I would welcome any and all feedback! Thanks in advance for reading…I have more chapters on the way.
Quest for Rest: My Surprising Struggle with Postpartum Mania, Hypergraphia and Bipolar Disorder
As a writer, it has always been my dream to write a book, but I thought I had nothing substantial to contribute to others. An avid reader since I was a little girl, I was extremely inspired by gifted, prolific writers such as Madeleine L’Engle, author of A Wrinkle In Time, and L.M. Montgomery, who wrote the Anne of Green Gables series. After I was diagnosed with bipolar disorder and had the toughest year of my life, I realized that my experience has not been a waste and I could share it with others through the written word. After enduring a time I can only describe as both heaven (the birth of my daughter) and hell (the year after being diagnosed with bipolar disorder), I wish to alert other women of the possibility of their tendency for bipolar disorder to become active once childbirth occurs. I want to help mothers prevent any unnecessary agony after the birth of their child. My ultimate hope is to help other mothers feel less alone if they’ve undergone a postpartum bipolar diagnosis.
Chapter One: My Biochemical Descent into Bipolar Disorder
On a warm Indian summer night, I was a sweaty nine months pregnant when my water broke. During my pregnancy I had tested positive for Group B streptococcus, or Group B strep, a bacterium in my body that could result in a life-threatening infection to my baby. Right after my water broke, my husband Craig called the hospital to see if there was a room available. Due to my having Group B strep, we were instructed by our maternity nurse to get to the hospital right away. In pain, I stayed up all night in labor, not sleeping one wink. This innocent-sounding act — enduring one night without sleep — would be my biochemical trigger for postpartum mania, hypergraphia and ultimately bipolar disorder, but I did not have an inkling that these mental illnesses lay in wait for me….
I began typing this book’s outline “hunt-and-peck” style with two fingers while simultaneously breastfeeding my eleven-day-old infant and suffering from a nasty headache. I had ideas pouring forth like Niagra Falls in my brain, but I could only type so fast. I felt that if I didn’t write each thought down that very instant, I would soon forget every single idea. A sense of urgency filled me with extreme anxiety, and my wrists ached from being so tense as I typed frantically on my laptop. Still, I could barely break away from writing.
My unusually strong writing compulsion was, in fact, hypergraphia, a conditon in which one experiences the overwhelming urge to write. Hypergraphia can be associated with temporal lobe changes in epilepsy, and also in bipolar disorder and mania. Hypergraphia can be pleasurable for some, but it was bittersweet for me, as fear encapsulated my every keystroke. I was terrified that this book would never become a reality unless I kept writing. However, for the first time in my 37 years, I literally felt words pouring out of me as I wrote incessantly and the sweet part of it all was that I felt that I was on my way to accomplishing my longtime dream to write a book that was meaningful to me.
Despite my newfound ability to write without hesitation, I had to admit that my priorities were inequivocally out of whack. I had a newborn by my side, and a precocious toddler who needed her mother’s attention as well. I wasn’t taking adequate care of myself, and I was unable to realize that I needed help since I was severely sleep-deprived from the get-go of my infant Marilla’s birth. While Marilla and our other daughter Avonlea napped, I should have been taking a nap, or at the very least, as my good friend Salle said, “being horizontal”. However, I couldn’t resist the lure of my laptop. My husband Craig noticed my nonstop typing, and in an effort to help me, he hid my computer. I was angry with him for resorting to such a seemingly childish tactic, but I didn’t comprehend that he was looking out for our family’s best interest in the only way that he could at that time.
When my computer vanished, I found a blank book that had been gathering dust around the house for years, and I filled it up with scrawls within a couple days. Hypergraphia was in full-force, as I simply couldn’t stop myself from writing. The only way I managed to extricate myself from my pen was when Craig insisted that I stop writing.
