linh nguyen - hecol 532 - family health and wellness model paper

Running head: FAMILY STRESS MANAGEMENT 1

Family Stress Management in Rohinton Mistrys novel Family Matters

Linh Nguyen

HECOL 532 Family Health and Wellness

Dr. Deanna Williamson

March 2014

FAMILY STRESS MANAGEMENT 2

Family Stress Management in Rohinton Histrys novel Family Matters

Introduction

In the first edition of her book on a Contextual Approach to Family Stress Management,

Boss (1988) began her discussion by raising the question The family stress reducing or stress

producing?. Is the family a refuge from the problems of the world or a source of even more

tension? (Boss, 1988, p. 9). Her answer for it was that For most of us, the family is neither the

solution to all problems nor the cause of everything that goes wrong. Reality lies somewhere in

between (Boss, 1988, p. 9). These statements imply important assumptions about family

functioning and family health and wellness: 1) individuals and their families experience and deal

with challenges as a normal part of life, 2) stress can originate from the external environment or

from within the family, 3) how a family as individual members and as a unit address life

stressors determine individuals and the familys health and wellness on physical, psychological,

and social levels (Boss, 1988, 2002). These assumptions have been widely supported by family

scholars through decades of theory development and empirical research on family stress, coping,

and health (e.g., DeMarco, Ford-Gilboe, Friedemann, McCubbin, & McCubbin, 2000; Kushner,

2007; McCubbin & McCubbin, 2001; Walsh, 2012a; Walsh, 2012b). The purpose of this paper is

to apply the Contextual Model of Family Stress (Boss, 2002) to illustrate how family functioning

mediates the implications of life stressors on the biopsychosocial wellbeing of individuals and

their family in Rohinton Mistrys (2002) novel Family Matters. The paper will include a

depiction of family background and the family issue, a description of the model, and the

application of the model to the selected issue with comments on its strengths and limitations.

The Family Issue

Family Background


Set in Bombay, India, in the mid-1990s, Family Matters by Rohinton Mistry (2002)

revolves around Nariman Vakeel, a 79-year-old widowed man with Parkinsons disease; Jal and

Coomy Contractor, his unmarried stepchildren; Roxana, his biological daughter with the

deceased wife; as well as Roxanas husband and sons. Nariman lives with his stepson, Jal, and

his stepdaughter, Coomy, who are both in their forties, in a large, rundown home called Chateau

Felicity, where he, as a Parkinsons patient, has been under their intensive care for 15 years.

Roxana, together with her husband, Yezad Chenoy, and their two sons, Murad and Jahangir, who

are thirteen and nine, reside in a small, crowded two-bedroom flat in Pleasant Villa, which was

purchased by Nariman as a wedding gift for his daughter when she got married. Narimans

decision to spend most of his savings on the apartment upset his stepchildren, who call it an act

of partiality favoring his flesh and blood (Mistry, 2002, p. 10). In addition, Coomy feels

bitter about her sister, whom she believes abandoned the family by moving out of the house and

left the siblings, especially Coomy herself, with the burden of caregiving for their fathers

chronic illness (Mistry, 2002, p. 23, 34, 82, 99). Moreover, Coomy has never considered

Nariman a real father who can replace her late father who died of a disease when she was small

(Mistry, 2002, p. 9, 62, 82), nor she has forgiven Nariman for his inability to reject his former

lover during his marriage with her mother, which brought about her mothers unhappiness and

subsequent tragic death (Mistry, 2002, p. 7, 28, 169). These thoughts make Coomy discontent

with being the primary caregiver for her stepfather.

Besides Coomys unresolved hard feelings, other issues related to Narimans chronic

illness include constant conflicts and arguments between Nariman and his stepchildren over his

daily routines, particularly his habit of going for a walk alone in the evening despite his

Parkinsons condition; financial difficulties resulting from medical expenses; as well as the


exhaustion from everyday caregiving tasks become chronic stressors that strain family

relationships and emotional wellbeing (Mistry, 2002). In Chateau Felicity, which is considered

the house haunted with misery (Mistry, 2002, p. 34, 481), Nariman often feels powerless and

lonely, Coomy is always full of frustration and resentment, while Jal time and again finds

himself helplessly torn between his sister and stepfather.

The Family Issue

On the night of his seventy-ninth birthday, Nariman came home after a walk with some

small scratches on his elbow and forearm (Mistry, 2002, p. 6). His fall, even though minor, really

upset Coomy, who feared that he may fall again and may have more serious injuries that would

aggravate the caregiving burden she had been enduring (Mistry, 2002, p. 7). In contrast, when

learning about the incident on his birthday party, the Chenoys believed that Coomy had

overreacted (Mistry, 2002, p. 32-33). They suggested that Narimans habit of taking walks is not

dangerous but actually good for his health (Mistry, 2002, p. 32-33). They gave Nariman a

walking stick as a birthday present despite Coomy and Jals strong opposition and apprehension

(Mistry, 2002, p. 32-33). This turned into a heated argument, at one point Coomy criticized

Roxana for being insensitive and unconcerned about her siblings hardship, and threatened that

if something terrible happened, [she] and Jal would deliver [Nariman] straightaway to the

Chenoy residence (Mistry, 2002, p. 34). This event foreshadows Narimans accident that has

the potential to put the family into crisis. This accident is the selected family issue for the

application of Boss (2002) Contextual Model of Family Stress.

