How to help a 5 year old cope with sudden mental illness in a parent?

November 20, 2011 9:05 PM

What can I say to a 5 year old, when his parent is mentally unwell? How can I explain, what can I do with him, and what structures can we put in place, to make his mother's (temporary, but severe) illness easier on him?

His parents illness is episodic, and has only happened twice before, under fairly extreme stress, during which she was hospitalized. She is currently anxious, manic, and a bit paranoid. Meds have just started.

During the last hospitalisation, when he was only 4, it was clear he was aware his mother was not well, and heartbreakingly, that even though he loves his mother, and is a very obedient, he would quickly and obviously check out what other adults reactions were, before doing anything she told him to do. Which was so the right action, but so, so heartbreaking that he was only 4, and aware enough that he had to do that with his own mother.

Things that helped when he was 4:
We watched My Neighbour Totoro, which turned out to be a huge blessing, because it showed how sometimes mummies have to go to the hospital to get well, and kids can't stay there, and yes it is disappointing when they can't come back home when we want them to. And we made cards for her, like how they gave corn with a message in the movie. I also talked about how people can be very confused, sad, or angry when they're sick. And that it's just because they're sick, not because of us, and they were in the hospital to get better enough to come home, and then when Mum came back, she might still be a bit confused, but we'd look after her til she was all better.

This time, she is not as bad, but she is also at home rather than hospital (Yay! No seriously, mental ward was scariest place ever. She has at least 1 other adult in the house at all times).

He is a bright kid. I remember how coherently, and logically I thought about things when I was his age, and while I was naive, I was fiercely intelligent, and he is the same. I also know that a 5 year olds perceptions don't have the experience of an adult behind them, so I want to make sure he's ok in that smart little head of his.
He's definitely reserved on things like this, even though I am (apparently) his favorite person in the world.

She would never, ever hurt him, but she gets paranoid about his safety, and keeps asking him questions to check on him.
I've just been working in the past couple of days on him telling Mum he needs 'quiet time' if she asks him too many questions, etc, and having her understand that that's what he will say if he wants to not talk for awhile.
He been acting out a tiny bit, by being a little manic and silly with her, which we're trying to get *her* not to worry about (and that the response is not to check on him/overstimulate him).

He calms down with us, and he's pretty mellow in general.

I haven't been searching the right terms to find any online resources for this situation, or for appropriate ways to explain it to 5 years olds, or things to do.

I did find a list for children of a bipolar parent, and am going to try to let him know:

• Her actions/behavior have nothing to do with me.
• Her actions/behavior have nothing to do with her love for me.
• If a conversation gets uncomfortable, get up immediately and leave the situation, do not engage.
• (Adapted to "I need quiet time, Mummy")
• If confused about unreasonable words/actions, seek counsel from a trusted friend/adult/parent
• Parents are not perfect

What else can you suggest?
In a few more weeks, she should be ok. She is normally an excellent parent. It is only the second time in his life this has happened, and it is triggered by stress.

Just so his safety is clear:
I am one of two other adults caring for him in the same house as him and his Mum, with backup from other relatives, he has a great school, afterschool care, and we have another relative who might be coming up in a few days to share the load, and being away from his mother entirely does not seem reasonable in anyone's opinion.

So yeah, story books (accessible ones?), movies?
What do you wish the adults around you had made clear to you if you had a parent who was unwell when you were a child?

posted by Elysum to human relations (19 answers total)

If he's as bright as you say, it might not be a bad idea to explain to him that mom has bad days sometimes, and that when she seems to not be herself, you should try to leave her alone (in my experience, kids can read adults pretty well). I'm very very sorry for your troubles, and I hope you can find a solution for both mom and Jr.
posted by Gilbert at 9:17 PM on November 20, 2011

One book that I've heard great things about for children whose mothers have bipolar disorder is Sometimes My Mommy Gets Angry. I don't know anything about this one, but it has good reviews: The Bipolar Bear Family: When a Parent Has Bipolar Disorder.
posted by la petite marie at 9:26 PM on November 20, 2011

To clarify -
She's obviously not herself, and will not be for a few more weeks, not just bad days sometimes.

Other than these two episodes, she is fine - ie not going up in down.

She has not been diagnosed with bipolar.

She doesn't get angry with him, just very confused.
posted by Elysum at 9:28 PM on November 20, 2011

It's amazing what kids can pick up on, isn't it?

I unfortunately had a mentally ill caretaker, but she was isolated enough from others that there were many times I and/or her son had to be witness to some of her breaks alone, in which case I hid in my room if I could. Sometimes, though, there was nowhere to go because she had no friends that knew what was happening, and ergo, no one to take her in to hospital when that's where she really needed to be.

