The Postpartum Psychosis Prophecies (with Ayana Lage)

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Intro – 0:00

 

BLAIR HODGES: This episode includes discussion of miscarriage, suicidal ideation, self-harm, and postpartum psychosis. Listener discretion is advised.

Welcome to Relationscapes, the podcast where we explore the world's most pressing issues while also learning more about ourselves. I'm journalist Blair Hodges in Salt Lake City, and our guide in this episode about postpartum psychosis is author Ayana Lage.

AYANA LAGE CLIP FROM THE INTERVIEW: I was very aware of the risks of postpartum mental health. I'd heard of postpartum psychosis—it didn't even cross my mind as something that could happen to me, but I'd heard of it. I think I kind of had this thought of, I've already been through so much when it comes to pregnancy and fertility and all of this. Like, I deserve to have a good experience, so that's what's gonna happen.

BLAIR HODGES: Following a devastating miscarriage, Ayana Lage was overjoyed to deliver a baby a little more than a year later, determined to have the best possible birthing experience. And so it made sense to her when the literal voice of God started talking, telling her that she'd been chosen as a prophet, a blessed mother who would share God's revelations with the world. What could possibly be better than that?

In reality, Ayana was experiencing postpartum psychosis, a potentially life-threatening psychiatric emergency that affects roughly 1 or 2 people in every 1,000 who give birth. The stakes of understanding postpartum psychosis are high. Right now, a woman named Lindsay Clancy is on trial for killing her 3 young children in a case that centers partly on whether she was experiencing postpartum psychosis. For many people, this case may be their first encounter with the disorder, and that's a dangerous way to learn about it.

We need to listen to medical experts, and we also need to hear firsthand accounts from parents themselves. Ayana can tell us what postpartum psychosis felt like to her from the inside, and what she wishes more people understood about it. She's the author of the book Missing Me: A Memoir of Postpartum Psychosis and the Long Road Back, and she joins us to talk about it right now.

 

Talking Mental Health on Main – 02:23

 

BLAIR HODGES: Ayana, welcome to Relationscapes.

AYANA LAGE: Hi, it's so good to be here.

BLAIR HODGES: I want to take a little risk to begin. Toward the end of the book, you're writing about the problem of self-disclosure, something that you wrestle with. And after you had spent time hospitalized for severe postpartum psychosis, you had to think through when you were going to talk publicly about it and how much you were going to say. And you had a big enough online following that being gone for a few weeks was noticeable, so you had to kind of consider what that looked like. You were kind of vague about it at first and then decided to just be more open.

And then there's a Cosmopolitan article and you're being interviewed on news shows and podcasts. And as all this is rolling out, it sort of starts to exhaust you. I wanted you to read from page 158 here about what you were going through, talking about such a traumatic and personal and stigmatized experience.

AYANA LAGE: Yeah, for sure. I always say that I'm not the child who is, you know, excited to read out loud in class, so I can write, but reading—

BLAIR HODGES: Really?

AYANA LAGE: Yeah. Reading is here or there. I mean, we'll see how it goes. [laughter] I'm just giving the disclaimer in case I'm stuttering or sound awkward.

BLAIR HODGES: Oh, and the good thing about a podcast is you can always reset yourself and I'll just scrub it out. So nobody will even know.

AYANA LAGE: All right.

I cry through interviews, speak solemnly on podcasts, and pour my heart into articles and blog posts. This is what coping looks like. If I cannot undo the psychosis, I think I will help other people who are suffering. The goal is admirable, but I often fall short. It all exhausts me, a truth I try my hardest to ignore.

Answering the same questions repeatedly, trying to explain how my life fell apart without talking too much. The struggle is worth it if I can help even one person. Or maybe not. People ask the same questions, wondering how it all began and what it's like to experience delusions. Occasionally they scramble for something to say and struggle to find the words.

Awkward silence becomes the norm. When they catch their verbal footing, they look at me with admiration. I couldn't have gotten through it, they say. This is meant as a compliment. Making it to the other side means I'm determined and I've proven something to myself. But I find myself resenting the sentiment. What were my options?

BLAIR HODGES: You're resenting the sentiment. I mean, if there's something more tedious than talking about it, I wonder how talking about talking about it is, because that's what I'm trying to do. [laughs]

AYANA LAGE: It's all very meta. [laughs] No, I mean, I think that I've reached a point now where I, especially after releasing the book, am a lot more comfortable with it. But in the beginning, I had a lot of conflicted emotions about all of it. Mm-hmm.

BLAIR HODGES: Do you still get tired of explaining or talking about any particular part of it that's just like, oh, that part?

AYANA LAGE: Okay. I think—now, this is maybe a bad thing. I don't know. Depends. I don't know what my therapist would say about this, but I feel like I've kind of distilled it into a story, like, and then this happened and then that happened. And then I was in the hospital and then I, you know, was combative and then I was released and then, you know, so I feel like I've told the story probably publicly about twenty-plus times now.

So yeah, I don't know. I don't want to say that I've compartmentalized, but it's easier to tell it now than it once was, for better or for worse.

BLAIR HODGES: You've just practiced it. I mean, maybe that's just repetition, right?

Is there anything that still energizes you about the conversation where you kind of get into a flow about it that you feel more excited about?

AYANA LAGE: I think that I—how do I want to put this? I think the religious aspect of it, how it affected my faith, my already complicated relationship with faith, is still very interesting to me because it's something that I'm still experiencing. So that is something that when it comes up, you know, how hearing from God and talking to God changed how I viewed God.

I don't know. It's still, again, I'm still figuring it out 6 years later. So it's all very interesting to me.

BLAIR HODGES: We'll circle back to that too and talk a little bit about faith deconstruction and how—just, yeah—how God played into your postpartum psychosis is a really important part of the book.

 

Childhood Panic Attacks and Self Harm – 06:05

 

BLAIR HODGES: There are a lot of books on childhood trauma, and most of them include stories about how parents were dysfunctional or even abusive. And your own traumatic childhood experiences didn't seem to really be about that, though. This, I think, in some ways set your book apart from a lot of these books that I've read, in that you didn't really have, like, abusive parents.

AYANA LAGE: Yeah, no, my parents were wonderful. I still talk to my parents multiple times a day. I mean, it's a running joke with my husband that if he can't reach me, I'm probably on the phone with my mom.

BLAIR HODGES: She's with us right now, actually. Let's bring her on.

AYANA LAGE: Let's go. Can you imagine? But it's not totally far-fetched that she would be. Um, yeah, no, I love my parents. They have been fantastic my entire life. They've done a really good job. So I think that I got really lucky in that the things that I experienced, my pain wasn't exacerbated by them, and they helped me a lot once they knew some of what I was dealing with.

BLAIR HODGES: And what you were dealing with pretty early on, you started struggling. You remember your first panic attack happening at 11 years old?

AYANA LAGE: Yes.

BLAIR HODGES: Take us there. What did 11-year-old Ayana experience as a panic attack? I'm sure it must have been completely—I mean, this was a totally new experience, it must have been really scary.

AYANA LAGE: I think that I genuinely briefly thought that I'd lost touch with reality. I was 11, so I don't think that my mind really put all that together in that way, but I just felt like something was very wrong. But it also felt almost shameful. Like, I didn't know why, but something that I shouldn't be talking about because, you know, if I told someone, they might look at me and think, like, okay, like, you know, something is really wrong with her.

I think that I was afraid that that would be people's perception of me.

BLAIR HODGES: Yeah.

AYANA LAGE: That something was wrong with me. So I just—I pushed it out, and, I don't know.

BLAIR HODGES: The shame of it's really interesting because it's like, I'm sure you didn't have too many experiences growing up where, like, mental health was stigmatized to a child. Like, I'm sure your parents weren't going around saying, you know, if you have a dissociative episode, that makes you really messed up. But there's something about the experience of it that's scary and that you want to keep secret, and where does that come from? I don't know.

AYANA LAGE: Yeah, it's very interesting. I mean, I don't even think that I had the framework to view what was happening as, like, a mental health problem or episode. I think I just tried to push it out of my mind because it was so scary.

BLAIR HODGES: Yeah. Describe it. Like, you sort of felt trapped in another body or something? Talk about what the actual experience of it was like.

AYANA LAGE: I think that it's so hard for me to explain even now because it—it sounds so—I don't know, it's, like, impossible for me to make it sound as big and overwhelming and, like, all-consuming as it was. But, you know, I'd have these moments where I would just basically feel like everything around me was unfamiliar.

I didn't recognize—I looked down at my hands, I didn't recognize them. I didn't recognize the walls of my room. I didn't recognize my loved ones. Um, so, which I later learned, obviously, there was a dissociative episode of panic that I was dealing with.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: But in the moment, of course, I thought, like, am I real? You know? So there's, like, derealization as well. So it was a whole, a whole thing that thankfully I eventually was able to overcome, but it took a lot.

