"Like a drunken nightmare." I spent 108 days in hospital with postpartum psychosis.

This post discusses sexual assault and may be triggering for some readers.

The following short story originated as a piece of writing about my hospital. I want to share this story to help future suffers of postpartum psychosis by creating awareness of the illness. This will not negate the risk of future women suffering from this condition, but I believe greater understanding may help women and families who experience such a condition for the first time because they will have a vocabulary of such experiences. 

"Blackness as black as black;

Black like a miner’s cave

Without a light burning blue

Searching in the dark for something;

a memory, something tactile, something tangible,

something to touch but finding nothing."

That is the only way I can describe six weeks of my life.

I’ve never taken illicit drugs, but initially, when I became unwell, I was manic, like I’d taken speed. I felt intelligent, alert, confident. I am a teacher, but I started giving history, literature and art lessons to anyone and everyone, whether they wanted to listen or not. 

I had no register. 

Then days later, with virtually no sleep, the illness became a drunken nightmare. I wandered the halls of Sutherland Hospital’s Psychiatric Unit, trying to connect the numbers on the patient doors to the mystery that would unlock me from the nightmare I was in. 

It felt like I was sleepwalking through a lucid dream, but I wasn’t dreaming. I was awake. Or rather, my body was, but my mind wasn’t. 

I can only describe postpartum psychosis as a drunken nightmare because waking from it, I can recognise my cognition was impaired like it is when you’re drunk. 

My memories are also extremely limited just like they are when you wake with a bad hangover. I cannot remember screaming all profanities known to me, I cannot remember kneeing a nurse in the balls, and I cannot remember being forced into a straitjacket let alone wearing one. 

My parents say I don’t want to remember it, but I do; losing control of your mind and soul while being physically confined to a small room that is a prison minus the bars is traumatic. The only thing I can do is accept it, somehow. 

What is postpartum psychosis?

My family, close friends and I had never heard of it until I had it. Postpartum psychosis is a medical condition that affects approximately one to two of 1,000 mothers, usually within days of giving birth to their child. 

Its symptoms include paranoia, anxiety, insomnia, mania, hallucinations (audio and visual), ultimately leading to a complete break from reality. The condition is so severe that it is considered a medical emergency, which is a prosaic way to describe my experience. 

My 'emergency' was approximately 10 days postpartum. I have no memory of that night. 

My husband called an ambulance, and later that night I was scheduled under the Mental Health Act. The Mental Health Act in NSW deals with the care and treatment of persons with severe mental illness and has the power to hold you on an involuntary basis to ensure you comply with treatment. Like most other women, my postpartum psychosis happened out of the blue. 

I had no previous history of mental health issues besides anxiety in my late teens. The condition escalated rapidly; within 10 days, I had delusional thoughts and beliefs, hallucinations, paranoia and could not sleep more than an hour a day. With all things mental health, there is a difficultly in accepting that I couldn’t help what happened to me more than a person diagnosed with cancer can. 

The condition is not visible unless the person is acutely unwell. 

What causes the condition? 

I've spoken to several psychiatrists, and not one can provide a definitive cause. Instead, all they've been able to do is list several risk factors such as bipolar or schizophrenia, a genetic predisposition caused by a family history of bipolar, schizophrenia or postpartum psychosis, dramatic hormonal shifts after childbirth, a traumatic birth, extended labour, sleep deprivation, and a prior history of sexual abuse. 

However, you can have all these risk factors and still not develop postpartum psychosis. 

I fit the criteria for most of these risk factors, but I did not have bipolar or schizophrenia or a family history of it. It is also important to remember that correlation doesn't equal causation.

Trying to describe my experience is difficult. Remembering it feels like waking from a lucid dream and being reminded of something - a smell, a person, or a fragment of lost words that I heard somewhere long ago. Briefly, in that moment of surreality, caught between reality and delusion, impressions of memories take shape in my mind. 

The earliest fragment of a memory I have of my postpartum psychosis is waking up in a hospital bed with my hand being held by one of my best friends Peta. 

Unable to comprehend the gravity of the situation, I remember confusedly asking, "Have I been in a car accident?". I talked to her about it a few months later, a tear rolled down her cheek and she said, "You didn’t even remember you’d been pregnant". As I recollect my journey, it will be fragmented and may, at times, drift because I simply cannot remember it chronologically.

