What do people think of schizophrenic parents?

The effects of parents' mental illness on children's mental development

Table of Contents

List of tables

Abstract

1 Introduction

2 Overview of Mental Illnesses
2.1 Affective disorders
2.2 Obsessive-compulsive disorder
2.3 Anxiety Disorder
2.4 Schizophrenia
2.5 Personality Disorders
2.6 Alcohol addiction

3 Basic psychological needs of children
3.1 Need for attachment
3.2 Orientation and control
3.3 Protection of self-worth and enhancement of self-worth
3.4 Gaining pleasure and avoiding discomfort

4 stresses on children
4.1 Perception of the mentally ill parent
4.2 Taboo
4.3 The search for the explanation of the illness
4.4 Children's emotional world
4.5 Parentification
4.6 Inpatient treatment

5 Disease-Related Problems and Risks
5.1 Children of parents with mood disorders
5.2 Children of parents with schizophrenia
5.3 Children of parents with anxiety disorders
5.4 Children of parents with obsessive-compulsive disorder
5.5 Children of parents with personality disorder
5.6 Children of parents with alcohol addiction

6 Strengthening and promoting affected children through child and youth welfare
6.1 General resilience factors
6.2 Specific resilience factors
6.3 Promoting the fulfillment of basic psychological needs
6.4 Challenges for child and youth welfare
6.5 Preventive Offers

7 Conclusion

literature

List of tables

Table 1: Frequency of the forms of obsessive-compulsive disorder in the sick

Table 1: Proportion of informed children by age group

Table 3: Alcohol addiction and co-diseases

Table 4: Disease-specific risks

Table 5: Classification of protection factors

Abstract

It is estimated that around 3 million children over the course of a year experience a parent who is mentally ill. Mental illnesses such as depression, anxiety and obsessive-compulsive disorder, schizophrenia or personality disorders change the sick parent's thinking and behavior, which in turn influences the children. You experience a changed parent who seems confused and disconcerting to you. The tabooing of the illness in the family leads to them blaming themselves for the illness. Parents burden children with inappropriate responsibility, which leads to parentification. Inpatient treatment of the sick parent causes fear of loss and separation. The children live in a situation that is stressful for them and has a negative effect on their psychological development.

The children have a much higher risk of developing a mental disorder themselves. Under these stresses, in connection with the disease-specific behavioral patterns of the parents, they develop an insecure bond, show externalized and internalized behavioral problems, and their social skills are limited. The basic psychological needs of children cannot be satisfied. Resilience research has identified protective factors for children: support through contacts outside of the family, good social skills in the child, open handling of the illness in the family and psychoeducation for children. Preventive offers within the framework of child and youth welfare take up these protective factors in order to strengthen the children in coping with their living situation. In the practical implementation of the aid, a strong network and good professional competence of all supporting actors is necessary.

keywords: Mental illness of the parents, stress of the children with mentally ill parents, basic psychological needs of the children, resilience factors, prevention through child and youth welfare

1 Introduction

I tried to distract my mom from her sad thoughts, to be there for her, to make her happy [...]. She has incomprehensible fears, for example that we will have to move out of the apartment, that everything will break, that she is worthless, that her whole life will collapse. I said to her: “You have us! We'll help you so that doesn't happen! ”But that didn't help. The worst part was feeling helpless. And I was ashamed of her because she no longer cared for herself (Jeanette, 18 years old, daughter of a mentally ill mother, Roedenbeck 2016, p. 127)

An 18-year-old daughter tells of her life with the mentally ill mother and gives everyone who reads an insight into her life. Such and similar stories are told by many children and adolescents, or later also by adults who grew up with a mentally ill parent. How many children grow up can only be estimated, as the actual numbers are not yet available. Mattejat (2014) assumes around three million children who experience a parent with a mental illness in the course of a year (cf. Mattejat 2008, p.75). Gehrmann and Sumargo (2009) estimate that around half of all children who are supported in the context of youth welfare have a mentally ill or psychologically stressed parent (cf. Gehrmann / Sumargo 2009, p. 384). That is, the likelihood that a social worker will work with children of mentally ill parents is high. As the introductory quote shows, these children live a slightly different life and this work deals with this different life.

