I get emotional over the tree in our tiny garden in Peckham. Which is silly.
But I watched it bloom into beautiful blossom in the spring…
and drizzle pink flowers every time the breeze blew…
…and, to my surprise, the delicate butterfly-blossoms became apples, which twatted me on the head every time I went to hang the washing up…
Not pictured: me swearing.
…and grew big enough to be picked (or picked up, as in this case) and eaten.
And the apples will disappear, and the tree become bare and anonymous like it was when we moved here last year, then it’ll blossom again and, again, become laden with fruit. And the cycle will repeat. We didn’t do anything to make it happen. I thought the tree was dead when we moved in. All it’s had is rain and sun, and it lives on.
My friend Ben insisted it was just a useless little crab apple tree, but it wasn’t. (And crab apple trees aren’t useless anyway).
I want to be part of a cycle. Of that cycle: of renewal and birth and endlessness. Even though I have PCOS, I just assume it’ll happen. Granted, those aren’t great reasons to have kids. But recently, I’d been broodier than usual (as has my husband). Awwing at the photos of babies my friends post on Facebook, wanting to be part of that seemingly perfectly imperfect life. My friend, a mother of two, wisely told me, “Having kids is like a bomb going off in your relationship”. But I want to be standing in that wreckage. Not the sometimes-inconsequential feeling neatness of now.
If you follow me on Twitter (I am there as brain_opera), I probably depressed you the other day by posting the heartbreaking Daksha Emson inquiry. Daksha Emson was a psychiatrist who committed suicide, in the violent way horrifyingly typical of women with postpartum psychosis, by stabbing herself and her baby daughter, Freya, then immolating both of them. Daksha survived for 3 weeks before succumbing to her injuries, and Freya died at the scene. They were both found by her husband, David.
Daksha died in the perfect storm. A psychiatrist, she worked in a profession with stigmatises their own having mental illness. Whose illness was downplayed, “doctor to doctor”. Daksha had bipolar disorder, and, although she experienced periods of unwellness where she was hospitalised (and had ECT, on one occasion), she managed to excel in her field. She took medication and didn’t have a relapse in the 8 years she and her husband were married until she became pregnant.
When I was a nursing student, I attended a conference on perinatal psychiatry. If I’d stayed in nursing, it’s where I’d have liked to specialise. It was a fascinating day. Firstly, we looked at how infants develop, and how vital those early attachments are. It’s why mother and baby units, which keep them together and help support the mum and partner, are better than just chucking the mother into a psychiatric ward.
We watched a video of some mothers who were experiencing psychotic and depressive symptoms while caring for their children in a mother and baby unit. We saw the baby’s increased agitation due to the lack of reaction from the mothers. The Still Face experiment illustrates this:
Then, we saw the improvements, in both mum and baby, a few months later when the women had recovered. We learned (or at least, I did), how peri/postnatal mental illness can often strike those who one would least expect; first time, middle class mothers in their thirties. And this in itself is where women like Daksha were let down. How could this high-achieving psychiatrist and mother become mentally ill? As the inquiry says, isn’t mental illness for, “the great unwashed”? And when the great unwashed do get pregnant, they don’t experience the trauma those professional women do of becoming a mother, the role that’s been created for them since the universe began, which they must now inhabit fully, and which everyone is else is watching you shape yourself into. Surely?
Dr Margaret Oates (who has a mother and baby unit named after her) was there. She spoke acidly of cases where women, clearly unwell, were discharged from services with the label, “personality disorder”. One mother, who was previously diagnosed with bipolar disorder, was deemed to instead have a personality disorder and sent home with antidepressants. ”And what happens to a woman with bipolar when you just give her antidepressants?”, she snapped. She got worse, walked into incoming traffic and died.
Daksha Emson had bipolar disorder. Postpartum psychosis is so closely linked that it’s sometimes called postpuerpal bipolar disorder. The inquiry into her death states that doctors must assume one will become ill, not the other way around. Therefore, it’s all about that lovely phrase we all know so well as patients and practitioners; risk management.
