Tuesday, April 15, 2014

Does bad parenting cause mental illness?


Over on our Facebook page, a reader posted: 

Supporters of families should protest SAMHSA's distribution of its new "Family Therapy Can Help" booklet. It's full of statements that imply that faulty family dynamics are the underlying problem in the development and persistence of mental illnesses. At the same time, SAMHSA does nothing to educate the public or clinicians or people with severe illnesses on what is known about psychotic disorders from a science based perspective. Here's a link to this free document:
http://store.samhsa.gov/shin/content//SMA13-4784/SMA13-4784.pdf

Around the same time, a Shrink Rap reader wrote in to us saying:

    I get tired of the stories about the noble families caring for their wayward child. It's that way sometimes, but a lot of times, it's NOT that way!
   What I don't understand is this: I have NEVER EVER read an article anywhere that talked about families and an adult child with serious mental illness that did anything but praise the family of origin and their noble quests to save their unfortunate children. (Well, on Dr. Allen's site, which is like the only exception).
   I have bipolar and came from an incest family. Just about every psychiatrist I have ever seen, and every single community mental health worker (social services) has said that so many of their patients come from abusive families. In fact, the community workers who only see people with serious and persistent mental illness say that nearly ALL their clients have extremely abusive families.
   So what is going on here that there is NEVER EVER a mention that perhaps some of these sacrificing, noble family members may have been the catalyst for the mental illness and are continuing to abuse the person by committing them and placing all the blame of the messed up family at the feet of the one who has a label? And bipolar or schizophrenia labels are handy for parents or other abusers to escape culpability.
   I understand that NAMI is all about moms not wanting to be blamed for their kids' mental illnesses, which probably did happen unfairly quite a bit. But come on! Often parents are the major cause, by abusing or failing to protect their kids (in my sexual abuse support group, all the ladies were blamed and ostracized by their moms and others when they told about what happened. What I learned from that is that kids who are abused and their mom has their back don't end up so messed up that they need to be in a support group)
   So it always ticks me off when I read blogs written by mental health providers, or newspaper articles, or see something on TV showing these wonderful, loving parents, and come on, statistically, some of those families are probably very abusive and the motives for promoting involuntary commitment are very dark indeed, a legal way to continue abusing an adult who has tried to escape.
  And keep in mind that many people who have been in a mental hospital found it to be further abuse.
  Or did all those mental health workers lie to me about mental patients and their toxic families?
 
Clinically, I've seen all combinations.  I've seen people with really dysfunctional families and very sad histories that have included horrible losses and abuse, who have turned into very functional, loving, and productive adults.  I've seen people who have been raised by wonderful parents have serious mental illnesses, and I've seen people with awful family lives who have been come seriously mentally ill.  It's often hard to sort out the role of genes versus environment, because often the dysfunctional and abusive parents also suffered from mental illness.   People differ with their individual sensitivities to what has been sad and done to them -- some feel injured by parents who seem to have good intentions but sometimes say the wrong things, and others have no problem dismissing what sounds to be flagrant abuse.  Certainly, objectively traumatic events color who people become and how they react to the world.  But does childhood trauma cause psychotic disorders?

What do our readers think? 

30 comments:

Blogotic said...

My visceral reaction to the abuse hypothesis of psychosis is no. From what I know about psychosis, it's a brain-based disorder.

But it's an overreaction on my part. After all, there are brain-based disorders that are affected or even caused by trauma. People with dissociative disorders have neurological differences from a typical person; people with DID may have different fMRI signatures depending on the identity. Why is it so hard for me to believe that psychosis can be caused by trauma?

It shouldn't be. There are several abstracts on Google Scholar that suggest that trauma is a causative factor in psychosis. Okay, but couldn't that be PTSD-related hallucinations and delusions?

I don't think that there's enough research. I definitely don't think that someone without a predisposition to psychosis will develop psychosis at all.

I don't personally know anyone with psychosis, let alone several. My only hospital experiences have been on pediatric wards, as I am under eighteen, and the psychosis rates are in my experience very low there. So I don't have anecdotal evidence either way.

Also, unless there is another part of the second letter/email/comment that you haven't published, I don't see any mention of psychosis besides the mention of children with bipolar or schizophrenia. Does the writer mention psychosis as the illness caused besides that? Certain personality, mood, and anxiety disorders can be more debilitating than some cases of psychotic disorders, and can be caused by trauma/abuse.