BLAIR HODGES: And you talk about a friend that you made. You're 12 years old. A new friend named Crystal moves in and she starts to talk to you. You guys are having, like, you know, really personal conversations with each other. And she starts talking about self-harm, which I don't know if you—if that was the first time you kind of confronted the idea of self-harm, but if you'd thought about it before, this is when you started to kind of try it out.

AYANA LAGE: Yeah, I think I was vaguely familiar. I mean, like many, many children my age or people who grew up around my time, I had access to the internet probably a little bit too early.

BLAIR HODGES: Yeah. What's your time?

AYANA LAGE: I—so I'm 33. So I feel like, so, you know, when I was, like, you know, early to mid-2000s, my parents didn't really know all that the internet could be. So I was able to pretty much have free rein at, you know, 10 years old, which is not—not what my children will experience.

But, um, yeah, so I think that I maybe vaguely knew that this was something that happened just from, like, LiveJournal and Xanga and all of that, but I hadn't considered it as something that could be useful to me until I met a friend who told me about it.

BLAIR HODGES: I see. And what seemed useful about it?

AYANA LAGE: I think that, you know, as I mentioned, when I'm having these moments where I'm like, am I even real? Like, I have no concept anymore of reality or, you know, what is actually happening, that it almost felt like this could be a release. It could be grounding. It could be a tangible reminder that, like, yes, I am.

And this sounds, I know, very probably twisted, but in my mind I was like, this could be something that would help me at least feel real. So yeah.

BLAIR HODGES: Well, I mean, it may sound twisted, but the reality is that people do engage with it because it performs a function for them. Like, I think if it didn't do something for people, they wouldn't do it. So that makes sense that you're describing it as sort of centering and coming back into yourself through self-harm, but there was more as well.

You even started thinking about suicide a few months later. So talk about that experience because you're still so young, and I think—I'm not sure how many people are aware that this isn't super common for children, but it's also not extremely rare either. So talk about your experience with suicidal ideation, and your parents had no idea that this was going on.

AYANA LAGE: Yeah, I think that for me it was unfortunately just a natural progression once I was already harming myself to kind of just start wondering. I mean, it started, like, very lightly, like, what would my life look like, or what would the world look like if I wasn't here? Well, you know, how would—like, is my life worth living?

So, like, these very abstract, not really specific thoughts. But then, like, as anyone who's dealt with suicidal ideation or, you know, considered suicide can tell you, it can get very dangerous very quickly.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: So, um, yeah, my thoughts kind of spiraled pretty quickly. And again, I think that I was also still dealing with this, like, panic that I couldn't place. And then I had all of these—I talk about later in the book, you know, issues with self-image and all of these things, like everything kind of just swirling together.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: So yeah, I mean, thankfully I got some help, not all of the help that I needed, but I did get enough help to not be in that middle space.

 

Faith-based Therapy – 12:26

 

BLAIR HODGES: Let's talk about the help that you did get, because the—yeah, the way you describe it in the book is that it was helpful, but it wasn't perhaps everything that it could be. You talked to a school counselor who alerted your parents, so now they're aware of what's going on. Must have been terrifying for them.

First of all, were you scared that they found out, or how did that go?

AYANA LAGE: I think that at that point, I was not even thinking about the consequences. I think I was secretly relieved, I think. I think that I realized that—I mean, again, I'm 12 years old, so who even knows what I'm actually thinking? But in retrospect, I feel like I knew that I didn't actually want to do this.

So it kind of felt like, okay, you know, I'm at an age still where, like, my parents are the safe people. They know what to do. So they knew. So I knew that they would know what to do. So, I mean, I did feel a little bit of relief. Yeah.

BLAIR HODGES: Right. And you didn't feel scared of your parents. You didn't have that sort of, um—it could have been a totally different circumstance for some kids if they had a broken relationship with their parents. Or if their parents don't even care.

AYANA LAGE: Yeah.

BLAIR HODGES: There's a lot of different ways parents can react to that, but they want to connect you with therapy.

AYANA LAGE: Yeah.

BLAIR HODGES: And you come from a Christian background. So talk about that background and the therapist that you ended up meeting with.

AYANA LAGE: So when I first started therapy at 12, 13 years old, it was not faith-based counseling. I think it was just someone who specialized in adolescent treatment. But when I restarted therapy a few years later, it was important to me to have a Christian counselor, to have someone who understood how faith played in it.

I felt very strongly that faith played a role in all of this somehow, and I felt like I needed someone who understood that as well.

BLAIR HODGES: Hmm. What do you think the role that faith was playing in the struggles that you were having?

AYANA LAGE: You know, I grew up Pentecostal, so I did hear a lot of times in church that, you know, Satan, the devil, all of that was behind these, you know, spiritual attacks, these mental problems people were having. So, I mean, obviously that was kind of ingrained in me, but I also think that I just thought, like, okay, God really cares about me and wants me to be better, and I want to keep that in mind as I, like, process this and seek treatment.

So I think that I thought that faith-based counseling was the best solution.

BLAIR HODGES: Okay, tell me if this sounds familiar. Um, I know a little bit about Pentecostalism. Um, one of the things that Pentecostals will sometimes point to is, like, in the Bible, in the New Testament, Paul talks about principalities and powers that exist in the world that are all around us, and a lot of them can be negative.

They're sort of like evil influences, demonic spirits, and things like this that are a real part of the world. And Christians that are raised with that kind of background, like, experience that as a reality, that there's demons around, that they can mess with you, and they could put thoughts in your head, or they can make you feel certain ways about yourself, etc.

Is that kind of the thing that you were dealing with? Was it that specific?

AYANA LAGE: To an extent, yes. I mean, I think that, like, I fully believed people could be possessed by demons.

BLAIR HODGES: Okay.

AYANA LAGE: Um, which now in my current—where I'm at in life is not, not where I'm at. So it's kind of even weird to say. But yeah, I mean, I think that we, just like people believe in God and, you know, people can conceive, okay, they believe in God, we believed in the devil just as much as we believed in God.

You know, both were real, very real.

BLAIR HODGES: Yeah, I grew up within Mormonism and I remember sort of growing up with the idea of a literal Satan as a person who was, like, there to tempt you or make you do bad stuff or whatever. And then also evil spirits that were around to do kind of the same thing. And I, you know, made a transition away from believing in, like, a literal person who was Satan.

AYANA LAGE: Yeah.

BLAIR HODGES: Like literal demons or something. But I think I can kind of relate there to a younger me, like a child who would think about those kind of powers. And it's pretty scary. It's a scary thing to deal with. Like, they could be around you. Like, I would sometimes get scared at night going to sleep because I'm like, is there, like, some kind of devil in here?

AYANA LAGE: Right. Yes. Yeah.

BLAIR HODGES: Okay, so that resonates. Okay, so getting with a Christian therapist, they're gonna have that worldview as well, but also have some therapeutic tools based on research, not just based on Scripture. What was that therapy experience like for you?

AYANA LAGE: You know, I feel like when I write about it in the book, I almost, in retrospect, feel like I reduced it—not unfairly, but maybe I didn't paint the clearest picture because it was very helpful for me in some ways when we talked about, like, the body image stuff and just some of, like, some of my anxiety, you know, situational anxiety.

And there were things that she was extremely helpful with, but there was never a mention of psychiatry or medication.

BLAIR HODGES: Right.

AYANA LAGE: Never a mention of seeking additional help when I was describing these very intense panic episodes.

BLAIR HODGES: So that's the impression I got from the book.

AYANA LAGE: Yeah.

BLAIR HODGES: I mean, it seemed like you saw this person using the tools that they had, but also having, like, a set limitation perhaps over talking about medication or something, which was probably somewhat ideological. I would imagine that some Christian therapists shy away from that. But also there's, like, more naturalistic or holistic type of therapists who don't want to go the route of medication.

And there's a lot of stigma around medication and there's conversations around whether people are overmedicated or not. But I think your experience and my own really show that medication can make a big difference for people and can be part of a really—of a necessary part of an overall plan to address mental health issues.

And I think having a therapist that way for you, that avenue was just cut off and that wasn't great.

AYANA LAGE: Yeah.

BLAIR HODGES: But also you did get some stuff out of it.

AYANA LAGE: I did, yes.

BLAIR HODGES: We're talking with Ayana Lage. We're talking about the book Missing Me: A Memoir of Postpartum Psychosis and the Long Road Back.

 

You Can't Outrun the Breakdown – 18:17

 

BLAIR HODGES: All right, Ayana. So as a 19-year-old college student, you're still having different struggles. A boyfriend of yours at the time suggests therapy. So you're still kind of having these ups and downs, these backs and forths.

