When a parent has mental illness, how to support kids

When a parent has mental illness, how to support kids

Between the long hours, many responsibilities, and lack of control, few jobs in our society are as demanding as parenting. If a parent has a mental illness like depression or anxiety, raising kids becomes even more difficult. Many parents live in secrecy, believing that they are the only ones who struggle like they do.

But parenting with mental illness is far more common than many people suspect. In a survey of U.S. parents, more than 18 percent reported having a mental illness in the past year. While a parent’s mental illness increases child’s risk for a future mental disorder, this is by no means the only possible outcome.

“Having a parent with mental illness does not always lead to clinically significant distress in a child,” says Dr. Patricia Ibeziako, associate chief of clinical services in the Department of Psychiatry and Behavioral Services at Boston Children’s Hospital. “It depends on many factors, including the type and severity of the parent’s mental illness, how long it lasts, and the age of the child.”

A parent’s mental illness affects children differently at different ages

Children are most vulnerable to the effects of a parent’s mental illness at specific stages of emotional development. The first stage starts early, from infancy until about age 5. “This is an important period of brain development when infants and toddlers form strong attachments,” says Dr. Ibeziako. But a parent with mental illness may not be able to meet their child’s need for bonding. An infant or toddler deprived of positive emotional connections may develop problems regulating their own emotions and behavior. This may play out in tantrums, trouble sleeping, regression in potty training, or bedwetting.

The next vulnerable period is adolescence. As difficult as their behavior may be at times, adolescents rely on their parents for structure and positive reinforcement. But a parent struggling with mental illness may be less attentive to their teenager’s needs. Or they may focus entirely on things their child is doing wrong without balancing negative feedback with praise. “A parent’s depression, irritability, or low frustration tolerance can cause teens to act out in disruptive ways,” says Dr. Ibeziako.

The lack of energy that depressed parents often experience may also affect their ability to pay attention to their child’s school routines. Without a parent’s support, school-aged children may struggle to get to school or after-school activities on time. Completing homework can become an overwhelming challenge.

A parent dealing with an anxiety disorder may be overprotective, depriving their child of the chance to learn problem-solving skills. Or a child who witnesses their parent’s anxious behavior may in turn develop fears and worries.

How to help kids develop positive coping skills

Despite these challenges, many children do find positive ways to cope. Parents can help.

Getting Stuck in Negative Emotions and Relationship Patterns

  • Our current moods set up “emotional filters” that only let thoughts, memories, and emotions that are congruent with those moods through.
  • Competing (maybe positive) thoughts, memories, and emotions get filtered out by your attentional system when you are feeling down.
  • Developing emotional intelligence and learning to direct your attention and thoughts away from negative cues can let you shift your experience.

You are having a bad day. Like most days lately, you feel anxious and worried — maybe even a bit hopeless and depressed. Nothing seems to be going right. You might think, “My life just sucks.”

Now ask yourself: Why do I have to wake up tomorrow feeling the same way I did today? The truth is that you don’t.

Changing Your Negative Experience and Thoughts

The main reason for the continuation of negative experience lies in how your brain’s attention and memory systems work. But each day you wake up, you don’t have to tell yourself the same painful story.

What if you lost your memory overnight and forgot the painful experiences and tortured thoughts you were having today. Would you still feel sad and anxious? I think not. You would literally wake up with a new outlook on life — one that is fresh and clean.

At this point, you might wonder if I am suggesting staying in negative circumstances. But that is not at all the case. If you woke up in a negative environment and experienced pain, you would probably get out of there and change your environment. So, why don’t you? If you say it is not that simple, then you probably need to consider whether the problem is with the situation or with the story you are telling yourself about it.

For example: Let’s say that this afternoon I have a disagreement with my wife about how to handle a behavior problem with one of our children. I then have a difficult conversation with that child in front of my wife. The result might be that the child has a strong negative emotional experience, I feel bad and dysregulated, and my wife feels bothered that she had to witness the exchange and see her child have a negative experience.

You might know people who would bounce back from this and 30 minutes later it is like nothing happened. You also might know people for whom the negative experience lasts all day or beyond. If I or my partner are in depressive mood states, we might perceive more negative emotions in each other and respond to each other assuming disapproval or bad feelings where they need not (or may not) really exist.

