A Closer Look at Children of the Mentally Ill in Missions

by Vicki Hornung Reyes

An overview of mental illness and the potential blessings and challenges of having missionaries who come from families with mental illness.

They did not even have a name until 1989. This was when My Parent’s Keeper: Adult Children of the Mentally Ill was scheduled to be published. California psychotherapist Eva Marian Brown had finally given an identity to this scantily-researched group who had grown up “with a parent suffering from a serious psychological impairment that profoundly affected the functioning of both the parent and the family” (Brown 1989, xiii). As indicated by her website homepage, www.adultchildrenofthementallyill.com, Brown also crafted the corresponding acronym, ACMI.

Unfortunately, the term “mental illness” made her book distributors uncomfortable. Brown reluctantly changed the subtitle to the more palatable Adult Children of the Emotionally Disturbed. Twenty-three years later the term “mentally ill” still makes most people uncomfortable.

According to licensed mental health professional Steve Edlin, director of the counseling office at The Evangelical Alliance Mission (TEAM), “In my experience doing assessments of new candidates, more and more are coming from dysfunctional families” (2012, personal email). According to Edlin, an informal estimate is that over fifty percent of new candidates were raised by one or more dysfunctional parents.

While on staff at Link Care Center, Tim Boyd and Brent Lindquist concurred that “a disproportionate number of those going into missions come from wounded backgrounds and often have a strong desire to rescue or help others” (Boyd and Lindquist n.d.).

These missionaries may have been children of divorce or of a single parent home. One or both parents may have had an addiction or may have suffered from some form of mental illness such as chronic depression, schizophrenia, or bipolar disorder. Sometimes, missionary applicants have expressed that a parent had “something wrong” but had never been formally evaluated. 

How do adult children of the mentally ill react in cross-cultural settings? Although it takes effort to uncover research about other types of adult children involved in missionary service (such as adult children of alcoholics), it is extremely difficult to find any specific research on adult children of the mentally ill in a cross-cultural situation.

Unfortunately, there has not been much written about ACMIs at all. Victoria Segunda, author of When Madness Comes Home, laments,

The lay literature is top-heavy with books about the problems of parents of the mentally ill. To the extent that the needs of offspring and siblings are also addressed, generally it’s in the context of their usefulness as adjuncts to the family-as-treatment team. (1990, 7)  

This still seems to be true over twenty years later. In Growing Up with a Schizophrenic Mother, the authors observe, “The fact that relatively little has been written about children reared by women with this severe psychotic disorder suggests that we members of the mental health community have been averting our eyes for far too long” (Brown and Roberts 2000, 1).  

More commonly, adult children and siblings of the mentally ill have ventured to share their personal stories themselves in spite of the stigmas. “It’s time to bring madness, its stories and its legacies out of the social shadow. It’s time society faced its unseen and unwanted parts. We are all part of the social body,” states Catherine E. Camden-Pratt in her dissertation (2006, 2).

What Characterizes a Mental Illness?
“Mental illness” is the term used by medical professionals. The National Alliance on Mental Illness (NAMI) states, 

A mental illness is a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning…Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD) and borderline personality disorder. (2013)

Most of the available literature about ACMIs focuses on adults whose parent has suffered from schizophrenia, bipolar disorder, or major depression. The following are lay descriptions and relevant information about these three mental illnesses. For a professional explanation of these disorders, refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM) used by medical professionals in the United States or the World Health Organization (WHO) International Classification of Diseases.

About 2.4 million Americans, or 1.1% of the adult population, live with schizophrenia (NAMI 2013). The Mayo Clinic website states,

Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behavior. Contrary to some popular belief, schizophrenia isn’t split personality or multiple personality. (2013)

The genetic risks have been studied since the 1960s. “If a parent has schizophrenia, the chance for a child to have the disorder is 10 to 15 percent. Risks increase with multiple affected family members” (University of Rochester Medical Center 2013).

Bipolar disorder affects 5.7 million American adults, approximately 2.6% of the adult population (NAMI 2013). The NAMI describes the condition this way:

Bipolar disorder is a chronic illness with recurring episodes of mania and depression that can last from one day to months. This mental illness causes unusual and dramatic shifts in mood, energy and the ability to think clearly. Cycles of high (manic) and low (depressive) moods may follow an irregular pattern that differs from the typical ups and downs experienced by most people. (2013)  

Diagnosing bipolar disorder is not always easy. As his Johns Hopkins professor advised Francis Mondimore, “When you can’t figure out what the patient has, he or she probably has bipolar disorder” (Mondimore 2006, 1).

