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Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv University, Sackler School of Medicine, Israel. Vice President of the International Association of Child and Adolescent Psychiatry and Allied Professions Miri Keren Head of the Infant Psychiatry Program, Tel Aviv University, School of Medicine, Israel. Director of Infant Mental Health Unit, Geha Mental Health Center, Petach Tikvah. President Elect of the World Association for Infant Mental Health Helen Herrman Professor of Psychiatry, Orygen Youth Health Research Centre, The University of Melbourne. Director, World Health Organization Collaborating Centre in Mental Health, Melbourne. Secretary for Publications, World Psychiatric Association John Cox Professor Emeritus, University of Gloucestershire, UK. Immediate Past Secretary General, World Psychiatric Association A John Wiley & Sons, Ltd., Publication
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Page 1: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Parenthood andMental HealthA Bridge between Infant and Adult Psychiatry

Sam TyanoProfessor Emeritus of Child and Adolescent Psychiatry,Tel Aviv University, Sackler School of Medicine, Israel.Vice President of the International Association of Child andAdolescent Psychiatry and Allied Professions

Miri KerenHead of the Infant Psychiatry Program, Tel Aviv University, School of Medicine, Israel. Director of InfantMental Health Unit, Geha Mental Health Center, Petach Tikvah. President Elect of the World Associationfor Infant Mental Health

Helen HerrmanProfessor of Psychiatry, Orygen Youth Health Research Centre, The University of Melbourne. Director,World Health Organization Collaborating Centre in Mental Health, Melbourne. Secretary for Publications,World Psychiatric Association

John CoxProfessor Emeritus, University of Gloucestershire, UK. Immediate Past Secretary General, WorldPsychiatric Association

AJohn Wiley & Sons, Ltd., Publication

Page 2: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv
Page 3: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Parenthood andMental Health

Page 4: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv
Page 5: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Parenthood andMental HealthA Bridge between Infant and Adult Psychiatry

Sam TyanoProfessor Emeritus of Child and Adolescent Psychiatry,Tel Aviv University, Sackler School of Medicine, Israel.Vice President of the International Association of Child andAdolescent Psychiatry and Allied Professions

Miri KerenHead of the Infant Psychiatry Program, Tel Aviv University, School of Medicine, Israel. Director of InfantMental Health Unit, Geha Mental Health Center, Petach Tikvah. President Elect of the World Associationfor Infant Mental Health

Helen HerrmanProfessor of Psychiatry, Orygen Youth Health Research Centre, The University of Melbourne. Director,World Health Organization Collaborating Centre in Mental Health, Melbourne. Secretary for Publications,World Psychiatric Association

John CoxProfessor Emeritus, University of Gloucestershire, UK. Immediate Past Secretary General, WorldPsychiatric Association

AJohn Wiley & Sons, Ltd., Publication

Page 6: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

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Page 7: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Contents

Foreword xix

List of contributors xxi

I Introduction 1I.1 A historical overview: infants, parents, and parenting from ancient

times to nowadays 2

I.2 Definition of some major concepts 4

I.3 Structure of the book 6

I.4 References 7

SECTION 1 Parental Orientations

Normal processes

1 Mothers’ and fathers’ orientations: patterns of pregnancy,parenting and the bonding process 9Joan Raphael-Leff

1.1 Introduction 9

1.2 Pregnancy and the ‘placental paradigm’ 11

1.3 The model of maternal orientations 13

1.4 Mothering 14

1.5 Postnatal disturbances 16

1.6 Contagious arousal 19

1.7 Paternal orientations 20

1.8 Conclusion 21

1.9 References 21

Page 8: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

2 The competent fetus 23Sam Tyano and Miri Keren

2.1 Introduction 23

2.2 Continuity from intrauterine life to infancy 24

2.3 The competent fetus and its receptive sensorial capacities 25

2.4 Fetuses remember and therefore can learn . . . 26

2.5 Fetuses can feel pain 26

2.6 Fetal psychology: an emerging domain 27

2.7 Conclusion: the fetus can no longer be thought as a ‘witless tadpole’ 28

2.8 References 28

Challenging pregnancies

3 Single parenthood: its impact on parenting the infant 31Sam Tyano and Miri Keren

3.1 Introduction 31

3.2 Single-parent families come in a variety of profiles 32

3.3 Single parenthood as risk factor for parental mental health 32

3.4 Risk factors for mental health problems among single mothers 33

3.5 Single-father families versus single-mother families 34

3.6 Single custodial parenthood 34

3.7 Psychological characteristics of single mothers by choice 35

3.8 A double-edge risk situation: being a single parent of aninfant at risk 35

3.9 Clinical implications 36

3.10 Summary 36

3.11 References 37

4 Surrogate mothers 39Olga B.A. van den Akker

4.1 Introduction 39

4.2 Characteristics, motivations and experiences 43

4.3 Attachment, bonding and pregnancy 44

4.4 Relinquishing the baby and the social context 47

4.5 Conclusion 48

4.6 References 48

At-risk pregnancies

5 The impact of stress in pregnancy on the fetus, the infant,and the child 51Miri Keren

5.1 Introduction 51

5.2 Data from animal studies 52

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5.3 Human studies of the impact of maternal stress on offspring 52

