html xmlns=”http://www.w3.org/1999/xhtml” xmlns:mml=”http://www.w3.org/1998/Math/MathML” xmlns:epub=”http://www.idpf.org/2007/ops”>
Introduction
Parental psychiatric disorder affects children’s ability to make meaning of their experience. For this reason, it can have more enduring and more detrimental effects on children than more obviously dangerous conditions such as child abuse. We propose that the process by which parents’ psychiatric disorder affects children is through distortions of children’s processing of information about safety and danger and that the child’s age (neurological maturation and functional development) is crucial to understanding these effects (Crittenden, 1999). We focus on attachment because it is in attachment relationships that children learn how to use information for protection and comfort.
Obtaining accurate information about safety and danger is not easy. In this chapter, we offer ideas about how children learn to extract meaning about safety and danger from their experience with their parents. Our focus is on transformations of sensory information that generate representations that dispose behavior (cf. the use of “dispose,” in Damasio, 1994). We offer three clinical examples that explore how parental psychiatric disorder can affect children’s attachment and, through the information processing that underlies attachment, their overall adaptation.
Information processing and attachment
Meaning-making
Humans make meaning from sensory information in at least three ways: somatically, cognitively, and affectively (Crittenden, 2008). These terms stand for complex biopsychological processes and attempt to clarify the relation between experience and adaptation. All convey information about danger and safety. The most immediate information is somatic information – that is, information generated by bodily organs. Sometimes this is perceived and sometimes it is not. It includes such responses as crying, butterflies in one’s stomach, yawning, heart rate, pain, and limb rigidity that inhibits action. Experience can change the range of eliciting conditions and the form of expression. In infancy, the state of the caregiver’s body is a powerful source of somatic information. In the school years, clarity regarding the source of information (whether from the caregiver or the self) becomes possible (Schacter, 1996); if there is excessive physical contact (for example, co-sleeping with an anxious parent), the source of information may be confused. Cognitive information results from feedback. Cognitive representations are learned. Behaviorally, they are sensorimotor schema and, conceptually, they take the form of the when/then or if/then contingencies. Cognitive representations predispose the individual to repeat, modify, or inhibit prior behavior. Affect is the most complex type of information. It is innate, but can be modified by experience. It represents the relation of the self to the context in the form of sensory images (for example, the sound of sudden shouting, the sting of slaps, the bitter smell of tobacco, “off” tastes, an eerie silence) when there is a marked change in the intensity of stimulation. Affective images signal a change in the probability of danger even prior to the experience of danger.
Transformations of somatic, cognitive, and affective information
All three forms of information function at birth. However, because consciousness does not develop until about 18 months of age (and is not fully mature until adulthood), early information is known implicitly, without delay for transformation into language or conscious thought. By 3 years of age, some representations are transformed into language, making communication easier and reducing the need for “embodied” information. Conversely, language can hide meanings. When somatic and verbal representations differ in meaning, the somatic representations are likely to be more self-protective. After about 6–7 years of age, concrete thinking about experience becomes possible. Beginning in adolescence and continuing in adulthood (when one relies increasingly on oneself for protection), conscious reflection about one’s representations becomes possible. Conscious reflection is a slow but thorough process.
The function of representation is to predict the future; to accomplish this, representations of the past can be transformed. Early in life, information is understood simplistically as “truly” predictive; that is, as meaning what it appears to mean. Later, six transformations become possible.
(1) Error: Information can have no self-relevant meaning but can “erroneously” be given predictive significance. For example, the blue shirt of an attacker might be “erroneously” understood to signal danger; henceforth, people wearing blue shirts are feared. When a transformation is applied inappropriately, instead of promoting safety, it can be dangerous. For example, responding in fear to everyone in a blue shirt not only reduces access to safe people but can also expose a person to danger that comes without a blue shirt.
(2) Omission: Self-relevant and protective information can be “omitted” from processing. In the example above, the dark alley, seductive clothing of the victim, and absence of other people might be overlooked as offering predictive information.
(3) Falsification: Sometimes information means the opposite of what it appears to mean. For example, smiles might precede outbursts of anger; this is “false” information.
(4) Distortion: Information that is partially predictive can be “distorted” to seem more predictive than it is. Idealization and derogation are examples of distorted semantic information.
(5) Denial: When information is too threatening to countenance, it might be “denied.” For example, a child might deny that his mother had tried to murder him. Denying true information, rendering it “unspeakable,” both prevents discrepancy and decreases the possibility of finding solutions. Common “unspeakable” topics include infidelity, spousal violence, and past trauma.
What does this have to do with attachment?
Somatic, cognitive, and affective representations connect individuals to their context. For infants and children, the primary feature of the context is the parent. All children become attached to their parents; this is adaptive because it promotes immediate safety and furthers the process of learning to represent and transform information that leads to protective behavior.
