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MENTAL ILLNESS
The Effects On Family
MENTAL ILLNESS DEFINED
- Serious mental illness is defined as a diagnosable mental, behavioral, or emotional disorder that meets the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and results in function impairment that substantially interferes with or limits one or more life activities (i.e. employment, self-care, social relationships)
SERIOUS MENTAL ILLNESS
- Approximately 15 million adults are diagnosed with a serious mental illness that result in comparatively severe impairment
- Schizophrenia (unable to tell the difference between real and unreal experiences), bipolar disorder (manic depression/mood swings) and major depression are common forms of mental illness
- Recovery from mental illness is possible, however the mental health system has been known to simple manage symptoms and label it as a long-term disability
RECOVERY
- Recovery is the process of being able to work, learn and participate fully in the community
- Recovery from mental illness was once thought to be impossible but more documented long-term outcome studies have shown otherwise
- Treatment focuses on the impairments resulting from the illness, such as hallucinations, with the goal of alleviating or eliminating these symptoms
PARENTS WITH MENTAL ILLNESS
- Women with mental illness have normal fertility rates and bear an average or above average number of children
- Most women are diagnosed with mental illness prior to pregnancy but approximately 10 to 15% are diagnosed postpartum
- Most state mental health agencies are unaware of their adult patient’s parenting status
- When custody is taken from a parent with mental illness, the decisions are typically made by child services rather than the treatment team
PARENTS WITH MENTAL ILLNESS
- In many states a diagnoses of mental illness justifies the removal of children and termination of parental rights
- The parents are often viewed as permanently being unable to fulfill parental roles and face great barriers in trying to prove they are fit to be parents
- In reality, a person with a serious mental illness may or may not be able to care for a child but with treatment functional abilities to raise a family may change
- Parenting sometimes regulates the life of individuals with mental illness
IMPACT ON PARENTING
- Mental illness can compromise parenting ability and affect parent-child relationships
- Parenting may be interfered by symptoms of mental illness:
- Psychotic- hallucinations and delusions
- Negative symptoms such as low energy, lack of initiative, social withdraw and diminished emotional expressiveness
- Mood symptoms- manic depressive episodes
- Cognitive problems- attention, concentration and memory
- Stigmatization and isolation
- Neglect or harmful behaviors
RISK OF MENTAL ILLNESS FOR CHILDREN
- Research has shown that children of a parent with mental illness are at a greater risk for developing psychosocial and mental health problems
- Common problems these children may experience
- Confusion in response to unsettling behavior
- Embarrassment
- Isolation
- Keeping family secrets
- Neglect
- Stigmatization
- Concern about their own vulnerability to mental illness
OUTCOMES ON CHILDREN AS ADULTS
- Research has shown there are different feelings these children experience when becoming adults:
- Feelings of grief or loss
- Empathetic pain for their parent
- Guilt that they somehow caused the illness
- A belief that their own needs were not met as children
- A sense of growing up too fast
- Feelings of hopelessness and helplessness
- Regret for their unfulfilled potential
PARENTING WITH MENTAL ILLNESS
- Not all parents with mental illness are ineffective parents, nor do all of their children suffer from such adverse consequences
- Many children of parents with mental illness are successful across social and educational domains
- These children may also grow up to be stronger and more compassionate towards others with a greater appreciation for life
HAVING A CHILD WITH MENTAL ILLNESS
- Societies attitude towards mental illness has been fearful, stigmatizing, blaming and shunning the afflicted individual as well as their family
- A physical problem may be seen, but the cause of mental suffering can not be seen and mind functions are under control of the individual so they are often seen as responsible for their behaviors
- Therefore, individuals and families dealing with mental illness tend to become isolated and overcome with shame
FAMILY LIFE CYCLE
- Depending on the time of diagnoses for the child, the family life cycle may be disrupted
- Information about the disorder may not be fully discussed within the family and communication problems begin to develop
- In some families, the pain and stigma that comes with the diagnoses causes them to go into denial and try to appear as if everything is normal. It may be discouraged to discuss the problem
- There have been interventions designed to address this serious problem on the individual level through family and group therapy settings
ILL VS. WELL SIBLING RELATIONSHIPS
- Sibling relationships have a profound impact on development and is a connection in which the child learns to impact with peers, explore different roles, manage disagreements, and learns to share secrets, belongings and feelings
- When a child has a sibling with a mental illness the impacts can be profound:
- You may be ashamed you are related
- Guilty that you have a better life
- Envious that nothing is expected of them
- Relieved that you are not the sick one
ILL VS. WELL SIBLINGS
- The well sibling very often is presented as high functioning and independent whose symptoms of dysfunction and pain are hidden or dismissed
- They have apparent adjustments and secret distresses
- Well sibling attempts to disassociate themselves from the ill sibling
- Well sibling becomes overly responsible caregivers
- Well sibling becomes mature and independent prematurely
- Well sibling feels guilty
- Well sibling feels neglected by parents
- Well siblings are neglected by the mental health and healthcare systems
FAMILY RECOMMENDATIONS
- There are ways to enhance the quality of relationships within the family
- When possible engage the entire family soon after someone develops a mental illness
- Provide information and education about the illness, even is there is uncertainty about the nature of the problem
- Facilitate grieving process for everyone in the family
- Connect siblings to other siblings with similar family situations
- Reconnect family members to each other and establish appropriate boundaries
RECOMMENDATIONS CONTINUED
- Create opportunities for genetic counseling
- Allow for discussions about future planning
- Provide support and normalize reactions
- Ask about well siblings and their feelings about ill siblings
Overall it is very important to keep in mind the family functions that may be affected by having an individual with mental illness within the family
REFERENCES
Abrams, M. S. (2009). The well sibling: Challenges and possibilities. American Journal of Psychotherapy, 63 (4), 305-317.
Costea, G. O. (2011). Considering the children of parents with mental illness: Impact on behavioral and social functioning. The Brown University Child and Adolescent Behavioral Letter, 27 (4), 1, 5-6.
Marsh, D .T. (2009). Parental mental illness: Issues in custody determinations. American Journal of Family Law, 23 (1), 28-36.