Insight: The Essential Ingredient

One morning, a few years ago my heart thudded against the tight metal bands strapped around it. Adrenalin ping ponged through my system. I was out on a run, and the air hummed with a kind of malevolent electricity. I sensed something terrible was about to happen. And it did. I was heading down the hill when I saw them. Severed limbs, pale and bloated – tossed carelessly in the gutter.

My breath lurched in and out of me as I stood and stared in horror. Should I call the police?

Then insight broke through and with it a reality more terrifying than the severed limbs. I didn’t need the police. The limbs were sandbags. I sprinted inside, hit the call button next to my bed and clenched my eyes shut while I waited for a nurse.

When he popped his head in the door, I opened my eyes and said:

‘Can you please page my doctor. I’m starting to have visual hallucinations and delusional thoughts.’

He went and, having paged my psychiatrist, returned very quickly with a cupful of antipsychotic medication. I gulped it down and waited for the jumbled sharpness inside my head to soften and slow.

If this had been my first experience of psychosis I may have been terrorised by the severed limbs (and worse) for longer. I may have tried to tell other people about what lay in the gutter at the bottom of the hill. But it wasn’t my first experience.

I had admitted myself to hospital several days before with precursor symptoms. Speeding thoughts, pathological irritability, non existent concentration and short term memory. I was in hospital waiting, the potential for psychosis hovering darkly over me. So, when it descended I knew what was happening. And that insight got me treatment quickly and saved me from the embarrassment of a family member, nurse or doctor having to convince me I was delusional.

Developing insight usually requires multiple episodes of illness and hard, proactive, psychological work. You have to dig around inside yourself to learn what are normal feelings and behaviours for you and which ones herald the onset of illness. The hard work of gaining insight is even more challenging for anyone who hasn’t had access to effective early management of their illness.

And no one ever has insight into their first episode of illness because that first episode hijacks you. It catapults you from being someone who could always trust the contents of your head to those contents not only being unreliable versions of the truth, but sometimes your worst enemy.

And unlike experiencing symptoms of a physical illness you can’t just lie back and expect others to know you are sick. If you are vomiting or have a nasty cough your suffering is obvious to everyone. You don’t need insight to tell your family or your doctor about what is going on with you in order to get the help you need.

With a mental illness, painful symptoms are often expressed as behaviours. They can mercilessly present you to the world as:

 negative, unmotivated, slow, shuttered, insecure, nervous, scattered, indecisive, irritable, unfocussed, unintelligible, uninhibited, nonsensical, lost, delusional, racing, jittery, and more.

In part insight means learning to recognise that what can feel like personal failings are just symptoms of an illness. You have to internalise this before you can translate what is going on with you for the people around you.

But regardless of how someone manages their mental illness, they won’t do so successfully in the long term without insight. Or they will rely heavily on others to tell them when to seek help.

 I absolutely loathe anyone else speaking for me in any area of my life, but particularly when it comes to my Bipolar Disorder. So, doing the work to gain the insight was and continues to be non negotiable for me.

My psychiatrist and I now communicate very efficiently. He doesn’t waste time asking about how my family think I’m going because he knows he will get the most accurate answer directly from me. I can recognise and name the symptoms I’ve gotten to know so well over the last 14 years.

I am practiced at translating overwhelming feelings into symptoms. For example, I know now that when my life feels as though I am running through chest high water with concrete boots on that is depressive symptoms setting in, and if I ignore them, the water will continue to rise.

My symptoms will always affect me, and they will always hurt when they flare into life. But recognising and naming them shrinks the overwhelming into the manageable. Insight has built a safety barrier between me and this illness. It ensures I can see that even though I may live with its symptoms, those symptoms have nothing to do with who I am.

You may also be interested in:

Vulnerability And The Exploitation Of Kanye West

Razor Blades In Mud: Laziness Or Depression?.

My Mental Illness Makes Me A Better Parent

The ‘Breast Is Best’ Myth

Alex baby foto
Alex March 2010

Last week was breastfeeding awareness week, and the irritation I feel when I see strong pro-breastfeeding messaging flared. I usually bite my tongue and suppress my politically incorrect opinions about this emotive subject. I don’t care about how anyone chooses to feed their baby. But I do care that the ‘breast is best’ myth is still being drip fed to (especially first time) mothers like a sugary subtle poison.