One evening, when Nariman was taking his usual little stroll, he fell into a hole dug by

the telephone company, broke his ankle, and became bedridden (Mistry, 2002, p. 47-57). At first,

the Chenoys were not informed of the accident because Coomy feared that Roxana and Yezad


would only provide useless advice and criticism regarding how to care for Nariman (Mistry,

2002, p. 75). However, when the added burdens of nursing their paralyzed, disheartened

stepfather gradually overwhelmed and exhausted them both physically and emotionally, Coomy

and Jal, in their hopelessness, decided to turn over their caregiving responsibilities to their sister

(Mistry, 2002, p. 82). Without advanced notice, the two called an ambulance, took Nariman to

Pleasant Villa, where the Chenoys reside in a crowded two-bedroom flat. They informed Roxana

of Narimans accident and his broken ankle as well as his recent diagnosis with depression which

may inhibit the recovery process and impair his health. Claiming that only the Chenoys could

uplift his depressed mood, Coomy and Jal requested Roxana to look after Nariman until his ankle

was supposed to recover (in three weeks) (Mistry, 2002, p. 96-104). Although the home- and

role-switching situation was originally planned to be short-term, the prospect of advancing

Parkinsons condition and its related caregiving burden terrified Coomy (Mistry, 2002, p. 165),

driving her to scheme a wicked plot in order to avoid the caregiver role (p. 169). As Jal also

dreaded the cumbersome tasks of nursing his stepfather, he finally gave in to Coomys plan (p.

169). They deliberately caused damages to the house so as to have an excuse for extending the

time Nariman would stay with the Chenoys (Mistry, 2002, p. 170).

In summary, the family issue that this paper will analyze is Narimans accident which

resulted in his bedridden state. The Contextual Model of Family Stress (Boss, 2002) will be

applied to understand how family functioning in the context of accumulation of existing and

piled-up stressors determines health and wellness of individual members and the family unit.

Due to limited space, this paper will adopt Boss conceptualization of family as a continuing

system of interacting persons bound together by shared rituals and rules even more than by

shared biology (Boss, 2002, p. 17) and focus on the family system consisting of Nariman, Jal,


and Coomy, their stressors, as well as their stress management processes and outcomes. The time

frame for analyzing the selected family issue is from the beginning of the novel (when Nariman

was living with Coomy and Jal in Chateau Felicity) up to the point when Coomy and Jal

damaged the roof of the house in order to prevent Nariman from coming home. This time frame

is helpful for providing the background of existing strains and stressors, presenting the

occurrence of the stressor event (Narimans accident) and its ensuing stressors, capturing family

stress management processes, and displaying family outcomes (family crisis).

Contextual Model of Family Stress

Research on chronic illness has shown that it can cause emotional, physical, and financial

stress and thus can adversely affect the wellbeing of not only the patients but also their families

(Frain et al., 2007; Patterson & Garwick, 1994). Parkinsons is a particularly demanding disease.

It presents tremendous challenges for individuals and families due to complexities of motor

symptoms (e.g., rigidity, tremors, slow movement or loss of movement, balance and walking

problems) and non-motor symptoms (e.g., depression, memory problems, mental confusion,

sleep disturbance) (Blanchard et al., 2009; Dyck, 2009; Lau & Au, 2011; McRae et al., 1999;

Parrish et al., 2003; Sanders-Dewey et al., 2011; Waite, 2000). Also, the disease has progressive

nature and long duration (Blanchard et al., 2009; Dyck, 2009; Lau & Au, 2011; McRae et al.,

1999; Parrish et al., 2003; Sanders-Dewey et al., 2011; Waite, 2000). To be specific, Parkinsons

causes progressive physical disability and cognitive impairment, making patients increasingly

reliant on others - to the extent of totally dependent - for basic daily activities such as eating,

dressing, and hygiene (Blanchard et al., 2009; Dyck, 2009; Lau & Au, 2011; McRae et al., 1999;

Sanders-Dewey et al., 2011; Waite, 2000). In addition, although there is currently no cure for

Parkinsons, medical advancement has increased life expectancy of patients, thus extending the


time of the illness and allowing the debilitating progression of symptoms (Blanchard et al., 2009;

Dyck, 2009; Lau & Au, 2011; McRae et al., 1999; Sanders-Dewey et al., 2011; Waite, 2000).

Therefore, over a long period of time, individuals and families with Parkinsons have to make

continuous adjustments to cope with the diseases changing demands (Blanchard et al., 2009;

Dyck, 2009; Lau & Au, 2011; McRae et al., 1999; Sanders-Dewey et al., 2011; Waite, 2000). In

other words, in the presence of Parkinsons, managing stress becomes an essential day-to-day

task for the family.

