Iatrogenesis

Iatrogenesis

I know I’m not the only one who dreads a visit to the doctors. I generally dislike GP surgeries, although I’m not phobic of them in the way I am of hospitals, but it isn’t the sitting in an overly-warm badly decorated waiting room surrounded by sick people, or even the mind boggling rudeness of the average receptionist that fills me with dread. It’s the fact that I always, always end up feeling worse upon leaving than when I went in.

I’ve been consulting my GP (ha! Actually many because it is a group practice and I have never successfully managed to book successive appointments with the same doctor), primarily about the significant weight loss I’ve undergone over the last year. I am now underweight by some margin and look and feel like death. I’ve had a bunch of blood tests to rule out anything nefarious and thankfully, my body doesn’t seem to be the cause: I had been worried that my thyroid had been playing up again. I stepped on the scales again and my weight was the same it had been four weeks ago – that it hasn’t gone down further is a reassuring sign.

While that is a relief, it also means that my weight loss is tied to either my anxiety, or breastfeeding, or most likely both. I have been calorie tracking and I do eat ‘enough’, but probably not enough if we factor in lactation and the high metabolism that comes with anxiety. 

I have been receiving CBT with an aim to challenging the anxiety and OCD since June. I will probably only have one or maybe two more sessions. My PHQ9 and GAD7 scores show that I haven’t made significant progress, and while the tools I have been learning (or rather relearning as I’m no stranger to CBT) are useful,  they haven’t made a big difference yet. So I ask my doctor, what can we put in place for when these sessions end? 

His response was firstly to explain CBT and anxiety to me like I didn’t understand what I had been experiencing, and then summed up by saying that I had to wait until I had a crisis and then request further therapy. I pointed out that I have two very young children and that I was not willing to let myself get to that point, especially keeping in mind it had been a six month wait to get this lot of therapy even though I was supposedly a high priority patient. 

‘Hmm’

I sigh and bite the bullet – does he think it would be sensible for me to perhaps restart on an SSRI? I had not taken any since being pregnant with my second child, but now she is well over a year old I have less misgivings about potential effects on her. Oh yes! That’s a good idea (it was by this point clear he’d not actually looked at my notes at all, and knew nothing of my long history with mental illness or even if I was taking medication). He then tried to put me on a different SSRI than the one I had taken successfully before but I managed to persuade him to stick to the old drug as I know I have almost no side effects on it after the initial few weeks. 

When I ask for a note to send off to the DWP to make sure my ESA payments continue for the next four weeks, he pouts, and doesn’t look me in the eye for the rest of the appointment. He requests I book another appointment in four weeks to assess the SSRI dosage. He doesn’t say goodbye as I leave the room.

At no point did he attempt to make any kind of human contact. No, how are you? How are you finding it? What are your worries? How are your kids? A prescription and an instruction to call the crisis helpline if I relapse further once my therapy is cut off. 

I left the surgery feeling like the biggest pile of shit. I was more convinced than ever that I was somehow going to have to fix myself because no medical professional (therapists not included) I have seen has seemed remotely interested in my actually getting better – they just want me out of their hair. It’s like they know it’s hard, that it’s outside of their comfort zone, so they don’t even extend the courtesy of trying. Take the pills and bother the non-existent MH team. This can’t be because they don’t care. I think they are probably good people. But because they know there’s fuck all they can do they just put a barrier up to protect themselves. 

But it left me feeling entirely worthless. Like I was totally on my own. I’ll take the meds but I know from before they just leave me pretty vacant – they don’t alter my thought patterns or anxiety symptoms. If I’m hung out to dry with no access to further therapy I am really scared about how I’m going to get through the winter.

This isn’t a competition…?

This isn’t a competition…?

It’s been a difficult few days. Not in the grand scheme of things, there’s no war, famine or pestilence, but certainly they could have been better.

Firstly my eldest has been ill. Only a cold, but it’s knocked her little socks off and given her a high fever and made her very out of sorts. Three days in and the baby is also snotty and miserable. None of us have had very much sleep. Apart from their dad that is, who can sleep through anything and has been happily snoring away in the other room while I deal with two snotty, radiating and squirmy babes.

