The Groves Conference on Marriage and Family: History and Impact on Family Science

Chapter 5: Family Health, Medical Issues, Stress, and Coping

Since its founding during the Great Depression, the Groves Conference has developed a long legacy of interest in the connection between family life and personal health. In the early years of the family field there were concerns about the response of families to the Depression. These ventures sought to look at family adjustment and processes as a consequence of economic conditions. With its birth in 1934, the Groves Conference focus was on the interest of college teachers in instructional methodology and preparation for marriage. Early meetings addressed marital and family problems through the prism of mental hygiene and family counseling. By 1938 Groves had broadened its perspective to include, among others, physicians with more physiological knowledge. Through the cooperation of Duke University Medical School, the program included “Medical Aspects of Marital Adjustment” and “By the Services of the Medical Specialist” (E. Groves, 1938). The eminent psychiatrist Harry Stack Sullivan gave a Groves address in 1939 titled “The Psychiatric Approach to an Understanding of Marital Incompatibilities.” Although  Sullivan presented from a mental health viewpoint, another speaker emphasized the value of a general medical background for marital instruction. There was also a discussion on “The Doctor as a Marriage Counselor” (E. Groves, 1939). In 1940 Robert Dickinson, an internationally known medical authority in the field of marriage appeared on the Groves program. Dickinson was one of several medical doctors, including Abraham and Hanna Page  114Stone, Valerie Parker, and Robert Laidlaw, who were early pioneers in marital and sexual study. Other physicians participating in 1940 was Richard Pearse, who spoke on “Pregnancy and Prenatal Care,” E. C. Hamblen on “Endocrinology and Adolescence,” and Bayard Carter on “The Venereal Diseases with Emphasis upon Those Less Known than Syphilis and Gonorrhea” (E. Groves, 1940). In the post World War II conferences, prominent physicians, including LeMon Clark, Walter Stokes, and Lena Levine continued contributing to Groves.

Although not the focus of these Groves meetings, the word “health” appeared occasionally in the program. During the 1951 conference on “Social Class Differences and Family Behavior” there was a discussion on “Variability Among Families in the Pursuit of Health” (G. Groves & Hill, 1951). A full recognition of the relationship between families and health arrived in 1955 at the Philadelphia conference titled “Health and the Family.” Quoting from the program (G. Groves, Hill, & Himes, 1955):

The interplay of marital and family stresses and successes with physical and mental health was the focus of the meetings. The renowned anthropologist M. F. Ashley Montagu gave the conference dinner address. Emily Mudd chaired a session on “Family Competence and Health.” General Charles Lindbergh was a discussant at the panel “The Makeup of the Healthy Family and Heredity Counseling.” Another discussion group was titled “Influence of Heredity on Family Health” chaired by Frederick Osborn, Secretary of the American Eugenics Society. Perhaps this reflected the 1950s continued valuing of eugenics. The program was dominated by sociologists, other social scientists, and marriage counselors whose interest in health issues had become evident.

“Understanding and Serving Families Under Stress,” the theme of the 1958 Groves Conference in Washington D.C., brought attention to stress as a recognizable variable in family studies (Hill, 1958). This reflected the pioneering research interests of Reuben Hill, the program chair. Crises brought about by war, natural disasters, dismemberment, mental and/or physical illness, substance abuse, divorce, unemployment, and bereavement were addressed. E. E. Le Masters presented his seminal work on “Pregnancy and Parenthood as Crises.” Counseling families under stress and in shock and bereavement served as sessions. Of great importance were the efforts of the “Working Committee on Conceptual Frameworks and Theoretical Models” chaired by William Goode. Applying a social system approach for investigating families in crisis was a major contribution to family science in melding theory with practice. Symbolic interaction and the interactionist framework and family crises were also discussed. A “Working Committee on Community Services for Disaster Stricken Families” reported on the policies and procedures of the Red Cross and Salvation Army.

In 1963 Groves returned to the theme “The Family in Health and Illness” in St. Louis (Vincent, 1963). Once again, the family was the paradigm for understanding and treating illness. The conference was structured around counseling, research, teaching, and education as the primary paths toward health intervention. Marvin Sussman led the research session “Family as Treatment Setting.” Seminar leaders discussed mental retardation and mental illness, sexual activity and its relationship to health and illness, and how intergenerational relationships are implicated in the health and social well-being of family members—especially the aged.

