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Blame the Parents

Behind the conflict of mental health professionals with parents.

The Pelletier case at Children’s Hospital in Boston, in which a teenager's parents are suing the hospital after it forcibly separated her for nine months, raises an old problem in psychiatry and mental health:

It’s all too easy for clinicians to blame parents.

In fact, this problem was rampant and extreme for decades, tapering off in the 1980s and 1990s. Before that time, when Freudian ideas held sway, most American mental health clinicians believed that all mental problems stemmed from unconscious emotional problems rooted in childhood. It was but a step to argue that any blame had to rest not with the child, but with adults: the parents.

In the 1950s and 1960s, this viewpoint was highly respected: the prestigious National Institute of Health funded research found that schizophrenia was caused by bad parenting. The “schizophrenogenic” mother took the brunt. When new studies from Denmark indicated that schizophrenia was caused mainly by genetics, not parenting, the psychiatric profession reacted with derision. It was clear that the parents were to blame because of cold, unfeeling, mixed-signal interactions with their children. The parents were to blame, it turns out: but the blame lay at conception when genes were distributed.

In the late 1960s, when Sigmund Freud’s granddaughter, Sophie Freud, began a course of study in the Boston area to become a psychiatric social worker, she was stunned by the hostile attitude of the profession toward parents of children with autism (which we now know also is highly genetic). She wrote decades later about how “the staff of [a] clinic was well-meaning and eager to help, and yet their theoretical framework led them to make foolish and malevolent interpretations.”

It is, of course, ironic that a Freud would realize that this pseudo-Freudian thinking was so wrong.

Even today, when a young adult goes to psychotherapy, the majority of psychotherapists will follow a line of investigation rooted in a century of Freudian influence. What was your childhood like? What was your relationship with your parents? The parents will be found to be absent, or overinvolved; cold, or smothering; hostile, or seductive; too permissive, or helicopter pilots. You always can blame the parents; they’re easy targets.

Nine months of forced separation by a hospital is unusual, but it is very common for psychotherapists to separate adults from their parents emotionally with a comment here and a comment there. Physical separation is rare; emotional cut-off is rampant.

I like what my old psychotherapist always used to say, as we talked about my parents: If responsibility is anywhere, it’s everywhere. Sure, parents can be blamed, in part, but only if you take responsibility yourself too. The client/patient has blame, if you want to call it that: responsibility is a less pejorative term. And frequently, clinicians and psychotherapists have blame and responsibility too.

If responsibility is anywhere, it’s everywhere.

It is said that first, you love your parents, then you hate them, then you forgive them.

Parents make mistakes; sometimes they cause harm; sometimes they are even abusive. But most parents, as the pediatrician T. Berry Brazelton always taught, are just trying to do their best, and if anything, are overly self-critical. Usually, they need compassion, not blame. As a parent for two decades now, this point has become clear to me. When children come to psychiatric clinicians, it’s usually because parents have done their best, failed terribly, and desperately seek help. That’s not a time, if ever, to blame them. Psychiatric clinicians have hated parents for a century, without ever previously loving them. The residues of that suspicion persist. It’s time to forgive.