Major depressive disorder affects 6.7% of adults, or about 14.8 million American adults (NAMI 2013). According to NAMI:

Major depression is a mood state that goes well beyond temporarily feeling sad or blue. It is a serious medical illness that affects one’s thoughts, feelings, behavior, mood and physical health. Depression is a life-long condition in which periods of wellness alternate with recurrences of illness.” (2013)

Offspring of the severely depressed also seem to be very prone to depression, as well as other serious mental illnesses, according to a longitudinal study done by Marian Radke Yarrow and fellow researchers (Radke-Yarrow 1998, 192). A more recent study had similar findings:

Those with at least one depressed parent had about a threefold higher risk for developing mood disorders (mostly major depressive disorder) and anxiety disorders (mostly phobias), more than twofold greater risk for alcohol dependence, and sixfold greater risk for drug dependence. (Weissman et al. 2006)

Characteristics of Adult Children of the Mentally Ill
Every son and daughter of the mentally ill has been affected in one form or another. Psychotherapist Julie Tallard Johnson notes, “Every family member is damaged by the family’s inability to cope effectively with the mental illness” (1988, 4). While ACMIs share many problems with the offspring of different types of dysfunctional parents, they also “have had a set of experiences which is unique to them as a group,” declares Eva Marian Brown (1989, xiii).

#1: They often have painfully low self-esteem and feelings of unworthiness. When adult children of schizophrenics were compared to a matching control group in a recent study, the first group had a “significantly poorer self-concept compared to the control group” (Manjula and Raguram 2009). Segunda observes,

“Schizophrenic mothers… have difficulty in responding emotionally to their offspring… Depressed mothers tend to experience more friction with their children and judge them more negatively than do other people who know the children” (1990, 44). Unfortunately, mentally ill parents are often unable to treat their children in ways that would build self-esteem (Brown 1989, 39).   

#2: They are often victims of abuse. In many cases, the mentally ill are very cruel to their children. Many victims of mental illness act out violent delusions and threaten their families (Johnson 1988, 16). Some children may even suffer from “post-traumatic stress disorder,” having suffered prolonged, terrifying experiences (Segunda 1997, 280). The Mayo Clinic defines post-traumatic stress disorder (PTSD) as a “mental health condition that’s triggered by a terrifying event. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event” (2013). The website adds, “One of the risk factors is having first-degree relatives with mental health problems… Women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition” (2013).

#3: They have experienced a “lifetime of losses.” Feelings of chronic loss occur as the parent cycles between periods of stability and psychosis or instability (Johnson 1988, 12-13). Diane Marsh and Rex Dickens explain to families affected by mental illness:

You are far more likely to experience continuing feelings of grief and loss that wax and wane in response to the course of your relative’s illness or to events in your own life. These powerful emotions are woven into the familial fabric on a continuing basis…It’s like someone close died. But there’s no closure. It’s never over. (1997, 24)

#4: They are often “parentified children” (Brown 1989, 1). All too often, they were “relegated to the role of surrogate spouse and parent to their siblings” (Brown and Roberts 2000, 2). They likely attempted to keep the mentally ill parent safe, as well as their younger siblings. They listened to the pain and confusion of the well parent and may have entreated that parent to remain with the family. They likely implored the mentally ill parent to take his or her medication, to see the psychiatrist, or even to bathe.

ACMIs usually have had to ignore their own needs to take care of others. As one adult child blogs, “As a child in this environment, you are never as important as the mentally ill parent—the parent and ‘protection’ of the parent comes first” (Itzettl n.d.).

#5: Many have felt alone growing up. “Persons with schizophrenia are, by and large, feared and ostracized by society. By association, their families are ostracized along with them” (Brown and Roberts 2000, 15). Even relatives usually back away from them (Segunda 1997, 12). Catherine Camden-Pratt shares her personal experience:

To be in everyday society we had to censor our lives and learn what not to say. Yet to have authentic self-acceptance we had to find others who listened without our needing to censor our experiences. This is hard; not many want to hear. (2006, 2)

#6: They are usually very compassionate. Most ACMIs “move into adulthood with a keen sensitivity to others’ pain and a tendency to rescue and take care of people” (Brown 1989, 12).

#7: They often have a great need for structure and predictability (Brown 1989, 128). The homes of schizophrenics may have been similar to a psychiatric ward at times. There was no predictability, no safety (1989, 4). For this reason, ACMIs may tend to be controlling.

