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Pregnancy

Pregnancy brings a unique set of challenges to adults living with mental illness. The percent of unplanned pregnancies among women with serious mental illness is high (Miller, 1990; Ritsher et al., 1997). Mothers with schizophrenia have higher rates of spontaneous miscarriages, stillbirths, and induced abortions (Coverdale, McCollough, Chervenak, Bayer & Weeks, 1997; Miller, Resnick, Williams & Bloom, 1990). Psychotic denial of pregnancy happens with greater frequency in women who have previously lost custody of children (Miller).

Women with mental illness who are uninformed about issues of psychotropic medication and pregnancy, may stop taking their medications unnecessarily, thinking they are protecting the fetus. Clinicians are advised to make decisions regarding medication jointly with pregnant women (Empfield, 2000). A pregnant woman with schizophrenia may be maintained on a dose of antipsychotic that will not negatively impact her infant (Altshuler & Szuba, 1994). ECT has been suggested as a treatment option for pregnant women with severe depression (Miller, 1994).

Custody and Experiences of Loss. The literature suggests parents with mental illness are quite vulnerable to losing custody of their children, with custody loss rates in some studies as high as 70% to 80% (Joseph et al., 1999; Mowbray et al., 1995b). Rates of custody loss may vary by diagnosis; women with affective disorder diagnoses are more likely to be primary caregivers than women with psychotic disorder diagnoses (White et al., 1995). This finding is corroborated by Miller and colleagues, who indicate that children of women with schizophrenia are more likely to be raised by someone else (Miller, 1997; Miller & Finnerty, 1996). In Joseph and colleagues' study, the majority of mothers felt it was very important to continue to help raise their minor children, even though only 21% of the mothers had custody, and only 12% had primary responsibility for childrearing.

Maintaining relationships when children are living with relatives or in foster care may be difficult (Nicholson et al., 1998b). Visits may be stressful to both parent and child, particularly if not well planned or managed. Parents may experience their children's divided loyalties when children are split between family members or homes. They may feel angry or jealous when their children call others "mommy" or "daddy." Children may express anger to parents about their current living situations. Visits may be painful for parents and children who reminded of their losses each time a visit ends.

Separations may undermine parents' recoveries, particularly if children are placed with grandparents or other relatives who are known by parents to have been abusive in the past. Mothers with mental illness describe themselves as needing help getting their children returned to them, and in dealing with sadness about being apart from their children (Joseph et al., 1999). Parents explain that when their parental rights are terminated, the pain never goes away (Nicholson et al., 1998a). To fail as parents may be quite traumatic.

Victimization and Trauma

Researchers and providers are becoming aware of the high likelihood that adults with mental illness have histories of childhood abuse or are exposed to current violence (Goodman, Rosenberg, Mueser & Drake, 1997). The prevalence of victimization among samples of women with serious mental illness in published studies ranges from 53 to 97%. Having been abused as a child does not necessarily result in being an abusive parent. In fact, having been abused may motivate a parent to treat his or her own children differently (Nicholson, 1998 presentation). Other phenomena that co-occur with both victimization and serious mental illness, however, such as poverty, substance abuse, and homelessness, may have serious implications for safe parenting, and may increase risks to children and parents. It may be difficult to tease out the influence of each to the overall risk a family faces.

Symptoms associated with trauma histories may interfere with successful parenting (Nicholson, 1998 presentation). Children develop ways of coping with trauma to survive. For example, children exposed to repeated trauma such as sexual abuse may learn to depend on avoidance or withdrawal to deal with stress. These "survival skills," however, may mitigate against healthy adult functioning; they may come to be framed as the symptoms of posttraumatic stress disorder. As adults, victims of childhood violence may have difficulty with trust and intimacy in relationships; may develop coping mechanisms that mitigate against emotional and physical safety, such as substance abuse or sexual acting-out; may have issues related to "power" and feelings of "powerlessness;" may have dissociative or "numbing" episodes; and may have feelings of low self-esteem, guilt, and shame (Harris & Landis, 1997).

While these coping strategies or "symptoms" may have kept victims of childhood abuse alive, they may affect an adult's capacity to parent effectively. For example, mothers may have difficulty trusting their own assessments of their children's needs and their ability to meet them, and difficulty building relationships with helping professionals. They may need support to establish a physically and emotionally safe home environment for their children if they have never experienced a safe home environment themselves. If parents have been disempowered by their victimization experiences, or the stigma that is associated with victimization or a consequent diagnosis of mental illness, they may have difficulty advocating for themselves or their children. Children's developmental stages or ages, or their particular experiences may remind parents of unpleasant times in their own past, and may actually trigger parents' flashbacks, or contribute to parental anxiety or depression. For example, mothers who were victimized in the bathroom when they were children may have difficulty bathing or toilet training their own children (Nicholson, 1998 presentation).

Tags: Parenting and Families, Pregnancy & Childbirth

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