What Postpartum Psychosis Is Actually Like

I have bipolar II, so I knew, even before I got pregnant, that I would have postpartum depression. It was a foregone conclusion, like your iPhone slowing down as soon as the new one’s announced, or y’know, a depressed person getting postpartum depression. This was not going to be a shock.

When I did get pregnant, it was ON. My therapist and I started to prepare for my inevitable transition from Depression Classic™ to Depression New—Now With 100% More Child™. We trained for it like a depression marathon, only there was zero exercise, but still a whole lot of carbo-loading. We talked about medication, self-care, and building a support system. We talked about how our sessions would work in the first few weeks and maybe there could be a few home visits too. But we never talked about it being anything other than PPD. There were mentions of postpartum psychosis and anxiety, because PPD was the goal—it was the darkness at the end of the tunnel. 

Throughout my pregnancy I was reminded to “watch out” for signs of postpartum depression. The problem was, I didn’t know the difference between PPD and regular D. I’ve lived with manic depression for years, one could say I was quite the depression maven, but that would be extremely weird and unhealthy, but I was! I assumed the key distinction between the two would be the amount of crying.

When it came to postnatal mental health, the main focus during my appointments was the “Baby Blues” and how it makes you cry a lot. But what we really should have been talking about is how the term “Baby Blues” is bullsh*t and should be renamed to “The Crying Out All The Moisture In Your Body Oh God Please Make It Stop Reds.” It felt as though most of these materials and classes were aimed at people who didn’t have a mental illness or had never experienced clinical depression, both of which I find deeply disturbing. The point is, as an already severely depressed person, I didn’t know which “signs” to “look out for.” That’s like telling a nineteen-year-old me to look out for red flags in the men I dated. How do you expect me to do that when they’re all one giant red flag?!

I went off my medication for my pregnancy. I regret it now, but at the time I was scared and confused. There were no official guidelines for lithium during pregnancy, and every time I thought I had a handle on what to do, a new study or classification would come out and rip the handle out of my hands. The medication goalposts kept changing, so I decided to wean off under the careful monitoring of my psychiatrist. I fell into a deep depression early on. From there it just kept getting worse, and as my stomach grew so did my feelings of guilt and shame—how could someone LUCKY enough to get pregnant now be DEPRESSED and NOT WANTING TO BE PREGNANT? 

I felt confused and ridiculous, but more than that I felt lonely. There’s not a lot of information about pre-natal and during-natal depression. And when it came to discussing PPD, the most I’d received during my entire pregnancy was a one-sheeter and a leaflet. I also took a childbirth prep class where the instructor played a video on postpartum depression, but before doing so, polled the class on whether they wanted to watch it because it may be a “bit of a bummer.” The issue with PPD isn’t the lack of information, it’s the distribution. 

I’m lucky to have a therapist who I’ve been with for years, who understands my mental state and manages my medication. And I’m lucky I made it through most of my pregnancy without anything dangerous happening. I spoke to my therapist a week before giving birth—by that time I was experiencing suicidal ideation and we agreed I’d get right back on my meds after birth, maybe even a higher dose. This seemed like a solid plan as it was clear PPD was on its way. But we’d been training for the wrong thing and I was in for a shock.

The first day back from the hospital I cried. I cried more in that day than I’ve ever cried in my life. I cried so hard I gagged. It felt endless, and at some point, I thought “I guess this is my life now. I will go through the rest of my life suffocated by tears and overwhelming grief.” And that was all perfectly normal. Two weeks later, it all went wrong.

I woke up feeling wired, like I’d already had a gallon of caffeine. The baby was crying so I fed and changed her. I put her in her (now massively dangerous and recalled) rocker and watched her from the sofa. I’d only left the apartment once for a short walk with the baby and my husband. I couldn’t bring myself to leave alone. I felt safe inside. Outside was evil. People were outside. I had started to develop agoraphobia but everyone, including myself, put it down to “just being a new mom.” My husband would drive me to a postpartum group every Tuesday and I’d ask him to stay and wait outside because I was vibrating with anxiety. Every moment in that group was torture. The other moms and babies with their talking and crying, I hated it and them. It’s important to note here that this venomous behavior is not my modus operandi. I am normally a kind, funny, generous person and you’re just going to have to take my word for it.

I knew how depression felt, I knew how mania felt, but I couldn’t quite grasp what was happening to me. I felt different but I couldn’t describe it. A couple more weeks passed. I had quit the group and spent all my time indoors. But in a few days my husband would be returning to work and every time I thought about it, I cried. These weren’t hormonal, “normal” tears, these were terrified tears. I knew something wasn’t right, but I’d also convinced myself this was just a “new mom thing” and that everyone had fantasies of murdering or being murdered by someone trying to kill their baby. I was filled with so much anxiety and paranoia it felt like I had electricity for blood. I was deathly afraid of being left alone with my baby for fear of something bad happening to her, and for that something to be me. 

