The National Society for the Prevention for Cruelty for Children has produced a report, “All Babies Count”, which starts from the idea:
All babies need to be safe, nurtured and able to thrive. The early care they receive provides the essential foundations for all future physical, social and emotional development. Whilst most parents do provide the love and care their babies need, sadly too many babies suffer abuse and neglect. The emotional abuse, neglect or physical harm of babies is particularly shocking both because babies are totally dependent on others and because of the relative prevalence of such maltreatment.
No one’s going to argue with that. However, the report repeatedly refers to the “toxic trio” (their words) of “domestic abuse, substance abuse and parental mental illness”. Whilst the first two are fairly obvious indicators of potential harm to children, why is mental illness parity-linked with them? Some forms of parental mental illness, such as psychosis or dissociative disorders, may indicate an increased risk of the potential for harm, but not all mental illnesses involve psychosis or dissociative disorders. So should parental mental illnesses be part of this “toxic trio” at all? Or is there due to a lazy stereotyping and stigmatic approach from the NSPCC?
Let’s look at the report:
144,000 babies under 1 year old live with a parent who has a common mental health problem.
So what? Post-natal depression is a common mental illness but it doesn’t mean the mother is at risk of harming her baby, just that she needs support to see that her perception of not being able to cope is not the same as her actual ability to cope. All the statistic tells us is that more information is needed.
The report makes that case that prevention of child abuse isn’t just a moral intervention but one that saves money too. The effects of abuse in early infancy cast a long shadow over both the child’s own development into adulthood and their own ability to parent in turn. Again, not an argument anyone’s likely to disagree with.
Some families face additional challenges that can negatively impact on attachment. These include poverty, relationship conflict, domestic abuse, mental illness and substance abuse. Such families will require additional more intensive and coordinated support if they are to get off on the right tack.
Replace “mental illness” with “physical disability” and see if you read the paragraph any differently. Physical disability is an additional challenge to parenthood, but the NSPCC daren’t mention it. Wonder why?
No one wanting to be a parent can predict the future and no one can predict how they will react when becoming a parent. In the UK a third of pregnant women lose their jobs simply for being pregnant. Some parents face redundancy, serious illness or bereavement during or immediately after pregnancy. Some of
these life-changing events can trigger a mental illness, it is right then to taint these parents with being part of the “toxic trio”?
Disorganised attachment patterns are particularly likely when parents:
• have unresolved losses or have themselves suffered traumatic experiences, including childhood abuse
• have serious affective disorders, including depression
• are active alcoholics or heavy users of hard drugs
• are maltreating.
It is therefore not surprising that the majority (typically around 80 per cent) of maltreated infants are classified as disorganised in their attachment behaviour. However, by no means all ‘disorganised’ children have been maltreated.
Pity the mother suffering from post natal depression, then. Don’t expect a supportive reaction from the NSPCC. Don’t they know depression isn’t always a “serious affective disorder”?
Mothers with depression are more likely to harm themselves rather than their baby. In some cases depression acts as a spur to become better parent, as it distorts the parent’s view into believing they are not good enough so strive to become better. I am not suggesting that parents with depression should not have proper support, but that the NSPCC are demonstrating that they do not understand depression so cannot support children who have one or both parents suffering from depression.
The report moves on to consider mental illness in pregnancy and infancy.
Mental illnesses affect a substantial poportion of women of childbearing age and their partners. The impacts on children and the family can vary considerably according to the specific condition, its severity, the timing of onset and its duration. Below we consider evidence on maternal depression, on mental illness in fathers, and on serious mental illnesses.
Maternal depression, characterised by a prolonged period of low mood and a profound loss of interest and enjoyment, is the most common mental health condition. The emotional swings experienced by many mothers shortly after childbirth should not be confused with major depression. Depressive symptoms include difficulty sleeping and concentrating, loss of appetite, feelings of worthlessness and guilt, and low energy.
Compared to older children, very young babies are especially vulnerable when mothers experience depression because of their total dependence and the frequency of care they require. Deep depression is debilitating, making it difficult for mothers to provide routine care and maintain nurturing relationships with their children. There is considerable awareness of the prevalence of ‘postnatal depression’. Consistent with other developed countries, it is estimated that around 14 per cent of mothers in the UK experience postnatal depression.
