In 2012 I wrote a thesis entitled: "Lives Unseen: Unacknowledged Trauma of Non-disordered, Competent Adult Children Of Parents with a Severe Mental Illness (ACOPSMI)" (Misrhi, 2012). I wanted, among other things, to achieve clinician-friendly understandings to capture the plight of individuals from this population whom I refer to hereafter as “survivors” (the full thesis is available from link in reference list). I did this research as a parallel process to my clinical practice. This meant I was practicing with my clients in a relational/emotional way while researching in a theoretical and conceptual manner.

It is important to realise that the legacy of trauma can facilitate a chameleon-like effect in the daily lives of survivors. Research on survivors reflects just how possible it is  socially to function as a citizen and still be trauma-affected (e.g., see testimonies in Camden-Pratt, 2002, 2006; Nathiel, 2007). The community of survivors include philosophers (Gaita, 1998), nurses (Blair & Cowling, 2004), psychologists, doctors (Nathiel, 2007), social workers (Burdekin, Guilfoyle, & Hall, 1993), authors and playwrights (Lachenmeyer, 2000), and physicists (Blizard, 2008). Who then would think these people are traumatic stress-carrying individuals?

Australia’s 1993 National Inquiry into the Human Rights of People with Mental Illness (Burdekin, et al., 1993) reports that the offspring of people with a mental illness “live their lives acceptably to society” (p.498). Society may wonder what is the problem since “[a]fter all, they survived, didn’t they?” (Bloom, 2002, p.8).. My thesis highlights a variety of elements that can become obstacles in preventing access to the client’s psychological injury for treatment.I will  outline a few here:

In my clinical practice I found that competent, non-disordered individuals come to therapy for reasons other than “trauma” as such.

 Clients may describe extraordinary and intrusive mental states that seem to pop up uninvited in their ordinary day-to-day routines. Their dramatic, seemingly unsolvable, dilemmas in their daily interpersonal exchanges may also work against them in their relationships. Yet their high functioning capacity serves to conceal what lies beneath their skin – but only up to a point. They may have tried hard to integrate their relational and intrapsychic intrusions into their everyday world. But then this may have became too much, too overwhelming – somehow bubbling over. They may have started to lose a grip on their relationships, their job or their identity in terms of self confidence and who they were and are becoming. Such individuals come to me for different, somewhat socially acceptable, reasons such as marital difficulties or the death of a pet or sibling.

Just by having been a child raised within a family where one or both parents had a severe mental illness  a (now adult) client is  at risk of presenting with concealed trauma.  In one case, a mental health practitioner came to see me because of the death of his sibling. As a child and adolescent he was in and out of mental hospitals even at one point suffering from conversion disorder.  This client encountered psychiatrists, social workers, psychologists, etc., over decades, but nobody was able to to recognise that he was suffering the impact of trauma. Evidence of a relationship between childhood traumatisation and conversion disorder, i.e., ICD-10’s dissociative disorders of movement and sensation,  was overlooked (Roelofs, Keijsers, Hoogduin, Naring, & Moene, 2002).  He became quintessentially their family’s ‘designated patient’ within his family system. The mental health professionals he was surrounded by had the effect of colluding with the mentally unwell parents. From my client’s account, both his parents clearly displayed serious levels of mental instability that  were never attended to. Instead, they got away with “soul murder” (Shengold, 1989).

 The severity, chronicity and overall extent of their parent(s) mental instability is often reflected in type and nature of early abuse and neglect which the client experienced or witnessed. Their historical relationship with mentally unstable parents is also informed by attachment theory, which acts like a compass to help guide me as their therapist. The client is enabled to move towards creating at the very least a potential understanding, if not an unofficial diagnosis, that their parent was to a certain degree unstable. For instance, if the client’s parent went against the natural instinct to protect and nurture them during childhood then we can safely presume something was awry.

In taking a thorough history, one can often determine whether or not my client’s parent had an undiagnosed mental illness. Sometimes together we speculate what type of mental illness it might be. I allow the process to unfold until I sense that the client feels safe enough to introduce the possibility that   they [ Suzette please clarify. As written it sounds like you are referring to grandparents being ill]  were likely to have been survivors of parents with some kind of a severe mental instability.

 In my practice experience, the client expresses great relief when they realise that their parent was likely to have been an undiagnosed, under diagnosed or even an un-diagnosable severely mentally-ill person   Boundaries become clearer and problem ownership more easily delineated. This process facilitates greater control over the internal work to be done for the sake of recovery.

There are clear benefits in helping clients unofficially “diagnose” their parent. Conversely, there are distinct risks in not identifying them as survivors. Since non-disordered, competent survivors are well-camouflaged, they may be viewed as “better off” than parents with a severe mental illness by virtue of being competent and not disordered. This adds to their risk of their needs remaining invisible and therefore forgotten. Undetected trauma may stop or delay prevention of physical diseases and illnesses (Felitti et al., 1998).

