The gallagher family

The Gallagher Family

of the TV show Shameless (Hissrich & Mylod, 2011)

By Jake A. Laws

Image retrieved from: http://untitledtv.com/wp-content/uploads/2017/03/why-you-should-be-watching-shameless-912474.jpg

The Gallagher’s Frank

Early fifties, suffers from severe alcoholism. Has an estranged ex-wife that is the mother of the children. Lives with children, strained relationship with children, no friends, infrequently physically violent towards family, unemployed, scamming disability insurance, relies on children to pay bills.

Fiona

19 YO, has a matriarchal/caregiver role, ensures everyone gets to school and gets fed, works, pays bills, runs household, HS dropout, smokes, role conflict as both “mother” and being a teenager

Philip

16 YO, academic, intelligent, entrepreneurial, delinquent, straight-A’s, tutor, drinks & smokes

Ian

Debbie

14 YO, hard working, homosexual identity conflict, relationship with married man, JROTC member, smokes, close with Philip 10 YO, works a newspaper route, loves Frank

Carl

9 YO, tortures animals, steals from church donation basket, drinks alcohol

Liam

2 YO, not Frank’s biological son, African-American

Erikson’s Psychosocial Developmental Stages

(King, 2014)

Frank

Generativity versus Stagnation, working towards creating a legacy that can be passed on

Failing in this stage. Frank is not only stagnating but failing. He has almost no relationships outside his family. His family ties are stretched thin. Although, he does have a great pride for creating his children.

Fiona

Identity versus Role Confusion, seeking and finding an identity that fuses one’s past with one’s future

Failing in this stage. Fiona wants to go out, meet people, stay out late, but she has to instead care for her drunken father, work multiple jobs, and care for Liam.

Philip

Identity versus Role Confusion, seeking and finding an identity that fuses one’s past with one’s future

Succeeding in this stage. Philip recognizes himself as an academic who prioritizes his school work. He tutors other students and cares for siblings in his role of brother.

Ian

Identity versus Role Confusion, seeking and finding an identity that fuses one’s past with one’s future

Failing in this stage. Ian is frightened to share his identity as a homosexual as part of fear of how others will react. He hides his sexual preference and trys to act heterosexual.

Debbie

Industry versus Inferiority, learning what skills one excels at and recognizing that one cannot excel at every task

Succeeding in this stage. Debbie has a sense of industry due to her income from her newspaper route and her ability to bring people together by showing her love for others.

Carl

Industry versus Inferiority, learning what skills one excels at and recognizing that one cannot excel at every task

Failing in this stage. Carl is still learning what he is good at and how he can help out and gain a sense of industry. Currently he only has a sense of industry from stealing from the church collection basket. Money which his family frowns upon but still accepts.

Liam

Autonomy versus Shame and Doubt, one learns to control their bodily functions or develop shame through, overly demanding or ridiculing parents.

Succeeding in this stage. Liam appears brushing his teeth and toileting on his own.

Genogram

Symbols by McGoldrick, Gerson, & Petry (2008), as displayed

by Kaakinen, Coelho, Steele, Tabacco, & Hanson (2015).

Family Systems and Illness Model

Model adapted from Kaakinen, Coelho, Steele, Tabacco, & Hanson (2015).

Family Functioning Traditions/Background ● ● ● ● ●

Caucasian-American family living in Chicago.

Roman Catholic family, non-practicing Children eat breakfast together (Frank is sleeping/hungover/passed out) Children arrange family get togethers (Frank is out at bars) Children value school and working (to help pay bills)

Communication ● ● ● ●

Frank respects Fiona, communicates well with her Children communicate well with one another, except Ian who hides his homosexuality to all but his older brother, Philip, who is supportive Communication between Ian and Frank is strained due to incident of abuse Communication between Philip and Frank is strained due to Frank ignoring Philip who Frank thinks is disrespectful

Strengths ● ● ● ●

Children work together as a team to run household and pay bills (besides Liam) Neighbors help the family where they can (assist with petty theft, lend items) Family has strong ties to each other, cares about one another, including Frank Children obey Fiona

Weaknesses ● ● ● ● ● ● ● ●

Frank does not support the household in any way The children have to focus attention on Frank when he is drunk or lost Frank doesn’t recognize his problem or desire to change Financial resources are severely limited All but Liam and Debbie use drugs, drinks alcohol, and/or smokes Fiona’s personal resources are stretched thin as caregiver and provider as well as having competing social desires Most of the family is involved in petty crime Frank’s relationship with Ian is damaged due to an incident of physical abuse and Ian believes Ian reminds Frank of his mom and Frank’s ex-wife, Monica

Alcoholism: Inability to control alcohol consumption despite negative consequences.

