Syndicated from the Bipolar Blog

I grew up in a household with mental illness in a parent. The illness was never fully identified or named, yet it decimated our family life. I was enormously relieved to realize, over time, what was going on in my family when I was growing up. It helped me understand my parent more and to tell my family story in a way that is less judgmental and critical and more compassionate – toward my parent with mental illness and toward me and my siblings and my other parent. As a professional and as someone who lived with this, I feel strongly about the need for honest, open communication in families when a parent is struggling with mental illness.

The battle to fight stigma in the outside world is important but can’t be done without first facing it at home.

Growing up with a parent with mental illness impacts children at many levels, but too often the effects on children and the children’s responses are pushed to the side. Sometimes there is simply no time or energy left in the family system after taking care of the parent who is struggling with mental illness. More often, it is simply too hard and too scary to deal with.

In my practice, I treat mostly children and adolescents – but in some situations I have also worked with the whole family – including a parent with mental illness. And even when I treat just the child, there is often mental illness in the family as well. The challenges to children in this setting grow from every facet of the illness – from the genetic vulnerability to illness to the affected parent’s emotional skills and availability throughout the child’s development; from drained financial resources to the non-affected parent’s exhaustion and grief; from instability and conflict in the home to stigma in the community and often extended family.

To manage the risk factors and mitigate potential difficulties, the first step is to identify the presence of the illness and put the problem on the table for discussion. Without taking this step, families talk in circles and euphemisms – such as “Mommy is having a tough time today” and “Daddy is just not feeling himself.” This limits opportunities to solve problems and deal directly with the full range of emotions.

Several factors may contribute to a family’s inability to take the first step of identifying and discussing the situation:

  • They don’t have a diagnosis yet. Without a name for what’s going on, they don’t know how to initiate a discussion. Often patients and their families have spent a long time looking for a diagnosis before it finally comes. They simply do not understand enough about what’s happening to discuss it.
  • They are too afraid to discover the truth. Patients and their loved ones may go for years watching symptoms grow worse and more painful, but they avoid getting help due to stigma and fear.
  • Patients or their loved ones lack insight. Insight is the ability to recognize that something is wrong. Sometimes patients just don’t see the symptoms and won’t seek help to get a diagnosis.

All of these situations create enormous difficulties for families trying to start a conversation about mental illness with their children.

In working with families who are trying to talk to their children about mental illness in a parent, I rely on two principles – transparency and developmental appropriateness. Transparency (openness) and honesty are essential for any conversation to work. Too much beating around the bush or “reframing” will not work – kids are perceptive, and they know when things aren’t right. Telling them that a parent is “tired” or “having a hard time” will fly for only a short period of time. If the symptoms of mental illness are impacting the family, then the fact that it is an illness and it is real needs to be clear.

Kids can spend a lot of time trying to figure out what they have done wrong to bring on the illness or what they should be doing to fix things. We need to be very clear with kids that they aren’t at fault and they aren’t going to be able to fix it.

Within transparency, though, is the necessity for using developmentally appropriate language and concepts. You will talk differently to a seven-year-old than you will to a teenager. The younger the child, the more general the discussion needs to be. Above all, parents want to practice listening to their children about this as much as talking to them about it. We want to make it safe for kids to ask any question they may have or express their own feelings about what is going on. A primary goal is to reduce stigma in the intimate family setting. The battle to fight stigma in the outside world is important but can’t be done without first facing it at home.

Understanding that the parent is not the enemy – but the illness is – changes things completely and evolves into a more helpful and therefore hopeful story.