Int J Adolesc Med Health 2015; aop
Mini Review Leo Shera,*
Parental alienation: the impact on men’s mental health DOI 10.1515/ijamh-2015-0083 Received August 11, 2015; accepted September 20, 2015
Abstract: Parental alienation is defined as a mental state in which a child, usually one whose parents are engaged in a high-conflict separation or divorce, allies himself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification. Parental alienation may affect men’s mental health: a) parental alienation negatively influences mental health of male children and adolescents who are victims of parental alienation. Alienated children/adolescents display guilt, sadness, and depressed mood; low self-esteem and lack of self- confidence; distress and frustration; lack of impulse control, substance abuse and delinquent behavior; separation anxiety, fears and phobias; hypochondria and increased tendency to develop psychosomatic illness; suicidal ideation and suicide attempt; sleep and eating disorders; educational problems; enuresis and encopresis; b) parental alienation negatively affects the mental health of adult men who were victims of parental alienation when they were children and/or adolescents. Long-term effects of parental alienation include low self-esteem, depression, drug/alcohol abuse, lack of trust, alienation from own children, divorce, problems with identity and not having a sense of belonging or roots, choosing not to have children to avoid being rejected by them, low achievement, anger and bitterness over the time lost with the alienated parent; c) parental alienation negatively influences mental health of men who are alienated from their children. Fathers who have lost some or all contact with their children for months or years following separation or divorce may be depressed and suicidal.
Dr. Leo Sher is the Chair of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force on Men’s Mental Health. *Corresponding author: Leo Sher, MD, James J. Peters Veterans’ Administration Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA, Phone: +1-718-584-9000x6821, Fax: 1-718-741-4703, E-mail: [email protected]; and Icahn School of Medicine at Mount Sinai, New York, NY, USA a
Keywords: adolescents; children; depression; men’s mental health; parental alienation; parents; suicide.
The concept of parental alienation and parental alienation syndrome Parental alienation is defined as a mental state in which a child, usually one whose parents are engaged in a highconflict separation or divorce, allies himself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification (1, 2). Parental alienation is anomalous, maladaptive behavior (refusal to have a relationship with a loving parent) that is driven by an abnormal emotional condition (the false belief that the rejected parent is evil, dangerous, or unworthy of love). The alienating parents recruit children as allies in a fight against the other parent (1–3). Through continuing bad-mouthing, lies, exaggerations, overlooking positives, and drum-beating negatives, they manipulate their children to reject the other parent. Parental alienation comes about when one parent puts her or his own needs and emotions above the best interest of the child. The concept of parental alienation has been recognized by mental health professionals around the world for many decades (2, 4). Almost every mental health professional who works with children of divorced parents acknowledges that parental alienation affects thousands of families and causes enormous pain and hardship. In 1985, Richard Alan Gardner, an outstanding New York child psychiatrist, suggested the concept of parental alienation syndrome, a condition “in which children are obsessed with depreciation and criticism of a parent – denigration that is unjustified and/or exaggerated… The concept of the parental evaluation syndrome includes the brainwashing component but is much more inclusive. It includes not only conscious but subconscious and unconscious factors within the parent that contribute to the child’s alienation” (5).
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2 Sher: Parental alienation: the impact on men’s mental health Gardner described eight behaviors of a child that he suggested indicated that the child was unreasonably and unjustifiably alienated from one of the parents because of manipulative behavior of the favored parent (5). The eight behaviors are: –– The child’s campaign of vilification against the target parent; –– Thoughtless and frivolous rationalizations for the child’s denigration of the target parent; –– Absence of ambivalence; –– The independent-thinker phenomenon which refers to the behavior seen in alienated children where they state that their resistance to seeing the unfavored/targeted parent originates from their own independent thought and is not the result of the other parent’s impact; –– Reflexive support of the alienating parent against the target parent; –– Lack of guilt over exploitation and maltreatment of the target parent; –– Borrowed scenarios; –– Spread of the child’s hostility toward the target parent’s extended family. It has been suggested that there are three clinical levels of parental alienation syndrome: mild, moderate and severe (6). –– Mild: The alienation is comparatively superficial. The children generally cooperate with visitation but are occasionally critical and unhappy with the victimized parents. –– Moderate: The alienation is stronger. The children are more disruptive and rude with the victimized parents. There are transitional problems at the time of visitation. –– Severe: The children are so antagonistic that visitation rights are impossible. The children are hostile to the point of being physically aggressive toward the allegedly disliked parents. In some cases, the children direct extremely severe allegations of evil behavior against these parents.
