Practice Research: Gothic Fiction for Postpartum Psychosis

Georgia Poplett discusses her PhD research methodology, developing original novel-writing as academic discourse in order to expand cultural dialogue around postpartum psychosis.

In 1913, reflecting on The Yellow Wallpaper, American author Charlotte Perkins Gilman wrote: “When the story first came out, [a] physician made protest in The Transcript. Such a story ought not to be written, he said; it was enough to drive anyone mad to read it […] It was not intended to drive people crazy, but to save people from being driven crazy, and it worked” (Gilman 2011, 265).

The Yellow Wallpaper is both a staple of 19th Century Gothic and one of the most prominent depictions of what we might interpret as postpartum psychosis (PP) in fiction. PP is a mental illness which affects 1-2 out of every 1,000 individuals who give birth in the UK and requires treatment in a Mother & Baby Unit (MBU) or general psychiatric unit (Perry et al. 2021, 2). Beginning soon after childbirth, its symptoms may oscillate between insomnia, hallucinations, mood instability, and suicidal or infanticidal ideation interspersed with periods of lucidity (Bergink et al. 2016, 1180). Despite the first treatise on PP appearing in 1858, there remains ‘no universally accepted definition’ (Trede 2009, 157). Nor does it have its own entry in the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition and known as the DSM-5 (American Psychiatric Association 2013).

This absence compounds a lack of discourse about PP more broadly. Building on Gilman’s text, my interdisciplinary practice research asks: what might it mean to think about the lived experience of PP in terms of the Gothic haunted house? What could this bewildering, confined narrative space offer for capturing the terror and isolation of maternal mental unwellness? In responding to these questions, my methodology develops original novel-writing as academic discourse. This unlikely partnership works to expand cultural dialogue around PP and locate the fiction novel as an important site for exploring maternal mental health experiences. Fictionalising this experience, however, walks a delicate line between presenting and perpetuating stigma. In this article, I hope to gesture towards some of the troublespots, ambivalences, and insights of this approach.

History of a diagnosis: postpartum psychosis (PP)

While we might trace fragments of PP back to antiquity, historian Hilary Marland has illuminated how it first crystallised into a diagnostic category during the 19th Century (Marland 2004, 26). The full depth of its mercurial clinical picture is beyond my remit here, but debate persists about its presentation and outcomes. As a result, it is difficult to apply PP to the taxonomic framework of the DSM-5, whose criteria includes the ability to which clinicians may conceptualise the diagnosis, communicate information to practitioners, and deploy effective interventions (Spinelli 2021, 819). The above has briefly indicated how PP’s very nature presents unique challenges to this model – the common ‘waxing and waning’ comprises a particular obstacle (Spinelli 2021, 819). In many ways, then, PP’s intersubjectivity may be only glimpsed in the interstices of clinical practice, owing to both the challenge its lability presents to empirical study, and to certain cultural stigmas around maternal mental illness. For example, mid-19th-Century puerperal fever epidemics and infanticide crises ossified associations between PP, contagion, and infanticide (Marland 2004, 160) – a misconception which clinical opinion has since struggled to undo (Perry et al. 2021, 4).

A collage of Victorian images showing a worried mother figure and a ghostly child with the cut-out text 'Caution to Parents' and '"This is the way we wash our hands."' from a Pears' Soap ad.
Original collage. Georgia Poplett, 2023. For full credit see end of article.

In 2020, Catherine Cho and Laura Dockrill’s memoirs raised awareness of how PP is experienced in the Western world today. Despite this recent visibility in the life-writing, there remains a paucity of explicit literary depictions of PP in fiction. To this end, I return to The Yellow Wallpaper. What about Gilman’s text makes it such an enduring account of maternal mental illness? What exactly is the importance of this fictional representation for expanding cultural discourse around PP, using the clinical knowledge and life-writing we have now? And why does practice research in this area matter?

On several levels, this project is a self-reflexive undertaking. I have not given birth, so I do not have personal experience of maternal mental illness; for these reasons, my work is indebted to the courageous testimony of experts-by-experience, who have so generously shared their stories. However, I am inextricably bound up in the matrix of birth trauma due to circumstances around my own birth and family history, bringing a relevant perspective to how atypical birthing experiences may be particularly difficult to think or speak about.

Gothic fiction, real lives

Five years before she wrote The Yellow Wallpaper, Gilman underwent three months of the Rest Cure – the very 19th-Century-sounding clinical pathway for 19th-Century ‘hysteria’, designed by the eminent physician Silas Weir Mitchell. Gilman was bed-bound, prescribed a nauseatingly rich diet, and prohibited from touching ‘pen, brush or pencil’ for the remainder of her life (2011, 265). For the intellectual Gilman, such an existence brought her ‘so near the border line of utter mental ruin that I could see over’ (2011, 265). It was only in writing what would become The Yellow Wallpaper that she ‘recover[ed] some measure of power’ (2011, 265).

