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A Lyrical Memoir About Postpartum Psychosis

A Lyrical Memoir About Postpartum Psychosis

Following the birth of her first child, Sarah C. Townsend suffered and recovered from postpartum psychosis, which she interrogates in her memoir, Setting the Wire (The Lettered Streets Press). As a mother who has written about my postpartum depression and anxiety, I jumped at the opportunity to read an advanced copy of the book. I both devoured and savored it, in a constant state of eagerness to read on and a desire to reflect on my own memories. The effect, for me, was a kind of powerful intimacy — in coming to know her experience, though not the same as mine, I also felt known — which speaks to both Townsend’s vivid rendering of image and her technical craft in organizing her fragmented narrative, while utilizing white space as an invitation to the reader.  

Townsend, who is also a practicing psychotherapist, folds into her visceral personal account keen insights about the nature of traumatic memory, which is “insufficiently encoded,” and theories about healing, the maternal need for “containment” following childbirth, and “the idea that something torn apart can be more healthfully reconstructed.” Lyrical and potent, Setting the Wire gives a vivid glimpse into the often-misunderstood and potentially life-threatening mental health emergency of postpartum psychosis. Simultaneously, the book speaks to the human need to make meaning out of disorder, braiding narrative threads of family history, film, hospital records, visual art, music, and psychology through what Townsend calls her “riff on insanity: endless association.”

Recently I had the pleasure of interviewing Townsend via email. What follows is our conversation, lightly edited for clarity and length. 

MS: You had your first daughter in 1999. How long was it before you began looking at the artifacts — the photos, notes, etc. — from the time of your postpartum psychosis, and what was your intention when you started? 

ST: My husband Roger saved the paperwork from my hospitalization, my own writing, and other documents from that time period and, for many years, they lived in a drawer in the basement of our house — deep in the underworld — but I knew they were there for safekeeping. We kept the photographs of Sophie’s birth and early infancy in our family albums and most captured the outline of what was, in so many ways, a beautiful birth and the sweet beginning of our life as a family.

I never looked through the contents of that drawer (and ultimately a box when we moved houses) until two-thirds of the way into writing Setting the Wire. As it turns out, I waited fourteen years to examine these artifacts. For a lot of that time, I had felt afraid of those papers. Initially, a psychiatrist encouraged me not to make efforts to recall my experience, which is interesting in and of itself, but Roger and I continued to share our memories regardless. Once I started writing in 2013, I had the thought that I wasn’t interested in researching myself because I wanted to get as close as I could to what I believed to be the more intimate version of the experience which lived in my mind.

Toward the end of writing Setting the Wire, I did make my way through the items in the box and found the documents to be very useful as an overlay to what I had already written. As it turned out, they were not particularly haunting. Maybe I was more prepared to be in contact with this material having already reviewed the experience on my own. I also requested my hospital records during this period. I lingered in the memorabilia of my younger daughter’s birth as well.

Earlier on in the writing, I listened to recordings of my father rehearsing cabaret acts and read newspaper articles about his work as a music director and arranger. In my initial efforts to think about Sophie’s birth story, I found myself writing about my father.

MS: The book’s structure mirrors and enacts the process of making meaning by suggesting connections among its parts, by looping back and sometimes revising, by accumulating and resonating in a way that feels like intuition. You say in the book that traumatic memory is “shot through with holes.” Is this form an answer to or a byproduct of writing about trauma?

ST: Since Setting the Wire is in part an effort to sort out questions of memory, I would say that its form is both a response to the nature of traumatic memory and an account of one. What I recall is porous and overall it was a porous experience, a time of heightened exposure to the sensory world. Eventually, I was playing with form although I was encouraged throughout to avoid prematurely arranging the material so as not to foreshorten the generative process. The writers Maggie Nelson and David Shields both describe a similar effort toward “accumulation.”