There are most likely some parents who label their children as mentally ill to avoid legal action. I can't imagine that there are very many- it seems like it would be so, so hard to convince doctors of a psychiatric illness when there isn't one besides what came directly from trauma. Approval for hospitalization, which seems to be a popular measure of the severity of a child's psychiatric illness, is very difficult to get even when your child actually has a psychotic disorder. I'm talking being discharged from the ER while making threats to harm the child's brother difficult. I am, of course, talking about me.

In summary: I am biased against the idea of psychosis being caused by abuse, but there is some evidence for it; I don't have any evidence either way; I'm not sure that the writer was talking about psychosis in particular; and it's really hard to get treatment for a child's nonexistent psychiatric disorder. This might be slightly incoherent- if anything isn't clear then just ask me!

Also, thanks for this blog. It's a great way for me- and probably many others- to learn about psychiatry from the doctor's side.

Anonymous said...

Although I suspect Dr. Allen and I don't agree on much, in this area I think we are on the same page. I am with LW2. When I was an inpatient on an adolescent ward, literally every other patient I spoke to identified their extremely chaotic/messed up/invalidating/abusive family environment as their primary problem. Usually they had tried to tell those in the "helping" profession about it which only invited more abuse. When you're an adolescent psych patient it's made VERY CLEAR to you whose side the doctor is on (hint: not yours). Nothing bad ever happens that's the parent(s)'s fault, up to and including driving you mad.

Stephanie King said...

Aren't some mental illnesses like PTSD and DID caused exclusively by trauma? I always heard that schizophrenia, bipolar etc. we're biological in basis and genetic. I know that sometimes a traumatic event can trigger the onset of an illness like schizophrenia that might have otherwise remained dormant. I have been diagnosed with Schizoaffective for 15 years and I come from a loving and supportive family. My case was one of genetics in my opinion.

Susan Inman said...

As the person who posted the link to SAMHSA's troubling document, I'm glad to see relevant issues discussed here.

I hadn't realized that some mainstream psychiatrists believe that abusive parents can cause schizophrenia and bipolar disorder. The Canadian Psychiatric Association writes explicitly in one of its educational documents that: "Schizophrenia is not caused by poor parenting." http://www.cpa-apc.org/roadtorecovery/en/ p.2

One of the positive things that has happened in the wake of our younger daughter developing a schizoaffective disorder, is that we have met so many inspiring parents. These parents have managed to deal with an often hostile mental health system and get the treatments that have helped their sons and daughter learn about their disorders and how to manage them. We have been very fortunate in the past ten years that our daughter's psychiatrist, a Canadian expert in schizophrenia, was willing to have a very collaborative relationship with us. This has enabled our daughter, who had a two year psychotic episode before an effective dose of an effective medication was found, to go on to build a stable life that she enjoys. Like many people with schizophrenia, she struggles with predictable cognitive losses, the kinds of losses that NIMH funding now investigates.

I write about mental health policy issues from the perspective of family caregivers. Here's a link to an archive of some of these articles:

www.huffingtonpost.ca/susan-inman/

My most recent article suggests that an unexplored research topic is the damage that unjustified family blaming does to people with psychotic illnesses and to the families who are trying to help them.

Steven Reidbord MD said...

I like how you presented this topic, Dinah. The stress-diathesis model is hard to escape. That is, a predisposition ("diathesis", possibly genetic) plus stress (environment) leads to illness or disease. The relative contributions vary. Studies of identical twins raised apart suggest that schizophrenia is roughly half genetic; we don't know where the other half comes from. There are clearly genetic contributions to bipolar disorder as well, and even disorders (and features) we think of as "personality." It's a false dichotomy to think nature VERSUS nurture; it's both.

Susan Inman said...

NIMH discuss the causes of schizophrenia this way:

"In addition, it probably takes more than genes to cause the disorder. Scientists think interactions between genes and the environment are necessary for schizophrenia to develop. Many environmental factors may be involved, such as exposure to viruses or malnutrition before birth, problems during birth, and other not yet known psychosocial factors."
http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

I'm not sure why others equate all environmental factors with "nurture" since NIMH doesn't.

Susan Inman said...

