My journey in to postpartum psychosis was as rapid as it was terrifying

My journey in to postpartum psychosis was as rapid as it was terrifying.  

I was so excited when I found out that I was pregnant. My partner and I had fertility issues so getting pregnant seemed like a bit of a miracle. I felt stable during my pregnancy, mental health wise, and so I was full of optimism about the whole thing. However, I knew the statistics. Any woman having a baby can develop postpartum psychosis, but I had a particularly strong chance. I have a diagnosis of bipolar disorder so I had about a 1 in 4 chance of developing postpartum psychosis. It was a worrying statistic but I tried to forget about it. 

When I gave birth by cesarean section, I was filled with excitement. I had been stressed for weeks about having surgery so I just felt elated that it had all gone to plan. I had a healthy baby boy and it felt like I was the luckiest person alive. I invited all the grandparents round to visit hours after I had given birth. I had done my hair and make-up and was trying to get out of bed as soon as the epidural wore off. I was so happy and chatty. It was just hours after I had given birth and my manic symptoms were already beginning to develop. 

It starts innocently enough. You are happy you have just had the baby you always wanted. You feel ready to conquer the world. You wake up when the baby cries and can’t get back to sleep. After feeding the baby and putting him back to bed, you might end up watching the news over and over again on a cycle in the middle of the night. You believe that you should do something useful. Perhaps you could clean the bottles for tomorrow. Maybe you could clean the kitchen whilst you are at it. Maybe organise the fridge and clean it thoroughly like you meant to do months ago. Suddenly jobs that aren’t pressing seem like they are of the upmost importance. Only, you start one job and your brain skips to another task, so you abandon the first job half way through. And so it goes on. 

The first few weeks after birth are all blurry in my memory. All I know is the it felt like I was on top of everything and I convinced everyone around me, families and professionals alike, that I was fine. I was just coping really well looking after a baby and multitasking at the same time. They weren’t to blame for not realising something was wrong. I was kidding myself and persuaded everyone else that I was ok. For once, I was just coping with something most people have to deal with at some point. That was my logic anyway. 

Fairly soon after my hypomanic feelings began, they started to get a bit more manic. I would laugh wildly at inappropriate times. I would sit on the floor singing away, rolling around and making up little songs. My eyes apparently became very wild and I would stare at people in my family and get in to their personal space, poking them and pulling their legs and screaming things out loud. It became very clear to my family that something was wrong. However, I hid all of these manic behaviours in public and with friends. I was terrified for anyone to see that I was acting strangely. I still had insight in to my difficulties and knew that I could hide them well. I have always hidden my mental illness from everyone outside of my intimate circle. And I am very good at it. 

Things escalated, and I started feeling very scared. I was walking around and glaring at people. I felt that I was being looked at. For some reason this overwhelming feeling of not being safe hit me. In public places, I felt like people were watching me and were acting suspiciously somehow. I became suspicious of buildings, trees and other objects too. For some reason there was a malintent there which I couldn’t explain. This strong sense of mistrust was running contrary to other thoughts in my brain, which told me not to be so ridiculous. But it didn’t matter. However much I tried to rationalise myself out of the paranoid delusions I was having, the delusions still felt as strong as ever. I knew it wasn’t true in my head, but my gut feelings were somehow more powerful.  

My paranoid delusions took hold of me one evening when I couldn’t get through on the phone to my mum. I walked over to her house and was convinced that something terrible had happened. When I couldn’t find her, I forced my husband to phone the police. I saw a man walking in the dark outside her house and immediately assumed he was my mum’s rapist and murderer. I was terrified. In the end my mum had just gone to the cinema and was fine. I realised I had overreacted but I was still scared of the man I had encountered and felt like he had probably attacked someone. I still held on to some of the delusion. 

Aside from the paranoid delusions, my sense perceptions all went a bit haywire. When I was walking my dog in the woods surrounded by the suspicious trees, the colours in the wood would transform in to something amazing. It was like a multicolored filter that you can put over a photo. The colours were bold and striking and I felt overwhelmed by the joy of nature. Things were moving, lines were no longer straight and everything had an over-worldly feeling about it. Sometimes these hallucinations and derealising experiences made me feel deliriously happy and, at other times, terrified of my own mind.  

I was manic and I was depressed, all at the same time, which is hard for people to understand. The amazing ways of life would hit me with a feeling of euphoria, and then the distress of the complexity and sinister ways of it all left me feeling terrified and low. Although I was euphoric at times, I was also very distressed by the way the world seemed and I just wanted it all to stop. I was very jumpy and wired so I was feeling manic but in a very dysphoric way. 

