Authors: Ayelet Waldman
Then, after two weeks of pleasant calm, I found myself sitting in my bathroom, pants around my ankles, staring in shock at a pregnancy test flashing two cheerful pink lines.
I stopped the drugs right away. I made the decision on my own, not so much consulting my psychiatrist as informing him. I’d never allowed myself to indulge in much of anything during my other pregnancies. I didn’t drink coffee, I went off ahi and Gorgonzola, I avoided the products of both Napa and Humboldt counties. It never occurred to me to stay on the meds. I wasn’t profoundly mentally ill; I wasn’t about to leap off the Golden Gate Bridge. I was just mean and unpleasant, given to fits of weeping and flashes of inexplicable rage. And isn’t that how pregnant women are supposed to feel?
Except that I’d had two weeks of something different. I had had two weeks of contentment, two weeks of being in control. For
two weeks when Sophie and Zeke fought over whether to watch
Thomas the Tank Engine
or
The Simpsons
, when Michael forgot to pick up the dry cleaning, when baby Rosie wouldn’t stop crying, when an editor passed on one of my essays, I responded with equanimity, with disappointment perhaps, but never with apoplectic gall or soul-crushing misery. I now knew what it was like to be a person whose happiness was governed by the conditions of her life, not by those of her brain chemistry. Even more important, my family now knew what the experience of stability was like. Did we really have to give it all up?
I turned to the Internet. The pregnancy Web sites gave forth with a chorus of reassurance. Care should be taken, of course, but if my well-being required it, I should go ahead and take my antidepressants. Define “required,” I thought as I read. How bad did things have to be before I could safely put myself in that category? I read further and found a Danish study that showed no damage to infants from maternal use of SSRIs. An analysis of Swedish birth records confirmed this. I was especially comforted by this last report. The inventors of the Volvo, the very architects of safety consciousness, seemed to be telling me that even if I wasn’t in danger of slitting my wrists without it, I could still take my medication. I didn’t have to be suicidal; miserable and unpleasant did the trick. The Swedes gave me the green light.
This time, before I did anything, I called both my obstetrician and my psychiatrist. The research I had found reassured them, too, and they agreed that I could go back on the meds. I took Celexa for the rest of the pregnancy, and managed to weather events, among them the death of my best friend, that would otherwise have sent me rocketing into bouts of volatile despair.
Since then, however, there have been studies showing that taking SSRIs during pregnancy can cause a series of neonatal
problems. Nonetheless, the CDC recently concluded that antidepressants are safe for women and their developing fetuses. And by and large, they are. The vast majority of the babies of women who use antidepressants while pregnant are perfectly normal. But some infants present with a variety of birth defects and symptoms of SSRI withdrawal.
Abe had none of the birth defects described in the studies. Nor did he experience convulsions, constant crying, or breathing difficulties. But he did have that malformed palate, those feeding problems; he never learned to nurse, despite six months of aggressive intervention. When I read about these studies, I felt a nauseating twist in my gut. It sickened me to think that the treatment I took for my disease might have damaged him. For a long time I assessed every one of his flaws and minor disfigurements with the cold eye of a clinician, appraising and evaluating for subtle hints of gestational damage. I wondered if his chin failed to drop forward at seven weeks’ gestation when it should have because of the medication I took. I wondered if his failure to latch onto my breast was a sign of something deeper and more profound. I Googled the words “hirsute” and “birth defect.” I cupped his sweet, long foot in my hands and worked his little ankle, trying to figure out if the limp he had when he first learned to walk could really be blamed on womb positioning, as the doctor said, or if, somehow, the drugs that made me feel so good could have caused my baby to hover uncomfortably in the very place in which he should have been most secure.
I feel for the pregnant women facing this decision. It’s hard enough to be either pregnant or depressed, let alone both, without having to make sense of conflicting medical research and objectively evaluate the quality and seriousness of your own despair. Add to this the cacophony of condemnation from the Bad Mother
police, damning you if you expose your baby to medication and if you don’t, and the decision seems nearly overwhelming.