5.4 Discussion 55

5.5 Conclusion: implications for social health policy 56

5.6 References 57

6 Unintended pregnancies 59Myriam Szejer

6.1 Introduction 59

6.2 The insistence of desire 59

6.3 Abortion 63

6.4 Rape, incest and denials of pregnancy 63

6.5 Pregnancy and mental illness 64

6.6 Conclusion 65

6.7 References 65

7 Clinical challenges of adolescent motherhood 67George M. Tarabulsy, Annie Bernier, Simon Larose, Fanie Roy,Caroline Moisan and Claire Baudry

7.1 Introduction 67

7.2 Early challenges faced by young mothers 69

7.3 Adolescent mother–infant interaction and the elaboration ofattachment 73

7.4 Intervention with adolescent mothers and their infants 74

7.5 Conclusion 76

7.6 References 77

8 Psychopathological states in the pregnant mother 79Carol Henshaw MD FRCPsych FHEA

8.1 Introduction 79

8.2 General guidelines 86

8.3 Conclusions 87

8.4 References 87

9 When something goes wrong with the fetus: rights, wrongs andconsequences 89Julio Arboleda-Florez

9.1 Reproduction and threats to the unborn 89

9.2 The rights of the fetus and of the newborn 91

9.3 Parental reactions 93

9.4 The fate of persons with developmental disabilities 94

9.5 Conclusions 97

9.6 References 98

CONTENTS vii

Page 10: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

10 Multiple fetuses pregnancy and other medical high-riskpregnancies 99Micheline Garel, Elise Charlemaine and Sylvain Missonier

10.1 Medical high-risk pregnancies: definition 99

10.2 Psychological aspects of multiple pregnancies 100

10.3 Pregnancy and HIV, a public health problem 103

10.4 Conclusion 107

10.5 References 107

Assessment of prenatal parenting

11 Prenatal self-report questionnaires, scales andinterviews 109Massimo Ammaniti and Renata Tambelli

11.1 Introduction 109

11.2 Semi-structured interviews 110

11.3 Self-report questionnaires and scales 115

11.4 Inventories 117

11.5 Conclusion 118

11.6 References 119

12 Observational tool: the prenatal Lausanne Trilogue Play 121Elisabeth Fivaz-Depeursinge, France Frascarolo and AntoinetteCorboz-Warnery

12.1 Introduction 121

12.2 The Lausanne Trilogue Play paradigm 122

12.3 The prenatal LTP 123

12.4 Discussion 125

12.5 Conclusion 126

12.6 References 126

Treatment of abnormal states during pregnancy

13 Psychopharmacological treatments during pregnancy:risks and benefits for the mother andher infant 129Martin St-Andre and Brigitte Martin

13.1 Introduction 129

13.2 Depression and anxiety during pregnancy 130

13.3 Bipolar disorder 137

13.4 Schizophrenia 143

13.5 Post-partum psychosis 144

13.6 Conclusion 145

13.7 References 145

viii CONTENTS

Page 11: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

14 Psychotherapeutic, psychosocial, individual and familyinterventions for abnormal states during pregnancy 147Prabha S. Chandra, Geetha Desai and Veena A. Satyanarayana

14.1 Introduction 148

14.2 Maternal–fetal attachment disorders 148

14.3 Anxiety disorders 149

14.4 Eating disorders 152

14.5 Depression 153

14.6 Suicide 155

14.7 Substance use 157

14.8 Conclusions 158

14.9 Acknowledgements 158

14.10 References 159

SECTION 2 Delivery and birth

15 Perinatal loss: its immediate and long-term impacton parenting 161Miri Keren

15.1 Introduction 162

15.2 Historical and cultural perspectives 162

15.3 Psychological effects of perinatal death on mothers 163

15.4 Psychological effects of perinatal death on fathers 163

15.5 Impact of perinatal loss on the couple 164

15.6 Impact of perinatal loss on the subsequent pregnancy 164

15.7 Clinical implications 165

15.8 Conclusion 168

15.9 References 168

SECTION 3 Parenting of the infant during the first year of life

Normal processes

16 Transition to parenthood 171Antoine Guedeney and Susana Tereno

16.1 Introduction 171

16.2 Pregnancy and emotional upheaval: risks and resiliency 172

16.3 The psychological unfolding of pregnancy 173

16.4 Psychopathology in pregnancy 175

16.5 Prevention and early intervention 176

16.6 CAPEDP-Attachment: a French project to promote parentalskills and decrease disorganized attachment 177

16.7 References 178

CONTENTS ix

Page 12: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

17 Role of parenting in the development of the infant’sinterpersonal abilities 181Deborah Weatherston and Hiram E. Fitzgerald

