The Other Person in the Illness
Motherhood and marriage in the shadow of a husband's strange disease.
Our household produced a lot of books this year. The reasons for this self-promoting Substack’s existence, the updated paperback of The Decadent Society and the hardcover of The Deep Places, came from my end of the attic — but then from the other end of our third floor came my wife’s book on the science of the maternal instinct, Mom Genes.
A few weeks ago I wrote something here on the themes shared by my own two books, but there’s a more direct overlap between my memoir and Mom Genes, because my story is literally part of Abby’s and vice versa. Her book weaves personal maternal experience into its exploration of mom science, and a late chapter takes up the subject of how relationships affect the maternal experience and the maternal psyche, with a particular focus on her own experience of being pregnant in an isolated house in Connecticut with a husband suffering some kind of mysterious breakdown — one that lay, at the very least, on the frontiers of medical understanding if not beyond the borders completely.
Based on reactions from readers I think The Deep Places does a reasonably-good job of conveying the reality of how chronic illness envelops more people than just the sufferer, how the whirlpool can carry not just individuals but entire families downward to the depths, how much of a burden a spouse ends up carrying when their husband or wife gets sick and can’t manage to get better.
But I’m doing secondhand labor in trying to convey that part of the story, and there’s more power in a kind of intertwined narrative, which as a two-writer household we have the usual opportunity (if that’s the right word) to convey. So as part of my own book discussions here, and with her permission, I thought I’d share an excerpt from Abby’s book where it directly overlaps with mine — both because I think the overlap is illuminating and because her book is great, there are seven shopping days till Christmas, and, well, you know what do.
From Mom Genes, Chapter 8, “No Mom is An Island”:
Fetus Number Four’s first kicks are tiny but concussive, as if my uterus were one of the endlessly battered free balloons my kids collect from the shoe store. Every time I stand up or sit down, I issue an Old Faithful–like belch.
So this pregnancy is progressing just as it should be. I’m only about twenty-four weeks along, but thanks to the scheduled C-section, the likely birthday has been on the calendar for months, and as a repeat surgical customer, I don’t have to worry about a lot of weird stuff, like rolling an enormous “birthing ball” into the becrumbed back end of the family SUV. Especially given what I now know about the material realities of the maternal instinct, I ought to feel confident that the doctors will do their jobs, that nature and hormone receptors will take care of the rest, and that once the new baby is snug in my arms everything will once again fall into place.
Only last time it didn’t. My third child was conceived during a personal high for my husband and me: our careers were going better than we’d hoped, and we’d just made the somewhat out-of-the-blue decision to trade our compact row house in Washington, DC, the value of which had miraculously increased even as the walls seemed to shrink around us and our two rampaging preschoolers, for an idyllic antique farmstead in the far-out suburbs of Connecticut, just a few miles from my childhood home. It was not really a mansion, because we were journalists and not financiers, but it was pretty close—and truth be told, it had been a lifelong goal of mine to get back in the big house again, to shower my own kids with every conceivable material comfort, and to raise them in conspicuous view of all who’d observed my family’s downward arc.
I wanted this house so much, in fact, that no amount of long, meaningful stares and pregnant pauses from the home inspector made any difference to me as we discovered this rotting post and that one, and my husband followed him down a green tunnel in between the rearing bushes that threatened to engulf the sun porch. The previous owners— who actually were financiers, come to think of it—had obviously died a slow fiscal death here, as Mother Nature took her course and then some. But for us, I thought, it would be merely romantic.
Baby Number Three was the capstone of our perfect plan. And while we didn’t know it yet, this latest addition was a first for our family, a boy. Science might see this male-in-the-making as my body’s subtle vote of confidence in our mutual environment and the promise of the future.
Then, on the very morning I proudly displayed the still-damp pee stick, mere days after that shaky house inspection had sealed the deal, my husband discovered, with fumbling fingers, a small red lump on his neck.
