The Four Stages of the Tour De Recovery

After surviving a severe postnatal mental illness, I felt almost euphoric.  I survived Postpartum Psychosis.

I. Can. Do. Anything.

I felt invincible - as if going to hell and back had somehow given me an armour coating.  And the bond I felt with my son? Well, although it had been forged in a mental hospital it seemed all the more unbreakable for it.

Surviving any illness that lands you in hospital for so long is an achievement, for sure.  It takes you places you could only ever dream about before and teaches you more about yourself and your relationships than you ever thought possible.

But the immediate recovery period is not *the* recovery.  It turns out, recovery is a life long journey.  I don't mean to dishearten anyone: the journey is unpredictable, erratic and hard.  But it is also awesome, amazing, and life-changing.

Stage one of the journey: immediate aftermath / initial recovery.  As I mentioned above, you can feel almost euphoric during this stage.  Surviving a life threatening condition can make you feel invincible.  And there is a huge amount of relief too.  You are one of the lucky ones, you have your little family intact, and now you are full of gratitude and thankfulness for - life.

Stage two of the journey: your first set back.  A difficult but important staging post to get past.  For me, it came as a nasty shock one day.  I had been happily bowling along with my almost-one year old, marching from baby massage to rhyme time to play dates and parks when a stranger accosted me outside my house (I had parked him in the buggy fast asleep at the bottom of our front steps, for just a minute) and accused me of neglecting my child for leaving him unattended. That one very short altercation was enough to evaporate my fragile confidence and send me into a tail spin.  Was I good enough? Would I ever be good enough?  Luckily for me, I pulled through this. It took a lot of soul searching and a lot of support from my nearest and dearest but I came through thinking. No, actually, I WAS a good enough mum and most mums would have left their sleeping child within view at the bottom of the steps for less than a minute.  But the episode was important, as it taught me that my confidence was important and that I had to take steps to ensure it was protected.

Stage three of the journey: finding your fellow riders.
Without your peloton you can't get up that hill.  Finding your tribe, your gang, the women (or men!) who "get it".  I can't begin to describe how thankful I am for my family of fellow PP survivors, #PNDhour participants and all the friends I've made in the perinatal mental health world.  And for the friends from before my illness who have pulled through with me and for me and helped prop me up and made me feel - normal.  I was lucky to find my voice through twitter and blogging, and in turn many other voices joined me.  Having a support network like this (whether virtual or real life) is imperative.  It is one reason why peer support is so effective and should be a high priority for all local commissioning teams.

Stage four of the journey: taking in the view.
For many months (if not years) all I could think about was maternal mental health.  Perinatal clinical networks, RCPsych quality assessments, speaking engagements, media work - you name it, I was on it.  I was like a blinkered cart horse, pulling my "lived experience" load all over town, but not really seeing anything other than the road ahead.  More recently the blinkers have come off and I'm able to enjoy my life without constant reference to perinatal mental health.  I'm still involved, but it is no longer what defines me.  I work (part time, in a fun job that suits me fine).  I read (a lot!).  I exercise.  I'm involved in local politics.  I'm also a mum.  And then (way down the list) I'm also someone who needs to take care of their mental health.

I'm not at all perfect.  I have days where I panic that I am slipping into a depression or spinning into mania.  But I take my pills and I protect my sleep and I get out the house and go to work or the gym and do what I need to do.  And my son has a mum who loves him with all her heart, but who no longer has to define herself by the first three months of his life.  He's a busy four-and-a-half year old and has places to go and people to see and he has little time for wallowing. :)

Speed book reviews

My reading list from Cayman, London and Italy... 29 books reviewed in around 2-3 sentences each.

War and Peace by Leo Tolstoy

• When we travelled to Cayman back in April last year, my hand luggage contained a half-read copy of War and Peace by Tolstoy.  I'd seen the BBC adaptation over the preceding winter and was totally seduced by it.  And it made tackling the famously convoluted epic novel less daunting.  Don't get me wrong, it still took me several months of off-and-on reading to finish it, and I never did manage the second epilogue.  However I really enjoyed the book, and found it quite different to the TV series.  In the book, Tolstoy devotes much more time to Maria and Nikolai's romance, and less to the (let's face it quite annoying) Natasha and Andrei. 

