Yesterday, I stumbled across a disturbing article that shows just how mired in stigma postpartum mood disorders (PPMDs) are, particularly postpartum psychosis (PPP), and how people just cannot understand why it is necessary to have a separate category of infanticide in cases where it is proven that an infant < 1 year of age dies by the hands of his/her mother who is suffering from postpartum psychosis. I am not going to post a link to that article because it is completely ludicrous and not deserving of any further attention than it may already be getting. Nor am I going to quote any portions of the article or any of the biased comments. Instead, I’m getting my thoughts out via my own blog. I wasn’t about to post a comment and be eaten alive by people who haven’t a freakin’ clue and who insist on voicing their self righteous opinions, going off on anti-women and anti-abortion tangents. Not worth my effort whatsoever.
All I will say is this. As long as society doesn’t educate people on the truth behind the various PPMDs, they are going to continue to be stigmatized and mothers suffering from a PPMD will be afraid to get the help they need. In my opinion, the medical and mental health care communities are largely responsible for not educating the public about PPMDs. Keeping quiet about PPMDs isn’t going to make them go away. Most people are not aware that the rate of PPD in new moms is ONE IN EIGHT. I just blogged about that in my last post. Per the Postpartum Support International website, PPP occurs at a rate of approximately 1-2 of every 1,000 deliveries (or approximately .01% of births) , with a 5% risk of infanticide/suicide. And we don’t even know just how many mothers out there fall through the cracks as far as proper diagnosis and treatment for PPMDs are concerned.
In the United Kingdom, because PPP is recognized as an illness rather than a crime, infanticide by a woman diagnosed with PPP is treated rather than put in jail for murder. There are about two dozen other countries that have put infanticide laws in place, which they have basically modeled after the British one. Australia, Austria, Brazil, Canada, Colombia, Finland, Germany, Greece, Hong Kong, India, Italy, Japan, Korea, New Zealand, Norway, Philippines, Sweden, Switzerland, and Turkey.
How many times do you hear about mothers killing their children via drowning, suffocation or some other terrible means? Yes, these stories reflect the unthinkable, the unimaginable. But who knows what condition these mothers were in? Did these women try to warn anyone that they weren’t feeling themselves? Did they show signs of severe depression that went ignored by loved ones and even doctors? Did they get help but were prescribed the wrong course of treatment?
People ignorant about PPMDs don’t understand why a mother who isn’t feeling well after childbirth doesn’t just get help. These people prefer to stay in the rut of ignorance they’ve fallen into and can’t (or refuse to) climb out of. These people would prefer to blame the new mom for their actions without considering what the woman’s situation may have been like. In my humble opinion, if a new mom is diagnosed with PPP by an expert in that field, that determination MUST be factored in during the trial for sentencing purposes.
Barriers to progress include, but are not limited to, the following…..as I’ve said time and time again:
- All too many mothers are still afraid of speaking up and getting help today. Look at the stigma and the awful things that get written in the media and on blogs. Due to lack of public awareness campaigns, all too many mothers still don’t know enough about PPMDs to know when they are suffering from one, let alone how to get help.
- Not all mothers who need help have access to doctors, therapists and support services within their communities that are adequately equipped and trained to help moms suffering from PPMDs.
- Not all mothers have family members that can help care for the new baby and the new mom. There are all too many moms out there fending for themselves and their babies on their own, including single moms and moms whose husbands don’t help at all, either because they’re always at work or are unwilling to help (yes, there are men like this).
The main keys behind reducing the occurrence of PPMDs among new moms include:
- SUPPORT: Ensuring moms get the emotional and practical support they need after childbirth
- EDUCATION: Ensuring an increase in public awareness about PPMDs, including what they are, why they occur, how to minimize risk of occurrence, and how to recognize when someone has a PPMD and how they can get help (medical/therapy)
- EARLY DETECTION AND PROPER TREATMENT: Ensuring all medical/mental healthcare practitioners are trained to detect, diagnose, and treat PPMDs properly
Until these 3 points are satisfied, women will continue to fall through the cracks with sometimes tragic consequences, and they are victims of a society that all too often focuses its priorities in the wrong places.
I’ve blogged about these 3 points before, but I haven’t really ever blogged about PPP or postpartum OCD (which is all too often confused with PPP). Both Postpartum Progress and Beyond Postpartum contain many helpful posts–too many to list here–on both these PPMDs. Just visit these blogs and do a search of those two terms.
What is PPP?
