One of the few websites I've visted almost every day since 2000 - the year I became wired - is
salon.com. Sometimes it's infuriating. It's certainly a rarefied atmosphere, consisting mostly of the vapors emitted by extremely self-satisfied liberals. But I love the site despite its literary-liberal pretentions. My ex-husband gave me a subscription to Salon Premium years ago, and I renewed it a while back, because I think it's important to contribute to websites that try to foster and nurture writers of all stripes. It's a site that sometimes frustrates me but more often rewards me with nuggets of wisdom embedded in personal essays and thought-provoking articles.
Last night I clicked on Salon before bedtime, which I usually do to check what tomorrow's articles will be. It's sort of akin to sneaking downstairs the night before Christmas to take stock of the number of presents beneath the tree. I don't generally read the articles until the following day, but the lead essay grabbed me and pulled me right in.
It's entitled "Madness, medication, and motherhood", and it's by a writer named Maud Casey. It's an essay that's contained in a new anthology called Maybe Baby: 28 Writers Tell the Truth About Skepticism, Infertility, Baby Lust, Childlessness, Ambivalence, and How They Made the Biggest Decision of Their Lives.
I've managed to sidestep the Baby Question for most of my adult life. But this year I turn 37, and I realize that time is short, that my eggs have an expiration date, and that it's getting close to the time that I'll need to make some very binding decisions about having - or not having - children. I've been mulling this reproduction thing over for the past several months, and Maud Casey's essay brought me up short.
Casey's bipolar, as am I. The psychiatric history she discloses in her essay is eerily similar to my own. She's about a year younger than I am, and she's openly asking herself the same questions I've been asking myself lately: As a mentally ill woman who is medication-dependent, is it a good idea for me to get pregnant? Would the medications I'm on harm the fetus? If so, is halting the medication for the sake of a healthier pregnancy a viable option? Is it a reasonable option? More to the point, should I take the chance of passing this terrible illness along to future generations?
It's miserable to have to ask myself any of those questions. Childbearing is something that shouldn't take that much thought. It should be something I decide to do or not do based on the usual calculations. But my particular calculus is skewed by this illness, and Casey's essay brought all those things into stark relief for me.
Here's the truth: I love children. I adore them. I'm besotted with babies, particularly my five-month-old niece, who coos at me as though I'm the Madonna every time I walk into her field of vision. She's so cute that holding her makes me ovulate, I swear. I took care of children through most of my twenties, both as a Montessori preschool teacher and as a nanny to a small flock of wonderful children (with horrible parents). Kids slay me, and that's a fact. They love me, I love them. I get kids, and they instinctively know I get them. I'm one of those people that babies grin at and kids tug on in supermarkets so that I'll ruffle their hair and smile at them. I want one of my own, and quite desperately.
And see, that's the thing. It's only been over a period of the last three years or so that I've allowed myself to face that single, inescapable fact: I want a kid.
My ability to reproduce coincided almost exactly with my diagnosis of bipolar disorder. By the time I was sixteen years old, it was readily apparent to me, my family, and anyone who knew me well that something was terribly wrong with me. When I was diagnosed at age eighteen with rapid-cycling bipolar disorder (Type I, with psychotic features), one of the first things that occured to me was that I would never be a mother. It felt like a given - not a death sentence, exactly, but an immutable truth. I decided way back at the age of eighteen that I am Mentally Ill, And Therefore Not Mother Material. I purposely entered relationships with men who didn't want children. A large part of the reason I married Sam is that he didn't want kids.
But my diagnosis came back in the late 1980's, when this illness was treatable by nothing aside from lithium. Lithium is not only a blunt psychopharmalogical instrument, it's also toxic to developing fetuses. It's poison. Since that time, a wealth of new drugs have been developed or discovered that act as incredibly efficient mood stabilizers, most notably the entire class of anticonvulsant medications that have been used to treat epilepsy for decades. Tegretol (Maud Casey's drug of choice), Depakote, Neurontin, and Lamictal were all used for epilepsy before recently being greenlighted by the FDA to treat bipolar disorder. No one seems to know exactly why these neuroleptics work so well as mood stabilizers, but they do. And as long as I take my meds, exercise daily, watch my diet, and get enough sleep, I am more than okay.
Lamictal, the drug on which I've been happily stabilized for over a year, is one of the drugs that's okay for pregnant women to take. It's passed along through breast milk, so breastfeeding would be contraindicated, but I could have a fat healthy formula-fed baby. And ever since I turned 32 or so, the idea of having children has grown exponentially more intriguing as each year passes.
But the real question, the one that's kept me up nights with its leaden implications, is one that Maud Casey chooses not to broach in her essay. The real question is not Can I become pregnant? The real question is this: Should I be a mother?
Casey deals mostly with the easy stuff. She worries about going off her meds for months while she conceives, gives birth, and breastfeeds. That's not an issue for me, at least not on the medications I currently take. She glances at the ramifications of passing faulty genes along, which is a bit more philosophical.