And as a 20-year-old college student, you got this really big internship opportunity. And it was a big deal for you, kind of the next logical step in the advancement of your future career, right? And you visit home in between school semesters. And instead of going home and, like, celebrating and everybody's happy with you for getting this opportunity, you have a big breakdown here.

So take us to this breakdown and describe it for us.

AYANA LAGE: I think that I've been running away from my thoughts for a really long time. I mean, dating back to being 11 years old, but I had almost, like, a cloud looming under me. And maybe I, like—you know, maybe it's raining and I have an umbrella that's, like, about to buckle under the weight of the rain.

I don't know the way to describe it, but I think that I just naturally reached a breaking point because I was still feeling all of this panic and I had no solution. And I think a part of me felt like, I'm in therapy and it's helpful, sure. And I really like my therapist, but this hasn't fixed me.

Like, I don't know what to do. I don't know what I'm going to do. So I, um, busied myself with school and extracurriculars and, you know, family and all of this. So I had no time at all to process or think. I mean, I was leaving early in the morning, getting home late at night, basically just showering and sleeping at home.

Like, everything, every moment of my day was consumed by something. I was very, very busy.

BLAIR HODGES: So from the outside, you probably looked like a big overachiever, someone who really had their shit together.

AYANA LAGE: Oh, 100%. But when I got home and that all kind of fell away, I just crashed. And I think it was going to happen eventually. I think that just being home and not having all of these things going on is what triggered it. But it would have happened one way or another, I think.

BLAIR HODGES: Yeah, like all the scaffolding fell away.

AYANA LAGE: Yes.

BLAIR HODGES: You were just there. What exactly happened, like, uh, with the breakdown?

AYANA LAGE: I just started—I mean, it started with, like, a lot of crying and, like, sadness and all of that, but I felt like I couldn't get out of bed, uh, within a couple of days of feeling weird. And I was struggling to eat. I was struggling to do anything. I was struggling to get dressed.

Um, and it all happened pretty quickly. Uh, I mean, I don't—I can't think of the timeline right now without a calendar in front of me, but I want to say it was maybe a week between me getting home from—uh, maybe a week and a half between me getting home from school to being hospitalized.

So it happened, it happened pretty quickly.

BLAIR HODGES: And how'd the hospitalization happen? Was that your call or did somebody—did your parents encourage you?

AYANA LAGE: Yeah, we tried to visit a couple of, like, outpatient therapy practices. And one of the ones we drove to and waited to be seen, they were like, you know, we can't really—we're super packed right now. We can give you tools that you can use at home, but, you know, we can't see you.

Like, they did a consultation, but they were like, we can't actually see you today. And so at that point, I think that my parents are like, okay. At that point I'd said the words, you know, I am suicidal. So they were treating it as an emergency. And I think that when it was not being treated as an emergency at these outpatient facilities, it was like, okay, the only place to go is the emergency room.

So that's how that happened. I wasn't opposed. I was scared, but I don't think I was opposed to it. I think that I was just really desperate for help.

BLAIR HODGES: And you describe going through the intake questions and your later self will come back to this moment and sort of, I don't know, maybe even see a little bit of ableism, I guess, in the way that you, like, first encountered these questions. But you started getting these questions about hearing voices and whether you believed there were secret messages. Talk about some of those questions and your initial reaction to those.

AYANA LAGE: When I was admitted to the hospital, I mean, as anyone who's ever had a psych stay or psych hold can tell you, they do go through, like, a detailed questionnaire to kind of figure out where you're at. And some of the questions, as you mentioned, included things that I thought sounded ludicrous, like hearing voices, having the TV talk to you, having the radio send you secret messages.

And I remember thinking, like, do I want to be here if there are people who say yes to those questions in this hospital? I don't want to be here. I was just—I was, again, I'm 20 years old. 20 years old. So, like, I am old enough to know some things, but young enough that, like, this is a completely foreign, scary experience.

And I think that for whatever reason, that just made it even scarier for me, the idea of, like, I'm going to be here with people who are seriously ill, which I didn't view myself as at the time. So yeah.

BLAIR HODGES: Right. And this first hospitalization you kind of describe as overall a positive thing. It sounds like it helped you get stabilized, get some footing. Is that right?

AYANA LAGE: Yeah.

BLAIR HODGES: Now, you would have another hospitalization coming up that was not like that. That was quite the opposite. Walk us through that hospitalization, the second hospitalization, how it was different from the first one.

AYANA LAGE: So about 4 years after that, at this point, I've been married for about 2 years and I'm living in a different city than my hometown with my husband. And I'd been laid off from a job. We had, like, some interpersonal drama with his workplace that was—he worked at a church, and so it wasn't, it wasn't really a normal workplace.

It kind of consumed his whole life. So if he had work drama, it became our life drama as well.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: So there was just a lot going on. I don't think that I was on the proper combination of medicine.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: But I, um, I reached a moment where I called the suicide hotline because I just felt like I don't really know what to do. I'm feeling very overwhelmed. And then decided to go to the hospital, assuming that, maybe foolishly now, that they would have counselors there who would be able to help me, or a psychiatrist who'd be able to talk to me, and then, you know, we'd go from there.

But instead, I was involuntarily admitted because I mentioned suicidal ideation.

BLAIR HODGES: Hmm.

AYANA LAGE: I found the hospital stay mostly pointless, which I stand by. I mean, it was a unit that was so crowded. I saw the doctor for maybe a couple minutes every day. I just was waiting out the 72 hours that I had to be there, you know, that they were holding me there for.

Um, legally. So I left that hospital stay feeling like, yeah, I don't really want to do that ever again, even if it requires me not being open with someone about my mental health. Like, I'm not going to do that again because it was just, it was just so terrible.

BLAIR HODGES: Yeah, it seemed like one of the biggest things was that you just felt that the whole thing was against your will. Like, the first time that you went wasn't great, but you had an experience that wasn't so uncomfortable. You went there and it felt more like your choice.

AYANA LAGE: Yes.

BLAIR HODGES: And this one felt more like an imprisonment, it sounded like.

AYANA LAGE: Yes. Yes, for sure.

BLAIR HODGES: And you say that it kind of made you lose your faith in the system at that point, like you didn't want to get involved again, if that—if, you know, like you said, maybe you'd rather lie than wind up in a place like that again.

AYANA LAGE: Yeah, I think that I didn't have an idea. I mean, I guess I probably knew on an intellectual level, but I never thought that you could go to a hospital and not leave, uh, again, like, you could want to leave and not be able to leave. I hadn't encountered that before.

BLAIR HODGES: Right.

AYANA LAGE: So I think that, you know, I think that having, like, psych programs and having involuntary holds, like, there's obviously value in that. For me, though, it was applied in a way that just ended up feeling a little bit traumatic. So yeah, I definitely had less faith in the medical system than I started with.

 

The Pivotal Moment of Going Public – 25:48

 

BLAIR HODGES: Mm-hmm. In between those 2 hospitalizations, the kind of more positive experience one and the really negative experience one, you decided to talk publicly about your mental health struggles and about being hospitalized the first time. And you talk about how depression didn't rob you of feeling good about yourself, it just stopped you from feeling anything at all.

So you're really, maybe for the first time publicly to a lot of people, talking about your experience. And you say in the book, I don't know it, but this is one of the most pivotal moments of my life. Why was talking about it publicly like that so pivotal?

AYANA LAGE: I think it was just such a radical shift going from not wanting even my therapist to know the details of what I was feeling to the entire world knowing and opening myself up to people's criticism and to people reaching out in positive ways, but sometimes overwhelming ways.

And so, I mean, and I also think that I, at that point, had an idea of, you know, I'm in college, I am trying to build a career for myself as a journalist, but if someone Googles me and I start to write about this and talk about this, like, they might find out that I deal with depression and anxiety, and that could affect their perception of me.

And that was my thought process. And I mean, this was now—12 years ago, I want to say 13 years ago, that this is all happening. I can't do math on the fly, but it was, it was a long time ago. I've been out of college for 11 years, and it was, like, you know, in the middle of my college experience.

So I, um, I think felt like people were talking about it a lot less then than they are now. So there was just a lot going on in my head.

BLAIR HODGES: In retrospect, you're reflecting on how you felt at the time. This part really stood out to me. You're saying, most important to me, I, I never lost touch with reality. Um, and you talk about, you talk about kind of being relieved that your experience of your mental health difficulty this time were somewhat more palatable, uh, that, like, oh, I'm not crazy, I just have this.

So you're still kind of distinguishing between kind of a more palatable version of mental health struggles versus, like—

AYANA LAGE: Yeah. You know, I think that I also, I felt grateful that I was so high achieving because of my, you know, coping mechanisms. I mean, it's, it's kind of silly, but as I mentioned, you know, before I was hospitalized, I was going, going, going, but I became successful because of that. You know, I did very well because I put all of my energy and time toward work and school instead of thinking about my feelings.