Secondly my dad, who I’m very close to, got some bad news from the DWP. They’ve cut his welfare payment by £100 a month, despite him having COPD and mental health problems. So as a family we’ve had to do a lot of consoling/problem solving/reassuring to try to figure out how we can ensure he has enough to eat and a roof over his head. Fuck you DWP.

Thirdly, my partner and I have started couples counselling and as expected, it’s brought a lot of stuff to the surface that has been bubbling away. My constant stream of intrusive thoughts now have additional ones that seem harder to dismiss: “Are we going to get through this?”, “Are all our problems my fault?”, “God, he’s such a bastard” etc (spoiler alert: he’s really not a bastard at all).

My tentative steps towards adequate self care measures (eating/sleeping/doing stuff for me) have gone out of the window and I’ve been navigating the last few days through a fug of extreme tiredness and malnourished hyper-awareness and anxiety. Those sound like they should be mutually exclusive states but trust me, they ain’t.

Today when I was walking my girls back from feeding the ducks, my eldest (who is finally on the mend) was dragging her feet and insisting she take her coat off. I was thinking about money problems and how pathetic it is that my partner and I can never talk about the subject properly. I could feel my temper rising and I tried to cajole my daughter gently through gritted teeth, but I was aware I wasn’t being as calm and understanding as I should have been. I had the thought that my kids would be better off if I just handed them over to my partner. Then they went something like this:

“They’d be much happier with him, he’s very calm and patient and better with them than I am.”

“And then he’d see what it’s really like having to deal with two under threes twenty-four seven”

“No he wouldn’t: he’d go back to his mum’s and make sure he had his family around to help. He’d get off Scott free.”

“Plus, that’s what he wants anyway. He’d give anything for it to just be him and the girls. He never wanted to be the breadwinner and he resents me being the one at home. That would be letting him win.”

What. The. Actual?

Letting him win?! Is this a competition? Is that actually how I feel? That somehow I’m being unsupported because I’m being set up to fail? Could that possibly be true or is this just the ravings of a mind existing off two hours sleep in forty eight hours and half a packet of fig rolls? 

It’s certainly given me something to take to therapy next week anyhow…

Panic and parenting

Panic and parenting

I thought I’d share a small example of how it can be hard to be a parent while battling a mental health condition that means you see danger everywhere and feel paralysed by the sense of responsibility for keeping everyone safe.

I’m still working through this particular issue as it’s still fresh so I apologise if this post is a little rambling. And it’s by no means serious in the grand scheme of things: I’ve no doubt there are parents who struggle with far more serious battles on the day to day. All respect to them.

I am terrified of contagious illness, particularly sickness bugs or food poisoning. (Weirdly no issue with bloodborn illness, in fact I used to volunteer with people who were HIV+, and that didn’t freak me out at all). I am particularly frightened of my children getting sick. I know, rationally, that kids get sick, and most of the time, no real harm is done and their immune system is even strengthened as a result. But I cannot stand the thought of it. 

I had to fight against my fear to enroll my eldest at a nursery. I know it’s likely that she’ll pick something up from it, but that the risk is far outweighed by the positives she gets from her time there, the way it bolsters her socialisation and education. She’s been attending a couple of days a week for just over a year, and so far picked up nothing more serious than a nasty cold or cough. But every time I drop her off I feel a sense of dread. 

This morning, while dropping her off, I overheard the nursery manager complaining that she had a few staff members off sick with a sickness bug. A fellow parent piped up that his daughter had been violently sick all day Saturday. He’d brought her to nursery regardless. It was all I could do not to grab my daughter and pull her straight out of there and bring her home. Perhaps I should have.

For the last three hours I’ve been sitting and ruminating and catastrophising. Should I go collect my daughter early? Am I irresponsible for leaving her there? If she gets sick, will this be my fault? What if we all get sick? My partner has an essay due this week, if he gets sick and isn’t able to hand it in that will be my fault. We have couples counselling booked and have waiting months for the appointment, if we miss it because we are sick I don’t know if we’ll be able to get another and we will break up and it’ll be my fault… etc etc.

