When mum is always sad
Niklas says: «If mum has to go to hospital, we'll give her something. I'll give her a teddy bear.» - «And I'll give her an elephant case,» says Lena. And Emilia, the smallest? «A dirty sock. So that mummy doesn't forget me.» Niklas, Lena and Emilia have a mentally ill mum. They are not alone. According to a study by the Winterthur Integrated Psychiatric Centre, 20,000 to 50,000 school-age children in Switzerland live with a mentally ill parent. This figure is likely to rise to 300,000 if those parents who conceal their illness or do not even realise that they are ill are included. It can take ten years from the first symptoms to a possible diagnosis. But how do you explain to children why their mum or dad is leaving? And who looks after them? What is challenging for healthy parents can be overwhelming for sick ones. Yvonne B., the mother of three siblings, knows this. The 43-year-old from the canton of Bern battled severe depression for two years. Antidepressants, 14 electroconvulsive therapies under general anaesthetic and 30 weeks in hospital brought no relief. Signs of a zest for life only emerged when the anaesthetic ketamine was used. «It also helps to relieve pain when someone is trapped in a car after an accident,» says Yvonne B. Her description of the illness sounds like being trapped: leaden tiredness, abysmal sadness, back pain. And in her thoughts, she is always a little closer to death than to life.
I hugged my mum. It didn't help.
At the same time, motherhood continues. But she can't comfort the children. The children comfort her. At least they try: «I hugged them. It didn't help,» says ten-year-old Niklas. But Niklas was lucky. His mother's psychiatrist explained to him why his mum was sad. That is not a matter of course. Because children are not included in the treatment plan. Sleep, appetite, work, relationships: the doctors' questions cover all sorts of things. But the well-being of the children is usually ticked off with two questions: «Do you have children? How many?» For psychiatrist Thomas Ihde, head of the psychiatric services at Frutigen, Meiringen and Interlaken hospitals, that's not enough. Over a cup of tea at Bern railway station, he says: «If things go well, the psychiatrist still knows who is looking after the young children during a hospital stay. But if they're older than ten, they're hardly interested in them: «They're big enough,» is the idea.» Children and parenting issues are also non-existent in therapy manuals. A rethink is needed here. He is convinced that the question «Do you often lose your temper with your children?» could become the starting point for important conversations. Some types of therapy, such as system-orientated therapy, are interested in family relationships. However, the focus there is on adult children who can support the person with the illness. The fact that children of sick people need help themselves is not considered. Or, as Thomas Ihde says: «There is a gap in the system. » Conversations with adults who were themselves affected years ago show just how helpless children can be when they are left alone with their parents' suffering. «Our father didn't speak to us for ten days in a row.» - «My mum gave me her own obituary: Location, obituary, everything in it.» - «If I was scared at night, my father put a rifle next to my bed to calm me down.»
Inability to translate medical expertise into children's language
Some only realised after leaving home that what they had experienced was an exceptional situation: «She cooked food in an empty pan for guests who didn't come.» - «She didn't give me a single hug.» Some knew about their parents' suffering, but kept quiet out of shame or because talking was forbidden. «I stole fruit on the way to school because I was ashamed of my empty snack box.» Others had to experience that mental illness can end fatally: «She was lying dead in the bathroom. A note on the table: I have to go.» Even when parents are undergoing treatment, the irritation remains for children. The doctor looks after the sick person. Nobody talks to the children themselves. As a result, mental illness becomes the «elephant in the living room that nobody talks about», as Thomas Ihde says. Why is this the case? Inhibitions are one reason. The inability to translate specialised knowledge into children's language is another. How do you explain to a four-year-old why sleep doesn't help against tiredness? This knowledge is not a compulsory part of either medical or psychology studies. You get the specialist title of psychiatrist without ever having conducted a family interview.
If it's a bit bad, quite bad, you go to the clinic.
