Different types of dysfunctions may be due to parental pathology. We refer to psychotic disorders, perversions or psychopathies, personality disorders, narcissistic disorders, rigid characteropathic structures that are not very permeable to the emotion of the other, endogenous depressive states or situations of emotional deprivation, separations and migrations, etc… Parents can establish pathological bonds in their interactions with their children. In spite of this, not all mentally ill patients have a total and absolute incapacity to exercise parental functions and an in-depth analysis can delimit the degree of satisfaction or not of the development of the parental functions of these patients.
Generally, when parents suffer from a serious mental disorder, other family members substitute the parental functions. When this is not possible either because there is no family support network or because it is disconnected from the patient, the services that warn about the situation of unprotected minors (school, health, social services, etc…) intervene.
Different characteristics give content to the necessary delimitation between pathology and health in terms of relational interaction and mental functioning, and this is an aspect of knowledge that is constantly being updated and must be differentiated in the good treatment-maltreatment continuum. In other words, mental pathology does not necessarily presuppose the perpetration of child abuse.
Many of the symptoms and affectations of the child who is psychologically abused are related to different psychological disorders: guilt, fear, states of anguish, hyperactivity, suicide attempts, etc… They may correspond to depressive states, neurotic, identity or psychotic disorders. To find out and to delimit that which corresponds to the child’s own pathology from that which responds to a psychological reaction to a relational situation on the part of the adult on whom he depends affectively, is a priority.
In the severe infantile mental disorder, we must consider, apart from the treatment, the real collaboration and involvement of the parents in the treatment. Therefore, in autistic or psychotic disorders, where early attachment has been affected due to parental and/or family pathology, an indicator of protection is the parents’ awareness of the disorder and the consequent involvement in a psychotherapeutic-psychiatric treatment.
The assessment of the maltreatment received and the actions and measures to be proposed will depend on the possibilities of parental repair and recovery.
Bolwby revealed to us the implications and processes for the establishment of the attachment bond and untied it completely from the Freudian sexual libido and unconscious phantasmatic, bringing psychoanalysis closer to the reality of affective interactions and infantile maltreatment. He speaks of a number of family situations that predispose to the development of 3 different types of pathology in the face of a loss: the anxious and ambivalent bond, the need for compulsive caregiving, and affective independence. According to Bolwby, the establishment of a pathological mourning process and the installation of a depressive syndrome depends to a large extent on the nature of the relational bond with the parental figures and the treatment received by the child during these delicate moments.
Although parents with mental disorders find it more difficult to cope with the emotional needs of their children, given that they themselves have suffered limitations in overcoming stages of mental suffering and in processing perhaps important and traumatic losses, this cannot be an excuse for not taking responsibility for the child’s well-being. From the work of identifying their limitations in the development of their parental functions, it will be possible to involve them in the necessary measures to be taken.
Thus, depending on the approach of the professional, we sometimes find that more emphasis is placed on the psychological pathology (of the child, parent or family) than on the interaction or situation of maltreatment which may be more or less evident, often both problems are present at the same time.