17.1 Introduction 181

17.2 Transformative theoretical concepts ofhuman relationships 183

17.3 Infant mental health service structure 190

17.4 Summary 191

17.5 References 191

18 Welcoming a stranger: cultural and social aspects ofparenting 195Nathalie Zajde and Catherine Grandsard

18.1 Introduction 195

18.2 Jimmy 196

18.3 Ethnopsychiatry 196

18.4 Ethnopsychiatric therapy sessions 197

18.5 Treatment 197

18.6 Psychotherapy and diplomacy 198

18.7 The conflict between the two families 199

18.8 Sorcery: from the Antilles to the Congo 199

18.9 Pentecostal churches in the Congo 200

18.10 Misunderstanding no. 1 200

18.11 The Bakongo kinship and parenting system 201

18.12 Misunderstanding no. 2 201

18.13 To whom does the child belong? 202

18.14 Back to the treatment 202

18.15 Identifying baby Jimmy 203

18.16 Epilogue 203

18.17 Conclusion 204

18.18 References 204

19 Filicide: parents who murder their child 207Sam Tyano and John Cox

19.1 Introduction 207

19.2 Prevalence of filicide among Western societies 208

19.3 Filicide and the child’s age 209

19.4 Filicide and parent’s gender 209

19.5 Parental motivations for committing filicide: at thepsychiatric level 210

19.6 Parental motivations for committing filicide: at thepsychodynamic level 211

19.7 Characteristics of the child at risk for filicide 212

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Page 13: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