Our current moods set up “emotional filters” that only let thoughts, memories, and emotions that are congruent with those moods through. Competing (maybe positive) thoughts, memories, and emotions get filtered out.

In a recent paper on happiness at Widener University, clinical psychology doctoral students David Albert, Amanda Blazkiewicz, Ariful Karim, and Ariana Swenson, uncovered the following:

Research has demonstrated that when we are socially anxious or otherwise in a negative mood state, we are more likely to perceive that others are in negative mood states even when they are actually feeling neutral or happy (Garcia & Calvo, 2014). Obviously, if we think that others are looking at us with negative expressions, we are likely to tell ourselves a negative story that will further increase our own bad feelings.

Another study by Beevers et al. (2009) showed that, when people are in more negative moods, they are likely to perceive more negative moods in others. The authors of this study suggested that partners of those who are depressive might need to regularly focus on exaggerating their positive expressions in order to compensate for this effect. Over time, this might cause undue stress on the relationship and lead to more negative feelings. So, you can see that over time being in a negative mood could actually increase the chance that you will get even more depressed and less likely that you will be able to shift your focus to positive experiences.

How Parents Can Keep Kids Talking and Protect Mental Health

How Parents Can Keep Kids Talking and Protect Mental Health

My community is grieving. Everyone knows someone who has been affected by the suicides this past month in our local high schools. “That was the fifth suicide this month,” one distressed mother told me. “They were successful kids; some were top athletes. I worry for my kids. How can I keep them talking to me so this doesn’t happen to us?” Her kids were in elementary school.

Parents know that keeping our kids talking to us is one of the most important things we can do. But how can we make sure that happens? There are specific and actionable steps parents can take to create a culture of open communication in their families. If parents set the right tone, kids will keep talking. When parents provide support, they can make a huge difference in their child’s mental health.

Mental Health Crisis in Our Youth

Kids and adolescents have just faced more than a year and a half of intense pandemic stress at a vulnerable time in their development. They experienced social isolation, fear, and uncertainty, and unique educational challenges. Now, they are back in school with teachers who are under pressure to increase student workloads to make up for lost time — all while the pandemic smolders on.

The impact of sustained stress on these young brains has now materialized into a rapidly worsening mental health crisis. In my own pediatric practice, I have never seen anything like it. Both the number of kids and the severity of their mental health struggles have skyrocketed. Tragically, so have the suicide attempts by teens across the United States.

There are no guarantees, and terrible tragedies can and do happen to parents who are trying their very best. But parents do make a difference in preventing suicide. In one research study on middle schoolers, parent support was found to buffer the effect of life stress on the kids. Middle schoolers with supportive parents had notably lower rates of suicidal ideation — i.e., thoughts that they’d be better off dead or of harming themselves.

Creating a Culture of Communication

When kids are young, the goal is to create a family culture of openness and honesty about hard things. One of the first steps is to simply call things what they are. Either minimizing problems or blowing them out of proportion sends the message that we can’t really talk about things. But telling it like it is sets us free to grapple with challenges.

For example, when kids in my practice ask me, “Doctor, will the shot hurt?” I say, “Of course it will.” Because kids are used to adults soothing them with lies, my response surprises them, and they start listening. “Would you like to know what you can do to make it hurt less?” I ask them before telling them how.

Once you’ve told the truth about a situation, try to take a collaborative problem-solving approach with your kids. Instead of telling them what to do, express your faith in them by exploring the issue together. Listen to them without immediately trying to fix them. When your message is “We can figure this out together,” and you invite kids to work with you, it is amazing how often kids will simply tell you the solution. Practice with little things so you have the skills in place when the big problems come up.

Kids are more likely to engage in collaboration with us if we have sent a consistent message that their opinions matter. When they are young and are constantly telling you about what they notice, say, “That’s an interesting observation. Tell me more.” When they are sorting something out, ask, “What’s your perspective on that?” or “How are you thinking about that?” These questions send a message of respect for them and their abilities to figure things out.

Avoiding Shutting Kids Down

When taking steps to open communication, well-meaning parents often undermine themselves with two bad habits. Often, these mistakes happen when parents get worried about what they should say and forget to listen openly. But both of these habits shut down communication by sending the message that emotions are unacceptable.

