Mothers instinctively protect children

08/27/2002 10:44

The forgotten children

Dr. Marion makes it Corporate communication
University Medical Center Hamburg-Eppendorf

Half a million girls and boys have mentally ill parents and are at risk of getting sick themselves later - the special outpatient department at the University Medical Center Hamburg-Eppendorf wants to intervene early and spare the children the worst

Verena B. (25, patient name changed) suffered from paranoia for a long time. Again and again she reacted aggressively to her environment; no one was allowed to come too close to her or her son Mark. When the boy was two years old, he got to feel his mother's pathological behavior up close. She barricaded herself in the apartment with him and did not want to let anyone in anymore. This time everything was much worse than usual; persuading neighbors and relatives to do no good either. Finally the police came, broke open the apartment door, overpowered the fiercely defensive, mentally ill woman and led her away in handcuffs. Mark stood by, scared and felt alone.

"The boy may not have very precise memories of the incident, but he has been severely traumatized: Such events never leave a child without a trace. Fortunately, he was able to visit relatives who took him in when his mother was in the hospital." , says child and adolescent psychiatrist Dr. Christiane Deneke. When the senior physician at the Hamburg University Medical Center Eppendorf (UKE) got to know little Mark in the "Special Clinic for Mentally Ill Parents with Infants or Small Children", he was on the one hand completely scared and on the other very imaginative. "In the game he processed his experiences. Sometimes he had to defend himself against tigers and snakes, sometimes dinosaur mothers and their babies were attacked. He himself was usually armed to the teeth to shake off his pursuers."

Mark belongs to a group of children that experts refer to as the forgotten - they are largely left to fend for themselves with their fears and needs. Children whose mothers or fathers are haunted by schizophrenic delusions; Children whose parents are pathologically anxious, depressed or unpredictable, whose personality is disturbed and who seem to be someone completely different from one moment to the next. The children suffer with and under their parents and are neglected themselves in the process. The emotional warmth is completely or partially missing, as is the feeling of security that children so badly need. They do not understand their parents, have no one to talk to, and therefore run the risk of becoming mentally ill themselves.

"The care and psychological counseling of these children belongs in the public sector," says Christiane Deneke, "but obviously nobody feels really responsible here." So it is mostly reserved for private institutions, which have been increasingly founded in recent years, and for personally committed doctors, therapists and nurses in clinical institutions to take care of the well-being of the children that have been forgotten up to then. The UKE plays a pioneering role here: In addition to the special outpatient clinic, there is a day clinic in which mentally stressed mothers and their babies are admitted. In addition, the establishment of the "SeelenNot" association was initiated from here and is chaired by Deneke. (At a symposium on Wednesday *, various Hamburg initiatives that look after the children of mentally ill parents will be presented.)

The need is great: around every thirtieth child has a mentally ill parent; almost one per school class. Nationwide, the number of children affected is estimated at half a million - with an upward trend. They lack attention and care, they feel abandoned and are disoriented. Because mother or father are already overloaded with their own problems, they do not receive any instructions from them as to what is right or wrong. "The worst thing for the little ones is that their parents don't react to their children's feelings and they are often very, very lonely," explains Dr. Deneke.

That has consequences. At least one in four children who receive psychiatric inpatient treatment today has a mentally ill parent. The risk of later becoming schizophrenic, neurotic or depressed yourself is many times higher if the parents are already sick. Up to two thirds of the children of mentally ill parents are affected. However, this is only partly due to the hereditary predisposition: the everyday chaos in the family and the general psychosocial stress (isolation, poverty, lack of support, etc.) have a much worse effect on the children's mental health, as many risk studies have shown .

Parental anguish leaves its mark on the youngest children's souls. When women cannot cope with their new role as mothers, feel overwhelmed and become depressed, it is often at the expense of the newborn. Many of them manage to hide their state of mind from the mother-child relationship. But the basic mood towards the baby is often negative, it experiences too little attention and love. Deneke: "We can already notice developmental delays in three-month-old children. The little ones are more passive and less curious than their peers. They orientate themselves less towards their environment and are more withdrawn." Other newborns, on the other hand, whose mothers deal impulsively with their own mood and the helpless offspring, react very excitedly, with a lot of screaming and crying, sleeping and eating disorders. These are all not uncommon phenomena: According to various studies, around six to 22 percent of women suffer from so-called postnatal depression.