I’ll ignore the sudden invented commas around postnatal depression. The problematic sentence is actually “Depressive symptoms include difficulty sleeping and concentrating, loss of appetite, feelings of worthlessness and guilt, and low energy”. Show me a new parent who doesn’t feel all of those in the first three months (not necessarily simultaneously). Lack of sleep can be caused by having to feed a baby every three hours and can be a cause of loss of appetite, tiredness, difficulty concentrating, feelings of worthlessness and guilt and low energy. Similarly loss of appetite can be cause of the listed symptoms too. So can being an isolated mother also recovering from a caesarean with a husband working long hours and not offering support. And how about preventing postnatal depression in the first place?
The report doesn’t show understanding of the difference between perfectly normal reactions and reactions that are warning to a more serious underlying illness. But report’s not finished with depression yet:
Seminal research in the 1980s with depressed mothers living in conditions of high adversity found elevated levels of maternal insensitivity. Two types of insensitivity in parenting styles have been highlighted, typified by ‘intrusive and hostile’ communication at one extreme, and ‘withdrawn and disengaged’ at the other. In turn, the infant of the depressed mothers in these studies showed high rates of distress and avoided social contact. Studies with lower risk samples have shown less marked disturbance in the contacts between depressed mothers and their infants, though there is still evidence of reductions in maternal responsiveness, particularly in cases where depression persists. Recent research has found that the adverse effects of maternal depression on child attachment were reduced when the mothers themselves were securely attached.
There is accumulating evidence of the long term impacts of maternal depression. We know that women who have suffered from postnatal depression are twice as likely to experience future episodes of depression over a 5 year period, implying continued or recurrent vulnerability among the dependent children concerned. Halligan’s longitudinal analysis of a sample of families in Cambridge found that maternal withdrawal during early interactions predicted elevated levels of cortisol at age 13 among the children of postnatally depressed mothers.
It can happen to men too. All these tells us is that mothers need support, not stigma.
Finally the report considers fathers:
Whilst researchers and practitioners have made enormous strides in understanding maternal depression, until relatively recently there has been a dearth of work around fathers and depression.
Fathers matter both because of the direct impacts of their depression, and because of their indirect(potentially ‘buffering’) role in relation to maternal mental illness. A recent study has found that the prevalence of paternal depression is around 4 per cent during the first year after birth (compared to 14 per cent among mothers). The peak time for paternal depression is between 3 and 6 months after birth. By the time a child reaches 12 years of age, two fifths of mothers and a fifth of fathers had experienced depression. A recent systematic review identified low relationship satisfaction as a key element of a father’s depression when his partner had depressive symptoms. Between 24–50 per cent of new fathers with depressed partners were depressed themselves. Research has found that fathers experiencing depression have less involvement with their children and higher rates of ‘infant directed negativity’ Severe depression in fathers has been associated with high levels of emotional and behavioural problems in their infant children, particularly boys.
The report doesn’t clarify what it means by “infant directed negativity”. That’s worrying because there’s a big difference between thinking something and acting on it. All parents have moments where they have negative thoughts about their children or their partners, but not all parents will act on them, and thinking it doesn’t make an individual a bad parent. Again, there’s no differentiation between behaviour accepted as normal and behaviour considered worrying. More worrying is that depression, with all its apparently serious outcomes, is not included in the section headed “Serious Mental Illnesses”.
Serious Mental Illnesses (such as schizophrenia and related psychoses, and affective disorders) can pose significant challenges to parenting and risks to dependent children, particularly when mothers lack insight into their disorder and are acutely unwell.
There are two problems with this statement. Firstly “serious mental illnesses” is too broad an umbrella term. Secondly it immediately focuses on mothers. The report does mention that fathers may ‘buffer’ the effects of a mother’s mental illness, but doesn’t acknowledge that mothers can do the same when fathers suffer mental illness. So why the focus on a mother’s mental illness?
The report continues:
The peak age of onset of schizophrenia among women is in their 20s, coinciding with the main reproductive years. The condition affects around 4 in 100,000 of the population. Development of babies may be adversely affected during pregnancy because of a range of factors associated with chronic schizophrenia, including poor attendance at antenatal appointments, unhealthy lifestyles, poor nutrition, smoking and the effects of both prescribed and illicit drugs. Once the baby is born, research has found that mothers with schizophrenia can experience a range of problems in care giving, including lack of emotional warmth and intimacy, remoteness, attention deficit, impaired maternal sensitivity and responsiveness to an infant’s cues, self absorption and intrusiveness. Intrusive interactions can interfere with an infant’s activities and lead the baby to avoid contact with the mother. Consequently, the infant may internalise an angry and protective coping style. Early experiences with mothers suffering from SMIs [Serious Mental Illnesses] may interfere with infants’ regulation of emotion and attention, with cognitive and memory function and with the ability to make self/other distinctions. These impacts may continue to exert direct effects on children’s lives over a decade later. Women with a diagnosis of schizophrenia are significantly more likely to have higher scores on perceived risk of harm to their babies compared to mothers with a diagnosis of psychotic depression. Around half of mothers with schizophrenia receiving inpatient psychiatric care in the postnatal period do not retain custody of their babies. Mothers who lose custody of their children may grieve for several years and are often not supported adequately when this occurs.
