The child as the presenting symptom, and what happens when things go wrong?

In this paper I wish to draw attention to Balint's concept of 'the Child as the presenting symptom' and ask whether this concept is relevant to us as psychiatrists. What arises is whether this concept might illuminate situations where there is serious mental illness in the family, and whether the presentation of a child to a doctor might be indicative of mental illness in the family. If such an interpretation is possible, then there are important clinical implications, since at present, all UK government guidance, based on the analysis of many high-profile cases where children have been severely abused, is that the needs of the child are paramount, and thence it may be that, whilst quite dramatic intervention may well occur in order to protect the child, perhaps the mental health needs of the parents might be somewhat overlooked. Examples of the interplay between child and parents in the context of mental illness are given, and the present way in which children within families where there is mental illness are cared for is described, also considering the consequences for the parents.