Across all cultures parenting is the foundation of family life. It is the domain where adult mental health meets infant development. Beginning in pregnancy, parenting involves many conscious and unconscious processes which have recently been shown to affect a child’s development significantly. This book focuses on pregnancy and the first year of life, providing a thorough account of the points of encounter between adult and infant psychiatry. In a fresh and comprehensive way, it summarises knowledge about early parenting, including a critical analysis of parenting, what it means to be a ‘good enough parent’, and its relationship to infant, parent and family outcomes. In addition to the psychiatric dimension, the book emphasises the biological aspects of parenting, parental psychopathology and normal and abnormal infant development.
Praise for Parenting and Mental Health:
“Tyano, Keren, Herrman and Cox have edited a thoughtfully prepared guide on normal and abnormal parenting. They have, with enormous skill and wisdom, helped to unite the important aspects of pregnancy, infant and childhood development and parenting for adult and child and adolescent psychiatrists. World-class internationally recognized clinicians and researchers help make this book useful throughout the world. This is a masterful, culturally sensitive and important book which provides a long overdue and much needed guide on relationships among children, parents and families.”
—Michelle Riba, M.D., M.S., Professor and Associate Chair for Integrated Medical and Psychiatric Services, Department of Psychiatry, University of Michigan, USA
“During recent decades, progress in the field of infant mental health has been revolutionary; at the same time, there has been rapid development in women’s mental health. By bringing these two together, this pioneering book leads its readers to the vital new focal point around perinatal mental health. The book integrates the origins of developmental psychiatry in attachment and systemic contexts and shows concretely how relationship experiences and biology interact when new life begins.
After describing the fascinating world of early parenting, the book focuses on problems, difficulties and disorders during this phase of life and above all on how to support, intervene and treat disorders in parenting. When infants, mothers and fathers are understood in a holistic way, professionals in many fields will be able to promote the transmission of meaningful life through parenthood and parenting.”
—Tuula Tamminen, Professor of Child Psychiatry, University of Tampere, Finland; Past-President of World Association for Infant Mental Health, President of European Society for Child and Adolescent Psychiatry
Cover design by Reouth Keren
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Foreword.
List of contributors.
I Introduction.
I.1 A historical overview: infants, parents, and parenting from ancient times to nowadays.
I.2 Definition of some major concepts.
I.3 Structure of the book.
I.4 References.
SECTION 1 Parental Orientations Normal processes.
1 Mothers’ and fathers’ orientations: patterns of pregnancy, parenting and the bonding process (Joan Raphael-Leff).
1.1 Introduction.
1.2 Pregnancy and the ‘placental paradigm’.
1.3 The model of maternal orientations.
1.4 Mothering.
1.5 Postnatal disturbances.
1.6 Contagious arousal.
1.7 Paternal orientations.
1.8 Conclusion.
2 The competent fetus (Sam Tyano and Miri Keren).
2.1 Introduction.
2.2 Continuity from intrauterine life to infancy.
2.3 The competent fetus and its receptive sensorial capacities.
2.4 Fetuses remember and therefore can learn . . . .
2.5 Fetuses can feel pain.
2.6 Fetal psychology: an emerging domain.
2.7 Conclusion: the fetus can no longer be thought as a ‘witless tadpole’.
Challenging pregnancies.
3 Single parenthood: its impact on parenting the infant (Sam Tyano and Miri Keren).
3.1 Introduction.
3.2 Single-parent families come in a variety of profiles.
3.3 Single parenthood as risk factor for parental mental health.
3.4 Risk factors for mental health problems among single mothers.
3.5 Single-father families versus single-mother families.
3.6 Single custodial parenthood.
3.7 Psychological characteristics of single mothers by choice.
3.8 A double-edge risk situation: being a single parent of an infant at risk.
3.9 Clinical implications.
3.10 Summary.
4 Surrogate mothers (Olga B.A. van den Akker).
4.1 Introduction.
4.2 Characteristics, motivations and experiences.
4.3 Attachment, bonding and pregnancy.
4.4 Relinquishing the baby and the social context.
At-risk pregnancies.
5 The impact of stress in pregnancy on the fetus, the infant, and the child (Miri Keren).
5.1 Introduction.
5.2 Data from animal studies.
5.3 Human studies of the impact of maternal stress on offspring.
5.4 Discussion.
5.5 Conclusion: implications for social health policy.
6 Unintended pregnancies (Myriam Szejer).
6.1 Introduction.
6.2 The insistence of desire.
6.3 Abortion.
6.4 Rape, incest and denials of pregnancy.
6.5 Pregnancy and mental illness.
7 Clinical challenges of adolescent motherhood (George M. Tarabulsy, Annie Bernier, Simon Larose, Fanie Roy, Caroline Moisan and Claire Baudry).
