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One of the things people don't realise is that during their childhood and adolescents, many adults who grew up with one or both parents that had a (diagnosed or undiagnosed) mental illness were traumatised. The research contained in the following thesis explains the needs of such adults and why their unique needs should be met.


Abstract

This theoretical thesis attempts to make visible the needs of adult children of parents with a severe mental illness (ACOPSMI), a population which has attracted little scholarly attention to date. It employs a methodology in which established trauma and alternative grief theories are applied to existing multidiscipline, scholarly and lay ACOPSMI literature. The thesis attempts to broaden the definition of ACOPSMI to include non-disordered, competent individuals. It argues that the unique, trauma-based needs of ACOPSMI are not being adequately met within existing family-focused policies and practice, which focus on the needs of parents with an SMI to the potential detriment of their adult offspring. Limitations, implications, and recommendations of this research are outlined.


The full thesis is available through the University of Melbourne ePrints Repository:

http://hdl.handle.net/11343/37852






Comments from Readers on the thesis:
 

“Your paper is important and does address a seriously ignored group of traumatised people. Let me reassure that I think you have identified a treatment group that has been neglected. One might even say that your group is a subset of the wider trauma group”.

 

- Dr Joseph Schwartz, PhD. Author of: Einstein for Beginners (1990), The Creative Moment: How Science Made Itself Alien to Modern Culture (1992) and Cassandra's Daughter: A History of Psychoanalysis in Europe and America (1999). Former experimental physicist (University of California); psychoanalysis (New York/London); supervisor and training therapist at The Bowlby Centre, London; and founding editor of the journal Attachment - New Directions in Psychotherapy and Relational Psychoanalysis (published by Karnac) which seeks to make a contribution to attachment approaches to clinical work.

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Suzette's work contributes to the trauma literature.

We can safely assume that the population Suzette researched, competent, non-disordered adults of parents with a severe mental illness, were to varying degrees traumatised. I agree with Dr Joseph Schwartz (PhD), supervisor and training therapist at The Bowlby Centre, London, U.K. who believes she is the first to have identified a treatment group, i.e., a subset of the wider trauma group, that has been neglected.

In her thesis, resource website and clinical-practice workshops, Suzette shares what she has learnt from her training in loss and grief and her treatment and studies of traumatized individuals across their lifespan in a clear, straightforward way. Without losing her audience, Suzette highlights the importance of adopting multiple perspectives regarding their struggle to be recognised as a traumatised population, not only at policy and practice levels but also to themselves as individuals. Her work helps the confused therapist and the suffering individual.

Suzette’s trauma-informed research has international clinical applications. These clinical implications include a better understanding of the grief that such individuals face. I suspect her work will influence or shape the way therapists might relate to our patient's/client's lived experiences; adding to the way we might understand and view how their trauma may have impacted on their lives across their lifespan and across generations.

Suzette's research is compatible with my co-authored book The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization as the foundation of her approach is to support the clinician towards a better understanding of the various obstacles that interfere in the trauma recovery of adult survivors of parents with a severe mental illness. I agree with her when she once told me: “We live in a world that expects and anticipates little drops of resilience to conquer early trauma in an instant”. In my opinion, any over-emphasis on resilience would certainly interfere in the trauma recovery of adult survivors of parents with a severe mental illness.

Often competent non-disordered survivors attempt to hide their distress beneath the common strategy of engaging with a facade of normality. Therapists can feel confused by their presentations and not fully appreciate their trauma-based issues hiding beneath, what Suzette has referred to as 'their mask'. In her thesis, Suzette unmasks their legacies. At the same time, she reveals the obstacles they face not only internally, as a result of their traumas, but also as a result of the type of policies and practices that fail to recognise what working with the lasting trauma for adults raised by parents with a serious mental illness implies.

Suzette Misrachi’s work will be of interest to current and future clinicians, students of clinical psychology, psychiatry, social work, as well as to researchers and policy-makers, including all those interested in survivors of chronic child abuse and neglect, who in their well-camouflaged demeanour, would otherwise remain ‘invisible’ and ‘silent’.

 

- Onno van der Hart – Emeritus professor of psychopathology of chronic traumatization, Utrecht University, Utrecht, The Netherlands.




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“I was extremely impressed by your thesis, which certainly highlights a lacuna not only in the counselling and psychotherapy literature, but in the policies and services which could potentially pertain to this group. While the ACE Study includes `parent with a mental illness’ as a specific category, the dynamics to which it gives rise are not well known and the hidden costs of this – which you elaborate with skill – would indeed seem to be high.

 

The way in which you organised your material (historical perspective; `waves’ of research; progression to discussion of the implications from varied angles) was also impressive. Building on the work of pioneers who have researched this largely `invisible’ cohort, you illuminated many facets of their experience which you persuasively argued to be not so much dismissed as not recognised as significant in the first place.

 

Throughout the course of your analysis, you also make a number of observations and suggestions which, based on the analysis you present, would seem to merit not only consideration by health professionals, policy makers and service-providers, but potential implementation. That the now familiar categories of `competence’, `resilience’ and `high functioning’ can serve to conceal both the existence and enormity of ACOPSMI (internal) experience which may be very contrasting is a single powerful illustration of the many you cite.

 

I took many notes from my reading of your thesis, and will certainly reference your work in this area as appropriate. Thank you so much for the opportunity to read your thesis; I have benefitted greatly from doing so”.