Parental alienation may affect the men’s mental health Parental alienation negatively affects the mental health of –– male children and adolescents who are victims of parental alienation; –– adult men who were victims of parental alienation when they were children and/or adolescents; –– men who are alienated from their children.
The impact of parental a lienation on the mental health of male children and adolescents Parental alienation has multiple negative effects on children/adolescents. According to the available publications, these effects include (7–12): –– Guilt, sadness, and depressed mood. This is probably related to a painful conflict in loyalty but may also be related to other factors. –– Low self-esteem and lack of self-confidence. In the case of boys, identification with a male figure has been reduced, especially if the alienated parent is the father. –– Distress and frustration. –– Lack of impulse control, substance abuse and delinquent behavior. There is substantial evidence that the presence of fathers and their impact can do a lot to prevent and reduce the possibility of delinquency in boys. It was observed that adolescents were especially likely to engage in externalizing behaviors when they were involved in their parents’ unresolved disputes or felt torn between their parents. –– Separation anxiety, fears and phobias. –– Hypochondria and increased tendency to develop psychosomatic illness. –– Suicidal ideation and suicide attempt. –– Sleep and eating disorders, including anorexia nervosa, obesity and bulimia. –– Educational problems. –– Enuresis and encopresis. Judge Michele Lowrence (Domestic Relations Division of the Circuit Court of Cook County, Chicago, IL, USA) wrote: “It is very easy for a parent to malign another parent. It is tempting when you are angry. Even if it does not go to the level of full-out alienation, parents need to know that even a smallest act of maligning crushes the children’s ability to feel good about themselves… From my perspective, destroying the child’s loving attachment to one parent interrupts the child’s intrinsic need to feel confident that he or she will be well taken care of by that parent” (2). Baker and Ben-Ami (13) stated that “to turn a child against the other parent is to turn a child against himself or herself”. In summary, parental alienation negatively affects mental and physical health of male (and female) children and adolescents. Parental alienation also has long-term consequences for children/adolescents who are victims of alienation.
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Sher: Parental alienation: the impact on men’s mental health 3
The impact of parental alienation on the mental health of adult men who were exposed to alienating behavior as children/adolescents Adults who reported childhood exposure to alienating behaviors are more likely to have psychological problems in their adult lives compared to adults who were not exposed to such behaviors (9, 13–21). Baker studied the long-lasting impact of parental alienation and published many works on this subject (16–20). She identified the following long-term effects of parental alienation (16): –– low self-esteem, –– depression, –– drug/alcohol abuse, –– lack of trust, –– alienation from own children, –– divorce, –– problems with identity and not having a sense of belonging or roots, –– choosing not to have children to avoid being rejected by them, –– low achievement, –– anger and bitterness over the time lost with the alienated parent. Baker has also observed that adults whose parents alienated them from their other parent described the alienating parent much the way former cult members describe cult leaders (20). A recent study found that those who report childhood exposure to alienating behaviors have higher scores on most of the Symptom Checklist-90-R (SCL-90-R) scales and are more likely to be above the clinical cutoff on the SCL90-R scale scores (14). The degree of exposure to alienating behaviors was positively associated with higher scores on the SCL-90-R. The SCL-90-R assesses symptoms of psychopathology and provides global distress indices.
The impact of parental alienation on the mental health of fathers alienated from their children The predominant feelings among alienated parents are helplessness, powerlessness, and growing despair (9). Fathers who have lost some or all contact with their
children for months or even years following separation or divorce may be depressed and suicidal since the loss of contact or restriction of the relationship between the children and the father is a very upsetting and painful experience for both the children and the father (9). Some alienated fathers seek to escape through alcohol, benzodiazepines, and/or other drugs (8). Clinicians should be vigilant regarding symptoms of depression, post-traumatic stress disorder, suicidality, and other psychiatric conditions among alienated fathers (8, 9, 21, 22).
