Book Review and Interview - Unlike the Heart by Nicola Redhouse

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Reviews of Nicola Redhouse’s extraordinary book - Unlike The Heart called it a memoir or as an editor called the rise of books about women with Post Natal Depression, a Mum-oir.

This book isn’t a traditional memoir in my opinion. It is more than that. It is a study of the brain, of family, of birth and of healing, all while using her own life as the study which she examines with intricate detail.

The question is, what happened in her life to bring her to this state of anxiety after having a child? Things happen to us as children that force us to wear a mask to be what our parents and siblings need us to be, and somewhere, we lose who we truly are in that process. Having a child unmasks you and this generous book of candid self awareness and meticulous knowledge gathering is the outcome of her examination.

Unlike The Heart is a dense book and not a light read because of the topic but there is a lightness to Nicola’s writing that made me love her from the first few pages. Her descent into her illness is so painful, I wanted to rush over and take the baby and whip her down to the GP and make her soup and let her sleep until everyone is better. It was hard to read and hard to not wonder how good she was at hiding the struggle she was going through that no one really caught on.

Unlike The Heart is a wonderful combination of candour, knowledge, healing and also love. There is so much love in the authors life and it spills onto the page giving the reader a sense of peace she is looked after, she is looking after her children but above all, she is looking after her heart.

If you like smart books that delve into the ‘why’ of the human condition, then this is the next one to add to the pile on your bedside table. It is one of those books you will keep and mark and highlight, because it’s just so damn knowledgable and yet readable.

I had the pleasure of talking to Nicola about the book and asking her a few questions which I have shared below.

Interview with Nicola Redhouse

1.    One of the things I loved about this book is that I learned from it! Your story is painful and difficult but it is also tempered with great insight and psychological knowledge. So thank you for that. I know when I have been in therapy, I want to know why I do something. Why my brain is saying that thing to myself? Why I am behaving a certain way.

Was it important to you that you also explore the academic rigour behind the illness? Do you think it helps people when they know the why, not just the what?

 I’m so glad to hear that. I love nonfiction that opens up a reader’s curiosity by offering them rigorously researched history, culture, thought. Partly the love of that quality is what made it important to my work, but partly it was simply a by-product of the book being an account of my own attempt to answer a number of complex questions that you can’t answer satisfactorily without rigour. One of the key tensions I am bringing to the fore in the book, both as an actual concrete question (posed by my science-minded sister, and which became a driver of my research) and as a subtext (in the way I bring scientific research papers together with the more lyrical personal narrative) is: how can scientific endeavour meet the unbordered, ephemeral space of the human mind?

In terms of whether it helps to know the why, I have to return to my psychoanalytic roots, which is to say that it is always better to know the truth. I do believe in (and feel I found scientific explanation for) the idea that we often have feelings whose conscious origin we are unsure of, and that we continue to invoke in ourselves repeatedly, often with no gain. And that knowing why gives us a way to change that repetition.

 

2.    Sigmund Freud said -  “One day, in retrospect, the years of struggle will strike you as the most beautiful.” 

When you look back at the time of your struggle after your first child, I.e. the learning of your baby and the having to look at everything in your life at a granular level after the depression, do see any of the struggle as beautiful?

Oh, gosh, yes. I don’t mean in the sense of idealising depression or suffering. But when it comes as part of an emerging new self in motherhood, there is so much beautiful tied up in it all. There was the incredible tenderness and bodily pleasure between me and my babies, the sheer love. And there was the transformation of my self, which continues throughout motherhood as you relate to your children, and which can be highly creative and fulfilling.

But I think it is really important in the realm of motherhood (and all emotional experience, really) to not wipe out or erase the pain in order to elevate the joy, either in the moment or on reflection, because -- and here we come back to psychoanalytic ideas -- there is pain and hatred and frustration and terror along side the love and pleasure and joy, and if we deny this dual experience for mothers we not only do a disservice to maternal reality but we deny our children ( as the famous analyst Donald Winnicott set out) the ability to embody the full range of human emotions themselves.

 

3.    Dr Shefali Tsabry says that “Our children pay a heavy price when we lack consciousness. Despite our best intentions, we enslave them to the emotional inheritance we received from our parents, binding them to the debilitating legacy of ancestors past. The nature of unconsciousness is such that, until it’s metabolized, it will seep through generation after generation. Only through awareness can the cycle of pain that swirls in families end.”

In your story you go into your relationship with your parents and how you had to be what I call an emotional archaeologist to dig up the past so you can make a better future for yourself as a parent and for your sons if they choose to be parents one day.

I think that it’s vital we explore what we have through to be true when we have children and wherever possible, relearn and remodel what might be lacking or not healthy. How much different is your approach to raising your sons different to how you were raised?

