A Remembrance of Braulio Montalvo
I am in Albuquerque New Mexico. I have just come back with my wife Tana, Braulio’s widow Margarita Montalvo, and their daughter Maria, from visiting Braulio’s ashes in the mountains where they were scattered. On the beautiful mountain slopes, I said Kaddish, the Jewish prayer for the dead, for my devout Roman Catholic friend Braulio.
Desolate, as I walk towards the car, I pull this photograph that Margarita had given me a few hours earlier, out of my pocket. I look at the photo, Braulio Montalvo, middle-aged, handsome, strong-faced, probably taken in Argentina. I notice the graffiti word next to Braulio’s shoulder, “Huevos”, a Spanish colloquial term for balls or courage. I wonder whether Braulio’s hosts in Buenos Aires thoughtfully selected the setting for this photo.
How fitting. Braulio was a role model for a generation of family therapists because of his brilliance, framed by his moral and intellectual courage.
Braulio came to New York City in the early 1960s to study psychology at Colombia University. Fortunately for all, he began working with Salvador Minuchin and his colleagues at the Wiltwyck School for Boys, a residential school founded by Eleanor Roosevelt. Their sentinel work is memorialized in their book, Families of the Slums (Minuchin, Montalvo, Gurney, Rosman & Schumer, 1967). For one of the first times in psychiatry and psychology, efforts were directed not just to the troubled individuals but also to the family as a whole.
I had often wondered how Sal, Braulio, and their colleagues came to break with the orthodoxy of the time and involve families. When I asked Sal recently, he told me the following anecdote: “At Wiltwyck, I had a very smart secretary who said to me ‘You know, this boy was here two years ago and you wrote exactly the same thing about him now as you did then.’” Sal said this made them realize that they needed to look further and examine the families of these children.
Braulio and his colleagues were guided by pragmatism. Even though Sal was, by then, a welltrained psychoanalyst, they made sure that common sense trumped theoretical orthodoxy. Involving families must have seemed an act of heresy in the rarified psychoanalytic world of the day, where double doors protected each patient encounter. This new approach was unthinkable. Particularly for Braulio, who at the time was a young man and had to break from the teachers in his conservative Ivy League Master’s program.
Following Wiltwyck, Braulio went with Sal and Jay Haley to the Philadelphia Child Guidance Clinic where they all worked closely together. Of note were the legendary Mount Airy carpools, riding to work together and developing theories for this new field. Along with Sal and Braulio, Jay had been challenging no less august an institution as the Holy Bible in his book, The Power Tactics of Jesus Christ and Other Essays (Hayley, 1969).
Once in Philadelphia, they wasted no time in taking on the establishment. Jay Haley and Braulio started a family therapy training program in the inner city (Institute of Family Therapy; IFT program). Challenging the academic gatekeepers, they determined that the better prerequisite to being an excellent family therapist was not academic credentials but having rich family and life experiences. They feared that an excess of academic training around treating the individual would actually interfere with learning family systems theory, it would entail too much to “unlearn.” Thus, they recruited non-credentialed people from the community and trained them to be family therapists. History has proven that Braulio and Jay were prescient; some of the finest family therapists at the Philadelphia Child Guidance Clinic were from this program.
In these training programs, family therapists eagerly embraced videotape technology. Breaking from the secrecy of the psychoanalysts’ inner sanctums, they asked families’ permission to videotape sessions and for the trainees to observe. Video soon proved to be for family therapy what the microscope was to biology. A whole new world of analysis opened up. Braulio came to be the master at analyzing and describing these fertile family interactional patterns. His micro-dissection of interactions highlighted that the processes were not random but held significant meaning and were recursively connected to the symptoms. The Master’s exquisite eye for understanding and explicating the family “dance” became legendary for all of those who came across his work.
Included in Braulio's lasting legacies are his invaluable, classic teaching tapes. One such tape, Family with a Little Fire (1973), finds a seven year-old girl, one of four children to a single mother in the inner city, who had set fire to her mother’s mattress. Braulio gently enters the system and masterfully works with the process, restructuring the family. One psychological interpretation might well be that the girl set the fire because she was angry with her mother. Speculation aside, Braulio sees the emotional distance between them. The mother was highly critical of her daughter and Braulio introduced enactments to foster closeness between the mother and daughter. At one point in the session, Braulio noted that the girl was reading quietly. Braulio commented to the mother, “Your daughter is reading. “ The mother says, “She’s not reading, she’s just memorized the words.” Braulio challenged this idea and asked for the child to read out loud. A 20-minute precious, segment ensues where the increasingly competent, tearful, youngster read almost fluently to her mother, much to the mother’s surprise. This was ground breaking, innovative therapy in 1973. It introduced to this young field, a “therapy of experience”, where the therapist helps the family in the session find new and more functional interactional patterns.
