Elaine Hanzak's book 'Eyes Without Sparkle' starts with the line:
'Sandwiched between a bedside cabinet and wardrobe, I sat rhythmically banging my head against the wall'.
It's an autobiography about living through postpartum depression and psychosis.
I think it's amazing the book exists, as mothers experiencing mental illness are unlikely to write anything at the time. Life itself is challenging enough. Then when they recover, details of what happened to them often feel too personal to discuss.
Therefore I'm grateful for the courage of Elaine in writing about what happened to her and her family. Her narrative not only challenges the stigma of mental illness, but is an engaging way of learning to support Mums in this situation. Information tends to stick better if it's attached to a real person's story.
We still don't have many clear answers when it comes to treating mental illness, especially mental illness in mothers.
After all, the diagnosis of depression itself is controversial. Depression is diawignosed using a checklist of questions as opposed to a solid diagnostic test like an x-ray that can show broken bones. This means the diagnosis of depression is somewhat subjective.
I'm not in any way saying depression isn't real - in fact, I have a family member who studies depression and many people close to me suffer with it themselves. I'm saying depression is complex, we can't often pin down what's causing it for the individual and questions about why it's occurring in epidemic proportions in our society remain unanswered.
3-5 % of mothers will develop postpartum depression and 0.1%-0.2% will develop the terrifying and dangerous condition 'puerperal psychosis'. This is a severe episode of mental illness during pregnancy or the postnatal period that can include mania, anxiety, paranoia and hallucination.
All women are at risk of postpartum depression and puerperal psychosis, no-one should be crossed off the list as a potential sufferer. This may sound like fear mongering but there are no 'types' of women who are immune and puerperal psychosis can develop in women with all the right support and who have no history of mental illness.
Risk factors do however include being a first time Mum, being older, those who have family or personal psychiatric history, hormonal imbalance such as premenstrual syndrome, infant loss or miscarriage, morning sickness and complications during birth.
Treatment for postpartum depression includes psychosocial treatments (teaching self-help strategies, mindfulness, peer support), psychological treatments (like cognitive behavioural therapy and interpersonal psychotherapy) and antidepressants.
Treatment for puerperal psychosis includes mood stabilisers, antipsychotics and other medications and electro-convulsive therapy - something Elaine found very helpful.
But my heart sinks a bit as I sift through the data, relevant Cochrane reviews and writing from authors that I trust. I always seem to be hit with statements like 'further research is needed' or 'this treatment depends on clinical judgement'.
The women and families suffering from the impact of perinatal mental illness often have no clear path and this is distressing on top of an illness that's hard to understand. A physical disease that you can see is often easier to tolerate.
Having yourself, your partner or another loved one change dramatically and experience anguish and confusion at the limits of human experience is a cruel situation to be in.
This is why I think Elaine's book is so helpful. When there aren't any solid answers the best you can hope for is someone kind and understanding who'll explain to you what their experience was like. From her writing, you can tell Elaine is a confident, professional and these days joyful person.
Her path, even without puerperal psychosis, hasn't been easy so her resilience and enjoyment of life must be incredibly heartening to hear about for women in the depths of mental illness. Elaine's writing is a great reminder than women who are so ill that they're barely functioning can, in fact, be our leaders when they're well. We must remember this.
Particularly heartbreaking is Elaine's description of being told off by a nurse for breaking a vase when she was very unwell and confused. It's crucial that care for women who are mentally ill is based on respect and kindness. These women are going through their most vulnerable moments.
Elaine's new book 'Another Twinkle In The Eye' covers the decision to have another baby after perinatal mental illness. Earlier chapters discuss the considerations and experiences of women in this situation and later chapters are targeted more towards healthcare professionals with experts contributing writing on current research and treatment options.
Elaine also covers the self-help strategies that fall under 'psychosocial intervention' and I love that she acknowledges these are healthy ideas for everyone, including staff!
Elaine's books are also awesome for reminding us how much of an impact the little things can have on women - the reassuring smile of a midwife, time taken to explain, the knowledge that you're in a room with a professional who cares about you and what you think, regardless of how ill you are.
I want to end on a very exciting note......drumroll!
I highly recommend both of Elaine's books: 'Eyes Without Sparkle: A Journey Through Postnatal Illness' and 'Another Twinkle in the Eye: Contemplating Another Pregnancy After Perinatal Mental Illness'.
I hope to hear your questions and see you in the Secret Community, it's one of my favourite corners of the online midwifery world.
I'd love to hear from you here on the blog too, leave me a comment telling me:
1. Have you or a loved one experienced mental illness during pregnancy or the postnatal period? Did you wish care was better in any way? Or is there any part of care you thought was excellent?
2. Do you have a desire to work with mentally ill Mums? What first step can you take in this direction (putting this into words and leaving me a comment will makes it a lot more likely you'll achieve your goal!)
Hope you can join us tonight! Much love, Ellie x