Mental Health Issues and the Links to Abuse

by Elaine Riley
(Lancashire, UK)

I've got a big "bee in my bonnet" about this issue, both personally and professionally. You see, I really think that much more ought to be done about mental health than is currently the case, both in terms of treatment, and prevention/education.
Mental illness is an internationally recognised phenomenon, but also apparently an international "taboo". Generally, we find it a difficult and unpleasant issue; one which presents many challenges. How do we talk openly about it? How do we address the "stigma" and embarrassment which has become attached to it? How do we dispel the many myths that have arisen, due in the main to our general level of ignorance concerning this subject?
As the daughter of a parent with mental health problems, and a qualified Social Worker, I've seen "both sides of the coin". I am more than aware of the devastating effects that mental illness can have on a family. I have lived with the legacy of my upbringing by parents plagued by this issue. I have also spent time providing assistance and care for those hospitalised under the Mental Health Act, 1983.
There are many problems in the way that we currently deal with the issue of mental illness. To an outsider, it can still seem a scary, rather "seedy" prospect. Many are the images that abound, of the psychopathic axe-wielding murderer; or the gibbering "down-and-out" ranting and raving about hearing voices! We are often lead down this path by sensationalist media articles, a minefield of misinformation and prejudice.
Historically, we've always had a problem with the mentally unstable. Even the terminology we use can be degrading. Would YOU like to be known as UNSTABLE? How about PSYCHOTIC? Or NEUROTIC? Or HYSTERICAL? GA-GA anyone? NUTS? LOON? MORON? LOOPY? BATTY? Funny, when you look at them, how many of the terms we used to describe the mentally ill are also general INSULTS!
So, in the past, we've wanted to hide these people away. After all, why would a society want to be faced with having to accept that not everyone is "perfect"? It was shame and embarrassment which brought about the construction of Asylums and Workhouses - places where the mentally ill so often ended up. It was fear and shame that lead to the "discovery" of "treatments" intended to make the mentally ill "normal" again (by the way, what is normal?!). Treatments which were so often invasive, traumatic and risky - such as E.C.T. and Neurosurgery (e.g. Lobotomy). Before such things had been ushered in by the Victorians, bastions as they were of "morality" (a morality which was very questionable behind closed doors - the Victorians might well have invented "hypocrisy" - corsets, anyone? How about a nice tablecloth to cover your table legs, to avert your gaze? Don't want to be caught staring at legs; even those of a table! How about a bit of Church? Followed by a "what the Butler saw" slide-show?)there had been other ways of punishing the undesirable... "Scolds Bridle", anybody? Stops your nagging wife from chattering! How about "Witch-hunts" and "Ducking Stools"? Fancy being branded? Or made to wear a "Chastity Belt"?
I kind of figured your answer to the above might well be NO! But these treatments, and more, were meted out frequently to the mentally ill, and to those suspected of living their lives in a way that did not easily meet with conventional ideologies of the time.
But while we continue to hold on to outdated and incorrect notions of what mental illness means, we fail also to take on board the reality of the situation. Not ALL people with mental illnesses are dangerous. And of the ones who are, they are MOST OFTEN a danger to THEMSELVES.
Now think about the implications of this in relation to child-rearing. I ask you, at this point, to take account of the fact that many people with mental illnesses are totally unaware that they are ill. In Psychiatric Services, this self-awareness; the ability to recognise that one is NOT rational, that one has problems; is known as "INSIGHT". Not all sufferers of mental illness have insight. Unfortunately, lack of insight and a poor prognosis are more often than not linked.

I hope that you are now beginning to realise that this is a MUCH MORE complicated field than might initially be envisaged. I hope, too, that you are beginning to understand that the implications of mental illness in relation to child abuse are manifold.
Mental illness can be both a RESULT OF abuse; but also a PRECURSOR TO abuse. It is a well-documented fact that trauma in childhood (i.e. abuse) can bring about mental illness, such as Depression, Anxiety and Eating Disorders (amongst others).
However, mental illness may also CAUSE some individuals to abuse. A small minority (hopefully) of these will be the sort of cold, unfeeling individuals who become labelled as "Psychopaths"; people for whom the "everyday" range of emotions which we take for granted are almost impossible. Others may be suffering from "Personality Disorders", where an individuals personal ideologies have become distorted, and their overall personality traits interfere with functioning. Often, such disorders are seen as hard to treat, and can lead to significant problems, including "antisocial" behaviours, and an inability to empathise with the feelings of others.
But the majority of individuals may, behind the illness, be genuinely well-meaning, caring people. However, the nature of their illness means that delusions, feelings of persecution, grandiose ideologies, lack of self-esteem (to name but a few issues) interfere with their ability to relate to others. Such people may be utterly unaware, therefore, of the way in which their problems affect their children. Delusional belief systems can be extensive, and encompass family members, friends, workplace colleagues - all of whom might be much more aware of the effects of such beliefs, than the person actually experiencing them.
Whilst I am in no way excusing those who abuse their children as a result of having mental health problems, I AM suggesting that there ought to be much more scope for addressing such issues in a pro-active and sympathetic manner. Many individuals with mental illnesses present one "face" to the outside world, and another to those close to them. The strain of keeping up this pretence means that cracks are likely to show at home. They may even (as can my mother) be able to fool many Mental Health Professionals, who only see them for occasional reviews.
It is a difficult balance. The individual who is mentally ill may be genuinely unaware that their behaviour is having negative consequences for those around them. They may truly feel, in their own skewed way, that they are acting in others' best interests (e.g. by preventing their child from playing outside, they can stop them being abducted - a possible fear for those with persecutory delusions). Professionals need to be much more aware of the "what happens behind closed doors" scenario, and there should be greater input into providing resources aimed as much at preventative action, as at crisis resolution (where action is often too late). We need more dedicated workers, who can engage with families from the outset, monitoring problem behaviours, giving advice and support, educating about the need for compliance with treatment. We also need more seamless service delivery, with the ability to coordinate care between Health and Social Services staff, sharing of information, quick assessments... to name but a few improvements that COULD be made.
Remember the Child Protection rule - "the rights of the child are paramount". Only by correctly educating everyone about mental health can we ensure that society is able to keep children safe.