Fatherhood and mental illness

A review of key issues
CFCA Paper No. 30 – February 2015

Introduction

It has been estimated that more than one million Australian children live in a family in which at least one parent has a mental illness (Maybery, Reupert, Patrick, Goodyear, & Crase, 2009). Furthermore, roughly 20% of mental health service users have reported that they live with dependent children (Howe, Batchelor, & Bochynska, 2012; Maybery et al., 2009). While mental illness does not preclude parents from providing appropriate care for their children (Beardslee, Gladstone, & O'Connor, 2011), it can potentially expose them and their families to a number of risks.

Parents experiencing mental health concerns are more likely than others to report parenting difficulties and strained parent-child relations (Kane & Garber, 2004; Wilson & Durbin, 2010), and their children are at increased risk of a range of emotional and behavioural problems, including psychiatric disorders (Connell & Goodman, 2002; Ramchandani & Psychogiou, 2009). Families in which a parent has a mental illness are at higher risk of experiencing socio-economic disadvantage (Eaton, Muntaner, & Sapag, 2010; Murali & Oyebode, 2004), substance abuse problems (Reupert, Goodyear, & Maybery, 2012; Tiet & Mausbach, 2007), family violence (Howard et al., 2010; Oram, Trevillion, Feder, & Howard, 2013) and child maltreatment (Darlington, Feeney, & Rixon, 2005; Whitaker et al., 2008). They are also likely to be the subjects of stigma and discrimination (Angermeyer, Schulze, & Dietrich, 2003; Galasinski, 2013), and, if and when they seek professional help for their problems, to be met by service systems struggling to adequately acknowledge the interconnections between parental mental health, family functioning and children's wellbeing (Berlyn, Wise, & Soriano, 2008; Maxwell, Scourfield, Featherstone, Holland, & Tolman, 2012).

Most of the existent research on parental mental illness has focused on mothers (Ramchandani & Psychogiou, 2009; Styron, Pruett, McMahon, & Davidson, 2002). There are a number of reasons for this, including the well-known difficulties of recruiting men into research studies, mothers' greater involvement in daily childcare activities, and higher prevalence rates among women for the most commonly studied disorders (e.g., anxiety, depression) (Elgar, Mills, McGrath, Waschbusch, & Brownridge, 2007). However, there are also a number of reasons why it is important to separately study fathers' mental health.1 Men tend to experience certain mental health concerns (e.g., depression) differently to women (Bronte-Tinkew, Moore, Matthews, & Carrano, 2007; Cochrane & Rabinowitz, 2000), to use different strategies to self-manage their health problems (Fletcher & StGeorge, 2010; Smith, Braunack-Mayer, Wittert, & Warin, 2008; Williams, 2007), and to be more reticent than women to seek professional help for health and welfare concerns (Addis & Mahalik, 2003; Galdas, Cheater, & Marshall, 2005). Also, mothers and fathers are subject to different gender and parenting norms and expectations, which can influence the ways in which mental illness impacts on parenting experiences and behaviours (Condon, 2006; Galasinski, 2013; Styron et al., 2002). For example, Galasinski (2013) found that a particular source of pain for fathers with severe mental illness was a sense of paternal inadequacy - the feeling that they had failed to fulfil the responsibilities expected of them as fathers, such as providing financially for their families.

It is an important time to be studying the connections between fatherhood and mental illness. As Smyth, Baxter, Fletcher, and Moloney (2013) have argued, "parenting roles, expectations and responsibilities are in transition, and the defining features of the father's role are expanding" (p. 377). Cultural images of what makes a "good father" have shifted significantly over recent generations: from the "moral teacher" of the early 20th century, to the "breadwinner" and "sex-role model" of the mid 20th century, to the "nurturant" and "involved" father that began to emerge in the 1970s and continues today (Flood, 2003; Lamb, 1987; 2010). Although changes in fathers' contributions to childcare and domestic labour have not kept pace with recent cultural ideals of gender equality in the home, many men are contributing to family life in ways that were comparatively rare in their grandfathers', or even their fathers', generation (Flood, 2003; Redshaw & Henderson, 2013; Smyth et al., 2013).

Social scientists, too, are recognising fathers in new ways. The discipline of developmental psychology, for instance, has gradually moved from one "dominated by an attitude of mother-blaming", to one in which both mothers' and fathers' contributions to children's development are increasingly acknowledged (Connell & Goodman, 2002, p. 761). However, while some areas of scholarship on fathers' mental health have developed quite substantial evidence bases (e.g., research on the effects of paternal mental illness on children), other areas remain seriously neglected (e.g., qualitative research on fathers' experiences of mental illness) (Lefrançois, 2012). Indeed, very often fathers' mental illness is considered solely through the lens of children's wellbeing, meaning "the very experience of fathering with mental illness is nowhere to be found as a topic, issue or problem to be considered" (Galasinski, 2013, p. 21, emphasis added). Such gaps have obvious negative implications for understanding the service needs of fathers and their families. Mental health and welfare service providers in Australia and internationally have often struggled to effectively engage fathers, either failing to see men as members of a family unit, or failing to offer services tailored to the specific needs of fathers (Berlyn et al., 2008; Featherstone, 2009).

