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Parents might unconsciously communicate their own unresolved trauma to their children.

Those children might communicate their parent's distress in psychiatric symptoms.

Trauma and adversity may travel through generations unless deliberately interrupted.

One of the challenges that analytic writers have with sharing their ideas about serious mental health diagnoses with a lay audience is that many parents of those with diagnoses of mental illness may be part of that audience. Those family members are trying to learn more about their child’s illness, and are often desperate for new perspectives.

However, from a psychoanalytic perspective, there is no way to talk about more serious psychiatric presentations without taking into account a patient’s childhood difficulties with their parents. How can we write about these important topics, these formative years, without sounding like the analysts of old discussing “schizophrenogenic mothers”, “refrigerator mothers”, and the “double bind”?

This is where biological psychiatry has a significant edge on analytic formulations of serious mental illness. Biological psychiatry places the blame squarely on a “bad brain” – bad genetics, bad neurotransmitters, bad wiring. This alleviates parents and patients alike of any personal contribution to suffering, and allows parents to unambivalently commit themselves to helping their child without worry of being blamed by the providers. In contrast, analysts like myself can’t help but notice common patterns among families who have children with psychotic organizations. And we feel that at least some of the etiology for psychosis lies in these disturbed relationships. But to say this to an audience made up of family members feels dangerous or even cruel.

And yet, when I am working with these families, I don’t feel blame. I feel empathy and compassion. I am often reminded of Selma Fraiberg’s paper “Ghosts in the Nursery”. Fraiberg eloquently describes how some mothers bring their own painful childhoods and difficulties with their mothers into their experience of mothering, where the unhealed wounds of fear and terror, neglect and abandonment, haunt them and their infants like the ghosts of mothers past.

A clinical example – woven together from several different patients to protect privacy:

Let’s call this patient Jane. Her mother, Laura, was an immigrant from a country where children were seen and not heard. In Laura’s nuclear family, a child’s worth was tied to the income they could bring in to their impoverished family, and there was little time to dwell on the deprivation, hunger, and illness of subsistence farming. Laura came to the US in pursuit of the American Dream and realized it, marrying a business owner who did very well. Laura, hungry for stability and security, prized displays of material wealth, cleanliness, and beauty as signs that she would never need to return to the hunger and ignominy of poverty. She insisted her children see her and the family as perfect. Yet she was unpredictable and inconsistent in her affection, because of shameful and therefore denied feelings of envy for her children’s easy childhoods. She loved her children deeply, but also hated them for having it all and not being sufficiently grateful. She would get them unrequested gifts and tell them they were spoiled as she handed them over.

Laura was especially hard on her only daughter, who she saw as a confused mixture of her childhood self and her own overworked, harsh, and at times abusive mother. Jane’s sensitive disposition and emotionality was seen as weakness, but her efforts to separate from her mother were seen as insolence. Laura wanted to love Jane unconditionally, but haunted by her own unresolved deprived and traumatic childhood, she would attack her daughter verbally, and occasionally physically. When Jane was a teenager, she slid slowly into a psychotic episode which both terrified her mother and disgusted her with its imperfection. When I began working with Jane, I noted the ways Laura insisted that her daughter stay close, too close, so that it was confusing to both of them where the mother left off and the daughter began. But she also insisted that Jane “get better”, which meant “be perfect”, no matter the cost.

When I met with Laura, she came off as cold and withholding. But under the chill I could feel her terror. She was watching all her dreams for Jane falling apart. She alternated between blaming Jane for not being “tougher”, or me for not being better at my job when Jane failed to improve quickly enough. She had great difficulty acknowledging any family conflict that might be adding to Jane’s stress, though Jane described terrible screaming fights between her parents, and a brother who had all but disappeared into cannabis use and online communities. For Laura, the cracks in her family were starting to show, and in a completely humiliating way – in front of me, a woman who looked like she had it all. She looked at me and saw a well-educated professional woman who did not have a psychotic child. Her imperfection was exacerbated by her fantasy of my perfection, and immediately she was transported back to her home country in her mind, where her poverty was made even more abject by the wealth inequities of the upper class.

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Who is the patient and who is the parent? My loyalties in this case lie with Jane and I sometimes felt frustrated at the way it felt like Laura both communicated to Jane a need to rigidly improve and also to stay over-enmeshed and unboundaried with her mother. But Laura could have easily been my patient instead, and my loyalties would have been with her, and I would have felt instead often angry at her own mother who was alternately so neglectful or violent. Laura's mother (Jane’s grandmother), had her own difficult childhood, of course — living in a developing country and subsistence farming, often unsuccessfully. Several of her siblings had died of malnutrition-related diseases. Her own trauma was passed down to her children, themselves often half-starved and unwell. Laura learned to manage her terror and deep sense of unloveability by becoming tight, rigid, uncompromising, and deeply unreflective. If I was working with the mother and not the daughter, I would understand that the daughter was enacting the trauma and terror of her mother, because Laura herself was not able to express it, but my sympathy would lie with Laura primarily.

It is difficult to feel judgmental when I look backwards and see the thread of trauma, maltreatment, and neglect weave its way through the generations. Causation is the wrong word; transmission is closer. Trauma doesn’t originate with a parent; it passes through them. Perpetrators become victims when we pull the lens back and widen the frame. This is not a perspective I reserve for my clinical work. If you are a parent trying to understand your child’s suffering, the compassion I feel for the families I work with extends to you as well. I believe we are all trying our best with what we have been given, however difficult our pasts may be. We are all, to some degree, haunted by our own ghosts in the nursery — but naming the ghosts begins to weaken their hold on us.

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Fraiberg, S. , Adelson, E. & Shapiro, V. (1975). Ghosts in the Nursery. Journal of the American Academy of Child Psychiatry, 14 (3), 387-421.

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