Sometimes even I have a hard time following my own story. It’s complicated.
So I’m going to try to provide some context to help make my stories a little bit clearer.
One of the first questions I always get is “Wait, did you have postpartum bipolar or postpartum psychosis?”
Even after talking to multiple health care providers, this was a hard question to answer for a long time, because people refer to the same set of experiences in lots of different ways. As a data person, it feels most useful to make a visual. So the visual below is how I would describe it.
Put simply, psychosis is a symptom of bipolar, which is more likely to happen postpartum.
The easiest part to explain is probably the postpartum part. In the time after childbirth, the hormones, lack of sleep, and trauma to your body can exacerbate all kinds of mood disorders, including but not limited to depression, anxiety, OCD, PTSD, bipolar, and psychosis.
So what exactly is psychosis?
The easiest way to explain it is that you lose touch with reality. Sometimes you see or hear hallucinations, but other times you just believe things that aren’t true. I, for example, thought that I was being filmed for a reality TV show, and that my baby had special powers. Both of these delusions are very common when psychotic, as are religious delusions.
Some people have a single, isolated psychotic episode that is brought on by childbirth. This can happen even if you have no other history of severe mental illness.
But many people who have postpartum psychosis have their episode because they have bipolar disorder.
This would be straightforward if all of us knew we had bipolar disorder. But many of us (myself included) don’t get diagnosed with bipolar until the postpartum psychotic episode happens.
There’s a good reason for this, which you can see in the visual below (not one I made, from Wikipedia!)
I have bipolar I. This means that I’m on the purple team in this image. That big purple bump you see at the top of the diagram is where I had my psychotic episode: it was what’s called a manic/psychotic episode. In order to be diagnosed with bipolar I, you need to have had a manic episode. And for many people, their first incidence of mania is precipitated by childbirth.
This is why some people call it “postpartum bipolar.”
Mania is basically the opposite of depression: you feel invincible, on top of the world, like nothing could ever stop you- including sleep. You have racing thoughts, talk fast and loud, and get distracted easily. You take risks that you should not take. Not sleeping makes your brain even less able to function, which is one reason why mania often induces psychosis (though some people with bipolar get psychosis during their depression as well).
And, of course, not everyone who has bipolar experiences psychosis (see Venn diagram above), especially if you have bipolar II, which involves hypomania, but not mania.
Hypomania is sort of mania-lite. Symptoms include excess energy, being extra talkative, feeling like you can’t calm down, irritability, and needing less sleep.
I can recognize now that I had periods of hypomania throughout my life, but it was never identified as bipolar- partially because I didn’t appear to have suffered much with depression.
The tricky part is that my depressive episodes most often manifested themselves as extreme anxiety. The two are kind of codependent besties. It’s annoying, and confusing.
I was therefore just known as a textbook generalized anxiety sufferer. Who happened to come out of her periods of bad anxiety feeling REALLY good and like everything had been magically fixed and would never be bad again (see description of hypomania).
And so the cycle continues.
My experience is not everyone’s experience, but the more I talk to survivors out there, the more I learn how many of us are piecing together bits of the same story.
It’s a story that’s hard to tell. Sometimes because others haven’t taken the time to summarize the key plot points for us. Sometimes because of the sense of shame that comes along with some of these words and diagnoses. Sometimes because, as you just read, we’re doing a lot of work just to manage our emotions and we’re exhausted.
But hard stories get easier and easier every time you tell them.
So here’s mine.
And if any part of it is yours, too, I see you.
I appreciate you.
You are strong and brave and resilient.
And I would love to join my story with yours.