I saw my psychiatrist and some other mental health professionals, with my husband, and explained what had been happening. I couldn’t hide it anymore and I had come to realise that things weren’t right and that I needed help. My psychiatrist acted immediately and admitted me and my baby to a mother and baby psychiatric hospital. I was terrified of going but I was resigned to it. Something had to be done and I just couldn’t cope anymore.  

I spent a month in the unit with my baby. A lot of it is a blur because I was heavily medicated. However, I started feeling more like myself and all the feelings of suspiciousness and strange perceptions had gone. It took me a while to recover but I was discharged and sent back home. I recovered amazingly quickly, thanks to the swift intervention of my doctors and the appropriate medication and support from the team. 

How do I feel about the whole thing now? It’s been a year and I still think about it every day. I think about how distressing being in hospital was and how scary it is to lose your mind like that. But the trauma is fading, and I'm gradually getting some confidence back. I know that my bipolar symptoms will flare up again; they always do. But the mind has an amazing ability to forget the worst and to, rightly or wrongly, be positive about the future. For now, I am just praying that something like this never happens again. But if it does, I’m more ready for it this time. 

Postpartum psychosis

I haven’t been writing for my blog in a while and I can’t really give you a good reason as to why I stopped. I suppose there were a few factors. One of the reasons was that I just felt too overwhelmed to get my thoughts down properly. My brain was buzzing and it is hard to write coherently when your thoughts are darting around aimlessly at top speed. I’m not sure if that was down to manic energy, anxiety feelings or a combination of the two. Needless to say, I felt that I couldn’t cope with writing even though that was probably one of the best things I could have done for myself; writing has always been therapeutic for me. 

  

Anyway, a lot has changed. I still struggle with intense anxiety every day. However, what I am anxious about is different. Now I have a baby so a lot of my anxieties have grown around that. I also worry a lot about being alone, or being alone with my son, stuck with my own thoughts; it’s my own mind that scares me. The biggest change has been that soon after I gave birth, I developed postpartum psychosis and ended up staying, with my son, in a mother and baby psychiatric hospital for a month. That was one of the most traumatic things I have been through and I hope that by writing about it extensively, I can finally come to terms with it and move on. Maybe I can help people understand it along the way or write something that someone can relate to so they feel a little less alone.  

I want to write posts relatively frequently over the next few months. I hope that it will at least provide a little insight in to postnatal mental health: an area that is not well known about. 

Losing a piece of me

Every time I become ill again, I lose a little piece of me.

As with many mental illnesses, my symptoms are episodic. I am never completely symptom free but the severity changes all the time. With bipolar disorder, I get episodes of depression and mania interspersed with some relatively normal periods. I still have a lot of problems with anxiety all the time but this can sometimes improve and sometimes get worse again.

The problem with having episodes like this, is that I never know what is going to happen and how my moods and behaviour are going to change. Each time an episode hits me, I’m almost shocked that the same thing could be happening all over again. I shouldn’t be. I know that a bipolar diagnosis is a lifetime diagnosis and many mental illnesses are long-term problems. I should be prepared but I never am. 

I have many memories of how I have been when I'm ill.  I know that I have felt extreme despair, frustration, elation, anxiety and agitation. I remember staying in bed all day and recall some of the strange things I did. Surely this should prepare me to some degree for the next episode. But my mind seems to try to protect itself: the worst memories get buried and the other ones feel like a dream.

Maybe mental illness is not the kind of thing that you could be properly prepared for. It’s such a strange thing to feel like you are losing your mind. There is nothing that can quite describe it. I'm still me when I'm ill but I don’t behave the same or feel the same emotions. I feel out of control and I realise that my behaviour and mood may be affecting how other people see me. I feel so strange that it is hard to believe that I haven’t been drugged sometimes. I don’t know why I feel the way that I do when I am ill, but I know that there is nothing I can do to stop it. How could you ever be prepared for this kind of life altering switch to occur?  

Each time I get ill again something happens to me. First, I suddenly feel jolted back to the times when this has happened before and the memories come rushing back. I realise that it is all happening again and I didn’t even notice the warning signs. Then I feel myself letting go, allowing myself to fall in to misery, anxiety or elation. With this comes a certain acceptance that my life is once again going to change forever and there is nothing I can do to stop it.

Every time this happens I lose a part of myself. One of the biggest changes is to my confidence. It keeps getting knocked back and there is not enough time between my periods of being ill for me to regain back any self-esteem that has been lost. I don’t trust myself to behave properly anymore and, because I socially withdraw when I am ill, I forget how to interact with other people. This has lead to all sorts of social anxiety problems.

