(Re)storying postpartum psychosis: a critical narrative analysis of women’s stories of postnatal distress

Research indicates that postpartum psychosis is extremely rare, occurring in approximately one out of every 1000 births (Sit et al., 2006). Nevertheless, the postnatal period is considered a time in which women experience the greatest probability of psychosis, with research suggesting that women are 20-30 times more likely to be hospitalised after childbirth that at any other point in their lives (Twomey, 2009). Whilst there is a growing field of psychologically-informed research into postnatal distress more broadly, research into postpartum psychosis continues to be dominated by a biomedical framework. As a result, psychologically-informed understandings and interventions are markedly lacking, as reflected in the literature and in recommended guidelines for clinical practice (NICE, 2014). This research speaks to this gap in exploring the subjective experience of postpartum psychosis through women’s narratives. Using a feminist social constructionist approach, it also intends to examine critically the role of broader discourses in shaping how women make sense of, and narrate, their experiences of postnatal distress.

In this research, five women told their stories of postpartum psychosis, conveying a rich and profound sense of the experience of postnatal distress. Participants’ stories were analysed using Critical Narrative Analysis (Langdridge, 2007). The following identity constructions were proposed: ‘a lost self’; ‘a medicalised self’; ‘a transformed self’ and ‘the good mother’. Tensions around agency and disempowerment were also explored in the context of identity work. Five main themes were noted across participants’ narratives: ‘explanatory frameworks’; ‘power’; ‘the multidimensional nature of family support’; ‘stigma’ and ‘recovery’. Finally, a biomedical discourse of ‘mental illness’ and a canonical narrative of ‘good’ motherhood were problematised from a feminist perspective in a critical hermeneutic of suspicion, with the suggestion that participants navigate discursive constructions of motherhood and mental health in restricted yet agentic ways.

This research builds upon a small body of literature that explores the subjective experience of postpartum psychosis. It is, to date, the only research that has considered the narrative construction of postpartum psychosis from a counselling psychology perspective. This research points to an unaddressed need for more considered and specific support for women experiencing this kind of postnatal distress, along with their partners and family members. It also raises important questions regarding the nature and timing of information provision for women experiencing these kinds of difficulties, and points to the importance of future research exploring women’s relationship with psychiatric diagnosis in the context of postpartum psychosis. Finally, this research underscores the importance of integrating discursive representations of motherhood in psychologically-informed interventions for postpartum psychosis, particularly if and when women’s experiences deviate from normative representations.