I am a student in my 20s without any children or dependents. You could argue that there is no role in life granted more freedom than mine. In my position, you have the flexibility to choose how you spend your time and who you spend it with. You can spontaneously choose to meet a friend after work and rashly elect to sleep in past lunch. You can dedicate your existence to rowing or decide to work into the long hours of the night. With a child your whole identity changes. You take on the label of ‘parent’, ‘mother’, or ‘father’, and for some this becomes their most important identity. Your responsibility now is to love and nurture your child and to ensure they have all the resources they need to succeed. We expect parents to act selflessly by consistently putting the needs of their children before their own, and we chatter about ways the parent must have failed if we see their child exhibiting just a slightly odd behaviour. The advent of parenthood marks a permanent change in your goals, your daily activities, and your identity, and can be argued is the most challenging and important task in one’s life. Now along with this life change, imagine also having a diagnosis of a severe mental illness.
Having psychosis means dealing with intrusive and disturbing hallucinations, managing medication, dealing with its accompanying side effects, as well as continuing to function socially daily. If you are also a parent, it means having responsibility of another person. Psychotic symptoms can often hinder the ability to proficiently parent. During a relapse parents will often become emotionally and practically unavailable. In turn, the nature of parenting may exacerbate psychotic symptoms. It has been well documented that a psychotic relapse can be caused by high amounts of stress in the home environment [1]. Psychosis can even be brought on by pregnancy in the form of postpartum psychosis.
This detrimental bidirectional relationship between the facets of parenting and psychosis is mirrored in their stereotyped definitions. Being a parent and having psychosis are two identities that seem almost incompatible. One implies responsibility and the other implies a lack of control. There is stigma attached to having psychosis. Those with psychosis are depicted as ‘crazy’ in the media and the symptomatology is often wrongly thought to consist of having multiple personalities. Due to this stigma, there is a reluctance among those with psychosis to reach out for help from services for fear of being deemed unfit and losing custody of their children. Indeed, many parenting interventions actually exclude those with psychosis from taking part. The incompatibility between these two labels mean parents with psychosis often find themselves split between the dual identities of ‘parent’ and ‘person with psychosis’.
The children in this situation must not be forgotten. Any child whose parent cannot fully care for them either physically, socially, or emotionally will naturally face some disadvantage. What frequently occurs is these children become carers. For children with parental psychosis, their childhood is likely to be disrupted by psychotic relapses and hospital visits, and they are much more likely to develop a mental health difficulty themselves. Despite the responsibility these children are forced to assume, they are rarely kept in the loop with their parent’s mental state. These children will have gathered valuable knowledge on their parent’s typical symptom pattern and will likely have an awareness of both their own needs and those of their parents.
To effectively help parents with psychosis and their children, an intervention must be developed. First, however, we must gather information to determine the specific needs of these parents and their children. My research will explore these from various methodological perspectives. I will start by doing a database search to understand the proportion of patients with psychosis that are parents and which characteristics are associated with having children. I will also conduct interviews with parents with psychosis, their partners, their children, and healthcare professionals. This will allow me to understand what parental psychosis means from the perspectives of the patient, the child, the family, and the healthcare system. Later on, we will ask parents with psychosis to install an app onto their phone which will give them 2-3 minute surveys a few times a day inquiring about parenting factors, psychosis symptoms and other daily challenges. With this data, we will be able to make predictions about what helps and hinders parenting.
Parenting has the potential to be rewarding experience for both the parents and the children no matter the parental symptomatology. For this to be possible, we must develop a clear picture of the needs of both, and who better to do this than a PhD student with a lot of free time.
[1] Vaughn, C.E., Snyder, K.S., Jones, S., Freeman, W.B. and Falloon, I.R., 1984. Family factors in schizophrenic relapse: Replication in California of British research on expressed emotion. Archives of General Psychiatry, 41 (12), pp. 1169-1177.