The Diver's Clothes Lie Empty by Vendela Vida

• the first time I've read a book written entirely in 2nd person.  This style is clearly not for everyone, but it worked for me.  I found the voice really captivating and the story was devastatingly sad.

The Girl on the Train by Paula Hawkins

• an over-hyped book, sadly.  I thought it was ok, and would probably have enjoyed it more if I wasn't thinking "when is it going to get really good?".  So many convenient coincidences and in the end it was hardly a huge surprise. 

All The Light We Cannot See by Anthony Doerr

• a real treat of a book club read.  I thoroughly enjoyed the dual narrative style and the way the two young protagonists were eventually brought together.  

Promise Not To Tell by Jennifer McMahon

• I really enjoyed this one (another book club read): two murder mysteries, plus a bit of mysticism.  Hard to describe/pigeon hole but definitely recommended!

The Yellow Wallpaper by Charlotte Perkins Gilman

• one of the best short stories I have ever read, and certainly the one that will stay with me the longest.  It charts the emerging psychosis of a young wife and new mother as she is confined to an attic room in their supposedly convalescent summer house. 

After You by JoJo Moyes

• like most of the rest of the world I had really enjoyed Me Before You.  This is the promised sequel and it does what it says on the tin.

Luckiest Girl Alive by Jessica Knoll

• I didn't enjoy this as much as I thought I would.  For a modern novel it is a dense and frustrating read.  

I Let You Go by Claire MacKintosh

• this was a great holiday read, with all the components I most value in a novel: likeable but flawed characters, mystery and plot twists, and a bit of romance.

The couple next door by Shari Lapena

• a holiday page turner that delivers a pacy, looping story in stylish fashion.  Don't read if you're anxious new parents!  Baby goes missing while parents are over having dinner with their unlikeable neighbours.  Drama ensues.

The Bell Jar by Sylvia Plath

• this book has been on my "to read" list since my teen years.  It doesn't disappoint, with its acerbic tone and put-downs.  The autobiographical content is fairly obvious and that lends the book a great pathos, as obviously we all know what happens to the protagonist next.

Islands in the Stream by Ernest Hemmingway

• reading this on a warm Caribbean beach was a perfect treat. Hemingway evokes casuarina trees, palms, warm reefs and cool drinks.  He devotes one long chapter to an abortive fishing expedition which transports the reader right there.  If you are going to read one book about alcohol, it should probably be this one.

Commonwealth by Ann Patchett

• this is a great, sweeping, American novel that frustratingly somewhat peters out.  I did enjoy it but was left wanting to know much more about the six grown children and their hapless adulterous parents.

Modern Lovers by Emma Straub

• argh.  This book was so well written it was almost soulless. I didn't warm to any of the characters (three former 80s bandmates now settled in supposed domesticity in a middle class part of Brooklyn) so really didn't care who was sleeping with who or how or why.  

The Quiet American by Graham Greene

• a short novel set in early 1950s Vietnam.  A romance and a war/spy thriller at the same time.  I didn't exactly "enjoy" this book, but it was an education.

The Pursuit of happiness by Bertrand Russell

• a bit of nonfiction for a change and who better than modern philosopher Russell. This book had quotable wisdom on almost every page.  His authority isn't really from any great intellectual pursuit (although clearly he is an academic master) but through his obviously hard-learned life experience.  A great read for anyone pondering the meaning of it all.

The Bonfire of the Vanities by Tom Wolfe

• picked this off the shelf at our holiday apartment, for want of anything else to read.  Really enjoyable book: full of humour and hubris as the main character tries (and mostly fails) to navigate his way through the 1980s.

Reasons to Stay Alive by Matt Haig 

• the one book I want any of my friends or family who are struggling with mental illness to read.  Really interesting / voyeuristic journey into one man's struggle with depression and anxiety.

Americanah by Chimamanda Ngozi Adiche

• hard to review this novel.  It is clearly a very well written work, but seems to have been stitched together somewhat: political point-scoring, social commentary, all written almost in blog post style.  Seems the main character was created as a mouthpiece for the author herself.  But if I had as much intelligent things to say as Adiche then why the hell not.

