CMAJ/JAMC The Practice of Medicine
Parenting

 

All in the family

Harvey Armstrong, MD

CMAJ 1997;157:1693-4

Dr. Armstrong is Associate Professor of Psychiatry with the University of Toronto, Staff Psychiatrist with the Hospital for Sick Children, and Executive Director for Parents for Youth Ltd., Toronto, Ont.

© 1997 Canadian Medical Association

Parenting is the key to our future as a nation and a society. It is expensive, in terms of money, time and energy, and evidence is accumulating that parents are not as happy as their childless age-mates. Although some principles of parenting, such as needs for attachment, nurturing and structure, apply to all children, what children need from their parents changes dramatically as they grow and develop, and the parents themselves must adapt to their own life circumstances and values, as well as the values of the community in which the family lives.

Evidence is increasing that the parenting received early in life is represented not only in the psyche but also in the underlying brain structure and chemistry throughout a person's lifetime.1,2 The Healthy Start Program, pioneered in Hawaii,3 and other similar programs have demonstrated that nurturing and support received from parents in early life can reduce subsequent rates of delinquency and mental disorder. The long-term savings of such programs are substantial.

The most critical psychological period of parenting is its beginning. The nature and qualities of attachment at that stage (secure or insecure, avoidant, resistant or disorganized), which are products of temperament and mother­infant interaction, determine many central aspects of later life.4

teenager Despite the importance of family ties, many factors conspire to make stable nurturing difficult. Steep rises in geographic mobility and the associated lack of nearby extended family have left many parents in desperate need of support and better understanding. This need is accentuated in periods of family stress, all too common in today's world, and in cases of disturbed children. About 20% of children are seriously disturbed, yet only 1 in 6 encounter a professional who is even nominally qualified to help them.5 Medical training used to teach that parents were to blame when children were disturbed, giving licence for physicians to be much less supportive of the parents than their children. Fortunately, parents rarely want to harm their children, and I now understand the struggle of parents of troublesome youth.6 Family has meaning and presence long after professionals are no longer part of a child's life, so our support and nurturing of parents is crucial at all ages of children, but especially for parents of troubled children.

In addition to the stresses within families, children and their parents are subject to stresses due to rapid change in society. Values based on authority and tradition, values that support conformity and obedience, still exist in many families, but there has been a powerful societal movement to have parents value autonomy, independence and individualism in their children. Doing so sometimes results in a loss of the parent's sense of competence and confidence. Furthermore, we see an increasing number of youth who cannot accept limits and structure because of a lack of both within their homes and communities.

Parenting of children by single mothers is on the rise, but the social and economic stresses associated with the competing demands of parenting and making a living has left many of these women feeling exhausted and depleted. The fathers of the children frequently provide neither emotional, social or economic support, and the most impoverished of these mothers are terribly distressed by their overwhelming burdens.

There are many stages of parenting. No stage is more demanding than infancy, when the parent is completely responsible for the child's comfort and safety. Toddlerhood is an age of local mobility in which the child experiences enormous growth in skills and language but has no ability to keep himself or herself safe. The school years are accompanied by a decreasing need to carry out activities required for the comfort and safety of the child. As children enter adolescence, they begin to distance themselves from the family, challenge the parents' authority and lose interest in cohesive family life. Parents whose lives have been over-involved with parenting suffer some decline in well-being at this stage, although this occurs to a lesser extent among those who have other roles from which they can derive satisfaction, identity and meaning. Adolescents experience a variety of problems: girls may become pregnant, boys may attain a size and strength allowing them to physically threaten their parents and others. Adolescents with these and other serious problems shatter their parents' dreams, and the parents may react with fear, rage, over-protection or over-control. The end result is that the youth may become infantile or, at the other extreme, intensely rebellious.

If the adolescent becomes hostile and antisocial, there are enormous losses: the loss of the dreamed-of child, the loss of love and intimacy with the child, the loss of equanimity and control in the home as all of the rules are ignored or challenged and extensive damage is done to the home and other people living there. The unendurable emotional pain often results in parental depression and sometimes ill health. The rounds of helpers, including police, vice-principals, psychologists, doctors, courts and probation officers, is time consuming, expensive, exhausting and often not very productive.

The helplessness and confusion parents may feel when in conflict with their adolescents may stem from negative earlier experiences either in their primary families or in other relationships. They may feel like impotent, helpless children themselves in the face of their adolescent's temper tantrums. Such reactions often point to unresolved trauma in the life of the parent.

Parents can and do lose their sense of self in parenting. The needs of children may become paramount, swallowing up the needs, wishes and feelings of the parents. If their own childhood has been unhappy, some people will do anything to ensure that their own children do not suffer in the same way. They begin to lose their equilibrium and immerse themselves in parenting to the extent that there is often very little of the individual left. When parents identify their own past hurts in their children, they react by unrealistic over-protection. They may over-react to adolescent limit-testing and experimental behaviour and become unable to set effective limits. When this happens they lose confidence in themselves and set limits only in desperation, which is neither effective nor constructive.

In this situation the child never "grows up," and as a result, this chaotic parent­youth relationship may continue indefinitely or at least until the child leaves home. At this stage, the parent must restore his or her own personhood. Over-involvement and over-investment in trying to raise a successful, adjusted, achieving adolescent must be replaced by the relinquishing of control over the adolescent's life to that adolescent.

Most responsible middle-class parents with problem children have taken the parenting courses and read the how-to books, but often these activities do not prepare them for a specific child with a unique personality and problems. Nor do they heal the hidden wounds that are much more common in the parent's history than most of us realize. Unless these wounds are healed, all the didactic material in the world may not help.

Parent management training7 works well if the parent lacks an awareness and understanding of successful methods of parenting. Group therapy with other parents who have similar problems6 or techniques such as eye movement desensitizing and reprocessing8 may assist traumatized parents.

Parenting is too often under-valued and under-appreciated. For some parents, it is not as difficult as for others. Those in difficulty require support, help and understanding if they and their children are to prosper.

References

  1. Friedman MS, Yehuda R. Post-traumatic stress disorder and comorbidity. Lippincott-Raven: Philadelphia; 1995. p. 429-45.
  2. Shalev AY. Stress versus traumatic stress. In: van der Kolk BA, McFarlane AC, Weisaeth L, editors. Traumatic stress. New York: Guilford; 1996. p. 77-101.
  3. Mansfield H. Hawaii's Hana Like Home Visitor Program, a Healthy Start program. J Psychohistory 1997;24(4):332-8.
  4. Lieberman AF, Zeanah CH. Disorders of attachment in infancy. Child Adolesc Psychiatr Clin North Am 1995;4(3):571-87.
  5. Offord DR, Boil MH, Racine Y. Ontario Child Health Study -- correlates of disorder. J Am Acad Child Adolesc Psychiatry 1989;28(6):856-60.
  6. Armstrong H, Wilkes C, McEvoy L, Russell M, Melville C. Group therapy for parents of youth with a conduct disorder. CMAJ 1994;151(7):939-44.
  7. Kazdin AE. Parent management training: evidence, outcomes, and issues. J Am Acad Child Adolesc Psychiatry 1997;36(10):1349-56.
  8. Shapiro F. Eye movement desensitizing and reprocessing, basic principles, protocols, and procedures. New York: Guilford; 1995.

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| CMAJ December 15, 1997 (vol 157, no 12) / JAMC le 15 décembre 1997 (vol 157, no 12) |