Which word in “postpartum psychosis” are you having trouble understanding?

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Years ago, when I was a chief resident, I received a call from the local women’s prison. They wanted to send over an inmate who was 9 months pregnant so she could have an ultrasound. I asked why and was flabbergasted by the reply. The woman had told the prison staff that she believed that she was carrying the child of the devil. Apparently the staff imagined that if I performed an ultrasound I could convince her that the child was not Satan’s baby. It seemed not to have occurred to them that the woman was suffering psychotic delusions and that an ultrasound was not the appropriate treatment for that problem.

I was reminded of that incident when I read about a recent tragedy in New York City.

On Wednesday afternoon, Cynthia Wachenheim did the unthinkable: She strapped her 10-month-old son to her chest and leaped from the eighth floor of her building.

Wachenheim, 44, died. But baby Keston Bacharach survived, his fall cushioned by his mother’s body, with only a few scratches.

New information reveals the motivation — guilt and fear — that led to Wachenheim’s fatal decision to end her own life and try to end her son’s.

According to a law enforcement official who spoke with the New York Times, Wachenheim left a 13-page suicide note explaining the guilt she felt over two previous incidents in which her child had fallen.

Wachenheim wrote of her belief that the “shameful incidents” — one, when Keston had fallen from a play set onto a wooden floor, and another, when he had rolled off a bed — were the fault of a series of seizures and concussions that would cause Keston suffering his whole life.

No, no, no. She was not suffering from guilt and fear. She was almost certainly suffering from postpartum psychosis.

According to the Massachusetts General Hospital Center for Women’s Mental Health:

Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth…

… Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. Risk for infanticide, as well as suicide, is significant in this population.

In other words, Cynthia Wachenheim was in the grip of a psychotic delusion that probably arose in connection with the hormonal changes of the postpartum period.

But amazingly, that didn’t stop Elie Mystal at the legal blog Above the Law, from writing this ignorant, unspeakably cruel piece:

I know that society requires and expects me to use restraint or even show sympathy for suicide “victims.” But I just can’t muster the will to conform to social conventions in this case. This woman left behind a 13-page suicide note (of course a lawyer leaves a 13-page suicide note) explaining that she thought her baby had cerebral palsy based on internet research (doctors found nothing wrong with the child). When nobody believed her crazy rantings, her solution was to try to kill her own child — as if even an actual diagnosis of CP was worse than death.

Screw this woman….

Screw this woman? The woman was in the throes of a psychotic delusion. Psychotic: that means it was the product of a mind afflicted with a very serious illness. Pretending she should have just “bucked-up” when people dismissed her delusional fears makes as much sense as pretending that an ultrasound is going to convince a psychotic woman that she isn’t carrying the devil’s baby.

The blogger continues to express his mind blowing stupidity:

Having just been through the process of having a newborn, I’m acutely aware of all the time hospitals, pediatricians, and psychiatrists put in telling new parents how to handle the feelings of anxiety and sometimes depression that affect new parents. According to the reports filtering in about Wachenheim’s suicide note, it seems like she refused to listen to anybody else or seek out readily available help for her mental health issues.

Of course she didn’t listen to anybody else, and whether she did or did not seek out psychiatric help is irrelevant. She was delusional!

Finishing with a flourish of ignorance, the blogger concludes:

I don’t know, Casey Anthony (allegedly) kills her child, and she’s a monster. This woman most certainly tries to do the same thing, but she’s a “victim” because she tried to kill herself at the same time?

Don’t let the fancy law degree and respectable job fool you; she’s a monster.

She was not a monster. She was suffering from psychosis. She should not be held responsible for her actions because they were the product of a mind that couldn’t tell the difference between what was real and what she feared.

Defending Wachenheim, Slate columnist Jessica Grose goes overboard in the other direction.

The specific anxieties that Wachenheim mentioned in her suicide note are extreme and obviously the thoughts of a disturbed mind. Still, it’s alarming how much they reflect the current thinking about how much mothers are responsible for the ultimate sound health of their newborns. What they eat, what they don’t eat, what mood they are in, how long they wait to get pregnant, even what music they listen to—mothers are constantly reminded that every move they make can leave lasting damage on a baby and make them more prone to get even serious diseases like autism and other developmental disorders… Of course Wachenheim’s psychotic mind could have grabbed onto some other anxiety if fears of autism weren’t so outsized in the United States. But her case should give us a slap-in-the-face reminder to lay off a little—new mothers can be vulnerable enough without the extra anxiety.

Grose’s heart is in the right place, but even she fails to appreciate that Wachenheim’s delusional thinking was a direct result of her illness, not societal pressures. Yes, those pressures exist, and I have spent a great deal of time railing against them on this blog, but that’s not even a small part of Wachenheim’s problem. It’s the equivalent of blaming the movie Rosemary’s Baby for my patient’s delusion about carrying Satan’s child. The pressures of contemporary parenting ideologies are responsible for tremendous amounts of anxiety, guilt and unhappiness, but they don’t cause psychosis or contribute to it.

Postpartum psychosis is an illness, just like type 1 diabetes is an illness. And like type 1 diabetes, it is almost certainly related to hormonal imbalances. It is not the fault of the patient who is afflicted by it and it is not the fault of society. It’s just a disease, a disease that can strike previously healthy women with little or no warning and like any serious disease, it deserves our compassion, understanding and intense efforts to understand and treat it. To blame a dead woman for her own psychotic delusions is a sign that we have a long, long, long way to go in educating people about postpartum psychiatric illness. Elie Mystal and Above the Law should publicly apologize to Cynthia Wachenheim’s family for adding to their unimaginable pain by expressing their painfully retrograde, woefully ignorant views.

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  • ugh this reminds me of a time when I was working in an ER and a woman who was post menopause was convinced she immaculately conceived jesus’s baby. she was talking to jesus the entire time she was there. the staff was trying to have her give a urine sample to do a pregnancy test. ????

  • No opinion, but Andrea Yates was diagnosed bipolar and treated for it while in prison. n=1, for what it is worth.

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  • Depression interferes with reasoning in a way that makes things *look* hopeless, terrible, insurmountable

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  • MT2

    Thank you for this Dr. Amy. I visit your blog as a welcome respite to all of the judgment and mommy-shaming sites out there that tell me I’m a bad mother because I don’t do or haven’t done x/y/z. As someone who has suffered with a mental illness for the entirety of my
    adult life, and someone who frequently speaks to and supports other
    women/mothers with mental illness, this post, and the ensuing comments/stories of courage are a huge blessing.

    I, like many women, live with my illness in the shadows mostly. Yet on a daily basis I’m talking to other sufferers, encouraging them to get help be it in the form of meds, therapy, or a support group. Most of them being pregnant or new mothers, all terrified and hurt by the hell that is what we go through. And the biggest part of why we suffer in silence are the actions of people like Elie Mystal. For fear that we will be lumped into a category of “worthless psychopaths” who deserve zero compassion and care. Unfortunately some times there are even medical professionals out there who react the same way, only further alienating people who so desperately need their help.

    Thank you once again, for being a voice of reason. For seeing mental illness for what it is, and using your blog as a platform to bring awareness and compassion for those who are suffering from it.

    And extra thanks to all of the commenters on this site. This is one of the few websites where I actually enjoy the comments as much if not more than the original post.

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  • It’s the message innit? If you say: “it’s not the poor widdle woman’s fault; she was in the grip of a nasty psychosis”, then all of a sudden you find yourself in the grip of an epidemic of baby killers. Just like suicide, psychosis is catching. To save other inncoent children, the only sane message is: “Any woman who tries to kill her own baby is a monster”. A psychotic monster maybe. But still a monster.

    • Psychosis is catching?
      Which pathogen is responsible?

      (On a serious note, the above is misogyny. Men kill far more men, women and children than women do – but few call them monsters or suggests we have an epidemic.)

  • I remember being in my last year at Uni when the Andrea Yates trial was going on. So much judgement when it was clearly obvious to me this woman was mentally ill and had post partum psychosis. People wanted to blame her for what happened, instead of seeing the whole thing as a tragedy, and something which the poor woman would be horrified of herself if she was in her right mind. I thought her judgement then was wrong, and I still do. It was a new concept though PPP back then, and I think 10 years later, people still don’t understand it well.

    • I still think her husband was partly responsible. The couple were advised not to have another child because of the chance that she’d suffer severe mental illness again. I can’t imagine seeing someone suffer that much and risk it again.

      • The Computer Ate My Nym

        That’s because you have a conscience and care about your partner. Russell Yates has no conscience and his only concern is making someone have as many babies as he can force on her. He doesn’t care about the children. He certainly doesn’t seem to care about the children being dead. I read an interview with him once. His only agenda was finding another woman to put through the same thing again. And, bizarrely, he found one. I hope she has the sense to divorce him soon. He is far more responsible for what happened than Andrea Yates.

        • Gene

          From what I understand, the Yates family were part of the quiverfull movement. In the most basic understanding, it means that you never use birth control because God will give you as many children as you can handle. I have a friend who just had her seventh, another with six. A friend of a friend has 15. In these families, there is a lot of “traditional” gender roles (man is head of household, women stay home, etc). As a woman, your “success” is based on your children and family. So anyone who told the Yates family to stop having children (aka: birth control) would have been telling them to ignore God’s wishes. It was a perfect storm.

          • The Computer Ate My Nym

            Odd how God’s wishes seem to have aligned so well with Yates’. May he die alone, deserted by the wives and children he abused.

  • notahomebirthlactivist

    It just comes down to pure ignorance. I have worked with several mothers with post partum psychosis in the past few months. It’s extremely distressing. To blame anyone for these tragedies is nothing more than a selfish need. It’s the need to blame SOMEONE, in order to make sense of something which to most people seems completely bizarre. People want to hold someone accountable, because they can’t accept that anyone would be so mentally unwell that they could kill their baby.. it seems unnatural, but its very very real.

  • T.

    I have problems with depression. It is one of the reasons I have choosen not to have children. This is a personal choice and in no way should be choosen by people who aren’t sure of it. But is IS a possibility.

  • My god, this poor woman. :'(

  • anne

    I love your rough edged compassion.

    It may sound weird but I truly appreciate how you don’t talk down to women.

  • Captain Obvious

    Lawyers…………………if you had taken Paxil or other SSRIs while pregnant, reglan, levaquin, or pradaxa call our office. If you have had vaginal mesh placed, a metal on metal implant, or a mirena call our office. Good grief. If you have had a lawyer wrongly represent you or make medical diagnoses about you and we’re wrong about their assertions call my mafia hit crew so we can send over a beating.

    • Susan

      Did you see that they already have one of those disgusting ads about Robotic surgery? Every time I see one of those ads I think about the John Grisham book “King of Torts”.

  • mamaellie

    Thank you for this article and many of the comments. I have panic disorder that flares up when I am pregnant and nursing. I will regularly be going about my daily business when I am overcome with a feeling of impending doom. Just yesterday I had to leave a store with my two littles, sweating and dizzy, feeling sure that I was going to collapse dead. I had to get to the car before anyone saw me like that. What would they think? I obviously wasn’t fit to be caring for these little people ! Meanwhile I wasn’t sure how I was going to get the babies and stroller into the car the feelings were so intense. I finally did make it into the car, where I sat with my phone in my shaky hand ready to call 911. It took 10-20mins to calm down. Then I drove to the ER parking lot where I fed my toddler a snack and read her a story while I made sure I wasn’t going to fall apart again. I sometimes go into the ER where I mostly feel judged. I know it will pass. It always does. I wish more people would talk about these problems. I look around and feel so inadequate sometimes. All the other mothers seem to have it together. I feel terrible for this mother. I have never felt that I might harm myself or my children, but I know what it feels like to try desperately to regain control of your mind and body.

