Dyane Harwood is my June 2018 shero.
Birth of a New Brain, by Dyane Harwood is a very important book. Dyane’s autobiographical account of her life with bipolar disorder is as stunning as Dr. Kay Redfield Jamison’s autobiographical account. The PLUS here is that Dyane shows us how bipolar disorder can manifest after childbirth. She lets us know we need to protect our mothers and families during the vulnerable postpartum time.
She tells us that Dr. Alain Gregoire, postpartum specialist, says the postpartum period “carries the highest risk of developing bipolar disorder in the human lifetime” (Gregoire; as cited in Harwood, 2016, p. 10) although exact reasons are unknown.
Recall Andrea Yates suffered from undiagnosed bipolar disorder, which manifested in episodes of hypomania over her lifetime. Yet, the hypomania episodes were not detected as unusual nor diagnosed. Yates’ disorder worsened under the stress of caring for a large family of young children. This so very tragically manifested in psychosis after her last child was born. The story of her life and court trial are found in the haunting book, Are You There Alone?
Despite the tragedy shadowing this diagnosis, Dyane was willing to come out publicly about her struggle. Her effort is important to all of us. She shows us what bipolar disorder, peripartum onset, looks like. She is both educating all of us and advocating for the mental health community.
Dyane is more than brave to overcome her inner reticence and shame to come out despite external societal shaming and stigma and her own internalized shame about her mental illness. Bipolar disorder is treatable, as is diabetes or cancer, but it takes focus and commitment. Many people have a level of denial and shame about being diagnosed with a mental illness. Social stigma and self-stigma are real and active around mental illnesses in a way that is not found with the diagnosis of a physical disease.
In 2014, I interviewed Dyane Harwood about her struggle with what the DSM-V now calls Bipolar Disorder, Peripartum Onset. This diagnosis is more commonly known as postpartum bipolar disorder. At the time of the interview, Dyane was working on her book about her decade long struggle to find a way to stabilize her bipolar disorder. In her individual case, bipolar disorder was triggered shortly after the birth of her second daughter.
Her book was finished 10 years after her diagnosis of postpartum bipolar disorder. She says, after 10 years, she’s realized that bipolar is a part of her and that she cannot pretend it’s not there. She has stopped relegating this part of her to the shadows; this part of her has to stand in the light of acceptance. Her story her long journey to stability and towards the ability to be present in for herself, her husband and her two daughters.
Dyane’s bipolar disorder manifested within 24 hours after the birth of her second daughter. The confluence of lack of sleep, her genetic predisposition to the disorder and her body’s postpartum hormonal adjustment were most likely the trigger for the manifestation of bipolar disorder. Postpartum is a vulnerable time in a woman’s life. To repeat, Dr. Alain Gregoire, perinatal psychiatrist, says the postpartum period “carried the highest risk of developing bipolar disorder in the human lifetime” (Gregoire; as cited in Harwood, 2016, p. 10). We need to protect our mothers and families.
At first, Dyane’s symptoms weren’t dramatic. Her first symptom was hypomania, a state that’s less than full blown mania. To her medical practitioners at the hospital, and her family and friends, Dyane appeared to be “elated” after the birth of her child.
Once she was home, another, much rarer, symptom presented itself: hypergraphia. Hypergraphia is the overwhelming urge to write. I’d never heard of this until I read her book. Thank you, Dyane, for introducing me to this symptom. Dyane describes hypergraphia as having racing, obsessive thoughts and not being able to stop writing for even one second, even though her wrist was cramped up in excruciating pain. She didn’t just write on paper; she wrote on her hands, on furniture, on the bathroom mirror, and incessant typed on her computer.
Fortunately, Dyane’s mother had given her a practical postpartum gift in the form of a postpartum doula named Salle Webber. A postpartum doula is trained to help with mother and baby’s postpartum adjustment on both emotional and practical levels. A postpartum doula will cook meals, do light housework, help with the baby, help with other children and let the mom get some rest. Ms. Webber noticed that something was off and tried to help as much as possible, but the incessant writing, the inappropriate busyness, the bitter fighting with her husband were apparent. Ms. Webber wasn’t judgmental; she knew the family needed help and did what she could.
However, Dyane needed psychiatric help. Dyane herself realized after night after night of sleeplessness, excessive writing, elevated mood and pressure speech that something was really wrong. She had enough presence of mind to do some online research.