So I think that I kind of felt like the anxiety especially, like, empowered me to do more, to be more successful than I would've been without it.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: And also made me more self-aware. So those were things that were very important to me. And I think that, I don't know that I would ever have actually said, like, oh, I'm not crazy, that person is. But I think that there was an undercurrent in my mind of, okay, like, I'm not actually mentally ill.

Like, this is just—I deal with this, but I'm not actually someone who has, like, mental illness.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: So it was a distinction that was important to me, but obviously, like, I was humbled very quickly a few years later.

BLAIR HODGES: Yeah. As, as we'll get to, I feel like maybe the issue, the crux of that is maybe feeling in control.

AYANA LAGE: Yes.

BLAIR HODGES: That, uh, yeah, that if, if things had escalated more, if you had experienced a deeper version of these difficulties, that you wouldn't be able to control it at all. You wouldn't be you. And maybe even you wouldn't be you in some sense anymore at all. Like, maybe you couldn't trust your own sense of reality or something beyond that.

AYANA LAGE: For sure. I think that I still felt very secure in who I was, especially once I was medicated and seeing a psychologist. Even though I was dealing with these things, I felt very in control. I felt very self-confident. I felt like, okay, like, I know who I am and what I'm doing. Uh, so those were things that were really important to me.

 

Risk Factors, the Reverse Secret, Black Maternal Mortality Rates – 29:45

 

BLAIR HODGES: So leading up to your first pregnancy, had you thought much about postpartum depression? Had you heard about it? Had you, like, learned about it in school or anything like that?

AYANA LAGE: Like, what was your familiarity with postpartum— So I knew on, like, a very high level that I was at a higher risk because I had a mental health history. So I wasn't super terrified of it. I wasn't spending a lot of time worrying about it, but I was aware, okay, this is something that could happen. Yeah.

BLAIR HODGES: Was that a thought that you'd sort of, like, push away really quick, or you just felt like, yeah, that could happen, but I'm not worried about it because it's not likely?

AYANA LAGE: Yeah, and I read about it. I knew some of the warning signs. So I still felt like, okay, this probably won't happen, but if it does, like, we'll be able to figure it out.

BLAIR HODGES: The book is helpful because it lays out some of the risk factors for postpartum psychosis. And like you said, you were somewhat aware of those. You talk about, like, a history of mental health issues. Bipolar disorder is a risk factor, sleep deprivation, hormonal changes, and also previous experience with traumatic birth or loss.

And you had experienced that 16 months before you gave birth to your child. Talk about that, uh, as a component of the later postpartum psychosis.

AYANA LAGE: I think so. I, I did have a miscarriage near the end of my first trimester due to a, um, chromosomal abnormality. And so I think that I, going into my second pregnancy, which is the one that ended in postpartum psychosis, I think that I—I don't know. I, I had a lot of thoughts about what was and wasn't fair.

And I think that I kind of had this idea of nothing going wrong in my pregnancy because I'd already experienced something that was so horrible to me.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: So I, I was very aware of the risks of postpartum mental health, especially postpartum depression. But, you know, I'd heard of postpartum psychosis. It didn't even register. It didn't even cross my mind as something that could happen to me, but I, I, I'd heard of it. But I think I kind of had this thought of, I've already been through so much when it comes to pregnancy and fertility and all of this.

Like, I deserve to have a good experience, so that's what's gonna happen. Kind of like a manifestation thing.

BLAIR HODGES: You paid your dues.

AYANA LAGE: Yes. So I was kind of manifesting.

BLAIR HODGES: It's like cosmic bargaining, or yeah, manifesting.

AYANA LAGE: Yeah.

BLAIR HODGES: It's so funny that you use that word because I feel like your book describes, instead of the power of positive thinking, it describes the power of negative thinking. This is like this coping mechanism that you picked up where you would, like, you'd think through the worst-case scenarios, 'cause then it would become super unlikely, right?

So you'd be like, oh, my mom's totally gonna die in a car crash on the way home. And then you're like, then it won't happen, 'cause, like, the odds of you thinking of it would, like, cancel it out or something.

AYANA LAGE: Yes, yes, it is. It was and sometimes is still a problem.

BLAIR HODGES: Really? You still kind of experience that sometimes?

AYANA LAGE: Yeah, I think that I have a lot of anxiety about bad things happening, and I think that because I've had bad things happen to me that weren't likely to happen, I feel even more so like, I don't know, like the odds are low, but they're still there. So it's, it's still a constant process.

BLAIR HODGES: Have you ever read The Secret by chance?

AYANA LAGE: I haven't. I've heard of it, obviously, but I haven't read it.

BLAIR HODGES: Yeah, I mean, it was huge. Like, Oprah did it. It's this whole idea of, like, manifesting. Also, a lot of Christian communities will kind of have a Christian version of this. And it, yeah, it really is that you, like, if you only sow positive thoughts, you'll only harvest positive outcomes. And it's kind of really problematic.

It's sort of a way of blaming people for their suffering, and it kind of sets the universe up as this magical, where you can just do a magical formula and get the outcome you wanted.

AYANA LAGE: Yeah.

BLAIR HODGES: Where, yeah, if you just think positive, only positive—the only positive will happen. You're the first book I've ever encountered where someone said, like, the opposite of that, of, like, if you think the negative, then you'll kind of ward that off. But it reminded me that I've kind of done that a few times in my life.

I remember my mom going on a trip when I was a little kid, and I was sure that the plane would go down. And I ruminated on it and thought about it a lot. And I had that thought of, like, well, if I'm thinking about it like this, it's probably not gonna happen then.

AYANA LAGE: Yeah, it's, I mean, it's just obviously statistically dubious to think this way, but it does feel like, what are the odds that this thing that I've come up with is going to happen?

BLAIR HODGES: Yes.

AYANA LAGE: But, you know.

BLAIR HODGES: And that first pregnancy, that was a big loss for you. You were excited to be a parent. You lost a child. You experienced it as a lost child, not as, like, a pregnancy anomaly. And that becomes a heightened risk factor as well, in addition to just being terrible in and of itself, becomes a heightened risk factor for postpartum psychosis.

So the second pregnancy, I don't know, it seems scarier to me because, like, now you're dealing with the anxiety of possibly losing another pregnancy, in addition to the fact that you're Black and pregnant in America. And I want you to kind of touch on that component of it because Black maternal mortality rates are a really serious concern.

And so you had that on your mind as well.

AYANA LAGE: Yeah, it was kind of like the timing wasn't great because this was also near the beginning of the COVID-19 pandemic. So I was unable to take my husband or anyone with me to doctor's appointments. I wasn't able to have anyone other than my husband in the delivery room, and I'd hired a doula but then wasn't able, you know, to have her there.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: So I think that I, um, it was just like there was a lot going on. I was aware that as a Black woman that I was at a higher risk of dying during childbirth or postpartum.

BLAIR HODGES: 3 times more likely. That's the stats, right? It's bonkers.

AYANA LAGE: Yeah, it's, it's wild. But, um, I—so I had, I had a lot of anxiety. I don't think that I had as much anxiety about what was going to happen to me postpartum. I think that after the miscarriage, I was so convinced that something would go wrong with the baby that I was so, like, hyper-focused on that.

But I was, I was also in my spare time not worrying about that, worrying about the element of, like, Black maternal health. I don't think that I spent as much time on my postpartum mental health because there was just so much else going on, but that was also a thought that was in my mind.

BLAIR HODGES: And that's a big piece too, because sometimes maternal mortality isn't just, like, up until the baby's delivered. They can count, um, complications that happen after delivery and mental health episodes that happen after delivery, including suicidal ideation.

 

The Mania Begins – 36:03

 

BLAIR HODGES: So for you, your description of the beginnings of postpartum psychosis—I don't want to sound insensitive, but, like, the way you describe it was sort of kind of funny.

Like, your initial symptoms of it were manic and very excited. Like, you started texting everybody and updating everybody about the baby. Like, you loved your baby and you wanted everybody to know.

AYANA LAGE: Yes.

BLAIR HODGES: And some of the moments in there were… [laughs] Is that a gross reaction to kind of be like, oh, I see an excited mom and I'm just like, that is kind of funny to text random people out of the blue that you hadn't talked to in, like, years and be like, updating about the baby.

AYANA LAGE: It's taken me a long time to view it as funny and not horrendously embarrassing. But I do think that the complicated part of it was that I was being egged on, for lack of a better word. You know, I was posting so much on social media, and I was getting so many texts like, you're, you know, basically you're doing a great job, you're, you know, you're such a good mom.

