Parental mental illness has a profound impact on children.

dad and baby
“All family members are affected by a loved one’s mental illness. The entire family system needs to be addressed. To assure us we are not to blame and the situation is not hopeless. To point us to people and places that can help our loved one. The impact still lingers on.”

Based on research with children and other family members, I’ll discuss the shared family burden, the special vulnerability of children, and the impact of parental mental illness on their early years, their legacy for adulthood, and their potential for a resilient response to this catastrophic family event. I’ll explore the needs and concerns of children, along with their coping resources and services. Finally, I’ll offer some suggestions.

Shared family burden

The disruptive force of mental illness is often referred to as a family burden. This burden has a subjective component, which consists of the emotional consequences of the illness for other family members, and an objective component, which consists of their everyday problems. At the core of the subjective burden is a powerful grieving process. Family members may mourn for the relative they have known and loved before the onset of the illness, for the anguish of their family, and for their own losses. One adult child wrote about “my loss of a healthy mother, a normal childhood, and a stable home.”

Another mentioned other losses: “I lost self-confidence. I lost a sense of knowing who I am, of what I wanted. I lost the ability to set my own agenda, to control my own life. I lost sight of my own needs. I lost the ability to care for myself properly. I feel out of sync with the normal developmental rhythms. I have been saddened in a chronic way.”

In addition to their subjective burden, family members are confronted with an objective burden — the daily problems and challenges that accompany the mental illness. Family members must learn to cope with symptoms of the illness, with caregiving responsibilities, with the limitations of the mental health system, and with social stigma.

This man describes the impact of his father’s mental illness on his own life:

“My father’s paranoid schizophrenia meant we moved frequently, because he felt the conspiracy was closing in on him. He battered my mother, because he felt she was part of the conspiracy. I was too frightened to go to her aid. I couldn’t have friendships with peers because my father felt they might ‘poison’ my mind against him.”

Special vulnerability of children

Young family members are especially vulnerable to disruptive or traumatic events such as the mental illness of a close relative. Compared with adults, children have more limited coping skills and strategies, are more dependent on the other people in their lives, and have fewer psychological defences. Moreover, early development accomplishments provide the foundation for later ones, and delays or disruptions in development may have long-term consequences, including a residue of “unfinished business” that reverberates through future years.

Our research with adult siblings and children suggest a significant relationship between age at the onset of a relative’s mental illness and its impact. In essence, the younger the family member, the greater the potential impact. Here is one child’s account:

“ I became the perfect child to spare my parents more grief. I was forced to become responsible. In many ways it forced me to accomplish things in my life I might not have otherwise done. But I have spent my life trying to run away from this problem. Feeling guilty and helpless, the unending sorrow for not being able to help. I have not felt entitled to be happy most of my adult life.”

Impact on childhood and adolescence

Mental illness has a pervasive impact on children during their early years. For example, young children may become enveloped in their parent’s psychotic system, with lasting consequences for their own lives:

“My mother has been sick practically my whole life. It is hard for me to decipher which of my experiences are ‘normal’ and which are not. I had many difficult times and often have a great deal of anxiety.”

As the illness consumes their family’s energy, young family members may feel that their own needs have been neglected or that they have grown up too quickly. Their family relationships are also affected, and children may assume a parent role that places heavy responsibilities on their immature shoulders. One adult child wrote: “I feel like I missed out on being a kid.”

Children may be subject to a “survivor’s syndrome” that exposes them to feelings of guilt for having been spared. In addition, there may be adverse effects on their academic life and peer relationships. For instance, children may experience a sense of social deviance, have difficulty straddling the different worlds inside and outside their family, and be reluctant to bring friends and dates to an unpredictable home environment. Some of these concerns are described by the following adult child:

“Very much of my young life was affected. I had trouble concentrating in school, was afraid Dad would appear at the school grounds when he was sick. I could not bring any school friends home for fear that they would not understand. Mom was busy working full time to make ends meet. Not much time was spent helping me get prepared for school.”

Legacy for adulthood

Even after they have left home, children carry a legacy that permeates all the crawl spaces of their adult lives. This legacy has personal, interpersonal, occupational, and family components. Their personal legacy colors their feelings about themselves, and they may experience problems with identity and self-esteem that leave them unsure of themselves and uneasily dependent on the approval of others. They may also develop an excessive need for perfectionism and control to compensate for their chaotic and unpredictable family situation. Often they have concerns about their own mental health:

“As a child, I tried desperately never to have a problem because our family had so many. So I became perfectionistic and hid my fears, concerns, and needs from everyone. On the outside, I always appeared strong, self-assured, and able to handle anything. But I developed a lot of shame, felt that I was going crazy too. I always had tremendous anxiety that someday, somebody would find out that I was a fraud.”

Their interpersonal legacy imprints their adult relationships. Possible problems include feelings of social alienation and isolation, difficulty with trust and intimacy, inappropriate continuation of a caregiving role in close relationships, and reluctance to make a long-term commitment. Some of these problems were experienced by this multigenerational family member (someone who has both a sibling and a parent with mental illness):

“I have spent the last 25 years trying to find confidence, love and acceptance. I am extremely sensitive and weep easily. I avoid intimacy but crave it desperately. I want more friends but fear to trust.”

The occupational legacy of children often influences their career plans. In our research, many participants told us they had been drawn to a career as a professional caregiver in the fields of mental health, health care, or education, which offers a familiar and satisfying role. Others may flee from such a career to avoid experiences that echo their painful past.

