One of my patients is a woman in her thirties who suffers from bipolar disorder, also known as manic depression. When she is depressed, her self-esteem can plummet until she feels utterly worthless. During her manic episodes, she has spent thousands of dollars on jewelry, slept with men she knew only casually and stopped going to work.
She connects these uncontrollable highs and lows, which have destroyed her marriage and left her unemployed, with abuse she suffered as a girl at the hands of her father. Her earliest memories are of being beaten by him for forgetting to do chores or for not finishing her food or sometimes for no obvious reasons at all. She says that she learned quickly not to show any anger or resentment during the beatings, lest they become even more severe.
"My father did this to me," she said recently, referring to her illness. "Now he just says, 'My daughter has bipolar disorder. It's an illness, like diabetes.' It makes me so mad. If I hadn't had to bury all my feelings in the first place, I wouldn't be on this rollercoaster now."
This patient, like others I have treated, has come to resent the absolution of the family that seems inherent in the teachings of biological psychiatry.
Biological psychiatrists, whose views have become dominant in the field during the past two decades, regard psychiatric illnesses largely as the result of chemical imbalances in the brain rather than as the result of psychological trauma. Their theories -- that depression is caused by too little of the brain chemicals serotonin and norepinephrine or that schizophrenia is due to excessive amounts of the chemical dopamine -- seem to entirely exonerate parents whose children have been diagnosed with serious mental illness.
One of the reasons for this presumed innocence of families is that some biological psychiatrists have promoted the public perception that such chemical imbalances in the brain are either inherited or simply a biological accident.
But it may be that stressful experiences temporarily or permanently change brain chemistry. Scientists generally accept the notion, for example, that the anxiety, nightmares and flashbacks that are the hallmarks of post-traumatic stress disorder, while often relieved by drugs that alter brain chemistry, are the result of traumatic experiences. When the trauma is more subtle or long buried and the symptoms are less obvious, however, the connection between experience and illness seems to have been widely dismissed.
For generations of parents, particularly mothers, who had been blamed often unfairly for their childrens' serious psychiatric problems, this biological view is a profound relief. But to some of us who treat patients, the notion that parents have nothing to do with the problems of their children is both simplistic and incorrect.
I do not mean to condemn parents whose children are seriously mentally ill. The notion that family dynamics sometimes contribute to psychiatric disorders does not mean that anyone has acted with malice; each parent may have done the best job he or she could.
Furthermore, countless cases of mental illness are not the result of abuse, just as all those who have been abused as children are destined to become mentally ill adults. Millions of psychiatric patients would have been far worse off without the love and support of their caring families.
I do believe, however, that dismissing the potentially destructive role of parents can mimic the abuse some patients have suffered. Doing so suggests that patients have not been victimized and implies that their feelings of anger, fear and hopelessness are unjustified.
A young man with schizophrenia I treated described nearly constant, sometimes violent, fighting between his parents when he was a boy. When he cried during their fights, they would lock him in the basement, leaving him there alone in the dark for many hours.
Eventually, in order to avoid being locked up, he learned to conceal his fear and stifle his tears when screaming erupted in the house. Sometimes he would distract himself with a toy or game, always in an attempt to appear unaffected by the chaos around him. He would often pretend he was invisibile.
When neighbors visited, they found him to be a model child. But while well-behaved, he was also increasingly disturbed.
He made few friends. As a teenager, he began to withdraw even more from those around him, insisting that no one understood him and that he had lost touch with himself. At the beginning of his first romantic relationship, he grew paranoid that his girlfriend might want to kill him or might be part of a plot to steal his mind. Shortly thereafter, he began to hear voices that told him to kill himself.
Having learned so well to hide his feelings in order to maintain a lifesaving distance from those around him, it was not surprising that intimacy could seem like an overwhelming threat -- even a plot to do him in. Schizophrenic patients can experience closeness as attempts to capture their souls.
Was there no connection between what To some of us who treat patients, the notion that parents have nothing to do with the problems of their children is both simplistic and incorrect. this patient suffered as a boy and his illness as a man? I think the connection exists, just as it did in the case of the woman who suffered from manic-depression.
Another patient I treated grew up with parents who abused drugs. Her father routinely fondled her sexually and often beat her mother. During her childhood, she experienced such severe separation anxiety from her parents that she often refused to go to school.
As an adolescent, she developed anorexia. Her life-threatening eating disorder, I believed, was her way of trying to control her environment and to stave off her father's sexual advances.
Because drugs that alter the brain's serotonin system are often helpful in treating anorexia, some researchers have suggested that it is primarily a biological disorder. But disordered biology may well be rooted in traumatic experience.
The woman I treated came to understand the psychological roots of her anorexia and the fact that her illness was not due to random biological chance. Doing so helped her make use of behavioral therapy and medication, which helped her overcome the disorder that long had dominated her life.
The rise of biological psychiatry has accelerated the development of effective medications that have been helpful in relieving the suffering of psychiatric patients.
But its growth has been accompanied by an unwarranted diminution in the importance of life events. It has distracted us from the crucial and still important task of making sense of psychiatric symptoms for those who suffer with them, deciphering the meaning of events, sometimes long submerged, that underlie these illnesses.
Keith Russell Ablow is a writer and medical director of the Tri-City Community Mental Health Centers in Lynn, Mass.