family functioning is associated with good outcomes for patients with all kinds of illnesses from medical to psychiatric (Families, Health, and Behavior: A Section of the Commissioned Report by the Committee on Health and Behavior, Institute of Medicine [Families, Systems & Health 2002;20:7-46]). In addition, "a growing body of research finds that healthy family processes ... matter more than family form for effective functioning...," writes Froma Walsh, Ph.D., (Normal Family Process [N.Y.: Guilford Press, 2003]). To cope well with illness, families need to be able to problem solve, communicate, and stay connected. However, good family functioning looks different in different cultures, from the highly organized rigid religious sects to the looser counterculture New Buffalo community. So how do we describe families and their functioning?

One easy approach is to look at the Global Assessment of Relational Functioning, or the GARF Scale, found in Appendix B of the DSM IV-TR (Washington: American Psychiatric Association, 2000). It has three subscales: problem solving, organization, and emotional climate. The choices for rating families range from 1-20 "Relational unit has become too dysfunctional to retain continuity of contact and attachment," to the 81-100 range in which the "relational unit is functioning satisfactorily from self-report of participants and from the perspective of observers." This scale is easy to learn and use. Also, the scale is independent of culture and can be used for any group of people who call themselves a family. So yes, after observing the New Buffalo community for a few days, I would rank it a solid 88.

Bob is in the kitchen, settling down his family to preparing a celebration dinner with produce from the communal garden. He is a tall, wiry man with a gray beard and kind gentle eyes. His current family includes his wife, who is a therapist in a nearby town; a tall, blonde Scandinavian man who is spending time "finding himself"; a young, eager couple who tend the garden and teach the intricacies of organic farming; and a reclusive artist who works with metals and found objects.

Bob bought the dilapidated commune buildings several years ago, after retiring from his fast-paced, stressful life as an internist in California. He has meticulously restored the adobe buildings using the expertise of traditional builders. There are different types of adobe throughout the compound, sparkling mica walls in the bedrooms, and deep, rich brown in the large circular communal living room. Bob conceptualizes this historic setting as a retreat for meditation and a place to teach organic farming to the next generation. As I observed during my visit a few months ago, Bob is the elder and wise man of this communal family who gently quiets the demons in the spider-phobic Scandinavian.

This is a "family" in the best sense: a group of people who share a spiritual belief in their connection to the land, the goodness of the human spirit, and the importance of connection between people. Like the hippies before them who established New Buffalo in Arroyo Hondo, N.M., the residents reject many Western values, at least for a few years, and try out this alternative way of living. The community’s website says it is no longer a commune but that members are "connected by a common sense of ideals and a strong sense of place."

Communes have always existed in the United States. Native Americans live communally but are not recognized as communes. The largest recognized U.S. communal living group is the Hutterite community. About 42,000 people live in rural Hutterite communities across the United States. They are derived from the Anabaptists, a Christian sect dating back to 16th century Austria, which also spawned Amish and Mennonite communities.

Whatever type of family our patients live in, be it a religious sect, a down-to-earth commune, or a traditional family, to run well, that family needs to be organized, to communicate well and to have good boundaries (Fam. Process 2003;42:1-18).

Why is this important to psychiatry? Good family functioning is associated with good outcomes for patients with all kinds of illnesses from medical to psychiatric (Families, Health, and Behavior: A Section of the Commissioned Report by the Committee on Health and Behavior, Institute of Medicine [Families, Systems & Health 2002;20:7-46]). In addition, "a growing body of research finds that healthy family processes ... matter more than family form for effective functioning...," writes Froma Walsh, Ph.D., (Normal Family Process [N.Y.: Guilford Press, 2003]). To cope well with illness, families need to be able to problem solve, communicate, and stay connected. However, good family functioning looks different in different cultures, from the highly organized rigid religious sects to the looser counterculture New Buffalo community. So how do we describe families and their functioning?

One easy approach is to look at the Global Assessment of Relational Functioning, or the GARF Scale, found in Appendix B of the DSM IV-TR (Washington: American Psychiatric Association, 2000). It has three subscales: problem solving, organization, and emotional climate. The choices for rating families range from 1-20 "Relational unit has become too dysfunctional to retain continuity of contact and attachment," to the 81-100 range in which the "relational unit is functioning satisfactorily from self-report of participants and from the perspective of observers." This scale is easy to learn and use. Also, the scale is independent of culture and can be used for any group of people who call themselves a family. So yes, after observing the New Buffalo community for a few days, I would rank it a solid 88.