#8: They have probably not been able to share their story with others. Unless a person has had “firsthand, day-to-day experience with mental illness, it’s a conversation killer to say that you are a veteran of such devastation” (Segunda 1997, 2). Since most people feel uncomfortable talking about mental illnesses, few ACMIs have had the luxury of talking normally about their childhoods.

#9: They are generally very hard workers. “Achievements at work can compensate for many of their losses in childhood” (Segunda 1997, 237).  

#10: They dislike artifice and are usually painfully honest both about themselves and what they observe around them. They hunger for truth, since so many have grown up with silence and denial both within the family and outside the family (Brown 1989, 130).

Not every ACMI will share all of these characteristics. Various factors determine the extent of his or her trauma: the severity and age of onset of the mental illness, his or her ordinal position in the family, if the well parent abandons the family or remains, as well as the emotional role that the child took in the family. Julie Tallard Johnson discusses common emotional roles in her book Hidden Victims: An Eight-Step Healing Process for Families and Friends of the Mentally Ill.

Are ACMIs Good Cross-cultural Workers?    
ACMIs can make very competent workers. Below are a number of positive characteristics they may have.

#1: ACMIs who are accepted by mission boards have proven to be very resilient. It takes “enormous ingenuity and perseverance” to survive a childhood with a mentally ill parent (Segunda 1997, 215).

#2: They are “copers”—those people described by Agnes Hatfield who make efforts to “master conditions of threat, harm, or challenge when the usual strategies are insufficient” (Hatfield and Lefley 1987, 63).

#3: They have found the healing love of God, the Perfect Parent, and want to share this love with others. Edlin marvels, “What I am amazed by is how some [missionaries] from very difficult backgrounds have worked through things and found a level of wholeness. It is evidence of God’s grace” (2012, personal email).

#4: ACMIs usually have the gift of compassion and can empathize with the many victims of abuse and trauma worldwide. Boyd and Lindquist warn, however, that adult children from any type of dysfunctional home may

…be the type of person whose inner conflicts become increasingly manifest under the stresses of a cross-cultural ministry. These conflicts often disrupt the effectiveness and satisfaction of a missionary’s work. Furthermore, too many missionaries return home as casualties because of inner weaknesses. (n.d.)

These missionary appointees may need time to heal from their childhood, allowing Christ to free them from hurts and bitterness before they serve in a cross-cultural setting. Esther Schubert expresses a similar concern:

The missionary who as a child was the rescuer or the hero in the dysfunctional childhood family may grow up feeling he/she has to be a rescuer as an adult. They may perceive this “psychological agenda” to rescue as being a spiritual “call” to the mission field rather than understanding that it is an unhealthy pattern of thinking and behavior. If these individuals get to the mission field before obtaining psychological insight and healing, they often burn out quickly when they discover that the nationals and colleagues in their place of service do not want to be rescued. (O’Donnell 1999, 76)

Potential Struggles for ACMIs on the Field
As there does not seem to be formal research specifically on ACMIs in missions, the following is a list of possibilities:

•  Because of a lack of normal social experiences, support-raising may be initially awkward. Johnson observes that when a parent first shows signs of mental illness, the family feels shame and uncertainty and begins to “isolate themselves even further by staying home more and inviting company less” (1988, 7).

•  Relatives may not support the ACMI, either financially or emotionally when he or she leaves for the field. It often takes many years for adult ACMI siblings to begin to support each other emotionally.  

•  The ACMI may feel guilty for leaving the care of the parent to the spouse or other siblings (Brown 1989, 16-17).  

•  The ACMI’s poor self-esteem may plummet when he or she arrives on the field until he or she feels confident using a second language and living in a new culture.

•  The ACMI may feel isolated because he or she is unable to share his or her story with many people. A member care provider can be a welcome friend and may be the only one willing to listen. “Survivors of adversity who do best are those who reveal their feelings to sympathetic relatives, friends, or mental health professionals” (Segunda 1997, 181).

•  The ACMI may struggle with the chaos of living and working in certain cultures.

•  The ACMI may overreact when there are church splits or mission upheavals because of his or her background of chronic loss and abandonment. Boyd and Lindquist write:

…children from these families typically have a strong desire to belong. To a person from a wounded past, a missionary team—created for the purposes of furthering the gospel among the unreached—may become primarily a place to meet his need for personal belonging. (n.d.)

