h e r . J . Orthopsychiat.

63(2), April 1993

GROWING UP WITH A PSYCHOTIC MOTHER:

A Retrospective Study
Bonnie Dunn, M.S.W.
~~

Nine adults who had been reared by mothers diagnosed with psychosis reported
on their childhood experiences. Analysis of the retrospective data revealed the
five common themes of abuse and neglect, isolation, guilt and loyalty, grievances
about mental health services, and social supports. The resilience and coping
strategies of the participants are examined, and implications for therapeutic
interventions with .such families are discussed.

ople commonly joke about the crazy

have a schizophrenic parent (Gottesman &

Shields, 1966; Kev, Rosenthal, Wender,
such families are a grim reality for the many Schulsinger, & Jacobsen, 1978; Tienari et
children who grow up with a seriously men- al., 1987), and it is known that children
tally ill parent. Of patients discharged from born to a parent with schizophrenia have
mental hospitals in the United States, 65% about a 13% chance of developing schizoreturn to their families every year (Gold- phrenia themselves, a marked contrast to
man, 1982). For the children, living with a the estimated 0.5% to 1% chance for the
psychotic parent can make for a confusing, general population (Gottesman, 1991). Alisolating, and painful childhood. This study
though statistics concerning children of bipresents the childhood experiences, repolar and psychotically depressed parents
ported retrospectively, of nine adults who
grew up with such a parent. It explores their are less clear, studies have cited evidence
childhood memories in an attempt to dis- of increased disturbance in these children
cover what it is like to live with a psychotic as well (Billings & Moos, 1983; Rutter &
parent, with the goal of understanding the Quinton, 1984).
The environments of children who live
needs of this group, both as children and as
with
a psychotic parent affect their develadults.
opment. Early childhood studies underline
the importance of parental attunement and
LITERATURE REVIEW
Being born to a psychotic parent carries affect in the development of the growing
both genetic and environmental risks for a infant. Psychoses involving disorders of eichild. A large and growing body of re- ther thought or mood greatly influence an
search describes the risks of children who individuals behavior and affect, thus hin-

pfamilies in which they grew up, but

A revised version of a paper submitted to the Journal in April 1992. The author is at the Woodburn Center for
Community Mental Health, Annandale, VA.

0 1993 American Orthopsychiatric Association, Inc.

177

178

CHILDREN OF PSYCHOTIC MOTHERS

dering his or her ability to be an effective

parent.
Spitz (1%5) emphasized the importance
to the developing child of the reciprocity of
mother<hild affectual interactions. Mahler
and her colleagues (1975) considered parental attunement to be essential to the child,
and they, too, stressed the importance of
the interactional nature of the mother-child
relationship. Bowlby (1952, 1969) theorized that attachment, beginning in infancy
with a warm and continuous relationship
with the mother or mother-figure, is the
cornerstone of adult mental health. Stem
(1985) emphasized the intersubjective nature of the developmental process and assigned critical importance to affective attunement of the parent to the child. He
believed that this attunement allows for the
sharing and modification of affect between
parent and child, gently propels the childs
further development, and forms the basis
for a sense of self. If parental attunement
and appropriate affective response are critical to a childs development, the psychotic
symptoms of a parent whose affective range
is severely limited or inappropriate, or who
is out of touch with reality, would have
serious consequences for the child.
Researchers have documented other environmental factors that have an impact on
the development of children in families
where there is mental illness. Marital difficulties (Merikangas, 1984; Rutter & Quinton, 1984; Weintraub& Neale, 1984; Weissman, 1979), stress and discord among family
members (Anthony,1969; Billings & Moos,
1983; Hatfield, 1978;Noh & Avison, 1988),
and social alienation and lack of supports
(Hatfield, 1978; Hill & Balk, 1987; Noh &
Avison, 1988; Scottish Schizophrenia Research Group, 1987) are common for families of the mentally ill. Family members
are afraid of being physically harmed by
their psychotic family member (Anthony,
1986; Hatfield, 1978), and these families
economic resources are strained by the illness, leaving the children economically, as

well as emotionally and biologically, vulnerable (Hatfield, 1978).

