Five days in the psych ward for post-partum depression
by Adrienne Martini
Everyone has a secret rhythm, beating like a drum.
All of us have an albatross and this is the one...
I could hide it in the attic
I could bury it in static
I could only put it out in Japan.
I could tape my mouth closed,
I could take another dose,
I'm dancing as fast as I can.
This is what I do for a living.
—"This Is What I Do," Rhett Miller
None of the other drivers pumping gas at the Weigel's will look at me. Odd, considering that this particular convenience mart has seen some intense action because of its location on Summit Hill. You know your life has taken a surreal turn when you freak out folks who've seen some pretty strange behavior.
In my day-to-day world, I would have looked away from me as well. Picture it: crazy-haired woman sobs breathlessly as she pumps gas. Her bruised-looking eyes focus vacantly on some inner distance. It is raining, but she seems to not notice how wet she's getting. A poster child for mental stability she most definitely is not.
This was not supposed to happen and, at the same time, it was inevitable.
Discovering the absolute beginning is like playing pick-up sticks. Each object touches another. Isolation of the events is impossible. The landscape shifts with each move. And my hands have never been steady.
A short version of the story would read thus:
Two weeks previous, I had a baby and took to motherhood the same way a brick takes to water.
After Weigel's, I will spend the next five days on Tower Four, St. Mary's name for its Psychiatry Ward.
Important things will be discovered and should be shared.
Maddy, my daughter, is beautiful, thank you for asking.
Mom is, currently, as close to sane as she ever was, which may not be saying much.
While the last few months have been an Everest-sized ordeal, I wouldn't trade one second of it. Not even for a nap.
Some snapshots from Tower Four:
 From the window of my room you can see how Knoxville sinks into the valley. From the far left of this mountain bowl rises an Eastern European-esque apartment block that is eye-catching simply for its concrete ugliness. If I mash my forehead against the shatterproof glass, I can see the Fulton High School football fields. Gray drizzle hangs over it all. It is a magnificent, if gloomy, view.
The window's blinds are sandwiched between two panes of glass. There are no trash can liners. The showerhead attaches to the wall via a flexible tube. Plastic utensils only. The staff controls grooming items like razors and, oddly, conditioner. Every 15 minutes, your whereabouts are recorded. Yet, you are given sheets and a potentially lethal mechanical bed.
The TV is generally tuned to Great American Country; the radio to 107.7, which proves something I've long suspected—only the mentally unstable like commercial country.
The night and weekend staff is more fun than the regular day staff. Plus, the weekend crew doesn't wake you up at 5 a.m. to take your vital signs.
Trite observations are inescapable. A few members of the staff could easily be admitted as patients. The psych ward really is a lot like the movies make it out to be. Pieces are missing from all the jigsaw puzzles.
anhedonia n. The absence of pleasure or the ability to experience it.
Despite sounding like a nation ruled by Groucho Marx, anhedonia is one of the signifiers of depression (and for more symptoms, please see the sidebar). Anhedonia and hedonia have the same root, which is hedone, the Greek work for pleasure. Hedonia is a lot more fun.
In rough numbers, there are more than four million births per year in the United States. In 40-85 percent of them, the new mom will experience what is frequently called "baby blues." According to doctors Kathryn Leopold and Lauren Zoschnick, "Practitioners and patients often view [baby blues] as a 'normal' phenomenon. Nonetheless, patients and their families are distressed by the patients' depressed mood, irritability, anxiety, confusion, crying spells, and disturbances in sleep and appetite. These symptoms peak between postpartum days 3 and 5, and typically resolve spontaneously within 24 to 72 hours."
Post-partum psychosis resides on the far end of the post-partum mental health scale. PPP complicates a relatively tiny 0.1-0.2 percent of deliveries but tends to grab most of the headlines. Andrea Yates, the Houston mom who drowned her five kids, was probably suffering from psychosis. The hallucinations and/or delusions that are the staple of PPP "frequently focus on the infant dying or being divine or demonic."
Resting in between these two points is post-partum depression, which affects 10-15 percent of all deliveries. PPD is pretty much like garden variety depression—chock full of anhedonia, delusions, suicidal thoughts, changes in appetite and sleep, feelings of worthlessness and guilt (especially with regard to motherhood), and excessive anxiety, except with PPD the root cause is easily identified. In half of these cases, PPD is the first time a woman has ever experienced depression. What separates PPD from the baby blues is its duration; with PPD, the symptoms drag on for two weeks or more.
