Perinatal mental illness

Bipolar Day 2022 – Great Inequality

I remember my response the first time my psychiatrist suggested I could have an underlying bipolar disorder. That it had been the fountain of chaos that erupted in the form of postnatal psychosis the first time it came to call.

Denial. I believed he was telling me as a duty of care, because that was the case for some people. But not me.

I remember my response and where I was when he confirmed my diagnosis of bipolar 1 disorder several years later.

He was standing at the door to my hospital room that looked like a stack of post it notes had thrown up all over the walls. They were covered in technicolour squares that I had scribbled random ideas on and reminders of where I had put my fountain pen or my toothbrush.

I had no short-term memory. My thoughts raced delusionally down corridors in my brain that had been emptied of the rational. At night, I wrote and wrote thousands of mostly nonsensical words. Sleep wouldn’t come, even with high doses of medications. I didn’t want sleep to come anyway. It ate into my thinking and writing time.

But back to that moment when I looked up at my psychiatrist in my neon rainbow dump of a room and asked: ‘Postnatal psychosis or bipolar?’

He didn’t torture me with hesitation. Just delivered the sentence: ‘Definitely bipolar!’

Those words spread through my insides like a cold, nasty liquid. For nearly four years I had teetered on the edge of believing that my mood disorder would be confined to the perinatal period like so many other women. That there would be an end to it.

‘Definitely bipolar’ felt like a life sentence. Devastated doesn’t begin to describe my sick feeling. Then that sickeningness was replaced by questions I cringe at now:

‘How can I subject my children to a mother with this illness? How can I ever achieve anything again?

I was very achievement oriented back then, and self-stigma told me vicious lies.

It will be 16 years in August since bipolar disorder flew fiery through my life the first time. I am glad I didn’t know what was ahead of me then because fear would have told me I wasn’t strong enough to get to the other side of hell so often.

If I could go back now, I would tell myself that although my life would be different, it would still be my life. I would tell myself that my entire relationship with fear would change because of this illness. For the better.

That I repeatedly reach points of wellness where I stretch out my hands and grab fear by the shoulders. I stare deep into its eyes and compare it to what I feel during psychosis. And I find most everyday fears evaporate in the memories of what I’ve survived.

I wish I had known that my children would benefit from having a mother with insight, not only into her illness, but life. A life I’d describe as good.

I am not naïve enough to believe I’ve had these empowering experiences through force of will, intelligence, doing the work, taking the medication, fairy dust…

I will say this repeatedly in different mediums and articles, because it is important to acknowledge, again and again and again: I live with immense privilege. I am a straight, white, cis-gendered tertiary educated woman with no concurrent disabilities, who can afford private health insurance.

It is helpful that I have worked to gain insight into my symptom pattern. Exercising and taking medication that works for me, is also crucial. I am not shackled by addictions to substances that could derail my stability. But every one of those things would be much harder to enact and maintain, without my privilege.

My privilege does not mean I haven’t suffered. It doesn’t invalidate my experience, but it must be acknowledged for context every time I tell my story, otherwise that story is shallow, loses meaning, and does a great disservice to the many people who live with this illness, but without privilege to boost them to the head of the line when it comes to accessing the best care, and being the most supported they possibly can be, during the challenge that is living with this chronic, intermittent, potentially fatal illness.

You may also be interested in:

The Well Times

My 2018 World Mental Health Day

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

Mental Health Snobbery

Is stigma surrounding mental illness only generated by people who have never been mentally ill?

No.

There is a version of the S-word that lurks below polite conversations about ‘stigma surrounding mental illness’. It occurs amongst people who experience mental ill health, and it is camouflaged by the notion that we are all in this together and all experience a similar level of stigma.

But we are not, and we do not.

I first became aware of this after my encounter with acute Postnatal Psychosis, and the rupture from reality that accompanied it. My experience didn’t fit the binary mould of the common Perinatal Mood Disorders: Perinatal Anxiety (PNA) or Perinatal Depression (PND).

Over time, I discovered that (not all but some) mothers who have experienced PND or PNA, especially if it is mild, carry harsh opinions about those of us who need medication and hospitalisation or who live with other diagnoses.

