Introduction

Mental health problems observed in society affect an increasingly wide range of people. According to the latest research results collected by the “Pokonaj Lęk” Psychotherapy Centre between 2018 and 2022, one in four Polish men and women suffered from a mental disorder at least once in their lives, of which specifically, mood disorders were experienced by approximately 5% of Polish women and men. Mood disorders affected 4.65% of Poles at least once in their lives, with depression experienced at least once in their lives by 3.85% of Poles and mania by 0.81%. Mood disorders affect people of all ages, including those who are parents and actively create the process of raising their children (“Pokonaj Lęk” Psychotherapy Centre: https://www.pokonajlek.pl/zdrowie-psychiczne-polakow/ ). W hen observing the family as a system, it is important to point out that mental health problems occurring in one family member will trigger reactions and changes in other members within the family system. Affective disorders arising in parents, i.e. those who are largely responsible for the functioning of the family in many areas, as well as for raising children within it can be a particularly difficult challenge for families.

Specificity of affective disorders

When discussing the functioning of families with parents suffering from affective disorders and the potential for dysfunction within such families, it is important to first define the characteristics of these disorders. The International Statistical Classification of Diseases and Related Health Problems defines them as disorders ‘in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity; most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations” (International Statistical Classification of Diseases and Related Health Problems (10th Revision Volume II, 2008, p. 220). These include depressive episodes, manic episodes and bipolar affective disorder. Their characteristic symptoms and the specificity of functioning of the people who suffer from them will be discussed in more detail in the following section when other family functions are discussed. It should be noted, however, that when disorders belonging to the group of affective disorders affect one of the family members, they can significantly affect not only his or her life, but also change the functioning of the family system he or she is part of, and highlighting the specificity of these disorders makes it possible to demonstrate the possible generation of the risk of dysfunction in such families.

Family dysfunctionality concept and families at risk

Families in which there are disruptions to their basic functions and the various needs of their members are not adequately met may be at risk of becoming dysfunctional. Izabela Krasiejko noted: “In every family there are various situations that point to inappropriate parental behaviour and attitudes and some elements that demonstrate the inappropriateness of various family life situations. However, if negative situations become more frequent in the everyday life of the family, accompanied by a lack of emotional bonds, then it can be concluded that the family is not fulfilling its functions properly. It then becomes a dysfunctional family in which there is a lack or serious deficiency in the satisfaction of biological, developmental and emotional needs, later followed by a disorganisation of the entire educational, social, as well as emotional and structural environment.” (Krasiejko, 2019, p. 55). The quoted definition of a dysfunctional family indicates that the dysfunction can result from an insufficient satisfaction of the needs of its members. The ability of the families to cope with the problems that occur and the quality of the relationships within the family are also important as these factors can effectively enable the family to understand the situation and put corrective measures in place to cope with the new family reality.

A broad understanding of the dysfunctional family was provided by Barbara Smolińska- Theiss who pointed out: “the term covers different categories of families that do not fulfil the socially defined parental role or redefine this role in a way that is not socially acceptable. In a narrower sense, a dysfunctional family can be said to be failing to fulfil one or more of the functions assigned to it.” (Smolińska-Theiss, 2006, p. 330). A dysfunctional family, therefore, is one in which the needs of family members are neglected or completely ignored, and which fails to fulfil the tasks and functions assigned to it taking into account the needs of all members. The occurrence of dysfunction within the family is also influenced by relationships and interactions within it. The lack of emotional bonding and the growing frustration resulting from difficulties arising within the family negatively affects the situation within the family system and contributes to the emergence and intensification of dysfunctions.

It is also worth adding that family dysfunctionality can be total or partial. “The dysfunctionality of a family may have to do with a different range of tasks performed, it can be: total dysfunctionality, meaning that there is a complete misunderstanding when it comes to the performance of tasks of the family and it has to be replaced in this performance by specialised families; partial dysfunctionality that means that the family is not able to perform some of its tasks and basic functions properly.” (Kawula, 1997, p. 132). Experiencing the dysfunctionality of the family system does not involve permanently maintaining this state of affairs: “naturally this process can be inhibited, interrupted, but not necessarily, not in every case” (Kawula, 2009, p. 492). Therefore, the family acting together are able to cope with the difficulties and return to the how it was before they occurred or to reorganise family life completely in such a way that the needs of each member are met.