My husband and I wanted nothing more than a healthy baby. We had unsuccessfully tried IVF in early 2018 because my husband has Neurofibromatosis Type 1. 

This genetic disorder can be screened out at the embryonic stage, and because the heritability is 1:2 we didn’t want to risk having a child born with a life-threatening condition. Then, I accidentally fell pregnant. By some miracle, my baby boy did not have Neurofibromatosis and was genetically cleared. 

My pregnancy was relatively smooth, except that I developed Gestational Diabetes. I was also quite stressed throughout my pregnancy with the pressure of holding a leadership position at an elite private school.

After a 22-hour labour, I had my son at 4:20am on July 20, 2019. He was two weeks early but weighed 4.2 kilograms. The birth was traumatic to say the least. My son’s heart rate dropped, and he was in an OP position, so we were rushed to emergency surgery. 

He was stuck. 

With my legs up in stirrups, the doctors gave me an episiotomy and pulled him into the world with a vacuum and forceps. At the time, they said, "If forceps don’t work, we may have to conduct an emergency caesarean and give you a hysterectomy to save your life." 

This was absolutely terrifying. 

Words cannot describe how daunting the prospect of potentially losing your baby is while being given a hysterectomy. Though terrifying, I’m glad I can remember giving birth to my son. I remember him being placed on my chest and he looked up at me with a strangely small version of my father's eyes. 

The following night, I was alone in my room hopping about, with a catheter in while cluster feeding. 

I’d sent my husband home for a good night's sleep because we both hadn’t slept for about 36 hours at that point. I didn’t sleep that night. He fed, pooped, peed, or cried the entire time. I have some memories of extended family visiting but it’s all a bit of a hazy blur - almost like being wildly drunk; only it wasn’t a fun bender - I woke up with the worst hangover I’ve ever had.

My son was also born with talipes equinovarus nicknamed 'club foot', a deformity of the foot that causes it to turn inwards. Initially, I was really concerned for my baby's health and kept asking any paediatricians for a second opinion. I didn’t sleep for the first two days my son was alive.

"My husband and I wanted nothing more than a healthy baby." image: Supplied. 

When I finally closed my eyes to rest, I found surreal images that belonged in Alice In Wonderland. I laid still in my hospital bed without sleep for over 48 hours, but my mind swayed giddily as if I’d stepped off a boat for the first time all day. As soon as I had closed my eyes I began dreaming almost instantly, I saw what looked like a Cheshire cat riding on a roller coaster and other bizarre things, but I wasn’t yet asleep. 

If I blinked my eyes open, they were gone but as soon as I closed them again; they were there. I didn’t see them with my eyes open, but I knew the hallucination type images weren’t real, so I just tried to sleep and stupidly didn’t tell anyone. 

Later in the maternity ward, I asked why I was allowed to give birth the way I did and one of the nurses said to me privately something like, "In hindsight, you should have never been allowed to progress naturally with your son in the OP position". 

After this, I vaguely remember being aware some of the nurses were judging my character, but with nothing tangible to support this intuition, I put it down to the hospital 'ass-covering'. I remember evaluating the situation in the shower and drawing the conclusion that they were walking on eggshells around me because they feared I’d sue the hospital.  

Here is a snippet of a text message I sent to my husband at this time:

 "I want you to read but don’t use it as evidence with any medical staff don't worry but please could you share my feelings with a sensible and responsible adult. I'm trusting you with my life here and Oscar’s. I get it. I also get that I wrote an essay yesterday. I'm an art and English teacher!!!…"

The rest of the text was very long and convoluted but showed my rapidly declining mental state.

Towards the end of my stay in the maternity ward, the psychiatry consultant came to visit me and diagnosed me with bipolar and prescribed some medication, one of which was Lithium. Apart from being treated for some mild anxiety years earlier by a private psychologist, I was a complete foreigner to the mental health department. 

I cried during his diagnosis and I felt as though he used it as evidence against me, evidence of a diagnosis I couldn’t accept. I kept thinking at the time, "He’s baiting you. Just shut your mouth and you’ll think of something to get out of here back to your GP". 