19.8 Clinical implications 212

19.9 Conclusion 213

19.10 References 214

Parental risk factors for parenthood

20 Maternal postnatal mental disorder: how does it affect theyoung child? 217John Cox and Joanne Barton

20.1 Introduction 217

20.2 Postnatal mental illness: immediate effect onparenting 218

20.3 Mother–infant relationships 220

20.4 Risk and resilience 220

20.5 Infant outcome and child development 221

20.6 Child mental health problems 222

20.7 Child abuse and neglect 223

20.8 Family aspects 223

20.9 Considering the child in the management of maternalmental illness 224

20.10 Conclusions 226

20.11 References 227

21 Psychopathological states in the father and their impacton parenting 231Michael W. O’Hara and Sheehan D. Fisher

21.1 Introduction 231

21.2 Prevalence of psychiatric disorders in men 232

21.3 Paternal psychopathology and child internalizing andexternalizing problems 233

21.4 How depressive symptoms may affect parenting 233

21.5 Paternal psychopathology and parenting 234

21.6 Summary 237

21.7 Research agenda 237

21.8 References 238

22 The impact of trauma on parents and infants 241Joy D. Osofsky, Howard J. Osofsky and Erika L. Bocknek

22.1 Introduction 241

22.2 The problem of abuse and neglect 242

22.3 Other trauma exposure in young children 244

22.4 Lessons learned 245

22.5 References 246

CONTENTS xi

Page 14: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

23 Substance problems: bridging the gap betweeninfant and adult 251Ilana Crome

23.1 Introduction 251

23.2 The prevention and policy framework 252

23.3 Epidemiology: the magnitude of the problem 253

23.4 Health and welfare: context and consequences 255

23.5 Assessment and treatment: uniting families 259

23.6 Specific interventions for pregnant substance misusers 262

23.7 Pharmacological treatments for pregnant substance misusers 263

23.8 Catalysing change by implementation of research: service models 265

23.9 Conclusion 265

23.10 References 266

Environmental risk factors for parenthood

24 Foster parenthood 271Yvon Gauthier

24.1 Introduction 271

24.2 Foster children symptomatology 271

24.3 The use of attachment theory 272

24.4 Foster children’s special needs 273

24.5 How to help foster parents to provide best care forthe fostered child 274

24.6 Kin vs. non-kin foster parents 275

24.7 Visits to the biological parents 275

24.8 Need for permanency 275

24.9 References 276

25 Parenting the chronically ill infant 277Barbara G. Melamed

25.1 Introduction 277

25.2 Asthma 279

25.3 Congenital heart disease 280

25.4 Cystic fibrosis 282

25.5 Very low birth weight infants 284

25.6 Conclusions and future studies 286

25.7 References 287

26 Parenting an infant born of rape 289Frances Thomson Salo

26.1 Case vignette 1 289

26.2 Case vignette 2 289

xii CONTENTS

Page 15: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

26.3 Case vignette 3 290

26.4 Introduction 290

26.5 Context 291

26.6 Outcomes of pregnancy 292

26.7 Perinatal period 293

26.8 Maternal representation of the infant 293

26.9 Maternal attachment 294

26.10 Infant attachment 295

26.11 Representations of the father and disclosureto the infant 295

26.12 Adoptive and foster parenting 296

26.13 Siblings 297

26.14 Being parented in ongoing difficulty 297

26.15 Support and therapeutic interventionfor the family 297

26.16 The infant’s view of their life 298

26.17 Conclusions 298

26.18 References 298

27 Parenting an infant with a disability 301Sheila Hollins, Stella Woodward and Kathryn Hollins

27.1 Introduction 301

27.2 Parental expectations 301

27.3 Antenatal diagnosis 302

27.4 Case vignette 1 302

27.5 Case vignette 2 302

27.6 Postnatal diagnosis 303

27.7 Case vignette 3 303

27.8 Case vignette 4 303

27.9 Diagnostic uncertainty 304

27.10 Parental responses 304

27.11 Parent–infant relationship development 305

27.12 Case vignette 5 305

27.13 Case vignette 6 305

27.14 Depression in parents of childrenwith a disability 306

27.15 Responses of family, friends andwider society 307

27.16 Economic and social implications 307

27.17 Positive implications 308

27.18 Supporting parents 308

27.19 Conclusion 309

27.20 References 309

CONTENTS xiii

Page 16: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

28 Being a parent with a disability 311Adil Akram and Sheila Hollins

28.1 Being a disabled parent 311

28.2 The UK context 312

28.3 Parents with physical disability 312

28.4 Parents with intellectual disability 314

28.5 Parents with mental illness 316

28.6 A recovery perspective on disabled parents with mental illness 317

28.7 The social model of disability 317

28.8 Cultural representations of parents with disabilities 317

28.9 UK policy perspectives 318

28.10 Solutions to support disabled adults as parents 318

28.11 Involving disabled parents in research 321

28.12 Conclusion 322

28.13 References 322

29 Parenthood: the impact of immigration 325Olivier Taıeb, Thierry Baubet, Dalila Rezzoug and Marie Rose Moro

29.1 Introduction 325

29.2 The ingredients of parenthood 326

29.3 Pregnancy and childbirth in exile 329

29.4 The infant, a cultural being 332

29.5 Conclusions: parents in exile 334

29.6 References 334

30 Parenting and poverty: a complex interaction 337Mark Tomlinson

30.1 Introduction 337

30.2 Poverty 338

30.3 Upstream and downstream factors 338

30.4 Parenting and its determinants 339

30.5 Parenting and poverty 340

30.6 Maternal depression 342

30.7 Poverty, parenting, depression and infant attachment 343

30.8 Malnutrition and non-organic failure to thrive 344

30.9 Conclusions 345

30.10 References 345

Assessment of parenthood

31 Assessment of parenting 349Marc H. Bornstein and Magdalen Toole

31.1 Introduction 349

31.2 Self-report measures 350

xiv CONTENTS

Page 17: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

31.3 Reports by others 352

31.4 Observational methods 352

31.5 Experimental testing 353

31.6 Parental influence 353

31.7 Conclusion 354

31.8 References 354

32 Principles of effective co-parenting and its assessmentin infancy and early childhood 357James P. McHale and Elisabeth Fivaz-Depeursinge

32.1 Introduction 357

32.2 What is effective co-parenting? 358

32.3 Co-parenting as a triangular concept 358

32.4 Co-parenting and division of labor 359

32.5 Co-parenting and children’s adjustment 359

32.6 What do mental health professionals need to know?The essentials 360

32.7 Instruments of choice: observational, interview and self-reportsurvey data 363

32.8 Conclusion 368

32.9 References 368

33 Legal assessment of parenting competency 373Jean-Victor P. Wittenberg

33.1 Introduction 373

33.2 Definitions of maltreatment 374

33.3 Assessment is an intervention 375

33.4 Infants and toddlers are a special group 376

33.5 Models of parenting capacity assessment 377

33.6 Core competencies for professionals doing parentingcapacity assessments with infants 379

33.7 Conclusions 381

33.8 References 382

Treatment of dysfunctional parenting

34 Psychotropic drugs and lactation: to nurse or notto nurse 385Zivanit Ergaz and Asher Ornoy

34.1 Drug excretion into breast milk: generalconsiderations 385

34.2 Benzodiazepines 387

CONTENTS xv

Page 18: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

34.3 Phenothiazines 388

34.4 Butirophenones 389

34.5 Atypical neuroleptics 390

34.6 Antimanic drugs 392

34.7 Anticonvulsants that are also mood-stabilizers 392

34.8 Central nervous system stimulants 393

34.9 Tricyclic antidepressants 393

34.10 Tetracyclic antidepressants 394

34.11 Selective serotonin reuptake inhibitors 395

34.12 Serotonin and norepinephrine reuptakeinhibitors 396

34.13 Noradrenaline reuptake inhibitors 397

34.14 Conclusions 397

34.15 References 398

35 Parent–infant psychotherapies and indicationsfor inpatient versus outpatient treatments 401Kaija Puura and Palvi Kaukonen

35.1 Introduction 401

35.2 Different forms of parent–infant psychotherapy 402

35.3 Indications for inpatient versus outpatienttreatment 407

35.4 When parents reject treatment 412

35.5 Conclusions 412

35.6 References 412

Pathological parenting: from the infant’s perspective

36 The symptomatology of a dysfunctional parent–infantrelationship 415Campbell Paul

36.1 Introduction 415

36.2 ‘Good-enough’ parenting 416

36.3 Parenting in the context of mental illness 416

36.4 Qualities of infant–parent interaction 417

36.5 Assessing infant–parent interaction 418

36.6 The infant response in the context of adysfunctional relationship 421

36.7 Implications for prevention and intervention 425

36.8 Conclusion 426

36.9 Acknowledgements 427

36.10 References 427

xvi CONTENTS

Page 19: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Concluding chapter

37 Mental health of parents and infant health and developmentin resource-constrained settings: evidence gaps andimplications for facilitating ‘good-enough parenting’in the twenty-first-century world 429Jane Fisher, Atif Rahman, Meena Cabral de Mello,Prabha S. Chandra and Helen Herrman

