growing up with a psychotic mother

8/17/2019 Growing Up With a Psychotic Mother

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h e r . J . Orthopsychiat. 63 2) , April 1993

GROWING UP WITH

A

PSYCHOTIC MOTHER:

A

Ret rospec t i ve Study

Bonnie Dunn M.S.W.

~~

Nine adults who had been reared by mothers diagnosed w ith psychosis reported

on their childhood experiences. Analysis of the retrospective data revealed the

fiv e comm on themes of abuse and neg lect, isolation, guilt and loyalty, grievances

about mental health services, and social supports. The resilience and coping

strategies of the participants are examined, and implications for therapeutic

interventions with .such families are discussed .

ople commonly joke about the “crazy”

p” amilies in which they grew up, but

such families are a grim reality for the many

children who grow up with a seriously men-

tally ill parent. Of patients discharged from

mental hospitals in the United States, 65

return to their families every year Gold-

man, 1982).For the children, living with a

psychotic parent can make for a confusing,

isolating, and painful childhood. This study

presents the childhood experiences, re-

ported retrospectively, of nine adults who

grew up with such a parent. It explores their

childhood memories in an attempt to dis-

cover what it is like to live with a psychotic

parent, with the goal of understanding the

needs of this group, both as children and as

adults.

LITERATURE REVIEW

Being born to a psychotic parent carries

both genetic and environmental risks for a

child. A large and growing body of re-

search describes the risks of children who

have a schizophrenic parent

Gottesman

Shields, 1966; Kev, Rosenthal, Wender,

Schulsinger, Jacobsen, 1978; Tienari et

al., 1987), and it is known that children

born to a parent with schizophrenia have

about a

13

chance of developing schizo-

phrenia themselves, a marked contrast to

the estimated

0.5

to

1%

chance for the

general population Gottesman, 1991). Al-

though statistics concerning children of bi-

polar and psychotically depressed parents

are less clear, studies have cited evidence

of increased disturbance in these children

as well Billings Moos, 1983; Rutter

Quinton, 1984).

The environments of children who live

with a psychotic parent affect their devel-

opment. Early childhood studies underline

the importance of parental attunement and

affect in the development of the growing

infant. Psychoses involving disorders of ei-

ther thought or mood greatly influence an

individual’s behavior and affect, thus hin-

A revised version

of

a paper submitted to the Journal n April 1992. The author is at the Woodburn Center fo r

Community Mental H ealth, Annandale,

V A .

1993 American Orthopsychiatric Association Inc.

177


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178 CHILDREN

OF

PSYCHOTIC MOTHERS

dering his or her ability to be an effective

parent.

Spitz

(1 5)

emphasized the importance

to the developing child of the reciprocity of

mother


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BONNIE DUNN

179

be

interviewed in a timely manner and were

within a one-hour drive; this reduced the

size of the final sample from 18 to nine

subjects.

Although schizophrenia is equally com-

mon among men and wom en, there are many

reasons for the significan t difference in the

number of respondents with a psychotic

mother versus those with a psychotic fa-

ther. The known ratio of schizophrenic

mothers to fathers is two to one. Because

onset for schizophrenia is generally later in

wom en than in men, and marriage and pro-

creation occur earlier for women, women

have a g reater chance of finding a mate and

bearing ch ildren before their first psychotic

episode Gottesman, 1991). In addition,

children usually remain with the mother

when the parents do not live together, even

in cases in which the mother is severely

mentally ill. Thus, psychotic women

are

more likely than are psychotic men to be

caregiving parents. It would be important

to explore, in future studies, more about

the consequences of having a father with a

psychosis.

Four of the mothers of study participants

had been diagnosed with schizophren ia, wo

with bipolar disorder, and three with mul-

tiple disorders that included either schizo-

phrenia or bipolar disorder.

Procedure

Information was obtained through use of

a three-part semistructured interview. In Part

One, participants were asked about their

family structure and history, parental diag-

noses, hospitalizations, and treatments, as

well as about any mental-health treatment

they received as children and other contacts

with mental-health prov iders. In Part Tw o,

questions addressed participants’ childhood

relationsh ips with their mentally ill mother

and with other family members and friends.

Participan ts were asked to identify what their

needs were at the time and how those needs

were or were not met. They were also asked

for their opinions about contacts with m en-

tal health professionals. In Part Three, sub-

jects discussed their current relationship with

their mentally ill mother, with other mem-

bers of their family, and with m ental health

providers. Finally, they were encouraged to

comm ent on experiences that had not been

specifically addressed by the interview ques-

tions; all did

so.

Each audiotaped interview was tran-

scribed verbatim. Discrete, important quotes

were placed on cards, and sorted into the

categories covered by the interview (con-

tacts with mental health services; past and

present relationships with family and friends;

childhood needs). A subsorting within in-

terview categories (such as expressions of

guilt that emerged from a question regard-

ing childhood needs), derived from a con-

tent analysis of these quotes, identified

themes common to all study participants.

These them es, which recurred in

all inter-

views with regu larity, became the focus for

reporting the study’s results.

RESULTS

Five themes characterizing common ex-

periences emerged from these childhood

mem ories, which were striking in their sim-

ilarity. The themes were abuse and neg lect,

isolation, guilt and loyalty, grievances with

mental-health services, and supports. Since

the participants’ own statements power-

fully convey their earlier experiences, rep-

resentative excerpts from the in terviews, or-

ganized by the five themes, are presented

here.

Abuse and Neglect

All participants spontaneously described

the abuse or neglect they experienced due

to their mother’s mental illness, ranging

from maternal withdrawal to extensive phys-

ical, and in one case sexual, abuse. The

mother’s distorted sense of reality had a

profound effect on her ability to provide

consistently for her ch ild’s basic needs . One

young man

in

the study, a college student

whose father was a respected professional

in

his community and whose mother had

been diagnosed with paranoid schizophre-


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18 CHILDREN OF PSYCHOTIC MOTHERS

nia, described this early neglect in the fol-

lowing way:

I was never bathed; I didn’t hav e clothes. There was a

period when I had no friends-easy to understand; I

was a ragamuffin. .

. .

didn’t understand what bath-

ing was. In fourth grade we

used

to

drink

beer

before

school. There was just a com plete lack of supervision.

As a result of having a parent who was

often nonfunctioning, these children be-

came caregivers for the parent and younger

siblings at an early age. A participant whose

mother was diagnosed with paranoid schizo-

phrenia described her situation when, at the

age of 15 her m other’s delusional and para-

noid behavior worsened considerably and

the girl supported them both:

She stopped functioning. It was definitely the biggest

trauma of my life. W e got evicted from our apartment

because she’d scream all night

.

. she’d bother all the

tenants. We lived in real dumps, and I remember liv-

ing in a hotel with pimps and prostitutes. We finally

got an apartment, but it was four subway [changes]

from my s chool. It took me two hours to get to school,

two hours to get home. I had a job that was our only

income. I’d get up at 5:00 , go to school, go to my jo b,

go to the public library

so

I didn’t have to

go

home

because my mother was

so

crazy. I’d stay till it closed.

and then I’d take my four subways home. S he was up

all night screaming . The windows were broken. . . . t

was terrible-it was a nightmare.

hreeparticipan ts were physically abused.

One woman recalled her fourth-grade year

as being especially difficult. Her mother

was in a full-blown paranoid schizophrenic

episode, believing that people were plan-

ning to kidnap her three children:

That was a temble year. She was just in a constant

delusion

for

a full year. She wouldn’t let us go to

school, we couldn’t even leave the house, s he used to

lock us in our mom s because she was so scared people

were gonna get

us.

And we were really abused. . . .

remember the bruises, and no o ne ever noticed that.

.

. .

I had this dream that I was going to jump out the

window and break my leg. just

so

they could see what

was going on. So many people didn’t see so many

people that should’ve seen.

Another woman who experienced what

she called ritualistic abuse by her schizo-

phrenic m other said,

I was abused with some regularity. I’ve got multiple

fractures, and was out of school for a good amount of

time during my elementary-school years with bruises

and things like that.

As is evident in these accounts, surpris-

ingly little effort was made to protect the

children from the abusiveness of the psy-

chotic parent.

Three

participants spoke of

occasional support from their fathers, and

one father won custody of the children from

their bipolar mother, but fathers were gen-

erally seen by these children as physically

or emotionally unavailable to them . Four of

the fathers were alcoholics, and three left

their families when the children were very

young (after the mother had had her first

psychotic episode). Participants described

a childhood in which they received little

consistent attention from either parent and

where abuse or neglect were com mon .

Isolation

Participants spoke of feeling isolated from

their

peers,

heir communities, and their own

families, and of being confused by these

feelings. Eight of the participants reported

that their mother’s mental illness was not

discussed in any real way with them when

they were children:

Everybody pretended like nothing was goin g on. My

mother would go off and be hospitalized, and nobody

would tell us where she was, nobody would tell us

when she’d be back-my father included. . . .Once,

they took my mother off to a mental hospital, and they

left

my brother and me [aged six and eight] by our-

selves.

I

recall this very vividly. We were alone in the

house until the next morning. Nobody ever said any-

thing.

One woman remembered that when her

schizophrenic mother received shock treat-

ments, no one explained to her what was

happening. Such silence was a com mon ex-

perience among the people in this study.

Family members rarely acknowledged or

explained to the children anything relating

to their mother’s illness. Psychotic epi-

sodes and behavior, which were confusing

and frightening, remained unacknowledged

and unexplained, leaving the children w ith

a confused sense of their own reality and a

feeling of being isolated within the family:


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BONNIEDUNN

181

My mom [a paranoid schizophrenic] used to always

think someone was in the house. She always thought

it was my father’s mother, and she would send [me

and my sister] upstairs to

go

look . . and give

us

oast

and sandwich es to bring up to Grammy. And my sister

and I would

go

up and look, and come back down and

say, “Gram my’s not here”-and then we’d get

the

belt.

So

we learned to adapt.We’d run upstairs, [eat]

the sandwich, come down and say, “Grammy said

thank you very muc h.”

. . .

But my sister and I never

talked about it.

Another young woman expressed anger

at her family’s failure to acknow ledge the

illness and went on to describe the loneli-

ness and pain it caused her:

People didn’t say what was going on; enial is a form

of lying in

our

family. The way I coped was to be a

very good girl-shut dow n, didn’t make waves.

So

I

was always in a good mood-happy; at least other

people saw me as happy. I never told anybody. Ev-

erybody thought I was easygoing, sweet, and nice

. . .

there was so much pain in my family that I couldn’t

add to it, so if I was sad I couldn’t let anybody know.

In addition to feeling isolated from fam-

ily members, study participants also de-

scribed a sense of a lienation from the com -

munity and their peers. Although most

reached out to others at some time, whether

it was to a friend, a friend’s family, or a

teacher, they described feeling different from

these other, “normal” people, almost

as

if

they had two lives, each with its own real-

ity. One man described his awareness of

never quite belonging, even while actively

seeking the company of a neighborhood fam-

ily that welcomed him:

They had a nice home; I was comfortable and tem fied

at the same time, because I knew I was different-

there was always a time when I was going to have to

go home.

.

.

. I

was always an outsider there, even

though I was always very glad to go over. I

used

to

have to limit myself to the times I’d

go

over, because

I was pestering them-I knew I was pestering them.

Another woman described very similar

feelings about her connection with a friend’s

family:

Even though

I

was welcomed an d the friends and their

parents were very nice, I think a lot of them felt bad

for me. They always welcomed

me,

but I felt differ-

ent. I

so

much wanted to fit in and be a part of their

family that I let that part go.

Six participants recalled their reluctance

to invite friends to visit because of their

mother’s bizarre behavior. Because the men-

tally ill mother and her family were ostra-

cized by the community, the child’s feel-

ings of isolation were further reinforced:

[Once]

I heard some kids talking, they were daring

each oth er to ring her doorbell.

You

know how neigh-

borhoods have witches? Well, my mother used to be

the witch of the neighborhood. I heard people talking

about the witch-I wondered who it was-but it was

my mother.

Another woman recalled a very similar pain-

ful memory:

People or kids in the neighborhood used to make fun

of her, and I used to get really upset, and I would cry,

but I also got really angry. I would get angry at my

mother; it was easier to get angry at her. I felt differ-

ent; I felt like there was something wrong with her,

and something wrong with us.

Feeling isolated and differen t was a com -

mon experience for the participants in this

study. Several individuals described the con-

fusing consequences of having a parent

whose reality was different from the one

experienced outside the family, and they

detailed the feelings of alienation that re-

sulted. One woman described her sense of

being different due to her mother’s dis-

torted sense of reality:

I remember being embarrassed because my mother

would use words to describe things that

I

found out

later were not what things were. I remember Show and

Tell in school, and bringing something that was nor-

mal in my house, and the kids really laughed-they

thought it was really funny. Kids would laugh; teach-

ers would whisper. I thought it was me-that there

was something wrong with me.

