PARENTAL MENTAL ILLNESS AND ITS COVERAGE PATTERNS IN PRINT
MEDIA: A CONTENT ANALYSIS
A Project
Presented to the faculty of the Department of Social Work
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
by
Alysia Marie Dellaserra
SPRING
2014
PARENTAL MENTAL ILLNESS AND ITS COVERAGE PATTERNS IN PRINT
MEDIA: A CONTENT ANALYSIS
A Project
by
Alysia Marie Dellaserra
Approved by:
__________________________, Committee Chair
Jude Antonyappan, Ph.D
____________________________
Date
ii
Student: Alysia Marie Dellaserra
I certify that this student has met the requirements for format contained in the University
format manual, and that this project is suitable for shelving in the Library and credit is to
be awarded for the project.
__________________________, Graduate Coordinator
Dale Russell, Ed.D., LCSW
Division of Social Work
iii
___________________
Date
Abstract
of
PARENTAL MENTAL ILLNESS AND ITS COVERAGE PATTERNS IN PRINT
MEDIA: A CONTENT ANALYSIS
by
Alysia Marie Dellaserra
This study examined the extent to which the news coverage of parental mental illness is
bias free, and if print media’s portrayal of parental mental illness indicates a pattern of
disempowerment of parents’ capacity to parent.
Using a content analysis method
featuring fifty articles focusing on parental mental health within the text of two major
newspapers during the period of 2001-2011 were used as cases for the content analysis.
The study examined the experiences and challenges of mentally ill parents, as presented
in the print media. Study results did not indicate conclusively that the print media
participated in stereotypical portrayals of the mentally ill in general and parents living
with mental illness in particular. In fact, 96.9% of the print media articles analyzed for
this study did not contain any indicators of a hostile attitude or approach to presenting the
details pertaining to parents living with mental illness. However, 11.8% of the articles
presented the details about the cases in ways that were harmful to the mental health
community. More articles focused on women with mental illnesses than men. The
articles the researcher used had many components to them.
Socioeconomic status,
criminal history, whether or not the individual had health insurance, education, religious
affiliation, and custody arrangements regarding the children were covered in very few
iv
articles. It is crucial to note that only 15.7% of the articles mentioned the resources
available to the mental health community, including both service utilization and
discussion of resources for the public as a whole. The trends in the identification of
factors that were presented in the news media demonstrated the fact that while the print
media did not do too much damage in reinforcing negative stigmas, they did not attempt
to depict mentally ill parents in a more positive, realistic light.
__________________________, Committee Chair
Jude Antonyappan, Ph.D.
_______________________
Date
v
ACKNOWLEDGEMENTS
The researcher would like to give a special thanks to Jude Antonyappan, Ph.D.,
the advisor of this study, for her guidance, support, and wealth of knowledge throughout
the process of completing this thesis. The researcher would also like to express gratitude
to her parents, siblings, and cohort for the unwavering encouragement they have offered
during the past two years in the Master of Social Work program.
vi
TABLE OF CONTENTS
Page
Acknowledgements……………………………………………………………………… vi
List of Tables…………………………………………………………………………….. x
List of Figures…………………………………………………………………………... xii
Chapter
1. STATEMENT OF THE PROBLEM ………………………………………………… 1
Background of the Problem .................................................................................... 2
Statement of the Research Problem……………………………………………… 5
Purpose of the Study ............................................................................................... 6
Theoretical Framework ........................................................................................... 8
Definition of Terms……………………………………………………………... 11
Assumptions.......................................................................................................... 12
Social Work Research Justification ...................................................................... 13
Study Limitations .................................................................................................. 14
2. LITERATURE REVIEW ........................................................................................... 15
The Prevalence of Mental Illness .......................................................................... 16
Stigmatization and Portrayal of Mental Illness in the Media ............................... 17
Parental Mental Illness as a Precursor for Child Abuse and Neglect…………... 19
Reported Consequences for Parents with Mental Illness………..……………… 21
Parents with Mental Illness and the Law……………………………………….. 22
Stereotypes about Mental Illness as Depicted by the Entertainment Industry….. 23
vii
Sensationalization of Incidents Related to Mental Illness .................................... 25
Policies and Procedures for Serving the Mentally Ill ........................................... 29
Custody Concerns .................................................................................... 30
Barriers to Services for Families Living with Parental Mental Illness...……….. 33
3. METHODS .................................................................................................................. 37
Study Objectives ................................................................................................... 37
Study Design ......................................................................................................... 37
Sampling Procedures ........................................................................................... 38
Data Collection Procedures................................................................................... 38
Instruments ............................................................................................................ 40
Data Analysis ........................................................................................................ 40
Protection of Human Subjects .............................................................................. 40
Limitations ........................................................................................................... 41
4. STUDY FINDINGS AND DISCUSSIONS ............................................................... 42
Overall Findings.................................................................................................... 42
Specific Findings .................................................................................................. 43
Interpretations of the Findings .............................................................................. 66
Summary ............................................................................................................... 67
5. CONCLUSION, SUMMARY, AND RECOMMENDATIONS ................................ 69
Summary of Study ................................................................................................ 69
Implications for Social Work ................................................................................ 70
Recommendations ................................................................................................. 71
viii
Limitations ............................................................................................................ 73
Conclusion ............................................................................................................ 73
References ......................................................................................................................... 75
ix
LIST OF TABLES
Tables
Page
1.
San Francisco Chronicle keywords by frequency and percentages……………...45
2.
A cross tabulation of harmfulness to the mental health community and
hostility…………………………………………………………………………. 47
3.
The association between harmfulness to the mental health community and
hostility…………………………………………………………………………. 47
4.
Opinion pieces in the selected articles………………………………………….. 50
5.
Harmfulness to the mental health community in the selected article…………... 50
6.
Information regarding care in the selected articles……………………………... 51
7.
Inclusion of mental health statistics in the selected articles……………………. 51
8.
Support system(s) mentioned in the selected articles…………………………... 53
9.
Public assistance addressed in the selected articles…………………………….. 53
10.
A history in the Child Welfare System in the selected articles………………..... 54
11.
Job status in the selected articles……………………………………………….. 54
12.
Housing situation for the family unit mentioned in the selected articles……….. 55
13.
Substance abuse in the selected articles………………………………………… 56
14.
Resources mentioned in the selected articles…………………………………… 56
15.
Relationship status of the adults mentioned in the selected articles……………. 57
16.
Whether a professional in the mental health field was quoted in the selected
articles…………………………………………………………………………... 58
17.
Hostile tone by the author in the selected articles……………………………..... 59
x
18.
The distribution of reference to diagnoses of subjects covered………………… 59
19.
Drug compliance shown by the individuals in the selected articles……………. 60
20.
Sympathetic tone expressed by the author in the selected articles……………... 60
21.
Negative tone expressed by the author in the selected articles…………………. 61
22.
Adult age of the subjects was provided in the selected articles………………… 61
23.
Hospitalizations of the subjects mentioned in the selected articles…………….. 62
24.
Relatives or friends quoted in the selected articles……………………………... 62
25.
A cross tabulation between writer hostility and mental health professionals
quoted…………………………………………………………………………… 63
26.
A cross tabulation of support systems and relatives and friends quoted in the
articles…………………………………………………………………………... 64
27.
A cross tabulation of drug compliance and prior hospitalization.…………….... 65
28.
Values and levels of significance for drug compliance and prior hospitalization
mentioned in the articles………………………………………………………... 66
xi
LIST OF FIGURES
Figures
Page
1.
The frequency of keywords in The New York Times.…………………………. 44
2.
San Francisco Chronicle keywords percentage results………………….……… 46
3.
Bar graph displaying the prevalence of mental health statistics………………... 52
4.
A pie chart showing the percentages of resources mentioned.............................. 57
xii
1
Chapter 1
STATEMENT OF THE PROBLEM
This study focused on some of the factors that impede parents with mental health
in their functioning as indicated through the content publicized in articles focusing on
parental mental health within the text of two major newspapers. Ideas the public has
about mental illness can be learned and reinforced through media coverage over time and
to the extent the public values influence policy making, it is important to study the ways
in which the media impacts the conception of the public about parental mental illness.
Certain cases involving child abuse or even child death that earn news coverage may
come with an agenda about parental mental illness. Presenting biased information about
the mentally ill has implications for their national welfare, policy on mental health
services, and for those who serve in the field of social work.
Mass media provides the public with new information daily and serves as a source
for influencing the topics its consumers reflect upon. When individuals start honing in on
a particular issue, it becomes a public opinion. The mentally ill remain a vulnerable,
often misunderstood and misrepresented population. The print media has the potential to
shape beliefs and attitudes regarding the mentally ill, and in particular, parents who suffer
from a mental illness. Many articles in print media deal with cases of child abuse,
neglect, and child mortality, but do not always deliver an accurate representation of
mental illness. According to Parrott (2010), the media has often managed to “link mental
2
illness and violence without providing accurate background and qualifying information”
(p. 1). The portrayal of mentally ill individuals is sometimes incorrect, negative, and
exaggerated.
This study is based on analyzing content directly related to parental mental illness
in The New York Times and San Francisco Chronicle across a period of ten years. The
findings from this study are important to social work practice in that it will seek to
address present gaps in mental illness education, the appropriateness of interventions, and
help determine how cases of parental mental illness as reported in the media may
reinforce stereotypes regarding the mentally ill.
Background of the Problem
In the context of understanding mental illness, this research focuses on identifying
the behaviors, needs, experiences, and challenges of mentally ill parents, as presented in
the print media. The media is often problematic when covering mental illness because of
its failure to present an accurate, unbiased account of the entire incident. Facts and
statistics can be included, but may just show one side of a story. The coverage itself can
be biased, depending on the source of the information and if the source has an agenda.
The stigma surrounding mental illness is based in large part on what we absorb
through mass media. Much of what is reported in national news is meant to encourage
readership and sales, and thus gets presented in a sensationalized way. This is a concern
because the lack of education the general public has about mental illnesses causes them to
3
see mentally ill parents as being incapable of child-rearing. Public opinions are justified
when the print media promotes damaging coverage on cases that involve child abuse or
worse at the hands of a mentally ill parent. Child welfare has a long history of being
presented this way. Stories are often depicted in a way to increase ratings or readership
by zeroing in on cases that lean towards the dramatic side. Myers (2008) stated, “The
only time child protection makes the front page or evening news is when something goes
terribly wrong: social workers fail to remove an endangered child who ends up dead, or
social workers remove the child when they should not” (p. 462).
In terms of drama, the media also determines what stories are and are not worthy
of earning attention. In their research on mothers who kills newborns, Meyer and
Oberman (2001) discussed their belief that cases which get the most exposure are
selected by the media because the women who commit these murders—often white,
attractive, and financially stable—do not fit our characterization of murderers, and thus
the case becomes more interesting. The authors state that to kill one’s child seems
“somehow understandable, if not excusable, when committed by poorer, more desperate
women, or for that matter, a woman of color” (p. 47). However, the authors’ research
shows that white women from affluent families are not “the norm” when it comes to
infanticide.