Also losing your mind has a huge impact on how you view yourself. Your personality can seem to change. For example, when I get depressed I can become very introverted and hostile. When I am manic I can becomes overly exuberant and over the top. Even though I know my basic personality has remained the same it is hard to match these behaviours to my sense of self. I sometimes end up feeling incredibly self-indulgent and guilty all the time. I feel like I should be able to control myself and go back to the steady self that I imagine I used to be.

As each episode of illness hits me, and my confidence and sense of self are eroded, I feel like I have lost this huge part of who I am. I remember being well as a child. I remember being quiet but sociable, being imaginative but grounded and being relatively happy. I know I must still be the same underneath, but so much has changed. Because of my mental illness, some of who I was seems to have been lost forever.

CBT didn't work for me. Why am I made to feel guilty and ashamed?

Cognitive Behavioural Therapy (CBT) is one of the main types of therapy available to those suffering from mental illness. It is supposed to work by changing the way you think and behave in response to external events. You are taught to identify negative thought patterns, weigh up the evidence for these thoughts objectively and come up with more balanced thoughts. By doing this, you are supposed to be able to change the way you feel and behave.

I’ve tried CBT a number of times: twice with two different therapists every week for a year and once in a group for 20 weeks. I definitely think that therapy should be explored and would advise anyone with a mental illness to give it a go. However, with CBT, I found that it didn’t made me feel any better and at times it has actually made me feel worse. I don’t wish to diminish the help it may give to other people, but for myself, I have found it lacking.

When I read about CBT it sounds like it is based on good common sense. Your thoughts, feelings and actions are certainly connected. The idea behind CBT is that by changing one of these (your thoughts) you change the rest. One of the problems I have had with CBT is that my thoughts are so ingrained that they have proved impossible to change. Most thoughts that we have are automatic. We are not always aware of where they come from, they just appear. Changing these is an uphill task. I found it impossible to change these thoughts once they had already ‘lit up’ in my brain. 

CBT teaches you to assess your thoughts and come up with more balanced thoughts. When I did this however, I found that although I could easily come up with the more balanced thoughts, I didn’t really *believe* them. I found myself in the strange situation of having a balanced thought and an ingrained, unbalanced thought fighting with each other in my mind. For me, CBT created a situation where I believed two contradictory things and this caused me quite a lot of stress. The more the negative thought popped up in the brain, the more I punished myself for thinking it and the more stressed I became.

In doing CBT, I was aware of what thoughts were more balanced but it still didn’t change the way I felt or the way I behaved. Perhaps this was due to the cognitive dissonance happening in my brain. Maybe other people are able to hold on to the balanced thought whilst discarding the unbalanced, automatic thought and so their feelings and behaviours change. But for me, this never happened.

One potential problem with CBT is that you don’t know which comes first, the automatic thought or the feeling. CBT seems to be based on the idea that it is the thought which originally causes the feeling which, in turn, causes the behaviour. However, I find that I often feel distressed, depressed or anxious for no good reason and that this then causes me to start having negative thoughts. Changing the thought then won’t necessarily cause a change in the feeling if the causal relation is the other way around. 

One of the difficulties I had with CBT is that I was made to feel guilty for my feelings and behaviours. I kept being told that my unbalanced thoughts were causing my illness and this made me feel ashamed. Thoughts seem like something you should have control over so I was sometimes made to feel like it was my lack of control over my own mind that was leading to my illness. 

It seems to me that it is fairly controversial to say that a certain therapy wasn’t helpful. I found that when I attended CBT, the therapists believed in it so strongly that I wasn’t able to say that I didn’t think it was helping. When I filled in forms before and after therapy that assessed how I was feeling, they made lots of excuses for why I wasn’t feeling better. There was no allowance that CBT may not be effective for everyone.

If you don’t find a certain therapy helpful and express this opinion, you are often treated like you just aren’t trying hard enough. You feel like a failure for not being able to take control of your life and fix your mental health problems. The reality is that I am trying really hard every day. I try and eat healthily, take long baths, go on walks, listen to relaxation CDs and take medications with horrible side effects. I don’t *enjoy* doing any of these things and I am not even sure if any of them are effective but I give them a go because I am told that they work and I want so badly to feel normal. 

CBT may be effective for some people and I am glad that it is available for people to try (although of course many people have to wait months to receive treatment on the NHS and it is often a short course with not enough allocated time). I think that it is good practice to try and become aware of your thoughts and see how they might not be accurate. However, personally as a therapy I found it didn’t help cure my mental illness. In fact I felt guilty and ashamed as a result and was made to feel like I wasn’t trying hard enough. Therapists should always be aware that some therapies don’t suit everyone and that this is no reason to judge someone for not getting better.We are all trying our hardest. No one chooses to be unwell.