While there is much in the research literature that delineates the various possible
effects that parental psychosis may have on
children in the family, very little is known
about the experiencesof these children from
their own perspectives. There is little in the
literature that calls on the experiences of
people who have lived with a psychotic parent to explore the unique aspects of such
lives, or to inform the development and implementation of interventions designed to
help families, specifically the children, in
which there is a mentally ill family member.
METHOD

Subjects
Nine adults who grew up with a psychotic parent participated in this study. Four
men and five women, all Caucasian and
ranging in age from 2 1 to 4 1, were interviewed. One was a journalist, one an engineer, one owned a small business, three
were students, one was in human services,
one was a market analyst, and one (who
had also been diagnosed with schizophrenia) was unemployed.
Study participants comprised a selfselected, purposive sample solicited through
classified ads placed in newspapers, notices in newsletters of the Alliance for the
Mentally Ill, and referrals by mental-health
providers. The criteria used to select subjects were that a parent had been diagnosed
with psychosis, that the subject lived with
that parent during the early childhood years,
and that the subject no longer lived with
that parent.
Twenty people conforming to the study
criteria responded to the notices; 18 had a
mother diagnosed with psychosis and two
had a psychotic father. In view of the small
number with a psychotic father, it was decided to limit the study variables by interviewing only those who had grown up with
a psychotic mother. It was also decided to
include only those respondents who could

179

BONNIE DUNN
be interviewed in a timely manner and were
within a one-hour drive; this reduced the
size of the final sample from 18 to nine
subjects.
Although schizophrenia is equally common among men and women, there are many
reasons for the significant difference in the
number of respondents with a psychotic
mother versus those with a psychotic father. The known ratio of schizophrenic
mothers to fathers is two to one. Because
onset for schizophrenia is generally later in
women than in men, and marriage and procreation occur earlier for women, women
have a greater chance of finding a mate and
bearing children before their first psychotic
episode (Gottesman, 1991). In addition,
children usually remain with the mother
when the parents do not live together, even
in cases in which the mother is severely
mentally ill. Thus, psychotic women are
more likely than are psychotic men to be
caregiving parents. It would be important
to explore, in future studies, more about
the consequences of having a father with a
psychosis.
Four of the mothers of study participants
had been diagnosed with schizophrenia,two
with bipolar disorder, and three with multiple disorders that included either schizophrenia or bipolar disorder.

jects discussed their current relationshipwith

their mentally ill mother, with other members of their family, and with mental health
providers. Finally, they were encouraged to
comment on experiences that had not been
specifically addressed by the interview questions; all did so.
Each audiotaped interview was transcribed verbatim. Discrete, important quotes
were placed on cards, and sorted into the
categories covered by the interview (contacts with mental health services; past and
present relationshipswith family and friends;
childhood needs). A subsorting within interview categories (such as expressions of
guilt that emerged from a question regarding childhood needs), derived from a content analysis of these quotes, identified
themes common to all study participants.
These themes, which recurred in all interviews with regularity, became the focus for
reporting the studys results.
RESULTS

Five themes characterizing common experiences emerged from these childhood

memories, which were striking in their similarity. The themes were abuse and neglect,
isolation, guilt and loyalty, grievances with
mental-health services, and supports. Since
the participants own statements powerfully convey their earlier experiences, representative excerpts from the interviews, organized by the five themes, are presented
here.

Procedure
Information was obtained through use of
a three-part semistructuredinterview. In Part
One, participants were asked about their
family structure and history, parental diag- Abuse and Neglect
All participants spontaneously described
noses, hospitalizations, and treatments, as
the
abuse or neglect they experienced due
well as about any mental-health treatment
to
their
mothers mental illness, ranging
they received as children and other contacts
from
maternal
withdrawal to extensive physwith mental-health providers. In Part Two,
ical,
and
in
one
case sexual, abuse. The
questions addressed participants childhood
mothers
distorted
sense of reality had a
relationships with their mentally ill mother
profound
effect
on
her ability to provide
and with other family members and friends.
consistently
for
her
childs
basic needs. One
Participants were asked to identify what their
young
man
in
the
study,
a
college student
needs were at the time and how those needs
were or were not met. They were also asked whose father was a respected professional
for their opinions about contacts with men- in his community and whose mother had
tal health professionals. In Part Three, sub- been diagnosed with paranoid schizophre-

180

CHILDREN OF PSYCHOTIC MOTHERS

nia, described this early neglect in the following way:

time during my elementary-school years with bruises

and things like that.

I was never bathed; I didnt have clothes. There was a

period when I had no friends-easy to understand; I
was a ragamuffin. . . . I didnt understand what bathing was. In fourth grade we used to drink beer before
school. There was just a complete lack of supervision.

