Mothers - Living with Mental Illness and their Children - Research Proposal Example

Mothers: Living with Mental Illness and their Children First Last of People with mental illness suffer not only from the negative effects of their conditions but also from the ridicule of the society for not being able to function as efficiently as they should. Whether the concept of the women’s inability to function as mothers with severe mental illness is based on facts or was created only as a result of social stigma, the answer is still basically unclear. By presenting available peer-reviewed related literature and examining the research designs and methods utilized by the studies involved, this paper will evaluate how social factors such marital status, gender, socioeconomic state and others have contributed to the lesser capability or total inability of mentally-ill mothers in performing their responsibilities as parents and primary providers of the basic needs of their children. Some ethical issues surrounding the topic will also be tackled while some personal accounts of affected mothers will be raised to allow sufficient and fair analysis of the situation. Introduction There are many negative consequences of a mental illness that can affect not only the person who has it but also his or her family or anyone who is part of his or her immediate community including authorities, workmates, and many others. As each person suffers from conditions with mild to severe “changes in... thinking, memory, perception, feeling and judgment resulting in changes in talk and behavior,” his or her ability to function as an individual and as a part of a community are put in line as they tend to bring about “disturbance in day-to-day activities, work, and relationship with important others (social and vocational dysfunctions)” (Sreevani, 2007, p. 3). Because their ability to control their thinking, emotions and reactions are beyond reasonable limits, reports about mentally-ill people going outrageous or displaying bizarre outbursts have become fairly common. As they do, mental-illness-related occurrences has resulted to the nonetheless worsening assumptions of the public about how almost every person with mental health condition become simply unable to perform usual activities of daily living including socialization and many others as normally as those who are not ill do. Consequently, a social stigma has emerged. This existing stigma has also affected mothers with mental health illness who are supposed to play very important roles in the lives of their offspring’s. Issues of the incapability to fulfill their parenting responsibilities have lead to incidences of separation of the children from their affected mothers, whether voluntarily or otherwise, as social beliefs about the importance of parenthood are perceived to be threatened secondary to their condition. Existing related literature supports that these affected women “experience many challenges to successful parenting, which are exacerbated by the lack of services specific to their needs” (Park, Solomon, & Mandell, 2006, p. 493). Concerns surrounding their vulnerability to alcohol and drug use, inability to follow routine prenatal check-ups and other related healthcare activities regarding pregnancy and child rearing, increased susceptibility to obstetric complications, and decreased tolerance to the pressures of the responsibilities of being a parent as compared to the non-affected mothers have been recently transformed into substantial grounds of the affected parents’ loss of custody over the care of their children. Due to the considerable effects of this emerging trend to the relationships between mentally-ill mothers and their offspring, this paper will try to examine and present how this negative view about the population in question has developed and how ongoing research and studies have created the course that this topic has taken. To do so, it is held relevant to relate the society’s perception of parenting and how mental illness can affect it as well to review other socially-related matters surrounding the issues that are being faced by this under-represented population. Parenting and the Effects of Mental Illness on It Chase-Lansdale and Pittman (2002) noted that “in reality, parenting is a complex, multifaceted phenomenon that ignites controversy in scientific and policy circles but is also very personal, private experience” (p. 167). Reports about parents with mental illness expressing guilt and resentment over the issue of their incompetence which most of the times lead to situations wherein they have to give up their children’s custody, or even leave their caring responsibilities to their relatives or friends are continually cited through the studies and researches conducted (Fox, 1999, p. 193; Miller & Finnerty, 1996, p. 502; Hearle, Plant, Jenner, Barkla, & McGrath, 1999, p. 1354). Another important circumstance revolving this topic involves the society’s view about parenting and how it becomes affected with the presence of a psychotic disorder. It is clear that the majority, if not all, of the cultures greatly consider “good parenting” as an integral part in maintaining the basic unit of the community, the family. It demands a person to perform “functions related to nurturing, discipline, stimulation, values, activities, and routines” for his or her children (Chase-Lansdale & Pittman, 2002, p. 167). Proofs of how extensive the issue of good parenting is to human communities may be evaluated by how societies have advocated it in several aspects of human living. Legislative reforms, continuing research to further improve knowledge on factors surrounding parenting, and even societal norms reflect