37.1 Introduction 429

37.2 Social model of mental health 432

37.3 Parenting and mothers’ social position 433

37.4 Human rights, mental health and child healthand development 434

37.5 Promotion of infant health and development and prevention ofmaternal mental health problems 434

37.6 Preventing and ameliorating maternal mental health problems andpotential benefits for infant health and development 435

37.7 Addressing the social determinants of compromised early childhooddevelopment and maternal mental health problems 437

37.8 Implications for facilitating ‘good-enough parenting’ in thecommunities of the twenty-first century 438

37.9 Conclusion 439

37.10 References 440

Index 443

CONTENTS xvii

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Page 21: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Foreword

After World War II, the newly created World Health Organization asked a British childpsychiatrist to prepare a monograph on the mental health needs of children. The WHO wasconcerned about the large numbers of children who had been orphaned or experiencedextended separations from their parents in the war. John Bowlby reviewed the world’sliterature and consulted with experts. His monograph, Maternal Care and Mental Health[1], appeared in 1951 and concluded that the quality of parental care which children receivein their earliest years is of vital importance for their future mental health. Specifically, hesaid, ‘‘. . . essential for mental health is that an infant and young child should experience awarm, intimate and continuous relationship with his mother (or mother substitute. . .) inwhich both find satisfaction and enjoyment (p. 13).’’

Over the next several decades, Bowlby pursued his life’s work of synthesizing a theory ofattachment that elaborated these ideas on the importance of early experiences betweenyoung children and their parents. Bowlby’s colleague, Mary Ainsworth, operationalized histheory by developing an observational method of assessing the young child’s behavior withattachment figures. This groundbreaking work led to a large body of research that hasextended and refined many of the ideas of attachment theory but, in the main, the accuracyof Bowlby’s basic premises seems clear.

Indeed, Bowlby’s emphasis on the importance of early experiences has implications wellbeyond attachment theory. Much of the excitement in contemporary developmentalneuroscience is about attempts to describe the importance and effects of early experienceson human brain development. Moreover, the entire field of infant mental health rests onthe premise that relationships between infants and caregivers are the most importantdevelopmental context affecting the child’s social and emotional behavior. These relation-ships are the most important focus of assessment and the most important target ofinterventions.

Not all have found the emphasis on parenting meaningful. In 1998, Judith Harrispublished The Nurture Assumption [2], asserting that parents were not nearly as importantfor child outcomes as was generally believed. Instead, she asserted that genetic and peerinfluences were both underappreciated and far more important than parenting.

The intensity of the reaction to these assertions illustrates how far we have come in the50 years since Bowlby published his monograph. In 1951, it was big news that parenting was

Page 22: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

considered vital for children’s mental health. Fifty years later, Judith Harris provocativelystaked out the contrarian position that parenting matters little. Although her selectivereview of the evidence and debatable conclusions have been strongly challenged, her thesisusefully invites us to reconsider our assumptions about parenting. Indeed, since her bookwas published, a great deal of research on the extraordinarily deleterious effects of childrenraised without parents has demonstrated the limitations of her basic thesis. This researchredirects us to review what we know about parenting and its effects.

With that in mind, the present volume is timely and much needed. The editors of thisbook, Sam Tyano, Miri Keren, Helen Herrman, and John Cox, have assembled an out-standing group of international scholars who contributed to this comprehensive review ofparenting in the prenatal, perinatal, and early infancy periods. Bridging a gap betweeninfant and adult psychiatry, the volume considers in some depth normal parenting pro-cesses, risk factors for parenting, and a variety of special circumstances related to parentingunder atypical conditions. Their developmental orientation reminds us that our emphasison understanding infant trajectories ought to be accompanied by an understanding ofparents’ trajectories. For clinicians, the psychological origins of parenting, and the myriadfactors that influence their development over time, are critically important topics.Investigators will find the reviews of special topics both interesting and stimulating withregard to questions that need to be addressed, and thus they can guide future research.

The sober assessment of children’s mental health needs that followed the second WorldWar and inspired Bowlby’s illuminating vision has given way to even more complexitiesand challenges in the 21st century. Good enough parenting has never seemed more difficultnor more important. This volume promises to enhance our understanding of all that weknow and all that we need to learn about this most vital human endeavor.

Charles H. ZeanahJanuary 2010

References

1. Bowlby, J. (1951) Maternal Care and Mental Health, The World Health Organization:

Monograph Series, WHO Geneva.