As is evident in these accounts, surprisingly little effort was made to protect the
children from the abusiveness of the psychotic parent. Three participants spoke of
occasional support from their fathers, and
one father won custody of the children from
their bipolar mother, but fathers were generally seen by these children as physically
or emotionally unavailable to them. Four of
the fathers were alcoholics, and three left
their families when the children were very
young (after the mother had had her first
psychotic episode). Participants described
a childhood in which they received little
consistent attention from either parent and
where abuse or neglect were common.

As a result of having a parent who was

often nonfunctioning, these children became caregivers for the parent and younger
siblings at an early age. A participant whose
mother was diagnosed with paranoid schizophrenia described her situation when, at the
age of 15, her mothers delusional and paranoid behavior worsened considerably and
the girl supported them both:
She stopped functioning. It was definitely the biggest
trauma of my life. We got evicted from our apartment
because shed scream all night . . . shed bother all the
tenants. We lived in real dumps, and I remember living in a hotel with pimps and prostitutes. We finally
got an apartment, but it was four subway [changes]
from my school. It took me two hours to get to school,
two hours to get home. I had a job that was our only
income. Id get up at 5:00, go to school, go to my job,
go to the public library so I didnt have to go home
because my mother was so crazy. Id stay till it closed.
and then Id take my four subways home. She was up
all night screaming. The windows were broken. . . . It
was terrible-it was a nightmare.

Three participantswere physically abused.

One woman recalled her fourth-grade year
as being especially difficult. Her mother
was in a full-blown paranoid schizophrenic
episode, believing that people were planning to kidnap her three children:
That was a temble year. She was just in a constant
delusion for a full year. She wouldnt let us go to
school, we couldnt even leave the house, she used to
lock us in our moms because she was so scared people
were gonna get us. And we were really abused. . . . I
remember the bruises, and no one ever noticed that.
. . . I had this dream that I was going to jump out the
window and break my leg. just so they could see what
was going on. So many people didnt see, so many
people that shouldve seen.

Another woman who experienced what

she called ritualistic abuse by her schizophrenic mother said,
I was abused with some regularity. Ive got multiple
fractures, and was out of school for a good amount of

Isolation
Participants spoke of feeling isolated from
their peers, their communities, and their own
families, and of being confused by these
feelings. Eight of the participants reported
that their mothers mental illness was not
discussed in any real way with them when
they were children:
Everybody pretended like nothing was going on. My
mother would go off and be hospitalized, and nobody
would tell us where she was, nobody would tell us
when shed be back-my father included. . . . Once,
they took my mother off to a mental hospital, and they
left my brother and me [aged six and eight] by ourselves. I recall this very vividly. We were alone in the
house until the next morning. Nobody ever said anything.

One woman remembered that when her

schizophrenic mother received shock treatments, no one explained to her what was
happening. Such silence was a common experience among the people in this study.
Family members rarely acknowledged or
explained to the children anything relating
to their mothers illness. Psychotic episodes and behavior, which were confusing
and frightening, remained unacknowledged
and unexplained, leaving the children with
a confused sense of their own reality and a
feeling of being isolated within the family:

BONNIE DUNN
My mom [a paranoid schizophrenic] used to always
think someone was in the house. She always thought
it was my fathers mother, and she would send [me
and my sister] upstairs to go look . . . and give us toast
and sandwiches to bring up to Grammy. And my sister
and I would go up and look, and come back down and
say, Grammys not here-and then wed get the
belt. So we learned to adapt. Wed run upstairs, [eat]
the sandwich, come down and say, Grammy said
thank you very much. . . . But my sister and I never
talked about it.

Another young woman expressed anger

at her familys failure to acknowledge the
illness and went on to describe the loneliness and pain it caused her:
People didnt say what was going on;denial is a form
of lying in our family. The way I coped was to be a
very good girl-shut down, didnt make waves. So I
was always in a good mood-happy; at least other
people saw me as happy. I never told anybody. Everybody thought I was easygoing, sweet, and nice . . .
there was so much pain in my family that I couldnt
add to it, so if I was sad I couldnt let anybody know.

In addition to feeling isolated from family members, study participants also described a sense of alienation from the community and their peers. Although most
reached out to others at some time, whether
it was to a friend, a friends family, or a
teacher, they described feeling different from
these other, normal people, almost as if
they had two lives, each with its own reality. One man described his awareness of
never quite belonging, even while actively
seeking the company of a neighborhood family that welcomed him:
They had a nice home; I was comfortable and temfied
at the same time, because I knew I was differentthere was always a time when I was going to have to
go home. . . . I was always an outsider there, even
though I was always very glad to go over. I used to
have to limit myself to the times Id go over, because
I was pestering them-I knew I was pestering them.

