Why Do I Write? Lisbeth Coiman

I write to survive the shipwreck of my childhood, holding on a piece of debris, adrift in the dark, deep ocean that is my mind.
When delusions and anxiety take hold of me, threatening my integrity, I sit at my desk and pound for hours on my keyboard.

When I have too much energy to hold inside my body, I let it run through my fingers onto the keyboard and brighten me up with the power of creativity, the fragmented characters I create invariably reflecting my impossible life.

When the sun seems to go away and leave me in darkness with destructive thoughts, I write to save my life.
I write, and for that I have opened several files in my computer.

If the thoughts are delusional in the form of far-fetched stories, I type them and save the story under fiction.
If the thoughts are incoherent, or represent isolated images that evoke strong emotions, I type them and file them under poetry.

If the thoughts are cathartic, I write a journal entry.

A few years ago, I opened yet another file for my musings, what I have learned through this experience, about letting go of the pain of my formative years and of the hand of my dying friend who rescued me from my demons. I called that file “Memoir” and I hope to publish it one day.


Lisbeth Coiman writes about living with bipolar disorder and psychosis in her blog She is currently writing a book about her experiences as a mentally ill woman. She also writes fiction and poetry in her blog


Bueller? Bueller? Walker Karraa, Ph.D.

The table of contents from the upcoming Journal of Obstetric, Gynecologic, & Neonatal Nursing landed in my inbox this week.

As I read it, the list kept going and going, and I scanned for research on mental health. The list bordered on the absurd if not obscene. How is it that preeminent peer-reviewed scientific obstetric and gynecology journals continue to get away with ignoring women’s mental health altogether? If this isn’t evidence of stigma in medical science I don’t know what is. It is evidence of the three components of stigma identified by the amazing Graham Thornicroft (2007). First, this demonstrates a lack of knowledge about the topic itself, or ignorance. Secondly, it demonstrates a prejudice or negative attitude toward mental illness through avoidance of the topic altogether. Third, it demonstrates a discrimination in behavior, an editorial choice to not include research regarding women’s mental health.

From this, we can then pretty safely assume that the providers associated with the professions publishing these journals know very little about perinatal psychiatry, or perinatal mood and anxiety disorders, and that the systems of education and institutions that teach this material don’t acknowledge it either. This is how stigma is born and bred in obstetrics. The trickle down effect creates lack of knowledge at the provider level, and lack of education for women. Even down to the delivery of services in the hospitals, offices and clinics where women get treated. Even down to the public health campaigns and free products given at prenatal visits and after delivery. There is no there, there. And women are charged with the responsibility for recognizing symptoms and disclosing them to providers who come from systems of learning that produce journals like this.

Despite the wealth of hard science demonstrating direct negative impact on fertility, intrauterine growth, fetal development, obstetric outcome (including low APGAR scores, preterm birth, low birth weight). Despite the science. Despite the science, we are still an elective course in the curriculum of women’s health. Obstetrics and gynecology has the power, the funding and therefore the paradigm of maternal health by the ovaries. Maternal mortality is the hot topic, but the wealth of public policy and research does not include suicide–despite the growing prevalence. Entire organizations and public health institutions outraged at the rate of postpartum hemorrhage–say nothing about the rate of postpartum suicide. How wrong is that? How violent is it to allow women to kill themselves through institutionalized stigma, negligence, and intolerance. If providers aren’t going to treat maternal mental health, who will?

This is why I promote the few intrepid scientists out there doing the majority of research in a field brimming with evidence. And they experience stigma, too. Professional stigma. I once interviewed a leader in the field who shared that in the beginning of her career, her colleagues thought there was no such thing as postpartum depression and that researching it was pointless.

On some core level I think we still don’t believe it is real, much less worthy of scientific inquiry. Look no further than this long, long list of upcoming articles. I am tired of playing Where’s Waldo with obstetrics and gynecological journals and maternal mortality organizations. Tired of the stigma. Tired of telling maternal health advocates that the uterus is connected to the brain and hearing crickets. Bueller? Bueller?

Thornicroft, G., Rose, D., Kassam, A., & Sartorius, N. (2007). Stigma: ignorance, prejudice or discrimination?. The British Journal of Psychiatry,190(3), 192-193.