Ewa Kantowicz points out that due to the current social context, a family facing various difficulties can currently be described as a family at risk, i.e. one that “experiences internal or external tensions (crises, problems) as a result of social issues affecting it such as poverty, unemployment, disability, homelessness, social pathologies (addictions, violence, crime), single parenthood. If a crisis is short-lived and the at- risk family has ‘regenerative’ capacities, or if preventive and compensatory measures are taken in the early stages of the crisis, it need not become a dysfunctional or pathological family. In fact, when we speak of a dysfunctional family, we are referring to a family that does not fulfil any or only partially fulfils the functions assigned to it by society: controlling and protecting, caring and upbringing, socialising and emotional functions as a result of poverty, illness, disorganisation or any other cause indicative of a crisis or pathology in the family system. Families affected by dysfunction(s) are usually offered multiple forms of support to stimulate their normal functioning, restoring their caring capacity and confidence in their own ability to change.” (Kantowicz, 2010, p. 212-213). It should therefore be borne in mind that, in the event of the occurrence of affective disorders in a parent, it should not be assumed that the family is dysfunctional while it may be a family at risk which, with an effective response from the family system and with support from preventive and compensatory measures, will be able to cope with the crisis and it will not significantly disrupt its functioning, leading to the occurrence of family dysfunction.

When discussing the characteristics of the functioning of dysfunctional families, attention is drawn to a number of factors that may contribute to the occurrence of these dysfunctions. Agnieszka Wloka pointed out that “the primary factors causing family dysfunctionality are considered to be: deprivation of parental care for the child, lack of material resources, insufficient care for the child due to the parents’ work, functional disorders of the family, lack of personal role models for the child, the parents failing to instilling basic moral values in the child, parents’ lack of pedagogical and psychological knowledge, parents focusing exclusively on material aspects of life and parents’ concern mainly for their own needs’ (Wloka, 2016, p. 131). Anna Maria Seweryńska added that dysfunction in the family system means “a communication disorder in the family, e.g. communicating indirectly, lack of acceptance for the expression of emotions; structural disorders in the family, e.g. role swapping (...); blurry own boundaries, e.g. not opposing violence, distrust of all people (...); disruption of boundaries between individual family members, e.g. not respecting one’s intimacy, feelings and opinions; use of destructive defence mechanisms such as role playing – coping strategies to deal with the behaviour that is the source of this dysfunction” (Seweryńska, 2004, p. 11-12).

Fundamental functions of the family environment

The family environment is supposed to pursue objectives that, if executed properly, are intended to provide all-round conditions for the proper development of its members, especially children. As Stanislaw Kawula noted: “A specific feature of the family environment is that its functions constitute a limited whole, complex and homogeneous, which cannot be performed separately in everyday life. Therefore, any disturbance that impedes any of the basic functions results in a short-term or long-term incapacity of the family in its overall functioning” (Kawula, 1997, p. 56). Therefore, a family and its actions perform many different functions that affect the quality of life of its members and the family as a whole.

Sociologist Zbigniew Tyszka believed that “the functions of a family are specialised and permanent activities and interactions of family members resulting from tasks they are more or less aware of, undertaken within the framework set by the norms and patterns in force, and leading to specific main and side effects” (Tyszka, 1997, p. 37).

A broad division and description of the basic functions of the family was provided by Zbigniew Tyszka who distinguished four groups of family functions:

Due to its specificity and the systemic view of the family, mood disorders can significantly disrupt the family’s fulfilment of its functions. The affective illness of one parent significantly influences the whole system and its functioning, thus posing the risk of temporary dysfunction related to the time required to achieve morphogenesis in the family system. When analysing the performance of key family functions in families with a parent suffering from a mood disorder, the family functions distinguished by Zbigniew Tyszko should be juxtaposed with the diagnostic criteria of people suffering from affective disorders in an attempt to outline the functioning of these people and thus the impact of mood disorders on the family’s performance of basic family functions.

