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David Baxter PhD

Late Founder
Growing Up with a Mentally Ill Mother - "Daughters of Madness", a New Book
August 23, 2007

Daughters of Madness is a new book on daughter's experiences with mentally ill mothers. The book is unique in that it includes an introduction on how children are affected by mentally ill parents and the related research. The rest of the book is full of interviews, and personal stories of women who have experienced a mother suffering from mental illness. Although the book is about daughters and their mothers, anyone with a mentally ill parent or family member may find it beneficial.

Susan Nathiel, the author, is an accomplished psychotherapist who is also a "daughter of madness" - and wrote this book with a wide range of audiences in mind; from professionals, to students, adults, and teens. The book is divided into sections based on age relevance of the stories, and includes perspectives from many different mental illnesses; including schizophrenia and bipolar disorder.

We are fortunate to have had an opportunity to ask her some questions that may be helpful and hopeful to the reader. Below we have included an extensive Q&A with Susan. There is also have an FAQ on the book's website.

From Susan Nathiel, author of Daughters of Madness: Growing Up and Older with a Mentally Ill Mother, Praeger/Greenwood Press, 2007.

What is your background and education?
I have an ABD (all but dissertation) in clinical psychology from the University of Connecticut, and a Ph.D. in Family Studies from the same school. My licensure is in Marriage and Family Therapy. I've been in the field for over thirty years, worked in hospitals and clinics, and have had a full time private practice for the past 20 years or so. I've trained with Carl Whitaker (a leader in the family therapy approaches) and had a good deal of training with other family therapists, as well as training in trauma work, EMDR, and so forth. I'm a founding member of the Connecticut Guild of Psychotherapists, a group dedicated to working outside managed care and educating people about the dangers of the managed care system. I was also a founding member of a group that existed for about 6 years : The Center for Illness in Families, dealing with chronic and life-threatening illnesses affecting families. My approach to psychotherapy is rather eclectic : I do a fair amount of long-term work with individuals, and treat couples and families as well, usually for shorter periods of time.

Can you tell us a little about your own family background to provide some perspective? What did your mother have, how did it impact the family?
Since I continue to be in full time practice, I prefer to keep some confidentiality for myself as I did for the women I interviewed for the book. I do disclose in the book that my mother had a serious mental illness, with mixed diagnoses over a period of years, and she was hospitalized several times. My interest in writing the book had much to do with the fact that we never openly discussed her illness among ourselves until I was an adult. Part of the impact of her illness was the long years of silence and mystery surrounding her illness, and that is part of what prompted me to want to interview other women whose mothers were mentally ill.

What are some of the topics covered in the book?
Some of the major topics addressed include:

  • Feelings of guilt in the child - Is it my fault?
  • Keeping the secret (and why thats bad for the child)
  • Role reversal - when child acts as parent
  • Fear of the same fate
  • Building resilience and accepting help
  • Insights from daughters of mothers who were schizophrenic, psychotic, severely depressed, paranoid, and personality-disordered.
What was your goal with the book? Who are you writing the book for?
My goal has been to give a voice to women who have been silent or isolated about their experience growing up with a mentally ill mother. I hope that hearing a multitude of stories from different women will help break open that isolation, and will make it possible for women to talk more freely about their experience. I hope, too, that the book will help people understand why their early experience can still have powerful effects in the present.

What type of audience is the book intended for, and who can benefit from reading it?
Daughters of Madness is based on interviews with daughters of mentally ill mothers so obviously they are the core audience. But anyone growing up in a family with mental illness, or anyone growing up with a mother with serious problems, will benefit a lot from the book. It's also helpful for professionals since there are chapters about maternal mental illness and the impact on child development. And since there are so few books about adult children of mentally ill parents, the interviews themselves are a great source of information for professionals. As a professional in private practice, I look for books like this to inform me about a broad range of experience that I might only encounter occasionally in the office. Students in mental health fields would definitely find it very useful.

What would be some of the suggestions to children who are in their teens (common visitors to our web site) on how to overcome challenges of a mentally ill mother?
My first suggestion would be a very strong one: find someone to talk to about your mentally ill family member. If at all possible, find a mental health professional - any professional degree - who seems to "get it." That might very well be a school guidance counselor. If not, it might be somebody in a clinic, it might be your pediatrician. It's very important to talk to someone, though, and not carry this as a shameful secret. Find some adult to talk to.