The Effect of Environment on Nursing and Health Promotion for Women (pages 541–542)
Marilyn Stringer
Article first published online: 14 AUG 2014 | DOI: 10.1111/1552-6909.12501
Guest Editorial
The CROWN Initiative: Journal Editors Invite Researchers to Develop Core Outcomes in Women’s Health (pages 543–544)
Khalid Khan
Article first published online: 13 AUG 2014 | DOI: 10.1111/1552-6909.12500
Principles & Practices
Integrating Quality Improvement and Translational Research Models to Increase Exclusive Breastfeeding (pages 545–553)
Peggy A. Brown, Katherine Laux Kaiser and Regina E. Nailon
Article first published online: 22 AUG 2014 | DOI: 10.1111/1552-6909.12482


Safe Management of Chronic Pain in Pregnancy in an Era of Opioid Misuse and Abuse (pages 554–567)
Ursula A. Pritham and Laura McKay
Article first published online: 14 AUG 2014 | DOI: 10.1111/1552-6909.12487
A Randomized Comparative Trial of Two Decision Tools for Pregnant Women with Prior Cesareans(pages 568–579)
Karen B. Eden, Nancy A. Perrin, Kimberly K. Vesco and Jeanne-Marie Guise
Article first published online: 14 AUG 2014 | DOI: 10.1111/1552-6909.12485


Barriers to Cervical Cancer Screening and Follow-up Care among Black Women in Massachusetts(pages 580–588)
Jacqueline Nolan, Tajan Braithwaite Renderos, Jane Hynson, Xue Dai, Wendy Chow, Anita Christie and Thomas W. Mangione
Article first published online: 19 AUG 2014 | DOI: 10.1111/1552-6909.12488


Urban African American Women’s Explanations of Recurrent Chlamydia Infections (pages 589–597)
Melva Craft-Blacksheare, Frances Jackson and Theodore K. Graham
Article first published online: 20 AUG 2014 | DOI: 10.1111/1552-6909.12484


The Efficacy of an Intervention for the Management of Postpartum Fatigue (pages 598–613)
Rebecca Giallo, Amanda Cooklin, Melissa Dunning and Monique Seymour
Article first published online: 19 AUG 2014 | DOI: 10.1111/1552-6909.12489


Barriers and Facilitators to Implementing the Baby-Friendly Hospital Initiative in Neonatal Intensive Care Units (pages 614–624)
Britney Benoit and Sonia Semenic
Article first published online: 20 AUG 2014 | DOI: 10.1111/1552-6909.12479
Case Report
A Case Report of Pink Breast Milk (pages 625–630)
Jenny Jones, Joan Crete and Robin Neumeier
Article first published online: 20 AUG 2014 | DOI: 10.1111/1552-6909.12492
In Focus Editorial
The Role of Environmental Context, Faith, and Patient Satisfaction in HIV Prevention among African American Women (pages 631–632)
Jillian Lucas Baker and Loretta Sweet Jemmott
Article first published online: 13 AUG 2014 | DOI: 10.1111/1552-6909.12490
In Focus
A Multilevel Understanding of HIV/AIDS Disease Burden Among African American Women (pages 633–643)
Bridgette M. Brawner
Article first published online: 19 AUG 2014 | DOI: 10.1111/1552-6909.12481
Socioecological Factors in Sexual Decision Making among Urban Girls and Young Women (pages 644–654)
Robin Stevens, Stacia Gilliard-Matthews, Madison Nilsen, Ellen Malven and Jamie Dunaev
Article first published online: 19 AUG 2014 | DOI: 10.1111/1552-6909.12493


Implementation of Evidence-Based HIV Interventions for Young Adult African American Women in Church Settings (pages 655–663)
Jennifer M. Stewart
Article first published online: 19 AUG 2014 | DOI: 10.1111/1552-6909.12494


Results from a Secondary Data Analysis Regarding Satisfaction with Health Care among African American Women Living with HIV/AIDS (pages 664–676)
Jillian Lucas Baker, Caryn R. R. Rodgers, Zupenda M. Davis, Edward Gracely and Lisa Bowleg
Article first published online: 19 AUG 2014 | DOI: 10.1111/1552-6909.12491
AWHONN Position Statement
The Use of Chaperones during Sensitive Examinations and Treatments (page 677)
Article first published online: 14 AUG 2014 | DOI: 10.1111/1552-6909.12498


Non-Medically Indicated Induction and Augmentation of Labor (pages 678–681)
Article first published online: 5 SEP 2014 | DOI: 10.1111/1552-6909.12499
Special Report
Current Resources for Evidence-Based Practice, September/October 2014 (pages E42–E48)
Nicole S. Carlson
Article first published online: 18 AUG 2014 | DOI: 10.1111/1552-6909.12503
In Focus CNE Post Test
A Multilevel Understanding of HIV/AIDS Disease Burden among African American Women (pages E49–E50)
Bridgette M. Brawner
Article first published online: 18 AUG 2014 | DOI: 10.1111/1552-6909.12480

I’m Still Here, by Sara Berelsman

I haven’t been in this dark of a place in a while.  And every time it happens, I pray to God that I won’t return to this place.  As much as I wish it wouldn’t happen, I come out stronger every time I emerge, and it brings me closer to God.