- Dr Pam Stavropoulos, PhD. Head of Research and Clinical Practice Adults Surviving Child Abuse (ASCA), Sydney NSW Australia

 

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Context: The following quote is an emailed response (19/12/08) in reference to a conversation with Dr Paul Valent, 4th August, 2002 lecture on 'Child Survivors of the Holocaust' by the Australasian Society for Traumatic Stress Studies (ASTSS) at Mindful. The question related to the grief and trauma associated with being a child of parents with mental illness and how, in Dr Valent’s opinion, this type of trauma could be compared with Holocaust survivors was asked.

“I remember that conversation. I had long ago been struck by the trauma of incestuous sexual abuse of children resembling those of child survivors of the Holocaust, and arguably being even greater, because the abusers were their own fathers. They were their Nazis.

Analogously, children who grew up with psychotic mothers/fathers suffered multiple abuses from infancy, and again the “Nazis” were their own parents. Child survivors of the Holocaust knew at least on one level that their parents were their allies and rescuers and were loved and valued by their parents”.

-Dr Paul Valent, psychiatrist, traumatologist, researcher and child Holocaust survivor.


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"Overall, I found this Masters research by Misrachi to be quite remarkable. It investigates an under-studied topic, non-disordered, competent adult children of parents with a severe mental illness (ACOPSMI). The thesis is articulate, extremely well-referenced (with an amazing 30+ pages of single spaced references), - organised, and cogent in its objective of making the case for more research attention being given to ACOPSMI. The thesis also presents solid arguments about why ACOPSMI needs to be more fully appreciated in counselling circles and among policy makers. In this latter regard, the work begins to redress a paucity of concern among Western governments and relevant authorities about children who experience significant trauma associated with their parents’ mental illness.

I was most impressed by the organization of the thesis, including the helpful personal commentaries, overview, and limits section. The thesis appeared to represent quite well relevant literature in areas such as traumatology, grief and bereavement, and attachment theory. As a scholar working in the area of loss and trauma, Misrachi’s work focuses a spotlight on a phenomenon that is barely recognized in extant loss and trauma literature. She does an excellent job in connecting ACOPSMI to concepts such as trauma and grief and in reviewing the modest available literature on these linkages. I was particularly interested in what she refers to as Third Wave Research on this topic, emphasizing the adult children’s own accounts and phenomenology of being in homes in which the parents’ mental illness dominated relationships and experiences. I think that this type of research approach would be fruitful would Misrachi go further at some later point in collecting qualitative evidence about ACOPSMI.

In terms of the criteria presented in the “Standards of examination” statement, I believe that Misrachi’s thesis:

1.    Demonstrates superbly an advanced learning in research skills and mastery of appropriate techniques associated with ACOPSMI.
2.    Demonstrates quite well specialist knowledge in the area of ACOPSMI research.
3.    Presents in great detail and with scores of citations the results of research incorporating these findings in such a way as to eloquently lay out needed future theory, research, and policy endeavours.
4.    Demonstrates an understandings of, and commitment to, research ethics or code of practice.

In sum, Misrachi writes with great passion and reason in giving voice to adult children of parents with severe mental illness. The thesis and her related web site should advance our understanding of ACOPSMI [i.e., Adult Children Of Parents with a Severe Mental Illness], as well as related mental health policy. In my opinion, the work would qualify a doctoral level document at universities where I've taught over the last 40 years in the U.S."



- Thesis examiner: Professor Emeritus, John H. Harvey. Editor for Journal Of Loss & Trauma and Author of: Odyssey of the heart: The search for closeness, intimacy, and love (1995).  New York: W.H. Freeman.  1997 Translated into Japanese by Japanese Publisher Kawashima Shoten.  1999 translated into Croatian by Zagreb Press; Embracing their memory: Loss and the social psychology of story-telling. Needham Heights, MA: Allyn & Bacon; Harvey, J.H., & Fine, M. (2004).  Children of divorce: Stories of loss and growth.  Mahwah, NJ: Lawrence Erlbaum Associates. 2nd ed. 2010 NY: Taylor & Francis.

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“This is an extremely well written and presented thesis, which addresses a topic instantly recognisable to practitioners and academics in health and social care. As Suzette argues, the ACOPSMI issues are not fully understood from a theoretical, and subsequently a policy perspective.

It is always refreshing to read a thesis that is ‘meaningful’. Suzette’s enthusiasm is threaded through the work and has a most infectious quality. Suzette demonstrated considerable knowledge of the research topic and successfully integrated a wide range of literary sources, from disparate fields, in an effort to compensate for what Suzette saw as the limited ‘scholarly attention to date’. That the study was not empirical did not detract from its value. Indeed, by providing a putative theory Suzette laid the necessary foundations for any future empirical study.

In the early stages of reading I wondered why Suzette had not been encouraged to pursue a doctoral dissertation such was her commitment to the topic and background knowledge. I found the thesis to be highly original and would wish to congratulate her on the work. I am sure that this will not be the end of her ACOPSMI research story”.

- Thesis examiner: Professor Phil Barker, PhD. Honorary Professor, School of Medicine, Dentistry and Nursing, University of Dundee, Scotland; nursing theorist, teacher, therapist, and UK’s first professor of psychiatric nursing practice  (University of Newcastle).

