The Neurobiological Disease: The Case of Michael


Michael, eleven, had been hospitalized earlier in the year for what was diagnosed as suicidal ideation and was currently in a self contained sixth-grade classroom designed to give children specialized attention. He had previously spent about six weeks in each of two well-known psychiatric centers. At the first center, the staff had put him on a strong dose of a popular antidepressant medication; at the second facility, the staff had gradually reduced the dosage. Both hospitals, and other psychiatric and educational professionals, had supported a diagnosis for Michael of a "neurobiological disease." When Michael had begun to show "suicidal" signs again in sixth grade, the school social worker arranged a collaborative team intervention.

Assessment and Intervention

Prior to agreeing to meet with the whole team, Michael's mother requested a private meeting with the school social worker and the ecosystems consultant to discuss the philosophy and procedures of the collaboration program. It became clear that the mother was overly protective of Michael, her only child, even against her husband's efforts to elicit more effort from him. This mother described her husband as somewhat rigid and gruff in his interactions with Michael until the consultant suggested that, perhaps, he was resistant to attending meetings at school. At that point, the mother became hostile toward the consultant and protective of her husband. The mother left this meeting in a huff, but a call from the school social worker was successful in getting both parents to return to school for a collaborative meeting with school personnel.

After hearing teacher reports at the first collaborative team intervention session attesting to Michael's psychological normalcy and ability, the consultant suggested that it was his opinion that Michael's mother's and father's interactions were probably the main cause of his problems. The consultant suggested that their belief in the "neurobiological disease" concept was interfering with their expectations of normal performance from Michael. He suggested that his impression, based on what he had heard from school personnel and observed at this meeting, was that Michael was quite normal, very bright and creative, and that he was internalizing low self-esteem from the incorrect diagnoses and treatment of the "professionals" he had been exposed to. The consultant suggested that if there were any disease Michael may have contracted, it was one resulting from exposure to "psychiatric mismanagement."

Although the parents were quite perturbed with the school consultant, and upset that his assessment contradicted the judgment of other professionals whom they respected, they agreed to "experiment with" being less protective of Michael and expecting normal behavior and achievement in school. Arrangement was made for regular, daily communication between home and school regarding Michael's performance. Michael indicated that he wasn't sure if he was normal, but that he would try to behave like normal children, that is, do his work and be sociable. He did think his parents were too protective. The parents were given a copy of my manual on interactive and motivational ideas, Parenting by Automatic Pilot, to read at home.


After this one collaborative meeting, Michael's behavior, effort, and achievement improved dramatically. The parents were amazed. Michael was very pleased with himself. There were no signs of suicidal ideation. Three collaboration sessions were held in all following the initial meeting with the mother. All meetings took place within four weeks. Plans were instituted to fully mainstream Michael in the near future. At a one year follow-up, Michael was continuing to improve, and the parents were very happy. They continued in ongoing individual and family therapy with a therapist of their choosing.


School-based and ecosystemic collaborative intervention with a child and his family can help to correctly identify most child home and school problems, even suicidal ideation, as primarily interactional and motivational, not psychiatric or "neurobiological." The private, confidential, and intrapsychic model of diagnosis and treatment, which is referred to here as "neuroedumedical," will predictably lead to restrictive, medicational, and residential efforts that take children out of the natural, and mainly functional, environments of home and regular classroom. The ecosystemic collaborative approach can head these destructive procedures off at the pass and find the missing piece of the puzzle without resorting to bizarre hypotheses and behavior.

Reprinted with permission from "School-Based Collaboration With Families" by Dr. J.B. O'Callaghan, Jossey-Bass Publishers,1993.

More case studies:

Greg | Melanie | Jared | Samantha | Jeremy | Marie | Linda | Michael | Jonathan

For appointments and scheduled consultations, please contact Dr. J. Brien O'Callaghan at or write to him at J. Brien O'Callaghan, Ph.D., 246 Federal Road, C-32, Brookfield, CT 06804