About a Boy – a review for healthcare staff

(See also what the International Movie Database says about About a Boy)

Please note: This article may spoil your spontaneous enjoyment of the film. A number of significant events are revealed, so if you want to watch the film without preconceptions, we advise you to read the article after watching the film.

"About a boy" is a film which, helped along by humour, describes how life works out for 12-year-old Marcus. Marcus is an unusual boy. He neither swears nor does other cool things. He is frank and straightforward, and usually tells the truth.

Marcus has many problems in his life. He is bullied at school. He has practically no friends. His divorced mother is periodically depressed and has also contemplated suicide.

The mother's depression naturally affects Marcus. He feels sad and powerless when he cannot help his mother. By being a good boy he tries in his own way to make his mother happy.

Parallel to the story about Marcus, the film is also about the bachelor Will. He leads an empty, meaningless life. He is economically independent and does not need to earn a living. Will's aim in life is to be free and independent - he lives by the motto "mankind is like an island". The sexual relationships he has are brief and he never risks getting involved. His friends attempt to get him interested in children and marriage, but in vain. Will's only concern is for himself.

Will hits on the idea that single mums can be a never-ending source of new female acquaintances. He therefore looks for a conversation group for single parents and fabricates a story about being the single father of a two-year-old boy.

Through the contact group and its members, Will meets Marcus's mother and gradually gets to know Marcus himself. Marcus is allowed to come on a picnic to the park in an attempt by Will to seduce a single mother. Marcus goes off alone and feeds the birds in the park – not entirely without an incident. Will and the woman take the rather distressed boy home - only to find his mother lying unconscious having taken an overdose.

Marcus has always tried to keep the people around him in the dark about his weaknesses at school or about his mother's depressions. He likes Will from the word go and wants him to get to know his mother. Perhaps they should make a couple, and then his mother would not need to get so depressed. Or, as Marcus puts it, Will could function as a backup for Marcus. That could make life feel more secure.

Nothing comes of the partnership between Will and Marcus's mother, although it does mark the beginning of a friendship between Will and Marcus. Will discovers that life can feel less empty and meaningless if you have someone to care about. Will becomes a source of support for Marcus, both when he gets bullied at school and when his mother enters her next depression. Marcus proves to have an inner strength which enables him for the first time to look for someone's help. He asks Will to help in connection with his mother's inclination to suicide. This unusual friendship leads, after a good deal of complications to life becoming better for Will, Marcus and Marcus's mother. A person is NOT an island.

TO BE THE CHILD OF A MENTALLY ILL PARENT

Background

In the course of the last 10 years, psychiatry has begun to be more aware of the situation of children in families in which one or both parents are mentally ill. Support groups have been established for the children of the mentally ill and the children's representatives are available at psychiatric clinics.

These efforts have been inspired by the realisation that the mentally ill also have a family and may need help to function as well as possible as parents. It has also been realised how traumatic it can be for a child to be alone in the crisis caused by the mental ill-health of a parent.

The crisis is exacerbated if the child experiences being forced to take responsibility for the sick parent and thus having to function as an adult far too early in life. This early assumption of responsibility can lead to mental ill-health in the child and possibly also later in life as an adult.

In modern nursing it is still not unusual for care to concentrate on the illness of the adult and to take it for granted that someone else will take care of the child. Today, many children in our society live alone with only one of his or her parents.

This means that the network around the child becomes more vulnerable if the parent becomes mentally ill. The child risks having no other adult from whom he or she can get help and support.

Everyday clinical psychology provides us with many examples of how adults get on today after a childhood spent with the mentally ill parent. This applies by no means only to single parents. It can be that the healthy parent works like mad and is therefore rarely at home, or that the healthy parent denies the fact that his or her partner is sick.

Some of the usual reactions of children

Here are some of the reactions seen among children with a mentally ill parent:

• Keep it secret
  Children are generally very loyal to their parents and are often unwilling to reveal to their surroundings the fact that all is not well.