My hypergraphia was one drastic clue that my brain’s synapses were not working normally, but there were other signs that began soon after Marilla’s birth. Marilla was born at noon, on August 26th, 2007. Being a life-long worrywart, I was extremely relieved that she was a robust seven pounds. Unfortunately, it would take a full week of my being unable to sleep before anyone noticed that something was seriously wrong with me. During the first few days of Marilla’s infancy, several doctors examined me, and I visited with family and friends, but no one detected my mental illness: postpartum mania as associated with bipolar one disorder. It was possible to appear relatively normal, and sweet Marilla attracted most of the attention anyway. However, my intuition was strong as I sensed I was in growing trouble of some kind.
Since we didn’t have family members available to help us after the baby’s birth, my mother gave us the gift of a postpartum doula named Salle Webber. Salle and I had planned that she help us immediately after Marilla’s birth, but Salle had a completely unexpected allergic reaction, and she wasn’t able to join our family until a week following the birth. As Salle hadn’t known my personality before coming to work with us, she did not realize that my manic behavior was quite different than how I had been before Marilla was born. Salle had worked with over 150 mothers; while some of them suffered from postpartum depression, none of them had postpartum mania like I did.
The deceptive part of postpartum mania is that sometimes people think the manic person is simply happy to have a baby and that she has no mental disorder. After Marilla’s birth, I was filled with an overwhelming amount of joy and energy. At first,, none of my highly-trained maternity center nurses, OB-GYN’s or our pediatrician detected the fact that I was manic since it is expected for a new mother to be elated with the birth of her baby. Yes, there is the awareness of postpartum depression, but not postpartum mania. I was the only person who identified that I had an actual DSM-IV disorder termed “postpartum hypomania”; even then, I had no idea what was to come: acute mania, hypergraphia, depression and a bipolar disorder one diagnosis.
During my hypomanic state, I could feel my brain thinking much, much faster than it had before, and, in some ways, more accurately and expansively. I liked my new brain activity…but it also scared the living daylights out of me. During those five sleepless nights after Marilla’s birth, in some ways I had become my mother, who had obsessive-compulsive tendencies to clean relentlessly. What else can you do when you’re up all night and raring to go? I cleaned for a good part of the night as quietly as I could, every night, for five nights postpartum. As I scrubbed countertops and organized drawers at 3:00 a.m., I yearned to have some semblance of peace and balance in my life. I also went online, where I penned lengthy emails to friends. I didn’t realize that my friends would be able to view the actual time I sent these emails, and some of them later told me they were puzzled that I was writing them such long epistles in the wee hours, night after night.
After not sleeping for so long, I was feeling much the way I imagined a coke addict would feel. I was revving with energy, but simultaneously I felt exhausted and frequently on the brink of an emotional outburst. Still, nothing too dramatic happened, so no one thought to get me checked out with a psychiatrist.
During that fateful postpartum week, my brain chemistry was markedly awry in every part of my body. Apart from cleaning the house, I had the other classic signs of mania: tons of energy, pressured speech, no appetite and loss of weight. Because it was hard for me to sit still for any length of time, my mania affected my ability to adequately breastfeed my baby. At Marilla’s one-week check-up we discovered that her weight had dropped almost a pound, which perplexed my pediatrician, but he did not see enough at that point to recognize my mania.
When I was five days postpartum, I endured a horrible morning that affected me deeply. My mother, who lived over three hundred miles away from us, called me on the phone, sobbing uncontrollably. Mom and I had a rocky relationship over the years, and I tried my best to simply listen to her and not hang up the phone like I usually would. She told me she felt suicidal and then she said the kicker: “I think I’m having your postpartum depression.” I was aghast, deeply shaken, and furious that she wasn’t getting the help she obviously needed from her doctors. I was also heartsick and repulsed by her childlike, pathetic manner, and of course I felt guilty. Something in me cracked as I heard her cry on the phone for such a long time. Here I was, the exhausted mother of a 5 day-old-newborn, and my mother was acting like an emotionally shattered little girl. Her comment about having my postpartum depression unnerved me – what kind of mother says that to her daughter? I implored her to take an antidepressant that her general doctor had prescribed for her the very day before, and she promised me she would. Our depressing conversation had taken its toll on me and I was relieved when our talk ended. Little did my mother know that her own daughter was suffering from postpartum mania and bipolar disorder; however, I believe that if she did know what was happening to me, she would have tried her best to act differently with me.
