Wrapping up Maternal Mental Health Awareness Month: Interview with Lindsay Lipton Gerszt on the Documentary “When the Bough Breaks”

Introduction:

When the Bough Breaks follows the journey to recovery for Lindsay Lipton Gerszt.  It also includes interviews of celebrity mothers (i.e., co-producer Tanya Newbould, Carnie Wilson of Wilson Phillips, celebrity chef Aarti Sequeira, Peggy Tanous of The Real Housewives of Orange County), interviews with other mothers, subject matter expects on postpartum mood disorders (like Diana Lynn Barnes, whom I know), and those who helped Lindsay during her recovery (including her doula, her therapist, her acupuncturist, her OB/GYN).

The film is educational in that it touches on the statistics of postpartum mood disorders and what they are, importance of social support, risk factors, importance of screening new mothers, treatment methods, and the stigma/shame surrounding such disorders…..fundamentally, the same elements that are covered in my book.

The film encourages mothers to speak up and share their experiences, and seek help as soon as they feel something isn’t right.  There should be no shame in being sick with a postpartum mood disorder.  It is not your fault.  It is your body’s physical reaction to your childbirth experience.  The more mothers share their experiences, the less stigma there will be.

I smiled when I saw my lovely friends, Jane Honikman, founder of Postpartum Support International and Postpartum Education for Parents (PEP) and Walker Karraa.  Tears flowed when I listened to the tragic stories, one of which I had blogged about previously (Naomi Knoles). One of my favorite lines from the film referred to PPD as a “sickness of the brain, which is an organ of the body.”  If the public and healthcare folks all treated PPD this way, we would be leaps and bounds ahead of where we are today.  My hope is that one day, the diagnosing and treating of PPD will be as routine as diabetes.  The film ends very much like how my book ends.  There is hope, as there is progress thanks to efforts of many of the folks mentioned in the film.

