Historical novelists engage in research to ensure the authenticity of facts, and read as many related books, non-fiction and fiction, as possible. In my blogs I share the more fascinating fruits of my labours.
Spoiler alert, this book is essential reading for everyone in the ‘helping’ professions, notably social workers, doctors and nurses.
After the first few pages of being engrossed by Catherine’s description of her life in the secure ward of an American mental hospital, I realised that there are no chapters although there are significant spaces between sections. Normally, I dislike any form of ‘experimental’ writing, however chapters would not have worked in Inferno. This is because we follow Catherine’s thoughts wandering and drifting, in an entirely credible way. The closest analogy I can think of is being on a long train journey late at night when tired. Our mind takes in our present situation, the carriage and other passengers, then it drifts off to maybe the events that led to being on the train, then after a brief intrusion of random ideas, we again notice our fellow passengers or return to past events. And so, Catherine moves from describing the hospital ward, to reflections on her Korean heritage, to memories of her childhood, returning to the ward then an account of Cato’s birth. Later she provides details of what happened when she and her husband, London residents, took Cato to see his extended family in America. This might sound confusing but it works, it works supremely well. Had she given us a chronological account of events, it would not have been so engaging, nor indeed so terrifying.
Her description of her thoughts when she was in her psychotic state is truly alarming, and Catherine helps us see how a loving mother can become a danger to herself, her baby and those close to her. ‘’Your son needs to die.”’ she recalls her mind telling her, continuing, ‘The voice was simple, straightforward. The light was shining dimly now, but I could sense it fighting.’ As my favourite poet, Gerard Manley Hopkins writes:
What is clear is that no one is to blame for her sudden illness. It can occur without any obvious triggers, and Catherine had none of the factors which might have flagged up a susceptibility, such as a history of psychiatric disturbance. It is possible to identify elements that cannot have helped her mental wellbeing, including a testing childhood, abuse perpetrated by her first husband, difficulties giving birth to Cato, and an emotionally demanding time as she and her husband travelled across America to enable Cato’s grandparents to meet their new grandson. Nevertheless, as research as established ‘adverse life experiences and reduced social support appear to play less of a role in the onset of postpartum psychosis’4 compared to the development of post-natal depression, often called ‘baby blues’.
One of Catherine’s regrets is that she was not in London when she became ill.
She comments that ‘if we had been in the UK, I would have been admitted to a mother-baby unit, and not as a regular psych patient as I was in the US.’ (p249).
In the Spinningdales series, Helena is based on my colleague Dr Margaret Oates OBE,5 a pioneer in perinatal psychiatry. When I was working with her at Mapperley Hospital, Nottingham (St Guthlacs in the novels), she was deeply concerned about the damage to the parent-child bond if mothers are separated for any length of time from their new-borns. In 1974, Margaret persuaded the hospital authorities to convert side rooms off the main wards into a provision enabling new mothers, suffering from psychiatric conditions, to be admitted with their babies. Subsequently, a larger mother-baby unit in Nottingham and one in Hackney were named after Margaret. There are now about 19 similar units in the UK.
Inferno is not a large book but it is an intense read which provides hugely valuable insights into the mind of a mother experiencing a totally unanticipated postpartum psychosis. Catherine Cho is to be congratulated on producing such a readable, engaging and important work, and for having the courage to tell her story.
References
1. Cho, Catherine (2020) Inferno: A Memoir of Motherhood and Madness. London: Bloomsbury Publishing.
2. Postpartum psychosis: beyond the baby blues and postpartum depression. May 23, 202. https://blogs.bmj.com/ebn/2021/05/23/postpartum-psychosis-beyond-the-baby-blues-and-postpartum-depression/
3. Hopkins, Gerard Manley (1844-1889). No worst, there is none. Pitched past pitch of grief. https://hopkinspoetry.com/poem/no-worst-there-is-none/
4. Perry, Amy (2021) Postpartum psychosis: beyond the baby blues and postpartum depression. Evidence Based Nursing. May 23rd . https://blogs.bmj.com/ebn/2021/05/23/postpartum-psychosis-beyond-the-baby-blues-and-postpartum-depression/
5. Tubb, Amy (2023) Remembering and celebrating Dr Margaret Rose Oates OBE. Maternal Mental Health Alliance. 10th January. https://maternalmentalhealthalliance.org/news/obituary-dr-margaret-oates-perinatal-psychiatrist/