Guilt and Loyalty

Guilt and loyalty, though not directly ad-

dressed

in

the interview questionnaire , con-

tinually emerged as im portant them es. Most

participants were (and continue to

be)

quite

loyal to their mentally ill mothers, although

living with them was extremely difficult and

painful. One young college student ex-

plained why he returns to live with his

mother every summer:


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CHILDREN OF PSYCHOTIC MOTHERS

I want to be there for my mother instead of shipp ing

out

and abandoning her. As long

as

I can

stand

it,

I

think it’s

good

for her. It’s not

good

for me-it’s

pretty

bad, actually-sometimes intolerable, and I have

to leave.

Another woman left her foster home to

return to her mother before she was legally

free to do so, knowing that it would be

“hellish at times” but feeling loyal to her

mother, who she felt needed her care. Loy-

alty often contributed to the participants’

feelings of isolation:

I couldn’t

see

my friends because

. . . I

couldn’t

t l k

to

them about what was going on . . . I couldn’t tell

anybody. It was terrifically hum iliating-plus I knew

it was totally disloyal.

Difficult loyalty conflicts emerged over

issues of child custody. Some of the most

emotional responses of these interviews

arose when describing those conflicts:

Social workers came to interview us [during a custody

battle between her mother and father]. I was in such a

bind.

I

didn’t want to hurt her. Now

I

feel furious

about it because the way they did it was

so

stupid.

After the social worker left, [my mother] sat me on her

lap and asked me, “Don’t you love

me?

Why do you

want to leave me?” .

.

. It was hard, because we

wanted

to

be with [my father].

[My mother] alienated herself from [family friends

who were trying

to

help]. Thcn I was really alone.

[The friends] would come to school with a child-

welfare worker, ca ll me

to

the principal’s office, and

sit down and talk to me about “wha t’s happening with

your mother,” and I wouldn’t t l k about it. But the

agencies

they

called should have known that it shouldn’t

have been up to me to blow the whistle on her-they

should not have given me that responsibility They

should have made an adult decision to take me out of

the home. . . . I felt my loyalty had to be with her.

Perhaps the most telling expression of

the conflict experienced by these children

was embodied in this paradoxical statement

of one man: “The best place for me to

be

was home. It was bad. A lot of it was sheer

hell.

Expressions of guilt were tied to the fee l-

ings of loyalty. All but one of the study’s

participants expressed a belief that they had

caused or contributed to their mother’s men-

tal illness. “S he was sicker after I was born ”

and “One doctor told us it was our fault,”

were comm ents from two participants that

revealed this sense of guilt. Many partici-

pants described the guilt they felt at being

separated from their m entally ill mother. It

did not m atter if the separation was the

re-

sult of their own choice or resulted from

decisions made by the adults around them;

leaving their mother, while providing re-

lief, also led to feeling guilty. After her

father won a custody battle to get the chil-

dren from their mentally ill mother, one

participant recalled:

My mo ther always wanted me to visit her, but I didn’t

want to go; it was depressing. My brothers and sisters

wouldn’t go.

. . .

was the youngest and I would be

the

one who felt like I had

to

go, because

she

was

alone if I didn’t. . . . never went because I wanted to

go. It was an obligation. . . . It was painful when I

lived with my father. I wanted to live with him, but

I

felt like I’d abando ned my mother.

Many participants expressed guilt that

they were healthier and that their accom-

plishments exceeded those of their mother

or other family members. One wom an, de-

scribing her considerable personal and pro-

fessional achievements, said, “All the things

I’ve managed to accomplish-none of it kept

her from being crazy.” One young woman,

concerned for the older sister who was very

protective of her during their tumultuous

childhoods, said,

I feel bad . . . my s ister] gave

me

all her strength and

had

none left for herself. Now she’s having all the

problems.

. . .

I feel gu ilty.

. .

. I just want

to

make

her better.

Another expressed guilt at going away to

college, thus “abandoning” his schizo-

phrenic mother, and described his feeling

that his father (who remains married to his

mentally ill wife)

sacrificed his life.

. .

. It’s been good for my mother,

it’s been good for

us

wds]

But it’s important to have

a life, and to have som ebody love you, and he’s totally

sacrificed that.

Contacts With Mental Health Services

All but one study participant found child-

hood contacts with mental health services


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BONNIE DUNN

to be negative. (Th e exception was a young

woman who, as an adolescent, went into a

psychoeducational treatment with her mother

and learned different ways to deal with

schizophrenia. However, an earlier experi-

ence with therapy had left this same girl

temfied when the therapist encouraged her

mother to describe her delusio ns, which se-

riously frightened her young daughter.) As

children, they often witnessed their mother

being taken away to be hospitalized, but

rarely received explanations of what had

happened or what to expect. Visits with

their hospitalized mother were recalled as

terrifying experiences that caused them much

pain and gu ilt. Often these children felt that

they were to blame for their mother’s hos-

pitalization. Many suspect that their mother

was mistreated or abused while hospital-

ized:

It felt like animals. The sm ells, the sounds, the screams,

the cold, sterile beds that barely had covers on them.

