Posted by Dave: Think about this question, What is a child? There are at least 53 answers, all correct. Another way to think about the question: How do children affect the world around them? I am asking these questions as an introduction to talking about “psychiatric” or mental health problems in children. Try to give a few answers before reading on. What is a child?
I am a child psychiatrist, but sort of a double agent, in that my practice pattern is grounded in Family Systems Therapy. I am a medication minimalist. I find if I can get the family involved in a therapeutic process, medications seem less necessary. Being involved in a therapeutic process means the family members have the willingness to question themselves, and to make efforts to change.
When I teach third year medical students I ask them the same question. I am inviting them to think about the impact of relationships on people, particularly children. In the world of conventional modern psychiatry, this is an alternative view, some might even use the adjective “ridiculous”. When Child Psychiatrists give a child a diagnosis, then start a medication, they seldom take the relational components of the child’s life into serious consideration. If they are thinking about the emotional environment in which the child lives, they do not have the language to consider it in a clinical situation.
In the clinical world we have boundless permission for talking about children and their problems, but there is little capacity to talk about parents and parenting. In the current Child Psychiatry belief system, it is an error to connect the child’s behavior to parental behavior. But for me, I cannot talk about the nature of the child without considering a relational perspective on child and adolescent emotional/behavior problems.
Here’s a response I got from a Medical Student when I posed the question, “What is a child?”
A child is a developing energetic sponge who absorbs energy from the family and social environment in which it lives and gives back what it has absorbed as it grows.
Children, whatever you think they might be, are powerhouses when it comes to their effect on the world around. They change so much about the world when they are anticipated and when they enter. Generally the changes produce growth in the parents in the way of increasing maturity. But genuine growth begins with disruption. A symptom of health in a family is that the parents are able to learn from experiences with their children. The arrival of a child increases intimacy, a valued experience. But in some families the increase in intimacy is not well tolerated and relationships are strained.
Children disrupt the parent’s view of themselves. Unfortunately some parents are bogged down or partially fractured by the disruption. I found a way to think about emotional and behavioral problems in children/adolescents that came from my experience of the 1985 movie Back to the Future. Michael Fox played Marty McFly, an adolescent in a family with an irritable, disappointed probably alcoholic mother, and an anxious, defeated father. They 
lived in a small gloomy apartment. Marty had a therapist, the crazy man building a time machine out of a Delorean sports car. In science fiction time Marty traveled into the past. There he met his parents as high school students. He interacted with them in such a way as to change the conditions under which they married, so that when he returned to future time they were living in what appeared to be a healthier world, that is, if owning a convertible, living in the suburbs and wearing pastel is evidence of mental health. An increase in self-esteem is suggested in the movie.
A few days after seeing the film, walking our dog around 10:00 PM in quiet suburban darkness, my mind, as usual, began wandering. It occurred to me that Marty McFly had changed things in the relationship so that the parents had more self-esteem or self-respect. The next thought was, that’s what all adolescents are trying to do. They are trying to improve parental self-esteem so they can have more self-esteem.
So in Family Therapy sessions I began asking adolescents, “When you worry about your Father/Mother, what do you worry about?” “When you worry about your family what do you worry about?”
Many kids would say, “Nothing.” Then I would say, “Just so you know, I don’t believe you. I never heard of a kid who didn’t worry about his family.”
As I went along it occurred to me that all children/kids/adolescents worry about or react to their families, most specifically the parents, and much of what we consider pathological in children arises out of that worrying. This includes anxious kids, depressed kids, defiant kids, kids with body symptoms. A prototype is the infant crying in response to mother’s non-verbal anxiety. The child’s worry is not intentional or conceptual, they respond with their body, with the whole person. Kids rarely have much explicit to say about the parents. They don’t have words for their concern. Remember Amy Begel’s story of the Five Year Old Boss. The mother was hesitant to control the five-year-old. I think of his hitting her as saying, “Take charge of me. I want some real affect/emotion here.” When the father held him, the boy ended up cuddling with Father.
We wrote a book in 2001, Defiance in the Family: Finding Hope in Therapy, in which I developed the idea that defiant kids are pushing their parents to be more adequate parents. That is not an obvious conclusion. So give this some thought. I hope it makes some kind of sense. Children worry about their families, because with their biological consciousness they know they need their families. When their effort to help their family fails, their behavior becomes more desperate and destructive to their emerging personhood.
Keep in mind, this is a reflection. It is not a logical equation, a formula to apply to your family or the neighbor’s family. I am sending it to you to affect your imagination. This is part of the clinical imagination I bring to work with a family. Put it into your imagination and see how it affects your thinking.