Later on that same Friday, I did something unusual. While my husband was away at work, I went on a “phone call bender” in which I called different people to ask for help. I realized that I was sinking fast and something needed to improve. I had two little girls depending on me! First I called my OB/GYN and told her medical assistant Priscilla I couldn’t sleep. Priscilla suggested I try an over-the-counter drug such as Benedryl, but I sheepishly asked if I could try something stronger than that, because Benedryl had never made me very sleepy in the past. With my OB/GYN’s approval, Priscilla phoned in a prescription for Ambien. While I didn’t think I needed to pick up the Ambien the same day it was prescribed, I also felt in my heart that it was a good idea that I lined the prescription up. For a fleeting moment I felt proud that I asked for what I needed, as assertiveness has never been my strong point. Meanwhile, I figured my husband could pick up the Ambien the following day.
I also felt compelled to speak with another mother who had experienced a postpartum crisis. I called our local Postpartum “Warmline” but the number was disconnected! I was incredulous and angry that such an important hotline had vanished. (I later found out it disappeared due to a budget cut.) I called information for a Postpartum Support Line, but the operator could not find one, to my anguish. Finally, I called our local maternity hospital’s lactation center and they gave me the number of the Postpartum Support International (PSI) Bay Area hotline. The Bay Area PSI’s hotline is staffed by seven volunteers/moms who have been through postpartum struggles. The PSI volunteer I called, Linda, encouraged me to consider medication to help me sleep, which validated my earlier decision to ask my OB/GYN for a sleep aid. Linda also advised me to get local counseling, and she gently made it clear that she was not a licensed therapist and wasn’t attempting to be one. After we ended our conversation, I felt comforted by speaking with someone who understood how difficult the postpartum period could be.
Next I called Mrs. Finnston, a local therapist who I met when I took her parenting workshop the year before. She was instrumental in helping me weather this first crisis. I was incredibly fortunate that she offered me phone counseling and a sliding scale fee for that same evening. Most importantly, she wanted to speak with my husband after I spoke with her during our session. My husband poo-poohed the idea of phone counseling, but I was so incredibly wound up at that point, I yelled something at Craig that I did not take lightly: “Either you get on the phone with Mrs. Finnston, or I’ll go tomorrow and file divorce papers.” He got on the phone with her a moment later. As soon as Craig hung up, it was clear that Mrs. Finnston had explained to Craig how critical it was for me to get a good night’s sleep, for he left to pick up my Ambien medication. Despite battling sleep deprivation as a new parent, and having an obviously very distraught wife, my husband was doing all he could to keep our family safe.
After taking my first Ambien pill, I got the first good night’s sleep I had in five nights and I felt much better the following day.
In the past, I never would have called a hotline, nor would I have called a doctor for medication only, or seek emergency phone counseling. I think perhaps a guardian angel was watching over me when I embarked on my phone call crusade.
Over the next few weeks, my sleep patterns improved and I seemed to be getting better. My hypomania subsided and no one suggested that I see a psychiatrist. However, I suspect my brain chemistry was set in motion by my sleep deprivation, general brain chemistry and hormones, and my entire system was hypersensitive.
Once again, another seemingly innocent and joyous event occurred that triggered another of my manias. My brother was to be married in just a few weeks, and his fiancé had a “girls day” planned with several of her friends, including me. I was thrilled to be participating, although I felt some guilt in leaving my six-week old baby at home for a long day frolicking about the Bay Area. However, I set my guilt aside, for I ached to have fun and be treated to some luxury. Starting in San Francisco, we’d have pedicures; then be carted off by limousine to have lunch in Napa Valley. The day would be capped off by touring several beautiful wineries such as Peju and Coppola.
