The opportunity to reflect on pre-Covid days has provided important insight into the blind spots in contemporary social structures, both local and global. Aspects of existence that we had taken for granted have been challenged and we are now aware of how precarious our world can be. The greed and selfishness that guided our decisions as a species and as individuals lie exposed as we face the pandemic and its consequences. In this week’s essay, we focus specifically on the configuration of family relationships to examine whether the recent crisis will result in modifications in family life and social organisation.
From the earliest reports out of Wuhan (See Documentary link in Notes section), we learned how quickly the virus spread among people living in close proximity. This brought attention to the fact that the size and composition of a family unit played a critical role in the spread of the virus. Yet, as news broadcasts reached worldwide, people took decisions to ‘return home’, whether that implied travel within or between countries. It also true that as the pandemic has advanced, family relationships have become accentuated. Stories from different parts of the world demonstrate the desperate need for people to return to their loved ones, yearning for familiar surroundings and ‘safe’ spaces. Between enforced isolation and accidental overcrowding, life-changing decisions were made to separate from or live with other people. Long spells of quarantine were endured in the attempt to get back home as our physical worlds became smaller than ever before. People who lived with their loved ones were quick to realize their good fortune, while those who lived alone gained a new perspective on their isolation. For those who live with psychological or physical difficulty or under a risk of domestic abuse, the threats of separation or coexistence will have become escalated during the lockdown. All shades of family life have become heightened in recent times. For the multi-generation Indian family, for instance, physical mobility provides periodic escape from potential tensions of intense co-existence with a large group. The comfort of collective support survives with the underlying possibility of inter-personal conflict that is often circumvented by temporary distancing. Without access to open spaces and/or temporary absence, conflicts can escalate to a breaking point. Between isolation and over-crowding, the range of circumstances in which people are locked in, compel the re-examination of family life and social relationships in a post-pandemic world.
Those who were stuck in places where they did not feel a sense of belonging had a hard time in dealing with the lockdown. From students in hostels to migrant workers in cities, the desire to ‘return home’ to the family has been a universal trend during these uncertain times. But we also need to analyse what ‘home’ means for people. Camporesi writes that this (home) “..isn’t an abstract question in a pandemic. It becomes a concrete matter of where, and with whom, you wish to be confined – if you’re lucky enough to have the choice, that is”. Those who had the resources to be airlifted to their native place took the first chance they could get, others walked hundreds of miles to get to where they could feel safe and at home. As schools shutdown, shopping centers closed and streets became abandoned, it seems that it was the family that came to the rescue. Family ties may indeed have been revived as an outcome of the pandemic.
Over the last couple of centuries, social change has impacted (and been impacted by) the configuration of family. Several factors contributed to the possibility of ‘independent’ existence and the neo-liberal model of a successful, wealthy, globe-trotting, independent individual became idolized. More people live alone now than ever before. Among wealthier nations, social policy stepped in to respond to these shifts in age and gender relations, facilitating and fuelling the pursuit of a life unencumbered by responsibilities that had ‘burdened’ earlier generations. Traditional options of dependency on the family became discarded for the excitement and exploration that this fresh appraisal provided. Happiness was re-imagined to emerge from speed, adventure and novelty rather than predictable slowness. Very few places in the world remained untouched by rapid and rampant urbanization. Alongside the consistent reduction in family size, both on account of reduced fertility rates and breakdown of large households, traditional family roles and relationships became threatened. Tasks that were earlier performed by family members became gradually outsourced to other individuals or institutions. The care of vulnerable members of society is an important case in point.
Has the recent crisis created a dent in this model of an independent and self-sufficient person? Have family relationships regained some of their former significance? The vulnerability and uncertainty caused by the spreading pandemic has certainly positioned us to rethink our choices as individuals and collectives. Stories from around the world resonate with themes of intense closeness, specifically with family members.
