The Individual and Family Life Cycle

Abstract

A family physician was worried about a patient, a 53-year-old woman whose blood pressure had become progressively elevated despite appropriate treatment; no cause for secondary hypertension or noticeable changes in her life were identified. Mrs. Garcia, the patient, a pleasant and energetic Latina widow, was living with her daughter and two grandchildren. One day, she brought her 18month-old granddaughter to her physician for a routine medical visit with complaints of sleep problems. The toddler often cried or had temper tantrums at bedtime. While assessing the child’s development, the physician also explored the family situation. The child was the result of an unexpected though welcomed pregnancy of a a full-time working mother, who already had a 12-year-old son. When the grandmother was asked how this unexpected return to childrearing responsibilities had been for her, she confessed that in her enthusiasm to have a granddaughter, she did not anticipate the emotional and physical demands posed by an active toddler at this stage of her life. The patient’s stress was exacerbated because of feelings of discomfort in renegotiating childcare arrangements with her daughter, whom she had promised to support when her husband had left home. Moreover, given the present situation, she could not pursue her plans to spend the winter holidays with siblings in her hometown. At this point, the physician realized the impact of the family dynamics and life cycle issues on his patients’ health. The grandmother’s blood pressure and the child’s sleep problems were successfully addressed as the physician promoted a dialogue between grandmother and mother focusing on the symptoms as responses to the family’s adaptation to a new life-cycle stage.