It stands to reason that a mental illness leads to changes in the family. Within the scope of this work, the following question should be answered: What effects does the mental illness of a parent have on the psychological development of the children and how can child and youth welfare contribute to strengthening the affected children?

In order to answer this question, the existing literature on the topic of “children with mentally ill parents” and related areas was examined and key findings were worked out.

In order to be able to deal with children of mentally ill parents at all, an idea about mental illness should be available. Chapter 2 contains an overview of the symptoms and the course of the most common mental illnesses. This knowledge forms the basis for later understanding the influence of the disease on the psychological development of children. When talking about the psychological development of children, the question arises, what do they need in order to develop mentally healthy and what basic needs do they have that must be met. Chapter 3 explores these questions. Chapter 4 deals with the daily stresses and strains children experience as a result of the illness and creates a connection with psychological needs. In this way, the influence on psychological development can be specified more precisely. After the stresses have been worked out, Chapter 5 discusses how the stresses work in connection with specific mental illnesses and what risks the disease-specific symptoms lead to. Chapter 6 explains whether there are factors for the children that protect them from the effects and risks, and to what extent the child and youth welfare service can derive its tasks and challenges from them and implement concrete actions in order to strengthen and support the children. At the end of this work, the central findings are summarized in Chapter 7.

2 Overview of Mental Illnesses

Mental disorders occur in a variety of forms. In order to get a picture of the symptoms and courses that children of mentally ill parents experience in their life together with the sick parent, the most common mental disorders are set out below. The Robert Koch Institute in Berlin recorded the twelve-month prevalence of mental disorders in the German population. The following disorders can be found here: unipolar depression and bipolar disorder, obsessive-compulsive disorder and anxiety disorders, psychotic disorders and alcohol disorder (cf. Jachertz 2013, p. 61). These diseases can also be found in the surveys by Grube / Dorn (2007) on the parenting rate among the mentally ill. Thus, around 70 percent of those suffering from affective disorders, 47 percent of those suffering from schizophrenia and 44 percent of patients with a personality or neurotic disorder are parents (see Lenz / Wiegand-Grefe 2017, p. 3). So you are dealing with mental illnesses that occur just as often in the general population as in the parents.

2.1 Affective disorders

Mood disorders are divided into two types: unipolar and bipolar. If the course is unipolar, either depressive or manic episodes occur; if the course is bipolar, these episodes alternate. The most common affective disorder is depression (cf. Lieb et al. 2012, p. 147f.). Depression is one

[…] Change that is so fundamentally different from healthy experience that […] [the] scientific terminology can hardly find appropriate formulations for it. [...] Even the person affected can hardly imagine this condition after having survived a depressive episode. (Tölle / Windgassen 2014, p. 234)

The sick have a depressed mood and cannot feel joy. They feel incapable of feeling sympathy, love, and affection for others, including their own children, spouses, or parents. The drive is strongly inhibited. You brood and your thoughts relate to only a few subjects.

Conversation turns out to be difficult because they can only hold it with great effort. They behave tearfully, are quickly irritable and are subject to daily fluctuations. In addition, there are poor concentration, slowdown in formal thinking and sleep disorders. Many also suffer from anxiety symptoms, especially about their family's future. Thoughts of suicide occur in 82 percent of patients; two to eight percent of this group choose death as the solution (cf. Lieb et al. 2012, p. 152f.). Suicide is the leading cause of death in depression. Tölle and Windgassen speak of at least ten to 15 percent in the presence of severe depression (see Tölle / Windgassen 2014, p. 245).

The depressive episodes last from three months to a year. If they persist for more than two years, they are diagnosed with chronic depression. After short episodes, most people with the disease can continue their normal life. After long episodes, returning to normal is rather difficult (cf. Tölle / Windgassen 2014, p. 247).

Treatment of depression involves pharmacotherapy for severe episodes, while waiting for mild episodes. Psychotherapy should take place for this purpose (cf. Lieb et al. 2012, p. 167). Psychoeducation plays a special role here, with the aim of helping the patient learn how to deal with the disease in a self-competent manner. Psychoeducational groups are also offered for family members, especially partners, as these are very badly affected. In such groups, the family members find emotional relief and help in dealing with the sick. Lieb et al. (2012, p. 171) point out that around 40 percent of relatives need therapeutic help.

