Helping children to survive sick parents

It is difficult to believe that only a short time ago parents were routinely vilified when their children developed psychiatric illness. Obvious examples are “the schizophrenogenic mother” and the lack of maternal communication skills that were blamed for the development of autism. Since we have come to understand the biological basis of psychiatric disorders, such blaming concepts appear foolish.

On the other hand, people who are or who will become parents may suffer from mental illness. The children of these parents may be affected through genetic inheritance, quality of parenting, family relationships, and psychosocial adversity. The editor, a social worker and psychologist, has estimated that, in 1995, 27 000 Australian children were affected by maternal psychosis alone. Many ill parents parent well, and not all children are affected, but up to two-thirds probably experience negative consequences. Amazingly, the needs of these children have been largely ignored.

Cowling has brought together 20 contributors from various disciplines to produce a highly instructive book addressing “coalface” issues for children of mentally ill parents. Four of the contributors had experienced parents suffering from schizophrenia, depression, bipolar disorder and Huntington’s disease. These personal accounts are extraordinarily revealing and I regret that there were not more of them included.

The first part of the book provides some vital background information on the genetics, behavioural and psychosocial effects of major psychiatric illnesses. An excellent chapter outlines the possible impact of different illnesses and their symptoms on infants and children of different ages. Different treatments for disorders, as well as preventive interventions, are also outlined. The role of the partner of the mentally ill parent and wider family ramifications are also considered. There is a chapter with advice on how to talk to children and another that examines the impact on adolescents. In a welcome departure from the political correctness of cognitive behaviour therapy, a chapter relates anecdotes from the psychoanalysis of an 11-year-old boy who had been adopted away from his mentally ill mother at the age of 2½. There are other chapters on placing children in out-of-home care and adoption.

A highlight of the book is its description of peer-support activities — various ways of organising group therapy for children of parents with mental illness. Group peer support combats isolation, shame and despondency and the benefits of group therapy can be enormous, but are frequently underestimated.

In summary, this is a book that provides irreplaceable insights about children whose parents have mental illness. I found most of the book easy to read, highly instructive and often deeply moving. Medical students and doctors should set aside some reading time for this wonderful book.

Nicholas A KeksPsychiatrist Box Hill, VIC