I couldn’t imagine anything worse-to see your parent

in a place like that was temble.

Don’t ever throw your mother in a state institution.

Tha t’s one of the hardest periods

I

ever went through.

It was a cruel place.

I

think my mother was sexually

abused there

. . .

when she came out, she was very,

very frightened.

While contacts with the mental-health sys-

tem in general were perceived negatively

by study participants, direct contacts with

mental health providers were described even

more strongly as unpleasant, guilt-provok-

ing, or even harmful. One young man re-

called a family-therapy session when he was

in seventh grade in which the therapist told

the family that his schizophrenic mother’s

bizarre behavior was the family’s fault. His

initial feeling of guilt was later expressed

young woman, who described herself as a

child who had hidden her real feelings for

the sake of her family, remembered how

devastated she was to hear that she was not

doing enou gh. Still another participant, w ho

had had her bones broken on several

occa-

sions during her mother’s frightening psy-

chotic attacks, was “coerced” at the age

of

18 by her mother’s psychiatrist into staying

with her delusional mother when no one

else would:

Her psychiatrist appealed to me to stay. He guilt-

tripped me into staying in the household for another

18

months. .

. .

These crazy psychiatrists What was

most frustrating is that the psychiatrists would violate

her confidentiality by hooking family membe rs in when

it was useful, but wo uldn’t respond to family members

when it wasn’t convenient for them.

These direct contacts with mental health

professionals, though possibly having some

value to the mother as patient, are remem-

bered by the children as personally hurtful

and damaging.

Despite their negative views of their child-

hood contacts with mental health services

and professionals, eight of the nine partic-

ipants in this study had entered individual

therapy as adults. T his information was im-

parted spontaneously during the inter-

views. With the exception of two partici-

pants (both male ), their reasons for seeking

treatment-whether they were symptom-

atic or had received a diagnosis-are not

known. The participant who had been di-

agnosed with schizophrenia entered treat-

ment when he became delusional. Another

man entered treatment when he had a

“breakdown” several years ago.

All eight found therapy helpful in under-

standing the impact of their mother’s men-

tal illness on the family and on them as

individuals. One young woman recalled

fi

nally being told by a therapist what was

wrong with her mother:

That was one of the greatest

days,

when

said , “You r mother is a paranoid schizophrenic.” They

with anger:

They try to peg what is a medical problem as some-

thing else

. . .

it’s just reprehensible to tell a bunch of

kids it’s their fau lt, but it’s still going on. . . . It’s like

treating a cancer in the Stone Age.

more understanding of her mother. This

concrete.


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84 CHILDREN OF PSYCHOTIC MOTHERS

In therapy , participants were able to dis-

cuss their fears for their own sanity, very

common among children of psychotic par-

ents, and reported working on setting lim-

its, both emotional and physical, with their

mother. Some emphasized the relative safety

of the therapeutic setting; it was a place

where they could begin to explore their

re-

lationship with their mother, who had so

often seemed om nipresent and om nipotent

to them:

The biggest help is finding a place where you know

you won’t get hurt if you tell the secrets. What’s easy

is finding a place to tell your own secrets.

. .

. What’s

more difficult

is

if you tell your mother’s secrets

.

.

.

if you report her behavior it still feels dangerous.

I was in therapy with a wonderful therapist for about

eight years. It’s sort of a reparenting. I would actually

think of it as critical to getting on with life.

I

think that

many of us who live

through

that kind of stuff don’t

ever let ourselves feel anything about it because it

doesn’t feel safe . . . you have to] create a safe space .

But it ma& a big difference to me-it really changed

the course of my life.

Social Supports

All nine of the study participants identi-

fied one or more people whom they saw as

supportive and helpful when they were chil-

dren. In some cases

it

was the grandpar-

ents; often it was neighbors, family friends,

teachers, or coaches. These people were

available to the children on a somewhat reg-

ular basis. The children rarely, if ever, talked

to them about their family situations, but

they saw these people as safe and saw their

homes or places of work

as

places in which

they were welcome. In retrospect, these s u p

portive others were viewed as lifelines to

the world outside the chaotic and bizarre

family situation and as providing them with

care, attention, and a certain amount of re-

ality testing. Many participants described

these people as having made a very big

difference in their lives:

I som etimes wonder why I’m not crazy .