There’s a danger that I will stay in a het-up state of high anxiety over this for days. Possibly weeks. I’m frightened that I will stop eating and avoid leaving the house as a result. And if we do get sick – well I just don’t know how I’ll cope. It was a bout of food poisoning that caused my mental health to relapse back in January and I’m only now starting to get ever so slightly back on track.

I’m writing this down in part to get it out of my head – and by reading it back can see that some of my thinking is twisted. But I also wanted to share it because, as parents and responsible adults, we don’t talk about things like this, the little fears, the creeping insidious doubts, that can threaten to derail you if you’re already vulnerable.

I know I can’t keep myself and my kids wrapped in cotton wool – that my own anxiety limits my own life and enjoyment significantly and I fight so hard to try to limit its impact on my kids. It’s getting harder as they get older, but ultimately they are the spur for me to keep going and continue to challenge myself. I refuse to have this fuck them up too.  

Back to basics 

Back to basics 

Yesterday I wrote about how the last couple of months have been pretty grim. I’ve been functioning day to day, but barely, and have found myself plagued by intrusive thoughts and occasional ‘suicidal ideation’ as the shrinks would call it. Scary stuff when you’re a stay at home mum to two small children.

But, oddly, the return of such terrifying thoughts has been enough of a kick up the arse to get me to take my mental health seriously again. So today I’m going to share a few of the ways I’ve gone back to basics with self care and it seems to be (s…l…o…w…l…y) helping to lift the cloud.

  1. I visited my GP. I didn’t tell him about my suicidal thoughts. This was probably a mistake, but I didn’t feel strong enough (I’d never met him before for one thing). I have a therapist I see regularly who is aware of them, so I’m not trying to deal with them alone. Instead I talked to him about the physical symptoms I’m experiencing. My weight has plummeted leaving me with an ‘underweight’ BMI for the first time in my life, and while I do struggle to eat in a balanced way, I don’t feel the weight loss is warranted. I’ve previously had thyroid problems, which can cause mental health symptoms like anxiety. Malnutrition, more specifically certain mineral and vitamin deficiencies, can also completely mess with your mind. So I wanted to be sure that I wasn’t trying to battle my mental health alone when actually, there might be a physical cause and hopefully, solution. I’ve a blood test booked and should know more in a week or two.
  2. I let people in. When I feel really low I just want to hide. I feel ashamed of my feelings, and don’t want comforting or sympathy. But that just compounds the problem, and drives me further into my own head. So I’ve made a considered effort to accept invitations and reconnect with friends and family. Small things like a long walk and trip to the pub with my dad, a visit from my godmother, a play date with my best friend and her children. And I’ve talked about how I’m feeling, and received kind words and advice (useful or otherwise, it was well meant). And I’ve listened to how they are, and connected with something outside of myself.
  3. Planned my days. This is so important for me, especially on those days where my eldest isn’t at nursery and I’m alone with the kids all day (my partner works 12 hour shifts and leaves before the girls are up and gets home after they’re in bed). I write down a schedule for the next day each evening. I don’t have times, just an order of play. I stick it to the kitchen cupboard and me and my eldest discuss it over dinner, and I take ideas from her (would she like to do some painting? Baking? Exploring?). Then the next day I know where I am and so does she. It helps me to avoid getting stuck in a mind-trap of ‘Oh my god there’s so much to do I don’t know where to start’ which so often leads me to feel useless and overwhelmed. And avoids her being stuck in front of the TV for hours because she knows that there are other fun activities planned.
  4. Simplify my culinary expectations. As you’ll know if you’ve read my blog previously, I have a particularly shitty phobia (cibophobia) which makes cooking and eating really stressful and difficult. I know I’ve got to eat, I really want to eat, and I really enjoy cooking when I’m well. But when I’m unwell, like now, I invariably freak out while cooking and more often than not don’t end up eating what I’ve prepared. This is costly and depressing. I realised that far too often I expect too much of myself and decide that I will try to cook like I used to (complicated recipes with lots of ingredients). This leaves me wide open to being blindsided by insidious doubts. So I found a few cookery books with bare-bones recipes, using very few ingredients (sometimes as few as three!) and have been cooking exclusively from these.   It’s really made a difference and the food has been surprisingly delicious! And I’ve tried to keep my fridge full of good snacking food I can grab when I notice my blood sugar dipping.
  5. I claimed my benefits entitlements. Money is very tight. My partner works 30plus hours a week, and has just begun a higher education course in the hopes of progressing his career. I was feeling intense pressure to find work (I was made redundant just before the birth of my second daughter) although I’d no idea where I could find local work that paid enough to offset childcare costs. I was so exhausted (am exhausted) and just couldn’t imagine having the energy to work on top of everything else I’m doing (or failing to do) right now. My therapist told me straight: ‘You are ill, you shouldn’t be trying to find a job right now, you should be convalescing’. So I bit the bullet and put in a claim for ESA. Hopefully it will start coming through in a few weeks and just take a bit of the pressure off while I continue to focus on getting on a more even keel.