2. Harris, J. R. (1998) The Nurture Assumption: Why Children Turn Out the Way They Do

Bloomsbury Publishing PLC, London.

xx FOREWORD

Page 23: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

List of contributors

Adil AkramDivision of Mental Health

St George’s University of London

Cranmer Terrace

London SW 17 ORE, UK

Massimo AmmanitiDepartment of Dynamic and Clinical

Psychology, Faculty of Psychology 1

University of Rome, ‘Sapienza’

Via dei Marsi, 78

00185 Rome, Italy

Julio Arboleda-FlorezDepartment of Psychiatry

Queen’s University

Kingston ON K7L 3N6, Canada

Joanne BartonNorth Staffordshire Combined

Healthcare

NHS Trust Stoke-on-Trent

Staffordshire, UK

Thierry BaubetAvicenne Hopital, APHP, Paris 13 University

125, rue de Stalingrad

93009 Bobigny, (Seine-Saint Denis) France

Claire BaudryEcole de psychologie

Universite Laval

Quebec, G1K 7P4, Canada

Annie BernierDepartement de psychologie

Universite de Montreal (Quebec)

Canada

Erika L. BocknekDept. Pediatrics

LSU School of Medicine

Children’s Hospital

200 Henry Clay Ave

New Orleans, LA 70118, USA

Marc H. BornsteinChild and Family Research Program in

Developmental Neuroscience

Eunice Kennedy Shriver National Institute ofChild Health and Human Development

Suite 8030, 6705 Rockledge Drive

Bethesda MD 20892-7971, USA

Meena Cabral de MelloDepartment of Child and Adolescent

Health and Development

World Health Organization

22 Avenue Appia

Geneva, Switzerland

Prabha S. ChandraDepartment of Psychiatry

National Institute of Mental Health andNeurosciences

Hosur Road

Bangalore 560029, India

Page 24: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Elise CharlemaineHopital Port Royal

123, Boulevard de Port Royal

75104 Paris, France

Antoinette Corboz-WarneryCentre d’Etude de la Famille

Site de Cery

1008 Prilly-Lausanne, Switzerland

John CoxUniversity of Gloucestershire

58 St Stephens Rd

Cheltenham GL51 3AE, UK

Ilana CromeCoton House

St George’s Hospital

South Staffordshire and Shropshire

Healthcare NHS Foundation Trust

Corporation Street

Stafford, ST 16 3SR, UK

Geetha DesaiDepartment of Psychiatry

National Institute of Mental Healthand Neurosciences

Hosur Road

Bangalore 560029, India

Zivanit ErgazThe Department of Anatomy and Cell

Biology

The Institute of Medical Sciences,Faculty of Medicine

P.O.B. 12272, Jerusalem 91120, Israel

Jane FisherCentre for Women’s Health, Gender and

Society

Melbourne School of PopulationHealth

University of Melbourne

Carlton, Victoria 3010, Australia

Sheehan D. FisherDepartment of Psychology

E11 Seashore Hall

The University of Iowa

Iowa City, IA 52242, USA

Hiram E. FitzgeraldPsychology Kellogg Center

Michigan State University

East Lansing

MI 48824, USA

Elisabeth Fivaz-DepeursingeCentre d’Etude de la Famille

Site de Cery

1008 Prilly-Lausanne, Switzerland

France FrascaroloCentre d’Etude de la Famille

Site de Cery

1008 Prilly-Lausanne, Switzerland

Micheline GarelINSERM

Epidemiological Research Unit onPerinatal and Women’s Health

Villejuif, F-94807, France

Yvon GauthierHopital Sainte Justine

Department of Psychiatry

3175 Cote Ste Catherine

Montreal (Quebec) H3T 1C5, Canada

Catherine GrandsardUniversite Paris VIII

Centre Georges Devereux

98 Bd de Sebastopol

75003 Paris, France

Antoine GuedeneyHopital Bichat Claude Bernard APHP

CMP Binet, 64 rue Rene Binet

75018 Paris, France

xxii LIST OF CONTRIBUTORS

Page 25: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Carol HenshawFaculty of HealthStaffordshire UniversityBrindley BuildingLeek RdStoke on Trent, ST4 2DF, UK

Helen HerrmanORYGEN Youth Health Research CentreCentre for Youth Mental HealthThe University of MelbourneParkville, Victoria, 3052, Australia

Kathryn HollinsPerinatal and Parent-Infant Mental

Health ServiceChelsea and Westminster Hospital369 Fulham Road, LondonSW10 9NH, UK

Sheila HollinsDivision of Mental HealthSt George’s University of LondonLevel 6 Hunter WingCranmer TerraceLondon, SW17 0RE, UK

Palvi KaukonenDepartment of Child PsychiatryTampere University and University

HospitalPo Box 200033521 Tampere, Finland

Miri KerenTel Aviv UniversityGeha Mental Health CenterHelsinky str. 1.P.O.B. 102Petach Tikvah 49100, Israel

Simon LaroseDepartement d’etudes sur l’enseignement

et l’apprentissageUniversite LavalQuebec, G1K 7P4, Canada

Brigitte MartinProgramme de psychiatrie,

neurodeveloppement et genetiqueCHU Ste-Justine3100 EllendaleMontreal, QC H3S 1W3, Canada