Parental alienation and suicidal behavior Suicide rates in men in Western countries are very high (23–27). For example, age-standardized suicide rates among men in the US, Germany, Finland and Hungary are 19.4, 14.5, 22.2, and 32.4 per 100,000 population/per year, respectively (23). Worldwide, men commit suicides 3–10 times more frequently than women (24–26). In the US, males die from suicide attempts three to four times more often as females. From 1999 to 2010, the suicide rate among Americans aged 35–64 grew by almost 30%, to 17.6 deaths per 100,000 people, up from 13.7 (27). While suicide rates are increasing among both middle-aged men and women, much more men take their own lives. In 2010, the suicide rate in the US for middle-aged men was 27.3 deaths per 100,000, while for women it was 8.1 deaths per 100,000 (27). It has been proposed that men are markedly overrepresented among suicide victims because men use more lethal means to attempt suicide, more frequently use/abuse alcohol, and less frequently seek a psychiatric and/or medical help compared to women (24, 25, 28). I recently proposed that parental alienation may contribute to suicidality in adult men who were victims of parental alienation as children or in men who are alienated from their children (29). This suggestion is consistent with the observation that divorced men are 9.7 times more likely to kill themselves than comparable divorced women (24).
Prevention of parental alienation The issue of parental alienation is getting more and more attention. Several important books on this subject have been published in the past 10 years (2, 9, 19, 30, 31). Parental alienation has been internationally conceptualized as a violation of the civil rights of the child (2). However, it
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4 Sher: Parental alienation: the impact on men’s mental health remains difficult to reduce the number and intensity of parental alienation cases. The alienating parent’s task is simple and easy (32). Many alienators are adept at using the inertia endemic to social welfare agencies, law enforcement, and the courts. The playing field is not level. It is biased in favor of the alienating parent. We must acknowledge this if it is to be overcome. Tough legal actions may help (2, 33, 34). The pretrial planning methodology includes an integration of fact proofs with the scientific data on the manipulation of children’s memories, child suggestibility, interviewing, and delayed disclosure of distorted recollections (2). A methodology for trial planning includes science data integration between attorney and chosen expert. The attorney for the alienated parent must be able to demonstrate how the behavior of the alienating parent contributed to the development of parental alienation. Also, the attorney must prepare with the expert to describe the sequelae of parental alienation. If there is no threat of harsh fines, prison time or sole custody to the targeted parent, the chances are remote that the alienating parent can be stopped (33, 34). Dr. Ludwig F. Lowenstein, one of Britain’s most quoted authorities on psychology in education wrote: “Judges have a moral duty to provide justice for the alienated party, this usually being the father. The threat of punishment for the alienator must be supported by punishment, including removing the child from mother’s care to a neutral place or to the alienated parent, and to use incarceration when necessary. Failure to carry out this distasteful, but necessary, action against the obdurate party would constitute a mockery of the judicial system. It is my experience as an expert witness to the Courts as a forensic, clinical psychologist, that most alienating parents, whether mothers or fathers, will obey a court order if punishment is threatened for failure to adhere to the ruling” (33). A New York attorney, Chaim Steinberger states that “because alienation can be subtle and insidious and its devastating effects potentially permanent and irreversible, most experts conclude that in severe instances the only “treatment” that prevents alienation from continuing, effectively reverses it and enables reconciliation with the target is the immediate transfer of custody to the target parent” (34). Multiple studies related to parental alienation have been performed over the past 30 years. However, parental alienation remains a relatively unstudied field and more research on parental alienation is merited. It is important to educate mental health and legal professionals. There are some efforts in this direction. For example, in France, training courses on parental alienation issues are offered for attorneys, social workers, and
police officers (35). Victims of parental alienation as well as fathers alienated from their children should be evaluated and monitored by mental health professionals and the larger health care community. The issue of parental alienation needs more attention from legal and mental health professionals, and, probably, from lawmakers. Children/adolescents should have a chance at having the best relationship they can with both of their parents. This is necessary for their mental health.