Luckily, she found Dr. Flaherty of Massachusetts General Hospital, a neurologist, who had suffered from bipolar disorder postpartum onset with that rare symptom of hypergraphia. In order to help others, Dr. Flaherty wrote a book about her experience. She generously spoke to Dyane on the phone and told her what she needed to do, which was get professional medical help right away and get stabilized on medication. Dyane confided in her husband and started to go to a psychiatrist on an outpatient basis.
As is often the case with bipolar disorder, the outpatient treatment wasn’t effective. The balance of medications for bipolar disorder is different for each individual. Sometimes it’s best to be admitted into a psychiatric unit in a hospital. This way, the psychiatrists can work with trying different medications and find the correct balance for the individual person. This process of tweaking medications for bipolar disorder can go on for years.
Denial, shame and internalized stigma can manifest in a person not seeking treatment at all, or not believing that medication is needed. So, hiding symptoms, trying to go it alone, not sticking with a treatment plan, nor with realistic medication management is a common reaction for psychiatric patients.
The psychological process of acceptance of the disease, developing the will to comply with treatment, including lifestyle management and medication management, can takes years to achieve. Bipolar disorder doesn’t have a physical scar or a blood test to diagnose, so it’s all noticing and describing and managing symptoms, which may or may not be explained away as something else.
In an interview in People magazine, Mariah Carey recently revealed that she has been diagnosed with bipolar disorder. She talks about how her bipolar disorder went undiagnosed and untreated for decades. She passed off her manic symptoms and lack of sleep as the drive to work and succeed. She now has a proper diagnosis and is receiving treatment. She is presently working on getting stabilized on the correct mix and dosage of medications.
Like Mariah Carey, Dyane took many years, a decade, to stabilize her bipolar disorder. She describes her first hospitalization as one of seven.
Dyane describes bipolar disorder as “..morphing her into a shadow of her former self…” I read about Dyane’s lifeline struggle with mood swings, multiple bouts of depression and low levels of hypomania that had always been with her in various guises throughout her life. Dyane learned many ways to manage her emotional swings and is disciplined at using multiple self-regulation skills. Reading and writing were always her passion. All of her life, she used bibliotherapy as adjunctive self-care, immersing herself in uplifting literature to help her mood. Also, hiking was another passion, and she took advantage of the benefits of forest-bathing to lift her spirits. She watches her diet, her sleep schedule and her stress levels carefully and uses aromatherapy as an adjunctive method of self-care.
Dyane fought her way through years of denial, then multiple psychiatric inpatient stays, trying more than 20 different medications and multiple psychiatrists. Some of the medications had horrendous side effects and some of the psychiatrists were insufferably arrogant, unhelpful and judgmental. In addition, her family’s health insurance didn’t cover all of the psychiatric bills and their savings was depleted.
Dyane describes the years of experimentation honestly. The medications caused a roller coaster of side effects and didn’t stabilize her properly. One in particular triggered intense suicidal ideation, something she called ”…hideously dark..” After this dark episode, she says her life was in a shambles. She tapers herself off of all of her medications and then becomes acutely manic and suffers from psychosis. She ends up in a psychiatric unit again.
Then, another stress is added. Fifteen months after the diagnosis of postpartum bipolar disorder, Dyane’s father passes away. She becomes morosely depressed. During this depression, Dyane decides to undergo electroconvulsive therapy (ECT), which has a stigma as an extreme therapy for “crazy” people. But the ECT is successful for her. The treatment brings her emotional equilibrium. She says, ECT saved her life. And then she found herself addicted to benzodiazepine and alcohol, and she needed to conquer her addictions as well.
Dyane fought long and hard for her stability.
This is an important book that needed to be written. It’s a raw story as bipolar disorder is not pretty. It’s not an easy disease to manage; the treatment options have side effects and there is a long struggle to balance medications.
Dyane’s story is a story of hope, courage, love and determination. With the help of her family, Dyane fought her way through years of denial, multiple psychiatric inpatient stays, trial and error with different medications and psychiatrists, finally undergoing electroconvulsive therapy (ECT) until she found an equilibrium in her mental health.
Dyane was brave to bring her story out into the public realm. She says she still feels shame and self-stigma, particularly around unaccepting people.
More power to Dyane and much love to her and her family, who were committed to her with love throughout all of her suffering.
Dyane’s story is for all of us, and especially for someone who needs to know that you are not alone, you have a treatable disease, help is available and with help, you can get better.
You Are Not Alone
You Are Not to Blame
With Help, You Can Better