I'd be sad if my child had this illness, but it wouldn't cause me (or my child) to come unglued. The truth is that we're light years from thirty-seven years ago, when lithium was first greenlighted for treatment of bipolar disorder. The meds available now are incredibly effective, and they have minimal side effects. I have every faith that even better medications will be available thirty-seven years from now. The latest research suggests that Omega-3 fatty acids, of all things, act as powerful supplements in the treatment of many types of neurological abnormalities, particularly severe depression and bipolar disorder. Almost every day brings new advancements in the treatment of this disorder.
I've never been one to romanticize this illness - far from it - but the correllation between bipolar disorder and a high degree of creative ability is irrefutable. I wouldn't exchange my "flawed" brain - abnormalities and all - for a neurologically stronger but less creative specimen. I like the way my mind works, and I think that at least some of that is attributable to the ways that this illness has shaped it. It's a complicated issue, and best left to the neuropsychiatrists. But I'm at peace with the fact that when treated and managed - and I do emphasize treated and managed - this illness can actually be something that's more like a blessing than a curse. It's enabled me to see things from a different angle. It's made me incredibly attuned and empathetic to the sufferings of others. And I can't shake the feeling that my creative gifts are inextricably tangled up and jumbled together with this managed madness. It will always be a balancing act, and I understand that. Sometimes it's wearying. But it's also rewarding in ways I could never have anticipated. It's not a disability on the order of, say, cystic fibrosis, and I'm not sure that it should ever be something that's treated through genetic screening. So the idea of having a child who inherits this disorder isn't such a terrible concept, at least not to me. It's manageable.
But the fact remains: I may never live a "normal" life. By that, I mean that there is a distinct possibility that no matter how good my meds are, how assiduously I monitor and care for myself or how stellar my surroundings are, I might succumb to another severe episode. I might land in a psych ward again. I might descend into another dark period of madness - and I don't use that word lightly.
When I take an honest inventory of my life thus far, I have to admit that many, many of my closest relationships have been scarred, tested, or destroyed by the fallout of this illness. Because it took me so very long to be correctly treated, I spent a lot of years in an extremely labile state. I'd go through periods of withdrawal that caused even my dearest friends to lose all patience with me. I could be by turns irritable and despondent. I was not an easy person to get along with for most of my adult life, though many kind souls managed to see the good in me and soldier through the bullshit this illness put all of us through. But it's been a hard road, and there have been many casualties, my marriage being one of the most brutal. Sam abandoned me, it's true, but I have a sneaking suspicion that the burden of this illness was the reason behind his choice to leave. I'll never be sure, of course - he denied me any truth or closure - but it's a reasonable conclusion.
And that's it, really. I was untreated at the time, but the truth is that this illness made me a miserable wife. And I can't discount the idea that it might make me a miserable mother as well. I'd like to think that now that I'm treated correctly, now that I'm invested in staying healthy, that things will be different, that I'm entering a new phase of my life. That's what I'd like to think, but with the awful weight of my psychiatric history behind me, sometimes that brand of optimism seems a bit foolhardy.
More interesting to me than Casey's essay were the several dozen letters from readers that appended the essay. Several of the letter-writers took it upon themselves to answer Casey's central question of Should I have a child? Many of the letter-writers were children of bipolar mothers, and all of the children of mentally ill mothers said the same thing: Maud Casey, listen to your body: it's telling you the truth. You are unfit to be a mother. My own mother damaged me in ways you cannot imagine. Do not inflict yourself on a child.
It's profoundly hurtful to read comments like that, but part of me reluctantly agrees. They certainly resonate with the fears I've had my whole life about having children, that's for sure. And those sorts of comments savage the fragile new hopes that I've just started to entertain - the hopes of actually having a child of my own one day, perhaps even one day soon.
I want to believe that these new medications will help me be a "normal" parent - that is, a person who screws her kid up in all the mundane, "normal" ways that every parent does. I want to believe that my possible future child - not to mention my possible future spouse - will never have to deal with the misery of escorting me through the labyrinth of depression and psychosis. I want to believe that I can not only have a child but be a good parent; that I can not only marry but be a good wife.
Adoption might be an option, but agencies don't tend to smile on applicants with a history of mental illness. And maybe that's a sign right there, isn't it? Maybe I am simply what I decided I was back when I was eighteen - Unfit. Less Than. Maybe my place in this world is as an aunt, as a caretaker of others' children. I could do far worse than being Aunt Ashley.
But oh, this desire.
"Baby Lust" is a relatively new (and wholly distasteful) term, and I don't think it's truly applicable here. It's more that I think I might possibly have managed to store up a small but precious stockpile of gems to share with a child. I believe I have some lovely things to pass on, things that are good and nourishing and enriching. I like the idea of mashing my genes up with someone else's - someone I love very much - and tossing the dice on the promise of a new little person. I like the idea of being a mother more deeply and intensely than I've ever really allowed myself to admit until these past few months with my own niece. Seeing my sister - my sweet baby sister - so perfectly, peacefully happy with her new baby has been one of the greatest joys and one of the most profound revelations of my entire life.
The other day when I was playing with baby Lucy, my sister Elizabeth looked at me and said, "You really ought to make one of these yourself, you know." And time is so much shorter than it ever was before.
Can a woman with bipolar disorder - however well-managed - be a good mother? Can she do it with the help of a good doctor, with a supportive husband, with painstaking care taken toward her own well-being? Can she function in that role?
Should she?
Should I?