If there's anyone in the family to form a bond with on this, find that person and talk to them and let them know what's happening. That could be a brother or sister, father, aunt, uncle, grandparent, whoever. If they deny or minimize it, go to someone else.

There's a book for teens that I just reviewed on my website, called I'm Not Alone: A teen's Guide to Living with a Parent Who Has a Mental Illnessby Michelle D. Sherman and published by Seeds of Hope Books.

The more information the teen has, the better off they are. Information helps you know that it's not your fault, that it's an illness the parent has, even if they blame you for it which they often do. Once you know that, it's easier to ask questions. If you have a good relationship with the ill parent, talk to them when they?re doing ok. Don?t participate in the avoidance, if you can help it.

It can also be really important to find other adults to turn to, to get support from, and spend time with. The teen doesn?t necessarily have to tell the whole story to everyone, but it's ok to let a coach or a teacher or an employer that things are tough at home. Find outside activities that you like, where you can do well and make your mark. Don?t take on the responsibility of keeping the household together emotionally. The kids who do best usually have some outside thing that?s all their own, that's separate from the family. Don't forego chances to do things, or the chance to go away to school, in order to take care of the family. If you're bearing the whole burden of taking care of the family, then that's a big red flag that things are too far gone, and you need to get some help.

Do you include interviews about daughters who also have a mental illness?
Yes, I do. There are several daughters who were diagnosed with mental illnesses in adulthood. In one case, the daughter of an undiagnosed and untreated severe personality disorder herself has been in and out of hospitals with her own depression and suicidality. For her, it wasn't about having the same illness as her mother because her mother denied that anything was wrong with her and was never diagnosed. A couple of the women were diagnosed bipolar as adults and made the decision to handle their illness in a very responsible way with full communication with people close to them. This came directly out of their experience growing up with the same illness where it wasn't handled well by the family or by mental health professionals.

People with mentally ill family members often talk of the fear of repeating patterns: this could be the fear that they would become mentally ill or have a child who is mentally ill. Was this a common thread in the daughters? stories?
Yes, it was certainly a common theme. Women growing up with very depressed mothers feared becoming depressed, and women with bipolar mothers were fearful of both depression and also being "too happy" ? which might mean they were becoming manic. A couple of the women whose mothers were schizophrenic had fear of developing that illness, often more intensely when they reached the age their mother was when she became ill.

A number of the women in the book chose not to have children, and that's not uncommon among people growing up with mental illness in the family. In some cases they felt their own recovery wasn't sufficient to enable them to be good mothers, and in some cases they didn?t want to pass on a genetic predisposition to any mental illness. Women who had children often worried about their kids if the kids seemed to have any difficulties that looked like they might be related to the grandmother?s illness.

You talk about the importance of the connection between mothers and daughters because daughters identify with their mothers, and the mother is the first model for how to be a "woman." What impact does having a mentally ill mother do to a daughter?s sense of self?
There are two parts to this answer. First, when a child's primary care-giver (usually mother) is impaired psychologically, this has an overall effect on the child's developing sense of self. A core sense of self is strongest when the caregiver can be reasonably attentive, can have many more positive interactions than negative with the child, and can mirror the child's expressions and experiences. No mother is perfect, obviously. But a child's sense of the world and her place in it, and her place in her own body and mind, is formed in the web of interaction with the mother, hour to hour and day to day and year to year. I talk about this in detail in the first chapter of the book and also talk about the newest research in neurobiology and attachment theory and so forth. It's a complicated subject!

The second part of the answer has to do more specifically with being the daughter of an impaired mother. For a young child, "how mother is" and "how women are" can be one and the same. So if mother is volatile, mean, depressed, or neglectful, this can be confusing to the daughter. Being a woman may seem to be a bad thing, so a girl may do her best to be not-like-her-mother. Many women I interviewed said they didn?t really know how to be a "woman" - they didn't admire their mother, or want to be anything like her. It was very hard to separate what was the illness, what was the person, and what was the woman. So if a girl doesn?t want to be anything like her mother, where does she find a role model? "Being a woman" is something we learn most easily by identifying with a woman we want to emulate - it?s not something we naturally know how to be.

