Maintenance and Management of the System

Again the family functioned without much disruption in this area. Mrs. Dale participated as much as she could in decision making but was quite willing and happy for her husband to do what was in the best interest of all of them. It was her profound trust in her husband that contributed to the relatively smooth functioning in this domain.

In terms of the instrumental roles, the Dales showed a remarkable capacity for adaptation. This was made possible by the willingness of Mr. Dale to assume a great deal of the family responsibility, which he did as a matter of course. Mr. Dale, the daughter, and Mrs. Dale's mother put their collective protective arm around Mrs. Dale with the clear message that her principal task was to get well.

Affective Roles Nurturance and Support

In the affective domain, the nurturing and support was compromised simply by the virtue of Mrs. Dale's level of incapacity. But it ought to be acknowledged that Dales could not possibly function like a "healthy" or "effective" family as prescribed by the MMFF. She was wholly dependent on her husband for her physical and emotional care. She was not in a position to reciprocate. On the other hand, the fact that Mr. Dale so willingly assumed his extra responsibilities on top of his regular job was a clear indication of the strength of their relationship. The quality of their life was seriously compromised. Their sexual relations had come to a halt, their social life was nonexistent, and all their activities had come to a halt. From being a fully engaged partner, she was thrust into the role of a very disabled patient, and her husband a nurse and a caregiver. Their role function, under these circumstances, could not be construed as effective, and yet, given the magnitude of change in the family functioning brought on by Mrs. Dale's illness, this family in terms of its role function was successful. The massive reorganization of roles necessitated by Mrs. Dale's illness proved to be very efficient in terms of what the situation demanded.

The only major struggle Mrs. Dale encountered was with the workers' compensation board, but even that problem, over time, was settled. However, it is noteworthy that the role function of this family as per the MMFF was not "effective." This particular problem of trying to ascertain what may be the effective or healthy role function of a family with a sick or disabled person in its midst is illustrated in some detail by a case of an elderly patient with multiple health problems, which we shall presently discuss.

The next two cases differ significantly from the previous two in terms of family life-stage issues. The previous two cases represented the problems of families in their early forties with very young children in one family and a teenage daughter in the other. The next two cases represent a recently married young couple in which the wife suffered from severe migraine, and an older couple in their late sixties in which the husband had many chronic health problems including herpes zoster, which is a very painful condition.

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