7.1 Introduction.
7.2 Early challenges faced by young mothers.
7.3 Adolescent mother-infant interaction and the elaboration of attachment.
7.4 Intervention with adolescent mothers and their infants.
8 Psychopathological states in the pregnant mother (Carol Henshaw MD FRCPsych FHEA).
8.1 Introduction.
8.2 General guidelines.
9 When something goes wrong with the fetus: rights, wrongs and consequences (Julio Arboleda-Florez).
9.1 Reproduction and threats to the unborn.
9.2 The rights of the fetus and of the newborn.
9.3 Parental reactions.
9.4 The fate of persons with developmental disabilities.
10 Multiple fetuses pregnancy and other medical high-risk pregnancies (Micheline Garel, Elise Charlemaine and Sylvain Missonier).
10.1 Medical high-risk pregnancies: definition.
10.2 Psychological aspects of multiple pregnancies.
10.3 Pregnancy and HIV, a public health problem.
Assessment of prenatal parenting.
11 Prenatal self-report questionnaires, scales and interviews (Massimo Ammaniti and Renata Tambelli).
11.1 Introduction.
11.2 Semi-structured interviews.
11.3 Self-report questionnaires and scales.
11.4 Inventories.
12 Observational tool: the prenatal Lausanne Trilogue Play (Elisabeth Fivaz-Depeursinge, France Frascarolo and Antoinette Corboz-Warnery).
12.1 Introduction.
12.2 The Lausanne Trilogue Play paradigm.
12.3 The prenatal LTP.
12.4 Discussion.
Treatment of abnormal states during pregnancy .
13 Psychopharmacological treatments during pregnancy: risks and benefits for the mother and her infant (Martin St-Andre and Brigitte Martin).
13.1 Introduction.
13.2 Depression and anxiety during pregnancy.
13.3 Bipolar disorder.
13.4 Schizophrenia.
13.5 Post-partum psychosis.
14 Psychotherapeutic, psychosocial, individual and family interventions for abnormal states during pregnancy (Prabha S. Chandra, Geetha Desai and Veena A. Satyanarayana).
14.1 Introduction.
14.2 Maternal-fetal attachment disorders.
14.3 Anxiety disorders.
14.4 Eating disorders.
14.5 Depression.
14.6 Suicide.
14.7 Substance use.
SECTION 2 Delivery and birth.
15 Perinatal loss: its immediate and long-term impact on parenting (Miri Keren).
15.1 Introduction.
15.2 Historical and cultural perspectives.
15.3 Psychological effects of perinatal death on mothers.
15.4 Psychological effects of perinatal death on fathers.
15.5 Impact of perinatal loss on the couple.
15.6 Impact of perinatal loss on the subsequent pregnancy.
15.7 Clinical implications.
SECTION 3 Parenting of the infant during the first year of life Normal processes.
16 Transition to parenthood (Antoine Guedeney and Susana Tereno).
16.1 Introduction.
16.2 Pregnancy and emotional upheaval: risks and resiliency.
16.3 The psychological unfolding of pregnancy.
16.4 Psychopathology in pregnancy.
16.5 Prevention and early intervention.
16.6 CAPEDP-Attachment: a French project to promote parental skills and decrease disorganized attachment.
17 Role of parenting in the development of the infant’s interpersonal abilities (Deborah Weatherston and Hiram E. Fitzgerald).
17.1 Introduction.
17.2 Transformative theoretical concepts of human relationships.
17.3 Infant mental health service structure.
18 Welcoming a stranger: cultural and social aspects of parenting (Nathalie Zajde and Catherine Grandsard).
18.1 Introduction.
18.2 Jimmy.
18.3 Ethnopsychiatry.
18.4 Ethnopsychiatric therapy sessions.
18.5 Treatment.
18.6 Psychotherapy and diplomacy.
18.7 The conflict between the two families.
18.8 Sorcery: from the Antilles to the Congo.
18.9 Pentecostal churches in the Congo.
18.10 Misunderstanding no. 1.
18.11 The Bakongo kinship and parenting system.
18.12 Misunderstanding no. 2.
18.13 To whom does the child belong?
18.14 Back to the treatment.
18.15 Identifying baby Jimmy.
18.16 Epilogue.
19 Filicide: parents who murder their child (Sam Tyano and John Cox).
19.1 Introduction.
19.2 Prevalence of filicide among Western societies.
19.3 Filicide and the child’s age.
19.4 Filicide and parent’s gender.
19.5 Parental motivations for committing filicide: at the psychiatric level.
19.6 Parental motivations for committing filicide: at the psychodynamic level.
19.7 Characteristics of the child at risk for filicide.
19.8 Clinical implications.
Parental risk factors for parenthood.