181

Six participants recalled their reluctance

to invite friends to visit because of their
mothers bizarre behavior. Because the mentally ill mother and her family were ostracized by the community, the childs feelings of isolation were further reinforced:
[Once] I heard some kids talking, they were daring
each other to ring her doorbell. You know how neighborhoods have witches? Well, my mother used to be
the witch of the neighborhood. I heard people talking
about the witch-I wondered who it was-but it was
my mother.

Another woman recalled a very similar painful memory:

People or kids in the neighborhood used to make fun
of her, and I used to get really upset, and I would cry,
but I also got really angry. I would get angry at my
mother; it was easier to get angry at her. I felt different; I felt like there was something wrong with her,
and something wrong with us.

Feeling isolated and different was a common experience for the participants in this
study. Several individuals described the confusing consequences of having a parent
whose reality was different from the one
experienced outside the family, and they
detailed the feelings of alienation that resulted. One woman described her sense of
being different due to her mothers distorted sense of reality:
I remember being embarrassed because my mother
would use words to describe things that I found out
later were not what things were. I remember Show and
Tell in school, and bringing something that was normal in my house, and the kids really laughed-they
thought it was really funny. Kids would laugh; teachers would whisper. I thought it was me-that there
was something wrong with me.

Guilt and Loyalty

Guilt and loyalty, though not directly adAnother woman described very similar dressed in the interview questionnaire, confeelings about her connection with a friends tinually emerged as important themes. Most
participants were (and continue to be) quite
family:
loyal to their mentally ill mothers, although
Even though I was welcomed and the friends and their living with them was extremely difficult and
parents were very nice, I think a lot of them felt bad
for me. They always welcomed me, but I felt differ- painful. One young college student exent. I so much wanted to fit in and be a part of their plained why he returns to live with his
mother every summer:
family that I let that part go.

CHILDREN OF PSYCHOTIC MOTHERS

I want to be there for my mother instead of shipping
out and abandoning her. As long as I can stand it, I
think its good for her. Its not good for me-its
pretty bad, actually-sometimes intolerable, and I have
to leave.

Another woman left her foster home to

return to her mother before she was legally
free to do so, knowing that it would be
hellish at times but feeling loyal to her
mother, who she felt needed her care. Loyalty often contributed to the participants
feelings of isolation:

I couldnt see my friends because . . I couldnt talk

to them about what was going on . . . I couldnt tell
anybody. It was terrifically humiliating-plus I knew
it was totally disloyal.

Difficult loyalty conflicts emerged over

issues of child custody. Some of the most
emotional responses of these interviews
arose when describing those conflicts:
Social workers came to interview us [during a custody
battle between her mother and father]. I was in such a
bind. I didnt want to hurt her. Now I feel furious
about it because the way they did it was so stupid.
After the social worker left, [my mother] sat me on her
lap and asked me, Dont you love me? Why do you
want to leave me? . . . It was hard, because we
wanted to be with [my father].
[My mother] alienated herself from [family friends
who were trying to help]. Thcn I was really alone.
[The friends] would come to school with a childwelfare worker, call me to the principals office, and
sit down and talk to me about whats happening with
your mother, and I wouldnt talk about it. But the
agencies they called should have known that it shouldnt
have been up to me to blow the whistle on her-they
should not have given me that responsibility! They
should have made an adult decision to take me out of
the home. . . . I felt my loyalty had to be with her.

and One doctor told us it was our fault,

were comments from two participants that
revealed this sense of guilt. Many participants described the guilt they felt at being
separated from their mentally ill mother. It
did not matter if the separation was the result of their own choice or resulted from
decisions made by the adults around them;
leaving their mother, while providing relief, also led to feeling guilty. After her
father won a custody battle to get the children from their mentally ill mother, one
participant recalled:
My mother always wanted me to visit her, but I didnt
want to go; it was depressing. My brothers and sisters
wouldnt go. . . . I was the youngest and I would be
the one who felt like I had to go, because she was
alone if I didnt. . . . I never went because I wanted to
go. It was an obligation. . . . It was painful when I
lived with my father. I wanted to live with him, but I
felt like Id abandoned my mother.