    • thepragmatist

      Have you considered having a rescue med, like Ativan, on hand for these times? You can often still drive on .5mgs (I did for years) and sometimes just having it with you can help. A good test to see if you can parent on it would be to take it while a partner is with you on a weekend. Sounds like you can make it through it. But panic disorder is a kindling disorder– meaning, the more your brain goes through the motions, the more likely it is to go there again. Also, a lot of panic attacks are actually because you are not breathing correctly and the balance between oxygen and carbon dioxide in your body becomes out of sorts. Making sure you are not chest breathing can help that a lot!

      • auntbea

        I also find that severely low blood sugar can mimic a panic attack and that –rather than the hormones — was why I had trouble during pregnancy. I find it much easier to maintain my emotional equilibrium when I also maintain my blood sugar.

      • mamaellie

        I have coping techniques such as breathing and I use relaxation tracks on my iPod. I have a bottle of Xanax in my bag, but I have yet to take one. Unfortunately, by the time I realize I should take one I am more afraid of taking the medication than of riding out the attack. I worry (unreasonably) that the meds will slow my heart and it will just stop. I have quite a few things stacked against me. I have thyroid issues (hashimotos), mitral valve prolapse, and I am 5 months postpartum.
        I wanted a large family (5), but we may stop now at 4 and just enjoy them. I know a lot of moms have it worse, but it’s very draining.

        • fiftyfifty1

          Some docs recommend that their patients try the med first when they are NOT having a panic attack so they know what to expect. It won’t slow your heart.

        • Laural

          I developped an anxiety and panic disorder after having my first. I was young and got married and followed my military husband overseas… I carried that Xanax around with me for years before I threw it away. My anxiety still flares during pregnancy and postpartum, but I am so grateful to have learned some wonderful coping techniques with a good therapist. My panic attacks are rare, I go years without one at times, and when one comes I am no longer consumed by fear. I just suffer through the symptoms and wait until they pass. That has been the biggest gift. I am always so sympathetic to women who suffer post-partum anxiety. It’s rotten!

    • auntbea

      As someone with an anxiety disorder, I would like to suggest that at least some of the judgement/inadequacy you feel is the disorder talking. I have learned with time and treatment that the vast majority of people of people witnessing an intense anxiety attack are compassionate and concerned, if unclear on what to do to be helpful.

      • mamaellie

        Thanks for that. You are probably right. I am definately paranoid about what people will think of my capabilities as a
        mother. It’s an ongoing battle. 🙂

  • sarah m

    I could have easily been this woman. My mind was completely taken over by something else after my third child was born. I thought that my children were going to have horrible lives because I was such a useless mother/person. I thought they would be better off without me, yet I also felt that they couldn’t survive without me either. I had an elaborately crafted plan as how to kill us all. The day came when I was to carry out my plan. Just like someone else posted in the comments, the teeny tiny rational voice that was left in my brain got bigger and bigger. I, obviously, didn’t do it. I slowly woke up from the hellish trance I was in. My husband had NO idea that I was as bad as I was. He knew I was depressed but all he did was tell me to call the doctor. I needed him to call the doctor and drag me to the hospital. There was no way that I could have done it on my own. I was isolated with really only one friend. She was worried about me, but she didn’t do anything to help either. I was so close to doing it, that I consider it a miracle that I didn’t go through with it. That episode is the sole reason why I will not have anymore children.

  • I have no personal experience of psychosis, though I am acquainted with several people who have had to struggle with finding help for relatives, and the helpless devastation that severe mental illness brings in its wake. I have no idea whether post-partum psychosis is something separate and distinct that can just happen out of the blue. I have heard interviews with women
    who have graphically described the effects it is had on them, the misery, fear,
    and the conviction that they were a source of harm to their children. I don’t know whether it is something that can grow and worsen from PPD, or something quite distinct unrelated to depression. In reading round this story,
    I was quite relieved to read that it effects only a very small number of women,
    and an even smaller proportion go on to harm themselves or their children.

    Neverthless, it is horrifying to think that someone could be in that very dark place and that no-one around them either realises the depth of their despair or that systems are not in place to identify the problem and provide help – as it goes more or less without saying that no-one in the throes of it would be capable of helping themselves.

    Several things are striking about this. For me, of course, the fact that she thought her child might have cerebral palsy catches my attention. Was that, in fact, a delusion, or a suspicion? Did none of the doctors she
    consulted see that as a warning sign? Is suicide always an irrational act centred in delusion or can it sometimes be seen, when in a very depressed and despairing state, as the only option?

    Another is that this is the very black reverse side of the idea that motherhood is destiny – empowering, fulfilling, blissful. Clearly, for many it is not, and the gap between this ideal and the reality doesn’t appear to be taken very seriously, if a woman like this can slip so fatally though the net. I once read that the crime of infanticide was treated differently because it was acknowledged that birth could affect the mental state of women – that idea is now considered outrageous – but is the idea that we can all handle it effortlessly a sign of progress?

    Like many others here, I have had my brushes with severe, suicidal depression – in my case reactive, in my late teens. When it came to having children, I feared it, but fortunately, and somewhat incomprehensibly, I managed to avoid it. Reading through the risk factors that someone posted yesterday, I had all of them – and my early mothering years were rather a long way from the blissful babymoons. But I avoided even a hint of PPD. Was this a chemical or hormonal fluke? Or could it have had more to do with the fact that I was not
    anticipating bliss or perfection, having a rather more realistic idea of what
    mothering involved? It seems to me that for a brief period in the late 70s/80s, the discourses around childbirth got a lot more honest and realistic, before NCB allied with strands of feminism took them down a path which only benefits the minority who are very, very fortunate. (Or suffering from rather more benign delusions) Psychosis, it seems, is rare, and maybe can
    strike anyone. Human misery, and depression unfortunately, are not. How
    terrible that this poor woman, her family, and in particular her child, could
    not find help.

  • Playing Possum

    I am in such awe of all you strong mothers who come through it. And my heart breaks for the ones who don’t.

    This is the reason I will not have children. I am too afraid of a) coming off the drugs and getting catatonically depressed, b) the almost certain ppd/ relapse that will follow and c) the time it will take to get well again. Even well prepared, I’m not willing to risk it. I’ll just satisfy myself with being the cool aunt…

    • My kids have a cool aunt, and she’s awesome.

    • I was, (I hope) a cool aunt for years before I had my own children – and I love my nieces as much as my own. Differently – but still a powerful relationship I cherish.

      It does make me sad when people find the (perfectly rational) fear of childbirth too much. I don’t know much about which drugs are a problem, nor do I know what the odds are of you being seriously affected. For sure, no-one can say for certain that you wouldn’t – but that can apply to those who least expect it as well, and perhaps that makes it more devastating.

      I don’t think it is necessarily a question of strong mothers coming through – I think it is more arbitrary and complicated than that. The right kind of support clearly can make a huge difference. Maybe sometimes the experience of dealing with other tough issues, and not having unrealistic expectations has something to do with it. I nearly lost my child – I have never been sure that I could have “come through” that.

  • Eddie

    FYI: The author of the hit piece (Elie Mystal) added a note (but not an apology) leading to this defence of Cynthia Wachenheim: http://abovethelaw.com/2013/03/in-defense-of-the-suicidal-columbia-law-mother/ Mr Mystal just says “for a difference perspective …” (and os on) before the link but he doesn’t retract anything he said.

  • Very sad story. I know from my own experience with a family member who suffers from delusions that you can’t simply expect the person to snap out of it and start thinking reasonably. People like that blogger need to understand the difference between “insanity” in the colloquial sense of the word which means acting erratically but, still knowing the difference between right and wrong, fantasy and reality vs. actual mental illness. For people who are suffering from psychosis, the
    delusion IS reality, period. It is frustrating, confusing and upsetting for people on the outside looking in but, this is no reason to be cruel to the sufferers.
    This woman died as the result of a horrendous illness that stole her mind and ultimately her life. The blogger who wrote the negative story about her should be ashamed. My heart goes out to Ms. Wachenheim’s family, especially to the little boy who will grow up without his mom.

  • fiftyfifty1

    There needs to be more education about Post Partum Psychosis (PPP). I barely learned about this in medical school or residency. For instance, I graduated without knowing that the #1 risk factor for PPP is having Bipolar (whether previously diagnosed or not). The saying among psychiatrists is actually “PPP is bipolar until proven otherwise”. I am ashamed to admit that I had just assumed that PPP was a severe depression that became psychotic over time. Or maybe a sign of undiagnosed schizophrenia. And yes, both of those causes can happen. But the vast majority of PPP episodes are due to Bipolar. And these can come on VERY fast and VERY severe.

    • Alicia

      I’ve read that PPP is more considered acute polymorphic (cycloid) psychosis/schizophreniform than bipolar.

      • No opinion, but Andrea Yates was diagnosed bipolar and treated for it while in prison. n=1, for what it is worth.

      • fiftyfifty1

        My understanding is something like 80% of postpartum psychosis cases are Bipolar related. Especially in the early onset cases (less than 1 month PP). The ones that are more distant from birth can also still be Bipolar, but sometimes are just severe depression that stays untreated long enough that it develops delusional and other features that bump it into the psychotic category.

        • Alicia

          That’s something good to know since I have bipolar II. My therapist has already given me strict instructions to call her as soon as I find out I’m pregnant so monitoring can start. Reflecting on this whole post and the comments, I think I did in fact have some delusions starting while I was pregnant with my son (before I was diagnosed with bipolar II). I had this strange, obsessive fear in the last trimester that the ghost of Sharon Tate was haunting me and going to hurt me out of jealousy. So crazy…

    • thepragmatist

      I’m Bipolar 1 and after the birth of my son had a few episodes of psychosis. The only other times I’ve ever had psychosis were related to SSRIs. Anyway, we were already mitigating for it as we knew I was high risk, so I was getting a lot of sleep and had a lot of care, and was never alone with our son until I was stable again. One was pretty funny: there were birds chirping in the faucet and it took my husband quite some time to get me to leave the faucet alone! Had a couple in the hospital were I fled on foot, which was crazy, given that I had just had surgery (I told my OB she could just sedate me next time, don’t care if I miss those first days).The others were just persistent baby crying until I could not tell if the baby was crying or not and crazy delusions that people would take him away, especially my MIL who seemed very malevolent at the time (she is quite a sweet lady!) and abject terror that I would abuse him to the point where I couldn’t change his diaper until he was out of the newborn stage (I was abused sexually as a child, so it morphed into some crazy intrusive delusional thinking). I’d say it went on for about four months. And every time it got bad, the husband would say “emergency plan!” and then would sedate the shit of me and I would go to sleep and wake up ok again. But I can imagine that had I not had enough sleep and was not cared for as thoroughly as I was (because we knew the risk was high) that something bad would’ve happened. Instead, it was a pretty good time. The worse hallucination was the birds in the bathtub and the anxiety that went around that. But we got me to sleep. The answer, in my mind, to most problems is to sleep.

      • Karen in SC

        Wow, pragmatist, your husband quite the problem solver and a loving and caring partner! I think the code “emergency plan” is perfect and says it all. Thank you for sharing.