No one is certain what causes PPD. Certain factors seem to play a role, however. Previous episodes of depression or a family history of same up the risk factor, as do other stressors like a straining marriage, lack of other social supports, or substance abuse. PPD is a cross-cultural condition. It doesn't care how much money you make or how many years you spent in school.
I woke up this mornin' with the sundown shinin' in
I found my mind in a brown paper bag within.
I tripped on a cloud and fell eight miles high.
I tore my mind on a jagged sky.
I just dropped in to see what condition my condition was in.
—Mickey Newbury
By the morning of what would lead up to my stay on Tower 4, I had slept for a grand total of one hour (not all at once, mind you) during the last 72, despite the ingestion (also not all at once) of three prescription sleeping pills, some Tylenol PM, a Xanax left over from the time I flew to London, and a shot of cheap Scotch left over from my 30th birthday party.
I'd nod off for 10 minutes, then spend the rest of the night staring at the ceiling, letting my mind weave its weird little webs, until the baby or the spouse woke up. Somewhere during the first two sleep-shy weeks every new parent experiences, my circadian clock had sprung a gear. Life had become a permanent 4 a.m., that bleak hour when you know you should be sleeping like the proverbial baby, but feel compelled to greet the sun, since you have already made it this far.
Also in the last 72 hours, I had eaten one peanut butter sandwich. I was chalking up my lack of appetite to some biological hardwiring that helped new moms lose baby weight. But other signs indicated that all was not well. Even the most mundane of decisions had become impossible. I could not stop listening to Gillian Welch's Time (the Revelator) and would slowly sway to it, baby hugged to my chest while tears leaked. Snippets of other songs got stuck in my head—most notably a few lines from Willie Nelson's version of "Condition My Condition Was In" along with a line or two from a Broadway musical, and a commercial jingle, lyrics I can no longer remember—and they would endlessly repeat, drowning out that interior monologue that most adults run during their days.
Additionally, I was terrified to be alone with the baby—not because I feared harming her (and the saving grace of all of this is that my dark thoughts were always self-directed), but because I felt so very helpless and inept. Once my husband had to return to work, my days became grim affairs. My goal, unstated until much later, was that we both be alive when he got home. Joy of motherhood, indeed.
While those last three sleepless, foodless days would finally make me seek help, there were signs that all was not well leading up to them. The crying jags that I chalked up to baby blues were becoming longer and more intense. My moods cycled from elation to despair fairly rapidly, until they eventually got stuck on despair. And there was a nagging, hard-to-put-a-finger on feeling that this just wasn't normal. But not having had a baby before, who was I to say?
When my husband woke up on the morning in question, two weeks into my motherhood, he looked at me and asked if I'd like his mom to come back down. I said yes. Later, I would learn that he asked because something scared him. When pressed, he describes my expression as "vacant."
In the shower, thoughts haunted me like restless ghosts: blood mixing with the shower water and pinkly dripping from my fingertips; the cool metal kiss of a gun's muzzle on my vulnerable temple; the crush of trying to breathe air that tastes too thin. All of this added up to the inescapable truth that a large part of what makes me me had died, and the shell could not continue along its present path. Fortunately, the gap between dreaming and acting is a wide one—otherwise the world would be full of more adulterers and novelists.
It's hard to be this naked in front of public eyes. To mention any of this is to expose a weakness. I have never had any patience for weakness, especially my own, and I am ashamed. Yet I do this for a variety of reasons: to explain what comes next, to implore anyone having similar thoughts to get help now, to prove that it is possible to come back from such a dark ride. You don't have to be where you are, even though that first step feels mountain-sized.
After the shower, I placed yet another call to my OB/GYN's office, who I'm sure was growing tired of my daily (and, occasionally, middle-of-the nightly) post-partum phone calls.
"I'm still not sleeping," I told one of her nurses. Then I added, as if discussing the weather, "Someone else needs to raise this baby. I just can't do it."
"Where will you be?" she asked.
"I'll be gone." I started to cry, then, and wouldn't stop for the next three days.
There is a world inside the world that you see
And it's OK to count the minutes, 'cos how many could there be?
And if love is all around us,
How could this have found us?
And the move you know is don't let go of me.
—"World Inside the World," Rhett Miller
I spend too much time probing the insides of my own head, a move akin to Neanderthal man poking with a stick at beached jellyfish. Amusing to the poker, perhaps, but not so much to the pokee—and deadly dull to anyone who is unfortunate enough to watch the whole exercise.