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"This thesis is timely. I am beginning to 'come unstuck' on the very issues you discuss here and it is so nice to know that there is in fact some literature and support out there. I always figured there was, but as you would know, being the 'carer' rather than the 'cared for' means that you don't seek help. So your thesis will be my support - knowing that I am not alone and that some of my experiences are shared by others.

Of course, everyone's journey and experiences are unique so I would not expect that there be a significant overlap, but that there is any overlap at all is comforting. (And I know that you argue that this issue does not receive the attention it should, and I agree with that, but my need to read your work is a bit more personal than that - it is simply to read other people's stories so that I know that I am not alone).

I have a PhD in Psychology, and a Postdoc in Social Policy (specifically, child protection issues), so grief, loss, trauma, emotional abuse, mental illness etc., are not new to me. But they have always been addressed in the theoretical - and that ‘detachment’ allow you to function quite normally while still addressing your personal/psychological needs.

But since having a baby, things have been very different. My capacity to put the distance I need between myself and my mother has now become impossible. My mother, in my opinion, has undiagnosed borderline personality disorder, bipolar disorder and Munchhausen, and has had episodes of diagnosed major depression in the past involving violent suicide attempts, the two most dramatic being burning herself with petrol and then being hospitalised for a year when I was 14, and then swallowing 130 sleeping tablets a year later - surviving both. The emotional control and manipulation that is typical of these disorders is now manifesting in the way she grandparents. And the unintended effect of emotional abuse, now across two generations (including possibly Munchhausen by proxy), is beginning to make me very tired.

Anyway ... I am sharing this to let you know that you have explored an important topic and I am glad to know that it is getting some air time ... For we certainly are the unseen, just plodding along.

Thank you for conducting this research".


- Academic psychologist (Anonymous)


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"In the relatively short time I have known Suzette I have never felt that someone has been able to understand what impact the role of my parents influenced my life. I had already identified that my childhood, teenage years and early adulthood were not fulfilled by the loving nurturing parents that everyone desires. I had already identified traits in my siblings that were just not normal and realised they were just not nice human beings... even into early adulthood they were narcissistic, selfish, liars, who would manipulate and use people for their goodness and then criticize and humiliate them. However, partly due to wanting to be ignorant, I realised these were the traits of my mother also. It didn't really hit home until I had my own child and I realized I did not want my child to be surrounded or influenced by people who had these traits. So I have kept my distance to not be continually hurt and disappointed with what you expect from a relationship from a mother and siblings. My mother thinks there is nothing wrong with her and would never seek help, let alone accept a diagnosis of a mental health issue. Until meeting Suzette I thought I was just unlucky to have had a family like that and that there was no one in the world that could relate to me.

Meeting Suzette has helped me immensely. She had opened my eyes further as to the fact that there are many children out there who grew up in a home with a parent who had a mental health issue. And she has help me identify and label what was / is going on. I have just started reading her research (Lives Unseen: Unacknowledged Trauma of Non-Disordered, Competent Adult Children of Parents with a Severe Mental Illness) and realised this problem is a widespread issue that needs so much work and intervention in order to prevent the generations from continuing the same patterns and continuing this horrible cycle. She has awakened me as to how the affects of being a child of a parent with a mental illness is affecting my marriage and other relationships.

I'm uncovering that her work is ground breaking and is undoubtedly touching and helping many people's lives. I feel that there is a sense of urgency that people need to know about this work as it could help people immensely to improve, heal and facilitate fulfilling their lives. It needs further exposure to a wider population so it's effects can help and start healing.

Suzette's contribution to my life thus far has been a profound one and I hope many, many more people are able to be helped the same way.

Thanks Suzette so much for awakening me as to what the issue really was with my life".

- Physiotherapist (Anonymous); in multiple countries.


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"Thank you so much for the acknowledgment and the opportunity.  It is an excellent thesis. I would strongly suggest developing a series of articles based on the thesis -- aim some for thanatology journals (I would love to see one for Omega) as well as psych journals".
 

    - Professor Ken Doka  Editor of Omega: The Journal of Death and Dying and Journeys: A Newsletter for the Bereaved. Prolific author of journal articles and books including: “Disenfranchised grief: Recognising hidden sorrow" (1989) 

 