I am glad that this little boy has sustained emotional support in his own home from more than one other person. In my opinion, that's the most important thing he needs now and in the future. He can intellectually understand only so much, even though instinctively he knows that something isn't right with his beloved Mommy.

Hug him often. Reassure him often that he will be taken care of, that Mommy will be OK and that he can depend on you. Play with him often. Show interest in what he does, just like any other child. Take him to do fun things. Be nearby when he's with his mother in case it's a bit too much for her at that moment and he needs support. It's sustaining these actions that does the work in the long run. And it's important for all of you in the house to not be "on call" 24/7 as well, because your being rested, as it were, helps him.

Here's something that Fred Rogers (AKA, the American Bodhisattva) talked about after 9/11 with regard to helping children during a crisis. There are sure to be some parallels where you can adapt his advice to the situation you're in.

I wish you all peace.
posted by droplet at 9:37 PM on November 20, 2011 [9 favorites]

Give him a chance to work it out through play. Your job (or any other adult who wants to give him a chance for therapeutic play) is to let him take the lead or even just watch his game. Comment on what you actually see - "you made a very deep hole" or the feelings and thoughts of his characters "I wonder how GI Joe feels with his head buried in the sand" "If someone hit me that hard, I would be angry and hit back. I wonder what Zebra will do?" Be loving and non-jugemental - whatever he does in play is what he needs to be doing. Don't try to suggest any deeper meanings or make connections to real life - he doesn't need to put this in words to work things out. Furthermore, he will love being the center of your attention, especially at a time when he isn't getting as much attention from Mom.
posted by metahawk at 9:54 PM on November 20, 2011

Here's what I wish someone had said to me, and what I've had to say to various kids: different parts of our bodies do different things. Our eyes help us see. Our stomachs help us use the food that we eat. Our brains help us do everything--think and feel and make choices. Sometimes those parts get sick or don't work the way they should. When brains get sick or don't work the way they should, they might act like they're confused or sad or angry. A brain that isn't working right isn't letting that person make the choices they usually would.

He sounds like he's in really excellent hands. Thank you for being so concerned about this little guy--you are providing him with invaluable help.
posted by corey flood at 10:26 PM on November 20, 2011 [5 favorites]

She would never, ever hurt him.

There is no person on earth, in any state of health or illness, that you can say this about with 100% certainty. Please remain cautious, for the sake of everyone under this roof.

Really it should not be coming down to the child to have to ask for "quiet time" to remove himself from uncomfortable situations with a paranoid adult, because out of guilt or need of the mother's attention the child is likely to be overly tolerant; the well adults ought to be protecting him from these ambiguous and frightening interactions before they escalate.
posted by Scram at 10:53 PM on November 20, 2011 [12 favorites]

Sounds to me like he already knows and doesn't need to be told much, but I agree with other posters that you can't say with 100% clarity that someone will/will not hurt their children.

I'd ask him to have a talk with me at the end of the day about how he feels about parent and about everything that's going on.
posted by Ms. Moonlight at 12:04 AM on November 21, 2011

Posted for a Metafilter member who would like to remain anonymous:

It's a killer, isn't it, when little kids pick up on these things and learn, so very fast, the safest course of action? I've been through this with my son and my husband's illness.

When he was 2, we simply told him that his father wasn't feeling well, and couldn't play with him the way he usually did.

Now that he's about 5, I would also need to think about how to discuss it with him. Other illnesses, we've discussed with more detail than kids seem to get from their parents in my experience. He's seen ultrasound images from my abdominal exam, he's seen the scars from his father's surgery, and had all of those things explained to him in a simplified but accurate way. It seems to help him.

One thing that I think was really helpful for him was that after my husband's last episode ended, he sat down and talked about it with our son. I know this doesn't help you right now, but it's something to consider. It was good for both of them in our case. Perhaps it would be helpful for you too?

Make sure (It sounds like you are doing this already) that your son is getting an awful lot of emotional reassurance.

Sincerest of good wishes.

posted by taz at 12:33 AM on November 21, 2011 [1 favorite]

Another user also would like to contribute an anonymous answer:

I was your five year old. It's hard to tell from this distance what helped and what didn't help, but I'll give it a shot.

It didn't help when I was present for a couple of particularly unpleasant incidents that could have been predicted in advance. For example, if Mum is ever hospitalised against her will, please try your best to send kiddo on an outing with someone until the deed is done. Visiting Mum in hospital (if she's ever there again) needs careful attention to how you and kiddo will leave without drama. If that's not possible I honestly think it would be better for kiddo not to visit.