I don't want to write what should come next, which should be a set piece about what life is like on Tower 4. Other things offer so much distraction; for instance, I managed to waste a solid 10 minutes coming up with the above analogy. Think of the work I could have done had I invested another 10 minutes in it. The Pulitzer committee would have been dazzled.
Rather than force it, here, in brief, is what led up to my commitment: After my call to the OB/GYN's office, the nurse practitioner puts me on hold, then comes back and tells me to go with all reasonable haste to the emergency room. I call my husband. Rather than take him up on his offer to come home, I decide to take the babe down to his place of employment, the Bijou Theatre, where the burden of watching her could be spread among many. He agrees. I pack up our baby for our first solo car trip. I load her in the car without incident. She sleeps through the whole journey. I cry the whole way, drawing at least one curious glance from a fellow motorist. I arrive at the Bijou and notice there is virtually no gas left in my car. I hand the baby to the husband, who volunteers to come along. I decline, insisting that he stay with his child.
I drive to Weigel's, where the opening vignette occurs. I drive to St. Mary's. I walk into the ER, where I am crying so hard—mostly from relief at having gotten there and handing over control of my pathetic little life to someone else—that I can't tell the woman at the admitting desk why I am there. I fumble out my driver's license and insurance card and sort of fling them at her. She connects the dots.
I wait in an exam room, where I am visited by a doctor who looks surprisingly like Spaulding Gray. I am asked a series of questions that I answer in such a way that they decide that I am a suicide risk and post a guard. I am visited by the basketball-playing nun, who offers me coffee and gives me a pillow. I am visited by two wonderful doulas (a doula attends a baby's birth and is there to "mother the mother," as they put it) who had been called by the doula who attended my daughter's birth. I don't know either of them, yet they offer more moral support than I deserve.
After a few hours in the ER, I am whisked up to a standard hospital room, where I am to wait until a bed opens up on Tower 4. The conditions for my placement require that someone stay with me every moment until I move to the psych ward. One of the doulas and a few wonderful friends stitch together a chain of bodies to watch over me.
Just over 24 hours later, I am taken to Tower 4.
I don't really know what I'm doing
Just watchin' myself in some play
And the actress looks like she wants to go home
And lie in a big bed all day.
—"Chief," Patty Griffin
Describing the sensory assault of the psych floor is difficult, even for those in complete command of all of their faculties. So, then, imagine all of this happening at once: a woman paces around the perimeter of the nurses' station, muttering under her breath; the hands of another patient snake into your hair and start to braid it; the one person who makes you feel slightly OK is forced to leave because visiting hours are over; a dead-eyed woman wants to ask you questions; your bags are taken and searched and, save for a few chemically-induced hours the night previous, you are exhausted. Oh, and you cry almost constantly.
Before we go further, let me make note of one important thing. While I did not believe it at the time, Tower 4 was exactly where I needed to be. It is one of the safest places, physically and emotionally, I have ever been. My stay is both something I'm glad to have had and something I never want to do again. Everyone, mentally healthy or no, could benefit from spending some time up there.
That said, it is also an area of any hospital that is full of absurdities, most of which you fail to appreciate until you start to get your head back together. And by highlighting just a few of them, I'm not intending to whine. I'm merely trying to draw as complete a picture as possible. Except for the upcoming bit about one of the social workers who told me I could be cured if I accepted Christ. A certain level of hell is reserved for those who proselytize to those over whom they have power.
So, the first night.
It turns out the dead-eyed woman with questions was also one of the staff. We went back to the arts and crafts room, where she proceeded to pepper me with questions along the lines of "What year is it?" She speaks in a monotone the whole time. I do, however, make her smirk once. Somewhere in the L.L. Bean Christmas catalog-sized stack of forms we fill out is the command: write a complete sentence. On the blank underneath, I write "This is a complete sentence." Rather than bask in my cleverness, I cry.
After completing this batch of paperwork—and I continue to be amazed by how many trees must die for each patient—I am handed off to another woman, the one who explained to me that I was too smart for my own good and should seek out Christ.
If I could have left, I would have. And that is the rub of Tower 4: You are no longer in control of your hospital stay. Other people, some of whom also seem to be of questionable sanity, control your comings and goings. Even someone who is generally not very paranoid, like, say, me, finds herself second-guessing everything she says. After a few days, your speech becomes littered with hesitations, moments where you rethink every last word and scan it for any possible misinterpretations. If you weren't already slightly mad, this would pack you up and drive you to its doors.
