Parental Psychiatric Disorder: Distressed Parents and Their Families

This edited volume is an important contribution to the field. By virtue of its existence, Parental Psychiatric Disorder is formal acknowledgment that people with psychiatric disorders aspire to and carry out the role of parent. The reader is encouraged to "look at the mentally ill person in his environmental context," a context that is increasingly likely to include spouse or partner and children. This context is "uncharted territory," according to the editors, due to the complexities of mental illness, couple relationships, and parenting as well as arbitrary distinctions between adult and child services.

Thirty-four authors from four countries, representing multiple professional disciplines, contribute extensive literature review, detailed theoretical perspectives, well-conceived intervention strategies, and pragmatic recommendations for the assessment and treatment of parents and children. Families and their needs supply the motivation and focus for the book. Clinicians are the intended audience.

The editors provide a map for this complex terrain. Chapters are grouped into five sections. The first, on general issues, is drawn from the frameworks of adult psychiatry, child psychiatry, parenting, and family dynamics. Rob Poole, in the opening chapter, discusses the role of the adult psychiatrist in dealing with his or her patient's children and promotes a positive slant on what may seem to providers to be an intimidating problem. Chapters drawn from attachment theory and developmental and multigenerational family systems perspectives enhance our understanding of relationships among family members. Jonathan Hill's concept of parental "commitment" is useful in thinking about "the way in which parents give priority to, and refuse to give up on, their children."

Essential information about the medical and psychiatric management of pregnancy and the postpartum periods is offered in the second part, on medical and psychiatric issues. The chapters cover the spectrum of postpartum mental illness, psychotropic medication during pregnancy and lactation, and the drug-addicted mother.

Innovative model intervention strategies used in the United Kingdom and the United States are described in detail in part 3. McKay and Pollard make a unique contribution in their discussion of community support networks and the roles and responsibilities of professionals. In part 4, on parenting, contributors focus on specific disorders, consequent parenting difficulties, potential outcomes for children, and recommendations for intervention. The implications for parenting, and the impact on children, of schizophrenia, affective disorders, personality disorders, alcohol and drug problems, learning disabilities, eating disorders, and psychosomatic disorders are reviewed.

The primary virtue of the final section, on service issues, is the emphasis on family, community, and societal values and attitudes and the larger political and economic climates. The chapter on the assessment and prediction of parenting capacity by Michael Gopfert and colleagues is exceptionally thorough and thoughtful, particularly in relation to professional systems, values, and culture. Kavanagh and Knapp provide an interesting discussion of family policy and the resource environment.

A consistent theme throughout Parental Psychiatric Disorder is the family-centered approach. Individuals are seen as members of family systems, and families are placed in a broader societal context. The authors provide sophisticated analysis of the influence of contextual factors on individual and family functioning, assessment and treatment, and service planning and organization. Their understanding of the roles and responsibilities of providers and systems of care is thoughtful and sensitive. The value of the contributions is enhanced by the liberal use of case material and the personal accounts that open three of the five sections of the book. Clinicians will find the case material compelling, and the first-person accounts inspiring.

The editors and individual contributors have succeeded in bringing attention both to the "unidentified patients" they describe—that is, parents with mental illness who come to treatment when their children are identified as having problems—and to the "unidentified parents" we see, our adult patients with mental illness who have no notes in their charts about their parenting status. By focusing on the needs of patients as parents, we provide more effective, meaningful treatment to them and primary prevention services to their children.

Dr. Nicholson is associate professor of psychiatry at the University of Massachusetts Medical School in Worcester.