Coping with psychosis. An unwelcomed start to parenthood.

Many mothers experiencing psychosis feel ashamed if they aren’t coping, fear something terrible is happening to their baby or feel overwhelmed with fear and find it difficult to trust others. This makes it common to want to conceal how you are feeling and to try and cope on your own. So, it’s important to know that with the right people you trust and supportive healthcare providers, it’s okay not to be okay right now.

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Hope and Healing in Postpartum Psychosis

Postpartum psychosis is an emergency and requires immediate inpatient psychiatric care, however, it is highly treatable. If you are coping with postpartum psychosis, I hope this post can provide you with some information about the diagnosis and somewhat normalise and de-stigmatise it. Most importantly, this article will share some of the lived experiences of other parents coping with psychosis and talk about some of the coping strategies and treatment options available. Psychosis does not diminish your ability to be a parent, live a life full of value and meaning or have the relationship you want with those you love most.  

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Understanding Psychosis

Psychosis broadly refers to a mental state in which someone loses contact with reality. The word comes from the Greek words psyche (mind) and osis (abnormal) (Khadivi & Kleiger, 2015). Symptoms include the following:

• Hallucinations: Sensory experiences that aren’t real such as seeing, hearing, or feeling things that aren’t there.
• ‍Delusions: Strongly held false beliefs and in the case of postpartum psychosis often relate to the baby. For instance, you may believe your breast milk is poisoned. ‍
• Disorganised thinking: Fragmented thoughts, difficulties focusing attention and trouble communicating clearly or organising your thoughts. ‍
• Unusual or bizarre behaviour: Doing things that are out of character or that seem odd to other people and unusual body movements and facial expressions.  

Postpartum psychosis can also be accompanied by intense emotions, such as anxiety, depression or agitation and by what are referred to as “negative symptoms” such as apathy, minimal or flat facial expressions and low motivation. It’s not unusual to be unaware that what you are experiencing is psychosis - it often takes a mental health professional who knows about postpartum psychosis to help you to identify it. While it is relatively uncommon, you are not alone— anywhere between about 300 to 600 other women in Australia face postpartum psychosis each year (Friedman, Reed & Ross, 2023). 

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How Psychosis Feels

Postpartum psychosis is a confusing and terrifying experience. Researchers have interviewed many different women and their families during recovery from an episode to better understand how it feels. Women and their partners say they quickly sense something is wrong after giving birth and recognise the early warning signs like severe sleep deprivation in retrospect (Stockley, 2018). Many of the women interviewed reflect on experiences of paranoia, disturbing thoughts and losing touch with, or feelings detached from, reality soon after giving birth. Several report a traumatic birth and the devastating feeling of being disconnected from the baby or having trouble caring for the baby.

“It was a horrible feeling. I felt like her milk was dirty and I used to forget. My memory went, I would forget everything…I was so paranoid of making the baby sick. I was paranoid about everything” (as cited in Forde, Peters & Wittkowski, 2020).

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Onset and Early Days

Postpartum psychosis comes on suddenly, usually within three to ten days after birth (Friedman, Reed, & Ross, 2023). In some cases, symptoms may appear even in the delivery room. When interviewed by researchers, one woman reflects on her experience:  

“I remember thinking when I had him, angels had been in the room, and I’m not a spiritual person… Not long afterwards, I started to tell people that I could speak to dead people” (as cited in Stockley, 2018).

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Causes and Duration

The exact cause of postpartum psychosis is unknown. It appears to be linked to an underlying biological vulnerability, stress, or trauma. For approximately 40% of women coping with it, it is their first-ever experience with mental illness. With immediate psychiatric care, intense symptoms can improve within two to 12 weeks (Friedman, Reed, & Ross, 2023).  However, there is an aftermath, other symptoms can linger, or more intense symptoms can re-emerge. This means recovery isn’t always straightforward:  

“I thought I’m out of the woods you know…and then actually the depression afterwards, the deep, deep depression afterwards, was just such a blow, such a double whammy” (a mother interviewed and cited in Forde, Peters & Wittkowski, 2020).  

