This page intentionally left blank Parental Psychiatric Disorder DistressedParentsandTheirFamilies SecondEdition ‘Auniqueandinnovativeapproachtofamilyissuesinpsychiatricdisorders.Theauthorstacklea broadrangeofcomplexissuesthatarerarelycoveredinthedepthorwiththeexpertisethatthis volumebrings.Thisbookisamajorcontributiontothefieldandprovidesthekindofinternational perspectivethatenhancesourunderstandingofthecomplexdimensionsofpsychiatricdisorders fromamultigenerationalandcross-culturalperspective.’ FromareviewofthefirsteditionbyCarolNadelson, ProfessorofPsychiatry,HarvardMedicalSchool. Itisindisputablethatmentalillnessinaparenthasseriousandoftenadverseeffectsonthechild, something which is surprisingly not reflected in clinical service provision. In this completely rewrittennewedition,aninternational,multidisciplinaryteamofprofessionalsreviewthemost up-to-datetreatmentinterventionsfromapractical,clinicalpointofview.Itisessentialreading forallprofessionalsdealingwithadultmentalillnessandchild-care. MichaelGo¨pferthaspioneeredintegrativetherapeuticpsychotherapyservicesinLiverpooland recently has been involved in setting up treatment services for people with difficult-to-treat personalitydisorders. JeniWebsterwasbasedattheUniversityofManchesterbeforebecomingafamilytherapistin anadultmentalhealthsetting. MarySeemanisProfessorEmeritaattheDepartmentofPsychiatryattheUniversityofToronto basedattheCentreforAddictionandMentalHealth.In2001shereceivedtheGoldenAward of the Canadian Psychiatric Association for her lifetime contribution to the advancement of psychiatricresearchinCanada. Parental Psychiatric Disorder Distressed Parents and Their Families SECOND EDITION Editedby Michael Go¨pfert ConsultantPsychiatristinPsychotherapy, WebbHouse,Crewe Jeni Webster FamilyTherapist,Warrington and Mary V. Seeman ProfessorEmerita,DepartmentofPsychiatry, UniversityofToronto camʙʀɪdɢe uɴɪveʀsɪtʏ pʀess Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge cʙ2 2ʀu, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521534970 © Cambridge University Press 2004 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2004 ɪsʙɴ-13 978-0-511-13561-3 eBook (EBL) ɪsʙɴ-10 0-511-13561-0 eBook (EBL) ɪsʙɴ-13 978-0-521-53497-0 paperback ɪsʙɴ-10 0-521-53497-6 paperback Cambridge University Press has no responsibility for the persistence or accuracy of uʀʟs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. To the memory of ChanniKumar Contents Listofcontributors pagex Foreword xiii GrahamThornicroft Preface xv Part I Basic issues 1 Whatwewantfromadultpsychiatristsandtheircolleagues: ‘Tellingitlikeitis’ 3 SandraBilsborough 2 Parenthoodandadultmentalhealth 8 MaryV.SeemanandMichaelGo¨pfert 3 Parentalpsychiatricdisorderandthedevelopingchild 22 AlysonHall 4 Parentalpsychiatricdisorderandtheattachmentrelationship 50 JonathanHill 5 Theconstructionofparentinganditscontext 62 MichaelGo¨pfert,JeniWebsterandJuliaNelki Part II Comprehensive assessment and treatment 6 ‘Thesameastheytreateverybodyelse’ 87 VickiCowling 7 Formulationandassessmentofparenting 93 MichaelGo¨pfert,JeniWebsterandJuliaNelki vii viii Contents 8 Mentallyillmothersintheparentingrole:clinicalmanagement andtreatment 112 TeresaJacobsen 9 Perinatalmentalillness:nature/nurture 123 GertrudeSeneviratneandSueConroy 10 Assessmentandtreatmentissueswhenparentshavepersonalitydisorders 139 EiaAsenandHeinerSchuff Part III Specific disorders: the impact on parent—child relationships 11 Schizophreniaandmotherhood 161 MaryV.Seeman 12 Whenaparentsuffersfromanaffectivedisorder:effectonthechild 172 ChristinePuckering 13 Alcohol and drug problems in parents: an overview of the impact on childrenandimplicationsforpractice 185 RichardVelleman 14 Whenmothersabusedrugs 203 SydneyL.Hans 15 Personalitydisorderinparents:developmentalperspectives andintervention 217 GwenAdshead,AdrianFalkovandMichaelGo¨pfert Part IV Specific treatments and service needs 16 Psychopharmacologyandmotherhood 241 MaryV.SeemanandNeilSeeman 17 Socialworkissues 249 DavidClodman 18 Parentalpsychiatricdisorderandthelaw:theAmericancase 257 ColbyC.Brunt 19 Parentingandmentalillness.Legalframeworks andissues–someinternationalcomparisons 271 AmyWeir