independent

To Be or Not To Be a Parent

somewhat lonely feeling by yoshiko314Fear of what might be passed on to a potential child: four analysts interviewed around the topic of voluntary childlessness

Sheila O’Sullivan

In this paper I plan to present part of my PhD research findings into Voluntary Childlessness (VC). For my research I interviewed four female psychoanalysts and their pseudonyms are Angela, Beth, Cathy and Denise. I was interested in how psychoanalysts understood, conceptualised and responded to this phenomenon in the clinical encounter. An unexpected and interesting finding arose from my interviews and that was how patients had made a VC choice based on the fear of what might be passed on to a potential child. My main focus in this paper will be concerned with the fear of passing on a genetic illness or disability. Arising from this finding is the ethical question about ‘Fitness to Parent’ and the ‘Right to Parent’ and these debates are very prominent in social discourse. First, I would like to provide a brief summary of the psychoanalytic and sociological literature on VC.

Voluntary Childlessness has been written about extensively by sociologists and writers such as Mardy Ireland (1993) use terms such as ‘transformative ’ or ‘trailblazers’ to describe women who are prepared to stand up against the pro-natalist culture and forge a life for themselves where their identity is not closely tied to being a mother. However, there is a very little psychoanalytic literature on this subject and the way that it is portrayed is in stark contrast to the work of Ireland mentioned above. Psychoanalysis has made an inextricable link between femininity and motherhood, starting in 1925 with Freud’s ‘biology as destiny’ theory. A woman who chooses not to have a child has been viewed as having a masculinity complex (Deutsch, 1930) or as having an internalised negative experience of mothering that makes them either unwell or unfit to be mothers themselves (Chodorow, 1998; Pines, 1993). Indeed Rozika Parker in her book Torn in Two was concerned with unravelling femininity and motherhood. She argues that psychoanalysis has inadvertently contributed to many women, both mothers and non- mothers, feeling abnormal because they do not conform to a maternal ideal (Parker, 1995:176). Interestingly, psychoanalysis does not make the same inextricable link between fatherhood and masculinity.no child 1

Fear of replication
Both Shaw (2011) and Kamalamani (2009) have highlighted how VC choice is very complex. As part of my research, I chose to explore VC from an unusual and innovative angle by interviewing psychoanalysts about how they understood this phenomenon. I chose Interpretative Phenomenological Analysis (IPA) as my research method and in order to attract participants I broadened my research question to include patients who were childless for reasons other than medical ones. Early on in the research process I realised that words such as ‘voluntary’ and ‘conscious’ were complex terms for psychoanalysts. I will explore ‘fitness to parent’ and the ‘right to parent’ themes by referring to the interviews with participants as well as sociological and psychoanalytic literature.

Three of my participants discuss the conscious and unconscious aspects of a patient’s fear in relation to potential parenthood and how this will have affected an individual’s decision making. Before discussing in more detail the fear of passing on a genetic illness I will briefly outline the other fears that were highlighted by my participants. Denise and Angela also describe patients who fear passing on their experiences of bad parenting to a potential child. Some of the patients made a conscious decision based on their experiences whilst some of the participants felt that other patients were unaware of their unconscious conflicts and ambivalences.

The participants also spoke about how some of their patients feared passing on intergenerational depression or mental illness to any potential child and Angela described one patient who “felt he was doomed to be bad father like his own father.” She discussed two patients who chose to adopt or undergo surrogacy rather than risk having their own biological child. There was a general consensus amongst the participants that that reproduction choice or non-choice provoked earlier unresolved conflicts related to either the patient’s mother or father. These unconscious conflicts might manifest themselves in the actual fear of the mechanics of pregnancy and what might happen to the body. Cathy spoke movingly about a patient who had unconsciously identified with a stillborn sibling so her voluntary childless choice was based on the ‘any baby was going to be a dead baby’ scenario. One of the side effects of a voluntary childless choice was that some patients underwent abortions arising out of conscious or unconscious fear. Both Cathy and Denise discussed how some patients feared the dependency and commitment involved in having a child while Beth stressed how some patients feared what they would have to sacrifice financially and career-wise in order to be a parent.

