The Mind: A dangerous place

A reflection for Suicide Prevention Month

There are some things you learn from textbooks,some you are told and there are some things you learn because someone you love does not come home.

I have known depression and psychosis not as abstract medical terms, but through loss.

A close relative lived with depression-related psychosis for eighteen years on and off. For much of that time, she was receiving psychiatric treatment and taking medication. On the Friday she died by suicide, she had been cleared on the same week on a Monday by her psychiatrist to return to work.

She was considered well enough to go back.

What we did not anticipate was that she was returning to the very environment that had contributed to her distress.

Looking back, that distinction matters.

Being medically stable is not necessarily the same thing as being ready to return to every circumstance that once overwhelmed you.

Years later, another distant relative( the two are not geneticaly related) a much younger woman, just out of college died by suicide following postpartum psychosis.

There had been no history of depression,no history of psychosis.

She had, however, already carried a great deal. She had struggled to pay her way through college and, as the firstborn, had become a source of hope to those who looked up to her.

Then she had a baby and something changed.

Her mind began telling her things that were not true. She could not recognise the baby as her child. She could not accept the baby, look at the baby or breastfeed. Her perception of the child had become completely distorted.

Thankfully, she was at her parents’ home. Her mother stepped in and cared for the baby while the family tried to understand what was happening.

There were several suicide attempts within that period. Eventually, the family agreed that she needed psychiatric care.

But they were too late.She died by suicide.

That loss changed how I think about postpartum mental health and mental health in general.

We often prepare extensively for childbirth.We buy clothes.We prepare the baby’s room.We discuss feeding, nappies, vaccinations and sleep.

But how often do we prepare the community for the mother?

Because after the baby arrives, the mother is also undergoing an enormous transition physically, hormonally, emotionally, socially and psychologically.

Depression can occur after childbirth, and postpartum depression is more than the ordinary emotional fluctuations that can accompany the early days of motherhood. It can affect a mother’s ability to function, connect with her baby, care for herself and experience pleasure or hope.

And then there is postpartum psychosis.

It is rare, but it is a psychiatric emergency.

A woman can have no previous history of depression or psychosis and still develop postpartum psychosis. It can involve hallucinations, delusions, severe confusion, agitation or profound changes in behaviour and perception.

This is why a statement such as “She has never had mental health problems before” should never be used to dismiss a dramatic change after childbirth.

Sometimes the person we know is still there, but illness has temporarily distorted the way she experiences reality.

And when someone’s reality has changed, we cannot expect them to reason their way out of it alone.

This is where community matters…my relative was fortunate to have her mother nearby.

The mother took over the care of the baby. That was not a failure of motherhood. It was an act of protection.

The mother did not need to prove that she could breastfeed. She did not need to prove that she was coping. She needed treatment, supervision and someone else to make sure the baby was safe while she received care.

This is what community should look like.

Sometimes community is a grandmother holding the baby while the mother sleeps.

Sometimes it is a husband noticing that his wife is no longer herself.

Sometimes it is a sister saying, “Something isn’t right. Let’s get help.”

Sometimes it is a neighbour bringing food.

Sometimes it is taking the older children out of the house for a few hours.

Sometimes it is accompanying someone to an appointment.

And sometimes… it is recognising that love alone is not treatment but love can be the bridge that gets someone to treatment.

We should also remember that community does not end when the mother leaves the hospital or receives medication.

Recovery happens in an environment.

If someone’s illness has been connected to overwhelming circumstances, sending them straight back into those circumstances without addressing them may leave an important part of the problem untouched.

Depression does not always look like crying.

Psychosis does not always look like the dramatic images we have seen in films.

Postpartum depression does not always look like a mother who dislikes her baby.

And postpartum psychosis may not look like sadness at all.

Sometimes it looks like confusion,Withdrawal,Fear,Strange beliefs,Sleeplessness,Uncharacteristic behaviour.

A person saying things that make no sense to everyone else but makes perfect sense within the reality their mind has created.

And sometimes it looks like someone who desperately needs another person to notice.

This is why suicide prevention cannot belong only to psychiatrists, psychologists and hospitals.

It belongs to families.

It belongs to workplaces.

It belongs to faith communities.

It belongs to neighbours.

It belongs to all of us.

Not because we are all mental-health professionals, but because we can notice, listen, stay, remove judgment and help someone reach the people who are.

Perhaps these are the lessons i have cardied from these losses:

Do not only ask a person:

“Are you better?”

Ask:

“How are you really doing?”

Ask what they are returning to.

Ask whether they are sleeping.

Ask whether they feel safe.

Ask what has changed.

Ask what support they have when everyone else goes home.

And after a baby is born, don’t only visit to see the baby.

Check on the mother.

Hold the baby so she can rest.

Feed her,listen to her.

Give her permission not to be okay.

And if something feels seriously wrong, don’t wait for shame, stigma or family disagreement to delay professional help.

There are moments when intervention is not an overreaction.

It is love.

During Suicide Prevention Month, I remember two women.

One lived with mental illness for eighteen years.

The other had no psychiatric history and had barely begun her adult life.

Both remind me that mental illness does not always announce itself in the way we expect.

And both remind me that sometimes the question is not simply, “Does this person have treatment?”

It is also:

“What happens when they leave treatment?”

“What environment are they returning to?”

“Who is watching over them?”

“Who will notice if they begin to disappear into themselves?”

We may not always be able to prevent every tragedy.

But perhaps we can build communities in which fewer people have to fight their darkest battles alone.

And perhaps, when a new mother enters the fragile season after childbirth, we can remember that a baby is born into a family but so is a mother.

She needs a village too.

May we become that village.

The Faithful Steward Chronicles