I first met Barrie Miskin in the summer of 2023 in Astoria, about a mile away from the titular Hell Gate Bridge. All I knew then was that she was a writer, and she lived in my old neighborhood. We had coffee at Martha’s Country Bakery and talked about our kids, our teaching careers, and the endless struggle to find writing time. I found her endearing and sweet, and I asked her to send me the memoir she was editing.
When I got the PDF of Hell Gate Bridge, I read it in a single night. It was like watching a horror movie that happened to star my new friend. I wrote her an email the next morning: “Jesus Christ. I can’t believe the bright, funny woman I had coffee with is the same woman who endured this crushing ordeal.”
Hell Gate Bridge is the account of Miskin’s years-long experience battling a dissociative disorder that almost claimed her life. It begins with a very pregnant Miskin checking into a psych ward and descends into a nightmarish tour through our carceral mental healthcare system. She describes feeling as though she is “viewing the world through the scratched and filthy film of a glass box I was locked inside,” and no one can seem to help her get out. Instead, she is prescribed drugs that exacerbate her dissociative symptoms, and she starts learning how to game a broken a system to secure her own freedom.
In the book, part of Miskin’s trouble is that her unusual symptoms are mysterious and poorly understood. Eventually, with the help of her psychiatrist father, she figures out her rare diagnosis—Depersonalization Derealization (DPDR)—and finds a specialist who helps her recover. This April, I sat down with Barrie to discuss her disorder, her thoughts on the current state of maternal healthcare, and the process of turning this harrowing experience into a book.
Kate Brody: Depersonalization/derealization: what is it? How did you find your way to that diagnosis?
Barrie Miskin: I was diagnosed with major depressive disorder and generalized anxiety disorder when I was in my early 20s. I had these brutal panic attacks, and during them I would have the sensation that I was leaving my body and watching everything as if through a dream. I didn’t have a name for it then. It was just part of my panic attacks.
When I got pregnant, I felt a sense of shame about being on an antidepressant, so I went off the Zoloft I had been taking for fifteen years. Then, my depression and anxiety returned with a vengeance, and I left them untreated for so long that I began to dissociate. Again, I started feeling like I was watching everything through a dream, which I later learned is called derealization. And this time, I went very deep into it. Family and friends became like alien proxies of themselves. Everything was so scary. When I Googled my symptoms, I kept landing on depersonalization/derealization syndrome or DPDR. But there’s no medication or treatment for that diagnosis, so I kept slamming the laptop shut, trying to will it away.
Eventually I had to do a lot of exposure therapy, and what I believe is called radical acceptance. I started thinking of it like Alzheimer’s or MS. Something I’d have to live with forever. But, in the end, since the DPDR occurred within the context of pregnancy, I did end up getting well. I got lucky.
KB: At what point in that process did you start conceiving of this experience as a story that you wanted to write?
BM: Once I was able to find a therapist who treated dissociative disorders, we had a really long road to recovery—about two years. That whole time I wasn’t conceiving of it as a story; I just wanted to get better.
About a year after I felt like I had fully returned to myself, my psychiatrist suggested that I take a writing class and explore the experience in that way. I enrolled into the Intro to Memoir class at the 92nd Street Y with Sarah Perry, which was life-changing.
I’ve always turned to books to help me feel less so. 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.
KB: One thing that comes up in the book is your grief for your younger self. At one point, you ask Patrick, your husband, “do you remember her?” Obviously, it’s specific to your experience, but I think it also resonates with anyone who’s been severely ill or even more broadly women who feel they lose touch with who they were pre-motherhood. Do you still feel that sense of grief? Have you been able to return to that earlier version of yourself or has some new version emerged?
BM: I feel back to myself as far as my ability to experience joy and my sense of humor. When I was trying to get better, I found myself gravitating towards friends who were 15 years younger. I was mourning our old life in Brooklyn, even though it wasn’t there anymore. All our friends had moved on and had kids. Now that more time has passed, I feel settled. I’m a mom and a wife and someone who’s gone through a major change. I have a confidence in myself that I didn’t have before. I’m a writer, which came as a surprise. Once I started writing, I felt like: I have this for me, this is mine. And I was able to become a part of this amazing, supportive writing community. I was also not expecting that at all.
KB: In terms of writing the book, did you rely on notes or diary entries from your time being sick? Was it mostly drawn from memory or other people’s accounts? How did you put the story together?
BM: I was not taking notes. I could barely read when I was deep in my illness. Once the story got some momentum and I could see that it was taking shape as a book, I relied on my husband and my parents and friends and my psychiatrist to help me piece together details and conversations. I was also able to get the notes from each hospital stay as well as my stay at the clinic. Those were pretty detailed. But honestly, I remembered most of it. I could remember a lot of specific conversations and scenes. When I wrote the first draft, I was in this sweet spot where I had enough space to be objective, but also, it was close enough where I remembered what had happened.