The media can also have an effect on public policies and laws with implications
for those living with mental illness. “The Court of Public Opinion” has a big role in how
cases play out in the American legal system, no matter what the outcome of a trial.
4
Constant media coverage conditions the public to have a vested interest in the decision of
the jury. Examples include the trials of Susan Smith, Casey Anthony, and Andrea Yates.
These cases were heavily discussed before, during, and long after the trials. Additionally,
the insanity defense is not used often in court, but many high-profile cases that receive
round-the-clock exposure involve it, which is perhaps part of the reason for the coverage.
Meyer and Oberman explained that when it comes to the judicial system for parent
mental illness in relation to child abuse or murder, “We as a culture remain undecided at
best, and bitterly divided at worst, about whether its focus should be to rehabilitate or
punish” (p. 58). We learn about cases through the media, and unless we do our own
additional research, we are only parroting what the media has told us we should know
and believe about the case.
The use of negative and disingenuous words in print media can create a dislike or
fear of those who are mentally ill, and evoking certain emotions will only draw in more
readers. According to Meyer and Oberman (2001), the crime of killing children,
particularly infants, is seen as either “a manifestation of illness or as a manifestation of
evil” (p. 17) or “mad or bad” (p. 69) on the part of the parent. An individual cannot be
both in this case. Of course, a parent does not have to be mentally ill in order to abuse
their child, and all parents have challenges when it comes to child-rearing, no matter what
their mental health status. However, the logic behind the “mad or bad” position tends to
apply mostly to those who have a mental illness. There is a split dichotomy: normal or
other. You either have a mental illness, or you do not.
5
Mental illness itself is a widespread social problem that has been around for a
long time. We cannot just look at it through a medical discourse if we want to ensure we
are working with a system that is designed not only to protect children, but also protect
parents and address their needs as well. Appropriate and timely interventions need to
take place. Social workers should have a bigger role in the mental health field because
they deal with social inequalities—whose factors can lead to mental health struggles—
and because medications are not a cure-all, for “in general, psychotropic medications
control the symptoms of mental illness, but do not treat the illness” (Meyer and Oberman,
2001, p. 75). People are managing having a mental illness rather than being a mental
illness. In this particular circumstance, the individuals being talked about are also
parents. Therefore, it is important to address both their mental health needs and their
parental needs, which will subsequently emphasize the well-being of their children.
In order to manage a mental illness, the right treatment must be offered. The
public has a certain view of those who are mentally ill, especially when their stories wind
up in print media. This is a problem because our societal beliefs have created a negative
impression of mental illness, which may lead to mentally ill individuals not wanting to
seek help because of the stigma.
Statement of the Research Problem
This research examines through articles spanning a ten year period, in two
national newspapers, the extent to which stereotypes are communicated to the public
6
about mental illness and the capacity to care for children. The National Association of
Social Workers calls for certain ethics and principles to be in place to maintain
professionalism, client empowerment, and to serve those in need. Among the Ethical
Principles, a social worker is required to promote welfare and social justice. The
National Association of Social Workers states in its Code of Ethics, “Social workers
strive to ensure access to needed information, services, and resources; equality of
opportunity; and meaningful participation in decision making for all people” (1996).
Social workers have an obligation to provide services to the mentally ill. Treatment is
available, but not everyone has the means to access it, and many individuals do not want
to make it known they want help because of the fear of existing stereotypes about the
mentally ill. The Mental Health Council of Australia (2005) acknowledged, “Any person
seeking mental health care runs the serious risk that his or her basic needs will be
ignored, trivialised, or neglected” (as cited in Macfarlane, 2009, p. 201). Providing
support and resources is essential to ensuring the well-being of mentally ill persons, and
also their children.
Purpose of the Study
The purpose of this study is to examine to what extent the stereotypes about
parental mental illness are reinforced in an unempowering way in the news coverage of
parental mental illness. This study seeks to determine if print media’s portrayal of mental
illness based on the analyzed content indicates a pattern of disempowerment of parents’
capacity to parent.
7
A primary benefit of conducting this study is that through the acquired research,
the researcher hopes to draw attention to indicators that can foster change in services to
families that have one or both parents living with mental illness. The author also wishes
to make recommendations for educating the public, the social work profession, and
policy makers about the need for change. Social workers, mental health professionals,
and mass media need to be further educated on the realities of parenting with a mental
illness. Mental health training should be required of all professions that interact directly
with those struggling with mental illness.
A secondary purpose of this study is to address misconceptions about mentally ill
parents that are learned through news coverage reports. Social workers have an
obligation to society and to those in their field to share knowledge and ideas. According
to Tew, “Factors such as oppression, injustice, social exclusion or abuse at the hands of
powerful others may be implicated in the sequence of events that led up to many people’s
experiences of mental or emotional breakdown (as cited in Macfarlane, 2009, p. 205).
Society itself has a role in exacerbating mental illness. Additionally, social workers can
work side-by-side with mental health professionals in some cases, rather than acquiescing
to doctors. Dallos and Boswell (1993) explain that the overall role of a social worker in
the mental health field should include “a prominent place in mental health assessment,
intervention, policy and research” (as cited in Morley, 2003, p. 75). Social workers need
to take on more of a leadership role in the mental health field.
8
Theoretical Framework
Two theories that are relevant to the above mentioned research are Crisis Theory
and the Ecosystems Perspective. Both theories served as useful frameworks by which to
understand the struggles that mentally ill parents face.
Crisis Theory
Crisis Theory seeks to explain the behavior and coping struggles of a person who
is experiencing a trauma, or is going to experience it. According to Samantrai (2004), a
state of crisis will involve “an increase in the level of tension and distress” (p. 129) when
a problem cannot be solved, wherein a state of crisis will ensue. It is a breakdown in a
person’s ability to cope. Caplan described the four stages of an individual experiencing a
crisis: 1) Initial rise of tension from the impact of an external event. 2) Feeling
increasingly upset and experiencing more tension if problem-solving attempts are not
successful. 3) While tension continues to build, other problem-solving techniques are
drawn upon. The crisis can be alleviated if the individual can implement a “reduction in
the external threat, success of new coping strategies, redefinition of the problem, or
giving up tightly held goals that are unobtainable” (as cited in Slaikeu, 1990, p. 21). 4)
So if none of the problem-solving techniques in stage 3 work, then severe emotional
disorganization will begin to set in (as cited in Slaikeu, 1990, p. 21). Emotional
disorganization centers around the individual struggling to stay connected with reality.
Disorganization involves a “general feeling of bewilderment, helplessness, anxiety,
9
desperation and sometimes apathy, often accompanied by a state of cognitive confusion”
(Samantrai, 2004, p. 129).
Crisis Theory is relevant to this research on the coverage of parental mental
illness because parents who have harmed their children may be in a state of distress if the
crisis they were experiencing could not be mitigated quickly enough. If an intervention
takes place in a timely manner, the individual or family can be helped in a way that will
return them to their level of functioning before the crisis set in. O’Hagan (1986) stated
that “the need for crisis intervention by social workers has never been greater” (p. 138)
and the goals of such an intervention are “to replace blind ugly passion with
enlightenment and tolerance, chaos and panic with order and safety, helplessness and
despair with a sense of hope” (p. 142). Research done by Strickler and Bonnefil (1974)
added that “crisis is not in itself, then, an illness although some individuals with chronic
and severe characterological problems may of course be more prone to crisis than others”
(p. 36). Individuals who have a mental illness may already struggle with a diminished
functioning when it comes to how they are coping with their feelings on a daily basis.
Ecosystems Perspective
The Ecosystems Perspective is a framework designed to understand individuals
and families in an environmental context. There are layers to a person’s environment. In
order to understand an individual, both the person and the environment they live in need
to be assessed. In social work practice, applying an ecological approach is best
10
understood by looking at persons, families, cultures, communities, and policies. This is
used to identify and intervene upon strengths and weaknesses between these systems.
Germain and Gitterman (1980) added that the Ecosystems Perspective “focuses on the
degree of person environment fit and on the reciprocal exchanges (transactions) between
people and environments, which either support or inhibit the striving for adaptedness” (as
cited in Wakefield, 1996, p. 3).
Factors often not considered in covering cases involving mentally ill parents that
are relevant to Ecosystems Perspective include: racism, poverty, patriarchy, isolation, and
cultural dynamics. Mental illness is designed to be oppressive by nature. When it comes
to mental health, “the role of social experiences and environmental factors is denied”
(Morley, 2003, p. 70). Morley (2003) argued there is an implication in social work
literature that “medical labels cannot be objective descriptions of biochemical imbalance,
but are socially constructed” (p. 72). Not every client–in particularly those with mental
illnesses–can be treated in the same way. Meyer and Oberman (2001) also cited
language barriers and cultural differences as things that can influence an altered mental
state (p. 90). In connection to Crisis Theory, crises can come about because individuals
may not have many external resources available to help them. Each person will respond
to a crisis differently, and a lack of resources and services will negatively impact a crisis
in an individual or family. Puleo and McGlothlin (2009) added, “The person in crisis
will experience the crisis differently than someone else due to the unique and personal
ecological determinants” (p. 5). McCubbin and Patterson (1992) explained:
11
When resources are adequate to meet the demands created by a stressor
situation, the situation is less likely to be perceived as problematic—and
less likely to lead to crisis. Two types of resources are important: those
that are available and used to mediate the initial stressor and those that are
acquired, developed, or strengthened subsequent to a crisis situation. (as
cited in Puleo & McGlothlin, 2009, p. 8)
An Ecosystems Perspective can be used to assess what is going on in a family,
why the family is struggling, and what the strengths are in each family member. Such a
strategy can be useful in getting mental ill parents services they need.
Definition of Terms
Mental illness. Mental illness can be defined in abstract terms as an illness of the
human mind that can affect an individual’s behaviors and emotions. There are a wide
range of illnesses that are classified as mental illnesses. The term mental illness can be
operationally defined in regards to this content analysis, as how many times the word
appears throughout the collected articles as a single word or phrase, and how often the
word is used in a context that supports the researcher’s hypothesis. The word will also be
analyzed for how it relates to parenting capacity.
Child abuse/neglect. The abstract definition of child abuse and neglect can be
defined as the mistreatment of a minor child in regards to behaviors that involve physical
harm or disregard for the child’s safety and well-being. In extreme cases of serious harm
12
or neglect, child mortality may occur. For the purposes of this study, the operational
definition of child neglect/abuse will involve the words abuse and neglect being tracked
for frequency in relevance to children who have one or more mentally ill parents.
