Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Friday, October 23, 2009
Only Perfect People Should Have Children
I hope you know that the title of this post is sarcastic.
A reader wrote to us and asked if we'd address the issue of whether people with bipolar disorder should have children:
"I have been asked how I could have had children knowing I had bipolar and the person asking would never have known I had bipolar if i did not told them."
I enjoyed thinking about this, but I'm punting. I really don't like the idea of putting a value judgment on who should or shouldn't have children. Truly, there are a lot of people out there who shouldn't have babies (because they can't take care of them), but do, and a lot of wonderful people who've been born to people who maybe shouldn't have had babies, but did, and we're all glad they got born anyway. There are no guarantees in life, and I've never heard anyone put out a blanket statement that people with psychiatric disorders shouldn't have children.
Posted by Dinah on Friday, October 23, 2009
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Did you mean facetious?
Anyway, no, they should not, and people should not breed pets when animal shelters are full of perfectly good ones that might be euthanized. And think of all those orphans out their who need homes and could be adopted. That's another question, isn't it? Should imperfect parents raise kids with perfect genes?
But someone suggested that America was settled by manics who could stay still in the old country. I'm not sure we should want to eliminate those genes.
Regardless, the (prospective) parents should get to decide.
First, I think the question - how did you go about deciding to have biological children knowing that you have a disease with a significant genetic component - is genuinely interesting. It's the kind of question I might ask someone if I thought I could do it tactfully and be perceived as non-judgemental. I'd ask because I was curious about the answer; because I would be hoping to learn something from someone who would have thought about it a lot.
No, I am not so naive as to think that the question is always, or even often, asked in this spirit. But I still think it's an interesting one.
Second, the question I really want to ask (but don't) is this one: how did you go about deciding to create a new human being - especially a high-consuming North American one, as opposed to, say, a lower-impact African one - to a world that cannot support it? HOW CAN YOU BE SO F***ING IRRESPONSIBLE?
There are several reasons I don't ask this question.
One is that the answer is very uninteresting: having children is just something people do. Dogs bark. Roosters fight. Living things breed. Most people don't think about it. Everybody does it, so they don't even stop to think whether there's an ethical component or whether it's a responsible thing to do.
Another is that it's rude. Once people have had children, the only possible helpful response is to be part of the village it takes to raise a child. Attacking parents for being parents is not helpful to anyone. (Because yes, I am judgemental about this. This question would be an attack.)
Moviedoc thinks that to build family, instead of biologically creating new human beings for the purposes of having relationships with them, people should adopt instead.
That's fine as far as it goes. But I take it further: if adoption isn't an option for you, then just don't breed. Period. Forgo the family.
Family's great. But so are trips to Hawaii. No matter how wonderful Hawaii is, it's irresponsible to incur debt you can't repay to go there. And creating babies - no matter how beautiful and marvellous and miraculous - is incurring a debt you can't repay.
(Hey - you asked!)
Kind of shocked by what "moviedoc" just said.
Especially: "Anyway, no, they should not, and people should not breed pets when animal shelters are full of perfectly good ones that might be euthanized."
Wow! That is a pretty strong statement and judgment.
There are a couple issues to consider here:
1) Are the patients managing their illness? Are they willing to continue to do this? Are they aware of the stress and strain (but also beauty and hope) that a child could bring. Just because people are sick doesn't mean they can't be great parents and offer a lot to their children especially if the parents manage their illness well. If we set boundaries on who can and cannot have kids because of an increased risk of propagating hereditary diseases, there would be no reproduction. (What about people with cardiovascular disease or diabetes or HIV even for that matter?)
2) What is the genetic profile of the partner of the patient. (This may increase/decrease the likelihood of passing on an illness)
3) Even in the worst situation where both parents have a hereditary disposition for developing a mental illness, this does not mean that the child will 100% have the illness. I can't think of that many mental illnesses that are attributed to single gene dominant/recessive pattern. Rather illnesses are linked to a variety of different genes, which can be offset by other genes and we are nowhere near knowing how all these genes interact.
4)Also, one important thing that I haven't mentioned is environment. If parents anticipate a possible hereditary disposition then hopefully they will make the necessary changes to enhance the environment to suit the child.(A tutor, a nanny, a good GP, psychotherapist, or staying home to care for the child instead of working)
5) Many children with parents who suffer from mental illness have extraordinary gifts, just as people with mental illness do. They are patrons of the arts, or amazing writers, scientists, mathematicians who work toward bettering our word and community. Perhaps some may be view as eccentric but if it is not "harmful" or "dysfunctional"who are we to judge.
