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Infants
of Parents with Mental IIlness Edited
by
Anne
Sved Williams Vicki
Cowling
During
the last 100 years infant mortality rates have improved dramatically,
yet even in a developed country such as Australia the physical health
of infants varies greatly, despite advances in science and technology.
It has now become clear that emotional and physical development is
affected by many different variables. Not only must physical development
and health support be adequate, but the presence of factors such as
good-enough parenting, and the absence of others such as substance
abuse and domestic violence, are now becoming better understood. So
how best to work with families where infants are at risk? This is the
substance of this book: to understand how to achieve improved outcomes
for infants growing up in situations of risk, mainly in the area of
the parents’s mental health, but also in other related psychosocial
circumstances that may impair parental functioning. These include migration,
substance abuse, and infant hospitalisation.
Throughout this book, the authors examine the effects of adverse life
circumstances on infant and family and, in most cases, also describe assessments and interventions. Several
chapters have been written by people personally
affected by mental illness, or mental illness of a family member. This
provides in-depth and often poignant understanding of the perspective
of those living with the effects of such illnesses, and helps to expand
our knowledge and skills to work with at-risk families.
About the Editors Vicki
Cowling, OAM, is an advocate for children
of parents with a mental illness and their families, and has contributed
to research, service development, professional education, and publications
including editing two books concerning children of parents with mental
illness (1999, 2004). Partnerships with consumers, carers and family
members are integral to this work. Vicki is a member of the Reference
Group for the National Children of Parents with a Mental Illness (COPMI)
Initiative.
Dr
Anne Sved Williams is the Director, Perinatal and Infant Mental Health Services, Children,
Youth and Women’s Health Services, South Australia and Clinical
Senior Lecturer in Psychiatry, University of Adelaide. Anne trained
in family therapy at the Ackerman Institute in New York, and in psychiatry. Her major work foci have included perinatal
and infant psychiatry particularly as a trainer, general practitioner
training and support systems in psychiatry. REVIEW by Nick Kowalenko in Australasian
Psychiatry, June 2009 REVIEW by Beth Macgregor in AAIMHI Newsletter March 2009
Groan. That's what I did when I remembered that I had agreed to review Infants
of Parents with Mental Illness: Developmental, Clinical, Cultural
and Personal Perspectives for this AAIMHI Newsletter. It had
seemed like such a good idea when I volunteered last year. But now
- at the end of summer, when the sky is blue, the weather is warm
and the beach beckons - it seemed like a dumb thing to do.
Then I opened the book. And I couldn't put it down. While the title lead
me to think I would find dry material, what I found was a book rich
with insight, fascinating research, stories and thought-provoking material.
Broken into seven sections, Infants of Parents with Mental Illness examines
the effects of a person's mental illness on their experience of being
a parent, and on their infants' experience and development But it doesn't
stop there - the book deeply examines the question of how best to assess
the needs of these families, and how to work with them to improve outcomes
for infants And while the bulk of the material does relate to families
where parents have a mental illness, It also considers other related
psychosocial circumstances that may impair parental functioning, such
as drug and alcohol abuse, domestic violence, and trauma due to mandatory
detention.
The book's seven sections are:
1. In the beginning, which examines the perinatal period, including anxiety
and depression that can arise at this time
2. Assessing the situation, which considers how to assess attachment
disorganisation, parents' protective capacity, and also provides a
child protection perspective on high-risk infant assessments.
3 Fathers, which looks at the experiences of partners of mothers
with a mental illness, and the importance of including fathers in the
assessment and treatment process.
4. Personal perspectives, which tell the stories of the experiences
of grandmothers of infants whose parents have a mental illness, mothers
who have a mental illness, and adults who grew up with parents with
a mental illness
5 Political and cultural influences, which examines
the needs of Aboriginal children and their families, as well as children
in refugee and asylum-seeking families.
6 Working with infants and their parents with specific disorders, including
parents with schizophrenia, borderline personality disorder, parents
who misuse drugs. and those in a mother-baby inpatient unit
7. Working with infants and their families in particular settings, including
sick babies in a paediatric hospital setting. and working with infants
and their parents with mental illness in childcare settings.
Each chapter is written by a different expert, and the authors come from
a variety of disciplines and backgrounds, including psychiatry, social
work, occupational therapy, psychotherapy, early childhood education,
nursing, infant mental health and child protection. This rich array
of contributors helps create a book with diverse appeal.
Almost all of the chapters pay attention to the issues of assessment and
intervention, and make use of case studies to bring these topics to
life. This intertwining of research and theory with detailed vignettes
is one of the factors which make this book so absorbing.
It would be impossible in this short review to highlight the key ideas
in this book, because each chapter has its own specific focus and the
book covers such a wide range of topics. However. I can offer some
bite-sized samples.
In Chapter 1, Increasing knowledge, increasing /lope for infants?, Anne
Sved Williams provides a clear and succinct account of the basis of
emotional health for infants, explaining how 'Those parents who can
sensitively tune into their infants and better provide them with relief
from stress will help those infants' brain growth and the associated
external signs: more exploration, enhanced learning, calmer behaviour
and better coping mechanisms when anxious' (p. 5).
In Chapter 4, More than a question of safety: Assessing attachment
disorganisation and protective capacity in highrisk parent-infant
dyads, Jennifer E Mcintosh addresses the question: 'Do we have
a biological right to parent our own children?' She says 'It has
taken the sobering force of neurobiological evidence to confirm the
enduring neurological trauma done to a young child who is not permitted
a responsive, intimate, protecting relationship with a caring adult
This implies an imperative for preference of attachment above biology
in the developmental health of the young child' (p. 49). She provides
a powerful and coherent argument for 'legislative efforts to uphold
the right of the child to early psychological security within an
organised and continuous attachment relationship' (p. 61)
In Chapter 12, Children are our future. Understanding the needs of
Aboriginal children and their families, Helen Milroy explains
how understanding cultural frameworks
can greatly assist better outcomes for Aboriginal families, and explains
how the Aboriginal view of health is 'holistic and interconnected
with mind. body, spirit and nature in balance' (p. 125). She also
gives a fascinating account of Aboriginal Family Systems, and explains
why 'From a clinical perspective, it is important to map the family's
kinship system as this will establish the broader nature of attachment
relationships and what roles others play in the family system' (p.
128).
In Chapter 13, Infants in
refugee and asylum-seeker families, Sarah Mares and Rosalind Powrie
explore the developmental risk and protective factors impacting on
infants and young children in families who, as a result of forced migration,
seek refuge or asylum in countries other than their own. They explain
how 'culture influences the expression of distress and illness and
the way it is explained, 'labelled' and treated. and the acceptability
and efficacy of treatment' (p. 144). They suggest that questions such
as 'What do you call the problem. why is it happening and what do you
think caused it?' help to elicit an explanation of symptoms in a way
which can help practitioners understand a client's mental health problem
from within a cultural perspective. They also explain that, when doing
assessments with refugee families, 'A skilful balance is needed to
allow parents to tell their story. without retraumatising them, while
focusing on issues relevant to parenting and their children' (p. 151).
This chapter also gives a heart-wrenching account of the impact of
Australia's detention policies on families and children.
Another factor which makes
this book unique is the stories of people personally affected by mental
illness, or the mental illness of a family member. The chapters written
by these people provide a poignant, and at times painful, glimpse into
the realities of being a parent with a mental illness. One mother,
Nichole, wrote with brutal honesty about the effects of her illness
on her children: 'From the time my eldest son was born, I slowly replaced
his unconditional love with fear, sadness, anger and confusion ...The
reality of my life soon became his life, complete with all of the obvious
damage that I alone would cause in times of madness and confusion,
which lead to the emotional abuse and neglect of my children. Today,
I am still a witness to the devastating effects that my life and my
illness has had on my children, and for all they have had to endure'
(p. 110). While Nichole's journey ends on a positive note - 'I am proud
of the person that I am now The wisdom and the insight that I have
gained and experienced through my journey has given me the confidence
to be able to help. sympathise and assist other people living with
a mental illness' - she ends her chapter by sounding a cautionary note:
'let us never underestimate mental illness and the devastating effects
that it can cause to our children when we are unwell' (p. 111).
The chapters written by people
personally affected by mental illness also give a clear - and at times
distressing - sense of what it can be like to be a client of mental
health services and how individual case managers and services c. l
make a profound difference - positive and negative - to clients' experience
and outcomes. One mother, Amy, describes how flabbergasted she was
when she excitedly informed her case manager of her pregnancy, only
to be told that it was the case manager's 'duty of care' to book her
in for a termination (which Amy refused) She also describes how unsettling
it was during her pregnancy to feel that the health professionals around
her doubted her ability to be a good mother.
Amy also describes how in
the end - after suicide attempts and many hospital admissions - becoming
a parent transformed her "I had always thought of myself as unworthy
of being a mother to such a precious soul, but it dawned on me that
day that if she had been entrusted into my care that I surely must
be of some worth".
There is something for everyone
in this book. While most obviously people working directly in the provision
of mental health services to adults and/or children would find it a
most worthwhile read, it would be of great interest to people from
a wide variety of disciplines working with parents who have a mental
illness and/or their children. For example those working in the fields
of child protection, early intervention domestic violence, alcohol
and other drugs and family support.
So while I did miss out on
a few trips to the beach, reviewing this book has greatly expanded
my knowledge about the needs of families where parents have a mental
illness, and for that I am very grateful.
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