Had these various studies been published before I became pregnant with Abraham, I would have tried harder to do without my medication. I would have tried, knowing the toll it would have taken on my older children, my husband, and myself, in order to spare Abe any potential harm. I would have done this, whatever my doctors’ considered sound advice, bracing myself for months of upheaval and unhappiness and strapping my family in for a very bumpy ride.
But I didn’t know. Those studies weren’t available to me. It is of course not my fault—you can only make the calculus based on the information that you have. And so, even as I fret over the chances of any of my children becoming bipolar, I am especially worried about what I may have done to Abe.
Since my diagnosis, my disease has been more or less controlled. Unfortunately, however, medication and cognitive behavior can only go so far in reining in the bipolar demon, especially if you resist, as I do, the more hard-core drugs. Although I always take my medication, and never miss a therapy appointment, there are times when, in spite of my diligence, I begin to cycle. The red haze descends and I find myself lying in bed, weeping with shame because I sent a hateful e-mail, fought with my husband, or screamed at one of my children at the top of my lungs.
Of my various concerns for my kids, I think I am marginally more worried about
my
disease hurting them, warping who they will become and how they will live in the world, than I am of what will happen to them if they are themselves bipolar. But that’s sort of like trying to compare my fear of being attacked by a shark with my fear of being eaten by a mountain lion. It depends on where I am; in the ocean I am in a semi-constant state of shark panic and
don’t waste worry on land predators; when I am hiking alone in the hills above our house, where the paths are posted with mountain lion warning signs, I’m not particularly concerned about being mistaken for a seal. I frequently wake up in the middle of the night with terror clutching at my throat and belly, wishing my beloved children had a mother who deserved them, and just as often I lie awake parsing out their temper tantrums, looking for signs of an unusual loss of control.
When I am feeling stable, I understand that there are worse legacies. I tick off the myriad of genetically transmitted fatal diseases. All four of Michael’s grandparents died of cancer, as did his aunt and his uncle. God forbid he passed on some as-yet-unmapped cancer-related genetic defect.
Moreover, the dirty little secret of bipolar disease is that it’s not all bad. It is often strongly correlated with creativity. I’m not the only writer who does her best work while hypomanic. When I am feeling most like a literary fraud, like a lawyer who managed only by dint of a lucky marriage to publish ten books and dozens of essays, I take great comfort in knowing that although I might not share the talents of the writers whom I best love, I share their disease. If my kids are crazy like me, they’ll also be crazy like Virginia Woolf, F. Scott Fitzgerald, Leo Tolstoy, William Faulkner, and Henry James.
The buzz of hypomania is one of the reasons that I, like my siblings, refuse to take lithium. Lithium and other mood-stabilizing drugs work on mood from above, flattening the highs that can be so dangerous. Lows, while debilitating, do not usually result in an involuntary stay in the hospital. It’s the mania—the spending sprees and racing thoughts, the paranoid delusions and frantic rages—that get you locked up. But I have never been manic. At my worst, I suffer from those mixed states, which are unpleasant
and destructive but not dangerous enough (so far) to bring out the heavy joy-sucking and creativity-destroying artillery. And at my best? At my best, I am glorious. When hypomanic, I am busy and confident, vivacious and funny. I bring a laser focus to my writing, like a kid who pops Adderall before the SATs. I produce reams of prose of far better quality than the tiny constipated bundles I normally squeeze out. I entertain crowded dinner parties with anecdotes, and cheerfully volunteer for tasks that others avoid. In fact, one of my biggest problems with my bipolar disorder is struggling while depressed with the commitments I make while hypomanic.
