Bedfordshire and Luton Partnership Trust, UK.
Psychiatr Danub. 2009 Sep;21 Suppl 1:137-41.
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.
在本文中，我希望提请大家注意巴林特的“儿童作为表现症状”的概念，并探讨这个概念是否与我们精神科医生相关。由此引发的问题是，这个概念是否可以阐明家庭中存在严重精神疾病的情况，以及儿童向医生就诊是否可能暗示家庭中的精神疾病。如果这种解释是可能的，那么就会有重要的临床意义，因为目前，所有英国政府的指导方针都是基于对许多备受瞩目的儿童受到严重虐待案件的分析，这些指导方针认为儿童的需求是最重要的，因此，为了保护儿童，可能会采取非常戏剧性的干预措施，而父母的心理健康需求可能会被忽视。本文还介绍了在精神疾病背景下儿童与父母之间相互作用的例子，并描述了目前在家庭中有精神疾病的情况下照顾儿童的方式，同时也考虑了对父母的影响。
