Serious illness can be a tricky thing to explain to children at the best of times. While it’s relatively easy for them to understand physical pain or injury, how do you explain mental illness to children?
At the end of 2013 my husband was diagnosed with bipolar disorder and severe anxiety. We’d been together for more than eleven years and had two children: a daughter then aged four and a half, and a son who was about to turn two. The diagnosis was a surprise to both of us; although he’d had occasional periods of depression, he was generally a happy and enthusiastic man who took care of me when my own mental health wasn’t great. (I have cyclothymia and suffered with severe post-natal depression after the births of both children; thanks to medication and an outstanding GP I’m well these days).
It soon became clear that not only was the diagnosis correct but that it was long overdue. What my husband and I had innocently thought were long periods of normality interspersed with depression turned out to be periods of hypomania interspersed with depression. It was all so obvious once we knew what to look for.
Bipolar disorder can be hard to live with, both for the person with it and their family. Previously known as manic depression it causes the individual’s mood to swing unpredictably between highs and lows. The highs are known as mania and are often characterised by very energetic behaviour, enthusiasm, and sometimes impatience.
The lows of course are depression and cause feelings of sadness, worthlessness, worry and extreme tiredness. While medication and psychiatric support can lessen the effects (so the highs are less high, the lows aren’t so low and hopefully the periods in between are longer!) it’s still a difficult illness to live with. The anxiety doesn’t help; my husband often feels uncomfortable in crowds or social situations, and rarely leaves the flat without me.
Don’t get me wrong – my husband is a kind, loving man and a fantastic father. But mental illness isn’t something that’s easy to talk about in our society. There’s a stigma attached to it that simply isn’t there where physical ailments are concerned, and this can isolate not just the person with the illness but also their family. My husband and I used to be very open about our health issues; until, that is, a ‘friend’ who hadn’t seen us since before the children were born reported us to the NSPCC as unfit parents, solely because we both have a mental health diagnosis. Naturally Children’s Services investigated and cleared us fully, but for a long time we felt unable to talk to anyone outside the NHS or our immediate family.
Now that our children are older (they’re 6 and 3.5) they’re more aware that their dad isn’t like other dads and have begun asking questions. Why is Daddy sad? Why is Daddy still asleep? Why does Daddy have so many headaches? We’ve discussed these and many more questions several times now, and I’d like to share several key things to remember when explaining mental illness to children.
First of all, keep it simple and age-appropriate. This may seem obvious but it’s surprisingly difficult! When talking to our six year old we’ve explained that part of Daddy’s brain doesn’t work properly, and so sometimes he gets sad or cross even if he doesn’t want to be. Our three year old understands that sometimes Daddy has sad days when he sleeps a lot. They both understand that Daddy takes special medicine to help his brain work better.
Be honest. You don’t have to be explicit or even detailed about the illness and its effects, but do tell the truth (again, in an age-appropriate way). Children are very good at detecting when an adult is covering something up, and they need to know that you will be open and honest with them.
Reassure them that the illness isn’t their fault. For young children especially, the world revolves around them and the way that adults behave is, in their mind, directly related to their behaviour and feelings. Explain that they are not responsible for how the person with the illness feels or behaves.
Make sure that the child understands that it’s not their job to look after the ill person either. There’s a very fine line between a child being aware and understanding of an adult’s illness, and trying to protect and care for them. I’ve made it very clear to our children that looking after Daddy is my job, not theirs. That’s not to say that they can’t be considerate (no bouncing on Daddy when he’s having a sad day!) but you need to be firm that their only job is to be a child.
Can Daddy’s brain be fixed? This is the question I find the hardest to answer. Sometimes mental illness is curable and sometimes it’s merely manageable; bipolar disorder falls into the latter category. Again, be honest: if it’s possible that the person will recover, say so but explain that it may take time. If the illness is only manageable, explain that too but try to emphasise that that’s ok.
Let the child know that you’re always there for them to talk to and that they can always ask questions. If the person with the illness agrees, remind the child they they can talk to them as well. As the child gets older they will think of more questions and be able to understand more, so be prepared to have conversations about mental illness every now and again.
If your child attends school, consider making their teacher or keyworker aware of their relationship with the ill person. When my husband has a prolonged period of depression our daughter feels it keenly, and if she should become upset or behave out of character at school it’s reassuring to know that an adult there will understand why and be able to help her.
Above all, be calm, honest and reassuring, and then carry on as normal.