A New Mother's Struggle with Dissociation

Source: Used with permission by Miskin

In Hell Gate Bridge (2023), Barrie Miskin confronts her struggle with derealization depersonalization (DPDR), a little-known dissociative disorder. Miskin is searching for grounding through connection: to a diagnosis that can explain her elusive experience, to herself in trusting she’s a good mom, and to other mothers in a way that isn’t burdened by shame or judgment. But through Miskin’s willingness to write her story of dissociation and disconnection, what she offers is connection for readers who feel unmoored by uncertain diagnoses and for mothers adrift in expectations, shame, and self-doubt, questioning, “Am I good enough?”

Searching for Diagnosis and Narrative

Understandably, doctors and patients gravitate toward structured medical explanations to create a sense of control. In her monograph titled, How Doctors Think, Montgomery postures that “[t]o know the cause of disease is to have control. Medicine is driven by it, and patients and their families are part of that drive” (57). Though she acknowledges that disease is anything but simple and linear, Montgomery points out that we as a society want to view medicine as “[s]atisfactorily linear” and operating according to a “simple causal norm” because doing so carves out space for intervention (60, 62). If medical providers can identify the cause and effects, then they can intervene in this chain “so as to alter outcome” (62).

Miskin addresses the counterpoint that diagnoses can confine people into labeled boxes, but she yearns for the certainty of one: “I would have given anything for a label, a box, a checkmark on a chart. I would have given anything not to be a pioneer in this surreal nightmare” (194). For months, she bounced between diagnoses and medications, enduring side effects for a misdiagnosed condition outside her psychiatrists' expertise.

Miskin discovered DPDR on her own and repeatedly brought it to her doctors' attention, only to be dismissed. Given that there is no known cure for DPDR, Miskin too began to will away “the diagnosis that [she] knew to be true, wanting desperately to have a disorder that could be medicated or even cured” (82).

When Miskin was finally diagnosed with DPDR, the lack of a cure and limited information only further unmoored her. Her psychiatrist could not tell her when, or if, she would get better. Miskin envied people whose diagnoses could be explained in simple terms. She often told others she had postpartum psychosis because “it was just easier that way” (193).

Medical narratives, like the hero’s journey she references, usually follow a simple, progressive path. For medicine, we long for the simplicity and closure of moving from cause to crisis to cure. In the hero’s journey, the hero moves from “the departure” to “the initiation” before “return[ing]” home (179).

But with no cure for DPDR, Miskin’s experience didn’t fit this mold. She remained stuck in the “initiation” and crisis phases, navigating an unfamiliar world for years (179-80). Since her DPDR began during pregnancy, she hoped it would end after giving birth.

The Mom Wars

Miskin’s confidence as a mother was shaken by relentless and pervasive societal expectations surrounding motherhood on social media and at playdates and doctor visits. Having been on a low dose of Zoloft since her 20s for anxiety and depression, Miskin faced external pressure to avoid medications. She felt that the “message filtering through the ether seemed clear: If you take medication, you’re going to hurt your baby. You’re being selfish. You’re a Bad Mom” (201-02). When she asked her PCP whether she should go off it while trying to get pregnant, he said “‘Sure’” (8) and her ob-gyn referred her to a reproductive psychiatrist “who only offered natural remedies instead of prescription drugs” (202).

Even during childbirth, a nurse told Miskin, “You do not need to take medication. You need to stay natural, for the baby” (91). Internet surfing only further contributed to her fear of hurting her baby. But when body dysmorphia and hallucinations joined her anxiety and depression, fear, guilt, and self-reproach about taking any medications consumed her. If the baby suffered at all, she writes, “I had to live with the fact that it was my fault. I was the one who got sick. I was the one who took the medications. I was the one who couldn’t properly care for my baby, and she hadn’t even been born yet” (78).

Beyond the debate about medication, Miskin felt judged and demoralized in other ways through conversations with friends and scrolling through mommy-influencers’ pages. What a mother “was supposed to be” was palpable in the social climate (15). A friend offhandedly suggested that two cups of coffee every morning might have caused her chemical pregnancy; the creams, hair dyes, and waxing she did as a result of her body dysmorphia were dangerous. She hadn’t read What to Expect When You’re Expecting. She didn’t fit the image of a gentle, nurturing, and natural mother. All of this deeply affected her confidence.

Dissociation Essential Reads

The Neuroscience of Dissociation

Dissociation in Borderline Personality Disorder

Staging “The Perfect Mom”

Feeling inadequate, Miskin compensated by trying to prove to others that she was “the perfect mom” (210). She writes that she “play-act[ed] at normalcy” but it was more than normal: it was staged to perfection (180).

She took staged pictures of her daughter in darling outfits that caught, for a glimpse, a perfect world that she could share with others on social media. Everything, from their routine to their outfits to the way the diaper bag was packed, had to be “tightly controlled” (213).

She was convinced that, if she was “[c]areful and deliberate, as though by following this pristine ritual, [she] would be able to leave the previous months behind me and reemerge from the darkness as a radiant, perfect mother.” She sent holiday cards with these perfect images to her ob-gyn and former outpatient programs, willing the image that all had turned out perfectly. If she acted normal, she would be normal. But beneath the surface, guilt remained.

Over time, Miskin unplugged from social media, distancing herself from the unrealistic standards set by mommy-influencers. With less external pressure, she began to take it easier on herself, letting go of the guilt and starting to believe in her abilities as a mother.

A Call for Access

Miskin’s DPDR was likely triggered by untreated major depressive disorder and discontinuation of antidepressants prior to pregnancy, which she had been on for years. Dr. Sarris, the specialist who diagnosed her, explained that months of untreated depression had evolved into a more severe, agitated form, leading to DPDR.

This, Miskin’s memoir pointedly suggests, reflects a larger issue in the U.S. healthcare system, where perinatal mental health is often overlooked or inadequately treated. Miskin herself could not see the specialist early on because no psychiatrists would take her on as a patient for under $500 per session. Miskin also contrasts her experience in a New York City psychiatric ER with how her sister-in-law in Paris would have received care in a dedicated Mother-Baby unit, highlighting the stark differences in prenatal and perinatal mental health care between the U.S. and other countries.

Miskin’s memoir issues a stark warning: Perinatal mental health care is not a privilege or a luxury—it’s a fundamental right. Her journey exposes the cracks in the U.S. healthcare system, where the high cost and exclusivity of some clinics or programs leave many mothers without the necessary resources and support.

The failure to provide sustained, accessible treatment isn’t just a gap in care—it’s an urgent crisis of equity, where only a few can afford proper help while others are left unmoored and unseen. Her story demands a reckoning, calling for systemic reform to ensure that no mother is left to face this struggle alone.