That was probably the beginning of my irrational, paranoid delusional thinking. Somehow, with the help of my husband, I managed to disregard the information given to me and discharge myself from the hospital.

So I went home and visited my old psychologist and my local GP twice. I filled out the Black Dog institute’s mental health questionnaire, but no alarm bells rang. 

As I explained to my doctor, I wasn’t depressed - instead; I felt like the hulk. I clearly could comprehend that something was not right, but I simply couldn’t accept a diagnosis of bipolar. More so, I had researched enough to know that the medications prescribed to me would be the end of breastfeeding. 

I was determined to breastfeed for two reasons; the literature I’d read stressed the nutritional importance of breastfeeding and the emotional importance. I wanted the best for my son, whatever the physical or emotional cost to me. 

I also wanted to be the perfect mother.

Days went by. I watched movies, went to coffee, hardly slept, tried to start a book club, launched a photography business and planned an educational conference but most importantly to me - I breastfed. 

I remember giving my grandmother a vague history lesson, and I also remember my most manic friend visiting me and saying he couldn’t keep up with my rambles. I babbled about Hitler, Stalin, B.F Skinner, Milgram, Orwell and many more to everyone. 

"I wanted to be the perfect mother." Image: Supplied. 

However, while I was rambling to my manic friend, an unknown caller from the hospital accidentally called me Racheal. 

I calmly replied, my name’s not Racheal, it’s Emily. Little did the hospital know at the time that Racheal was the fictitious character I’d been writing short stories about for years. I remember handing the phone to my husband and just staring at the Google mini, thinking they’re listening in. 

I didn’t say this because I was somewhat aware of how bizarrely embarrassing that would sound but also because if they really were listening in, then they’d know I knew. 

My GP made arrangements for me to go to the Mother-Baby Unit (MBU) at St. John of God Hospital. I didn’t make it. The night before I was due to be admitted, my husband had to call an ambulance. I don’t remember that night, and my husband is very guarded about my behaviour that night. He now says I became quite violent and manic. But my early journal writings state that he said, "That night haunts him". 

He is a police officer, so I must have been terrible for him to consider my behaviour to be violent enough that he needed to call an ambulance. I was scheduled under the Mental Health Act. The Mental Health Act is powerful. It removes all treatment choices from the patient and their family. My family has since explained to me how frustrated they were by the limitations placed on them, but they also say it was what was needed in hindsight. On the night I was scheduled, I texted the following message to my father:

"F**k she left. We’re going to die. Dad you’re good. Buy gold! We’re in for World War Three! Show the doctor. See you soon. Kill me before I ruin the book. A war is coming. I am going to be Shakespeare. Dad, you picked the right book. Shut up. I’ll kill her but I’ll never crack. I’ll kill myself and I can see fuck get Ben. Get everyone I hate and love. Listen. Holy shit, you’re right. Let us protect. I’m not ready To die. Kill me. I’m not ready. Time."

I also sent out SOS messages to several friends, including this message:

"It's time. You know where to find me next week. I can see Plath. SOS."

Plath is a reference to Sylvia Plath who was a poet who died by suicide. 

I have a vague dreamlike memory of Sutherland Hospital Psychiatric Ward and trying to find the right 'doctor' and believing it was all in the numbers. That and trying to feed imaginary chickens my food, which I feel is some vague reference to Orwell’s Animal Farm. 

This brings me back to my first memory of my friend, Peta, squeezing my hand in recovery at St George Hospital. I’m not sure which Electroconvulsive therapy (ECT) it was because I had 24 ECT treatments in total. 

There are different regions where they can run electroconvulsive therapy through the brain, and they had to attach the currents to an area of the brain that affects memory. 

This coupled with extreme sleep deprivation and psychosis has greatly impacted my memories both long and short term. Since I’ve been out, I have re-met people who have been confused as to why I didn’t know them. Obviously, this was quite humiliating at first and I guess still is. 

Being unable to explain my illness quickly to acquaintances is frustrating, especially since I physically look well. 

People generally confuse postpartum psychosis with postpartum depression. I don’t blame them because I probably would have three years ago too. The silver lining of my memory loss is that I remembered the people I loved and mattered most.