Genetics and future generations
Angela and Cathy discuss patients who are consciously struggling with life threatening illnesses and a genetic condition that involves agonising decisions about whether or not to be a parent. Both participants express deep empathy and a sense of helplessness in the face of the difficulties that these patients are grappling with. The question of risk loomed large both for the participants and patients in these situations. Angela gave an example of a patient who was born with a deformity and it was only as the menopause approached that she became conscious of a desire for a child. The patient used analysis to wrestle with this decision and eventually chose not to become a mother. Angela’s view was this was a generous act, not only for the patient’s own welfare, but also for that of an unborn child. The fear of passing something on to a child was, according to Angela, “more common than you think.” Cathy too referred to a patient with a cancer gene in her family and she also chose not to have a child because of the risk involved. Another patient that Angela described was a woman who had a life threatening illness and she did not know how long she had to live. She was still in analysis and in the throes of making the decision. Angela described how the patient’s partner was not keen on the idea of a child as he did not want to be solely responsible for it if his partner had an early death.

The participants discussed the professional challenges they faced when trying to help their patients make very painful life choices. Cathy implied that she saw her role as being one of a witness and supporter. Her empathy for her client is clearly evident in the statement “the most horrible predicament I can imagine.” Similarly, describing a patient with multiple sclerosis trying to make the right decision about having children, Angela uses an equally powerful empathic statement: “I wouldn’t want to be in her shoes”, and then goes on to state: “Because one doesn’t know what is…remotely, what is the best decision.”

Experience of care
The data extract above reveals that sometimes the participants feel confusion about their role as therapists working with VC clients and this is not surprising bearing in mind the multi-layered dilemma that the patient is facing. Angela expresses humility in her not knowing. It is an illustration of the depth of her empathy as she sits alongside her patients who are dealing with such complex existential concerns. However Angela does state that therapy is a good opportunity to make a decision.

Psychoanalytic writers have touched on this fear of passing on a genetic illness but have glossed over the agonising nature of such decision making as outlined above by Angela and Cathy. Jennifer Stuart in her paper ‘Procreation, Creative Work and Motherhood’ discussed a patient who was a very successful writer, whose decision not to have a child was in small part related to a half-sibling who had been institutionalised because of a genetic condition (Stuart, 2011:422). Eilss Benedek and Richard Vaughn discuss how some voluntary childless individuals might have arrived at their decision because of having to care for siblings with a genetic condition (Benedek and Vaughan, 1982:213). For these individuals one needs to turn to other literature in order to gain a flavour of the ethical and personal dilemmas described by Angela and Cathy.

Dis-abilism and risk
In her 1997 paper, ‘The Baby and the Bath Water’, Carol Thomas discussed the dis-abilism that exists in society rather than focusing on the disability experienced by the women. Dis-abilism includes the social barriers faced by people with impairments as a consequence of western culture’s antipathy towards those with “undesirable physical, sensory and mental abnormalities” (Thomas, 1997:623). Thomas carried out qualitative research with women who had a variety of disabilities or who were carriers of genetic conditions. She was interested in exploring their experiences of making the choice about whether or not to become a parent.

Her results highlighted how many of her participants had a different attitude to risk than that of the professionals involved in their care. Many of these women had lived with risk all their lives so the decision making process around whether or not to have a child was “murderously difficult” (Thomas 1997:362). This has the same flavour as that described by Angela, “I wouldn’t want to be in her shoes” and Cathy’s description of “the most terrible predicament that I can imagine.”no child 3

Some of the participants in Thomas’ research discussed how they chose to be sterilised after having a child. The women’s accounts reflect the emotional demands placed on those who encounter the dilemmas involved in the risk discourse – worry, anxiety, guilt, lost hopes and unfulfilled dreams (ibid:32). These themes were echoed by Angela and Cathy and, one can assume, many other psychoanalysts and psychotherapists working with this patient group. Some of the participants in Thomas’ study feared not being ‘good enough mothers’ and that their children might be taken away from them. Interestingly family members were seen as more of a threat than professionals.

Thomas highlights how the risk discourse is not a neutral one as some of the questions that are raised are based on judgements relating to “social assumptions about quality of life and intrinsic value of children and adults with impairments” (ibid:632). More importantly there is a social discourse around ‘what lives are worth living’. The participants in Thomas’ study expressed the views that they were fighting for the ‘right to be mothers’ and Thomas (ibid:636) highlighted how the socially defined obligations of motherhood hit those with impairments particularly hard. In her paper ‘Are we disabling our clients?’ Michelle Taylor draws attention to how counsellors need to be more aware of how their attitudes and behaviours create barriers for clients with disabilities (Taylor 2014:22). Although she is not referring to working with the ‘to be or not to be a parent’, she echoes Thomas’ view that it is important not to make assumptions about the experiences of those with disabilities.