Postpartum Depression. The abstract definition of postpartum depression is a
woman who feels depressed after she has given birth, or up to a year after she has given
birth. This depression can vary in terms of severity. The term postpartum depression can
be operationally defined as how many times the word appears throughout the collected
articles as a single word or phrase. The word will be analyzed for how it relates to
parenting capacity.
Depression. The abstract definition of depression is to feel hopeless or upset for
an extended period of time. Although depression may be due to situational factors, the
longer it continues, the more likely it is to become a serious medical concern. The term
can be operationally defined in regards to this content analysis, as how many times the
word appears throughout the collected articles as a single word or phrase, and how often
the word is used in a context that supports the author’s hypothesis. The word will be
analyzed for how it relates to parental mental illness and parenting capacity.
Assumptions
The examination of biases toward mental illness and parenting while living with
mental illness can be adequately captured through the content analysis of the news
13
articles from national newspapers that have a large audience. The main assumptions
based on this study are the following:
1) Print news does not do an adequate job of realistically portraying mental
illnesses, particularly individuals with a mental illness who also happen to be
parents.
2) Parents who harm their children are seen as either “mad or bad,” or even
inhuman.
3) The media focuses on cases they deem to be “noteworthy,” and these cases
and the individuals in them are subsequently sensationalized. Child welfare
cases tend to be featured in the newspaper when the situation is grim.
4) Men and women who are parenting with mental illnesses are portrayed
differently in print media, and the public reaction to mentally ill men and
women in regards to being a parent is seen as different.
5) The print media’s portrayal of mental illness based on the content analyzed
indicates a pattern of disempowerment of parents’ capacity to parent.
Social Work Research Justification
This research is important to the social work profession and the individuals it
serves because its findings can be used to advocate for better mental health services. The
findings will also be useful to the general public because the results of the data collected
14
and analyzed could help erase stereotypes that the public has about the mentally ill, and
alleviate concerns and fears surrounding mental illness. The findings can also put
pressure on print media and other forms of mass media to portray mentally ill parents
more realistically and positively.
Most importantly, because this study is a content analysis, it does not directly
affect anyone being studied and no one is at risk of having their privacy invaded. The
researcher analyzed the content in the articles with caution and objectivity.
Study Limitations
This study used a content analysis method, and therefore it is only focusing on
forms of communication that have already been recorded. The means of recorded
communication involved researching only written communication, in this case, print
media. Additionally, the collected data is coming from just two newspapers. Comparing
more newspapers, or different ones than The New York Times and San Francisco
Chronicle might yield different findings. Rubin and Babbie (2005) mentioned that both
validity and reliability problems can occur while conducting a content analysis study (p.
482). The external validity of the findings is limited. Furthermore, although this
researcher produced important findings that relate to how mental illness can be more
realistically and positively portrayed in print media, this study only analyzed 50 articles,
which is a small sample, thus limiting the extent of generalization.
15
Chapter 2
LITERATURE REVIEW
This literature review presents the findings of research studies and national
reports on the impact of parental mental illness and its difficulties on children in
the context of policies, programs, media portrayal of mental illness, and services
to address the same. In addition to the above-mentioned existing literature,
certain cases involving child abuse and mortality were reviewed to identify any
patterns or intentions when reporting about parents’ mental illness commensurate
with the themes of the literature review. This literature review aims to examine
the existing gaps in mental illness education and address how noteworthy cases
tend to be presented and reinforced in the media. The relevant themes in this
literature review include: the prevalence of mental illness, mental illness as a
precursor for child abuse and neglect, the consequences of having a mental
illness, and the stereotyping and sensationalizing of mental illness through mass
media.
Mental illness can have a strong impact on parental capability in raising
children. For the purposes of this research, the formal definition of mental illness
is defined by the National Alliance on Mental Illnesses as a “medical condition
that disrupts a person’s thinking, feeling, mood, ability to relate to others and
daily functioning…often result in a diminished capacity for coping with the
16
ordinary demands of life” (NAMI, 2013). Bipolar Disorder, Major Depressive Disorder,
Schizophrenia, and Postpartum Depression/Psychosis are discussed extensively in
existing literature. However, studies done on mental health problems due to situational
and environmental stressors are scant in existing literature. This literature review is
organized into the following themes.
The Prevalence of Mental Illness
Precise data on the prevalence of individuals who parent while living with mental
illness is not available. However, the frequency of mental illness is widespread with one
in four adults experiencing a mental health disorder in any given year (NIMH, 2013).
The National Institute of Mental Health states that 5.7 million American adults are living
with Bipolar Disorder and 14.8 million American adults are affected with Major
Depressive Disorder (NIMH, 2013). In a study that screened ten thousand women who
were four to six weeks postpartum, Wisner et al. (2013) determined that one in seven
postpartum women experienced depression within a year after giving birth. This was the
largest postpartum screening ever conducted. The most common primary diagnosis for
screened women was 68.5% for unipolar depressive disorder, and 22.6% presented with
Bipolar Disorder (Wisner et al., 2013, p. 490).
A survey conducted by Bassani et al. estimated that “12% of children under the
age of twelve live in a home with a parent who has a mood disorder, anxiety disorder, or
substance disorder” (as cited in Harstone & Charles, 2012, p. 15). Another survey done
17
in British Columbia indicated that 35% of adults who sought mental health services
reported having children (as cited in Harstone & Charles, 2012, p. 15). Harstone and
Charles (2012) presented a realistic interpretation of the stressors of living with a mental
illness, but did emphasize that there are benefits for children who grow up in a home with
one or more parents living with a mental illness. Abraham and Stein’s study, “When
Mom has a Mental Illness: Role Reversal and Psychological Adjustment Among
Emerging Adults,” and Meenakshi Venkataraman’s “Parenting Among Mothers With
Bipolar Disorder: Children’s Perspectives” (2011) presented some interesting findings,
but fathers were not included in their research. In fact, Nicholson et al. (2001) explained
in “Critical Issues for Parents with Mental Illness and Their Families” that most of what
we have learned about parents with mental illness is the result of research with small
samples of mothers, many of whom are poor and ethnic minorities (p. i). The body of
literature on mothers who are parenting with a mental illness is only growing, but the
same cannot be said for fathers. This may be due in part to the fact that mothers are more
likely to be considered the primary caretaker. While the experiences of parents with
mental illness can be similar to those of all parents in some ways, the literature has
emphasized their unique circumstances and, more commonly, their deficits and failures.
Stigmatization and Portrayal of Mental Illness in the Media
Mental illnesses come with a stigma that has yet to ebb, despite scientific
advances that have helped create a better understanding of genetic and
18
psychological factors that contribute to certain medical conditions. Having a mental
illness is recognized as a sign of weakness, and to be in possession of undesirable
attributes. Pescosolido et al. (2010) shared that a common stereotype is that people
believe mental illness “is brought about by a person’s action or inaction or are due to
moral character flaws” (as cited in Collins et al., 2012, p. 3).
False beliefs and prejudices circulate around mental illnesses, to some extent
because of mass media and entertainment stigmatization that will be addressed later: a
person with a mental illness is often characterized as violent, unpredictable, and resistant
to treatment. Such characterizations do not sound attractive when put next to the label of
“parent.” However, Cohler (1987) explained, “There is no reason to assume that parental
mental illness will necessarily lead to low levels of psychosocial functioning, or that
children will necessarily be unable to cope with problems that may result from living
with a mentally ill parent” (as cited in Harstone & Charles, 2012, p. 15).
Individuals with mental health struggles have both positive and negative
experiences with parenting. The scholarly articles reviewed for this study have been
careful to mention that having a mental illness does not automatically mean one is a poor
parent. Venkataraman (2011) conducted a series of face-to-face interviews with four
children from three different families who were growing up with a bipolar mother. The
children—who ranged between the ages 10 and 15—identified enough similar statements
about their mentally ill mothers that Venkataraman was able to compile her research into
19
five positive themes: “being helpful, providing for their wants, having a good
sense of humor, setting good limits, and being available whenever they need
them” (Venkataraman, 2011, p. 97). Overall, the children who participated rated
their mothers as good parents and valued their relationship with them. Ostman
(2008) also conducted interviews with eight children between 10 and 18, and the
participants reported that they “gained maturity because of handling difficult
situations” (as cited in Venkataraman, 2011, p. 96). Additionally, Harstone and
Charles (2012) mentioned that some of their study participants “believe that
having compassion and empathy as a child was a strength” (p. 22). Thus the
stigmatization associated with mental illness is largely due to ignorance that fails
to acknowledge the possibilities for living healthy and productive lives even with
the presence of mental health issues while discharging complex roles as parents.
Parental Mental Illness as a Precursor for Child Abuse and Neglect
There are few studies that have explored the experiences of the adult offspring of
parents who have mental illnesses. Harstone and Charles’s (2012) findings lend
themselves to more negative findings than positive ones, though the experiences of the
participants are subjective. The negative factors presented in their research included
children having to deal with physical and emotional abuse, not feeling safe, experiencing
a lack of control over life circumstances, having to take on the role of a caregiver and
more responsibilities, and feeling isolated due to having to “frequently experience
20
unpredictability and chaos at home” (p. 16). All six study participants spoke about the
unpredictability in particular. The concept of “parentified children” (Charles, Stainton &
Marshall, 2009) is mentioned in the literature, meaning that because demands and
pressures are placed upon the child of a parent who is not well, a role reversal takes
place, and the child must serve as a support for the parent and acquiesce to the needs of
the parent (as cited in Harstone & Charles, 2012, p. 17). A study done by Abraham and
Stein (2013) in questionnaire form also spoke of the parent-child role reversal, but there
was no association between maternal mental illness and lower levels of psychological
well-being for the adult child (p. 610).
Although children of those who are mentally ill may face challenges some of their
peers do not, there is no convincing evidence for the indication that the mental illness of
parents will inevitably leave their children emotionally unstable or unable to cope with
life’s difficulties. Positive outcomes for children who have a mentally ill parent is a
possibility, but more research needs to be conducted on the emerging adult children of
mentally ill parents. These children’s struggles in their youth do not automatically imply
they will be troubled adults, but Harstone and Charles (2012) revealed that “current
discussion continues to portray children of parents with mental illness as victims who are
unable to contribute to shaping their own lives” (p. 24). It should be noted that these
children’s perspectives, while valuable, only involved a small number of participants.
Gladstone, Boydell, and McKeever (2006) commented that “parental mental illness may
be experienced in different ways by individual children” (as cited in Harstone & Charles,
21
2012, p. 17). Each parent and child relationship is different. Large-scale descriptive data
are not available at this current time.