References 1. Bernet W, Baker AJ. Parental alienation, DSM-5, and ICD-11: response to critics. J Am Acad Psychiatry Law 2013;41:98–104. 2. Lorandos D, Bernet W, Sauber SR, editors. Parental alienation. the handbook for mental health and legal professionals. Springfield, IL: Charles C. Thomas Publishers, 2013. 3. Warshak RA. Divorce poison: how to protect your family from bad-mouthing and brainwashing. NY: William Morrow Paperbacks, 2010. 4. Lavadera AL, Ferracuti S, Togliatti MM. Parental alienation syndrome in Italian legal judgments: an exploratory study. Int J Law Psychiatry 2012;35:334–42. 5. Gardner RA. Recent trends in divorce and custody litigation. Acad Forum 1985;29:3–7. 6. Gardner RA. The three levels of parental alienation syndrome alienators: differential diagnosis and management. Am J Forensic Psychiatry 2004;25:41–76. 7. Lowenstein LF. Parental alienation syndrome – what the legal profession should know. Med Leg J 1999;66(Pt 4):151–61. 8. Schick A. Behavioral and emotional differences between children of divorce and children from intact families: clinical significance and mediating processes. Swiss J Psychol 2002;61:5–14. 9. von Boch-Galhau W. Parental alienation and parental alienation syndrome/disorder. English edition. Berlin: Verlag fur Wissenschaft und Bildung, 2013:168. 10. Steinberger C. Father? What father? Parental alienation and its effect on children. Part One. NYSBA Family Law Review 2006;38:1–24. 11. Kruk E. The impact of parental alienation on children. Undermining loving parent-child relationships as child maltreatment. Psychol Today April 25, 2013. URL: https://www.psychologytoday.com/blog/co-parenting-after-divorce/201304/the-impactparental-alienation-children. 12. Hetherington EM. Should we stay together for the sake of the children? In: Hetherington EM, editor. Coping with divorce, single parenting, and remarriage: a risk and resiliency perspective. Mahwah, NJ: Erlbaum, 1999:93–116. 13. Baker AJL, Ben Ami N. Adult recall of childhood psychological maltreatment in adult children of divorce: prevalence and associations with outcomes. J Divorce Remarriage 2011;52: 203–19. 14. Bernet W, Baker AJ, Verrocchio MC. Symptom Checklist-90- Revised scores in adult children exposed to alienating behaviors: an Italian sample. J Forensic Sci 2015;60:357–62.
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Sher: Parental alienation: the impact on men’s mental health 5 15. Amato PR, Afifi TD. Feeling caught between parents: adult children’s relations with parents and subjective well-being. J Marriage Fam 2006;68:222–35. 16. Baker AJL. The long-term effects of parental alienation on adult children: a qualitative research study. Am J Fam Ther 2005;33:289–302. 17. Baker AJL. Adult recall of parental alienation in a community sample: prevalence and associations with psychological maltreatment. J Divorce Remarriage 2010;51:1–20. 18. Baker AJL, Chambers J. Adult recall of childhood exposure to parental conflict: unpacking the black box of parental alienation. J Divorce Remarriage 2011;52:55–76. 19. Baker AJL. Adult children of parental alienation syndrome: breaking the ties that bind. NY: Norton, 2007. 20. Baker AJL. The cult of parenthood: a qualitative study of parental alienation. Cultic Studies Review 2005;4:1–29. 21. Kruk E. The impact of parental alienation on parents. Post- traumatic stress in the rupture of parent-child relationships. Psychol Today May 02, 2013. URL: https://www.psychologytoday.com/blog/co-parenting-after-divorce/201305/the-impactparental-alienation-parents. 22. Kposowa AJ. Divorce and suicide risk. J Epidemiol Community Health 2003;57:993. 23. World Health Organization. Global Health Observatory Data Repository. Suicide rates. Data by country. URL: http://apps. who.int/gho/data/node.main.MHSUICIDE?lang=en. 24. Sher L. Suicide in men. J Clin Psychiatry 2015;76:e371–2. 25. Rutz W, Rihmer Z. Suicidality in men – practical issues, challenges, solutions. J Men’s Health Gender 2007;4:393–401.
26. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, et al. Suicide and suicidal behavior. Epidemiol Rev 2008;30:133–54. 27. Centers for Disease Control and Prevention. Suicide among adults aged 35–64 years – United States, 1999–2010. Morb Mortal Wkly Rep 2013;62:321–5. 28. Sher L, Rihmer Z, Didia-Attas J, de Leon J, Lin S-K, et al. Future research and clinical directions in the field of men’s mental health: the Madrid declaration. Front Public Health 2014;2:242. 29. Sher L. Parental alienation and suicide in men. Psychiatr Danub in press. 30. Gardner RA, Sauber RS, Lorandos D, editors. The international handbook of parental alienation syndrome: conceptual, clinical and legal considerations. Springfield, IL: Charles C. Thomas Publishers, 2006. 31. Bernet W, editor. Parental Alienation, DSM-5, and ICD-11. Springfield, IL: Charles C. Thomas Publishers, 2010. 32. Bone JM. Access and visitation blocking: the first ingredient of parental alienation. December 20, 2012. URL: http:// jmichaelbone.blogspot.com/2012/12/access-and-visitationblocking-first.html. 33. Lowenstein LF. Parental alienation and the judiciary. Med Leg J 1999;67(Pt 3):121–3. 34. Steinberger C. Father? What father? Parental alienation and its effect on children. Part Two. NYSBA Family Law Review 2006;38:9–19. 35. Odinetz O. Parental alienation awareness in France: from training courses to court decisions. In: 16th World Congress of Psychiatry, Madrid, Spain, September 14-19, 2014. Symposium Abstracts, Vol. 2, 2014:67–8.
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Mini Review Leo Shera,*
Parental alienation: the impact on men’s mental health DOI 10.1515/ijamh-2015-0083 Received August 11, 2015; accepted September 20, 2015
Abstract: Parental alienation is defined as a mental state in which a child, usually one whose parents are engaged in a high-conflict separation or divorce, allies himself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification. Parental alienation may affect men’s mental health: a) parental alienation negatively influences mental health of male children and adolescents who are victims of parental alienation. Alienated children/adolescents display guilt, sadness, and depressed mood; low self-esteem and lack of self- confidence; distress and frustration; lack of impulse control, substance abuse and delinquent behavior; separation anxiety, fears and phobias; hypochondria and increased tendency to develop psychosomatic illness; suicidal ideation and suicide attempt; sleep and eating disorders; educational problems; enuresis and encopresis; b) parental alienation negatively affects the mental health of adult men who were victims of parental alienation when they were children and/or adolescents. Long-term effects of parental alienation include low self-esteem, depression, drug/alcohol abuse, lack of trust, alienation from own children, divorce, problems with identity and not having a sense of belonging or roots, choosing not to have children to avoid being rejected by them, low achievement, anger and bitterness over the time lost with the alienated parent; c) parental alienation negatively influences mental health of men who are alienated from their children. Fathers who have lost some or all contact with their children for months or years following separation or divorce may be depressed and suicidal.
Dr. Leo Sher is the Chair of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force on Men’s Mental Health. *Corresponding author: Leo Sher, MD, James J. Peters Veterans’ Administration Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA, Phone: +1-718-584-9000x6821, Fax: 1-718-741-4703, E-mail: [email protected]; and Icahn School of Medicine at Mount Sinai, New York, NY, USA a
Keywords: adolescents; children; depression; men’s mental health; parental alienation; parents; suicide.
The concept of parental alienation and parental alienation syndrome Parental alienation is defined as a mental state in which a child, usually one whose parents are engaged in a highconflict separation or divorce, allies himself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification (1, 2). Parental alienation is anomalous, maladaptive behavior (refusal to have a relationship with a loving parent) that is driven by an abnormal emotional condition (the false belief that the rejected parent is evil, dangerous, or unworthy of love). The alienating parents recruit children as allies in a fight against the other parent (1–3). Through continuing bad-mouthing, lies, exaggerations, overlooking positives, and drum-beating negatives, they manipulate their children to reject the other parent. Parental alienation comes about when one parent puts her or his own needs and emotions above the best interest of the child. The concept of parental alienation has been recognized by mental health professionals around the world for many decades (2, 4). Almost every mental health professional who works with children of divorced parents acknowledges that parental alienation affects thousands of families and causes enormous pain and hardship. In 1985, Richard Alan Gardner, an outstanding New York child psychiatrist, suggested the concept of parental alienation syndrome, a condition “in which children are obsessed with depreciation and criticism of a parent – denigration that is unjustified and/or exaggerated… The concept of the parental evaluation syndrome includes the brainwashing component but is much more inclusive. It includes not only conscious but subconscious and unconscious factors within the parent that contribute to the child’s alienation” (5).
