Premarital Screening for Mental Illness

By: Khadeeja Rana

For every role we want to adopt in this world, we follow a set procedure to learn the tricks of the trade: be it formal education or information passed down by elders. When it comes to parenting, we mostly rely on our instinct and experience, yet in some cases, people are ill-equipped to be successful parents. Mainly, it is due to parents’ struggling with their own issues unresolved from the past, or in a worse case: mental illnesses.

Following the recent news about premarital blood screening of couples to rule out thalassemia, the idea of premarital psychological screening of couples with mental health issues came to my mind. They say nothing is more powerful than an idea whose time has come. The importance of this radical idea can be understood from the detrimental effects parental psychopathology has on children. A parent with mental health issues would frequently experience rage, disorientation and relapses. It can significantly affect his/her ability to parent effectively. Children raised in such households have childhood memories tainted with trauma, punctuated with uncertainty, anger, depression, isolation, shame, fear, guilt, stigma and resentment, to name a few carry-overs. Decades of battling with surviving inconsistent parenting can traumatize a child’s life, and the emotional stings can seep into adulthood. Therefore, children of parents suffering from mental illness also need professional help and clinical attention.

Apart from the emotional problems likely to be faced by children of people with mental illnesses, it puts them at a higher risk for psychopathology. Anxiety, depression, drug use, psychosis and mood disorders are some of the particularly common inherited disorders. Living a person with mental illness is no easy job as such illness of severe and chronic nature sticks around for life. Medication may help stabilize the symptoms and the person can manage the illness, depending on the diagnosis, duration and prognosis.

However this raises an ethical question: are we supposed to stop people with mental health issues from having children? Or should we knowingly allow them to raise children with the risk of harming them or passing the illness genetically. Ethically speaking, professionals and guardians of vulnerable individuals are legally authorized to take decisions for them. Though it must be kept in mind that the purpose of the screening is not to deprive people of opportunities to have children, but it is to determine the risk and harm involved. Moreover, it would depend on the severity of the disorder to actually make the final decision. Although it seems like a far-fetched concept in Pakistan, but that does not vilify its necessity. The question is simple: if people cannot take care of themselves, how can we as a society expect them to look after and raise healthy children? If we sit down and discuss the details, it is likely for women with mental illnesses to become more vulnerable due to pregnancy hormones and the extra stress of a mother-to-be. Women with mental health issues are more likely to relapse in the postpartum period. Not just women, marriage is said to bring out the worst in both partners because it is something which makes us face ourselves like never before. This brings us to the next concern: should people with severe mental illness be allowed to marry? Some might say they have a right to marry, but we really need a hedonic calculus. Can we choose one person’s happiness over the misery of their spouse and future children? While a spouse may have an option to opt out, in case it does not work out but children have no such liberty. Moreover children are helpless, dependent and vulnerable.

However there can be no coercive restriction on couples to not have children; but being informed is not a bad idea either. Once aware, they can make the choice that makes most sense to them. Perhaps they can be recommended to seek treatment in order to ensure minimum harm to the mother and child. At the end of the day, the effort is directed at encouraging more people to actively seek treatment. There is no shame in being well-informed of the genetic code you’re carrying and enabling yourself to make wise choices. We have to think not only of ourselves but also of the future generation. It is our social responsibility to ensure that we are not mistakenly harming our children. Therefore, it is extremely important to work on the preventive side of problems, and premarital screening is one step towards that.