Boss (2002) Contextual Model of Family Stress provides a helpful theoretical model for

examining families responses to the changing stressors related to Parkinsons and the effects of

such responses on the health and wellness of individual members and the family unit. This theory

is founded upon the ABC-X model (Hill, 1958, cited in Boss, 2002, p. 46-47) in which A

represents the stressor event, B represents the coping resources, C represents the definition the

family makes of the event, and X stands for crisis. Boss (2002) has expanded the original ABC-

X model in many ways to better explain variability in family functioning and family outcomes in

the presence of a stressful event or situation.

Figure 1. The Contextual Model of Family Stress (Boss, 2002, p. 40)


One of the developments is the contextual approach to understanding family stress (Boss,

2002). To be specific, from a systems perspective, the family is conceptualized as a system

consisting of interdependent parts and embedded in a larger ecosystem (Boss, 2002, p. 21);

therefore, family stress is examined in relations with both the familys internal and external

contexts. The familys internal context encompasses three dimensions: the structural (the form

and function of the family boundaries, roles, and rules), the psychological (the familys

perceptions of an event), and the philosophical (the familys beliefs and values which might be

similar to or different from those of the larger culture) (Boss, 2002, p. 44-45). The external

context involves the particular historical, economic, cultural, heredity, and developmental

(related to stages in the life cycle) contexts in which the stressful event occurs (Boss, 2002, p.

40). While it is postulated that the family only has control over its internal context and thus this

context is the primary focus of the model, Boss acknowledges that the external context is critical

for understanding the family stress management process because it has significant impacts on the

familys perceptions of an event, the familys resources, and how the family manages or fails to

manage stress (Boss, 2002, p. 40).

Besides the emphasis on viewing family stress in context, another important assumption

of this model is that stress is a normal part of family life because changes in individual members

(and therefore the family system) and in the familys larger ecosystem over the life course are

inevitable and with any change comes disturbance what Boss refers to as stress (Boss,

2002, p. 17). Changes are likely to disturb the steady state or the equilibrium of the family

system and thus have the potential to increase the familys level of stress (Boss, 2002, p. 61).

Boss conceptualizes change as stress and stress as change, using the terms synonymously

and with neutral connotations (Boss, 2002, p. 39). Any event that provokes change, and


therefore, disturbance, pressure, or strain (stress), on the equilibrium of the family system can

be considered a stressor event (Boss, 2002, p. 46-48). Classification of stressor events can be

based on: 1) source: internal versus external; 2) normal developmental predictable events

that are expected during the life course versus catastrophic, situational, unexpected events; 3)

ambiguous versus clear in terms of the availability and clarity of facts about the event; 4)

volitional versus nonvolitional as regards to the degree of choice and control; 5) duration:

chronic versus acute; and 6) density: cumulative versus isolated (Boss, 2002, p. 51).

In addition, the C component, perceptions (both cognitive and affective), is proposed to

be the most important factor determining family stress management process and outcomes (Boss,

2002, p., 70). As a clinical psychologist who has extensive experiences working with distressed

families, Boss gives special attention to the meaning the family attributes to the event or situation

as she observes that how the family perceives of what is happening to them determines the

degree of stress they experience and how they cope (Boss, 2002, p. 57-59). Indeed, what is

distressing to one family may not be considered distressing to another (Boss, 2002, p. 59). Also,

perceptions of the event may vary among individual members within the same family (Boss,

2002, p. 23, 59). Moreover, perceptions determine if or how a family will utilize their

resources (the B component) to respond to a stressor event (Boss, 2002, p. 88).

Finally, to make a clear distinction between stress and crisis, Boss (2002) splits the

original X component, which represents the outcome of the family stress management process,

into two pieces: degree of stress and crisis. While family stress is a continuous variable

that indicates the degree of pressure or tension on the family system, family crisis is a

categorical variable (the family is in crisis or not) (Boss, 2002, p. 67). Although the family

may experience different degrees of stress, the family is not necessarily in crisis (Boss, 2002). In


other words, family stress does not always lead to family crisis (Boss, 2002). Boss (2002) argues

that a stressor event by itself and the resulting change or stress on the family system is not

inherently good or bad for the family. Family outcomes, particularly, the levels of stress

experienced by the family low, moderate, high, or very high, and the condition of the family

unit being in a state of crisis or not, are determined by how individual members and the family

as a whole perceive the stressor event (Does it potentially create change and stress?) and by

how they manage the stress (if the answer is Yes) (Boss, 2002). Crisis is not synonymous with

the highest point of the stress continuum (Boss, 2002, p. 66). Instead, crisis is a state at which

existing resources and patterns for managing stress become inadequate, thus the family system

collapses under the overwhelming pressure and is temporarily disorganized and immobilized

(Boss, 2002, p. 61). In crisis, the family system stops functioning: family boundaries and roles

are no longer maintained, and family members can no longer function at optimal levels,

physically or psychologically (Boss, 2002, p. 63). However, family crisis may be a turning

point, not an end point (Boss, 2002, p. 66). It is expected that the family will then engage in a

roller-coaster course of adjustment: hit bottom, reach a turning point (change in the

stressor event, or in the resources for coping, or in perception), then, begin the recovery

process, and repair itself (Boss, 2002, p. 66-67). Indeed, Boss argues that in some cases,

going into crisis and then reorganizing existing structures within the family system are not

necessarily bad because the family can reach an even higher level of functioning than was

possible before crisis, which she refers to as a second-order change (Boss, 2002, p. 68, 84).