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2 Sher: Parental alienation: the impact on men’s mental health Gardner described eight behaviors of a child that he suggested indicated that the child was unreasonably and unjustifiably alienated from one of the parents because of manipulative behavior of the favored parent (5). The eight behaviors are: –– The child’s campaign of vilification against the target parent; –– Thoughtless and frivolous rationalizations for the child’s denigration of the target parent; –– Absence of ambivalence; –– The independent-thinker phenomenon which refers to the behavior seen in alienated children where they state that their resistance to seeing the unfavored/targeted parent originates from their own independent thought and is not the result of the other parent’s impact; –– Reflexive support of the alienating parent against the target parent; –– Lack of guilt over exploitation and maltreatment of the target parent; –– Borrowed scenarios; –– Spread of the child’s hostility toward the target parent’s extended family. It has been suggested that there are three clinical levels of parental alienation syndrome: mild, moderate and severe (6). –– Mild: The alienation is comparatively superficial. The children generally cooperate with visitation but are occasionally critical and unhappy with the victimized parents. –– Moderate: The alienation is stronger. The children are more disruptive and rude with the victimized parents. There are transitional problems at the time of visitation. –– Severe: The children are so antagonistic that visitation rights are impossible. The children are hostile to the point of being physically aggressive toward the allegedly disliked parents. In some cases, the children direct extremely severe allegations of evil behavior against these parents.
Parental alienation may affect the men’s mental health Parental alienation negatively affects the mental health of –– male children and adolescents who are victims of parental alienation; –– adult men who were victims of parental alienation when they were children and/or adolescents; –– men who are alienated from their children.
The impact of parental a lienation on the mental health of male children and adolescents Parental alienation has multiple negative effects on children/adolescents. According to the available publications, these effects include (7–12): –– Guilt, sadness, and depressed mood. This is probably related to a painful conflict in loyalty but may also be related to other factors. –– Low self-esteem and lack of self-confidence. In the case of boys, identification with a male figure has been reduced, especially if the alienated parent is the father. –– Distress and frustration. –– Lack of impulse control, substance abuse and delinquent behavior. There is substantial evidence that the presence of fathers and their impact can do a lot to prevent and reduce the possibility of delinquency in boys. It was observed that adolescents were especially likely to engage in externalizing behaviors when they were involved in their parents’ unresolved disputes or felt torn between their parents. –– Separation anxiety, fears and phobias. –– Hypochondria and increased tendency to develop psychosomatic illness. –– Suicidal ideation and suicide attempt. –– Sleep and eating disorders, including anorexia nervosa, obesity and bulimia. –– Educational problems. –– Enuresis and encopresis. Judge Michele Lowrence (Domestic Relations Division of the Circuit Court of Cook County, Chicago, IL, USA) wrote: “It is very easy for a parent to malign another parent. It is tempting when you are angry. Even if it does not go to the level of full-out alienation, parents need to know that even a smallest act of maligning crushes the children’s ability to feel good about themselves… From my perspective, destroying the child’s loving attachment to one parent interrupts the child’s intrinsic need to feel confident that he or she will be well taken care of by that parent” (2). Baker and Ben-Ami (13) stated that “to turn a child against the other parent is to turn a child against himself or herself”. In summary, parental alienation negatively affects mental and physical health of male (and female) children and adolescents. Parental alienation also has long-term consequences for children/adolescents who are victims of alienation.
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Sher: Parental alienation: the impact on men’s mental health 3
The impact of parental alienation on the mental health of adult men who were exposed to alienating behavior as children/adolescents Adults who reported childhood exposure to alienating behaviors are more likely to have psychological problems in their adult lives compared to adults who were not exposed to such behaviors (9, 13–21). Baker studied the long-lasting impact of parental alienation and published many works on this subject (16–20). She identified the following long-term effects of parental alienation (16): –– low self-esteem, –– depression, –– drug/alcohol abuse, –– lack of trust, –– alienation from own children, –– divorce, –– problems with identity and not having a sense of belonging or roots, –– choosing not to have children to avoid being rejected by them, –– low achievement, –– anger and bitterness over the time lost with the alienated parent. Baker has also observed that adults whose parents alienated them from their other parent described the alienating parent much the way former cult members describe cult leaders (20). A recent study found that those who report childhood exposure to alienating behaviors have higher scores on most of the Symptom Checklist-90-R (SCL-90-R) scales and are more likely to be above the clinical cutoff on the SCL90-R scale scores (14). The degree of exposure to alienating behaviors was positively associated with higher scores on the SCL-90-R. The SCL-90-R assesses symptoms of psychopathology and provides global distress indices.