PPP can occur anywhere from 24 hours to 2-3 weeks postpartum. PPP is always considered a medical emergency that requires the mother to be hospitalized so she can be monitored and treated. A woman with PPP typically alternates between reality and losing touch with reality, with episodes characterized by command hallucinations to kill the baby or delusions that the infant is possessed. You may think that the one case you hear about that involves delusions relating to the devil—think Andrea Yates—is a purely isolated case. Unfortunately, it’s not.
The leading risk factor for PPP is a personal and/or family history of bipolar disorder, schizophrenia, psychosis, or mental illness. Bipolar disorder (more commonly known as manic depression) is characterized by extreme mood swings (thus, bipolar) alternating between highs (mania)—where they may experience elevated moods and increased energy levels, confidence, productivity, sociability and creativity—and lows (depression).
There is risk that some woman suffering from PPP—who experience symptoms of both mania and depression—can mistakenly be misdiagnosed with and treated for PPD. The danger of this is that some medications used to treat PPD can actually aggravate the symptoms and lead to disastrous consequences, as in the case of Andrea Yates, which I will talk about later in this post.
PPP can be hard to diagnose because the woman can have periods of high energy, which can be mistaken for happiness. This period is characterized by so much energy to the point of never feeling tired and no need for sleep. During the first couple of weeks after her baby is born, a woman in the hypomanic phase feels energized and on top of the world, thinking to herself: “Gee, this is how those supermoms out there feel. Motherhood is just as easy as those moms make it look.” After leaving the hospital and without ever needing to rest, she goes straight into taking care of the baby along with doing all the housework, cooking and shopping without any help whatsoever.
Symptoms of hypomania/mania may include some or all of the following:
- Increased energy; hyperactivity; restlessness
- Decreased need for sleep
- Feeling elated
- Racing/disorganized thoughts
- Increased energy, productivity, creativity
- Feeling overly confident
- More talkative, rapid speech
- More outgoing
- Impulsive behavior
Because the symptoms of hypomania have the tendency to create the impression that the new mother is merely excited about the baby and motherhood, PPP has the tendency to be missed until after the hypomanic phase is over and a mother sinks into a deep depression, after which the following symptoms may develop and become dangerous if she doesn’t get help quickly.
- Hallucinations (visual/auditory)—hearing, seeing, feeling and even smelling things that aren’t really there—often characterized by voices or a vision of someone instructing the mother to kill the baby. Inability to distinguish between reality and hallucinations; when hallucinating, fully believing what she is thinking, hearing and/or seeing represents reality.
- Paranoia and irrational/delusional thoughts/fears, such as denial of the baby’s birth or other random feelings of suspicion that can cause violent behavior. In the midst of a violently psychotic episode, some even seem to gain superhuman powers, such as being able to rip a radiator out of the hospital wall.
- Feeling like your thoughts are no longer your own and you can no longer control them.
- Rambling and incoherent speech
- Confusion, incoherence and poor judgment
- Extreme and rapid mood swings
- Extreme agitation
- Belief that she must kill herself and/or the baby
A woman in the delusional state of PPP should never be taken lightly by those around her, as there is a high incidence of suicide and/or infanticide when PPP goes undiagnosed and untreated. It’s during the extreme lows that new mothers with psychosis may try to commit suicide and/or hurt/kill her baby. It’s really sad when you hear about those who succeed.
What Loved Ones Should Be Aware Of:
Firstly, at the slightest hint of suicidal or infanticidal thoughts by a new mother, medical help should be sought immediately and the baby should not be left alone with her—not even for a minute. All it takes is a minute for disastrous consequences to occur. Do not wait to see if things get any better. I’ve read of many instances where the behavior was ignored until it was too late. The mother should be hospitalized to protect her life and that of her baby’s. The hospital is a place where the mother and baby can be safe, cared for and monitored until the mother is able to provide adequate care for herself and her baby. Going to an ER is the best way to guarantee medical attention immediately, since most doctors will not likely be able to see her right away without an appointment made in advance.
In any of these situations, call 911 or the national suicide hotline (National Hopeline Network) at 800-784-2433.
You should seek help for her immediately when any of the following occurs—don’t wait:
- At the first sign of a change in personality or bizarre behavior.
- If she insists she does not need rest and seems highly energized. If she doesn’t seem to be in keeping with the fact that she’s just given birth and should take it easy. For example, planting flowers is not typically unusual behavior but should be questioned if a new mom is doing it upon arriving home after a c-section.
- When you can’t seem to get through to her.
- She seems confused or on a different wavelength or lost touch with reality.
- Where there is weird/paranoid/delusional behavior (says/thinks illogical things about things/people).
- If she complains of imagining or hearing things.
