“If you tried to leave now, we would section you.” It was my second day in the mother and baby unit, a psychiatric ward that treats women with perinatal mental health issues, while helping them care for their babies. I was sitting on the edge of my single bed, with its squeaky vinyl cover, my son asleep next to me in a cot that was impossibly huge for a four-week-old baby. I bit my lip and tried to stop my leg twitching up and down.
“You’d section me?”
“You’re not safe at home.”
“I don’t think I need to be here.”
The nurse leaned forward.
“Elizabeth, there are 12 beds in this unit. We only take severe cases. You need to be here.”
“What would it mean if I was sectioned?”
“You’d be kept here under the Mental Health Act. There are different types of sections, each with different rules. The length of time that you’d be kept in hospital would depend on what your doctor thinks you need.”
I picked a thread off my trousers. The nurse continued. “Some people like being sectioned. It gives them a feeling of safety.”
I swallowed.
* * *
My pregnancy had been straightforward; we were very lucky. After almost a decade of marriage, the thrilling realisation that we wanted a child had hit us both at exactly the same time. A month later, I was pregnant, and our scans showed a healthy baby boy rolling and swimming in my belly. Everything was good. I mean, yes, we were in the middle of a pandemic, but we were all in the middle of a pandemic. As the lockdowns ramped up, I switched my preference to a home birth, so the midwife came to see us in our living room, meaning my husband, Jeremy, could be present, listening to the heartbeat with me. He was also able to be present at the birth. The labour wasn’t easy, but so few mothers have an easy first birth. Go ahead and do your hypnobirthing courses and rent the inflatable birthing pool, by all means, but only a handful of women get that beautiful dawn at home, our favourite song playing as we breathe our baby out into warm water.
In the end I was induced, hooked up to a drip in the labour ward, and it took three days. I then didn’t sleep for a further three days but – again – is that really so unusual? What definitely was unusual was finding ourselves at A&E four days after the birth, about to meet the psychiatric team because I was feeling very, very wrong. I remember being in the kitchen, backing away from my son and Jeremy, overwhelmed with raw terror. I wasn’t scared of anything in particular, but my body was on fire with stomach-twisting jolts of intense fear. I realise now that a cloud of doom had been inching its way closer to me every hour since the birth, and that this was the moment it first enveloped me, violent and black. “It’s just baby blues,” said the doctor at A&E. I later saw this same doctor on my first night in the ward when I was refusing to take my dose of sertraline (because I’d already been given the antidepressant earlier in the day; I was a good patient, I promise). “Dr Tom!” I said as if he was an old friend from school who had suddenly appeared next to me at a cousin’s wedding. “Oh, yeah, hi Elizabeth.” He didn’t seem as pleased to see me. “I heard your situation had deteriorated.” Yeah, just a bit.
During that first trip to A&E, Dr Tom prescribed sleep and said he could give me medication to help me drift off, but didn’t want to because I was breastfeeding. Well, I was trying to breastfeed, but it was such early days, neither my son nor I had got the hang of it. I switched to formula a few days later, so we never did.
A midwife from the home birth team came with us to A&E and mentioned that there were mother and baby units (MBUs) for mental health issues after giving birth, but they were heavily oversubscribed. They only took the very worst cases. I think I knew, even then, that was where I wanted to be.
After that first trip to A&E, when we spent less than an hour with Dr Tom and there seemed to be no solution other than “keep an eye on it” and “get some sleep”, we tried several different avenues of help. We Googled perinatal mental health charities and called their helplines at 4am; I had phone appointments with my GP, announcing to him that I was suicidal as I pushed our son’s pram around the park; and I visited A&E again. And then again, and once more. Sometimes I was OK; the sickly cloud of doom lifted and I could see my life as it really was, that everything was all right, and I was safe. But that only lasted for a couple of hours. Jeremy and I became increasingly desperate. One of the hardest parts of the ordeal was that we didn’t know what was happening to me; trying to communicate my illness to different people was the least of it.
Some women who suffer from perinatal mental health issues have experienced similar illnesses before. But not me. No one saw this coming. I remember our booking appointment with the midwife when I was eight weeks pregnant. Over the course of an hour she ran through a checklist of health questions. Any allergies to medication? Did we have diabetes? Was there a history of heart disease in our families? I remember we briefly touched on mental health. “Depression runs in my family, but I’ve never needed any treatment,” I told her. “Great. I’m not worried about that,” she said, and ticked a box. I’d never heard anyone talk about postpartum anxiety or psychosis. And when postpartum depression was discussed, it always seemed like the chance of it actually happening was small.