James P. McHaleDepartment PsychologyUniversity of South FloridaSt. Petersburg140 Seventh Ave. S.St. Petersburg Fl 33701, USA

Barbara G. MelamedSchool of Social and Behavioral SciencesMercy College555 BroadwayDobbs FerryNew York 10522, USA

Sylvain MissonnierL’Institut de PsychologieUniversite Paris Descartes71, avenue Edouard Vaillant92774 Boulogne Billancourt, France

Caroline MoisanEcole de psychologieUniversite LavalQuebec, G1K 7P4, Canada

Marie Rose MoroAvicenne Hopital, APHP, Paris 13University125, rue de Stalingrad93009 Bobigny, (Seine-Saint Denis) France

Michael W. O’HaraDepartment of PsychologyE11 Seashore HallThe University of IowaIowa City, IA 52242, USA

Asher OrnoyDepartment of Anatomy and Cell BiologyThe Institute of Medical Sciences,

Faculty of MedicineP.O.B. 12272, Jerusalem 91120, Israel

LIST OF CONTRIBUTORS xxiii

Page 26: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Howard J. OsofskyDepartment PediatricsLSU School of MedicineChildren’s Hospital200 Henry Clay AveNew Orleans, LA 70118, USA

Joy D. OsofskyDepartment PediatricsLSU School of MedicineChildren’s Hospital200 Henry Clay AveNew Orleans, LA 70118, USA

Campbell PaulRoyal Children’s HospitalFlemington RoadParkville, Victoria, 3052Melbourne, Australia

Kaija PuuraDepartment of Child PsychiatryTampere University and University HospitalPo Box 200033521 Tampere, Finland

Atif RahmanUniversity of LiverpoolChild Mental Health UnitAlder Hey Children’s NHS

Foundation TrustLiverpool L12 2AP, UK

Joan Raphael-LeffAcademic Faculty for Psychoanalytic

ResearchUCL/Anna Freud CentreLondon, UK

Dalila RezzougAvicenne Hopital, APHP, Paris 13University125, rue de Stalingrad93009 Bobigny, (Seine-Saint Denis) France

Fanie RoyEcole de psychologieUniversite LavalQuebec, G1K 7P4, Canada

Veena A. SatyanarayanaDepartment of PsychiatryEpidemiology and Prevention Research

GroupWashington University School of MedicineSt Louis, USA

Myriam SzejerHopital Antoine Beclere157 rue de la Porte de Trivaux92161 Clamart cedex, France

Martin St-AndreProgramme de psychiatrie,

neurodeveloppement et genetiqueCHU Saint-Justine3100 EllendaleMontreal, QC H3S 1W3, Canada

Olivier TaıebAvicenne Hopital, APHP, Paris 13 University125, rue de Stalingrad93009 Bobigny, (Seine-Saint Denis) France

Renata TambelliDepartment of Dynamic and Clinical

Psychology, Faculty of Psychology 1University of Rome, ‘Sapienza’Via dei Marsi, 7800185 Rome, Italy

George TarabulsyEcole de PsychologiePavillon Felix-Antoine-Savard, local 1210Universite LavalQuebec, G1K 7P4, Canada

Susana TerenoHopital Bichat Claude Bernard APHPCMP Binet, 64 rue Rene Binet75018 Paris, France

Frances Thomson SaloThe Royal Children’s HospitalFlemington RoadParkvilleVictoria 3052, Australia

xxiv LIST OF CONTRIBUTORS

Page 27: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Mark TomlinsonDepartment of PsychologyStellenbosch UniversityPrivate Bag X1Matieland, 7602, South Africa

Magdalen TooleChild and Family Research Program in

Developmental NeuroscienceEunice Kennedy Shriver National Institute of

Child Health and Human DevelopmentSuite 8030, 6705 Rockledge DriveBethesda MD 20892-7971, USA

Sam TyanoTel-Aviv University, Sackler School of

MedicineP.O.B. 65352Ramut Aviv Gimel, Israel

Olga B.A. van den AkkerSchool of Health & Social SciencesMiddlesex UniversityThe Town HallThe BurroughsHendon, London MW4 4BT, UK

Deborah WeatherstonMichigan Association for Infant Mental

Health13101 Allen RoadSouthgateMichigan 48195, USA

Jean-Victor P. WittenbergThe Hospital for Sick Children555 University AvenueToronto, Ontario, M5G 1X8,Canada

Stella WoodwardCardiff University Medical

SchoolHeath ParkCardiffCF14 4XN, UK

Nathalie ZajdeUniversite Paris VIIICentre Georges-Devereux98 Bd de Sebastopol75003, Paris, France

LIST OF CONTRIBUTORS xxv

Page 28: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

World Psychiatric Association Evidence and Experiencein Psychiatry Series

Series Editor: Helen Herrman, WPA Secretary for Publications, University of Melbourne, Australia

The Evidence & Experience in Psychiatry series, launched in 1999, offers unique insights into both investigation and

practice in mental health. Developed and commissioned by the World Psychiatric Association, the books address

controversial issues in clinical psychiatry and integrate research evidence and clinical experience to provide a stimulating

overview of the field.

