Louise Newman

Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia

Objective: To document the psychiatric status of a near complete sample of children and their families from one ethnic group held for an extended period of time in a remote immigration detention facility in Australia.

Borderline personality disorder, mother-infant interaction and parenting perceptions : preliminary findings

Objective: Parents diagnosed with borderline personality disorder (BPD) are likely to find the emotional aspects of parenting challenging. Research into the difficulties that these parents experience, however, is lacking. The aims of the present study were to (i) gain an understanding of the interactional patterns of mothers with BPD and their infants and (ii) to explore the parenting perceptions of mothers with BPD. Method: Two groups of mother–infant dyads were recruited: mothers with BPD and their infants; and community mothers and their infants. Groups were compared on mother–infant interaction patterns and on maternal self-perceptions of parenting. Results: Mothers with BPD were found to be less sensitive and demonstrated less structuring in their interaction with their infants, and their infants were found to be less attentive, less interested and less eager to interact with their mother. Furthermore, mothers with BPD reported being less satisfied, less competent and more distressed. Conclusions: Early intervention needs to be provided to mothers with BPD to promote maternal sensitivity and maternal perceptions of competence.

Seeking refuge, losing hope: parents and children in immigration detention

Objective: To record observations made by the authors on a series of visits between December 2001 and March 2002 to two of Australias immigration detention centers and to consider the mental health consequences of Australias policy of mandatory immigration detention of asylum seekers for families and children. Conclusions: Parents and children in immigration detention are often vulnerable to mental health problems before they reach Australia. Experiences in prolonged detention add to their burden of trauma, which has an impact not only on the individual adults and children, but on the family process itself. Immigration detention profoundly undermines the parental role, renders the parent impotent and leaves the child without protection or comfort in already unpredictable surroundings where basic needs for safe play and education are unmet. This potentially exposes the child to physical and emotional neglect in a degrading and hostile environment and puts children at high risk of the developmental psychopathology that follows exposure to violence and ongoing parental despair. Psychiatrists have a role in advocating for appropriate treatment of these traumatized and vulnerable parents and children.

Sex, Gender and Culture: Issues in the Definition, Assessment and Treatment of Gender Identity Disorder

As a diagnostic category, gender identity disorder remains problematic with ongoing debates concerning aetiology, definition and ethics of treatment. Inherent in the current DSM definition is a Western model of the relationship between sex and gender which epitomizes the tension existing between essentialist and constructivist accounts of gender development. This model determines that gender-aberrant behaviour and gender variation are, by definition, pathological, and reinforces a binary gender model. Studies of non-Western cultures reveal variations in models of gender and in the understanding of gender deviance. Cultures vary in their definition of gender roles and show varying degrees of tolerance for atypical gender behaviours and gender change. An understanding of cultural context is important in the clinical assessment of a typical gender development and challenges current models of sex and gender.

Parenting and Borderline Personality Disorder: Ghosts in the Nursery

This article reviews parenting issues for mothers with a diagnosis of borderline personality disorder. Motivation for parenting, conflicts and challenges associated with parenting and outcomes for infant and child development are considered. Implications for current therapeutic practice with families are outlined.

Children and young people in immigration detention.

Purpose of review This article reviews evidence about the impact of immigration detention and other restrictive immigration policies on the mental health of children, young people and the adults who care for them. We review the implications of this for clinicians attempting to assess or work with incarcerated child and adult refugees and asylum seekers. Recent findings There are increasing numbers of adults and children seeking asylum across the globe and many nations use incarceration and other harsh and interceptive immigration practices. There is mounting evidence of the psychological harm associated with detention of already vulnerable adults and children. Australia is used as a case study. Summary Clinicians are required to consider the intersection of mental health assessment and treatment with human rights violations, and the impact of restrictive immigration policies, not only on asylum seekers and refugees but also on clinicians, clinical practice and professional ethics.

Hormone treatment of gender identity disorder in a cohort of children and adolescents.

Objective: To describe the experience of hormone treatment of gender identity disorder (GID) in children and adolescents within a specialist clinic.

Issues in infant--parent psychotherapy for mothers with borderline personality disorder.

Mothers with Borderline Personality Disorder (BPD) and their infants have been largely neglected in the research literature. This is of concern, given that clinical reports indicate that mothers with BPD have difficulties with sensitive and empathic parenting and that their children are at risk of attachment disorganization. There is little available evidence on the use of interventions with this group of parents despite clinical need. This article describes our experiences in the use of an attachment-focused psychotherapy known as Watch Wait and Wonder for improving the interaction between mothers with a BPD diagnosis and their children. A case example is provided to illustrate one mothers response to the therapy and to highlight specific issues in clinical intervention for this group of parents and possible modifications of approach.

Comparing models of borderline personality disorder: Mothers' experience, self-protective strategies, and dispositional representations.

This study compared aspects of the functioning of mothers with borderline personality disorder (BPD) to those of mothers without psychiatric disorder using two different conceptualizations of attachment theory. The Adult Attachment Interviews (AAIs) of 32 mothers were classified using both the Main and Goldwyn method (M&G) and the Dynamic-Maturational Model method (DMM). We found that mothers with BPD recalled more danger, reported more negative effects of danger, and gave evidence of more unresolved psychological trauma tied to danger than other mothers. We also found that the DMM classifications discriminated between the two groups of mothers better than the M&G classifications. Using the DMM method, the AAIs of BPD mothers were more complex, extreme, and had more indicators of rapid shifts in arousal than those of other mothers. Representations drawn from the AAI, using either classificatory method, did not match the representations of the mother’s child drawn from the Working Model of the Child Interview; mothers with very anxious DMM classifications were paired with secure-balanced child representations. We propose that the DMM offers greater clinical utility, conceptual coherence, empirical validity, and coder reliability than the M&G.

The Child Asylum Seeker: Psychological and Developmental Impact of Immigration Detention

Asylum-seeking children are one of the most vulnerable groups of displaced persons. The experience of being a detainee, with limited ways of communicating ones plight, shapes the expression of distress. Clinicians need to see the distress and symptoms of mental disorder as emerging in the context of the detention environment rather than within a traditional medical model. The use of diagnostic labels without elaboration does not provide an adequate account of the childs difficulties. The clinician has an important role in bearing witness to the harm done to detainees as well as trying to prevent harm in whatever way possible.