When a mother loses her mind post-partum

When literary agent Catherine Cho became pregnant with her first child, she was so preoccupied with the idea of losing her body, it never occurred to her that she might lose her mind.

When her son Cato was two months old, Cho and her husband left their home in London and embarked on an extended trip across the United States to see friends and family.

While they were staying with her in-laws in New Jersey, something went horribly wrong.

She began to see devils' eyes in her son's face. A voice in her head told her that he had to die.

By the time her husband took her to the hospital, she was stripping off her clothes and screaming, fighting the nurses as they tried to restrain her. She sang in French as she was transferred to a psychiatric ward.

Cho was diagnosed with a rare form of post-partum psychosis that affects one or two in 1,000 women, the reasons for which are still not fully understood.

She has written a memoir about her experience, titled Inferno.

During her psychosis, she believed she was the character Beatrice in the mediaeval Italian epic poem Inferno by Dante Alighieri, and that she had to sacrifice her life to lead her husband through hell.

"With mental health around motherhood, there is a stigma, a secrecy," says Cho, 34, over Skype from London.

"I always assumed I knew about psychosis, and I always assumed I knew about post-partum depression. But I never really took the time to think about them. I hope the book portrays the experience in a way that you can imagine how it would feel and why it might happen."

Cho cobbled together her narrative from notes made during her stint in the psychiatric ward, which lasted for eight days in 2018.

As she did not live in the US, she was sent to a facility for those without health insurance, where she was heavily sedated and separated from her husband and son.

In the ward, she recalls being utterly unmoored in time, unable to distinguish what was real and not real.

She forgot visits her husband had made to the ward. She could not recognise photos of her son. At times, she could not remember who she was.

It took her several months to rediscover her love for her son, who is now 21/2 years old.

"That was something I worried about," she says. "But we have a really good bond now. We're very close."

Cho wrote her book not for catharsis - she approached it from a "mechanical, distant point of view", she says - but to start a conversation about motherhood.

She also wanted to address themes such as trauma, her identity as the daughter of Korean immigrants and the cultural expectations placed on women.

She weaves into the narrative an earlier abusive relationship in her 20s in Hong Kong, in which her boyfriend beat her and would not let her leave their apartment.

She hesitates to say that her past trauma played a part in her breakdown.

"But I do think that there are definitely things in the past that come up in the psychosis. I think it's up to the reader to decide how much of a correlation there is."

Cho was born in the US, where her parents had emigrated from South Korea so her father could be a mathematics professor there.

As she was growing up, her mother told her Korean folk tales through which sacrifice, surrender and suffering ran like seams.

"I hadn't realised how much of an impact they had on me as a kid," says Cho, who wove some of these tales into Inferno.

"But I think constantly hearing about sacrifice and suffering really left an impression on me."

She has asked her parents not to read Inferno.

"I don't think they would enjoy reading it," she says.

They and her in-laws expressed surprise that she would publish a book about a dark chapter in her life that they did not want to talk about. The story they had previously told others was that she was suffering from "exhaustion".

"We're all very private people," she says.

"But so far, they've been really supportive."

She has been heartened by the many women who have approached her to share their own stress and anxieties as mothers.

"Almost every woman who's a mother that I've spoken to has said they've experienced some form of mental dissociation," she says.

"By sharing it, they feel like it's okay to talk about it, when before, it might have been something they just felt they had to keep private."

She adds: "I want to show that it is a huge mental and physical transformation. As much as it's a very common experience, that doesn't make it less difficult.

"By showing that this is what can happen, maybe it would erase some of the self-blame that a lot of mothers feel for not living up to a certain standard."