When parents are Toxic to children

I sat with a 15-year-old girl in the interview room where I meet psychiatric inpatients for the first time, watching her as she gazed through her long black hair at her forearm. She gingerly traced the superficial cuts she had made with a razor the night before when she had flirted with a suicide.

Her chart indicated that since the age of 11 she had suffered repeated bouts of severe depression that antidepressant medication didn’t touch. At times she was intermittently paranoid, believing that someone was out to steal her mind or even to take her life.

“I’m not going back there,” she finally said, looking up at me. “I’ll kill myself, if they make me live with my parents.”

“What happens there?” I asked.

“Constant fighting. Screaming. Swearing. Hitting. It’s been like that my whole life.”

“Do they hit you?” I asked.

“They used to. A lot. They don’t any more. They hit my brothers, though. And they keep telling me I’m ugly… and stupid. Worthless.” She looked at her arm. “I don’t care where I get sent. I’ll go anywhere but home.”

I was certain she would return home. Social service agencies had been involved in her case for years. No doubt there would be another family meeting during her hospitalization, perhaps more frequent home visits by a social worker afterward. But the mental health system’s prejudice in favor of keeping families intact, as well as a perennial shortage of acceptable foster parents, would likely keep my young patient with her own parents and in peril.

I have repeatedly treated teenagers like this girl whose biological parents have inflicted irreparable psychological harm on their children. Some are the victims of sexual abuse, others of pervasive neglect. They end up in my office with symptoms that include panic attacks, severe depression and psychosis. Many are addicted to drugs before they even begin high school. Some see suicide as a reasonable way to end their pain. I prescribe them a variety of antidepressant, anti-anxiety and sometimes antipsychotic medications, hoping that their symptoms of mental illness are temporary, but worried that the damage they have suffered may be permanent. Worst of all I know that these are preventable illnesses.

Nor does the damage end with them. These teenage patients are tomorrow’s parents. And experience has repeatedly demonstrated that many of them are likely to reenact the same destructive scenarios with their own children. Most people who harbor rage from their childhood don’t expect it to surface after they become parents. Many fail to see the traumas they survived as sources of great risk for a new generation.

If we are to make a serious attempt to prevent some forms of serious mental illness, parenting must no longer be seen as an inalienable right, but as a privilege that can – and will – be revoked for abuse or neglect. Society must be much less tolerant of harm to children and also must be willing to devote considerably more resources to providing alternative living situations for children and adolescents who are in danger.

Only in the most egregious cases of physical violence or emotional neglect have I seen the state terminate parental rights. It seems that damage to children must reach the level of near catastrophe to justify cleaving a parent – child relationship that has been anything but loving.

Parents need to get a new message. If you do a lousy job parenting, you lose your job. In cases involving child custody, blood ties must be given less weight not only by the mental health system, but by the government and the court system. At the federal, state and local levels, keeping children with their parents can no longer be considered more important than keeping them safe.

Another young woman I treated had been repeatedly beaten by her older brothers for years. As a girl she had been raped by her mother’s boyfriend. Her moods had become erratic, and her temper unpredictable. She had turned to marijuana for relief and had been expelled from school for fighting. Yet she continued to live at home, with the blessing of the state Department of Social Services.

“She’s got to get off these damn drugs,” her mother complained in my office. “That [stuff] has got her all screwed…”

“I’m not gonna listen to you,” the girl interrupted. She turned to me. “This is the woman who let me get beat on for about 10 years and let her boyfriend sneak into my bedroom, without her saying two words. How am I supposed to live as a normal human being with a mother like her?”

Privately I agreed with her. I felt hopeless about the situation myself. I could see that this girl was trapped in a family that was eroding her emotional resiliency, leaving her increasingly vulnerable to severe psychiatric illness. And society had to plan to rescue her from this situation. In fact, it tacitly endorsed it.

One of the difficulties of working as a therapist with adolescents is that they often clearly perceive the psychological dangers confronting them, but are powerless to deal with them. It’s no wonder then that such experiences lay the groundwork for panic attacks, post – traumatic stress disorder, depression and paranoia that seem to come “out of the blue” later in life. The coping mechanisms of some of the teenagers I treat have short-circuited already. These patients “dissociate”: They unpredictably enter altered states of consciousness in which they lose touch with reality.

One 17-year-old whom I treated for depression asked me plainly: “if you were me, what would you do to make sure your parents didn’t get you even sicker during the next year? I mean, if I can get 18, I can leave home, maybe join the Army or something, and they won’t be able to do anything about it.”

I told him that he needed to be less confrontational in the face of his parents’ unreasonable demands for strict obedience, if only to conserve his emotional energy, not to mention avoid his father’s belt. “Prisoners of war don’t get in beefs every day with their captors,” I told him. “They lay low until they can escape.”

Like most of the abusive parents I have met, this young man’s father, for example, made it clear to me that he too had faced traumas as a young person, including horrific beatings. He tried to do his best for his son despite severe depression and alcoholism that limited his ability to function. Doing his best, however, was not nearly good enough.

This is why a social policy that would raise expectations for healthy parenting and more frequently and quickly impose the loss of parental rights should include a vigorous attempt to educate parents on how to avoid harming their children. The loss of parental rights is a tragedy we should attempt to avoid.

Another key requirement is to recruit good foster families. Too often such families have not proven to be much better for kids than the homes they have left; sometimes they are even worse. It makes no sense to take the admittedly drastic step of removing children from bad biological parents only to place them with bad foster parents.

One 19-year-old woman met recently had spent a decade living in a foster family. She had been beaten and neglected for the years prior to her placement and, even with obviously concerned and emphatic foster parents, had required years of psychotherapy to cope with her traumatic past.

With a support of a new family, however she had achieved in school, shunned drugs and made close and lasting friendships. She hoped to save money to attend college. While she considered leaving her biological parents as one of the major stresses in her life, she made it clear that she would have been much worse staying with them. “I’m one of the lucky ones,” she said. “I got out.”

The tragedy is that too few children do.

Keith Ablow / Washington Post, May 29, 1996 /

SET WORK

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