Reported Consequences for Parents with Mental Illness
There is a huge gap in current literature in that “although a significant
amount of research and program development has been devoted to the support of
families of mentally ill parents, there has been little examination of effects of
mental illness on the experiences of parents themselves” (Benders-Hadi et al.,
2012, p. 65). Though the subject has become less taboo in recent years, most
individuals do not share that they have a mental illness with just anyone, nor do
they acknowledge such information with a pride; no one wants to admit they have
a mental illness. It is safe to assume that mentally ill parents handle many of the
same challenges that parents who are not mentally ill do: they allow their children
to receive an education, and if they are married and employed, they attempt to
balance work, spousal support, and being a caregiver. However, as research
shows, parents with mental illnesses also have unique struggles and because of
these, their well-being may undermine some child rearing competencies. Some of
the symptoms of mood disorders include: drastic mood changes, feelings of
hopelessness, impulsive and reckless behavior, having problems focusing,
extreme irritability, exhaustion, and possible suicidal ideation and suicide
attempts (NIMH, 2013). It is easy to glean from just a sample of the many
22
symptoms attached to depression and mood disorders that it can be difficult to function
while living with that kind of invisible pain. If children are also present and the parent’s
mental illness is severe enough, it can certainly cause the child some of the fears and
commotion cited above. Parents with mental illnesses may be hesitant to seek help for
many reasons, but the stigma they are up against can be credited as one, given the
consequences that may come from admitting you are raising children while living with a
mental illness.
The stigma surrounding mental illness automatically lends itself to the idea that
consumers of mental health services have questionable, poor parenting skills. One
common misconception is that parents who have a mental illness are unpredictable and
violent (Corrigan & Watson, 2002, p. 17), and while being mentally ill can operate as one
of the “common risk factors for the maltreatment and neglect of children” (Webber et al.,
2011, p. 149), this is not always the case. Such stereotypes are damaging. It is evident in
situations like this, the stigmas and some of the profound realities of child-rearing the
mentally ill experience can place families in a lose-lose situation.
Parents with Mental Illness and the Law
One of the scariest consequences—and one featured prominently in existing
literature—is the possibility of having children taken away because of a parent’s mental
illness. Parents who have a mental illness are at a high risk of losing custody of their
children (Friesen et al., 2009, p. 103). Women with mental illnesses are more likely to
23
lose custody of their children than mothers who are not mentally ill (BendersHadi et al., 2013, p. 66). The results of a study done by Benders-Hadi et al.
(2013) did indicate that mothers who have a mental illness take the role of
parenting seriously, and if they lose custody of their children, a large portion of
them still play some role in helping to raise them. Women—and men—who are
mentally ill should be able to have a safe place in which they can talk about their
parenting struggles without worrying that their children will be removed from
their home or that they will be viewed as unfit parents. The flaws of the Adoption
and Safe Families Act (1997) will be addressed later, but it is worth mentioning
that five states in the United States currently list mental illness or disability as
“grounds for not providing reasonable efforts” (Hollingsworth et al., 2011, p. 154)
when it comes to a parent gaining custody of their children back.
Stereotypes About Mental Illness as Depicted by the Entertainment Industry
Stereotypes about mental illness in individuals are continually perpetuated by the
entertainment industry and the media. There is a connection between negative media
portrayals of mental illness and the public’s negative attitudes toward people with mental
health issues (Edney, 2004, p. 3). Movies like Silver Linings Playbook (Cohen, Gigliotti,
& Russell, 2012) and Girl, Interrupted (Wick, Konrad, & Mangold, 1999) have received
both positive and negative reviews for their portrayals of mood disorders, because both
contain accuracies and distortions. Girl, Interrupted, based on a 1993 memoir by
24
Susanna Kaysen, deals with a variety of mental illnesses in a psychiatric hospital, which
aids to broaden one’s mind and see past the stereotypes. Certain scenes, particularly one
where Susanna expresses confusion over her diagnosis, show that not all symptoms of
mental illness can be wrapped neatly in a box and treated accordingly. Most of the
characters in the film are not very “fleshed out” though, which proved disappointing.
Silver Linings Playbook did capture glimpses of a truthful representation of the range of
symptoms of Bipolar Disorder, but the fact that the word “crazy” (Cohen et al., 2012)
was used to describe the characters frequently throughout the film was disconcerting—
this only makes it okay to see all individuals with mood disorders as being so. During a
heated argument, one of the main characters, Tiffany, prides herself for not winding up in
a mental hospital, like her on-screen love interest, Pat, did. Again, the shame of a mental
illness and needing help in order to function revealed itself. The other concern is that Pat
was resistant to taking his medication, and it was not clear at the end of the movie if he
had resumed taking it—which fuels the stereotype that mentally ill individuals are
treatment-resistant. Although this movie had its moments of appreciated accuracy, it did
romanticize the idea of having a mental illness, and also does nothing to erase the
stereotype that people who are mentally ill are violent and aggressive.
Other depictions of mental illness are woven throughout daytime soap operas and
primetime drama shows (usually in the form of guest appearances with story arcs that are
wrapped up quickly). Signorielli (1989, cited in Diefenbach, 1997) did a study using
program samples as data and found that 72.1% of adult characters depicted as mentally ill
25
in television drama shows hurt or killed others in their screen time. A content
analysis done by Diefenbach (1997) showed that on television, mentally ill
characters were more likely to be violent criminals than the mentally ill in the
general population of the United States, and that “television portrays the mentally
ill as having a quality of personal life which is negative in value” (p. 289). Given
that these shows are fictional, they do not have to follow specific guidelines about
what it is like to live with a mental illness. Movies and television are about
entertaining their audience; they are allowed to amplify stereotypes because they
technically do not have a responsibility to accurately portray mood disorders.
Therefore, many shows that highlight mental illnesses tend to focus on the
symptoms (whether presented accurately or not) rather than treatment options and
how a mental illness can be managed.
It is important that there is a place and a platform for mental health on
television and in other forms of entertainment, but when it comes at the expense
of trying to enthrall the audience, there are concerns in place. While certain
character portrayals do much to raise mental health awareness, there are plenty
more portrayals which only serve as hindrances by perpetuating the stereotypes.
Sensationalization of Incidents Related to Mental Illness
The media’s continuing trend of depicting the mentally ill as violent and unstable
does nothing to change public perceptions about the failure of mentally ill individuals to
26
be good parents. The most pervasive factor affecting parents’ access to and participation
in mental health services is, once more, the stigma accompanying mental illness. Such a
stigma can keep some parents from seeking the help they need, particularly in cases
where they are afraid of losing custody of their children. Being labeled with a mood
disorder has become something that is seen as profoundly embarrassing and revealing of
apparent character flaws. There should be no guilt or fear in wanting to get help.
The media—in this sense print news, online content, and live news coverage—
will do whatever it takes to draw high ratings or readership. However culpable the media
is in this regard, they do seem to know exactly what it is we want: they know that
covering the shocking and the macabre gets our attention. In his 2013 book about
society’s inclinations towards morbidity, Everyone Loves a Good Train Wreck: Why We
Can’t Look Away, author Eric G. Wilson elaborated on such a notion by explaining, “We
are enamored of ruin. The deeper the darkness is, the more dazzling. Our secret and
ecstatic wish: Let it all fall down” (p. 8).
Perhaps one of the “train wreck” cases the media presented that “dazzled” us most
was that of Andrea Yates. On June 20, 2001, Yates drowned her five children—between
the ages of seven and six months—while her husband, Rusty, was at work. Originally,
Andrea was convicted of first degree murder, but in 2006 a second trial ended with a
different outcome: not guilty by reason of insanity. Andrea was transferred from prison
to a mental hospital. Existing literature does a detailed job of explaining her psychiatric
history, and reports from the media did become more accurate over time. Andrea was
27
hospitalized four times between 1999 and 2001, and suffered many suicide
attempts and ideations (Resnick, 2007, p. 148). Her mental anguish ran deep, but
her stays in psychiatric hospitals always ended in quick releases. Once she was
discharged even though she remained mute during her entire hospital stay.
Hatters-Friedman and Resnick, in their 2010 article, “Parents Who Kill: Why
They Do It,” explained that Andrea “believed that her house was bugged,
television cameras were monitoring her home, and that Satan was literally within
her. She became convinced that her children were not righteous and would
ultimately bum in hell. She believed that she needed to kill her children before
the age of accountability to save their souls” (p. 11). Killing her children was the
right thing to do, in Andrea’s mind. She was prescribed antidepressants and
antipsychotics, but did not stay on them for long. One psychiatrist even told
Andrea she could discontinue her medications (McLellan, 2006). She and her
husband decided to try and conceive another child, at his urging—their last child,
daughter Mary—even though Yates’s psychiatrist at the time advised against this,
certain that Andrea’s Postpartum Psychosis would flare up again. Mary Yates
was born in November of 2000 though, and seven months later, Andrea drowned
her children in the bathtub. Why did Rusty push for another child despite a
medical professional’s advice that they should not have more children, and why
did he leave Andrea alone with the children when he was advised not to? Did the
stigma enveloping mental illness persuade him to ignore warning signs, including
28
Andrea’s self-mutilation, delusional rants, occasional refusal to feed her children, and
catatonic state?
One positive is that Postpartum Depression and Postpartum Psychosis are now
being taken more seriously than they were at the time of Yates’ conviction. Thankfully,
not all cases end in filicide. Most do not. As for the ones who do commit murder, like
Yates, and also mothers Susan Smith and Fiona Anderson, so continues the tension when
it comes to what a mental illness can really make a person do. Resnick (2007) also
argued that the American public is skeptical when it comes to insanity defenses (p. 153).
Not as much literature exists on fathers dealing with mental illness. Tragedies
involving fathers tend to place the emphasis on cruelty and violence. Words like
“psychopath” and “narcissist” are used, but “depression” rarely is.
In the case of Josh Powell, the public was able to remove any possibility of a
mental illness; he was not viewed as a victim. His wife, Susan Powell, and the mother of
his two sons, was last seen in 2009. She was presumed dead, but public scrutiny later
turned to Josh, and the police labeled him a “person of interest.” In 2011, Josh lost
temporary custody of his two children, due to the arrest of his father for charges
voyeurism and child pornography, whom he and his sons were living with at the time.
On a visit in February of 2012 to see his sons, Powell managed to lock the child services
worker—who would be supervising the visit—out of the home. He proceeded to beat his
boys with a hatchet, and then set the house on fire; none survived. A quick Google
29
search, and one can see that Powell is described as a monster, pure evil, a
murderer, and a coward. Andrea Yates received a fair share of name-calling,
certainly, but an internet search on her produced an overwhelming amount of
comments on message boards and online articles that expressed sympathy, and
proclamations that she killed her children because she was very mentally ill.
“Mentally ill” comes up frequently in her case. In fact, many comments on
internet forums actually blame her husband for what happened to their children.
Josh did not appear to get the same “internet pass.” More research needs to be
done on the mentally ill and filicide, but for the time being, it seems that mentally
ill women are more likely to be seen as victims than mentally ill men.