We’ve all seen “the baby blues” depicted in films and on TV. A woman with milky vomit on her sweatshirt calls her mum and cries down the phone for a bit. Then she hangs up and eats some cake. How bad can that be, really? Let me know when they rename it “a complete dismantling of your reality in a way that makes you feel like you have been possessed by an evil being who wants to rip you apart from the inside out, ruin your life completely, make you seriously consider killing yourself and your child, and whispers in your ear that they’re never, ever going to leave”. Maybe then I’d have been worried.
I associated depression with sadness and lethargy, whereas my illness felt alive, growing, keeping me awake and on edge, desperate to run away. My severe postpartum anxiety began with that feeling of dread, although I knew there was nothing to fear. Everything was fine, I was safe. How funny that I felt nervous. How strange. Oh, well. It was a low hum in the background, an annoying gnat buzzing in my ear, but it got louder and louder. My appetite went completely. People would put my favourite food in front of me and I would try to eat but I couldn’t swallow. It was tasteless; it just sat in my mouth. Soon, insomnia was sliding into my bed. I lay awake, doom building, drenched in sweat, my body tingling with electricity. My heart would pound as I watched Jeremy gently drift off, the fear intensifying. If he wasn’t awake, then who would keep me safe? Because even though I knew this was my house, my room, my life, all the colour had drained away. I was in a horror film. I was definitely not safe any more. And the worst part? The person I was in danger from was me.
My friends and family tried their hardest to support me, but I increasingly began to feel as if I was a burden on everyone and they’d be better off without me. That included my son. I imagined that if I did die, they would be sad, sure, but would also say things like, “Ah, well, it is probably for the best.” I started imagining how I would do it, not quite making plans, but definitely weighing up my options. Then one day I nearly ran in front of a van, only stopping myself because I couldn’t bear to do that to another person.
* * *
It wasn’t until a month later that I was admitted to the MBU, after my fourth trip to A&E. That time I was driven to the hospital by a mother who had been through something similar; Jeremy was at home looking after the baby. She and I had met through a WhatsApp group, but until that morning we had never met in person. Throughout this experience I have been repeatedly overwhelmed by the kindness and compassion shown to me by other women. “People always say mental illnesses are like a broken leg. They’re nothing like a broken leg,” she grumbled, as she dropped me at the hospital doors and gave me a hug. Because of Covid, she wasn’t allowed in. “Tell them everything. That is what will activate the next level of care.” Everything, in this context, meant all the dark thoughts that were preoccupying me at an increasing rate.
On my first night on the ward, I thought about cutting off all my hair. Just get rid of it. Shave it. My hair that I had spent years growing. My curly hair that reached down to my waist. I loved my hair. I was my hair. But now it was just an annoyance, another thing I couldn’t deal with. The only problem was they’d taken my razors when I was admitted. And any cables I had. Any plastic bags. Did I have a dressing gown? No. Good, otherwise we’d take the belt. The problem with people taking away all the items that you might use to kill yourself is that it makes you think about killing yourself. I managed to hold on to my laptop charger and kept it hidden in a suitcase under my bed. One morning, about halfway through my stay when I was hit by a particularly intense wave of anxiety, Jeremy called the unit to tell them about my lethal contraband. I cackled about it later and called him a rat.
“Are you OK? The wait is horrible, isn’t it?” A woman with short brown hair, freckles and a baby strapped to her chest poked her head around my bedroom door. On arrival at the unit we all had to take a Covid test and couldn’t leave our rooms until it had come back negative. Or, I guessed, stay in our rooms for 14 days on our own with our babies if it was positive. I don’t know if that ever actually happened. I didn’t really want to ask.
Going into an MBU is horrific and surreal. It feels like prison, but one with 1970s drawings of teddy bears on the walls, well-worn high chairs and playmats covered in colourful toys that bleep nursery rhymes. And the kindest, sweetest, most patient staff who just want you to get better. But you are also not allowed out; someone checks on you every 15 minutes, 24 hours a day, and logs whatever you are doing. I have requested copies of my notes from the ward, although I imagine they will just say: “Elizabeth is lying on her bed”; “Elizabeth is lying on her bed”; “Elizabeth is in the toilet”; “Elizabeth is lying on her bed.” We were allowed our phones, although when you’re that ill, Instagram and work emails are of little comfort. We wore our own clothes and, as the weeks went on and summer turned to autumn, I started asking Jeremy to bring me different items from my wardrobe. He also took home all my pants and the baby’s clothes to wash, because I wasn’t capable of learning how to use the washing machines in the unit.
