INTERVIEW: Barrie Miskin, Author of Hell Gate Bridge

Interview by Leslie Lindsay

“I’ve always been good at remembering names,” writes Barrie Miskin in the prologue of Hell Gate Bridge: A Memoir of Motherhood, Madness, and Hope (Woodhall Press; June 2024). But soon, the names elude her. All she can remember are the dates. More specifically, the dates in which she lost her mind.

Having grown up the daughter of a psychiatrist father, Barrie examines the date she arrived at the psychiatric emergency room, the dates of the inpatient hospitalizations, the outpatient hospitalizations, the date of her baby’s birth. With all of this, comes a sense grief, one that is both tangible and elusive.

It’s summer 2016 when Miskin decides to go off her low-dose antidepressant in order to conceive. By January 2017, Barrie no longer recognizes herself. Her family is concerned. But she’s pregnant, and shouldn’t she be happy? Yet a pervasive death wish consumes her. In a desperate attempt to obtain a diagnosis and treatment, Barrie and her family traverse the bleak and often inhospitable world of mental healthcare in the United States. Occasionally, they are met with kindness and compassion, but often it’s dismissiveness and ignorance, even by those who “should know better.” This begs the question: is mental health a human concern or societal one? How can the mental health system better support mothers and their families?

When Barrie is finally diagnosed with the very rare condition of pregnancy-induced depersonalization and derealization disorder (DPDR), she begins an arduous journey of rehabilitation, with a few set-backs, all while bonding with and caring for an infant, maintaining her teaching career, and working through the intricacies of a young marriage. Barrie is determined to connect with her daughter while raising awareness not just of our broken mental health system, but to normalize maternal mental health, as well as advocate for DPDR.

As a writer-mother myself and a former psychiatric RN, I am particularly in-tune with the challenges of mothers and mental illness. As we move into the summer season of growth and abundance, one might also find it a time of loss and grief.

Please join me in conversation with Barrie Miskin.

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Leslie Lindsay: Barrie, I am so delighted to connect! Congratulations on your memoir. Hell Gate Bridge is such a darkly important topic—maternal mental illness—one which is often not talked about or accepted. Before we get into the specifics, can you talk about the genesis of Hell Gate Bridge?

Barrie Miskin: Thank you so much, I’m thrilled to connect as well!

When I became pregnant with my daughter, I developed severe peripartum depression that eventually devolved into depersonalization/derealization disorder or DPDR. Living with a severe mental illness, being pregnant and then trying to raise an infant all at the same time was a harrowing experience and it took a long time to find the treatment I needed to help me get well.

About a year after I felt like I had fully returned to myself, when my daughter was three years old, my psychiatrist suggested that I take a writing class and explore the experience in that way. I enrolled Intro to Memoir class at the 92^nd Street YMCA with Sarah Perry, which was life changing.

I’ve always turned to books to help me feel less alone. When I was sick though, I couldn’t find anything to match what I was going through. Once I picked up some momentum in my writing class, I started to get the idea that my story might become a book, and maybe it could be the book someone else suffering from severe maternal mental illness needed.

Leslie Lindsay: I always like to talk about titles, because, as a poet once told me, a good title unlocks the entire poem. While Hell Gate Bridge is not poetry, there is a bit of poetic play in this title. Can you walk us through that decision?

Barrie Miskin: When I was first getting sick, my first psychiatrist gave me the somewhat unhelpful advice to take walks. I would walk to Astoria Park, a park in the neighborhood where I live, and see the east river and have ideation about taking my life. There’s a bridge there with an ominous name – Hell Gate Bridge. It was just always in my mind. I became obsessed with rivers and bridges.

And then later in the book, I describe this day I was swimming with my daughter in the public pool at the same park, and I looked up and saw Hell Gate Bridge overhead and I could see that it was just a bridge. Nothing symbolic, nothing ominous. Just there.

Later when I was writing the book, I learned that the name “Hell Gate” actually comes from the Dutch term hellgat which means “clear passage.” There was this theme of clarity running through the book – this yearning to feel clear. So that stayed with me.

There’s also this idea of ascension out from the gates of hell, as in Dante’s The Divine Comedy. A lot of writers such as William Styron, Catherine Cho and Geoff Rickly play with this theme in their own work exploring severe mental illness.

Leslie Lindsay: As a former mental health nurse, I completely identified with the settings of many of the places you describe in the book, but I also shook my head in disgust when I read certain passages about the dismissive staff. I’m not sure if their attitudes were personal, due to caregiver burnout, or a state of the mental health system. What do you think might have been at play? And how can this be improved?

Barrie Miskin: Neither the mental health care or the maternal healthcare I received was particularly compassionate or effective during my pregnancy and my struggle to get well. I do live in New York City, so maybe it has to do with being treated in city hospitals within such a huge and hectic metropolis and healthcare workers are just busy and exhausted.