Many participants expressed guilt that

they were healthier and that their accomplishments exceeded those of their mother
or other family members. One woman, describing her considerable personal and professional achievements, said, All the things
Ive managed to accomplish-none of it kept
her from being crazy. One young woman,
concerned for the older sister who was very
protective of her during their tumultuous
childhoods, said,
I feel bad . . . [my sister] gave me all her strength and
had none left for herself. Now shes having all the
problems. . . . I feel guilty. . . . I just want to make
her better.

Another expressed guilt at going away to

college, thus abandoning his schizoPerhaps the most telling expression of phrenic mother, and described his feeling
the conflict experienced by these children that his father (who remains married to his
was embodied in this paradoxical statement mentally ill wife)
of one man: The best place for me to be
sacrificed his life. . . . Its been good for my mother,
was home. It was bad. A lot of it was sheer its been good for us wds]. But its important to have
hell.
a life, and to have somebody love you, and hes totally
Expressions of guilt were tied to the feel- sacrificed that.
ings of loyalty. All but one of the studys
participants expressed a belief that they had Contacts With Mental Health Services
All but one study participant found childcaused or contributed to their mothers menhood
contacts with mental health services
tal illness. She was sicker after I was born,

BONNIE DUNN
to be negative. (The exception was a young
woman who, as an adolescent, went into a
psychoeducational treatment with her mother
and learned different ways to deal with
schizophrenia. However, an earlier experience with therapy had left this same girl
temfied when the therapist encouraged her
mother to describe her delusions, which seriously frightened her young daughter.) As
children, they often witnessed their mother
being taken away to be hospitalized, but
rarely received explanations of what had
happened or what to expect. Visits with
their hospitalized mother were recalled as
terrifying experiences that caused them much
pain and guilt. Often these children felt that
they were to blame for their mothers hospitalization. Many suspect that their mother
was mistreated or abused while hospitalized:
It felt like animals. The smells, the sounds, the screams,
the cold, sterile beds that barely had covers on them.
I couldnt imagine anything worse-to see your parent
in a place like that was temble.
Dont ever throw your mother in a state institution.
Thats one of the hardest periods I ever went through.
It was a cruel place. I think my mother was sexually
abused there . . . when she came out, she was very,
very frightened.

While contacts with the mental-health system in general were perceived negatively
by study participants, direct contacts with
mental health providers were described even
more strongly as unpleasant, guilt-provoking, or even harmful. One young man recalled a family-therapy session when he was
in seventh grade in which the therapist told
the family that his schizophrenic mothers
bizarre behavior was the familys fault. His
initial feeling of guilt was later expressed
with anger:
They try to peg what is a medical problem as something else . . . its just reprehensible to tell a bunch of
kids its their fault, but its still going on. . . . Its like
treating a cancer in the Stone Age.

more understanding of her mother. This

young woman, who described herself as a

child who had hidden her real feelings for
the sake of her family, remembered how
devastated she was to hear that she was not
doing enough. Still another participant, who
had had her bones broken on several occasions during her mothers frightening psychotic attacks, was coerced at the age of
18 by her mothers psychiatrist into staying
with her delusional mother when no one
else would:
Her psychiatrist appealed to me to stay. He guilttripped me into staying in the household for another 18
months. . . . These crazy psychiatrists! What was
most frustrating is that the psychiatrists would violate
her confidentiality by hooking family members in when
it was useful, but wouldnt respond to family members
when it wasnt convenient for them.

These direct contacts with mental health

professionals, though possibly having some
value to the mother as patient, are remembered by the children as personally hurtful
and damaging.
Despite their negative views of their childhood contacts with mental health services
and professionals, eight of the nine participants in this study had entered individual
therapy as adults. This information was imparted spontaneously during the interviews. With the exception of two participants (both male), their reasons for seeking
treatment-whether they were symptomatic or had received a diagnosis-are not
known. The participant who had been diagnosed with schizophrenia entered treatment when he became delusional. Another
man entered treatment when he had a
breakdown several years ago.
All eight found therapy helpful in understanding the impact of their mothers mental illness on the family and on them as
individuals. One young woman recalled finally being told by a therapist what was
wrong with her mother:
That was one of the greatest days, when
said, Your mother is a paranoid schizophrenic. They

concrete.

