Friday, July 16, 2010

Good Parents and Toxic Kids: Exposing the Myths in Modern Psychiatry and Parenting

Bad kids happen to good parents. Mom and dad seem okay, well-adjusted, pleasant even but the child is just plain difficult. The boy or girl hits, argues, talks back, has no friends, sours the family outing, the block party, and recess. We all know these families and wonder what the heck is going on.

Nothing.  Not a thing's wrong according to the Diagnostic and Statistical Manual. Difficult kids, for better or for worse, defy diagnosis. They don't meet the criteria for any official disorder, not ADHD, Autism, Conduct Disorder, not even a personality disorder (e.g., Anti-Social, Borderline or Narcissistic Personality).

They're not pathological, psychotic or sociopathic. As psychiatrist Thomas Freidman, a professor at Weill Cornell Medical College, pointed out in a recent New York Times article, these individuals not only fall through the diagnostic cracks, they challenge our notions about psychiatry and psychology. Dr. Friedman wrote about one family, the woman who'd come to therapy depressed and anxious and her 17-year old son who had a history of being rude, defiant, and anti-social, basically the root of his mother's troubles (Accepting That Good Parents May Plant Bad Seeds):

If the young man did not suffer from any demonstrable psychiatric disorder, just what was his problem?

My answer may sound heretical, coming from a psychiatrist. After all, our bent is to see misbehavior as psychopathology that needs treatment; there is no such thing as a bad person, just a sick one.

But maybe this young man was just not a nice person.

For years, mental health professionals were trained to see children as mere products of their environment who were intrinsically good until influenced otherwise; where there is chronic bad behavior, there must be a bad parent behind it.
It's natural to point fingers at parents, their lack of discipline, the prenatal environment, the time span between siblings, the choice of preschool, too much tv, Wii, plastic bottles, sugar, white flour, or whatever we can think of to explain the disparity between good parenting and bad children.

It goes against not only modern mental health but our era of hyper-parenting where experts and authorities provide all manner of recommendations and directives. Do this, do that, don't do this or that and your child will turn into a smart, thoughtful, successful adult. But a genetic predisposition to be insensitive, disobedient or selfish, maybe a toxic mix of the Big Five personality features, challenges this deeply ingrained, American can-do parenting imperative.

Certainly there are things parents or a good therapist can do to ease living with or being one of the more trying but yet still functioning members of society.  Gotta fault the doc for suggesting otherwise. It's not like the mental health field has nothing to offer. Just because we can't diagnose them doesn't mean therapy is a lost cause. As I've written before, we get stuck on labels and diagnoses, for one because that's what many insurance companies require to reimburse therapy visits. But it omits the reality of many children and adults struggling with a collection of behavioral and psychological symptomatology that don't fit neatly into the DSM. In fact, it's not just these temperamentally trying kids who fall through the diagnoses.

I've witnessed families going through this and can report their strain and frustration is no less real than those with a child diagnosed with ADHD or autism. At least with a diagnosis there's a clearer path for therapists to follow and a clear explanation for the problems. I'd imagine it's not uncommon for the parents of unpleasant children to end up in therapy themselves, like the mother coping with depression and anxiety. Especially when they've been told there's nothing (officially) wrong with the kid who's complicated home life for years. I'd probably blame myself. It's easier to blame the environment (i.e., mom and dad) when there's no clear diagnosis. As much as we recognize the large genetic components of ADHD and other disorders the same is not true of troublesome personalities.

Whereas there's a large body of empirical literature speaking to the resilient child, the kid from the dysfunctional home or who suffered early trauma or adversity that rises above it to become a well-adjusted young adult - as Dr. Friedman noted, there is no comparable research about obstreperous children coming from well-adjusted parents. But the difficult child hasn't been neglected in pop psychology.

Check out all the How-To-Parent The Prickly/Wild/Spirited/Explosive/Strong-Willed Child books on Amazon.

For coping with the challenging adult there are even more books. In fact, at my local library I just picked up Difficult Personalities: A Practical Guide to Managing the Hurtful Behavior of Others (and Maybe Your Own). Sounds like a good one to have on hand for the next family reunion or PTA meeting. But my favorite has to be Perfect Phrases for Dealing with Difficult People: Hundreds of Ready-to-Use Phrases for Handling Conflict, Confrontations and Challenging Personalities. That one might stay in my car next to the emergency supply of Hot Tamales and Excedrin Migraine. 

I have sympathy for those irksome personalities when they're young but when they run the school, coach the soccer team or work in the children's library, somehow it all vanishes.  All the more reason why the mental health field shouldn't let these kids slip through.  

10 comments:

TherExtras said...

Indeed, toxic kids grow into toxic adults - who run the school, etc. Undoubtedly the world is full of less than pleasant people who came from perfectly pleasant parents. (I love alliteration!) Perhaps there are few among your relatives? (Can't safely say online regarding those who share same-DNA with me.)

Sans the diagnosis/treatment route, a market for the self-educable is created.

Thanks for a thought-provoking post, Polly, per your usual.

Barbara

Polly Palumbo, Ph.D. said...

Perhaps a few in the family/neighborhood?? Oh yes. But that's what makes life soooo interesting - I think of it is an opportunity to learn essential coping skills!

janetlansbury said...