In This Together During "Mixed-Up" Times

In This Together During “Mixed-Up” Times

The holiday season is a time for people to come together, take time off, and recharge. Unfortunately it can also be a time of conflict, busyness, and stress. During “mixed-up” times like the COVID-19 pandemic, people have a greater need of the former — but a greater chance of the latter. James Anderson, PhD, offers this reminder that in difficult times like these, everyone benefits from self-care and being patient and understanding with others.

In This Together

As we move through our brief time on earth, we experience a broad range of emotions — joy, sorrow, anger, excitement, and anxiety, among others. Occasionally, we are enveloped by a single, strong emotion; more often, we experience multiple emotions at once. “Daddy,” says my nearly five-year-old daughter when she recognizes this strange collage of emotion, “I am feeling mixed-up.”

We live in mixed-up times.

As fall continues, we grapple with the weighty challenges of this persistent pandemic. This strange period has offered some of us positive things: renewed closeness within our households, and new ways of connecting with loved ones from afar (hello, “ZOOM!”). However, for most of us, these slivers of good are mixed-up in unpleasant feelings — financial stress, loneliness, health concerns for ourselves and those we love, and many more.

Many of us hoped safe and effective vaccines would bring decreased death rates, fewer hospitalizations, and a return to normal. Instead, people’s feelings about the vaccine have been a new sort of “mixed-up.” Science and public health have become entwined in politics. Some people are more scared of the vaccine than they are of COVID-19. Some people resent being mandated to put something into their bodies. Some people feel angry at others for not taking a vaccine that science is telling us is safe, effective, and our best path out of the pandemic.

As a psychologist, but even more so as a neighbor, colleague, relative, and friend, I wish that there was a bit of advice, an exercise, a therapy, or a medicine that I could offer to take away the emotional pain this pandemic has wrought on each of us and our community. The best I can do, though, is suggest some tools to help to soothe the pain and find perspective:

  1. Find time for yourself. Whether that time is for physical exercise, meditation, time in nature, listening to music, or something else, value yourself enough to consistently keep up the activities that revive you.
  2. Assume people have good intentions. Even when people take a position that is very different from your own, remember that most of us want the same things. We want to be safe. We want to be free. We want to be secure. We want the best for our children. When somebody argues against the vaccine, they almost certainly do care about their neighbors and their children — they believe the vaccine is not safe or sufficiently studied. When somebody argues for the vaccine, they almost certainly do value freedom — they ardently wish to restore our freedom to move and operate without risk of serious disease. Assuming good intentions does not mean adopting another’s position. Rather, it means momentarily standing in someone else’s shoes and understanding their perspective. You can believe someone is wrong without thinking they are a bad person.
  3. Cut people some slack (including yourself). We are all very stressed and have been for over 18 months. Stress affects how we interact with others. Perhaps a coworker snapped at you. Perhaps an employee made a mistake. Perhaps some days you can’t engage your kids with the same level of energy you normally would. Nobody looks great if they are judged on their worst days or worst moments, and we are all trudging through some of our worst days and moments.
  4. Reach out for whatever help you need. While all of us experience times of sadness and stress, some of us experience a different level of emotional challenges indicative of mental illness. If you receive treatment for a challenge like depression, anxiety, or a problem with drugs, please continue to follow your treatment regimen. Remain in contact with your treating clinician so that together you can determine if changes are needed. If you are struggling to get out of bed on multiple days, having persistent negative thoughts about yourself, struggling to regulate your use of alcohol or other drugs, having panic attacks, or having thoughts of suicide, please seek help. Options include your primary care practitioner, Bassett Healthcare Network’s outpatient Psychiatry clinic, your county mental health clinic, and countless others. 24/7 free phone support is available by calling 1-800-273-TALK (8255) or texting GOT5 to 741741.

Remember: we’re all in this together. Be kind to one another. This, too, shall pass.

James B. Anderson, PhD, is a practicing psychologist and the medical director of Behavioral Health & Integrated Services at Bassett Healthcare Network.