NIMH discuss the causes of schizophrenia this way:

"In addition, it probably takes more than genes to cause the disorder. Scientists think interactions between genes and the environment are necessary for schizophrenia to develop. Many environmental factors may be involved, such as exposure to viruses or malnutrition before birth, problems during birth, and other not yet known psychosocial factors."
http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

I'm not sure why others equate all environmental factors with "nurture" since NIMH doesn't.

Anonymous said...

I think it's probably a mix of nature and nurture. I also think that just because parents love their children doesn't mean there is the healthiest of family dynamics going on in that family. The unhealthy family stuff can have a negative impact, even if unintended.

For example, from time to time I run across family members talking about their adult children with mental illness who seem quite controlling. (Not all, but a few). I don't doubt that those parents love their children, but they may not know how to listen and communicate well with their child. I find myself thinking how relieved I am that those aren't my parents, because I know that approach would drive me away.

I don't think blaming it all on parents is helpful, nor is refusing to acknowledge that even loving families can have all kinds of dysfunction going on that is negatively impacting members of that family.

Pseudo-Kristen

Steven Reidbord MD said...

@Susan Inman,
The debate, false in my opinion, between genetic and environmental causes of illness is often called "nature versus nurture." This doesn't mean parental nurturing literally, and I didn't mean it that way in my post. I agree with the NIMH statement you quoted, and apologize for any confusion. You should note, however, that even that statement allows for "not yet known psychosocial factors." Thankfully, this is a far cry from the "schizophrenogenic mother," from a dark period in psychoanalysis' past.

I just scanned through the SAMHSA booklet you criticize (linked in Dinah's post). Honestly, I don't understand your objection. There is not one word about the cause of any mental illness. Much of it is directed toward substance abuse, and unless I missed it, schizophrenia isn't even mentioned. The booklet says that family therapy can help patients and their families communicate better. This would be true even if the original problem were completely due to genetics, as Huntington's Chorea is. And it happens that in the case of schizophrenia, studies have associated "high expressed affect" in families with increased symptoms. This doesn't mean family dynamics caused the problem in the first place. But it's a great example of how family therapy could be helpful.

Susan Inman said...

Steven, I appreciate your comments.

Here's a link to research finding a genetic link between epilepsy and schizophrenia; epilepsy is another illness that appears to be related to genetic factors and some unknown environmental/psychosocial factors:

http://psychcentral.com/news/2011/09/20/genetic-link-between-epilepsy-and-schizophrenia/29598.html

However, families with a child who develops epilepsy aren't assumed to be in need of family therapy. Why would some assume this is necessary for families dealing with schizophrenia? And family systems therapy, as it is frequently practiced, is often still steeped in the parent blaming you refer to. What there is evidence about, from a 4 year U. of Maryland study, is the value of NAMI's Family to Family psych-ed program. I believe that, as with other severe illnesses, families need and deserve education and support as they take on these daunting challenges. One unnecessary difficulty they face is the inadequate education of many mental health professionals who have never received any science based curriculum on psychotic disorders. Parent blaming remains rampant in the delivery of mental health services.

Parent blaming is also rampant in the education that peers keep receiving from various workshops; since no national consumer organizations recognize that schizophrenia and bipolar disorder are brain disorders and since many leaders of these groups seemed to have had abusive parents, I often read parent blaming comments from peers who appear to have jobs within the mental health system. At the same time, I've heard from families at NAMI conventions that their vulnerable son or daughter became involved in a peer group and then decided that the parents had done something horrible even if the person didn't know what it was….

Re high EE research:
I thought this had been debunked but it seems to again be flourishing. I wonder about factors that could be influencing the outcomes that link high EE to relapse:
> Everyone does better in warm supportive environments but it's pretty hard for families to be supportive when their son or daughter may have learned nothing about their illness except in rare appointments from their psychiatrist. This education is usually left to the family to provide which is too much to ask of them.
> You must know this research, and was it clear that high EE wasn't stemming from re-emerging psychosis? Most families I know in Vancouver, where our children have had great psych-ed, have very positive relationships with their sons and daughters…..until meds need adjustment, or stop working, or street drugs enter the picture. When the person is unwell, I'm sure these families' quantity of EE rapidly increases.
> We have such poor public education about psychotic disorders (thanks to SAMHSA) and many families have received no education about these illnesses. I can imagine that it can be very stressful to watch a son or daughter, who may no longer be psychotic, but who creates tremendous physical chaos in the home. If these parents knew about the predictable cognitive losses associated with schizophrenia (and increasingly with bipolar according to some research I just saw), they might be much more understanding and their EE would dwindle.