Dads can have schizophrenia too, but that is ignored here. The peak onset of any mental illness tends to be when the sufferer is in their 20s simply because it is not always possible to diagnose a mental illness with confidence in someone younger and doctors often take a ‘wait and see’ approach. That this happens to be during the main reproductive years is coincidental but not inter-related. The report states that “poor attendance at antenatal appointments, unhealthy lifestyles, poor nutrition, smoking and the effects of both prescribed and illicit drugs” are associated with chronic schizophrenia but does not explain the association, which is only an indirect one. With proper care and support, the association can be broken. The implicit assumption here is that women diagnosed with schizophrenia should not have children: is this what the NSPCC is actually trying to say?
Surely the key point is that final phrase “often not supported adequately”. A diagnosis of schizophrenia should be a factor in giving increased support to parents not an automatic assumption that the baby is at risk. Generally women don’t have babies on their own, there is usually a biological father so why not focus the support on them? Notice how in the entire paragraph, fathers are not mentioned once.
The following statement is breath-taking in both its stigmatising assumptions and inability to separate cause and effect:
Affective disorders, characterised by dramatic changes or extremes of mood, include bipolar I (‘manic-depressive psychosis’) and bipolar II (recurrent episodes of depression with at least one episode of hypomania). Symptoms of mania include persistent and abnormally elevated mood. Because of the dis-inhibition associated with mania and hypomania, women are vulnerable to exploitation (including rape) and risk-taking behaviours (high numbers of sexual partners). Denial of pregnancy poses the risk of a host of problems, the most serious among them being neonaticide. Neonaticide is also associated with dissociative symptoms, dissociative hallucinations, depression and suspicion of early trauma in isolated, rigid family structures. Women who deny their own pregnancy are often young, fail to manifest symptoms of pregnancy and fail to attend antenatal clinics, a situation frequently complicated by their families’ collusion in denying the pregnancy.
Where did this come from??
For a start bipolarity or manic depression (or whatever it’s called this week) is not automatically connected with psychosis. In fact, there’s no link at all. One person with mental illness may suffer more than one mental illnesses, but that does not prove an interconnected link between those illnesses. In fact, as with most mental illnesses, people with a bipolar disorder are more likely to harm themselves than others. People with bipolar II may get recurrent episodes of hypomania and one episode of depression: the extremes of mood are not predictable. Hypomania and mania does not automatically lead to exploitation and risk-taking behaviour. Again the NSPCC have failed to understand that thinking and action are separate entities: just because you catch the eye of an attractive shop assistant and briefly think about an affair does not mean you will have an affair.
I don’t see the link between dis-inhibition, risk-taking behaviours and denial of pregnancy. Women without an affective disorder have denied pregnancies. Pregnancy occurs where contraception has not been used or failed, not because the women had a high number of sexual partners. It’s not just bipolar women that are “vulnerable to exploitation (including rape)”. Denial of pregnancy and bipolarity are not interlinked so what on earth are the two doing in a paragraph that clearly implies they are?
By failing to separate neonaticide from bipolarity, the report implies the two are inter-linked; that a mother with bipolarity is at a higher risk of committing neonaticide. This is so wrong.
Again the focus in on the mother. Bipolar fathers apparently don’t exist.
In conclusion, the NSPCC report contains breath-taking inaccuracies and ignorance about mental health issues. It also fails to convince that mental health should form part of the “toxic trio”. In fact, it shouldn’t. Parents with mental health issues need support, just as parents with physical disabilities do, but the NSPCC should leave it to those charities that can offer non judgemental, compassionate support.
Damagingly, what “All Babies Count” does is further stigmatise mental health and will deter parents from seeking help. If anything is toxic, it’s the NSPCC’s attitude towards mental health issues.
By Emma Lee