"schizophrenics shouldn't be allowed to have babies"

[chocomorsel]

Some nurse, on finding out that I was interested in psychiatry told me this today. Of course I felt like telling her to go screw herself because who the hell is she to make such a judgement call. Not to mention that I'm a product of a schizophrenic mom. She then went on to explain what a big burden it is for society to have to take care of them, and how the kids often have to be institutionalized for "just being born" to a person with some messed up genes.

So I guess I was wondering what you guys thought. I still think she can go screw herself, because there are plenty of kids out there with serious issues, who have some seriously sane parents, who just don't care or who end up leading a screwed up lifestyle. And just because someone is mentally ill, doesn't mean they shouldn't be allowed to reproduce for fear of passing their illness down to the next generation. Anyway, maybe my little personal rant, just wondering what my fellow psychiatrists thought is all.

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[Anasazi23]

Well, there is a component of genetic counseling that should be conducted when a potential parent has a serious illness such as schizophrenia, which has shown to be inheritable to some degree.

That said, blanket statements like this are rarely productive. It's probably a product of a partially burnt-out nurse who is just venting.

 

[toby jones]

Well, she is in good company, I suppose. Eugenic policys were all the rage around the time of world war II. In fact, it was thought that schizophrenia was the result of a recessive gene and not only did some people wish to exterminate people with schizophrenia they wished to exterminate their families as well so as to exterminate the gene from the gene pool.

There has been some work done on trying to see whether either schizophrenia is actually adaptive after all, or whether the genetic basis of schizophrenia may actually be adaptive. With respect to the first it might be the case that people who are institutionalised as schizophrenic in western culture may actually be revered as prophets or seers or holy people in other cultures. With respect to the genetic basis the best hypothesis currently seems to be the one that is trying to establish that people who are disposed to schizophrenia (but don't actually develop it) may be more creative than the majority of the population and hence the gene is actually adaptive in the absense of biological or social trauma that brings out the detrimental symptoms of schizophrenia. Of course this is all very controversial, but it is just to say that it is far from established that:

1) Schizophrenia is genetically based enough (which is to say environmentally invarient enough) for people to be considered 'very high risk' of developing the disorder if they have the genetic base.
2) Schizophrenia is inevitably harmful (regardless of social supports and the like)
3) Inheriting the genetic basis is harmful or detrimental (as opposed to being neutral or actually disposing someone to being more creative than usual)

 

[whopper]

I questioned the same as well. The illness has some definite genetic component. Is there any benefit to having it?

Some theorize that schizophrenia exists on a spectrum, where it is a more extreme form of delusional disorder or paranoid personality. Those in extreme circumstances can be argued to be advantageous in an evolutionary sense.

Anyways, I chalk the genes up to still being around because the illness usually hits after puberty--giving some time for people to reproduce while they still have it.

That's supposedly one of the theories as to why breast cancer is so highly prevalent. It usually hits after childbirth so evolution has barely had the chance to weed it out of the population.

Back to the original topic: I definitely think some people certianly shouldn't have kids. E.g. I drive by a crack neighborhood and think of all the kids that'll grow up in the neighborhood amidst all the crime, drugs and other terrible things. I worked in an Ob-Gyn clinic in Newark, and saw drug dealers proudly impregnate as many women as possible, each one of them a notch on the belt, saw prostitutes come in high on crack deliver their 6th baby.

I thought to myself--"these people shouldn't be having kids". Wasn't because of race, it was because IMHO-the problem with certain downtrodden urban areas is one the regenerates with each generation. The kids grow up in the same area and fall into the same problems. For the same reason, I'm all for things like Headstart because it hopefully can do some to break the cycle.

I know its not the same thing as saying out loud that a schizophrenic shouldn't have children, and I wouldn't say that to a patient. I've never felt anything but respect for family members of schizophrenics because they have a lot to deal with.

IMHO-someone with a genetic disorder needs to carefully consider having children (Actually that goes with everybody who wants a child) and needs to be educated & prepared to deal with the possibility that their children may have an inherited problem. However its very inappropriate for a health care provider to openly judge on this issue in a disrespectful manner.

I also have a theory that Bipolar--which we know does exist on a spectrum may have been responsible for some of history's greatest achievers. In which case there is some benefit to the bipolar genes.

 

[Tired Pigeon]

It seems like there are plenty of people out there who could be in the 'shouldn't be having kids' category. If we were to eliminate reproduction for 1) those at risk of passing on susceptibility to some form of disease, 2) those who are so f*cked up they make terrible parents, 3) those who have children they can't provide for financially, emotionally, etc. -- well, it seems like there won't be very many people left.

I guess what I'm asking is, if you believe in limiting reproduction for schizophrenics, shouldn't it also be limited for all of the above categories as well? Consider the example of someone with a strong familial propensity for T2DM. Their children have a much higher than average chance of developing the disease and thereby 'burdening' the health care system. Should these individuals also be prevented from reproducing?

