Not infrequently neglect is a by-product of some parental state of ill health, dis-ability or other preoccupation, such as the effects of alcohol or drug abuse.
There seem to be at least four common situations in which we can speak of children frequently being at risk of emotional neglect. In many instances the harm appears to be inflicted unintentionally and indirectly. In any case it fre-quently emerges that certain children suffer from both emotionalabuseandneglect, as when it is claimed that the emotional climate in which physically and/or sexually abused children are raised is frequently one of high criticism and low warmth. Parental rejection of children can involve all kinds of maltreatment, but particularly emotional abuse and neglect.
Three of the common situations in which children are exposed to emo-tional neglect have recently been the focus of considerable study by the Depart-ment of Health (Cleaver, Unell and Aldgate 1999). They are domestic violence, parental mental illness, and parental abuse of alcohol and drugs. Children growing up in these situations are more likely than others to be at risk from child maltreatment, including physical and emotional neglect. However, child maltreatment is by no means inevitable in these situations, and they are not the only situations in which children are likely to be subjected to emotional neglect. Cleaver et al. entitle their study: Children’s Needs – ParentingCapacity. The terms ‘seriously inadequate parenting’ and ‘emotional neglect’ often refer to the same parental deficits as each other. The Department of Health study has a wider remit than this chapter. It is concerned with all forms of child maltreat-ment in the three situations described. This chapter confines itself to emotional neglect and abuse, but examines four areas: the three areas already mentioned, and one further area: the aftermath of marital separation and divorce.
Whether or not children caught up in the predicaments of parental strug-gles and violence, parental drug and alcohol abuse or mental illness suffer from emotional neglect and abuse depends on the nature of their maltreatment, its chronicity, intensity and periodicity, and whether stressors come singly or in combination. Whether children suffer from child psychiatric disturbance as a result of the emotional neglect they have endured seems to depend on the outcome that emerges from the interplay between stressors and protective factors in the child and the situation. The main protective factors seem to be at least one loving parent to whom the child is securely attached, and whether the child has other supports such as good friends or concerned adults. The child’s temperament, intelligence and problem-solving skills can also be protective factors.
Exposure to marital violence and rows
The first of the three situations selected by the Department of Health in which children were deemed to be particularly vulnerable to emotional child neglect and abuse was witnessing marital rows, when parents fail to protect their children from their own hurtful arguments and fights. It is difficult to be precise about the prevalence of domestic violence but, however it is defined, its preva-lence seems to be high, with just over half the families where a child protection conference is held, admitting to parental domestic violence (Thoburn 1996).
Nor is it safe to assume that the instigator is always the male. Moffitt and Caspi (1998) in a review of this field found that whoever instigates the episodes, women and children seem to be the main victims. It is tempting to suppose that the parents often have no intention to hurt the child, but cannot contain their own anger or keep their arguments from the children. However, children are also often physically attacked, sometimes for trying to intervene. Child
physical abuse was found by Moffit and Caspi (1998) to be between three and nine times more prevalent in families where parents hit each other. Emotional abuse of a particularly distressing type occurs when a parent, almost always the father, insists on having the children present when he batters or humiliates his wife. This situation would seem another instance of the sadistic form of emo-tional abuse. Bifulco et al. (2002) found that such abuse is relatively rare, but that there was a strong association for women between having experienced sit-uations of sadistic abuse as a child and suffering depression as adults. There is evidence that children can be as upset and emotionally disturbed by watching parents hitting each other, as by being physically abused themselves (Jaffe, Wolfe and Wilson 1990); and emotional neglect is likely to be increased when the mother falls into depression or avoids social contact because of her shame.
Children of separated and divorced parents
When unhappy partners separate, in theory this should help the children involved, by removing them from distressing parental rows, but in some cases the bitterness only continues or even increases; and the child’s need to see an absent parent regularly is sometimes resisted, as part of the persisting resent-ment over past hurts. This itself could often be described as a serious form of emotional neglect. However, the level of emotional abuse and/or neglect may intensify when children are used as messengers between divorced parents who find it difficult to communicate directly themselves. One of the commonest occasions for misuse occurs when parents leave the arrangements for contact to the children. However, what has been agreed with one parent frequently does not fit in well with what the other parent wishes, and the child is left carrying the responsibility for the disagreement. Another common situation when children are left to carry messages is when the parent with residence tells the child to inform the other parent that it is time he/she pays for shoes, clothing or school trips – expenses that had not been previously agreed between the parties. There seems to be a scale of misuse of children as message carriers stretching from on one hand parental fear of the ex-spouse, and, at the other extreme, the deliberate use of the child as a guided missile.
Another unpleasant form of emotional child abuse occurs when one parent will make giving the child a treat dependent on the ‘reasonable’ behaviour of the ex-partner, for example ‘if your Dad won’t agree to this, you won’t be having a birthday party’. This is doubly destructive, since it is meant to hurt both the father and the child.
Parents abusing alcohol or drugs
A further set of situations in which parental neglect can impact on children involves parents who are dependent on alcohol or drugs. As Cleaver et al.