Just writing this post this morning has helped to remind me to keep all this up, that such simple steps have made a big difference almost overnight. I still feel like crap – but slightly more hopeful crap.

It’s been a while

It’s been a while

I’m not entirely sure where the last couple of months have gone.

I’ve made it through day to day, certainly. Managed to make therapy appointments, pick up my daughter from nursery, take the baby for check ups, the odd driving lesson, even to make it through a five hour long hairdressers session for a radical cut and colour (short and pink!). But I’ve skipped meals, thought dark thoughts, mentally planned escapes, forgotten conversations and even missed the wedding of a dear friend because I’ve been, well, ill is the only way I can describe. Ill or mad. Take your pick.

One positive to the weeks of fairly relentless shittiness has been that I am now more clear in my mind about what my triggers are. I imagine that they are not uncommon; I have to remind myself that even the most mentally robust would begin to unravel under their pressure. 

  • If my sleep is more disrupted than usual (and my youngest still wakes less than four times a night).
  • If I skip a meal. Just three or four hours without anything to eat is enough for my mood to crash and my anxiety rise.
  • If I spend a day inside. My mood lifts as soon as I step outside the house even if there’s freezing drizzle.
  • If I get trapped on the internet.
  • If I don’t take the time in talking to those closest to me, especially my partner.
  • If I don’t have a plan.

There have been days over the last few weeks where I have been so exhausted, so utterly ashamed of myself and what I perceive as my inability to be the kind of parent and partner I think I should be, so despondent about the future and the world that I have considered walking into traffic. For those moments (and thankfully they have only been moments) I am convinced that my no longer existing would be the best thing in the circumstances. Surely my daughters deserve better than I can give them? Aren’t they young enough that by removing myself it might mitigate any damage I must have caused them? Writing this down I can see just how horrible this way of thinking is. How defeatist. How completely nonsensical it is. But on the plus side – having these thoughts pop up has frightened me into taking my mental health more seriously again. Self care is an absolute necessity – I WANT to be around for my girls and I WANT the chance to do better. That requires me putting myself first for a change.

I’ve decided to go back to basics. I’d been trying to run before I could walk and every time I stumbled I felt more and more crushed. 

Tomorrow I’ll outline how I’ve paired down my day to day life in order to actually achieve more. I hope that maybe other people might find it useful. It’s still very much early days, a work in progress, but the experiment seems to be working. And now I’m off for an afternoon nap.

A rambling note to self 

A rambling note to self 

I am pissed off because I’m tired.I’m tired because I have been ‘working’ – either managing a household, caring for one or more children, actually working a job, or all of the above, every day for the last three plus years. I have not slept for longer than four hours in that same period. 

This makes me feel resentful. Resentful when my partner goes away for days on end, makes his own schedule, books himself a massage, takes a nap…

I’m told I should put myself first. I should take rather than wait to be given. But I am hamstrung. Hamstrung by poverty and economic dependence. Hamstrung by anxiety that makes me feel I have to constantly be in control to mitigate against risk I see everywhere. Hamstrung by depression which tells me I’m not worthy of the things I want or feel I need. Hamstrung by my beautiful children who cling to my body and demand it’s presence twenty four hours a day. Hamstrung by the bullshit Disneyfied  notion of romantic love that tells me that those who truly care for me would put me first.