First published in 1892, Gilman subsequently confirmed that The Yellow Wallpaper was not a work of memoir; she never experienced ‘hallucinations or objections to my mural decorations’ (2011, 265). The result is a hauntingly Gothic portrait of ‘the potentially nightmarish, “dark side” of motherhood’ (Davison 2004, 163). Holed up in a dilapidated mansion under the Rest Cure, Gilman’s newly-postpartum protagonist quickly develops psychosis, hallucinating a woman apparently incarcerated within the wallpaper of her sickroom. 131 years later, the story continues to resonate with lived experiences of maternal mental illness and, especially, PP.

Developed over the late 18th and 19th Centuries, the tradition in which Gilman wrote The Yellow Wallpaper performs what literary critic D. A. Miller calls the ‘feminine carceral’ – the idea that “the female protagonist not only inhabits Gothic domesticity: she is a symbolic Gothic dwelling, a mental habitation haunted by memories, fears and frustrated desires” (Heller 2020, 283). There are many different kinds of Gothic, and a full dissection of this complex generic categorisation is beyond the scope of this article. Critically, however, the genre is yoked to anxieties about entrapment and remnants of the past which infect the present. Professor of modern and contemporary literature Anne Whitehead gestures towards this type of fiction’s potency in generating “a narrative which is not straightforwardly referential, but which nevertheless offers a powerful mode of access to history and memory,” resonating with her work on trauma narratives (2004, 13). Whitehead elaborates: “In its disturbed and disrupted temporality […] trauma represents a mode of haunting,” in dialogue with the spectre of the woman inside the yellow wallpaper (2004, 13).

A collage image of Victorian cutouts featuring a head and shoulders of a smartly dressed woman with her face obscured by a black corvid and various flower images.
Original collage. Georgia Poplett, 2023. For full credit see end of article.

Similarly, the Gothic and medical humanities specialist Sara Wasson foregrounds how both deal with ‘suffering bodies and with trapped protagonists’, invoking connective ligaments between the two (Wasson 2015, 1). Gothic’s ‘sense of confinement and diminished agency’ dovetails with embodied experiences of illness, that of navigating ‘a menacing environment veined through with bewildering text – mysterious signs which must be decoded for the subject to survive, but written in a code which cannot be deciphered’ (Wasson 2020, 5). Importantly, Gothic also signifies a ‘willingness to hear the language of fear, and despair and terror’, at odds with the standardising language of clinical discourse (Wasson 2020, 2). Perhaps Gothic may help us disentangle this ‘menacing environment’ in offering the textual structures to oxygenate the ‘overwhelming feelings of fear and of being trapped in […] insanity’, which distinguished professor of obstetrics and gynaecology, Cheryl Beck, has identified in PP life-writing (2020, 1852).

Overall, several Gothic modes might provide entryways into representing the lived experience of PP for a contemporary readership, among them confinement, haunting, trauma narratives, and the uncanny. However, part of practice-led research means thinking through difference as well as similarity. Organising a Gothic exoskeleton which works with deep respect to PP’s lived experience is distinctly marshy ethical terrain; equally, instrumentalising PP life-writing to shape a commercial fiction novel negotiates some complicated ethics. Women’s mental illness in Gothic also navigates a troubled landscape in its proximity to the arguable ur-madwoman of the Western literary imagination: Jane Eyre’s Bertha Mason, who embodies shaky racial, gendered and ableist rhetoric (Pearsall 2020, 32). In the context of 19th-Century Gothic, moreover, ‘madness’ is often conflated with morality, used to vilify women who stray from regulated sociocultural frameworks (Heller 2020, 266). Consequently, in my work, it is paramount to model a Gothic narrative which works for the lived experience of PP, as opposed to the other way around.

Breaking the fourth wall(paper)

Thinking through this prism, there is an important distinction between using the life-writing’s insights to corroborate a fictional depiction of this lived experience, and to figuratively reinterpret what might be difficult to imagine or decipher about these insights in a Gothic register. The incarcerated madwomen and veiled spectres of Gothic may seem, at first glance, hyperinflated caricatures of a genre which trades in the sensational. However, I am struck by Gothic’s power to invoke terror in its readers as a potential framework for representing the uniquely terrifying experience of PP, eliciting an increased understanding of its disorienting intersubjectivity in those entirely unfamiliar with the condition. Gilman uses Gothic’s textual anatomy in a similar way, although her text arguably also fulfils a political function as Rest Cure critique: when she spoke about The Yellow Wallpaper ‘sav[ing] people from being driven crazy,’ she referred specifically to one woman whose family were so horrified by her depiction of the Rest Cure that they sought other treatment (2011, 265).