Some examples:

I once read an account by a woman who was able to resolve her mild PNA by going to a special mother’s group, which, she wrote:

‘Thankfully didn’t have any loonies in it, just normal mums who were struggling a bit.’

Another time, when I was hospitalised in the Mother Baby Unit of a private psychiatric hospital, I heard a group of mothers cackling in the common room:

‘At least we aren’t like the real crazies in the rest of the hospital.’

This snobbery irritated me at the time. Several years later, I became one of the ‘real crazies’ (patients in the main hospital) and… felt sad for these women who left their experience of mental illness with the same narrow mindset they had entered it with.

That said, most of us start the ride into mental ill health with biases.

I remember during my first admission, two of the mothers in the Mother Baby Unit were having ECT (Electroconvulsive therapy). I didn’t have any strong conscious opinions about ECT. But if I’d been asked, I suspect I’d have said: ‘That will never be me.’

Six weeks later, that was me.

ECT is still one of the most stigmatised treatments. Some of the strongest perpetrators of that stigma are those living with mental illness who have not had ECT.

A couple of years ago, I encountered another patient in the hospital to whom ECT had been suggested as a treatment option. She asked me about my experience, and then said:

‘Well, I am a scientist and need my brain to work properly, so I can’t consider having ECT.’

I swallowed the prickly implication she had just hurled my way and thought of the surgery I had performed, the book I’d written, all the ways I’d successfully used my brain post ECT. I avoided that person for my remaining admission.

Patients new to mental illness often inadvertently extend their self-stigma to others.

During my last admission another patient told me that they had been in hospital for a week and that they were worried about the length of their stay. They asked me how long I had been in for. I replied: ‘This admission? Three weeks’

They visibly recoiled. Their thoughts may as well have been printed on their forehead:

‘More than one admission? Three times the length of my stay? And you are still here?’

I didn’t add that for me, three weeks was a minimum length stay, that in the past I had spent months hospitalised, that I would never be cured. Instead, I said:

‘Just take one day at a time, and don’t compare yourself to anyone. Everyone is different.’

But I know it can be tempting to play the comparison game. When I feel frustrated and vulnerable, my thoughts can turn poisonous:

‘Must be nice, to only have to take one medication or none.’

Knowing very well that there is nothing nice about having to take even one medication or being unwell, even if you don’t need medications.

And that moves us on to the medication debates.

Before I came down with Postnatal Psychosis and Bipolar Disorder, I was a reluctant medication taker. I wasn’t specifically anti psychiatric medications. It had just never occurred to me that I would need them. Then I got so incredibly sick, that the prospect of refusing something that might help me was ludicrous.

Today the debates around psychiatric medication stigma tire me, because it is simple. If you don’t need medication to help manage your mental illness, that is awesome for you, but it doesn’t make you stronger, or better than anyone who does.

Anti-medication stances are a luxury not everyone can afford. Voicing that stance without acknowledging the accompanying privilege, can stigmatise those who do need medication to manage their illness.

And appearances can be deceiving. Someone experiencing moderate or mild symptoms without access to good mental health care, may suffer more than someone, like me, whose symptoms and treatments may look worse on paper (psychosis, ECT, etc) but who has had consistent access to excellent quality mental health care.

No one’s lived experience should be used to minimise or stigmatise someone else’s.

So, whether this is your first and only episode of mental illness or it is one of many, or you’ve been lucky enough to never experience one, when you form an opinion about others living with mental illness, please replace judgement with compassion and think before you speak or write.

You may also be interested in the following posts:

Psychiatric Medication And Stigma

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

Welcome To Motherhood

ECT: Blowing up some myths – Part 1

ECT: Blowing up some myths – Part 2

Am I A Stay-At-Home Mum?

Taken around 2008 – consent to share given in 2022

My 11 year old clobbered me with this question recently, and it felt complicated.

I say ‘clobbered’ because – for me – the words ‘stay at home mum’ come with baggage. This phrase and I have an uneasy history. My judgement started early.

As a child I never dreamt of future motherhood. At thirteen my family and I moved from Germany to Australia. The change in schools was ‘resilience building.’ The first year or two I learnt to live with being intermittently bullied. Then, to my relief, at the end of grade ten several of my tormentors left school. They were either pregnant or would soon be.

The idea of motherhood, when linked to these girls who had taken such joy in making my life hell, became abhorrent.