This bump, diagnosed at our local walk-in urgent care facility as “just a boil,” soon vanished, but the symptoms that followed didn’t. Three months, waves of pain and insomnia and phantom heart attacks, and a dozen doctor and emergency-room visits later, nobody could figure out what was wrong with him. Cardiologists, gastroenterologists, neurologists, and rheumatologists shrugged their shoulders. The psychiatrists had some definite ideas, but their prescriptions had no effect. Instead, my once-jovial and perpetually optimistic partner— our household singer of lullabies and clipper of toenails, my old high school debate foe who’d turned out to be my life’s companion— withered away before my eyes, losing forty pounds and gaining a new personality, frantic and pain-wracked and tearful.
As vulnerable pregnant ladies go, I was in a fairly strong position to withstand these trials. This was not my first birth, so my maternal machinery was mostly in place. I was financially insulated (although every day less so as the costs of our “farm” mounted and my husband’s capacity for work dwindled), well-educated, a seasoned former babysitter and a breastfeeding champ, raised by a good mother who had always loved me, in excellent health, and with two beautiful daughters. I was happily married and, at thirty-five, plenty old.
However, I also had a few hidden risk factors for peripartum mood disorders, like that impressive family history of mental health issues scrawled deep in my genes somewhere, some medium-T childhood trauma (especially my father’s early death), and a pattern of delivery by C-section. This time, too, there would be the problem of stingy anesthesia and rampant postpartum pain to boot. Although this research tidbit hadn’t been published when I was carrying my son, the birth of a third child, in particular, seems to herald a slight uptick of maternal mental woes, especially—hint, hint—if the new kid is a different gender from the first pair. And having a boy ratchets up a mother’s depression risk regardless.
But the most immediate threats to my maternal behavior had to do with factors beyond my own brain and body. In my case, environmental upheaval arose not from earthquake, typhoon, or war, nor grinding poverty. Instead, my world was being rocked by the turbulence of another human being, and by drastic changes in my “social support,” as its formally known.
I had given birth to my daughters with a feeling of safety, among trusted longtime friends going through similar experiences, tended by a husband who could be dispatched for Ben & Jerry’s at the drop of a hat.
But now, in my new house with old bones, perched on the side of a crumbling stone cliff, I felt totally alone.
A mother mammal’s behaviors are informed—and sometimes even defined—by her communal context: the other nearby members of her species. This is true especially of people, with our evolved need for communal care. Social-support deficits and perinatal depression are intimately linked.
Research from Columbia University suggests that the strength of a pregnant woman’s support system is the primary predictor of her mental health, for a whole buffet of reasons. New mothers depend on others for physical help (like the fragrant chicken pot pie a kind neighbor slips into your barren fridge), for practical guidance (such as my mom’s sage prepartum observation that it might indeed be wise to purchase more than a single undershirt for my forthcoming first baby), and also for the more mysterious matter of emotional sustenance.
This mushy-gushy last one—let’s call it love, for short—is the least understood but probably the most important. A deep bench of friends and family has physical oomph, lowering maternal blood pressure and optimizing placental functioning throughout pregnancy. During birth, supported mothers undergo easier labors and fewer C-sections; afterward, they have less fatigue and a better shot at successful breastfeeding.
Yet social support is equally key for adoptive mothers, who don’t physically deliver children, but whose future maternal well-being and competence rests in part on the amount of encouragement they receive before their new babies arrive.
To an extent, the identity of our cheerleaders doesn’t even matter all that much. Pregnant women who are visited at home even occasionally by paid strangers, like nurses, often fare better as mothers later on and are less likely to abuse their kids. Women attended in childbirth by professional doulas are “more alert and responsive” to their babies from the very beginning.
But, not surprisingly, it turns out that particular people in a pregnant woman’s life—her romantic partner, parents, and close friends— play essential roles in her making as a mother.
As my third child dug in his heels inside me, the people I had counted on for the first two pregnancies were gone. First there was the de facto disappearance of my husband, who was physically present, roaming the still-empty rooms of our decrepit farmhouse, but mentally and emotionally absent. Maybe the hard-charging life we’d chosen had imposed too much stress and now he’d finally cracked, like a Lego underfoot. My big dreams and greedy demands on behalf of our ragtag band of babies had broken him. Or maybe it had nothing to do with me, and some kind of unseen genetic glitch inside him was just now kicking in. He seemed consumed by either a dire physical disease or some bizarre perturbation of the mind—which wasn’t much better, as my own childhood experience had taught.