Application of Model to Family Issue

In this section, the Contextual Model of Family Stress (Boss, 2002) will be applied to

examining how the family reacted to Narimans accident influence the well-being of individual


members and the family unit. Components of the core stress equation (ABC-X) will be the focus

of the application, and references to the familys external and internal contexts will be made

when relevant.

A Event or Situation

Boss (2002, p. 48) defines a stressor event as an event that marks a possible starting

point for a process of change and subsequent stress in the family system. Narimans accident,

which broke his ankle and made him confined to bed, is a stressor event because it led to

significant changes in his ability to carry out his activities of daily living, in turn, leading to

changes in the daily routines of Jal and Coomy, who had been his caregivers, and other ensuing

changes that affected all family members and increased the level of stress within the family.

Using Boss classification of stressor events or situations (Boss, 2002, p. 51), Narimans accident

is an internal stressor (one that begins from someone inside the family). In addition, this is a

situational, unexpected event, although not entirely unexpected. Coomy and Jal had always

feared that Nariman would fall while going out alone for a walk in the evening. It is likely that

Nariman also knew that falling could be a possibility after he had fallen while crossing the lane

outside Chateau Felicity on the night of his seventy-ninth birthday. However, the accident was

still unexpected because they did not know for sure when he would fall. Also, Nariman had not

expected that he would have an accident with serious consequences that would significantly

affect himself and his family. It is an acute stressor event, because it happened suddenly and

would last only a short time. Also, it is nonambiguous because the family knew what was

happening, how it would turn out, and how long it would last: Nariman would need to stay in bed

for four weeks so that his ankle could heal, which means during that period he was totally

dependent on others in all daily activities.


Following the accident, Narimans functional disability in all aspects of daily living made

caregiving a particular challenging and stressful task for Coomy and Jal. As Nariman could not

go to the bathroom, his stepchildren had to help him with his toilet activities in the bedroom.

They first tried using a commode with the assumption that they could just move him to the

commode and he could do the rest by himself. It turned out to be not as simple as they had

expected because to lift an almost dead weight vertically required so much force that both of

them felt exhausted afterwards (Mistry, 2002, p. 61). Also, while they had hoped that he could

wash himself as usual, he could no longer manage the task because immobilized by the platter

mass, he did not have the strength to manipulate on the commode and almost fell off it in his

first attempt (Mistry, 2002, p. 69-70). As a result, Coomy had to do the job and could not help

feeling disgusted by it. Emptying the pot was also appalling to Coomy and Jal, and they kept

arguing over who would be responsible for cleaning the pot. Besides the labor-intensive task of

transporting the old man, sleep deprivation due to several toilet calls during the night made

Coomy and Jal exhausted. Another problem is that Narimans broken ankle hurt badly each time

he was moved, but he was afraid to tell them. The pain was so intense that one time he ended up

making a mess on his bed instead of asking for the commode. Then, Coomy and Jal decided that

a bedpan might be more helpful. However, while the back-breaking labor of lifting Nariman to

the commode was eliminated, the rest remained as repelling as before (Mistry, 2002, p. 75). On

top of it, all of the cumbersome tasks from feeding him to cleaning his dentures consumed all of

their time and energy. Over the week, their fatigue and frustration grew stronger to the point

that they felt overwhelmed and helpless (Mistry, 2002, p. 79).

To fully understand why this family was so vulnerable to stress in the presence of this

stressor event, it is important to view it in relations with existing and piled-up strains in the


family. Specifically, Parkinsons disease is a chronic stressor situation that has been putting

pressure and tension on the family system for fifteen years. The illness causes frequent conflicts

and arguments between Nariman and his stepchildren, over numerous issues related to his health

and safety, for example, not going to the bathroom by himself, not locking the bathroom door,

and not going out alone for a walk. In addition, Coomy has always felt dissatisfied with the role

of being Narimans primary caregiver. The reasons behind this are many. One, he is not her real

father; to her, he is a father in name only (Mistry, 2002, p. 9, 28). Second, he made her mother,

herself, and Jal miserable when being involved in shameful behaviors with his former lover

(Mistry, 2002, p. 7, 28), which led to marital discord and later the tragic death of her mother.

Third, he spent most of his savings on an apartment as a wedding gift for her half-sister, which

was condemned by Coomy as an evidence of his favoritism for Roxana over his stepchildren

(Mistry, 2002, p. 10). Coomy has always believed that she is forced to take on this role and is

stuck with it (Mistry, 2002, p. 34), she feels overburdened by the caregiving responsibilities (p.

74), she criticizes Jal and Roxana for not providing support (p. 75), and feels unappreciated for

her hard work (p. 7). These hard feelings have strained family relationships and made everyone

distressed. When family members are together, most of the times there are quarrels and negative

emotions.

Another concurrent stressor of the family is financial strains. An indicator is that Coomy

repeatedly complains about their lack of money. This stressor needs to be viewed in relations

with the familys internal and external contexts. The structural dimension in the familys internal

context encompasses instrumental and expressive functions that family members must be

perform for ensuring the survival and development of the family system (Boss, 2002, p. 21).