6) What about the positive effects the child would give back to the suffering parent? Perhaps offering stability and a purpose to live. (Maybe this is a little selfish for the parent but this could be a potentially life changing event for both parent and child. The parent may see this as another chance for them to have a positive, satisfying impact in another person's life. It also gives the parent hope that when they die they will leave some sort of positive legacy behind.
7) Don't misunderstand me, I am heart broken by the number of orphans and unwanted animals in this world but I think the choice to have children is a personal one and one which should be done with the maximum amount of information. (ie. making an informed decision)
8)Lastly, even though parents may not make the best decision (notice my word choice---- "best" versus "right") for their situation, I still don't think it is wise to judge. What good does judgment do? For the parent/patient? For the child?
I would still help the patient and child out in anyway I could because the decision is past tense and in the present we have to arrange a system to maximize support for the family. The future is not determined and providing a safe nurturing environment for both child and parent could only create more positive change.
Thanks for hearing my opinion.
There are no perfect people. Here are my imagined requirements for having children, easier to attain than perfection, still quite often ignored.
1. You should really, really, Really, want to have a child. It should not be something that just happens. It should be something that you plan, considering the pros and cons. Feasibility studies and part-time involvement in the care of other babies before conceiving your own should be required.
2. You should be physically, socially, and financially capable of raising a child. (Not perfectly, just enough.)
That said, I see no reason why people with mental illness should not have a child. It is not mental illness, but its all-too-often correlation with physical/social/financial disabilities which makes raising a child difficult, and those problems are certainly not restricted to people with mental illness.
The question being asked of the person with bipolar disorder is a revolting one. If anyone had said that to my mother, we three siblings might never have existed.
A bipolar mother (who never got better despite every treatment known to man), married 62 years to our loving father, can still raise kids who become a dancer, an actor, parents, a minister, a journalist and human rights activist (to name a few of the things we have done). All of whom improved the world and community around them in at least small ways, sometimes even when suffering themselves with depression or a similar condition to the mother's.
I might add that we are a devoutly Christian family and believe that God cares more about people struggling to be holy, people reaching out in love to a broken world, than about people being successful or feeling happy all the time. I suppose I should also add that I am pro-life.
There are hundreds of worse things than being bipolar or prone to depression: being rude, being stupid, being prejudiced, being dishonest, being judgmental, presuming to decide who should reproduce and who should not, being so shortsighted as to forget that if people with the love and resources to raise children do not reproduce, the next generation will be made up entirely of kids abused and neglected by the careless, promiscuous people who have them with multiple partners and who never rise above their own selfishness and hedonism to create a secure and loving home for their children. But do people tell multiply divorced people or insider traders, for example, not to reproduce lest they increase the frequency of dishonest people or divorces in the next generation? Do they tell selfish or stupid people they are not good enough or fit enough to raise kids? No.
Forgive the rant (do so at greater length on my own blog)
I have a bipolar parent and I'm glad they have kids.
My partner and I have decided not to do so. Admittedly, in part, it's because we are not that fond of children - but is only in part.
I am diagnosed with both BPD and bipolar. From what I have read, children of such individuals are much more statistically likely to end up with such diagnoses themselves, and I really, really wouldn't wish that on anyone - let alone the people I'm meant to love most in the world, ie. my children.
Our situation is compunded by the fact that my partner, owing in part to a congenital condition, is registered blind.
So my concern is that our phantom offspring would be both mentally ill and (at least) partially sighted. Not that there's anything wrong with individuals who have such illnesses/conditions, but I'm not sure I think that it's fair to the potential child to knowingly put them at risk of same nevertheless.
Should we ever change our minds and wish to gave kids, adoption may seem like a better option - but then, in the case of BPD at least, as I understand it the issues with it being passed on are environmental rather than genetic, so that's another kettle of fish. And would I even be able to adequately take care of him/her given my 'issues'?
Having said all that, I'm not suggesting for one minute that the same rules be applied to everyone with bipolar or BPD.
Genetic or otherwise, if the illness is managed well (and avoiding Lithium during pregnancy is a real possibility, in the case where it's the mother that has bipolar), then if anything, it could be a great thing to have a child for the bipolar person. As for the child itself, again if the illness of his/her parent is managed well, he or she may lead just as normal a life as any other child. Yes, statistically they may be at greater risk of of inheriting their parent's mental illness - but 'greater risk' does not equal "they will definitely get it".
