My ‘fit’

6 February 2012 Emergency team report

Team attended after a violence call had been put out by MBU staff. Heather had been shouting, throwing drinks and also had attempted to grab a staff member by the neck. Team were required to assist with intramuscular administration of medication. On arrival, Heather was being nursed in a seated de-escalation by 2 staff members, and we were informed that she had accepted 1mg risperidone and 50mg promethazine orally. She was difficult to engage in any meaningful conversation, unable to focus on any one topic. She insists she wants to go and breastfeed, though this is not an option for her. Staff attempted to get her to engage in meaningful conversations, but she was going off on various tangents. She wanted to return to her room, but as she was still unpredictable and there were concerns about her behaviour in the last hour/half hour, staff negotiated that she lie on the sofa in the lounge area, as she had calmed down before in this area. She eventually agreed, though reluctant initially to assist herself in lifting and wanting staff to do this for her.

 

I go to the conference room and I pace there, turning it over in my mind. Then I realise – Mum is the Svengali, she is Channi Kumar (but she isn’t is she?) and she set up this unit to save me, her beloved daughter. She knew this would happen from when I was very young, so she set out to arrange my life and make it possible. I realise – she found James for me. She set us up because he was the only person who could look after me. This is why she and Dad always look so tired with lines around their eyes – it’s the strain of supporting me for all these years (sorry, Mum and Dad). She must be far far richer than I know.

I pace, and my mind keeps turning until my head is spinning. I think I will die of thirst. I rush to the water jug by the pay phone, which is empty. I grab the bottle of lemon squash and drink it neat – it’s not too strong, I think I’m supposed to do this. I need the sugar to keep my blood sugar levels up. The squash spills down my clothes and I empty the bottle. A nurse comes into the conference room and I ask a question- it isn’t understood. I pace and spin until I am whirling, more and more convinced that the reveal is about to happen – the secret will be uncovered. I have passed the test I have cracked the code I have said the secret password. I chose Irn Bru – they will rip the plaster off any second and I will finally know the answer, they will tell me what’s going on and I am strong enough to take it, I am made from girders. I’m pacing and spun, and now my abdomen is convulsing and my heart is pounding and I’m falling to the floor. Can’t breathe. Am I breathing too fast or too slow -help somebody tell me before I stop breathing altogether or my heart bursts under the strain. I need to slow my heartrate- unless it’s too slow and that’s really the problem, it just seems like it’s fast but I can’t tell, I need someone to guide me through this I need a nurse.

No, I need a midwife to guide me through this I’m giving birth again, my abdomen is gripped by contractions. I want my Mum help me guide me breath with me to help me give birth again. Abeke is holding me down, together with Abby, because I’m throwing my body about, bucking and rearing, fighting the convulsions in my middle. I realise that I’m not just giving birth to a baby, I’m giving birth to myself. I am the goddess Gaia and this is the trial I must go through to become myself. This must be what happens to all the gods after their apprenticeship on earth. I have to focus and breath steadily, allow myself to relax and let it happen- but I can’t. I’m writhing on the floor trying to control the sensations in my abdomen and the beating of my heart. I throw my head back and it hits the ground. The nurses lift me up and I fall back in their arms. I try to relax and go with the rhythm and pulsation of blood in my veins. I am god and I am birthing myself. It is a difficult delivery.

I’m pacing the ward and I’m falling from a tree. I can’t breathe, I’m over breathing, I’m dying, I’m being reborn. I’m angry, I’m ecstatic, I’m anxious, I’m devil-may-care, I’m scared. I just want to talk, I want a rest from myself for just a second. Let me sleep; let me be rested; give it a rest for a second. Split seconds like atom bombs, split hairs, split brain? The world is in my head – why won’t it go away? It’s huge, I can take it, all mine. I want to remember – I mustn’t forget – anything! Will anything be the same again? Sublime, limn, lose a limb, lose my mind, it’s all the same to me. Ridiculous. What I need is to get a coffee and a biscuit.