Revisiting Family Relationships: Some examples
In a recent article in the Atlantic, David Brooks writes that the story of our times is “the story of the family, once a dense cluster of many siblings and extended kin, fragmenting into ever smaller and more fragile forms. The initial result of that fragmentation, the nuclear family, didn’t seem so bad. But then, because the nuclear family is so brittle, the fragmentation continued. In many sectors of society, nuclear families fragmented into single-parent families, single-parent families into chaotic families or no families.” Brooks continues “If you want to summarize the changes in family structure over the past century, the truest thing to say is this: We’ve made life freer for individuals and more unstable for families.” Further, reflecting on who has gained from these changes, he argues that “We’ve made life better for adults but worse for children. We’ve moved from big, interconnected, and extended families, which helped protect the most vulnerable people in society from the shocks of life, to smaller, detached nuclear families (a married couple and their children), which give the most privileged people in society room to maximize their talents and expand their options. The shift from bigger and interconnected extended families to smaller and detached nuclear families ultimately led to a familial system that liberates the rich and ravages the working-class and the poor.” If we look around the world, the article continues, the wealthy have the buying power to supplement the parents’ efforts to care for children through the use of gadgets, services and support, the relatively poor communities are the hardest hit because they cannot afford these personal and mechanical assistants, becoming even more stressed by the task of exclusive child rearing. When the nuclear family is treated as a global ideal, we run the risk of losing aspects of culture that have been favourable for people living with disadvantage. Brooks says it with great clarity, “Extended families have two great strengths. The first is resilience. An extended family is one or more families in a supporting web. Your spouse and children come first, but there are also cousins, in-laws, grandparents—a complex web of relationships among, say, seven, 10, or 20 people. If a mother dies, siblings, uncles, aunts, and grandparents are there to step in. If a relationship between a father and a child ruptures, others can fill the breach. Extended families have more people to share the unexpected burdens—when a kid gets sick in the middle of the day or when an adult unexpectedly loses a job. A detached nuclear family, by contrast, is an intense set of relationships among, say, four people. If one relationship breaks, there are no shock absorbers. In a nuclear family, the end of the marriage means the end of the family as it was previously understood.” The second important advantage of the extended family is shared socialization of young children. As we noted in last weeks essay, growing up in a joint family provided a range of role-models for children to learn from and with. “Multiple adults teach children right from wrong, how to behave toward others, how to be kind. Over the course of the 18th and 19th centuries, industrialization and cultural change began to threaten traditional ways of life.” However, the stability provided by extended families also placed a restriction on mobility, privacy and individuality, all crucial aspects of post-industrialist society. For Indians, the colonial experience was an additional source of social change. Despite dramatically different social ideologies and community practices, the submission of Indians to British rule had a long-standing influence on community life in addition to other social and economic changes. Despite this, some aspects of family dynamics have sustained, and we need to be aware of that. The classic Indian Joint Family, a social, economic and domestic unit of multiple generations, fulfilled all the roles that we have discussed.
Caring for someone implies that you are in a relationships with someone whose well-being is your concern. “Unlike engagement, caring does not demand balance or perfect reciprocity: it is enough if one person can take the good of the other to heart……Caring and interacting don’t always go hand in hand. The internet offers up many more opportunities for reciprocal engagement than for genuine beneficence, which means that those quarantined alone have been relegated to a space not optimized for care. But group quarantine exposes the opposite imbalance: so much unity there is little room for engaged reciprocal interaction. The more my husband and I “team up” to deal with childcare and household maintenance, the less we have to say to one another. How much is there to talk about when no one has left the house for weeks? It is possible to feel loved, safe and cared for, and, at the same time, to experience a lockdown of the mind. This too is loneliness, though of a very different kind.……Although social distancing measures have been (at least temporarily) well-received, there is an obvious-but-overlooked phenomenon when considering groups (i.e. families) in transmission dynamics. While social distancing decreases contact with members of society, it of course increases your contacts with group (i.e. family) members.” Agnes Callard (Link in Notes Section).