• Feelings of guilt
  Mentally-ill parents will often behave differently. Children will find this embarrassing and might not want to take friends home with them.
• Frustration
  The child may not initially feel his or her parent is ill - just that something is wrong and different. The parent's psychological reactions may, because of their illness, be peculiar and difficult to comprehend, and perhaps heavily influenced by the surroundings. The loss of understanding and sense of coherence between occurrences and the parent's reaction, leads to frustration.
• Powerlessness
  The child will usually help the parent to feel better, but if their efforts are inadequate a feeling of powerlessness will result.
• Feeling of responsibility
  The child endeavours to relieve the parent's burden by taking over responsibility for functions in the home. In the event of the sick person contemplating suicide, the child may also feel a responsibility for preventing the parent from realising their intentions. This may mean, for example, that the child plays truant from school in order to watch over the parent.

The reactions can vary in the degree of difficulty depending on the child's level of development and experiences. Similarly, reactions will depend on how sick the parent is and on whether other adults intervene and give the child support.

The child's reactions are most often a combination of all the above reactions. In serious cases, and if the strained situation continues for a long period of time, a reduction in the function and performance of the child may result. At worst, the psychological reactions as a child may persist and give rise to symptoms and difficulties in adulthood.

Build a network

When a mentally ill person has children living at home it is a good strategy to engage other adults in the life of the child and to make them aware of how children may react even though they do not speak openly about their emotions.

If there is another parent it is a good idea to invite them to attend the first or second consultation in order to inform them about the illness and how it manifests itself and also draw attention to the situation of the child.

Together with the adults around the child one can if necessary inform the school, kindergarten or crèche/childminder of the situation. The purpose of this is to allow the child to be a child and to feel secure.

There are situations in which the network will be inadequate and not be able to support and protect the child. In such an event, it should be contemplated whether the child is doing so badly that one should inform social services.

Obligation to notify

Responsibility of nursing services

In Sweden, as in probably most countries, it is mandatory for all health service staff to notify the authorities if they fear that a child is at risk.

It is preferable that the persons undertaking the notification can themselves inform the parents that contact is to be made with social services on the basis of concerns for the child, and that this contact can be done together.

This is, however, not always possible or appropriate. The very thought of the conversation can sometimes be the greatest hurdle. It has been shown however, that frankness often contributes to positive change being possible.

Local authority responsibilities

In Sweden, it is the responsibility of the local authority concerned to provide assistance to children when their legal guardian fails them for some reason. In order to discharge its duty, the local authority frequently relies on information from those who are in contact with children and adolescents. It is for this reason that this provision regarding the obligation to notify exists.

How does one provide security for the child of someone who is mentally ill?

Security for the child consists, among other things, of providing security by means of information and predictability.

• The first step is to provide information about the medication and its expected effects and side effects.

• Inform the patient and relations about the normal healing process and the expected course of events.

• Provide an overview of how progress will be followed up. It is best to provide a date for the next visit so that the patient does not experience "hanging in space" or being a nuisance.

• Information about how long treatment will take and how it will be concluded.

• Information about how and when the patient and relatives can make contact in the event of problems.

Everyday clinical life

Those who treat depressed adults should ask if they have children at home and whether they show symptoms that may be related to the situation. This may be playing truant, being less able to concentrate at school, getting poorer marks or showing signs of a behavioural disorder.

The child should also be informed about the parent's illness, although one should in this instance allow the adults close to the child to be involved and to decide how much information and which details should be given.

POINTS FOR DISCUSSION

It is important to be able to provide hope for the future and a sense of security to both the depressed person and their relatives – children in particular. It is a good idea to discuss the following issues, either among the nursing staff or with relatives in groups.

Here are some examples of the questions relatives often asked in a clinical treatment situation. Try in your discussion to bring up the subject of how you believe it is most appropriate to answer these questions.

• How can I support and help a mentally ill person?
• Can a mentally ill person get well again?
• What is the normal course of events, e.g. in the event of a depression? The treatment?
• Is depression inheritable? Are my children at risk? How great is the risk?
• How should I inform my children?
• Can I as a relative do anything to help the mentally ill person?
• How can I provide security for the children so that they do not need to feel the responsibility e.g. to keep an eye on the person who is ill?
• What can be included in a network around the child and how can this be activated?
• Which phone number should the child have in a crisis situation?
• Which questions will the child's friends ask and what should the child say in reply?
• How can one inform the sick person and their relatives that notification has been made to social services?