I think emotionally and intellectually the way I raise my children is very similar to the way my parents raised me - they were (and are) thinking, loving parents. I think my inheritance is in those qualities. But sometimes dynamics and the parents we are goes even further back than our own present moment historically and socially. So my mother’s mothering was unconsciously shaped by her own mother, who had suffered an undiagnosed psychotic depression postnatally, and my father’s fathering was shaped by an unconscious pattern  of denial in his own parents’ lives, and then there were the specifics of my parents’ relationship, which was largely shaped by the fact that my father left us shortly after I was born, when he came out. That, and the fact that we were living in Apartheid South Africa, which was (thank goodness) on the brink of collapse, and my mother left for Australia on her own at age 32 with two young daughters, meant my sister and I were very tightly bound to my mother emotionally. I really struggled well into adulthood, but unconsciously, with separations, and that had a huge role in my postnatal distress. So one thing I am very conscious of in my mothering is in allowing my boys safe distance from me emotionally and physically; a sense that they can go out into the world and be ok without me, symbolically or actually.

 

4.    Your illness shone a light on so much of your own childhood and you did the work as an adult and really self-advocated because you knew the emotional language and the psychological language. But many people don’t know the language or even where to start to begin to know themselves. How do you think we can start to understand ourselves better, particularly as parents?

 Absolutely, many don’t know where to start. Not only was I fortunate in being able to navigate the psychology, but in being able to navigate the systems. I understood, thanks to my father, the difference between a medical approach, a psychological approach, and when referrals were needed, how Medicare would support and not support me. I could ask him for reputable names in the field, and work out who was qualified in ways that could particularly help me. The field of mental health is, unfortunately, as speckled with fraudulent offers and misrepresentations as any other, and it can be hard as a lay person to know where to go.

It is awfully confusing for most people; and it is entirely underfunded. I think most families would benefit enormously at some crisis points from a decent amount of time with a psychotherapist who can look at the family unit as a whole and begin to pinpoint where everyone is repeating dysfunction. Unfortunately, our current system only funds ten sessions with a psychologist doing this kind of work. Ten sessions is not enough time to get meaningful work done. But we don’t also all need to be in this kind of therapy; I’m  not advocating that at all. I think not everyone can benefit from psychodynamic therapy (therapy that looks to what is not being said, to unconscious motivations, in the vein of Freud’s theory of the unconscious). You need to be able to think abstractly and accept that one thing might represent another to do this kind of work, and I don’t think everyone can do that. There are many other kinds of therapies with evidence bases of sorts that people can benefit from in different ways, but not all will help you understand, necessarily. I think if you are resistant to psychoanalytic thinking, at very least considering in your parenting that we all often act in ways that represent feelings we may not be in touch with is a hopeful and productive way to begin to understand each other.

 

5.    I remember saying to someone when I had had my first child, I made room for her in my house, my car, my life, but I forgot to make space for her in my brain. A baby takes up an enormous amount of mental space. You have to think about everything, especially if you’re the food provider! We never stop thinking about them. Anticipating what they needed and when and how we will provide it and so on and so on.  When you look back do you think you had made space for your children in your mind? How much do you think impacted your mental health?

I think a baby by necessity must take up initially almost all the space in their mother’s mind. That’s what Freud called the ‘necessary narcissism of babies’, and that’s simply adaptive. Newborn mammals rely on their mothers for survival, and the mother must intuit their every need. But what went wrong for me is that my anxiety about my baby separating from me prevented me allowing him what must happen next, which is, as Winnicott outlined, for the baby to experience disappointment. Crudely, for the baby to begin to not be in the mother’s mind every single second. If the mother is perfect and continues to respond without missing a beat, how can the baby gradually grow and learn? That’s why Winnicott spoke of the ‘good-enough’ mother. The mother who fails sometimes. I guess in the throes of my anxiety I was not able to begin to let anything else in to my mind other than my baby’s needs. Although you could argue that what I was letting in to my mind was not actually my baby’s needs but pre-emotive controls to even prevent him ever needing. His needing sewnt my anxiety through the roof! And in that way, yes, I perhaps failed to make space for him in my mind.

 

6.    Japan has the lowest rates of PND in the world. Part of this is attributed to the perinatal support systems that are in place, and that doctors look for it in their pregnant patients, the same way they would look for high blood pressure. It is considered something that can happen, not might happen. They encourage ‘Shinkiyo’, emotional wellbeing by working on their inner life by cultivating tranquillity and spirituality and they also encourage psychology and psychiatry while pregnant to ensure the Mum is going to be okay. Do you think this is something that should happen everywhere?

What about the system of looking after pregnant and post-natal women is lacking and how would you fix it?

I can’t answer this question without first pointing out that the incidences of PND in communities that suffer endemic social traumas and difficulties like poverty and racism are staggeringly high. In post-Apartheid South Africa, the rates among poor black women are through the roof. Likewise, the rates of infant mortality among poor black populations in America are the highest in the Western world. So I think there are serious questions to be asked about the way we care for and support mothers who face existing social disadvantage, and the ways those existing social disadvantages might need addressing first. Among the more advantaged, my self included, there are always deep personal lines to be traced that could benefit from better psychological support at all stages of life. I would advocate for much better funding for long-term interpersonal therapy at all stages of life for everyone, and also for other evidence-based therapies. Also for a much bigger focus in antenatal classes on the emotional experience of motherhood and the options if you are in crisis, rather than only on the practicalities of nappy changing, etc.

Finally, I would love to see research into things that we relegate to the female body given as much primacy as things that affect the male body. Postnatal hormones, hyperemesis gravidarum, pelvic instability, menopause... there is a lot more we could know that would help women and mothers.

You can buy Nicola’s book from here, and from all bookstores and online.