The day before giving birth to her second child, Fiona Shaw sat ‘clad’ in her overalls chipping concrete from the quarry tiles outside her cottage door. The nine months before that she had spent renovating the house and completing her thesis. She wrote and she swam every day, and went marching about in her ‘dungarees and desert boots’, with shiny hair, a huge appetite and ‘boundless’ energy. She was ‘invigorated’ yet calm, ‘a Renaissance woman’ – there was nothing she couldn’t do. Yet in the few days following the birth of her daughter she found herself crying and unable to explain it. She didn’t want to see anyone, or parade her baby proudly in the village. Her body became ‘inert, heavy and burden-some’. When her husband went for a walk she screamed with terror at being left alone. She gave up eating, and lay ‘curled, motionless’, in her bed, ‘shipwrecked ... on a rock of revulsion’, yearning for someone to look after her as she looked after her child.
Within ten days she was being led down the long corridors of a psychiatric hospital to the Mother and Baby Unit, where she and her baby Jesse were to stay for the next two months, in a room with scarified wallpaper and a smelly carpet. After a short while she was sectioned, allocated a nurse to be within touching distance, someone to watch her whether she was asleep or on the loo. She spent long hours crouched down in a space behind her bed, or in a corner of the room. She refused food, hid her pills, and injured herself whenever she could, sticking her hand under boiling water, ironing her finger, scratching herself until she burned, and banging her head against the wall, trying to get rid of the ‘claustrophobia’ in her skull. She was given sedatives, anti-depressants and – finally – a course of electroconvulsive therapy.
The ECT did appear to help the storm in her head, but it also ‘cauterised’ her memory. In the ‘immediate fallout’ she couldn’t find her way round the ward. Conversations were ‘lost’ before she’d even finished them. She can’t recall her state of mind. She has few memories of her husband or elder daughter, Eliza, at that time. And she has no idea what she felt for her baby Jesse. ‘I believe, I have to believe that I was as intensely connected to, as passionately in love with her in her first year as I am now,’ she writes. But she had no words to describe it at the time and she has no pictures for it in her mind now. ‘It’s as though someone had taken a black brush to my memory and covered the whole surface with tarry darkness, just by chance missing the few bits of canvas I can still see.’
Shaw complains that she was treated like a child, and that she acquiesced in treatment she would not have acquiesced in had she been stronger. She was misled about the ECT – no one warned her it would have long-term consequences. Psychotherapy did not seem to be available to her – though she expressed interest in it – and there was no therapeutic alternative for her. ECT, she says, not only robbed her of her memory: it left her with no resources with which to understand her depression. None of the doctors she talked to appeared to be much interested in her illness, and all seem to have thought ECT a good thing, dismissing doubts and queries about it ‘as the anxious product of the person’s depression’. The GP she saw in the first instance told her to grin and bear it. The hospital psychiatrist – Dr A. – had ‘a narrow account to give of postnatal depression’, and was in any case principally ‘a prescriber’ of medicine. Dr B. seemed ‘astonishingly complacent about the dilemma of depression’. He thought it ‘an unfortunate physiological illness’, easily treatable. The other depressed mothers she talked to met her in secret, one woman telling her story ‘against the clock, trying to give it all before her husband came back’. She describes them as ‘tongue-tied and ignored’, and uses words like ‘stigma’ and ‘blame’. In the course of her research, she felt herself ‘inducted into a silent community’ of women who ‘don’t understand what has happened to them’ and who ‘can’t get anyone to explain it to them’. In part Shaw’s book is about the failure, as she sees it, of her psychiatric treatment. Pills and medication simply delayed the dilemma: ‘they had no answers for me and they hadn’t erased the question,’ so she stopped taking them. The literature was no help either. Reading it left her open-mouthed with disbelief. She didn’t like its ‘dogmatic adherence to a language of science’ and its categorisation of lives. Sitting in the garden with her friends, she reads to them aloud, ‘amused’ at – and then ‘chilled’ by – ‘academic’ and ‘reductive accounts of human behaviour’. She doesn’t recognise herself in the person her hospital notes describe as displaying ‘inappropriate behaviour’ or making ‘good eye contact’.
