When I was growing up, I always felt awkward about how I should act around family, friends, and strangers. I knew I had a problem but didn't know what it was or how to deal with it. As a result, I self-medicated with drugs and alcohol. It was not until I was in my 30s that I was given a diagnosis of bipolar affective disorder. During all those years of confusion, self-hate, and emotional turmoil, I desperately wanted to someday be "normal." For me, being normal meant raising and caring for children; I wanted to tend to their physical, emotional, and spiritual needs.

Unfortunately, during most of my adult life, I have been very emotionally unstable and cried whenever one of my sisters became pregnant or when I saw a mother with her children. I constantly heard conflicting views on my being a mother. Some people told me my mental illness would compromise my ability to function well as a parent. My illness might cause me to lack patience. I would sorely lack the skills needed to be a mother at the time I would need them the most. For example, if my children were sick or misbehaved in school or at home, how would I quell my inner turmoil so that I could best handle whatever situation I would have to face to meet my children's needs?

I think what my family and friends most feared was that if I had any strong emotion—mania, depression, or anger—I would not be able to channel it appropriately or diffuse it. Others expressed various negative opinions that consistently left me feeling confused and doubtful. I was too scared to have even a tiny spark of hope of parenthood for fear of having this hope snuffed out. Feeling doubtful was my constant state of mind when I considered issues of pregnancy and parenthood.

My attitude was shaped by many people's opinions, not necessarily my own. My family and friends meant well, but they succeeded only in making me feel trapped, as if I couldn't make important decisions on my own. I felt especially oppressed by the media. Everywhere I looked the media was portraying "normal" women—who did not have a mental illness—with their children, and these children were always well behaved and well mannered. How could I ever live up to this version of a model mom? My own mother was right about one thing at least: I fell in love, and someone fell in love with me. Shortly after we were married, my husband and I discussed planning a family. However, it soon became apparent to both of us that childbearing might not be a wise decision.

Over the course of our marriage I have struggled with the decision of whether to become a parent, and I have often been sick. I frequently required admission to a mental health unit. My husband had many of the same concerns that my family, friends, and doctors had. However, he never blamed me for not being able to start a family.

Others, especially my mother, would gently remind me that not every woman was meant to be a mother. Maybe she was right. I hadn't had any patience with children in the past. My mother tried to soothe my pain and told me I was still a loving person and that not giving birth to my own child didn't make me any less of a woman. She said I shouldn't need a baby to feel complete and that I was deserving and worthy of a loving husband. However well intentioned she might have been, I interpreted her words as meaning that I absolutely wouldn't ever be able to have a stable life with children and that the sooner I accepted that fact, the better off I would be. I was left feeling even more patronized and unworthy.

For years, most people who knew me would have agreed with my mother, telling me that because I had been in and out of hospitals for years as a result of my psychiatric illness, I was not stable enough to function as a mother. Hearing my supposed friends agree with my mother one after the other was very frustrating and confirmed the feeling that my husband and I had little or no support for achieving our dream. Whenever I asked how stable I should be before I started a family, almost everyone I spoke to—my primary care physician, my therapist, my psychiatrist, my friends, and my family—replied "anywhere between one and five years, when you are stable on medication and out of the hospital." Often, meeting these criteria seemed like an impossible and daunting task.

Every once in a while I would mention to my family and friends that I was thinking about planning a pregnancy, in the hope that they'd be supportive of my decision. They never were. I was immediately told it was an insane idea. Their concerns offered me little comfort. My mother believed that my being pregnant and remaining healthy during and after a pregnancy was nothing more than a "pipe dream"; I began to doubt the wisdom of my dream. I hadn't a clue how to relieve their concerns and fears—or my own.

Being bombarded with all those comments, I came to believe I would probably remain childless. I was taking psychiatric medication, which was a very grave concern. I had so many questions about pregnancy and my mental illness. Could I continue to take the same medications, or would I need to make adjustments? What was the best way for me to remain emotionally stable while pregnant? And what would happen when I was actually faced with the reality of having a child? I still have many other concerns that will need to be dealt with on a daily basis if I plan to have a family. Having a mental illness and contending with medications is hard enough without being pregnant.

I also struggle with other issues, most of which are shared by practically every parent. I worry about whether I could develop and maintain communication skills between my husband, our children, and myself in a way that would help us grow together as a family. Like all parents and would-be parents, I am concerned about financial security, especially in these times of large budget cuts and corporate layoffs. Many parents who pursue a career seem to find ways to accomplish this without sacrificing their time, love, and attention in raising their children. I wonder about my ability to provide healthy food choices and to be responsible for my children's nutritional health. Do I have the stamina for tasks such as paying doctors' bills and school-related fees and saving toward a college education?

I know of other parents who have a mental illness. They have been good parents, even when the odds seemed to be against them. When one of them suffered a relapse, the family was still able to function well as a whole. These parents have shown me how to maintain a proper perspective and how I might balance my husband's, my children's, and my own needs.

Realizing that I may someday be a parent, I am trying to take an active role in maintaining my mental health. I am keeping all my therapy appointments, taking medication as prescribed, and keeping active through work, friends, and hobbies. I hope I will remain stable and will eventually be able to raise a family. For the first time in my life, I have a true conviction that it is indeed possible to have something that was missing in my life, something I had always been told and always believed was impossible—a family of my own.

I have shared my excitement and concerns about motherhood with my entire support system, including my primary care physician, my psychiatrist, my therapist, my family, my friends, people I know through church and 12-step groups, and my coworkers and fellow clubhouse members. We talk about my illness and my medications and how they may affect my ability to be the kind of mother all children deserve. I am sure I have started a plan that will help me to stay emotionally stable now and will help me later in raising a happy, healthy, and well-adjusted child.

During this process, my husband and I realized that because of my age, not necessarily my illness, pregnancy would pose too many risks for both me and a baby. I started searching the Internet for information about pregnancy and mental illness and found many articles about the risks I would face because of my age. As a result, I've decided not to give birth but to adopt. By considering adoption, my husband and I have made the first and most important decision. All our investigating has paid off. I have a much more realistic view of what parents who have any kind of mental illness may be challenged with. I have developed realistic expectations and goals, both for myself and for my family. Being mentally ill, in and of itself, does not deny a person motherhood.

The author lives in Massachusetts. Jeffrey L. Geller, M.D., M.P.H., is editor of this column.