Finding a Silver Lining

Finding a Silver Lining: The experience of Postpartum Psychosis for women with Bipolar Disorder

by Clare Dolman

Clare & EttieAs someone who has had many conversations with women who have had a postpartum psychosis – some of whom, like me, already had a diagnosis of bipolar disorder – I can say that the experience is very different in one very important respect.

If – as a woman with no previous history of mental illness – you have a postpartum psychosis (PP), the effect is devastating.  It is a bolt from the blue: none of the books about childbirth on ‘getting to know your baby in those first few magical months’ and ‘how to be a Supermum’ gave you the slightest inkling that your baby might instill nothing but fear in you; or that you might be spending those early weeks in a psychiatric hospital.

As APP’s research study on PP support needs illustrated, women for whom it was their first experience of mental illness “felt overwhelmed by the psychological enormity of the event” (Heron et al. 2012). If, on the other hand, you approach childbirth as a woman with bipolar disorder, you possess a distinct advantage: something similar to this has happened to you before.

Even if you are unlucky enough to be unaware of the much higher risk of PP for women with Bipolar, when it starts to happen to you in the days after the birth you won’t wonder ‘What on earth is happening to me?’ You’ll probably think ‘Am I having a bipolar episode – this is a bit like being high (talking too much and staying up all night) and a bit like being low (feeling anxious and irritable and maybe paranoid)?  Or if you are too ill to have insight into your condition, your partner or family may recognize aspects of behavior they have seen before – and know that you need psychiatric help.

That is what happened to me and when I was told after a week that I needed to go into hospital, I was obviously sad and perhaps worried, but –overwhelmingly – I remember feeling relieved.  Relieved that I would at last be able to sleep and not feel responsible for my baby and anxious that I wasn’t up to caring for her properly (I was fortunate to know she would be very well looked after at home).

Better still, if you have a treatment plan in place, you and those around you will know exactly what to do and what your wishes are. Being well-prepared is the best way of ensuring you stay calm in the run-up to the birth: hopefully it will help prevent you from getting ill and, if not, at least you can feel reassured that the professionals around you will know how to act quickly.

So although it is daunting for women with this condition to face all the decisions and potential risks of having children, one advantage we have is that we do not usually have to face the additional huge psychological burden of coming to terms with having a mental illness (and at such a vulnerable time) and all the stigma that brings with it.  Most of us faced up to that challenge to our sense of self when we were first diagnosed with bipolar disorder and accepted that we needed the help of medication to control our moods, probably a few years before.

When I met with a group of APP members all of whom had been free of mental health issues before childbirth, it struck me how lucky I was to already have dealt with the shock of being looked at as no longer ‘normal’ but someone who was mentally ill.  I had already had time to come to terms with the affront to my sense of self, the assault on my self-confidence and the injustice of being branded in some way a lesser human being (I’m in no way saying I accepted this description, just that it takes time to rise above society’s stigmatizing attitudes). They, on the other hand, were completely traumatized by ‘being seen as a mental patient’ and adjusting to the idea that not only were they not ‘the perfect mum’ they’d intended to be, but they were now part of that marginalized and often ostracized group of ‘people who have been in a psychiatric hospital’ (no longer able to sit on a jury and – in my case – despised at NCT meetings for not breastfeeding).

Obviously mental health discrimination is something that we are all trying to fight against, especially at APP, but it would be foolish at this point to say that it isn’t a massive additional problem for women trying to recover from the trauma of PP.  So perhaps the half of us who have suffered a postpartum psychosis but who have already coped with having bipolar can help the other half of our sisters to deal with the corrosive effects of stigma now – and do our best to help diminish them in the future.

Heron J, Gilbert N, Dolman C, Shah S, Beare I, Dearden S, Muckelroy N, Jones I, Ives J (2012) Information and support needs during recovery from postpartum psychosis. Archives of Women’s Mental Health:1-11

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