how the world sees it. Aspects such as “parent characteristics, child characteristics, family economic resources, family structure, parental mental health, marital or partner relationships, and the quality of parents’ kin and social networks” are seen to affect its effectiveness. As emphasized, the society perceives and believes that parenting is greatly influenced by the stability of a parent’s mental health. This is mainly evidenced by Ackerson’s (2003) assertion which states that “most of the social work literature has taken a negative view of parenthood by people with serious mental illness because of concerns about possible detrimental effects on children.” In addition to the failure of meeting the needs of their children, research about the tendency of mentally-ill parents to show maltreatment behaviors towards their children in any possible form have also caused increasing concern among the affected population including their families as well as the authorities and the immediate community surrounding them (Mullick, Miller, & Jacobsen, 2001, p. 488). Motherhood in Context. Although mental illness affect both men and women in almost the same degree, the issue concerning parenthood and mental illness “from the perspectives of mothers” will be the focus of this paper (Nicholson, Sweeney, & Geller, 1998a, p. 635) as surveys have shown “an increase in women with a severe mental illness bearing and raising children” which happens to be an unexpected trend (as cited in Ackerson, 2003, p. 187). This may be due to the fact that despite their condition, the mentally-ill women “marry and have children at the same rate as other women” (Nicholson, Nason, Calabresi, & Yando, 1999, as cited in Ackerson, 2003). Worse, Oyserman, Mowbray, Meares, and Firminger (2000) emphasized that “women with severe SMI (severe mental illness) have a greater number of children and begin their child-bearing early” (p. 297). Numerous researches have already been conducted to evaluate the effects of mental illness to the functions of women as mothers to their children wherein losing the custody of the care of their child is one of the most common consequences if undue treatment is observed. Mowbray, Oyserman, Bybee and MacFarlane (2002) stressed what Oyserman, Mowbray, Allen-Meares, and Firminger reported in 2000 which states that mothers with psychotic disorders “have significantly less adequate parenting skills and behaviors than mothers who do not have a mental illness” (p. 225). Additionally, the same study underscored the results of other researches that having a mental condition makes mothers “less emotionally available, less reciprocal, less involved, and less positive” in caring for their children (Mowbray, et al., 2002, p. 225). As an effect, the concept of taking away their custody over the care of their children turn out to be one of the routine interventions done by either the treatment personnel or the social workers once mothers are diagnosed to have a mental illness. Furthermore, causes of loss of custody of their children among mentally-ill mothers are said to be worsened by “having problems with parenting knowledge and skills, being younger at the birth of one’s first child, having a larger number of live births, never being employed or having a lower work history and lower productivity record, never or not currently married and more personal distress” (Hollingsworth, 2004, p. 199). Since “parenting is one of the most highly valued social roles in all human societies and cultures” (Ackerson, 2003, p. 187), it is not new to hear about negative attitude and conceptions about the disability of mentally-ill mothers in meeting their responsibilities as parents to their children. Whether assumptions about the incompetence of these mothers to function as “good parents” are true or not shall be explored. Social Issues: Women with Mental Illness and Parenting Why mothers with psychotic disorders are considered as incompetent parents is thought to be caused by a number of conflicting social factors such as the demographic characteristics marital status, the number of pregnancies and live births, and gender, as well as education, socioeconomic status, and even race. These are assumed to affect one’s effectiveness as a parent and instability in these areas in the lives of these psychotic mothers increases the risk of losing their children in any way possible. Table 1 of Appendix A shows the summary of these risk variables and their corresponding effects. Marital Status. It is believed that the marital status of a mother helps identify her parenting capacity and thus, the level of risk of losing custody of the care of her children. Firstly, the presence of a supportive partner aids in the affected mother’s recovery process (“When a Parent,” n.d.). Nicholson, Sweeney, and Geller (1998b) found this relationship in their study wherein mothers “described a range of relationships and attitudes of family members and provided examples of the ways in which family members contribute both positively and negatively to parenting” (p. 643). Specifically, a study documented that having a good marital relationship helps decreases the frequency of psychotic outbursts to mentally-ill, married individuals as compared to the single or divorced ones (Wilcox, Waite, & Roberts, 2007, p. 2). With partners, married mothers will “have a source of social support, someone to talk to about the troubles of life” which will create a “sense of meaning and purpose in life, protecting against suicide, depression, and encouraging healthy habits” (Wilcox, et al., 2007, p. 4). This in turn, will help promote better mental health status and therefore, affect one’s parenting capacity