A new study and research application was developed when Charles Figley chaired and Hamilton McCubbin keynoted the Gatlinburg, Tennessee conference “Stress and the Family” (Figley, 1980). The two-volume book they developed on stress and coping both in normative and catastrophic transitions has become a classic used in many disciplines, especially reshaping nursing and family medicine (McCubbin & Figley, 1983; Figley & McCubbin, 1983). It has had great impact on research and intervention programs by conceptualizing stress and coping and connecting to earlier Page  116work on families’ reactions to crises. At the conference McCubbin spoke on a decade of family stress and coping research. Seminars were held by McCubbin, Richard Needle, and Pauline Boss about stress from outside and inside the family. Few Groves conferences, before or after, focused so exclusively on this theme. Sources of stress and coping were examined in 24 workshops. Among the stressors were dual-careers, economic conditions, rural family life, substance abuse, parent-adolescent relationships, racial identity, parenthood, separation , divorce, remarriage, combining career and family, sexuality, terrorism, family violence, chronic psychophysical disability, job dissatisfaction, gender roles, crime, bereavement, teenage pregnancy, acculturation, and natural disaster. Almost two dozen roundtables covered a range of topics including geographical mobility, intergenerational relations, multiple roles, adolescent suicide, and mental health services. A second keynote address “Coping with Catastrophe: Family Adjustments to Natural Disasters” was presented by Ronald Nuttal, Director of the Laboratory for Statistical and Policy Research at Boston College and Director of the first National Institute of Mental Health Study of Families Coping with Disaster. A Task Force on Families of Catastrophe included Groves members Pauline Boss, Charles Figley, Hamilton McCubbin, Virginia Sibbison, Graham Spanier, Douglas Sprenkle, and Marvin Sussman. Additional participants drawn to this comprehensive conference included Charles Cole, Marcia Lasswell, Leland Axelson, Frank Furstenberg, Mollie Smart, Gerhard Neubeck, Harold Feldman, Eleanor Macklin, Marie Peters, Ira Reiss, and Harriette McAdoo.

In 1987 the recently formed Groves Task Force on AIDS and the Family met at the San Antonio conference site to begin work on understanding the impact of the epidemic on families (Settles & Fischer, 1987). Under the leadership of Eleanor Macklin the task force created the seminal book AIDS and Families (1989), perhaps one of Groves’ most important contributions to health education. Task force member G. Mary Bourne (1989) wrote in the book’s preface,

This perspective on AIDS and the book it produced illustrates the Groves conferences ability to respond to current issues. The meeting of the Groves Task Force on AIDS was a meeting-within-a-meeting in San Antonio. By 1987 the AIDS Task Force had grown to 45 members and included members of the Ackerman Institute for Family Therapy; American Association for Marriage and Family Therapy; American Association of Sex Educators, Counselors, and Therapists; Family Service America; The Hastings Center; The Kinsey Institute; Masters and Johnson Institute; National Council on Family Relations; National Hospice Organization; Planned Parenthood Federation of America; Sex Information and Education Council of the United States; and the Society for the Scientific Study of Sex.

“Family Health: Psychological, Biological, and Ecological” was the theme for the Groves Conference in Savannah, Georgia. Chaired by Charles Burnett and Sharon Price (1989), the conference,

Evident in the theme title are three science-based approaches for examining family health issues. Conference attendees were challenged to respond to numerous substantive questions:

• What is known about the promotion of family psychological health?
• How do we optimize psychological development and mental wellness?
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• What do family professionals have to offer to meet the needs of families and what can families offer the professions?
• What is known about the promotion of family biological health?
• What is the current relationship between family social science and medicine? Is there an ideal relationship?
• How can behavioral change enable families to enhance their health, especially in regard to the elderly and dependent members?
• What is the current state of policies and programs affecting family psychological, medical, economic, and political health?
• In times of economic austerity how do we maximize promoting family well-being?