        • thepragmatist

          It wasn’t just him. I had severe PTSD, too, from some recent traumas (indeed, one was still on-going at the time) and I had a whole lot of people involved in my care. My MIL came daily. I had different workers coming in and out of the house. A psychiatrist over seeing my meds. A 6 day hospital stay PP which was as much about getting stable enough to go home as it was about having had a c-section. Private room with generally very good nurses, some better than others. A MW who visited every day once we got home for a week and then every week for six weeks and another worker who visited every week until my son was 6 months old and then was immediately replace by a worker in infant development we still see. They taught me the basics of attachment. And, of course, meds. A fantastic support network. And since I had already been in therapy, when all of that failed, and I was really crazy at about 3 weeks PP, I had a therapist who showed up at my house one day and talked me down from the ledge. I recognize that it was a resource intensive, huge team effort. And I did my part working with it. I also knew that social services WERE watching me, which didn’t really help delusions about social services coming and taking my son, but the grand irony in that was that I had worked with the particular social worker, so the chats we had were all about HIS wife and new baby and shop talk. *facepalm* Not sure he would’ve been able to see a risk until long past the point of no return.

          The problem is that it only lasted so long but I never really stopped needing the support. My husband stayed home with us until his paternal leave ran out and we suffered financially for it– but had the good fortune of a family that was well off enough to support us. Those early months, however, gave my son a good jumping off point and despite any issues we’ve encountered a family since then, his attachment is strong and he thrives, in part, because of this and continuing intervention as I remain high-risk. I really appreciate the infant educator too, who has become a trusted part of our lives, and who has helped me form attachment and the therapist who educates me on appropriate parenting, since my role models were terrible. I wish so much other women and child could have that support. In the case of this mother, what would’ve happened if something else had happened? I think part of it is that, in general, it seems that the main providers of care PP– L&D nurses– seem to see people like me as just difficult patients. Many of those nurses did. No education whatsoever around my specific issues and so, as they arose, their was a lot of panic, despite having a pre-existing plan in place for both the immediate PP and the months after. Some of those nurses indirectly caused more harm than good, but no doubt with the best intentions. Some were absolutely fantastic and there was one in particular that if I remembered her name, I would give her chocolates! I just remember during a very particularly delusional time, this nurses face floating around in the dark, soothingly tell me I was safe and all was well and being very motherly to me and later openly mocking an intrusive and useless hospital social worker and forever winning my adoration. They also took the baby every night, despite it being a “baby-friendly” (read: we don’t want to pay for a nursery) hospital…

          I feel for this mother, so much: so many things could’ve gone wrong if I did not have a pre-existing issue and was not already involved through out pregnancy with services already and had a psychiatrist and careteam who worked together. We started early in many ways, with the worker that was assigned to me going as far as to bring an anatomically correct baby doll to the house, so we could sleep with it, change it, etc.

          I knew I would have trouble with certain aspects of care, having been unable to change my friend’s baby when caring for it, even though I wanted to, and I still would prefer not to as it really brings up a lot of negative issues for me. Things got bad around 8 months PP as resources disappeared, and I became primary care-giver and my husband returned to work, resulting in a shake up in medication and the introduction of new services. I think that mostly the workers involved had/continue to have no real idea of the severity of the situation because I really look and sound quite put together, but had moments of severe suicidal ideation that led to more than one uncompleted suicide attempt in there, especially dark was the gap between services. Those holes in public service are obvious. Like what happens when early child intervention ends?

          It was not and is not easy. It was more reason why I took such great issue with the way that the local community, as represented by 400+ women on this community board, would deride women asking for help with PPD, and then when I helped, would undermine my efforts and return to pushing the NCB/AP agenda, with absolutely no understanding of WHAT the ingredients of secure attachment are. A baby being worn and breast fed while mom is desperately sick and unavailable emotionally does not a secure attachment brew…

          • FormerPhysicist

            Powerful. Wow. I wish you all the best.

          • Karen in SC

            Again, I appreciate you sharing insight into what is involved with caring for a mother with PTSD and other mental illnesses. I had no idea and you have educated me.

          • S

            I want to echo Karen and FP — Thank you for speaking up for other mothers despite the cost to you (I am so sorry about the way you were treated), and thank you for sharing your experiences here.

      • Alicia

        As someone who has bipolar II, thank you for sharing. I’m a little concerned about what may happen if I can get pregnant again. I just hope that the support I’ve built up will be enough. Yay for awesome husbands who help us! And I agree about sleep!

  • fiftyfifty1

    I wonder about the role of breastfeeding. Some women report that breastfeeding helped them with their PPD by helping them feel they were doing one thing “right”. But a lot of other women say the opposite. A lot of times breastfeeding problems and depressive symptoms go hand-in-hand. Failing at something that you have been told is essential to your baby’s health cannot be good for a new mother’s mental health. A friend our family with no previous psych history killed herself and her baby (google Jenny’s Light). She had struggled with breastfeeding and was said to have taken that hard. Did this CAUSE her PPP? No of course not, not by itself. But no mental illness is 100% genetic. (Even with identical twins, one can have schizophrenia, one not). So if it’s not 100% genetic, we have to look at the other factors. And failing at something you have been told is “vital” and also “natural for mothers” will be fuel for feelings of guilt and despair and anxiety and unworthiness. Especially when combined with the sleep deprivation and physical pain that can go along when breastfeeding is going poorly.

    • mollyb

      When my sister-in-law told her best friend she was planning on formula feeding her third child (after EBF’ing her first two) because of the severe PPD she had with her second and her desire to stay on the anti-depressants that had helped her so much, her friend told her if she wanted something to love and didn’t feel like breastfeeding, she should just get a dog. Sick and sad, the pressure put on women.

      • Alicia

        I can’t believe her own best friend will say that! I’ll face the same situation if I have another kid, where I won’t be able to breastfeed because of my meds. I swear, if anyone tries to give me crap about it, they’ll get a nice middle finger right in their face and a “I would like to stay sane, thanks”.

        • Bomb

          People that need medication don’t deserve children. Didn’t you get the memo?

          • Alicia

            Oh, I know, we’re such horrible people for daring to have a bad brain! We should just crawl into a hole! /sarcasm

          • An Actual Attorney

            Alicia, I just wanted to share what my therapist said. I have really bad depression and am on Cymbalta. I talked to her about going off meds for pregnancy. She said, “Sure, there might be some danger to staying on Cymbalta, but do you know what’s really bad for a fetus? When the mother slits her wrists. That’s your other option.” She’s not of the coddling school of therapy, that woman.

          • Alicia

            Yeah, my therapist has talked to me about how the stress of dealing with my rapid cycling could cause more harm to the baby than any medication she would have me on. And that’s a good point your therapist made about a mother slitting her wrists. It’s just the reality of what could happen.

        • thepragmatist

          If you want to nurse, there are meds that are safer for lactation. It’s a personal choice, of course, but I wouldn’t want someone to think it couldn’t. Within reason. We also combo fed though, too. And I put up with less effective meds with a known safety profile and lowest transfer rate.

          • DiomedesV

            It really depends, thepragmatist. Nursing is generally fine on SSRIs. But many of the drugs on the list really haven’t been evaluated for safety. It is actually very surprising to me that many women would choose to breastfeed while taking some of the atypical antipsychotics, which can have devastating side effects at very high frequencies for adults.

            And some really are bad, like valproate and lithium. Recently I even saw a paper where psychiatrists were trying to justify ecouraging women on lithium to nurse, even though it has a pretty high transfer rate and is associated with infant kidney disorders. (I suspect they were trying to deal with the situation that some women on lithium will nurse no matter what they are told.) They had to take 1/10 (yes that was their sample size) off immediately because of infant blood levels and thought that 2-3/10 might have had problems despite unconcerning blood levels, all accompanied with the tripe about “the benefits may outweigh the risks.” Well, breastmilk is not liquid gold. It’s just not that important given some of the risks we could be talking about here.

            No one should feel pressured or even reassured about the prospect of switching a medication regime that is working for them so that they can breastfeed, especially given that the postpartum is already a vulnerable time for women.

            And finally, LukesCook is right. The biggest problem with nursing for many women with mental illness is not the medication issue itself, it is the sleep deprivation, which is a trigger for mania and psychosis. This is something that lactivists fail to understand because the overwhelming majority know absolutely nothing about psychiatry.

          • Alicia

            That’s exactly why I’m on Seroquel instead of Lithium. My therapist, who was an L&D nurse for a long time before becoming a psychiatric nurse, was present at a birth where the mom had been on Lithium, and the baby was born with severe disabilities. It really struck her hard, so any patient that wants to get pregnant at any point isn’t put on Lithium if she can help it.

          • Alicia

            My therapist and I have talked about switching meds (I take Seroquel and Effexor, both which pass through the breastmilk to the baby), but I think in the end I might stay on them. They are safe for pregnancy, and since weening off either med is very hard on the body, I might stick to formula. My son was formula fed, so I’m okay with that. There’s a small part of me that would like to breastfeed, but my health is more important.

        • DiomedesV

          Don’t sweat it, Alicia. The people who care about you will understand, and fuck everyone else. You should talk about this with your doctor and consider getting a second opinion. Many hospitals have a dedicated psychiatrist devoted to pregnancy and postpartum issues. It is worth it to schedule a meeting with that person and ask them their opinion, if you feel that your current psychiatrists may not be completely comfortable with pregnancy/postpartum stuff.

          • Alicia

            My therapist (a psychiatric nurse) was an L&D nurse for about 20 years before switching specialties and going back to school, plus she’s treated many women while they were pregnant. She’s awesome! 🙂

        • BigBlues

          I stopped nursing at 4 months because the meds considered safest while nursing were not working for me and I wanted to be open to more options. All of my friends were nothing but supportive and encouraged me to do what I needed to do to get better. If there were those who didn’t like it they were smart enough to keep their thoughts to themselves. And it ended up being the best decision for all of us as my baby did just fine and I was able to find a med combination that worked.

      • nomorequestionscatherine

        Disgusting!

        I hope your SIL immediately showed her the door AND let it whack her in the you know what on the way out.

        I would be flabbergasted and don’t think I could ever respect that person as a friend again. Women are the worst perpetrators of insulting and demeaning another woman’s parenting decisions. We need to stick together not alienate ourselves from each other. So sad.

      • thepragmatist

        I’ve heard this before, too. Common. Heard this when trying to advise women on how to sleep train their kids compassionately so they could get out of the pit of PPD. Although, you can nurse on certain anti-depressants, apparently. I nursed on meds. I don’t think it affected my son at all as he is absolutely meeting or exceeding milestones. WE just picked meds with low transfer rates and that would be used in pediatrics populations and stayed with very, very benign ones. As soon as I was done, we started to change the meds back to things that worked better.

    • quadrophenic

      I had a terrible time trying to breastfeed and it got pretty emotional for me. I somehow avoided PPD despite the fact that I suffered from dysthymia and 1-2 undiagnosed bouts of major depression as a teen as well as some PTSD issues stemming from childhood abuse and the mental illness in my family. The pressure to breastfeed and disapointnebt from failure is enormous – I don’t doubt that it’s enough to push susceptible women over the edge and/or make things worse in convincing women with PPD not to take meds.

      Seriously people could use a bit of perspective when counseling women about these sorts of things from day 1. Even when doctors say it’s ok to formula feed if bf isn’t working out, how is a woman suffering from PTSD going to take that at face value after being told for 9 months that breastfeeding is the ultimate thing you can do for your child?

    • nomorequestionscatherine

      This is why it makes me so upset when people treat breastfeeding as “one size fits all sunshine and roses” without allowing for the fact that it is a system of the human body that may or may not work “perfectly” for every woman. Do you insist that diabetics just need to try harder to make their pancreas work properly? Would you tell a man with erectile dysfunction that they were less of a man because they couldn’t “get it up”?