positively. Likewise, Wilcox et al. (2007) also justified that sharing a healthy relationship with a partner through marriage will encourage a parent “to create and sustain parenting bonds with children” as compared to the unmarried ones. Hence, the risk of losing the right to perform the parenting responsibilities of the mothers with identified mental health conditions will be significantly minimized. Married mothers with psychotic disorders who share unhealthy relationships with their husbands or single mothers, on the other hand, had been observed to have poor outcomes. The issue about which of the two most common circumstances (single parenthood or having poor relationships with partners/undergoing divorce) would cause greater negative effects, however, remains unclear. Pregnancy and Number of Live Births. Naturally, the changes that a woman has to undergo during period of pregnancy as well as in the postpartum period can be overwhelming to one’s emotional and psychological status that the terms pregnancy and postpartum depression and psychosis have already been coined to describe the either temporary or permanent mood and psychiatric condition that a woman may suffer as a result of childbearing (Kalsi & Burt, 2002, p. 193). Although others may regard pregnancy and child rearing as positive additions to a life full of turmoil as caused by a mental illness (Fox, 1999, p. 193; Perkins, 2003, p. 157), researchers believe that both the physical and psychological changes that a woman will have to experience during pregnancy and the postpartum period would constitute to poor well-being outcomes of both the mother and the child in the presence of an existing psychotic condition (Gold & Marcus, 2008, p. 391). Issues on the effects of some psychiatric medications on pregnancy and the fetus, as well as during the breastfeeding period have also arisen (Ward & Zamorski, 2002, p. 629). In Britain, records have shown that the presence of a psychiatric condition in addition to the psychological, depressive effects of pregnancy has led to 56% of psychiatric deaths and 68% of suicide rate of affected mothers leaving the care of their children in the hands of their relatives or friends, or under the custody those assigned or permitted by the law (Oates, 2003, p. 280). Nevertheless, validations about how an increasing number of live births cause more stress to ill mothers have also been identified to result to poorer outcomes than those who have only one child or lesser number of children (Asdigian & Straus, 1997; Hollingsworth, 2004; Fox, 1999). Gender. Gender difference has always been an issue in several fields and its relevance on this topic is not an uncommon feature at all. Despite the fact that "women patients (can) suffer from a range of mental disorders similar to those that men may experience" (Ramsay, Welch, & Youard, 2001, p. 85), being a woman and a mother and suffering from a psychotic condition at the same time is seen to cause irregularities in some important aspects of life such as childbearing and child rearing as well as maintaining the family (Ramsay, et al., 2001, pp. 86-87). While fathers do play an important role in raising a child, it is undeniable that mothers are most likely the ones who provide the majority of the nurturing and childcare especially when it comes to the provision of their basic physical and emotional needs; and as it has been discussed earlier, a stable mental health is vital in balancing all these functions in an optimal level. Just as Sherman (2007) stated that “when one person in the family experiences difficulties, everyone is affected” (p. 26), it is apparent that problems in the mental health of mothers caring for their children will result to severe disturbances in the child’s welfare besides the dysfunctional effect it may cause to the rest of the family. Nathaniel (2007) clearly illustrated these difficulties in her book Daughters of Madness as she tried to show how hard it had been and it still is for some children living with their mentally-ill mothers in a collection of their actual life stories. Although some mothers, especially those whose conditions are not severe, actually try to fulfill their responsibilities at the best of their abilities, they still “may be thwarted by difficulties due to specific aspects of mental illness (a main effect), the interplay between the childs needs and the limitation on the mothers capacities to meet these needs due to her mental illness, or the interplay between other contextual and clinical features (interaction effects)” (Oyserman, et al., 2000, p. 298). Davenport, Zahn-Waxler, Adland, and Mayfield (1984) also found out through a survey that the psychotic or mentally-ill mothers displayed lower emotional connections with their children and had lesser efficiency in identifying their children’s health needs which would have come easily to those who are mentally well as these form the basic functions of a woman in the lives of their children (p. 230). The women’s vulnerability to stress is said to greatly constitute to this. Education. Many researchers regard education as one of the indicators of a mother’s capacity to perform her anticipated functions (Sameroff, Seifer, Zax, & Barocas, 1987; Oyserman, et al., 2000; Brunnette & Dean, 2000; Nicholson, et al., 1998a). With higher level of education, it is thought that mothers will display increased capacity for caring roles including ability to anticipate health care, physical, emotional, and intellectual needs of their children, as well as greater adherence to medical and psychiatric treatments which will increase mental health well being and thus, better tolerance to their childbearing and child rearing functions. Furthermore, higher