Studies have demonstrated “that the recurrence risk for BPD in first-degree relatives of BPD patients is approximately 9%” or “nearly ten times that of the general population.” My bipolar disorder also put our kids at a three-fold higher risk of experiencing major depressive disorder than the rest of the world. In fact, the study, published in Neuroscience, says that “BPD is one of the most highly heritable medical disorders.” My paternal grandmother, in fact, had BPD.
The only other disorder more heritable than BPD? Anxiety. According to a meta-study (a study that took the results of other studies, examined them, and pulled them together) in Etiology, “Panic disorder, generalised anxiety disorder (GAD), phobia, and obsessive compulsive disorder” all cluster in families. “For panic disorder, GAD, and possibly phobias, genes largely explain this.”
Even the American Association of Depression and Anxiety bluntly states, “Researchers are learning that anxiety disorders run in families.” Another study in Neuroscience says that “a variety of studies have demonstrated that 30−40% of the variance contributing to these disorders is heritable.” We have plenty of family members with mental illness running around with undiagnosed anxiety disorders.
In other words, our kids will probably, at some point in their lives, have a mental illness. I’m not being negative, I am being realistic. They are six, eight, and nine. One day, their own brains could likely betray them.
How do we tell them this? How can we prepare them for what feels almost inevitable? I don’t want this for my kids. You understand this if you have ever lived with or through a mental illness yourself. You know what it means to lie in your bed and be at war with yourself: I must get up. I must do this. You know what it means to drive over a bridge and think: what if it breaks, right now? You understand the ashen taste of unwantedness, the deep pain of loneliness. You know the depression monster that tells you that you are worthless, you will always be worthless, everything you do is worthless. You have heard the siren song of nonexistence and perhaps you have even tried to answer it.
I am terrified for my kids.
The Psychiatric Times reports numbers from the WHO: “2% to 15% of patients with MDD die by suicide,” as well as “3% to 20% of those with bipolar disorder.”
These are the risks my children face.
I wish I had answers. I wish I could say: “We do this and this and this in my family, and here’s what worked for us. I am an expert, and you should listen to me when it comes to talking to your children about how they may be mentally ill in the future.” But it turns out we already do a lot of things we should.
Because we ourselves are mentally ill, we can use ourselves as first-person examples. We can talk about our status as mentally ill people and destigmatize mental illness for our children. This is crucial. If our children are mentally ill, they need to seek help. We need to assure them they should never be ashamed to seek that help.
Luckily, we already do that. My kids know that I have bipolar disorder, that I am mentally ill. It sucks. But they know, because we are honest with them. They know I take a lot of medication; they’ve seen it. They know I go to the psychiatrist to get my medication refilled, that when I go to that doctor, I just talk to her a lot, and she writes prescriptions for me. I explain to them that those medications keep me from getting sad and being mean and sleeping a lot. Instead, they make me feel better, so that I have more energy, more patience. “When I get sad again, it means they need to change my medication,” I’ve explained.
They know that sometimes Daddy worries too much, and when Daddy gets really worried, he has to take some medicine to help him stop worrying and maybe lie down for awhile. We haven’t used the word “panic attack” yet. But we will, when we feel they are able to process that.
And now we’ll start using words for “depression,” explaining what it is and what it means. I will, sometime, have to show them the scars that I meant a tattoo to cover up, but which only made them, ironically, more visible. They’re faint, but you see them if you look. We will have to talk about self-mutilation, that ugly facet of having a mental illness. We will have to say something like: if you find that you want to hurt yourself, you need help. Please seek help. Please tell us. And if you don’t want to tell us, please tell someone else that you trust.
We will have to start talking about warning signs. Not all at once. These conversations have to take place over time. They have to be little seeds in other conversations, little bits we drop as if they are normal things one says, just pieces of life.
“When I’m sad for too long, I go talk to my doctor.” Or “Sometimes people become mentally ill. It’s not their fault.” Or “Do you know sometimes people get ashamed of having a mental illness? Isn’t that silly? It’s like being ashamed you have diabetes or something.” We will have to talk, and talk, and talk. I’m not looking to scare my kids or make them grow up too quickly, but awareness is key. Even if they do not have a mental illness, they need to be aware of it, and they need to know how to support people who do.
And we can only pray that we foster a close relationship with them, close enough that if they feel these symptoms coming on, they will come to us. We can only pray that we will notice the warning signs — my anxiety and depression began in childhood. We can only hope that they will let us in, that they will, even as adults, let us help them, let us care for them, let us carry them through their own darkness.
I am scared, but I’m letting my fear fuel me to be proactive. We have to be proactive.