Chapter One

An Assessment of Family Interactions Using The Family Systems Model

Murray Bowens' Family Systems Theory suggests that families function through interconnected systems of emotional expression. These systems, eight in total, push and pull the balance of the family unit depending on the intensity of emotions expressed and how different members respond and cope with the emotional dynamics of other family members.

In the story of Melanie: Bird With A Broken Wing there is evidence of several components of Bowens Family Systems Theory in use as Beth, Clive, Melanie and other caretakers participate in raising Melanie. We have selected four concepts of Bowen’s theory that demonstrate how the family dynamic shits and changes as Melanie grows influencing the function and bond in the family unit.

Concept 1: Triangles

The triangle represents different positions of family members in relation to one another. In this regard two family members may be viewed as "inside" or on the same side of an issue while the third is "outside" or on the other side of an issue.

When Melanie is born Beth and Clive are the "insiders" as they collaborate to care for their newborn baby. While Beth was fearful of her ability to care for their child Clive remained calm and supportive resulting in a teamwork of the insiders. As time went by Melanie grew and became more stable in her condition. This lead to a shift in the triangle of family dynamic as Beth and Melanie developed a closer bond and Clive was pushed into the position of the "outsider". It was evident that while Clive remained supportive of Beth that his position of closeness had been diminished as Melanie's position of closeness increased.

Concept 2: Differentiation of Self

This concept acknowledges how ones strength of self identity influences the family dynamic. Individuals with a strong self identity are less likely to be influenced by others while those with a poor self identity are more susceptible to outside influence in their behaviors and actions as they seek approval and acceptance from others.

Beth has a well developed differentiation of self. Although she initially doubted her ability to care for Melanie, she grew into her role as the primary caretaker of her child with assurance and determination to provide Melanie with the best life possible. She was fearless in her risk taking when there was a possibility of helping Melanie and most of her efforts resulted in success. Less is known about Clive but it appears he too had a strong sense of self and was able to cope with the challenges of raising Melanie through his focus on work.

Bowens' Nuclear Family Emotional Process highlights four points that determine where family problems arise from. In Beth's story there doesn't seem to be evidence of struggle or arguing in the family although in the end Beth and Clive did divorce.

It is possible then, to imagine that their relationship may have suffered from "emotional distance" as describe by Bowen. In Beth's effort to care for Melanie and offer all the love and attention she could give to her child she may have become emotionally distant from her husband. As time went by this distance may have shifted from an acceptable compromise to an extreme emotional disequilibrium that ultimately had an impact on the success of their marriage.

The Family Projection Process describes how parents project their emotional problems on a child. Essentially this concept states that parents who project their issues or fears on their child will provoke those very issues in their child. This is a negative cycle that can be extremely detrimental to the child.

What we see in the family relationships between Beth, Clive and Melanie is that although both parents have an enormous fear of how their child will grow and develop they do not project their fear onto Melanie. In fact, to the contrary, their projection of faith, love, and support were likely crucial in how well Melanie did grow and mature in her life. By receiving consistent love, encouragement, and positive reinforcement Melanie grew to achieve many skills and abilities that no doctor would have imagined she could have achieved.

Chapter Two

Main Characters Perspective

Beth, Melanie’s Mother

Beth realized that she felt fear the moment she met her new daughter, Melanie. That fear turned into doubts about what she felt for Melanie as Beth had thoughts about what life will be like under Melanie’s condition, who was born with cerebral palsy. Beth even thought that if her daughter Melanie was going to give her trouble, she would prefer her daughter dead. However, as time passed, Beth grew both love for Melanie and the courage to do anything in her power to take care of Melanie and give her the best life that Beth can possibly offer her.

