RICHARD A. FRIEDMAN, M.D.
July 12, 2010
“I don’t know what I’ve done wrong,” the patient told me.
She was an intelligent and articulate woman in her early 40s who came to see me for depression and anxiety. In discussing the stresses she faced, it was clear that her teenage son had been front and center for many years.
When he was growing up, she explained, he fought frequently with other children, had few close friends, and had a reputation for being mean. She always hoped he would change, but now that he was almost 17, she had a sinking feeling.
I asked her what she meant by mean. “I hate to admit it, but he is unkind and unsympathetic to people,” she said, as I recall. He was rude and defiant at home, and often verbally abusive to family members.
Along the way, she had him evaluated by many child psychiatrists, with several extensive neuropsychological tests. The results were always the same: he tested in the intellectually superior range, with no evidence of any learning disability or mental illness. Naturally, she wondered if she and her husband were somehow remiss as parents.
Here, it seems, they did not fare as well as their son under psychiatric scrutiny. One therapist noted that they were not entirely consistent around their son, especially when it came to discipline; she was generally more permissive than her husband. Another therapist suggested that the father was not around enough and hinted that he was not a strong role model for his son.
But there was one small problem with these explanations: this supposedly suboptimal couple had managed to raise two other well-adjusted and perfectly nice boys. How could they have pulled that off if they were such bad parents?
To be sure, they had a fundamentally different relationship with their difficult child. My patient would be the first to admit that she was often angry with him, something she rarely experienced with his brothers.
But that left open a fundamental question: If the young man did not suffer from any demonstrable psychiatric disorder, just what was his problem?
My answer may sound heretical, coming from a psychiatrist. After all, our bent is to see misbehavior as psychopathology that needs treatment; there is no such thing as a bad person, just a sick one.
But maybe this young man was just not a nice person.
For years, mental health professionals were trained to see children as mere products of their environment who were intrinsically good until influenced otherwise; where there is chronic bad behavior, there must be a bad parent behind it.
But while I do not mean to let bad parents off the hook — sadly, there are all too many of them, from malignant to merely apathetic — the fact remains that perfectly decent parents can produce toxic children.
When I say “toxic,” I don’t mean psychopathic — those children who blossom into petty criminals, killers and everything in between. Much has been written about psychopaths in the scientific literature, including their frequent histories of childhood abuse, their early penchant for violating rules and their cruelty toward peers and animals. There are even some interesting studiessuggesting that such antisocial behavior can be modified with parental coaching.
But there is little, if anything, in peer-reviewed journals about the paradox of good parents with toxic children.
Another patient told me about his son, now 35, who despite his many advantages was short-tempered and rude to his parents — refusing to return their phone calls and e-mail, even when his mother was gravely ill.
“We have racked our brains trying to figure why our son treats us this way,” he told me. “We don’t know what we did to deserve this.”
Apparently very little, as far as I could tell.
We marvel at the resilient child who survives the most toxic parents and home environment and goes on to a life of success. Yet the converse — the notion that some children might be the bad seeds of more or less decent parents — is hard to take.
It goes against the grain not just because it seems like such a grim and pessimistic judgment, but because it violates a prevailing social belief that people have a nearly limitless potential for change and self-improvement. After all, we are the culture of Baby Einstein, the video product that promised — and spectacularly failed — to make geniuses of all our infants.
Not everyone is going to turn out to be brilliant — any more than everyone will turn out nice and loving. And that is not necessarily because of parental failure or an impoverished environment. It is because everyday character traits, like all human behavior, have hard-wired and genetic components that cannot be molded entirely by the best environment, let alone the best psychotherapists.
“The central pitch of any child psychiatrist now is that the illness is often in the child and that the family responses may aggravate the scene but not wholly create it,” said my colleague Dr. Theodore Shapiro, a child psychiatrist at Weill Cornell Medical College. “The era of ‘there are no bad children, only bad parents’ is gone.”
I recall one patient who told me that she had given up trying to have a relationship with her 24-year-old daughter, whose relentless criticism she could no longer bear. “I still love and miss her,” she said sadly. “But I really don’t like her.”
For better or worse, parents have limited power to influence their children. That is why they should not be so fast to take all the blame — or credit — for everything that their children become.
Dr. Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College in Manhattan.