DK: In an earlier post, Defiance in the Family: A Rebellion in the Name of Health, I described our idea that Defiance occurs as a result of a collapse of fealty, or a loss of faith in leadership. The defiance occurs as a way to get the parents to rise up and become the grown up parents needed to help the kids grow up. Thus, defiance begins as an effort to restore failing family health or family morale. Of course none of this occurs by intention. It is in the nature of families, of relational systems.
So what causes the disruption in the family leadership? There are obvious explicit answers; no money, depression, illness, marital disruption, alcoholism. But there are other causes that exist at the symbolic or process level. These are factors that tend to be out of the awareness of families, but it is possible to call them into awareness. But bringing them into awareness means using less reasonable tools like imagination, therapeutic attention and intuition.
In The Symbolic Meaning of a Child’s Symptoms I used a case illustration to identify some of the pain behind the pain or the problem behind the problem. I want to take you a little further into my obscure reality. Keep in mind that in the matter of human experience, objectivity is largely an illusion.
I assume that all we refer to as “psychopathology ” is founded in relationship experience until proven otherwise. This is an unconventional way of looking at the world of human emotional experience. Most clinicians don’t look at things in this way. Or, they may sense this is the case, but do not have the language to make use of their intuitions.
From our perspective there is a problem that occurs when parents bring a child to modern day mental health clinic. There, the clinician assesses the child. Our society gives boundless permission to talk about children, but very limited freedom to comment on parental behavior, or 
the marital relationships. So the assessment, then the treatment focuses on the child. If it is a Psychiatric Clinic the psychiatrist may feel obliged to start the child on a medication by the end of the second interview. Starting the medications says, “You shouldn’t feel like this, or you shouldn’t be like this.” Starting the medication also suggests the problem is in the child. This behavior is symptomatic of a medical disorder and the symptoms will be modulated with the medication. Conventional Psychiatric thinking directs attention to individual persons and their symptoms. Psychiatric language is not good at thinking about or attending to context or to relationships.
Although a psychiatrist, I am writing not as a psychiatrist but as a therapist. My goal is to have an effect on your consciousness, to invite you to consider the nature of symbolic experience. Changing consciousness has an effect on what it is possible to see and to think. A different way of thinking does not make other ways of thinking wrong. And, keep in mind, there is little or no certainty attached to this way of thinking.
This is going to be a little obscure. Take your time with it. “A symbol is only a true symbol when it is inexhaustible and unlimited in its meaning, when it utters in its (odd, magical) languages of hint and intimation something that cannot be set forth, that does not correspond to words. It has many faces and many thoughts and in its remotest depths remains inscrutable…It is formed by organic process…and thus constitutionally different from complex and reducible allegories, parables, and similes…Symbols cannot be stated or explained, and, confronted by their secret meaning in its totality are powerless (Tarkovsky, 1986).”
That might be a little hard to take. But it is a crucial idea. Symbolic experiences have an effect, but the true symbol evades description. It took me a long time to come to understand and appreciate this.
In conventional psychiatry there is little or no effort to appreciate what is going on in the relational system that might create the ground for a child’s behavior. Often it is not obvious, but subtle, suggestive. It isn’t immediately apparent but depends upon caring and attention.
I look for pain and the results of pain. So when we are attempting to understand the effects of context we look for the pain behind the pain.
What we are putting across in this blog is that there is a common error in conventional mental health practices. The kid is defiant. He is being a ‘bad-boy” If he can be straightened out with CBT, by sending parents to parenting classes or teaching the child “skills”, good. But here’s a problem: the problem behind the problem, the pain behind the pain goes unacknowledged and continues to pressure family members and the pressured family puts implicit pressure on the child.
Most often the reasons for the problem are not entirely clear. In my next post I am going to offer some ideas about the origins of defiance, of the pain behind the pain of the problems behind the problem. The language of therapy is a different from the language of Psychiatry. Psychiatry is a practical language which attempts to say what it means and mean what it says. The language of psychiatry restricts possibility. In its effort to be clear, it limitations on what can be known. The language of therapy is more like the language of poetry, it opens up possibility. It reveals logic hidden in language. Changing how we think means changing the way we use language. The language is not definitive, it is suggestive, inferential.
When I start with a case, I sense the distress, and notice abnormalities, aberrations, but it is not clear what to add to it. How to see how they fit the situation. I have to develop a relationship. In the next post I will describe some of the factors behind the behavior.
