The sins of the mother...

The more we find out about how genes work,
the more we're going to see how much of who we are,
and everything in the world-- how it behaves--
is due strictly to our genes.

My father said this, a few years ago-- though he's been saying variations on this theme for longer than I can remember.

I grew up in a world of genetic determinism.

I'm not sure how to progress beyond that statement. There's too much I could say. After all, I spent over a year working out my varied responses to this particular concept of identity, producing page after page of manic writing, and a veritable deluge of photographs and artwork, that sit in an online repository, waiting for me to figure out how to edit them into something interesting and accessible.

That project culminated in a visit to a mental hospital-- and a diagnosis of bipolar disorder.

The general consensus amongst psychiatrists and other medical professionals is that bipolar disorder, along with other mental illnesses like depression, has a strong genetic component. My own family history seems to back this up. My sister has struggled with depression for most, if not all of her life. My cousin was diagnosed a few years back with borderline personality disorder. There are countless instances of undiagnosed depression amongst the older generations in my family-- those that are less likely to admit a problem or seek treatment, because of stigma, or notions of mental illness as moral failing. There are alcoholics, and the occasional drug abuser-- and I've come to learn that these behaviors often accompany mental illness.

And my mother tells tales of a great-aunt who never washed her hair, and had visions of Jesus Christ that she drew in crayola crayon. I sensed a connection with this faceless ancestor even in the midst of my own manic search for God and identity, before I learned we probably had a diagnosis in common.

For a few months before I was hospitalized, my husband and I had been trying to conceive. Then I got sick. Our plans had to change. I was put on medicines I was told could cause birth defects. And I wasn't sure, at that point, what my disease meant in terms of my being able to take care of myself-- never mind a child. I was heartbroken for the loss.

I shared these feelings with an occupational therapist at the hospital-- a woman who was pregnant herself. She told me what were, to me, terrifying tales, of mothers-to-be with bipolar committing themselves and undergoing electro-shock therapy to make it through their pregnancies without medication. She blithely offered to get me copies of articles about the procedures.

Then she told me that if I ever wanted to get pregnant, I really should consider using a donor egg, because "bipolar is genetic, and I wouldn't wish it on anyone."

Regular readers of this blog have encountered this anecdote before. The incident left quite an impression on me. The OT didn't seem to realize that what she was saying was that I, and possibly my family, would have been better off if I'd never been born.

Was she right?

I don't think so. In fact, I've never thought so-- in one example of the many ways mental illness expresses itself differently from person to person, I've never contemplated suicide. I've never lost my faith that even in the midst of the worst my life has had to offer me, there's a possibility for learning, for growth, for joy, somewhere in a future I can't predict.

So here I am, just over a year after receiving that judgment from my erstwhile OT, mid-way through my first pregnancy, with an offspring composed in equal parts from my husband's gene pool and mine. How dare I take such a risk, not only in choosing to become a mother, but in allowing the possibility that I could pass on dark matter lurking in the depths of my genetic past?

Will I be a good mother? I hope so, though I know already I won't be perfect. In that sense, I'm no different from most women who are about to give birth. But I have special challenges. I need to stay on top of my illness, as I've done successfully since receiving my diagnosis last year. I need to be scrupulously honest in my self-awareness, respectful of my limitations, and ready to reach out to others when I need help. Fortunately, I have a loving, intelligent man at my side, who's already proven his commitment to keeping me healthy, and who will be my partner in this scary adventure we're taking together. I have a team of doctors and therapists I trust. I have a family that has experience with mental illness in its many forms, and its management, who love me, believe in me, and want me to do well.

As a matter of fact, in many ways, my situation could be seen as enviable. There are many mothers, with and without mental illness, who must make do with less.

But what if I pass my illness on to my son?

According to my genetic counselor, there's a fifteen- to twenty-percent chance my child could develop mental illness at some point in his life. That's not a small risk. I certainly wouldn't jump out of a plane if there was a one-in-five chance I wouldn't make it to the ground alive. On the other hand, even in the worst-case-scenario, the odds are still in his favor.