. . .

That’sthe

only thing I can think of, that my grandmother took

care of me . . . really me. I was the youngest, I was

her pet. She was very attentive and I felt very taken

care of by her. She paid a lot

of

attention to m e, just

loved

me.

I had been saved-well, not saved, but helped a great

deal by being “adopted” by this family . .

.

they had

a healthy home, you could tell when you went in

there. They had regular

meals;

it was homey. But

I

used

to have to limit myself to

the

times I’d go over.

I connected with a teacher I had . . . she’s a friend to

this

day.

She

used

to have

her

[class]room open d uring

lunch

. . .

ultimately some of us got incorporated into

her

family. We used to go over

to

her house [for]

family dinner s, and it’s the first regular family I ever

saw. . . . She was a major changing point for m e.

These connections were often initiated

by the adults, but in many instances partic-

ipants described actively seeking certain peo-

ple out, targeting people with whom they

knew they could feel comfortable and ac-

cepted. The women in the study were more

likely to describe themselves as having ac-

tively sought out certain people, while the

men took a more passive role as children in

accepting the support or companionship of

others. These supportive relationships were

not without difficulty. Many participants de-

scribed feeling that they d idn’t quite belong

with these families or friends, and many

experienced loyalty conflicts, even while

pursuing these friendships.

Although all the participants clearly ar-

ticulated pain-filled relationships with their

psychotic mother, five recalled a special, if

inconsistent, loving relationship with her.

This love and support varied with the in-

tensity and duration of their mother’s psy-

chotic episodes:

She was extremely indulgent in some ways, and even

though we were poor there was a way in which I was

treated to think highly of myself.

. . .

I was the apple

of her eye, I had a sense of myself.

.

.

.

What I learned

to do was to connect real strongly with people. I learned

some of that from my mom who-when she’s not

crazy-is a very connec ted person. What I learned

from her did me well.

DISCUSSION

These extensive, first-person accounts of

daily life with a psychotic parent corrobo-

rate previous findings and contribute new

information that can add to our understand-

ing of the experiences and needs of chil-

dren of mentally ill parents. It must be re-


9/13

BONNIE DUNN

1

8

mem bered, however, that the small size of

the study sample limits the generalizability

of its findings, however informative.

The burden described by many families

of the mentally ill

Anthony, 1969; Hat-

field, 1978)

was experienced by all the par-

ticipants in this study, particularly the ne-

glect and the fear of physical harm they

lived with as a child of a psychotic mother.

The pervasiveness of the neglect is an in-

dication of the devastating effect that the

mental illness of one family member has on

the entire family.

These participants confirmed previous

findings Ha tjeld, 1978;Hill Balk, 1987;

Scottish Schizophrenia Research Group,

1987) that families of the mentally ill ex-

perience social isolation and alienation . They

described their neighbors’ and extended fam-

ily’s treatment of their mentally ill mother

as an outcast; further exploration found that

some children thought it was because of

something they themselves had done. In

part, the isolation was self-imposed

be-

cause they would not talk about what went

on in the family out of a sense of loyalty to

their mother, or from a sense of hum iliation

or sham e about their situation.

Adding to their isolation was the confu-

sion felt by these children when confronted

with the two separate worlds-that of their

family, dominated by their psychotic mother,

and that outside their family, represented

by school and peers. A cknowledging these

separate realities, usually in adolescence or

young adulthood, was accompanied by the

pain of having to acknow ledge their moth-

er’s mental illness, and this caused partic-

ipants to feel disloyal and guilty.

Feelings of guilt and loyalty, rarely men-

tioned in the literature regarding children of

mentally ill parents, emerged regularly dur-

ing these interviews, pervading their child-

hood mem ories and continuing to touch their

adult lives. Separation guilt Friedman,

1985; Weiss, Sam pson, the Mount Zion

Psychotherapy Research G roup, 1986), he

belief that pursuing one’s individual goals

and striving independently for personal well-

being is harmful to a loved one, was ex-

pressed by many of the study’s participan ts

in their sta tements that they somehow caused

or exacerbated their mother’s illness by leav-

ing or by wanting to leave home. Survivor

guilt

Friedman, 1985; Weiss e t a l . , 1986),

the belief that only a finite amount of good

things is available to each family, and that

the achievements of one member diminish

the possibilities for the others, was univer-

sally experienced. Even though the inter-

view protocol did not include questions on

the subject, all the participants expressed

some form of separation and/or survivor

guilt, both

as

children and as adults. This is

significant, and is generally overlooked in

the literature regarding children of the men-

tally ill.