education increases possibility for better occupation which can assist in the financial needs of the family especially when the parent is single. Yet, although these studies do present substantial data about how education play part in having better outcomes, others also found no significant difference between the insights and the performance of the mothers with mental illness subjected to their studies who have or have not had attended higher level of education (Mullick, et al., 2001, p. 488). Socioeconomic Status and Race. The level of one’s socioeconomic status is perceived as one influential aspect of life that will greatly influence his or her behaviors as a parent to a child who has needs that must be met. According to a report submitted to the United States Substance Abuse and Mental Health Services Administration (SAMHSA’S), poverty and low social status (e.g., belonging to a ethnic minority status) may cause stressful life events that are strongly believed to generate adverse effects on the mental well being of the affected mother and therefore, poor child outcomes (Nicholson, Biebel, Hinden, Henry, & Stier, 2001). Mullick, et al. (2001) recognize that problems regarding social and economic conditions, although may exist in every family, will have its negative implications in parenting children in the company of a mental illness (p. 488). In fact, this can lead to situations of child abuse which is considered to be directly related to the “growing number of parents with psychiatric disorders... losing custody of their children because of maltreatment” (Mullick, et al., 2001, p. 488). Mothers with mental illness and their families who live in poor social and economic conditions are expected to suffer further from the deficits and threats to health that come with it. Murali and Oyebode (2004) emphasized the negative effects of this in the following words: It is the poor who are exposed to dangerous environments, who (if employed) often have stressful, unrewarding and depersonalizing work, who lack the necessities and amenities of life and who, because they are not part of the mainstream of society, are isolated from information and support. (pp. 216-217) Besides the depressing effects of these situations to the ill mothers, a negative physical environment will also increase the child’s susceptibility to developing a mental illness which “may be particularly susceptible to the effects of abusive or neglectful parenting” (Mullick, et al., 2001, p. 488). Being part of a minority ethnic group, on the other hand, would also help indicate the deprivation of equal access to services that will help these mothers in their specific needs (Local Safeguarding Council Board of Haringey, n.d.); and thus, can be used by authorities or by anyone as an evidence that will pave way to take the mother’s custody over her child. Other race’s or social group’s susceptibility to mental illness is now being put under on-going studies. Nicholson, et al. (1998b) noted that the racial and ethnic background differences are regarded of most importance with regard to the networks of family support and patterns of care giving. They found that mothers who were from a non-Caucasian decent make up the majority of those who continue to care for their children while receiving case management services as provided by the government (Nicholson, et al., 1998b). In addition, custody issues concerning the children of African-American women were seen to have a notable pattern in which they were found to end up living with their grandmothers or in the care of a foster or an adoptive family instead of living with their fathers as their mothers are taken away for treatment. Issues from the Perspective of the Mentally Ill Mothers As it has been said, the presence of a psychiatric disorder contributes greatly to the increase of a mother’s risk of losing the custody over the care of their children. Although authorities, family members or other concerned individuals seem to have sufficient grounds for this intervention in protecting the welfare of both the mothers and the children, some studies have shown that many, if not most, of these under-represented population do not see this as a helpful move towards their treatment and for the welfare of their children. In an article, Hearle, et al. (1999) reported that more than 30% of the 107 mothers with psychotic disorders that they have interviewed did not ask for child care assistance as offered by authorities due to the fear of losing their children (p. 1356). According to them, the authorities most often focus on providing treatment services only instead of integrating “a range of services essential to assist women with mental illness who are mothers in managing daily parenting demands and in coping with the stresses of caring for children” (Blanch, Nicholson, & Purcell, 1994, p. 388). As a result, many mothers who will be or are already diagnosed with psychotic disorders are deprived of the chance to fulfill their caring responsibilities due to the lack of support from the society and the authorities in terms of child protective services agencies and in “protecting their parental rights and maintaining contact with their children” (Cook & Steigman, 2000, p. 22). Separation becomes inevitable; putting substantial burden to these parents and their children’s lives, especially in their relationships. Mentally-ill mothers also indicated that because of the social stigma, the society has made them feel left out. In a personal account, Fox (1999) also noted these glitches in the services system while Perkins (2003) has observed the patterns of underestimation of her capacity of becoming a mother coming from her family and