      People imply and outright say terrible things to women struggling with breastfeeding. And the perpetuation of many of the current “facts” surrounding it’s benefits are so harmful to the fragile psyche of new mothers experiencing difficulty breastfeeding. And if you are prone to depression or have PPD and breastfeeding is making it worse to have to choose between continuing to do “the most important thing you can EVAR do for your child” or stopping and fully formula feeding is agonizing. And then society paints you as selfish and an unworthy mother for not continuing to sacrifice your mental well being for your child to drink the magical breast milk.

      There is simply NOT a one size fits all approach to breastfeeding and its benefits and we would do much better as a society in supporting mothers and babies to recognize and embrace this instead of pretending lactation is the only bodily system that works perfectly for every woman 99.9% of the time.

      *off soapbox*

    • ratiomom

      2 words: sleep deprivation.
      Major factor contriibuting to both PPP and PPD. Whatefer the lactivists may claim, a mentally vulnerable patient should NOT be kept awake at all hours for weeks on end.

      Some weeks ago, a local paper here ran a story about a dedicated psych hospital for mentally ill postpartum women. They admit both mom and baby, but babies spend the night in a locked ward and they have a strict no nightfeeding policy for mom to help her recover.

      The local lactivists were ALL OVER this, crying shame that the hospital was ruining their patients’ breastfeeding relationships. Apparently there is no maternl illness severe enough to let a woman off the hook on the pressure to breastfeed.

      • thepragmatist

        I can speak to this because when I was reaching out to other moms publicly related to nursing, medications, and sleeping, I just got beaten down for suggesting it at all. Nope, there is really no excuse. And if you can’t, you should be feeding that baby a stranger’s breast milk that the local milk-sharing group trucks all up and down my local area… scares me to death!

        • ratiomom

          Great. On top of all your other problems, you can now give your baby hepatitis C for the low low price of 5$ an ounce

    • thepragmatist

      I had to come to terms with the fact that I had to sleep, so my son either needed a bottle of EBF or formula, and that was that. It was ordered by my doctors. I did give it a good go as I got more stabilized, but my supply had adjusted and settled by then. There are some ways to mitigate it, and we set up a plan where I nursed last at 1am and then again at 8am, as the MW felt that the one night nurse was important for establishing supply. I nursed but had intense D-MER and nursing was hell for me in the beginning. Like drove me crazy. Seriously, just hell. It wasn’t until lots of of counseling, it was okay. And it was never great. But there were aspects of it that were worth it (not the health aspect, actually) that I would do again, just next time I will supplement and not push so hard to EBF and not have any worries. Not sure what I would do, actually, to be honest. I don’t actually even remember most of it! It was traumatizing. And those societal expectations definitely made me crazy. I already felt like a flawed mother, so add to that not breastfeeding, and I felt I had no use at all…

    • LukesCook

      I also remember reading that she was in fact having treatment but that her husband was having difficulty persuading her to follow the treatment and take her meds properly. This is a common problem with psychosis, because the person truly does not believe that there is anything wrong with them. I did wonder if one of the reasons she was reluctant to take meds was a real or imagined concern that they might pass into breastmilk and harm the baby, or that she wouldn’t be able to breastfeed.

  • Disgusted

    Thank you so much for this. I have seen the most appallingly cruel things said about this poor woman.

  • Sue

    Armchair psychiatry is about as infuriating as armchair obstetrics.

  • Lisa the Raptor

    I have a ten month old as well. This case scares me to death and it’s so tragic.Having suffered from untreated PPD with my first and PP anxiety with my second, I was prepared with my third but luckily didn’t get either. This is just so freaking tragic. I’m so happy the baby lived, but I hate it was too late to help the mother.

  • Alicia

    OMG, this whole situation has struck me hard, and I have gotten so upset when reading ignorant rants from those who have never suffered from a mental illness. A part of me *hates* those people because they don’t get it, but at the same time I know how they don’t get it.

    I developed Bipolar II Disorder after my son was born. I’d suffered from periodic depression and suicidal thoughts as a teen, plus my dad struggled with major depression and alcoholism starting when I was a teen, so I was probably set up to develop bipolar II at some point, and the craziness of pregnancy and birth on my brain tipped the scales. The first two years of my son’s life were crazy (I’m getting teary eyed thinking about it), and while I never thought that my son was damaged, I did think I had to kill myself because I was going to ruin his life (and my husband’s life). I was able to find an awesome psychiatric nurse to treat me, but it still took two years for my meds to be adjusted to the point I felt myself again. In that time I took my marriage to the brink, I ruined my credit, and my son had to handle having an emotionally unstable mom (due to my bipolar being rapid cycling, meaning my moods swing back and forth in hours instead of over days).

    Even now I have to take care of myself carefully. I can’t handle a lot of stress like other people, because it sets me off on a cycle. Not enough sleep can set me on a cycle. I will have to take medication the rest of my life, and I have to be aware of if I’m no longer responding to the meds. I face the very real possibility of being locked in a psychiatric hospital if something changes and I start to go off the deep end. (And it’s something my husband and I have talked about at length, with me telling him how to contact my therapist and to put me in involuntary if I’m so far gone.) I’ve had to explain to my son his whole life that mommy has a brain that doesn’t work right, and I’ll have to do that the rest of his childhood so he’ll understand what’s going on. And there’s the very real possibility that my son or any future children will develop the same illness.

    It is not fun to say the least.

    So having been there, in the midst of the crazy irrational thoughts, and the at the brink of the abyss of suicide, I understand what happened in New York. I understand what happened with Andrea Yates (that poor woman). I understand it all, and it drives me nuts when others don’t understand. Or don’t even try to understand when people like myself, someone with a mental illness, try to explain to them what most likely was going through peoples’ brains. I mean, I know it can be hard for someone who has a healthy brain to understand what it’s like to have an unhealthy one, but is it really so hard to try?

    Ugh, I can go on and on, but Dr. Amy hits the nail on the head with this post.

  • WhatPaleBlueDot

    Thank you, Amy.

  • Bomb

    After Mindy Mcready died ( someone I didn’t know existed until her death..what can I say, pop culture isn’t my thing) I unfriended a quarter of my damn Facebook page. Vast swaths of people that I’d known for decades were spouting off that she was a selfish pig that just wanted attention. “She killed her dog! That PROVES she wasnt Mentally Ill, she was just an evil person!” ( because killing beloved pets and yourself is TOTALLY what sane people do on the weekend). “Once you have kids you have to put yourself second! I would never do something like that!”

    I pointed out to all of them that judging her for her illness is like calling someone an asshole because they have cancer. “If that douchebag really wanted to live they would have just gotten over the cancer!” Said no one ever. Have a mental illness? “Stop being so selfish!”

    Let me get this straight, because I’m a mother I am no longer allowed to have an organ in my body malfunction? And by your account I’m supposed to USE the malfunctioning organ to solve this problem?!? “Hey, bitch! Yeah you! The one with diabetes! You have a kid now! Tell your pancreas to get with the fucking program! It isn’t listening? You just want attention!”

    • S

      I would be really afraid for people who are in a bad place and come across those kinds of comments. So glad you spoke up.

      • Alicia

        No kidding. I know when I was deeply suicidal that I already felt like the scum of the earth and that I was ruining everyone I loved simply by existing. Comments like those only make things worse.

    • Bombshellrisa

      And it’s the combination of comments like that, along with the long talk about how happy you should be that you have a baby when there are so many people who want one, that you are healthy, and all the talk about “looking on the bright side, there are so many people who are having X, Y and Z happen to them” that is keeping women from being able to get the help they need.

      • Alicia

        Ugh, I hate that sentiment too, that people should be grateful they have kids when others want one, blah, blah, blah. I have secondary infertility despite wanting more kids, but I’m never going to tell someone they can’t complain about anything because they can have more than one kid! I’m happy for them! A little jealous, yes, but I don’t they’re forbidden from having bad moments in life simply because they can have more children than me.

        • Bombshellrisa

          It’s especially unwelcome when you are trying to nurse a fussy newborn and you have someone who just “stopped by” to see you and starts dumping on you because you have always listened to them before. You know the type. You might start saying (between trying to get the baby to latch and then stay awake long enough to nurse) you are exhausted, but they won’t let you vent. Then you get the pep talk about how you don’t have it that bad. I have never felt comfortable being able to talk about my depression, my parents would say “no, you aren’t depressed, you are just not busy enough” when I started feeling like that at 14. Having people insist “you don’t really feel that way” when I clearly DO is a trigger for me. Don’t try to make me feel better by telling me how good I have it, how bad other people have it, that there are babies that are sick, that I need to act like a grown up. I know all that crap. Why do you think I am crying in utter frustration?

          • Eddie

            Most people don’t get how depression works. They just don’t get it, and perhaps honestly think that their “pep” talks are productive rather than the exact opposite. Aren’t “busy” enough? #(@&@(&@#^@(#$. How ignorant! Anyone who has experienced depression (or who has listened *closely* to anyone who has) knows that objective reality is not the issue. Depression interferes with reasoning in a way that makes things *look* hopeless, terrible, insurmountable; whether or not that is actually true is irrelevant to the depressed person, and insisting that it is true only makes a depressed person feel *worse*. “Well, if I really have it good, I must be a terrible excuse for a person for feeling this bad about myself.” It frustrates me that so many people (some of them well-intentioned) are so totally blind about this.

          • BigBlues

            When I shared with my inlaws that I was struggling with PPD, my father-in-law said, “When I feel down I try to think positive thoughts and count my blessings.” Yeah, I tried that, and I could force my thoughts to stay positive for a few seconds, but as soon as I let down my guard, the negative thoughts took over. If I could have thought my way out of it, believe me, I would have!

          • Alicia

            My paternal family used to be the same way until they saw the train wreck that was my dad’s depression. At first everyone thought his alcoholism was simply a weakness he needed to “get over” until he tried to kill himself. That was a big wake up call for his parents and siblings about the reality of the situation (alcoholism being only a symptom of his depression), so fortunately since I was diagnosed with bipolar they have been very understanding. I think some of my maternal family still think I’m “faking it” or can just “buck up”. They can bite me.

            And I know what you mean about the whole “there are people in third world countries who have it worse!” or “there’s always someone with it worse!”. Yeah, that’s great, but the doesn’t stop the fact my brain is releasing chemicals that I can’t control that make me feel like the worst person in the world. Rationally I know my life isn’t horrible, but the irrational part of my mind is in control right now – just support me please!

      • Guestll

        The notion that you aren’t allowed to feel sad, resentful, angry, frustrated, shortchanged, incompetent, bitter, if you’ve “graduated” from infertility to motherhood is not uncommon. You’re supposed to be endlessly grateful, with a dash of guilt, because you got to be one of the lucky ones, and there are those who won’t be as lucky. Ergo, you have no right to complain.

        I didn’t suffer from PPD, thankfully, but I did spend the first 20 weeks of my pregnancy puking my brains out. And I was miserable and unhappy and I did complain. I was told more than once from a fellow infertility sufferer/veteran that I had no right to do so — after all, I was getting what I wanted.
        Women who conceive via ART are at greater risk for PPD. I believe this is something that needs to be discussed more openly in infertility circles.

    • Alicia

      As some psychiatric professionals pointed out in some articles about McCready, she shot her dog because her thoughts told her that her dog would be better off dead after she was gone than potentially mistreated. She did it out of her mind’s idea of love. I can’t imagine what would’ve happened if her kids were there because the mind obviously can take people down a very twisted path.

  • The Computer Ate My Nym

    Having just been through the process of having a newborn

    Mildly off topic rant about this phrase:

    Ok, so you had a baby. You know what having a baby is like. Specifically, you know what having one specific baby was like for you. You don’t know everything about having babies. You don’t know what other women went through to have a baby.

