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Vol. 4 Issue 8 March 12, 2017

Find out what’s been eating Gilbert Grape

Paramount Pictures (1993). Arnie and Gilbert Grape Photograph

The Grape Family The Grape family has been a fixture in Endora, Iowa for many

Paramount Pictures (1993). What’s Eating Gilbert Grape Photograph


years. The late Albert Grape built the family home with his own two hands in the early 70’s. Unfortunately, Albert battled depression off and on for much of his life. Albert and Bonnie had 5 children together, but not long after the birth of their fifth child he gave in to his suicidal urges, hanging himself in the basement of their home. Their oldest son, Larry, left home and joined the military as soon as he turned 18, leaving the rest of the family to fend for themselves. They are barely making ends meet on Gilbert’s income as a box boy at the local grocery store and Bonnie’s disability payments.

onnie Grape’s physical and mental health has slowly declined over time, allowing depression and morbid obesity to control her life. She weighs upwards of 500 pounds, and she hasn’t left the house in 7 years. She can’t even make Paramount Pictures (1993). Bonnie Grape Photograph her way up the stairs to her bedroom anymore. Bonnie is unable to care for her family, leaving all the household duties up to her children, Gilbert and Amy. Bonnie’s decline began with the loss of her husband nearly 15 years ago. Next, her eldest son left home, without ever looking back. She lives in fear of losing another family member to death or desertion. In addition, she hates herself and can’t bear to go out in public, let alone look in the mirror. She spends her days sitting on the couch watching television while being waited on by her daughter, Amy. She uses a cane to ambulate only to go to the restroom, and sleeps on the couch at night.


Paramount Pictures (1993). Ellen Grape Photograph


llen Grape is a hormonal 15 year old girl in need of parental discipline. She is the youngest of the Grape children and wants absolutely nothing to do with her mentally challenged brother, Arnie. She finds his behavior embarrassing, and she often loses her patience with him lashing out in anger. She has no respect for her brother, Gilbert, and resents him stepping into the father role. Ellen works at the ice cream parlor, but she does not help out much in the home. She is anxiously awaiting her 16th birthday and looks forward to the day that she can get out of Endora.


my Grape is the oldest child

rnie Grape is getting ready to turn 18 years old. He is mentally disabled and has a congenital heart defect. The doctors said Arnie would be lucky if he made it to 10 years old. Arnie loves piggy-back rides, climbing the big tree out in the yard, and making Gilbert and Amy search for him. On a number of occasions, he has gotten away from Gilbert and climbed the water tower in town. Just this week, the sheriff had to use a crane to rescue Arnie from the water tower. He was taken into the station and held until Bonnie came to get him out.

living in the home and is currently unemployed. She has assumed the motherly role in the family, managing all the household responsibilities including cooking, cleaning, and caring for Mama. Her duties never seem to end, as her youngest brother, Arnie, is always getting into things and making messes. She often gets frustrated with her brother, Gilbert, for not keeping a better eye on Arnie. Amy acts as a peacemaker in the family, but in her pursuit to keep her mother happy, she enables Bonnie to continue her self-destructive behavior.

Paramount Pictures (1993). Arnie in the tree Photograph


Paramount Pictures (1993). Amy Grape Photograph

ilbert Grape bears the brunt of the responsibility for the family and their dilapidated home, as it disintegrates under their feet and the weight of Bonnie. Gilbert works at the local market as a box boy, often with his younger brother Arnie in tow. He is Arnie’s primary caregiver. Not only must Gilbert take Arnie wherever he goes, but he is responsible for bathing him, keeping him safe, out of trouble, and entertained. At the young age of 24. Gilbert is under tremendous pressure to support a family of 5 while dealing with his mother’s depression and morbid obesity, a hormonal, 15 year old sister, his mentally disabled, 17 year old brother, the family’s unresolved loss of their father, and desertion by the oldest son.

