Opinion: Mentally ill women deserve more support to have children
The essay responds to a friend's approving anecdote about someone who 'talked' his schizophrenic adult son into a vasectomy. The author read 'talked into' as 'coerced' but said nothing, and instead thought, 'maybe I shouldn't be a mother.' This personal moment frames her argument that mentally ill women deserve more support to have children.
The author describes her own psychiatric history: she had a break with reality after stopping her antipsychotic 10 years earlier, frustrated with weight gain, then returned to medication and stabilized long before the vasectomy conversation. Despite a master's degree, a writing career that included Psychology Today essays, a successful marriage, and 10 years of treatment adherence and stability, she wondered while pursuing pregnancy whether she would be too unstable to parent. She had overdosed multiple times while psychotic, including twice within two weeks.
In one incident, she ran away from the group home where she had been institutionalized, ate Benadryl tablets 'like M&Ms,' drank Budweiser, and drove in a blackout. Her last memory was her hands on the steering wheel as she accelerated up a freeway on-ramp. While psychotic, she had been a danger to herself and others, raising the question of whether she would become a danger to a child.
The essay argues that the maternal mental health needs of women like her have been badly under-prioritized in American society. It says it takes a tragic case like Lindsay Clancy's for people to realize reproductive psychiatry is a medical field, much less recognize its critical importance. When Clancy began spiraling into postpartum psychosis, her husband, Patrick, did not understand the danger, as he said in a '60 Minutes' interview: 'I could piece together what it was like to be really, really anxious or depressed. But I didn't know how to manage a postpartum illness.'
Many women with a history of mental illness get pregnant, and others who were previously healthy experience symptoms for the first time while pregnant. Thirteen percent of all pregnant women use selective serotonin reuptake inhibitor antidepressants (SSRIs), according to Maria Muzik, a psychiatry and obstetrics and gynecology professor at the University of Michigan and director of its Perinatal and Reproductive Psychiatry Clinic. Eighty percent of them obtain their prescription from an OB-GYN rather than a psychiatrist, Muzik told the author.
Though severe mental illness and motherhood remain almost invisible in popular discussion, more than 100,000 women with severe mental illnesses have children every year in the United States, and most women with serious mental health conditions like schizophrenia and bipolar disorder are mothers. These women often experience gaps in care like Clancy's.
Average inpatient psychiatric hospitalization stays are five to seven days. Many outpatient psychiatrists and therapists do not take insurance; when they do, copays can be a significant barrier. Vast areas of the country, particularly rural regions, are deserts for psychiatric care and reproductive psychiatric care.