I martyr myself but no one lights a candle in a dusk vigil – instead I just wear myself down into dust while my family look on, concerned eyebrows and tight lips. They mutter that I am ‘difficult to look after’, excusing themselves. They acquiesce to my ‘irrational’ demands for some semblance of order, cleanliness, predictability and calm. With a roll of the eye and a sigh of frustration which further underlines my own feelings of inadequacy and unlovability. That’s probably not a word but it works well enough.

I wait for rescue: either the rescue by my sometime lover or the guts to rescue myself. I second, third and fourth guess myself – are my fantasies of escape and autonomy purely selfish dreams that risk ensuring I never achieve the inevitable humdrum resigned contentment of marital union all others see as their lot? Do I have to continue to strive alone for a relationship where communication is open, forthright and honest and basic needs mainly met? Can’t I cut my losses and just build a life where I am answerable only to myself? Where my head might stop echoing with my own screams? Where I could put others concerns aside and just focus on what my children need, and what I need? I live in frozen fear of repeating the mistakes of my parents, existing in my own head and making myself ill while my children try to figure this world out unguided, but realise in my efforts to escape that fate I’m already living it. I problem-solve all day – unsolvable problems, nonexistent problems, potential problems, crucial problems within the confines of my skull but when I open my mouth to spill out the answers I’m silenced by the sight of the cogs whirring behind his eyes: he is figuring out his own solutions. His own not ours. I feel I know this for certain despite zero evidence. Our conversations hover around music, poetry, religion and the ‘state we, the world, are in’. Nothing of substance is said. We are nearly always in agreement. Never arguing.

We’re (not) all going on a summer holiday – agoraphobia makes motherhood extra hard

We’re (not) all going on a summer holiday – agoraphobia makes motherhood extra hard

Today I packed my three year old daughter’s suitcase for her summer holiday. She helped me pick out which clothes she would like to wear, which books she’d like to read at bedtimes, which toys she thought would enjoy the trip. I packed her toiletries, nappies, medicines (just in case), some sticker books, pens and pencils, and snacks for the journey.

Then I waved her and her father goodbye as they drove off, and my heart broke.

We don’t have any money. After being made redundant during my second pregnancy last year, I’ve been a stay at home mum to my two girls, while my partner has been working as a nursing assistant, which pays a little above minimum wage. We knew we wouldn’t be able to afford to go away any time soon. My partner’s ex-wife and her husband had booked a holiday home in Norfolk, an hour and a half away from us, and were planning on taking his eldest daughter who is seven and their new baby girl away for a week, and very kindly invited us along. We are very fortunate that relations between all of us have always been warm, and I was very touched by the offer. I know how much my eldest loves her big sister, and they would have a blast on holiday together. But I knew that, for me, the trip would be nightmarish. Away from home, daytrips out to crowded, unfamiliar places, little privacy, among people who, as lovely as they are, have fairly old-school views of mental illness. I agonised over the decision, but made my mind up not to go. Me and baby would stay home and my partner would take my eldest.

I’m trying to rationalise the decision by telling myself that the danger would have been that if I had forced myself to go, my anxiety would have been so acute that it would have risked spoiling the trip for everyone else. I try very hard to hide my own anxiety from my kids, to make sure that they don’t pick up on it, and to ensure that they still get to the experience fun, exciting stuff being a kid is all about. It was better, I thought, for her to have a great time with her dad, sister and extended family, without me bringing everyone down. Kids are far more sensitive, far younger, than we tend to think: I suspect she would pick up on my discomfort and it might sully her own perceptions and experiences.

I’m hoping to use the time while they are away to do some back-to-basics self care: eat as much as I can, nap when baby naps, get out for walks, maybe see some friends. All the stuff that seems to go out the window when I’m trying to cope with running a household of four – it seems far more doable when it’s just me and the baby. Maybe by the time they return I will be a little braver and I can make up for the lost time by taking the girls out myself.