Risk of dysfunctionality in families with pa- rents with affective disorders

The first category of functions mentioned by Tyszka are biopsychic functions. As the author noted, “these functions are related to biological phenomena that have significant repercussions in the psychological sphere” (Tyszka, 1997, p. 59). For parents facing their own depressive episodes, their general psychophysical well-being can lead to temporarily stop performing their biopsychic function of a family. Patients with depressive symptoms may be reluctant to procreate, avoiding physical as well as emotional intimacy and consequently unable to think about expanding their family, potentially giving rise to various types of anxiety due to a lack of a sense of agency or low self-esteem, which may consequently lead them to negate their own value as parents. In the case of manic disorders, the situation is reversed, i.e. patients may be very sexually aroused and ready to satisfy their sexual needs also outside marriage, which may result in marital infidelity or family abandonment in favour of new relationships. In addition, attention should be paid to the general behaviour of people in a state of hypomania or mania that, as a consequence, often contribute to a decrease in trust in the ill spouse and perceiving him or her as someone unable to adequately fulfil the role of parent. People facing a manic episode can also often be highly self-centred, and may see the arrival of a new family member as a barrier to their current goals and needs.

Economic functions of the family are another group of functions identified by Zbigniew Tyszka that “have to do with the material existence of the family and the behaviour, actions and interactions of family members relating to the material affairs of the family. Interactions with the ‘outside world’ undertaken in the material interests of the family also come into play”. (Tyszka, 1997, p. 60). Due to the nature of their functioning, adults suffering from mood disorders may periodically reduce their contribution and involvement in the economic function of the family, while being subjected to care and protection activities by other family members in connection with their current mental health status. Characteristic of manic episodes is the presence of a strong belief in one’s own abilities, including investment or financial abilities, as well as tendencies to satisfy previously undisclosed material needs, often involving borrowing from individuals or institutions or engaging in gambling. People may also abandon their current job in favour of spontaneous participation in a project that the sufferer believes can significantly improve the family’s financial situation. Some activities related to the economic security of the family may contribute to the deterioration of the family’s material well-being and have long-term consequences in this area of family life. In contrast, people who suffer from a disorder characterised by depressed mood show a significant decrease in vital energy and general activity. People with this type of disorder quickly lose mental and physical strength, experience severe fatigue and a general lack of energy to perform. Employers may interpret such behaviour as a lack of willingness to work or a failure to perform one’s duties properly; this may involve the sick person having to resign or take temporary leave. In some cases of aggravated mood disorders in-patient treatment may be necessary and last for long periods so the sick person may be unable to work.

Mood disorders can therefore contribute to the loss of work, resulting in a reduction of the family’s income and potentially affecting the family’s economic and material functioning, especially if the affected person’s income is the only source of sustenance for the family. While discussing the impact of bipolar affective disorder, Elzbieta Michalowska noted that “the material-economic function is one of the basic ones that the family should perform and bipolar disorder usually has a significant impact on it, actually leading to its disintegration – the family ceases to be a source of livelihood for its members and begins to generate debts caused by the behaviour of the sick person, for which all members are responsible” (Michałowska, 2013, p. 110). In an attempt to describe the functioning of parents with affective disorders in terms of the caring and protective function, two points should be mentioned: the difficulties they face in caring for their families on the one hand and, on the other hand, the difficulties for other family members regarding an adequate support for the persons in question. “The immediate family of the person with the illness most often has a problem understanding the nature of the illness and, as a result, they do not provide the person with adequate care and mental support. In contrast, people with bipolar disorder are unable to care for their families because of both mania and depression occurring alternately.” (Michałowska, 2013, p. 112). People facing mood disorders, due to their very nature, may not be interested in providing care or support to other family members.

However, it should be added that the possible disruptions to its fulfilment of economic functions of the family are usually temporary and occur during the period of aggravation of the illness while other difficulties in the continued functioning of the family may be mainly related to its unbalanced material situation.