However, there is no clear designated instrumental role among those who live in Chateau


Felicity. Nariman already retired. Neither Jal nor Coomy works. The main sources of family

income are the deceased mothers investment in a share bazaar and Narimans meager pension.

They have been struggling with the stepfathers medical expenses and the familys living costs.

This chronic stressor situation is partly influenced by the historical (and economic) context. The

family is situated in Bombay in the mid-1990s, a period marked with government corruption,

social unrest, and political instability. In such context, prices for goods and products are high,

investments in the share bazaar are not fruitful, and social welfares are so poor that Narimans

pension hardly covers his medical expenses.

In addition to various existing stressors and strains, the family was continually presented

with a pile-up of stressors following Narimans accident. The draining tasks of caring for the

basic needs of their bedridden stepfather, especially dealing with his excretions and secretions,

depleted Jal and Coomys physical and emotional resources. To make it worse, Phoola, the

servant who usually helped with housework, quit the job because of the unbearable stink in

Narimans bedroom. This added extra burden on Coomys shoulder for performing household

chores in the spacious seven-room Chateau Felicity. Moreover, besides attending to Narimans

physical needs, Coomy and Jal were subsequently required to care for his depressed mood which

resulted from his feelings of powerlessness. As they themselves were also distressed, they found

it hard to uplift their stepfathers spirits. The accumulation of stressors and demands, rather than

Narimans accident by itself, determined the familys level of stress and their vulnerability to

crisis.

B Resources

Family stress theories in general and the Contextual Model of Family Stress in particular

postulate that while stressor events or situations have the potential for increasing the stress


degree in the family and the risk of family crisis, resources coming from individual members, the

family unit, and community as well as the familys positive perceptions of the stressors can help

mitigate the effects of stress on family functioning and family health and wellness (Boss, 2002).

In contrast, limited resources and negative perceptions may result in adverse outcomes for the

family (Boss, 2002). This section will focus on examining the B component of the ABC-X stress

equation, which is family resources.

In terms of individual resources, it can been observed that family members had limited

financial, physical, and emotional resources. No one in the family at that time had a substantial

source of income. In terms of biopsychological resources, Nariman became almost physically

disabled, which negatively affected his mood, put him into depression, and deteriorated his

physical health. Also, because of the pile-up of stressors and demands related to caregiving for

their helpless, debilitating stepfather, Coomy and Jal found themselves physically and

emotionally exhausted.

Regarding resources at the family level, paying for Narimans hospital expenses

exacerbated the familys financial situation, which made it impossible for them to hire an ayah (a

nurse) to help with the caregiving tasks. In addition, there is a lack of positive attributes such as

emotional connectedness, positive communication, and collaborative problem-solving, which

have been suggested to be some family strengths that facilitate healthy family functioning (e.g.,

DeFrain & Stinnet, 1992; Esptein, Ryan, Bishop, Miller, & Keitner, 2003; Olson & Gorall, 2003;

Wash, 2012a). Clearly, the emotional bonding among family members is weak, indicated by low

levels of warmth and affection expressed towards each other. Nariman is not emotionally close

to his stepchildren and often feels lonely in the house (p. 39). Coomy often openly shows

resentment towards Nariman and frustration towards her brother. Except for a few instances


when Jal tries to comfort Coomy when she is feeling upset or crying, he generally does not

express affection to her. In addition, communication in the family is usually marked with

arguments, disregard of others perspectives, mocking, and criticism while lacking discussion

and compromise. Such negative communication patterns result in unresolved or destructive

conflicts, hurt feelings, and strained relationships within the family. Moreover, these patterns of

interactions inhibit the familys ability to cooperate in solving problems. For example, while

Coomy often criticizes Jal for not providing adequate support and complains about the burden of

her responsibilities, she wants to make most decisions and tends to dismiss his contribution of

ideas about how to cope with problems. Therefore, following Narimans accident, Coomy and

Jal struggled with the new stressors and demands because they frequently argued and blamed

each other and could not reach an agreement on solutions to the problems. For instance, Jal more

than once suggested that they should inform the Chenoys of their problems and ask for some

support, Coomy kept dismissing his suggestions, even when she felt that the workload was too

much for her and Jal to handle.

Besides, there appears to be limited community resources. The family cannot rely on

government support even in paying for Narimans medical expenses. Additionally, the family

lack a strong network of social support (e.g., relatives, friends, community), which has been

suggested to be a critical predictor of adaptational pathways of families with Parkinsons

(Goldsworthy & Knowles, 2008; Parrish et al., 2003; Shin et al., 2012). The only potential

source of social support is from the Chenoys, who may be able to share the workload of day-to-

day caregiving for Nariman or provide emotional support (empathy, encouragement) to Jal and

Coomy. However, after Narimans accident, despite the fact that Coomy and Jal felt

overwhelmed and burnout by piled-up stressors, they did not utilize this potential resource.


In short, the familys limited individual, family, and community resources make the

family more vulnerable to experiencing high level of stress in the presence of changes and new

demands.