Reflecting on the process of motherhood for herself, Helen Hayward (Link in Notes section) writes that “Although we look after our children and devote our life to them, it is only what we do outside of it that we are recognised for. Is a devoted mother seen as having lost out on life, spoilt her children?……So why did I become a traditional mother, rather than the modern mother….? Why did I risk being consumed by a role that might leave me high and dry..? In part, I rather unexpectedly enjoyed being needed. Equally unexpectedly, I found being around my children very creative, far more than I’d been led to expect. Caring for them – loving them unreservedly and creating a way of life out of this love – has been a revelation to me. Least fashionably of all, I realised that my marriage might not survive if I didn’t bend, and that bending like a reed was far better than breaking something good. Family life has expressed a deep part of myself that was there, as a potential, well before I had children. Being at home with my children has given me an imaginative space in which to rethink every aspect of my life, in a way that the pressures of my previous life simply didn’t allow. Just as I had to get to know my children in every mood under the sun before I really understood them, so being around them has led me to know myself better. Yes, these past 16 years have marked a hiatus in my career. But they’ve also been a precious opportunity. I’m now much clearer about what I care about. I now know what I love enough to pursue. Perhaps, I say to myself, I had to let go of the old me before a new me – wiser, older and flawed – came out of the shadows.”
Health Care and Family Dynamics
The intersection between health care facilities and family dynamics is another important point of discussion, as we read about experiences from around the world. The model of health care promoted by the establishment of high-cost, private medical institutions has developed many cracks under the pressure of the pandemic. The most disturbing stories have emerged from the care of the elderly. Society may have successfully raised the life-span, but as the renowned physician Atul Gawande has asserted, we have failed to provide a meaningful life for the elderly. In a recent survey on how people would choose to die, an overwhelming majority of people interviewed in the US declared that they would prefer to die at home, yet almost 80% end up spending the last moments of their lives in hospitals or nursing homes (Link in Notes).
Another article highlights the conditions of elder care from the perspective of a health care provider. Talbot writes: “Of course, improving the circumstances and care of the sick, old and dying – doing what we can to ensure people get the good death they want – is critical; a humanitarian revolution that has yet to take place. But most of the circumstances of our deaths are ultimately beyond our control….. It could be me sitting in a drenched diaper with the TV blasting. It could be me having food shovelled in my mouth when I don’t want to eat. It could be me asking for morphine when I’m wracked with pain and hearing I’ll have to wait two hours for the next dose. The only thing that is within our control is inside. To die contentedly like that, in a dingy room with no privacy, filled with indifferent strangers, will take serious inner work. If I can get that ‘thing’ from the meditation, it will be the most reliable medicine I can have, accessible whenever I need it, when all else fails. As I see it, it’s the only hope for the good death I want – unburdened, unafraid, mindful.” The people who are dying are not just individuals, they are someone’s grandparents, mothers, uncles, aunts, neighbors, “They are us. Just a little ahead of us. Facing loneliness, quarantines and death in hospitals must be hard. Let us hope that no one has to refer to our loved ones as “bodies piling up….. History will record how we treated the elderly in this pandemic.” (Link in Notes Section).
The pandemic has also pushed for a review of the moral philosophy of individualism in Western medical practice. In a recent article about her father’s hospitalization, Ho observes that “According to rugged individualism, rational adults are separate from others by boundaries that can be justifiably breached only by the explicit and voluntary consent of self-determining subjects. Such individual boundaries support the patients’ moral and legal rights to give informed consent (or refusal) to various treatments without undue influence from others. In liberal societies, it is now generally accepted that patients are most invested in their own interests, such that they should be the ones to make voluntary decisions regarding their care……family members are seen mostly as a means to the patient’s clinical ends, and are sometimes considered an intrusion in the professional caregiving space……..Our family was welcomed at the bedside when we could help soothe my flustered and bewildered father, but less so when we had questions about his fluctuating heart rates, even as my mother was the one who first noticed and reported my father’s lethargy a couple of days before his respiratory failure. While professionals usually recognize that building rapport with family members is essential for good patient care, many clinicians still experience uneasiness in dealing with families. (‘They’re too emotional,’ one physician said when asked about including families in decision-making. ‘They don’t understand what’s going on.’) Subtle doubts about family members’ qualifications and motives for getting involved further strain relations between caregivers and families. This all makes some family members ….. very cautious in asking for information or being involved in the decision-making process….. Vulnerability during times of illness is a fact, not an impediment. This concern is heightened for patients from ethnic minorities. We see far greater numbers of non-whites when the pandemic statistics are seen. Surely, the strangeness of the medical culture could have contributed to the distress of dying alone and in a strange environment. Medical professionals need to better recognize that illness is a family matter and not an individual experience.” We need to take decisions to change the course of treatment in order to keep family care as the primary alternative and not the last resort.