Anyone reading the first few pages of Out of Me: The Story of a Postnatal Breakdown will see that language like that would not appeal to Shaw. A graduate student with a thesis on Elizabeth Bishop, married to an academic who was her tutor before he was her husband, Shaw prefers a slightly archaic, sometimes Elizabethan diction. She talks about ‘the burden’ in her ‘belly’, and ‘giving suck’ to her baby; and comes up with sentences like, ‘After a morning in my study with my fingers on the keys and my head in books, I pleasured myself’ – more renovation – ‘with a sledge-hammer and pickaxe.’ Her bent, she feels, is literary. She takes Elizabeth Bowen’s The Little Girls into the labour room with her (though she was not enjoying it), ‘slapping it down when a contraction rose, picking it up sweaty-fingered afterwards’, and finishing it shortly before her second daughter ‘appeared’. She and her husband read poems to each other in bed. Her house is full of books, among the clutter, the bottles of wine and plates of tortellini. The whole final section of the book is a description of Shaw’s desk. And her literary ambition is clear. ‘Given how much I like fooling around with words, it was inevitable that I should write about it all, the life, the horror.’ Or, strikingly: ‘I always wanted to write something special.’
This book is not it, though writing it helped her: it is not just a sign of her recovery, but a tool of it – a kind of occupational therapy. ‘It has been by way of words – my words – that I have gradually taken hold of my life.’ The story of her breakdown is also the story of her return to normal. The two are spiralled within each other, for what Shaw believes is that her ‘family history’ caused her depression, and that writing about her history is what will cure her. Postnatal depression doesn’t come out of the blue, but out of oneself – as her title makes plain. This is not a radical argument. It concurs with the layman’s understanding of what influences our states of mind and patterns of behaviour. But it is not without some difficulties for the reader. For one thing, Shaw’s analyses are often dangerously homespun. Explanations like ‘It had happened because it was me living my life’ do net enlighten one much. And her soul-searching can look like self-indulgent meandering. ‘Reaching deep into the opaque blue water of memory, I wanted to find a shape beneath, something of the vast mass underpinning that depression,’ she writes, as a prelude to her recollections of what she herself at one stage describes as an ‘uneventful, banal, happy-enough, middle-class childhood’.
It is not a childhood without its crisis points, however, principally her parents’ separation and divorce when she was about eighteen months (roughly the same age, it turns out, as her eldest daughter when Shaw broke down) and the complicated family arrangements when each of them remarried. Shaw remembers being ‘dragged unwilling’ from her father’s arms, and the ‘desolation’ she felt when her stay with him was over; how her step-siblings bullied her, how she resented her stepmother, how she ‘rarely’ had her father to herself. When she became a fundamentalist Christian in her teens, she found a family to which she could belong as she hadn’t belonged before; and ‘a father figure to end all father figures’. When she became a bulimic at the end of her teens, she knew she was vomiting up bad feelings about her stepfather.
There were also some bizarre incidents of invented illness. At the age of 14 Shaw invented a back pain so staggering she had to be hospitalised. She did it again when she was 17. Each time she had a major, unnecessary operation that took her out of school for weeks, cost her friendships, disrupted family holidays, and caused her parents acute anxiety. She discovered she could feign unconsciousness, and only decided to ‘return’ after a neurosurgeon whispered in her ear: ‘If I have to operate on your brain, I’ll have to shave all your hair off and then get a drill.’ Shaw continued to ‘black out’ regularly after that, sometimes for several hours, whenever she felt like it.
Why did she do this? Did she have Munchausen’s disease? This is what it sounds like, but Shaw doesn’t say she was sick, or that she had a disorder. Instead, she says: ‘I wasn’t happy doing all this. But there didn’t seem any other way to go’; ‘internally I was running away from something though I never got away’; ‘perhaps if those around me had noticed the other agony, I wouldn’t have had to invent this falsely literal one for them to attend to.’ And later: ‘The few people to whom I’ve told this tale have wondered what kind of despairing need lived in me that compelled me to go to such lengths. And I’ve found it hard to answer them.’