On the psychiatric wards where I stayed during my pregnancy, I was treated by a lot of residents and interns. They were very young and still learning. For many of them, the psychiatric residency was just a part of their rotation and they had no interest in eventually becoming psychiatrists themselves. As an educator, I don’t think it would have been appropriate for me to give advice to parents about their children while I was still in graduate school and student teaching. Maybe it’s different in medicine. I truly don’t know.

There also is an element of criminalization of the mentally ill. It’s as if you’ve done something wrong and need to be locked away. I don’t know why this is. We just go in asking for help, not to be stripped of our identities.

Leslie Lindsay: It’s not just that the psychiatric staff was dismissive or cruel at times, but your own family, at times, were also quite indifferent to your suffering and situation. For example, your father, a trained and practicing psychiatrist was aloof and angry much of the time, until you called him on it. Your parents often couldn’t be bothered to book a flight or miss a family wedding. And your mom’s painful refrain, ‘this was between you and [your husband].’ Mental illness affects the entire family system. Can you talk about that please? And how might we navigate this differently?

Barrie Miskin: The interesting thing about writing and publishing a book is that the process from having the experience, to getting the words on the page, to holding the book in your hands is so incredibly long.

I became sick in 2016, began writing in 2021, and still won’t hold the finished copy for another six weeks! That is to say, during this span of time, our family has had a long, painful but ultimately healing journey. My daughter is now seven years old and has a rich and loving relationship with her grandparents. We’ve all worked hard and have come to a place of acceptance and healing. In that sense, we are very lucky. Things look different now than they did eight years ago.

Leslie Lindsay: I’m also very interested in the books that were left behind in the room where you stayed at the psychiatric institution, two of which sound fascinating, but I am not familiar. Katherine Heiny’s short stories and an ‘infamous memoir’ by Cat Marnell, where she spends two weeks in the very same ward you’re hospitalized. Do you feel this was a way of the universe collaborating?

Barrie Miskin: It did feel good to discover objects that felt familiar, that reminded me of who I was at my core when I was feeling so disconnected with myself.

The books themselves are quite different – Katherine Heiny is a novelist and short story writer whose work I love. Her stories have a current of warmth running through them but a darkness around the edges – my favorite kind of stories to read. The book I found was a collection of short stories called Single, Carefree, Mellow and it is my personal favorite.

Cat Marnell was a kind of infamous “It Girl” if you will in New York who was a beauty editor and writer for fashion magazines. She struggled greatly with addiction and wrote candidly about her struggles in her memoir, How to Murder Your Life, which I think is a modern classic. I believe she is sober now and very serious about her recovery and is at work on a novel.

Leslie Lindsay: Even though I worked in psychiatry, I had never heard of depersonalization derealization disorder (DPDR). It seems as though it’s quite rare and often misdiagnosed as borderline personality disorder, bipolar disorder, even schizoaffective disorder. Can you give us a little insight, please?

Barrie Miskin: DPDR is a bit of a mystery, and is not very well-known, although the terms “dissociation” and “depersonalization” have been making their way a bit more into the mainstream vernacular lately. Last summer, Bowen Yang spoke out about how he had been suffering from bad bouts of depersonalization, and while I felt terrible for him, I was glad to see the disorder gaining more attention.

The main symptom of DPDR is feeling disconnected from your reality – as though you’re operating within a dreamlike state or observing yourself from outside your body. People who you know and love take on an almost alien-like quality. Everything feels very surreal. Oftentimes, DPDR happens as a symptom of a panic attack and goes away, however, chronic DPDR can last for years. It’s terrifying.

Currently, there is no medication that can directly treat it, and it needs to be treated through intensive exposure therapy.

Leslie Lindsay: Toward the end, your husband, Patrick, says something along the lines of, ‘it’s not the big events that are hardest to get through, but the days in between.’ I find that so true! I think it speaks to the idea that little things accumulate, that each day is often a small battle to be…won? Overcome? Can you expand on that some, and give us a sense of where you are now?

Barrie Miskin: I think my husband described the recovery process as a “slog”. It was winding, painful and slow. It was not always linear. Since DPDR is mostly healed through therapy, in my case through exposure therapy, I had to complete mundane tasks like taking our daughter for a walk in the stroller or sitting through a mommy group or making dinner. I had to live “as if” and it was so hard. But each time I completed a task or had a great time with my daughter at the library story hour, or made an edible vegetable for dinner, it did feel like a win, and it did contribute to my healing.

I do think I had this sense that when I got better, everything would be “perfect”. Our story would just have this happy ending and we could forget everything that had happened to us. Life, however, has a way of going on. We have rough days at work, we owe taxes, our daughter acts like a rascal at school sometimes. But we do remind ourselves of how lucky we are, to have made it through. We still end the days together with dinner and story time and a tub. There’s a lot of love in our home and we never take that for granted.

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