So in summary, as with anything of this nature I suppose, the answer is dependent entirely on the individual personnel concerned - not on generalities regarding illnesses or disorders.
The problem with proposing that "such people" should not have children is the assumption that those without a diagnosis are psychiatrically healthy.
I see no problem with responsible people having children, regardless of whatever personal struggles they may have, and yes, regardless of whether some of those are genetically transmissible. Everyone has some genetic defect or another.
When I think of how much I've suffered from MD, and how much my siblings have sufered, and now see both of my parents suffer in their late middle age (one due to a genetic medical condition), it seems terribly selfish to me to feel the need to propagate that pain. I love my sibling's toddler daughter and see her so happy right now but dread her arriving where every one of us has. Life truly is pain for some people. It's only compounded by the fact that we don't have a choice over existing so long as we don't wish to damage our loved ones farther, and that's where the desire to have never been born comes from. We weren't given a choice in the beginning and if we love our families, we have it taken away again when there finaly is an option. Catch 22.
Yes, I think it's selfish to have children just to keep you company or spread your genes or whatever. There are enough kids that need good homes, w.o. having you and your progeny pollute the pool even further. Yes, it all snow balls,
no I am not grateful for the socalled gift of life given for the sake of life. No ones perfect, but shouldnt you reconsider where to draw the line if you willl cause uncomprehendable pain for ego or whatever else.
I second Pleochroaia 100%.
I'm also unsettled by the very concept; it looms dangerously close to genetic engineering. We DON'T know what it is exactly that causes MDD, Bipolar, or any other mental illness. I have suffered for 20 years with MDD that's maybe probably really bipolar, according to the current shrink and semi-success with lithium. I've been on every med in the book and seen a slew of shrinks in assorted cities. I've attempted suicide and been hospitalized. How much of that was caused by my (non mentally ill) mother's nasty personality and how much was genetic? We don't know. Along the way, I've also reached countless disabled children and helped them live better. I've completed multiple ivy league grad degrees and had loving, fulfilling relationships. someday, i hope to have kids. i am terrified of passing on a genetic component of this to them...but if i do, i am hopeful that i will recognize the signs and insist on good and effective treatment.
The thing is, we don't know what is the exact cause. Which means that should we are selectively breeding out -- for a cause that we can't recognize. For all we know, perhaps a mandatory course teaching parents patience and kindness would be the most effective preventative course we could ever take.
This is exactly why I've never wanted to have children of my own: People in my family aren't happy, and I wouldn't want to pass that on. Of course, the answer probably depends on how glad you are that you were born yourself. I still haven't completely forgiven my parents for having me.
Better question: Should people with reflux have kids?
My aunt has schizophrenia. She got pregnant and had a child. She has screwed up this child so badly. My family tried to have him removed from the home but for some reason the state didn't give a rip. When mom is wasted on alcohol and drugs with psych drugs thrown into the mix and cycling in and out of the psych ward why does she get to keep her child? What about the child's rights? She should have had her parental rights terminated, and the child should have been removed as a baby and adopted out to parents who could stay sober.
It's sick the kind of home he had to grown up in, and he's now in high school and a complete mess. I have no sympathy for her selfishness. Contrary to what she thinks, it's not all about what she wants. Someone should think about what's best for the child.
Which people should have children--with whatever "disorders"--is dangerously close to eugenics.
Where does it stop, and who decides?
And then who takes them all away?
just to throw this out there: a diagnosis is a cultural construct, and what's abnormal for us, may not be abnormal for others; also, perhaps the question is not whether people with X diagnosis should or should not have children, but rather whether they should have children in a culture where parents alone seem to carry all the responsibility for raising these kids.
Thank you, anonymous above me, for clearly stating my beliefs as well.
It also saddens me that, illnesses are perceived as negative and not just part of life, and that is a pervasive belief system in my culture.
I have what is generally considered to be bipolar, and there are times when life feels very difficult, and times when I feel out of touch.
But I have the capacity to recognize such times, the support to attend to my needs, the knowledge that it will pass, and the faith to accept it as it is.
For the sake of brevity & staying on topic, there obviously is a lot more to it, but the majority of the time, I feel I have a very good quality of life.
When, should I elect to, have children, should my decision be based around their potential suffering, my genetic make-up, financial status, sexual preference, or race?
