I hate to say that moms are in the zeitgeist—to paraphrase Adrienne Rich, it’s literally how we all got here—but it’s also true that the last few years have seen the publication of a pile of novels and nonfiction accounts taking motherhood as their central topic. The nonfiction alone runs the gamut from explicitly feminist accounts of the science, history, and politics of motherhood, to struggles with fertility, and intimate accounts of the challenges of early motherhood. Some of the most valuable contributions to this emerging genre are the books that speak frankly about maternal mental health, most notably Jessica Friedmann’s Things That Helped and Sarah Menkedick’s Ordinary Insanity. And yet, for all this candor about the challenges of early motherhood, postpartum psychosis remains virtually untouched. There are occasional horror stories from the news, but it seems the mothers who have suffered with postpartum psychosis mostly don’t speak of it.
Even if the book’s only accomplishment were breaking the silence that still surrounds postpartum psychosis, Catherine Cho’s Inferno: A Memoir of Motherhood and Madness would be an important contribution to the emerging genre of the motherhood memoir. In addition to its frank examination of postpartum psychosis, Inferno is also an elegant and immersive contemplation of the demands American and Korean cultures make on new mothers and the legacy of trauma across generations.
Inferno begins as Cho has been involuntarily committed to a psych ward in New Jersey, where she and her husband traveled from their home in London to introduce their family to their new baby during their shared parental leave. As they traveled from California to Virginia to New Jersey, Cho became increasingly restless, unable to sleep, and flustered by her in-laws’ constant commentary on her mothering. They disapproved of her disregard for the Korean traditions surrounding the birth of a baby, which forbid the mother and baby to leave the house for the first twenty-one days. They worried that the baby was too big, wasn’t yet rolling over, was crying too much. Describing this time with her in-laws, Cho writes, “Each comment and criticism, although kindly meant, stuck at me like pinpricks of a needle. Was I such a terrible mother? Was I doing everything wrong?”
Cho becomes increasingly agitated under her in-laws’ watchful gaze, and notes in her spare, exacting prose that, “my son was eight days shy of his hundred-day celebration when I started to see devils in his eyes.” When she declares that their infant is “the chosen one” her husband is so alarmed by her erratic behavior that he takes her to an emergency room. In the ER, she screams and tears her clothes off; despite heavy sedation, she does not sleep for her four days in the hospital, and she’s sent to a psych ward for an additional eight days. While in the ward, Cho is treated with the antipsychotic haloperidol and separated from the baby she’d been nursing; some of the most poignant scenes are when she’s forced to self-express the milk from her swollen breasts in a lukewarm shower. Her stay in the ward is interwoven with flashbacks to her past, including her father’s erratic and occasionally abusive behavior, a violent relationship she’d had in her early twenties with a man in Hong Kong, and her family’s history of upheaval and forced migration in Korea.
Eventually, Cho is permitted a notebook and a pen, and writing becomes a path back to herself. “With a pen in my hand, I feel slightly less suffocated, like a window has been opened,” she explains. As she writes and tries to remember herself, she says, “I am following a thread from the past to the present, and then I will know, I think. I will know how I got here. I will know who I am. And then, maybe I will be able to find a way to leave.”
I struggled with the language to describe Cho’s book and in particular the candor of her description of her psychosis and hospitalization. The words that come to mind most quickly are inadequate and also lazy: to say, for example, that a writer is “brave” is often to suggest that they have disclosed something they should not have, and “unflinching” is shorthand that fails to convey the craft at work. The portions of the book set in the ward use present tense to place us in this timeless, disorienting place alongside Cho, who notes, “I’m not sure how long I’ve been here. I think it’s a few days. But I count today as day one. The first day that I’m aware of where I am.”
Cho’s ability to write rich, clear descriptions of a mental state that is by definition muddled and winding is remarkable. Cho presents her experience of psychosis with clarity and precise detail, with no meta-commentary from the self who’s emerged. Instead, the reader, like Cho, is caught in the dissociative state, with no external reference point to cling to.
For me, the most moving section of the book is at the end, when Cho discovers that, had she been in the UK, her treatment would have been vastly different:
I learned that if we’d 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 United States. I learned that the medication I’d been prescribed, haloperidol, would have been unusual in the UK, as it was considered to be extreme. The treatment in the UK is focused on keeping the mother and baby as close to each other as possible, in order to minimize emotional separation; I would not have been separated from Cato.
This separation from her infant son is especially devastating, and the final section of the book considers the long-term consequences of the twelve days they spent apart: “The separation from Cato had been unnecessary, the rules felt so trivial and arbitrary, but it had had such an impact on our lives. I had come back a stranger, and the distance I felt from Cato wasn’t something I could grieve; it went beyond loss. It was a severance, a removal that was complete.”
Though Cho’s book is not explicitly an indictment of the US healthcare system, it certainly serves as one. The kind of mother-baby care that Cho discovers is standard in the UK is available in only a small number of places in the US. An article from the Massachusetts General Hospital’s Center for Women’s Mental Health asks “If We Are So Concerned About Maternal Mental Health, Why Don’t We Have More Mother-Baby Mental Health Programs?” Although this care is highly effective and less expensive than the inpatient psychiatric hospitalization Cho was subjected to, it’s hard to access, with only 22 locations in the US and most of them clustered on the east and west coasts. In Pennsylvania, for example, where I grew up, there are only two sites offering mother-baby mental health care, one in Pittsburgh and one in Philadelphia. In Wisconsin, where my babies were born, there are none.
When Cho returns home to London, her experience is entirely different. In contrast with her care in the US, Cho is assigned a team to support her recovery, including a perinatal psychologist and a crisis team that visits her at home every morning. Her full recovery is long and difficult—postpartum psychosis is often followed by depression, and Cho struggles with this for many months—but, as the book concludes, Cho has found her way back to herself and to her son: “And then one day, an ordinary day, as I was holding him, I remembered him. His smile, the feel of his breath against my arm, the warmth of sun against our cheeks, the weight of his body against my own. And I was a mother again.”
I love that Cho closes the book with this moment of renewed connection. But I also love that the whole book doesn’t bend toward it; her recovery is never a foregone conclusion. Instead, the book lets us move with her through a profound trauma, one exacerbated by inadequate support for postpartum mental health and the demands that both American and Korean cultures place on new mothers to put their own needs aside and care only for their baby.
In the end, Inferno is a hopeful book, though perhaps not in an expected way. There is no lesson learned from this trauma; Cho doesn’t overcome or conquer her mental illness, as a more conventional approach might have it. Cho is remarkably clear-eyed as well in assessing how her psychosis and hospitalization impacted her husband. She writes that her hospitalization “changed something profoundly in James. The eternal optimist that I knew and loved, there’s a darkness in him, something that casts a deep shadow.” But that shadow isn’t the end of the story. As this long winter of the pandemic begins to bend toward spring, Cho’s book is a powerful example of the way that families can move through darkness and into something new.