We finish the forms. And I'm handed back over to the first woman for a tour. Tower 4 is shaped like a racing oval, with a big glassed-in nurses' station in the center and patient rooms, activities rooms, phones, and a few offices around the perimeter. Eighteen laps around the floor measures out to be a mile.
There are 24 patient beds, two to a room. Women outnumber men by about two to one. Anonymity is prized on the floor. Patients are given a code number and no incoming calls nor visitors will be allowed unless the other person has this code. The staff will neither confirm nor deny the presence of anyone asked for by name. On some levels, this is comforting. No one need know of this unless I tell them. But it's double-edged: keeping this a secret makes it shameful, and there is already enough shame attached to depression. However, without this promise, some who desperately need help wouldn't take this first step to get it. And so the sword cuts again.
In each room are two dressers, a mirror, at least one comfy chair, and a corkboard on which flyers about how not to fall down are tacked. In most ways, these look like traditional hospital rooms. What's striking is what's missing, like IV stands and all the other clutter that crowds the room of a physically sick person. The mentally ill person's room looks like a cheap European motel room, save that the bed is higher tech and it has a private bathroom. Plus, everyone walks around in street clothes, rather than hospital garb.
My bags, which have been thoroughly searched (so thoroughly, in fact, that they confiscate some aspirin that have been in there since my senior year in high school), catch up with me. In the TV room, I meet my roommate, who terrifies me, and a few of the other patients, who also terrify me. It's hard to pinpoint exactly where this terror springs from; perhaps it is simply because they are overtly friendly and I'm trying to remain aloof. My fear is not a response to them so much as it is a response to this place. I don't belong here. I don't want to be here. I want to go home. And go back to my life before all of this happened.
We finish the tour. I wander back to my room, where I hide, balled up on the bed, crying, until it is time for group.
Group therapy on Tower 4 is a remarkably non-linear affair. Of the two dozen people on the floor, most of them are suffering from a disorder of mood rather than one of thought. The other folk—those with disorders of thought—make this nightly exercise full of sudden diversions, roundabout progress, and the occasional low-hanging tree. During evening group, each patient is expected to discuss how he or she spent his or her day, illuminating whether or not the goals set at morning group had been achieved. Not being there for the morning group, I only had to introduce myself and explain briefly why I was there; but only if I felt comfortable doing so.
Perhaps one of the most refreshing things about Tower 4 is that very little is mandatory. Share if you feel comfortable. Get out of bed each day. Eat when you can. Have your vitals taken twice daily. And attend the day's groups, which can range from recreational therapy (better mental health through leisure activities) to mindfulness (better mental health through meditation) to drug information (better mental health through chemistry).
Behavior that would attract scorn in the outside world isn't even remarked upon during groups on the psych floor. Polite fictions abound. A woman, wrapped in a hospital blanket, dips in and out of consciousness. Another moans for 45 minutes, then wanders off. Whenever the conversation really gets rolling, someone never fails to veer us back into nonsense-land. The group leader, God bless him, presses on despite the distractions. My sobbing throughout the evening group session is ignored, more or less, except for one fellow depressive who mentions that she had the same thing happen when she had her son a few years ago. It is a small connection, but enough to offer comfort.
Sleep doesn't come that night. I flop around for a bit on the mechanical bed, then shuffle down to the nurses' station where they dispense meds through a small sliding glass window. They give me two Ambien. A few years ago, the option of pharmaceuticals on demand could have been a fun little experiment. Now, I'm just ashamed that I'm a failure at something so simple as sleeping.
I think we're all pretty crazy on this bus. I'm not sure I know anyone who's got all the dots on his or her dice. But once an old woman at my church said the secret is that God loves us exactly the way we are and that he loves us too much to let us stay like this, and I'm just trying to trust that.
—Ann Lamott, Operating Instructions
The next morning I am neither bright-eyed nor bushy-tailed. After an invigorating breakfast during which one of the disorder-of-thought patients bolts her oatmeal so fast she chokes, then pukes, I go to group. Halfway through, after I've set the goals of attending all of the days groups and writing a bit, I'm pulled out by my psychiatrist. "I don't belong here," I tell him. "I really just need some sleep." The irony is that I'm still sobbing as I try to convince him of my robust mental health.