    Let me give you an example: I had a c-section. Two days post-op I was walking, caring for the baby, and using tylenol for pain. Should I therefore say that people who take percocet for post-op pain are unworthy wimps? Or maybe just that I got lucky with a good surgeon, no complications, and reasonable healing and that others may have different experiences?

    You didn’t get post-partum psychosis. Even if you did, your experience was not hers. Stop using your very minute experience as a club to beat other mothers over the head with.

    • Rabbit

      Also, Elie is a man, so he doesn’t even know what having a baby is like. He knows what having a newborn in the house is like, sure. But he did not experience even the normal hormonal changes that accompany birth.

      • The Computer Ate My Nym

        Oh my frigging FSM, I entirely missed that! He doesn’t have the slightest idea what he’s talking about then. Though I will say that my partner was more emotional after the kid was born too, making me wonder if there’s not a bit of pheremone flying about after a birth…or maybe it was just the new babyness of it all.

        • AmyP

          For pregnancy, there’s something called Couvade syndrome, where fathers exhibit pregnancy-like symptoms. There must be a post-partum equivalent.

          • Bomb

            I’ve read various things that say 1 in 10 men get something that amounts to PPD after the birth of a baby.

          • thepragmatist

            Because of my health issues my husband was intensely involved in the caregiving of my son and not only did he get all soft and mushy, but he absolutely did develop some baby blues/PP anxiety. He would wake up at night freaking out he had lost the baby in the bed, for example. Eventually he went on an A/D but I think that is more to do with the enormous stress our family has been under for a long time. Though his depression started PP.

            Those days makes me kind of weepy, because it was intensely sweet, and to this day my son is equally attached to us. Deeply. He will always be very attached to his Dad who is intimately involved in caregiving. And it turned gender roles in our house upside down. Even then, knowing how sick I was, my Dad didn’t have much respect for my husband until much, much later when he realized how sick I had been. My dad is definitely one of those “pull yourself up by the bootstraps/never changed a diaper” kind of guys!

      • Bombshellrisa

        The hormonal changes, the sleep deprivation, trying to heal while taking care of your newborn, whose every cry reduces you to a lactating, shaking mess. It’s such a fragile time for a woman.

        • Alicia

          And the fact a mom’s brain physically changes during pregnancy and afterwards.

          • fiftyfifty1

            Or doesn’t. All the stuff everyone says happens to your brain never happened to mine as far as I can telll. Never felt I had pregnancy brain fog. Never got a “nesting urge”. Never had food cravings. Also didn’t feel a rush of love for the babies. Also didn’t experience any hint of the baby blues. I also never got any PMS mood symptoms (although frequently vomitted from menstrual cramps).
            Pregnancy, childbirth and lacation seem to be areas of life with a very very wide variation in experience. Unlike, say, serum potassium levels or finger number or other things that vary almost never.

          • Alicia

            I’ve read that brain scans show that women’s brains physically change during pregnancy, but it didn’t say anything to it meaning that every woman would experience the same things. Only that it changes.

        • Something From Nothing

          Such a fragile time for a man, too.

      • Even without the hormones, there is the sleep deprivation and the whole 24/7 call for weeks and weeks on end… and the woman almost ALWAYS carries the brunt of it. Taking care of every little detail around the clock day after day after day– and of course there is always someone who’s telling you you’re doing the wrong thing or not enough of the right thing. I am amazed that more women don’t have PPD.

    • Elle

      Amen! Pregnancy and birth is something that most women won’t experience more than what… 2 or 3 times in their lives? How can one person’s experience become a blanket for everyone else’s? I have heard the same thing about pregnancy – one woman will say that she was feeling just fine at 35 weeks, and therefore any pregnant woman who has trouble getting around is just being lazy and wants others to do her work for her. Maybe that happens once in a while, but to judge everyone else by your experiences is so inaccurate and wrong! (same goes for breastfeeding)

  • Hannah

    It’s similar to the idea that anorexia is just about wanting to be thin like the women in the magazines (although cultural pressures about weight can certainly trigger obsessive behaviour to manifest itself in that way.)

    Unfortunately, people are often extremely ignorant. Over here there have been two relatively recent cases of murder convictions, I would regard as unsafe, of obviously severely mentally ill women:

    http://www.dailyshame.co.uk/2013/03/satire/nicola-edgington-and-hannah-bonser-neglected-by-the-nhs-mental-health-services/

    In both cases, much was made of the fact that there was some some degree of planning, and the women were relatively calm, as if this were mutually exclusive with psychosis.

  • Dr Kitty

    We have a particular issue locally where people who are suffering from paranoid and persecutory delusions often have delusions revolving around paramilitary death threats.

    Of course, we also have people that the paramilitaries are trying to kill.
    Delusions fit into what makes sense to the person.

    Grose doesn’t understand that changing the paradigm just changes the delusion, it doesn’t STOP the delusion.

    If our local people didn’t think the IRA were trying to kill them, it would be MI5, or aliens, or the CIA or their next door neighbour.

    Same with PPP.

    • thepragmatist

      Mine were all related to people stealing the baby. Whomever. It could be anyone, but mostly fixated on my MIL, social services, but also strangers, too, and many, many times I was convinced DH would, and would have to sedated and put to sleep. I KNEW ahead of time that I had a good shot at being have a psychosis PP and had a lot of counseling, so I had some awareness, but at the same time it only took me far enough to accept being medicated and then it was really fair game until I was out. But I was aware enough during the bad times to take the medication. I have always meant to write about this more, because I think people assume women with mental illness or PPP are someone else, someone not articulate, someone who looks or seems different. But for all intents and purposes, to a stranger, I would have seemed quite normal and look and sound quite normal. Even now, I found out that there were quite a few women who, when I posted publicly about my experiences (in relation to other mother’s) insisted that I must have been making it up (for attention!) because I don’t seem sick. *facepalm* Do they think that people who are mentally ill get devil’s horns?

      • Wren

        My own post-partum issues focused a lot on my older child, who was 20 months old when I had my second. I was terrified I’d get to nursery to pick him up and find he had been taken. I couldn’t sleep at night without checking on him every hour or so. I had some depression issues as well, but the anxiety was the killer. I finally knew I needed to get help when I told my 24 month old son I had to leave because I was a terrible mother but I had to take his baby sister because she was still breastfeeding. I guess it’s one case where the lactivist crap came in handy, because that kept me from thinking I could disappear altogether. Nobody but my husband had any clue I was going through this and it was totally unexpected. A friend of mine in the US ended up hospitalised for her own PPD at the same time that I went through this. We are on a parenting message board together and the lack of support from the other women there for both of us was shocking in retrospect. We were both told to “snap out of it” and that we were making a big deal about nothing by mothers who were lucky enough to never face this themselves.

  • mimieliza

    I work in an acute care psychiatric hospital unit. Another issue is that women with underlying psychotic disorders, such as schizophrenia, can and do get pregnant. When this happens without planning, care and medical support, the results can be devastating. The ethical issues around provision of care to profoundly psychotic, pregnant women are staggering, and the risks and potential grief involved for mother and child are heart-wrenching.

  • AllieFoyle

    I hope that something good can come from this tragedy in the form of increased awareness and understanding of mental illness, especially peri-partum forms, which I think are often poorly understood and inadequately treated.

    It’s probably pointless to speculate on things none of us will ever know, but I wonder what actually could have helped this woman. It strikes me in reading the articles that maybe the environment surrounding mothering did play some part in her illness. I don’t doubt that she was in a psychotic state, but her delusions are of guilt and fear and are consistent with a very severe depression or anxiety. Based on what was reported, she had probably been ruminating over these beliefs for some period of time until they intensified to the point of psychosis. It sounds like she had received some professional help (reassurance from the pediatrician and psychiatric meds of some sort), but it was in a form that was either not helpful or simply not enough, too late.

    • BigBlues

      Even if she was receiving treatment, sometimes it takes a while for that treatment to work or to find the right treatment. I had severe PPD/A/OCD after both of my babies and it took me three months to start feeling better after my first and seven months after my second. Sometimes it was hard to hang on and maintain hope that things would get better. I really feel for women going through postpartum mental illnesses because I know how hopeless it feels. Some women respond to treatment quickly and feel better right away and for others it can be months (or years) of trial and error, trying to find the right combination of meds.

      • Alicia

        Yup, it does take time. It took two years for the right combo of meds for my bipolar to be found.

  • An Actual Attorney

    I have nothing to add but A-FUCKING-MEN!!!

  • This story is incredibly tragic, and the author in question (Mystal) seriously needs a lesson in empathy and an appreciation for what psychosis is.

  • anonomom_LLLL_IBCLC

    Whenever I see a postpartum woman to help with breastfeeding, I bring a copy of the Edinburgh Postnatal Depression Scale (found here: http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf). It is a screening tool that anyone can use. It is a great way to open up the conversation and get a sense of the urgency of contacting a mental health professional. I believe mothers tend to feel listened to and cared for when someone opens up this conversation, so I would encourage anyone who is worried about a particular mom to share this tool with her and sit with her to make a plan for getting help.

    • TheOtherAlice

      That’s such a great idea – all the nurses, doctors and family members who spend time with women just after birth should definitely be aware of the signs of PPD and PPP.

    • auntbea

      My pediatrician’s office does this screening for all new mothers. Well, it’s supposed to be mothers. But since my husband was the one to take the baby in that day, he got to fill out the form. Conclusion: no, he was not suffering from PPD.

      • My pedi did this too for the first few months at least– not just the first visit.

  • anon

    So horribly sad:( When I was in grad school, we had a guest speaker come and speak about her experiences with severe PPD, which ultimately required extensive hospitalization. It is real and terrifying- when I had my first child, one of my biggest fears was that I would develop PPD.

    I think it is a good thing that women are more honest about ALL of their postpartum experiences- even if one doesn’t meet the official criteria for PPD, many of us struggle with mixed emotions and difficulty adjusting to the role of motherhood, along with all the crazy hormonal shifts that go along with the transition, even if we have dreamed our entire lives about becoming a mom. But I wonder if it is a double-edged sword, and leads women to believe that significant postpartum psychiatric issues can be fought through, so to speak? I don’t know, I’m thinking out loud here. I just hate that this is something so many women struggle with and so many people dismiss as whining or the woman needing to pull up by her bootstraps or whatever.

  • E151

    The tone of the Myrtel piece is so upsetting. It’s not heroic to hate people who hurt kids. It feels good, self-righteous — comforts you with PROOF that yes, there is someone out there who is “bad” to your “good.” Really scary and ignorant.

    • AllieFoyle

      Yes, it was upsetting to read such a cruel and ignorant piece. I think it’s often easier for people to harden their hearts and minds against people than to be thoughtful and compassionate when people suffer things they’ve been lucky enough not to experience. Wackenheim was an accomplished, intelligent woman. People who knew her described her as warm, kind, and sane. She was not, as Mystal puts it, “a monster”; she was suffering from a severe mental illness. It took her life and it almost took her child’s. What a shame that someone would take it upon themselves at this time to add to the stigma surrounding mental illness by publishing a piece so self-indulgently blaming and ignorant.

  • Lori

    The idea that someone can merely rationalize their way out of true mental illness is one of the most damaging and most persistent myths around. Just deleted a bunch of what I started to write because I feel it started getting too personal (and yes,that stigma still exists) but let me say that people taking a strong stand against blaming and shaming those with mental health issues is something that is very personal to me.

    • Kalacirya

      I hear this all the time. The woo folks that rail against psych meds of any kind really make me angry, as if being anal retentive about your diet, positive thinking, and other tidbits of self help can reverse mental illness. My mother ceases to exist on the same planet as the rest of us if she is not medicated, no amount of positive thinking and quinoa is going to fix it.