Contacts with mental health profession-

als and the mental health services were re-

membered as unhelpful and sometimes

harmful by study participants. They re-

called feeling blamed for their mother’s ill-

ness. Perhaps once-popular (but since dis-

cred ited ) family-systems theories that

attributed a child’s schizophrenia to certain

parental behavior

Bateson, Jackson, Ha-

ley, Weakland, 1956; Fromm -Reich-

mann, 1948; Lidz, Fleck, Cornelison,

966;Sullivan, 1927; Wynne,Ryckoff, Day,

Hirsch, 1958; Wynne Singer, 1963 )

were generalized by some mental health pro-

viders into a belief that family behavior

could cause schizophrenia in any family

member. When social workers and welfare

agencies intervened, the child’s negative

feelings about the actions of adults re-

flected a keen sense of loyalty to and

re-

sponsibility for their mentally ill mother.

Guilt resulted when they fe lt they were be-

ing disloyal by leaving , or by speaking up

about the conditions in which they were

living. Thus, their perceptions of con tacts

with m ental health professionals

as

conflict-

ridden and negative may have been influ-

enced by feelings of guilt and loyalty. The

prevalence and strength of these emotions

have implications for therapeutic interven-


10/13


tions with a mentally ill family member or

the children.

The focus of this study was childhood

experiences and the common ground among

them. Nevertheless,

t

is interesting that eight

of the nine participants apparently over-

came earlier negative experiences with men-

tal health professionals and sought therapy

as adults.

As

children, study participants

described consciously overcoming feelings

of shyness, feelings of being different from

others, and fear of reprisal from their mother

in order to put themselves in safe and af-

firming situations with supportive peers or

adults. Entering therapy as adults despite

earlier negative experiences can be seen as

an extension of their developmental coping

strategy of overcoming negative or conflict-

ual feelings in order to seek support from

others.

It is also anecdotally interesting that study

participants who had had several years of

therapy generated rich sets of data, while

the participant with no therapy did not. Ther-

apy apparently helped them to verbalize their

memories and feelings, and perhaps al-

lowed them to achieve the perspective nec-

essary to share painful memories.

The feelings of study participants toward

the mental health profession were compli-

cated and reflected, to a certain degree, the

conflicts and incongruencies that were al-

ways present in their childhoods while par-

ticipants emphasized the child’s need to talk

about the difficult home situation, they also

told of how loyalty, guilt, and fear would

not allow them to do so; two who had been

removed from the home as children felt con-

flict about that intervention, and two who

stayed with their mother were angry that

mental health services did not intervene to

remove them; two described their child-

hoods as deplorable

in

many ways and great

in

many others. These contradictions and

conflicts embody the essence of growing

up with a psychotic parent. That eight over-

came earlier negative reactions to the men-

tal health profession and went on to have

positive experiences in therapy illustrates

their resilience and ability to cope, partic-

ularly in tolerating contradiction and con-

flict in the service of mental health.

It is known that one study participant

entered therapy after having a breakdown,

and that one was treated for schizophrenia,

but questions remain as to why the others

entered treatment and how that affected

outcome. Did they enter treatment because

of unresolved traumas? What are the

differences, if any, between those who

enter treatment and those who do not?

What is the general outcome for those who

receive treatment as opposed to those who

do not? The interviews, while revealing

the seeming contradiction of seeking ther-

apy after earlier negative experiences, did

not address these complex issues. Future

research oriented toward exploring these

questions could add greatly to our under-

standing of resilience and coping, and

could help to refine our understanding of

the therapeutic process with people who

have grown up with a seriously mentally ill

parent.

All participants reported having supports

of varying degrees outside the home. Re-

search has emphasized the need for sup-

ports

for children of the mentally ill (Gut?-

man, 1989; ice, Ekdahl, Miller, 1971;

Rurrer, 1975 , ut the support found by par-

ticipants in this study was informal, from

teachers, other family members, and friends,

rather than the more organized social-

service supports recommended in the liter-

ature. Many participants, mostly the women,

described actively and aggressively seeking

out individuals and families who would wel-

come them and with whom they felt com-

fortable and safe. The men described them-

selves

as

less aggressive in seeking out these

supports as children, and reported that, while

they were aware of help when

it

was of-

fered to them, they sometimes had diffi-

culty accepting it.