Are we assuming that these family therapists are well trained about schizophrenia? They certainly wouldn't be in British Columbia.

Steven Reidbord MD said...

Susan,

If you enter "epilepsy 'family therapy'" into Google Scholar, over 7000 citations are returned, 600 within the past year. Not all are pertinent, but a quick scan shows that many advocate family therapy, especially for adolescent patients with epilepsy.

The high-EE findings are old, perhaps they've been refuted. Regardless, family therapy can be helpful — not "needed" — for patients with schizophrenia, epilepsy, and other chronic illnesses, especially those with social stigma or behavioral dyscontrol. Avoiding blame, not finger-pointing, is central to professional family therapy. Peer groups are another thing entirely. I confess that I don't know anything about SAMHSA; I imagine they must anger you for reasons other than this innocuous little booklet.

That's all from me on this thread. However, I'm coincidentally in the middle of writing a post that's closely related, to appear soon on a blogroll near you.

Borderline said...

I think mental illness can be used as a cover for bad parenting. It's never the parent. It's always the illness. I agree with the one Anon that people in helping professions make it very clear to minor psych patients that they work for the parent.

I don't remember where this was, but I remember an NP commenting a long time ago on some site that she couldn't figure out why some kids would be diagnosed bipolar and some not. They had the same kind of symptoms and she wouldn't have diagnosed bipolar (there weren't too many kids that she actually thought had bipolar). But then she noticed a correlation between the diagnosis and how upset the parents were. The more upset, frustrated, and generally uncomfortable the parents were with the child, the more likely the child was going to be diagnosed bipolar. I just thought that was interesting that parents could play such a role in diagnosis. Cuz what that NP is saying is that you can have two kids with identical symptoms, but what gives the kid a diagnosis of severe psychiatric disorder is actually the behavior of the parents/

Parents do play a role

nature or nurture said...

I'm the person who was quoted in the article saying that I've been told many times that people with serious mental illness very often come from abusive families. It's fascinating to me that I have been told by virtually all mental health providers through the years (mostly psychiatrists) that it's a major factor, but here, several folks don't think it is. ??? This is over decades, multiple states, many different psychiatrists. Was I being lied to, or what? Perhaps I remember wrong.

Anonymous said...

yes I do believe trauma can reorganize a developing brain and introduce trauma hormone reactions that incite fight or flight reactions leading to increasingly widely oscillating behaviours secondary to the primary traumatic injury.
Of course the traumatic injury is a contributing cause but there is an underlying disease process which I believe is triggered by the trauma. One incites the other just like many organic medical conditions present in the population.
Once we used lead paint and the intellectual and behavioural damage done was environmental contamination leading to poisoning of the body as a whole.
I believe violent childhood trauma is the lead paint, the effects of the lead on the developing brain cause severe damage leading to behaviour we label as mental illness, mental deficits, inability to participate as a responsible adult with rights.
I don't believe illness happens in a vacuum. There are many pathways which start, expand and flame the fires which is why treatment is complicated and requires a team of specialists and not just one psychiatrist visit a month for med day.
If mental illness was actually considered an illness as damaging as cancer or heart disease we would see it being funded, researched and treated as such. Instead we have no treatment and an overwhelming amount of drug research that has shown over and over again that the drugs we have dont work, have never worked and in fact are killing the very people they are supposed to be helping. Until psychiatry moves out of the 1940's and and grows up as a profession and kicks big Pharma out nothing is going to change, remember there are still psychiatrists who believe Freud wasn't a drug addicted charlatan bilking rich old women but some kind of scientist whose obsession with sex which was obvious puerile self interest is still applauded as insightful commentary on the emotional maturation of the male of the species, Freud of course believing women were incapable of maturation of any kind. There hasn't been any new movement in thought in psychiatry itself in fifty years but their love of mixing and matching dangerous but useless medications has certainly become what they consider scientific thought, not their thinking of course, a chemists who is telling psychiatry how to think. How does an entire subset of the medical profession miss the irony in having to be told how to think by a drug company so they can then teach their patients how to think about their new disease label which they just happen to have the perfect new drug for.......
If the rest of the medical community tried this bs they would be defrocked and bounced out of the profession and back onto their coach with the snake oil sign.