In the context of the children of mentally ill parents, postnatal depression should be mentioned explicitly, from which around ten to 15 percent of women giving birth in Germany suffer in the first six months after giving birth (cf. Stiftung Deutsche Depressionshilfe, 2018). This disease affects the smallest children in a very sensitive phase of life and can quickly develop into a life-threatening situation for the babies if they are not properly cared for.

In bipolar disorders, a depressive phase is followed by mania. Mania is an exaggerated lofty mood associated with strong overestimation of oneself and increased drive. The sick perceive themselves as particularly productive, have a very creative ingenuity that is completely unrealistic. This condition leads them to behave completely uninhibited and without a distance. They are euphoric and show no insight into the illness, which leads to pronounced family conflicts. The lack of insight into the disease makes compulsory treatment or admission necessary in some cases (cf. Möller et al. 2013, p. 104f.).

Pharmacotherapy for manic patients offers good options, but it is usually difficult because people lack insight into the disease and therefore often reject drug therapy. Plattner (2017) expresses this fact as follows: "The mania means that the parent feels healthy and 'strong as a bear' and is convinced that they no longer need medication." (Plattner 2017, p. 41 )

2.2 Obsessive-compulsive disorder

Obsessive-compulsive disorder distinguishes between obsessive thoughts and compulsive actions. Obsessive-compulsive thoughts are thoughts that impose themselves, repeat themselves and cannot be controlled by the sick person. In the case of compulsive actions, the person concerned feels compelled to carry out specific actions, although these are perceived as meaningless. If these actions are not carried out, there will be strong internal tension and anxiety. By performing the action, the inner tension is reduced, but this effect only lasts for a short time and the action must be repeated. Complex ritual processes often develop from this, which can greatly influence the daily routine (cf. Möller et al. 2013, p. 149). According to Bebbington (1998), the lifetime prevalence of obsessive-compulsive disorder is around two to 2.5 percent (cf. Stengler 2008, p. 285).

Family members are often involved in the compulsive act. So z. B. Children of a mother with cleaning compulsory take off the clothes they have worn before entering the house, take a shower and those of the

Sick people put on prepared clothing to prevent contamination of the living area (cf. Stengler 2008, p. 249). Working with relatives is therefore of great importance in therapy, as they are also heavily stressed. Psychoeducation usually brings some initial relief (cf. Lieb et al. 2012, p. 255).

Table 2: Frequency of the forms of obsessive-compulsive illness in sick people (cf. Möller et al. 2013, p. 149)

Figure not included in this excerpt

The most common obsessive-compulsive disorder are compulsive control and compulsive washing. In almost 50 percent of those affected, mixed forms of action occur, as can be seen in Table 1. Many of those affected also suffer from another mental illness (cf. Lieb et al. 2012, p. 250).

2.3 Anxiety Disorder

In contrast to the prevalence of obsessive-compulsive disorder, which is still very low, the lifetime prevalence of anxiety disorders is 15 percent (cf. Möller et al. 2013, p. 128). Pathological fear is the same quality as real fear, but occurs in situations that do not present a real danger, such as: B. when driving the bus. The sick person is cognitively aware of this 'overreaction', but they feel completely at the mercy of fear. A feeling of powerlessness arises. Anxiety disorders include different forms of phobias, as well as panic disorders and generalized anxiety disorders. The last two have a strong impact on the formation of relationships and the daily routine. Affected people have low self-esteem, often resort to social retreat and are dependent on help from others.

As with obsessive-compulsive disorder, anxiety disorders have a high comorbidity with other mental illnesses. It can take up to 15 years from the first symptoms to diagnosis, which greatly favors chronification (cf. Lieb et al. 2012, p. 232f.).