20 Maternal postnatal mental disorder: how does it affect the young child? (John Cox and Joanne Barton).
20.1 Introduction.
20.2 Postnatal mental illness: immediate effect on parenting.
20.3 Mother-infant relationships.
20.4 Risk and resilience.
20.5 Infant outcome and child development.
20.6 Child mental health problems.
20.7 Child abuse and neglect.
20.8 Family aspects.
20.9 Considering the child in the management of maternal mental illness.
21 Psychopathological states in the father and their impact on parenting (Michael W. O’Hara and Sheehan D. Fisher).
21.1 Introduction.
21.2 Prevalence of psychiatric disorders in men.
21.3 Paternal psychopathology and child internalizing and externalizing problems.
21.4 How depressive symptoms may affect parenting.
21.5 Paternal psychopathology and parenting.
21.6 Summary.
21.7 Research agenda.
22 The impact of trauma on parents and infants (Joy D. Osofsky, Howard J. Osofsky and Erika L. Bocknek).
22.1 Introduction.
22.2 The problem of abuse and neglect.
22.3 Other trauma exposure in young children.
22.4 Lessons learned.
23 Substance problems: bridging the gap between infant and adult (Ilana Crome).
23.1 Introduction.
23.2 The prevention and policy framework.
23.3 Epidemiology: the magnitude of the problem.
23.4 Health and welfare: context and consequences.
23.5 Assessment and treatment: uniting families.
23.6 Specific interventions for pregnant substance misusers.
23.7 Pharmacological treatments for pregnant substance misusers.
23.8 Catalysing change by implementation of research: service models.
Environmental risk factors for parenthood.
24 Foster parenthood (Yvon Gauthier).
24.1 Introduction.
24.2 Foster children symptomatology.
24.3 The use of attachment theory.
24.4 Foster children’s special needs.
24.5 How to help foster parents to provide best care for the fostered child.
24.6 Kin vs. non-kin foster parents.
24.7 Visits to the biological parents.
24.8 Need for permanency.
25 Parenting the chronically ill infant (Barbara G. Melamed).
25.1 Introduction.
25.2 Asthma.
25.3 Congenital heart disease.
25.4 Cystic fibrosis.
25.5 Very low birth weight infants.
25.6 Conclusions and future studies.
26 Parenting an infant born of rape (Frances Thomson Salo).
26.1 Case vignette 1.
26.2 Case vignette 2.
26.3 Case vignette 3.
26.4 Introduction.
26.5 Context.
26.6 Outcomes of pregnancy.
26.7 Perinatal period.
26.8 Maternal representation of the infant.
26.9 Maternal attachment.
26.10 Infant attachment.
26.11 Representations of the father and disclosure to the infant.
26.12 Adoptive and foster parenting.
26.13 Siblings.
26.14 Being parented in ongoing difficulty.
26.15 Support and therapeutic intervention for the family.
26.16 The infant’s view of their life.
27 Parenting an infant with a disability (Sheila Hollins, Stella Woodward and Kathryn Hollins).
27.1 Introduction.
27.2 Parental expectations.
27.3 Antenatal diagnosis.
27.4 Case vignette 1.
27.5 Case vignette 2.
27.6 Postnatal diagnosis.
27.7 Case vignette 3.
27.8 Case vignette 4.
27.9 Diagnostic uncertainty.
27.10 Parental responses.
27.11 Parent-infant relationship development.
27.12 Case vignette 5.
27.13 Case vignette 6.
27.14 Depression in parents of children with a disability.
27.15 Responses of family, friends and wider society.
27.16 Economic and social implications.
27.17 Positive implications.
27.18 Supporting parents.
28 Being a parent with a disability (Adil Akram and Sheila Hollins).
28.1 Being a disabled parent.
28.2 The UK context.
28.3 Parents with physical disability.
28.4 Parents with intellectual disability.
28.5 Parents with mental illness.
28.6 A recovery perspective on disabled parents with mental illness.
28.7 The social model of disability.
28.8 Cultural representations of parents with disabilities.
28.9 UK policy perspectives.
28.10 Solutions to support disabled adults as parents.
28.11 Involving disabled parents in research.
29 Parenthood: the impact of immigration (Olivier Taıeb, Thierry Baubet, Dalila Rezzoug and Marie Rose Moro).
29.1 Introduction.
29.2 The ingredients of parenthood.
29.3 Pregnancy and childbirth in exile.
29.4 The infant, a cultural being.
29.5 Conclusions: parents in exile.
29.6 References.
30 Parenting and poverty: a complex interaction (Mark Tomlinson).
30.1 Introduction.
30.2 Poverty.
30.3 Upstream and downstream factors.
30.4 Parenting and its determinants.
30.5 Parenting and poverty.
30.6 Maternal depression.
30.7 Poverty, parenting, depression and infant attachment.
30.8 Malnutrition and non-organic failure to thrive.
Assessment of parenthood.