One of the things that becomes apparent as the book progresses, however, is how, having lived with a lie for so long, Shaw has trouble with the truth. Even her breakdown felt phoney to her, and she wondered anxiously at the time if she were making it all up. It seems unlikely that she was – but there are gaps in her account that make one think. Why, for example, was she sectioned? Was it because she went for a walk that happened to be alongside a railway line, as she says? Or was she thinking about suicide (as depressed mothers commonly do)?And what about her baby Jesse? A friend describes Shaw picking Jesse up and putting her down ‘like a fork in a drawer’. But did she really not blame her, or wish to harm her (as depressed mothers commonly do)?
Her invented illnesses are similarly baffling. How did she manage to make her pulse drop and her reflexes fail to respond, as she says she did? If she were faking it, how did she manage to make herself sweat with pain? As the book goes on, other things demand explanation. Like the story of her father – one of those men, she half-explains, who led a number of different lives, who made out he wasn’t married and proposed to other women, buying rings and meeting prospective in-laws. After his death, when Shaw was at university, ‘he left a litany of other lives, each unknown to the other.’ Joking that had she spent more time with her father she might have become a more skilful liar, Shaw says: ‘I’ve always wished I could tell better lies, not thinking of myself as someone very good at it’ – but what a strange thing to wish for.
Not surprisingly, perhaps, Shaw spends a lot of this book looking for justification, some sort of licence. She reads literary accounts of breakdowns, looking for ‘allies’; and compares herself to Elizabeth Bishop, Sylvia Plath, Charlotte Perkins Gilman, Margery Kempe, William Styron. Significantly, the book she finds most helpful is The Words to Say It by Marie Cardinal, an account of her breakdown which Cardinal has since admitted to making up. It doesn’t matter, Shaw says, if Cardinal invented it all. What matters is that Cardinal confirmed for her ‘the licence to be interested in the invention that is your own life’. Psychotherapy does the same. Making a 35-mile round trip twice a week, Shaw and her therapist visit the ‘hunting ground’ or ‘shrine’ of her ‘hidden self’. Here she can indulge her ‘curiosity’ about herself, ‘never till then given air’. Or, as she says elsewhere, ‘If I could listen to the sound of my rage, even though I didn’t like what I heard, maybe I could affirm it. Like the smell of my own shit, it was a necessary, even enjoyable, product of the person I am.’
The smell of one’s own shit, however, is not usually of interest to anyone else, unless they are specialists. And if this book fails to be of much interest to a general reader, it may nonetheless have an interest for a specialist – as the narrative of someone still speaking from within their illness, an extended form of medical notes, perhaps, from a patient who admits that, though she has come a long way, she is ‘not ready nor able, yet’ to give up ‘possession’ of her ‘desperation’, who is still too thin, and who still does harm to herself, though not as much as she did before, who says that ‘whatever was laid bare’ after her daughter Jesse’s birth is still ‘close beneath’ her skin, and that she needs it to be there.
For the rest, Shaw says, she is ‘a mother’ – ‘exhausted and exhilarated by turns’ – who has written most of this book in the spare hours in the afternoon when her children are watching Sesame Street. She wonders what kind of ‘emotional baggage’ they will have inherited. But she does not go into it, only hinting at it by describing, for example, how Jesse (now a toddler) makes her parents tell and retell the story of her birth, ‘how happy we were, how much pleasure she gave us’, and how Eliza (a little older) imitates her mother by hiding under a duvet and pretending to type. To begin with I found this attitude callous – odd to write a book about your postnatal breakdown and leave your children out of it. And not only leave them out of it, but to complain that they get in your way in bookshops and bother you when you are reading. But as I have got later and later with this review, and have frequently wished my own children could be got rid of for a while, I have changed my mind. Being ‘a mother’ isn’t everything in itself. Perhaps in this matter, Shaw is only being honest.