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.
By: Adeoye Oyewole
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