ACMI missionaries can enjoy a successful and joyful ministry, but they may require time to recognize how growing up with a mentally ill parent has affected them. If childhood trauma is recognized before leaving for the mission field, ACMIs can focus on healing and may avoid attrition in the future. With the support of mission leaders and member care providers, these resilient, compassionate gospel-sharers can help bring hope to a hurting world that so desperately needs to know the love of a perfect Father.

American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders. Arlington, Va.: American Psychiatric Association.

Boyd, Timothy and Brent Lindquist. n.d. “Dysfunctional Families.” Accessed January 14, 2013, from cart2pioneers.org/frd/MI_DysfunctionalFamilies.pdf. Used with permission of Pioneers, www.pioneers.org.             

Brown, Eva Marian. 1989. My Parent’s Keeper: Adult Children of the Emotionally Disturbed. Oakland, Calif.: New Harbinger Publications, Inc.

Brown, Margaret J. and Doris Parker Roberts. 2000. Growing Up with a Schizophrenic Mother. Jefferson, N.C.: McFarland and Company, Inc.

Camden-Pratt, Catherine E. 2006. Out of the Shadows: Daughters Growing Up with a “Mad” Mother. Sydney: Finch Publishing.

Hatfield, Agnes and Harriet P. Lefley, eds. 1987. Families of the Mentally Ill, Stress, Coping and Adaptation. New York: Guilford Publications, Inc. Quoted in Victoria Segunda, 1997, When Madness Comes Home. New York: Hyperion.

Itzettl. n.d. “Crazy in the Family: Children of the Mentally Ill.” Accessed January 4, 2013, from izettl.hubpages.com/hub/Crazy-in-the-Family-Children-of-the-Mentally-Ill.

Johnson, Julie Tallard. 1988. Hidden Victims: An Eight-Stage Healing Process for Families and Friends of the Mentally Ill. New York: Bantam Doubleday Dell Publishing Group, Inc.

Manjula, M. and Ahalya Raguram. 2009. “Self-Concept in Adult Children of Schizophrenic Parents: An Exploratory Study.” International Journal of Social Psychiatry 55(5). Accessed January 8, 2013, from isp.sagepub.com/content/55/5/471.abstract.

March, Diane T. and Rex M. Dickens.1998. How to Cope with Mental Illness in Your Family. 24. Quoted in Margaret J. Brown and Doris Parker Roberts, 2000, Growing Up with a Schizophrenic Mother. Jefferson, N.C.: McFarland and Company, Inc.

Mayo Foundation for Medical Research and Education. 2013. Mayo Clinic. Accessed January 4, 2013, from www.mayoclinic.org.

Mondimore, Frances. 2006. Bipolar Disorder: A Guide for Patients and Families. Baltimore, Md.: The Johns Hopkins University Press.

National Alliance on Mental Illness. NAMI: National Alliance on Mental Illness. 2013. Accessed January 4, 2013, from www.nami.org.

O’Donnell, Kelly and Michele, eds. 1988. Mission Care: Counting the Cost for World Evangelism. Pasadena, Calif.: William Carey Library.

Radke-Yarrow, Marian, Pedro Martinez, Anne Mayfield, and Donna Ronsavile. 1998. Children of Depressed Mothers. New York: Cambridge University Press.

Segunda, Victoria. 1997. When Madness Comes Home. New York: Hyperion.

Weissman, MM, P. Wickramaratne, Y.Nomura, V.Warner, D.Pilowsky, and H.Verdeli. 2006. “Offspring of Depressed Parents: 20 Years Later.” American Journal of Psychiatry 163(6). Accessed January 9, 2013, from ajp.pyschiatryonline.org/article.aspx?articleid=96673.

Word Health Organization (WHO). 2012. International Classification of Diseases, Tenth Revision, Sandy, Utah: Contexo Media.

University of Rochester Medical Center. 2013. Health Encyclopedia: Schizophrenia. Accessed January 14, 2013, from www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00762


Vicki Hornung Reyes and her husband, Art, have enjoyed being church planters with The Evangelical Alliance Mission (TEAM) in San José del Cabo, Mexico, since 1993. Vicki is also a PhD student at Biola University’s Cook School of Intercultural Studies.

EMQ, Vol. 50, No. 4, pp. 168-176. Copyright  © 2014 Billy Graham Center.  All rights reserved. Not to be reproduced or copied in any form without written permission from EMQ editors.


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