One fascinating aspect of our training as
psychiatrists is the psychodynamic
formulation. It is one of the major
formulations we construct as diagnosis of a
behavioural problem is made, which is useful
in designing a management plan.
Beyond the phenomenological expressions of
mental illness which, basically, consists of the
observable changes in behaviour and the
contextual inappropriateness, there are potent
issues behind the phenomenon.
Psychodynamic formulation explores the
circumstances of birth, achievement of
developmental milestones, physical and
emotional environment of childhood years
and the quality of the relationships that
existed.
The parenting style and the communication
strategy of the family unit are crucial factors
that are capable of determining the mental
status of the growing child. The children
come to this world carrying empty cognitive
slates — ‘tabula rasa;’ and family, as the first
socialising agent, paints pictures and imprints
codes of conduct that will be employed in
navigating the wider world.
One of the most crucial factors in the family
environment is the quality of the marital
relationship. This facilitates all kinds of
interactions for the child that will lead to
eventual socialisation. Values, prejudices,
attitude and development of core life
principles are shaped through this facility in a
way that is most unconscious.
It is amazing how some of the lessons my
parents taught me during the growing up
years remain strong, even in adulthood. Only
four days ago, my teenage daughter was
counseling me that I do not need to tuck in
my T-shirt, especially in the evenings when I
am expected to be a little more relaxed.
I had to explain my rigidity as emanating from
my mother’s insistence that you must always
tuck in your shirt to look smart. It is as
though she knew a time would come when
boys would hardly want to pull up their pants
to the waist.
Marriage is a challenging but worthwhile
relationship crucial for the fulfilling of the
spouses, but more importantly, for providing
an avenue for other minds to grow and
become responsible citizens, such that when
this relationship becomes dysfunctional, it has
a potent negative impact on the children.
The emotional environment of a dysfunctional
family is characterised by defective
communication styles which could have
pathological implications. Communication
could become defensive and amorphous as
the parents — especially the mother — may
be displaying her frustrations on the innocent
child.
Commands that could have been simple
become vague and amorphous, such that
when the mother intends to say ‘come,’ she
says ‘go away.’ This style is capable of setting
up a form of cognitive dissonance that may be
a foundation for future mental illness in some
children.
Wrong values may be inculcated into the
growing child as both parents strive to
exonerate themselves of any marital
dysfunction. In some situations, the marital
relationship is skewed as the mother assumes
a dominant role, leaving the father
authoritatively impotent.
Reactions could come from the children,
especially the male child, who may
sympathise with his psychologically castrated
father; or the daughter may approach life
with the notion of subduing men.
The prevailing socio-economic situation in the
country has created some scenarios where the
women are the authority figures in the family.
Some fathers may become alcoholic and
eventually abscond from home, leaving a
good number of our women technically as
single parent. The palpable absence of the
authoritarian male figure in the home may
produce children with lopsided mentality as
they enter the chaotic adolescent years. There
also cultural practices were children are
reared by surrogate parents, even when the
biological parents are alive. Examples exist
where a first child is left with the
grandparents as couples travel abroad, only to
come back some 10 years later to a child who
cannot relate with his siblings born overseas
because of inferiority complex. This child may
later compensate with drugs of abuse.
It is very common for mothers to abandon
their children to nannies as they pursue their
careers, invariably rearing children with
profound problems of attachment and
bonding. Such children may have defective
social connections to significant others
because of perennial changes in the faces of
the care givers.
Parenting is not essentially biological; it is a
sophisticated social skill that can be
administered to children without biological
relationship. Single parents can intelligently
adapt the parenting facilities of a father figure
in the extended family system or other
relationships.
The mental capital furnished by a strong and
loving family relationship provides the
building blocks for any secondary form of
socialisation. The contest between the
destructive influences of the peer group and
the school teachers becomes an opportunity
for wholesome development for children
coming from a secure family background. This
is one of the cheapest ways to reduce the
incidence of mental illness in our
communities.
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