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FAMILIES IN PSYCHIATRY: The institution of marriage--Part II.

The previous column reviewed the institution of marriage up to the middle of the last century. Since the 1950s, postmodernism has been gathering momentum, beginning as a critique of art, architecture, philosophy, and how we think about society and culture. Views on many aspects of our lives, as we live it, began to change.

Postmodernism stands in contrast to the "modern" or scientific view that touts a singularity of truth and a singular view of the world. Social construction is a type of postmodern theory that states that truth, reality, and knowledge are based in the social context of that particular person. This aspect of postmodernism is most applicable to mental health professionals assessing and treating patients, and to families in specific social and cultural contexts.

A postmodern view of the family considers the traditional view of the family, the "nuclear family" as only one view Other forms of family and other views of marriage that had been marginalized, considered deviant and nonconforming, are now brought forward and considered as viable alternatives. Postmodernism discards many assumptions that we have been taught. One assumption that is being reexamined, for example, is that sexual nonexdusivity or extra-relationship sex or romantic involvements are symptoms of troubled relationships or forms of sexual acting out.

Another assumption that needs to be reexamined is the notion that family structures found in other cultures are "abnormal" or "dysfunctional." These assumptions are not necessarily true or false but require assessment in context of the relationship at hand. Postmodernism challenges us to assess each family variation on its own merit.


In the 20th century, Monica McGoldrick, Ph.D., one of the strong voices in family therapy, advocated for increased sensitivity to cultural variation. Her book, Ethnicity and Family Therapy (New York: The Guilford Press, 2005), describes characteristics of common ethnicities in American society.

Family therapists have attempted to address "nontraditional" families with articles, for example, about raising a biracial child, what to do if your child identifies as gay, etc. Most older articles focused on helping families "cope" with the nontraditional. Family therapists are now more willing to acknowledge "difference" as a normal rather than a pathological variant, and to recognize strengths inherent in diversity.

Acknowledging diversity

Marlene F. Watson, Ph.D., brings a nuanced understanding of the African American family, detailing the effect of slavery on the individuals in the family, and how internalized racism can be recognized and managed in family therapy (e-book, Facing the Black Shadow, 2013). This is an important book for therapists, especially those who come from traditional families, as it articulates the reality of African American lives in a way that therapists can apply to clinical practice.

Dr. Watson illustrates through case examples how internalized racism affects marriages, and offers effective ways to help couples negotiate and overcome the negative aspects of their heritage. A postmodern stance also will help the couple recognize the resilience and strengths that are inherent in overcoming adversity

Linda M. Burton, Ph.D., and Cecily R. Hardaway, Ph.D., highlight the role of "othermothers" in raising children in low-income families, be they white, Latino, or African American. They define "othermothering" as a form of coparenting, distinct from stepparenting. Women othermother children who are their romantic partners' children from previous and concurrent relationships. Compared to stepfamilies, these multiple partner fertility relationships are more prevalent among young couples with limited financial resources, contentious relationships, and serial childbearing through serial repartnering.

In general, low-income women and women of color take on this style of coparenting to help the biological parents of relatives and friends who have limited social and psychological capital to protect and raise "good children"(Fam. Proc. 2012;51:343-59). Family therapists will become much more effective if they understand and recognize that the motivation behind this form of mothering fosters resilience in the mothers. The more we know and understand alternative family structures, the more we can work toward building and sustaining resilience.

Assimilation has for many decades been the main focus of political and therapeutic endeavors. In postmodern times, transnationalism described a new way of thinking about relationships that extend across national boundaries and cultures (Fam. Proces. 2007;46:157-71).

Immigrants maintain connections with their countries of origin with children who are parented by grandparents, or other relatives, perhaps in several countries at the same time. Family members use Skype, often daily, to connect with the matriarch or patriarch "back home."

Postmodern theories of social justice and cultural diversity work well with immigrants, bringing multiple perspectives into the treatment room. Immigrants bring many complex and diverse values in relation to marriage, gender, parenting, and religious practices. A social justice approach focuses on the racism and discrimination that is common in the lives of immigrants. Marriage might take place across nations, be arranged, or might be mixed race or mixed nationalities. Therapy that acknowledges these complexities will be most helpful. We still need to think further about global family life, how relationships evolve over long distances, and how to develop systemic and transnational interventions for separations and reunifications.

Sex and marriage

Nelson Mandela's father had four wives, and he reported in an interview that he considered all of them his mothers and gained support from them all.

Polygamy has flourished in Africa and Asia for centuries, and more than 40 countries recognize polygamous marriages. In the former Soviet republic of Kazakhstan, rich Kazakhs used to buy second wives from parents, often in exchange for livestock. Since Kazakhstan's independence in 1991, polygamy, although illegal, has again become common practice and is a status symbol for rich Kazakhs. Polygamy reportedly also is a way out of poverty for young women who save money and support their relatives back home.

In the United Kingdom, polygamy has become more common in Muslim communities. Successful British Muslim women, who have delayed marriage to build careers, may choose to become a co-wife. They choose to share a husband in a relationship that they see as sanctioned by Islam. These women retain an independent lifestyle. "I didn't want a full-time husband," one Muslim woman noted in an interview.

