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Post-partum psychosis and motivation

Last Chance Saloon is the story of Neil ‘Twink’ Tinning, a troubled, magnificent man living with bipolar disorder, and his unique attempt to understand the science behind his, and many other, mental health conditions – all while getting ready to play the biggest gig of his life.

In part 5, Twink’s mood dips as the implications of the gig begin to loom. His investigations into mental illness lead him to Professor Ian Jones at Cardiff’s Sixways Stadium. A rugby fan and expert on post-partum psychosis, Ian explains how severe this condition, affecting some women following childbirth, can be. Twink talks to Clare Dolman, a woman with terrifying firsthand experience of the illness, and starts to realise that different mental illnesses have similar features.

Previous episode: Part 4 - Brain scans, clichés and complexity

Next episode: Part 6 - ADHD, Newsnight and knowledge


[Previously on Last Chance Saloon…]

Scientist: It is very misunderstood. It’s probably the most stigmatised-against disorder. In some sense because it’s about cognition, it’s about perception, it’s about belief, it’s almost one of the most human disorders that exists. It’s kind of at the core of being a human being.

Twink: I didn’t realise at the time that that sort of high and low was going to be for the rest of my life. Unbeknownst to me, I think I’ve been bipolar all my life.

Twink: We’re talking life and death issues here, we’re not talking about some namby-pamby, can’t get out of bed because he doesn’t want to get out of bed or whatever it might be. It’s a little bit more serious than that.


Twink: We’re going to talk about post-partum psychosis – but we really need to find out what post-partum psychosis is like for a sufferer.

Clare Dolman: Yeah.

Twink: Now, you’ve been incredibly brave to agree to talk about it, so can you tell me a little bit about your experience of an episode of post-partum psychosis?

Clare: Yeah absolutely. When I had my first child, my daughter, I thought everything would be fantastic, as everyone does with their first baby. The pregnancy went very well and when I came home, like a lot of mums, I spent a lot of time up in the night, you know, trying to breastfeed – backwards and forwards – but I started to get more and more hyper, really. To the point where I knew it was not normal.

Twink: … A bit flatter than I have been over the course of the films. What normally happens is I go into these flat days, and they sometimes turn into bad days, and if you get a lot of bad days – i.e. more than, say, 21 days really not very well – it can lead into a suicide attempt. So I’m not at that stage, but I am very conscious of the fact that I’m very vulnerable at the moment. It either will sort itself out, or it’ll end in a clinical depression, which means I have to be very, very careful about what I take on, what I do, what me stresses of me life are. If I can get out of this flatness of mood and get a bit of motivation to walk the dog, that’ll probably help me mood level and hopefully that’ll come into place. So I need that motivation, get the gig planned right in my head, and have 12 weeks worth of walking Pebbles, so that means I can move my body in time to the music and that sort of stuff.

Twink: I haven’t got a clue what post-partum psychosis is – so, what is post-partum psychosis?

Ian Jones: Well, there’s a spectrum of illness, of mood disorder that comes on after childbirth, from the very common – what’s sometimes called ‘baby blues’, which can affect perhaps 50% of women or more, and that's just a few days of transient mood lability often – and then there’s post-partum depression, which affects probably around 1 in 10 women, something like that. But what we’re talking about with post-partum psychosis is the very severe end of the spectrum: women who become incredibly ill following childbirth, usually within a few days or a week or two of having a baby, and they get probably illnesses that are some of the most severe illnesses we see in psychiatry.

Twink: That’s nice, Ian. He's a big lad but the camera loves him.

Ian: These women often have mood symptoms, so they can have very high mood or very low depressed mood, but often actually with post-partum psychosis, the mood is very variable; it can vary from day to day, from minute to minute, from hour to hour. But also common are psychotic symptoms, as the name would suggest, like delusions, believing that things aren't true, or hallucinations, seeing things that aren’t there.

Twink: Yeah, that’s good.

Ian: Do you want me smiling or serious?

Twink: Just give us a range of emotions… [laughs].

Clare: I had these slightly scary hallucinations. I remember my brother gave me this brown teddy bear for the baby as a present – and for some reason we had very steep stairs in the house I was living in in Tooting – and I just remember standing at the top of the stairs and seeing the beady eyes of this teddy bear at the bottom of the stairs all the time. I kept sort of seeing it all over the place in strange places, and I think in retrospect, maybe that was in some way my subconscious warning me, you know: “Be careful, you could do something silly here.”