Paramount Pictures (1993). Gilbert Grape Photograph

Developmental Stages, Communication, and Traditions Paramount Pictures (1993). Arnie on the tower Photograph

Duvall’s Stages of Family Development The Grape family is not your traditional family, as the father is deceased and the children are caring for their mother. Using Duvall’s stages of family development, this family falls within two categories: teenage children and launching the children. The family with teenage children is tasked with balancing freedom with responsibilities, while parents begin to establish their own interests. Bonnie Grape provides meager parental guidance and has little or no interests of her own. Fifteen year old Ellen, depends on Gilbert and Amy to take her places, give advice, and provide discipline. Launching the children refers to sending them off into adulthood, while maintaining a supportive home front. Amy and Gilbert are adults but they are unable to spread their wings and explore their own interests due to obligations to care for their family. Their mother, Bonnie, is unable to care for Ellen and Arnie, so the burden falls on the oldest children.

Communication and Traditions The family has not been to church in over 7 years, but they do sit down to eat dinner together on a nightly basis. Amy prepares a home cooked meal, and the children carry the kitchen table over to the couch where Bonnie spends the majority of her time. The main topic of conversation tends to be Arnie, and Bonnie takes this opportunity to coddle him. Gilbert quietly listens as the girls do most of the talking, and Arnie parrots the phrases he hears. This is Amy’s time to spout off orders and make plans. Ellen participates by tossing in snarky remarks. Gilbert is often subjected to criticisms for not keeping a closer eye on Arnie, not earning enough money, or falling behind on home repairs. In addition to family dinners, Gilbert and Arnie have some traditions of their own. Together, they enjoy playing hide-and-seek, wrestling, and every summer they sit at the edge of the highway to watch the parade of recreational vehicles pass through town. Arnie enjoys seeing the bright sun reflect off the airstream trailers, while Gilbert dreams of one day travelling far from Endora -- far from his worries.

The Grape Family’s Strengths and Challenges

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The Grape family loves each other and the family members have certain roles in the function of their household. Unfortunately, those roles are very lopsided. The brunt of the work and strain falls on Gilbert and Amy. Bonnie tries to nurture her children, but she fails to perform any of the motherly duties in the home. This breakdown likely contributes to her feelings of inadequacy and feeds her depression, leading to more eating for comfort. The family also has a lot of in-fighting. They tend to be very critical of one another which may be a result of the high stress levels to stay afloat, and the pressure they feel to keep Bonnie from getting upset. Eating meals together is a healthy family function and it promotes communication and togetherness. Sadly, they tend not to talk about their personal matters, keeping most conversations focused on Arnie and town gossip. Gilbert’s affection for Arnie is apparent, but he has very little time away from his younger brother and carries the weight of the world on his shoulders. This results in moments of tension, impatience, and inattentiveness that can then endanger Arnie. When Gilbert gets upset, he tries to get away, driving as far as he can until he calms down. He doesn’t want to hurt Arnie and feels like he just needs some space. Ellen, at 15 years old, is self-centered. She does not help much around the house, she fights with Arnie, and she is disrespectful towards Gilbert. Ellen makes things much harder for Gilbert and does not offer him any help or breaks from Arnie.

Paramount Pictures (1993). Bringing Arnie home Photograph

Bioecological Systems Theory

Bioecological Systems Theory combines both Systems Theory and Developmental Theory to assess and understand the development of the Grape family. The basic premise is that what affects one member of the family affects the entire family over a continuum of time and situation (Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015). It takes into account genetics, and environmental influence, including: the various family members and microsystems, relationships between those systems, the community, culture and beliefs, and changes that occur over time (Kaakinen et al., 2015).

Microsystem: ○ The Grape family consists of teenagers and young adults living at home with their morbidly obese mother and caring for a mentally disabled sibling. ○ The family had traditional roles many years ago, but through death and illness, the roles have changed over time. Mesosystem: ○ Ellen is in high school and has a part time job. She is also in the band and plays the trumpet. ○ Gilbert works outside of the home at the local market. He has 2 friends that he frequently gets together with at the diner. Gilbert is having an affair with a married woman in town. Exosystem:

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Paramount Pictures (1993). Arnie at the cemetery Photograph