But then also, like, wow, you're being really funny. Because I mean, I was cracking jokes left and right. I was—

BLAIR HODGES: Yeah.

AYANA LAGE: Kind of the life of the party. That was, I mean, it was just like very true of mania. But even in person, I remember I was telling stories in a way that my family and my friends were laughing at. Like, not, you know, as I'm texting my close friends, I'm just talking about things that have happened and framing them in a way that is very, very, just like very funny.

So I think that people just kind of thought that I was just kind of an extreme version of myself and maybe sleep deprivation or giving birth had made me that way.

BLAIR HODGES: Huh.

AYANA LAGE: I don't think that anyone was worried when they were receiving the text messages because also, like, if you're a new mom who's just had an emergency C-section and given birth a month early, like, yeah, you might act a little weird. Like, yeah, things might not be what you expect. So I think that people gave me a lot of grace because of that, which is a good thing, but also led to it not being caught until a little bit later on.

BLAIR HODGES: Right, right. And you said it took a little while. So are there things about it now, at least in the early phase, where you can—that you do sort of see some humor in it? Because it sounded like you were saying there was more shame associated with it at first.

Like, one of the big things that comes to mind is texting people that it would just be really weird to get a text from somebody you haven't heard from in a long time and they're, like, telling you all about their new baby. And yeah, that'd be super weird. But now do you see any humor in that? Or, I mean, are you just like, yeah, I'll kind of laugh along with you on that, but it still sucks?

AYANA LAGE: I think it's more the latter. But then also it's funny because I actually, probably last year, had an acquaintance bring up, oh my gosh, after you gave birth, you texted me that and it was so funny. And obviously he wasn't thinking about—

BLAIR HODGES: Yeah.

AYANA LAGE: I don't think people realize that it was all intertwined and it wasn't just like I woke up one day and I was psychotic. Like, it was kind of a gradual journey there. But I agonized over that 'cause it wasn't a text about the baby, but I'd, like, texted him and been like, oh my God, this is so funny. You have to hear this story.

And so it was kind of healing in a weird way to hear him say, like, oh, that was so funny when you texted me that. I was like, okay, like, maybe it was funny. Maybe it wasn't all super embarrassing and cringe.

BLAIR HODGES: But yeah, well, even the way you tell it in the story brings a little—like, you bring—there's just a little bit of attitude behind it where that just kind of makes it—

AYANA LAGE: Yeah.

BLAIR HODGES: And I think it's really cool to hear you talk about it being, like, a ramp-up to getting worse because that makes sense that, like, it could be experienced that way by people around you without knowing that you were actually heading down a really scary slippery slope instead of, like, going up, because it could come across as charming or just a really excited mom here.

AYANA LAGE: Yeah, I think that my loved ones did not get worried until I started having mood swings and I was going from being, like, the excited, funny, you know, whatever, outgoing mom to, like, I can't get out of bed right now because I'm crying because I'm so overcome with emotion. So I think—and these were—it was, like, minutes apart.

It wasn't like days where I couldn't get out of bed and then days where I was happy. It was literally, like, within one day I'd have, you know, up and down, up and down, up and down. So I think that that's when they started to think, like, hmm, that's not normal behavior.

But again, you don't act normal after you have a kid. So, like, people—

BLAIR HODGES: Right! [laughter]

AYANA LAGE: Yeah, people weren't worried. I think they were just like, oh, this is interesting that this is happening. I think that it maybe struck a chord. They were making note of it, but they weren't like, okay, let's call her doctor.

 

Next Come Hallucinations – 40:38

 

BLAIR HODGES: And then hallucinations begin. Describe your memory of those hallucinations. What was that like?

AYANA LAGE: I think that it would just—I mean, it just felt like a really, really bad dream, but I knew that I was awake. I think that's the best way to describe it. So that's why it was so terrifying to me because it was almost like everything was distorted, like I was in a funhouse, but I knew that I was awake.

Like, I knew that what I was seeing was reality. You know what I mean? It's not like I'm gonna wake up and then say, oh, that was a bad dream. So I think that deep down, I just had this really awful feeling of, like, this is happening to me, and it doesn't make any sense, but I have no other way to explain it other than it being real.

So yeah, it was scary.

BLAIR HODGES: And up to this point, you'd kind of been going through some faith deconstruction and figuring out, like, what you believed about God. Your husband had worked, I think, as a—was it a music pastor?

AYANA LAGE: Yes.

BLAIR HODGES: And you had, as you mentioned earlier, interpersonal difficulties with the place that he worked before that were kind of tied up in racism or tied up in those sort of dynamics. And so you're not sure where you're at with God, but your hallucination was God. Like, God started talking to you.

AYANA LAGE: Yes.

BLAIR HODGES: And from what I can tell from the book, this sounds very literal. Like, it sounds like you experienced it as completely real that you were hearing God talking to you.

AYANA LAGE: Yeah, so some of it was scary, but I think the God part was so thrilling to me. I was just excited. I think that I hadn't realized how much I'd wanted that, and even in my then-current faith where I wasn't, you know, I wasn't Pentecostal, I wasn't seeking these supernatural miracles.

BLAIR HODGES: Yeah, or speaking in tongues or stuff like that.

AYANA LAGE: Yeah, I wasn't doing any of that, but I think that there was a part of me that still felt just overcome with emotion that God was finally talking to me. And I now know that if you have religious history, you're more likely to experience my flavor of delusion. So it all kind of makes sense that that's how that played out for me.

But yeah, it was very exciting.

BLAIR HODGES: Like, how real would you describe it? Did it literally sound like an actual real voice? Like, you experienced it as something you heard?

AYANA LAGE: Yeah, yeah, yeah. Like a conversation with someone who's right in front of you.

BLAIR HODGES: Just like this, just like we're talking right now. So it seemed that real.

 

Hospital Revelations – 43:00

 

BLAIR HODGES: And then you're going to end up being hospitalized again. How did that happen?

AYANA LAGE: My family did not want to take me to the hospital because, again, we're in the pandemic at a point where no visitors are allowed. If I go into the hospital, I'm going to have to walk in alone. I'm not going to see my baby for as long as I'm hospitalized.

BLAIR HODGES: So we are—

AYANA LAGE: They are very aware of this, how high the stakes are, for lack of a better term. But once I started to hear from God, I think that, you know, I asked my husband much later, like, when did you know that I was going to be hospitalized eventually? And he was like, yeah, once the God stuff started, like, he knew that it wasn't mood swings and it wasn't just, like, a random mental health episode that'll go away if she got enough sleep and drank enough water.

I think he knew, like, something's seriously wrong. So the conversations about the hospital were happening already, but nothing had been decided. And I had a moment where I just felt so full of panic that I was like, I need to go to the hospital right now.

BLAIR HODGES: Mm-hmm.

AYANA LAGE: And the hallucinations didn't get bad until I was in the ER. So I feel like that was when it became scariest. And if I'd experienced that at home, it would've been even more traumatic. So that is always so interesting to me, that I had this gut feeling that I needed to go in.

And I begged them to take me. I said, I need to go right now. Which doesn't make sense, you know, for the state that I was in to then be begging to go to the hospital. As I'm thrilled that God's talking to me, like, deep down I knew something was wrong.

I needed to be seen. So, yeah.

BLAIR HODGES: What kind of things was God saying to you?

AYANA LAGE: Oh my gosh, even when I look back in the notebooks, it's so funny because it's just, like, so much at once.

BLAIR HODGES: And you mention the notebooks, because you started writing a bunch of these revelations down.

AYANA LAGE: Yes.

BLAIR HODGES: You actually took some of these home from the hospital, a stack of these books of revelations.

AYANA LAGE: Yeah, so I started writing. I literally grabbed, like, a scrap of paper and a pen on my nightstand the night that God started speaking to me and started writing things down. And the big—the overwhelming delusion that I had, the thing that I was hearing, was that I was a prophet and that God was the one who was talking to me, that I was going to rewrite the Bible.

There were other threads there that kind of popped up, but those were the things that I fixated on.

BLAIR HODGES: Yeah, there was going to be this new Bible and you were going to be the prophet for it.

AYANA LAGE: Yes.

BLAIR HODGES: Now meanwhile, your new baby and your husband are on the outside, you're hospitalized, and you did get time—there were, like, hours when you could call home and talk to them.

AYANA LAGE: Yes.

BLAIR HODGES: And I thought it would be helpful to have you read from, I think this is on page 74, where you have one of these conversations. You call home and talk to your husband. And then the book—the book's really cool because you kind of go back and forth between your thinking when you were experiencing psychosis.

And that's in italicized text throughout the book. We kind of get to experience it alongside you, like your thought process and what you were thinking. So this excerpt, you're going to read from a phone conversation you had, and then you're going to go into kind of that internal dialogue you were having under psychosis.