2.4 Schizophrenia

Schizophrenia is one of the psychotic disorders in which the relationship to reality is at times severely impaired by delusions and hallucinations. The sick hear voices, often commenting or commanding. Optical and tactile hallucinations also occur. The sick feel persecuted (paranoia), consider themselves religiously chosen (religious delusion) or experience a relationship delusion, e.g. B. the television announcer gives them secret messages (cf. Renneberg et al. 2009, pp. 67–71). For people who live with such sick people, this can represent an acute danger if z. B. own children are experienced as threatening in a delusional state. In contrast to the ubiquitous delusion, hallucinations usually only occur in the acute phases (see Plattner 2017, p. 64). Formal thought disorders such as Hallucinations and delusions, such as delusion or inspiration, belong to the so-called positive symptoms that respond well to antipsychotics and are therefore easy to treat (cf. Lieb et al. 2012, p. 179ff.). In comparison, the negative symptoms can only be influenced to a limited extent by medication. These include a flattening of affect (emptiness and indifference) as well as impoverishment in language, facial expressions and gestures. The inability to feel pleasure and joy results in less interest in activities and little contact with friends and relatives (cf. Lieb et al. 2012, p. 181).

The course of schizophrenia varies greatly.Around 60 to 80 percent of patients experience a relapse within the first two years after initial treatment in a clinic (cf. Lieb et al. 2012, p. 185). The acute phase can be followed by a full recovery or it can change into a state with residual symptoms (often negative symptoms) (see Plattner 2017, p. 64).

Women often develop schizophrenia as early as their late twenties. Many of these women are already mothers at this point (cf. Schwartländer 2004, p. 335).

Lenz et al. (2011) found in their study 'Schizophrenia and Parenthood' with 370 inpatients that among all patients, the proportion of mothers is 43 percent and that of fathers is only 15 percent. 41 percent of parents lived with their children in one household, more than half of the patients (56 percent) lived separately from their children (see Lenz 2014, p. 63). This means that children live more often with a sick mother than with a sick father and almost every second child does not live in the same household with the sick parent.

This is also confirmed by the survey by Grube and Dorn (2007), who carried out a study on parenting among mentally ill people in Frankfurt. In addition to the patients from inpatient treatment, patients in outpatient treatment and day clinics were also surveyed. According to this, in 55 percent of cases children live with a mentally ill parent in the same household (cf. Grube / Dorn 2007, p. 69).

2.5 Personality Disorders

A personality disorder is used when certain characteristics of a personality are particularly pronounced and dominant and at the same time the person suffers from the symptoms (cf. Tölle / Windgassen 2014, p. 107).

According to Möller et al. (2013, p. 380) personality disorders in the general population have a prevalence rate of eleven percent.

Borderline personality disorder occurs particularly frequently, the main characteristics of which relate to a disorder of affect regulation, impulsiveness and instability of the ego identity (cf. Lieb et al. 2012, p. 304). The sick show themselves to be less stable in relationships, but very intense. They constantly live with the fear of being abandoned, thereby trying to keep the relationship under control and acting manipulatively. You have an unstable self-image and fluctuate between idealizing and devaluing your counterpart. The sick suffer from severe mood swings. Internal tension often leads to self-harming behavior (cf. Tölle / Windgassen 2014, p. 112). About 85 percent of the sick cut themselves, burn themselves z. B. with cigarettes or burn themselves with chemical agents (cf. Bohus / Schmahl 2006, p. 3345).

Many are suicidal, threaten to commit suicide or attempt suicide (cf. Tölle / Windgassen 2014, p. 113). The suicide rate can be classified as high at eight to ten percent (cf. Lieb at al. 2012, pp. 304, 307). 80 percent report one or more attempts to consciously commit suicide (cf. Bohus / Schmahl 2006, p. 3345).

The disease often begins between the ages of 13 and 17, during puberty, usually reaches its highest symptoms in the mid-20s, and weakens again in the course of life (cf. Lieb at al. 2012, p. 306). Thus, the most pronounced phase of the illness falls during the lifetime in which many adults start a family and have children.

Treatment with psychotropic drugs is considered supportive. Psychotherapeutic procedures are in the foreground of the therapy. For this, however, the sick person must bring their own appropriate inner motivation to be able to honestly look at and perceive their own behavior in order to be able to derive and implement changes for themselves. Overall, this is often very difficult to achieve, as many emotions suddenly dominate the person and cause the sick to have irrational thoughts and behaviors. The relatives often feel helpless that they often force the sick person to take therapeutic measures (cf. Möller et al. 2013, p. 397).