It helped to try and retain the trappings of normality even when things were really messed up. So: reading stories, bedtime, cooking biscuits, going to the park, eating meals at the regular time.

It also helped, I think, when I went away to stay with family for a while during an episode, for maybe a month. At the time I was a little older than your kiddo, and I just thought it was a super exciting expedition. Now my memories of that time are all pleasant ones - I spent some of it making "presents" to give to my parents when they came to pick me up.

Unfortunately I can't tell you what the impact of this was on my sick parent.

posted by taz at 1:35 AM on November 21, 2011 [3 favorites]

If his mum has been his primary caretaker and she's unable to do that job at the moment, I'd pay some attention to that dynamic and reassure him that while mummy isn't well right now, she's being looked after and that he has lots of people who love him and who are there to care for him, too. Then list those people (or ask him to) so it's concrete.
posted by DarlingBri at 1:51 AM on November 21, 2011

When I was a kid, an adult used to use the phrase "his/her mind is sick". That got it across for me, though it was said about people who weren't in my family and who I didn't have to live with. It won't be enough on its own, but it is a good way of framing it.
posted by tel3path at 2:47 AM on November 21, 2011

I grew up in similar circumstances. Your checklist is great and you are great for helping this child with such clear-headed and sympathetic intentions.

I would add:

1. Structured time away. He should be out of the environment being a kid as much as possible instead of enmeshed in all of this. His mother will be anxious and miss him, and he'll be anxious too. It will be very hard on him at times but otherwise he will never learn to manage the anxiety. As a kid, I had few friends my age, missed a great deal of school, and spent most of my time at home because I was always afraid the shit would hit the fan the minute my back was turned. The adults should be united in making sure that he gets to be a kid and not another caretaker.
2. Avoid metaphors. They don't help, and can confuse and scare him further. For example, a well-meaning adult once tried to tell me that my mother's fears were of things that weren't true, like being afraid of a monster under the bed or in the closet. The problem, of course, is that I was perfectly convinced that monsters were real and poised to eat me as soon as the lights went out and the naive adults were gone. Metaphoric language is just too easy for a child to misconstrue.
3. Be direct but don't predict. The problem with saying mom is "sick" or "isn't feeling well" is that we use the same language to describe a cold or even just an off day. Don't get too medical/technical, just use the facts as the child has observed them. Something along the lines of "Mom's having trouble thinking, so the doctor is giving her medicine to help her brain think clearly again. It takes time to find the right medicine and for it to work but all the grownups (carer, you, other adults) are here to help her while she's having trouble thinking." This will help him understand what's happening to mom, why she's not there, and the positive goal of her treatment -- without guaranteeing the goal.
4. Listen hard. If she is talking about her delusions or being manic around him he probably won't talk directly about it. For instance, my mother had a delusion about the mafia being after us that she only related to me, making me promise not to tell anyone about so they wouldn't know we knew, etc. I didn't tell, but suddenly I had a lot of questions about gangsters for my grandparents to ponder. Even if she hadn't sworn me to secrecy, my instinct was to hide her vulnerability from other people. It doesn't surprise me you've seen him act out in a way that echoes her mania. The adult that's with them 24/7 should hustle him the hell out of there whenever his mother uses that kind of language. Every adult should generally be listening to him actively, and countering delusions with reality whenever needed.

There's a lot more, but I'd call those things the most important additions to your already stellar checklist. Thank you, thank you for your involvement. It's an exceedingly rare and good thing you're doing, so please be gentle with yourself when you feel you're stumbling in the dark about what to do, or worrying you've made some mistake. Just being there, and blessedly stable and solid, is giving this kid a gift of incalculable value.
posted by melissa may at 4:06 AM on November 21, 2011 [1 favorite]

My mother has had poorly managed bipolar disorder for my entire life. I think that this child should stay with you or another friend or relative until his mother's medication has had a chance to kick in and stabilize her. He can be brought for visitation with her during this period, but he should not be staying with her. Like Scram mentioned above, he should not be placed in the position of having to decide which of his mother's delusions or paranoid behaviors are too much for him to handle.
posted by crankylex at 8:34 AM on November 21, 2011 [1 favorite]

You've gotten a lot of great suggestions so far, so I really just want to add something that would really have helped me when I was his age dealing with a bipolar mother.