Clive, Melanie’s Father

Clive, the father of Melanie, was supportive as both a father and a husband. Clive loved his daughter from the day she was born and he made sure to visit her in the nursery from day one. Clive had a much different perspective about Melanie than Beth. Unlike Beth, Clive had what seemed like an instant connection with his daughter Melanie. Although Clive was the financial provider for the family, he always made time to care for and be part of Melanie’s life. His way of dealing with Melanie’s disability was more about focusing and solving on the issue rather than thinking about what can’t be done. Overall, Clive had a special connection with Melanie and worked hard to provide for and support his family.

Melanie

Melanie was a bright and playful girl who was born with cerebral palsy. Despite her disability, Melanie was a happy child and her personality shined. Melanie also connected and developed a relationship with her family and the people who cared for her. Regardless of her limits, she had her way of communicating her needs and wants. Melanie was an intelligent and overall happy child who impacted the lives of all those who loved her during her short life.

Dr. Karen Pape, Melanie’s Doctor

Dr. Karen Pape was a young and bright doctor who took the time to explain Melanie’s development in detail to Beth. Dr. Pape explained Melanie’s brain development and how each section of the brain worked according to her disability. Beth learned a great deal of information from Dr. Pape and considered her as supportive because Dr. Pape was honest about all her thoughts and opinions and never gave Beth false hope. Dr. Pape was truly focused on all of Melanie’s strengths during her assessments. The results of the assessments helped Dr. Pape truly understand Melanie’s development and the progress that Melanie was making despite her disability. Dr. Pape was sure to help Beth understand the progress as well and she truly cared about understanding and helping Melanie. 

Dr. Mcdowall- Pediatrician from Trinidad

Dr. Mcdowall was the pediatrician from Trinidad who first examined Melanie when she was born. He was the one to diagnose Melanie with cerebral palsy. He was overall hopeful of Melanie’s condition and told Beth that Melanie’s mental development could be normal despite the diagnosis. Dr. Mcdowall was very patient and he proved this when Beth insisted with questions, sometimes the same questions multiple times. He focused on Melanie’s strengths and also made sure to point out that it was too early to really be able to tell the outcome of Melanie’s disability because she was so young. Overall, Dr. Mcdowall kept a positive attitude about Melanie’s development while staying realistic about the outcome. 

Dr. Wilmington- Ontario Crippled Children’s Center (OCCC) Doctor

  Dr. Wilmington was the doctor who assessed Melanie in Ontario, Canada. He is described as kind, friendly, and gentle. Although he was kind and attentive with Melanie, he seemed to have a different perspective on Melanie than her other doctors did. Dr. Wilmington seemed to be focused more on Melanie’s weaknesses rather than her strengths. He made it clear that he was very concerned about Melanie’s vision and in conclusion of the first assessment on Melanie, he diagnosed her with “gross global brain damage and severe mental retardation” which was devastating news for Melanie’s mother, Beth. Dr. Wilmington put more emphasis of Melanie’s weaknesses instead of putting at least some focus on Melanie’s progress despite her disability.

Sarah Blacha- Therapist

Sarah Blacha was a therapist recommended to Beth for Melanie by Dr. Pape. Sarah always believed in Melanie’s abilities and Beth considered her a big support for both herself and Melanie. Sarah was convinced of Melanie’s potential and was the person who helped Beth believe in her capability as a mother and also helped Beth believe in her daughter’s potential. Sarah was supportive during Melanie’s worst moments and even came up with techniques to help Melanie when necessary. Sarah disagreed with Melanie’s diagnosis of “severe mental retardation” because she believed that Melanie was an intelligent child despite her condition of cerebral palsy. Overall, Sarah was very supportive and Beth admired Sarah’s approach and view of Melanie.

Mercedes- Assistant at Immortelle Center

Mercedes worked at the Immortelle center since she was seventeen years old and she was the daughter of one of Beth’s closest friends. Mercedes was outgoing, friendly and lively. Beth truly trusted Mercedes and she soon became the family’s baby sitter. Mercedes treated Melanie as she would any other child, not letting Melanie’s disability restrain her playful personality or the loving relationship she developed with Melanie. Mercedes grew to see Melanie as her daughter and was part of many crucial moments in Melanie’s life including Melanie’s final moments of life. 

