A Family/Caregiver Analysis: What’s Eating Gilbert Grape

The film I chose to view for this analysis was What’s Eating Gilbert Grape. The problem presented in this film involves a single mother who has kept herself isolated from society for years following the death of her husband. Her children have assumed complete care for her and their mentally-disabled brother Arnie who is approaching is 18^th birthday. Gilbert Grape, who is Arnie’s brother, and his sisters (Amy and Ellen) have developed roles for themselves involving specific household tasks. Gilbert is presented as the main provider of the family, working at a small grocery store in town, and spending a majority of his time watching over and caring for Arnie.

Gilbert is the narrator of the film and explains at the beginning of the film that Arnie was not expected to live as long as he has. Gilbert described the setting of the plot, a town called Endora, as a place where “nothing much happens, and nothing ever will.” It is obvious from this statement that he has developed a negative outlook on life and the future, and as the film progressed it became clear why he had this attitude. Therefore, the problem I found within this film was the caregiver and role stress experienced by Gilbert and his sisters. This problem is relevant to nursing because nurses are responsible for assessing caregiver roles, support systems, and attempting to implement successful strategies of care. A research article by Margaret England stated that, “North American nurses typically rely on assessment tools for assistance in recognizing cues for caregiver strain in the self-reports of caregivers” (England, 2000). The Caregiver Strain Questionnaire (CSQ) is a 54-item, Likert type scale, implemented to determine the level of caregiver strain. Nurses should be alert to recognizing caregiver strain and aware of the interventions to adapt.

This issue greatly influenced family dynamics throughout the film. At the beginning of the film, Gilbert narrates and explains the roles of the family members. Momma is a morbidly obese woman, as he later refers to as a “beached whale”, that does not move from her chair in front of the television. The family moves the table from the kitchen to her seat at each meal, brings her food and cigarettes, blankets, and basically provides total care for her. Her condition has been this way since her husband/the children’s father committed suicide, unexpectedly, in their basement. Her state influences the dynamics of the family as the sisters are responsible to cook, clean, and help with Arnie.

Gilbert also participates in the daily rituals of catering to Momma and always gives Arnie his bath and puts him to sleep. One night, Gilbert was eager to meet with a new girl who had come into town, Becky, and he explained how Arnie was “a big boy” and told him how to bathe himself. Gilbert left him in the tub to complete the task on his own, so that he could go meet with Becky. The next morning when Gilbert went into the bathroom, Arnie was still in the bathtub, alert, but hypothermic. This incident caused anger in the other family members that Gilbert could have been so negligent. Gilbert did feel very guilty and sorry that he had expected Arnie to complete his bath on his own.

There were a number of incidents throughout the film where Gilbert was split between his role of responsibility for Arnie and just being a carefree young adult. Also, a few times throughout the film, Gilbert was supposed to be watching Arnie and Arnie ended up climbing the town’s water tower creating a riot. Gilbert loses his patience toward the end of the film and punches and slaps Arnie. Gilbert felt extreme guilt after this confrontation because he had never acted in this way, and he had always acted as a protector of Arnie. He told Becky that “nobody is supposed to hurt Arnie.” This was a very strong and sad scene; however, it revealed the stress that Gilbert was experiencing in his caregiver role.

With family dynamics, I think it is significant to mention the extent to which the children went to protect their mother. It seems apparent that this woman should have received counseling or mental support. Her grieving process for the husband was completely dysfunctional. I found that the children aided in her practice of isolation by providing total care for her. Gilbert was the only one who seemed to look at the reality of her situation and declare how bizarre it actually was, but he never told her. The children protected their mother from reality. For example, when Arnie kept repeating “Dad’s dead” at the table, the attention turned to the mother and getting Arnie to stop saying the statement. But why? Arnie was mentally disabled and he was stating the truth that the mother was unable to except after so many years.

Another important part of family dynamics that I recognized in this film was how much Arnie’s condition brought the family together. For example, when Arnie was arrested for climbing the water tower, after repeated warnings, his mother finally came out of the house with the children and they all went to get him out of jail. Also, Arnie’s 18th birthday party was a big collaborative effort. In the scene where Arnie was saying that he wanted hot dogs at his party, the mother and sisters seemed to be creating their own picture of what the party should be like. I felt that the party was also a way of celebrating the care that they had provided for Arnie over the years. The mother also places a lot of pressure on the children and their roles. Several times throughout the film she stated that they “need to try harder” to watch Arnie, take care of him and fulfill their responsibility. These children appear to be selflessly engaging themselves with Arnie’s and their mother’s needs. This creates a very complicated and dynamic family.

The theoretical model that is appropriate to describe the Grape family in this film is the Neuman Systems Model. “Neuman defined the family as a group of two or more persons who create and maintain a common culture; its most central goal is one of continuance” (Harmon-Hanson, Gedaly-Duff, & Rowe Kaakinen, 2005). I found this model useful in reference to the Grape family because throughout this film I learned that they have a culture unique to their family. This culture involved the children providing isolation for their mother and fulfilling her role in the household. Their priority goal appeared to be continuance of this culture because it was safe and protective.