Plenary speakers presented a broad range of topics, attempting to answer these many questions. Thomas Campbell, Assistant Professor of Family Medicine and Psychiatry at the University of Rochester School of Medicine, spoke on “Family Influences on Physical Health.” Barbara Elliot, Director of Behavioral Science and Research Family Medicine Residency Program at the University of Minnesota, School of Medicine (Duluth) presented on “Families and Ethics in Health Care.” Workshops and roundtables included discussions on integrating family therapy and family medicine in the treatment of the family system, federal and state health policies affecting family wellness and health promotion, and facilitating wellness in families with AIDS. Joy Schultebrandt, a frequent Groves participant from the National Institute of Mental Health, led a workshop on the NIMH perspective toward families and the course of health. The Groves Conference decided to join with other professional organizations in the National Prevention Coalition to promote prevention research in mental health. Roger Rubin’s presidential address “The Invisible Family: Implications for Health” sought to expose the roles and influence of people overlooked, ignored, and neglected by researchers, clinicians, educators, and policy-makers when examining health and the social ecology surrounding human development. Rubin said,

Finally, several Groves conferences deserve mention for their contributions to expanding an understanding of family health, medical issues, stress, and coping. Although not specifically designed to address these topics, these conferences promoted the interest Groves members have in improving the well-being of families. In 1986 Groves met in London, England with the theme “Victimization and Empowerment: A Family Approach.” Chairs Mary Hicks and Sally Hansen-Gandy noted the following in the program:

In planning that conference Hicks and Hansen viewed the sources of victimization as both internal and external to the family. For both individuals and families who experience trauma or catastrophe, the system context must always be considered. It is then, that prevention and recovery can be considered. Sources of internal abuse include discrimination based on gender, age, or race, intrafamilial physical Page  122or sexual abuse, divorce and custody issues, chronic illness, and family traumas and disasters. External sources include terrorism, hostage taking, kidnapping, hunger, war, natural disasters, political oppression, and societal discrimination. Rarely do these topics view the family as victim.

Charles Figley, former Groves president and, in 1986, President of the International  Society for Traumatic Stress Studies gave the opening plenary address based on work from the Task Force on Families of Catastrophes. Another plenary was presented by Marianne Kastrup of the International Rehabilitation Center for Torture Victims in Copenhagen, Denmark. Pauline Boss’ presidential address was titled “Family Victimization and Survival in a World Not Always Just.” The conference was primarily structured around a workshop format in which one series focused on victimization inside the family and a second series focused on victimization occurring outside the family. Examples of the “inside” series were suicide/death, sexual preferences, family violence through the lifespan, chronic illness, sexual abuse, rape, and incest. The “outside” series included helping profession biases, destructive institutional family policies, misdirection of political and judicial systems, war, negative cultural influences, racism, and women as victims. Workshop attendees were directed to suggest methods for empowering the victims of these circumstances. This conference resulted in the publication of “Coping with Victimization” a special issue of Contemporary Family Therapy (See Hicks & Hansen-Gandy, 1988).

The theme “Besieged Families: Creating Caring and Collaborative Communities” again suggested a Groves concern for the alleviation of stress and trauma to families. This 1995 conference in Lexington, Kentucky encouraged the discussion of social, economic, and political conditions that constrain families (Koepke & Skinner, 1995). How to identify and create policies, programs, and a cultural climate that would form communities supportive of family well-being was the conference goal. Conference chairs Leslie Koepke and Denise Skinner invited keynote speakers who, “... reflected differing ‘world views’ on the conditions that constitute family concerns, the factors contributing to them, the values that should drive policy decisions, and how society might respond” (Koepke, 2008). Keynote speaker Barbara Page  123Whitehead, Vice President of the Institute for American Values, was described by Koepke and Skinner as having publications that ignited controversial national debates about family values in the early 1990s. Her presentation, “Building a Culture of Commitment,” focused on the need for renewing a cultural ethos of community and for the strengthening of mediating systems (local community organizations, churches, neighborhoods) that are closer to families. A second keynoter, Karabelle Pizzigati, Director of Public Policy for the Child Welfare League of America, drew on her many years of experience developing, analyzing, and administering programs that assist children and their families. Her presentation, titled “New Challenges and Opportunities: Meeting the Needs of Children and Families in the Changing Political and Policy Making Environment” emphasized the need for strong effective public policy initiatives as a significant part of the culture of commitment. Uniting community agencies, family life education, conflict resolution, building alliances, and interactive technology were among the strategies mentioned in workshops seeking collaborative solutions.