Watching him through the ancient wavy glass of one of my new home’s many painted-shut windows, I tried not to think about how family histories repeat themselves.
In the week or so before the big move, I’d also bid adieu, in one fell swoop, to my group of close friends in Washington, DC—the comrade moms I’d grab coffee or hubcap-sized chocolate chip cookies with on a weekly basis. Oh, and I’d also recently quit my longtime magazine job, giving up good-natured communal griping to strike out on my own and write books in the attic by myself.
Oddly enough, the depression that quickly enveloped me brought to mind a scene from a comedy: The Magic Flute. I’m no opera buff, but decades earlier my elementary school music teacher had left a video of the performance for the third grade to watch whenever she was absent, which was apparently quite often, since it’s seared into my memory.
Dressed in deepest navy, the Queen of the Night would inch onstage, the train of her sweeping, star-sequined gown flowing, growing, my third-grader self waiting for it to end, until it dawned on me that her dress was in fact endless, and that this crazy lady was the midnight sky itself, caterwauling at the top of her lungs in terrifying German:
Oh, don’t tremble, my dear son!
You are innocent, wise, and pious;
A youth like you is best able
To console this deeply troubled mother’s heart.
As I wailed and stormed about my new house in the months before and after my third birth, or stared bleakly at the bedroom ceiling, I understood that this was how my two tiny little girls—and very soon “my dear son,” who, to be frank, I was no longer so very keen to meet— must now perceive me, a kind of infinite night queen who could roll in at noon: a living void, spangled with tears instead of stars.
How can a scientific discipline based largely on dissected rat noggins even begin to plumb this kind of uniquely human agony, which springs not only from a mother’s singular experience and biochemistry, but from her complex and shifting social milieu?
Class and privilege, of course, are crucial pieces in my own mom puzzle, explaining everything from my fond work memories to my husband’s ability to pick up and move on a whim while remaining gainfully employed to the presence of a grandpa who could spot us a nanny on short notice.
But my own peculiar and complex experience of class wasn’t always protective. It also helps explain why the sensation of reliving my childhood arc—with a husband lost in a dark wood while our household finances tanked—threw such a wrench into my mom brain.
It’s hard to appreciate the power of class until you’ve dropped like a stone out of one into another. In childhood, my family’s financial downfall meant more than no longer having pony rides at my birthday parties. It was more than the fact that we were never again able to afford a vacation, while other girls in my class came back every February sun-bronzed with their hair braided in brightly colored strings, status markers that stayed in until they rotted. It was more than trading the Mercedes for a Honda Civic so stripped down that it had only one side mirror. Many of our family’s connections realigned as well: our social network shrank, our status faltered. Old friends no longer called. And my sister and I became fair game for bullying in ways that other kids in town weren’t.
When you live in a place where there are no truly poor people— they’d been edged out of our hometown in a million ways long ago— the difference between being upper and lower middle class feels vast indeed. At the top of our town’s hierarchy were corporate vice presidents and minor Wall Street tycoons. At the bottom were the school bus drivers and their kids, who now politely invited me to smoke cigarettes in a nearby gazebo.
I’d like to tell you that the good mothers of this nice town grasped what had happened to us and treated me kindly, but by and large they didn’t. I was big and clumsy and got my period before anybody else, which some evolutionary biologists would tell you is a physical manifestation of growing up in an unstable environment, but in my case—since I’m from a family of big, sturdy gals—might just be my genes.
My sister and I spent much of our youth scheming to restore our family’s lost honor. We rummaged around in bags of barbecue charcoal (we’d heard that coal transforms into diamonds, given long enough), and dug in every place we could think of for rare dinosaur skeletons, which we figured would fetch a pretty penny once the American Museum of Natural History heard of our finds.
At some point it occurred to us that it might be easier just to get good grades. I was not the smartest cookie in my high school, but I was bound and determined, and accustomed enough to stress of many kinds that the SATs and even the biggest nail-biter of a high school debate seemed like no big deal. Emily, who was the daughter of our very strict middle school chorus teacher and thus a fellow outcast, joined me in the quest to turn our tables and defy our stars. And it worked: she got into MIT, I got into Harvard, and soon I scrambled back up the ladder into elite life.