Fourteen years ago I had my first baby. I lapped up all the breastfeeding propaganda from the hospital antenatal classes and my antenatal yoga classes. Because I trusted these sources.

And they didn’t exactly feed me falsehoods. But they did imply a mother who switched to formula before she had exhausted every possible option to keep breast feeding was not doing the best for her baby. Posters in the maternity hospital told me that exhaustion, blood streaming from cracked nipples and tears streaming down your face were all worthwhile prices to pay to feed your baby this liquid gold.

After going into thirty three hours of labour on two hours sleep, my daughter was delivered by caesarean. I fell asleep as I was being stitched up. The midwives wasted no time. I woke with a start, in recovery to find my baby attached to my left breast. It was so important to these midwives that my baby attached ‘immediatley’ that they didn’t even do me the courtesy of allowing me to wake up before making this most intimate of introductions.

The focus on the holy grail of establishing breastfeeding in the maternity hospital was so strong that I sat up for three hours at a time thinking I was feeding my baby, when she was comfort sucking for most of that time. It left me exhausted and my back a wall of pain from sitting in the ‘feeding chair’.

Now, if that were the worst of it, I would have probably gullibly pushed through all further discomfort to establish and continue breastfeeding. Had I succeeded, I would have probably felt proud of myself. And after being told time and time again children who are breastfeed are healthier, smarter, more empathetic, and more likely to poop rainbows, I may even have been arrogant enough  to attribute all of my daughter’s future, health, smarts, and empathy to my valiant efforts to persist with breastfeeding. (She has yet to poop out a rainbow – but I can live with that.)

But within a week of her birth, whether or not I breastfed was injected with some desperately needed perspective. She was at home with her father, contentedly guzzling formula while I was tipping my breastmilk, tainted with antipsychotics, down the sink in the Special Care Unit of a private psychiatric hospital. I had come down with postnatal psychosis and I was clinging to my life with my fingernails.

To my credit, I quickly forgave myself for ceasing my ‘breastfeeding journey’ 7 days into motherhood. And I didn’t look back. I had been too sick to ever be riddled with the guilt I saw in other mothers who had been less unwell but had also made the smart choice (for them) to stop.

But we shouldn’t need extreme circumstances to justify feeding our baby formula to anyone. Breastfeeding is a personal choice. Nothing more. Nothing less. But our society has turned it into a religion. And it’s opt out not opt in.  We are all automatically given anti formula education classes antenatally and then baptised in breastfeeding once the baby is born.

The high priests of this religion are lactation consultants and midwives who set ironclad commandments and rule with fear. The fear of harming our babies with our actions.

The pressure to breastfeed is a known contributor to and risk factor for developing perinatal mental illness. Mental illness that can leave a baby motherless if it is severe. Unlike the maternity hospital midwives, the nurses in the mother baby unit in the private psychiatric hospital I was an inpatient in don’t pressure new mothers about how to feed their babies.

But they do spend a lot of time undoing the damage done by overzealous midwives and lactation consultants who have bullied new mothers into believing they will hurt their baby if they consider formula anytime earlier than as a last resort.

For my second baby I had one breastfeeding aim: Get some colostrum into him. He went onto formula at day 7, just like my daughter. And just like my daughter, now you wouldn’t be able to pick what he was fed as a baby.

Breastfeeding is cheaper than formula feeding. It is more environmentally friendly. It is the safest and most convenient way of feeding a baby in a third world country and/or if you don’t have regular access to clean water or formula. If your baby is premature and/or has underlying health conditions for which a paediatrician has recommended breastfeeding or expressed breast milk, then – for that baby – breast is best.

But if your baby is full term, healthy, you have access to clean water and can afford to buy formula, then (beyond the first few days’ worth of colostrum) whether you choose to formula feed or breastfeed is as irrelevant to your baby’s wellbeing as the colour of your underwear while you’re doing it.


You may also like to check out:

World Maternal Mental Health Day: It’s Not All Postnatal Depression

Your Mental Load = Your Responsibility

Modern Martyrdom

My First Time

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