Parenting young kids while managing schizophrenia

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am 33. I live in Portland, Oregon, with my husband and our two kids — a girl who is seven and a boy who is four. I have had schizophrenia since I was 24. I want to write about what it actually looks like, day to day, to parent young children while also managing a chronic psychotic illness, because most of what I read online when I was pregnant was either terrifying or sentimental, and neither one was the truth.

The decision to have kids

My husband and I talked about having children for two years before we started trying. We met with my psychiatrist, my obstetrician, and a perinatal psychiatrist who specialised in serious mental illness. We talked about medication during pregnancy, the genetic risk, the postpartum risk, and what life would look like if I had an episode while caring for an infant. We made a written plan. None of those conversations were comfortable, and all of them were necessary.

Risk is real. The genetic risk of schizophrenia in a child of one affected parent is roughly 10%, compared with about 1% in the general population, per NIMH. The risk of postpartum relapse is significant for women with serious mental illness. We chose to proceed knowing those numbers, with a plan in place.

Our daughter was born when I was 26. Our son was born when I was 29. I stayed on a low dose of aripiprazole during both pregnancies under the joint care of my obstetrician and perinatal psychiatrist. I did not breastfeed long, by choice, to allow the most aggressive medication management postpartum. I had a wobble after my daughter — three weeks of broken sleep, voices returning faintly — and we caught it early. After my son, I did not wobble. The plan worked.

What our days look like now

Our family runs on routine. Routine is not a parenting choice for me — it is a medical intervention. Sleep is the single biggest predictor of my stability, so the kids' bedtimes are protected fiercely. They are in bed by 7:30. I am in bed by 10:00. My husband does the night wakings on weekdays so I get my eight hours. He gets his on the weekends.

I take my medication in the morning while the kids eat breakfast. They have seen me take pills since they were born, and they ask no questions about it. To them, this is what mornings look like.

We have a weekly menu, a chore wheel, a school calendar on the fridge, and a "tomorrow" basket where the kids put their school clothes the night before. The amount of decision-making this removes from my days is the difference between coping and not coping.

The hard days

I want to be honest about the hard days, because the romance about parenting with a serious illness erases them and makes other parents feel like failures.

There are days when the kids are loud and my brain feels too full and I have to lock myself in the bathroom for ten minutes to do breathing exercises. There are days when I cannot read them a second story because my voice has gone flat and I do not have it in me. There are days when I am physically present and emotionally not there, and they notice, and I see them notice.

Last winter I had a few weeks of poor sleep and a faint return of a voice. My husband and I implemented our "yellow zone" plan: he took over morning routines, my mother came to stay for ten days, my therapist moved me to weekly, and my psychiatrist adjusted my dose. The kids noticed Grandma was there a lot. They did not notice that anything was wrong with me. We had built the system to absorb a wobble before it became something else.

What I have told my kids

I have not used the word "schizophrenia" with them yet. They know I take medicine every day for my brain, the same way our daughter takes medicine for her asthma. They know my brain sometimes gets tired and I need quiet time. They know they can always tell Mom or Dad if something feels weird.

When they are older — around 10 or 11 — I will tell them the name of what I have. I have read enough guides on talking to children about a parent's mental illness to know that secrecy creates more anxiety than honesty does. NAMI's family resources have been useful for working out the language we will use.

What helps me parent well

• A psychiatrist who treats parenting as part of treatment. Mine asks about the kids at every visit. She has helped me think about medication choices through the lens of my caregiving role, not just my symptoms.
• A husband who is a co-parent, not a backup. The labour is shared. He does bedtime, he does pediatrician visits, he does laundry. I am not a "mom with help."
• A family doctor who knows my mental illness. When the kids are sick, I do not have to explain why I cannot pull all-nighters.
• A village. Two close friends, my mother, a babysitter we trust. I am not parenting alone.
• Therapy. Mine focuses partly on parenting, partly on managing my voices, and partly on the inevitable guilt that comes with both.

What I would say to someone considering kids

• Have the conversations. With your psychiatrist, your partner, your obstetrician, a perinatal mental health specialist. Make a written plan.
• Build the village before the baby arrives. Postpartum is not the time to make new friends.
• Sleep is medication. Protect it like medication.
• Tell your prenatal team about your diagnosis, even if you have to say it ten times. They cannot care for you well without knowing.
• The genetic risk is real but most kids of parents with schizophrenia do not develop it. Risk is not destiny.

For more, see the myth that people with schizophrenia cannot have children and parenting while on antipsychotics.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.