Do Mindfulness Interventions Improve Obesity Rates in Children and Adolescents: A Review of the Evidence

Do Mindfulness Interventions Improve Obesity Rates in Children and Adolescents

Mindfulness interventions have shown promise in improving self-regulation, depression, anxiety, and stress levels across all ages. Obesity rates in children are rising worldwide. It has been postulated that through improvements in self-regulation with mindfulness interventions, obesity rates can be improved in children and adolescents. In this review, we attempt to explain how mindfulness interventions may impact obesity rates and obesity-related complications and give the current state of evidence for the following mindfulness interventions: Mindful Eating, Mindfulness-Based Stress Reduction, Yoga, Spirituality, and Dialectical Behavior Therapy.

Over the last 20 years, childhood obesity has become a major public health concern in the United States. According to the most recent data from the Center for Disease Control and Prevention (CDC) in 2015–2016, 18.5% of American youth between the ages of 2 and 19 were classified as being obese using a body mass index (BMI) threshold >95% for age.1

The rate of obesity increases with age in children. Children between the ages of 2 and 5 have an obesity rate of 13.9% as compared to 20.6% in children between the ages of 12 and 19. In addition, obesity has some ethnic predispositions, with obesity rates being most prevalent among Hispanic and Non-Hispanic Black children with no significant difference between the sexes.1

Obesity begins in childhood due to a combination of genetic, social, physical, and psychological factors.2 As children with obesity age, they often develop obesity-related comorbidities including insulin resistance, early onset diabetes mellitus (DM), hypertension, hyperlipidemia, depression, and sleep apnea.3 These medical conditions often persist into childbearing years and adulthood.4 Pregnancies of women with obesity are more likely to have perinatal complications or be stillborn.5 Infants born to mothers with obesity have increased rates of neuropsychiatric disorders including autism, attention deficit hyperactivity disorder (ADHD), anxiety, depression, eating disorders,6 and adult obesity.7 This circular pattern perpetuates, increasing obesity rates in all ages.

With the increase in families with obesity, pediatric medical providers are consistently charged with finding evidence-based treatments. One area of interest is the use of mindfulness interventions to modulate eating behaviors.

According to Jon Kabat-Zinn, mindfulness is a psychological process of purposely bringing one’s attention to experiences occurring in the present moment without judgment.8 Mindfulness activities have been effective in altering human behavior to improve health promoting behaviors.9–11 In addition, mindfulness activities have consistently shown improvements in levels of stress and anxiety and increased stress has been associated with weight gain.9–12 For these reasons, it seems that mindfulness activities may provide value as a treatment option for patients with obesity.

Human Eating Behavior

To further understand how mindfulness may affect obesity, it seems paramount to understand the psychology of human eating behavior. Human eating behaviors are based on the existence of personal and psychological constraints that operate in addition to food availability. Figure 1 was created by Ulijaszek et al13 based on the initial work of Mela et al,14 and describes a mechanism where human body-weight homeostasis may be maintained or lost based on different factors including food availability, energy density of the diet, genetic, psychological, physiological, behavioral and cultural factors.

Through this theory of the psychological contribution of weight gain, it would be a logical deduction that being more mindful of emotions and how emotions affect eating behaviors would allow one to control what he or she eats. As a consequence, there may be decreased consumption of high calorie foods and increased consumption of healthier, low-calorie foods. With time, this change in food preference may lead to weight control or weight loss and decreased amounts of obesity.

Figure 1. This flow chart explains that when one is exposed to high fat, sweet, or highly processed foods combined with learned feeding behaviors, preferences for these foods may be established. The combination these preferences, Increased availability of unhealthy foods, loss of dietary control from social and cultural eating patterns, and emotional eating or eating environments, predisposes individuals to over-consumption of energy dense foods. This in turn leads to overeating, positive energy balance, and weight gain. Low physical activity and genetic predisposition may negatively impact the picture further.

Op-Ed: 1 in 4 adults are estranged from family and paying a psychological price

1 in 4 adults are estranged from family and paying a psychological price

Search “toxic parents” on Instagram, and you’ll find more than 38,000 posts, largely urging young adults to cut ties with their families. The idea is to protect one’s mental health from abusive parents. However, as a psychoanalyst, I’ve seen that trend in recent years become a way to manage conflicts in the family, and I have seen the steep toll estrangement takes on both sides of the divide. This is a self-help trend that creates much harm.

