Whatever the outcome, everyone with bipolar disorder seems to give serious consideration to whether to reproduce, especially if they’re as-yet childless, already have children that display symptoms of mental illness, or are a woman.
Why is it such a big deal for women? The pregnancy-friendly bipolar meds may not work all that well, and most of the time, the ones that do work are very bad for babies. If you breastfeed, that’s an additional XX months that you can’t take the meds that keep you from having postpartum depression on steroids or turning into a raving maniac. For many of us, the idea of being off meds for 9 months is simply absurd – it’s a serious risk to our own health, not to mention for the fetus. One of my girlfriends who is also bipolar tried going off her meds to conceive, and quickly concluded that there was just no way that it was going to work out without disastrous consequences.
The reasons that people with mental illness do choose to have children are the same ones as everyone else. Children bring them joy, are something that the parents always wanted, life somehow feels incomplete without them, they give people a sense of purpose and meaning in life, they think they’re some kind of gift to the world and that their genes should be perpetuated, they are socially pressured into it, they are required to procreate (or required not to practice family planning) by religious beliefs, and so on.
The reasons not to have kids can also be the same: you just plain don’t want them, think you’d be a lousy parent, consider it fiscally or socially irresponsible, have other goals in life, know that it’s often a career killer for women (especially academics), or have paid attention to numerous scientific studies covered in popular media that have shown that kids do not make people happier and can be bad for marriages. Especially if the marriage is already strained – but I think most people have seen anecdotal evidence for that one.
When you have a mental illness, however, it becomes an even more complicated equation. There are the reasons mentioned above for women, of course. There is also the fact that sometimes you may not feel that you can adequately care for or even handle them, regardless of how supportive your spouse is. And then there’s the big one: some mental illnesses, particularly the more serious ones, are inheritable. Environmentally-based biological abnormalities aside, “Mental disorders that are most likely to have genetic components include autism, bipolar disorder, schizophrenia, and attention-deficit/hyperactivity disorder (ADHD) (National Institute of Mental Health [NIMH], 1998).” This is not a trivial issue, and in fact, most psychiatric evaluations for these conditions involve rattling off the laundry list of family members with mental health problems.
I’m not denying the influences of “nurture” as well as “nature,” because although there’s a strong genetic component for these particular conditions, that’s never the whole story. Borderline Personality Disorder is much more clearly related to nurture, and BPD sufferers are victims of childhood abuse or neglect at a higher rate than the general public. That relationship doesn’t seem to hold for bipolar people, however, and many of us had perfectly normal childhoods, although no life is without traumas of one kind or another.
If a parent has a mental illness, that will almost certainly affect the nurture element in some ways, no matter how great the individual is as a parent overall. I’m not saying that mentally ill parents are screwing up their children or are necessarily worse parents than the general public. In fact, I believe the converse is probably true for many, who might take extra care to manage their symptom-related shortcomings and will notice and intervene earlier for emergent symptoms in their children. I’m explicitly not judging anyone who has chosen to reproduce despite knowing they have bipolar disorder (so don’t get all huffy with me!) It’s a very personal choice, and can also be a very responsible choice when the risks are known and carefully considered. For the many who already had kids when they found out they also had a mental illness – bipolar is often diagnosed much later than other serious mental illnesses – they should never ever be blamed or shamed for that.
Just how much of a risk is there? It’s statistically significant for the above-mentioned conditions, but less clear for depression. It’s been known for a long time, well before there was adequate scientific evidence to substantiate the correlation, that bipolar disorder runs in families. There is also a cumulative risk factor: the more family members (and more immediate ones) that have mental illnesses, the higher the risk. The relationship to mental illnesses in the family is pretty strong: 80% – 90% of people with bipolar disorder had family histories of bipolar or major depressive disorders. If one parent has bipolar disorder, the likelihood that the child will develop bipolar disorder is about 10% and substantially higher if both parents are bipolar, but they are also 14% – 20% likely to develop depression. In twin studies, the rate of the second twin developing bipolar disorder is 60% – 80%, and research has actually shown that bipolar disorder is one of the most heritable disorders. So heritability of mental illness is indeed a very serious consideration for those of us with bipolar disorder.
The choice was obvious for me: no way in hell am I going to reproduce, and we’ve surgically ensured that (hormonal birth control isn’t 100% effective and makes me even more insane.) There are a lot of reasons for that decision. Neither I nor my husband wants kids. I literally gave a sigh of relief when he told me that on our second date; I had never thought it would be optional but also had never really figured kids into my life plans. It is often a deal-breaker if spouses strongly disagree on this point.
I would rather have brain babies than biological babies, and children would really derail my academic career plans and ambitions. I don’t like kids in general, though I do like some of them in specific, particularly smart ones with responsible parents who do not permit them to be insufferable brats. I would rather spend my hard-earned money on travel and minor luxuries than worry incessantly about paying for children’s college educations, especially since I still owe an awful lot on mine. I am not stable enough off meds to think that I’d survive 9 months plus breastfeeding time (I consider that indispensable for many reasons) without a suicide attempt and being completely unable to work, much less care for myself or manage my household.
Plus there’s the cumulative risk factor issue: I’m not alone in my family with respect to having mental illness. 100% of my immediate family has been treated for mental health issues, and there is a good chance that one of my parents was an undiagnosed bipolar. If that’s not a genetic alarm bell, I don’t know what is. My entire paternal family is rife with a variety of mental illnesses; I don’t know if any of my dad’s siblings have gone entirely unscathed. That means the risk of passing on bipolar disorder is much, much higher than 10% – 20%. I would have a hard time forgiving myself if I passed on crappy genes to a child about whom I would inevitably care very deeply. I felt that way about the issue long before I ever knew just how serious my mental health problems really were. For me, it’s an unacceptable risk. I would never wish this illness, or even “just” major depression, on anyone.