In their research on resilient children,

Felsman and Vaillant

(I

987 oted the abil-

ity of some children to draw others to them

for support, a strategy reported by several


11/13

BONNIE DUNN

187

researchers who have studied children of

mentally ill parents Fisher, Kokes, Cole,

Perkins,

Wynne

987;Kaufm an, Grune-

h u m , Cohler, Gamer, 1979; Kringlen,

1978). In these outside contacts, study par-

ticipants never discussed their family’s sit-

uation; rather, they seemed to use the rel-

ative normality and safety of these interac-

tions to sustain them in the ir difficult fam-

ily life, and to ground them in a reality

different from the one experienced at home.

It is not possible from the present data to

define the specific quality and nature of the

supports the participants received as chil-

dren or to compare these supports to the

supportive relationships enjoyed by most

children. It is very important, however, that

these relationships were perceived by this

study’s participants as critical to their de-

velopment. Participants told of their sup-

porters being major chang ing-points n their

lives and described them as rescuers, sav-

iors, and people who kept them from grow-

ing up crazy like their mother. Further

re-

search into the quality and nature of the

supports that can sustain these children,

as

well as the propensity of such children to

take the most possible sustenance from or-

dinary supports, may be useful.

This was a very small, self-selectedgroup;

that they chose to respond to solicitations

raises the possibility that they differ in some

ways from those who did not respond . They

may possess certain characteristics not

shared by some other children of parents

with psychosis, such as curiosity about the

subject, a willingness to share painful mem-

ories for the greater good, or a certain ob-

jectivity about the parent’s mental illness.

In his research on invulnerable children,

Anthony (1974) found that the more resil-

ient children in his study were among the

most co llaborative, supporting the possibil-

ity that the participants in this study may

be

more resilient than others.

Eight of the nine participants of this study

were working and all described relation-

ships of varying degrees of satisfaction in

which they were involved. Despite the small

size of the sample, the resilience and the

coping strategies of these individuals may

be instructive in the search for new ways to

help the many children who are growing up

under similar very difficult circumstances.

Since all the participants in this study were

volunteers and all but one had had some

psychotherapy, these results may tend to

understate the severity of trauma and the

difficulty in overcoming it among the gen-

eral population of children with psychotic

parents. Although these participants were

resilient, pa in, confusion, and isolation char-

acterized their daily lives in childhood and

they continue to reverberate in their adult

lives.

Implications fo r Treatment

These findings have practice implica-

tions both for those professionals working

with psychotic individuals and their fami-

lies and for clinicians working individually

with adults who have grown up w ith a men-

tally ill parent. For the children in these

families, age-appropriate nformation about

the parent’s illness may be helpful,

as

might

inclusion in a multiple-family support group

Sigman,

John, Levinson, Betts, 1985).

Current psychoeducational amily interven-

tions could be modified to include children.

In all interven tions involving families of

the mentally ill, professionals must be aware

of the conflicts in loyalty posed by outside

intervention and of the gu ilt felt by the chil-

dren. They must recognize that the child

has a caregiving role, and encourage both

parents, where possible, to strengthen their

parental roles and skills. Clinicians must

realize that one of the most effective forms

of help is the support of other family mem-

bers (in some cases the parents, however

minimally), school personnel, friends, and

friends’ families. They should encourage

and help these children to seek out such

relationships.

Because many of these children will seek

out individual therapy when they become

adults, clinicians should be aware that the

loyalty conflicts and guilt they experienced


12/13


as children continue to reverberate in their

adult lives. Survivor guilt can keep them

from achieving to their fullest potential and

may hold them back from satisfying adult

relationships. Bleuler

(1974),

in his exten-

sive longitudina l study of over 200 families

of schizophren ics, referred to the “shadow ”

that is cast over the lives of children of

schizophrenics, and these childhood feel-

ings of loyalty and guilt may comprise a

large part of that shadow.

Clinicians must also be willing to ad-

dress the fears of adult children of psy-

chotic parents that they will become as

“crazy” as their parent; they can help their

clients to set realistic yet caring boundaries

with their mentally ill parent. Support net-

works, such as the Alliance for the Men-

tally I11 and support groups run by mental

health clinics and psychiatric hospitals, can

provide these adults with information about

mental illness and with the unique support

and understanding that can come only from

others who have shared a similar experi-

ence.

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growing up with a psychotic mother

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