In returning to my hometown, I was willing a different ending for my family. I imagined my daughters’ giggling wedding processions across a manicured side lawn at the new house, and quickly calculated that we could squeeze a couple of hundred guests out by the pool, if the weather only held.
Except now my white-knuckled climb back up the status ladder had ended in the familiar feeling of free fall. Trapped in a house that increasingly resembled the Overlook Hotel in the off-season, I’d been betrayed by my own ambitions, and that lifelong sense that I truly belonged back at the top. Class may be biologically inscribed, lingering as a throb of entitlement: even though I had ended up at the bottom of the local pecking order, with the scratches and bruises to prove it, there had always been the ghost of the spoiled brat about me. Now that little ghost, wearing her very own rabbit-fur coat, had led me down the primrose path once more. And how the landscaping bills for all those finicky rosebushes piled up on the kitchen counter! It was a classic act of hubris.
Yet, perversely, my sense of entitlement would yet turn out to be a saving grace.
In humans, there are plenty of measurable differences between poor and rich moms—everything from the number of frozen soy desserts we serve to the number of bottoms we smack. But it only became clear how social privilege can be a mother’s ace in the hole on the day that I finally decided to contact my doctor’s office for help.
It was about eight weeks after my son’s birth. He was sleeping downstairs in our emergency nanny’s arms. My daughters were watching Disney’s Frozen for the millionth time, their little faces pressed up near the TV; we had rolled right off the back of the no-screen-time wagon as soon as my husband’s illness hit.
The Queen of the Night was in her bedroom, staring at the cracked ceiling as tears dribbled from the far corners of her eyes. At the time I hadn’t yet contemplated the ancient potential evolutionary purposes of these numbing feelings, and I couldn’t have cared less whether their point was to prep me to walk through some impending firestorm for my kids or to bundle them in bark and plop them in a convenient river. I hadn’t really noticed whether I’d switched to holding my baby on the right, or whether his cries suddenly sounded duller to my ears. Maybe oxytocin was in short supply in my system. Maybe my nucleus accumbens just wasn’t what it used to be. But right then I didn’t give a fig about what my aching mess of a mom brain might look like on a scientist’s scanner, which neurochemicals didn’t quite add up, or whether some bum gene was to blame.
I just wanted it to stop.
I had put off this call for weeks, on the assumption that contacting my ob-gyn’s office for help with my depression was an unpleasant but perpetually available last-ditch option. I was someone who’d proudly scorned therapy all her life, and it was not a move that came easily. I stalled and stalled. But when I finally picked up the phone that afternoon, I fully expected to be summoned in that day for commiseration or medication and (as in Frozen) “warm hugs”—preferably all of the above.
A message was taken. An hour or so later, a harried-sounding doctor called me back. It wasn’t the nice “frank and beans” doc who’d delivered my baby boy. (“Oh, I love his cheeks!” I’d heard her shout in triumph amid my own botched-anesthesia screams.) I’d met this other doctor once during a monthly in-office visit, but he didn’t remember me and didn’t seem to have read my file, and I was crying too hard to make clever conversation or to transmit any other subtle signals about myself.
Unlike my DC ob-gyn office, which catered expressly to the city’s professional women, this was a diverse practice in a small Connecticut city, with all income levels and social backgrounds in the patient mix. This doctor couldn’t have known from his cursory (if that) glance at the paperwork that I was a well-heeled, highly educated, not-to-betrifled-with white lady who lived (for the moment, anyhow) in a large (albeit laughably dilapidated) home on one of the better streets in a wealthy town. At the moment I was just a sad little voice on the phone. I could have been any mom in America.
He listened to my story, and then said coldly: “You’ve been depressed before, haven’t you?” Not “Do you feel depressed?” or “Have you ever been depressed?”
It was a flat accusation. In fact, I had not been depressed before. Sure, I’d always been a bit high-strung—something of a stress freak, if you will. Cheerfulness was maybe not my default state. But I had also witnessed real depression, and knew all too well what it was and what it could do, and that I’d never lived it myself until now. Nothing in my chart would have indicated that I had, if he’d bothered to read it.