Research by Karl Pillemer, a family sociologist and professor of human development at Cornell University, indicates that 1 in 4 American adults have become estranged from their families. I believe that’s an undercount, because others have stopped short of completely cutting off contact but have effectively severed the ties.

“Canceling” your parent can be seen as an extension of a larger cultural trend aimed at correcting imbalances in power and systemic inequality. Certainly the family is one system in which power has never been balanced. In 1933, the Hungarian psychoanalyst Sándor Ferenczi described this dynamic, warning that any asymmetry, even the simple indication that someone has more power than we do, can potentially be traumatic.

Today’s social justice values respond to this reality, calling on us to censure oppressive and harmful figures and to gain power for those who have been powerless. But when adult children use the most effective tool they have — themselves — to gain a sense of security and ban their parents from their lives, the roles are simply flipped, and the trauma only deepens.

Certainly some extreme cases call for cutting parents out of one’s life, even if doing so comes at a psychological cost. Far more often, what I see in my practice are cases of family conflict mismanaged, power dynamics inverted rather than negotiated. I see the shattering effect of that trend: scenarios with no winners, only isolated humans who long to be known and feel safe in the presence of the other.

Some of my patients are young adults who decided to end, or are considering ending, their relationships with their parents. They try to process their parents’ harmful actions in their childhood, their lack of boundaries, and their narcissistic or intrusive behaviors. Those children struggle with anger, pain and guilt and are often feeling confused and lonely.

Certainly some extreme cases call for cutting parents out of one’s life, even if doing so comes at a psychological cost. Far more often, what I see in my practice are cases of family conflict mismanaged, power dynamics inverted rather than negotiated. I see the shattering effect of that trend: scenarios with no winners, only isolated humans who long to be known and feel safe in the presence of the other.

Some of my patients are young adults who decided to end, or are considering ending, their relationships with their parents. They try to process their parents’ harmful actions in their childhood, their lack of boundaries, and their narcissistic or intrusive behaviors. Those children struggle with anger, pain and guilt and are often feeling confused and lonely.

Other patients are parents on the other side of that dynamic, who feel betrayed and heartbroken. It’s hard for them to acknowledge or even recognize their aggression. In my experience, baby boomer parents are especially troubled. They perceive themselves as products of the 1960s social revolution; many of them rejected their own parents’ authoritarian style and followed a parenting approach that at least appeared to prioritize the children’s needs. Those patients feel trapped in generational limbo, neglected by their own parents who didn’t fully know them and abandoned by their children who don’t want to know them.

The vein of online advice about “toxic parents” is a self-help therapy approach that aims to empower younger people to give up on their parents and “re-parent” themselves. It encourages them to do the needed emotional work on their own and urges them to reject parental figures altogether, avoiding any kind of dependency on another person.

In this cultural moment, and especially because of COVID disruptions to young careers, adult kids are either becoming more dependent on their parents or are rejecting their dependency altogether. We’re in the era of millennials living in their parents’ basements, and also in the era of millennials cutting their parents out of their lives.

The catch is that after estrangement, adult children are not suddenly less dependent. In fact, they feel abandoned and betrayed, because in the unconscious, it doesn’t matter who is doing the leaving; the feeling that lingers is one of “being left.” They carry the ghosts of their childhood, confronting the emotional reality that those who raised us can never truly be left behind, no matter how hard we try. They live inside us, even without our permission. This is something that can never be canceled.

What I have found is that most of these families need repair, not permanent rupture. How else can one learn how to negotiate needs, to create boundaries and to trust? How else can we love others, and ourselves, if not through accepting the limitations that come with being human? Good relationships are the result not of a perfect level of attunement but rather of successful adjustments.

To pursue dialogue instead of estrangement will be hard and painful work. It can’t be a solitary project of “self-help,” because at the end of the day, real intimacy is achieved through mutual vulnerability and by working through the injuries of the past together. In most cases of family conflict, repair is possible and preferable to estrangement — and it’s worth the work.

Galit Atlas is a psychoanalyst in private practice in Manhattan. She is the author of the forthcoming “Emotional Inheritance: A Therapist, Her Patients and the Legacy of Trauma.”