I Made The Difficult Choice Not To Have Children Because Of My Mental Illness

“You’re going to be a zia.”

I looked at my brother-in-law, now an expectant father, as something in me shattered. For over a decade, I’d straddled the fence on whether I should have kids. I have bipolar disorder and know that the responsibility of parenthood would most likely throw me into relapse. After I was diagnosed at age 35, it took nearly three years to sort out my medications, but even then depression can hit and when it does, it’s hard. Despite my medications, I struggle with hypomanic episodes that leave me sleepless, unable to eat and repainting the living room at 3 a.m. I also can’t live with the possibility of passing my illness to any children my partner and I might have. Bipolar disorder also runs in his family. What risk would we be taking?

I’ve heard it all, though, from well-meaning friends, acquaintances and colleagues: You’d make a great parent! I wouldn’t. You don’t seem that sick. What does sick even look like? But you’re doing great. I work hard to put up that front.

And then, there’s my favourite: Have you even tried?

Right after we were married in our mid-30s, my partner, Uli, and I had considered children. But years later and now in our mid-40s, we are still only a family of two. We’ve decided that’s a good thing. But sometimes I wonder if that’s enough. If I’m enough.

I smiled at my brother-in-law. “When’s she due?” I asked. January, a winter baby.

The weather cooled and I watched from our shared porch as my brother-in-law’s partner, Chi, grew, her walk becoming more of a waddle. Our families live in semi-attached homes, and I spent time with her as she fussed over drapes and cribs, excited to show me a new rug for the baby’s room. She told me about constipation, sickness, kicks and fear. Meanwhile, I settled into a depression that would last for more than a year.

I tried not to look at her belly, instead envisioning the freedom of being childless: slowly sipping coffee in the late morning with nothing on but the radio. I tried to forget the real reason we didn’t have kids. Every time I swallowed my medications, I tried to forget what my mental illness took from us, or when I felt the perceptible mood change of hypomania or depression, like a switch being flipped in my brain, followed by a ripple throughout my body. I asked my partner if he regretted our decision. “No, piccolina. My life is perfect with you.”

I tried to believe him.

Bipolar disorder is one of the most heritable mental illnesses and is characterized by dramatic mood shifts, between extreme depression to mania. I experience hypomania, which is not quite as serious as mania, but can still be incredibly destructive. Behaviours like reckless spending, irritability, anger and an inability to sleep are just some of the outward symptoms. Inside, however, is another story. When I’m hypomanic, I feel a constant buzzing and an inability to compose a clear sentence or keep my thoughts on one particular target. I’m scattered and usually filled with great ideas that in the light of day are pretty reckless.

It’s the depression that’s the worst, though. Lows that are so low I don’t think I’ll ever scrape myself off the floor. I’ve dwelled in suicidal ideation for weeks while in a depressive state. If both my partner and I carry the genetic risk of bipolar disorder, how could we find any assurance that we wouldn’t pass this on?

“I have this conversation often with parents,” Dr. Ayal Schaffer says. Schaffer is a professor at the Department of Psychiatry, University of Toronto, and head of the Mood & Anxiety Disorders Program at Sunnybrook Health Sciences Centre in Toronto. “In general, I find people overestimate the likelihood that their kids will have bipolar disorder.” The lifetime risk of bipolar disorder in Canada’s general population is about 1 to 1.5 percent of the population. But those numbers don’t consider a biological parent having bipolar disorder, which increases the risk by about tenfold.

If both parents have bipolar disorder, the story changes. “[The] more than doubles, to about 30 percent,” Schaffer says. It’s not necessarily bipolar disorder that a child might develop, though. Anxiety disorders or depression are also common among those with genetic risk factors that someone with bipolar disorder could pass on to their children. Even then, simply because the risk factor is almost one in three, there is a possibility that the genes could be passed on, but symptoms never emerge.

The question I hear most often from others is about genetic testing: Why can’t we simply test to see if we might pass on the genes? “Even though [bipolar] is heritable,” Schaffer adds, “[it] not a simple condition.”

There’s a compelling theory called the Law of Behavioural Genetics, which proposes that all behavioural traits—including behaviours associated with mental illness—are heritable to a large degree. For example, extroversion and introversion, or a propensity towards melancholy or worry, are all behavioural characteristics that, according to this theory, could be inherited. The genes potentially involved in a single behavioural characteristic, however, can number in the thousands, each with different combinations, making it (as yet) impossible to map them out.