C Perceptions

According to the Contextual Model of Family Stress, the familys perception of the

stressor event or situation is central to the stress equation (Boss, 2002). This component, also

referred to by other scholars as the familys definition, meaning, appraisal, or assessment of the

event, encompass both cognitive and affective processes and play an important role in shaping

the familys adaptational pathways (Boss, 2002, p. 59). It has been suggested that when a family

is confronted with a members illness or disability, the familys perceptions involve appraisals to

the severity of the condition, level of burden, and perceived need for help (Lee, 2009, p. 3).

The familys perceptions determine the degree of stress that they experience as well as if and

how the family utilize resources to cope with stress. Coping, therefore, is the interaction between

resources and perceptions (Boss, 2002). Family resources alone cannot determine family

outcomes because some families cope poorly even when resources are available due to unuse,

underuse, or misuse of resources (Boss, 2002, p. 68-69). Clearly, for a period of time following

Narimans accident, Coomys perceptions led her to disregard potential support from the

Chenoys and to continue enduring the caregiving burden.

The familys perceptions of the event need to be viewed in relations with the cultural

dimension in the external context and the philosophical dimension in the internal context.

Cultural influences as well as family beliefs and values all affect perceptions of the stressor event

(Boss, 2002). Particularly, in Family Matters, the familys external context, India, can been

classified as a fatalistic culture (as opposed to a mastery-oriented culture like the U.S.), which


fosters the belief system that everything is predetermined by a higher power. In such cultural

contexts, people tend to accept whatever happens to them without trying to control or improve

the situation (Boss, 2002, p. 41, 136). It is possible that these cultural values may have some

influence on the philosophical dimension (the familys beliefs and values) and psychological

dimension (the familys perceptions of the event) of the internal context. Specifically, fatalistic

cultural values may have influenced the family members feelings of helplessness.

In addition, Boss argues that fatalism can generally refer to the opposite of a belief in

mastery and that fatalism is not necessarily caused by beliefs in predetermination by a higher

power but primarily by environmental conditioning that reinforces a sense of powerless (Boss,

2002, p. 137). It is likely that past experiences of lack of control over what happened to them has

shaped the familys fatalistic value orientation. To be specific, Nariman believed that he was

forced by his parents into the unhappy marriage. He felt that he had no control over the affair

among himself, his former lover, and his wife as well as over its tragic consequence. In his old

age, every aspect of his daily living has been restricted by Coomys rules, and after the accident

he learned that he would become bedridden and totally dependent on others. Jal and Coomy had

no control over their mothers remarriage and were forced to accept Nariman as their father

(although only a father in name) (Mistry, 2002, p. 28). Then, during their childhood, they

helplessly witnessed the conflicts and misery of Nariman and their mother. Later in life, after

Roxana got married and moved out of Chateau Felicity, Jal and Coomy were stuck with the

responsibilities of caregiving for Nariman. Also, they had no control over the deteriorating

progression of his chronic Parkinsons disease with its increasing demands. Moreover, they had

coped poorly with taking care of Nariman after the accident, indicated by the deteriorating


physical and emotional wellbeing of their stepfather and themselves, which made them feel

incompetent for the tasks and reinforced their sense of helplessness.

The familys fatalistic value orientation, or the tendency to perceive the stressor as

threatening and unmanageable, has been suggested to predict the familys high degree of stress

and negative coping (Boss, 2002). Clearly, Coomy and Jal perception that the problems related

to Narimans caregiving were insurmountable put them under a lot of stress. Also, it led them to

negative coping. Particularly, perceiving that they were unable to provide proper nursing to their

bedridden stepfather, especially when he needed emotional support to uplift his depressed mood,

Coomy and Jal gave up their efforts, turned over the responsibilities to Roxana, and moved

Nariman from Chateau Felicity to Pleasant Villa. Similarly, Narimans sense of powerlessness

due to his bedridden state put him into depression. Moreover, although he felt uncomfortable

about becoming a burden for the Chenoys family, he perceived no control over his fate and gave

in to whatever Coomy and Jal decided. According to the Contextual Model of Family Stress, this

is obviously an example of ineffective coping because family coping is supposed to be the

process by which individuals and their family system as a whole manage rather than eradicate

stressful events or situations with no detrimental effects on any individual in that family (Boss,

2002, p. 79). In this case, Coomy and Jal avoided confronting the problems and removed what

they perceived as the source of their stress (their stepfather) although these actions led to the

disintegration of the family system.

X Stress/Crisis

The familys limited resources and perceptions of the stressor as unmanageable made the

family experience high degree of stress; eventually, the family system broke down under the

severe pressure and the family fell into crisis when Coomy and Jal decided to move Nariman to


the Chenoys residence. Indicators of family crisis are inability of family members to perform

usual roles and tasks and inability to care for each other in the usual way (Boss, 2002, p. 64).

It can be seen that Coomy and Jal at that point had given up their usual roles of being the primary

caregivers for their stepfather. In addition, their action illustrates another indicator of family

crisis which is focus shifting from family survival to individual survival (Boss, 2002, p. 64).

Indeed, their individual needs became priorities, so they moved Nariman out of the family

system as a way to remove the stressor even at the risk of disintegrating the family unit.