184

In therapy, participants were able to discuss their fears for their own sanity, very
common among children of psychotic parents, and reported working on setting limits, both emotional and physical, with their
mother. Some emphasized the relative safety
of the therapeutic setting; it was a place
where they could begin to explore their relationship with their mother, who had so
often seemed omnipresent and omnipotent
to them:

CHILDREN OF PSYCHOTIC MOTHERS

I had been saved-well, not saved, but helped a great
deal by being adopted by this family . . . they had
a healthy home, you could tell when you went in
there. They had regular meals; it was homey. But I
used to have to limit myself to the times Id go over.
I connected with a teacher I had . . . shes a friend to
this day. She used to have her [class]room open during
lunch . . . ultimately some of us got incorporated into
her family. We used to go over to her house [for]
family dinners, and its the first regular family I ever
saw. . . . She was a major changing point for me.

These connections were often initiated

by the adults, but in many instances participants described actively seeking certain people out, targeting people with whom they
knew they could feel comfortable and accepted.
The women in the study were more
I was in therapy with a wonderful therapist for about
likely
to
describe themselves as having aceight years. Its sort of a reparenting. I would actually
think of it as critical to getting on with life. I think that tively sought out certain people, while the
many of us who live through that kind of stuff dont men took a more passive role as children in
ever let ourselves feel anything about it because it accepting the support or companionship of
doesnt feel safe . . . [you have to] create a safe space.
others. These supportive relationships were
But it ma& a big difference to me-it really changed
not without difficulty. Many participants dethe course of my life.
scribed feeling that they didnt quite belong
with these families or friends, and many
Social Supports
All nine of the study participants identi- experienced loyalty conflicts, even while
fied one or more people whom they saw as pursuing these friendships.
Although all the participants clearly arsupportive and helpful when they were chilticulated
pain-filled relationships with their
dren. In some cases it was the grandparpsychotic
mother, five recalled a special, if
ents; often it was neighbors, family friends,
inconsistent,
loving relationship with her.
teachers, or coaches. These people were
This
love
and
support varied with the inavailable to the children on a somewhat regtensity
and
duration
of their mothers psyular basis. The children rarely, if ever, talked
chotic
episodes:
to them about their family situations, but
they saw these people as safe and saw their She was extremely indulgent in some ways, and even
homes or places of work as places in which though we were poor there was a way in which I was
they were welcome. In retrospect, these s u p treated to think highly of myself. . . . I was the apple
portive others were viewed as lifelines to of her eye, I had a sense of myself. . . . What I learned
the world outside the chaotic and bizarre to do was to connect real stronglywith people. I learned
some of that from my mom who-when shes not
family situation and as providing them with crazy-is
a very connected person. What I learned
care, attention, and a certain amount of re- from her did me well.
ality testing. Many participants described
these people as having made a very big
DISCUSSION
difference in their lives:
These extensive, first-person accounts of
I sometimes wonder why Im not crazy. . . . Thats the daily life with a psychotic parent corroboonly thing I can think of, that my grandmother took rate previous findings and contribute new
care of me . . . really me. I was the youngest, I was
information that can add to our understandher pet. She was very attentive and I felt very taken
care of by her. She paid a lot of attention to me, just ing of the experiences and needs of children of mentally ill parents. It must be reloved me.

The biggest help is finding a place where you know

you wont get hurt if you tell the secrets. Whats easy
is finding a place to tell your own secrets. . . . Whats
more difficult is if you tell your mothers secrets . . .
if you report her behavior it still feels dangerous.

BONNIE DUNN
membered, however, that the small size of
the study sample limits the generalizability
of its findings, however informative.
The burden described by many families
of the mentally ill (Anthony, 1969; Hatfield, 1978) was experienced by all the participants in this study, particularly the neglect and the fear of physical harm they
lived with as a child of a psychotic mother.
The pervasiveness of the neglect is an indication of the devastating effect that the
mental illness of one family member has on
the entire family.
These participants confirmed previous
findings (Hatjeld, 1978; Hill & Balk, 1987;
Scottish Schizophrenia Research Group,
1987) that families of the mentally ill experience social isolation and alienation. They
described their neighbors and extended familys treatment of their mentally ill mother
as an outcast; further exploration found that
some children thought it was because of
something they themselves had done. In
part, the isolation was self-imposed because they would not talk about what went
on in the family out of a sense of loyalty to
their mother, or from a sense of humiliation
or shame about their situation.
Adding to their isolation was the confusion felt by these children when confronted
with the two separate worlds-that of their
family, dominated by their psychotic mother,
and that outside their family, represented
by school and peers. Acknowledging these
separate realities, usually in adolescence or
young adulthood, was accompanied by the
pain of having to acknowledge their mothers mental illness, and this caused participants to feel disloyal and guilty.
Feelings of guilt and loyalty, rarely mentioned in the literature regarding children of
mentally ill parents, emerged regularly during these interviews, pervading their childhood memories and continuing to touch their
adult lives. Separation guilt (Friedman,
1985; Weiss, Sampson, & the Mount Zion
PsychotherapyResearch Group, 1986),the
belief that pursuing ones individual goals
and striving independentlyfor personal well-