De-escalate. I’m having a panic attack. Gemma sits opposite me and I’m laid on the sofa. Gemma tells me to breathe slowly. I focus on her and match my rhythm to her own. I’m winding down, slower, calming. I realise she is the doctor and after the first time I was here I came to see her for a debrief where she counselled me on what to do if I had another baby. How could I have forgotten that? The memory is distinct in my mind, but it’s empty of detail. I know I sat here opposite Gemma and she spoke to me, but I don’t remember what she said. Gemma tells me she’s the psychiatric nurse. She thanks me later on for promoting her.

Context

I’m allergic to childbirth.

Have you ever gone eight days and nights without sleeping? The mind you have by the end of that period is not the same one you started with. That’s how I came to be sitting in A&E in the middle of the night talking to the duty psychiatrist about my electric cats. That one followed me around in my notes. If anyone needed evidence that I’d lost touch with reality, there’s always the electric cats. But that was the first time: this is all about the second time.

 Postpartum Psychosis (also called ‘Puerperal Psychosis’, ‘Postnatal Psychosis’, ‘Postpartum Bipolar Disorder’ or PP) is a severe episode of mental illness, which starts suddenly in the first few weeks following childbirth. PP occurs following 1-2 in 1000 deliveries, and can be very severe and serious. There are some groups of women, women with a history of bipolar disorder for example, who are at much higher risk. There are a large variety of symptoms that women with PP may experience. These include:

-symptoms of “high” mood (mania) – for example, racing thoughts and pressure to talk too much.

-symptoms of low mood – for example depressed mood, lack of energy, poor appetite and poor sleep.

-psychotic symptoms – such as believing things that are not true (delusions) or seeing or hearing things that are not there (hallucinations). Delusions may be grandiose, and can include fears of harm coming to herself or her baby.

With treatment, the vast majority of women will recover fully and there are usually no long term effects on the relationship between a mother and her baby.

Unfortunately we know little about the causes of PP. Research points to biological, probably hormonal, factors related to pregnancy and childbirth but many other factors are likely to be involved.

Action on Postpartum Psychosis

 

I’ve had it twice, following the births of my two sons, Kajek and Samek. The second time was the more severe – but far better than the first time, which was the worst. The second time I had a privileged experience: I experienced madness. The first time I had a shocker: I had a breakdown, Kajek came close to death, and social services incarcerated me in a psychiatric hospital for five weeks. Both times I had a baby, which in the longer term is the most important thing. The second time I thought I was dying, and being reincarnated, and that I was Gaia giving birth to myself. I railed and raved in an empty room, I begged the powers that be to record what I was saying, I was euphoric, inspired, desperate, a loon. I scaled the heights and I plumbed the depths. The first time I was afraid, trapped, angry, frustrated, abused and defeated. The first time I cried my heart out. The second time I laughed my ass off. Among other things, I actually had a great time. Among other things. There was darkness too – not least leaving Kajek unmothered for nine weeks. But – and take this with a pinch of salt – I enjoyed being mad. (Did I? I don’t know. You tell me).

After having postpartum psychosis following the birth of my first child, I had a 50% chance of falling ill after another child. I was unlucky to get postpartum psychosis again. I was lucky to get postpartum psychosis again. The second time created the conditions that made it possible for me to recover from the first time. (Have I? I don’t know. You tell me).

I have a souvenir from my first stay at the Mother and Baby Unit: one of the hospital towels that got mixed up with my belongings. It hangs, dirty and ragged, on the inside of the door of my garden shed. It is unlovely. I also have a souvenir of the second time, not-accidentally ferreted away in my packing before I left the unit. It is a soft, clean, comfortable woollen blanket which I would happily have on my bed, touching my face. I will keep it, unless they demand it back.

I write this as my record of my experience of psychosis and mania. I write this to abolish the ghosts of the first time and celebrate the highs of the second time. I don’t want to leave the scattered fragments of my mind unintelligible and unintelligent in a heap at the back of the wardrobe; I want to sift those fragments, shuffle and order them, curate them; make them cohere. I would do almost anything for this never to have happened to me, but it did, so I can either let that experience disappear into the mists of memory, throw away all my scraps and notes and memorabilia and delete my text messages. Or I can write it, and even let people read it, and I can own it. I choose to own it so this is my record. I’m letting it go by hanging onto it.

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