The theme of this blog, as well as of my last book, How Dysfunctional Families Spur Mental Disorders, is that family systems issues have been disappearing from psychiatry in favor of a disease model for everything by a combination of greedy pharmaceutical and managed care insurance companies, naïve and corrupt experts, twisted science, and desperate parents who want to believe that their children have a brain disease to avoid an overwhelming sense of guilt.I’ve also written about some of the family systems ideas that are being neglected. But the question many readers may still have is: What do systems-oriented family therapists actually do? In an excellent new book, Pills Are Not for Pre-Schoolers: a Drug Free Approach to Troubled Kids, author and therapist Marilyn Wedge shows, with a series of excellent case examples, what can be done. She demonstrates brilliantly how kids who might be labeled with serious mental illnesses (that they do not actually have) are, in fact, responding to trouble at home.
Marilyn WedgeSome of the key points that she illustrates are:
- If a child acts violently angry, the purpose of this behavior is to deflect the anger that one parent is experiencing against the other. Violence is, therefore, usually a sign of parental discord.
- Kids hear and understand much more than we think.
- A child will do anything to make his or her parents stop arguing.
- Kids act out parental feelings that the parent can’t express.
- Young adults that refuse to grow up and move out are doing so in order to covertly give their parents who are not getting along a reason to stay together.
- A parent’s obsession with a child is often a substitute for intimacy in the parents’ marriage.
- The pain of one family member always affects all other family members.
- Sibling squabbles can reflect parental discord.
She explains how family and home problems become far less likely to be addressed once a child is called bipolar or ADHD. (Magazines – and some advice columnists - are at present labeling any sharp change in mood as a symptom of bipolar disorder).Of course, even parents who are very much against the use of psychiatric medications are often very sensitive to the question of whether or not they are somehow to blame for the problems of their child. So if a mental health professional does not know how to handle this sort of parental guilt, and furthermore does not even know what questions to ask to find out if there is any family discord, they are not going to hear about family problem - as I pointed out in a previous post, Don't Ask, Don't Tell.Wedge shows clearly how this trap can be avoided.A lot of child psychiatrists these days are so focused on “symptoms” that they miss the forest for the trees. They do not even try to find out what is going on behind the scenes, and they seem to have lost all understanding of what constitutes normal child reactions to family stress. A clear case of "Don't Ask, Don't Tell."Wedge discusses some very simple and very crucial questions mental health professionals need to ask both “problem” children and their parents that can often lead to a torrent of new information.It is often necessary to interview children without parents in the room and vice versa. Simple but potentially fruitful questions for children include:
- Who are you worried about more, your mother or your father?
- What makes you scared at night?
- What would things be like at home if you did not have this problem?
Questions to ask various family members, alone in combination:
- What was happening in the life of the family when the symptom began?
- What is the SECOND biggest problem in this family?
- Where and when does the problem NOT occur? What is happening when the symptom is NOT?
The author goes on to illustrate several family psychotherapy techniques for inducing behavior change in family behavior, in clear and easily-understood language. Most of these techniques come from a subschool of family systems therapy called strategic family therapy, whose originators include Jay Haley, his wife Chloe Madanes, and Mara Selvini Palazzoli. My only quibbles with the book are minor. She may promise a little bit more than systems therapists can deliver. Like many family systems therapists before her, the family members who populate her case examples all seem to be either highly motivated to follow her instructions, or if not, can easily be handled using with a few well-timed paradoxical therapy interventions. She says she often cures a problem within seven sessions. While this can be the case, often it is not. Old habits are hard to break. The TV show Supernanny clearly shows how almost all of the family members she sees revert to old behavior once the Supernanny leaves. She leaves and comes back on purpose to deal with this phenomenon.While the behavior of the children in her examples may be extreme, most of them come from families that have many strengths. I often see a much more disturbed set of patients: parents (I do not treat children and teens) who have almost no personal or family resources on which they can draw, and/or have significant personality problems themselves. The author also clearly states that none of the children in her case examples were abused or neglected. I do not know how much experience she has with these other types of populations, but clearly they are far more difficult to treat, and there are a lot of them out there.All in all, however, I highly recommend this book for those parents who actually want to solve their children’s problems, not just cover them up with drugs.