I cried and begged for my husband to not go back to work. I told him I couldn’t look after our baby and I was scared of myself. As much as he sympathized and understood he still needed to go back to work because, money. I don’t have any family here and we didn’t have any childcare, so I decided to join another postpartum group; this one was a fifteen-minute walk away. Before my husband went back to work, we decided to do a dry run of the fifteen-minute walk. I still hadn’t left the apartment by myself with the baby and, unbeknownst to me, was deep in the throes of agoraphobia. But once again, I assumed this is how every new mother feels and acts – like they want to rip their skin off and carry out a murder-suicide on every person who walks too close to them. For me, if it wasn’t PPD then it was “just mom things.” The only mental illness I’d been somewhat “educated” on for postpartum was depression, so if I didn’t have depression, then I didn’t have an illness. 

We did the dry run and I was ok. Sweaty, but ok. The overwhelming anxiety had me sweating profusely. Once again, you’ll have to take my word for it, but I’m usually not a sweaty person. When the day came, I felt stable but nervous. I asked a friend if she could talk to me on the phone as I walked there because I needed to think of something that wasn’t dying defending my baby’s life or bursting into flames. My friend had a five-year-old daughter and had been to postpartum groups. I panted at her down the phone “did you hate the other babies when they screamed because it would disturb your baby?” She said, “My baby was one of the screaming babies.” I made it to the group, drenched in all the moisture in my body. Everything was going fine, but towards the end I felt it, a madness, surging through my body. I grabbed my baby, who was sleeping in her car seat, put her in the stroller and bolted. I was so panicked I didn’t even buckle her in. I ran, jostling my tiny baby from side-to-side. I prioritized getting home over her safety, and as I ran, I thought (and I don’t say use this word lightly) “I’m fucking crazy.”

Going to doctors didn’t help because they’d see “bipolar II” on my chart, and it was easy to dismiss my erratic behavior as a hypomanic episode. But I knew what those felt like and this wasn’t that. I cried and begged doctors to see me. I was told it would be a month before the next appointment, “I don’t have a month, I don’t even have a day” I cried down the phone. They said there was nothing they could do. I had now been in, what my therapist diagnosed as, a state of high-functioning psychosis for seven months. I finally saw an endocrinologist, a very old, white man who had previously claimed my issue was that I wasn’t taking my meds because I was mentally ill and prone to that behavior. He’d made this assessment before he’d even met me. I didn’t want to meet him in person, but I had to. There was no one else. After several blood tests and neck scans, it turns out I had a relatively rare postpartum thyroid condition that was set off by Hashimoto’s disease which apparently, I also had. And there was no cure. I just had to wait for the psychosis to go away on its own, which is the wildest sh*t I’ve ever heard. Waiting for PSYCHOSIS to go away on its own like it’s a wart, or hopefully the spider that’s currently chilling in the corner of my bedroom. 

After feeling literally insane for seven months all while being gaslit by doctors and looking after an infant, I decided to do my own investigation. I borrowed a book from the library called The Thyroid Solution by Ridha Arem, an endocrinologist based in Houston, Texas. In it, Arem talks extensively on how this postpartum thyroid condition affects people’s mental health. There were countless stories of women who, like me, had lost their minds and not been believed. Women whose husbands had left them because they were “crazy” or because their personalities had changed, and they weren’t “the woman I married” (side note: why are men?) These women had no idea what was happening to them, they’d just given birth and now they felt completely out of control. It was heartbreaking, but they only knew about postpartum depression and maybe postpartum anxiety, so in their minds, this was them. And that was me. 

At no point during your pregnancy does someone tell you there is a chance of a total personality change; they do but only in terms of like “you’ll be born a mother” to which I give a hearty Logan Roy style “f*ck off!” I’d spent seven months getting gaslit and scrambling for answers. I knew this wasn’t postpartum depression and I knew it wasn’t my mental illness, but I also knew this birth had changed me on a cellular level .

We will always need a wider and more honest conversation about postpartum recovery, both physical and mental. And even though PPD is the most talked about postpartum illness, it’s still not talked about enough. There’s more to postpartum than depression and anxiety, there’s psychosis, OCD, bipolar, PTSD, Hashimoto’s, and a lot more. We need just as much care and attention put into postpartum recovery as we do during pregnancy. The pain doesn’t go away after we’ve given birth—for many of us, it’s only just begun. We need better access to maternal health services, better maternal mental health care, and most urgently, better black maternal health care. We need medical professionals to give us more information and options for postpartum recovery, but most of all, when we tell them we’re unwell, we need them to believe us. Especially black women who are three to four times more likely to die during or after pregnancy than white women

My child is now thirteen months old, and while I may not be as sweaty or paranoid, I still have agoraphobia and, of course, still have depression and hypomania. I get regular blood tests to monitor my thyroid and haven’t had any flare ups since. Some days I wake up scared that that switch will flip again, and I’ll have to walk around out of my mind for god knows how long. But even if that did happen, at least I have a diagnosis and this time I’ll know that that’s not me and that I won’t be like that forever

Images: Alex Pasarelu / Unsplash