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This is the trouble with looking OK. That is, when you’re ‘too functional’ to have your mental health taken seriously, people say you’re looking really great. And there you are feeling like you want a hole in the ground to open up right there, right now, underneath you, so you can disappear. There you are with this look you’ve done since childhood. You’ve had to. This was the way in your household. ‘Mum must not see any sadness’ or dad for that matter. You may have been told this often enough by everyone in the family and anyone who met them, including medical professionals. It happened to me. I was told you and your twin sister were the problem for your mum’s mental illness and you must keep her happy. This became our daily mantra. ‘You must show yourself to the world to be perfect. Anything less and you are worth nothing’. It gets repeated to you so often throughout your life. It shows up in your life in nuances that people have no knowledge of. So the shape of you, the one you adjusted to decades ago, struggles in two worlds.
Yes this is what some adults, who cover up trauma, who have grown up in a family where a parent has a mental illness, and where the other parent is not supportive experience. When we look as though we have just stepped out of a fashion shoot we are using the old patterns we used in our childhoods. We learnt to protect others and ourselves from the deep shame we feel. I did not excel at school but boy did I excel at the life we had. I had no choice but to FAKE it. To keep every one happy except my self. There is so much more to my story that would make anyone wonder how I’m still alive. According to the stats I should be dead.
I went for years believing I was a social defect not only because of what the mental health system had given me, i.e., a label, but by the way that I had been rejected by so many. That was until I came across Suzette Misrachi. I read her work. I cried and cried. There was someone out there who got it and who really understood the nuances and the reality of growing up with a parent who has a mental illness.
Although I grieve daily I’m not depressed – never have been. I realised this even more since being involved in the fine arts for the past 3 years. I cried and grieved so many losses. Losses due to being so unaware of that what I was actually feeling was buried grief and the fact that I had been advised that it was depression and bi-polar and Post Traumatic Stress Disorder (PTSD). Yet I did not behave in ways that the books alluded to in the medical model of the disorder. I saw people in the throes of these episodes and wondered why I’d been considered to have such a label as I had never ever behaved in such a way… Current systems have a lot to answer for because I now know why and what these feelings are. They are all normal.
I have spent the past 25 years as a consumer consultant trying to inform the system, i.e., government policies, that just because a child presents SMILING it does not mean that they are coping. 20 or 30 years later it, i.e., being raised by one or both parents with a mental illness, still affects them just like it has done for me, my twin sister and also our adult-children. This issue is an epidemic. I know because I meet other consumer parents. We all grieve daily because no one believed us until Suzette came along. I knew in all my heart she got it. After reading her thesis multiple times, I cried and cried just like I am now. I cry because many of us are left bereft and unless this is fully investigated we will continue to have children grow up without love security and knowing who they are. Not only that. They will just become human doings going on to continue the family legacy.
There is still a lot to do to bring people out of the ‘dark ages’ in regards to children caring for parents who have a mental illness. I want for all of us to understand the reason why trauma can be transferred through the generations when children are raised by one or both parents with a mental illness. This is more than overdue. I just hope in my lifetime, and I’m approaching 72yrs this August, 2017, that people read Suzette’s messages in her research.
I do training to new staff of various organisations for all sorts of disabilities and mental illness. Often they say, ‘you look so well’.

- Margaret Cook. Practicing artist, grandmother and Advisor: Telethon Kids Institute Research Project on Children of Parents who have a Mental Illness, Western Australia.


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"Your article [in the AASW National Bulletin Autumn 2015 – Volume 25, Issue 1, pp 20, 21] leapt out at me and touched me deeply.
Thank you so much for the work you have done, are doing, and the way you imparted the fruit of your research in your writing.  Being an ACOPSMI myself and working as a therapist is an interesting combination.  I know of other colleagues who have experienced trauma but none who have lived with a severely mentally ill parent that I am aware of. I’m sure they are out there but perhaps the sense of invisibility and silencing that I’ve experienced affect others too; maybe they too have felt shame and not been willing to ‘come out.’  This is the beauty of your research – that it offers normalization and a sense of visibility.  It creates a voice when one can feel silenced and alone.
In addition to an experience of invisibility I have found it easy to second guess myself, especially in my professional life.  My (late) mother had Schizo-Affective Disorder and I must say that this fact has rocked my confidence when I have sensed a whiff of similarity – I became scared of perfectly normal emotions or distress reactions and can now reassure myself that I am not unstable or odd.

But I think the biggest thing to rock confidence has been the side effects of trauma; this has been the hardest to explain and accept.  However, I have done a lot of personal work over the years and feel more confident in myself and can now feel proud of how I work without second guessing myself so much. Incidentally I never intended to work in ‘mental health’ (avoided it like the plague!) but counselling fitted me like a glove and life has an interesting way of evolving. 

 

Your article did offer me much validation.  Thank you.  Even though I have explored my own territory of distress I think it’s fair to say that my journey is still a work in progress. I hope other ACOPSMIs find validation in your article too and it does help workers to be more vigilant and not so dismissive about the lived experience (still) of ACOPSMIs.  I have to say that your research title resonated with me in a very deep way Lives Unseen: Unacknowledged Trauma of Non-disordered, Competent Adult Children Of Parents with a Severe Mental Illness.  Wow.  That just says it all.  I have often thought how strange it is that so much focus can be on children but what of when they grow up?  I like the ASCA (Adults Surviving Child Abuse) website.  But often the descriptions of dysfunction don’t fit me.  I found a term Prolonged Duress Stress Disorder that fitted better but I still don’t have a disorder.

It has been with pride but strange disappointment that I have never been disordered (this does sound weird). My story is a doubled edged sword: on one side immense grief and shame; and the other side immense relief and pride that I was never overtaken with all I went through.  Family members are incredulous, “You’re amazing.  After all you’ve been through…”  Yes, but there have been costs that only now in my mid-life have I been brave enough to explore.  How do I respond to such compliments?  It’s nice to know that I’m not another statistic – as I know full well how many children who live with severe mental illness do not fair well – but the buried sensory effects of trauma do not then get to be seen, known, and cared for in the way that they deserve. 

A few years ago I learnt more about trauma. Complex Childhood Trauma to be exact.  It was only then that I started to see the strong parallels with my own sensory experiences, doubt, and shame.  By the way, I liked the AASW article picture because it conveys loneliness and shame – often a result of trauma - but it is a little too dark to embody an ACOPSMIs experience I think.  I wonder if a more relevant image would be a dichotomous representation - a sad face behind a happy face - that sort of thing.