Chapter Three

Assessment, Diagnosis and Intervention

Assessment, Diagnosis, and Intervention:

Through the book the Melanie, Beth and Clive go through numerous assessments diagnosis and intervention. Most of the assessments were helpful in getting the appropriate diagnosis and therefore the correct intervention. But in some other cases the assessments, diagnosis and intervention were not successful. In every single one the both Beth and Clive were involved, but more Beth who was so involved in Melanie's development that she felt "she was an extension of her". The first initial diagnosis the family receives is when she is born, although most professionals said it was too early to give an accurate diagnosis, most agreed that Melanie suffered from cerebral palsy. Melanie went through numerous assessments, where Beth was always present. As early as birth she was observed as she tried to eat to be able to provide the appropriate intervention to aide her in the process.

The OCCC also played a major role at assessing Melanie numerous times and providing Beth with helpful strategies to help Melanie thrive. At the Immortelle Center Melanie was involved in therapies and sessions that helped her develop in numerous areas. Joan, Wendy and Deidre "provided Melanie,... with skills that combined to build the bridge from a largely passive to an active existence". Sarah also plays a major role at diagnosing Melanie and providing the appropriate strategies to aide in her development, most importantly Sarah believed in Melanie, and this pushes Beth to also believe in her. Although, it is noticeable that Beth and Clive has to seek these services outside of her home country. For most of Melanie's assessment and diagnosis, they had to travel to Canada, and her best therapies for Melanie and lessons for Beth were learned in Canada.

I believe that professionals who had a deep understanding in children with disabilities made the most effective assessments, and diagnosis. I also believe that Beth’s involvement in the entire process was a major key to Melanie’s development. Through training and previous knowledge and her endless love for Melanie she was able to provide the best environment for Melanie to thrive in.

Chapter Four

Interventions Based From Cultural Values & Perspectives

Interventions Based on the Family’s Cultural Values and Practices

Melanie’s family was a well-educated family who sought to always find scientific answers. As Beth mentions, she did not believe in miracles and did not practice religion. Therefore they sought science-based interventions. Since they were well educated they were inclined to always choose what was best for Melanie. Melanie needed extra attention from professionals from early on in her life. Since she was born she had to be observed and treated for her eating difficulties, being fed through a tube numerous times. Beth also always researched and never gave up until she found an answer. She tried numerous methods she studied to help Melanie eat better. Later on in her life Melanie was observed for her motor skills and underwent therapy, which later made her be able to move around and stand.

She was also observed and intervened when in the Immortelle Center, where she showed how intelligent she really was. Later in her school in Canada, thanks to the interventions by Martha, Melanie was able to thrive and become the “class star”. What was most important is that all these interventions were done in time and in a manner to help Melanie thrive. Through these interventions Melanie was able to become an individual able to express needs and wants, emotions and certain movement. More than they expected from her at birth. Through the proper training, strategies and interventions Melanie was able to rise above expectations. One of the major keys in the success was the fact that her family valued knowledge, love and science. They went the extra yard to make sure Melanie received the appropriate care.  

Some interventions in the book include:

-Feeding aide (feeding tubes, Nestagel, pureed meat, night feedings)

- Physical Therapy (Included from playing with Melanie to help her move to helping her up and down a set of stairs)

- Speech/Cognitive Therapy: (Included asking Melanie to identify objects colors and body parts)

Chapter Five

Turning Points in

Beliefs and Perspective

Beth’s initial feeling after the birth of Melanie was fear. She did not understand what was wrong with Melanie feared her child may have brain damage. When Melanie was finally able to come home from the hospital Beth’s fear quickly turned to anxiety and a loss of her self-confidence. She believed she had “produced something less than perfect” (p. 12 ) and did not feel confident in her ability or will to care for a baby as fragile as Melanie.