Twink: It’s okay, I’m mentally ill and I’m under medication and I’ve got a full diagnosis, so whatever I say it’s because I’m ill. Oh, I tell you what, Ian, can we do some perspective shots in the seats?

Ian: Okay.

Twink: Can you still get that, Barry?

Ian: We know that some women are particularly vulnerable. For women who have had a history of bipolar illness, their risk is something like one in four or one in two even. We know that women who have had one episode of post-partum psychosis are at incredibly high risk in future pregnancies. What we don't know is what it is about childbirth that's triggering off these incidents of illness.

Clare: I would be sitting up in bed all night, and I had to have the television on, the radio on, writing a novel, going in to the baby every ten minutes… And because I have bipolar disorder and I already had a diagnosis of that previously, I knew, you know, something's wrong here; my head’s getting in a bad place.

Twink: I want to just probe a little bit further about what triggers post-partum psychosis?

Ian: That’s one of the big questions – and I think that question is what’s driving the work we’re doing in this area across the universities in Cardiff and in Birmingham University. We have some ideas, you know; these episodes of illness come on at a very characteristic time after having a baby, usually within two or three days of having a baby, and that’s a time where hormone levels such as oestrogen and progesterone drop precipitously, drop many hundred-fold from their very high levels in pregnancy.

The other thing that giving birth involves pretty universally is disrupting sleep patterns, and that may be something that can for some people with bipolar disorder be a trigger for episodes of illness. There are genes that run in families that make some women more vulnerable to having episodes of illness at this time; the genes we’re talking about maybe just nudge up or nudge down risk by a small amount. So the approach that we’re taking is trying to find out what those genetic factors are, with the hope that they’ll give us real clues about what causes the illness and what this trigger is.

Twink: That’s great.

Clare: I eventually went into hospital after ten days, I think, and I was in for about five or six weeks. You can imagine, it’s difficult enough if you’ve had a baby and everybody’s, say, asking your husband, “Oh what happened, how is she is? What does the baby weigh?” and all that, and you’ve had to stay in hospital because of high blood pressure or something. But if you say, “Oh she’s in the local psychiatric hospital and she’s not coming home for three or four months,” you know, it’s very difficult.

Twink: Devastating.

Clare: And there’s still, you know, a lot of stigma around.

Twink: What I’m finding out by doing these films is there’s this umbrella term of mental ill health – so is it fair to say that there are overlaps, say, between schizophrenia and bipolar and post-partum psychosis, and it’s just a matter of severity?

Ian: I think that’s an excellent question, Twink, and I agree, the labels we have at the moment are our best guesses and that’s all they are. What we’re definitely finding out is when we look at the factors that we know are important, they tend to be shared across these diagnoses.

Twink: So the big question: is post-partum curable?

Ian: I think that may be the wrong way of putting it.

Twink: How would you put it?

Ian: Can we do a lot better in helping people live with this condition? I think we probably can. Can we alleviate many of the symptoms that people suffer with now? I think we probably will in the future. Can we develop treatments that have less side-effects from the ones that we've got at the moment? I think that’s very plausible. Can we completely cure the illness? I don’t know, I’m not so sure.

When you’re a psychiatrist and you’re dealing with mental health, you’re dealing with the big questions of existence, really, the big questions of us as human beings. What it is to be a person.

Twink: Ian Jones, thank you very much.

Ian: Thank you, Twink.

Twink: Killer. I told you he was good.

Twink: We’re putting the effort in, we’re rehearsing, we’re doing new material. Some days I feel very, very pressured, other days not so pressured. My imagination of the gig is way, way bigger than it’s going to be, but the amount of emotional investment I’m putting into the 28th of March is what you’d expect Oasis to be emotionally committing to at Knebworth. It’s that huge a gig for me to go from being a recluse, doing an album, and finally getting up on stage in front of some people. At this stage we don’t have anything; we’ve only got ideals and ambitions.


[Coming up in part 6…]

Scientist: Whatever you feel about diagnosis, these individuals have got to be – are asking for help and we have to apply evidence-based knowledge to help individuals and recognise as a society that being judgemental is really not very helpful for these children or their families.

[Music continues]

Jeremy Paxman: But tonight and later this week our science editor Susan Watts brings news of medical developments which promise a revolution in the way many mental illnesses are treated and so literally may offer the promise of life over death.


Twink: We don’t know enough. We don’t know enough about the brain, we don’t know enough in research terms about bipolar, but I still want to continue doing the films.


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