The Collateral Damage of Bipolar Disorder
What Do Children Want to Know When a Parent Has Bipolar Disorder, and even more important, How Do We Help Protect Them from Adverse Developmental Trauma? Jennifer Safian posed these questions, minus my paraphrasing, in response to my previous blog on Family-Focused Psychotherapy for Patients with Bipolar Disorder, and subsequently shared personally with me, painful details of her growing up with a father with Bipolar Disorder. Bipolar disorder can devastate families if left untreated, and the impact on children is life long. The extent of the disruption to the family can easily meet or exceed the individual’s symptomatic suffering and impaired functioning.
Two-thirds of bipolar patients do not achieve full social and occupational recovery. Their families also experience ongoing functional distress and dysregulation. Repetitive emotional trauma is an ever present part of their life. When the family organizes itself around the ill person, many other aspects of the family’s growth and development will be impaired. The losses of trust, safety and security forever change the relationships.
In researching Jennifer’s query, much to my dismay (though in retrospect it should not have been surprising), I discovered that most of what is written, and all but a very few research investigations, concern how the family can be helpful to the individual with Bipolar Disorder and not how to help the family, especially young children and adolescents. Most studies, as one might expect in this over medicalized world, investigate and evaluate the risk of “mental illness” in “Children of parents with bipolar disorder”.
But how do we help protect children from the ravages of uncontrolled mania and suicidal depression? How do we help children address their own unmet emotional needs? Unfortunately, in these situations of Unbalanced Systems, the family is often not up to the task of working to successfully adapt to the physical, psychological, emotional, and spiritual challenges of severe and chronic psychiatric illness. Despair, helplessness, hopelessness, confusion, subjective incompetence and a sense of isolation cause both the patient and the family to withdraw from and avoid the challenges of illness management and adaptation.
Children are unable to influence the power dynamics of their family of origin. Psychoeducation and support groups such as the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA) can be helpful. Regulated early child care services reduce risk. Engaging at least one stable adult in the extended family system to help the children integrate the trauma and make sense of the loss can enhance resilience, defined as the ability to withstand and rebound from stressful disruptive crises that interrupt developmental tasks.
For adolescents, adult children, and younger children as they subsequently enter the life cycle stage of emerging adulthood, self-differentiation and family of origin work help make meaning out of adversity. The safety of secure attachments helps foster the ability to acknowledge suffering, restore dignity and reinvest in a meaningful way. Helpful skills include the ability to focus on your own life, seek support, set boundaries, manage stress, and ask for help. When all else fails, consulting with a well-trained family systems therapist can help keep the process moving forward in a positive direction.
What have I missed? Please share your thoughts and experiences concerning living with a parent with a severe and persistent psychiatric illness in the “Leave a Reply” box below. To request more information and/or schedule an initial consultation, click here. If you found this post helpful, please don’t keep it a secret. You are encouraged to click on the buttons in the second to the right hand column at the bottom of the page and share this article with your own networks. I look forward to hearing what’s on your mind.
|Ronald B. Cohen, MD|
Psychiatrist / Family Therapist
1 Barstow Road, Suite P-10
Great Neck, NY 11021