The impact of parental alienation on the mental health of fathers alienated from their children The predominant feelings among alienated parents are helplessness, powerlessness, and growing despair (9). Fathers who have lost some or all contact with their
children for months or even years following separation or divorce may be depressed and suicidal since the loss of contact or restriction of the relationship between the children and the father is a very upsetting and painful experience for both the children and the father (9). Some alienated fathers seek to escape through alcohol, benzodiazepines, and/or other drugs (8). Clinicians should be vigilant regarding symptoms of depression, post-traumatic stress disorder, suicidality, and other psychiatric conditions among alienated fathers (8, 9, 21, 22).
Parental alienation and suicidal behavior Suicide rates in men in Western countries are very high (23–27). For example, age-standardized suicide rates among men in the US, Germany, Finland and Hungary are 19.4, 14.5, 22.2, and 32.4 per 100,000 population/per year, respectively (23). Worldwide, men commit suicides 3–10 times more frequently than women (24–26). In the US, males die from suicide attempts three to four times more often as females. From 1999 to 2010, the suicide rate among Americans aged 35–64 grew by almost 30%, to 17.6 deaths per 100,000 people, up from 13.7 (27). While suicide rates are increasing among both middle-aged men and women, much more men take their own lives. In 2010, the suicide rate in the US for middle-aged men was 27.3 deaths per 100,000, while for women it was 8.1 deaths per 100,000 (27). It has been proposed that men are markedly overrepresented among suicide victims because men use more lethal means to attempt suicide, more frequently use/abuse alcohol, and less frequently seek a psychiatric and/or medical help compared to women (24, 25, 28). I recently proposed that parental alienation may contribute to suicidality in adult men who were victims of parental alienation as children or in men who are alienated from their children (29). This suggestion is consistent with the observation that divorced men are 9.7 times more likely to kill themselves than comparable divorced women (24).
Prevention of parental alienation The issue of parental alienation is getting more and more attention. Several important books on this subject have been published in the past 10 years (2, 9, 19, 30, 31). Parental alienation has been internationally conceptualized as a violation of the civil rights of the child (2). However, it
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4 Sher: Parental alienation: the impact on men’s mental health remains difficult to reduce the number and intensity of parental alienation cases. The alienating parent’s task is simple and easy (32). Many alienators are adept at using the inertia endemic to social welfare agencies, law enforcement, and the courts. The playing field is not level. It is biased in favor of the alienating parent. We must acknowledge this if it is to be overcome. Tough legal actions may help (2, 33, 34). The pretrial planning methodology includes an integration of fact proofs with the scientific data on the manipulation of children’s memories, child suggestibility, interviewing, and delayed disclosure of distorted recollections (2). A methodology for trial planning includes science data integration between attorney and chosen expert. The attorney for the alienated parent must be able to demonstrate how the behavior of the alienating parent contributed to the development of parental alienation. Also, the attorney must prepare with the expert to describe the sequelae of parental alienation. If there is no threat of harsh fines, prison time or sole custody to the targeted parent, the chances are remote that the alienating parent can be stopped (33, 34). Dr. Ludwig F. Lowenstein, one of Britain’s most quoted authorities on psychology in education wrote: “Judges have a moral duty to provide justice for the alienated party, this usually being the father. The threat of punishment for the alienator must be supported by punishment, including removing the child from mother’s care to a neutral place or to the alienated parent, and to use incarceration when necessary. Failure to carry out this distasteful, but necessary, action against the obdurate party would constitute a mockery of the judicial system. It is my experience as an expert witness to the Courts as a forensic, clinical psychologist, that most alienating parents, whether mothers or fathers, will obey a court order if punishment is threatened for failure to adhere to the ruling” (33). A New York attorney, Chaim Steinberger states that “because alienation can be subtle and insidious and its devastating effects potentially permanent and irreversible, most experts conclude that in severe instances the only “treatment” that prevents alienation from continuing, effectively reverses it and enables reconciliation with the target is the immediate transfer of custody to the target parent” (34). Multiple studies related to parental alienation have been performed over the past 30 years. However, parental alienation remains a relatively unstudied field and more research on parental alienation is merited. It is important to educate mental health and legal professionals. There are some efforts in this direction. For example, in France, training courses on parental alienation issues are offered for attorneys, social workers, and
police officers (35). Victims of parental alienation as well as fathers alienated from their children should be evaluated and monitored by mental health professionals and the larger health care community. The issue of parental alienation needs more attention from legal and mental health professionals, and, probably, from lawmakers. Children/adolescents should have a chance at having the best relationship they can with both of their parents. This is necessary for their mental health.