Make sure he knows that Mom has people taking care of her and that her care is NOT his job. His job is to be a kid. Of course, kids that age want to help, so don't let him feel helpless. Praise him and let him know when he does something helpful. This could be as simple as putting away his toys, helping you with chores (if appropriate) or maybe he could deliver the glass of water Mom asked for.

Also, thank you for what you're already doing. Things like this are really hard on kids and it's a wonderful relief to have other adults to turn to. I became my mother's caretaker at a very young age due to not having adults like you around. You are a wonderful person for caring so much.
posted by MuChao at 9:36 AM on November 21, 2011 [1 favorite]

MuChao, here, here. I completely concur; the child should never feel that it's his job to somehow take care of Mommy.

How many childhood hours I fretted away with feeling horrible about not knowing how to heal or help my caretaker! It fostered a lot of unnecessary guilt that lasted well into adulthood. And unfortunately she was violent. Had her mind been healthy, I doubt 90% of the violence done to me in childhood would have ever taken place. You never do know what will make ill individuals snap.

I agree also with everyone who said structured time with him as well as time away from the house. It happened very rarely for me that someone took me somewhere fun that was time for me and only me, but those are some of my fondest childhood memories.
posted by droplet at 10:11 AM on November 21, 2011 [1 favorite]

Re: "I need quiet time"
We definitely step in and redirect when she is talking to him, and at the moment one of us is always with her/him.
Fortunately, the questions are basically along the lines of, asking him what happened in his day, and wanting to hear everything about it, when the standard response from a kid to "What did you do today?" is "Oh, nuthin'".
Even if he seems to be happily (/patiently?) interacting with his Mum, and we are all there with him, I want him to know that he can always, *always*, call time out.

She's exponentially more coherent when talking to him. Every bit of her mind that she has working, is obviously devoted to him. She has trouble identifying names, places, time... She might take something written down as an instruction, or a warning. She sometimes can't follow a conversation if there is any background noise.
She's really struggling all the time, and yet even when she was at her worst, she knows who is supposed to be looking after him on what day, and knows he should be doing normal kid things (with people she trusts, and there has to be explicit handovers).

He is getting lots of time staying at the relatives houses he usually goes stays with. He went to a birthday party on Saturday, and stayed in his room at his relatives that night. He will be tonight, also.

The 4 of us live in the house all the time (her, me, other adult, 5 year old), so we are his normal caregivers anyway. We have another relative coming tomorrow, so there will be 3 adults in the house alternating care.


That actually makes us sound really on top of it. In this situation, we can't be, but he is first priority, she is second, and that is what she wants.

We're dealing as well as we can.



Taz:
That's what I have nightmares about.
I did fail during one hospital visit.
The Dr asked me to come out of the visiting room to answer some questions (another friend of mine was there with her), and while I was in the Dr's office answering questions, the nurses tried to end the visit and get her to leave the room and her son, without one of her trusted caregivers there (ie me, or one of more than a dozen others, mostly family, and his school, and afterschool care. Said friend, has now gotten to know her, and would be acceptable now, but was nearly a stranger to her then).
I am so, so upset with myself, but also so angry at the nurses, because when I got back there, they were both standing too close to her, shouting at her at the same time that she had to leave (at that point, she couldn't understand a conversation if more than one person was talking), while she cried, keeping her son protectively behind her.
It was awful.
I had to argue about as long with the nurses that I needed them to please step back, and stop shouting, and we would be able to leave, as I did calming her down.
That is what I am so, so afraid of.

So yeah, the Drs don't want her in hospital if it can be at all helped. She reacted badly (anxiously, starting to get catatonic).
posted by Elysum at 3:33 PM on November 21, 2011

I have been in a similar position as this child, and all I can say is let this kid get away from the situation if possible, and I mean for a few weeks, not an occasional afternoon or birthday party. It is horrific thing to go through. You say: 'She's exponentially more coherent when talking to him. Every bit of her mind that she has working, is obviously devoted to him.' I've been in that exact place, and it is a nightmarish amount of pressure. I wish someone had taken the time to realize how intensely children (even very young ones) can recognize these dynamics and how much they are willing to deplete themselves in the service of fulfilling adults' needs. I know that going away has its own set of challenges, but the current set-up sounds infinitely more destructive to me. I know I am too close to the situation to be objective, but this is my experience.
posted by asimplemouse at 5:18 PM on November 21, 2011 [1 favorite]

I was prepping for, and worried about, the 'worst case scenario'.
And... it didn't happen.
The meds kicked in, and although things were not 100% normal for a few weeks, they were ok, and everything is now now fine.

And the little guy is doing super-duper awesomely.
posted by Elysum at 3:08 PM on December 29, 2011 [4 favorites]