Chronic depression and bipolar disorder are chemical imbalances.  People with these conditions do not choose to feel these emotions and we can’t just “snap out of it.”  Please don’t criticize what you don’t understand.  People who make ignorant, insensitive, judgmental comments only perpetuate the stigma and certainly do not prevent the afflicted from taking their own lives.  Think about that.  People take their own lives to escape this pain.  That’s all it’s about.  Suicide is not selfish, and unless you’ve been suicidal, you have no right to say that it is.  Saying that clearly demonstrates your lack of understanding.  To other people, yes, suicide does seem selfish.  To the person who is suicidal, it’s about escaping the extreme pain that is there every second, every minute, every hour.  It’s about doing loved ones a favor by removing your presence from this planet.  Because you are nothing but a burden.  And that’s exactly how a suicidal person thinks.

Now that I’m coming out of that place, I can see clearer how wrong that is.  How flawed my logic is when I’m in a deep depression.  But when I’m there, there is no logic.  None.  It doesn’t exist.  All that is there is despair, agony, never-ending pain.  It doesn’t make sense.  It doesn’t.  But what I’m saying is true.  In depression, there is no future.  There is nothing to look forward to, and there is no reason for living.  On Saturday I could do nothing more but pace around the yard.  It hurt to sit down.  It hurt to sit still.  It hurt no matter what.  All I could do is pace and tell myself, “This too shall pass,” and “You are not alone.”  Even though I didn’t believe a word of it.  But I had to somehow stay alive.  I read books about depression, and I always read Andrew Solomon’s The Noonday Demon every time I’m in this place.  It is the depression Bible, and it has kept me alive many times.  I read the actual Bible, and it comforts me just a little.  It also keeps me alive.  I get on online depression forums just so I feel less alone.  Because a depressed person feels alone, even in a crowded room.  So alone.  But I am not alone.  I am among millions of people who suffer with this.  I just prayed and prayed and tried to feel God’s presence, until I actually did feel it.  I wondered why I had to go through this.  And I now realize that this is my fate, and I have the free will to kill myself or not, and so far I’ve chosen to live.  I don’t ever want to end my life, and though I’ve been suicidal many times, I’ve never had a plan.  I don’t want to end my life.  But I completely understand why people do it, and I understand their inescapable pain.  I wasn’t sure if I wanted to even talk about this, because right now I’m in an extra sensitive and vulnerable place, and I take the risk I always take of getting criticism and backlash from people who don’t understand.  I don’t care.  I’m getting better every day, and even though it’s been up and down, it’s been better.  I know my calling is to talk about this and hopefully allow others to be less afraid, to feel that they don’t have to suffer in silence.  Because they don’t.

I am so often amazed at the cruelty of this world.  As Maya Angelou said, “When someone shows you who they are, believe them the first time.”  We don’t say we’re depressed and suicidal for attention.  We say it because it’s true, and it takes everything we have just to admit it.  We make ourselves feel bad enough on our own, and the last thing we need is the opinion of people who know nothing about this, but seem pretty sure that they know best.  This is why people don’t seek treatment.  It shouldn’t be that way.  It needs to change.

Your kind words and reassurance has been wonderful, but I can only fully appreciate them as I come out of this depression.  Words mean nothing to a person who is chronically depressed and in the lowest of lows.  Logic, words, reasoning, it isn’t there.  I wish your words could make me better, trust me.  I would rather give birth ten times in a row without an epidural than experience the depression I’ve been in.  It is the worst thing in the world.  I would wish it on no one, ever.  I am a prisoner of my mind, and there is no escape.  I can’t escape the intrusive, obsessive thoughts, I can’t escape this discomfort of being around people or the discomfort of being alone.  It doesn’t feel comfortable; no matter what.  It’s just something I have to endure, just keep breathing to stay alive.  All I can do is breathe.

As much as I prayed this weekend for this pain to end, and as much as I didn’t believe it would ever get better, it has.  It’s made me stronger, and it’s made me want to talk about it more than ever.  In the throes of a depression, there is no end in sight.  Ever.  I know it’s hard to understand, because I live it and I don’t even understand it.  Coming out of the depression, I’m a different person, and it’s hard to comprehend that I was ever feeling that hopeless.  But in the depression, there is no chance in my mind that it will ever end or ever get better.  There is a giant, impenetrable brick wall between the dark emotions and hope.  There is no hope.  Every time I come out of it, it’s hard to look back and understand that.  But it’s true.  I’ve called suicide hotlines.  I’ve been there.  It is real.  It is very, very real.

So now that I am feeling better, I once again thank God that I got through this and that it has only given me more compassion and more empathy for anyone who suffers with this.  It makes me want to be a counselor that much more.  It makes me want to try harder to conquer my demons, as I can always keep them at bay, but they never go away.  This is my life, and I’ve accepted it.  Everyone is suffering in some way, and this is how I am suffering.  I know it doesn’t mean anything to someone going through what I’ve been going through to say that there is hope, but tell yourself that anyway.  Just keep breathing.  Pray.  And reach out to me anytime, because I’ll be there for you.