Sometimes it felt like a bizarre summer camp, but then you would be quickly reminded that, no, this is a psychiatric ward. We couldn’t go into each other’s rooms or touch each other’s babies. When – after a few weeks’ stay – we were allowed to wander around outside, we weren’t permitted to meet up with another patient. We were given our antidepressants every night in a little paper cup and they checked that we’d swallowed them. Just the fact that I needed to be there defied belief and was very upsetting. My son and I were sleeping every night in a building with seriously mentally ill people. And their babies. What if one of them was crazy? Oh, but wait, I was crazy, too. Idiot.
Inevitably, I fell in love with the other patients, and their babies. We ate all our meals together in the communal space, and sat at the doorways to each other’s rooms, chatting. Before lights out we slumped on the plastic sofas and compared symptoms. We became a strange family, holding each other when it all got too much; laughing when one of us said, “It’s a bit mad in here, isn’t it?” I remember once coming back from an afternoon out with my husband and baby to find one of the other mums surrounded by three hospital meals in metal trays. “I feel amazing!” she yelled. “I’ve got my appetite back!”
When one of us was showing signs of improvement, it was encouraging for all of us. Although we desperately wanted to get better at the same rate, we didn’t want anyone to be left behind. Before my baby was born, I was scared we would have to stay in hospital for a couple of nights without my husband. Now, my son and I were on our own together in a psych ward and, when I was admitted, I had been told I should expect to be there for at least four weeks. Thank God I was able to see Jeremy every day but, because of Covid, these meetings could only take place outside the ward. I wasn’t allowed to see anyone else.
My idea of psychiatric wards was shaped by what I’d seen in films and on TV; in real life there is a lot less drama and a lot more crying and talking about Drag Race. My son and I had an en suite bathroom. We ordered our meals for the day in the morning; then there might be a movement class, which we would sob through, or a lesson on meditation, or a workshop where you drew your tree of life with crayons, balancing your baby on your knee. There was a pretty courtyard filled with trees that I would walk around for hours while he slept on my chest.
At first, being left alone in a room with my newborn was the last thing I wanted, and although there were always brilliant staff to help you look after your child, it very much felt like being thrown in at the deep end. But, gradually, I realised that this was the magic of the MBU. You learn how to look after your baby, first with the constant help of the staff, as much as you need them. And then, bit by bit, they leave you to it, until you wake up one day and realise you’ve been doing all the childcare on your own. While there were a lot of people to thank for my recovery, it was my son who saved my life. He gave me focus, love and cuddles, and a reason to keep going every day. I now treasure that one-on-one time we had together in the ward.
Each patient’s recovery was hugely dependent on their cocktail of medication. Every week we had a meeting with the team at the unit to discuss our progress and whether our pills were helping us yet. A week before I was admitted, I had started taking sertraline. I began with 50mg and gradually went up to 150mg. I’m still on that dose today. In the second week of my stay, I told my beautiful Australian doctor, with her excellent trainer collection and smooth, tanned legs, that the sert wasn’t even touching the sides. I needed something else. “Well, it can take at least four weeks for it to make a difference.” I begged her: please. Help me. “We could try quetiapine. It boosts the effect of the sertraline.” Yes. Great.
After the meeting, my husband and I sat in the hospital’s Costa Coffee, at the same table where I’d stared at the ultrasound photos of my son after our 12-week scan, giddy and tearful with joy and relief. I was reading about quetiapine on my phone. “It’s an antipsychotic. They give it to people with schizophrenia,” I told him. I listed the gruesome side-effects and told him I didn’t want to take it. He told me I should give it a try. If it didn’t work, we could try something else. How long was this excruciating process of medication tweaking going to take? Would I ever get out? I took the quetiapine.
That night I dreamed about a cheeseburger. A soft, golden bun; melted cheese; rare, pink meat. Juices trickling down my chin. I had an entire dream just about eating a cheeseburger. I woke at 6am and was the first patient waiting by the counter when they opened the kitchen for breakfast. For the first time in six weeks I was hungry. I carried on taking the quetiapine. We gradually upped it from 50mg to 150mg.
Before my illness I never really took medication. I was wary of stimulants in general – no ibuprofen or paracetamol, no caffeine. I rarely got sick, and if I did I just braved it out. I didn’t drink alcohol, I didn’t do drugs. Now I take five pills a day, have tattoos on the veins I thought so much about cutting, and I did actually chop off all my hair. Although that was after I was discharged from the unit.