Pretty much everyone in this country has heard about the Andrea Yates case. After each of her children were born, she suffered PPD but never sought treatment until her 5th child was born and she developed PPP. She still didn’t seek any help because she did not realize the dangers of her PPP. On June 20, 2001, she decided she had to drown her children in order to save them from Satan. Instead of receiving treatment for her PPP, she was sentenced to life in prison. On January 6, 2005 the Texas Court of Appeals reversed the convictions due to the determination that the psychiatrist who served as a prosecution witness had given materially false testimony during the trial. On July 26, 2006, with an expert testifying in her defense, she was found not guilty by reason of insanity, as defined by the state of Texas. She is now staying at a low security state mental hospital in Texas.
Had she and those in her life known that her symptoms indicated she needed immediate hospitalization, her children would still be alive today. Not heeding her psychiatrist’s warning never to leave her alone with the children, her husband Rusty did just that. Between the time he left to go to work and the time his mother came to help with the children—a span of an hour—Andrea drowned all 5 of her children. In fact, without consulting the doctor and against medical advice, Rusty began to leave his wife alone with the children for several weeks prior to the drownings. It appears that Rusty is in large part responsible for what happened, not only for ignoring the psychiatrist’s warning but also to persuade Andrea they should continue to have children despite warnings from Andrea’s psychiatrist against doing so.
Additionally, Dr. Lucy Puryear, the expert witness for the defense regarding PPP, indicated she did not think Andrea would have ever drowned her children if it hadn’t been for the religious influences of her minister, Michael Woroniecki. Per Wikipedia, it was because of him that Rusty and Andrea “built a framework of homicidal and suicidal delusions in [Andrea’s] ill mind through ‘relentless gloom and doom sermonizing’….and [Andrea] had come to believe [through his sermons and a 1996 video they had received from the minister] that she was a ‘bad mother’ who was spiritually and behaviorally damaging her children, and that it was better to kill herself and her offspring rather than to allow them to continue ‘stumbling’ and go to hell.”
This tragedy would not have happened if everyone with whom the Yates came into contact during those years in which Andrea was obviously not well were educated about her risk for and dangers of PPP, advised them on what to do and actually tried to do something along the lines of helping to provide adequate social support and even intervention. In terms of Andrea’s risk for PPP, Andrea’s father and brother both had bipolar disorder and her mother, sister and other brother had a history of major depression. Her story is a prime example of how our healthcare system and society overall fail mothers. Even today, most people know about the Andrea Yates case but very few individuals realize that she had suffered from PPP. Only those educated about PPD and PPP or have experienced either one firsthand can truly emphathize with her. The general public thinks such a monster deserves to be put away for life or have her own life taken away for snuffing out the lives of all 5 of her children. Her story shows how desperately in need we are of putting public awareness of perinatal mood disorders up at the top of the priorities in this country.
Difference between Postpartum OCD and PPP
It is unfortunate and quite scary that these distinctions still elude many doctors, which does nothing to motivate mothers to reveal their experiences. Unfortunately, because not all healthcare professionals are adequately trained about postpartum mood disorders, they are unable to successfully distinguish between postpartum OCD symptoms and PPP. If you are experiencing postpartum OCD symptoms, share them as soon as possible with someone you trust and who is nonjudgmental and sympathetic, most preferably a therapist who can help treat your condition. If you do not know any therapists or don’t know anyone that can recommend one to you, you can contact Postpartum Support International for names of therapists in your area.
The mother with postpartum OCD experiences recurring, obsessive, sickening, frightening and mostly violent thoughts/mental images. The postpartum OCD mother, realizing these uncontrollable, unwelcome thoughts are repulsive, irrational and not normal, would never let any harm come to her baby—even taking specific steps to protect the baby, like making sure she is never left alone with the baby and letting someone else take care of the baby until she is herself again. Deep inside she knows she loves and would never hurt her baby, but her thoughts are terrifying enough to make her doubt herself and feel anxious about being left alone with the baby.
The mother with PPP, on the other hand, has delusional beliefs about the baby (e.g., baby is a demon or Satan said she had to kill the baby in order to save the baby’s soul), and is capable of acting on her thoughts of harming the baby. Women with PPP are unable to tell right from wrong, fully believing the delusion they are experiencing is real. The PPP mother may—thinking that she is doing something difficult but morally right—hurt and possibly even kill her baby and/or herself as a consequence of her delusions.
In short, a woman with postpartum OCD realizes that these thoughts are disturbing, not normal and not real, while a woman with PPP isn’t disturbed by these thoughts because she thinks they are real, rational and in some cases are coming from someone else, like God or Satan (unfortunately there is something to the saying “the devil made me do it”) telling her that the baby is possessed or destined for a terrible fate, and she must follow his instructions if she hopes to set things straight.