"You do," he says, then goes on to explain in great detail that he won't keep me here one minute longer than absolutely necessary, that psych floor beds are in great demand, and that he wouldn't waste one on someone who didn't need to be there. He continues, but I've already started insisting that I'm just fine, thanks, now let me out of here. And he again says no.
We repeat this little exercise every morning of my confinement save the last, when I finally admit that I might have a bit of a problem re: the whole mood stability issue and probably do belong on Tower 4. That day, I was released.
But I am getting ahead of myself.
The days were filled with groups, visits from the hubby and child, reading, writing, interviews (of me, not by me) with social workers and nursing staff, medication, and groups. To break it down further:
Reading and writing are the best ways to fill the free time that floats around the psych ward like a mugger looking for a victim. Free time can lead to too much thinking; not that thinking is bad, per se, but too much of it is a lousy thing when you're already clinically blue. When reading and writing fail to sufficiently distract, I head to the common room to do jigsaw puzzles. Another patient and I become rather obsessive and complete quite a few nature scenes (save for the missing pieces) before I'm discharged.
The medication comes with a matching set of mental baggage. I hate it. Over the years, various licensed professionals have tried to soften the ego blow of antidepressants. "It's just like a diabetic taking insulin," they placate. I don't care. Despite all of our warm and fuzzy talk about how depression is a physical disease cause by a chemical imbalance, it still has a big stinking stigma attached to it. If I could just mass my will behind it and decide to be happy, I wouldn't have to lean on a chemical crutch. Because I can't, I take my drugs like a good little girl. They help, damnit. While they aren't happy pills that make your heart sing, they do make everything just a little bit easier.
The bite, however, is that most anti-depressants can take two weeks to make a difference and most doctors want to see that they've at least started to work before you are released. I can't exactly put my finger on when I started to feel better. My second night on the floor, I slept soundly without any medical help. Twenty-four hours into my stay I could get through complete sentences without sobbing. No one moment marked the turning point.
The interviews are used both to help the staff get to know you and to help you get to know you. Questions range from those about your family history to your future plans. After describing the hillbilly gothic patchwork of suicides, manic depression, bi-polar disorders, and drunks that is my mother's family and the notable suicide attempt on my father's side, coupled with my own undiagnosed-but-likely depressed teen years that included some not fun years of living with my own depressed mom, one social worker comments that it is a wonder I haven't been there before.
Visits with the spouse and baby are both too brief and too long—and still painful to talk about. Seeing my husband is wonderful. Seeing my daughter is not. Here is this crying, cranky thing who has ruined my carefully constructed life. Here is something that grew inside of me yet feels like an alien. At the same time, I have never seen anything more beautiful, which makes it seem impossible that she has come from me. All I can say is that, now, I love her so much it is impossible to quantify.
The groups, if nothing else, provide a benchmark for what crazy truly is. But the groups offer more than that. No one can better understand where your head's at than someone who has been there. No matter how down you may be, your words can still offer succor to someone further down than you. Listening to other people, no matter how nuts they appear, is worthwhile. It sounds like the group therapy experience should be made into a feel-good movie with Robin Williams, but that doesn't make it any less true. And it is one of the things that helped the most.
And every day is gettin' straighter.
Time's a revelator.
The revelator.
—"Time (the Revelator)," Gillian Welch
And so, five days later, I was released. The first few days out were shaky, at best. Despite my keenings to get off of Tower 4, I wanted to go back, back where I was safe and little was expected of me. Now I had to be someone's mom and I had no idea how to accomplish that. The models of mothering I had—from Roseanne Barr to my own mom—were inadequate. Birth turned out to be the easiest part.
The only way I got through those first three months was to focus, laser-like, on each individual day, rarely planning future events or weighing the past. Sometimes, time passed second by second. Good days passed hour by hour. Additionally, I found help. A doula cared for both the baby and me three afternoons a week. Family drove hours to lend a hand. Things slowly became easier, and the panic and guilt and shame loosened their grip enough for me to breathe. I came back to work part-time and found a wonderful day care. I wish I could point to a magic cure, a balm that made it all better. There isn't one. The only way through is to keep moving forward.
There are no happily-ever-afters in real life. Most of the time, things move swimmingly. Yet there are still moments when it's all just too much, when I'm so overwhelmed and convinced that I will be a lousy mom, I can't do anything but cry. They pass. Maddy gets bigger. I get stronger. I don't know that I'll ever be "well," but then, I know few people who are. Onward we go.
November 7, 2002 * Vol. 12, No. 25
© 2002 Metro Pulse
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