By Diana Jefferies, Western Sydney University
The fourteenth-century Book of Margery Kempe opens with an account of an illness Margery experienced after the birth of her first child. The account describes how Margery believed that she was going ‘oute of hir mende’ because she was being attacked by devils who forced her to deny God and to slander her husband and friends. She was so distressed by this experience that she says that she tried to commit suicide on many occasions. To prevent her causing harm to herself and others, she was bound and locked up for eight and a half months. Today, many medical historians recognise Margery’s illness as postnatal psychosis.[i]
There is a general expectation that the period after childbirth should be a time of great happiness for the mother. However, it is a time when women are most vulnerable to developing mental illness. One mental illness, postnatal psychosis, is particularly severe and terrifying, and occurs during the first four weeks after childbirth. It affects approximately 600 women and families in Australia every year.[ii] A play called Mockingbird uses music, mask and humour to raise awareness about postnatal psychosis by tracing the illness through four generations of women.
Mockingbird was developed from several sources. First, New Zealand writer and Le Coq performer, Lisa Brickell, conceived Mockingbird while completing her MA in Drama at the University of Auckland. The play is based on experiences within her own family. Concurrently, I had been researching postnatal psychosis in historical healthcare records from the Gladesville and Callan Park hospitals in Sydney from 1885 to 1955. Following a chance meeting between myself and another Mockingbird collaborator, Taimi Allan, CEO of Changing Minds – a mental health advocacy service in New Zealand, the stories of the women in the healthcare records were included in Mockingbird. Finally, Taimi Allan’s own story of mental illness after childbirth has been incorporated into Mockingbird.
By combining stories from Lisa’s family, the historical record and Taimi’s own experience, Mockingbird presents an authentic account of how women experience severe mental illnesses, such as postnatal psychosis, after childbirth. This is very important because a lack of recognition leads to poor health outcomes for the women and their babies. Women diagnosed with postnatal psychosis experience hallucinations, delusions, confused thinking and rapid mood swings.[iii] They have an increased risk of suicide and, on occasions, infanticide.[iv] Another insidious effect of this illness is the disruption of the mother-baby bonding process, possibly resulting in life long psychological problems for both mother and baby.[v] One of the best ways to keep women and their babies safe during an episode of postnatal psychosis is to ensure that the condition is diagnosed early. Doing so means that treatment can begin before the symptoms become so severe that the only viable treatment option is to admit the mother to a general psychiatric unit where she is separated from her baby and all family support.
Women who have experienced postnatal psychosis in the last 10 years complain that they know that the symptoms they are experiencing are unusual but because postnatal psychosis is such an under-recognised condition, they find it very difficult to access treatment and care. Also, they are reluctant to disclose these symptoms because they fear they will be seen as failures and that they may lose their babies.[vi] These are realistic fears, because one of the major findings of my historical research is that the records describe these women in formulaic terms – such as being ‘incoherent’ or ‘unable to make an account of themselves’ – to fit diagnostic categories. Thus, their voices are lost from the record and their views of their situations are recorded only when they provide evidence of mental illness.[vii] Such evidence was then routinely used to justify decisions that they should be admitted to hospital against their will, separating them from their families and their babies.[viii]
Mockingbird challenges these views of the women and creates a powerful format for raising awareness about postnatal psychosis. Rather than leaving the women’s stories on a flat page, the women are embodied and are given a voice. This takes the women away from the medicalised accounts normally used to describe their mental illness, often based on healthcare professionals’ observations about their behaviour, to the women’s lived experience. This includes their experience of treatment and care. It is a very powerful way of connecting the women with the audience, evoking an empathic response to their situation. Also, it becomes an opportunity for the audience to consider their own responses and attitudes towards mental illness, because they are asked to consider mental illness from the women’s point of view.
So what can Mockingbird do to make a difference for women experiencing severe mental illness after childbirth? In Australia today, there is no national clinical guideline for women experiencing postnatal psychosis. The appropriateness and value of treatment and care is dependent on which state the woman lives in. For example, women in Melbourne have access to a 20-bed publicly funded mother and baby unit at Monash Medical Centre. Whereas, currently in NSW there are no publicly funded mother and baby beds, although a 14-bed unit is planned for Royal Prince Alfred Hospital. This means that many women in NSW are admitted to general psychiatric units where staff have limited knowledge of postnatal psychosis. The lack of mother baby beds means that women are separated from their babies, leading to poor health outcomes. As women say, they miss out on some of the most important moments of their babies’ lives. The aim of Mockingbird is to raise awareness of women’s experiences so that guidelines are produced to promote better health outcomes for women, their babies and their families.
Mockingbird is an Australian, New Zealand and Norwegian production that first premiered in Auckland in 2016 after Lisa joined forces with the Director, Ruth Dudding, and Italian commedia dell’arte and clowning expert, Giovanni Fusetti. In 2017 Lisa took the play to Norway with actress, singer and musician, Siri Embla, who performs Sarah Macombee’s evocative musical score.
In 2017, Lisa expanded the script of Mockingbird using the stories of women found in my historical research. The play is now set in Sydney, rather than New Zealand.
We are very grateful for sponsorship received from the Sydney node of the ARC Centre of Excellence for the History of Emotions. Without their financial support, Mockingbird would not be performed.
Mockingbird is being launched at Western Sydney University on 14 February 2018 at 6.30pm. The performance will follow a one-day conference that examines current research into perinatal mental health. Tickets can be purchased at:
Two further performances will be held on 15 and 16 February 2018 (starting at 7pm) at 107 Projects, 107 Redfern Street, Redfern, NSW. Tickets for these performances can be purchased at:
Diana Jefferies is a Lecturer in the School of Nursing and Midwifery at Western Sydney University. She is a registered nurse with an academic background in the humanities. Her research examines historical and literary representations of mental illness after childbirth to investigate the cultural background of stigma.
[i] D. Jefferies and D. Horsfall, ‘Forged by Fire: Margery Kempe’s Account of Postnatal Psychosis’, Literature and Medicine: Special Edition Literature, Medicine, and Religion 32 (2014).
[ii] A. Essali and others, ‘Preventative Interventions for Postnatal Psychosis (Review)’, Cochrane Library (2013).
[iii] Shelley Doucet and others, ‘Interventions for the Prevention and Treatment of Postpartum Psychosis: A Systematic Review’, Archives of Women’s Mental Health 14 (2011).
[iv] Margaret Oates and R. Cantwell, ‘Deaths from Psychiatric Care: Saving Mothers’ Lives, Reviewing Maternal Deaths to Make Motherhood Safer: 2006–2008′, BJOG 118 (Supp 1) (2011).
[v] B. Posmontier, ‘The Role of Midwives in Facilitating Recovery in Postpartum Psychosis’, Journal of Midwifery & Women’s Health 55 (2010).
[vi] Odette Megnin-Viggars and others, ‘Experience of Care for Mental Health Problems in the Antenatal or Postnatal Period for Women in the Uk: A Systematic Review and Meta-Synthesis of Qualitative Research’, Archives of Women’s Mental Health 18 (2015).
[vii] Diana Jefferies, Margaret Duff and Daniel Nicholls, ‘Understanding the Experience of Women Admitted to a Psychiatric Hospital in Sydney with Psychosis or Mania Following Childbirth after World War II (1945–1955)’, International Journal of Mental Health Nursing (2017).
[viii] Diana Jefferies and others, ‘Historical Perspectives: A Snapshot of Women Admitted to Psychiatric Facilities with Psychosis or Mania after Childbirth in the Late Victorian and Inter-War Periods’, Journal of Advanced Nursing 71 (2015).