Vheronika Santiago Family Assessment Visual Report CSUSM NURS480
MARCH 2022
EUPHORIA’S HOWARD FAMILY
INTRODUCTION: THE HOWARDS HBO’s ongoing Euphoria series focuses on multiple main characters and their highschool lives. In this, the Howard Family comprises of Cassie Howard (one of the series’ main protagonists), Lexi Howard, and their parents Suze and Gus. Though not many details of the family are established specifically, the Howard family is seen as dysfunctional. Before their divorce, Suze and Gus presented themselves as a loving family. The reality of this was that they were constantly arguing around their children. Suze uses alcohol as a form of stress relief from her relationship with her now ex-husband— embarrassing her daughters because of it. Gus became the primary parental figure to his daughters due to this, but after a major car accident, became addicted to pain medications and ultimately other drugs. Once divorced, Suze and Gus created a dysfunctional family dynamic. Although according to the Duvall Developmental Stages, the Howard family is seen as a Family with Adolescent Children, the absence of their father and the ignorance of their mother lead Cassie and Lexi to grow up by themselves. Although there is not a lack of communication between the girls and their mother, there is an absence of support between them all. This leads to the prioritization of Cassie and her life, leaving her mother and Lexi to become separated from each other as well.
Suze Howard
Gus Howard
Suze is a 40 yr old woman and the mother to both Cassie and Lexi. She is currently in the generativity vs. stagnation stage of her life according to Erikson's Stages of Psychosocial Development. Though more specifically in stagnation as one in this stage usually refocuses on the marriage relationship (Kaakinen et al., 2018, pg.396) and Suze has found herself drinking most problems away and does not want to focus on her divorce or her children.
Gus is a 41 yr old man and is also in the generativity vs. stagnation stage of Erikson’s Stages of Psychosocial Development. As he is now the ex-husband of Suze, he prioritizes drugs over his children. While he should really be trying to maintain ties with the younger generation (Kaakinen et al., 2018, pg.396) Gus in fact does the opposite. Only going to the Howard family when in need of money or healthcare.
Cassie Howard At 18 years old, Cassie is the oldest of Suze and Gus’ children. According to Erikson’s Stages of Psychosocial Development, she is in the identity vs. role confusion stage. Those in this stage have increasing internalization of ethical standards which can use to make decisions (Kaakinen et al., 2018, pg.396). With her mother not being an ideal support system and having to take care of her younger sister, Cassie thinks she is on her own. She became mentally insecure and dependent on male validation in order to try to make up for her missing father figure. She tends to only feel secure in her life if she was in a relationship. Though this aspect of her life has lead her into a long strand of abuse. After a year long relationship, she was forced to have an abortion by her partner. This then became another event in her life that greatly affected her mentality. She grows to have the mindset of “at least I’m loved” going into another abusive and toxic relationship. As the show Euphoria continues, Cassie is seen spiraling into madness as her role confusion increases.
Lexi Howard Being 17 yrs old, Lexi is also in the same stage as her sister. Being in the identity vs. role confusion stage of Erikson’s Stages of Psychosocial Development, Lexi should be balancing freedom with responsibility as teenagers mature and emancipate themselves (Kaakinen et al., 2018, pg. 396). Lexi does exactly this, although her maturity hurts herself in the process. Although having the same childhood and experiences as her sister Cassie, Lexi grew up very differently. She noted all that her father was going through and development anxiety from it. Lexi sees herself as an “observer”, being forgotten or in the sidelines of family decisions. Introverted, she is very mature and supportive towards her family and friends. She is seen as the caretaker of the family- putting their needs before her own. Being surrounded by people with multiple addictions and mental disorders leads Lexi into a state where she can no longer prioritize herself. Though primarily idolizing her sister, Lexi slowly learns to put herself first and accepting her trauma as the series continues.
CASSIE’S BORDERLINE PERSONALITY DISORDER Though not stated in the series, it is implied that Cassie has a textbook definition of Borderline Personality Disorder (BPD) and abandonment issues. BPD is a condition where a person has varying moods, images of themselves, and overall behavior. People with borderline personality disorder may experience mood swings and display uncertainty about how they see themselves and their role in the world National Institute of Mental Health (2021). Being very insecure without validation herself, Cassie tends to change her emotions and values based on who she is seeing. She also has to have a clear good or bad answer— which ultimately ruins her friendships. She sees those who do not agree with her as enemies and constantly gives reasoning as to why she is doing horrible things. Those with BPD also have symptoms such as Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating National Institute of Mental Health (2021). Cassie also had episodes of suicidal behaviors and threats. She is also seen having difficulty controlling her anger when called out about her actions. This entirety of her disorder heavily affects the Howard family dynamic and daily life. Suze is constantly trying to tell Cassie what is right and wrong— even hiding knives from her. All while Lexi is trying to take care of herself for once she becomes an enemy to her sister while exposing her wrong doings and personality through a public play.