Thank you from the bottom of my heart the fact that you noticed and took action".


- CaN-ACOPSMI and Mental Health Social Worker, Adelaide, Australia (Anonymous)

 
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"Thank you for your work, as it is truly very important and timeless.  The things that you have written about, in my opinion, should have been woven into ancient texts long ago, as it would have made an enormous difference in how human history has played out.

Again some many months later, I was thinking about you and your work this weekend when I decided to see what there was of yours out there on the Internet.  I quickly came across your masters thesis, and I read through about a quarter of it this afternoon.

The diligence with which you presented your thoughts and the care you took in deciding what exactly was and was not included in your thesis was extremely significant.  I especially appreciate the fact that you are giving a substantial voice to what you call the Third Wave of literature, in particular, the ‘Competent, Non-Disordered’ individual.  This part was extremely poignant:

"The subjective views of ACOPSMI are valid (Kinsella, et al., 1996) so they should be taken as able to speak authoritatively about their plight. Yet few studies seek the opinions or investigate the needs of ACOPSMI (Knutsson-Medin, Edlund, & Ramklint, 2007). The profile of Third Wave literature in this thesis is therefore elevated."

This is very meaningful, as what you are doing with this is making a strategic advance in breaking down the stigma of mental health.  By targeting the Competent, Non-Disordered individual, you are allowing people to admit their struggles without admitting professional deficiency or incompetency.  

This is huge.

As you’ve noted in your research, the study of psychology isn't limited to the traditional classroom setting and that, as you have coined in this field, "Third Wave" literature has some inherent authority to it as well simply because individuals have lived through this experience and not just studied it.

Intuitively, I would think that some of the mechanics of what is known about the ‘Stockholm Syndrome’ might very easily carry over into studies on ACOPSMI.  The torqueing and twisting of emotions on the mind as one is forced to override the fight/flight response and remain in an a psychologically abusive environment because that is the only option could easily be compared to the repeated bending and fatiguing of a piece of thin metal. Eventually, both the mind and the metal deform, become very fragile and fatigue.  In order to survive on a daily basis, the war time response of attacking an enemy has to be overridden and the rules of engagement have to be rewritten.  The Stockholm Syndrome is very similar to this dynamic, and I would think that large portions of this area of mental health could be cut and pasted into the study of ACOPSMI. 

It seems as if the hardest part of getting help is realizing and then admitting that we need it.  It goes against the fierce grain of the empowerment and ego of independence, as admitting we are in need feels like we are showing weakness.  In a case like this, it's almost as if you have to take someone through the process before you tell them what the intention of the journey was to begin with.  Otherwise, they may never embark on it at all.

The analogies that many ACOPSMI make to war and yet the difficulty that exists in comparing the terms "parent" and "enemy" is an important issue. You also say in your thesis in a discussion of grief that what exactly ACOPSMI are grieving is unexplored. I imagine it would not be at all easy to be in a house with so few walls and so many clear windows, but at least those ACOPSMI who have the courage to read your thesis are likely to know it is a safe place to be. 

I hypothesize that a presidential candidate who used a trauma-informed approach to his/her administration and used professionals in an organization as one of the primary sources for creating their domestic and foreign policies would be beneficial. I could easily see your work also being used for something like this.  Instead of using individual therapy as a place for a discussion of CaN-ACOPSMl, assume that an entire people group has been culturally traumatized but that they are non-disordered and competent enough to bring their own Third Wave discussions to the table in an attempt to stop perpetuating their own culturally traumatic dysfunction and stabilize their own society. If I were a candidate, I think this is what I would do, but that kind of dialogue is so far from the norm in politics...a universe apart from what is allowed...yet right next door to where the current needs lie.

You introduced me to the important word "iatrogenic". Thank you again for your significant work in this area. I have yet to find anyone that packages and discusses relational trauma as you do. I have personally downloaded your thesis because I truly value what you have to say.

What I am also writing about is to see if I might have your permission to post a link to your thesis.  There are many people these days that are in the mode of mental self-help, and your thesis goes a tremendous distance to acknowledge, in lay terms, the plight of people that are trying to be healthy, productive citizens but who have some really screwed up parents.  As you point out, though, this is much more about being healthy than it is to point fingers, as many ACOPSMI have parents who are also ACOPSMI.  These unfortunate family traditions may go back for generations.  This area of study could even lead to a sociological study of generalized social anxiety and trauma that is perpetuated by some deeply held cultural beliefs and practices.

While I am obviously not a mental health professional, I believe your work is significant enough to warrant further publicity in the everyday channels of life and not just in the often sterile libraries of the practitioner.  You have written it in an accessible enough manner that I believe most relatively educated individuals could gain a lot by reading your words.


One of the reasons I like your thesis so much is that it opens the door to the machine room of humanity. For me, this is where I see all of the gears of human behavior turning and meshing, and it reinforces what I have known for a long time but haven't had the vocabulary to describe.  It stabilizes me greatly, and provides a significant (and healthy) challenge to know how and why to self-regulate, what defines competency, and what healthy attachment actually looks like.

Another thing that is so valuable about your work is that people DON'T have to have SMI parents to benefit from your approach.  All of our own parents are messed up to some extent and we as parents will also make mistakes that will negatively affect our children.  Your work acknowledges this at the extreme level, but the theories you use and the intuition from which it originates can be scaled back even to the everyday parent. Your work is relevant to the average individual simply seeking to stop even minor dysfunctional family traditions.  