On my way to San Francisco to meet the others, I stopped off at a liquor store to buy champagne to share with my friends. I was giddy with anticipation, and I wanted to celebrate being a new mother. I made sure to bring my portable breast pump so I wouldn’t engorge (but I’d “pump and dump” since I’d be drinking alcohol) and I thought I had everything well planned. We started drinking champagne and wine early in the day, and we also ate lots of delicious chocolate. During lunch, we had yet more wine and dessert. It was a feast of excesses, even for me, the well-known “Chocolate Queen”. I filled my system with tons of sugar, and I didn’t realize that by doing so, I would be unable to sleep that night. Insomnia due to high sugar consumption had never been a problem for me in the past, but this time around, my tolerance level was different. My brain had changed on a cellular level, and I was incredibly sensitive to all the sugar. As a result, I stayed up most of the night and the hypomania returned. It grew worse over the next couple weeks.
Finally, on September 27, 2007, I surfed the internet looking for anything related to postpartum mania. I found the startling statistic that one in one thousand mothers who give birth will succumb to postpartum mania; not psychosis, but mania. Then I found the goldmine: Dr. Alice W. Flaherty, neurologist at Massachusetts General Hospital, Harvard professor, and renowned writer of The Midnight Disease. I located the description of Dr. Flaherty’s book on Amazon.com. Dr. Flaherty’s book is an examination of the drive to write, writer’s block and the creative brain. In The Midnight Disease Dr. Flaherty also courageously shares her own experience with hypergraphia, the heartbreaking death of her newborn twins, and her hospitalization for a postpartum mood disorder. I surfed some more and found a website listing her resume of impressive credentials. I couldn’t believe my luck, for I had the gut feeling that this woman could help me. I made the necessary calls to track down her assistant.
Miraculously, I was able to reach Dr. Flaherty the following day and she generously made time for us to have a brief phone consultation. I asked her if she’d speak with Craig as well. She made it clear to us that she didn’t want to get involved in a marital dispute; however she agreed to speak with him for a short while. Dr. Flaherty helped me calm down and said right off the bat, “I need you to focus right now.” Focus I did. Dr. Flaherty shared with me how medication helped bring her own mania down. She also strongly encouraged me to consider using formula as a supplement for Marilla, which would take the pressure off the tandem breastfeeding I was doing with my two girls. I had breastfed our daughter Avonlea for two and half years, but again my intuition was working powerfully and I “allowed” myself to go the formula route with baby Marilla. Dr. Flaherty and I also spoke about the aspects of different medications for mood disorders.
After hanging up the line with Dr. Flaherty, I decided to ask my former psychiatrist Dr. Aileron for a prescription for Zyprexa, a powerful antipsychotic that has been found useful in helping those with acute mania. I called Dr. Aileron, whose services I could no longer afford due to our bare- bones health insurance, and I began to sob hysterically. In that moment, I was scared literally out of my mind. I begged Dr. Aileron to phone in a prescription for Zyprexa. I explained, through my snorts and tears, that I had spoken with Dr. Flaherty, and I felt that Zyprexa could really help me. I will always be grateful to Dr. Aileron for listening to me and making his own decision that Zyprexa could potentially help me. After we spoke, Dr. Aileron called in a Zyprexa prescription for me.
Zyprexa, at a low dose, helped subdue my mania, but my mania returned after yet another night of total sleep deprivation.
My inability to sleep happened after an upsetting event. I went down to Craig’s office to look for some papers, and I glanced at his desk. There I noticed a printout of a letter I had written to my mother. I decided to re-read the letter, and I turned over the page. To my horror, the other side had information from a local divorce website’s frequently asked questions page. I was in utter shock, as it hit me that Craig must have been researching the site, and was considering divorcing me after almost a decade of marriage.
As a result of my awful discovery, I didn’t sleep the entire night. The following morning I was more manic than ever before, and I knew I needed help. Craig, who looked more scared than I had ever seen him look in our years together, asked me to volunteer to be evaluated at our local hospital’s mental health unit. I wholeheartedly agreed with him, thinking a psychiatrist could evaluate me, give us some advice, and we could leave the facility within a few hours. Of course, I didn’t see it then, but it wasn’t going to be as simple as that…not one bit.