"It takes a toll. There’s not a lot of joy and happiness in raising Michael."

Fearful as it is, I can empathize deeply with the parents of a nine-year-old budding psychopath. Children with severe RAD aren't necessarily malicious in the same way as sociopaths are. But they are manipulative and calculating, and there's often a question of how genuine their behavior is at any given moment. In our case, we've given up trying to find our child's authentic self; there doesn't seem to be one, because the personality has not come together in any real sense. So there are different aspects of the self that are presented to meet her needs at different points, but we're under no illusions that those aspects are stable or given without an eye to what can be gained from the situation. Usually, the game is to be the center of attention and/or receive nurture while minimizing responsibility. It looks normal, even charming, on a superficial level. But when you start to spend time with the kid, you start to realize that not all is well.

There's a lot of judgment that comes the way of parents of very difficult children, both explicit and implicit. We actually had someone tell us that we should take a parenting class to help us deal with our RAD-afflicted child. That, after years of therapy, medication, interventions, hospitalizations, and diagnoses by multiple M.D.'s and Ph.D.'s. But, you know, if we were only better parents, our kid would be doing just fine!

People meet your kid and think he or she is fine, so what's wrong with the parents? Or they encourage you to be more positive or less sarcastic or more nurturing or use this dietary supplement or that parenting technique. In the meantime, you're locking up more and more of your house, and you're limiting the time you spend out in the community because it's just too damn difficult to stay on top of your kid's behavior out there. Half the time, people make suggestions without realizing that you've already tried it and it hasn't worked. They don't understand that the kid they see isn't necessarily the one you see, and they certainly don't see how a child can slowly grind you into dust. They don't see the behavioral problems day after day, they don't get the multiple phone calls from school, they don't realize the cumulative weight of appointment after appointment, of new diagnosis after new diagnosis, of treatment plan after treatment plan. They don't get that these things have a history of their own, that they stick with you long after everyone else has forgotten them.

Most of all they don't understand why they stick with you: because after a time, you begin to realize that they don't work, and they don't work for the very simple reason that the kid doesn't want them to work. Some kids, particularly those with the emerging traits of personality disorders, figure out very early that it's much more fun to stay sick than to get well. And the toll it takes is the knowledge that you have spent untold energy, expense, and heartache to get to an outcome that looks something less shitty than the alternatives. For that, you get no thanks and a lot of "If they were only less strict…"

Like the lady says, don't judge until you've walked in our shoes. There's not a lot of joy and happiness in raising a profoundly disordered child.