For those societies where medical facilities are far less developed than is the case in Ho’s story or Talbot’s case description, we need to reflect on the future of primary and urgent care facilities that we develop in our own countries. Changes are bound to happen and as we develop the directions in which to invest resources, we need to understand that what seems to have worked in other parts of the world may not apply in our case, and furthermore, it may not even be working as well as we have believed in the past. Privilege has concealed the inadequacy of the health care system even in the most affluent countries. Yet again, the place of the family is an important consideration, since so much of the care and support is provided by the family. Medical practice needs to push for what Jacob Stegenga calls ‘gentle medicine’, shifting away from profit incentives to people-cantered practices. (Link below).
The present crisis will have long-lasting consequences on our lives. What we can hope for is that we make good use of this opportunity to navigate our choices towards a more compassionate world. How we deal with the current situation will serve as a model for the future since the problems have hit everywhere. The nature of the crisis has forced the collaboration between and within countries. Without that level of cooperation, it is difficult, if not impossible, to find a speedy and effective solution to the advancing numbers. Why have we failed to find a solution to the global crisis of climate change? Jared Diamond explains that the reason for this failure is because no one nation takes this seriously enough since it is an international problem, and not one that can be hinged on national identity. To climate change, maybe we can also add the issues of poverty and uneven distribution. Why has the world not yet been able to address the problem of hunger despite the fact that we produce more than enough food for everyone? “So, the world has not rallied together against the common enemy of climate change. Now, we do have an enemy that kills people visibly and fast. It’s not going to kill nearly as many people as will climate change. Yes, it is a setback to the economy, but in the long run, it’s not going to be nearly the setback to the economy that climate change and resource overuse will be…..I can foresee a good outcome, a silver lining to what’s going on now. Now, for the first time the world recognizes we have a common enemy, and it’s clear that all countries have got to deal with this problem, because if 215 countries get rid of COVID and the 216th country still has it, it will infect the rest of the world. This is a world problem that requires a world solution.”
Until next week, stay safe and “cautiously optimistic”!
Wuhan: The Early Days https://www.bbc.co.uk/programmes/p08cwv6p
Families under lockdown, Agnes Callard: https://thepointmag.com/examined-life/family-feuds-agnes-callard/
More than just a mother, Helen Hayward: https://aeon.co/essays/is-motherhood-always-about-self-sacrifice
Health care and the individual, Anita Ho: https://aeon.co/essays/why-doctors-should-involve-a-patients-family-in-decisions
How to die, Mary Talbot: https://aeon.co/essays/in-a-secular-age-what-does-it-mean-to-die-a-good-death
Gentle Medicine, Jacob Stegenga: https://aeon.co/ideas/how-gentle-medicine-could-radically-transform-medical-practice
The crisis of elder care: https://www.euronews.com/2020/03/24/coronavirus-elderly-found-dead-and-abandoned-in-spanish-nursing-homes?fbclid=IwAR1B9BbPU7hJckamewol64T73QWzKVXhG-QzOXI2IzVpi41uWlQliCa24_s
Hidden costs of lockdown in Italy, Silvia Camporesi: https://aeon.co/essays/a-bioethicist-on-the-hidden-costs-of-lockdown-in-italy
Best case and worst case scenario, Jared Diamond: https://www.edge.org/conversation/jared_diamond-best-case-and-worst-case-scenarios