 

[whopper]

Don't know if you're addressing that question to me but my answer is no. There should not be legal factors mandating who can and can't have kids, and no I don't think people with a mental illness should have the law saying they can't have kids.

However a woman coming into the delivery unit, high on crack, her 6th child and each child was delivered while on crack or heroine, is certainly a messed up thing and its an issue that society is not really dealing with in a positive manner IMHO. Don't know what the answer is there. There's a lot of grey area there and policies that don't work or are controversial in this area to the point where no one wants to touch it.

Again, there's a difference between the and someone with mental illness having children.

Bottom line-its really up to the individual, the health care providers should at best only offer advice & guidance, not judgement.

 

[Tired Pigeon]

Don't know if you're addressing that question to me but my answer is no. There should not be legal factors mandating who can and can't have kids, and no I don't think people with a mental illness should have the law saying they can't have kids.

However a woman coming into the delivery unit, high on crack, her 6th child and each child was delivered while on crack or heroine, is certainly a messed up thing and its an issue that society is not really dealing with in a positive manner IMHO. Don't know what the answer is there. There's a lot of grey area there and policies that don't work or are controversial in this area to the point where no one wants to touch it.

Again, there's a difference between the and someone with mental illness having children.

Bottom line-its really up to the individual, the health care providers should at best only offer advice & guidance, not judgement.

My question was really rhetorical.

I do agree with you that there are some really messed up situations out there & society is not dealing with them constructively. No idea what the answer is either.

 

[strangeglove]

My question was really rhetorical.

I do agree with you that there are some really messed up situations out there & society is not dealing with them constructively. No idea what the answer is either.

This is a slippery slope. If you decide that any group of people, no matter how bad of a genetic or social hand they have been dealt, should have restrictions on their ability to reproduce, you then open up the door to all sorts of eugenic arguments. For all you know, your own personality traits may one day be deemed maladaptive and you will be prohibited from having children. While you may think it is beneficial to restrict the numbers of some "undesirable" group, there is great harm in playing God without a license. Also, to make such a decision on someone's behalf is dehumaniziing. So, there is a right answer: Better to accept the fact that certain groups with mental health/social problems will always exist and try to focus on how we can help them, rather than trying to figure out how we can "get rid" of them.

 

[Tired Pigeon]

This is a slippery slope. If you decide that any group of people, no matter how bad of a genetic or social hand they have been dealt, should have restrictions on their ability to reproduce, you then open up the door to all sorts of eugenic arguments. For all you know, your own personality traits may one day be deemed maladaptive and you will be prohibited from having children. While you may think it is beneficial to restrict the numbers of some "undesirable" group, there is great harm in playing God without a license. Also, to make such a decision on someone's behalf is dehumaniziing. So, there is a right answer: Better to accept the fact that certain groups with mental health/social problems will always exist and try to focus on how we can help them, rather than trying to figure out how we can "get rid" of them.

Um ... I'm definitely not advocating for 'getting rid' of anyone , or starting down the proverbial slippery slope. My earlier rhetorical post was an attempt to underscore the exact arguments you are making.

The reference to a 'right answer' has to do with the question of how society can best address the problem of children born to impoverished drug addicts with few prospects. If you think this is not a problem for both those children and for society as a whole, you're not operating in the same reality as the rest of us. And, no, no one's advocating 'getting rid' of these people or creating some prohibition on reproduction.

Strangeglove, sorry if I sound a little ticked off, but I really try to make my posts clear and comprehensible. To have them misinterpreted, in a really negative, judgmental-sounding way, by someone who clearly didn't take the time to read them really bugs me.

 

[tennreb]

Some nurse, on finding out that I was interested in psychiatry told me this today. Of course I felt like telling her to go screw herself because who the hell is she to make such a judgement call. Not to mention that I'm a product of a schizophrenic mom. She then went on to explain what a big burden it is for society to have to take care of them, and how the kids often have to be institutionalized for "just being born" to a person with some messed up genes.

So I guess I was wondering what you guys thought. I still think she can go screw herself, because there are plenty of kids out there with serious issues, who have some seriously sane parents, who just don't care or who end up leading a screwed up lifestyle. And just because someone is mentally ill, doesn't mean they shouldn't be allowed to reproduce for fear of passing their illness down to the next generation. Anyway, maybe my little personal rant, just wondering what my fellow psychiatrists thought is all.

I'm sure she was just expressing her frustration of dealing with a specific burden. You can hear the same kind of talk in any resident's lounge in any hospital in the country, especially in public hospitals. People make outrageous statements that they don't really believe all the time.

 

[Chewbacca Jung]

I'm sure she was just expressing her frustration of dealing with a specific burden. You can hear the same kind of talk in any resident's lounge in any hospital in the country, especially in public hospitals. People make outrageous statements that they don't really believe all the time.