In the United States, the practice of polygamy was officially ended in the Mormon church in 1890. Nevertheless, several small "fundamentalist" groups continue the practice. One family of 14 wives and 17 children, the Browns of Nevada, are stars of a reality show that they reportedly hope educates the public about the choice.

Polyandry, a woman with multiple husbands, is described in many cultures. This practice frequently involves the marriage of all brothers in a family to the same wife, which allows family-owned land to remain undivided. In some cultures, such as the Inuit, a man might arrange a second husband (frequently his brother) for his wife because he knows that, when he is absent, the second husband will protect his wife. Should she become pregnant while he is gone, it would be by someone he had approved in advance.

Penn State's Stephen Beckerman, Ph.D., and his colleagues, in their study of the Bari people of Venezuela, found that children understood to have two fathers are significantly more likely to survive to age 15 than are children with only one. This is called "informal polyandry," because while the two fathers might not be formally married to and living with the mother in all cases, the society around them officially recognizes both men as legitimate mates to the mother, and father to her child.

Polyamory, the practice of open, multiple-partner relationships, is a structure that is increasingly common in Western countries, according to sociologist Elisabeth Sheff, Ph.D. Dr. Sheff's 15 years of research leads her to believe that polyamory is a "legitimate relationship style that can be tremendously rewarding for adults and provide excellent nurturing for children."

She said she has found that children aged 5-8 do not seem to care about how the adults relate to one another, as long as they are taken care of. Overall, such children seem to fare well as long as they live in stable, loving homes.

Making this practice work, she acknowledges, is "time consuming and potentially fraught with emotional booby traps." People in polyamorous relationships emphasize that their relationships are about emotional connections with others, as opposed to primarily physical relationships.

The term polyfidelity, a subset of polyamory, was coined in the 1970s by members of the Kerista commune, which started in New York City in 1956. Polyfidelity is a concept in which clusters of friends form nonmonogamous sexual relationships. Under this family structure, group members do not relate sexually to anyone outside of the family group.

Although mainstream Judaism does not accept polyamory, some people do consider themselves Jewish and polyamorous. Sharon Klein-baurn, the senior rabbi at Congregation Beit Sirnchat Torah in New York, has said that polyamory is a choice that does not preclude a Jewishly observant, socially conscious life. Some polyamorous Jews also point to biblical patriarchs having multiple wives and concubines as evidence that polyamorous relationships can be sacred in Judaism.

Jim Fleckenstein, director of the Institute for 21st-Century Relationships, has said that the polyamory movement has been driven by science fiction and feminism. He states that disillusionment with monogamy occurs "because of widespread cheating and divorce."

One fact going for the polys (as they are often known) is the belief that polyamory is more honest and less hypocritical than monogamy with secret affairs. A manual, "What Psychology Professionals Should Know About Polyamory," for psychotherapists who deal with polyamorous clients, was published in September 2009 by the National Coalition for Sexual Freedom.

The late Michael Shernoff, who was an openly gay psychotherapist, wrote that nonmonogamy is "a well-accepted part of gay subculture," and that somewhere between 30% and 67% of men in male couples reported being in a sexually nonmonogamous relationship. A majority of male couples are not sexually exclusive, but describe themselves as emotionally monogamous.

Mr. Shernoff stated: One of the biggest differences between male couples and mixed-sex couples is that many, but by no means all, within the gay community have an easier acceptance of sexual nonexclusivity than does heterosexual society in general. Research confirms that non-monogamy in and of itself does not create a problem for male couples when it has been openly negotiated (Fam. Proc. 2006;45:407-18).

The role of affairs in marriage can now be subjected to a more nuanced discussion, after digesting the above views and practice of marriage. What is the meaning of an affair? What is an open relationship? What are the models of intimacy? Is an affair a breach in the couple's definition of intimacy? What are the rules? How does a couple define an affair within the context of their own relationship?


Postmodernism provides family therapists a new set of theories and a new language for describing the variety of families. As Jacqueline Hudak, Ph.D., and Shawn V. Giammattei, Ph.D., have written: 'As family therapists, we are uniquely poised to transform the meanings attached to 'marriage' and 'family' to focus on the quality of relationships rather than on the gender of a partner or the assumption of particular roles" ("Expanding Our Social Justice Practices: Advances in Theory and Practice," Washington: American Family Therapy Academy, Winter 2010).

The traditional view of marriage is referred to as "heteronormativity" and is defined by the belief that a viable family consists of "a heterosexual mother and a father raising heterosexual children together" ("Handbook of Qualitative Research," Thousand Oaks, Calif: Sage, 2000).

Despite the above expansion of views on marriage and families, heteronormativity remains the current organizing principle of family theory, practice, research, and training.

It will take many decades to shift the dominant paradigm.

Developing awareness, and listening to families and couples is the first step.



Dr. Heru of the department of psychiatry at the University of Colorado at Denver, Aurora, is editor of the book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013). Scan the code to read more at
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Title Annotation:OPINION
Publication:Clinical Psychiatry News
Date:Feb 1, 2014
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