However, Gothic’s hidden and deadly intramural spaces may further usefully reflect the feelings of incarceration legible in PP life-writing which Beck identifies. “When women wrote their illness narratives,” she writes, “this action transformed their private experience into a social and political narrative which then became a collective experience” (2020, 1859). Perhaps this, then, is the power of practice-led interdisciplinarity. By drawing out what is traumatic or difficult to communicate about the lived experience of PP through a Gothic modality, does this go some way towards making it a collective experience? To be clear, we should not look to Gothic as a cathartic or therapeutic medium in the way that life-writing and memoir may be. But perhaps it holds value for allowing readers to momentarily join those in the affects of what can be a profoundly lonely and frightening experience. There may even be something freeing in it.

About the Author

Georgia Poplett is a Postgraduate Researcher based between the Department of English Studies and the Institute of Medical Humanities at Durham University, where she is currently completing an interdisciplinary practice-led PhD. Her research investigates literary models for representing the lived experience of postpartum psychosis in fiction. Find her on Twitter @GeorgiaPoplett.

References

American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Virginia: American Psychiatric Association Publishing.

Beck, Cheryl Tatano. 2020. “Pentadic Cartography: Mapping Postpartum Psychosis Narratives.” Qualitative Health Research 30, no. 12: 1851-1860. https://doi.org/10.1177/1049732320938357.

Bergink, Veerle et al. 2016. “Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood.” American Journal of Psychiatry, 173, no. 12: 1179-1188. https://doi.org/10.1176/appi.ajp.2016.16040454.

Cho, Catherine. 2020. Inferno: A Memoir. London: Bloomsbury.

Davison, Carol Margaret. 2009. History of the Gothic: Gothic Literature 1764-1824. Cardiff: University of Wales Press.

Dockrill, Laura. 2020. What Have I Done?: Motherhood, Mental Illness and Me. London: Vintage.

Gilman, Charlotte Perkins. 2011. “‘Why I Wrote The Yellow Wallpaper?’” Advances in Psychiatric Treatment 17, no. 4: 265-65. https://doi:10.1192/apt.17.4.265.

Gilman, Charlotte Perkins. 2015. The Yellow Wallpaper. London: Penguin Classics.

Heller, Tamar. 2020. “Victorian Domestic Gothic Fiction.” The Cambridge History of the Gothic. Cambridge: Cambridge University Press.

Marland, Hilary. 2004. Dangerous Motherhood: Insanity and Childbirth in Victorian Britain. London: Palgrave Macmillan.

Pearsall, Cornelia D.J. 2020. “Burying Bertha: Race and the Ungraveable Body in Jane Eyre.” In Charlotte Brontë, Embodiment and the Material World, edited Justine Pizzo and Eleanor Houghton, 27-48. London: Palgrave Macmillan.

Perry, Amy et al. 2021. “Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review.” Brain Sciences 11, no. 47: 1-14. https://doi.org/10.3390%2Fbrainsci11010047.

Spinelli, Margaret. 2021. “Postpartum psychosis: a diagnosis for the DSMV.” Archives of Women’s Mental Health 24, no. 5: 817-822. https://doi:10.1007/s00737-021-01175-8.

Trede, Katharina et al. 2009. “Treatise on insanity in pregnant, postpartum, and lactating women (1858) by Louis-Victor Marcé: a commentary.” Harvard review of psychiatry 17, no. 2: 157-65. http://dx.doi.org/10.1080/10673220902891802.

Wasson, Sara. 2015. “Useful Darkness: Intersections between Medical Humanities and Gothic Studies.” Gothic Studies 17, no. 1: 1-12. https://doi.org/10.7227/GS.17.1.1.

Whitehead, Anne. 2004. Trauma Fiction. Edinburgh: Edinburgh University Press.

Image credits

Figure 1. Original collage. Georgia Poplett, 2023. Featuring Millais, John Everett and Joseph Swain. Kept in the Dark – When the Letter was completed she found it to be one which she could not send. 1882. Photo by Birmingham Museums Trust, licensed under CCO; Morris, William. Wild Tulip, 1884 by William Morris. Design for wallpaper. Photo by Birmingham Museums Trust, licensed under CCO; Ghosts. June 11, 2021. Photo by Photos_frompasttofuture on Unsplash; Background. March 3, 2019. Photo by Steve Johnson on Unsplash; An 1888 advertisement for Pears Soap that was adapted from an 1887 painting by James Hayllar titledSoap Suds. 1888. Photo via Wikimedia Commons; Design assets (border, Latin text) via Adobe Stock.

Figure 2. Original collage. Georgia Poplett, 2023. Featuring Lummis, C. F. Charlotte Perkins Gilman. Circa 1900. Photo via Wikimedia Commons. Design assets (postcard, crow, flowers) via Adobe Stock.

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