This illness (or whatever it is) feels like it has sucked the very core of who I am away from me. I am not by nature a timid person. I traveled a lot, by myself, in my late teens and early twenties: North Africa, Asia, Australia. I moved to big cities. I took risks, and while there were some hairy moments, I generally had a blast. But it feels so different now there isn’t just me, but two extra parts of me out there in the world. It’s like my responsibilities have just crushed me: I am full of self doubt and fear and panic. I want to do the best I can for my children but when I get outside my comfort zone (an area which feels like it has shrunk to a few cubic meters), I experience such intense anxiety I can barely focus. How can I possibly keep them safe if my brain has turned to grey, spikey clouds (a weird description but that’s what it feels like), and my body is urging me to find the nearest toilet?!

So I’m going to bed this evening feeling like a failure – it is my job to be alongside my daughters as they experience the world and the fact that I’m just not brave enough right now makes me feel like a sack of pathetic shit. I know that her father will take excellent care of her, and will be the kind of fun, spontaneous and joyful parent that she needs. Meanwhile, me and her youngest sister will have a quiet but enjoyable time close to home. I hope it will be restorative, healing maybe. I hope so. But I don’t think the guilt I feel will go away any time soon.

The dangers of ‘self-help’

The dangers of ‘self-help’

I don’t tend to go in for self-help books. My preference is to read up on things from the point of view of the professional; the therapist, doctor or academic. Even when I was an out-patient in a psychiatric hospital, attending twice-daily group therapy sessions for months on end, it took me a good fortnight to realise that I was just as ill as everyone else in the room (I had been sitting their feeling like an ethnographer, not a fellow-patient). This tendency to pretend I’m the expert rather than the sufferer is, I’m sure, excellent evidence of ‘intellectualisation’. Ho hum…

My partner, on the other hand, has purchased many well known self-help titles over the years. He invariably fails to read them, but they sit there on the bookcase. Over the last year I’ve flicked through a few of them, but this week I read one through cover to cover in 24 hours (no small feat when you’ve a toddler and a baby hanging off you). This book grabbed me. It’s over twenty years old and has a terrible cover, but by the end of the preface it had already spoken some truth to me and I was eager to read more.

I won’t name the book, but it’s one which usefully breaks down patterns of thoughts and behaviours into several types, suggests route causes (usually from childhood), typical manifestations and issues each one might cause, and explains how someone afflicted by these might overcome them. These include cognitive exercises, behavioural experiments, inner-child work and flash cards. 

I’m sure the authors intended the book to be one which spurs the reader into action, inspired by the possibility of change and the feeling of empowerment which comes with doing better for yourself. 

By the time I had read the last page, I pretty much collapsed into a heap of despair.

I could see elements of myself and my own issues in nearly every one of the types described. I had been reminded of previous traumas, personal failures, and current self-defeating behaviours. I’d experienced flashbacks to painful childhood memories. I was filled with anger, sadness and an overwhelming sense that I was doomed to be stuck in a perpetual cycle of fucking up. I felt physically ill. I had no idea what on earth to do with all these feelings that were threatening to completely drown me.

I am lucky that I am receiving therapy, however my therapist is on holiday for the next two weeks. I’ve done my best to talk through some of what I’ve felt able to share with my partner, who is always an empathetic listener (he was a fellow patient in those group therapy sessions many moons ago). I’ve made plans to sit my parents down and lay out some of the memories that have floated up to perhaps achieve some kind of *shudder* ‘closure’. But I’m still left feeling intensely vulnerable and even more dispirited than I was before I picked up that book.

So I guess this is a caution. Be aware that, even the best intended books, or blogs, or podcasts or whatever, can come just too close to home when you’re already in the grip of the big black dog. Be sure to brace yourself for the potential repercussions. Try to have your support network there around you already. Because I know that if I didn’t have my partner and my beautiful girls with me, if this was ten years ago, that book would have had me straight down the local off-licence for a box of wine and I would be in the middle of a major self-pity-wine-crisps-and-Marlboro-soaked-binge. 

5 ways to support your partner through a perinatal mental illness

5 ways to support your partner through a perinatal mental illness

This article first appeared on musicfootballfatherhood.com – “The Mumsnet for dads.”

It is a sad fact that for many mothers, a time is supposed to be one of the most magical in their lives, pregnancy, birth, and the first years of their child’s life, can be marred by suffering from pre or postnatal mental illness. I know this only too well. Although I have suffered from depression and anxiety on and off all my life, I was lucky to be healthy during my first pregnancy and for the first year or so after the birth of my eldest daughter. During my second pregnancy, I had a major relapse, and nearly twelve months after my youngest daughter’s birth, I’m still in the process of recovering. I’ve learnt a lot along the way, as has my partner. He hasn’t always been able to support me as I would have wanted, and I wasn’t always in the right frame of mind to even know what might have helped. At times we’ve both felt overwhelmed, frightened and isolated. So I’ve written down a few insights in the hope that others might learn from our successes and mistakes.


1. Educate yourself

Perinatal mental illness comes in many forms. Prenatal depression strikes during pregnancy. Postnatal depression, anxiety, OCD, and the most severe and thankfully rarest, postnatal psychosis, are all well studied and documented illnesses. They are not the ‘baby blues’ (a relatively short period of tearfulness and mood swings caused by hormonal changes in the few days after delivery). They are not something she can ‘snap out’ of. They are not a reflection of her, of you, of your baby or her ability to mother. And unfortunately, they are not something you can fix. If your partner has received a diagnosis of a mental health issue, or you suspect she might be suffering, do your homework. Ask your GP, her midwife, or your health visitor for information. Read up online (see below for links to support organisations). Get a realistic idea of what she is dealing with, and how she might be supported by you and others. Don’t rely on her to educate you – do your own research so you know just what she’s up against.


2. Take the load off

A new baby brings with it an extraordinary amount of extra work. Feeding, changing, washing, soothing, entertaining – it is relentless and can seem overwhelming even when a mother is healthy, especially as she is likely doing it on very little sleep. Add this to what already needs doing to maintain a household; the cooking, cleaning, laundry, shopping, bills and admin and looking after any older children or relatives. Maybe she’s already back at work too. For someone suffering with a mental illness, trying to balance all these plates is a recipe for disaster. One would hope you’re already doing a fair amount as a twenty-first century father, but be prepared to take as many extra household chores and parenting tasks on as you can. If you don’t know how to programme the dishwasher, find out. If you can’t cook, now is your chance to learn, or get better acquainted with your local takeaway delivery drivers. If you’re already back at work after your paternity leave, talk to your employer about temporarily reducing your hours or even taking additional leave to be at home more to support her. If that’s not an option, look into hiring some domestic help if you can afford it. The key here is not to wait to be asked for help: chances are she is not in the right place to act as operations manager for your family. Even the smallest tasks and decisions can feel completely overwhelming. If you see something needs doing around the house, do it. If the baby needs changing, change it. If the kids are bouncing off the walls, take them to the park. The idea is to allow her time to just be, ideally to take some time for her (a walk, a bath, a nap, a phone call to a friend), and for her to feel like you’ve got her back.


3. Keep listening

On top of the general stigma of mental illness that regrettably still permeates society, mothers who suffer from mental illness often feel an additional level of shame and guilt. There remains an idealised notion of women and motherhood, of the ‘perfect mother/housewife/lover’ with dinner on the table, lipstick on, ready to welcome her husband back to her immaculate home, while a happy baby sleeps quietly upstairs. The stereotypical housewife of dubious nineteen-fifties advertisements has been replaced by an almost identikit Instagram version, all home-made jam and baby-wearing while doing yoga. A lot of women genuinely feel they are letting their partners and their children down if they aren’t reaching some unattainable ideal all the time. Encourage her to talk to you about how she’s feeling, what she’s thinking, how her day was. Validate where she is by meeting her there and listening to her in a non-judgemental way. And to balance any skewed ideas she might have about her own ‘performance’ as a mother or partner, reinforce to her just how much she has already done, and continues to do.