      • Signed out for now

        I came across a conversation on a mainstream-seeming site about how gluten causes leaky gut, which in turn causes mental illness. Yes, I’m depressed because I like bagels. Well done.

      • Bombshellrisa

        Don’t forget the things that people suggest along with the diet and herbal supplements: things like chiropractic and “resonance repatterning” massage to “resync” your “frequencies”. Wish I was making that up. http://www.resonancerepatterning.net/

      • Eddie

        The woo I used to hear from that crowd was that the mentally ill are not suffering, that they simply experience other realities. That if we only understood that, these people would be OK.

        • Kalacirya

          My biological father is Middle Eastern. When I was very young, the original World Trade Center bombing occurred. It was at the time that my mother had her first severe psychotic break. She had kicked my abusive father out, and had come to the conclusion that he was a terrorist working with Bin Laden. Her plan was to put bowls with gasoline in them around the house, with the idea that she would light them and then run out the house with the two kids (3 and 5/6 at the time) if he were to show up. Good thing he didn’t show up until after she had been committed, because I easily wouldn’t be here now if he had. Her reality without medications is a sad, scary, and lonely one. Terrorists, mad scientists, conspiracies, she’s constantly paranoid, delusional and extremely anxious without medication. When she’s at her worse she’d progressed into both auditory and visual hallucinations. I wouldn’t wish it on anyone.

          • Eddie

            Agreed, that I wouldn’t wish it on anyone. I’ve known too many people suffering from different mental illnesses …. when I encountered the “they are just experiencing other realities” view, I do my best to — gently but firmly — shut down that line of reasoning, and explain the tremendous suffering that is experienced by the mentally ill, and the wonder of living in an age where we are just beginning to have effective treatments.

      • Eddie

        Hey, I once had someone tell me that while psych medicines were terrible (“chemicals, BAD”), lithium was OK because it was an element. The thought of someone taking elemental lithium …. OUCH, as it reacts explosively with water! I had to point out that the lithium in question is a lithium SALT, and that even a salt counts as a “chemical.”

        • LukesCook

          And of ALL the psych medicines you could be taking, I think lithium carries by far the highest risk of causing fetal abnormalities if taken when pregnant.

          • fiftyfifty1

            No, I don’t think it’s the worse. It’s not absolutely contraindicated.

          • LukesCook

            The benefits may outweigh the risk. We were concerned about medication I had to take during my second pregnancy (our first child was born with a heart defect) and during the course of the discussion my OB mentioned that the drugs with the highest risk of fetal deformations were roaccutane, another that I can’t remember and lithium, in that order. We were not at that stage discussing any other type of complications, and he may only have been referring to drugs available here, or commonly prescribed drugs.

          • DiomedesV

            My understanding is that there was an early Danish study in the 1980s that found a high rate of congenital heart malformations associated with lithium. I think it may even have been ~10%. But subsequent studies failed to replicate that and have found much lower rates; some even found that it is not much higher than the background level of heart defects. But because of that early study, many providers are reluctant to prescribe it. Also, OBs are not experts in psychopharmacology and may not keep up with the literature on it.

      • Lori

        Yep, psych meds gave me my mom back. I sometimes wonder if it is just a certain level of naivety that allows people to think you can just eat healthier, exercise, and positive-think your way out of severe psychiatric illnesses.

    • Anon

      I have unfortunately come across this sort of attitude from a few mental health professionals as well. Outpatient and inpatient. You don’t fuck around arguing with someone who is acutely suicidal and refusing to contract for safety (I ended up in ICU a few days later). For the record, I’ve had some excellent providers since. – Anon just for this one

  • LukesCook

    I’m especially irritated by the suggestion that she’s culpable because she didn’t seek medical care or cooperate with the treatment prescribed. I have a family member with schizophrenia and while a psychotic person may in time learn to recognise a typical delusion, the reason it’s called a _delusion_ is because it seems real to the sufferer. It isn’t reasonable to expect a psychotic person to identify their own delusional behaviour and take rational steps to treat it. It’s the same as telling a quadriplegic that if they don’t get up and walk then they have only themselves to blame. Lots of people with spinal injuries walk and run and jump, after all!

    • Lori

      Exactly! It’s not like the hallucination is transparent and clearly “fake” like a ghost on Scooby Doo or something. I have never experienced it myself but I had one patient tell me his hallucinations were, “as real as you and me,” and said there really was no way to distinguish what was “in his head” and what was reality. It sounds terrifying. Hearing those stories has made me wonder why anyone would deliberately induce hallucinations with psychedelic drugs.

      • Amazed

        It’s not like the hallucination is transparent and clearly “fake” like a ghost on Scooby Doo or something.

        This. This. And this again. I still remember my aunt’s cultured voice as she explained to the doctor something along the lines of “my brother and I, we have problems and that’s why he wants to imprison me in this clinic”. At this time, she was a beautiful, elegant lady. Very sophisticated. And also, a shizophrenia sufferer. My mother actually asked the doctor, “Why don’t you believe her? I almost do!” And he said that it’s part of the diagnosis, that it feels so real to them that sometimes, they can convince others, too.

        She absolutely wasn’t and isn’t to blame. And I am ready to lash out at anyone who claims she is. At the same time, I am furious, furious when people make all sort of excuses for grown-ups who couldn’t possibly understand what they were doing and shouldn’t be held responsible. To me, there is two groups of people who can’t be held responsible: children and mentally impaired.

        This author is an ignorant, self-righteous bitch. I’ll say it again: an ignorant, self-righteous bitch. Please don’t ban me.

        • Amazed

          Oh. I saw an L where there wasn;t one and there was no picture of the author on his blog. Substitute “bitch” for “asshole”.

          Oh, and while we’re at it, may I say that I get very irritated with those who claim that the “label” of a mental diagnosis puts a stigma on sufferers and singles them out? In my experience it is sufferers’ BEHAVIOR that stygmatizes them. They have a problem. A real problem. And you won;t fool anyone by substituting “depression” with “she often cries”. My aunt, weird for having shizophrenia and I, weird for painting each of my nails in fdifferent colour because I feel like I have to celebrate the fact that spring is coming? Puhleeze. I feel it’s disrespectful to those who suffer from such conditions. I can get rid of the nail polish in a few minutes. They can’t get rid of the conditions so easily, yet there are those who expect them to? WTF?

      • WhatPaleBlueDot

        Hallucination and delusion are different. You can hallucinate and know you’re hallucinating. You can also hallucinate and NOT know you’re hallucinating. It’s complicated 😀

        • Eddie

          I’ve known people experiencing hallucinations who knew they were false, but this doesn’t make them go away. It just makes it even that much harder to bear.

    • Dr Kitty

      “Lack of insight” is part of the illness. Not knowing you are ill is part of being ill. Not seeking help is entirely consistent with psychosis, particularly PPP which can have a particularly rapid and severe onset. By the time you are unwell, you can be TOO unwell to be able to seek help yourself.

      • Alicia

        Yes! It’s taken me years to start recognizing when I’m hitting a mood cycle, and even then most of the time is my husband asking me, “Do you think you’re reacting this way because you might be cycling?” A lot of times he helps me so much because it causes me to pause, reflect, and realize that, yup, I’m cycling. Because when I’m in the midst of a cycle I feel like my thoughts and emotions and reactions are completely justified! That’s the insidious nature of mental illnesses – since it’s your brain telling you these things, it’s your reality, whether it’s really real or not.

  • mollyb

    It’s deeply tragic and infuriating that mental illness is still viewed as primarily a character flaw, and perhaps secondarily as an illness. With proper treatment, this woman could have weathered this illness and likely been a wonderful, loving mother. It’s likely that her family was in denial or perhaps simply under-educated about the seriousness of her symptoms.

    • AmyP

      Or was having trouble getting her into treatment.

      • mollyb

        That’s very true–however, I believe the husband left her home alone with the child which I suspect (or hope) someone who knew the seriousness of her illness would not do.

        • That was one of the things that infuriated me about the Andrea Yates case. Her husband knew she was mentally ill, yet left her alone with the children. If he had left his children with a non family member who he knew was mentally ill he might have been charged with child endangerment. But he was considered another victim when his wife killed their children.

          • Not a Knight

            ” Her brother, Brian Kennedy, told Larry King on a broadcast of CNN’s Larry King Live that Rusty expressed to him in 2001 while transporting her to Devereux treatment facility that all depressed people needed was a “swift kick in the pants” to get them motivated.”

            He had also been expressly instructed by her care provider to not be left unattended at any time, especially with the children. He started leaving her alone because she was becoming “too dependent” and shirking her “maternal responsibilities”.

            And they wanted to give her the death penalty.

          • I think she’d had PPD with the previous kid too– but hubby wouldn’t think of perhaps not having another one, or being proactive with therapy/ meds etc. even though he knew she was high risk.

        • Disgusted

          That’s part of a larger societal problem, where women are routinely left alone to care for infants – even new mothers who may not have any coping skills and may have never dealt with an infant alone before. The isolation is almost ubiquitous, and seems to spring from an idea that once the baby pops out, a woman becomes an instantly good nurturer who needs no fulfillment other than what comes from caring for the baby (or else she just shouldn’t have had children/should have thought of these issues before). Combined with the brutal hatred directed toward anyone who exhibits mental problems, and a ridiculous view that PPD is something you can get over by going on a walk, and you end up with things like this. I’m actually surprised it doesn’t happen more often – or maybe it does and it just doesn’t make the news.

          • Eddie

            Part of this is the romanticization of motherhood, the simplistic idea that having a child there will make a magical difference. I’ve seen it in pregnant young teens, the idea that “the baby will be someone who loves me” or “someone who is all mine” or “I’ll have someone to love.” I met — when she was 19 — a young woman who deliberately got pregnant at the age of 15 for one of these reasons.

            Part of this is the simplistic thinking that women are innately nurturing in a way that men are not.

          • Anaesthetist

            Thats an an interesting point Disgusted and Eddie- theres a cultural construct of idealised motherhood and instantly falling in love with your baby and ‘defensive mummy bear who protects’ all of which can be true for many women

            But in nature there are lots of variations in mammalian births, from pseudo pregnancies and induced mothering behaviour in non pregnant animals to variations around birth eg complete disinterest or confusion, rejection or harm/destruction of the offspring and while I dont want to in any way compare humans to a hamster eating her brood there is a huge swathe of hormonal changes, environmental etc stressors involved in the physiological process of pregnancy and birth

            The variations eg pregnancy denial, concealments, phantom pregnancy, pseudo pregnancy and postpartum mental changes from weeps, depression or psychosis all seen in humans too and probably has been seen in all cultures througout the world – theres a huge other potential side of being a mother thats just not acknowleged in our cultural constructs, (although I hope that medicine and midwifery are catching up with it).

  • moto_librarian

    I have a history of severe depression. A combination of several years of therapy and continuing use of antidepressants have kept the symptoms in remission for nearly seven years. While depression is certainly not the same as psychosis, people fail to grasp the irrationality that is inherently a part of mental illness. When I was profoundly depressed, I honestly believed that suicide would relieve my loved ones of the burden of caring for me. That I once felt that way seems shocking to me now, but it seemed completely normal to me then. And while this woman’s particular focus seemed to be on potential cognitive impairment of her child, if it wasn’t this topic, she would have become obsessed with something else. As Dr. Amy has said, she was delusional, and this obsession was how her delusions manifested themselves. If someone had only recognized earlier that she was in this place, she could likely have been treated successfully and be around to raise her son.