The nonlinear form also speaks to the intergenerational and cumulative losses that contributed to the onset of postpartum psychosis and the related effort to make meaning from experience.

MS: When you began to conceive of the book, did you know you would write this in such a nonlinear, lyrical form, or did that choice arise from the process of excavating your memories and the pieces in your box? 

TS: Initially, that’s just how the writing came out — flashes of memory. I didn’t know what I was working on exactly. I found myself writing images or moments from childhood, renderings of my parents. Eventually, I read Cheryl Strayed’s essay Heroin/e in which she juxtaposes her use of the drug with the loss of her mother to cancer. I loved its form and immediacy. I knew then that I would like to write a book composed of panels of varying lengths and that this might have something to do with braiding.

Later, the form supported, and ultimately reflected, the ways in which my memory of psychosis, and traumatic memory in general, is not linear or “whole,” and that both thinking and integration require white space. I was also interested in sound and how it could be captured on the page. Beyond that, I’m an associative thinker (isn’t this the nature of thought?) and a thematic writer, so a nonlinear form was the most authentic portrayal of my internal experience.

MS: What do you wish more people understood about postpartum psychosis?

ST: Postpartum psychosis is no one’s fault and it’s treatable. The condition is a “psychiatric emergency” in the immediate postpartum period triggered by elevated hormones and sleep deprivation, and should be carefully assessed, so as not to be missed or misdiagnosed. Postpartum psychosis is most often associated with bipolar mood disorder and can be mistaken for unipolar depression, which is particularly concerning with respect to appropriate medications. The risks of this illness include suicide and infanticide.

The consensus of research on maternal infant care is that the highest standard for treating postpartum mental illness is “to admit the mother and baby into the hospital together, on a specialized mother and baby unit, where they’re treated as a pair.” Supporting the mother/infant dyad should be a priority in treatment. I was fortunate that my care providers allowed visits with my baby, but that is not the norm.

In most cases nationally involving hospitalization, women are separated from their babies in facilities that are unfamiliar with the needs of postpartum women and families. In the most devastating cases, women have been incarcerated for crimes committed during this involuntary illness.

What would be even better is to screen for perinatal mood disorders beginning in pregnancy and to provide increased support for all women through the first year of life. As the pediatrician D.W. Winnicott is known for saying, “there is no such thing as a baby,” and “a baby alone doesn’t exist.”

MS: One idea repeated throughout the book is a need, upon becoming a mother, to be mothered. I experienced a similar need. Why do you think we yearn for this primal comfort and safety just when we are meant to provide it for our babies?

ST: This is the notion of maternal containment as articulated by British Object Relations theorists. According to this model of the mind, which is associated with the close observation of dyads from early infancy through the first or second year of life, the way we come to know ourselves in the world as separate beings is through the literal holding, swaddling and feeding by our earliest caregivers — all the ways in which the body is touched and responded to — in addition to being held in mind.

Childbirth splits a woman open and she needs to be held together physically, spiritually, and emotionally, so that she might provide a similar containment for her child.

MS: You refer to this need for containment and boundaries as well as to the loss of intuition during the psychosis. The pronouns shift from first person to third during your hospitalization, a period when time is also difficult to pin down, when your memory goes blank. Your touchstones of reality and your ability to trust your perceptions are compromised. Was it difficult to assert authority over your experience after you recovered? Your choice to get as close to your remembered experience as possible before reviewing the saved writings and hospital records feels to me like an assertion of autonomy and trust in yourself. 

ST: I think this question might have something to do with memory. In the initial weeks following my hospitalization, I felt assaulted by imagery. When I closed my eyes, I saw visuals — some kind of waking hallucination most often associated with post-traumatic stress. It’s not that I saw a particular scene — such as a bomb exploding in war — but rather that my mind was discharging images at random and in a way that was unwanted. Eventually, I came to realize that much of what had seemed so threatening were in fact distorted memories of dailiness: the shadows of fuchsia plants on our living room wall, a toy caterpillar. It’s as if I were discharging my own terror.