The term “cutting edge” has for decades described the Groves Conferences’ efforts to explore the frontiers of family science. This is particularly applicable to the Washington DC conference “The Impact of Human Genetics Research on Families: Psychosocial Implications” (Lasswell,1998). Under the leadership of Marcia Lasswell this conference is perhaps the first and only one of its kind. It pre-dates by several years the successful mapping of the human genome. Attendee Patricia Nelson took copious notes of the sessions and remarked, “I went to the Groves Conference thinking, ‘What on earth does the Human Genome Project have to do with me?’ I came away thinking that this project will affect all of us - and the sooner we start thinking about it, the better” (Nelson, 1998, p. 1). Thus, Groves brought to the attention of family professionals the profound implications associated with advances in genetic research. Lasswell stated,

David Reiss, Professor and Director of the Division of Research, Department of Psychiatry and Behavioral Sciences, at George Washington University Medical Center, was a featured speaker. Reiss, a long-time Groves member, described the pervasive influences of genetic factors on family members and how they change over the lifespan. He presented preliminary findings from a longitudinal study suggesting that genetic factors regulate how people relate to their families and how family processes mediate genetic influences. Another speaker was Reginald Burgess, Deputy Executive Director of the American Association of Pastoral Counselors, Director of Research, Development, and Administration, and Adjunct Professor of Psychology at Marymount and Loyola Universities. Burgess discussed three levels of genetic intervention requiring increased attention: (a) individuals who seek to alleviate a specific medical problem; (b) genetic testing for prenatal diagnosis and possible eugenics implications; and (c) genetic pattern alterations which may affect future generations. Finally, Lasswell invited Evon De Renzo, Senior Staff Fellow of Clinical Bioethics at the National Institute of Health and Adjunct Professor at Johns Hopkins and Marymount Universities to speak about the protection of privacy and confidentiality when being involved in genetic studies and how genetic information may affect insurability, housing, and employment.

Discussion panels led by Groves members followed each presentation and explored issues related to research, clinical concerns, education, economics, and society. Case studies were used to explore possible scenarios which individuals continued to face and the role that family professional will play in genetic decisions. The exposure to knowledge generally not within the purview of a predominantly social science audience was a significant contribution of the 1998 conference. Groves attendees learned about Fragile X Syndrome, the single greatest cause of inherited retardation. Being informed about dwarfism and other anomalies, genetic diseases affecting religious, Page  125ethnic, and racial groups, the Cancer Genetics Project, breast cancer research, genetic testing, and the impact on couple and family relationships of knowing one’s personal genetic history, provided new avenues for family science exploration.

The following year, 1999, Groves met at St. Pete Beach, Florida around the theme of “Late Life/New Life: Creative Aging in Changing Families and Communities” (R. Hanks & Pearson-Scott, 1999). Any conference devoted to aging will have a natural affinity toward health, medical issues, stress, and coping. Chaired by Roma Hanks, the conference sought out ideas for innovative approaches to aging and health in the context of family and community. Panels on “Family Caregiving for the Elderly” and “Long-Term Care in the 21st Century” recognized the wide diversity of needs within the aging population. Workshops such as “Privacy in Medical Records: Issues for Elders and Their Families” addressed growing concerns related to increasingly sophisticated, technologically based record keeping. A workshop led by Barbara Settles and Nancy Kingsbury titled “Making Plans between Generations: Whose Best Interests?” exposed the stress and coping mechanisms among family members when elders lose their independence.

Oklahoma City was the setting for the 2004 Groves Conference “Integrity and Survival in Families and Communities”(Hicks & Koepke, 2004). The city’s history as the location of the worst act of domestic terrorism in the United States was purposely chosen for the setting of this conference. This followed the idea of former Groves President Roma Hanks to pursue such a theme. The goal was to examine how families and communities meet and rise above cultural, economic, religious, ethnic, and political adversity to overcome the many challenges of catastrophic events. Resilience in the face of disaster was the theme of Judith Landau’s opening plenary session “Enhancing Family and Community Connectedness to Access Resilience.” She discussed post-traumatic stress disorder (PTSD), how psychological stress can trigger other illnesses, and how therapists, families, and communities can successfully cope with disasters. The second plenary was led by Pauline Boss who applied her pioneering research on ambiguous loss to the lives of five panelists who were personally affected by the 1995 Oklahoma Page  126City bombing of the Alfred Murrah Federal Building. The five individuals were an Oklahoma City Police Chaplain, a survivor, two family members, and a police responder (2004). Their first- person accounts of the tragedy were in the Groves tradition of bringing its members into direct contact with the local community.