Homing in on my goal of becoming a vet drove me through my last two years of school and into university. I worked hard, and with tunnel visioned arrogance. I saw children as a hindrance and the women who devoted their lives to staying at home and looking after them as little more than shepherdesses tending their flock while life passed them by.

When Michael (my now husband) and I started going out I spent the first years of our relationship reiterating that I would never want children. My career would always come first. He supported me.

8 years later we married and moved to the UK to work and travel. After we returned to Australia I continued working and started a second university degree.

Then, somewhere between 31 and 32, I sensed I would regret not trying to have a baby. It took one month to conceive that first baby. The plan was for me to stay at home in the beginning and go from there.

The universe laughed heartily.

I spent close to the first four months of motherhood in the mother baby unit of a psychiatric hospital. Along with parenthood I was served postnatal psychosis, catatonic depression, electroconvulsive therapy, and a lot of medication. I had no history of mental illness before the birth.

At times I was too unwell to look after my baby. And even when I could – my survival and care had to come before caring for my baby. I didn’t have the luxury of martyrdom. My baby and husband needed me alive.

Eventually I recovered from that episode of illness. But as much as I loved my baby, I found the stay-at-home mum loop of feeding, cleaning, settling, on endless repeat mind numbingly dull.

I returned to veterinary work part time.

My work re-engaged my brain. A day’s work felt like I had achieved tangible results, instead of running on the hamster wheel of domesticity all day.

Three years later, we had a carefully considered second baby whose arrival was also accompanied by a savage return of psychosis, mania, depression and a now definitive diagnosis of Bipolar 1 Disorder.

Once I’d recovered, I struggled with the same aspects of stay-at-home motherhood I had with my first baby and returned to part time veterinary work.

Veterinary work is not particularly compatible with motherhood.

Shift ending times are academic. Needing to be home by a set time after work guarantees an emergency turning up, a regular appointment blowing out, or needing to catch up on phone calls and notes.

Childcare centres with their sharp closing times were not an option. My husband took over childcare when he wasn’t working. My mum helped too. But we largely relied on a nanny to cover my work shifts during the week.

By the time the nanny had been paid, my hourly rate sat at around $15 hour – to consult, perform, diagnostic tests, soft tissue surgery, dentistry, radiography, radiology, pharmacology, emergency medicine, euthanasia – for my patients and to communicate effectively and compassionately with my clients.

I worked for my sanity rather than the money.

At one point I switched to weekend work to make it a little more financially worthwhile. My husband was the stay-at-home parent for those days. He worked weekdays. We tag-teamed parenting and never had any time together as a family.

Veterinary work is rewarding.

It is also emotionally and mentally demanding. Many clients carry anxieties into the consulting room with their pet. At the end of a workday I had little emotional energy left for my family because I’d spent it on my clients.

Thankfully my children’s demands on my emotional energy were minimal when they were little.

But now, at 15 and nearly 12, it is all about being emotionally available. And unlike changing a nappy or cleaning up pureed fruit, sensing where on their emotional barometer they sit and responding appropriately, is something I don’t believe can be outsourced.

Just over 2 years ago I stepped away from veterinary work. In large part to focus on having my book published and explore my writing interests further, but also to be there for my children at ages when I feel they need me most.

I am grateful we can afford this choice.

My thoughts on stay-at-home motherhood have thankfully changed since I was fifteen. But some flinty fragments of my old views persist. I still don’t like the term ‘stay at home mum’. It implies too much domesticity, and that the bearer of this title has no interests outside of her children.

I would be a terrible mother if I hadn’t built a career first, and if I didn’t have interests outside of mothering. But the balance has shifted from shoving my family around the demands of an unyielding career to finding interests and opportunities that drape themselves more gently around the needs of my family.

So, in answer to ‘Am I a stay at home mum?’ My answer is ‘Sometimes.’

My memoir Abductions From My Beautiful Life was published in April 2021 and is available through most online booksellers including Amazon, Booktopia, and Fishpond. You can find an excerpt here Book

You may also like to check out these links

Welcome To Motherhood

Veterinary Work And Bipolar Disorder: A Podcast Interview

Your Mental Load = Your Responsibility

The ‘Breast Is Best’ Myth

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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