Ginger Schenck's comments are well spoken. I, too, was fascinated by the "China" story. I learned so much from the patient in the entire episode - from the overwhelming reaction to the Tienamen Square Massacre to her finally being able to understand and explain the meaning of all that emotion a full year following the experience! One of the things I learned in this was the exquisite case-specificity of each person's pathogenic beliefs. Many factors go into the developments of pathogenic beliefs including specific developmental and environmental events. At the time of her brother's death, Kathy was working on issues related to being in the spotlight which included her fears of hurting others in the process (previously mother by "robbing" her of father, but now also Dan - which hurt both Dan and mother) of getting attention. No one had helped her understand what happened to her brother when he died, so her mind tried to make what sense it could of everything. So there she is, in the middle of class when what her teacher says about digging a hole in the ground clicks with her vivid memory of her brother's burial. So she spends the rest of her life looking for Dan - in China. So when the Tienamen Massacre occurs she is overwhelmed with emotion and does not understand that emotion. She mumbles over and over, "It's like the loss of innocence - like when Dan died and father and I became blameworthy." So, as you can see, I, too, am fascinated with this sequence especially in light of the absolute case-specificity of pathogenic beliefs.
Now, in terms of Kathy's mother's sudden ability to talk about Dan - even during the treatment when I first heard about it from Kathy, I thought to myself that I could think of no other explanation for her mother's newly-found capacity other than Family Systems Theory. And I believe this would be an example of Family Systems Theory accounting for change in the whole system by bringing about change in only one member of the family. Although Kathy's mother was aware that she was in treatment, Kathy was never close to mother, so that the content of therapy was unlikely communicated to mother. Kathy did, however, work on her relationship with her mother and Kathy did change that relationship in healthy ways. She was more direct with mother. She set clear limits with mother. She also did, over the course of treatment, change her attitude toward her mother - but most of the change was to become more aware of her anger, guilt, and worry about her mother. Although in some ways, it seems mysterious to bring about such a healthy change in mother by Kathy's changing on her own, I actually do believe that this is, in fact, what occurred. Perhaps someone else with more expertise in Systems Theory would like to comment further.
In terms of mother's silence being a "mistaken but well meaning attempt to shield Kathy from pain," perhaps mother had some idea of protecting Kathy, but I tend to doubt that could explain the comprehensive collapse of the entire extended family after Dan's death. That huge family ceased celebrating any holidays ever again! Not only did no one talk about the loss of Dan, but people were overcome with depression and unable to continue life in any form at all - ever again. Maternal grandmother had lost a child years earlier, and now Kathy's mother lost a child, and the family could not go on. Now, certainly the loss of any child is probably the most unbearable grief there could be. So there is no doubt that this family suffered a tragic loss. But the way they handled that loss demonstrated outrageous blame and attack, serious divisivness, coping by diving into alcohol(father) or else just total withdrawal from life(mother). I agree with you that many parents believe that not talking about a sibling death is more helpful to the surviving children. But I also know from working with other patients who have lost siblings in childhood, that silence is deadly in that situation. The mind must make sense of the tragic loss and if adults don't help the children make sense of it, the children will create with their undeveloped minds the most unique pathogenic beliefs - like Kathy's about Dan having "gone to China." I have often thought about the need to inform and educate physicians or any social agency that might come in contact with a family suffering such a tragic loss. Kathy's family is not alone in being overwhelmed by the death of children. I think we could help stop the passing on of pathology from generation to generation if we could intervene with such families when they really need help. Has anyone had such experiences? I would be interested to hear about them.