Anonymous said...

I'm in an incest survivor group, and there are many psychological issues that we all share at our core (PTSD/anxiety/depression). Then some of us have our own "flare ups" that are uniquely ours -- dissociative disorders, addictions, etc. My unique trait with the group, primarily, is hallucinations. I have self-diagnosed as having complex PTSD with secondary psychosis. Do I think it was my family that is responsible? ABSOLUTELY! No question, whatsoever. The traumas endured are at the root of every symptom I have. And it's exactly why 2x week individual therapy, weekly group therapy & medications are now undoing much of that damage and restoring me to a better quality of life and minimizing the symptoms dramatically. The night terrors, panic attacks, general but constant anxiety/worries and negative self-talk have finally stopped.

And I have also noted that when I hear stories of "disturbed" people, my first thought goes to what form of abuse must they have endured in their lives to cause it. It's definitely not the last thing I could possibly imagine…

Anonymous said...

While I do believe family can play a huge role, I don't believe it does with everyone with mental illness. I have two siblings, and I am the only one who ended up in a psych hospital. My siblings, and I share the same parents. I am not comfortable with saying this is my parents fault, because in my case I don't believe it is. Sure, there were screwy family dynamics, but I come from a loving family. I had trauma outside of the family that my siblings did not have, so maybe that is part of it in my situation. I don't think I'll ever find a single cause. I think it's a bunch of things in my case- genetics perhaps, chaotic family situation, trauma from outside the family, punitive & scary religious indoctrination (watch the documentary Jesus Camp and you will get an idea of what I grew up with as it was similar), and so forth.

But, I really cannot look at where I ended up and say 25%, or 50% or 75% is my parents' fault. I just cannot do that. They were imperfect parents of an imperfect child. I realize with others who are dealing with incest and so forth that the family has a much larger impact on the outcome than in my case where there was not sexual abuse.

Still, because family can be part of the problem (and in some cases "the problem") I think we have to be very, very careful about giving families control over adult family members. As much as I love my parents we have very different ideas about autonomy and so forth. I would much rather my sister, who shares a belief system similar to my own, make decisions for me if I were unable to as she would respect my wishes.

Pseudo-Kristen

Anonymous said...

But Pseudo-Kristen, where were your parents when you were being traumatized by Jesus Camp, and the like? And I do know what you mean. I grew up in the town where Jesus Camp was filmed, and went through the exact same stuff. I get it. And it was a (of many) product of my family dynamics.

Anonymous said...

There are also situations where the otherwise loving, well-intentioned but totally misguided parents *exacerbate* their child's mental illness.

My baby sister and I come from a family with a long history of mental illness severe enough to necessitate a psychiatrist, meds and the odd in-patient stay starting in elementary school.

When we were falling apart, off to the doctor we went -- there was no shame, no hiding it, no refusing to medicate when warranted. No lying about it during hospitalizations. Timely and appropriate medical treatment saves lives. My sis and I are alive (and educated, mostly happy, etc) as a result.

I know way too many people with mental illness that presented in childhood who didn't make it -- in no small part due to shame/stigma/refusal to believe mental illness is "real", which translated to not getting any treatment for their mentally ill child til it was too late.

Anonymous said...

Anon, you're right ultimately my parents were responsible for taking me to that church. I'm not sure how aware they were of what was going on in the youth dept, but they should have been aware.

It's just complicated, I guess, because I know my parents love me even if they took me to a wacko church. And, I'm not sure that it was the church that sent me over the edge, but it probably didn't help much.

Pseudo-Kristen

Anonymous said...

Anon, you're right ultimately my parents were responsible for taking me to that church. I'm not sure how aware they were of what was going on in the youth dept, but they should have been aware.

It's just complicated, I guess, because I know my parents love me even if they took me to a wacko church. And, I'm not sure that it was the church that sent me over the edge, but it probably didn't help much.

Pseudo-Kristen

Patricia Jane said...