Policies and Procedures for Serving the Mentally Ill
Pleading “insanity” is becoming more of a frequently used defense, and when
horrible tragedies unfold, there is reason to believe some of the public is loathsome to
such a term. Given the stigma and the fact that not everyone sees the many shades of
gray in an insanity defense, in some ways the media and society failed Andrea as well.
The National Alliance on Mental Illness has a policy platform they have created due to
what they believe is the criminalization of those who are mentally ill. The case of
Andrea Yates is an extreme one, so it is not possible to know whether or not NAMI
stands by this in regards to her as well, but generally they do favor treatment over
punishment, explaining that, “persons who have committed offenses due to states of mind
30
or behavior caused by a brain disorder require treatment, not punishment…prison or jail
is never an optimal therapeutic setting…mental health systems have an obligation to
develop and implement systems of appropriate care for individuals whose untreated brain
disorders may cause them to engage in inappropriate or criminal behaviors” (NAMI,
2013). Much needs to change in the field of mental health. There need to be stronger
ethical and legal responsibilities in place in order to provide quick, effective treatment to
those with mental illnesses.
All reports indicate that Andrea suffered from severe Postpartum Depression and
Psychosis. However, many witnesses at her trials stated that Andrea was a good mother.
It seems likely that she could have been, but when her mental illness swooped in, she was
probably very overwhelmed; her psychological problems were destroying her. Her
obvious mental illness and fragile state were not taken seriously enough. Healthcare
failed her. Why was she released from the hospital so soon each time? Why did one
psychiatrist tell her she could wean off her medications and that instead she should just
try to “think positive thoughts” (McLellan, 2006, p. 1953)? Was there ever an idea to
work with the family unit as a whole? Or both Andrea and Rusty? Were Andrea and her
husband able to afford all her medical expenses, or did the high costs make them resist
additional treatment?
Custody concerns. Even for those who have not engaged in any abuse or neglect
on behalf of their children and are managing to raise their child in a positive way, there
31
still exists the fear that seeking help for a mental illness may offer up an impression of
being an unfit parent once the individual discusses the symptoms they are dealing with.
Therefore, families may not always seek help, and without certain supports and services
in place, their parenting abilities may be affected because of the fear of some state laws
citing mental illness as a justifiable condition for losing one’s parental rights. To live in
this kind of terror must be unbearable, and to actually lose custody of one’s children
while battling a mental illness might only exacerbate the symptoms the parent is living
with and cause more harm.
Five states and the territory of Puerto Rico view parental mental illness as
potential grounds for not pursuing reunification. For example, Kentucky statute 610.127
says,
Mental illness as defined in KRS 202A.011 or mental retardation as defined in
KRS 202B.010 or other developmental disability as defined in KRS 387.510 that
places the child at substantial risk of physical or emotional injury even if the most
appropriate and available services were provided to the parent for twelve (12)
months (Friesen et al., 2009. p. 104).
Arizona, another state that can use mental illness as grounds for a parent not providing
reasonable efforts to get their child back states: “A mental illness or mental deficiency of
such magnitude that it renders the parent or guardian incapable of benefitting from the
reunification services” (Friesen et al., 2009. p. 104). Being mentally ill does not mean
32
custody rights will automatically be taken away; the problem is that the services needed
may not actually be available. A study by Hinden et al. (2006) shares some chilling
information (as cited in Friesen et al., 2009, p. 106):
A recent study of programs across the U.S. that included services to parents with a
mental illness and their respective families revealed that of fifty-three such
programs, only twenty had been specifically designed to meet the needs of these
parents. In most cases, the type of funding source—its particular mission and set
of priorities—dictated or shaped the program’s distinctive target group, eligibility
requirements, and intended outcomes. The programs’ theoretical orientations,
geographical settings, and relative comprehensiveness of outreach also varied
widely. Despite these differences, however, the programs shared an essential set
of family-centered and strengths-based services, such as flexible family case
management, parent support, education, and parent skills training. Unfortunately,
few of the programs reviewed had undergone formal evaluations from which it is
possible to generalize about their effectiveness.
Services offered to the mentally ill need to be preventative and strength-based, not
problem-focused—given that the stigma of having a mental illness is already
powerful, it would seem more beneficial to offer help that is constructive in a
positive manner. Friesen et al. (2009) argued that “decisions about child
placement, custody, or termination of parental rights should never be based solely
33
on a diagnostic label or on assumptions about the possible ramifications of a
parent’s mental illness” (p. 102).
Barriers to Services for Families Living with Parental Mental Illness
There needs to be time for comprehensive family evaluation and treatments,
patience on behalf of the service providers in regards to the efforts of a mentally ill
person to get well (if they are complying with treatment and want to reunify with their
children), and more relevant, available, and accessible services. It is also essential to
keep in mind that a mentally ill parent may have a difficult time coping if their child is
removed from their care. The symptoms they deal with on a day-to-day basis may be
amplified—services must be available to them right away. It is understandable that child
welfare agencies should want to provide services necessary to reunify children with their
families—but are they doing enough for those who are struggling with psychological
problems? Parents have the right to receive services.
When it comes to mental health, there seems to be a fine line between parental
rights and the best interests of the children. Friesen et al. (2009) stated that “parents with
mental illnesses and their families deserve a thorough assessment that takes into account
all dimensions of parent and family functioning and needs, and thus can better inform
service planning and/or legal proceedings” (p. 102).
Universal and affordable health insurance would also be a step in the right
direction. Medications for mood disorders and depression can be expensive, as can visits
34
to a psychiatrist or therapist. Even with health insurance, these things can be costly;
without health insurance, the amounts are even more debilitating. There need to be
financial resources available to clients, and other forms of support as well. Friesen et al.
(2009) suggested that “a fresh approach to designing systems and services should build
on the strengths of families by meeting their needs for safe housing, employment and
financial support, medical and mental health care, childcare, and other vital resources” (p.
110).
In addition to not having health insurance or adequate coverage, much of the
reason for not seeking medical attention goes back to the aforementioned stigma that has
latched itself on to mental illness: to be mentally ill is shameful. Social service providers
need more competent training on what mental illnesses entail. The child welfare system
should provide mandatory caseworker training related to parents with mental illness.
Perhaps some of the concerns need to be taken to policymakers. Webber et al. (2011)
shared that “rather than using a diagnosis of mental illness as the basis for terminating
parental rights, policies should be adjusted to allow for appropriate training for social
service providers” (p. 167). Services for families and children should include
opportunities to focus on strengths and enhance resiliency. The timeline for the Adoption
and Safe Family Act should be allowed to be extended if it can be proven that a mentally
ill parent is trying to get the help they need; treatment can take time. Services should also
be long-term—mood disorders come in cycles, and having supports in place would help
to keep the home environment stable. A parent who is mentally ill should not have to
35
fear what the personal cost might be of asking for help. Friesen et al. (2009) elaborated
on the issue of not having permanent resources in place:
Illnesses may wax and wane, with periods when the parent is functioning well and
other times when he or she requires greater attention and help. Or, a parent with a
mental illness may function well in one area and face challenges in another; for
example, he or she may be able to provide care for children, but have difficulty
balancing care-giving with the demands of work. Thus an instance of perceived
child neglect may stem from an inability to sustain employment, or perhaps a
consequent loss of housing, and yet be attributed to a more basic incapacity to
parent (p. 108).
Providing care for the mentally ill is essential, but it cannot just be about treating the
patient’s symptoms—the person as a whole must be treated and cared for with dignity.
More literature needs to be done on the lesser extremes of mental health, such as every
day stress and anxiety, and how these can affect child-rearing.
A significant amount of research seems to focus on how children cope with the
mental illness of a parent and what is in place to help support the family of a mentally ill
individual, but less research is focused on what can be done for the mentally ill individual
himself or herself. Portrayal of mental illness in the media and the sensationalization of
the events related to parenting while living with mental illness are studied without the
36
necessary empowering framework that can be supportive in helping individuals and
families living with mental illness to perform their roles effectively. This study will
present more descriptive information about the needs, experiences, characteristics,
challenges, and successes of those who are parenting with a mental illness.
37
Chapter 3
METHODS
Study Objectives
This chapter presents the methods used to conduct this study on the portrayal of
parental mental illness in print media to the extent as related to the disempowerment of
parenting while living with mental illness. These research methods have been organized
into the following sections: study objectives, study design, sampling procedures, data
collection procedures, instruments, data analysis, and protection of human subjects. The
content to be analyzed is published articles that focus on parental mental illness within
the text of two national newspapers, The New York Times and San Francisco Chronicle,
over a period of ten years (2001-2011). The purpose of this study is to examine the
patterns and a set of indicators in the news coverage regarding how mentally ill parents
are portrayed in print media, with the hope that such understanding can be implemented
in policies and social work practices with the mental ill population.
Study Design
This study is an exploratory content analysis, which according to Rubin and
Babbie (2005), involves “coding and tabulating the occurrences of certain forms of
content that are being communicated” (p. 471). Sampling in the case of this research
focused on key words and themes that appeared in the selected articles. The researcher
looked for newspaper articles that included coverage of parental mental illness, and
38
variables that could be used to compile a set of indicators around empowerment, parental
capacity, resources for families with parental mental illness, and the patterns of coverage
on this particular subject.
Sampling Procedures
This study involved reviewing 50 articles on reported events surrounding parental
mental illness as reported by The New York Times and San Francisco Chronicle. Articles
involving parental mental illness were considered in order for the researcher to develop a
more cohesive understanding of how newspapers portrayed mental illness. Articles were
searched for by going through the online archives of both newspapers and searching by
keywords such as: mental illness, parenting, suicidal, mental health care, children or child
deaths, mental illness stereotypes and stigmas, depressed parents, infanticide, insanity,
bipolar disorder, and postpartum depression. High profile cases where the author knew
that mental illness in direct relation to a parent was written were also searched for in the
archives. The author made sure the articles gathered were written during a ten year
period, from the years 2001 to 2011.
Data Collection Procedures
Newspaper articles were the unit of analysis in this researcher’s study, specifically
The New York Times and San Francisco Chronicle. These newspapers were selected
because of their wide circulation, and because the author felt it was important to look at
two newspapers that were not located in close proximity to one another. Criteria for
39
inclusion of specific reported cases were that the report contained information about
parental mental illness.
More specific themes emerged after the author explored articles dealing with mental
illness. The final codes that examined parental mental illness coverage in The New York
Times and San Francisco Chronicle were: whether the article was an opinion piece,
whether the article was harmful to the mental health community, whether the article
provided information on access to care or was informative, the socioeconomic status of
the individual(s) mentioned in the article, whether the article provided at least one mental
health statistic, whether any support systems were mentioned, whether the individual(s)
was on public assistance, whether the individual(s) had any history in the Child Welfare
System, whether the individual(s) had a criminal history, the job status of the
individual(s), whether the individual(s) had health insurance, the housing situation,
substance abuse, resources mentioned, relationship status of the individual(s), whether or
not the individual(s) had a college education, whether the individual(s) had a religious
affiliation, whether or not a mental health professional was quoted in the article, if the
article had a hostile tone, if a diagnosis was mentioned, if the individual(s) was
medication compliant, if the article had a sympathetic tone, if the article had a negative
tone, if the age(s) of the individual(s) mentioned in the article were provided, prior
hospitalizations, if there was any custody arrangements, and if any friends or relatives
were quoted in the article.