Differences in child–parent protective relationships are “patterns of attachment.” By this we mean (1) the tie of children to their parents, (2) the behavioral strategy that children use to elicit parental protection, and (3) the information processing that underlies the strategy (Crittenden, 2008). The protective function is most important early in life when children cannot protect themselves. Learned patterns of information processing become increasingly important as children become more independent. Being able to assess one’s inner state as well as its context, and to combine this information with recalled past experience to achieve immediate protection (without generating future risk) is the hallmark of adult adaptation.
According to the Dynamic-Maturational Model (DMM) of Attachment and Adaptation (Crittenden, 2008), people using type A protective strategies rely excessively on cognitive information while omitting or falsifying somatic and affective information. People using Type C protective strategies rely excessively on affective and somatic information while omitting, falsifying, or generating erroneous cognitive information. In extremely dangerous situations, both Types A and C strategies may be employed. Type B reflects a balanced and accurate use of predictive information.
When parents’ behavior is tied meaningfully to their children’s, development proceeds well. This is true even if parents act dangerously when children do something specific (for example, running into the street) or when parents look or sound neglectful (for example, when inebriated). Under predictable conditions, children learn to modify their behavior to increase their own safety (Crittenden, 1999). To do this, children transform somatic, cognitive, and affective information so as to dispose safe action and inhibit dangerous behavior. Doing so is adaptive in the short term even if it does not feel “secure” or comfortable.
Information processing and parental psychiatric disorder
The hallmark of psychopathology is that behavior is not tied to current circumstances in meaningful and safe ways. When children have a parent who responds to information that the child cannot perceive – that is, invisible information – children can experience great confusion, leading to distortions of their information processing and consequent maladaptive behavior. Of course, all children live in contexts that are too complex for them to perceive and understand fully. When parents are adequately attentive to the child’s perspective (that is, they can “mentalize” about the child’s experience), they adapt their behavior to children’s ability to comprehend. When, instead, “invisible” information organizes parents’ behavior, children’s understanding is incomplete and they may draw inaccurate conclusions. For example, if a boy’s mother fears men who have hurt her in the past, including the boy’s father, the boy might think that he, as his father’s son, is also dangerous.
When children cannot make meaning of their experience and when parents cannot help them, children may take psychological short-cuts. Doing so omits important information while exaggerating the importance of the remaining information (thus distorting it). This can reduce long-term adaptation. For example, children might learn to use extreme emotional displays to break through parental self-preoccupation; the result would be intense somatic and behavioral displays (that is, a type C coercive strategy). Clinically, this is often called “emotion dysregulation,” but, functionally, it is a self-protective strategy. If such an intense display of affect changes parents’ behavior and reduces their own stress, the behavior will continue and the children may be diagnosed with behavioral problems. If they cannot reduce their stress, the problem may become somatic and they might be diagnosed with intense and inexplicable anxiety. In most cases, parental psychopathology is associated with children’s very anxious attachment (cf. Crittenden et al., 2010).
Family functional formulations
Knowing a parent’s psychiatric diagnosis is not enough for understanding how parental psychopathology affects children’s development. A “family functional formulation” is needed; that is, an integrative explanation of how family members’ protective attachment strategies function for both each person and other family members. This requires the following: (1) developmentally attuned assessments of attachment for each family member, (2) each person’s history of exposure to danger, (3) clarity regarding sources of information, (4) a hypothesis regarding current critical dangers for the family and whether these create conflicts of interest between family members, and (5) a summative hypothesis that can organize therapeutic action. The goal is to discover a parsimonious set of actions that might instigate a cascade of positive changes (i.e., a “critical cause”) (Crittenden and Ainsworth, 1989). A family functional formulation is the basis for a treatment plan, and includes contraindicated approaches.
Three cases of parental psychopathology and the effects on children: an attachment perspective
We offer three family functional formulations that highlight the importance of development: the transition from infancy to childhood, the period between school-age and adolescence, and the transition to adulthood.
Chronic maternal depression: a cluster of family adaptations
Presenting problem
Glenda Bloom’s mother was depressed during and after pregnancy. At 18 months, Glenda neither walked nor talked and was dangerously underweight. Her pediatrician sought specialized evaluation.
Family history
Glenda’s older brother “Champ” (now 7 years old) was born prematurely, leading to Mrs. Bloom’s first postnatal depression. A second pregnancy (Toryn, now 3 years old) was medically uncomplicated. Early in her pregnancy with Glenda, Mrs. Bloom was diagnosed with depression and given a low dosage of antidepressants. After Glenda’s birth, stronger medication was needed. With medication, she was considered “recovered”.
The family was upwardly striving across three generations. However, all four grandparents were chemically addicted (to alcohol and prescribed medications). Now perinatal depression was erroneously considered an “illness” by both family members and doctors and the relation of it and substance use to family problems was not explored by either the family members or their doctors. Indeed, family members did not acknowledge having problems.
Related posts:
Parental diagnosis and children’s outcomes
Parenting and borderline personality disorder
Enhancing depressed mothers’ sensitivity
E-learning professional development resources for families where a parent has a mental illness
Preventing unnecessary loss of child custody
Parental psychiatric disorder: translating The Family Model into practice change
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