With bipolar disorder, there are dozens of genetic components that could be involved in the expression of the disorder, and in various combinations. In fact, Schaffer says, bipolar disorder itself may not be a single disorder, but a combination of different types of genetic influences that can lead to the condition, which can vary from person to person and change how the disorder is expressed. The ability to predict which genes and in what combination they occur that could cause the onset of bipolar disorder is very slim. This makes genetic testing impossible, leaving my partner and I with more questions than answers.

That winter, the first snowfall arrived and holiday lights went up. I noticed Chi taking particular care with her decorations, arching her back as she pressed her hand against the tender muscles there. “He’s so heavy,” she said. I looked away and wondered, Will the baby like me? Would I be able to teach him things? Could I help him with his school essays, readings, history and science? Or would I be the sick aunt, the one with mental illness who disappears for weeks at a time?

Would I be a shameful secret?

The last time I was hospitalized was 2015. My partner doesn’t like to talk about it, and I can’t blame him. In the weeks leading up to that hospitalization, and in the weeks after, he became my caregiver. He’d make meals, help me shower, monitor my moods and behaviours, which often left me oscillating between extreme irritability and gratefulness. The feelings of dependency and incompetence followed me, making it difficult for me to see myself as someone capable enough to be a good parent, let alone a good partner.

But learned experience is not something to ignore when it comes to mental illness. “That experience that [parents] have had from the path that they’ve taken to diagnosis and treatment, would help a child with mental illness,” Schaffer says. There are skills and experiences that a mentally ill parent has that could help them with a child’s warning signs, navigating the mental healthcare system, and even with ongoing management. In essence, a mentally ill parent could actually help a mentally ill child through their own illness. “They [can] much more perceptive,” Schaffer says.

While that’s not enough to assure me that I’d be a good parent, it does make me wonder: Could I be a good role model for my nephew?

In a 2017 study, scientists examined a variety of psychiatric and neurocognitive disorders, among them bipolar disorder and schizophrenia. They then analyzed hallmark personality traits, clustering them into different quadrants. From their analysis, they found that there was a significant correlation between bipolar disorder and the personality trait of “openness to experience.” This openness basically means a willingness to try new things, to explore, and not be shy about challenges.

While having an openness to trying new things may not always lead to wise decision-making, when I think about possibly having that personality trait, there’s one word that comes to my mind: bravery.

Maybe I could try being a brave role model for a child who is not my own, bringing my unique wisdom and life experience. Would this allow me to do what I can, in the best way that I can, while still giving me the space to be mentally unwell when it happens? If parenthood isn’t in the cards for us, could we still have a family, just a different iteration of one?

On a mid-January morning, Greg texted us to let us know the baby had arrived, born at home, and we could come over to see them. I was filled with excitement. As I entered their quiet house and walked down the hall to the bedroom, I held my breath. I saw Chi first, snuggled in loose pajamas and lying on the bed. Her eyes were half-closed, a weak smile on her lips. She lifted her hand and pointed down. Cradled in a blanket on her thighs lay a tiny baby, swaddled and wrinkled.

“Can I?” I whispered. She nodded. I lowered onto the bed beside her and stared at him. His impossibly tiny fingers as they ground against his ruddy cheek. His swollen eyes and shock of thick, dark hair.

I reached out, my hands trembling as I slid them under his seven-and-a-half-pound body, and lifted the most precious bundle to have entered all our lives. I lowered my nephew—Nico—into my lap and introduced myself. I told him I was his zia and that I would love him and do everything I could for him. Silently, I promised him I would try my hardest to be healthy, but that I hoped he’d forgive me if I couldn’t always be there for him.

Over the following weeks I would hear Nico crying through the walls. I’d text Chi and ask if she needed help. She would respond with a crying emoji, and I’d cross our shared porch and visit. Nico put on weight; Chi put on worries. I could see doubt always hovering. She’d browse parenting websites, read everything she could about breastfeeding and diapers and how to pee in peace. She’d ask me for reassurance or to look after Nico for a moment so she could take a bubble bath. I gave her what I could and to my surprise, that was exactly what she needed.

On a hot July day during the quiet pandemic months, we three were resting in the shade, lemon water by our side, Nico sweating and bouncing on my leg. I scooped him up, planting as many kisses as I possibly could on his forehead, cheeks, his little nose. He rubbed his face against mine, leaving a smear of drool. I breathed him in and looked over at Chi. Her chin was tight, lines rippling across her forehead, her eyes shaded by a sunhat. She held out her hand, gesturing to Nico. “I’ve always wanted this,” she said.

Her gesture changed and she reached for my hand. I shifted Nico’s weight, balancing him as he smeared more drool over my arm. I slipped my hand into hers.

“This,” she added. “Family.”

I said, “Me too.”