Their family legacy has many elements. Adult children may enter an early marriage to escape their troubled family or may delay or avoid marriage in light of their unresolved issues. When they do marry, children may worry about the mental health of their own children and are likely to struggle to balance their commitments to their own families. Almost universally children worry about their caregiving responsibilities for their parent. Here are the words of one woman:

“When I was 18, I became my mother’s caretaker. My mother lived with me until she died. I married, had children, and took care of Mother throughout my whole life. That placed our family under severe emotional stress. Every stressful life experience precipitated a crisis in which Mother’s hallucinations or delusions were exacerbated.”

Risks and resilience

Certainly, parental mental illness is a catastrophic event for their children. In addition to the family burden, children are at risk for a traumatic reaction that causes intense emotional and physical distress or even for a posttraumatic reaction that persists for many months or years. Posttraumatic symptoms may include heightened fears and anxieties, recurrent images or thoughts, intrusive flashbacks, emotional numbing or constriction, loss of interest in normal activities, and withdrawal from other people.

Aside from these risks, however, it is also clear that children have the potential for a resilient response to this tragic family event. Resilience is the ability to rebound from adversity and to prevail over the circumstances of our lives. In the words of one family member, “I can now say that, like that old aluminium foil ad, I am ‘oven-tempered’ for flexible strength.”

We found evidence of resilience in our own research. A large majority (86%) of our participants reported some positive consequences as a result of the mental illness in their families. Adult children told us they had become better and stronger people. They described greater empathy and compassion more tolerance and understanding, healthier attitudes and priorities, and greater appreciation of life.

Resilience comes at a high price, however, and is usually accompanied by intense feelings of anguish and loss, as the following family members attests:

“My adolescent years were filled with a hollow dread. I felt somehow that I was responsible. I felt incredibly angry, resentful toward my mother, unable to escape and very guilty. Gradually I have come to see my mother’s mental illness as just one part of my life. I have my life, dreams, and goals. Her illness has caused me to develop tremendous strength, discipline and personal stability.”

Needs and concerns of offspring

In our research we asked adult siblings and children to rate the relative importance of various needs during their childhood, adolescence and adulthood. At each developmental phase, they share three central needs with other members of their family. First, children need information about mental illness and its meaning for their family. In the words of one adult child, “Knowledge has kept me from the depths of hopelessness.” This knowledge also facilitates the process of “naming and taming” and illness that is often incomprehensible and frightening to family members.

Second, children need skills to cope with the mental illness and with its impact on their own lives. For example, they need to learn to deal with the symptoms of their parent’s illness and with their own anxiety and stress. Third, children need support for themselves. As one family member remarked, “The isolation was profound.” Potential support is available from family and friends, from professionals and other service providers and from NAMI (formerly the National Alliance for the Mentally Ill). This adult child offers some suggestions for meeting these needs:

“Make sure children are informed that this illness is an illness that has a name and that many people have. It has nothing to do with their actions or their parents’ displeasure with them. There are treatments and medication for it, just like a heart problem. Tell them what behaviours they can expect and what to do and say if those behaviours are exhibited. Encourage them to discuss it.”

In addition to their needs for information, skills, and support, many offspring face a special challenge–to recognize that their needs and desires matter. So often they deny or minimize their own needs in their effort to meet the needs of their family:

“I am just learning, at age 49, that I can be me. I have only just begun to identify what I want and who I really am. I adapted my behaviour at home totally in the interest of keeping the equilibrium in the family. I felt responsible for making everyone happy. I took on emotions of others as something I had to fix. I developed a pattern of putting others before myself, lost my identity in relationships.”

Adult siblings and children share many other concerns. The following were cited most frequently in our research:

  • concern about caregiving for their relative (94% experienced this concern at least sometimes)
  • family disruption (83%)
  • difficulty balancing personal and family needs (81%)
  • a sense that their own needs had not been met (79%)
  • feelings of helplessness and hopelessness (75%)
  • poor self-esteem (75%)
  • guilt feelings (74%)
  • psychic numbing (70%)
  • problems trusting (69%)
  • problems with intimacy (69%)>
  • a sense of growing up too fast (67%)
  • personal depression (66%)

Coping resources

We also explored the coping resources of adult siblings and children, asking them to rate the relative value of various resources during their childhood, adolescence, and adulthood. Resources included their personal qualities; their family; their friends; NAMI: a support group for adult siblings and children; mental health professionals; clergy; and unique resources, such as creative activity.

Based on average ratings, our participants evaluated no resource as “helpful” during the first 10 years of their lives. In fact, when we examined the overall availability of resources during the three developmental phases, we found that children had the fewest resources available to them. Thus, during their period of greatest need, offspring have limited resources to assist them in coping with this cataclysmic event. In the words of one family member, “I don’t think anything has helped.”

As adolescents they found just their personal qualities helpful. Only as adults do they benefit from other coping resources. Nevertheless, in spite of their struggle, ultimately most offspring do adapt to the mental illness in their family, often developing impressive qualities along the way:

“I feel that being a concerned family member has helped me become a better person in many ways. I learned to become self-sufficient at an early age. I am gratified that I helped my mother. I am a person who enjoys being alive, despite having had the trauma of an adolescence with a severely mentally ill parent.”

Diane T. Marsh, PhD, is a Professor of Psychology at the University of Pittsburgh at Greensburg, PA.

This article originally appeared in Family Connections (Spring 2000), published by the BC Council for Families.