Bolstered and documented by countless video analyses, Braulio understood the veracity of the Batesonian concept of “mind in context:” the self as multi-faceted and changeable as it responds to fluid contexts. Most importantly, for him, the systemic family therapy paradigm, to use a phrase popular today, was a “disruptive technology”, disconnected from earlier paradigms. It could not be reduced into another, earlier paradigm. TS Kuhn, in his seminal book, The Structure of Scientific Revolutions, documented that over the course of scientific history, successful paradigms functioned discontinuously from earlier ones (Kuhn, 1962).
Braulio owned a purity of vision understanding the centrality of contemporary context. We analyzed countless tapes together over the years with wide-ranging problems from divorce to anorexia to post traumatic stress disorder. Braulio was razor-sharp at detecting the contextual “smoking gun” that would unlock the clinical roadblock. Once successfully addressed, symptoms resolved.
My dear friend was much loved for his brilliance, generosity, loyalty, kindness and his social commitment. Of the people I’ve spoken to after his death, especially the old Philadelphia Child Guidance crowd, it became clear that Braulio provided unique contributions to all of our lives over the years. I think this special gift was best said by Sal in his book, Families and Family Therapy: “Braulio, who I consider my most influential teacher, has the rare capacity of receiving an idea and giving it back enlarged” (Minuchin, 1974, p.vii)”. He gave that gift to us all countless times.
Years ago there was a movement advocating that clinicians study the ethnicity of their clients. I asked Braulio what he thought of this idea. He advocated that the clinician should employ the practice of “informed one down”. That is, tell the family they are the experts on their culture. They teach me about their culture and I’ll use my expertise about families and we’ll work together. Braulio Montalvo was a modest, gentle man. His interest was not in promoting himself but helping people around him, his friends, family and his mentees to excel.
We need Braulio’s passion and perspective. A recent New York Times article reports, “about 15,000 American toddlers 2 or 3 years old, many on Medicaid, are being medicated for attention deficit hyperactivity disorder” (Dell’Antonia, 2014). This reflects an unwillingness or lack of capacity to address the social issues in their context. Similarly, Allan Frances, M.D., one of the authors of the DSM-IV, has written a new book which condemns the acontextual DSM-V for creating an avalanche of new diagnoses, many of which conveniently have psychiatric medication claiming to mitigate them (Frances, 2014). Braulio’s incisive wisdom is necessary as an antidote to these “hair-brained” practices.
Braulio’s legacy would challenge clinicians and policy makers to look beyond symptoms and to seek understanding of the intricate Mobius strip connections between the individual and their most influential context, their family. Unfortunately, these concepts are still radical today in many circles.
Even in Braulio’s last weeks, when he was very ill, struggling for breath, he was irate about the plight of the poor in America. He fervently believed that what children and families needed was respect, the respect to acknowledge their struggles and their circumstances, not the tunnel vision of quick fixes. He believed clinicians needed the courage to buck “groupthink” as he did many years ago and to address the dynamics and context in an individual’s and family’s life and create lasting change. We must deal with the messy realities of families. This brings to mind a joke that Braulio loved. Quoting Woody Allan, “I hate reality but it’s still the best place to get a good steak.”
In the spirit of Braulio, I encourage you family therapists to commit to rolling up your sleeves, to continue on this courageous path. Our clients and their families need you.
Who knows, you may even get a good steak along the way.
Reference List
Dell’Antonia, K.J. (2014, May 16). The new inequality for toddlers: less income, more Ritalin. The New York Times. Retrieved from parenting.blogs.nytimes.com/
Frances, A. (2014). Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric, Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. New York: Harper Collins.
Haley, J. (1969). The Power Tactics of Jesus Christ and Other Essays. Grossman Publishers
Montalvo, B., Gurney, B. G., Rosman, B. L., & Schumer, F. (1967). Families of the slums: An exploration of their structure and treatment. New York: Basic Books
H. Charles Fishman, MD is Clinical Professor of Psychiatry, University of Hawaii, John A, Burns School of Medicine. http://intensivestructuraltherapy.com