Another group of functions performed by families according to Tyszka consists of the social- determining functions and, as the author noted: this group clearly demonstrates the “external regulation of family life – but through the mechanisms of its internal functioning. The impact of external social arrangements and their axionormative systems must be taken into account here. (...) The social status of the family and its associated existential position are ‘designated’ or regulated, as are the characteristics, behaviour and consciousness of the family members. Regulation also takes place through the active control of family members exercised by the ‘forces’ of the family group with the participation of a collective of relatives external to it.” (Tyszka, 1997, p. 65). When it comes to performing the socio-defining function, the functioning of the families of people suffering from affective disorders can be particularly difficult and have long-lasting effects on the family system as a whole. As far as the stratification function is concerned, mood disorders can affect a person’s perception of their place in society and, depending on the nature of the episode of the disease, the person understates or overstates their actual place in the social hierarchy. During a depressive episode, people have low self-esteem that distorts their self-image, which affects other family members, reducing their sense of security or triggering social anxiety related to the stigmatisation of mental disorders in their environment. In contrast, when mood is elevated, the sense of self-worth is high and this self-image is inadequate, which often involves seeing oneself as an outstanding individual who is extremely socially valuable. The beliefs of a parent confronting a mood disorder can have long-lasting consequences for children in particular, when confrontation with social reality may reflect negatively on the children’s perception of themselves. It should be added, however, that the family’s stratification function does not need not be impaired, and the risk can be minimised by family members’ knowledge of the specifics of the mood disorder and by other adults in the family system changing their beliefs about the sick person.

Difficulties may also arise when it comes to the legitimising and control function. People with mood disorders have problems related to the control and stability of their behaviour and with interpreting the behaviour of others. Those affected may sometimes react in an inappropriate way to the behaviour of family members and promote the development of inappropriate patterns of behaviour in them. People facing an episode of mania may find it significantly difficult to follow social norms and rules set in the family, which is a characteristic symptom and behaviour of a person in a manic episode. Frequent lability of actions, thinking and words is characteristic for people in mania, which can contribute to a loss of the sense of security or trust by the partner and children. The sick parent’s behaviour, for example assertive and direct comments that are often hurtful to the addressee, as well as the parent’s impulsive and emotional reactions may contribute to emotional distancing in the relationship with children or make the children believe that they have done the right thing even though their behaviour goes against accepted norms. In the case of depressive disorders, the lack of any response from the parent is often apparent, which can also widen the distance between parents and their children. Inappropriate parental response or lack of response affect the relationships in the family, “emotional stress, somatic problems and other symptoms of depression reduce the tolerance of both parents to negative child behaviour” (Tyra, 2000, p. 327). Therefore, the parents may control their children’s behaviour in inappropriate ways. A person undergoing a depressive episode may misinterpret another family member’s behaviour and react inadequately. As Tomasz Tyra noted when describing the behaviour of mothers suffering from depression: “an important feature of the parenting behaviour of depressed mothers is inconsistency in the use of disciplinary measures, frequent use of verbal and physical punishment, controlling children’s behaviour by inducing guilt and anxiety, less tolerance, and rare demonstration of parental warmth. Although most of the research presented is on clinically depressed mothers, findings on milder forms of depression also indicate that it is associated with increasing inconsistency of discipline and with increasing mother-child conflict.” (Tyra, 2000, p. 329). Disturbances in the performance of this function can be temporary but they can also have long-lasting consequences in terms of the upbringing of children, who may have difficulties in assessing their own behaviour as a result of a parental reaction modified by the illness episode. As with each of the functions discussed, there need not be any disruption in the family’s fulfilment of the validation and control functions during the re-emission of the illness in a family that has previously performed the validation function correctly.

The last group of functions distinguished by Zbigniew Tyszka are the socio-psychological functions of the family, which “are dominated by two processes: the psychosocial interactions taking place between individuals in the family, shaping their personalities and consciousness, and the influence of the family on the individual in terms of satisfying his or her higher needs” (Tyszka, 1997, p. 68). These include the following sub-functions: socialising and educational, cultural, religious (in families where religious values are practised), recreational-social, and emotional-expressive.