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Sher: Parental alienation: the impact on men’s mental health 5 15. Amato PR, Afifi TD. Feeling caught between parents: adult children’s relations with parents and subjective well-being. J Marriage Fam 2006;68:222–35. 16. Baker AJL. The long-term effects of parental alienation on adult children: a qualitative research study. Am J Fam Ther 2005;33:289–302. 17. Baker AJL. Adult recall of parental alienation in a community sample: prevalence and associations with psychological maltreatment. J Divorce Remarriage 2010;51:1–20. 18. Baker AJL, Chambers J. Adult recall of childhood exposure to parental conflict: unpacking the black box of parental alienation. J Divorce Remarriage 2011;52:55–76. 19. Baker AJL. Adult children of parental alienation syndrome: breaking the ties that bind. NY: Norton, 2007. 20. Baker AJL. The cult of parenthood: a qualitative study of parental alienation. Cultic Studies Review 2005;4:1–29. 21. Kruk E. The impact of parental alienation on parents. Post- traumatic stress in the rupture of parent-child relationships. Psychol Today May 02, 2013. URL: https://www.psychologytoday.com/blog/co-parenting-after-divorce/201305/the-impactparental-alienation-parents. 22. Kposowa AJ. Divorce and suicide risk. J Epidemiol Community Health 2003;57:993. 23. World Health Organization. Global Health Observatory Data Repository. Suicide rates. Data by country. URL: http://apps. who.int/gho/data/node.main.MHSUICIDE?lang=en. 24. Sher L. Suicide in men. J Clin Psychiatry 2015;76:e371–2. 25. Rutz W, Rihmer Z. Suicidality in men – practical issues, challenges, solutions. J Men’s Health Gender 2007;4:393–401.
26. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, et al. Suicide and suicidal behavior. Epidemiol Rev 2008;30:133–54. 27. Centers for Disease Control and Prevention. Suicide among adults aged 35–64 years – United States, 1999–2010. Morb Mortal Wkly Rep 2013;62:321–5. 28. Sher L, Rihmer Z, Didia-Attas J, de Leon J, Lin S-K, et al. Future research and clinical directions in the field of men’s mental health: the Madrid declaration. Front Public Health 2014;2:242. 29. Sher L. Parental alienation and suicide in men. Psychiatr Danub in press. 30. Gardner RA, Sauber RS, Lorandos D, editors. The international handbook of parental alienation syndrome: conceptual, clinical and legal considerations. Springfield, IL: Charles C. Thomas Publishers, 2006. 31. Bernet W, editor. Parental Alienation, DSM-5, and ICD-11. Springfield, IL: Charles C. Thomas Publishers, 2010. 32. Bone JM. Access and visitation blocking: the first ingredient of parental alienation. December 20, 2012. URL: http:// jmichaelbone.blogspot.com/2012/12/access-and-visitationblocking-first.html. 33. Lowenstein LF. Parental alienation and the judiciary. Med Leg J 1999;67(Pt 3):121–3. 34. Steinberger C. Father? What father? Parental alienation and its effect on children. Part Two. NYSBA Family Law Review 2006;38:9–19. 35. Odinetz O. Parental alienation awareness in France: from training courses to court decisions. In: 16th World Congress of Psychiatry, Madrid, Spain, September 14-19, 2014. Symposium Abstracts, Vol. 2, 2014:67–8.
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![[A case of parental alienation].](/assets/img/hold.png)
