Posted by Dave: Just one month after Trish left for college, her mother, Carol Marie, called me. I was surprised because she wanted to be a patient and come in to see what she could learn about herself. I saw her biweekly for six months, twelve visits. Father, Arthur, would not participate because he was busy hunting for another permanent job (he never found one), and working as a car salesman. Carol Marie was upset with him she wanted him to come to the sessions.
Carol Marie was a deeply repressed woman. She felt cornered by her marriage. She told stories of their life, which sounded pain-filled, and explained the distance between herself and her husband. In my work with them about Trish’s problems, she became enticed by the idea that she might find a way to love herself. Much to my surprise, she enjoyed being in therapy and became very enlivened. She would arrive for an interview feeling surprised about something she had done.
Occasionally the subject of Trish arose. Trish was away at college and sometimes her poor judgment made her a source of distress. She did have the college freshman’s way of doing dumb things. Carol Marie saw these things as symptoms of her bipolar disorder. But bad judgment in a college freshman is not yet a diagnostic category. In her case the troubles she got into were more symptomatic of naiveté and an unusually soft heart.
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. 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 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 scared 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.
In January she developed a protracted upper respiratory infection. In February she had an unexplained, extended seizure-like 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. 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.
What follows may be characterized as parent blaming. I don’t see it that way, however. I believe that the parents were part of the reason Trish was diagnosed with bipolar disorder. Parents outrank the kids and rank has its privilege, but rank also has its responsibility. The parents did not do anything morally wrong, thus they should not be blamed. The problem with the parents was that while they were successful in their social roles, they were immature, personally. The parents were naïve about relationships and they were both emotionally hungry people. They disguised their hunger in different ways.
In my biometaphorical family systems model, the family includes at least three generations. All Trish’s grandparents were deceased. Mr. Maher came from a family in which his father was successful in a small 
auto parts business. His mother was portrayed as domineering, harsh and emotionally unpredictable, the Queen of Hearts incarnate. As a byproduct, Mr. Maher hated emotion and acted to quell emotion in himself, his spouse or his children. His demeanor and behavior were repressive, but his hidden motive was fear. Emotion made him feel like an overwhelmed little boy. Mr. Maher didn’t take the severance from his job personally. However, he took nothing personally. He was emotionally distant, humorless. His personal style is what I refer to as “culturally invisible pathology”.
Carol Marie came from a timid, frightened family. Her father seemed invisible in her memory. Her mother protected the father but was herself fearful and depended on religion and her daughter for emotional sustenance. In the first 10 years of the Maher’s marriage there were infertility problems. Carol Marie resigned herself to having no children. Then, like a miracle, Trish appeared.
Carol Marie discovered an intimacy with her baby she had never known before. The experience was a deep comfort and soothed much of her pain. But babies are unfaithful. They inevitably disappoint us and grow up, they individuate, say “no”, become defiant, even at age two. Then there was another baby, born when Trish was three. So the family naturally became emotionally chaotic.
The husband Arthur became more distant, more repressive and more demanding. “You keep quiet. You know I hate it when you get so emotional. And keep those kids quiet. Dammit! Can’t you see that Billy needs changing? You didn’t iron my shirt. I told you I needed that shirt this morning.” Carol Marie felt overwhelmed. If only her four-year-old (Trish) was not so difficult, things would be better.
Thus, they went to see a child psychiatrist. The point here, which is easily lost, is that the problem did not belong to one person; it belonged to the family. When the diagnosis was made, it offered an explanation for why Carol Marie felt so overwhelmed: her daughter had a mental illness. Their anxiety now had an explanation that they were hesitant to disrupt.
Our culture gives all kinds of freedom to talk about children. Thus it was easy for Trish to be defined as the problem. There is little freedom to talk about parents and the language for talking about parents is very limited, partly because any discussion of their participation in family problems has come to be (incorrectly) understood as blame.
In my clinical work, I assume that if a person has a problem it is a manifestation of a group problem. This example shows how the diagnosis and medical treatment of a family problem as an individual problem organizes a family. My not encouraging the medication to be restarted had a profound effect on the reality organization of the family. It frightened and exasperated them, but simultaneously in the mother’s case, it stimulated her curiosity.
She never went ahead with the café idea, but she did buy herself a pickup truck. She got a new truck.
So let the philosophical part of your mind go on break and check out Tracy Nelson, Got a New Truck, on YouTube: