“To love and work” was how Freud saw the goal of psychiatric treatment. Mental illness robs people of many meaningful roles, from work to parenting. We spoke with Marie Yap, director of the award-winning Parenting Strategies program, to learn how to help our patients function better as parents and prevent psychiatric disorders in their children.
TCPR: When a parent has a psychiatric disorder, how do you recommend they talk about it with their children?
Dr. Yap: Children do better when parents talk openly about the reality of the illness and its impact on the family. Openness can also dispel the stigma around mental health. The talk needs to be age-appropriate. In younger children, I would use analogies with physical illness: “It’s like if Dad had a really bad case of flu. It would sap his energy, and he would be in bed most of the day.” As the child gets older, for example after puberty, you can speak more directly about the condition.
TCPR: Would you use the actual diagnostic terms?
Dr. Yap: If they want to know a name, I think it’s good to tell them, “This is what the doctor calls it. When you talk to your friends, you can just tell them, ‘My mom has an illness. She is unwell.’” But more important is to address how the condition is affecting the family and to let children know that it’s safe to talk about it within the family and with trusted adults. It’s an ongoing conversation, and it involves practical matters. You might say, “So, during this time Mom won’t be able to cook dinner; we might get takeout, or Grandma will come in and help.”
TCPR: What else can parents do in the face of active mental illness?
Dr. Yap: They can talk about specific strategies to manage the effects on the family, such as, “I’ll let you know when I’m feeling unwell and need to be alone. Here are some things you can do if that happens.” Find age-appropriate ways for the child to help out. Children need to have a role, but the burden of the illness should not be their responsibility. It may not be appropriate for a 7-year-old to cook dinner, but a teenager could take that on. Also, draw on support from friends, teachers, counselors, and extended family.
TCPR: What about more damaging effects, like when a parent yells or breaks things during a manic episode? How should this be addressed with children?
Dr. Yap: I do think parents should address the effects of their illness openly with children. That doesn’t mean the illness is an excuse. They could say something like, “I’m sorry. You don’t deserve to be treated that way, and that’s not how I want to treat you.” Clearly, when the interaction was traumatic, it’s more complicated. I’d want to make sure the parent is stable enough to have that conversation without getting triggered. If the parent doesn’t feel ready, there could be a family meeting with a mental health professional there to mediate. That could contain any further explosiveness.
TCPR: Often these families are worried that their children will grow up to have the same problems. Are there parenting strategies that can prevent psychiatric disorders?
Dr. Yap: A lot of research has gone into that question, and if I had to boil it all down, it would be these words: acceptance, support, and autonomy. Parents need to develop an accepting and warm relationship with their children, while encouraging them to step out more on their own as they grow. A big challenge is to adapt as they age; to know how much to let go and when. Can they trust their 7-year-old to cross the road at a traffic light?
TCPR: Sounds like it takes a lot of flexibility—not an easy task for someone with anxiety or depression.
Dr. Yap: They have to try and think, “What’s the worst thing that could happen if I don’t step in and it turns out wrong?” The process of the child’s learning is as important as the child’s success. Encourage children for trying! When they make mistakes, it’s an opportunity to talk about what happened. What led them to the decision? What could they do differently in the future? When there’s a foundation of support and acceptance, children will know that the parent is available if they need to reflect or bounce ideas off someone, or if they need a shoulder to cry on.
TCPR: Are there any counterintuitive findings in the parenting research?
Dr. Yap: Not exactly, but we have found that over-involvement, or “helicopter parenting,” increases the risk of mental health problems in a child. It’s quite a robust finding in depression and anxiety (Yap MB & Jorm AF, J Affect Disord 2015;175:424–440). It gets back to autonomy: “Am I doing things for my children that they could reasonably do themselves?”
TCPR: What are some examples of appropriate involvement?
Dr. Yap: Knowing where your children are when they’re not with you. What are they doing? Who are they with?