I was only sleeping for around an hour a day. I didn’t feel either hungry or tired; I felt remote and unreal, as though the wind blew through me. My thoughts wandered and morphed into what I believed to be reality. They did not obey logic. Try as I might to ground myself via a journal, my thoughts strayed away. 

I recounted my horrific birthing story over and over and could feel the switches literally holding me together. 

Then I started being slowly given day release from the St. George hospital. So what did I do? I went straight out and bought another copy of Animal Farm; an anti-Communist allegorical novel written by George Orwell last century. I have kept the copy of Animal Farm I had in hospital and had a look at my delusional annotations. 

I also kept three journals while in hospital, all of which were filled with coded time metaphors that I knew only I’d understand in case the hospital staff (aka the thought police) picked them up. 

It’s funny that I can still make sense of most of my coded journal metaphors, some strange internal working that I can interpret hidden in all that mess. I remember the beautiful nursing staff on the psychiatric ward, particularly one nurse who prayed for me and blow waved my wet hair in the middle of winter. Her name was Neta, and I remember being thrilled each time she came on staff.

I have a vague memory of drinking lots of water to help flush all the medication out of my body. A plumber had to be called in to turn off the water because I blocked the toilet, would shower clothed, and managed to induce a physical reaction to the copious water I consumed. I also had Lithium toxicity twice while in hospital, which is fine if managed correctly but fatal if not. 

Sadly, I relapsed at St. George and was sent back to Prince of Wales which I didn’t and still don’t remember ever being there the first time. There are multiple theories for why I relapsed, a leading theory is that I never recovered from the first. That I just learnt to hide my milder symptoms. 

I tend to favour this one because my psychosis delusions had me convinced that the government was trying to control me and ironically; they were. After all; I was scheduled by a government act, which gave the hospital the power to place me in solitary confinement with a nurse and security guard 24 hours a day while wearing a straitjacket. This landscape only strengthened my delusional reasoning. 

After coming out of my second psychosis, the first memory I have was kicking the door violently, and a poor nurse was trying to console me. There was also a security guard, but I was doing roundhouse and front kicks on the door. I then remember saying, 'Fine you win. I crack. You can have my secrets'. 

From this time, I started to become better quite quickly. Though I have vague memories of collecting twigs from outside, shoving these inside the power points and trying to electrocute myself to end the reign of Big Brother and leave the torturous dungeon I literally believed I was in. 

One of my friends Georgia said I rambled about leprechauns coming out of trap doors and raping me. Knowing my history, she said it was really sad that I genuinely believed I was being raped again.

I remember being initially scared of going for ECT but the staff were exceptional. The lady who always admitted me, Fiona, I think her name was, was overly cheerful. The doctors were respectful too throughout the whole process at Prince of Wales. In the end I became somewhat addicted to the feeling of being anaesthetised and started to look forward to ECT. Though I’m told I put up quite the fight when they initially conducted ECT. 

My friend Peta has since told me that she was banned from seeing me when I came to theatre and that all she and anyone else could hear on the level was me screaming my lungs out and desperately trying to get away. She said just as they were about to take me back to the psychiatric ward; she came into the corridor, and with that, I was immediately calm. 

I yelled out to her as my long-lost friend, and she came to me and asked me calmly if the nurses could inject me while holding my hand, and I agreed. 

I only have one vague memory of being reunited with my son at Prince of Wales. It was when I was allowed to leave escorted by my mother, sister and son Oscar. We made it as far as the carpark before my mother and I got into a fight. My sister bawled her eyes out and I just demanded to be taken back to hospital. All I wanted to be was a proud and independent mother and I couldn’t be.

"I only have one vague memory of being reunited with my son at Prince of Wales." Image: Supplied. 

I recall one of the nurses from the PIMS team Kerry, saying, 'Emily I know you don’t like me very much' - I didn’t. She was assertive, knowledgeable and confident about parenting; everything I was not. She worked very hard with a psychiatrist named Michelle who worked between Prince of Wales and St. John of God to get me an earlier placement in the Mother and Baby Unit (MBU). I am extremely grateful that she did this now. She believed in me even though I was still being paranoid and thinking illogically. 