Moreover, in crisis, family members are unable to make decisions and solve problems (Boss,

2002, p. 64). The role-switching situation was originally intended to last for only three weeks so

that Coomy and Jal could take a break, find another servant to help with housework, and come

up with better solutions to cope with the demands related to Narimans caregiving. However,

weeks passed by with endless arguments between Coomy and Jal but no agreement on solutions

to their problems. Coomy and Jal deliberately damaged the house in order to postpone Narimans

return, which prolonged the family crisis state.

However, Boss argued that crisis is not necessarily bad for a family because it shows the

inadequacy of existing patterns of managing family stress and thus reorganization of the family

system may lead to a higher level of functioning than before crisis (Boss, 2002, p. 84). Although

a system has a natural inclination to maintain the status quo and resist change (Smith &

Hamon, p. 154), dysfunctional patterns within the family system may need to be altered to foster

family functioning and family health and wellness (Boss, 2002, p. 22, 84). Clearly, previous

rules, roles, and patterns of interactions within the family in Mistrys novel made them

experience high levels of stress and impaired their ability to address challenges and promote the

biopsychosocial well-being of individual members and the family unit. In order to effectively


manage the increasing demands of Parkinsons and other life stressors, it is expected that there is

a second-order change to the family system so that it can recover and grow after crisis (Boss,

2002, p. 84).

Critical Examination of the Models Strengths and Limitations

The Contextual Model of Family Stress (Boss, 2002) has several strengths that make it

particularly appropriate for studying the selected family issue. First, its contextual approach

makes it relevant to be applied for families from diverse cultural backgrounds such as the one

depicted in the novel Family Matters by Rohinton Mistry. In addition, a detailed classification of

stressor events helps guide the analysis of the causes, characteristics, and management of stress

in families with Parkinsons, who are continually presented with changing demands resulted

from the debilitating progression of this chronic illness as well as accumulation of existing and

piled-up stressors. Moreover, unlike the Resiliency Model of Family Stress, Adjustment, and

Adaptation (McCubbin & McCubbin, 2001) which focuses on the adaptation of families after

crisis, the Contextual Model of Family Stress focuses on the processes that prevent or lead to

family crisis, which makes it more suitable for the selected issue and its time frame. Moreover,

the Resiliency model seems to assume that the family prior to crisis is in a state of harmony and

balance and that the goals during the adjustment phase (before crisis) are to regain this state of

harmony and balance (McCubbin & McCubbin, 2001). Bonadjustment, the positive outcome

of this phase, is defined as the maintenance of established patterns of functioning, and

maladjustment, the negative outcome, is the family crisis (McCubbin & McCubbin, 2001, p.

14). In contrast, the Contextual Model posits that existing patterns of functioning may be

dysfunctional and crisis is not necessarily bad for the family because it allows reorganization of


the family system so that family functioning can reach a higher level (Boss, 2002). Clearly, the

Contextual Model fits better with the characteristics of the family in Mistrys novel.

Although the Family Stress Management theory provides many advantages, it also

presents some challenges in the application of the theory to the selected family issue. First, the

goal of the author is to provide an umbrella-like theoretical framework with broadness of

theoretical ideas for understanding family stress and crisis instead of a how-to list of steps

detailing how to manage stress (Boss, 2002, p. 1). Therefore, it is obviously more challenging to

examine family stress management processes using the Contextual Model than if using Walshs

(2012a) Family Resilience Framework or McCubbin and McCubbins (2001) Resiliency Model.

For example, it is possible to use Walshs (2012a) detailed list of key processes in family

resilience to assess family functioning in the face of a stressor by checking which processes are

present in the family system and which are not. Second, the novel does not provide enough

information to fully apply all of the components of the familys external context (although it did

mention that the family are Parsi and they live in a corrupted society). In addition, the C

component, Perceptions, appears to overlap with the psychological dimension in the familys

internal context. Accordingly, instead of having separate sections describing the familys

external and internal contexts, I decided to focus on the core ABC-X stress equation and make

references to factors in those contexts when appropriate.

Conclusion

Neither do I agree with the statement All happy families are alike; each unhappy family

is unhappy in its own way (Tolstoy) nor with the statement All happy families are more or less

dissimilar; all unhappy ones are more or less alike (Nabokov). Indeed, share family scholars

views that each family is a unique living organism and goes through periods of ups and downs as


a normal part of life (Boss, 2002; McCubbin & McCubbin, 2001; Walsh, 2012a; Walsh, 2012b).

How a family deals with situational and developmental demands at different points over the life

course determine whether they are in the up or down stage and how long they will remain in

that stage (Boss, 2002; McCubbin & McCubbin, 2001; Walsh, 2012a; Walsh, 2012b). In

addition, family functioning needs to be viewed in context with consideration given to the

familys larger ecosystem and the familys own values, resources, and challenges (Boss, 2002;

McCubbin & McCubbin, 2001; Walsh, 2012a; Walsh, 2012b). These points have been illustrated

throughout this paper by applying the Contextual Model of Family Stress (Boss, 2002) to a

family system depicted in Rohinton Mistrys (2002) novel Family Matters. Specifically, the

model was used to examine how factors in the external and internal contexts influence family

functioning in the face of existing and piled-up stressors related to caregiving needs of a family

member and determine family health and wellness on physical, psychological, and social levels


References

Blanchard, A., Hodgson, J., Lamson, A., & Dosser, D. (2009). Lived experiences of adult

children who have a parent diagnosed with parkinson's disease. Qualitative Report, 14(1),

61-80.