Gilbert’s relationship with the married woman is a distraction which has put Arnie in harm’s way at times. The new supermarket just outside of town has hurt business at the market where Gilbert works, affecting his hours and reducing his pay. Macrosystem: ○ The community and law enforcement do not have much compassion for Gilbert’s situation. When Arnie climbs the tower, the whole town turns out to watch, and it becomes a law enforcement issue. Rather than fence off the water tower property, the police resort to taking Arnie in and locking him in a holding cell. ○ Bonnie Grape is viewed as a circus act to the townspeople because of her weight. Children sneak up to the windows of the house to have a peak. When she finally left the house to get Arnie out of jail, a crowd had gathered in front of the Sheriff’s Department and people were snapping pictures. Chronosystem: ○ The death of their father eliminated the family’s primary income source. ○ The oldest son, Larry, deserted the family, leaving Gilbert and Amy to care for Bonnie and Arnie. ○ Bonnie’s depression, weight gain, and decline in health has created a burden on the children. ○ Arnie has outlived the predictions of the doctors and requires continuous care and supervision.

Family Health Interventions The Grape family faces various health issues ranging from Arnie’s mental disability and congenital heart defect, to Bonnie’s obesity and depression. It is important to note the family history of depression that resulted in Albert Grape’s suicide and to evaluate the mental health of the Grape children, considering the great responsibilities they have been saddled with. As seen through Bioecological Systems Theory, what affects one family member, affects all family members. Arnie and Bonnie’s conditions have put tremendous strain on Gilbert, Amy, and Ellen, with Gilbert bearing the greatest load. He displays signs of caregiver burden, and it is essential to intervene and provide needed outlets and relief in order to preserve the mental health and safety of the entire family. Caregiver burden or burnout can be defined as the response to stress, brought about by caring for a mentally and/or physically ill person, manifested in physical, emotional, financial, and social difficulties (Tabeleão, Tomasi, & de Avila Quevedo, 2018).

Caregiver Burden Interventions: 1.



Provide Gilbert, Amy, and Ellen with psychoeducation that informs each of the caregivers about the patient/family member’s disorder, gives emotional support, encourages autonomy, informs the caregiver what to do in a crisis, and assists with family emergency planning (Tabeleão et al., 2018). Caregivers should be encouraged to take part in leisurely activities with the patient, and share caregiving duties with another family member (Tabeleão et al., 2018). Rationale: In a randomized control study by Tabeleão, Tomasi, and de Avila Quevedo (2018), live-in caregivers of psychiatric patients that received psychoeducation as described above, experienced a significant reduction in caregiver burden.

Counseling will be offered to Gilbert to assess and treat possible depression. Rationale: A study by Mitchell and Pössel (2017) found a strong correlation between repetitive negative thinking by caregivers experiencing finance and schedule burden and symptoms of depression. Given Gilbert’s family history of depression, his role in the family, and recent events, it is possible that he is suffering from some depressive symptoms and should be assessed.

Amy and Ellen may gain a better understanding of the stress that Gilbert is undergoing. The 3 siblings may be able to develop a dialogue allowing them to voice frustrations and ask for help when needed. Knowing that someone else understands and can help if it becomes too much is a huge relief. Arnie will likely be safer, and happier, experiencing fewer outbursts from Gilbert.

Gilbert may experience relief from talking with a professional about his situation and his feelings about it. It may be concluded that medication is necessary to help Gilbert for a period of time.

Family Health Interventions Continued Interventions: 3.


Develop a physical activity regimen with Gilbert that he can fit into his schedule and adhere to. Rationale: Several studies have highlighted the benefits of regular physical exercise by caregivers. Engaging in regular exercise can increase stamina and strength, in addition to reducing stress, anxiety, depression, and fatigue (Rosney, Miller, O'Donnell, & Horvath, 2017). Connect Gilbert with resources providing daycare or learning activities for young people with special needs, in order to give Gilbert much needed respite from caregiving and provide beneficial stimulation and activity for Arnie. Rationale: Dyches, Christensen, Harper, Mandleco, and Roper (2016), examined depression in caregivers of children with autism and the effects of respite care on those caregivers. They found that respite care for just 1 hour per day resulted in daily uplifts which have a negative correlation with depression.