When analysing the socialisation-educational function in families where the parent suffers from affective disorders, it is worth pointing out, following Elżbieta Michałowska, that “we can assume that mental illness is not conducive to the creation of a ‘harmonious family environment’, regardless of, whether it is the child who is ill and whose condition is aggravated by the conflicts in the family, or whether a parent is ill, which destroys the relationship between the spouses and negatively affects intra-family socialisation, as well as creates an atmosphere of negative spontaneous socialisation, both because the child observes the parent’s abnormal behaviour and because of the consequences (tensions, conflicts, etc.) that these behaviours cause among family members” (Michałowska, 2013, p. 116). The socialisation and educational function is carried out on a continuous basis in the family and is not usually stopped or abandoned as a result of a mood disorder occurring in at least one parent. However, it is necessary to point out that their appearance, even of a short duration, can negatively affect the parental influence or hinder the child’s socialisation. A parent’s behaviour resulting from the specifics of an affect disorder they are dealing with can have wide-ranging consequences for the behaviour or personality of the children who experience it. A change in a parent’s behaviour, a departure from previous interests or shared leisure activities, the introduction of new rules and rituals, neglecting or ignoring family rules and rituals that were part of family life before the onset of the episodes of illness can create dissonance among children or confuse them, with potential consequences in the child-rearing process. Parents confronting affect disorders, as was mentioned when discussing the legitimising and control function of the family, may also be inconsistent in the application of educational measures. The other parent or other adults present in the family environment can continuously undertake socialising and educational activities that compensate for the behaviour of the sick parent in a way that promotes the child’s development.

A parent’s mood disorder does not necessarily significantly affect the fulfilment of cultural and religious functions by the family. This function may be temporarily limited due to the family members focus on the sick person, or it may also be a source of new hope or inspiration for other family members to seek new solutions to the problem.

The recreational and social function can be significantly limited in families where parents are confronted with affective disorders of a manic nature. This is because an excessive expression of emotions and a high degree of social activity, which manifests itself in a desire to meet new people are characteristic for such individuals. The sufferers’ views may also become more radical and their previous value system may change. These types of changes and fluctuations, especially if they differ from the sick person’s previous behaviour, can introduce chaos into the life of the family who can also fear the sick person’s behaviour, resulting in withdrawal from social life and the maintenance of intra- family relationships. Difficulties in engaging in conversations and contacts with other people, as well as problems in expressing the accompanying emotions can be observed in people facing depressive episodes. This is due to the specific functioning of the person affected by depression, particularly a reduction in his or her general life activity and low self-esteem. Such people tend to avoid contact with other people, lack assertiveness or have limitations in expressing themselves and maintaining relationships with others. Difficulties in performance of the recreational-social function of the family may arise from difficulties of family members in building a good family atmosphere and nurturing social contacts, which may be significantly disrupted during a parent’s illness. Elżbieta Michałowska who examined the impact of bipolar affective disorder on the performance of basic family functions noted that “in all families, there were conflicts so strong and long-lasting, so significantly stigmatising for the sufferers, that in fact, out of fear of the reaction of those around them, they ceased to play a recreational and social role” (Michałowska, 2013, p. 118). The nature of mental illness can result in stigmatisation of the person with the illness as well as of the whole family, with the consequent abandonment of social contacts, both by the person with the illness and of other family members. The withdrawn attitude of the family affects the continued functioning of its members in other areas of life in society, as well as the personal experience and beliefs of individuals.

In the context of the emotional-expressive function, Elżbieta Michałowska noted that “actually, this function ceases to be performed by the family for two reasons. The first is that the illness comes to the fore when it becomes the main concern of all its members, and their own problems, emotional needs or need for contact recede into the background, and the need to care for the sick person becomes the main task. The second reason is that the person suffering from the bipolar disorder, especially in the extreme stages of the illness, is no longer able to find common ground with other, healthy family members. Common topics of conversation are no longer there, and there is also a break in the kind of intellectual solidarity that is so important for maintaining harmonious relationships within the family.” (Michałowska, 2013, p. 119). Family members of people with unipolar or bipolar affective disorder may struggle to understand and accept changes in their behaviour. Spouses/partners and children of such people may feel unappreciated due to the relatively low involvement of the ill family member in matters that are important to them, or may be disturbed by their expressive behaviour. While describing mothers suffering from depression, Thomas Tyra wrote that they tend to be “less empathetic, reactive and warm, and more punitive and negative towards the child. This is associated with a lower capacity for empathic relationships and pro-social behaviour. A depressed woman may be so preoccupied with her inner state that she is unable to read and respond to signals from her child, which interferes with her overall ability to be emotionally available. Depression makes mothers more self-absorbed and less attentive to their children’s emotional needs”. (Tyra, 2000, p. 328). Affective disorders that emerge among family members emotionally involve the whole family system and revolve around trying to support the person with the illness, which may lead to other family members’ emotional needs being neglected, as well as result in various forms of rebellious behaviour in adolescent children. In situations described above, many revealed and undisclosed conflicts and difficulties may arise in family relationships, with various consequences both for the whole system and for each individual being part of this system.