AYANA LAGE: Sure. Me, God told me I'm in big trouble. Him, I love you and miss you. Me, people are trying to kill me here. Him, her umbilical cord stump fell off. Me, you don't believe me. Him, I love you and miss you. God has chosen me and they're trying to kill me because I know the truth.

I'm thrilled and terrified. And my husband wants to talk about meaningless things. I'm not sure the baby he keeps mentioning is mine anyway. God sends me dreams. She might only exist in my mind. I have more important things to consider, even if she exists. If she's even real. Possible she's performing experiments on me without my consent.

I'd never say yes to this. I have a gnarly wound on my stomach, proof of the abuse. I ask God to help me forget the pain, but it throbs incessantly. If that isn't enough, I can't escape the other patients. Or are they demons? I'm desperate to get out. My husband can only say he loves me.

Useless. My partner, my protector, except now I'm entirely alone. He doesn't sound the same anyway. His voice strained instead of strong. Has he been replaced by an actor pretending to be my husband? I have to ask Jesus. And then I realized he was desperately trying not to cry. Yeah.

BLAIR HODGES: So you, I mean, you were thinking about other patients trying to kill you.

AYANA LAGE: Yeah.

BLAIR HODGES: You were thinking about, I mean, kind of everybody trying to kill you. You also talk about being thrilled and terrified 'cause God had this mission for you that you were trying to fulfill. And you also saw visual hallucinations as well, right?

AYANA LAGE: I did, yes.

BLAIR HODGES: Okay, the one that really kind of stuck with me is seeing corpses in the showers at the hospital.

AYANA LAGE: Whoa.

BLAIR HODGES: And I just—I'm asking the same thing again. Like, you're telling me it was as literal as looking at me right here on this screen, right? Like, you saw this?

AYANA LAGE: Yeah. And I think that that was maybe the scariest part of it for me in retrospect, is knowing that this could happen to anyone and you have no idea. You know, I always explain it as, you know, if I went outside and said the sky is green and it's literally green and everyone around me is like, it's blue. Are you okay? Like, that's not true.

That's how it felt. Like, I'm in this weird situation where things don't feel right and no one believes me. But yeah, I mean, I'd have very detailed, very gruesome hallucinations and it was very difficult.

 

The Pretty Prophet – 48:08

 

BLAIR HODGES: There's a chapter called The Pretty Prophet. You had spent—you'd spent a lot of time in your life worried about your appearance, worried about your size. A lot of women experience this, and increasingly men, not to mention trans and non-binary folks, dealing with feelings about body image. So this was a struggle for you, but you say the psychosis actually kind of took all that away for a time.

And this is the chapter, The Pretty Prophet. Talk about that experience.

AYANA LAGE: It was very interesting because I think that that was, in the moment, one of the bright sides of the psychosis. I was so focused on my mission from God and my daughter being real or not being real and all of that. I didn't have much room in my head for anything else.

But I think deeper than that, I had God telling me that I was so special and that I was so beautiful and that I was the smartest person in the world. I was the only prophet of his, that the old Bible didn't mean anything anymore because he had me. So I mean, I had all of this and I had such an inflated sense of self that's kind of embarrassing.

But in that moment, I—

BLAIR HODGES: Yeah.

AYANA LAGE: I did not have the capacity to think, oh my God, like, oh, my thighs are so huge. You know what I mean? It's just like there was no—there's no room for that.

BLAIR HODGES: Yeah. It's like, I mean, there's that scripture, the Lord gives and the Lord takes away. Blessed be the name of the Lord, right? From Job. And, like, you were having that. Like, you were having some things given to you, some things taken away, but it wasn't always good. But getting out of the headspace of hating your body or having those kind of anxieties you describe as almost being a relief.

AYANA LAGE: Yes.

BLAIR HODGES: Almost a positive part of the experience. Also with anxiety and fear, you say you're a really fearful child. You were scared of roller coasters and bugs and being home alone and, like, scary movies.

You were scared of the rapture, which is this Christian belief that, like, believers will be taken up into heaven suddenly. And if you're not a believer, you're going to be left behind on earth.

But all that fear around everything also kind of went away in and out during the psychosis as well. You felt kind of free of fear some of the time.

AYANA LAGE: I did. And I do have to say that I'm so jealous of anyone who was wondering, what's the rapture? And then heard your explanation and was like, okay, I get it. Because I'm like, I wish that was me. I wish that I did not have this deep-seated religious trauma. Yeah.

BLAIR HODGES: Yeah. Like, people would be worried that they'd wake up and their parents would be gone or something.

AYANA LAGE: And because of the Left Behind movies, you thought that their clothes would be there and they wouldn't be there. It was very weird. But yeah, I mean, I no longer felt the anxiety that I'd once knew. I mean, I was anxious that people were going to kill me or that I was going to be sent to hell, but I wasn't anxious about, you know, a burglar breaking in or Jesus coming back.

So I guess it's a trade-off.

BLAIR HODGES: You say, like, the panic attacks would kind of go away a little bit too. You say that, like, it felt like—here's a quote. You say, for 21 blissful days, my lifelong struggle with anxiety is over. I don't care what anybody thinks. And then one of the things you wrote in—you have these, you know, you have these journals that you wrote.

One of them in all caps that you wrote, STOP TRUSTING RANDOM PEOPLE.

AYANA LAGE: Yes. Because I think that I was worried. I mean, to an extent, there may have been some truth in that because I was, as I mentioned in the book, giving prophecies left and right and trying to fight other patients. So I think that I could have kept myself a little bit. But yeah, I think that I just felt so free.

I felt—yeah, I understand. And I say this in the book, I think, maybe not, but I understand why people sometimes don't go back on their medication, on their psychiatric medication, or choose to stay off, because it is, like, very liberating. It is very freeing.

BLAIR HODGES: Hmm. You just mentioned, like, kind of getting into it with other patients. Did you have any violent impulses or anything? Because I think some of the most famous instances of postpartum psychosis are when a mother kills a child or multiple children. And there have been, you know, some really publicized cases about this.

Did you have any violent tendencies?

AYANA LAGE: I think overall my delusions centered around someone trying to hurt my daughter. I didn't know if she was real, but she was still important to me. So I had all these ideas that she was out in the world and someone was trying to hurt her. So I think that as far as violent tendencies go, I never had any delusions toward my daughter, like any violent delusions toward my daughter, which is pure luck.

But I do think that I was irate. I was convinced that if anyone tried to hurt her, that I was going to have to kill them. So I think that that was how it kind of manifested for me. But as I mentioned, like, me not wanting to hurt my daughter is just pure, like, luck of the draw because with psychosis, you don't have a say in what you're thinking.

 

Religious Deconstruction – 52:50

 

BLAIR HODGES: We've talked a little bit about your religious background. I want to talk a little bit more about your relationship to God because your symptoms, like we said, were hearing God literally talking to you as a real voice.

AYANA LAGE: Yeah.

BLAIR HODGES: And you had already kind of let go of the idea of a God who would intervene like that already. Your deconstruction—this is going to be an oversimplification, but to give people a sense of it—you kind of had trouble with what theologians call theodicy, the problem of evil or the problem of suffering.

And it's like, why do bad things happen to good people? What is God's role in that? Because what's worse, not answering somebody's prayer—like, say some child is dying of cancer and God doesn't answer that prayer—or that there's no God to answer that prayer? Both of those outcomes seem really bad.

AYANA LAGE: Right.

BLAIR HODGES: And so you were kind of maybe coming to a view of God that was just more disconnected than that, not so intervening in life. But then your psychosis literally brings the voice of God to you.

AYANA LAGE: Yes, it does.

I think that I'd kind of reconciled it because I still called myself a Christian. Things just happen. Like, I didn't view God as like I once did, as like this puppet master who's in control of everything. I kind of had a thought that there was a higher being, that there was something out there, and that, you know, basically like—and this is, like, you know, heretical—but I think that to make peace with my Christianity, I thought, okay, maybe God isn't, like, all-powerful and all-controlling.

Like, he's just there and he loves us, but he's not, you know, pulling the puppet strings for whether or not someone dies of cancer or whether this war breaks out, you know? He's just kind of, like, more so walking with us. So that was kind of where I landed. And then again, I started to hear the voice of God and all of that went out the window.

BLAIR HODGES: Yeah, like suddenly you had this fervent—not even a fervent belief, it was a fervent knowledge. Like, you experienced life as someone who knew God existed and knew God spoke directly to you. And you even talk about it with a little bit of, I don't know, like you almost miss it a little bit.

Like, when it was over, there was something about having such a sure knowledge of God that you lost, obviously, after the psychosis ended. You almost kind of look back a little wistfully about it. Is that right?