In lay terms, your specialty describes a subset of the population who are "normal people trying to recover from having a very screwed up parent or parents." While there is obviously much more to it than that, I find that your approach goes great distances to diminish the stigma associated with mental health simply by acknowledging the fact that your own personal experiences give you a voice that should be acknowledged and considered by the mental health community.

Of course, now that I am well into the parenting years myself, I tread much more lightly on the subject of parental dysfunction, lest my own children seek out advice on CaN-ACOPSMI themselves someday!

You know, when you write something from the heart as I believe you have done with your thesis, it resonates deeply with people in a very real way.  I imagine that this is one of the reason why your thesis has been so popular.

I don't need to read your thesis in it's entirety at all because what I pick up on is your "trajectory of thought."  It is the brush strokes, the colors, the shadows and hues of what you write that tell my mind that this is a safe place where I am understood and acknowledged.  

As with most artists, they do not need to stand next to every piece of work and talk to the viewers for their artwork to be valuable and very meaningful.  In fact, the majority of them will eventually buy your art because of its impact on them, take it home, and hang it on the walls of their minds to admire and reflect on as the years go by.

Not many out there can do what you do in the way that you do it.

I would also dare say that your work could warrant an academic major all its own both at the undergraduate and graduate level, as it could be expanded both in breadth and depth in many ways.  You are speaking to such a widely affected audience.  Rather than simply diagnosing a disorder, you are aiming at putting an end to a family tradition of dysfunction".  

 

- Adam Read, Assistant Construction and Superintendent – Pennsylvania, USA
Owner of IatroGenesis, a LinkedIn Discussion Group


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“I’ve just finished reading through your thesis. It is a major work! I found it beautifully detailed, extensive, and a needed contribution for an underestimated issue. I also found some new references I wasn’t familiar with (such as, Lanius, et al., 2010).

I, too, find the trauma research to be needed. It is provides a remarkably comprehensive way of understanding emotional and other pain, as well as addictions and health issues of all kinds from mental to physical health and more. Your elucidation of this particular group of Adult Children of Parents with a Severe Mental Illness (ACOPSMI) is a great example of how subtle, invisible, unrecognized the role of trauma is, and how difficult it can be to identify by these individuals, as you describe, but also by a culture that doesn’t see it either. 

 

I think that chronic illness may stem from similar experiences and that childhood trauma can come from even the most subtle of attachment disruptions and misattunements. I don’t think the more overt (and easier to recognize) experiences of experiencing childhood with parents with PTSD or severe mental illness is needed to influence risk for chronic illness.

 

The subtlety of emotional unavailability in the face of otherwise competent adult behaviour is part of why the effects of our own trauma can be so difficult to recognize. Many parents fit within what we think of as “normal” but experience tremendous unresolved and unrecognized pain. There may be no known overt abuse or mental illness in a family. Sometimes, however, you find trauma, abuse, great losses and more just a few generations back. This brings up the question of how far down the line the effects of SMI in one generation can impact the next. My sense is that they go much, much farther than we’ve ever imagined.

 
I’ve been exploring the role of trauma in the origins of chronic physical illness and find your work to be completely applicable to this group of people as well.

The role of type II (and even type I) trauma in chronic illness is unrecognized by most individuals who have a disease, as well as by providers of mental and physical health within the traditional medical model – despite research such as Felitti’s ACE studies.

Treatment approaches for chronic illness, similar to what you describe in the review of treatment options for ACOPSMI, does not consider trauma. Instead, people who have a chronic illness can be judged as lazy, weak-willed, or seeking attention when their behaviors actually reflect survival strategies. They may be shamed and blamed by their health providers, just as they were by their parents in childhood.

Another barrier to treating trauma in chronic illness is the way our culture has denigrated the concept of psychosomatics. When people with chronic physical illness are referred to psychotherapy, they often feel offended and unseen. They feel they are not being taken seriously. This happens in part because their health care providers really don’t see them. And because the medical model really does think it’s all in their heads rather than in their body-minds”.

Dr Veronique Mead – somatic psychotherapist and physician specialized in family medicine (previous assistant professor at Dartmouth Family Practice Residency program teaching residents/medical students and providing full spectrum outpatient and inpatient community hospital care).



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"Your research was recently forwarded to me via a Facebook group called 'Sons and Daughters of Parents with a Mental Illness’.  I am an Adult Child whose parent has paranoid schizophrenia, I am also a counsellor and I'm currently completing my MA. I have read your thesis and it’s extremely interesting, would you mind if I make reference to you and quote your research in my MA?"

 

Rada Graovac:  Psychological Therapist, working for the National Health Service,

Child & Adolescent Mental Health , UK
 



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"I have read your thesis and would like to add my congratulations to the many already on your resource website list.  I think you have written a stunning thesis which addresses a very overlooked area.

My PhD (working title: A narrative inquiry into the lives of adults who grew up with mentally ill parents) is now in the writing up stage and is research which explores the retrospective stories from ACOPMI. I belong to this group too and am writing reflexive aspects throughout the thesis. You are the first person I think who I have heard acknowledge the trauma which is something I feel strongly about, since I am sure my siblings and I have all had PTSD. Also, at the moment in the UK there is no similar resource website as yours".



