Parental mental health, intergenerational loss, and parent-infant relationships

Where parents or carers have serious problems of their own, this can interfere with their ability to support their children and can make it difficult for each generation to achieve a developmentally appropriate relationship with the other. If there is a deficit in the parent's or carer's capacity to contain the young person's emotional communications or to "mentalize" (Fonagy, Fearon, Steele, & Steele, 1998), this can lead to confusions between bodily and mental experience, to somatic symptoms, and to the experience of being invaded by frightening thoughts.

Parental mental illness, such as depression, is known to be linked to childhood depression and functional impairment (Kovaks & Sher- ill, 2001; Todd et al., 1996). While the interaction of genetic and environmental factors is complex, there is some support for a "diathesis-stress" model whereby genetic predisposing factors interact with environmental stressors to produce a mood disorder (Carr, 2007). Particular stressors are parental psychopathology, conflict, stressful divorce, domestic violence, and child maltreatment (Shortt & Spence, 2006). Such factors may also have adverse impacts on children's emotional development (Garoff, Heinonen, Pesonen, & Almqvist, 2011, p. 227).

People who have had significant histories of problems in the parent-infant or early parent-child relationship, particularly with closeness or enmeshment, are also more likely to experience depression in adulthood (Bifulco, Brown, & Harris, 1987) or adolescence (Mikulincer & Shaver, 2012). Equally, for adolescents whose early relationships were very distant, promiscuous sexual behaviour may be more likely, along with other risk-taking such as drug or alcohol abuse (Carol Hughes, unpublished data). Such young people may conflate and confuse emotional intimacy with sexuality and be driven by fantasies of all their emotional needs being met. Where unreasonable expectations lead, as they often do, to relationship breakdown, this constitutes a further loss and generates feelings of abandonment. This may precipitate a suicide attempt.

Midgley et al. (2013) describe such a case, where the young person desperately sought a relationship of total, yet fragile, intimacy:

At the age of 14 ["Josie"] developed an intense relationship with a boy who lived nearby, in which the two of them "felt like we were one person, we always knew what the other one was thinking". The breakup of this relationship clearly precipitated her depression, although it was only with a second loss (when her sister left the family home) that Josie broke down more overtly. . . . Once Josie's mood lifted she described how being depressed had felt as if she were liquid: "I felt sorta like water, liquid, just draining away. In fact, I wanted to soak away, just not to be anymore. Now I am not depressed I feel kind of solid. The wind can blow, I am solid - I am here." [pp. 70-71]

Some young people, faced with such a sense of loss or abandonment, experience it as an unconscious realization of the fragility of their internal and external relationships or "core self"—a common feature of depression in adolescence (Gretton, 2011). They may experience profound anxiety about annihilation, as though they believe themselves to be living in a "black hole" and to lack the right to exist (Rhode, 2011).

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