Outcomes: ●

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With increased physical activity, Gilbert may experience improved mood, coping abilities, and feel healthier overall. Gilbert’s establishment of a physical regimen may influence his family members, improving their overall wellbeing too. The breaks that respite care will provide for Gilbert will enable him to be more patient with Arnie and provide better care and attention when he is with him. Arnie may gain new skills, friendships, and interests in his activities. Gilbert will experience a lift in his mood and a decrease in depressive symptoms.

Possible Barriers: ●

Paramount Pictures (1993). The Grape house Photograph

Gilbert may refuse to speak with a professional and deny any symptoms of depression. Provide Gilbert with contact information that he can use at a later date. Gilbert may decide that he does not have time to exercise or he can’t take time from Arnie to exercise. It is important to point out that exercise can mean taking a brisk walk with Arnie to work after parking a few blocks away, or playing ball or tag with Arnie in the yard. It may be difficult for Gilbert, Amy, and Ellen to take part in psychoeducation at the same time due to household and caregiving responsibilities. Suggest that they attend psychoeducation separately if needed.

References Dyches, T., Christensen, R., Harper, J., Mandleco, B., & Roper, S. (2016). Respite Care for Single Mothers of Children with Autism Spectrum Disorders. Journal Of Autism & Developmental Disorders, 46(3), 812-824. doi:10.1007/s10803-015-2618-z Kaakinen, J.R., Coehlo, D.P., Steele, R., Tabacco, A., & Hanson, S.M.H. (2015). Family Health Care Nursing: Theory, Practice, and Research (5th Ed.). F.A. Davis Company. Philadelphia, PA. Mitchell, A. M., & Pรถssel, P. (2017). Repetitive Negative Thinking: The Link Between Caregiver Burden and Depressive Symptoms. Oncology Nursing Forum, 44(2), 210-216. doi:10.1188/17.ONF.210-216 Paramount Pictures (1993). Amy Grape [Photograph]. Retrieved from characters/laura-harrington-whats-eating-gilbert-grape/ Paramount Pictures (1993). Arnie and Gilbert Grape [Photograph}. Retrieved from 4/01/26/ whats-eating-gilbert-grape-1993-film-review/ Paramount Pictures (1993). Arnie at the cemetery [Photograph]. Retrieved from galleries/34877/20-amazing-years-of-leonardo-dicaprio/2 Paramount Pictures (1993). Arnie in the tree [Photograph}. Retrieved from Paramount Pictures (1993). Arnie on the tower [Photograph]. Retrieved from 01/ 07/whats-eating-gilbert-grape-1993/ Paramount Pictures (1993). Bonnie Grape [Photograph]. Retrieved from Paramount Pictures (1993). Bringing Arnie home [Photograph]. Retrieved from https://theweeklyinquisition.wordpress. com/tag/whats-eating-gilbert-grape/ Paramount Pictures (1993). Ellen Grape [Photograph]. Retrieved from Paramount Pictures (1993). Gilbert Grape [Photograph]. Retrieved from -gilbert-grape-where-are-they-now-60517308/#/ms-22621/9

Paramount Pictures (1993). Gilbert Grape [Photograph]. Retrieved from -gilbert-grape-where-are-they-now-60517308/#/ms-22621/9 Paramount Pictures (1993). The Grape house [Photograph]. Retrieved from -at-20-when-johnny-met-leo/ Paramount Pictures (1993). What’s Eating Gilbert Grape [Photograph]. Retrieved from /tt0108550/mediaviewer/rm2836430848 Rosney, D.M., Miller, C.E., O'Donnell, K.T., & Horvath, P.J. (2017). The Case for Exercise as a Therapeutic Modality for Home Caregivers of Dementia Patients. J Aerobics Fitness 2: 107. Tabeleão, V., Tomasi, E., & de Avila Quevedo, L. (2018). A Randomized, Controlled Trial of the Effectiveness of a Psychoeducational Intervention on Family Caregivers of Patients with Mental Disorders. Community Mental Health Journal, 54(2), 211-217. doi:10.1007/s10597-017-0126-7

N480 visual report  
N480 visual report  

The Grape Family Assessment