Is it common for younger children to fear "catching the mental illness?"
I didn't interview anyone who said that they felt that, specifically, when they were young children. But the vast majority of people I interviewed weren?t even told there was an illness at all, so it's not the way a child would have thought about it. Generally young children view adults as being so very different from them that they don?t fear being like them until they're older. By adolescence, that fear is more likely to surface.

You stated that many children were "shamed into silence about the mothers conditions, because of the stigma and prejudices surrounding mental illness." What kind of impact can this silence have on a child growing up?
When a child feels deeply ashamed of a parent, and shamed-by-association with a parent who is stigmatized, this has a huge impact on the child. The child often feels damaged and flawed by having a close family member who is "wrong" or "bad" in some way. Children often feel in a very deep way that it's a reflection on them when something is wrong with their parent.

Second, the child keeps important secrets from other people and that has a big impact on the way the child lives in the world. Ideally, children should be free to go to school, make friends, let people get to know them, be able to be unguarded about who they are and what's important to them. If a child has to avoid a whole huge topic like "my family" then they have to be on guard all the time. They learn to mistrust other kids and adults, which means they have fewer resources in times of trouble. They isolate themselves either internally or externally. Some kids have lots of friends but no close friends, because no friend can ever come to the house to play, and no friend is allowed to know what?s really going on. Some kids just isolate themselves and have trouble even making friends. Trust is a huge problem.

Since silence is not the best way for a child to deal with a mentally ill parent, how can someone discuss mental illness with a child? Is it better to acknowledge that their parent is sick and be direct and open about it?
Yes, is the short answer! Adults often want to protect kids, and think that if the child seems not to notice anything, they can just not tell them anything and they'll be fine. Children pick up an amazing amount of information in the family, and even if they don't know what?s going on, they pick up on the emotional tone. Left to their own devices, they usually make up incorrect and damaging explanations for things.

Only one woman I interviewed had a really excellent experience with being told exactly what was wrong with her mother. Her father consulted a very enlightened psychiatrist who directed the father to tell the children, in an uncomplicated and matter-of-fact way, that their mother had an illness, that it has a name, that it wasn't caused by anything the mother or the children did, and that sometimes the mother would need to take medicine for it or go to a special hospital for people with that illness. They were told that their father and the doctor would take care of everything and they could ask any questions they wanted to ask.

There?s been research done with families and children of mentally ill mothers, and the overwhelming result of that research is that children want to be told, they want to be included, and informed. And they want resources, they want someone to call or talk to if things are difficult. Interestingly enough they also want to be able to help and alert professionals to problems that might be developing at home.

So yes, the best course is to explain calmly what the problem is, and to explain that it has nothing to do with the child, and to convey that the adults are handling the situation. An older child might well want to be included in helping and if feasible, that would be good.

What do you mean by a sense of "loss" that these children and adults with mentally ill parents can experience?
There can be so much loss for everyone when there's a serious illness in the family. For a child, it can be an early loss of innocence, of childhood, of time trusting that the world is a good place and that they'll be taken care of. Many of the women I interviewed, when I asked them the biggest negative impact of their mother's illness, said very simply: "It was like I didn?t have a mother." And for the mothers, too, they lose the relationship that might have been possible with their children. People have the feeling that they?ve lost their family, or a happy family life. Children may lose out on an extended family if the family they grow up in has to be secretive and isolated.

Most of the mental health field focuses on the negative, or what's "wrong." But clearly many people have overcome difficult obstacles, and lead healthy fulfilling lives. What do you see as some of the protective factors that foster resilience in children of mentally ill parents?
There's a lot that we know about resilience, and I think a lot we don't know, too - there's always that question of how someone survived difficulties so well. First of all, even when a child is very resilient, it doesn't mean that damage isn't done. That used to be the misconception, that resilient children were "fine." But their ability to overcome and go forward often comes from having someone else in the environment who is supportive and loving, even if for a short time. So a teacher, a coach, a neighbor, the father, or another relative - any of these people can have a huge positive influence. If that person can be consistent, and loving, and supportive, that can have an enormous impact. I found, too, that many of the women I interviewed had very active imaginations as children. They pretended that their dolls were families and they acted out scenes of happy family life, or they made their stuffed animals into comforting friends. Many of them found some place outside the home where they had a more positive life: school, a part-time job, church, sports. They often had almost two separate lives which they carefully kept apart so in one part of their world, they felt good, competent, appreciated, and worthwhile. Some kids spent a lot of time in nature and found solace and comfort in that. Then as adults they were able to build on the positives even though there were still many struggles.

