Children of parents with psychosis

When you’ve had one call after another and your little one is tugging on your shirt, remember what really matters. When the milk is splattered all over the floor and those little eyes are looking at you for your reaction, remember what really matters. It takes 5 minutes to clean up the spilled milk but it takes much longer to clean up a broken spirit. Rebecca Eanes wrote this in her book and opened the door towards the poetical nature of parenting. “Parenting”, a task like a steeplechase game in which every step is moving towards a hurdle and pits which needs to be crossed. It’s not so easy for normal parents with a normal child to travel on this road of parenting, but when it comes to parents with mental illness; the task becomes arduous for the parents as well as the children. Global data and various indexes are appealing to the world in this era of morbidity. The institute for health matric and evaluation reported in their flagship global burden of disease study (2017) that estimated 792 million people lived with a mental health disorder. This is slightly more than one in ten people globally. It could be any disease, for example - anxiety, OCD, depression, psychosis, substance disorder or anything else, but it makes a major impact on the related people and their dynamics. The 20th century witnessed the work of John Bowlby (1907-1990), the notable psychologist who worked on the area of attachment and its impact on personality development of a child. He states that the important component of the personality development is attachment and if compromised in anyways can lead to difficult results. The relationship of the parents with psychosis and child’s personality development is linear but not very straight. Since the era of  Sigmund Freud and Erickson, in the history of psychology and human behavior, the interaction of the children and caregivers have been depicted in detail and it was almost the root of all psychological and psycho-social conjectures. It clearly shows that lots of personality components are based on the dynamics among the children and parents. Genetic loading is precisely decisive but here the discussion is about the psychological component which had been seen in children of parents with psychosis.

In a remarkable study (Anthony, 1969), it has been shown that parental psychiatric illness impacts the child in a deep way. The toddler is more sensitive if the behavior of one parent is more chaotic. A child learns to perceive the world through his parent’s eyes. He learns to trust people through the perceived social interaction. He learns the emotional reciprocity from his parents. Research suggests that the primary lessons of emotional intelligence are taught by the parents only (Goleman, 1995). The idea here is that parents are sole trainer for a child in area of social, emotional, cognitive, interpersonal, and other developmental perspectives but in psychosis, their way of seeing the world is different and it affects the child in a bottomless manner. There are three types of relationships; first are those children who develops psychosis with the genetic loading, second are those whose disturbance are directly attributed to symbiotic relationship between them and their parents and third group that is disturbed by the vagaries of the peculiar environment engendered by the sick parents (Anthony 1995).

The relationship between a child and sick parents revolves around a different world colored with the darkness of illness and it gives birth to shared delusions and a peculiar personality. In case of a younger child, these symptoms can result in an acute primitivization with a massive loss of ego skills which means the touch with absolute reality gets shaken. In the case of an elder child or adolescent, it may lead to transient disorders such as brief psychosis, acting out behavior or the development of such neurotic disturbances as nightmares, obsession, and phobias.
If we look at the type of psychosis in the psychotic parents and the clinical status of the non-psychotic spouse, the approximate estimate of genetic risk is 15 to 20 percent in a given sample. On a rating scale ranging from “most likely” to “least likely” to develop psychosis in their adulthood, about 15 percent fall into the “most likely” category. Studies further confirm that there are risks of developing personality disorders in the children of parents with psychosis. Generally, the behavior contains the occurrence of difficulty in thoughts, mistrustfulness, or extreme childlike behavior. These micro episodes are absolutely easy to differentiate from the normal behavior of the child and last up to three days to three months and even the separation from the sick parents doesn’t help much in these episodes because of their deep rootedness. In some children, there are micro-paranoid episodes which include expansion of suspiciousness and a sense of persecution. As notable psychologist Piaget has described that elder children during their middle years, may achieve miniature systems based on simple dichotomous cataloging. Due to the ability of abstraction and propositional thinking, an internally consistent group of suspicious ideas becomes possible and these are unshakable most of the time. There are many noted cases in which young children presented with episodes of aggression, suspiciousness, disturbing emotions, difficulty in the thinking process, and uncontrollable communication. In all the above cases, there was a direct link with the parental psychotic illness. The home environment plays a very important role in shaping the personality of a child. The atmosphere surrounded by a parent with psychosis can’t be considered normal. The first thing is ‘neglect’, in the case of a parent with psychosis, the children start to lead separate lives of their own, unsupervised and undisciplined, and there is a high incidence of behavior problems and delinquency. The second thing is ‘suspiciousness’; growing up in a pseudo-community, there is disorganization in the whole system of family, and family life is incorporated into those cycles of delusions.
Among all these, the reactive environment is characterized by its inconsistency, chaotic management, contradictory communications, highly ambivalent but powerful effects, incoherent intentions and motives, and high level of intrusiveness. This ‘environment of irrationality’ envelops the family and makes for the unpredictable crisis that hovers over the lives of the children. At one moment there is an intimate closeness and at the next, bitter and unjustified accusations. The following story attempts to illustrate the “climate” of such a psychotic environment fostered by ill parents.
“The family lived in a shattered building in need of repair. Two of the children, a boy aged nine and a girl aged seven squatting comfortably on a wall and sharing a cigarette. The girl was in poorly maintained clothes. When asked about the whereabouts of their parents, the boy said that “old Amma” was where she always was, in the back room. “Take care you don’t hurt her when you go in” he added; she lies on the floor by the door.

It’s a typical example of environment. Story doesn’t get complete without discussing resilience. There are various studies which show that lots of children demonstrate high resilience and that helps them in dealing with the parents and to structure their own world. Generally, the typical treatment consist the holistic rehabilitation of the person with psychosis but somehow we corner the child, adolescent or adult. The recent approaches are literally seeing the child as an independent entity for psychological treatment so the damage can be prevented before a complete devastation.