31 Assessment of parenting (Marc H. Bornstein and Magdalen Toole).
31.1 Introduction.
31.2 Self-report measures.
31.3 Reports by others.
31.4 Observational methods.
31.5 Experimental testing.
31.6 Parental influence.
32 Principles of effective co-parenting and its assessment in infancy and early childhood (James P. Mc Hale and Elisabeth Fivaz-Depeursinge).
32.1 Introduction.
32.2 What is effective co-parenting?
32.3 Co-parenting as a triangular concept.
32.4 Co-parenting and division of labor.
32.5 Co-parenting and children’s adjustment.
32.6 What do mental health professionals need to know? The essentials.
32.7 Instruments of choice: observational, interview and self-report survey data.
33 Legal assessment of parenting competency (Jean-Victor P. Wittenberg).
33.1 Introduction.
33.2 Definitions of maltreatment.
33.3 Assessment is an intervention.
33.4 Infants and toddlers are a special group.
33.5 Models of parenting capacity assessment.
33.6 Core competencies for professionals doing parenting capacity assessments with infants.
Treatment of dysfunctional parenting.
34 Psychotropic drugs and lactation: to nurse or not to nurse (Zivanit Ergaz and Asher Ornoy).
34.1 Drug excretion into breast milk: general considerations.
34.2 Benzodiazepines.
34.3 Phenothiazines.
34.4 Butirophenones.
34.5 Atypical neuroleptics.
34.6 Antimanic drugs.
34.7 Anticonvulsants that are also mood-stabilizers.
34.8 Central nervous system stimulants.
34.9 Tricyclic antidepressants.
34.10 Tetracyclic antidepressants.
34.11 Selective serotonin reuptake inhibitors.
34.12 Serotonin and norepinephrine reuptake inhibitors.
34.13 Noradrenaline reuptake inhibitors.
35 Parent-infant psychotherapies and indications for inpatient versus outpatient treatments (Kaija Puura and Palvi Kaukonen).
35.1 Introduction.
35.2 Different forms of parent-infant psychotherapy.
35.3 Indications for inpatient versus outpatient treatment.
35.4 When parents reject treatment.
Pathological parenting: from the infant’s perspective.
36 The symptomatology of a dysfunctional parent-infant relationship (Campbell Paul).
36.1 Introduction.
36.2 ‘Good-enough’ parenting.
36.3 Parenting in the context of mental illness.
36.4 Qualities of infant-parent interaction.
36.5 Assessing infant-parent interaction.
36.6 The infant response in the context of a dysfunctional relationship.
36.7 Implications for prevention and intervention.
36.9 Acknowledgements.
Concluding chapter.
37 Mental health of parents and infant health and development in resource-constrained settings: evidence gaps and implications for facilitating ‘good-enough parenting’ in the twenty-first-century world (Jane Fisher, Atif Rahman, Meena Cabral de Mello, Prabha S. Chandra and Helen Herrman).
37.1 Introduction.
37.2 Social model of mental health.
37.3 Parenting and mothers’ social position.
37.4 Human rights, mental health and child health and development.
37.5 Promotion of infant health and development and prevention of maternal mental health problems.
37.6 Preventing and ameliorating maternal mental health problems and potential benefits for infant health and development.
37.7 Addressing the social determinants of compromised early childhood development and maternal mental health problems.
37.8 Implications for facilitating ‘good-enough parenting’ in the communities of the twenty-first century.
37.9 Conclusion.
37.10 References 440
Index.
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Sam Tyano is Professor of Child and Adolescent Psychiatry at Tel-Aviv University. He is also visiting Professor at Lille University, France. Author of more than 200 scientific articles in international scientific journals, and editor of three textbooks on psychiatry, child psychiatry and ADHD. His main scientific interests are suicidal adolescents, ADHD, infant psychiatry, personality disorders and PTSD.
Miri Keren, also of Tel-Aviv University, is President of the World Association of Infant Mental Health.
Helen Herrman is Director, WHO Collaborating Centre in Mental Health., Melbourne; Secretary for Publications, World Psychiatric Association; Regional Vice-President Oceania, World Federation for Mental Health; and Vice-President of the International Federation of Psychiatric Epidemiology.
John Cox is a past President of the Royal College of Psychiatrists. He was awarded the Marcé Medal in recognition of his distinguished contribution to the field of perinatal psychiatry and he served as President of the Marcé Society.
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