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


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.