Representation, especially accurate, empathetic and nuanced representation, is an essential part in the process of destigmatising mental-ill health. Lobeh Osagie-Asiah, a volunteer with the charity Action on Postpartum Psychosis, writes for us on this essential part of the process by reviewing ‘afterbirth’, a play exploring postpartum psychosis (PP).a

As someone who has experienced postpartum psychosis, I was really intrigued to see ‘afterbirth’ at the Omnibus Theatre as I knew it explored the illness through its main storyline. Postpartum psychosis affects around 1-2 in every thousand women who give birth (or approximately 1400 women every year in the UK) and it’s an illness that isn’t very well understood.

Raising awareness for postpartum psychosis

PP can come on quickly in the hours, days or weeks following childbirth and its symptoms can include hallucinations, delusions, mania and severe confusion – but a wide range of other symptoms can occur alongside these as well.

I was diagnosed with bipolar prior to having children so I had some experience of mental health problems that put me at greater risk of developing PP. However, many women experience it seemingly out of the blue, having had no previous mental health problems. Either way, PP is always a medical emergency, and the onset of the illness is really shocking which is why more awareness is needed. ‘afterbirth’ does a great job of shining a light on PP and tackling the stigma that surrounds it.

‘afterbirth’ was written by Zena Forster and directed by Grace Duggan, portrayed PP very accurately. It explored all the components of the illness – the delusions, the racing thoughts and the paranoia. The way the cast delivered the dialogue to show what was happening in reality versus what was happening inside the mind of the main character, Ann, was so powerful – particularly a scene with the family and doctor talking and Ann feeling confused and lost and unable to understand what they were saying.

Showing all aspects of postpartum psychosis

You could really see how the psychosis was affecting Ann, through the confusion, the rapid thoughts and her speech being really fast and then slowing back down again as she began to recover.

But it was so good to see the recovery element as well, the talking therapies involved, the family re-building relationships and the scenes exploring the fears around medication.

It touched on some of the root causes and historical experiences of Ann and her mother too which was interesting, as well as the hush hush culture around mental illness and how times are changing.
Something else that was also interesting was the small conflict between the psychologist and psychiatrist regarding the best way forward and the best treatment. Whether this was happening in reality, or whether it was happening in Ann’s mind, was unclear, either way, it was really powerful.

In addition to Ann there was also another character experiencing PP and it showed how recovery isn’t linear, by seeing her unwell with delusions, getting better and slipping back into it again before finding recovery.

Striking a balance

We really loved the comical scenes too; they were very funny. I brought my brother and my two friends who were very supportive of me when I was unwell and so they have seen me in my psychosis, and they were crying so it obviously really struck a chord.

It wasn’t emotive in a triggering or negative way but in a wow, you really got through this, this is real kind of way. They were really impressed and very happy to see the story unfold and brought to the public in this way.

The cast (Leona Allen, George Fletcher and Sally Tatum) were all fabulous. It was really well acted, and it felt as though the cast all had a great understanding of the subject. The play was set within a Mother and Baby Unit and there weren’t many props but the performances really filled the stage. Each scene was amazing.

I think the play tackles stigma brilliantly because it raises awareness of maternal mental health difficulties which can affect anyone. So just the fact that the play is having that discussion and bringing it to the forefront in a powerful way can open everybody’s eyes as to what can happen to some women and their families.

It shows that it’s something we can talk about, and, once awareness is raised, although it will take time for stigma to be removed, this is an important step, and it makes me feel even more positive that times are changing and that it isn’t something that needs to be hidden or something that you should be ashamed of.

Postpartum psychosis needs to be discussed and shared because it’s real. We talk so much about maternal mental health in terms of anxiety, depression and low moods – but we don’t talk as much about the elated moods and PP symptoms that can occur. I’m a big believer in early intervention and awareness is a strong driver for that, allowing us to detect problems before they become too big.

You can never be too informed and, the more we talk about the realities of maternal mental health in movies and plays and books, the better able we are to support others going forward.

It’s so important for our stories to be told – the good, the bad and the ugly – and I applaud ‘afterbirth’ for doing this so brilliantly.

‘after birth’ opened at London’s Omnibus Theatre and ran from February 22nd to 26th, it will then set off to tour various locations around the country such as Norwich, Graves End, Wolverhampton, and Lyme Regis throughout March so be sure to track it down in a city near you.