Beth’s feelings went as far as wishing Melanie would die. This was not out of a lack of love for Melanie but again, her fear of her inability to care for her child. Although Beth quickly resolved her issue of wishing for Melanie to die her remaining fears and anxieties continued over the first year of Melanie’s life.

Beth began to feel greater optimism during her time spent in Toronto. Indeed, both she and Melanie were receiving excellent support from the Ontario Crippled Children’s Center, which is also where she met Dr. Pape who came a trusted doctor and advisor. Beth's perspective changed as she began to develop a sense of communication with Melanie that released her of any doubt about her ability to love and care for Melanie.

After a frightening incident surrounding Melanie's sudden weight loss and lethargy Beth's hope and faith was renewed with the discovery of how to ensure Melanie's food would stay down. One of the nurses had noted Melanie was never sick while being fed at night. This discovery renewed Beth's feeling of power and strength to care for her child and just as Melanie grew is size and abilities so Beth grew in her capacity to love an care for Melanie.

As Melanie’s health stabilized Beth began to feel more “intact” (p.111) and able to consider advancing in other areas of her life. The most significant outcome of this shift in beliefs being that she was ready to try for a second baby. During her second pregnancy Beth was unable to feel joy and excitement feeling instead a constant fear that something would go wrong.

Around this same time Beth had a dramatic shift in perspective as she realized Melanie was actively communicating through the use of her eyes. She decided to begin using more specific language with Melanie to support in the development of her communication skills. Beth was incredibly pragmatic in her approach to working with Melanie using positive reinforcement for all activities and actions she tried to teacher her. Beth recognized that this was a wonderful and joyful time in her life as she watched Melanie grow and knew also that a new baby was coming.

Beth acknowledged a specific turning point in her perception when she realized Melanie would be able to use at a minimum receptive speech to communicate (p. 121). This change in perception occurred as she realized Melanie was able to indicate responses to questions using gestures meaning that Melanie could understand language. Beth took great joy in showing off her daughters developing skills and also made the significant step of ceasing to use feeding tubes with Melanie.

Beth's pride and joy was struck down with an unexpected diagnosis of Melanie as having "Gross global brain damage with severe mental retardation" (p.132). This pronouncement was devastating and influenced Beth's beliefs about her daughter for the next two years as she acknowledged the diagnosis caused her to lower her expectations for Melanie's cognitive development.

Over time Beth regained confidence in Melanie's development as her personality began to show through in her actions and behaviors. The distinct turning point for Beth at this time was watching Melanie go off to school for the first time.

The results of Melanie's CT scan lead Beth to an important shift in her perspective and beliefs as she realized how profoundly she had continued to be influenced by Melanie's initial diagnosis of gross brain damage. The CT results clarified that Melanie did not in fact have global brain damage as was capable of developing intelligence. Beth finally realized she should not be comparing Melanie to a typical child of four years old but assess her in the frame of what would be expected of a four year old with cerebral palsy.

Beth's ability to come to terms with her expectations of Melanie led to a period of pride and joy for Beth and their family. Melanie grew in both her skills and abilities as well as her personality and character. Beth was filled with joy when Melanie did unexpected things that caused trouble because it showed that, in some way, Melanie was just like any other four year old child getting into mischief.

Beth's final turning point in perspective occurred with the passing of Melanie. Although she was filled with grief and sorrow she also felt incredible gratitude to have known and loved Melanie. She was thankful for the years they shared together and felt she had become a wiser, stronger, and more empathetic person because of her relationship with Melanie.

Chapter Six

Relationships Between Family, Medical Professionals and Education Professionals

Interactions Between Family & Medical Professionals

Throughout the course of the book, Beth and Clive had to rely heavily on doctors to understand what was happening with their daughter. For the most part, the interactions between the medical professionals was positive. Sometimes, Beth would challenge and question them. But for the most part, they got along well and gave Beth and Clive the confidence and encouragement they needed to understand Melanie's condition.