AYANA LAGE: Yeah, I think that it was, especially in the immediate aftermath, so hard for me to make peace with the God that I'd come to terms with before psychosis. You know, okay, he's not all-powerful, he's not all this, he's not all that, he's just there. Because I was like, but he is all those things, and he is my friend, and we talk all the time.

So I think that it was a lot for me to process. I didn't expect to miss it at all, so I think I felt a little bit guilty because—

BLAIR HODGES: Mm-hmm.

AYANA LAGE: I'd been away from my daughter, and I felt like that should've been my focus, not missing. But I mean, that's where I ended up.

BLAIR HODGES: And is that kind of where you're at today? Do you still, like, do you still consider yourself a Christian? Like, where did your religion end up with the postpartum psychosis in the rearview?

AYANA LAGE: I think that I'm, like, relaxed, loosely Christian. I mean, I still go to church. We go to a progressive church. We love the people there, my husband and I. But when it comes to God and prayer and the Bible, it's a touchy subject for me. So I am a Christian who does not pray or read the Bible, but that's unfortunately where I've had to land on that.

BLAIR HODGES: Do you have to worry about, like, people online giving you crap about faith stuff from either direction? Like, do you have to be careful about how you talk? Like, you mentioned, like, this is going to sound heretical. Like, do you have to worry about sounding heretical?

AYANA LAGE: I feel like I have shied away from those conversations on social media just because it is overwhelming to me to get feedback from people about deeply personal things sometimes. So I'm very open on social media. When it comes to faith, I just don't talk about it because, again, I feel like it's so hard to be nuanced and people are just ready to jump down your throat.

So, in my experience, I just don't touch it.

BLAIR HODGES: Yeah. Well, to remind people, we're talking about your memoir, Missing Me: A Memoir of Postpartum Psychosis and the Long Road Back. It's Ayana Lage. She's also a freelance writer. You might have seen some of her work in The Washington Post, Cosmopolitan, Glamour, and other places. She earned her bachelor's in journalism from the University of Florida.

She lives in Tampa with her husband and 2 kids.

 

Infanticide – 57:14

 

BLAIR HODGES: I mentioned infanticide a minute ago, and you helpfully take some time in the book to talk about that because postpartum psychosis is heavily associated with infanticide. And it's—you say it's hard not to angrily wonder what kind of parent could do that to your child.

But you say once you hear the voices yourself, there's a perspective shift. These women are not villains. Often, they believe they're protecting their children, like any good parent would, and I easily could have been one of them. So it seems to have kind of changed your perspective on how you think about those cases of infanticide, or, you know, what other women are going through.

AYANA LAGE: It definitely did. I think that if anyone took the time to really dive in and read more about postpartum psychosis, they would have no choice but to also acknowledge, obviously, that it is a horrible tragedy when a child is hurt or dies, like, full stop, obviously. But also that, you know, these mothers are not monsters who have plotted this.

I mean, one example that I read while researching was a woman who had a delusion that her house was on fire, that there were firefighters on the first floor. She was on the second. She was getting ready to throw her baby out the window to the firefighters to save them. And her husband found—like, basically caught her in the process of all this and took her to the hospital.

She recovered. The baby was fine.

BLAIR HODGES: Nothing happened.

AYANA LAGE: But even that, hearing that, I was like, that, as someone who experienced psychosis, it still shifted my perspective because I was like, this really is a disorder that can twist everything. You know, this mom would have been on the news as a monster if this had happened. In her mind, she's saving her baby from a house fire.

So it's just like—

BLAIR HODGES: Mm-hmm.

AYANA LAGE: It's the—yeah, there's definitely layers to it. And I think that it's much easier to just shake your head and say, oh, this terrible person, but it's not that easy.

 

In the Aftermath – 59:02

 

BLAIR HODGES: And because you've experienced it, you know, you talk about having more compassion and being able to empathize a little bit. I wonder if your own confidence was shaken at all. Like, once you've experienced such a radical break from reality that you can now recognize for what it was, but you also remember how real it was at the time, did it, like, make you lose any self-confidence in your own brain?

Like, how do you think about that? Like, is any of this real? Like, can I trust my brain to not be misfiring at any given time? Like, do you struggle with that?

AYANA LAGE: Yeah, I mean, not so much now, but I do have my moments. But especially after, it'd be as simple as me saying, like, oh, what was that sound? And I describe one of these incidents in the book, but, you know, something like, what was that sound? And then my husband and daughter not hearing anything and me being like, okay, it's happening again. I'm losing my mind.

So as I mentioned, I describe it in the book, but there's so many different examples of it that I could have probably spent, like, 3 chapters just on that. But I think that with therapy it has gotten a little bit easier, but I'm never going to trust my mind as much as you trust yours.

Like, it's just—I don't think that'll ever happen for me again.

BLAIR HODGES: Wow. Does that change day-to-day life much? Like, do you recognize it each day, or does it not really come up very often?

AYANA LAGE: I think that I'm used to it. I think that my anxiety was so bad after the psychosis that I now have a manageable level of anxiety, so I can live with it. You know, I, yeah, I'm fine with it. But I definitely will have triggering moments where I am reminded of what happened.

BLAIR HODGES: Right. And some of your memories are painful. You talk about some of the regrets that you have about maybe some of the terrible things that you did or terrible things that you said, and you didn't include all of them in the book. And you've even wondered sometimes, like, if you should apologize for some of the things you did during that time.

AYANA LAGE: Yeah.

BLAIR HODGES: Where have you landed on that about, like, do I owe somebody an apology for saying something to them while I was experiencing psychosis?

AYANA LAGE: I did apologize to my husband, and he was like, are you kidding? Like, that's the least of my worries. But I think that I was so overcome by embarrassment that the idea of re-embarrassing myself by bringing it up again and not just burying it under the rug was really difficult for me.

But also, I think that I had to believe, or told myself, you know, they know what was happening. This isn't a case of me, like, suddenly becoming a terribly mean person, and you're like, what's happening there? You know, I was hospitalized right after, and I was there for 17 days. Like, something was clearly wrong with me.

So to answer your question, I think that there were a lot of reasons why I haven't or didn't apologize to everyone who I probably hurt. I don't know if that was the right decision, but I mean, that's where I landed.

BLAIR HODGES: Any specific apologies that you were glad to give?

AYANA LAGE: So for my husband, I think, and I talk about this in the book and it still makes me cringe, but I went on social media and wrote a long rambling screed and signed his name on it. Basically making him look as erratic as I was in the moment.

So I felt so bad about that and I finally, like, worked up the courage to apologize, and he was like, I don't give a shit what people on the internet think about me. Like, what are you talking about? So that was, like, very freeing. 'Cause I'm like, okay, like, I'm overthinking a lot of this.

BLAIR HODGES: Yeah. You also kind of worried about the effect it would have on your child. Like, people talk about how important the first period of life is for attachment and all those things. And how are you feeling about that now?

AYANA LAGE: She is going to be 6 next month, and I think that I've finally reached a point where I am like, okay, this sucks that I missed it, but it didn't change anything long-term. You know, she's incredibly attached to me, sometimes, like, as parents can attest, too attached. I'm like, okay, can I just, like, go to the bathroom, please?

BLAIR HODGES: Yeah, they know when you go in there.

AYANA LAGE: Yes, they do.

BLAIR HODGES: They could be anywhere in the house and be like, okay, they're in the bathroom, let's go.

AYANA LAGE: Yeah, let's ask for a snack. But yeah, I think that now, just with time, I'm like, okay, we have such a good, solid relationship that I can't imagine it being any different. Like, I feel like what we have is so special. Yeah.

BLAIR HODGES: God, I would just encourage you to hold on to that because in the ups and downs of parent-child relationships, obviously I can't predict, like, what's going to happen with your—but I know that, like, teenage years, there are no guarantees about how it's—so all of that. And I hope that you really remember how you feel about that right now.

AYANA LAGE: I would also recommend—

BLAIR HODGES: There's a Fellow Traveler episode I'm going to recommend with this one. I don't know if you've heard of Nancy Reddy's book, it's called The Good Mother Myth. And I would recommend checking it out because she has some really fascinating reporting on attachment theory and how the data's not really great on that.

It helped me a lot in terms of, okay, we put so much pressure on ourselves as parents and whether we messed up or whether—and we're going to mess our kids up in certain ways. That's just how life is.

AYANA LAGE: Mm-hmm.

BLAIR HODGES: I recommend checking out Nancy's book, or at least her episode, to kind of, like, give you better context for that attachment stuff. It's a lot more—yeah, it takes the pressure off a little bit, so.

AYANA LAGE: That sounds great. I'm gonna look it up, thank you.