    This tragedy happened because we continue to stigmatize mental illness. It’s better than it used to be, but we’ve still got a long way to go. I know plenty of people who would disagree with my decision to remain on my medication during pregnancy (or even suggest that if I couldn’t quit taking antidepressants, I shouldn’t get pregnant in the first place), but I seriously doubt that anyone with this attitude has ever confronted the black hole that is severe depression. I shudder to think what could have happened had I not gotten (and maintained) a treatment regimen. Elie Myrtel should be ashamed for perpetuating the stigma about mental illness.

    • Sunandstarshinemommy

      Perhaps you should be the next guest post. Your honesty could help so many.

      • Not a Knight

        I’ll bite and share a personal story.

        Risk Factor 1) I’ve had a history of depression going back 15 years. Plus family history of abuse and depression.

        A year ago we moved to a new place where we did not know a single other person. Risk factor 2).

        I had a 6 month old baby, and an 18 month old baby, and no outside support system except my husband. Risk factors 3) and 4).

        I was staying home with the kids, no job, no friends to visit (Facebook really doesn’t count). I was extremely isolated. Risk Factor 5).

        Shortly after moving the baby became extremely ill and suffered many months of complications, and because of the illness we ceased breast feeding. Caring for a sick family member + hormonal changes surrounding ceasing BF = Risk Factors 6) and 7).

        6 months after moving I tracked down a psychiatrist because my depression was becoming overwhelming. 2 months after beginning treatment I was convinced that I was ruining my children, setting them up to spend the rest of their life being miserable having learned to be depressed and unhappy from their mother. That if I were dead, my husband could tell them I had died in a car accident and they wouldn’t even remember I’d ever existed and be free from the burdon of having a mentally ill parent. That my in laws would pay for them to go to an exclusive daycare/preschool where they would be surrounded by bubbly teachers and friends rather than trapped in a dark house with their insane mother. That my husband, who is quite desirable would have no problems finding a new partner. That everyone that had ever known me would be better off if I were dead.

        So in October I put the kids to bed, tied a rope up, and hung myself. Except making nooses isn’t something I had any kind of experience with, so I woke up to my husband screaming at me to wake up. I’d lost consciousness, hurt my neck and back, but not broken anything before the rope came undone and dropped me to the floor.

        I spent the next three weeks in a treatment facility. It has been five months and I really still think I’m ruining my kids by being a depressed parent, but I am no longer suicidal. I’m hopeful that someday I won’t think that I’m ruining them anymore. The people at the center say even abused kids want their mommy and seemed generally exasperated by my insistence that not having a miserable person around you 24/7 is far preferable to the desires and beliefs of 2 year olds. So yeah. Half a year later and I’m still battling the destructive thoughts that nearly killed me.

        You know what doesn’t help with that battle? Armchair psychiatrists that say people like me are monsters. That we are selfish and just want attention. The further reinforcement that we really are terrible people that really aren’t deserving of love, empathy, or anything else because our brains aren’t functioning flawlessly.

        In fact I wanted SO MUCH attention that we didn’t tell a single solitary friend or relative outside of a friend (a practicing doctor my husband grew up with) that he called out of desperation and sheer terror. This is the first time I’ve written about it at all, anonymously or not. I was so selfish that I fully believed everyone surviving me would be *greatly* relieved that I was gone. That I demanded I have no funeral, grave marker, or indication I’d ever existed so that I could be 100% forgotten.

        So, to all the scoffers, eye rollers, and holier than thous: Shut up. Just shut up. If you wouldn’t spit on someone for having breast cancer, don’t spit on me.

        Which brings me to the end of my story/rant where I struggle over whether to use my real name, the name I’m known for on this board, or some other anonymous name. Will my friends that read here recognize the story up to the suicide attempt and put 2+2 together? Will they judge me? Back away from me? Why do I fear admitting I’ve had a roller coaster of an illness that almost killed me? Oh yeah, because of the people that say I’m a monster.

        I can’t be standing up to the face of stigma if I don’t use my name, but I also don’t feel strong enough to weather the judgements and sideways glances if someone from IRL read this. So in the end I guess it is just an example of the all too common shame and defeat living like this entails.

        • FormerPhysicist

          I’m literally crying for you and I hope you feel like yourself soon. Just reading this, I know the world would be a poorer place without you.

        • BigBlues

          Thank you for sharing your story. So much of your story was my story as well – hoping that I would die in a car accident because everyone would be better off without me. It’s so hard for others to understand – heck, my kids are now 7 and 2, and it’s hard for me to imagine how I could have had those thoughts, but I know that I did and they were real and I couldn’t control them.

        • anonomom_LLLL_IBCLC

          I just want to give you a big hug for the pain you went through and are still going through. Please stay in treatment, be kind to yourself, and kick depression’s ass hard. In time you will figure out how to handle this with your kids. Maybe someday they will have a brush with depression (@$&!?*@ genetics), and you will know the early warning signs and be able to help like no one else will. Hugs. I am pulling for you, and hoping for peace and happiness in the future.

        • Alicia

          I stand beside you.

          I’m so sorry you went through that experience. I too thought I was ruining my son by existing, and even reached the night where I said goodbye to him when I put him to bed (he was about 16 months old), and wrote my letters. I had the knife ready to go. The only thing that stopped me was that the very tiny, very quiet rational voice suddenly got very loud, telling me to tell my husband that I needed help. I literally dragged myself down the hall to the computer room to tell him, and I started treatment within a few days.

          It took several years, but I now *know* that losing me would cause more damage to my son than dealing with my crazy ass. He’s now six, and since I’ve started treatment I’ve talked to him about how my brain doesn’t work right. Recently we had a more in-depth discussion about the nature of my mental illness. And you know what? He’s okay. He does have to still deal with my crazy days, but I’m open and honest with him when I’m having those days, and he’s okay. .He’s a happy, playful, intelligent, and caring little guy.

          And you know what? Your son will okay too. You are *not*, in any way, ruining them or hurting them with your depression. You are showing them love, and tenderness, and protection. You’ll also teach them how it is to be human, that we all have flaws, but it’s okay. That we all have bad days, but it’s okay. That sometimes our brains don’t always work the way they should, but there are ways to help that, and that it’s okay, both to have a brain that works differently and to seek help for problems. By watching you work hard to take care of yourself, they will learn perseverance and how to take care of themselves.

          Trust me, they’re okay. The worst of my days were when my son was around your sons’ ages, and he doesn’t remember it at all. He just knows that he has his mommy, and that she loves him. That’s all your boys know and will know.

          You’ll get there where you know this in your heart, that having you in their lives is the absolute best thing for them, warts and all. Take care of yourself. <3

          • fiftyfifty1

            ” He’s now six, and since I’ve started treatment I’ve talked to him about how my brain doesn’t work right”
            I think that’s the trick. Kids don’t need perfect parents. But they do need to understand when things aren’t their fault. I have a number of patients with severe persistant mental illnesses (examples include schizophrenia, bipolar, severe depression, OCD,chem dep. Many of whom need hospitalization from time to time, some even frequently) who have lovely families and do a beautiful job of parenting. They are open and matter-of-fact about the mental illnesses. They do their best to set good examples of self care. They do not use their kids as therapists. They accept outside help. They take their meds. They cultivate a sense of humor. They work hard on these things even the ones that don’t come naturally to them at first.
            Their kids feel safe, and loved and accepted. Their kids do not love them because “kids are programmed to love their parents” or somesuch idea. They love them probably for the same reason I love a lot of them—because they are good people.

          • Alicia

            I do try to make sure my son knows when I’ve made a mistake, or I’m wrong, or I’ve gone overboard with my reactions. I’m not always on top of it, but I try to admit my mistakes and we always talk a lot about things. My husband has adopted the same. I just hope I don’t screw my son up too much in the end!

          • Anon

            Yes, just going on my own experience, I’d guess it’s the ones who never come to terms with their mental illness who end up hurting their kids more, and that once you’ve done the work to know and regulate your own emotions, you’re better equipped to help your kids navigate that messy task (or at least I’m hoping so). – Fake Anon (S)

        • Sue

          “Not a Knight” – your post took my breath away. Thank you for your courage in telling the story. If you don’t mind some advice, I suggest you feel no obligation at all to “expose” yourself until you are completely well. When you have put the episode behind you and are feeling strong and well, it might benefit others to know what you have been through. Until then, there is no reason to create any additional anxiety for your self.

        • fiftyfifty1

          I am very very glad you are bad with ropes.

        • Sunandstarshinemommy

          I am a child psychologist. Please hear me when I say how desperately your children want you around and that having a mental illness is not child abuse. Please tell me that you are still in weekly treatment. You deserve that for yourself. And it is clear how much you love your children. Use your name or don’t. You owe no one an explanation or an apology.

        • Christina Maxwell

          I’m so very sorry that you are going through this. In fact ‘sorry’ is totally inadequate. I’m using my real name because it feels right to do so. What can I say? The obvious? You are not a monster. You are not ‘deficient’, you are not inadequate, you are not weak. But that’s not going to do anything to help you through this, is it? Having been there myself all I can really do is offer you the fact that I got through it, not by ‘pulling myself together’ or ‘growing a spine’ as some people thought I should but by (eventually) confiding in my lovely GP. He asked me the right question on the right day and provided me with the help I needed. My biggest regret is that it didn’t happen sooner. If only I had known what was going on after my 2nd daughter’s birth and all the way through to several months after my youngest daughter was born I could have got the help I needed much faster.
          I’m not going to soft soap you, it did take a long while to get myself sorted but within that time there was noticeable improvement which really helped. Even though life was still crap and my brain played lots of tricks on me I could feel it …subsiding for want of a better word. Things just felt more normal. I lost my terrible fear of my youngest dying, the anxiety diminished, the guilt faded and I began to accept that I could be a half-decent mother. And so it has proved, I have done a half decent job! My three are now 22, 25 and 28 and my relationship with them is good, full of trust and love. We all have our ups and downs (depression runs strongly through all generations of my family) but we deal with it as and when needed, as best we can.
          If nothing else I truly hope that you will soon see little rays of light in the darkness, that you will start to believe that you can do this job called motherhood, because you can. And one thing I can promise you, your children will NOT hold your present illness against you. They love you and will continue to do so.

          • you will start to believe that you can do this job called motherhood,

            Maybe we could start from some kind of acknowledgement that it is a job, it is not instinctive or easy, and it doesn’t rely on following some set of prescriptions dreamed up by aspiring Birth Goddesses. You are not a failure if on occasions you struggle with it.

            As I have said above, I was not depressed, but like everyone else I was anxious to do it “right”. Given that I had a strong interest in child development anyway, a child with special needs (and a bad start) and a fairly academic approach to most tasks, I did do a fair bit of reading of various approaches to child rearing. The closest I ever came to getting depressed was after reading Bowlby – where just about every ill was put down to failures on the mother’s part. Depression lifted when I came across the much more sane idea of the Good Enough mother – which we can all manage to be! Children are resilient and forgiving, and have not read the books!

            The idea that this poor women’s distress could have been exacerbated by, perhaps, believing bf was more important than her own well-being is in itself insane.

          • Me

            Hey. I admire and respect you. Life is hard, huh?

        • Lori

          Wow, I gasped out loud while reading your account. I am glad you were brave enough to share your powerful story, anonymous or not! Take care of yourself and I hope you continue to do well on your road to recovery.

          • Wishful

            You both are so brave for getting treatment for you and your kids sake. I was raised by two people who were mentally ill, both of them were diagnosed professionally (dad had major depressive disorder and mom was Bipolar). Neither of them were ever treated for there disorders. Growing up they raised us in almost total isolation until I was around 10 (I mean we had zero family friends and I rarely saw family outside of them. I also was not allowed any friends of my own.) Even after that they never let anyone close enough to notice what was going on. Let me tell you life with a mentally ill person, who is never treated for their disorder is a rough one. I wish my folks had sought treatment like you guys are, both for myself and for their sake.

