A human being is not a machine – and no one was born to work. At least that is the basic humanistic orientation of a society that still recognizes the primacy of politics as a principle.
At the same time, the most diverse sub-sectors of society are everywhere placed under the premise of economic success: A university must prove itself on the market; a clinic must be profitable.
It is therefore somewhat surprising that entire groups are denied the appropriate attention and support, preventing them from fully developing their economic potential. After all, this full development would also be a gain for the common good, and that would be right up there with Adam Smith. Nowadays and in the western industrialized countries, we achieve this gain first and foremost by levying taxes at the national level.
12 to 16 million COPMI
The group we are talking about here are the children of mentally ill parents and they comprise more than 10 million people. That would already be an eighth of the German population.
How is this figure made up?
The data situation is extremely poor and sometimes relies exclusively on estimates from the early 10s:
“Experts now assume that one in four children (i.e. an estimated three to four million children) has a parent with a temporary or permanent mental illness”
Deutscher Bundestag Drucksache 18/12780, p.1
and:
“around 2.6 million children grow up in families with addiction problems”
Drug and Addiction Report of the Federal Government, June 2016, p.117
In total and across all generations, there are around 12-16 million children with a temporarily or permanently mentally ill parent. And 9-12 million of these are adult children.
The figures are 10.4 million for children in families with addiction problems and 7.8 million for adult children.
This amounts to just under 17 thousand per 100,000 inhabitants – calculated across all generations (approx. 17%) Children with a mentally ill parent and approx. 12.7 thousand (approx. 13%) adult children.
In Berlin alone, this would mean that around 587 thousand children live with a mentally ill parent across all generations. Of these, around 440 thousand are adult children. In a city like Heidelberg with only 154,000 inhabitants, there would still be approx. 26,000 children and approx. 19.5,000 adult children.
PTSD as a mitigating factor
It can be assumed that their childhood and the associated stresses do not contribute to improved performance. Further information on this can be found in the relevant publications of the last 20 years.
The fact that growing up in a home with mentally ill parents can also have trauma consequences is still not a widespread doctrine at the time of writing this article. At the same time, a great deal has changed in traumatology in the last ten years, which will continue to promote this perspective in the future.
For example, the symptoms of complex post-traumatic stress disorder (CPTBS) have been included in ICD 11. The fact that #COPMI (Children Of Parents with a Mental Illness) are to be included in this group of symptoms can be seen from the symptoms described – although research is certainly still needed to provide quantitative evidence of this.
From personal experience and conversations with other COPMI in the Seelenerbe e.V. association and in other contexts, my focus has been on this topic because the similarities, especially in the symptoms, are frighteningly true. I was surprised myself when reading Bessel van der Kolk’s classic and was able to underline every other sentence, as I found myself in it so often.
In the following, I would like to refer primarily to the German Trauma Consequence Cost Study (DTfs 2012) from 2012. In my opinion, even the simple definition of trauma often applies to children with mental illness:
In this context, traumatization is understood as extreme stress in childhood/adolescence, either in the form of a single stressful event (e.g. one-off sexual abuse) or as a result of a sum of stresses (e.g. neglect), which results in an increased risk of trauma-related disorders.
Trauma-related disorders, on the other hand, are mental and somatic illnesses and health disorders as well as impairments in all other areas of life that are more likely to occur in the course of a person’s life as a result of trauma.
DTfs 2012, p. 118
The focus for COPMI is therefore primarily on traumatization due to a sum of very different stresses. In my opinion, this includes the aforementioned neglect (which can manifest itself in very different ways) or constant boundary violations (the child is not allowed to sleep in peace), excessive demands (the child is entrusted with tasks that are not age-appropriate) or the failure to develop a healthy identity because the adult counterpart cannot act as a reliable communication partner and point of orientation.
It should be noted that this is not about isolated situations, but about the child’s constant, or at least frequently recurring, experience of frustration in contact with the parent.
In my case, for example, communication with my mother was no longer possible because I was no longer accepted as a fully-fledged conversation partner. Instead, I was denied my own competence to act, as my mother was of the opinion that we were being controlled by external powers using boxes and strings. My sentences and statements were no longer recognized as being spoken by me, which was tantamount to negating my own opinion – and that made me angry.
€ 11 billion per year
In the study on trauma-related costs, COPMI are not clearly defined as those affected. One could also say that COPMI are once again overshadowed and forgotten here – which also fits in with the picture of the expected link between the two topics described above.