(1999) point out, not all parental alcohol or drug abuse seriously harms children, but children can be grossly distressed and/or neglected by parents who are unable to play with them, protect or feed them because they are drunk or semi-conscious, and who may spend most of the family income on alcohol or drugs. Alcohol and drug abuse may lead to unemployment, debts, evictions, and crime to sustain a drug habit, with increasing isolation for the family. In addition, alcohol abuse is often a factor in physical and sexual abuse, and also of acute embarrassment to children, as when birthdays and Christmas celebra-tions are ruined by a parent’s alcohol abuse. The partner of a drug or alcohol abuser may be so worried and upset in relation to coping with the abuser and the situation that they have little time for the children, who consequently get emotionally neglected by both parents.
The children of mentally ill parents
Third, there are situations where mental illness in one or both parents leads to a deterioration in parenting capacity, and failures to meet children’s needs, both physical and emotional. The subject is vast, and can only be briefly dealt with here. Depression is by far the commonest form of severe mental illness affecting mothers. The effects on the children are mediated considerably by severity, fre-quency and the presence or absence of an intimate spouse or partner who can offer support and mitigate the effects of the mother’s depression on the children. Depression could be described as a state of misery and hopelessness, often leading to irritability with others, agitation or retardation, marked changes in eating patterns and in difficulties either in getting off to sleep, or in early morning waking. It is often accompanied by anxiety and deficiencies in self-presentation and the care of children. Depression occurring in the post-partum period may have serious and lasting consequences for the child’s cognitive development (Murray et al. 1996), and affect security of attachment formation (Sroufe 1983). Depressed mothers and their children will be likely to get out of step in their relationship, and such important aspects of parenting as praising, supporting, planning ahead, playing games and sharing homework will either not occur, or will be conducted less appropriately than when the parent was not depressed. Caring and patient fathers may be a lifeline to children and to the mothers, but some fathers find the situation more than they can cope with, and stay away from the home more than they need, or even find other partners. Social workers need to know that depression lifts, and also to be familiar with support groups like Newpin (Jenkins 1996) for depressed and isolated mothers. In my experience many depressed mothers have a resistance to taking anti-depressants. It could be said that the ultimate form of parental emotional neglect and abuse is suicide, and this is strongly associated with being depressed. Social workers and health visitors should acquire the skills to
be able to ask gently but firmly about suicidal ideation and plans, and what action to take to help the seriously suicidal (see Box 4.4 for a case example).
SCHIZOPHRENIA
Schizophrenia is a serious mental illness usually striking in the late teens or early twenties, which causes sufferers to experience particular kinds of auditory hallucinations and delusions, usually involving grandeur or threat. There are also what are called ‘negative symptoms’, including apathy and withdrawal. It is difficult to see how parenting in severe cases could not at times be neglectful both physically and emotionally. However, there is a huge range of severity of symptoms, and new atypical anti-psychotics seem capable of reducing the symptoms very considerably – provided, of course, they are taken regularly.
Box 4.4 Case example: Sean
Sean (four years old) seemed to be the butt of his mother’s frustration and depression. His father had recently obtained a job as a newspaper distrib-utor after many months of unemployment, during which time the family had got seriously into debt. His present job involved working long hours, but was well paid. The mother was left to cope with Sean and Lindsay (two years old). Sean appeared to spend much more time in his bedroom than with his mother and Lindsay, having been sent there by an angry mother, who had been obliged to do all the child and household care, and also work two half days a week in a fish and chip shop. She had very little support from her husband, who dealt with her emotional outbursts by laughing at her, or leaving the house. As a psychiatric social worker working with Sean and his mother, I was phoned at 4.30 pm one evening by a debt collector from the housing department, to say she had called, and the mother, Debbie, had just slapped Sean hard across the face for no good reason. Debbie was extremely angry with me when I called. Her husband was present and sat silently and was apparently amused, until the
‘storm’ blew over. He neither supported his wife, nor attacked me. The father and mother agreed to attend a planning meeting, and the whole incident seemed to jolt Debbie and her husband into a realization that she really was depressed and needed help for herself and in relation to Sean, and that her husband had to assist. The father pledged himself to be more supportive, and he kept his word. The mother began to attend a parenting workshop, and improved greatly in herself.
Children are particularly at risk if they become involved in the patient’s delu-sions.
PERSONALITY DISORDER
Individuals with a severe personality disorder tend to suffer from a chronic lack of empathy, and awareness of other people’s rights and feelings. They tend to abuse illicit drugs and alcohol in order to numb the pain of their existence.
They have usually experienced abusive and/or neglectful parenting, and may have a considerable criminal record. Some are prone to making threats of injury to others and self-harm, sometimes in the presence of partners and children.
Some may enjoy hurting other people.
Issues of whether and when it is safe to allow children, especially young children, to live with birth parents with a personality disorder or schizophre-nia, severe depression or bipolar disorder need to be dealt with by multi-disciplinary discussion, involving psychiatrists, social workers, GPs and rela-tives, and not simply by social workers or psychiatrists.
These situations are not the only ones in which children get neglected. The children of parents with moderate or severe learning difficulties may lack adequate care and control unless there are other supports in the community;
and the same could be said of a number of parents who suffer from chronic and severe physical illnesses and disabilities.