This movie was really good at illustrating the complex issues within the family and also in society. I thought there was an interesting parallel between the brothers' wife's obscession with having a baby and the first scene where the mother is talking about this with her husband before the car is hit by another driver.
I had actually wondered whether the girl was genetically related to her mother and might have inherited her Bi-Polar Disorder but then it was explained that she was adopted. That explained alot; not only that she did not have her genetic predisposition, but also that the reason she adopted a child so late in life was because she felt like a failure in not being able to conceive again.
The brothers' wife similarly was not cut out for motherhood because when confronted with a real child to care for she couldn't and wouldn't see it through and instead chose to walk away.
The social worker's and school psychiatrist's societal biases made them both blind to the individual circumstances right in front of them. The social worker wanted to try to force the mother and daughter back together even though they could not connect emotionally because of society's pre-conceived notion that a child HAS to have a mother and is best with her regardless of her fitness (or lack thereof) to care for a child. Clearly the mother was financially stable, but her total emotional unavailability would not have been in the best interest of the child. The mother seemed to want the daughter to make her feel successful but really had nothing to offer her as she was growing up.
Similarly the school psychiatrist made the assumption that just by reading her records that those previous doctors must be right and that the girl needed to be on medication, rather than looking at the person right in front of him and using his own critical thinking skills. He was very invested in credentials and authority and had control issues, just like the social worker and the mother, but they just manifested in a different way.
It showed how too often people's control issues get in the way of making sound decisions.
It was amazing how the doctor ended up doing a complete 180 and admitting that medication is not necessary for every child placed on it and that seeing so many children who did need it made him tend to assume when it came to her case. Some doctors never admit this throughout their entire career.