Within this model, “the family has the ability to open or close its boundaries to protect its members and preserve the integrity of the family as a whole” (Harmon-Hanson, Gedaly-Duff, & Rowe Kaakinen, 2005). This characteristic of the model is perfectly depicted in various scenes of this film. One example is that the children are consistently closing in on society to protect their mother. The scene in which the children went with their mother to the jail to pick up Arnie was a display of the family preserving their integrity. The children helped their mother and stayed together as the crowd of townspeople gathered around them snapping pictures and making cruel comments. At the end of the film, when the mother passed away, the children burned the house down to protect their mother’s integrity. In this scene, Gilbert stated, “No one is going to make a joke out of my mother.”

This model is unique in that it “addresses family health promotion, family reaction when a stressor affects the family and restoration of the family via family functions to achieve balance or equilibrium” (Harmon-Hanson, Gedaly-Duff, & Rowe Kaakinen, 2005). This aspect of the model was evident when Gilbert left the house after his fight with Arnie. The family was very distraught and the mother was uncertain whether Gilbert was going to return. The family was restored following this stressor by Gilbert’s return home for Arnie’s birthday party. Gilbert also went to talk with his mother when he returned home and he promised that he would never “up and leave” the family as his father did. This event provided balance and trust to be restored to the family dynamics.

An article related to my discussion, titled “Caregiver Strain: Considerations for Change,” presents information that can be used to diagnosis and treat caregiver strain associated with parent care. I chose this article because it relates to this film in that the adult children were acting as caregivers for their mother and brother. This article clarifies that there are three components to diagnosing caregiver strain. These characteristics are “exhaustion, emotional arousal, and goal-discrepancy distress” (England, 2000). Exhaustion occurs when the child does not have enough energy to perform the necessary tasks. This may have been evident when Gilbert did not express any interest in helping with the tasks to prepare for Arnie’s birthday party. Emotional arousal is defined as the occurrence of varying feeling states. For example, Gilbert would be in a playful mood with Arnie and then the event occurred where he became very frustrated and hurt Arnie. Also, emotional arousal was exhibited in the scene when Ellen (Gilbert’s sister) was yelling, screaming, and kicking Arnie to keep him from climbing up the water tower. Goal-discrepancy distress is evident when there is anxiety over not being able to meet personal needs. This was apparent in the scene where Gilbert left Arnie to bathe himself so that he could meet with Becky. It also occurred when Gilbert left Arnie in the truck alone, so that he could have an affair with the married women, and in the meantime, Arnie walked off and climbed the water tower. Based on these three principles (exhaustion, emotional arousal, and goal-discrepancy distress), a nurse would diagnose these children with caregiver role strain.

Another point from this article was that “one third of all adult children who have been caring for a cognitively impaired parent for more than 1 year show clinical signs of depression, anxiety, and loss of subjective health” (England, 2000). I found this statement significant because at the beginning of the film it is apparent that Gilbert has been experiencing depressive symptoms. For example, he describes that “nothing much happens, and nothing ever will” in his town. He also refers back to how beautiful and fun his mother used to be, implying that things used to be much better than they currently are.

This article also presented interesting findings regarding termination of the caregiver role, “Research shows that adult children with high caregiver strain are at risk for terminating the role of caregiver…adult children who frequently adjust day-to-day work schedules and other routines to accommodate the demands of parent care are less likely to sustain a commitment to give effective care to a parent” (England, 2000). The film seemed to disprove this statement because despite their ongoing care for their mother, the children did not terminate their role. Although, when Gilbert left the family after his fight with Arnie, I was questioning whether or not he would return. Even after their mother’s death, the children continued to provide care and allowed her to rest with integrity.

Some recommendations for nursing practice would include assessing for caregiver role strain through questioning the caregiver about emotional and physical status and by completing the caregiver strain questionnaire. Some interventions to include in the plan of care are: encouraging involvement of all family members and dividing tasks, suggest the use of respite care, meals-on-wheels, adult day care, home health aids, and support groups, encourage the caregiver(s) to set aside time for themselves(s), teach stress-reducing techniques, & encourage the caregiver to become involved in a support group. The recommendations that I would make for future research include qualitatively analyzing family dynamics of a child with mental retardation. Through my research, I could not find an article that specifically depicted this topic. I think that the results would be very informative and beneficial. I would also recommend more research about sibling roles and interactions in a family with a mental challenged child.

References

Harmon Hanson, S. M., Gedaly-Duff, V., & Rowe Kaakinen, J. (2005). Family health care nursing. (3^rd ed.). Philadelphia: F.A. Davis Company.

England, M. (2000). Caregiver strain: considerations for change. Nursing Diagnosis, 11(4), 164-175.