Another angle on this debate was the BBC Radio 4 programme called ‘Rosemary’s Baby’, broadcast on ‘Inside the Ethics Committee’. Rosemary was diagnosed with Ehlers-Danlos Syndrome in her twenties. Despite being in a lot of pain Rosemary always pursued her love of sport, driving herself to ever-harder challenges like competitive swimming. However through the years her condition worsened and at the age of 36 she is now a full time wheelchair user and her breathing is impaired. She receives her nutrition via a tube fed directly into her bloodstream and she empties her bowels into a bag. Now that she is in a relationship she wants to start a family and a range of professionals came together to discuss her case. The welfare of the child featured prominently in the discussions and the possible risk for mother and baby. Rosemary was able to counter any of the arguments put to her about the risks by arguing that she could put measures in place to cope, stating:

“If I had a child affected by my condition and then maybe worse affected I would be heartbroken. But equally if I chose not to have a child as a result was I saying that I wouldn’t have wanted to have been born? And I definitely don’t regret being born and I think that I have a good quality of life and I didn’t think it was an unfair risk on the child.”

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One of the individuals on the Ethics panel for this programme was Franklyn, who herself has the same condition as Rosemary and she made an interesting comment:

“I think that the risk is particularly interesting because Rosemary and other disabled people understand risk in a very different way from people who aren’t disabled and particularly from clinicians because we live with that risk as part of our everyday life, so we learn to accept that and deal with it.”

Franklyn argues that it is the most natural feeling in the world for Rosemary to desire a baby of her own. Referring to the social discourse about quality of life, Franklyn observes that disabled people have a different view from those who aren’t disabled. Interestingly the consultant argued that it was a slightly dangerous thing to take someone who is as driven by a very clear desire to have a child as in Rosemary’s case. He considers her innate desire to produce to be as much a problem as her physical problems. Another panellist described the need to be really careful to unpack the desire for a child because wanting it too much might be pathological and encourages Rosemary to do so in her genetic counselling sessions. He has refused to take patients on again if they chose to have an abortion after a previous IVF treatment.no child 2

Pathology?
Some of the participants in my study also highlighted how the desire for a child might be pathological. In A Woman’s Unconscious Use of Her Body, Dinores Pines describes patients who frequently become pregnant only to immediately abort the child. Pines also states “that there is a marked distinction between the wish to become pregnant and the wish to bring a live child into the world to mother” (Pines, 1993:98).

One of the dilemmas that the ethics committee grappled with was the fact that Rosemary had entered a competition set by a private health clinic that enabled her to have free treatment. The doctors felt this was a value shift around who deserves treatment and the terms and conditions under which such treatment is offered.

The right to parent
As part of his research, Campion (2005) spoke to many hundreds of parents with physical disabilities and a theme was that they are still more likely than able-bodied parents to be offered abortions and sterilisations and to have more professional supervision of their pregnancies and parenting. It is more likely that women rather than men will be offered sterilisation. In a moving paper about working with disabled and abused patients, the psychoanalyst Valerie Sinason (2008) observes that her disabled and abused patients, no matter what their cognitive ability, know the meaning of menstruation, pregnancy, abortion and sterilisation. She strongly objects to the numerous discussions on public media about aborting any foetus that may have some defect when there are thousands of individuals living with disabilities. She considers that these messages are a “psychic minefield” (ibid:274) for those with a disability.

There are others in society, beside those with disability, that also face what they perceive as discrimination over the right to parent. Karen Lawson et al (2013) argue that there is a high level of stigma attached to women in particular who have Aids or HIV (ibid:676). HIV positive women report the belief that society views mothers with Aids or HIV as morally and socially irresponsible. These women face a ‘double-bind’ in that societal norms regarding the value of motherhood are in conflict with societal messages framing reproduction as deviant for HIV positive women. Their research concluded that future research should focus on the societal mental construction of the HIV positive pregnant women, in order to discover what are the dominant stereotypes and judgements.
Lawson’s findings together with Thomas’ research and Rosemary’s story told in this section highlight how counsellors and psychotherapists might well have to grapple with ethical and moral dilemmas around the ‘right to parent’ and the ‘fitness to parent’.

Eugenics?
More recently there have been schemes in various western countries to pay individuals who have HIV or are drug addicts to either delay childbearing or to be sterilised in order to prevent pregnancy. Jayne Lucke and Wayne Hall (2012) wrote a paper about a US based organisation that offers $300 to addicted individuals who agree to either undergo surgical sterilisation or use long-acting forms of contraception. They want to enquire into the reproductive rights of drug-using women and whether this initiative undermines the ability of addicted women to make free and informed decisions. They argue that Project Prevention has been criticised for its eugenist language and for targeting poor women from minority groups. This scheme has been extended to the UK and it raises debates about the rights of the unborn child.

