The child, whose EEG had shown minimal brain damage, was brought to family therapy when a child psychoanalyst refused to continue his treatment. The child seemed totally inaccessible to psychoanalytic approaches and, moreover, intolerably hostile. After four sessions with the parents, two in the presence of the child, the therapists realized that, apart from being exposed to intense interparental conflicts, the child had been forced into a double bind situation from which he could not extricate himself. Labeled "sick" by the neurologists and having been doctored with massive doses of sedatives, he was treated like a maniac at home and hence allowed to behave in a way that no parents would have taken from normal children, such as vicious kicks at the mother's face as she bent down to tie his shoelaces, lunges with the table-knife, and plates of soup over the mother's dress. By contrast he was invariably treated to long sermons and reproaches about his past misdeeds whenever he behaved like a normal child of his age. The therapists saw quickly that their first move must be the eradication of this double bind situation, and this by destroying the parents' conviction that their child was "mental." But they also realized that they could not achieve this end by verbal explanations, which would have been disqualified there and then. Instead they decided to prescribe the following family ritual: that same evening, after supper, the entire family, consisting of the father, the mother, the patient, his little sister, and the maternal grandmother, would go in procession to the bathroom, the father carrying all the child's medicine bottles and solemnly addressing the following words to his son:
Today we were told by the doctors that we must throw all these medicines away because you are perfectly well. All you are is a naughty child, and we simply won't take any more of your nonsense.
Thereupon he would pour the contents of the bottles, one by one and with great ceremony, down the lavatory, all the time repeating:"You are perfectly well."This ritual proved so effective (notwithstanding the mother's fears that the child would kill her without his sedatives) that it led to the disappearance of the aggressive behavior and, soon afterwards, to an amicable solution of the secret interparental conflicts (ten sessions).
Another ritual, this time repetitive, was prescribed to a family with a grave anorexic patient, whom we shall call Nora, and who, during the course of family therapy, had tried to commit suicide so effectively that she had to be resuscitated. This attempt showed that her therapists had made a serious miscalculation: they had focused attention so exclusively on her nuclear family as to miss the secret rule that nothing but good must be spoken of any members of Nora's extended family, a close-knit and powerful clan. It was only during the dramatic session following Nora's suicide attempt that her elder sister dropped some vague remarks about Nora's particularly "difficult" relations with one of her female cousins. Apparently the latter, backed by her mother, and envious of Nora's undoubted good looks, treated Nora with a mixture of affection and great cruelty. Both parents immediately hastened to repair the damage by harping at length on the angelic goodness of the cousin, "a real sister to our Nora." This caused Nora, who had never before mentioned the cousin to us, to speak of her throughout the rest of the session. She had clearly come to distrust her own feelings: if the cousin seemed spiteful and nasty, it was, no doubt, because she, Nora, was herself spiteful, envious, and bad.
In their meeting after the session, the therapists decided to keep their new knowledge to themselves, and not to engage in what were bound to be futile discussions. Instead they decided to prescribe the following ritual.
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