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_{"Psychosis does not diminish your ability to be a parent..."}

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The Impact of Psychosis on Parenthood

Psychosis affects parenthood in many ways, with hospitalisation often being the first major challenge for you and your family. Treatment is either provided in a psychiatric mother-baby unit or a general adult psychiatric unit. Mothers and babies can stay together where a mother-baby unit is available.  

Mother-baby units are important for recovery, yet, in the NT, ACT and rural and remote areas in Australia, these units don’t exist resulting in a general adult psychiatric unit admission. The family unit experiences separation and an unexpected shift in roles can be overwhelming—one partner may suddenly become the primary caregiver while the other struggles with painful feelings of isolation.

Regardless of the type of hospital admission, psychosis can temporarily rob parents of time and a sense of connection with their baby, adding to the emotional burden. Feelings of guilt, loss, and shame can follow. As one mother shared in a research study:  

“All these feelings of guilt because you missed out, or not being there for your new baby, and guilty because you left your husband to deal with it all when it’s the first time for him as well” (as cited in Forde, Peters & Wittkowski, 2020).

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Emotional Toll

Postpartum psychosis can deeply affect how mothers see themselves. Forde, Peters & Wittkowski (2020) cited how this felt for one new parent:

“Your whole being, how you see yourself, the kind of person you are, and your whole sense of identity is completely devastated really because you will have behaved in ways that shock you completely.”  

Parents often worry about their baby’s well-being and feel inadequate. As another mother revealed:

“I really, really worried about the impact on [my baby] because I’d read about mums who have mental health problems affecting their kids. I worried about the genetic side of it. What did I not worry about?” (as cited in Forde, Peters & Wittkowski, 2020).

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Day-to-Day Challenges

Parents coping with psychosis face the usual pressures of caring for a newborn while also managing their symptoms. Negative symptoms like low motivation or fatigue, make daily tasks—changing nappies, feeding, or household chores—even harder. It’s okay not to be okay during this time, and seeking support is vital for any parent, let alone those carrying the sometimes-heavy symptoms associated with psychosis.

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Seeking Help: It's Okay Not to Be Okay

There are barriers to seeking help with stigma and societal biases being the most significant hurdles. Many women fear their children will be taken away or feel ashamed of not coping. Ariane Beeston, a mother who has experienced postpartum psychosis and author of Because I Am Not Myself, You See: A Memoir of Motherhood, Madness & Coming Back from the Brink, shared in her heart-rending memoir just how shameful it can feel when you are not coping. She describes finally getting her son settled into daycare and returning to work only to re-experience some of her delusions. She felt shame returning to her doctor and writes “This failure feels particularly shameful, perhaps because it is visible – so clearly on display.” (p. 167)

Trusting professionals at your most vulnerable is an act of courage. You may feel protective of your baby and unsure who to trust, making it vital to find a supportive professional. While facing psychosis as a parent is daunting, there are diverse treatment options and coping strategies. Recovery is not linear and requires a dynamic approach. Remember, it’s okay to not be okay as you navigate this journey.

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Recovery from Psychosis

Recovery from postpartum psychosis is more than just symptom relief—it requires adapting to a new way of living and parenting.

Treatment Options

1. Hospitalisation: Staying in a mother-baby unit is the best thing you can do for recovery, it allows you to bond with your baby, get the care you need and provides practical parenting support. Having your baby with you with the right support can be grounding and improve mental health. If a mother-baby unit is unavailable, seeking admission to a general unit it still incredibly valuable and can literally be life-saving. Speak with the psychiatrist and nurses about your baby, hospital leave arrangements, breastfeeding needs and visits from family.  ‍
2. Psychotherapy: Therapy helps you understand and adapt to the illness. It also improves self-awareness and can reduce paranoid thoughts. Researchers have found there are two different approaches people naturally take toward recovering from psychosis. They either do something called ‘sealing over’ which is essentially trying to move forward and ignore this ever happened or they integrate psychosis into their identity. Those who integrate recover better than those who try to avoid it (Jackson et al. 2019). ‍
3. Psychoeducation: Learning about postpartum psychosis from trusted sources or personal accounts can help you and your family understand the illness. (When you are ready and you feel you may be able to cope with a vivid account of psychosis, I recommend Because I’m Not Myself, You See: A Memoir of Motherhood, Madness & Coming Back from the Brink by Ariane Beeston). ‍
4. Medication: Psychiatrists specialising in perinatal mental health can tailor treatment plans for lactating and breastfeeding mothers. ‍
5. Support Groups: Peer support provides validation and shared experiences, making recovery less isolating.