White Teeth by Zadie Smith

• I'm sorry it took me so long to read this famous novel.  Smith's style is so engaging that I was very quickly engrossed.  It tells the long tale of two wartime friends, reunited in a fast-changing London.  It is insightful on race, marriage, bringing up children and friendship.

Homegoing by Yaa Gyasi 

• my new book group all loved this debut novel, although it is not without a few faults.  I thoroughly enjoyed the tracing of two sisters' family lines up through the generations: from slave master's mistress and captive slave bound for the cotton plantations up to modern day America and Africa.  The lack of plot was sometimes problematic, as was the lack of space for each character to come through, but it was an ingenious premise for a book.  I was left wanting to know so much more: about the slavers in Africa and what factors drove them to sell their own cousins to the white men, and about the modern day dynamics between different colours and nationalities and economic groups in both Africa and the US.

Jane Eyre by Charlotte Bronte

• one of my favourite reads in a long, long time.  I could lose myself in these pages.  Jane's story is melodramatic, but she is such a worthy heroine I never tire of it.  The friendship, scandal, separation and then reunion with Mr Rochester is a masterpiece of romantic fiction.

Wide Sargasso Sea by Jean Rhys

• Mr Rochester is never actually named in this book, but it is more than apparent who he is and what he does to the poor woman he eventually decides is insane and locks in his attic. The young creole girl is taken from her idyllic Caribbean life and married off to an aristocratic second son with a name but no money.  You finish this book nothing less than appalled at the way he dominates and castigates his young bride.  It puts an entirely different spin on his second marriage to Jane Eyre.

Outline by Rachel Cusk

• I thoroughly enjoyed Cusk's writing.  It's not really a novel, more a series of vignettes tied together by one woman's encounters during a few days in Greece.  But it's so well written I really didn't mind.  Makes me want to read her entire works!

The Humans by Matt Haig

• an awesome idea for a novel: you never know whether this is one academic driven out of his mind by work, or a sci-fi caper about aliens landing on earth.  Either way it is maddeningly realistic with loads to say about the modern human condition.

A River Ran Out of Eden by James Vance Marshall

• a short story I had read in high school, I happened across it again while clearing out my old bedroom.  It's a great example of descriptive naturalist writing, with the setting of remote Alaska hard to beat.  You immediately take against the stranger who intrudes on the family's harsh but harmonious existence.

The Color Purple by Alice Walker 

• I read this book as a young teenager, but got so much more out of it as a 36 year old mum. The story is absolutely heartbreaking and heartwarming: it is a love story between two sisters, forced apart by the cruelty of their times and a racist and misogynistic society.  I loved following Celie as she gradually "finds" herself: from her clitoris up to her own mind.  Would recommend this book to all young girls, and old ones too.

Revolutionary Road by Richard Yates

• this was billed as a classic American novel, adapted into a fairly so-so film.  Having not seen the film I was curious about the book.  It seemed to take ages to plough through: what should have been an easy read seemed laboured, as none of the characters (apart from perhaps poor Mrs Givings) were easy to warm to.  And there was never much of a plot or story arc.  It did make me think: about relationships, what we do and what we say to keep domestic peace.  And the well trammelled paths of least resistance that we all tend to take.

My Name Is Lucy Barton by Elizabeth Strout

• I read this short novel in less than a day.  It was so engaging: writing of the highest quality.  Simple, pure and true.  Strout never divulges the hideous childhood abuse suffered by Lucy, but we instead are given an insight into how her past shapes her present.

Black dogs are labradors

It doesn't happen very often, but when conversation turns toward mental health, I'm sometimes asked about my "Black Dog".

I can see why it became a useful shorthand for depression (first popularised by Churchill, among others).  The black dog follows the person like a shadow, sometimes oppressively so, sometimes so large it shuts out all light and prevents any normal activity whatsoever.  It is an entity outside of the person it visits: the person is pursued by the dog, hunted and hunter.  And then the hound can be chased away, tamed or quietened by various treatments and remedies.