I then spent a month in the MBU at St. John of God. While I was no longer suffering from psychosis, the therapeutic nature of that hospital allowed me time to bond with my son. I knew I had the help and support of nurses. I made friends with the other women and met women with similar stories. It was nice not to be on a general psychiatric ward where a male patient followed me and stroked my foot. I remember in one of the group therapy sessions, a psychologist said feelings are not facts. It was a light bulb moment, and I suddenly saw reason. The hospital also allowed partners to stay the night and my room looked like it belonged in a hotel, not a hospital. St. John of God also had an exercise physiologist run specialised personal training programs for patients.

In total, I spent 108 days in psychiatric care. I still have memory loss. I only recently stopped taking any medication as you must stay on Lithium for a minimum of two years proceeding a psychotic episode. The PIMS team at Sutherland Hospital were fantastic I had the pleasure of being in the care of a fantastic psychiatric nurse named Jenny. I worked with this team for over a year. I also saw the initial psychiatry consultant who made a diagnosis of bipolar and surprise, surprise he wasn’t actually by all accounts a robotic evil doctor leading humanity off a cliff. It’s been two and a half years since my son was born and I’ve returned to full-time teaching. I started teaching within three months of being discharged from the hospital. I see a private psychiatric at St. John Of God who has been involved in my care since the beginning. She’s gentle, kind and compassionate and helped me forgo all medication a couple of months ago. 

My family and friends loved me every step of the way. My husband has been an absolute rock throughout the whole ordeal. He has constantly been so patient and compassionate throughout the whole journey. Despite being so tough, he still shed a few tears along the way and sought the help of a counsellor to help process everything that has happened. 

I wholeheartedly know that if I had been discharged directly from the public system and not spent the time that I did in the private hospital, I would have relapsed for a third time.

My father says he had no idea what the illness was prior to me contracting it. Dad also says that I was extremely protective, didn’t sleep, and fixated on small issues. He also explained that when I was scheduled under the Mental Health Act, all of my care was administered by the state. 

My parents and my husband were taken out of all decisions, and this was again heartbreaking. However, as previously mentioned, in hindsight, he says it makes logical sense. Not all families, partners and parents get on and if one made the wrong decision, the other would never forgive them. So, my family had to trust the system, the very system I was paranoid about.

Am I me again? Yes, and no.

When I returned to work last year, a friend said you still seem dazed, and a bit drugged. One friend said it’s like you’ve gone from being an extrovert to being an introvert. That’s probably true. I’ve probably lost the confidence to speak my mind openly and I’m always tired these days but I’m honestly generally and consistently happier than I’ve been for years. My official diagnosis is postpartum psychosis with a pending dash against bipolar. I get anxious if I don’t sleep for eight hours each night, fearing that I am becoming manic. Apparently, if I enter psychosis once more (without pregnancy), I’ll be diagnosed bipolar.

If I could freeze a moment in my life, it would be now. Perhaps it’s because it’s the start of the enviable school holidays. But honestly, even when I was commuting to work almost two hours a day, five days a week this year (pandemic aside) my life was balanced. Stressful at times, but balanced. My son has a hilariously cheeky personality. His independent nature is quite frustrating most of the time but his joy for life is infectious. 

Yet somehow, those thousands of words don’t completely articulate exactly what I went through and how bad it was. Every psychiatrist involved in my care uses the adjectives 'profound' or 'severe' to describe how bad my condition was. If I didn’t receive treatment, I probably would have ended my life, not because I was depressed but because I genuinely believed I was a type of martyr against a corrupt government. I remember trying to find the cyanide tooth capsule with my tongue discretely. It wasn’t there. Surprise. I’m not and never was a Cold War spy agent imprisoned. 

Despite all of this we’re now considering baby number two. 

Knowing the odds are 50 per cent likely that I’ll have postpartum psychosis again.  

If this post brings up any issues for you, or if you just feel like you need to speak to someone, please call 1800 RESPECT (1800 737 732) – the national sexual assault, domestic and family violence counselling service. It doesn’t matter where you live, they will take your call and, if need be, refer you to a service closer to home. 

If you think you may be experiencing depression or another mental health problem, please contact your general practitioner. If you're based in Australia, 24-hour support is available through Lifeline on 13 11 14 or beyondblue on 1300 22 4636.

You can also call safe steps 24/7 Family Violence Response Line on 1800 015 188 or visit www.safesteps.org.au for further information.

Feature Image: Supplied.