185
being is harmful to a loved one, was expressed by many of the studys participants
in their statementsthat they somehow caused
or exacerbated their mothers illness by leaving or by wanting to leave home. Survivor
guilt (Friedman, 1985; Weiss etal., 1986),
the belief that only a finite amount of good
things is available to each family, and that
the achievements of one member diminish
the possibilities for the others, was universally experienced. Even though the interview protocol did not include questions on
the subject, all the participants expressed
some form of separation and/or survivor
guilt, both as children and as adults. This is
significant, and is generally overlooked in
the literature regarding children of the mentally ill.
Contacts with mental health professionals and the mental health services were remembered as unhelpful and sometimes
harmful by study participants. They recalled feeling blamed for their mothers illness. Perhaps once-popular (but since discredited) family-systems theories that
attributed a childs schizophrenia to certain
parental behavior (Bateson, Jackson, Haley, & Weakland, 1956; Fromm-Reichmann, 1948; Lidz, Fleck, & Cornelison,
1966;Sullivan, 1927; Wynne,Ryckoff, Day,
& Hirsch, 1958; Wynne & Singer, 1963)
were generalized by some mental health providers into a belief that family behavior
could cause schizophrenia in any family
member. When social workers and welfare
agencies intervened, the childs negative
feelings about the actions of adults reflected a keen sense of loyalty to and responsibility for their mentally ill mother.
Guilt resulted when they felt they were being disloyal by leaving, or by speaking up
about the conditions in which they were
living. Thus, their perceptions of contacts
with mental health professionals as conflictridden and negative may have been influenced by feelings of guilt and loyalty. The
prevalence and strength of these emotions
have implications for therapeutic interven-

CHILDREN OF PSYCHOTIC MOTHERS

tions with a mentally ill family member or
the children.
The focus of this study was childhood
experiencesand the common ground among
them. Nevertheless, it is interesting that eight
of the nine participants apparently overcame earlier negative experiences with mental health professionals and sought therapy
as adults. As children, study participants
described consciously overcoming feelings
of shyness, feelings of being different from
others, and fear of reprisal from their mother
in order to put themselves in safe and affirming situations with supportive peers or
adults. Entering therapy as adults despite
earlier negative experiences can be seen as
an extension of their developmental coping
strategy of overcoming negative or conflictual feelings in order to seek support from
others.
It is also anecdotally interesting that study
participants who had had several years of
therapy generated rich sets of data, while
the participant with no therapy did not. Therapy apparently helped them to verbalize their
memories and feelings, and perhaps allowed them to achieve the perspective necessary to share painful memories.
The feelings of study participants toward
the mental health profession were complicated and reflected, to a certain degree, the
conflicts and incongruencies that were always present in their childhoods (while participants emphasized the childs need to talk
about the difficult home situation, they also
told of how loyalty, guilt, and fear would
not allow them to do so; two who had been
removed from the home as children felt conflict about that intervention, and two who
stayed with their mother were angry that
mental health services did not intervene to
remove them; two described their childhoods as deplorable in many ways and great
in many others. These contradictions and
conflicts embody the essence of growing
up with a psychotic parent. That eight overcame earlier negative reactions to the mental health profession and went on to have
positive experiences in therapy illustrates

their resilience and ability to cope, particularly in tolerating contradiction and conflict in the service of mental health.
It is known that one study participant
entered therapy after having a breakdown,
and that one was treated for schizophrenia,
but questions remain as to why the others
entered treatment and how that affected
outcome. Did they enter treatment because
of unresolved traumas? What are the
differences, if any, between those who
enter treatment and those who do not?
What is the general outcome for those who
receive treatment as opposed to those who
do not? The interviews, while revealing
the seeming contradiction of seeking therapy after earlier negative experiences, did
not address these complex issues. Future
research oriented toward exploring these
questions could add greatly to our understanding of resilience and coping, and
could help to refine our understanding of
the therapeutic process with people who
have grown up with a seriously mentally ill
parent.
All participants reported having supports
of varying degrees outside the home. Research has emphasized the need for supports for children of the mentally ill (Gut?man, 1989;Rice, Ekdahl, & Miller, 1971;
Rurrer, 1975),but the support found by participants in this study was informal, from
teachers, other family members, and friends,
rather than the more organized socialservice supports recommended in the literature. Many participants, mostly the women,
described actively and aggressively seeking
out individuals and families who would welcome them and with whom they felt comfortable and safe. The men described themselves as less aggressive in seeking out these
supports as children, and reported that, while
they were aware of help when it was offered to them, they sometimes had difficulty accepting it.
In their research on resilient children,
Felsman and Vaillant (I987)noted the ability of some children to draw others to them
for support, a strategy reported by several

