Further Into The Family Inner Sanctum

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This is a continuation of the case “A Bipolar Child…”


At first Carol Marie was a careful patient. But she liked the idea of being a patient and liked to come to the sessions. Much of her life had been characterized by apprehension. A fear of an undefined catastrophe fueled her apprehension. But now she began to do new things. In fact, she was a little like Trish had been. She decided to drop “Marie” and become a less prissy, less Catholic Carol. By her report, the family was surprised and sometimes upset by this new version of Carol Marie. She went for a walk alone one Sunday in the rural area where they lived, and got lost. She was gone for four hours. The family was frightened by her long absence, but she was exhilarated by the experience. She began looking into the possibility of buying a café in a small town near her home.

Unknown-1In January she developed a protracted upper respiratory infection. In February she had an unexplained, extended spell, which resulted in a trip to an emergency room. There was no diagnosis; she never lost consciousness. It sounded like a pseudo seizure to me, maybe a dissociative episode. She had a series of medical evaluations with no clear conclusions. From a metaphorical point-of-view, I had the impression she was trying to regain herself, to become a somebody. She was energized by the process on the one hand, but on the other, this new self she was becoming had new feelings, and those new feelings were creating distress not only at home, but also inside herself. I made a working assumption that was a partial explanation for her somatic problems:

As I indicated earlier, the language inside this “biometaphorical” model tends to be vague. At the end of the six months, she left therapy because she was feeling better about herself and because she felt she had learned enough for the time being. When Carole Marie became a patient on her own, her struggles were implicitly parallel to her daughter’s. Her getting lost and being gone over-long was a milder model of Trish’ staying out all night long. Her plan to buy the café was typical of behavior they would regard as unrealistic in Trish.

I chose this case because it represents on one level a long term study of a family in which the daughter was treated in the bioscientific model, as if she had a disease. The child psychiatrist who saw her then did not have any language for considering the silent distress in the marriage that had its origins in both background families, and was covered by polite, orderly suburban success.

images-3As an institution modern conventional Child Psychiatry has little capacity to think about let alone work with families. One of the reasons Child Psychiatry does not like family systems therapy is that it “blames” parents. From my point of view part of the problem is that they get hung up on the biomedical model for thinking about and describing human experience. Thought is converted into language. Language which attempts to be very clear becomes a limiting factor in what can be known or even seen in experience. Thus those who operate in a biomedical language system, do not have language for engaging in work with families. What follows may be characterized as parent blaming. I don’t see it that way, however. And few who work with me feel blamed. But I say, if you can’t stand guilt, don’t have children. Love and guilt go hand in hand in the struggle to be human and to raise humans.

I believe the parents’ personal and relational dynamics were part of the reason Trish was diagnosed with bipolar disorder. I will attempt an explanation. The parents’ way of thinking and behaving was not the result of a moral failing. The problem with the parents was that while they were successful in their social roles, they were personally immature, naïve about relationships and both were emotionally hungry people. They disguised their hunger in different ways. The explanation for limited maturity shows up in the story of the families in which they grew up.


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