I knew something was wrong when I was pregnant, but I couldn't afford the psychiatrists I was sent to. I looked for answers on my own.

• Barrie Miskin is a teacher and writer living in Queens, New York.
• This is an excerpt from her memoir, "Hell Gate Bridge," which is her first book.
• She dealt with depersonalization-derealization disorder after learning she was pregnant.

Seven hundred and fifty dollars out of pocket is on the cheaper end for a consultation with a "repro psych," and waiting lists can be months long. When we had asked our OB-GYN for a referral for a reproductive psychiatrist early on in the pregnancy, he gave us the number for a physician who prescribed nutritional supplements and a grain-free diet plan with no nightshade vegetables — and no medication. She cost $1,500 per session.

Reproductive psychiatrists are wealthy, well-educated white women. If you are lucky enough to pay the entrance fee into their exclusive club, you are probably a wealthy, well-educated white woman, too.

I tried to find a reproductive psychiatrist I could afford

As mandated, I went to see the reproductive psychiatrist assigned to me by the social worker a few days after I had returned from the hospital. I took the subway to her hushed penthouse office suite on the Upper East Side. It was a January day when the city was all gray and stone, the tall buildings leaning in on me. I'd lived in New York City for nearly 20 years — it belonged to me. But that afternoon, I felt small and lost in the city's cold maze.

The doctor had the brusque demeanor unique to chic New York women who are used to getting what they want. Even so, she was sympathetic, and I could sense that beneath her all-business exterior, she was a little afraid for me. I repeated my story, now with the addition of my brief institutionalization.

My daughter's due date was on April 6, 2017 — the day after my birthday. I had 13 weeks to find a way to reverse the course of my insanity and get ready to be a mother. The doctor understood our urgency. She also understood that I would not be able to afford her. That afternoon, she spent most of our 45-minute meeting on the phone with other psychiatrists in her network, fast-talking in a broad, Long Island accent, like she was a day trader and I was a stock to sell. No luck.

No one would take me for under $500 per session. As our time together came to a close, she did promise to keep trying to find me help. She would put my case on a message board where psychiatrists throughout the city could read about the undiagnosable pregnant woman who was too poor to afford their treatment and bid on me online instead.

Before I left her office, I told her I still wasn't sleeping. It had now been almost a month and a half, and the most I had slept was three hours per night — and that had happened only once.

"OK." She leaned in closer. "I'm going to prescribe you something that is gonna Knock. You. Out," she said in the manner of someone offering up a line in the bathroom of a Downtown loft party. "You'll be sleeping like a baby in no time."

I left the appointment with no psychiatrist to treat me, still no real diagnosis, but I did have a new prescription for 50 milligrams of Seroquel. An antipsychotic. And knock me out, it did. The next morning, Patrick had to lightly slap my face several times so I could wake up, get out of bed, and go to work.

The antidepressants didn't work, and I kept searching for answers

I don't believe in God, but I prayed like an earnest schoolgirl for what Dr. Abrams had told me in our therapy session to be true: that in three weeks' time, the medicine would kick in, and I would be feeling back to normal. At the three-week mark, though, I was worse than ever. If the Zoloft wasn't working, then I probably wasn't depressed. If the Seroquel only seemed to help me sleep, then I probably wasn't psychotic. What was wrong with me?

I searched for pregnant women who have been treated in psychiatric hospitals (a few), pregnant women who have experienced suicidal ideation (more than a few), and reviews of psych wards (many — there are a number of sites heralding themselves as "A Yelp for Psychiatric Facilities," as well as several actual Yelp reviews of psychiatric facilities). Most reviews begin with the patient's often grotesque mistreatment by ward staff and end with how much more traumatized and unwell they felt when they were released.

My greatest fear was that I was hurting the baby, through my stress, through the medications I was taking. When you are pregnant, the internet is not your friend, even if you are in the soundest state of mind. My OB/GYN constantly implored me to stop self-diagnosing, saying that if I wanted to find research articles that stated, "Apples cause autism in unborn children," they existed. I couldn't stop though: Each day, I went deeper down the hole, reopening the wound.

My searches kept landing on a disorder I had never heard of before: depersonalization-derealization disorder. And I kept finding my truth. The feeling that you're observing yourself from outside your body or you have a sense that things around you aren't real, or both… you may feel like you're living in a dream . . . alienated from or unfamiliar with your surroundings... feeling emotionally disconnected from people you care about, as if you were separated by a glass wall… surroundings appear distorted, blurry, colorless, two-dimensional or artificial… distortions in perception of time… distortions of distance and the size and shape of objects.

Scrolling down the pages for the treatment plan, my heart pounded with longing, but I was always met with the same death knell: There are no medications specifically approved to treat depersonalization-derealization disorder. Contact your primary care provider.

Unable to help myself, though, I dug deeper. Peeking through my fingers like a child watching a horror movie, I sifted through articles, Facebook groups, threads on Reddit, books on Amazon.

The books had titles like "Stranger to Myself" or "Feeling Unreal." On their covers were pictures of crying clowns, black tears dripping down painted-white faces. The Facebook group greeted visitors with a blown-up picture of Edvard Munch's The Scream as its cover photo.

Images posted at the tops of articles showed young men and women trapped inside hallucinatory fractal designs, like darker versions of a poster you might find on a college dorm room wall.

I learned that DPDR was a dissociative disorder. The only dissociative disorder I had ever heard of was dissociative identity disorder, more commonly known as multiple personality disorder. I knew that once you had a dissociative disorder, there was no coming back.

I compared the sites on dissociative disorders with the pages and pages of peripartum and postpartum mood disorders. The pictures I saw there were of pretty, long-haired women wearing yoga clothes and dejected faces as they cradled plump babies. There were lists of medications, support groups, doctors, promises that things would get better. Please, I thought, please let that be me.

But the world of dissociative disorders continued to reach out its long, sharp-nailed and crooked finger, beckoning me to come and join them where I really belonged.

"Please, God, no," I silently begged. And I slammed my computer shut.

Excerpted from Hell Gate Bridge by Barrie Miskin. Copyright 2024 Barrie Miskin. Published by Woodhall Press.