While it's a popular metaphor, it has never been one that I have applied to my own clinical depression.

Point one: I love dogs.  Especially black labs, which is often how the black dog of depression is drawn.  A bit like choosing a baby name ("no it can't be called George because that's the name of my tyrant boss") you can't help the mind associations you have and for me dogs represent fun, comfort, companionship and silliness.

Point two: my depression is not some "thing" that visits me.  It is part of me.  It IS me.

This is the reason that matters.  Because, in my experience, depression cannot be chased away or tamed.  To suggest that I can out run or out fox depression makes no sense. Depression is integral to me, a body part that starts off as a small knot in my chest then grows like a tumour until it encompasses my entire body.

When I'm depressed, I am depression.  There is no me and it, only It.

It is my hand's hesitation to pick up a buzzing phone.

It is my stomach's insistence that it is full, despite not having eaten a proper meal in days.

It is my eyes' reluctance to look my husband in the face.

It is my arms' inability to reach for my son when he is clamouring for a cuddle.

It is my legs' leadenness when asked to move from the sofa.

It is my mouth's paralysis stopping words caught in the back of my throat from ever coming out.

It is everything, and yet nothing.  A big negative void that eventually fills me up to the eyeballs.  I cannot run from or fight it any more than I could gouge out my own heart. Instead I must treat recovery as a more gradual process: slowing filling the void: with words, with actions, and then even further down the line with thoughts and feelings.   The words and actions must come first (CBT 101).  There will always be several weeks - months maybe - when I am going through the motions of life.  But eventually the thoughts and feelings return and the void is filled with my sense of self.

Terms such as "get a grip" and "snap out of it" are not PC but are actually quite accurate to how I get over depressive episodes.  People who know me well tend to know when to push.  What nobody can do is chase away a Black Dog for you, or save you from it: the illness (and the recovery) can only start from within.

A different path to "well being"

It's safe to say I'm not "postnatal" any more.  Not by any stretch mark of the imagination.  The Boy is a thriving four year old and I'm a woman rapidly approaching 40 who happens to be his mum.  He's my reason for everything.  The very air I breathe and all the sustenance I need.  But he's becoming quite an autonomous little person, and that invisible umbilical cord is getting longer by the day.  He's out there in the world: making decisions, voicing his fears and desires, finding out things for himself.

Rather than wist and mope after days gone by, and an obsolete role I can no longer occupy, it's time to move with the times.  I have a job now.  Not perhaps my alma mater's traditional idea of a career, but a vocational job which I love and a position which should grow as the young business expands and progresses.  I'm meeting new people and my days are busy and full.  I love telling the Boy, as I kiss him goodbye at nursery, that mummy is off to work.  I love that feeling of being Kat, just Kat.  Not mummy, not a wife, just part of the team.  The other day I twisted my hair into little knots and put some make up on.  I love serving customers with a smile and having a bit of human interaction that has nothing to do with Fireman Sam or bleeding Paw Patrol.

Sometimes I ache as I limp onto the Northern line at the end of a busy shift.  Sometimes I wonder whether I am too old and too arthritic for such a young person's game.  But I'm not going to give up easily.  This is the start of something really exciting and different and creative and fun.   And whatever physical detriments I may suffer (legacy from a broken femur 8 years ago), the new role is working wonders with my mental health.  What is that "five elements of wellbeing" that researchers came up with? *quick google search*
PERMA
* Positive Emotions (P) –  Feeling positive emotions such as joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe and love.
* Engagement (E) – Being fully absorbed in activities that use your skills and challenge you.
* Relationships (R) – Having positive relationships is a universal requirement to well-being.
* Meaning (M) – Belonging to and serving something you believe is bigger than yourself.
* Accomplishment (A) – Pursuing success, winning, achievement and mastery for their own sake.
(Seligman, apparently)
Check, check, check, check and check.  In fact, I would add to that list another P, for Physical activity.  Being on my feet and moving (without having to do monotonous exercise) is great for feeling energised, and in turn happier.