2.6 Alcohol addiction

One speaks of an addiction disorder when there is a strong desire for a substance that is associated with loss of control, physical withdrawal symptoms, development of tolerance and continued use despite harmful consequences (cf. Lieb et al. 2012, p. 204). In the course of the disease, there are recurring substance uptakes, which develop into a habit, often combined with the training of special rituals. Wine and beer are drunk in front of the television in the evening to relax. The possibly purely subjective degree of efficiency is discontinuous with respect to the dosage. A psychological and physical dependency arises (see Tölle / Windgassen 2014, p. 141).

In the case of alcohol addiction, there is always a state of intoxication with memory gaps, secret drinking activities and neglect of social contacts up to and including their complete breakdown. Everyday life is structured and controlled by the substance (alcohol procurement and consumption), which leads to a counterproductive feeling of security. The symptoms are aggravated by the fact that in the long term anxiety and organic damage that cannot be concealed from intoxicating substances can arise.

The prognosis for the addiction disorder is not favorable. The recidivism rate for alcohol addiction is still 50 to 80 percent after five years (cf. Buchner 2014, p. 207). The therapy consists of a detoxification phase and a process in which the behavior change is learned. Outpatient aftercare is one of the most important steps in therapy.

Since the whole family is affected by the addiction disease, targeted prevention programs and special therapeutic support for the children living in the household are of great importance (see Plattner 2017, p. 77). During the active phase of substance abuse, the parents' ability to raise their children is to be assessed as limited and, in acute intoxication, as suspended and endangering (see Plattner 2017, p. 78).

In conclusion, it can be said that mental illnesses have very different symptoms and courses, but all illnesses can change into a chronic state after a certain period of time. As a result, the children of the sick parents can be influenced by the disease for a very long time. There are also big differences in the treatment options. While depression and schizophrenia can be treated well, personality disorder or alcohol addiction are difficult to treat.

Due to the diverse symptoms, some of the sick people are severely impaired in their way of life and may also need the help of others. A mentally ill father / mother changes the family, as the mental illness affects the nature and behavior of the person and thus the dynamics and action between the sick and the other people. It is important to be able to distinguish whether the change is due to illness or simply a willful behavior of an adult.

In this way, many misunderstandings, both in the family and in the social environment, can be avoided if the person concerned suddenly acts unnaturally and inappropriately. With changes like these, it is critical to consider a possible visit to the doctor to minimize the severity of symptoms and initiate appropriate treatment quickly, as the likelihood of recovery is higher. Thus, a basic knowledge of mental illnesses is a basic requirement when working with mentally ill people and their relatives in the context of social work. Building on this basic knowledge, access to the affected family and their environment can be easier and more optimal.

3 Basic psychological needs of children

As shown in Chapter 1, mental illnesses change human behavior and nature. The changed sick father / changed sick mother in turn affects the family, especially children. If it is assumed that this effect of the disease influences the psychological development of children, the first question that arises is what psychological needs children have and what they need in order to develop mentally healthy. In order to answer these questions, this chapter addresses the basic psychological needs of children.

When it comes to naming a child's basic needs, social work most often follows the widely used model of the 'hierarchy of needs' by Maslow (1954). In this model, the needs are arranged hierarchically. That is, they have to be satisfied one after the other so that the next level of need can be reached. However, there is no empirical support for this model. In contrast, the Grawe model of basic psychological needs is largely supported by empirical findings (including neurobiological studies). Based on the current state of knowledge in psychology, it can be said that four basic needs are predominant: 1) attachment, 2) protection / enhancement of self-worth, 3) orientation / control and 4) avoidance of pleasure / pain (see Borg-Laufs / Dittrich 2010, p. 7f.). Thus, in this work reference is made to the Grawe model.

3.1 Need for attachment

Today, the need for attachment is the best empirically secured basic need (cf. Grawe 2004, p. 192). Bonding is a central need of every person for love and affection and is especially shaped in early childhood. Ainsworth investigated how children react to separation from their caregiver, based on the attachment theory of Bowlby (1976).