Are mental illnesses caused by bad parents? Frankly, I don't see any value at all in asking such a wide-sweeping, general question that can only lead to gross generalizations and harmful stereotypes. People with mental illnesses are a very diverse group of individuals and their families are just as diverse. We can't know the "cause" of any one individual's mental illness because science hasn't precisely identified the genetic/biological factors that predispose the individual to a mental illness, and we also don't know all the possible environmental triggers and how they interact. A competent psychiatrist or mental health therapist does not assume anything based on preconceived generalizations, but assesses each individual and prescribes an individualized treatment or therapeutic plan. The rest of us should also beware of making generalizations about this very diverse group based on examples from our own experience. If you spend a lot of time in a group where people with mental illness talk about having abusive parents, you might overlook the many other people with mental illness not in this group who say their parents were great and not at all abusive. If you go to a family education group, you are going to see a lot of committed parents willing to do the hard work of supporting their ill family member through thick and thin because these are the parents who show up at these groups, and you could overlook the abusive parents not in this group. Most of all, we should be wary of any mental health practitioner who generalizes about the parents of people with mental illnesses based on his or her own personal work experience -- that is hardly scientific research! The more valuable question for a person with mental illness and his or her family is: how helpful is it to you, personally, to search your past for possible "cause"? For some individuals, this might be helpful. For others, it might be a waste of time, or even harmful, and serve only to delay more effective treatment and therapeutic action.

Anonymous said...

I hate to hear that parents cause mental illness. However, some things are caused by dysfunctional family settings and I think all families live with some sort of reality in that.

I also believe that each generation has a chance to be better at parenting and stopping the family dynamics of say abuse, chemical dependency, sexual abuse, and so on.

I don't believe that we can control bipolar, depression, schizophrenia, or other such disorders... they are physical diseases.

PTSD is one diagnosis from trauma. Anxiety can also be an either or thing... but watch a baby..some are more anxious than others.

I would think it is both. But not always.

I also read about major infections like mono and herpes 1 causing the body to physically be more prone to mental illness... it would seem right because one of my children ended up with cold sores from my sister and she had problems early on.

I tried to address the issues as best as the mental health sytem would allow me to but the "blame the parent" thinking is well established in social services.

I have lived with depression, childhood sexual abuse, major physical abuse, and alcoholism... I became depressed in my early 20's as a young mom. Anxiety then came and next binge drinking. I also got sober at 23 and made many changes in my life. Counseling. Meds when needed etc. 12 Step groups and support.

I changed. I learned. But no matter what, I cannot control my depression by nurturing it away. I can address it, sometimes need medications, and other times not.

My PTSD is from trauma and again, I can address that, work with it, get counseling and I have not needed medications to deal with this ever.

The sexual and phsyical abuse I can also deal with. And learning that my parents/family did the best they could with what they had. I know that no matter what my parents were like,I would have been the same.

The only "problem" I have with my family was not believing me about being sexually molested. It didn't ruin my life but still...it would have been nice to have somone in my corner.

That is also why I try very hard to help my children. IT's not easy being a parent, but when you become one, it changes everything in how you look at the world.

My depression and PTSD have led to times of being suicidal and trying to do that. However, I do talk to my children as they are now adults about making a better system for the grandchildren. And we are all striving for that.

I think some mental health concerns are family/growing up related and then there are the others that are part of who we are like our eye color. Depression and alcoholism run deep in my family. I suspect that anxiety does as well. Those things I may have passed onto my children in the genes.

My general opinion is that a lot of parents have always gotten the bad wrap for CAUSING mental illness.

Trauma causes mental illness. Sick people hurt people. Hurt people hurt people. Abused people abuse people. Healed people reach out to help others. People addressing life on life's terms reach out to help too.

Being your own best advocate and educating yourself on YOURSELF, your needs, and your biology, that is important.

Anonymous said...

@ Patricia Jane - Of course there are all kinds of people with mental illness, from a wide variety of backgrounds and family systems. I think the point is, way, way, way too infrequently in society we are often blind, or at best reluctant, to go there. There isn't a national dialogue on child abuse despite staggering numbers of it occurring. Why is that? I think it's hard to dispute that abuse of children and the mental games they have to play to survive it can lead to mental health issues. It'd be hard for adults!

Anonymous said...

"how helpful is it to you, personally, to search your past for possible "cause"?

- Seriously? An end to the crazy-making of your past is the beginning of good future mental health. Abuse or no.

waltinseattle said...

""NECESSARY", SUFFICIENT" these words should be at the heart of it. There are a mixture of observations, but someone wants to "nail it down." somebody wants the world nice and simple, an easy map to follow when it goes off course. Tough! Its not that simple, all maps are imperfect and we need to recognize this from the start. The question posed shows that this is not recognized.