Once started, the spiral is difficult to stop. Even two-year-old children of mentally ill parents have significantly more mental problems than their peers. This later has an effect in the form of very different child and adolescent psychiatric abnormalities such as school difficulties, aggressive attacks, wetting and nail biting. The symptoms are often an expression of serious disorders in relationships with other people and in self-esteem.

The aim of the various treatment approaches at the UKE is to meet the needs of children more adequately and to protect them from later becoming mentally ill themselves. "Better care early than treatment late" is Christiane Deneke's motto. First of all, it is important to relieve the parents of their everyday stress and to organize help at home. Nursing staff support single mothers in dealing with their children on a daily basis. They try to give them a sense of how to receive their children's signals free of disease-related distortions and how to react accordingly. Parent-child psychotherapy as well as couple and family talks complete the offer for adults.

Children especially feel at home in the discussion and contact groups of the Auryn project initiated and supported by the UKE and supported by the "SeelenNot" association. Auryn is invincible
making amulet from the "neverending story" by Michael Ende. The six to 16-year-olds meet once a week in small groups that are suitable for each other in terms of age, to talk to each other about experiences and emotions or just to play carefree with each other.

It is here that many children find out for the first time that they are not alone with their problems. In discussions with experienced child therapists, they are given age-appropriate information about their parents' illnesses. They also learn strategies to protect them from their own psychological impairments. "The experience with Auryn shows that the children become freer and step out of their isolation. This strengthens their self-confidence and personal development over the long term," explains Christiane Deneke.

Mark also benefited from the advice and support options at the UKE. Did Dr. Deneke visited him at home at the beginning of therapy, because his fear of the clinic was too great, he gained noticeably trust. His mother also received regular advice. Today, at almost eight years of age, Mark is even more fearful than his peers. But he lives again with his mother in his own apartment, goes to school, has friends - and good prospects. Dr. Deneke: "The early support was very good for him. In all probability he will be able to lead a completely normal life later."

Brief information

- In Hamburg, the number of children who grow up with a mentally ill parent from birth is estimated to be at least 5,000.
- Only a quarter of six to ten year olds and half of ten to 14 year olds even know that their parents' problems can be explained by an illness. Most of them just sense that something is wrong.
- Most families keep silent about the parents' illness and make it taboo. Parents fear that their children will be taken away from them if their condition becomes public; the children are mostly silent instinctively and because they do not want to "betray" their father or mother.
- The social situation of those affected is usually bad. Often the man leaves the family when the woman falls ill. Older children in particular take on more responsibility than their age. You take care of the household and younger siblings, forgetting yourself.
- Sick parents can pose a threat to their offspring: 40 percent of all child abuse occurs on babies under one year of age. "Addiction problems and generally violent family relationships also play a role here. However, the risk of mentally ill patients being overwhelmed by abuse of their children is significantly higher," says Dr. Deneke.
- The special outpatient clinic at the University Medical Center Hamburg-Eppendorf (appointments under 040 / 42803-2215) takes in around 100 new families every year.
- The advice center of the association "SeelenNot" (Bahrenfelder Stra├če 169, supports families with mentally ill parents), has consultation hours on Mondays from 10 a.m. to 5.30 p.m. Advice phone: 040 / 3910-9050. The association does not receive any public funds and is dependent on donations. Account no. 4268 58 201 at Postbank Hamburg (bank code: 200 100 20).
- The association is urgently looking for rooms for events and for the children of the Auryn project. Offers of help under the telephone numbers mentioned.

By Uwe Groenewold
(This article was created on the occasion of a specialist conference on August 28, 2002 on behalf of the press office of the University Medical Center Hamburg-Eppendorf. It has been released for printing free of charge. A specimen copy is requested.)

* August 28, 2002, 9 am-5pm, University Medical Center Hamburg-Eppendorf, Martinistra├če 52, lecture hall of the Clinic for Psychiatry, Psychotherapy and Psychosocial Medicine. Journalists are very welcome. Registration requested under Tel .: 040 / 42803-2215.

Criteria of this press release:
Medicine, Nutrition / healthcare / nursing, Psychology
transregional, national
Miscellaneous scientific news / publications, Scientific conferences