Their reaction was categorized into four patterns: 1) secure attachment, 2) insecure attachment with avoidant relationship behavior, 3) insecure attachment with ambivalent relationship behavior, 4) insecure attachment with disorganized relationship behavior. The attachment a child develops depends on the primary caregiver. If this shows empathy, recognizes the child's signals and is always available, the child has the feeling of security, receives enough closeness, experiences comfort and forms a secure bond. If this caregiver cannot be reached reliably and does not behave sensitively, the child develops an insecure attachment (cf. Grawe 2004, p. 193). Numerous studies show that the differences between children with secure and insecure attachment always favor children with secure attachment (cf. Grawe 2004, p. 207).

3.2 Orientation and control

According to Epstein (1990), every individual lives in a reality that they have constructed through their own perception and real experiences. This image of reality, which everyone carries within themselves, usually helps people to have orientation and control in life and thus to experience themselves as self-effective and to pursue and achieve their own goals (cf.Grawe 2004, p. 230) . So z. B. is a fixed daily routine for a child who cannot read the time yet, a model to which it orientates itself and which it can control for its psychological well-being. Otherwise the child would not even know what was happening around them and thus also with them, and would be overwhelmed with the situation. This means that excessive demands also mean loss of control for the child. Grawe emphasizes that such a situation can be unbearable without orientation and control (cf. Grawe 2004, p. 233).

Depending on the life experience, which is mainly made in early childhood, people develop a basic conviction as to whether foreseeability and control are possible or whether everything is uncontrolled and disoriented and nothing can be achieved through personal commitment (cf.Grawe 2004, p. 231 ). People, whose need for control and orientation is not satisfied, hardly stand up for their own goals or needs and tend not to feel that their existence is effective and controlled.

3.3 Protection of self-worth and enhancement of self-worth

The striving to overcome a feeling of inferiority was already postulated by Alfred Adler (1920, 1927) as an important human motivation (cf. Grawe 2004, p. 250). Every person wants to experience themselves as valued and therefore strives to develop the greatest possible acceptance for themselves. People are social beings who live in social groups, want to have their own place there and see themselves in this context. Here they receive feedback on who they are and, in the best case, develop a self-esteeming self-image. Grawe (2004) makes it clear that this self-image "[...] is to a large extent the result of linguistic communication and self-reflective processes" (Grawe 2004, p. 250). It is precisely this linguistic feedback that is particularly important for younger children, as they are only able to reflect on themselves in late kindergarten age. Thus, the feedback from the caregivers is crucial for the satisfaction of the need. In the later years, according to Berk (2011), events such as leaving school or sports clubs are decisive for the development of self-esteem, as the children also receive feedback here (cf. Schär / Steinebach 2015, p. 30).

3.4 Gaining pleasure and avoiding discomfort

Everyone evaluates the situations in which they find themselves (e.g. how was the visit to the doctor? How was the family meal?), As well as their own perceptions (did it taste good? Did the music they hear?). Grawe (2004) states that this evaluation takes place automatically and is not only based on pleasurable physical experiences, but also depends on whether something is experienced as positive or negative (cf. Grawe 2004, p. 265). On the basis of this evaluation, the aim is to avoid bad experiences or perceptions as far as possible and to be able to repeat the good ones as far as possible. According to Grawe (2004), however, the other basic needs also play a role here. If the need to bond is not satisfied in a situation, it is most likely assessed as bad (e.g. a child cries and is not comforted by the mother) (cf. Grawe 2004, p. 265). Here it could happen that the child will avoid going to the mother crying in the future due to the bad experiences.

On the one hand, avoiding displeasure protects against disappointment, but on the other hand also blocks the possibility of satisfying the need for attachment.

In conclusion, it can be said that the satisfaction of basic psychological needs is essential for healthy psychological development. While the basic needs in infancy are closely related, they can increasingly also be met individually with advancing age. However, children (less than adults) cannot meet their needs on their own; they need an appropriate environment. As a result, the presence of a primary sensitive caregiver is necessary in order to pursue the need for attachment. The social environment is required to support the children in building stable self-esteem. The need for control and orientation is also satisfied by a secure, stable and recurring behavior of the adults. Thus, family relationships are one of the deciding factors in how children develop psychologically. Since the family of children whose mother or father suffers from a mental illness acts in a different way (due to the illness), it can be assumed that - against the background of the basic psychological needs - the conditions for the children's psychological development also are changed. The following chapter thus illuminates the changed conditions and stresses that arise for the children as a result of a parent's mental disorder.

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