BONNIE DUNN
researchers who have studied children of
mentally ill parents (Fisher, Kokes, Cole,
Perkins, & Wynne,1987; Kaufman, Gruneh u m , Cohler, & Gamer, 1979; Kringlen,
1978). In these outside contacts, study participants never discussed their familys situation; rather, they seemed to use the relative normality and safety of these interactions to sustain them in their difficult family life, and to ground them in a reality
different from the one experienced at home.
It is not possible from the present data to
define the specific quality and nature of the
supports the participants received as children or to compare these supports to the
supportive relationships enjoyed by most
children. It is very important, however, that
these relationships were perceived by this
studys participants as critical to their development. Participants told of their supporters being major changing-pointsin their
lives and described them as rescuers, saviors, and people who kept them from growing up crazy like their mother. Further research into the quality and nature of the
supports that can sustain these children, as
well as the propensity of such children to
take the most possible sustenance from ordinary supports, may be useful.
This was a very small, self-selectedgroup;
that they chose to respond to solicitations
raises the possibility that they differ in some
ways from those who did not respond. They
may possess certain characteristics not
shared by some other children of parents
with psychosis, such as curiosity about the
subject, a willingness to share painful memories for the greater good, or a certain objectivity about the parents mental illness.
In his research on invulnerable children,
Anthony (1974) found that the more resilient children in his study were among the
most collaborative, supporting the possibility that the participants in this study may be
more resilient than others.
Eight of the nine participants of this study
were working and all described relationships of varying degrees of satisfaction in
which they were involved. Despite the small

187

size of the sample, the resilience and the

coping strategies of these individuals may
be instructive in the search for new ways to
help the many children who are growing up
under similar very difficult circumstances.
Since all the participants in this study were
volunteers and all but one had had some
psychotherapy, these results may tend to
understate the severity of trauma and the
difficulty in overcoming it among the general population of children with psychotic
parents. Although these participants were
resilient, pain, confusion, and isolation characterized their daily lives in childhood and
they continue to reverberate in their adult
lives.
Implications for Treatment
These findings have practice implications both for those professionals working
with psychotic individuals and their families and for clinicians working individually
with adults who have grown up with a mentally ill parent. For the children in these
families, age-appropriateinformation about
the parents illness may be helpful, as might
inclusion in a multiple-family support group
(Sigman, John, Levinson, & Betts, 1985).
Current psychoeducationalfamily interventions could be modified to include children.
In all interventions involving families of
the mentally ill, professionals must be aware
of the conflicts in loyalty posed by outside
intervention and of the guilt felt by the children. They must recognize that the child
has a caregiving role, and encourage both
parents, where possible, to strengthen their
parental roles and skills. Clinicians must
realize that one of the most effective forms
of help is the support of other family members (in some cases the parents, however
minimally), school personnel, friends, and
friends families. They should encourage
and help these children to seek out such
relationships.
Because many of these children will seek
out individual therapy when they become
adults, clinicians should be aware that the
loyalty conflicts and guilt they experienced

CHILDREN OF PSYCHOTIC MOTHERS

as children continue to reverberate in their
adult lives. Survivor guilt can keep them
from achieving to their fullest potential and
may hold them back from satisfying adult
relationships. Bleuler (1974), in his extensive longitudinal study of over 200 families
of schizophrenics, referred to the shadow
that is cast over the lives of children of
schizophrenics, and these childhood feelings of loyalty and guilt may comprise a
large part of that shadow.
Clinicians must also be willing to address the fears of adult children of psychotic parents that they will become as
crazy as their parent; they can help their
clients to set realistic yet caring boundaries
with their mentally ill parent. Support networks, such as the Alliance for the Mentally I11 and support groups run by mental
health clinics and psychiatric hospitals, can
provide these adults with information about
mental illness and with the unique support
and understanding that can come only from
others who have shared a similar experience.
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