KB: There’s this heartbreaking moment in the book where you talk about seeing those hospital notes. And there’s this character, Dr. Abrams, who for me was almost a tragically villainous character, because at first, he’s so warm. But then when you see his notes later on, he had written that you were manipulative and inappropriate. I can’t imagine what that was like to go back see the way your trusted medical practitioners were writing about you.
BM: It was shocking. He said I was flirtatious and sexual with him. I mean, I was seven months pregnant and in a psych ward. I had already drafted that section before I received the notes, and he was the hero in that first draft. And then when I got the notes, I felt dirty and disgusting. I curled up in bed after and fell asleep in the middle of the day. I couldn’t believe he saw me in that way. I thought he was trying to help me.
KB: You touch upon how you went into debt and had to borrow money from family to pay for certain treatments. How do you see class and money having played into your experience?
The maternal and mental healthcare systems are beyond broken and it’s impossible not to notice the severe injustices within them.
BM: My husband and I are middle class. I’m a teacher; he works in the arts. We live in Queens and rent in a middle-class neighborhood. We are white and educated and come from white, educated middle to upper middle-class families. We know that puts us in a place of privilege as far as receiving medical care. I will say, we did go into debt for this care and it took us years and years to pay if off. That being said though, as with most systems in our country, the maternal and mental healthcare systems are beyond broken and it’s impossible not to notice the severe injustices within them. Patients in the psych ward who were white-presenting received care the fastest. All the doctors were white. All the doctors and the patients at the private clinic were white. You can’t unsee that, or turn a blind eye to it. That’s the depressing reality of where we are at right now.
KB: As I was reading, I was feeling so much anxiety that you were putting this all on credit cards. At the same time, I’m thinking, thank God Barrie’s dad is a psychiatrist. You had people who were helping you navigate this and find this obscure diagnosis and the right providers and still you came up against so many obstacles. There’s another world, obviously, where you get stopped at any one of those points. It was harrowing to think that this version of events is maybe the system functioning at its best, and it’s still not functioning very well.
BM: And I’m just there like, could someone please help me? One of my best friends just went through a psychiatric emergency that none of us saw coming. She was relying on me to tell her where to go. I said, go to NYU or Weill Cornell. The rest of the hospital systems, even in a major city like New York are awful. You get treated inhumanely. There’s already so much shame wrapped up in being mentally ill, and then the medical establishment, which is supposed to be there to help you, makes you feel like a criminal instead.
KB: The way inpatient mental healthcare is first pitched you by your psychiatrist, it sounds nice. You’re like, I’m going to go to the hospital, I’m going to rest and get better. But then immediately what you describe is so different from any hospital experience I’ve ever had. To start with, you’re visibly pregnant and they strip you down, they’re barking orders at you. There is an immediate dehumanization. We treat mentally ill people with such disdain and suspicion, even when they are in the right place, voluntarily seeking help. Did you have any apprehension about writing the book given that stigma, given that you’re still teaching and you have a social life?
BM: Well, first of all, I use a different last name in my teaching career, which will hopefully deter any students from finding the book. Mostly people have been very supportive, especially my principal and the admin at my school. The people affected by the book have already read it and okayed it. It was definitely was something I had to think about, but the response has actually warmer and more positive than I had anticipated, if anything.
KB: I’m a teacher, and I found the teaching parts of the book is so wild, because you have to return to this high-stress, high-touch job when you’re obviously not well. There’s just no way for you to take more time off. What was that experience like returning to work when you’re still in the throes of this dissociative disorder?
BM: I was just super lucky, because my boss—I’m going to start crying, because he’s amazing—he wanted to keep me and see me get better. We had co-teachers, and he paired me with one of my close friends and colleagues, and she took the reins. They let me ride it out. I was blank for months. And actually, I have a new job in education. My old boss, my mentor, moved to a different school, and I followed him.
I had really good union insurance, and we stretched it as far as we could, but we didn’t have enough money. I had to go back to work. I was just lucky to have a really gentle landing and a strong community at the school where I had worked for eight years. It made all the difference.
KB: In the book, the catalyst for this whole episode is that you go off Zoloft when you get pregnant. It’s not medically recommended exactly, but you just feel like it would be best for the baby for whatever reason. And I think everyone who’s been pregnant has had this experience of making choices that are more backed by mommy blogs and peer pressure and vibes than actual science. Is there anything that you like to see emerge in terms of the way we talk about prenatal health care?
There’s already so much shame wrapped up in being mentally ill, and then the medical establishment, which is supposed to help you, makes you feel like a criminal instead.