STRENGTHS
The Howard family is very communicative. They often discuss what is bothering them although their responses to each other are not healthy. Suze encourages her children to be themselves and is very accepting of their personalities/faults.
CHALLENGES
Though they communicate often, they do not engage in healthy communication. Instead they put each other down without realizing. Suze’s alcohol problem has also lead to her throwing parties and allowing her daughters to also excessively drink alcohol while being underage without repercussions. Because of the entire family’s focus on Cassie and her BPD, Lexi is often pushed to the side left to deal with her own emotions.
HOWARD FAMILY FUNCTIONS VERBAL COMMUNICATION Cassie often expresses all her thoughts whether it is negative or positive. Suze when needed will tell Cassie about her wrong doings. Lexie often sits in the background of each conversation.
CULTURE Before the divorce, the Howards often went to family gatherings and outings with extended family. Now to make up for their absence in those events, Suze throws parties as an excuse to drink excessively. The Howards are not known to associate with any religion.
NON-VERBAL COMMUNICATION Lexie turns her trauma and emotions into art. Often writing about her perspective on her sister’s life as well as her family matters. Suze often ignores the girls unless drawn into a problem.
DEVELOPMENTAL & LIFE CYCLE THEORY In this theory, Families are seen as a system in that what happens at one level has powerful ramifications at other levels of the system (Kaakinen et al., 2018, pg. 79) It is based around two concepts: families develop and change over time, and due to this, experience transitions from one stage to another. The relationships among family members are affected by changes in individuals, and changes in the family as a whole affected the individuals within the family. Families are stressed at common and predictable stages of change and transition and need to undergo adjustment to regain family stability (Kaakinen et al., 2018, pg. 79). This can be seen almost outlined with the Howard family. Each member has taken Suze and Gus’ divorce differently, and has not had the chance to properly adjust from it before moving into the next stage of their lives. It is important to take into consideration which stressors can affect the Howard family. Based on the stage of family development and how long the family is in that stage can also affect how the family unit acts (Kaakinen et al., 2018, pg. 80) The Howards divorced well into their daughter’s developmental years. They have also been dealing with this separation for multiple years with no proper closure. When transitions occur, families experience changes in kinship structures, family roles, social roles, and interaction (Kaakinen et al., 2018, pg. 81) It is important as a nurse to realise this when looking at the Howard family, that they may all be experiencing different emotions which will all need to be addressed.
NURSING OUTCOMES The Howard family should identify with the nurse three healthy coping behaviors. It should also be outlined what negative coping behaviors they have.
Cassie and Lexi should state one reason that their mother’s alcoholism has affected the health of their family.
Cassie should accept responsibility for her actions and acknowledge that she needs a change in how she copes.
NURSING INTERVENTIONS Refer for family therapy and other family-oriented resources (Ackley, 2020). (Reference: Evidence-based interventions targeting affected family members have been shown to improve health outcomes for all family members, result in better addiction treatment outcomes, and prevent adolescent substance use (Ventura & Bagley, 2017))
Encourage parent communication about alcohol use with adolescents (Ackley, 2020). (Reference: Identified parent–adolescent communication as important in delaying the onset and escalation of alcohol use.(NIH, 2017))
Teach coping skills to clients and caregivers (Ackley, 2020). (Reference: In a trial of a culturally adapted cognitive behavioral therapy intervention to promote coping skills among Chinese Americans with type 2 diabetes, strategies and coping skills that addressed personal, family, and illness-specific topics were included; researchers reported enhanced efficacy for self-management (Chesla et al, 2013))
REFERENCES: Ackley, B.J., Ladwig, G.B., M. M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care. Elsevier. A.S. Ventura S.M. Bagley (2017). To improve substance use disorder prevention,treatment and recovery: Engage the family, Journal of Addiction Medicine 11:(5):339-341 10.1097/ADM.0000000000000331. C.A. Chesla K.M. Chun C.M.L. Kwan (2013).Testing the efficacy of culturally adapted coping skills training for Chinese American immigrants with type 2 diabetes using community-based participatory research, Research in Nursing & Health 36: 359-372. Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018) Family Health care nursing: Theory, practice, and research. F.A. Davis Company. NIH (2017). National Institute on Alcohol Abuse and Alcoholism: Parenting to prevent childhood alcohol use, Retrieved from https://pubs.niaaa.nih.gov/publications/adolescentflyer/adolFlyer.pdf. National Institute of Mental Health (2021). Borderline Personality Disorder. Retrieved March 25,2021, from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
IMAGES: https://euphoria.fandom.com/wiki/Cassie_Howard https://euphoria.fandom.com/wiki/Gus_Howard https://euphoria.fandom.com/wiki/Lexi_Howard https://euphoria.fandom.com/wiki/Suze_Howard https://www.instagram.com/p/B0qjn4OFDx0/ https://www.instagram.com/p/CZmnJ6RKTVJ/