But that’s complex in itself. A woman who becomes unwell in pregnancy, or who was already taking medication for a pre-existing mental health problem, might be limited in her choice of treatment. Then they may have to- or want to- stop taking medication so they can breastfeed their child. They can become unwell astonishingly quickly. There’s also the shame factor. The shame factor that permeates all mental ill health, but especially mental ill health when it’s supposed to be the happiest, most wonderful, shiny, Mothercare advert time of your life. Where do you even start with that? We’re shamed anyway for having mental health problems, then further shamed for being women- how much shame and guilt must a new mother feel?
Then the father of the child, if he’s employed and you’re with him, might have to go back to work after two weeks. It becomes easier to hide how bad things have become. In the shadows, they disintegrate. And the stress of looking after a new life, utterly dependent on you, would take its toll on anyone- lack of sleep, worry about the infant, recovering from childbirth, financial implications, everything.
Afterwards, I asked to spend the day with the perinatal psychiatry team at a local hospital. The nurse explained who was referred to their team. I felt the blood rush to my head as I read:
Referrals are essential for women with:
- Bipolar Affective Disorder
- Schizophrenia / Schizoaffective disorder
- Previous Postpartum Psychosis
- Severe Depression
- Other psychotic illness
- Family History of Postpartum Psychosis
I have (or probably have, I haven’t had a hypo/manic episode for 2 years and my recent psychiatrist who has only seen me well and heard me speak with a very, “I’m okay” now spin on things) bipolar disorder and my mum had 2 episodes of postpartum psychosis. It was strange to see it in black and white. Here is your future. This is what your pregnancy is going to look like. Someone asking you questions. Somewhere, you’re going to be a file and they’re going to be watching you. Someone’s going to come and visit you and someone is going to know more about you that you’re comfortable telling them. They might take your baby away. They might take your baby away. They might take your baby away.
I should have felt relieved. Isn’t for the best that I’d be referred if I was pregnant? Isn’t it good I’d be looked after and had some support? But it still scares me because it feels like an intrusion- another intrusion in a lifetime of intrusions- by mental health services into my life. Resenting bitterly that mental illness may steal another part of my life, that mental health services may be the ones who define it at all.
When I was initially diagnosed, I was advised to think twice before even becoming pregnant. I did, briefly, a few years ago and I did become unwell, first with depression, then with hypomania, but that could have been the circumstances of the pregnancy rather than any sort of organic reason. What would happen now? No matter what has gone before, I have imagined myself pregnant and beaming with a wanted child. Well, happy, blooming then fruitful. I blot out the fact that pregnancy and having children is one of the most stressful things a couple can do and that a quite shocking amount of partners have affairs during these periods. And that my husband isn’t great at coping with me when I’m not very well (but he’s getting better, and I know he’d be an amazing dad). And that I live in a tiny flat and I’d have no money and wouldn’t be able to cover the rent on SMP. And that I take antipsychotic and antidepressant and mood stabilising medication and have tried to kill myself. And suicide is the leading cause of maternal death.
But then I wish someone had been there when my mum was suffering when she had my brother and sister. I can’t remember what happened (particularly when my sister was born, because I was still a far-off idea at the time), but I do remember she thought there were rats in the bath, blood, that my brother was some sort of god and that she was mad for years after- still is, really- and that my dad’s drinking got worse and worse until it killed him. I try to tell myself that just because it happened to her, it doesn’t mean it will happen to me. I’m not married to my father, and my father was an alcoholic, and I’m not. I’m not living her life, in her circumstances. I’m not her. I’m not her.
And even if I was, how badly did having two parents with a mental illness affect me? On a good day, I’d say, “Ach, hardly at all”. On a bad, I’d be flung back into a cobwebby corner of my memory where I’m hiding behind a door with my hands over my ears listening to my parents scream at each other, and the years that followed where I spun in my mother’s confused untruths, not sure what was true, not sure what wasn’t and remember my joyful time in CAMHS.
I have my brother and sister, though. I have them.