But what was “before,” anyhow? Even though my life had been pretty spectacular nine months earlier, I had a hard time remembering way back then—or anything, really, more distant than the previous night’s brutal 3 a.m. baby feeding. Had I ever in my whole life truly been happy? And then in a flash I recalled that once in college sixteen years earlier—faced with the due date on a particularly onerous English paper—I’d had to go to the campus hospital to lie down for an afternoon, receiving no medication or further treatment, just a few words of encouragement. Did that count as depression?
“I guess so,” I blubbered in reply.
Clearly this was the out this doctor needed, as my answer translated somehow into “not his problem.” He rattled off the phone number of a therapist in a nearby city and hung up.
His office never contacted me again.
When I collected myself enough to call this other number, I learned, via an answering service, that there was a two-month wait for a first appointment.
Now two months is a long time by any standard, but it’s eons for somebody who has had a baby only eight weeks earlier, and whose every midnight lasts a million years. Mothers under these conditions can abandon their families. They can also kill themselves. It’s a sign of how little respect the modern world has for mothers that many countries don’t even track maternal suicide statistics. In rapidly aging Japan, though, where new mothers have become somewhat scarily scarce of late, a study found that about 30 percent of pregnant women and new moms who died in a given year had committed suicide.
In no way do I think I could ever contemplate, let alone commit, these actions. But then again, what mom imagines that she would?
This is the moment when the vital relevance of my station in life became apparent. If privilege is an inner sense of entitlement and personal indignation unfairly bestowed upon the upper class, then here it was. Someone with bared fangs and puffed-up fur reared inside me—call her my inner Grapefruit. My children and I were in trouble. How dare this man dismiss me? In my world, dark as it seemed right then, medical doctors were still a dime a dozen. I had many friends and relatives and even stoner college roommates who were now celebrated doctors of various types; I interviewed famous scientists for a living. This guy didn’t know who he was dealing with. A deep, angry voice—the kind most commonly heard at monster truck rallies—rumbled deep in my throat. If a laundry basket had been handy, I would have smashed it. I would have swung a baseball bat at a bear. But this threat, and my gut-level maternal response, was more abstract than a hapless home invader or a grizzly. It was about my social standing in relationship to another human being’s, this doctor’s power versus my power, and his view of my reality versus my own. I would not accept his version of me, nor believe in the limited options he presented.
In a chattering rage, I called Emily in Minnesota, who (female support, check) always answers, and who is now a physician herself (hello, privilege). She’d already been able to pull some strings and connect me with an old pal of hers, the best general practitioner in the area, even though he technically wasn’t taking any new patients. Because I wasn’t quite thinking straight, it never occurred to me that another type of doctor could help with a textbook obstetric malady. But now she commanded me to call this other doctor, so I did.
By the following afternoon, two orange cylinders of pills rattled reassuringly inside my purse, and I had a scheduled follow-up appointment a couple of weeks out. Easy-peasy-lemon-squeezy, as my kids say.
But in truth I don’t think the chemistry of the medications themselves helped me as much as the feeling of restored control that they conferred. I only downed a few doses; four years later, the bottles are un-refilled and still in my purse, a talisman. The helpless feeling engendered by that first short phone call reverberates today, along with the hard realization that my outcome could have been quite different.
Back then I was in mommy mode and cared only about saving myself and my own kids. Today, pregnant again, I ponder that phone call every time I sit in the waiting room for my monthly prenatal appointment, at my new (obviously) but just as diverse ob-gyn practice, sneaking looks at other with-child women from all walks of life as we yank at the waistbands of our maternity jeans, which sag universally no matter the brand. It’s now so much less mysterious to me why the most vulnerable women often don’t receive treatment for postpartum depression—even though they suffer at much higher rates—and have such miserable dealings with the medical system in general, counting far more on family members than on doctors for vital support.
Once I believed that there were many types of women who quite naturally became many types of mothers. Now I know that any one woman has the potential to become many different mothers, depending on conspiring circumstances, support systems, and access to resources, including powerful strangers’ sympathy and respect.
I have been many mothers myself.