It's not that I couldn't derive feelings of wellbeing from motherhood alone. But it was certainly harder to accomplish: positive emotions were clouded by maternal anxieties and feelings of inadequacy.  Full engagement was hard amidst the monotony of nappy changing and making up bottles.  Relationships - well yes, there is no relationship in the world stronger than that of a parent and baby.  But man oh man, when they are screaming and screaming and giving you nothing but screams it is hard to remember that loving bond!  Likewise Meaning and Accomplishment: clearly nothing in life is more meaningful and important than bringing up baby.  But tell that to the sleep deprived parent facing another morning of a sodding soft play play date and luke warm coffee.

So forgive me, for depositing the child in nursery and taking a slightly more direct path to PERMA well being.  I haven't been this well for years.  It may not last but for as long as my arthritic hip allows I'm taking it.

Time to Talk 2017: stigma and psychosis

This is the first blog post here for almost a year.  I haven't felt the need to write about mental health matters for a while.  We've been living abroad and generally having a grand old time.  But Time To Talk day has rolled around again and I thought I'd put down a few thoughts about stigma.  The last time I wrote about stigma and mental illness, I managed to offend a number of my lovely friends: they couldn't understand how I felt stigmatised, they had all wanted to reach out to me during my illness but didn't have the opportunity.  I know how caring my friends are, and how they would have been the first to visit if they had been told where I was and what was wrong.

But the fact was, for me, I spent a considerable period of time (the precious first few months of my son's life) in hospital with no visitors other than immediate family.  It was a very isolating time, without a smart phone to stay connected and with my confidence to initiate any form of communication at a very low ebb.

When a loved one is psychotic, and unable to make rational decisions for themselves, the presumption is that they would not want anyone to know about their illness.  This well-meaning stigma (but stigma it is nonetheless) perpetuates the myths surrounding psychosis:

- psychosis is to be feared

- psychosis is shameful

- psychosis is dangerous.

Psychosis is absolutely terrifying, for  sure.  For me it dredged up all sorts of agonising, humiliating, disgusting thoughts.  Thoughts that quickly crossed over from mere nightmare to the realm of warped reality.  A reality that I fought and fought - there was no way I wanted to be burned alive, to be locked up and alone forever, to be responsible for the end of the world.  

But underneath all that terror, I was still Kathryn.  I still remembered who was top of the leaderboard in Strictly Come Dancing.  I still loved my husband and family.  I still liked to eat Rice Krispies with a generous sprinkle of sugar.

I'm not sure what I would have done or said to anybody who did venture along to the Mum and Baby Unit ward of the Royal Bethlem Hospital.  No doubt I would have attempted to make tepid cups of Tetley tea while sharing out the Marks and Spencer's goodies.  No doubt I would have tried to make some sort of conversation (assuming I wasn't in the middle of one of my full blown psychotic episodes as mentioned above, causing the whole ward to go on lock down).  No doubt I would have tried to ask how they were and enquire as to their own health and happiness.  The conversation would be stilted and one sided. But I would have known they were there and it would have been a precious bridge to the "real world".

Being locked in a psychiatric ward (no matter how homely the staff try to make it seem) is far from most peoples' reality.

As I've said before, one set of friends did persevere enough to make a visit (but this was after my first visit back home, when I was well on the way to recovery and discharge).  But I really appreciated the effort they made to make a walk around the wintery Bethlem grounds - past the psychiatric ICU, past the forensic high security wing - as normal as a stroll through a National Trust property.

I'm also grateful to my family: to my husband who visited each day, no matter what state I was to be found in.  Who reassured and reassured and reassured me again that Yes, he was there and Yes, the baby was OK and Yes, he loved me.  To both my sisters who (in different ways) provided unmeasurable levels of support and unconditional love.  To my parents, who understood and respected the consultant's strong advice to stay away for the duration of The Bad Weeks, even though they wanted desperately to be with me.  And to my in laws, particularly my MiL, who provided so much practical help and assistance and acceptance.

Yes, my loved ones kept me in a bubble for a time, but I understand completely why they did so.  And every single family member since has wholeheartedly supported me in both my ongoing recovery and my campaign to raise awareness of severe mental illness.

I'm a lucky, lucky lady.

With love and gratitude,

Kathryn x