On balance, though, I think my experiences have had a positive impact on my personality rather than a negative one. I grew up to be compassionate, to want to help people, to be independent since we largely had to look after ourselves, to value creativity as a way to express myself when I lived with people who could be wordless, and to be someone who stands up for themselves and for others. On the downside, I’m one of those people who struggles to make close relationships (and this scares me about having kids- who would help me? Who could I ask?), who runs away when people try to get close to her, who is super-sensitive, who seeks validation too often, who feels overburdened with a sense of responsibility and guilt for things I can’t control, and who shuts down if someone shouts at me as it throws me back into the centrifugal force of my parents rage. (And yes, I’m aware that my traumatic upbringing and subsequent traumas have probably contributed a fair bit to me being mentally interesting. But I certainly don’t blame my parents for that. They’re people, first). But those things don’t hold me back to any huge degree and the slightly reclusive part of my personality is one I’d miss having, too.
And they weren’t always like that. Sometimes, my parents were wonderful. It was something I was wildly jealous of when my dad died- other peoples’ memories of their parents. I had friends who lost their parents to cancer at similarly young ages to when I lost my dad. But their parent, “battled”, was, “brave”. Was proud, was strong, had friends, were blissfully and memorably ordinary. They had coffee with their parents and bought them places, to events that didn’t end with them screaming at them to stop, slumping into sobs. I was so jealous that, then, all I had left of my dad were horrible memories. They were the ones that floated to my mind when I thought of him. Memories that drenched me in shame and regret, regret of such a short, wasted life, and shame that we weren’t enough for him to want to live for.
But as time has passed, I remember more good about him.
I understand he couldn’t, “just” stop drinking. I thank him for the good influence he had on me. To be silly, to be strong, to read. I mourn that my children won’t have him as a grandad, to be bounced on his leg like he used to do me. Now whenever I talk to my somewhat transformed mum on the phone, I ask her to think about getting herself a wee fella. I hate the thought of another life not being lived, being wasted without love, without someone, even a good friend, to share with.
And on the plus side of me not really being close to many people, I have a lot of love. Tons of it, pouring out of me, for anyone to have if they want it. So that’s something.
But my parents were never really helped for their problems. No-one really supported them when they needed it, when we needed it. How different things might have been if someone had recognised they needed help. These somewhat self-regarding entries are a protection. A way of acknowledging what could happen. Save yourself by being self-aware in case there comes a time when you can’t be. So it doesn’t come.
So I think I need to give up any expectations I have of pregnancy or motherhood, both good and bad. I may not suddenly have a giant gleaming kitchen and long, russet hair (it’s purple right now, but for some reason, when I think of my hair when pregnant, it’s long and not falling out like it does during pregnancy and russet and smells of apples, the latter being a probability considering we are currently buried in them) and have that kind of flattering slimness that accentuates my bountiful bump (I’m newly obese again, so that’s not going to happen anyway). I may not have a husband who’s endlessly patient with me and who listens to my stomach like a shell for the sea and sings to me (I fucking hope not- he’s the most effortfully bad singer I’ve ever heard) and keeps everything clean and is never bad tempered and never misses sex or the nights out with his previously young wife and the nights in with his previously girlfriend. He won’t become depressed himself and will continue to bring me coffee and breakfast and call me beautiful.
Likewise, I may not go mad and may not end up struggling to bond with my baby, and may not be like my mother, and may not spend every waking minute thinking I’m a shit mother and a shit person and shit feminist, and may not have to come off my medication and if I do, I may be fine, and it may, may be, just a gloriously ordinary time of my life, like it is in the lives of lots of women, like it is for lots of women with mental health problems, too. Apart from panic attacks, I’m fine now. I may continue to be fine. And even if I wasn’t, it’ll all be worth it in the end.
I hope so.
P.S: I’m not pregnant, don’t worry.
P.P.S: Daksha Emson is an exceptional case, hence the inquiry. Although women can be so unwell they commit suicide and take their children with them, it’s incredibly rare. And what has changed since they inquiry? Not much.
P.P.P.S: If I’ve depressed the shite out of you with this entry, here’s some Eddie Izzard:
Filed under: Bipolar Disorder, pregnancy | 12 Comments »