Focused on common psychiatric disorders, each volume follows the same format: systematic review of the available

research evidence followed by multiple commentaries written by clinicians of different orientations and from different

countries. Each includes coverage of diagnosis, management, pharma and psycho- therapies, and social and economic

issues. The series provides insights that will prove invaluable to psychiatrists, psychologists, mental health nurses and

policy makers.

Depressive Disorders, 3e

Edited by Helen Herrman, Mario Maj and Norman Sartorius

ISBN: 9780470987209

Substance Abuse

Edited by Hamid Ghodse, Helen Herrman, Mario Maj and Norman Sartorius

ISBN: 9780470745106

Trauma and Mental Health: Resilience and Post-Traumatic Stress Disorders

Edited by Dan J Stein, Matthew J Friedman and Carlos Blanco

ISBN: 9780470688977

Schizophrenia 2e

Edited by Mario Maj, Norman Sartorius

ISBN: 9780470849644

Dementia 2e

Edited by Mario Maj, Norman Sartorius

ISBN: 9780470849637

Obsessive-Compulsive Disorders 2e

Edited by Mario Maj, Norman Sartorius, Ahmed Okasha, Joseph Zohar

ISBN: 9780470849668

Bipolar Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan Jose Lopez-Ibor, Norman Sartorius

ISBN: 9780471560371

Eating Disorders

Edited by Mario Maj, Kathrine Halmi, Juan Jose Lopez-Ibor, Norman Sartorius

ISBN: 9780470848654

Phobias

Edited by Mario Maj, Hagop S Akiskal, Juan Jose Lopez-Ibor, Ahmed Okasha

ISBN: 9780470858332

Personality Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan E Mezzich

ISBN: 9780470090367

Somatoform Disorders

Edited by Mario Maj, Hagop S Akiskal, Juan E Mezzich, Ahmed Okasha

ISBN: 9780470016121

Page 29: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

Other World Psychiatric Association titles

Series Editor (2005– ): Helen Herrman, WPA Secretary for Publications, University of Melbourne, Australia

Special Populations

The Mental Health of Children and Adolescents: an area of global neglect

Edited by Helmut Remschmidt, Barry Nurcombe, Myron L. Belfer, Norman Sartorius and Ahmed Okasha

ISBN: 9780470512456

Contemporary Topics in Women’s Mental Health: global perspectives in a changing society

Edited by Prabha S. Chandra, Helen Herrman, Marianne Kastrup, Marta Rondon, Unaiza Niaz, Ahmed Okasha,

Jane Fisher

ISBN: 9780470754115

Families and Mental Disorders

Edited by Norman Sartorius, Julian Leff, Juan Jose Lopez-Ibor, Mario Maj, Ahmed Okasha

ISBN: 9780470023822

Disasters and Mental Health

Edited by Juan Jose Lopez-Ibor, George Christodoulou, Mario Maj, Norman Sartorius, Ahmed Okasha

ISBN: 9780470021231

Approaches to Practice and Research

Religion and Psychiatry: beyond boundaries

Edited by Peter J Verhagen, Herman M van Praag, Juan Jose Lopez-Ibor, John Cox, Driss Moussaoui

ISBN: 9780470694718

Psychiatric Diagnosis: challenges and prospects

Edited by Ihsan M. Salloum and Juan E. Mezzich

ISBN: 9780470725696

Recovery in Mental Health: reshaping scientific and clinical responsibilities

By Michaela Amering and Margit Schmolke

ISBN: 9780470997963

Handbook of Service User Involvement in Mental Health Research

Edited by Jan Wallcraft, Beate Schrank and Michaela Amering

ISBN: 9780470997956

Psychiatrists and Traditional Healers: unwitting partners in global mental health

Edited by Mario Incayawar, Ronald Wintrob and Lise Bouchard

ISBN: 9780470516836

Psychiatric Diagnosis and Classification

Edited by Mario Maj, Wolfgang Gaebel, Juan Jose Lopez-Ibor, Norman Sartorius

ISBN: 9780471496816

Psychiatry in Society

Edited by Norman Sartorius, Wolfgang Gaebel, Juan Jose Lopez-Ibor, Mario Maj

ISBN: 9780471496823

Psychiatry as a Neuroscience

Edited by Juan Jose Lopez-Ibor, Wolfgang Gaebel, Mario Maj, Norman Sartorius

ISBN: 9780471496564

Early Detection and Management of Mental Disorders

Edited by Mario Maj, Juan Jose Lopez-Ibor, Norman Sartorius, Mitsumoto Sato, Ahmed Okasha

ISBN: 9780470010839

Also available in electronic editions only, through Wiley Online Library:

WPA Anthology of Italian Language Psychiatric Texts

WPA Anthology of Spanish Language Psychiatric Texts

WPA Anthology of French Language Psychiatric Texts

Page 30: Parenthood and Mental Health · Parenthood and Mental Health A Bridge between Infant and Adult Psychiatry Sam Tyano Professor Emeritus of Child and Adolescent Psychiatry, Tel Aviv

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