-Zoe Cowie Phd (in progress) UK.

 

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“I didn't thoroughly read your entire thesis; I skimmed through it, focusing on the parts relevant to me.  I reluctantly read your paper the night before a session with my psychologist, I say reluctantly because my mother died about three years ago and I liked to think that any problems my mother caused me, ended when she died.

Obviously I must have absorbed the important facts to have broken down over it during counselling the next day. When talking to my psychologist, my mother was mentioned and I became quite agitated. In the end, after my psychologist prompted me to talk about my mother (till now discussions have centred on my ex-partner) I just said my mother was always very homesick and then I burst into tears.

I questioned why I didn't see the obvious sooner, especially given the fact that my mother and ex-partner were so similar. But on reading your resource website (i.e., before reading your thesis) I think the term 'parent diagnosed with a severe mental illness' threw me. Firstly mum was never diagnosed and secondly I never, ever saw her as having a severe mental illness.  I just saw her as misogynist and abusive.  I think severe mental illness conjured up the picture of a crazy axe murderer for me!

My main emotion after reading your paper was indignation - it’s not over yet, and irony - at least I'm high functioning. But mainly I was pissed off because a) my mother screwed up my life and b) no one would believe me.

Even saying that my mother screwed up my life causes conflict because we are supposed to take responsibility for our lives and not blame our parents for our losses and failures. As adults we are discouraged from using our parents for reasons to be dysfunctional. We are expected to ‘move on’. I needed my mother to [physically] die to ‘move on’. I finally owned my life – not the life she owned inside me.

Having a mother who abused me, clearly didn't like or love me, caused me to go through life thinking "even my own mother doesn't love me" and often feeling that I didn't even deserve to live.  And then there is all that pressure to "be good to your mother".

I told my psychologist about your paper and she took it all in and suggested I extend my sessions into next year and focus on my mother.  Just when I thought I was 'cured' dam!

So what I'm left with and what I wanted to pass onto you, because you might find it helpful, are two main points.

Firstly, I think your use of experiential accounts in your research, i.e., “Third Wave literature”, when discussing the parent with mental health issues is key and served as a trigger for me. Many of the authors were talking about their mothers. Society’s views of mothers centres on the notion that they love you, they care for you, they are self sacrificing, and lift mothers to an almost saintly status, and then there's Mothers Day.This made it impossible for anyone to believe that I was being abused by my mother.

It seems everybody else has been so brainwashed with the image of the ideal loving mother that nobody would believe me when I said my mother abused me – nobody including some of the counsellors whose support I was seeking! I even lost friends over it. Yet if I'd told people that my father abused me, they’d just believe it. They wouldn’t hesitate to validate that. So in your resource website under “TASKS for Recovery” I found Task #1. Believe all your experiences did happen to you and were real” very helpful and validating.

Secondly, a woman growing up around an abusive mother creates a double whammy.  This person is supposed to be your role model.  There is supposed to be a special bond between you. Your mother is supposed to teach you how to become a woman, how to be a good wife and a good mother.

I will give my psychologist the links to your thesis and resource website at my next appointment, I'm sure she will find it helpful to her practice.  I should also alert my GP because I have mentioned my mother’s emotional abuse to him over the years and he has always appeared incredulous, as have the many counsellors I have seen since becoming a mother myself.

I lived in absolute horror of turning out like my mother. Being told how much I resembled my mother caused me actual pain and I always felt insulted which in turn made me feel ashamed of myself.  I used my father as a role model and told myself that mum was there to teach me how not to behave.

A female growing up with an abusive same sex parent carries many additional problems, you are less able to divorce yourself from your mother and, while everyone is only too willing to believe in abusive fathers, nobody, and I mean nobody will believe you when you say you are an adult and still being abused by your mother.  You are simply dismissed and you never receive the validation that you need.  We all wholeheartedly believe and support a victim of paternal abuse, addressing maternal abuse still appears to be very much taboo.  Society still won't go there unless of course the abusive mother is a junkie or promiscuous. That's the generally held stereotype for an abusive mother.

The most frustrating part, in my lifelong attempts at having my problems with my mother validated, is that everyone brushed it off as a generational thing.  They believed all women my mother’s age dispensed “tough love” and that supposedly made us strong.

I'm pretty certain that, like my ex partner, my mother was Borderline (i.e., had Borderline Personality Disorder) but my mother was never diagnosed. As far as my mother was concerned, any sign of mental health problems a person might suffer were regarded by her as a sign of weakness.  For example she had no compassion for anyone suffering depression or anxiety.

I don't think I would have carried this around with me for as long as I have if my pain around my mother’s rejection of me, or the longing for her love and approval, would have been validated.

But I'm there now so thanks Suzette!  It's really helpful to me to know why my mother treated me the way that she did, that it wasn't my fault (not even her fault, she had a mental health illness), that I was a good daughter and therefore, in turn, that I am a good person.  Being a good person has always been paramount for me throughout my life, because my mother always challenged that.

So again, thank you, thank you, thank you for all your time and support – both rare and so very much appreciated”.


- Careers Counsellor (Anonymous)

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"I've read through some of the comments about your research. Clearly you've made a great contribution on the trauma issue of competent adults with parents with mental difficulties. The issue is apparently very crucial today as modernity intrudes into every corner of the globe, connecting people with different background and difficulties, such as mental issues, together in every aspect of life. I assume the mental issue of parents do not only affect their children in a vertical way but also in a horizontal way towards their neighbours, friends, colleagues, etc.”