There are social advantages in helping this population group become more visible both to themselves and to others. Competent, non-disordered survivors could function as role models. Just as career-competent and famous individuals have come forward, in Australia’s beyondblue initiative (beyondblue, 2012), declaring they are or were depressed, survivors need a vehicle where they may feel safe to communicate their trauma-based needs and similarly be helped. Raising the public profile of survivors may “normalise” (Gilbert, 2011) their fundamental needs. Strengthening and uniting them as a population group may serve to reduce their sense of shame as a trauma-affected population because like trauma, shame shapes people’s lives (Dearing & Tangney, 2011).

Author’s Note: I came to my research topic as a result of frustration over a shortage of literature addressing the grief of this understudied population. Their sadness seemed mysteriously endless. So based on my practice experience and knowledge of grief theories, I authored a resource website addressing their grief (Misrachi, 2008). This website is a resource accessed by clinicians in Australia by The Royal Melbourne Children's Hospital, the Victoria VVCS - Veterans and Veterans Families Counselling Service Department of Veterans' Affairs and internationally by other mental health teams and institutions – including individuals (see link in reference list). I welcome feedback on my thesis or resource website suzette.misrachi@gmail.com

About the author:

Suzette Misrachi is a psychotherapist and counsellor (since 1999) specialising in trauma, loss and grief, children, adolescents and adults. She is also an educator and group facilitator designing and giving professional and personal development programs (since 1992). Recently she presented on grief and trauma to medical personnel in Japan, post tsunami and earthquake tragedies. She lives in Melbourne working in private and institutional practice with traumatised individuals. She plans to move to the Netherlands to seek professional opportunities with her husband (a Dutch national) in 2014. She welcomes correspondence – email: suzette.misrachi@gmail.com

 

REFERENCES

beyondblue. (2012). From:   http://www.beyondblue.org.au/

Blair, K., & Cowling, V. (2004). In a daughter's voice: A mental health nurse's experiences of being the daughter of a mother with schizophrenia. In V. Cowling (Ed.), Children of parents with mental illness 2: personal and clinical perspectives (pp. 85-98). Camberwell, Vic: ACER Press.

Blizard, R. A. (2008). The role of double binds, reality-testing and chronic relational trauma in the genesis and treatment of borderline personality disorder. In A. Moskowitz, I. Schafer & M. J. Dorahy (Eds.), Psychosis Trauma and Dissociation: Emerging Perspectives on Severe Psychopathology (pp. 295-306). Hoboken, NJ: John Wiley & Sons, Ltd.

Bloom, S., L. (2002). Beyond the beveled mirror: Mourning and recovery from childhood maltreatment. In J. Kauffman (Ed.), Loss of the assumptive world. New York: Brunner-Routledge.

Burdekin, B., Guilfoyle, M., & Hall, D. (1993). National inquiry into human rights and mental illness. Canberra: Australian Government Publishing Service.

Camden-Pratt, C. E. (2002). Daughters of Persephone: Legacies of maternal "madness". University of Western Sydney, Sydney.

Camden-Pratt, C. E. (2006). Out of the shadows: Daughters growing up with a 'mad' mother. Sydney: Finch Publishing.

Dearing, R. L., & Tangney, J. P. (Eds.). (2011 ). Shame in the therapy hour (1st ed.). Washington, DC: American Psychological Association.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., & Edwards, V. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.

Gaita, R. (1998). Romulus, my father. Melbourne Text Publishing.

Gilbert, P. (2011). Shame in psychotherapy and the role of compassion focused therapy. In R. L. Dearing & J. P. Tangney (Eds.), Shame in the therapy hour (1st ed., pp. 325-354). Washington, DC: American Psychological Association.

Lachenmeyer, N. (2000). The outsider: A journey into my father's struggle with madness. New York: Broadway Books.

Misrachi, S. (2008). Surviving parents with mental illness.  From: https://sites.google.com/site/workwithin/survivingparentswithmentalillness

Misrachi, S. (2012). Lives Unseen: Unacknowledged Trauma of Non-Disordered, Competent Adult Children of Parents with a Severe Mental Illness (ACOPSMI). Department of Social Work Melbourne School of Health Sciences Faculty of Medicine, Dentistry and Health Sciences. From: http://repository.unimelb.edu.au/10187/16566   Please note: For tabulation reasons, please only use or forward the link – never the actual thesis itself.

Nathiel, S. (2007). Daughters of madness: Growing up and older with a mentally ill mother Westport, CT: Praeger Publishers.

Roelofs, K., Keijsers, G. P. J., Hoogduin, K. A. L., Naring, G. W. B., & Moene, F. C. (2002). Childhood abuse in patients with conversion disorder. American Journal of Psychiatry, 159, 1908-1913.

Shengold, L. (1989). Soul murder: The effects of childhood abuse and deprivation. New Haven: Yale University Press.