Biography and desire for children among women with mental disorders. The 3rd Qualitative Research on Mental Health Conference The disabled self: theoretical and empirical approaches to stigma and recovery University of Nottingham, England 2010, August 25 th – 27th Silvia Krumm Ulm University, Department of Psychiatry II, Germany

Psychiatric dehospitalisation rising fertility rates Although lower fertility among people with mental disorders compared to general population Autonomous reproductive rights vs. reproductive risks Difficult borderland between individual and societal rights and responsibilities (American Journal of Psychiatry, 1973) Lack of research regarding desire for children Background

Sensitising concept Mental Illness Desire for children Biography Reproductive Biography Illness Coping Reproductive Risks

How do women with mental illnesses present their desire for children against the background of their mental illness? Research Question

Narrativ Biographical Approach Biographical narration (Life Story) –Daily routine vs. complex structure –Meaningful order Access to subjective meaning Narrative Identity Making her own person understandable and accountable in her life story given in a special, socially meaningful situation (Lucius-Hoene 2000)

Methods Recruitment: Mental hospital inpatients, newspaper advertisement Inclusion criteria –Childless women; age ~ 25 to ~40 years –Severe mental disorder –Two hospital admissions –Age at first hospital admission < 30 years n = 16 interviews with women; n = 1 interview with couple N = 5 intensive hermeneutic-reconstructive analysis (Rosenthal, Oevermann, Bohnsack, Lucius-Hoene)

Main Results Separation between desire for children and mental illness Interrelation between desire for children and coping styles Biographic coherence of desire for children / mental illness

1.) Separation of desire for children from mental illness Women without desire for children explicit separation: Motherhood as overburden risk for relapse Maternal mental illness vs. well-being of potential child(ren) Women with desire for children implicit separation: Postponing motherhood Desire for children depends on remission Mental illness as temporary deviance from normal biography desire for children as expression of normal biography

2.) Interrelaton between desire for children and coping style Distance between self and mental illness (~ sealing over) desire for children as aspect of normal biography Integration of mental illness negation of desire for children postponing desire for children controlling reproductive risks

3.) Biographic coherence of desire for children / mental illness Inclusion of desire for children into biography Construction of biographical coherence and continuity (before and after mental disorder) Successful coping, if mental disorder is not the main reason for decision against children

Hypothesis Hypothesis 1: Dealing with desire for children is influenced by the perception of normative expectations for exclusion of motherhood from mental illness -Social representations of good mother vs. mental illness –Strategies: Meeting social norms while acting against Hypothesis 2: Desire for children and illness coping styles are interrelated –Mental illness as part of identity exclusion of desire for children –Sealing over inclusion of desire for children Hypothesis 3: Construction of desire for children is part of illness coping / illness identity work –Reproductive Illness Identity Work

Implications for pratice Considering the concept of reproductive illness- identity-work within therapeutic context Reflecting therapeutic attitudes towards desire for children / motherhood Developing counselling services for women with desire for children

Sample Age 26 – 42 years (AM 32,3) Education Low Middle High n = 1 n = 8 n = 6 Partnership Yes No n = 12 (+ n = 1) n = 2 Living situation Residential care With parents Living alone With partner n = 1 n = 2 n = 4 n = 8 Employment status Employed University studies Retiremenet Jobless Self-employed n = 8 n = 2 n = 3 n = 1 Mental Illness Affective disorders Schizophrenia Personality disorders Eating disorders Compulsive disorder n = 7 n = 5 n = 1

CasesAgeDisorderAge at Incidence Living situation Desire for children Mrs. R36Schizophrenia17Partner*, Residential Housing No Mrs. B42Depression25MarriedYes Mrs. K33Schizophrenia26Partner*, Living Together No Mrs. P34Borderline17Partner*, Living apart Together Yes Mrs. S27Schizophrenie24Partner, Living together Yes