Every once in a while the hypomania goes a little too far before it abates. I have to take an extra Ambien to fall asleep, or I monopolize the conversations at those dinner parties, unable to keep myself from interrupting. Worse, I over-share. I can always spot the other bipolar at the party. She’s the one regaling the room with the hysterical tale of her husband’s virulent herpes outbreak. Hypomania, like its bizarro twin, the mixed state, involves a loss of control. Normally people maintain a decorum in their actions and conversations that is appropriate to the circumstance they are in. Hypomanics lose that judgment. While hypomanic, I am capable of writing three books in a single year, but I am also in danger of posting intimate details about my marriage on a blog. The bipolar inability to resist the impulse to reveal inappropriately intimate details of one’s life is why there are so many bipolar memoirists. Writers who lie, who try to put themselves in the best possible light, who shy away from the ugliest parts of the truth, don’t in the end teach us very much about anything other than their own narcissism. It’s only when you do the bipolar dance on the razor’s edge of brutal honesty, when you are willing to put yourself in danger, that you can move beyond self-absorption to some kind of universal honesty. And yet, at the same time, indulging one’s bipolar
compulsion for self-revelation can all too often end up as solipsism. It’s a thin, thin line, one that I spend a lot of my time worrying about crossing, or regretting having crossed.
However, while lots of us enjoy our hypomania so much that we feel an ambivalence toward the idea of curing our disease, our families rarely take the same pleasure. While they can appreciate our high-spiritedness and the fruits of our over-productive labors, the downside is too costly. Our families are the ones who suffer at the hands of our rages, and they are brought almost as low as we are by our despairs.
However much I embrace my hypomania, however much I’d love for my children to be writers and artists, to enjoy the madness of creativity, I love them far too much to wish this burden on them, or on the people they love. And so I watch them. I calibrate their moods the way they calibrate mine. Is he more angry than he should be after that quarrel with his sister? Was her wildness in the playground just high-spiritedness or did it evince a troubling lack of control? Is that
normal
adolescent melancholy? Is that a
normal
tantrum? Is he okay? Is she okay? Have I passed this to them, along with my green eyes, my short stature, my intelligence, and the shape of my pinkie toe?
This unremitting vigilance is itself a cause of anxiety. Even parents who aren’t crazy struggle with the balance between monitoring their children and allowing them independence, between keeping them safe and giving them space in which they can make their own mistakes. For Michael and me, our inherent natures—his optimism, my pessimism—influence our different approaches to the way we monitor our children. Convinced that things could turn out terribly wrong, I observe and evaluate like a safety inspector at a nuclear facility. My dear cheerful husband (most often correctly) dismisses my concerns.
What happened with Rocketship was such a devastating blow to us in part because that bad test result bore out my pessimistic vigilance. If it had been up to Michael, we probably wouldn’t even have had the amnio. But, unwilling to trust fate or probability, I insisted. And look what happened: as blessed as we had always been, here now the universe had dealt us a shitty hand. Being right about this added fuel to my fatalistic fire. If we could be that unlucky once, then anything—everything—could happen.
Since then, my eye for the evil eye has been proved right on other occasions. For years I fretted and worried about Zeke’s behavior in school. He was unhappy. He acted out. When his standardized test scores came back off the charts—at both ends—I pressed his teacher about whether he should be evaluated. Something was off. Again and again I questioned and was rebuffed, told to calm down, not to worry so much. Finally, sure that there was something going on that we were missing, I insisted, over Michael’s objections, that we take Zeke to a neuropsychologist.
He has, it turns out, a series of fairly minor problems. He has ADHD, and processing-speed delay, and a really bad working memory. None of these rises to the point of disability, and all are eminently treatable, and had I just insisted on testing him earlier, we would have spared him what was a truly agonizing fourth-grade year. And again with his little sister; for a year I felt like a neurotic nut, asking over and over again if it was really okay that she wasn’t reading, even though I knew that it sometimes took kids a long time, even though it had taken her sister until she was seven to comfortably read a book. But I pushed for evaluation, and it turns out Rosie has a decoding problem, and now that she’s got a tutor to teach her how to work around it, she’s making progress by leaps and bounds.
So the vigilance works, right? Oh, the glory of being able to say “I told you so,” a mother’s four favorite words. Except that, by constantly watching for defects and disability, you run the risk of pathologizing your perfectly healthy children. You risk focusing so hard on the possibility of the negative that you lose sight of the positive. You risk, in the words of my friendly neighborhood Berkeley scold, imposing “your negative view of the universe” on your kids.