immediate social community. Ethical Issues: Women with Mental Illness and Parenting Just as it affects certain socially-related factors, the topic also imposes a certain ethical tension in many of its aspects. Authorities such clinicians, nurses and others personalities making up the medical team as well as law enforcers and social workers are burdened with certain ethical dilemmas once the mothers become subjected to treatment or call for specific support from the different agencies available. The patient’s autonomy regarding her treatment options and other related interventions, her decision-making capacity, the use of psychotic medications which can affect not only the patient herself, the child in her womb in case she is pregnant, and those who are around her; the utilization of some existing policies which are considered to exist only to cater only a part of the affected population; the bases for custody decisions; the reproductive rights of these women as well as their equal access to agencies that can provide appropriate social, labor, and parenting support which may put off the need for custody loss; and the mental health system impose on each other valid ethical and legal ramifications which influence the success of their treatment programs (Desai & Chandra, 2009, p. 75; Nicholson, 2005, p. 357; Chaudron, Szilagyi, Campbell, Mounts, & McInerny, 2007; Stanton, Simpson, & Wouldes, 2000, p. 1451). Researches in Focus Exhaustive and informative the involved researches that are tackling all about women with mental illness, their children, their role as mothers to them, and the risk of losing as they may seem, it is apparent that only a few of them specified and utilized a dependable research method and followed a research design that allows measurement of validity or was able to measure what it intended to measure (Gravetter & Forzano, 2009, p. 157). Specifically, researches of Hollingsworth (2004), Miller and Finnerty (1996), Mowbray, et al. (2002), Mullick, et al. (2001), Nicholson, et al. (1998a, 1998b), and Park, et al. (2006) were the only ones that used specific research framework, designs and methods which warranted them to draw conclusions that have added to the knowledge about the topic in question. Each one provided how they come up with the collected data, how they controlled their variables, the questionnaires for the interview as well as the steps on how to analyze the information in hand that would render them the results needed for their papers. However, only Hollingsworth (2004) and Mowbray, et al.’s (2002) researches involved a large sample size which (e.g., N=379), according to Berg and Latin (2008), is essential in drawing reliable and sound conclusions because the utilization of a small sample size may cause the invalidity of the paper for the lack of statistical power (p. 269). Singh (2007) also added that such a large sample size justifies the descriptive theme used (p. 178). Nonetheless, despite their use of a smaller sample size, Miller and Finnerty (1996), Mullick, et al. (2001), Nicholson, et al. (1998a, 1998b),and Park et al.’s (2006) researches still are deemed efficient in their purposes in conducting their studies. It is to be noted that the rest of the involved researches were not evaluated as to the applicability of their research designs and methods due to several reasons. The accessibility of the whole article and their formats contributed to this inability. Nevertheless, all of the information permitted the success of this paper. Anyhow, future studies can either follow a quantitative and qualitative approach to gathering the needed data in finding out answers related to the issue about mothers with mental illnesses and the risk of losing their children in the course of their fight against it. Quantitative approaches, such as using a reliable measurement tool -- like standard intelligence or emotional tests to measure the capacity of the mothers to fulfill their responsibilities to their children, would help ensure the readers the accuracy of the results of a study with a particularly large sample. This approach is necessary to show the dependability of the study, especially because all researches need to present data which are “tightly defined and validated” to represent the conclusions drawn (“Qualitative and Quantitative,” n.d.). A qualitative approach, on the other hand, which can be done by using an unstructured interview with the subjects, will aid in identifying data such as behaviors, routines, or pattern of outbursts for the mentally-ill mothers which are critical in determining their capabilities regarding their roles. Nonetheless, it is in the hands of the future researchers to efficiently analyze in what approach their studies will gain the appropriate data to accomplish the purpose of doing so. Conclusion Many believe that the inherent increase in the risk of losing the custody over the care of their children among mentally-ill mothers are due to their mental incapability and incompetence to totally control their emotions and actions. 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Marriage and mental health in adults and children. Research Brief, 4, 1-6. Appendix A Table 1. Summary of risk variables Risk Variable Low Risk High Risk Chronicity of illness Anxiety Parental perspectives Spontaneous interactions Education Occupation Minority status Family Support Stressful life events Family size ≥ 1 contact 75% least 75% highest 75% most High school Skilled White Father present 75% fewest 1-3 children ≥ 1 contact 25% most 25% lowest 25% least No high school Semi- or unskilled Nonwhite Father absent 25% most ≥ 4 children Source: Sameroff, Seifer, Zax, & Barocas, 1987, p. 390. Read More