The painful legacy of untreated or under-treated mental illness

Shadow outline of a person and a child. The person is holding the child's hand.

When I write about the deplorable state of our mental healthcare system, I often draw attention to a clinician’s responsibility to care for the whole person – not just their symptoms, but also their functioning and quality of life – and to consider those closest to them: their families, other loved-ones or caregivers.

When I work with my own patients, I ask if I can include their loved-ones in their care because we know this heightens engagement and treatment adherence, supporting recovery. However, when a patient also happens to be a parent, the loved-ones who are often left out of the conversation, but can be profoundly impacted by my involvement, are their children. In fact, about one in five children has at least one parent with a mental illness.

We know, unequivocally, that childhood physical, sexual or emotional abuse can have a profoundly negative impact on a child’s development and heighten their risk of developing a mental illness. What is less well known is that childhood neglect and chaos can also be a risk factor for mental illness and may have an enduring negative impact on functioning and wellbeing.  

As a psychiatrist, I care for patients with severe mental illnesses and most are also parents. It’s important to state, unambiguously, that having a mental illness does not mean you can’t be a competent, loving, nurturing parent. In fact, when you consider that by age 40, 50% of adults have had a mental illness, that suggests a good percentage of the best parents in the world also have, or have had, a mental illness. However, every mental illness can impair functioning in any realm of life: at work, school or home. This means mental illnesses, especially when acute and severe, can impact the ability to parent optimally. 

The impact of mental illness in the family

With poor access to high-quality mental healthcare, too many people are living with untreated or under-treated mental illness, leading to greater symptom severity, more impaired functioning and higher rates of relapse and recurrence. Studies have demonstrated the association between growing up with an untreated or under-treated parent with a mental illness and emotional and behavioral difficulties, which can reduce vocational achievement, overall well-being and life satisfaction. 

Childhood chaos and neglect may lead to family estrangement, as children become teenagers and young adults. These negative early life experiences can also create challenges when young people attempt to form trusting relationships, whether with friends, colleagues or intimate partners. In some cases, early life trauma and chaos can ultimately lead to personality pathology, such as borderline personality disorder, which is associated with severe emotional instability and profoundly impacts the ability to form stable relationships. 

Adults who grew up in chaos might be unaware of the long-term repercussions of their parent’s mental illness. Making the connection with their own adult challenges can be difficult, because they might reflect on their childhood as being “normal”, at least for them. Commonly, I hear, “That’s just how it was at our house”, “We just coped with it- what other choice did we have?”, or, “We weren’t being beaten, so it wasn’t so bad. She just wasn’t present”. 

Importantly, when adults exposed to childhood chaos, neglect or abuse eventually have their own children, they may experience even more emotional turmoil. As they learn how difficult parenting can be, they might develop empathy for their own parent. At the same time, they might feel a profound responsibility to protect and nurture their own child and contrast that with their parent’s inability to protect and nurture them, triggering painful memories and distress.

While they might eventually understand their parent’s struggle with mental illness and lack of access to appropriate care, adults sometimes struggle to understand why those who could have stepped up to provide additional support did not. Whether it’s their other parent, another family member, a friend, or doctor, defensiveness and conflict can arise with confrontation, as they grapple with their own inaction, or even complicity.

Moving forward is possible

Long-term negative effects aren’t a certainty. There are many protective factors that reduce the risk of a child experiencing negative repercussions related to their parent’s illness:  illness severity, their parent’s ability to cope with their illness, the family’s mental health literacy, and social support, which is critical for building emotional resilience. These factors are influenced significantly by access to appropriate mental healthcare.

Many adults have been able to survive and thrive, despite difficult childhoods, by shifting their focus away from the painful aspects and towards their parent’s gifts, some of which they might share. Perhaps their parent is curious, brave, creative or compassionate. Through the eyes of an adult, who recognizes the challenges of adult life, parenting and mental illness, edges can be softened, compassion can grow, and forgiveness can follow. 

If you’ve had an unstable childhood and you’re still struggling, finding a skilled therapist can be extremely helpful. The right therapist can validate your feelings, build understanding and help you to realize that you’re not responsible for your parent’s behaviour, which is a common belief of those raised in chaotic households. I often hear, “Maybe I deserved it,” or “Maybe I wasn’t worth being nurtured”, from adults who had to sublimate their needs in a household where their mentally ill parent required so much of the family’s attention.  

Critically, you are not your parent and your child is not you. As simple as that sounds, most of us struggle to varying degrees with that concept. Integrating that belief can be freeing, because it allows you to be you and your children to be themselves, without bearing the weight of your past experiences.

It's time to address the collateral damage

From a system perspective, the need to care for the whole patient, to engage their family, and to assess and support their ability to care for themselves and others, especially their children, is often lost under the weight of our overwhelmed mental healthcare system. We need innovative solutions that support clinicians to be more effective, giving them the tools they need to make an accurate diagnosis and provide the right treatment. This should give clinicians the time to support their patient beyond their symptoms and to find compassion in their care delivery.

The impact of our broken mental healthcare system goes far beyond the harm done to individuals who are waiting too long for care or never receive appropriate care. Behind every person diagnosed with a mental illness are the people who love and support them. The ripple effects on families, friends and workmates can be profound and add to the burden of mental illness, needlessly amplifying and prolonging suffering.

Overcoming long-standing, painful emotions, and especially the fear of similarly affecting your own children, can sometimes feel overwhelming and hopeless. However, there is always a path ahead. We can’t change the past, but it is possible to overcome the power that negative childhood experiences continue to exert, build resilience and self-confidence as an adult, partner and parent, and gain equanimity.

This blog post is part of a series looking at the state of our mental healthcare system and ways we can create sustainable change to improve quality and outcomes for anyone impacted by mental illness. 

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