4. Be her advocate

Any mental illness requires proper medical assessment and care. One of the things that sucks about mental illness is it’s so hard to ask for the help you need: it’s not like you can point to where it hurts, and you might not be able to put it into words, in fact you might not be able to face going to the doctor’s office in the first place. Even if she’s lucky enough to get a quick diagnosis, access to the treatment she needs might not be forthcoming, and she’s not necessarily going to be in a position to fight for it. If she’s agreeable, attend any appointments with her. Ask what treatments are available in your area. Medication can help, especially in more severe cases, but talking therapies are often more beneficial and unfortunately sometimes far harder to come by on the NHS. If the GP or Health Visitor can’t get her access to appropriate therapy or counselling, find out if there are any local practitioners or charities operating. If you’re on a low income, you might find they offer a sliding scale of rates. If either of you have got health insurance, or can afford to self-fund, consider going private as the waiting lists are often far shorter. It can still be a tough fight to get the right help and support services often aren’t adequately advertised, so be prepared to do some research and fight her corner.

You might also find you need to be her advocate even among friends and family. If at all possible, try to help her deal with anyone close to her who might have unhelpful ideas about mental illness and motherhood, or better still, try to educate them yourself on the reality – ideally you want her to have as wide a support network as possible.


5. Look after yourself

Supporting someone through a mental illness can be incredibly tough. While you try to do as much you can for the person you love, you also need to make sure you keep yourself healthy. As well as making sure she’s getting enough sleep, fresh air and eating well, make sure you are too. She might want to isolate herself and hide away from friends and family, but try to make sure you stay connected to other people who can support the both of you. It is not going to be appropriate to share all of your own worries, fears and frustrations with her right now, so make sure you’ve got people you can rely on to listen if you need to decompress. If you don’t think friends or family are going to cut it, seek out safe spaces online where people share their experiences and support one another. And keeping your own hobbies and interests going, even if you can’t do them as frequently as you might have otherwise, can help to keep you in a better place to help her.

One final note. It’s not often talked about, but fathers can suffer from postnatal depression too. If you are worried that you might be suffering, please don’t hesitate to seek medical advice and support, and reach out to those around you for help. The stigma around mental illness will only be beaten if men and women are brave enough to speak out and share their experiences.


Support is available from: PANDAS FoundationMindNHS Choices

 

An apology to the mother I blanked at the playground

An apology to the mother I blanked at the playground

I’m not being rude. Well, I guess I am, but that’s certainly not my intention. I’d love to be able to wave and smile, indulge in idle chat and get to know you and your kids better. Yes, I recognise you from my daughter’s nursery, or the children’s centre. I probably know your kid’s name, but I’ve never managed to find out yours. 

My daughter, with all the amazing self-confidence of a three year old, exclaims “It’s my friend!” when she spots her playmate across the park. As she runs towards your little girl, she stops to look back for me. I’m following behind, pushing her little sister in the pram, and while I smile encouragingly, she must sense some unease on my part, because she pulls back, then heads towards me muttering that she’s “a bit shy”. This is the moment I should reassure her that there’s nothing to fear, take her hand and take the lead, demonstrating how to approach a friendly acquaintance, to smile at you and strike up a conversation so she and her little friend can relax and make sand castles together. Instead, I mutter “that’s OK”, and try to direct her attention to the slide or swings. 

It has already taken a great deal of courage and determination for me to get us to the playground that morning. Where once I was confident and self-assured, although always naturally an introvert, I am now cowed and anxious. This period of mental illness has been ongoing since that moment at my eldest’s first birthday party where, house packed full of people, I locked myself away upstairs to rock back and forth and pray that the first panic attack, and worst, I’d had in years would soon dissipate. It did as soon as I heard the car doors start to slam as friends and family made their way home, having been kindly but firmly ushered out of my house at the end of the afternoon by my mother. Since that June day, two years ago, barely a week has gone by without a similar attack, and my world has continued to shrink, even as my daughters has expanded. Friends have fallen away, jobs lost, weight dropped along with the confidence I was a good mother. Now, most days, I only see my failings. 

The fear that you will see them too is what keeps me from reaching out. 

I tell myself I will get there. I tell myself my kids will be OK – after all, they are blessed to have the love and support of a gregarious grandmother who makes friends with anyone and everyone, a quietly brave father, who although shy, has an aura around him that people gravitate to, and a grandfather who enjoys the outdoors and knows the names of all the local flora and fauna. 

I also tell myself that maybe, without me having to apologise or explain, you might already understand.