Libu Lakhi Phd (in progress)


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"I think you opened up a field of study that no one had ever considered before, let alone know how to go about collecting information about it.  Both from my practice and from personal experience, I would like to see more exploration and discussion on this topic. It's a context that needs to be provided, for I suspect there are many people who have no context within which they can feel validated, normal, and free to share their experiences, their feelings, and the burden they have been carrying alone."

Shoshana Hayman, parenting consultant and group facilitator, Neufeld Institute Intl.


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“Thank you, Suzette. I like the quote by Felitti: "Time does not heal the wounds that occur in those earliest years; time conceals them. They are not lost; they are embodied". I think your writing touches upon a confusing aspect of being raised by a 'mentally ill’ parent. Often as a young child, we do not understand our parent's dysfunctional behavior. For me, it just felt like living with a 'crazy' person. I had no frame of reference in which to make sense of what I experienced. I think this is traumatizing in and of itself: the disconnect between what I understood to be 'normal' behavior exhibited by 'normal' people as opposed to what I experienced at home. Trauma is treated as a mental illness when there is no framework given to understand it as otherwise”. 

Jennifer Mourrain Writer · Educator · Mental Health & Child Advocate


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"It sounds like such a valuable contribution to the field, and your website is very user-friendly, and your thesis is very easy to understand and apply. I am so glad you are getting downloads on such an important piece of work."

Kylie Hickey, Social Work PhD (in progress)


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“Thanks so much for sharing your Masters thesis. Your research of the topic is so comprehensive. You have written it so beautifully, with lovely quotes from other research that brings tears to the eyes. 

Some of the quotes from children who had suffered trauma from parents unable to help them feel safe and loved, are so descriptive. This reminds me of stories I have heard from relatives and clients who had difficult childhood experiences. So I started to think about how this research might be good for some to read, to help feel validated. Perhaps I might use some of the quotes to help others who might resonate with their experiences, and help give expression to their own unhappy times. Meanwhile, I was personally moved by your work. Thanks.”

Julie Morsillo, PhD, psychologist and lecturer



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"A first responder said to me recently, 'hurt people hurt people' and that is one of the reasons your work is so fundamentally important.  If we can get to a point as a species where we give ourselves permission to pause from attacking one another....to take a momentary break from the barrage of aggression and conflict that continues to be seen, then maybe...just maybe...we might get a small glimpse of how far off course we really are and how we are more than likely fighting against the unrest in our own minds more than anything else.

My hope is that as people begin to educate themselves on topics such as attachment, emotional intelligence, restorative practices, restorative justice, etc., we will begin to corporately move past the heavy-handed, vertical authority models that have been in use for so many centuries. I believe greed is not a vice, but a secondary symptom of fear and of being terrified. Arrogance and narcissism are also defense mechanisms that say we do not feel safe enough to admit we are wrong. Rebellion is a form of self-defense, too, and we must be careful not to crush the virtuous desire for justice and equality by assuming that every form of rebellion is instead an act of insolence. Anger often masks hurt. Pride often masks insecurity; and revolutions are often an indicator that no one is listening.  Yet we continue to preach immorality and depravity are to blame.  This diagnosis is fundamentally inaccurate and may in part perpetuate some of the trauma due to its iatrogenic treatment of the true problem.

I believe even Freud also made a comparison at some point to the ability to assess large groups of people as if they are acting as one individual, with one common mind.  In that regard, I believe your work has the ability to be scaled up to diagnose groups of people rather than just individuals.  It is the same concept as an architect or engineer who draws a building at a scale where 1/4 inch on a page is equal to 1 foot in real life, so that a wall that measures five inches on the page is in fact 20 feet long on site.

Your work might also be compared to diagnosing a single celled organism (i.e., an individual person) that is surrounded by other single celled organisms, and the often traumatic effect that those other cells have on the one individual.  What I am suggesting is that your same theories may apply very well to the interaction of multi-cellular organisms (groups of highly complex people, cultures that interact with groups within their own cultures or with other cultures, etc.), and this is where I believe the impact of your work may be logarithmic in its impact on society. Logarithmic graphs are ones where every point on the graph is the previous value, multiplied by some number, hence the suggestion that your audience might grow from 35 to 350, to 3,500, etc., (a logarithmic factor of 10)”.

 

- Adam Read, Assistant Construction and Superintendent – Pennsylvania, USA

Owner of IatroGenesis, a LinkedIn Discussion Group

 

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"So glad I chanced upon you. You said you would carry a torch as we journeyed together and you did a marvelous job. You supported me as I gained perspective on my early life. I now realise I had no option but to problem solve as I did from a very early age. I feel wiser and more free moving forward and will be kinder on myself. 

Heartfelt appreciation for your work Suzette".

 

- Client who also read the thesis (Anonymous)


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To access a brief article entitled: “An Unacknowledged Trauma: The Adult Legacy of Growing up with a Mentally Ill Parent” click on this link:

https://www.linkedin.com/pulse/unacknowledged-trauma-adult-legacy-growing-up-ill-parent-misrachi?trk=prof-post




Last Modified: 11th Feb, 2017. 

All content copyright 2017 Suzette Misrachi unless otherwise noted. No unauthorized duplication of materials, in part or whole, without written consent.