Not everyone on the ward came from the same white, middle-class background as me, and it was fascinating – and devastating – to see how the system treated us differently. I cannot make it clear enough that it was not the staff, but the system. Some women were in custody battles, others were suffering from illnesses that made them psychotic, and would try to take other women’s babies into their room because they mistook them for their own. Some women needed translators. Some were so young they were barely women. Others had no family or support in the UK. And the thing that struck me the most was the effect that the involvement of the law would have on a mother’s case: even more limits on their freedom, more assessments, longer stays. I’m not talking about weeks or months, I’m talking about years. I saw how easy it is for people to become trapped in the system. The way people treat you is what you become.
I was mostly terrified that, at the end of it, social services would deem me an unfit mother and take my baby away. The good news is that rarely happens. Social services do not want your baby, and fear of that shouldn’t hold anyone back from telling medical professionals what is really going on. You need to tell them everything. Complete honesty is the only way to be taken seriously.
* * *
Being released from a psychiatric ward is as strange as going into one. They don’t wait until you’re 100% better (will anyone ever be 100% better?). Instead, they discharge you when they know you can cope with being at home. And it’s gradual. At first, you visit your house for the afternoon, then a whole day, then overnight. After one of my overnights, I remember another mother on the ward telling me they’d overheard a nurse saying I would be getting out of the MBU soon. I wasn’t sure I was ready: I loved the MBU and wanted to stay there. They told me to try going home for the weekend.
When the day came, Jeremy picked us up. He’d packed the fridge with all my favourite food. I was so touched but also so scared that I wouldn’t be able to cope, that I would let him down. But the next morning I woke up and I was OK. I took my son out for a walk to a nearby market and realised the credits had rolled on the horror film. Suddenly the world looked like a Richard Curtis movie. I sobbed with relief. I knew that no matter how hard this parenting job would get, we would survive. We had made it through the darkness.
I remember the last day I was in the ward. I had gone back to pick up the rest of my belongings. The nurse who had admitted me was working that day and he helped me with my bags. There was no ceremony, no big display of emotion. He just carried my suitcase to the other side of the locked ward door and said goodbye. Later on, I realised I had left a T-shirt on my bed. I never went back to get it. I think, subconsciously, I wanted an excuse to visit. Like when you stay over at your crush’s house for the first time and leave something behind.
Since coming out of hospital, I have been working on a film about maternal mental health illnesses and the way they are depicted and treated in western society. With the right to abortion being overturned in America, it feels as if we are regressing to a place where women are yoked to the home; forced into being nothing but mothers, filled with shame and guilt, our insecurities capitalised on by the booming parenting industry. The idea that women must want to be mothers, and then must be glowing and thrilled with their babies, that they mustn’t complain or be unhappy with their new role, is still intricately woven into our culture. And that pressure creates shame that women swallow and pass on, and it is that shame that stops women from asking for the help they so desperately need.
This is an incredibly dangerous place for us to be. In the UK, 27% of new and expectant mothers experience perinatal mental illness. In the US, mental health conditions are the most common complications of pregnancy and childbirth, and suicide and overdose combined are the leading cause of death for new mothers in the first year. While women of colour are more likely to experience these conditions, they are also less likely to seek help.
I was lucky enough to receive world-class care. But in many countries perinatal mental illness goes unrecognised and untreated, leading to avoidable suffering for women and their families.
Someone asked me recently how Jeremy coped when we were in the ward. I remember him being so brave, solid, and constantly reassuring me that I was going to get better, that I was in the right place. But I’d never actually asked him how it was for him. He thought for a moment, then said: “The buildup to you going into hospital was so horrible that any relief from that – even what at the time felt like a huge, drastic and irreversible step – was massive. And as we soon discovered, the cliches about mental hospitals are completely unfounded.” But didn’t you feel like you were missing out on time with us? “No, I don’t remember feeling that. Knowing that you were being looked after was so comforting that there wasn’t room for any negative feelings about it. I don’t have a bad word to say about the whole experience.” Neither do I.
My son is now two and a half. He is so sweet and happy, and we are so lucky and in love. I am still on my medication and I’m not sure if I will ever go off it. People ask me if what happened makes us reluctant to have another baby. The answer is no, not at all. MBUs are very special places and I would be more than happy to stay in one again. But I don’t think I would need to. Nothing is as scary the second time round.
In the UK and Ireland, Samaritans can be contacted on 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
