In a recent post, CNN columnist Dr. Charles Raison suggested that the family of a child with bipolar disorder try psychotherapy before medication. He reasoned that, because the child was only acting out in the home, the diagnosis might be incorrect--the problem could have more to do with family dynamics than a psychological disorder. In response, Raison received a slew of angry emails from parents who felt like he was blaming them for their children's mental health problems.
Last week Dr. Raison responded with a thoughtful post acknowledging that the scientific literature, as well as his own clinical experience, suggests that bipolar disorder has a genetic component. In his earlier post, he says, he was encouraging parents to seek therapy where there is evidence that familial tensions may be contributing to a child's difficulties. Even this suggestion, however, was painful for some parents to hear since it still appears to impose "blame" on them for some non-biological contribution to their child's problems.
I would reply that, even in cases where an environmental trigger like family tension causes or exacerbates mental problems, parents shouldn't blame themselves. Family tensions are not necessarily a sign that something (or someone) is off-kilter. That's because we don't choose the personalities of our relatives. Sometimes they will resonate beautifully with ours, but just as often, through no fault of our own, they may clash. When that happens, miscommunications and misunderstandings are bound to occur.
Personalities develop in surprising ways, and a low-key parent can, for instance, wind up with a high-strung, anxious kid. Imagine how that child feels when his parents can't understand his pain. What if they laugh when he is terrified of a puppy because they don't understand the level of distress his phobia causes? Does that cause pain, even psychological damage? Sure. But it's no one's fault. The best this family can do is to seek help to bridge the gap in their understanding. Maybe that means family therapy, maybe it just means sharing more, but it's a common scenario.
When parents get caught up in blame, however, they all too often get caught up in denial, failing to seek the therapy their family needs. Eliminating blame from the discussion, then, can open the door to healing. In the example above, parents willing to go to therapy to better understand their son will learn how to help him. Parents who refuse to examine their behavior, however, not only fail to learn how to help him overcome his phobia, but they also risk leaving him with the impression that they laugh at his pain, cannot be counted on for comfort, and cannot be trusted. Ultimately these collateral effects will prove more damaging to his emotional health than the intitial phobia.
The no-fault approach to family conflict shortcircuits the defensiveness that parents sometimes feel when confronted with their children's problems, and encourages them to seek understanding. It's based on the reality-centered oberservation that family tensions will always contribute to psychological distress, but these tensions are just as inevitable as the genetic contributions we normally think of as absolving parents of responsibility for their children's disabilities.
I'm lucky to have a family so willing to work hard to understand me (and I've had plenty of irrational phobias and feelings--far worse than being scared of a dog).