The current paper

The purpose of this paper is to provide practitioners and policy-makers with an overview of some of the key issues identified in the growing literature on paternal mental illness. It is divided into six main sections:

  1. Men's mental health during the transition to parenthood;
  2. Paternal mental illness and child development;
  3. The effects of mental illness on men's parenting behaviour;
  4. Fathers' experiences of mental illness;
  5. Mental illness stigma and fatherhood; and
  6. Fathers and the service sector.

The topics in sections 1-3 have attracted a moderate amount of research interest in recent years, and so, where possible, the focus is on the results of systematic reviews and meta-analyses. Section 4 focuses in some depth on the scant qualitative research on fathers' experiences of mental illness. Sections 5 and 6 draw on literature other than that focused specifically on fathers' mental health, and are intended to contextualise the research outlined in other sections. Where appropriate, Australian literature is emphasised throughout this review.

This review also includes three case studies, which were generously provided by families in contact with the national Children of Parents with a Mental Illness (COPMI) Initiative. It was considered important to highlight the voices of family members, as it can be easy to forget that people's lived experiences rarely conform to the structures and categories of social-scientific research. Consider the host of complex and interrelated issues raised in the six short paragraphs in Box 1: identity, race, ethnicity, place, abuse, trauma, repression, shame, cultural beliefs, work-life balance, marital relationships, men's help-seeking behaviour, fathering, therapy, healing … the list could go on. This is how mental illness manifests in the lives of individual fathers, and no single study in this review comes close to capturing such complexity. This is not meant as a disparagement of any particular form of research, but rather as a reminder that intellectual humility and an openness to diverse perspectives - including the perspectives of the subjects of the research themselves - are appropriate in the face of topics as complicated as fatherhood and mental illness.

Box 1: Dad's story

Healing from trauma

I am a father of two children, aged 11 and 5, born in New Zealand of Samoan/ Maori heritage.

Growing up in Sydney with four siblings, I experienced trauma and sexual abuse from my mother and lived in fear every day. It was a very unstable childhood, but through my own determination I completed Year 12, went on to university, and tried to move on with my life.

My childhood abuse had given me an ingrained belief that sex equals love, and my early adult relationships reinforced this idea. In 2000, I married and my wife and I soon welcomed our first son. Becoming a father shifted the focus of our relationship to our child and I found my beliefs being challenged. How could my wife and child love me when they weren't showing me their love in the only way I knew? I loved my child and wanted the best for him, but my emotional state was regressing to that of my childhood. I felt redundant, lost, depressed and alone, and I couldn't acknowledge that what I was experiencing might be depression or the result of trauma.

Our second child was born and I continued to ignore my depression and the trauma of my childhood. I didn't talk about any of my feelings with my wife, believing instead that everything was fine. I had never told my wife about my childhood and didn't want her to know. Instead, I threw myself into my work, becoming so busy that I didn't need to think about it.

Looking back, I can see I was deeply affected by my childhood and my mental state was not good, but at the time I didn't want to see a doctor or counsellor. I was determined that my children would have a far better childhood than I had and that what happened to me would never happen to them. However, I was very disengaged, not present for them, and working too often and too hard. The shame I carried from my own childhood meant that I was very strict and angry with them, somehow believing this would mean they had a better life.

All these insights have only come to me in retrospect since I recognised I had depression and entered a 28 day rehab program in Sydney. I now have a therapist, see a GP, and have started medication, for the first time, for depression. My wife and I have recently separated, and it was through our marriage therapy that I recognised my depression. I see my boys several days a week and am focused on being a good father - I have learned to be present with my boys, doing things such as just kicking a ball around with them and giving them my full attention.

I have also learned that you can't do it all yourself, and that it's ok to ask for help. I think it can be very alien to a male to ask for help but I took that step when I asked my GP for anti-depressants. It was a big change, and made me nervous to do it, but I wanted to be there for my children and not pass on the shame that I experienced. I haven't talked to them yet about my depression but I am planning to soon. I want them to know that I'm fully there for them. I want to be a father that my children are proud of, regardless of all my failings and imperfections. My children are my life and I am proud of them both.

Provided by Children of Parents with a Mental Illness (COPMI).

 

1 Defining fatherhood is no easy task. For instance, Marsiglio, Day, and Lamb (2000) have distinguished between biological, economic, social, and legal forms of fatherhood. In this paper, the term "fatherhood" generally denotes what is called "social fatherhood", which refers to "men's actual relationships, involvements and activities with respect to children, whether with children who are biologically 'theirs' or with children who are socially 'theirs' because of an intimate relationship with the child's mother (as stepfathers) or primary responsibility for parenting the child (as adoptive, gay or single fathers)" (Flood, 2003, p. 3)