            That being said, even with no treatment and the full force of their illness effecting my life. They still didn’t ruin me. I still love them, despite their illness, and being an adult I can see that they love me, even if they are sick.

            So even if I haven’t really been there per say, I do understand a bit of what mental illness means…and I think you should be proud that even in the darkness you found the will to do what is best for your kids…some parents never do that.

        • Susan

          Tears in my eyes. I am so sorry you have had to go through this. Thank you for being so brave as to share this. It’s so important.

        • Jennifer2

          Not a Knight, thank you for sharing this. So much of it resonates with me from my own experience as a new mother. While I was never actively suicidal, on my worst days, I truly, deeply believed that my son would be better off without me, that my husband could find him a new mommy, and they could go on with their lives much better without me.

          I would like to say that my own mother suffered from depression when we were little. I’m not going to say that I never resented that. But I never once thought that she had ruined me or that I would be better off without her. And when I was really struggling myself, some little part of my mind realized that and was able to remind me that if my mom hadn’t ruined me, then I wasn’t going to ruin my son. So as a woman whose depression and anxiety have not ruined her child and who was not ruined by her own mother with the same mental illnesses, I want to tell you that you will not ruin your children, and you may actually benefit them in some way through your struggles.

        • Guestll

          I’m so glad you’re still here. You aren’t a monster, and you don’t deserve shame or stigma. Thank you for having the courage to tell your story.

        • moto_librarian

          Not a Knight – my heart hurts for you. Remember that you are still relatively early in your recovery. It can take a long time to fully move beyond the place that you are in now, but it will happen. I know that when the fog began to lift for me, I felt a great deal of shame about having been suicidal. At that point, I still hadn’t fully grasped that mental illness wasn’t in some ways a personal failing. I know better now, but it has also been 14years since my formal diagnosis.

          I used to be very embarrassed to talk about my own mental illness, and part of me doesn’t like to alk about it because those memories are still deeply painful. The turning point for me was when a colleague was utterly stunned by a close friend’s suicide. She just couldn’t understand. I told her that when I was suicidal, the thoughts seemed perfectly rational, and that it almost seemed selfish to keep on living and being a burden to others. I think that we have got to get to a place where society can have open conversations about this.

          My fervent hope for you is that in a few short years, you will look back on this period of time and KNOW that your struggles to recover we’re worth it, that you will KNOW how much your children need and love you. It will get better – just hold on.

        • Charlotte

          I’m not sure how to properly convey in words what I want to say, but it would be expressed in person as a hug. I’m so sorry you went through that and I hope you recover soon, and that the stigma surrounding mental illness is one day eradicated.

        • S

          What you experienced was pretty much my worst nightmare while pregnant. I know how quickly and completely those thoughts can take you over. I was lucky, just dumb luck. I’m so sorry for what you’re going through right now. You will come out in an entirely different place, i hope it’s soon, and fuck the fuckers.

          Beautifully written post, by the way.

        • Siri

          No one can replace you; you are a unique, irreplaceable, precious, flawed and wonderful creature, and to your children you are the world. Mental illness is not child abuse!! Terrible things have happened to you, but you are still here, and life holds many, many good things in store for you. I have spent lots of time planning my own demise, and only physical cowardice stopped me from actually doing anything. I am still here though, and life is much better and brighter than I imagined. I thought nothing good would ever happen to me again, and that I had no value. Well, I was wrong, luckily! Only ignorant and frightened people judge those who struggle; only those who have faced their own dark struggles are able to make a difference to others. You are not alone; I honour you.

    • Alicia

      It’s not just a stigma, it seems to be an overall reluctance to try and understand.

      • Eddie

        I honestly think that part of this is …. “If it is a mental illness, then maybe it could happen to ME. But if it is a problem with that person, they are just weak in a way that I am strong, then it cannot happen to me.” I think for many people, they have such an irrational view of mental illness as a defense mechanism so they can believe it won’t happen to them.

        It’s a very damaging way of viewing things, but I think this is part of why so many people see things this way.

  • auntbea

    When I was in high school, the wife of a beloved coach shot and killed him while suffering from PPD. It always hurts my heart to think, not only of the poor man and baby, but about what this woman must have gone through (still goes through?) when she came out of the psychosis and realized what she had done. By all accounts, they were a very happily married couple.

    • Alicia

      This is why my heart aches for Andrea Yates. From the reports from her re-trial in 2006, she is now fully aware of what she did to her children. I can’t even fathom the pain.

  • quadrophenic

    I liked Jessica Grose’s Slate article but I agree that it misses the point that there is a very real, dangerous illness at work here first and foremost.

    I do think it is still important to remember that these types of pressures may exacerbate PPD and PPP. Getting rid of the pressures of perfect motherhood will help others see warning signs of mental illness rather than chalk it up to new mommy stress, which may help some women get real treatment. The pressure to be perfect makes mental illness out to be a character flaw rather than a sickness and discourages people from treatment.

    I think about mental illness a lot because my brother is severely mentally ill. Despite his constant suicide attempts and hospitalizations, some people see him as simply mentally weak rather than someone with a debilitating illness. (No one thinks I’m mentally weak for having rheumatoid arthritis). You tell someone that they’re a bad person because they’re mentally ill, and they’re not going to seek help, they’re going to get worse for fear of judgement. No one cares if I go to the doctor for my physical pain. I’m so fed up with the way we treat (and ignore) mental illness in this country.

    • The Computer Ate My Nym

      You tell someone that they’re a bad person because they’re mentally ill,
      and they’re not going to seek help, they’re going to get worse for fear
      of judgement.

      Oh, yes. It’s a lovely vicious cycle. People who are depressed have a difficult time working up the energy to do anything. For example, finding a psychiatrist, getting to therapy appointments or sometimes even taking a once a day medication. Add to that the voice already in their heads saying that they’re bad or not deserving of help and the voices OUTSIDE their heads saying that they should just snap out of it…and, oddly enough, some people with severe depression never get treated. Major depression has a 20% mortality rate when untreated. And that’s without the psychosis component.

    • Eddie

      I still remember Andy Rooney’s commentary on Kurt Cobain’s suicide, where he so clearly missed the point. Not that I ever cared what Rooney said, but that was the day I really stopped taking him seriously.

  • Gene

    Having seen PPD and post-partum psychosis, I get ragey when people compare their lives to these women. Andrea Yates killed her children when I was a med student (I didn’t treat her, but have friends who were involved in her care). I knew a women who planned to baptize herself in the ocean to cleanse her sins…so she started running naked down the middle of a major eight lane freeway (ocean 50 miles away). Luckily she was not hit by a car before the cops brought her in. I recently saw a young man who was obsessed with a celebrity (they were getting married, don’t you know). Totally normal honors student before he tumbled down the rabbit hole. You cannot reason with psychosis. It’s a scary and horrible thing to have your mind leave you. I see psychotic people regularly and unless you have truly seen it, SHUT YOUR GOD-DAMNED MOUTH WITH YOUR PLATITUDES AND JUDGMENTS.

    • Sunandstarshinemommy

      Yes, yes and hell yes.

    • Bombshellrisa

      Amen!!!

    • GuestM

      I know of a woman who had postpartum psychosis and stepped in front of a truck, killing herself when her daughter was 3 weeks old, and leaving behind two older kids. A sane person doesn’t do that. Someone with regular PPD cries, doesn’t shower, thinks bad thoughts, etc. But it’s a serious mental illness when someone does something suicidal or homicidal. We need to be better at diagnosing and watching these women rather than condemning them for something they cannot control.

      • Alicia

        That’s part of the problem, though: A lot of partners, friends, and family of people developing a mental illness either don’t know the signs, or don’t recognize them, or won’t acknowledge them. My husband knew something was wrong, but didn’t understand how bad it was or that I was about to end it all. He was just stuck in the mindset that he couldn’t handle it anymore, and was about to leave me. It took me telling him I was this><close to killing myself for him to pay attention or to recognize what he'd been seeing. When people are involved with the sick person it can be hard for them to look at the person and the situation objectively.

        • Alicia

          Ugh. Stupid Disqus. Now I can’t remember what I was typing above. Sorry about that.

      • Siri

        The other day in the UK, a mother lay down on the tracks with her toddler son, and they were both killed by a train. How can anyone feel anything but pity for such a desperate human being? Mental and emotional illness can kill, just as surely as cancer.

    • Dr Kitty

      I think some of these people miss the fact that that a delusion is a FIXED, FALSE belief NOT AMENABLE TO LOGIC OR REASON.

      You can’t talk or argue someone out of a delusion. Their illness has taken them way, way beyond rational thought.

      Example, a patient who believed she was married to Prince Charles. Any time he was on the TV, it really wasn’t him, it was a body double, because he is really living in her walls and is talking to her RIGHT NOW. Any piece of logical or rational evidence you proffer will be countered with something that makes sense in the context of the delusion, but won’t necessarily make sense to anyone else. It doesn’t have to.

    • Charlotte

      My BIL has schizophrenia, and when he gets a delusion there is nothing anyone can do. He’ll do something drastic like suddenly get on a plane and fly out of the country because he thinks the CIA is blaming him for 9/11. People who suffer from mental psychosis need way more help and understanding than they get. It can happen to anyone.

  • anonomom_LLLL_IBCLC

    Thank you Dr. Amy. People with psychiatric illnesses desperately need compassion and medical treatment, not public shaming and condemnation for thoughts and actions that are out of their control. My heart goes out to that baby and the other survivors of Cynthia’s fatal illness.

    • theadequatemother

      Mental illness is so misunderstood isn’t it? Isn’t it comforting for the ignorant to blame the sufferer? I mean, if it’s something she did, then can’t we all relax and feel safe from a similar thing happening to us? I my mind, this is an extension of the the “your baby died or you had a complication because you didn’t trust birth” mentality…Much much more comfortating to blame the victim than realize that these things can strike suddenly and vicariously no matter how much kale you eat or how much you try to insulate yourself from societal pressures.

      • LovleAnjel

        It’s also comfortable to blame society. Societal expectations of motherhood did not either cause or contribute to her psychosis, anymore than societal understanding of the CIA causes a schizophrenic to believe they are controlling his mind via spy satellite transmissions. The illness exists completely independently of the “story” the ill person has constructed.

      • mollyb

        You see this all the time. A woman is raped? What was she doing walking around at night/drinking/hanging out with guys she barely knows? A child is kidnapped? What kind of mother lets her six year old walk to school by herself? A child is killed in an accidental fall? Where were the parents supervising? We all want to believe nothing bad will ever happen to us and blaming the victim gives us the assurance that we can somehow avoid that fate. It’s very sad.

        • Eddie

          It’s a coping mechanism. Doesn’t excuse it, mind you. Just like how people assume when looking at historical genocide that there was something specifically wrong with the society or the people involved, that it could never happen *here*.

      • Elle

        And how much placenta you eat…

      • SkepticalGuest

        @theadequatemother: I was going to like your comment, but…what’s with the kale obsession??? I have never once heard anyone claim that kale prevents serious depression, let alone post-partum psychosis.

        • Bombshellrisa

          It’s part of the mentality that getting enough vitamins is the key to not having ppd. The same with sunbathing during pregnancy, lack of vitamin D is what is causing all the C-sections supposedly.

  • Elle

    Such a terrible tragedy! My first thoughts also centered on our culture of judgment and criticism… I am so sad that those things are the way they are, but you’re right, there is more to it than just that.