Resilience, too, comes from knowledge and information. Being told about their mother?s illness in a straightforward way was always, 100% of the time, helpful no matter at what age they got the information. Even women in their 20s and 30s, when they found out objective clear information about their mothers, found that it made a big difference in their ability to live their own lives in a healthier way.

As a professional and someone who experienced mental illness in your family, what treatment do you see as being most beneficial? Is it one modality of therapy, or a combination of treatments?
I see two kinds of treatment as being the most helpful. I've experienced both, and talked to many people who have similar opinions. Probably the first kind of therapy that's useful is straightforward talk therapy, with someone who understands the issues, and can listen and can also give feedback and information. I think it?s useful when the professional can help the patient identify and understand the parent's diagnosis and not skirt around it. I didn?t find it helpful when some therapists avoided "labeling" my mother because it just added to my confusion. When I talked to someone who was able to say "it sounds to me like this kind of psychiatric problem" that was very helpful to me. But talk therapy, understanding the family dynamics, being informative and understanding - that?s all good and necessary. You have to be able to feel whatever you feel, and accept that, and have some validation.

Second, and I think this is better as the second part of the treatment and not the first, is some kind of experiential approach. That usually means a different therapist who specializes in something like psychodrama, or gestalt therapy, or some of the expressive therapies like art therapy or movement therapy. There's a huge non-verbal component that has to be acknowledged, and these therapies are really great at tapping into the physical and creative ways of expressing things. I think groups are very good, too, and the right group can be enormously helpful although the right group can be hard to find.

Some people benefit from medication, too, and other kinds of collateral mind-body approaches can help anyone : yoga, exercise, relaxation techniques, and that kind of thing. Often growing up in a chronically difficult family means that you never really learn how to relax, or how to play, and anything that helps you enlarge yourself in those ways is very good. So overall I guess I'm saying, you have to talk, and use your mind, and you have to take care of your body and the non-verbal, non-intellect aspects of your self and experience, too.

I use talk therapy a lot, and I also have a sand tray where people can "show" instead of tell important things, and I use some art techniques, writing, and so forth, and I encourage people to explore other modalities where they can express themselves however they need to (these expressive or art forms of therapy are commonly used with younger children, because often time children, and even adults are unable to express in words how they feel or things they have experienced).

Is it common for children with a mentally ill parent to be placed in someone else's care? What are your thoughts on residential treatment in this situation, is it harmful to the remove the child from the family?
It really depends on what's going on the family and what dangers might be present. I feel very strongly that because there?s such stigma about mental illness, and especially mentally ill mothers, that professionals shy away from assessment and treatment and support of the family. Wherever there is a parent diagnosed with a mental illness, I'd like to see professionals available for support and guidance and assessment of the family situation. Sometimes mothers with illnesses can be supported in such a way that they can be good mothers, and sometimes they cannot. Foster care or residential treatment are obviously tough choices because so many foster homes or residential treatment centers are worse than the original homes. But if the child is in danger, or is being neglected, or if the child's development is off-track, then obviously outside intervention is essential. If a child has to be removed, it would also be essential that the child be told, very plainly, that the removal is not his or her fault, that the parent has an illness and cannot care for the child. And that message would have to be repeated many times, because children assume that whatever happens around them is their fault.


I look at it as just the opposite Janet. I would be happy and greatful to have a mother like you that was so open and caring. Imagine down the road if Abby needs comforting and support in a specific difficult situation then I know that you will be the type of mother to give that to her unconditionally and that is a true gift that not all mothers can give. Be proud that she will grow up with an understanding, caring, loving mother who is non-judgment especially to issues surrounding mental illness.
i think you are assuming you are going to be where you are today during all her years of growing up. i don't think you are factoring in any improvements in your health over the next 18 years. as the article states, as long as you talk to your child about what's going on (age appropriate of course) and make sure that they understand it's not their fault, that goes a long way.

you love her dearly and that means you'll continue to do the best you can for her. she'll know she's loved. that means the world to a child.
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