"Genetics, Epigenetics Nurture"...we see that nurture has already started when the cells adapt to the placental sack. So nurture begins almost a year before baby meets moms eyes. Durring that time not only nurturance, but changes in the gene setting, a process that diet and environment etc etc and ad infinitum will affect till death.

And someone wants that simple answer? YES and NO" and I stand by it!

Patricia Jane said...

@ Anonymous #1 & #2, the point I am making is that a competent psychiatrist or mental health therapist does not start with generalizations or assumptions that the individual client has had bad, abusive or "crazy making" parents. And also does not assume that they have not. A competent therapeutic/treatment plan is based on an individual's personal history and assessment, not on generalizations. With all this being said, I certainly do not want to dismiss the seriousness of child sexual abuse. Whether it causes mental illness in a particular individual or not, it is just plain wrong! I would support a national investigation, but the scope would have to go well beyond parents. Too often, sexual abusers are priests, ministers, scout leaders, choir masters, hockey coaches and other community leaders whom the parents believed in good faith they could trust. Could the parents have known and protected their child? Hindsight is 20/20, and many parents say in hindsight they wish they had seen signs they did not see at the time. Sexual abusers take great care not to be caught and institutionalized abuse, such as by churches or scouting organizations, is hidden behind massive cover-ups that go as high up in the hierarchy as the Pope. What precautions can the ordinary, well intentioned parent take? Public education about recognizing early signs of child abuse -- whatever the source -- and appropriate interventions would be helpful.

Patricia Jane said...

@Anonymous #2: "An end to the crazy-making of your past is the beginning of good future mental health. Abuse or no."

Sorry, but this is the kind of sweeping generalization that is not helpful. Many people with mental illness or mental health problems who do not have either abuse or "crazy making" behaviors in their past. Research shows that the causes of mental illness are a complex interaction of genetic/biological predisposition and environmental factors. The possible environmental factors for a person with schizophrenia, for example, go well beyond family relationships and include such possibilities as a virus when one's mother was pregnant or having an older father or being born in the winter months. Such possible environmental factors cannot be changed or ended by talking about them. That is why some people really do find it helpful to deal with their mental illness by focusing on the here and now and moving on to future recovery rather than spending a lot of time searching their past. So yes,really, a valuable question for a person with mental illness and his or her family is: how helpful is it to you, personally, to search your past for possible "cause"?

Joanne Isaacs said...

This is an intensely sensitive topic. As a forensic psychiatric nurse in Australia, my observations have been mixed, however a large percentage of chronically unwell people and people with substance use problems have, to our society's shame, been through unbearably traumatic childhoods involving ETOH, exposure to violence, sexual abuse, forced acts of incest, genetic predisposition to schizophrenia exacerbated by this abuse. Then there are siblings who have grown to adulthood in the same household as well adjusted adults, who can't even visit the unwell member of family for their own personal reasons. I wish I could turn back the clock for some of my patients. I do not blame them for their crimes committed. Our so called 'systems' failed. And continue to fail. I will work until I can work no longer to help my patients experience the best life that they possibly can.

Anonymous said...

@ Patricia Jane from Anon 2
The question was, can bad parenting cause a mental disorder. I believe that yes, it can. But what I'm really saying is why is this so taboo? It should be discussed so victims of abuse can best understand ALL root causes and begin their healing journey. It seems now the default is to hold the parents blameless.

Anonymous said...

"rather than spending a lot of time searching their past." If you've had a childhood of abuse, you need to search your past so you don't repeat abuse cycles. Many people don't go to therapy to talk about their abuse… they go because they are depressed or having relationship issues or struggling with addition or anxiety. If they don't understand their past, not that all root causes are 100% knowable, then they are destined to continue patterns that work against them being able to thrive in life. Also, abuse victims tend to minimize past abuse and hold their abusers blameless in favor of blaming themselves and altering the way they interact with others. They need to know how to live authentically, and they can't do that as easily if they don't understand their root trauma(s). We have surprisingly few abuse survivor groups relative to groups for additions, rape (adult), PTSD (veterans), etc… and in my opinion, too few diagnosis and treatments that fit the traumas that stem from inadequate and abusive childhood traumas.