Thomas Ihde is convinced that time and financial expenditure are not the reason. «Talking to the child relieves the family, and that speeds up the healing process.» Nevertheless, changes are gradually becoming apparent. Professionals are becoming more aware, and the first clinics are offering programmes for children. Former patients are breaking the taboo and talking about their illness in schools. But something is still missing: the voices of the children. In the B. family, these voices are polyphonic. «You're tired and don't like it anymore. If it's a bit bad, quite bad, then you go to hospital.» Eight-year-old Lena knows how to deal with her mother's illness. What can happen. She seems reserved with her soft voice, her salmon-coloured skirt and her hair tied up. She likes to leave the talking to her big brother: «You get sadder and sadder and don't go out anymore.» Six-year-old Anina speaks up between two potato crisps: «That's what you get when you do a bit too much. It's like that with our mum.» Emilia, Lena and Niklas struggled with their mum to find a name for the elephant: «sadness disease» is what they are talking about on this summer's day. Boats rock on the lake behind them. Through language, the family found a way of dealing with depression in everyday life. When her mother was tired, she set an alarm clock. «When it rings, you can wake me up.» The children helped with the housework. Nils learnt how to take the mattress down from the bunk bed, Emilia learnt how to cook. «Chli water, chli la blöderle, chli Hörnli dri, chli warte, chli Anke dri, done.» Yvonne's husband was also a support. When she had to go back to the clinic, he organised childcare and did as much as he could himself. Yvonne B. missed this support from the professional side. «The social worker sat in front of us with an empty notepad. I couldn't take the children to the clinic. They don't have a mother-child room. Just a room where you can take pets.» Yvonne B.'s clinic is not an isolated case. Although more and more psychiatric clinics in Switzerland are offering mother-child places, they are usually only for children «up to walking age», as some places put it. What's more, a place for a child costs around CHF 50 per day - and is not covered by most health insurance companies. Some Spitex organisations and the Red Cross now offer childcare services. However, many sick people lack the energy to look for such a service. In Yvonne B.'s case, her husband and a neighbour took over the organisation: childminder, home help, neighbours and friends. They all took over part of the week and the father the weekend.
Children develop feelings of guilt
But there was one burden they could not relieve the mother of: the feelings of guilt when she had to leave the children. The fact that children also develop feelings of guilt when a parent is ill can be explained by developmental psychology. Stephan Kupferschmid, head physician at the Department of Child and Adolescent Psychiatry in Bern, says: «From the age of four, children develop egocentric thinking. If you ask them why the tree is there, they say: So that I can stand in its shade. Why is mum feeling bad? Because I wasn't good.» If the child grows up with this feeling of guilt, it cannot develop healthy self-esteem. And the risk of becoming mentally ill themselves increases fourfold. Some children have attachment problems, for example if the reaction of the sick mother is unpredictable. «A child like this may not respond appropriately to attempts at contact. Perhaps it is very trusting of strangers and immediately wants to sit on its knees. Or it may be very suspicious and inhibited.»
That's what you get when you do a little too much. That's the case with our mum.
Yvonne B.'s feelings were also unpredictable. That's why she never made a secret of her illness, talked to the children, let them talk to the psychiatrist and informed those around her. «The neighbours often took the children on outings. They didn't offer. They did it.» How well a child survives the stress depends on many factors. On their inner resilience and whether they have good carers. «The partner, a teacher or a neighbour - it doesn't matter who they are,» says Kupferschmid. And: «Children are stronger than you think.» If a family finds a good way of dealing with the illness, nothing stands in the way of the children's healthy development. Studies confirm this: only a third of children who grow up in difficult circumstances later struggle with ongoing mental health problems themselves. Another third do so temporarily. The final third cope successfully with life and remain healthy. How are Lena, Niklas and Emilia doing? «It's not actually that bad,» says Niklas. Lena has her doubts. «It's sad though. My heart is aching. It's throbbing a bit more.» When she's sad, she talks about it. Or draws. It helps to combat her own sadness. The elephant then gives way to small everyday wishes. Like today, on this sunny day: «I want to go swimming now.»
This text was published on 10 September 2015 in DIE ZEIT Schweiz, issue no. 37. Reprinted with the kind permission of the author. We have changed the names at the request of the family.
Tips and links with further information
www.wikip.ch: Offered by the Swiss Foundation for the Promotion of Mental Health in Children and Adolescents. These include: SOS family help, sponsor family services or counselling and contact points.
www.strong-kids.eu: This platform for children, parents and professionals offers information material and support services in ten languages on the subject of children and young people with mentally vulnerable parents.
www.promentesana.ch: Offers for those affected and their relatives. Counselling hotline: 0848 800 858
Guidebook: A. Lenz and B. Brockmann: Strengthening children of mentally ill parents. Verlag Hogrefe, 2013 - A book with specialised information for parents, educators and other interested parties.
Picture book: E. von Mosch: Mummy's monster. What's wrong with mum? Balance-Verlag, 2008 - A book for children aged 4 and over, with text and illustrations on the subject of depression.