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Coping Strategies

• Delegate Tasks: Allow others to help with chores and baby care. ‍
• Set Realistic Expectations: Avoid the pressure of perfection; a "good enough" approach to parenting is healthier. ‍
• Limit Social Media: Avoid comparing yourself to unrealistic portrayals of parenthood. ‍
• Basic Emotion Regulation Skills: Accumulate positives and do activities you enjoy with your family, build mastery, prioritise physical health, get a balanced diet and prioritise sleep – it is essential. It is uncanny how many parents report extreme difficulties with sleep as a warning sign for relapse. Stay active – walking every day as a family or with friends is a great way to achieve this.

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Building a Support Network

Having a strong support network is vital for both recovery and parenting. Caring relationships can offer emotional and practical support, easing the challenges of parenting while managing mental illness.

Building Your Network

• Friends and family: Involving trusted and supportive friends and family in aspects of your care will go miles in helping you to recover.  ‍
• Postpartum Doula or Peer Support Specialist: Provides guidance and emotional support during recovery. ‍
• Health Care Team: Keep regular appointments with your GP and work together with other services like psychiatry, psychology, physiotherapy, and dietetics ‍
• Parent Support Groups: Online and in-person groups offer a safe space to share experiences.‍
• Community Activities and Peer Support: Local activities and peer groups will help connect you to others with similar interests.

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Self-Care for Parents

Self-care is essential in managing symptoms, coping with parenthood, and preventing relapse. Self-care needs to be comprehensive. Consider ways you can look after yourself physically, emotionally and psychologically.

• Physical Health: Taking care of your physical health means making sure you treat physical illness, you wash regularly, your living situation is safe and stable, and you get enough sleep, eat healthy foods and exercise. It also means doing things your body responds to positively and gains benefits from such as having a cuddle, getting a massage, having a bubble bath, stretching, meditating, having sex etc.  ‍
• Emotional Health: Emotional health refers to an ability to understand your emotions and to manage and express them. Some ideas for emotional self-care include practising mindfulness and self-compassion, connecting with others, watching something funny or moving, engaging in a hobby, setting healthy boundaries, and practising gratitude.  ‍
• Mental Health: Psychological self-care is about actively protecting and nurturing your mental health. By developing self-awareness, setting boundaries, practising mindfulness, expressing emotions, and engaging in positive self-talk, you can build resilience, reduce stress, and promote better mental health. Some self-care practices in this domain include attending therapy, keeping a journal, taking time to self-reflect, reading self-help books, joining a support group etc.

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Moving Forward: Hope and Resilience

Many mothers who experience postpartum psychosis demonstrate something called post-traumatic growth. Posttraumatic growth occurs in the aftermath of trauma and it is when someone experiences positive changes in their life that they might not have otherwise experienced. These positive changes can include lifestyle changes, a stronger sense of self, new possibilities and perspectives, greater appreciation for life and improved relationships. At the end of her book, Because I am Not Myself You See: A Memoir of Motherhood, Madness and Coming Back from the Brink Ariane Beeston writes:  

“You will fall in love with life again. It will happen slowly and then, one day, you’ll be dancing with your little one in the lounge room, or swimming in the ocean or tasting coffee…and you’ll smile and know you are getting there. And you will get there. Let me hold that hope for you” - Ariane Beeston, [Because I'm Not Myself, You See: A Memoir of Motherhood, Madness and Coming Back From the Brink], (2024). 

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Conclusion

Recovery might feel overwhelming but is possible with the right support, treatment, and coping strategies. Building a strong support network and prioritizing self-care are essential steps in this journey. Remember, it’s okay not to be okay, and seeking help is a courageous and vital step toward healing. Despite the difficulties, it’s still possible to find joy in parenthood and grow stronger through the experience.