BLAIR HODGES: Yeah, totally. Okay, we talked a little bit about the records you kept while you were in the hospital, the notebooks that you wrote in. You also checked out the records from the hospital stay that the hospital kept, and you were discouraged from doing that, actually. Why discouraged, and why did you decide to look at the records?

AYANA LAGE: I'm not great at following directions and sometimes engage in self-sabotage. That's sort of the second question. But for the first, my psychiatrist—not my psychiatrist, my psychologist—felt pretty strongly that medical records are not, especially sensitive medical records, written with the patient in mind as far as they're going to read this one day.

You know, it's very clinical. It's very, like, black and white. They're not softening anything that happened. So she was aware that that was going to be the situation that I was in if I read them. And I kind of was like, oh, whatever, it'll be fine. And it was not fine.

BLAIR HODGES: Oh no.

AYANA LAGE: But eventually, you know, I include excerpts in the book, so I was able to return to them. But those first few times reading it were really difficult.

BLAIR HODGES: Just made you feel shame, or—

AYANA LAGE: I think I just felt really sad, honestly. You know, I think that I had some corroboration for some of the things that I remember, and I was like, this did happen, you know, this happened to me, and, like, there's nothing I can do about it.

 

The Risk and Joy of Having Another Child – 01:05:42

 

BLAIR HODGES: Well, your book doesn't end on that note. You also talk about, like, life moving forward, and you decided to have another child, which was a risk. You say that—I think the statistics show that about 50% of women who experience postpartum psychosis can experience it again. And I imagine that people are really going to judge you for taking the risk.

And how did you process it to a point where you'd take the risk to say, okay, I know there's a high risk of postpartum psychosis again, but I want to have another child. I'm going to go for it.

AYANA LAGE: It took me about a year and a half to reach a point where I was thinking about this regularly, a year and a half to reach a point where I was like, okay, like, I definitely want to do this. I think that I was less so worried about, like, people's perception and more so just thinking about what if this messes up my relationship with my existing child?

If I am in a psychotic or depressive state or something, you know, happens after birth and I'm not really available to her, how will that affect her in the long run? Because she's now old enough that she is, you know, incredibly, incredibly aware and attached to me and wants to be with me every second of the day.

So I just, I was very much like, is it selfish? I'm so glad—I mean, my son's gonna be 2 next month, and I'm so glad, obviously, that I went with that. But it was a hard decision.

BLAIR HODGES: What if you're like, this was a disaster? Like, yeah, I don't even like my son. Second kid.

AYANA LAGE: Yeah. No, I'm really glad that we did it, but it wasn't an easy choice.

BLAIR HODGES: Was your spouse worried about it? Like, I think that's—when I was thinking through it, I'm thinking, like, okay, I would worry about the infanticide possibility. I would worry about, like, whether you would get more scarred, whether my—or I should say whether my partner would get more scarred by another hospitalization experience.

Like, what was his calculation?

AYANA LAGE: He was definitely worried. I think that he kind of had the approach of it would be happening to me if it did happen. So if I was willing to brave the risk, then he was going to brave it too. But I mean, I talk about this sometimes, you know, I'd much rather be in my shoes than his.

When I think about the idea of me calling him and him, you know, speaking gibberish and not knowing whether or not he's ever going to come back to himself, and I'm at home with a new baby and nothing makes sense.

BLAIR HODGES: Yeah.

AYANA LAGE: I'd rather be in the hospital. So I mean, I think that he definitely dealt with a lot during and after.

BLAIR HODGES: Did the experience kind of change your views? You know, I'm going back to that first hospitalization where you saw the questions that you thought were, wow, whoa, I'm not that. Has that kind of changed your perspective now that you've experienced both sides of that?

AYANA LAGE: Yeah, I think I'm a lot more sensitive, which, I mean, can be a good or bad thing. But, you know, I think, like, obviously it's common for people to describe something as psychotic. Oh my God, he's acting so psychotic right now.

BLAIR HODGES: Yeah. And psycho.

AYANA LAGE: Yeah. Even now I'm like—like that. Like, I feel a little, you know, tinge of something when I hear that because it is such a sensitive topic. But I definitely think that I have a lot more compassion now.

BLAIR HODGES: I feel that sometimes when people say crazy. I've kind of stopped using that as a word, like, that's so crazy.

AYANA LAGE: Yeah.

BLAIR HODGES: Because, yeah, it's connected up into these bigger—wow, these really bigger real experiences that people have. And that kind of language has been used to demean and even harm people that are experiencing mental health issues. So I'm not trying to—I don't want to come down on anybody. It's a very common word.

AYANA LAGE: Right.

BLAIR HODGES: But I think if people can find substitutions for it, it certainly hasn't hurt my life to use other language.

AYANA LAGE: Yeah.

BLAIR HODGES: Yeah. Well, I talked a little bit about trusting your cognition again after experiencing such a disconnect from it. And there's a quote here I'll read where you say, I'll never move on from psychosis. I don't want to. It's taught me too much. But there is room in the aftermath for joy. What does the joy look like in the aftermath?

AYANA LAGE: I think that I just find myself feeling—and again, like, when I say this, like, this has taught me a lot, even what we talked about, about mental health stigma and me being more sensitive and compassionate to, like, the conversations I'm having and things like that. You know, I think that I just find a lot of beauty now in daily life.

I think that I'm—which, I mean, I'm sure that anyone who's had a traumatic experience can probably relate to on some level—I am much more appreciative, and I think that I am just less likely to take things for granted, which is a really nice thing. So I'm grateful for that.

 

Regrets, Challenges, & Surprises – 01:10:00

 

BLAIR HODGES: That's Ayana Lage. We're talking about her book, Missing Me: A Memoir of Postpartum Psychosis and the Long Road Back. And Ayana, I always like to close with regrets, challenges, and surprises. This is a moment for you to reflect on the book itself and, like, kind of your relationship to the book. So is there anything now that the book is out that you have regrets about?

Maybe something you—maybe I shouldn't have put that in there. Oh, I wish I put that in there. So that's one. Or what was the most challenging part of writing this book? Or what surprised you in the course of doing this? Maybe you learned something more about yourself, or you did some research on a particular thing and learned something new.

So you can kind of choose your own adventure here about regrets, challenges, and surprises.

AYANA LAGE: I love that. I think I'm gonna go with surprise. I think I was really nervous when I was even working on the book proposal because I was opening these notebooks again and I wasn't sure where it would take me. But I think that I have been surprised by my own resilience, that I'm able to have these conversations and I'm able to talk about it and to not break down, you know, and to process it and to be something terrible that happened to me, but not something that I am kind of chained to or bound to forever.

Like, I've taken what I need to from the psychosis and am now living with that. And so writing that, I think that I was honestly surprised at how easy some parts of it were because I thought that it was going to be, like, this hugely traumatic, terrible experience where I was, like, slaving to meet a book deadline and weeping because of all the trauma that I'd lived through.

But it really wasn't, you know? I think I was able to really connect with myself in new ways thanks to the process. So I'm glad I wrote it.

BLAIR HODGES: Yeah, I think there's something about self-narration that can be healing. Not always—

AYANA LAGE: Yes.

BLAIR HODGES: But, like, just finding a coherent story behind something that seems so incoherent could be encouraging.

I wish more people would talk about postpartum psychosis. It's not the rarest thing in the world, and I'm glad that this book exists. I just want to thank you for being vulnerable and for being willing to put yourself out there. That doesn't seem like a small thing to me. To me, it seems like a pretty big deal to be willing to do that.

AYANA LAGE: Well, thank you, Blair. This was a wonderful conversation, so I really appreciate you having me.

BLAIR HODGES: It's been my pleasure. Thank you.

 

Outro – 01:12:19

 

BLAIR HODGES: That's it for this episode of Relationscapes, but we're going to hear more about this topic over the next little while. We'll hear from guests like Theresa Wong, artist and author of the acclaimed graphic novel Dear Scarlet: The Story of My Postpartum Depression, as well as Dr. Chris Chukalis, author of Even the Darkest Night: A Father's Journey of Hope and Healing from Paternal Depression.

We'll also hear from influencer activist Rosie Card, who will join us to share her own experience of postpartum psychosis. The Fellow Traveler episode I recommended during this episode is Nancy Reddy's interview. It's called The Bad Dads Who Helped Invent Modern Motherhood.

If you're enjoying Relationscapes, please take a second to rate and review it in Apple Podcasts or rate it in Spotify. Another way you can help me grow the show is by recommending it to a friend. So if somebody in your life came to mind while you were listening to this one, send them a link.

You can follow me on Instagram or TikTok, where I post videos from each episode and other bonus stuff. It's @_relationscapes.

Mates of State provides our theme music. I'm your host, Blair Hodges, an independent journalist in Salt Lake City, and I hope to spend more time with you soon here on Relationscapes.