Madness, medication and motherhood

I have bipolar disorder. I want a child, but I am terrified of going off my meds -- and of birth defects. Do I dare trust this body to create another one?

Editor's note: This story is excerpted from Salon's new anthology, "Maybe Baby: 28 Writers Tell the Truth About Skepticism, Infertility, Baby Lust, Childlessness, Ambivalence, and How They Made the Biggest Decision of Their Lives," edited by Lori Leibovich. Based on Salon's popular series "To Breed or Not to Breed," the collection includes 24 original essays from writers including Anne Lamott, Rick Moody, Kathryn Harrison, Alisa Valdes-Rodriquez and Rebecca Traister.

By Maud Casey

Read more: Abortion, Parenting, Pregnancy, Motherhood, Mental Illness, Life

April 3, 2006 | In the trees, the sci-fi chirring of the seventeen-year Cicada's call to mate haunts the air. May 2004: war and now, but of course, pestilence. Here in Baltimore, where I've landed in my nomadic thirties, the Cicadas lie spent on the sidewalk, fluttering one post-coital wing for hours before they die. With their buggy red eyes and cartoony paned wings, they careen lustily into car windshields, leaving behind a sticky smear of longing that no amount of window wiper fluid can erase. One of them (Pre-coital frenzy? A swoon of dying delirium?) flings itself into the arm of my windshield wiper as I drive down the road and I leave its corpse stuck there for days out of a kind of admiration. These fiercely determined insects seem symbolic, important. A symbol of what? Biological destiny? Perseverance? I imagine they have something to tell me, a thirty-five year old woman who may someday want to have children. After seventeen years of muffling their Cicada desire deep in the dirt, these determined insects have risen from the earth on the same night with a sole purpose: to breed. All day long, that sci-fi chirr, a plea in the trees, where they've instinctively climbed from their underground burrows to molt and get it on. The male Cicadas vibrate their timbals, drum-like abdominal membranes. Chirr, chirr. Let's do this thing and make more of us to burrow deep and rise to do this thing again.

The seventeen-year Cicadas are also known as Magicada and there is, in fact, something magical about their trilling refrain. It's not a question. In the face of the resolute nature of nature, my own quandary over whether or not to have children takes on a poignant human quality. No, the Magicada are unfettered and uninhibited in their commitment to their evolutionary task. They don't wonder whether they should bring their bug children into an overpopulated world of torture, natural disaster, poverty, disease, cruelty, injustice, not to mention the sometimes numbingly banal trudge, trudge of just getting through the days. They don't wonder how they'll afford it all or whether they'll be good parents because parenthood isn't part of the deal. For them, there is no why. Their mission is pure: rise up, breed, and die. I can't help feeling a slightly bizarre twinge of jealousy for the chirr, chirr in the trees outside. The female Cicada will lay between 200 and 600 eggs that will hatch into Cicada nymphs who will burrow deep, suck the juices from trees in order to survive for seventeen more years. In the seventeenth year, the nymphs will climb the trees and emerge from their split skin to begin the chirr, chirr and find female Cicadas with whom to mate. Burrow, rise up, breed, die, repeat. In the throes of my reproductive years, surrounded by friends who are new parents or on the verge of parenthood, the Cicada's song has a keen resonance. Lurking behind the buzz in the trees, I hear a different sort of sweet biological chirping: will you or won't you? Will you or won't you?

But for me, the question of how to be pregnant occurs simultaneously with the will I or won't I, the why and the whether. At the age of eighteen (around the same time the last batch of recently hatched Magicadas had gone underground to nourish themselves with the juice of trees), I was diagnosed with bipolar disorder. Ever since, I've been taking medication to prevent a relapse into the whirling circus of psychosis and mania, where, among other things, my mother was disguised as Madonna sending me messages through her videos, and wearing shoes meant you walked on souls (soles). This medication also prevents another foray into the dead land of depression where the idea of my mother-cum-Madonna seemed like the good old days and putting on shoes took all of the energy I could muster, never mind worrying about trampling spirits. The bipolar disorder is located somewhere between my animal body and my human mind, a combination of genes that have ingeniously conspired with that various and complex thing called life to create a chemical imbalance and I am down-on-my-knees grateful for the relief the medication brings me. I often find myself staring at the drugs in my cupped palm in amazement and wonder: Lexapro, an anti-depressant, is a tiny white bitter-but-blissful tablet; the anti-depressant Wellbutrin is a curvaceously round, pink cheerleader of a pill; and the Stepford-wife sounding mood-stabilizer, Tegretol, is a humble medium-sized pill that looks deceptively like a run-of-the mill aspirin. My marriage to this medical cocktail has been a relatively stable and happy one and pregnancy would require a separation. The most alarming aspect of this separation is the break from Tegretol, that miracle aspirin that keeps my moods, well, stabilized.

According to various studies, if a woman takes Tegretol during the first trimester of pregnancy, there are risks: a 1% risk for neural tube defects, such as spina bifida (versus the .01% risk associated with women not taking Tegretol); an increased risk of heart malformations, cleft lip and stunted growth (particularly in head size); and, bizarrely, a heightened risk of abnormally large spaces between the nose and upper lip. The research is incomplete and hard to come by because there are ethical considerations, more risks, involved with doing research on pregnant women.

There is also evidence that the more depressive or manic episodes a woman has had, the more likely she is to have another. In other words, there's a cumulative effect, a building of one upon the other, like sedimentary layers. There have been studies in which over half of the women observed relapsed into the whirling circus when they went off their medication during the first trimester of pregnancy. Questions beget questions. Will I risk my hard-won mental health for motherhood? Certainly there will be scientific progress. There are National Institute of Mental Health initiatives dedicated to finding mood-stabilizers that are less dangerous during pregnancy. Women with bipolar disorder can, and do, work closely with psychiatrists and therapists during the first trimester to monitor mood shifts, to keep track, to balance the risk of relapse with the risk of birth defects. So let's say that I will risk it. Let's say I begin to consider the why and the whether. Again, the answers are questions. What if my child, having been spared spina bifida, a deformed heart or a tiny nose, inherits the worst version of my haunted genes and it turns out that he or she is shouldering the 10-15% risk of suicide that accompanies bipolar disorder? How do I assess that ephemeral feeling of mania, see it through the eyes of my child? The day I sat on my bed as a freshman in college and felt for the first time something alive rising in my throat, terrifying and exciting, slippery silver like mercury streaking up my throat, the elusive thing that later would be identified as a disease? This becomes something wholly different if that hard-to-pin-down feeling might be passed on to my child in some form. How do I measure the sub-lingual, elusive grind of depression, the days of staring at my bedroom ceiling, its blankness a generous projection of my mind? Because when I think of having a child, I fear the day I look into her eyes and realize the unquantifiable "it" of bipolar disorder is in her too. The day I realize that, knowing the risk involved, I did this to him. Will I risk the mental health of my unborn child? Like the branches of bonsai trees, the questions loop back on themselves to the central trunk: why would I want to have a child? Before the questions, there is history, the history of imagined and accidental pregnancy. Chirr, chirr, a rattling of my grown lady timbals, a fugue in three parts.

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