Polly, thanks for this interesting post! You've got me thinking... As much as I adore the movie "The Bad Seed", I find it difficult to accept that some of these "born difficult" children couldn't be handled a LITTLE more effectively. My sense is that there are factors that make matters worse...the parents feel overwhelmed, or feel guilt about not liking the child, so they don't give the firm and consistent boundaries this kind of child ESPECIALLY needs. Or, maybe they respond to him inauthentically, act kind and loving when they are seething inside, giving the child a mixed message. Or, perhaps they are just lovely and sensitive people who are too soft on limits generally. Sometimes, I sense a sort of parent/child incompatibility -- the parent isn't naturally sensitive in areas where the child IS extremely sensitive.

All of these responses to a highly difficult child are completely understandable, so I don't mean to imply parental guilt! I just wonder if there aren't some ways parents can be proactive -- to help the child -- or at least build a healthier relationship with him.

And these are just a layman's observations and ramblings... But maybe because I work with parents, I hate to think that we could be so powerless over the fate of our children!

Polly Palumbo, Ph.D. said...

Yes but good observations and ramblings! I too had some of these thoughts rambling around my brain too, especially the idea of poor fit between parent and child. Can you give us an example of a parent who doesn't fit/understand/get their child?

TherExtras said...

"an opportunity to learn essential coping skills!" Yes, agreeing with you and not believing in coincidence myself, I believe there is a reason we cross paths with particular individuals.

I have an example of "poor fit between parent and child" - the same example used to explain "goodness of fit" to me in grad school.

A parent - let's say mother for the sake of simplicity - has a very serendipitous lifestyle: eats when she is hungry, sleeps when she is tired, seeks entertainment at will, is responsible only for her own maintenance. Perhaps it is even cultural - living life at a pace not dictated by employment or time-clocks. But then she gives birth to a child who needs to eat on a regular schedule, not to mention other needs. Mothers like this might struggle to provide all the emotional responses that are considered optimum. This kind of out-of-sync relationship can continue to cause issues up until school age - where the parent struggles to get the child up and ready for school on time.

The opposite circumstance is also revealing - the mother who is wired for schedule and consistency has a baby that is nigh-unto unpredictable for every feeding and diaper change. I imagine this mother to struggle mightily with the need to be flexible.

These examples are the representative 'extremes' of mismatch for personality and physiological time-clock. But these examples have helped me perceive mother/child relationships and provided a direction in educating the parent.

Barbara

Polly Palumbo, Ph.D. said...

Oh yes, great example, in fact, we have some of that ying-yang need for structure vs free spirit going on here in this house!

janetlansbury said...

I often have parents in my classes with the kind of mismatches Barbara describes. Recognizing the disparity in temperaments between parent and child while the child is still an infant or toddler helps enormously! In these cases, parents begin to understand the challenge they face, and they can work to tap into something different in themselves to better serve the child's needs.

Sometimes the child needs more assertiveness from a more tentative parent. Other times, the child needs a high energy parent to slow down and be less stimulating. And I agree with Barbara that these match-ups seem serendipitous, because the baby seems to help the parent grow in positive ways.

But these are not highly difficult children... My example of that situation is a person who is brilliant and talented, but intense, explosive, and self-centered... to the extent that she can seem like a sociopath. She is one of 4 sisters. Her mother is vivacious, loving and sensitive, but does not confront difficult issues head-on -- she reacts passive-aggressively, turns a cold shoulder on anger and rage, can't accept those feelings from anyone.

While the other 3 sisters continued to have a close, loving relationship with the mother and each other, the 'difficult' daughter became completely estranged from the family. She battles serious addiction issues, was abusive to her own child, and never put her brilliance or talents to any positive use.

My thought is that this intense woman had a LOT of anger and rage as a child. She needed to be helped to safely express her feelings, rather than be labeled "The Bad One" in the family, a brat and a bully. Most of all, she needed to know that those feelings weren't 'wrong', and that those parts of her were acceptable to her loved ones.

What do you think? Sorry for the novella!:)

Polly Palumbo, Ph.D. said...

Oh not, love reading your thoughts. I think there are a variety of routes to becoming difficult as you and Barbara have pointed out. It's sad when you see the misunderstood kid or the one who the mom or dad doesn't favor, or the one that's always "bad". But what do you all think about children who might be hard-wired to be more insensitive? I'd like to think parents can help the child to become more emphathetic, in fact, there are protocols for teaching it. But of course, the parent has to be able to do it and want to do it.

TherExtras said...

I believe empathy can be taught, to some - those that have the neural capacity (some might call EQ or emotional intelligence potential).

Speaking of parents who want to....in the example of the self-centered parent I described above, think teen mother.

Among the 3 of us, the whole idea of parents parenting with purpose (whoohoo!) is within a values system not everyone shares.

Barbara

Anonymous said...

I really resonate with what Dr. Gordon Neufeld says about the challenges of raising highly sensitive children, and needing to come into an alpha position with our children ("right relationship").

I get a bit wary when we describe children as being "difficult" - as if there was some sort of intentionality behind it, or they are wired this way and pre-meditating, and lack to appreciate all the instincts that are driving his or her behaviour (e.g. not wanting to be told what to do by someone not attached to - go figure!). And they are trying to get their needs met best they can - for autonomy, and yes (egads) for attention - as we all do. Acting out is exactly that - acting out a feeling that isn't able to be expressed, or there is no invitation for it from caring big people. Most children under about 7 (and some older if they are highly sensitive) just don't have the capacity and integrative functioning available to be as sophisticated as adults in the same goals.

Let's get beyond reductionistic blaming of children, and blaming of parenting - let's see that the power to slowly change things comes from the RELATIONSHIP between the parent and child.