BM: I don’t read mommy blogs anymore. I have not touched a mommy blog. I do not Google a single thing. I am only asking questions of doctors whom I trust. Honestly, I feel like the shame around pharmaceuticals during pregnancy is a way to dehumanize women. I dyed my hair before I knew I was pregnant, and in the hospital, I kept telling people that was the catalyst, even though that’s so ridiculous. I love Emily Oster’s writing around pregnancy. There’s a lot of misinformation out there, but I hope that there is more and more information being brought to light about how pregnant women can take ownership of their bodies.
KB: Sometimes I feel like we’re making progress, and then other times—
BM: They’re banning abortions.
KB: Right, as we’re doing this interview, Arizona is reaching back to the 19th century to try to ban abortion. Speaking of, I love the way that Hell Gate Bridge contributes to the conversation around abortion by introducing the idea of a medically, psychologically necessary abortion. The idea that pregnancy doesn’t need to be an imminent physical threat to be endangering your life. It felt very new and necessary.
BM: There is this bizarre notion that your brain and your neurotransmitters and everything going on up there in your head is somehow separate from your body. To me, it’s the same thing. I could die if I were to get pregnant again. And now, there are medications that I’m on that you really can’t take while you’re pregnant. So I’d have to go off my benzodiazepine, and for me, that could mean severe depression or DPDR. I have a daughter, and I have to be a present mom for her. The abortion discourse feels like part of that same misogynistic impulse: don’t dye your hair, don’t eat this, don’t eat that. I have a few friends from the from The Clinic, who were severely depressed and suffering from PPA or bipolar, and they’ve had second children successfully in the intervening years. But that’s a really personal choice. As it should be.
KB: Have you thought about your daughter Nora reading the book in the future? Your love and your desire for her is so powerful and palpable in the book. You talk a little bit about the origin of her name as “light,” and that love does feel like the only glimmer when things are really dark.
BM: My biggest fear is her reading the book. I am speaking with my psychiatrist about different ways we can approach discussing it with her, but we haven’t really hit on anything yet. It breaks my heart. I didn’t think hard enough about any of this when I was writing the book. I wanted to get the story out, to maybe it could help somebody else. But in my mind, it was always somebody far away. I wasn’t thinking about all my family and friends who are going to read it.
KB: I wanted to talk about the title a little bit. I lived in Astoria for six years. So immediately, I recognized Hell Gate Bridge. But for people who are unfamiliar, what is it and how did it begin to take on this symbolic power for you?
I feel like the shame around pharmaceuticals during pregnancy is a way to dehumanize women.
BM: When I was first getting sick, my psychiatrist gave me the sage advice to take walks. So I’d walk to Astoria Park and see the river and have ideation about taking my life. And there was a bridge there with this 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, and I look up and see it there, and I could see that it was just a bridge. You know? And then later, when I was writing the book, I realized that it’s actually from the Dutch hellgat which means “clear passage.” And there was this theme of clarity running through the book. I just want to feel clear. So that stayed with me.
KB: It reminds me of the end of Darkness Visible, where Styron talks about Dante ascending from Hell: we came forth and once again beheld the stars. Are there books that you feel are like in conversation or related in some way to Hell Gate Bridge?
BM: Catherine Cho’s Inferno and Susannah Cahalan’s Brain on Fire were the two that I went back to again and again. Also Suleika Jaouad’s Between Two Kingdoms about her recovery from cancer. My mentor Sarah Perry wrote a book called After the Eclipse about discovering her mother murdered when she was twelve. That stayed with me. I don’t know if these are necessarily in conversation with Hell Gate, but they are the books I kept turning to for comfort. I have a special place in my heart for Sarah Gerard, because hers was the first fiction I could read when I started to get better. She explores mental illness in her writing and gets the surreality of it just right.
I was drawn to books about medical mysteries more than mental health memoirs, because my illness felt really mysterious for so long. There are a lot of mental health memoirs out there, but often I’d get this completely irrational sense of envy reading them, because those writers had diagnoses. I didn’t, and that made me feel even more alone.
KB: Towards the end of the book, your sister-in-law, Celine, who has suffered from post-partum depression in the past, basically tells you to get off your ass, and you end up coming around to the idea that it’s great advice.
BM: Celine is a terrifying, a gorgeous French woman, and my psychiatrist is also a gorgeous, terrifying European woman. And they both knew exactly what I needed. I couldn’t have whatever the coddling kind of therapy is. I needed exposure therapy. I had to come around to the idea of: you have to do it yourself. That’s the scariest part of mental illness because I wanted to be taken care of, but you just have to take it step by step. Celine’s advice was basically echoed by my psychiatrist. And it’s what ended up working for me. I lived as if, and that healed me.
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