How could I possibly ever guarantee the future happiness or life satisfaction of myself or any children? Can you?
Can anyone, just work hard enough, or try hard enough, or be healthy enough, to make everything ok?
And, if it is genetic, do we really want to breed out traits that we see as not fitting into our current culture?
I've always thought I shouldn't have biological kids but rather adopt. There's just too much genetic misery in my family...and I'm the best off of them. I would never wish what I've been through on anyone.
That said, once I was offered sterilization by a gynecologist (apropo of opening the computer and seeing my diagnosis pop up, she knew NOTHING about me, and had already had the contraception talk) and that was tremendously offensive.
But then I see patients who are SO horribly equipped to be parents - not because of mental illness - and they have like 6 kids always, and then I wonder...
Sorry, my comments were very facetious. I have owned several pure bred dogs myself, and have my own children. I try to practice what I preach. I suspect there are very few of us who could claim to do what we "should."
I am intrigued by Alison's reference to "high-consuming North Americans." My '71 undergraduate thesis was something like World Population: An Ultimate Limit. It was based on the number of people that could be sustained by the amount of solar energy striking the earth, assuming we each get 2000 calories/day. I have wondered recently whether anyone has painted a picture of what really sustainable life would be like.
My boyfriends mom has bipolar, and she was so manic when he was a toddler she kidnapped him, (she thought her husband was gonna kill her), and they roamed around in homeless shelters for months. Once in a while she will yell at him and be so vicious.It doesn't help that his dad can be abusive to him and he doesn't have any family members near by as a support system. Thankfully my boyfriend turned out so well despite his horrible upbringing. I think if you know you have a disorder like bipolar, you need to make sure theres a family support system to help raise your child when you can't. Its no fair to bring a child in this world if they have to live in constant fear and confusion, it's utterly selfish. I'm glad my boyfriend is alive, but his parents should have given him up to adoption after his mom kidnapped him.
I am saddened by many of these certain thoughts people have on this issue. I have BP2, I am steady and follow docs recommendations. At what point are we playing god?
As an American women living in a free country I am saddened by others ideas as if it is their choice to take the "moral" Route.
Noone will decide the fate of my uterus! I am educated strong independent women, and to the " holier than thou" who think they have any influence on me and people like me.
You my friend are mistakingly wrong!
Why don't you use your focus on something that you could actually make a difference!
It is not your decision and is a total disgrace to those who are managing what we have been dealt with life,
I suggest you put your "studies" to better use! And not destroying the dreams many of us have! We are women you pass everyday in the hallway, see at the grocery mart, we are you,
We have just been dealt a different hand in life, I'm willing to take that hand and make my own decisions, I don't need anyone telling me otherwise! No one can influence my life, especially A man or women who has no idea about my life and family!
My mom is bipolar. And as we got older it just got worst one time she ran me and my siblings with a knife as if she wanted to kill us and its very hard for a son to grow up emotionally unattached from a mother .Many times my dad wanted to put her away because of us but he never did. ... Guess he loved her too much and we loved her as we got older when we were little we never understood what was going on with our mother we had thought our mother hated us but as we got older we started to understand and tried to cope and help my mother through her sickness
The only people who should be allowed to have kids are... ?? WHO? If we made a list of all the NON-PERFECT people and then made a law to restrict them from reproducing... guess what? Our species would very quickly become extinct.
Well. Let's see, here. Should people with epilepsy have children? I can't imagine wanting to pass on that kind of suffering to a child. Should people with symbrachydactyly have children? I mean, we don't think it's heritable, but then again, no one really knows what causes it, so ... better safe than sorry, yes? Or how about little people? I'm shocked that anyone would want to pass on such a limiting condition. Or, God forbid, migraine sufferers. Have you ever had a migraine? Days on end of unbearable pain and vomiting, no cure in sight, and no one really even knows why they happen at all. What a hopeless way to bring children into the world. We should all want to spare them such misery.
OH, WAIT. NO.
What an insulting question. What an insulting concept.
My life is not lesser because I am bipolar. If my children are bipolar, their lives will not be lesser, either. Do I suffer? Yes. Will they suffer? Yes. Can anyone in the entire world be promised a life free of suffering? NO.
Everyone suffers, often greatly. Much of the world suffers profound poverty and hunger. Small parts of it don't. And in those parts, people sit around debating whether or not it's acceptable to allow a child to suffer. Because they're under the impression that it's an avoidable state.
What a luxury.
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