40
Instruments
Information was gathered by extensive studying of written content in the
aforementioned articles. A list of variables identified for the content analysis were used
to code the information contained in the reports and for the subsequent conceptual and
relational analysis. Keywords were counted manually by the researcher.
Data Analysis
Data analysis involved detailed coding of the different attributes of the events
reported and key words used repeatedly to describe parental mental illness and parental
capacity. The analysis included coding for both manifest content and latent content. The
reports selected for content analysis constituted the units of analysis for the study. Chisquare tests, cross-tabulations, and frequency tables were done using SPSS (Statistical
Package for the Social Sciences) to explore various ways in which parental mental illness
was portrayed in the print media.
Protection of Human Subjects
The author submitted a Human Subjects Protocol Application to the Sacramento
State Institutional Review Board (IRB). The application was approved as exempt. The
Human Subjects Protocol number was 13-14-029. The study was exempt because it
intended to use publicly available newspaper reports for the purposes of content analysis;
therefore exemption 45 CFR 46.101(b)(4) applied. The information for this study was
already in the public domain, so there was no breach of confidentiality. No human
41
subjects were used in this study. Individual cases would have been identified as such in
the reported articles and the researcher proceeded with utmost caution and objectivity,
and used ethical methods while analyzing the content.
Limitations
The only form of media studied for this content analysis was two newspapers. No
research subjects were used in this study due to the sensitive nature of the topic. Only
The New York Times and San Francisco Chronicle were considered, and the content was
limited to fifty total articles over a ten year period, 2001- 2011. Additional research
involving other newspapers or even different forms of mass media might have yielded
different results. The external validity of the findings is limited.
42
Chapter 4
STUDY FINDINGS AND DISCUSSIONS
This chapter discusses the findings from the data retrieved from the online
databases for both The New York Times and San Francisco Chronicle. The data set
consisted of 25 articles from each newspaper. The articles collected had to be dated
anywhere between January 1, 2001, and December 31, 2011. The text of the articles was
examined closely for specific themes, statements, patterns, and keywords when it came to
deciding which articles would be used for this study. Articles had to discuss parental
mental illness in some capacity in order to be considered. Chi-square tests and frequency
tables were used to explore the various ways that print media may communicate
stereotypes about mental illness to the public. This research sought to find out if print
media’s portrayal of mental illness based on the analyzed content indicated a pattern of
disempowerment of parents’ ability to care for their children.
Overall Findings
Based on the data and analysis conducted, the media’s portrayal of parental
mental illness was not sensationalized overall. Many of the articles presented the
information associated with cases as both factual and neutral in tone, if not sympathetic.
There were articles in both newspapers that focused more on the curative and recovery
aspects of living with a mental illness. Articles that included mental health statistics,
quotes from mental health professionals, and addressed some of the stereotypes head-on
43
helped show that the print media can be an ally to those who are parenting while living
with a mental illness. Most of the articles were not hostile in tone. However, the articles
that were found to be hostile were also found to be harmful to the mental health
community. Most articles, as the researcher assumed, focused more on women with
mental illnesses than men.
The New York Times tended to bring up the words “illness,” “stigma,” “blame,”
“violence,” and “victim” more. The findings did not show that either newspaper
appeared to be more hostile or agenda-hungry than the other, but in some instances the
San Francisco Chronicle presented as more aggressive when it came to the tone of their
stories. Examples included titles such as “State Frees Baby Killer” and a rather glib
article entitled, “And now, about Russell Yates.” Debra Saunders, who wrote the article,
“Mom Kills, NOW Blames Postpartum Depression” for the San Francisco Chronicle,
about the Andrea Yates trial and its aftermath, commented, “What is it with women who
are so busy relating to [Andrea Yates] that they feel no outrage over the fate of [child
Noah Yates] who ran for his life?” As such, Saunders’ article was one of the ones
determined to be hostile by the researcher during the coding process.
Specific Findings
The tables and figures below serve to explain the specific findings that this
researcher’s study produced. These tables reflect frequencies, and levels of significance
or insignificance as pertaining to the variables delineated for this study.
44
Figure 1 presents the frequencies of keywords the researcher selected for articles
from The New York Times. The researcher chose to focus on twelve words for both
newspaper. The keywords were selected based on their possible connection to parental
mental illness and how it is presented in the media. The words were chosen and given
numbered values in order to analyze the data: blame (1), crazy (2), evil (3), illness (4),
kill (5), murder (6), overwhelmed (7), stigma (8), stress (9), suicidal (10), victim (11),
and violence (12). The frequencies in the bar graph below show that The New York
Times used the words illness (180 times), kill (52 times), stigma (26 times), and violence
(103 times) pretty extensively in the selected articles. Of the remaining words, blame
was mentioned 9 times, crazy 2 times, evil 2 times, murder 13 times, overwhelmed 2
times, stress 17 times, suicidal 11 times, and victim 15 times.
Figure 1. The frequency of keywords in The New York Times.
45
Table 1 presents the frequency of keywords, this time pertaining to the San
Francisco Chronicle. The words were given the same numbers that they were for The
New York Times: blame (1), crazy (2), evil (3), illness (4), kill (5), murder (6),
overwhelmed (7), stigma (8), stress (9), suicidal (10), victim (11), and violence (12).
Table 1
San Francisco Chronicle Keywords by Frequency and Percentages
Keywords in the San Francisco Chronicle
Frequency
Percent
Valid Percent
Cumulative Percent
blame
4
.9
1.8
1.8
crazy
2
.5
.9
2.7
evil
1
.2
.4
3.1
illness
56
12.8
25.1
28.3
kill
64
14.6
28.7
57.0
murder
25
5.7
11.2
68.2
stigma
7
1.6
3.1
71.3
stress
46
10.5
20.6
91.9
suicidal
10
2.3
4.5
96.4
victim
4
.9
1.8
98.2
violence
4
.9
1.8
100.0
Total
223
50.8
100.0
System
216
49.2
439
100.0
Valid
Missing
Total
Figure 2 shows in bar graph form each keyword and its valid percentage. It is a
response chart that focuses both on the frequency of the aforementioned words, and also
the percentages regarding their usage. In terms of percentages, the words illness (12.8%),
46
kill (14.6%), murder (5.7%) and stress (10.5%) captured the largest percentages of the
words that were analyzed.
Figure 2. San Francisco Chronicle keywords percentage results.
Table 2 is a cross tabulation involving the variables “harmful to the mental health
community” and “hostility.” Harmful to the mental health community was coded based
on whether or not the researcher felt that the tone of the article or the information (or lack
thereof) provided in the article could be harmful to those in the mental health community.
Hostility was meant to focus on whether or not the writer of the article approached the
story in a hostile tone, rather than a neutral tone or sympathetic tone. The association
47
between the two variables is shown below. Though the association was low-to-medium
at best, it is still significant.
Table 2
A cross tabulation on harmfulness to the mental health community and hostility
Cross tabulation
Hostile
Total
YES
NO
Count
5
1
6
% within Hostile
27.8%
3.1%
12.0%
Count
13
31
44
% within Hostile
72.2%
96.9%
88.0%
Count
18
32
50
YES
Harmful to the mental
health community
NO
Total
% within Hostile
100.0%
100.0%
100.0%
Table 3
The association between harmfulness to the mental health community and hostility
Chi-Square Tests
Value
Pearson Chi-Square
Continuity
Correctionb
Likelihood Ratio
df
Asymp. Sig. (2-
Exact Sig. (2-
Exact Sig. (1-
sided)
sided)
sided)
.018
.018
6.630a
1
.010
4.501
1
.034
6.522
1
.011
Fisher's Exact Test
Linear-by-Linear
Association
N of Valid Cases
6.498
1
.011
50
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.16.
b. Computed only for a 2x2 table
Table 3 above shows the specific details regarding the association. Of the articles
48
that were considered to be hostile, 27.8% were also harmful to the mental health
community. The most promising statistic in this table is that of the articles that were not
harmful to the mental health community, 96.9% also did not contain any hostility. As for
other articles that presented as harmful, 72.2% were not found to be hostile.
The following tables looked at the variables developed for the content analysis that
examined parental mental illness coverage in The New York Times and San Francisco
Chronicle. The variables are listed below in the following order: whether the article was
an opinion piece, whether the article was harmful to the mental health community,
whether the article provided information on access to care or was informative, the
socioeconomic status of the individual(s) mentioned in the article, whether the article
provided at least one mental health statistic, whether any support systems were
mentioned, whether the individual(s) was on public assistance, whether the individual(s)
had any history in the Child Welfare System, whether the individual(s) had a criminal
history, the job status of the individual(s), whether the individual(s) had health insurance,
the housing situation, substance abuse, resources mentioned, relationship status of the
individual(s), whether or not the individual(s) had a college education, whether the
individual(s) had a religious affiliation, whether or not a mental health professional was
quoted in the article, if the article had a hostile tone, if a mental health diagnosis for the
individual in the article was mentioned, if the individual(s) was medication compliant, if
the article had a sympathetic tone from the author, if the article had a negative tone, if the
age(s) of the individual(s) mentioned in the article were provided, if there were any prior
49
hospitalizations, if there was any custody arrangements, and if any friends or relatives
were quoted in the article. The frequency distributions of these variables are presented in
table 4 through table 25.
Both hostility and harmfulness to the mental health community were described in
detail for tables 2 and 3. The remaining codes were also used to explore themes the
researcher thought were relevant to parental mental illness in the context of print media.
Many articles did not provide information that was relevant to the coding themes.
Anything that lacked information was coded as “not present.” The researcher was
interested in seeing whether a mentally ill parent’s criminal history—if there was any—
was mentioned in the article, but the statistics ultimately boiled down to criminal history
not being addressed in 94% of the articles. One article did include the criminal history of
a mentally ill parent, and just two were clear in addressing that the individual did not
have a criminal record. Custody arrangements were not mentioned in any of the articles.
An individual’s socioeconomic status was only present in five of the 50 articles, meaning
that it was not present in 88.2% of the articles. Although it might not have been hard to
assume where a family in the article stood in terms of finances, unless the article
specifically mentioned their socioeconomic status, the researcher coded it as “not
present.” Also, of the 50 articles examined, 49 did not mention whether the individual
had health insurance. Only five articles addressed the level of education the mentally ill
parent had received; four had received a college education, and one was a high school
graduate. For religious affiliation, six of the articles shared that the mentally ill
50
individual was a Christian. The remaining 44 did not mention anything about religion.
