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At times in our work we are faced with symptoms in our patients which, because of their complexity, seem to defy understanding or treatment. Driven by our own frustrations at not being able to find an easy answer, we cope with the problem by reifying it and describe the symptoms instead as a syndrome, further defining and qualifying the situations that it occurs under including or excluding data which either support or detract from the syndrome complex that we have discovered. Child psychiatry, by its very nature, has had more than its share of these syndromes and the one I wish to focus on is, as stated in the title of this paper, the hyperactive child. Without by any means describing a comprehensive list of causative agents for the syndrome, almost everything has been invoked from food additives and allergies to minimal, otherwise undiagnosable, brain damage. In this paper I will put forward the hypothesis that the hyperactive child is a visible symptom of a latent disturbance, a disturbance of, and distortion in, the mother-child relationship. I will attempt to support this hypothesis with reference to work by, among others, Balint, Laing and Winnicott, with clinical material from the analysis of a three year old child who was hyperactive and from the analysis of a 30 year old woman who was hyperactive as a child. I will then attempt to show by reference to case material that, using this hypothesis, brief intervention along these lines can quickly change the overt clinical presentation.
Laing (1959), in his work on family dynamics and interaction, showed how a member of the family can be designated as ill, to protect the mental health of the family and often one particular member of the family. In this process, unwanted and unacceptable feelings and affects are projected into the scapegoat who is then subjected to the family hostility and rejection. The victim, for his part, acts the ill or disturbed person that he has unconsciously at first and then later conscio