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Following my hospitalization, I was advised against trying to remember. This, for me, was a distressing directive. It seemed to imply, or even worse confirm, that there was something so terribly disturbing that I should never want to remember it. I was told that the brain has a way of sealing over memory. In the inverse, and perhaps as a result, I became very concerned by the idea that I would forget what happened to me and the most painful aspect of this fear was that I equated the absence of memory with the absence of time with my daughter.

It also feels shameful to recognize that one has lived outside of one’s knowing.

Ultimately, I was challenged by a creative writing professor to go deep into my own experience and write it like Sylvia Plath would. For a moment, I thought she had given me the keys to the kingdom only to realize that I had no idea how to do that and the prospect of it scared me. During this same residency, I attended a workshop with the poet and trauma writer Bhanu Kapil and I experienced what I would now call body memory. I walked into her classroom and my body began to vibrate involuntarily. Something about this breaking open was transformative.

So off I went with my Sylvia Plath and Kapil’s Ban en Banlieue to remote Ontario and while their books initially eluded me instead I dreamed them at night and wrote upon awakening. Something about the act of writing, pen on paper, was containing, and the subsequent sounds of my family waking, a swim in the afternoons.

MS: In addition to Kapil and Plath, did you look to any other writers or books in writing Setting the Wire?

ST: Books were my inspiration and my lifeline in writing Setting the Wire. In terms of form and immediacy, I was moved by Maggie Nelson’s Bluets and Sarah Manguso’s Ongoingness: The End of a Diary. These books and mine rely on what Claire Dederer, author of Love and Trouble and Poser, recently described to me as “the collapse of the author and the narrator.” Also, for lyricism and precision of imagery, I read June Jordan’s memoir Soldier and Mark Doty’s Firebird — the memoirs of poets generally. Alison Bechdel’s Fun Home showed me how one might weave another story into a narrative, in my case Philippe Petit’s high wire walk between the Twin Towers in New York City. In reading Elizabeth McCracken’s An Exact Replica of a Figment of My Imagination, I came to realize that a transformation of thought can serve as a narrative arc, although I was simultaneously inspired by the assertion of David Shields, author of Reality Hunger and many other books, that above all a literary collage must have momentum. I was also influenced by Kate Zambreno’s Heroines and Selah Saterstrom’s Slab.

MS: You were recently a guest on the Beyond Well podcast to talk about your book. At the very end of the episode, you said that being able to make art from this experience has been very important for you. What has been most meaningful about writing and publishing Setting the Wire?

ST: Writing Setting the Wire has allowed me an inroad to my creativity and connected me to others who view making art as an essential activity of living. My father was a musician and encouraged me to write lyrics as a child. I had a lot of pent up longing. This has been my first effort really.

The book is an amalgamation of every book I’ve ever read that has moved me. Over the course of the writing, I became more interested in questions of form and voice than content. I was curious about how to make contact with a reader. I had the impulse to shed everything that I’d written and try to get underneath it. I began writing in the present tense. I took comfort when the writer David Shields mentioned in an interview that literary collage is the most intimate kind of exchange with a reader because it requires an unspoken associative conversation. The same could be said of poetry.

The editorial exchange with Colleen O’Connor and Abigail Zimmer of The Lettered Streets Press, and with Ryan Spooner for cover design, has been the most impactful part of publishing Setting the Wire. The idea that other writers were spending time considering the manuscript as a whole: Should there be a line return here? It would be nice to have an “ing” word in the title. Could this fragment serve as a soft prologue? Their suggestions were sensitive, precise, and only served to make the book more itself. The experience of working this way with other human beings through language, layout, and cover design was profound. I have also found that publishing has provided the opportunity to connect with other writers who I admire, to claim my place at the table.

Setting the Wire
By Sarah C. Townsend
Published April 2019

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