And even if he inherits the genetic predisposition to getting sick, there are a host of environmental factors that are very much in play, to determine ultimately whether those genes ever get expressed. My father has an image-- a popular one-- of genes as a series of equations: this gene equals this height, this gene equals this eye color, this gene equals this personality trait. But I've done a lot of reading and lay research into the nature of genetics, and my understanding of the body of knowledge as it stands at the moment is that genes are actually a lot more like recipes. In other words, you can have the right proportions of eggs and flour and vanilla, etc., but if the oven isn't hot enough, you still won't get a souffle.

I wonder about this when I think about my own experience. After all, my mother, so far as I know, doesn't have bipolar-- though she's expressed different aspects of it, from time to time in her life: depression, insomnia, quick speech, and so forth. But anecdotal reports indicate that her mother-- who died when my mother was a child-- very well might have had it. I didn't develop manic symptoms until I was in my mid-thirties, at a time when I was under severe financial and emotional stress, isolated due to my unemployment, and smoking bounteous quantities of pot (which I've come to learn is thought by many, if not most mental health practictioners, to trigger both mania and psychosis in those who are susceptible.)

Why did my variety of mental illness skip a generation? And if any of the elements described in my perfect storm of environmental factors had been different, would I ever have developed bipolar myself? I'll never know, of course-- we only get to see what history actually plays out-- not all those alternate realities. All I can do is accept what did happen, and learn to live my life as best I can with the history I ended up with. But the knowledge that things honestly could have been different is freeing, when I think of my child's future. Genes aren't destiny. There are steps my husband and I can take, to try to keep him healthy.

And at the very least, we're in a uniquely privileged position of being able to recognize what this sickness looks like, if it does rear its ugly head. We'll be prepared. We'll find him the treatment he needs.

My son could develop bipolar disorder. That is simply fact. It is a risk my husband and I have decided we're willing to take. And we're taking that risk without being able to ask him what he would prefer. I'm assuming he's enough like his parents that he'd be willing to chance it, to see what life might have in store. I could be wrong.

Of course, I say to the phantom version of my former OT who lives on in my mind, I wouldn't wish bipolar disorder on anyone-- least of all my own child. But to be honest, I could list at least a dozen genetic ailments, just off the top of my head, that seem to me to be far worse than the possibility of living with my brand of mental illness-- inherited cancers, degenerative diseases, and so forth.

And, not to be overly flippant about it, but having bipolar does have its perks-- the bulk of scientific literature I've read (not to mention my own family history and experience) indicates there are strong correlations between having creative and artistic skill and having bipolar. Wordsworth, Keats, Shelley, Beethoven, Schumann, Virginia Woolf, Edgar Allen Poe, and even Abe Lincoln are thought to have had it. There's Nina Simone, Jaco Pastorius, Rosemary Clooney, Jackson Pollack, Mark Twain. Current luminaries include Jim Carrey, Carrie Fischer, Jane Pauley, and Stephen Fry.

This is an extremely truncated list. For more, click here. In short, my son would, like me, be in good company, if he were to inherit this illness.

While I'm on the subject of good company, I should point out how blessed I feel to live in the age of blogging, when I can turn to excellent mothers with bipolar, like Jenn Mattern from Breed'Em and Weep, when I need commiseration, or inspiration. (If you know other good bloggers I should consider on this front, please link to them in the comments.)

I want my son to be healthy and happy. I'm going to do everything in my power to ensure that he is-- short of denying him my genetic material. It's a mixed bag, I know. And I know what it's like to deal with the consequences of reaching in to the bottom and pulling out something unpleasant to live with. But there are good things in there, too.

Maybe, like me, he'll be good with paint, or with words, or with figuring out how things work. Maybe he'll be curious. Maybe he'll like to sing. Maybe he'll really enjoy a good argument.

And maybe, if we're lucky, he'll be the sort of person who's willing to risk loving someone, even if there's a good chance that someone won't turn out perfect.

I hope so.

Comments

[jayne]

I think your son is extremely fortunate that he has the two of you for parents. Your outlook is incredible, and you're right - being bipolar is not all that you are, or all that you may pass on to your child.

Again, I am so very happy for you. For all three of you.

[roo]

Thank you so much, jayne.

[mayberry]

This is really beautiful. It's clear-eyed, and yet hopeful too.

[tracey]

Anyone who can write so honestly and eloquently about her concerns about motherhood makes me sorry for all the kids who won't have you as their mom.