The Experiences of Parents with Mental Illness

by SAMHSA

(Page 4 of 20)

Most of what we have learned in the past decade in the U.S. about the experiences of parents with mental illness is based on research with small samples of mothers in the public sector with severe mental illness and multiple stressors such as poverty and ethnic minority status. We know very little about the experiences of parents whose diagnoses fall across the full spectrum of psychiatric disorders across the life span, or those who are Caucasian and middle class. While the experiences of parents with mental illness are similar to those of all parents in many ways, the literature has emphasized their unique circumstances and, most commonly, their deficits and failures. Parents with mental illness must cope with reproductive issues, custody loss, and past and present victimization, oftentimes without family support. They worry about the impact of their mental illness on their children.

Sources of Information About Parents' Experiences What is known about a phenomenon is influenced by the sources of information about the phenomenon. Unfortunately, little of what is widely understood about parents with mental illness is based on research. Most of what the public knows about parents with mental illness appears in newspaper accounts of tragic events in which children are severely injured or killed. People who abuse or neglect their children must be "crazy," according to common logic. Therefore, the general public assumes parents who are "crazy," that is, diagnosed with mental illness, probably abuse or neglect their children. What we do know about these high profile incidents is that they are, fortunately, rare. What we do not know is how many parents with mental illness are successfully raising children and participating in family life without incident.

The stories of adult "children" are another common source of information about parents with mental illness in the popular and professional literature. (See, for example, Frankel & Hewill, July 24, 2000, People Magazine, "Surviving a Mentally Ill Mother"; Marsh, 1996) The list of negative consequences of having a parent with mental illness, culled from the retrospective reports of adult children is lengthy and includes: anger, isolation, shame, fear, sadness, chaos, grief, neglect, feelings of helplessness, frustration, and confusion, identity problems, poor self-esteem, and trust and intimacy difficulties (Marsh, Appleby, Dickens, Owens & Young, 1993). However, adult children describe positive consequences as well, reflecting the development of resilience in the face of family difficulties: strength, empathy and compassion, tolerance and understanding, healthy attitudes and priorities, and an appreciation of life (Marsh et al.). Many adult children report living through very difficult situations during times, in years past, when the stigma surrounding mental illness precluded open family discussion or education; "disappearances" from the home, that is, parents' hospitalizations, were lengthy and unexplained; and treatments were less effective. The stories are yet to be told of children growing up in times when parents are more open in discussing their illnesses; hospitalizations are planned and shorter in duration; and treatments and rehabilitation provide increased hope of recovery.

In the past decade, researchers and providers have become more interested in the experiences of adults with mental illness who are parents. A growing number of studies have focused on the description of parents with mental illness, their circumstances, i.e., stressors and resources, and their service needs. However, findings are limited in generalizability, given the characteristics of studies and study participants. Studies in the U.S. over the past 10 years have, for the most part, involved small samples of women recruited in hospital, clinic, or other treatment settings (Joseph, Joshi, Lewin & Abrams, 1999; Miller, 1990; Miller & Finnerty, 1996; Mowbray et al., 1995b; Nicholson, Sweeney & Geller, 1998a, 1998b; Rogosch, Mowbray & Bogat, 1992; Rudolph et al., 1990; Sands, 1995; Zemencuk, Rogosch & Mowbray, 1995). A smaller number of studies have drawn larger samples from pools of existing data (Gamache, Tessler & Nicholson, 1995; Kelly et al., 1999; White et al., 1995), or clinic (Mowbray et al., 2000) or rehabilitation center populations (Ritsher, Coursey & Farrell, 1997). Nicholson and colleagues (1999), in the only published study of fathers, reported data on a sample of clinic clients. The vast majority of these recruitment settings or databases, to the extent we can determine from reading the literature, are public sector settings or rosters. Studies have been cross-sectional in design and descriptive in nature.

Study participants, for the most part, have been women with serious mental illness, as distinguished by diagnosis, illness duration, or hospitalization status. The majority of women, in the vast majority of these studies have diagnoses of psychosis, schizophrenia, schizoaffective disorder, or are described as having chronic or severe mental illness. Women with affective disorders outnumbered those labeled with psychotic disorders in only two samples (Nicholson et al., 1998a, 1998b; White et al., 1995), even though, judging from the NCS prevalence data previously cited, mothers with affective disorders far outnumber those diagnosed with psychotic disorders.

The background characteristics of women study participants limit the generalizability of the findings. The majority of women (from 55% to 70%) in seven of the 14 studies are African-American; in 4 of the studies they comprise from 6% to 39% of the participants. The remaining three study samples are described as ethnically and racially "diverse." In most studies, the majority of women are divorced, separated, or never married, i.e., single parents. In eight of the studies the percents of women never married or not living with the father of their children are above 50%, ranging from 51% to 82%. In studies in which employment status or socioeconomic status (SES) are indicated, most mothers fall into the unemployed or low SES categories. Given the public sector settings from which study participants are recruited, it seems plausible that most of these mothers are poor.

Issues and Themes

The experiences of parents with mental illness are similar to those of all parents in many ways. Parents with mental illness routinely describe their relationships with their children and fulfilling the parenting role as extremely important to them (Nicholson et al., 1998a). They may prioritize their children's needs, and neglect their own (Nicholson et al.) They may struggle to fulfill multiple role demands, and experience stress as they maintain a household, cope with the demands of work, and manage the behavior and activities of their children. Their marriages and family life may suffer under these circumstances, just as those of parents living without mental illness. However, parents with mental illness are prone to interpreting their difficulties managing the stresses of everyday life as illness-related personal deficits, rather than simply the "normal" stress of too much to do, judging themselves harshly against unrealistic standards and falling short (Nicholson et al.).

About the Author

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