PAC 230 Module 1 Health Psychology and the Family Example

Three Generations, One Kitchen Table: Health Psychology, Risky Families and the Dawson Family's Health

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 230: Families and Health Psychology

Instructor Name

Month Day, Year

Three Generations, One Kitchen Table: Health Psychology, Risky Families and the Dawson Family's Health

Every Sunday, four generations of the Dawson family's health problems sit at one kitchen table in Toledo. Walt, seventy-four, a retired autoworker, has coronary heart disease and smoked for forty years. His daughter Carla, forty-nine, a school bus driver, has become his main caregiver and has headaches and trouble sleeping. Carla's son Mike, twenty-six, is nine months into recovery from opioid use that began with pills after a roofing injury. Mike's niece Brianna, sixteen, has recently started vaping. The family receives care at Maumee Valley Family Health, an invented community health center where I am a student intern. Each family member could be treated separately, but their health is connected. This paper introduces health psychology through the Dawsons. They are a composite family made up for teaching; the research is real.

Health Psychology and the Biopsychosocial Model

Health psychology studies how psychological, behavioral and social factors affect health and illness, how people respond to illness and how health can be promoted. Its foundation is the biopsychosocial model. Engel (1977) argued that the biomedical model of his time, which explained disease entirely through biological processes, could not account for why people with the same biological condition experience it so differently or why psychological and social circumstances affect the course of illness. In its place he proposed reading every illness on three levels at once, the body, the mind and the person's social world, since each acts on the other two. Walt's heart disease, for example, involves narrowed arteries, but also forty years of smoking, the stress of a plant closure and the meals of a family that showed love through food.

How Families Shape Health

Families are among the most powerful social influences on health. Repetti et al. (2002) reviewed research on what they called risky families, characterized by conflict and aggression and by relationships that are cold, unsupportive or neglectful. They proposed that growing up in such families affects health through several pathways. Children may develop deficits in recognizing and managing emotions and in social skills. Their biological stress response systems, including the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, may become overreactive or poorly regulated after repeated exposure to stress. And they are more likely to adopt risky health behaviors, such as smoking, alcohol and drug use, as ways of coping. These pathways, the authors argued, help explain links between family environments in childhood and both mental and physical health problems later, from depression and substance use to heart disease.

Adverse Childhood Experiences

The Adverse Childhood Experiences study provided large-scale evidence for these links. Felitti et al. (1998) surveyed more than nine thousand adults in a health maintenance organization about seven categories of adverse childhood experiences, covering abuse of three kinds, emotional, physical and sexual, and four kinds of trouble in the household: a member who drank heavily or used drugs, one with mental illness, one sent to prison and violence against the mother. A majority of the adults described at least one of these. Risk rose in steps. Each added category of adversity went with higher odds of heavy drinking, illicit drug use, depression and attempted suicide, of smoking and inactivity, and of heart, lung and liver disease and cancer. People reporting four or more categories had several times the risk of substance use problems and depression compared with those reporting none.

The study has limits. It relied on adults' recall of childhood, its sample was largely white, middle-class and insured and its design shows association rather than proving cause. But its scale and its graded pattern made childhood adversity a central concern in health.

The Dawson Family Health Map

The map makes the family's connections visible. Walt grew up with a father who drank heavily, an adverse childhood experience. He coped with stress by smoking. Carla's stress affects her sleep and her health. Mike's opioid use began with pain but continued in a family where substance use had long been a way of coping. Brianna has watched her uncle's addiction and recovery and has started vaping with friends. The family also has strengths: they gather every Sunday, Mike's recovery has brought them closer and Carla is fiercely committed to all of them.

Strengths in the Family

A health map that showed only risks would misdescribe the Dawsons. Their Sunday dinners are a ritual of connection that many families lack, and connection is protective in its own right. Walt has kept every cardiology appointment since his heart attack, which shows he can change long habits when he decides to. Mike's recovery has given the family a vocabulary for talking about substance use that Walt's generation never had; Brianna has heard her uncle speak openly about how vaping and pills began for him. Carla's devotion, though it is wearing her down, is also the reason the family holds together. Any plan to improve the family's health should start from these strengths rather than from the list of diagnoses.

Implications for Practice

Three implications follow. First, clinicians should ask about family context, including family history, stressors and childhood experiences, when caring for any family member. Second, the family can be a unit of care: a single conversation about how the Dawsons handle stress could help Walt, Carla, Mike and Brianna at once. Third, the research should be used without blame. Repetti and colleagues and Felitti and colleagues describe risk, not fault, and the Dawsons' closeness is a resource for change.

Conclusion

Health psychology looks at health through biology, psychology and social life together. Engel provides the biopsychosocial model, Repetti, Taylor and Seeman explain how family environments shape stress responses, emotions and health behaviors and Felitti and colleagues show that childhood adversity is linked to adult disease and substance use in a graded way. The Dawsons' health problems are connected across generations, and so are the possibilities for improving them.

References

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136. https://doi.org/10.1126/science.847460

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128(2), 330-366. https://doi.org/10.1037/0033-2909.128.2.330