Of the 49 articles, only one mentioned that the subject had health insurance. These were
coded as “not present,” even if mental health services were discussed at length in the
article. A specific housing situation was not mentioned in 42 of the articles. The
following tables and figures show the results in terms of yes and no for the themes that
were coded.
Table 4
Opinion pieces in the selected articles
Opinion Piece
Valid
Missing
Frequency
Percent
Valid Percent
Cumulative Percent
YES
15
29.4
30.0
30.0
NO
35
68.6
70.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Total
Table 5
Harmfulness to the mental health community in the selected articles
Harmful to Mental Health Community
Valid
Missing
Total
Frequency
Percent
Valid Percent
Cumulative Percent
YES
6
11.8
12.0
12.0
NO
44
86.3
88.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
51
As presented in table 5 above, only 11.8% of the selected articles indicate a
harmful tone that could be disempowering to the mentally ill. The majority of the articles
were not considered harmful.
Information on access to care for mental illness treatment was mentioned in seven
articles, rounding out to 13.7% of the selected articles for this study. The information can
be seen below in table 6. Table 7 below shows that the majority of the articles did not
cite a statistic relating to mental illness. 33 of the selected articles did not have a statistic.
Table 6
Information regarding care in the selected articles
Provided Information on Access to Care
Valid
Missing
Frequency
Percent
Valid Percent
Cumulative Percent
YES
7
13.7
14.0
14.0
NO
43
84.3
86.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Total
Table 7
Inclusion of mental health statistics in the selected articles
Provides Mental Health Statistic
Valid
Missing
Total
Frequency
Percent
Valid Percent
Cumulative Percent
YES
17
33.3
34.0
34.0
NO
33
64.7
66.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
52
Figure 3 below shows the presence of included mental health statistics in the
selected articles in bar graph form. 34% of the articles did provide a statistic related to
mental illness, and 66% did not.
Figure 3. Bar graph displaying the prevalence of mental health statistics.
Table 8 indicates whether or not support systems were mentioned in the articles.
42 of the articles were coded as “not present,” due to support systems not being
mentioned in the selected articles. The results can be seen below. Table 9 is also shown
below and indicates that most of the articles did not mention whether or not the subjects
of the articles were receiving public assistance.
53
Table 8
Support system(s) mentioned in the selected articles
Support Systems
Frequency
Percent
Valid Percent
Cumulative
Percent
NOT PRESENT
42
82.4
84.0
84.0
YES
5
9.8
10.0
94.0
NO
3
5.9
6.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Valid
Missing
Total
Table 9
Public assistance addressed in the selected articles
On Public Assistance
Frequency
Percent
Valid Percent
Cumulative
Percent
NOT PRESENT
36
70.6
72.0
72.0
YES
2
3.9
4.0
76.0
NO
12
23.5
24.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Valid
Missing
Total
Table 10 indicates if the individuals mentioned in the selected articles had any
history in the Child Welfare System. Three articles did explicitly state that the
individuals in the article had prior history; six did not have any history. The remaining
54
articles were coded as “not present.”
Table 10
A history in the Child Welfare System in the selected articles
CWS History
Frequency
Percent
Valid Percent
Cumulative
Percent
NOT PRESENT
41
80.4
82.0
82.0
YES
3
5.9
6.0
88.0
NO
6
11.8
12.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Valid
Missing
Total
Table 11
Job status in the selected articles
Job Status
Frequency
Percent
Valid Percent
Cumulative
Percent
NOT PRESENT
37
72.5
74.0
74.0
6
11.8
12.0
86.0
7
13.7
14.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
EMPLOYED AT THE
Valid
TIME OF THE ARTICLE
UNEMPLOYED AT THE
TIME OF THE ARTICLE
Missing
Total
55
Table 11 above indicates whether or not the individuals in the selected articles
were employed. 37 of the articles were coded as “not present” due to employment status
not being mentioned in the articles.
Six individuals from the selected articles were employed at the time the articles
were written. Seven individuals were not employed. Six of the articles expressed that
the subjects had adequate housing, and one article stated that the subject was homeless.
The data can be seen below in table 12.
Table 12
Housing situation for the family unit mentioned in the selected articles
Housing Situation for the Family
Frequency
Percent
Valid Percent
Cumulative
Percent
NOT PRESENT
43
84.3
86.0
86.0
YES
6
11.8
12.0
98.0
NO - HOMELESS
1
2.0
2.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Valid
Missing
Total
Table 13 below indicates whether or not substance abuse was addressed in the
selected articles. 45 of the articles were coded as “not present” due to employment status
not being mentioned in the articles. Three articles were coded “yes,” and two were coded
“no.” 88.2% of the articles did not mention substance abuse as related to mental illness.
56
Table 13
Substance abuse in the selected articles
Substance Abuse
Frequency
Percent
Valid Percent
Cumulative
Percent
NOT PRESENT
45
88.2
90.0
90.0
YES
3
5.9
6.0
96.0
NO
2
3.9
4.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Valid
Missing
Total
Table 14 indicates whether resources were mentioned in the selected articles. 42
of the articles did not mention resources, which equates to 82.4%. The percentages can
be seen both below and in the pie chart for figure 4.
Table 14
Resources mentioned in the selected articles
Resources Mentioned
Frequency
Percent
Valid Percent
Cumulative
Percent
Valid
Missing
Total
YES
8
15.7
16.0
16.0
NO
42
82.4
84.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
57
Figure 4. The percentages of resources mentioned.
Table 15
Relationship status of the adults mentioned in the selected articles
Relationship Status
Frequency
Percent
Valid Percent
Cumulative
Percent
NOT PRESENT
32
62.7
64.0
64.0
YES
12
23.5
24.0
88.0
NO
6
11.8
12.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Valid
Missing
Total
Table 15 indicates whether or not the relationship status of the mentally ill
individual was addressed in the selected articles. 23.5% of the articles mentioned that the
58
mentally ill individual was in a relationship at the time the article was written. 11.8% of
the mentally ill individuals in the articles were not in a relationship. The remaining
percentage was coded as “not present” due to a romantic relationship not being
addressed. This percentage was 62.7%.
Table 16 below indicates whether a professional in the mental health field was
quoted in the selected articles. A professional was quoted in over half the articles
selected for the study, with the specific number being 33, or 64.7%.
Table 16
Whether a professional in the mental health field was quoted in the selected articles
Professional Quoted
Frequency
Percent
Valid Percent
Cumulative
Percent
Valid
Missing
Total
YES
33
64.7
66.0
66.0
NO
17
33.3
34.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Table 17 below indicates whether the author’s article contained a hostile tone.
Hostility was coded based on whether or not the researcher felt that the article was
approached with a hostile tone, rather than sympathetic or neutral one. Table 18 below
indicates that the majority of the articles did not mention a specific mental health
diagnosis as pertaining to the individual struggling with mental health problems.
59
Table 17
Hostile tone by the author in the selected articles
Hostile
Frequency
Percent
Valid Percent
Cumulative
Percent
Valid
Missing
YES
18
35.3
36.0
36.0
NO
32
62.7
64.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Total
Table 18
The distribution of reference to diagnoses of subjects covered
The Mention of a Mental Health Diagnosis in the Article
Valid
Missing
Frequency
Percent
Valid Percent
Cumulative Percent
NOT PRESENT
34
66.7
68.0
68.0
YES
16
31.4
32.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Total
Table 19 below indicates the frequency of drug compliance as shown by the
individuals in the selected articles. 78.4% of the articles did not mention whether or not
the individual was being compliant with taking his or her medication when the article was
written. Only five of the articles mentioned drug compliance, which factors out to 9.8%
of the articles.
60
Table 19
Drug compliance shown by the individuals in the selected articles
Drug Compliant
Frequency
Percent
Valid Percent
Cumulative
Percent
Valid
Missing
NOT PRESENT
40
78.4
80.0
80.0
YES
5
9.8
10.0
90.0
NO
5
9.8
10.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Total
Table 20
Sympathetic tone expressed by the author in the selected articles
Sympathetic
Frequency
Percent
Valid Percent
Cumulative
Percent
Neutral
14
27.5
28.0
28.0
Yes
31
60.8
62.0
90.0
No
5
9.8
10.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Valid
Missing
Total
Table 20 above indicates whether or not the author’s article contained a
sympathetic tone. Sympathy was coded based on whether or not the researcher felt that
the article was approached with a sympathetic tone, rather than hostile or neutral one.
61
Table 21 below indicates whether or not the article contained a negative tone, as
determined by the researcher.
Table 21
Negative tone expressed by the author in the selected articles
Negative
Frequency
Percent
Valid Percent
Cumulative
Percent
Valid
Missing
Yes
7
13.7
14.0
14.0
No
43
84.3
86.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Total
Table 22
Adult age of the subjects was provided in the selected articles
Adult Age Provided
Frequency
Percent
Valid Percent
Cumulative
Percent
Valid
Missing
Total
YES
10
19.6
20.0
20.0
NO
40
78.4
80.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Table 22 above indicates whether the age of the individual was mentioned in the
article. Only 19.6% of the articles provided an age. In table 23 below, 40 of the articles
62
did not disclose whether the individuals in the selected articles had any prior
hospitalizations as pertaining to mental health history.
Table 23
Hospitalizations of the subjects mentioned in the selected articles
Prior hospitalizations
Frequency
Percent
Valid Percent
Cumulative
Percent
NOT PRESENT
40
78.4
80.0
80.0
YES
8
15.7
16.0
96.0
NO
2
3.9
4.0
100.0
Total
50
98.0
100.0
System
1
2.0
51
100.0
Valid
Missing
Total
Table 24
Relatives or friends quoted in the selected articles
Relative and Friends Quoted
Frequency
Percent
Valid Percent
Cumulative Percent
0
22
43.1
44.0
44.0
YES
12
23.5
24.0
68.0
NO
16
31.4
32.0
100.0
Total
50
98.0
100.0
1
2.0
51
100.0
Valid
Missing
Total
System
63
Table 24 shows data regarding whether a friend or relative of the individual was
quoted in the article. Only 23.5% of the articles provided insight from a friend or relative
of the mentally ill individual.
Table 25
A cross tabulation between writer hostility and mental health professionals quoted
Hostility and Mental Health Professionals: a cross tabulation
Professional quoted
Count
Total
YES
NO
10
8
18
30.3%
47.1%
36.0%
23
9
32
69.7%
52.9%
64.0%
33
17
50
100.0%
100.0%
100.0%
YES
% within Professional quoted
Hostile
Count
NO
% within Professional quoted
Count
Total
% within Professional quoted
Table 25 above was a cross tabulation run on the categories “Hostile” and
“Professional Quoted” to see if there were any significant links between the authors
taking a hostile tone or not in the articles, and whether or not a mental health professional
was quoted and able to provide insight in the articles. The findings below show that there
was not a level of significance. Of the mental health professional quoted in articles, only
30.3% of those articles also included some hostility. 69.7% did not include hostility in
64
articles where a mental health professional was mentioned. As noted by the second
column, both treated the subjects with relatively less hostility.