Demands of Illness Physiological Can cause: cancer, heart disease, liver disease, malnutrition (increases excretion and decreases absorption and consumption of nutrients), kidney disease, hyper/hypoglycemia, obesity, and decreased drug metabolism.

Withdrawal

Image retrieved from: https://www.rehabcenterforwomen.org/recovery-stori es/hitting-back-my-struggle-alcoholism

Social Neglecting relationships, legal/financial/employment problems.

(Whitney & Rolfes,

Anxiety, delirium tremens “DT’s”, increased blood pressure, seizures.

Frank’s Signs & Symptoms:

Psychological

Depressant, inhibits nerve cells firing.

Chronic alcoholism can cause: insomnia, depression, anxiety, long term impaired balance and memory (Wernicke-Korsakoffe Syndrome), and death of brain cells.

● ● ● ● ● ●

Anxiety Depression Delirium tremens Alcoholic hepatitis Broken/strained relationships Financial/employment problems

The Problem: Dysfunctional family process related to Frank’s alcoholism, as evidenced by: Fiona leaving high school to provide for the children, multiple children abusing substances, physical abuse, disrupted family roles, and Ian’s fear of hostility from his family toward his sexuality.

Intervention 1

Intervention 2

Intervention 3

Assess the family's understanding of the illness, expected outcomes, and treatments available.

Assessing what the family knows can be used to discover errors in understanding of the disease process, the treatment, and prevention; leading to improved health outcomes (Heinrich & Karner, 2011).

Inform family of community resources that are available such as Alcoholics Anonymous and Al-Anon Family Groups. Alcoholism can be draining on the family’s resources (financial, psychological, spiritual). Family members caring for someone with a complicated disease may need outside support (Schrauf, 2011).

Teach patients to journal about their emotions. Journaling can improve one’s coping abilities according a study by Jenkins, Kerber, & Woith (2013).

Outcomes

Outcome 1

By the end of the appointment the nurse will understand the family’s beliefs about alcoholism and its treatment.

Outcome 2

By the end of the appointment the family when verbalize an openness and intent to content community resources.

Outcome 3

By the end of the appointment the family will verbalize understanding that journaling can improve their coping abilities. â—? Lorem ipsum dolor sit amet â—? Sed do eiusmod tempor incididunt ut labore

References Heinrich, C. & Karner, K. (2011). Ways to optimize understanding health related information: the patients’ perspective. Geriatric Nursing, 32, 29-38.

Hissrich, M. (Producer), & Mylod, M. (Director). (2011). Shameless (Season 1) [Television series]. USA: Bonanza Productions, John Wells Productions, Warner Bros. Television, Showtime Networks, Sterling Films Jenkins, S.D., Kerber, C.S., & Woith, W.M. (2013). An intervention to promote civility among nursing students. Nursing Education Perspectives, 34, 95-100.

Kaakinen, J., Coelho, D., Steele, R., Tabacco, A., & Hanson, S. (2015). Family health care nursing: Theory,

practice, and research (5th ed.). Philadelphia: F.A. Davis Co. King, L. A. (2014). The science of psychology (3rd Ed.). New York, NY: McGraw-Hill Education McGoldrick, M., Gerson, R., & Petry, S. S. (2008). Genograms: Assessment and intervention (3rd ed.). New York, NY: W. W. Norton.

Schrauf, C. (2011). Factors that influence state policies for caregivers of patients with chronic kidney disease and how to impact them. Nephrology Nursing Journal, 38, 395-405.

[Why you should be watching shameless]. (2017). Retrieved from http://untitledtv.com/wp-content/ uploads/2017/03/why-you-should-be-watching-shameless-912474.jpg [Women handcuffed to alcohol drink]. Retrieved from https://www.rehabcenterforwomen.org/sites/ default/files/styles/cover/public/women_handcuffed_to_alcohol_drink.jpg?itok=FpLg22aO