The discussed difficulties with the performance of the basic functions of a family referred to periods when one parent is in an episode of illness, and focused on the potential consequences for the future. However, it is important to emphasise that the situations and disruptions in the families’ performance of their functions mentioned above are usually temporary, and that once the sick person has recovered, the family systems perform the functions in question to a similar degree as before the onset or their performance changes. In view of the analysed factors influencing possible changes in the families of people whose parents face affective disorders, these families should be considered families at risk which, with appropriate support and the morphogenic capacities of the system, will be able to take steps to maintain their equilibrium and fulfil their basic functions in accordance with the current capacities of its members. The compensation of certain behaviours and missing needs by the other parent or by other adults, and the use of professional or institutional help also make it possible to minimise the negative consequences of temporary difficulties in meeting certain needs of the family system.

Final conclusions

Due to its specificity, a parent’s affective disorder can put families at risk of dysfunction. The changes induced in them as a result of the health condition of the sick person can significantly affect the fulfilment of the functions attributed to the family and thus contribute to the disruption of its structure, adequate fulfilment of its tasks and deterioration of its socio-economic situation. Knowing the specifics of the parent’s affective disorder also makes it possible to identify a number of difficulties that may occur in the family and may have negative consequences for its further functioning. The occurrence of an illness in a parent who shares responsibility for carrying out family functions and is responsible for the atmosphere of family life is a heavy burden on both the other parent and the children but not the only factor that can promote dysfunction in the family. When looking at the characteristic functioning of people with mood disorders and the factors that contribute to dysfunction in the families they co-create, one can notice some similarities that potentially contribute to the dysfunctionality of family systems. Disturbances may include material and economic difficulties mentioned above. Such situations can significantly affect the existing economic situation of families, which can lead to difficulties in meeting the basic needs of their members in extreme cases. A similar situation can also occur if the affected parent abuses various stimulants (especially during an episode of mania), which can lead to addiction and thus exacerbate dysfunction in the family system.

An equally important factor influencing the occurrence of dysfunction in the family is the disruption or loosening of the emotional bond within the family, the family structure breakdown and inefficiencies in care and parenting. These factors may be particularly relevant when it comes to the possibility of dysfunction in families where parents have mood disorders. By their very nature, mood disorders can change existing relationships within the family. Sufferers may withdraw from relationships, be less involved in family life or more irritable, demanding, and aggressive towards family members. The family may become more prone to conflicts and family members may withdraw from their relationship with the person with the illness. The original family structure may also break down in particularly difficult cases where the person with the illness refuses treatment.

The described situations occurring in the families of people with mood disorders may be temporary. The relationships previously developed and the ways in which family members cope with the illness are important. Understanding the nature of mood disorders and accepting that a partner/parent has an illness can minimise the risk of dysfunction arising from them. It should not be stated unequivocally that the occurrence of a mood disorder in a parent automatically causes dysfunction in the family system. Mood disorders, their specific nature, the personality and character of the sick person can contribute to dysfunctional factors to varying degrees but a number of multiple factors such as the attitude of the other parent, the support provided, the understanding of the nature of the mood disorder and the sufferer’s attitude to treatment can prevent them, thereby maintaining the way the family functions at a level similar to that before the illness or illness episode. It seems important, therefore, to look at families with parents with affective disorders, especially in the current situation characterised by the constantly deteriorating mental health of society, and to treat these families as ones at high risk of dysfunction. It is also important to provide adequate support to the members of these families in line with their needs, to point out the possible forms of assistance not only to the sick person but to all members of the family, and to educate the public on how to deal with such situations. Widespread public awareness of how to support people with affective disorders and the inclusion of these families in preventive measures can minimise the risk of dysfunction and protect them from a variety of health, emotional and social consequences.