The analytic challenge in the 21st century
In this paper my intention has been to highlight one of the ethical and personal dilemmas faced by psychotherapists and psychoanalysts when working with individuals who fear passing on a congenital illness to an unborn child. The psychoanalytical literature barely covers this topic and the sociological literature presented above shows that many individuals with disability feel that social discourse is rife with prejudices and misunderstanding. Further research from psychoanalytic and other therapeutic researchers might enrich our understanding of the psychological cost to individuals and how best to support them. The participants in my study demonstrated the challenges of working therapeutically with these dilemmas.

I have also briefly discussed how some of my participants understood that some of their patients were childless because of the fear of passing on the bad parenting that they had experienced as children. My participants stressed the difficulties the patients had, mainly with their fathers, that might have led to their childlessness. Some of the patients chose to adopt or to become a surrogate parent as a better alternative to passing on bad experiences to a biological child. The psychoanalytical literature highlighted how some individuals chose to have abortions or to be sterilised in order to secure their voluntary childless choice.

Some of my participants suggest that psychoanalysis can help patients become more aware of their fears and fantasies and this can then prepare them to provide healthy mothering. Throughout their narratives all of my participants struggled with the dilemmas about who is ‘fit to mother’ and the ‘right to mother’. Sociological writers focus more on the need to challenge the social discourse rather than locating the problem as the intrapsychic difficulty within the individual. How do we in the psychoanalytic and psychotherapeutic community meet these challenges in our post-modern age?

Sheila O’ Sullivan has been in practice as an integrative body psychotherapist for 18 years. She has both a personal and professional interest in the experiences of women who are childless, whether through infertility, or because they ‘left it too late’ or because they have made a choice not to have children. Sheila has just completed her PhD at the Centre for Psychoanalytic Studies at Essex University and her research question was interested in exploring how psychoanalysts understand, conceptualise and respond to voluntary childlessness in the clinical setting.

References
Benedek, E. and Vaughn, R. (1982) ‘Voluntary Childlessness’ in Kirkpatrick, E.B., Women’s Sexual Experience – Explorations of the Dark Continent. New York: Plenum Press
Campion ,M.J. (2005) Who is fit to parent? [Ebook Reader] London and New York: Routledge
Chodorow, N. (1978) The Reproduction of Mothering. London: University of California Press
Deutsch, H. (1930) ‘The significance of masochism in the mental life of women’ in Saguaro, S. (ed) Psychoanalysis and Woman – a reader. New York University Press: New York
Freud, S. (1925) ‘Some psychical consequences of the anatomical distinction between the sexes’, in J. Strachey, (ed and translator) The standard edition of the complete psychological works of Sigmund Freud, vol 19. London: Hogarth Press
Ireland, M. (1993) Reconceiving Women: Separating Motherhood from Female Identity. London: The Guilford Press
Kamalamani (2009) ‘Choosing to be childfree’. Therapy Today, 20(6)
Lawson K.L., Bayly M. & Cey E. (2013) ‘Judgments of pregnancy and parental fitness toward women with HIV/AIDS’. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV, 25
Lucke, J.C. and Hall, W.D. (2012) ‘Under what conditions is it ethical to offer incentives to encourage drug-using women to use long-acting forms of contraception?’. Addiction, 107(6)
Parker, R. (1995) Torn in Two: The experience of maternal ambivalence, Great Britain: Virago Press
Pines, D. (1993) A Woman’s Unconscious Use of her Body. London: Virago Press
Shaw, R.L. (2011) ‘Women’s experiential journey toward voluntary childlessness: An interpretative phenomenological analysis’. Journal of Community and Applied Social Psychology 21
Sinason, V (2008) ‘Gender linked issues in psychotherapy with abused and learning disabled female patients’ in Raphael–Leff and Perelberg, R. (eds) in Female experience: four generations of British women psychoanalysts on work with women. London: The Anna Freud Centre.
Stuart, J. (2011) ‘Procreation, Creative Work and Motherhood’. Psychoanalytic Inquiry, 31(4)
Taylor, M. (2014) ‘Are we disabling our clients?’ Therapy Today, 25(2)
Thomas, C. (1997), ‘The baby and the bath water: disabled women and motherhood in social context’. Sociology of health and illness, 19(5)
Inside the Ethics Committee, (2013), Radio 4, 8 August [online]. Available at www.bbc.co.uk/radio 4 (Accessed 6 February 2014).

Image: somewhat lonely feeling by yoshiko314 (on Flickr)