Table 26
A cross tabulation of support systems and relatives and friends quoted in the articles
Ta
Support Systems and Relatives and Friends Quoted: a cross tabulation
Relatives and friends quoted
Count
0
YES
NO
18
10
14
Total
also a
42
NOT
PRESENT
% within relatives
and friends quoted
Count
Support
Systems
YES
% within relatives
and friends quoted
Count
NO
% within relatives
and friends quoted
Count
Total
% within relatives
and friends quoted
ble 26 is
cross
81.8%
83.3%
87.5%
84.0%
tabulation,
2
2
1
5
this time
9.1%
16.7%
6.2%
10.0%
focusing
2
0
1
3
0.0%
6.2%
6.0%
22
12
16
50
100.0%
100.0%
on the
9.1%
100.0% 100.0%
relationshi
p between
present
support
systems addressed in the selected articles, and whether or not a friend or relative of the
mentally ill individual was quoted in the article. Support systems did not ultimately play
a huge role in this research study – few of the articles openly stated whether or not the
subject(s) had any supports in place. Thus, “not present” had to be coded for 42 of the 50
65
selected articles. In instances where friends and relatives were quoted, 16.7% of the
articles also mentioned at least one support system that the mentally ill adult had in place
at the time. At best, there was a minimal association between the two categories. The
results can be seen above in table 26.
Table 27
A cross tabulation of drug compliance and prior hospitalization
Drug Compliance and Prior Hospitalizations: a cross tabulation
Prior Hospitalizations
NOT
YES
NO
35
3
2
87.5%
37.5%
4
1
10.0%
12.5%
1
4
2.5%
50.0%
40
8
Total
PRESENT
Count
40
NOT
PRESENT
% within Prior
Hospitalizations
Count
Drug
Compliant
YES
% within Prior
Hospitalizations
Count
NO
% within Prior
Hospitalizations
Count
Total
% within Prior
Hospitalizations
100.0%
100.0
%
80.0%
0
5
0.0%
10.0%
0
5
0.0%
2
10.0%
50
100.0
100.0
100.0
%
%
%
Tables 27 and 28 feature a cross tabulation between drug compliance and
hospitalization, and the levels of significance, respectively. There was a significant
relationship between the subject’s willingness to take their prescribed medication and
whether or not they had previous stays in the hospital due to mental health reasons. Of
66
the articles that mentioned hospitalizations, 50% of those individuals were not consistent
or compliant with taking their prescribed medications.
Table 28
Values and levels of significance for drug compliance and prior hospitalization
mentioned in the articles
Chi-Square Test
Value
df
Asymp. Sig. (2sided)
Pearson Chi-Square
17.688a
4
.001
Likelihood Ratio
13.169
4
.010
Linear-by-Linear Association
5.312
1
.021
N of Valid Cases
50
a. 7 cells (77.8%) have expected count less than 5. The minimum expected count is .20.
Interpretations of the Findings
According to Baun (2009), “Inaccurate information in the media about mental
illness, even if the portrayal of an individual is positive, results in misunderstandings that
can have considerable and very real consequences” (p. 32). The researcher of this study
found that the majority of the articles studied did not appear to be sensationalized. The
articles did not contribute to the stereotypes regarding parental mental illness, but for the
most part they also did nothing to try and counter the stereotypes. The articles that
discussed cases involving child injury or death did not provide information to discourage
the public from making a link between violence and mental illness. If an article was
presented with a hostile tone, it was more likely to also be considered by the researcher to
67
be harmful to the mental health community. The frequencies of the keywords studied
showed that neither newspaper shied away from discussing mental illness.
The primary issue with the findings in this study is that many of the articles did
not provide information that was both necessary and relevant to the coding themes.
Criminal history, custody arrangements, socioeconomic status, health insurance, level of
education, religious affiliation, housing situation, and health insurance often did not merit
a mention in the articles that were studied.
Summary
Results indicated that most of the articles that were used in this study did not play
into stigmas or sensationalized descriptions. However, most of the articles also did not
focus on the curative aspect of mental illness. The articles that discussed child abuse or
death cases were written in a way that could generate conversation among the public, but
more about what actually happened and why, rather than how tragedies could have been
prevented in the first place. Resources for families with parents with mental illnesses
were rarely discussed. Results did not indicate a significant relationship between print
media and how it affects the attitude of the general public regarding mental illness, but
the variables pooled in the study did show that most articles did not offer information
regarding available mental health services, statistics about the accuracies of parenting
with a mental illness, or go into detail about support systems. Seventeen articles that
discussed parental mental health did not even have a quote from a mental health
68
professional in the article. Results suggest that by not providing enough valuable
information about the reality of mental illness, the public’s perception will not change.
69
Chapter 5
CONCLUSION, SUMMARY, AND RECOMMENDATIONS
Summary of Study
Public perception of mental illness has a lot to do with how the print media
presents their content. Exposing the public to either negative or positive connotations can
go a long way in shaping how people feel about mental illness, and also parental mental
illness. The media’s interpretation of mental illness is not always accurate. The purpose
of the researcher’s study was to examine to what extent the news coverage of parental
mental illness is accurate, and if print media’s portrayal of mental illness based on the
analyzed content indicated a pattern of disempowerment of parents’ capacity to parent.
The goal of the study was to compile valuable research to address present gaps in mental
illness education, the appropriateness of interventions, and help determine how cases
involving child abuse may reinforce stereotypes regarding the mentally ill.
In the case of this study, while the print media did not do too much damage in
reinforcing negative stigmas, the media did not attempt to depict mentally ill parents in a
more positive, realistic light. The literature review findings showed that for as common
as mental illness is, the tone of many of the articles—thought respectful for the most
part—made parental mental illness out to be something of an anomaly. The articles
examined also did not focus on the needs, experiences, and challenges of mentally ill
70
parents, as much as they did on “the event” that led to the individual’s story becoming
newsworthy in the first place.
Implications for Social Work
Social workers are called upon to work directly with families, which involves diving into
the environmental and situational factors the clients are accustomed to. Strengths and
weaknesses can be assessed when an effort is made to understand what is going on in the
mentally ill parent’ life. Factors such as poverty, lack of resources, and the pervading stigma of
mental illness can prevent an individual from seeking help to address their specific needs. The
social worker must step in and assist the client in receiving services. By being aware of how the
print media can negatively impact the public, the social worker can take steps to encourage an
individual to get help.
Social workers should also be try to advocate on a macro level in order to help
change the way the public perceives mental illness in part because of mass media. This
can be done by getting involved in the community and striving to focus on empowerment
approaches for everyone, particularly the vulnerable. A broader focus on empowerment
will be more successful in producing change. Social workers can help educate
communities about the realities of mental illnesses, and encourage newspapers to also
focus more on the realities than the sensationalized bits. As a helping profession, Social
workers need to play a bigger role in mental healthcare. There is no reason why Social
71
workers cannot work side-by-side with mental health professional in order to meet all the
needs of the parent and their family.
Social workers can also lobby for more adequate and accessible mental health
treatment on a policy level. The Government and its federal programs have a sizeable
role in funding mental health services, and although the mental health budget has
increased over time, but care can still be costly and the cutting of Medicaid funding
makes it harder for some individuals to get the help they need. The U.S. Substance
Abuse and Mental Health Services Administration collected data in 2011 that provided
reasons as to why more individuals did not pursue mental health treatment. The most
significant reasons were that 50.1 percent could not afford services and 8.3% reported
their health insurance coverage did not cover enough (SAHMSA, p. 26). Social workers
can advocate for more comprehensive services, particularly for the vulnerable.
Recommendations
There are several recommendations to be made for future research on the topic of
parental mental illness as seen in print media. The researcher recommends that more
studies be done focusing on to what extent the news coverage of parental mental illness is
accurate, and if print media’s portrayal of mental illness based on the analyzed content
indicates a pattern of disempowerment of parents’ capacity to parent. The additional
studies should involve different newspapers, different forms of media content, and a
considerably larger sample size.
72
Research should also be done in order to find articles that focus more on
treatment, recovery, and preventative care aspects of parental mental health. The
researcher recommends that professionals who work for newspapers and other forms of
media should be educated more about the realities of mental illness, so that reports can
accurately and impartially reflect parenting with a mental illness. Focusing on news
articles that emphasize education more than entertainment may yield different findings
about the perception of mental illness. Balanced news coverage can also foster truthful
information about mental illness and promote positive attitudes about mental illness.
Attitudes about mental illness can be positively or negatively shaped depending
on how information regarding mental illnesses is presented to the public. According to
Stout et al. (2004), “news coverage can also affect the perception of people with mental
illness” (p. 554). It would be beneficial for parents living with mental illness and mental
health services consumers to come forward and share their experiences in order to
advance research. Hearing directly from individuals with a mental health diagnosis who
experience both struggles and successes while parenting can inform society of whether or
not the portrayals of mentally ill parents in print media are without bias. This could be
achieved more easily if the stigma attached to mental illness was less pervading. Stout et
al. (2004) go on to state, “If the mass media can have a negative influence on the
perception of mental illness, it is reasonable to expect that it should also be able to exert a
positive influence to reduce stigma” (p. 555).
73
Limitations
This study was purely descriptive and despite the rigorous and exhaustive analysis
of the content using a well-developed schema. Conclusive findings were not generated.
The study was a content analysis, and involved cases from two national newspapers for a
ten year period. Comparing more newspapers, or different ones than The New York
Times and San Francisco Chronicle may have produced different findings.
The observed trends in print media in regards to parental mental illness that the
researcher found in the study may not be generalized to the overall presentation of mental
health issues in the public domain.
Conclusion
This study was designed to examine the extent to which the print media’s
portrayal of parents with mental illness was disempowering. Mental illness can affect an
individual’s quality of life, but symptoms can always be managed if the individual can
get treatment and support. The content of the articles support the general notion that
parenting with a mental illness is not easy, particularly due to mental health stereotypes.
The media remains an important source in helping the public develop a particular
perception about the mentally ill population. The coverage of mental illness as it relates
to parenting can often produce unfair coverage in the print media, if the articles at hand
do not accurately portray what parenting with a mental illness is like. However, the
findings of this content analysis reflect the general approach of the print media toward
74
mental illness to be non-judgmental. The print news media is certainly not an advocate
for parents with mental illness, but the news media is not a hindrance to parents who live
with a mental illness while parenting their children. The media should strive to have a
more positive impact in their coverage of parental mental illness. Print media should
make sure that the stories they run provide information regarding how a mentally ill
individual can seek help; quotes from mental health professionals and experts who can
present information in a realistic way; and not just running stories about the mentally ill
when something involving a mentally ill parent has happened.
75
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