Boss, P. (1988). Family stress management. Newbury Park, California: Sage Publications.

Boss, P. (2002). Family stress management: A contextual approach (2nd ed.). Thousand Oaks,

CA: Sage.

DeMarco, R., Ford-Gilboe, M., Friedemann, M., McCubbin, H. I., & McCubbin, M. A. (2000).

Stress, coping, and family health. In V. H. Rice (Ed.), Handbook of stress, coping, and

health: Implications for nursing research, theory, and practice (pp. 295-332). Thousand

Oaks, CA: Sage.

DeFrain, J., & Stinnett, N. (1992). Building on the inherent strengths of families: A positive

approach for family psychologists and counselors. Topics in Family Psychology and

Counseling 1(1), 15-26.

Dyck, C. (2009). Who cares for the caregiver? Parkinsonism and Related Disorders, 15, S118-

S121. doi:10.1016/S1353-8020(09)70796-5

Epstein, N.B., Ryan, C.E, Bishop, D.S., Miller, I.W., & Keitner, G.I. (2003). The McMaster

Model: A view of healthy family functioning. In F. Walsh (Ed.), Normal family processes.

Growing diversity and complexity (3rd ed.; pp. 581-607). New York: Guildford.

Frain, M. P., Berven, N. L., Tschopp, M. K., Lee, G. K., Tansey, T., & Chronister, J. (2007). Use

of the resiliency model of family stress, adjustment and adaptation by rehabilitation

counselors. Journal of Rehabilitation, 73(3), 18-25.


Goldsworthy, B., & Knowles, S. (n.d). Caregiving for Parkinson's Disease Patients: An

Exploration of a Stress-Appraisal Model for Quality of Life and Burden. Journals Of

Gerontology Series B-Psychological Sciences And Social Sciences, 63(6), P372-P376.

Kushner, K.E. (2007). Meaning and action in employed mothers health work. Journal of Family

Nursing, 13(1), 33-55.

Lau, K. & Au, A. (2011). Correlates of informal caregiver distress in Parkinson's disease: A

meta-analysis. Clinical Gerontologist, 34 (2), 117-131.

Lee, M. (2009). A path analysis on elder abuse by family caregivers: Applying the ABCX

model. Journal of Family Violence, 24(1), 1-9.

McCubbin, M.A., & McCubbin, H.I. (2001). Resiliency in families: A conceptual model of

family adjustment and adaptation in response to stress and crises. In H.I. McCubbin, A.I.

Thompson, & M.A. McCubbin (Eds.), Family measures: Stress, coping and resiliency.

Inventories for research and practice (pp. 1-64). Honolulu: Kamehameha Schools.

McRae, C., Sherry, P., & Roper, K. (n.d). Stress and family functioning among caregivers of

persons with Parkinson's disease. Parkinsonism & Related Disorders, 5(1-2), 69-75.

Mistry, R. (2002). Family matters. Toronto: McClelland & Stewart.

Olson, D.H., & Gorall, D.M. (2003). Circumplex model of marital and family systems. In F.

Walsh (Ed.), Normal family processes. Growing diversity and complexity (3rd ed.; pp. 514-

548). New York: Guildford.

Parrish, M., Giunta, N., & Adams, S. (2003). Parkinson's disease caregiving: Implications for

care management. Care Management Journals, 4(1), 53-60.

Patterson, J. M., & Garwick, A. W. (1994). The impact of chronic illness on families: A family

systems perspective. Annals of Behavioral Medicine, 16(2), 131-142.


Sanders-Dewey, N., Mullins, L. L., & Chaney, J. M. (2001). Coping style, perceived uncertainty

in illness, and distress in individuals with parkinson's disease and their

caregivers. Rehabilitation Psychology, 46(4), 363-381.

Shin, H., Lee, J., Youn, J., Kim, J., & Cho, J. (2012). Factors Contributing to Spousal and

Offspring Caregiver Burden in Parkinson's Disease. European Neurology, 67(5), 292-296.

Smith, S.R., & Hamon, R.R. (2012). Family systems theory. In Exploring family theories (3rd

ed.; pp. 145-163). New York: Oxford University Press.

Waite, L. (2000). Accommodating Parkinson's disease: a review of the perspective of the

caregiver and the Parkinsonian. Loss, Grief & Care, 8(3-4), 173-187.

Walsh, F. (2012a). Family resilience: Strengths forged through adversity. In F. Walsh (Ed.),

Normal family processes. Growing diversity and complexity (4th ed.; pp. 399-427). New

York: Guildford.

Walsh, F. (2012b). The new normal: Diversity and complexity in 21st-century families. In F.

Walsh (Ed.), Normal family processes. Growing diversity and complexity (4th ed.; pp. 3-27).

New York: Guildford.

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