Although relative proportions of those affected are mentioned, the focus is primarily on sexual abuse. In total, around 14,000 children (under the age of 18) are mentioned, which equates to around 54,000 people across generations.
In contrast to the 12-16 million (!) COPMI, which are also estimated, this is a fraction.
The potential costs caused by PTSD are therefore approximately 1000 times higher if one assumes that all COPMI have significant trauma symptoms.
EXCURSUS: I assume that a generalization of this kind is not permissible. It can be assumed that every situation of a child with a mentally ill parent is individually different, if only because psychosis manifests itself largely individually. In addition, not all family systems are set up in the same way, because available relatives, supportive friends, the environment in general and the associated resources are probably never exactly the same in different cases. At the same time, however, I assume that growing up as a COPMI is significantly different from that of a comparable child WITHOUT a mentally ill parent. END EXKURSUS
The study identifies annual costs of € 11 billion.
It summarizes various consequences under the PTSD aspect in order to ultimately highlight the cost factors more clearly and thus be able to calculate them better.
These consequences include:
- Post-traumatic stress disorder
- Depressive disorders
- Anxiety disorders
- Addictive disorders
- Somatoform disorders
- Personality disorders
- Disorders of social behavior
- Overweight
- Diabetes mellitus
- High blood pressure
- Ischemic heart disease
(cf. DTfs, pp. 32)
The cost estimate primarily relates to care and support costs, i.e. those from the healthcare system. Depending on the estimate, these alone amount to up to € 3.3 billion.
Many factors play a role in the calculation of follow-up costs, which need not only lie in the healthcare system (for example, the legal system could also be taken into account if negotiations have to be conducted because abuse is prosecuted, etc.). However, costs that those affected have to bear themselves, for example if they are subjected to violence and have to pay for damages, can also be taken into account. – – – –
The estimate of € 11 billion is also conservative:
Against this background, the result of 11.0 billion euros in annual trauma-related costs for Germany represents an approximation of the real costs. […] The results should be regarded as conservative, as the approach consistently attempts to avoid overestimating the costs.
DTfs, p. 118
This means that the potential additional costs that are not taken into account would be far higher if COPMI were also included.
Individual – microeconomic – potentials
In recent years, I have observed that the COPMI I meet often pursue jobs that are below their potential, their training and, not least, their abilities. In some cases, COPMI even choose not to participate in working life at all if they can (for example by being supported by their partner).
Many people are aware of this way of working and living – and would not do anything about it. This is due to fears that have to do with excessive demands, etc., which can be seen in the context of stress and therefore PBTS.
My thesis: As patients with PBTS, COPMI fall short of their potential.
In my opinion, this in turn has an effect on self-perception in terms of identity and, not least, on the opportunities for social participation. This is about that connection, which is recognized by employment research as a (positive) effect of (individual) employment on the employee’s own personality.
In short: pride, recognition and self-worth are – also – derived from professional activity. Conversely, this means that if it is not possible to pursue an activity that is appropriate to one’s own abilities, the positive effects cannot materialize accordingly.
Macroeconomic potential
This also establishes the link to macroeconomic effects. After all, a society whose members can come closer to their full potential can generally be classified as more efficient.
A better, preventive approach, which therefore also addresses issues of taboo and stigmatization (which is also mentioned in the study), could therefore not only reduce follow-up costs, but also unleash potential at a macroeconomic level.
This de facto includes material gains “only” as a last consequence. I.e., more overall economic productivity is one thing.
The other is development opportunities in the creative field: the use of potential can also be reflected in the development of increasing diversity, which does not have to be purely economic in nature. Art and culture are therefore just as much a part of utilizing this potential as founding start-ups or even taking on tasks that correspond to one’s own abilities.
In my opinion, this study is the only one to date that has even estimated the costs of trauma consequences in Germany. Nothing significant has been published in this regard since 2012 (as of 04/2020).
At the same time, the authors also complain about the poor data situation in order to make better statements, but even with a conservative estimate they arrive at € 11 billion in costs caused by the consequences of trauma. The group of more than 12 million COPMI adults is not even explicitly taken into account. Even if these were to overlap with the trauma groups considered in the study, the cost estimate would very likely be significantly higher.
In addition, the prevention of traumatization holds two noteworthy potentials: firstly, the full consideration of COPMI in pre- and aftercare would presumably significantly reduce their costs in the trauma context. Secondly, all COPMI who were spared the trauma in the parental home could approach their professional and life-shaping career more adequately and, in this sense, more successfully, because more satisfactorily.
There is still a lot to do!