I would actually argue that the nurse meant exactly what she said, but does not really understand the implications of what eugenisizing schizophrenics would do. She also misunderstands the demographics of schizophrenia-- while having the history of a first degree relative does increase your chances of developing the disorder 10-15 fold, most schizophrenics are not children of schizophrenics. It would be futile in the crusade against schizophrenia. ANd how would you possibly carry it out? it would cause absolute distrust among an already paranoid population. You'd never see a schizophrenic in your office again on his /her own volition.

About the breast cancer example that someone commented about above, with respect to evolutionary fitness, particularly in social animals like humans-- post reproductive period plays a heavy role. For most animals- including all other primates, the goal of an individual is to reproduce and then quickly die once your genetic contribution period is over (to stop competing with your children for resources). But human females (and you could argue males in MOST cases) live past their reproductive use period. This argues that the older generation contributes something social/cultural that compensates for using up precious resources. Anything that compromises that sociocultural contribution to ones offspring is an evolutionary disadvantage, no matter how past their prime each party is. Schizophrenia would be an evolutionary disadvantage to those who carry the supposed inheritable susceptibility genes, in a modern western society. However keep in mind that schizophrenia is 90+% spontaneous.

 

[whopper]

you decide that any group of people, no matter how bad of a genetic or social hand they have been dealt, should have restrictions on their ability to reproduce, you then open up the door to all sorts of eugenic arguments.

Exactly. Occurred before. Some eugenics did go into law, e.g. the Nazi era of Germany, and were based on notions which have now been disproven.

E.g. From Wikipedia's eugenics entry...

One of the earliest modern advocates of eugenic ideas (before they were labeled as such) was Alexander Graham Bell. In 1881 Bell investigated the rate of deafness on Martha's Vineyard, Massachusetts. From this he concluded that deafness was hereditary in nature and recommended a marriage prohibition against the deaf ("Memoir upon the formation of a deaf variety of the human Race") even though he was married to a deaf woman. Like many other early eugenicists, he proposed controlling immigration for the purpose of eugenics and warned that boarding schools for the deaf could
possibly be considered as breeding places of a deaf human race.

The problem with eugenics is that people have used it to identify a characteristic they found as attractive as a marker for genetic fitness. In reality the only thing that is "fit" is something that allows for higher reproduction of children that will survive to reproduction. That's it.

IMHO, the eugenics wet dream--genetic manipulation to create "perfect" children may one day be a reality--though it probably won't happen in our lifetime. It'll be decades before genetic engineering gets to the point where it weeds out even dangerous genetic diseases. Designer engineering probably won't happen for decades after that.

Anyways, every family has mental illness if you look hard enough and trace it across nuclear family units. Genes predispoing to mental illness may also have some benefit that we are not aware of as of now.

I do though sometimes worry that the movie Idiocracy has some validity to it. If you dont' know about that movie, the future is basically populated by idiots--because after generations of idiots having kids while the geniuses (e.g. professors) having no kids or only a few kids, while the Jerry Springer stereotypes end up having several kids---the world has "devolved" into idiocy.

Yeah--I know its only a movie but sometimes that notion does give me the creeps.

 

[Anasazi23]

...the future is basically populated by idiots--because after generations of idiots having kids while the geniuses (e.g. professors) having no kids or only a few kids, while the Jerry Springer stereotypes end up having several kids---the world has "devolved" into idiocy.

The future?

 

[toby jones]

ROFL

 

[strangeglove]

Um ... I'm definitely not advocating for 'getting rid' of anyone , or starting down the proverbial slippery slope. My earlier rhetorical post was an attempt to underscore the exact arguments you are making.

Strangeglove, sorry if I sound a little ticked off, but I really try to make my posts clear and comprehensible. To have them misinterpreted, in a really negative, judgmental-sounding way, by someone who clearly didn't take the time to read them really bugs me.

Actually, your position is clear and I actually agree with it. I'm not accusing you of trying to get rid of anyone. I merely used your words as a launching point for my own opinion, not as a way to disagree with you. Sorry if I sounded judgemental. However, my opinion still stands.

 

[Dartos Vader]

It is definitely a bad idea to limit who has children or encourage certain people to have more. Just because one set of parents is successful/intelligent/wealthy, doesn't mean their kids will inherit any of their good traits. Someone who works their way out of the ghetto to be successful will have a lot of important lessons to teach. One of the people I met on the psych interview trail was the child of a schizophrenic. Beautiful people can have ugly kids and vice versa.

Plus who knows what traits will be desirable in 100 years. When I was growing up all the girls wanted to have smaller butts, now look at what is attractive, a j-lo booty.

 

[pazoff]

Yes, you are right, but the problem is that some people with mental deseases tend to have a high reproductivity(probably because their low mental and social status) and thus giving the chance of there defective genes(if the desease is inheritable) to have a higher incidence in the population more and more in the next geneations.So such deseases are given a grater chance to endure and the problem is getting more complex.

 

[whopper]

Food for thought.

Since there are improvements in schizophrenia treatment and because schizophrenics often times hook up with each other during group tx and hospitals stays, the estimated number of schizophrenics may increase in further generations.

Good news--that we're doing our jobs for the pt, but where does that leave society?