I know what it’s like to be impassioned to share your experience so that other mothers don’t feel as alone, hopeless and caught off guard as you do.  My 429-page book has no doubt scared a lot of people away from buying and reading it, and I haven’t done a whole lot to market it.  But at least I have my blog, which reaches people via Internet all over the world.  For many people, images and movies have a greater impact.  You just sit back and take it all in.  Now that it’s available on Netflix, the film is available among all the other movies that could potentially be seen by the 94 million subscribers, which is a really huge deal.  And with Brooke, Carnie, Aarti and Peggy’s names attached, the film will surely draw in many, and hopefully, many more people will now have an awareness of postpartum mood disorders and as a result, more mothers with PPD will recognize when it’s not the blues and seek help sooner.  And hopefully, the film will help decrease the stigma associated with maternal mental health conditions like PPD, postpartum psychosis, postpartum OCD, etc.

~~~~~~~~~~~~~~~

Lindsay, I’m sure you have heard repeatedly about how wonderful this film is.  It is ground breaking.  It is educational.  It is chock full of information that is so important to share with the public.  Thank you for taking the time to participate in this Q&A on my blog!

Question 1:

When did the idea of filming your experience with PPD first come up? Was there a light bulb moment for you?  What was the pivotal moment that turned your desire to write your story into reality?  For me, there was a specific what I refer to as “light bulb moment.”  Tom Cruise’s words “There’s no such thing as a chemical imbalance” in 2005 was my light bulb moment to write a book about my PPD experience. Incidentally, seeing him included in When the Bough Breaks flashed me back to how I felt when he uttered those infamous words. It was my experience with PPD, combined with childcare complications and lack of social and practical support, that motivated me to write my book One Mom’s Journey to Motherhood.  My mission was to help other mothers realize they were not alone in what they were experiencing and not the only ones seeking practical tips in dealing with childcare complications (e.g., colic, eczema, cradle cap, which I had no idea how to address as a first-time parent), so new moms wouldn’t be as anxious and in the dark as I was on how to cope with these types of issues.

Answer 1:

Director and Producer, Jamielyn Lippman, and Producer, Tanya Newbould, had the idea to make a documentary about PPD.  They put an ad in a mommy blog and I responded, as I felt ready to share my story.  At the time, my son was only a few years old and I was still suffering greatly.  After my interview, Jamielyn reached out to meet with me.  We decided to continue the journey of making When the Bough Breaks with the three of us, and I came on as a producer.

We knew that, in order for this film to really resonate with the audience, we needed to follow someone on her journey.  We needed someone that people could root for and connect with.  When we first started talking about who we wanted this person to be we didn’t have to think further than myself.  I craved to feel better and I realized that I was so far from recovery.  It was also the perfect opportunity for me to seek out different treatment options and to further educate myself on perinatal mood disorders.

What I did not know at the time was how big of an impact making this film would have on me.  The emotions I felt while filming were real, raw and intense.  I had anticipated to “hurt” while sharing my journey but what I experienced through filming was life changing.

 

Question 2:

Can you give a brief overview of what the film is about ?

Answer 2:

When the Bough Breaks is a feature-length documentary about PPD and postpartum psychosis.  Narrated and executive produced by Brooke Shields, this shocking film uncovers this very public health issue that affects one in five new mothers after childbirth.  The film follows Lindsay Gerszt, a mother who has been suffering from PPD, for six years. Lindsay agrees to let the cameras document her and give us an in-depth look at her path to recovery. We meet women who have committed infanticide and families who have lost loved ones to suicide.  Babies are dying, women aren’t speaking out, and the signs are being missed.  When the Bough Breaks takes us on a journey to find answers and break the silence.

 

Question 3:

Is there anything in particular you’ve learned as a consequence of capturing your story and these other people’s stories on film?

Answer 3:

I have never learned more about myself, human nature, pain and love as I have with making When the Bough Breaks. I have always suffered from depression but to suffer while having to take care of a baby made me realize how strong I am and what I am capable of.  I also learned that you cannot judge anyone!  Everyone has a story to tell and we must learn from each story no matter how painful it is to listen.  As hard as it was to make this film, it was life changing and I would not take it back for anything in the world.

 

Question 4:

Who should watch the film, and why?

Answer 4:

When the Bough Breaks is not just a film for mental health professionals.  It is a film for everyone.  Since up to 1 in 5 new mothers will suffer from a perinatal mood disorder, everyone will know someone at some point who is suffering.  We need to know what signs to look out for and how to give the support that those whom are suffering so desperately need.  We need to know what treatment options there are and how those treatments work.  Most importantly, we need to keep talking about this very serious illness and fight the stigma that is attached to it.  With When the Bough Breaks being available in 64 countries, now we have a big opportunity to work with other advocates to keep this important conversation going and reach a huge audience that otherwise does not know anything about PPD.

 

Question 5:

What was the most challenging part in the process of filming this documentary?

Answer 5:

For me, filming the interviews that dealt with postpartum psychosis were the most challenging part of filming When the Bough Breaks.  As producers, you are there to tell a story.  However, when you meet and get to know the many people being interviewed in the film, you start to care for them on the deepest of levels because we are sharing this experience and journey together.  To see their pain in telling their stories–whether it was a mom who suffered from postpartum psychosis, her partner or the children who were affected by it–was very intense and heartbreaking for me.  I personally became very close to Naomi Knoles and her family.  When we lost her, we were devastated but it also made us work even harder to make sure the film reached as many people as possible so her story could be heard and help others.

 

Question 6:

Do you plan to screen this movie in major cities, and if so, is there a schedule?  Is there a plan to get OB/GYNs to watch this movie?

Answer 6:

We have just signed two educational deals that will help get the film out in markets to which we would not normally be able to reach out on our own.  We have also set up a screening license on our website so that organizations and communities can screen and share the film. We need the film to reach as many hospitals, OB/GYNs, pediatricians and any other organizations that work with new mothers, and I am and will continue to work hard to make sure that happens. The screening license can be found here https://www.whentheboughbreaksfilm.com .

 

Maternal Mental Health Awareness Month – 2017

Just like this time last year, I’ve come across so many things on my Facebook feed in the past few days–all in anticipation of Maternal Mental Health Awareness Month– that I’m just going to highlight all the exciting work, developments, other mothers’ experiences, and upcoming events all in one post.  It’s just a shame that these exciting developments, including articles to boost awareness, don’t happen all year round!  Think about how much more progress there would be if that were to happen!

As I stumble across more articles this month, I will add them to this blog post.

 

House Bill 1764 in Illinois

I saw an exciting announcement today on my Facebook feed from my friend Dr. Susan Benjamin Feingold, a nationally renowned expert on perinatal (pregnancy and postpartum) disorders and the author of Happy Endings, New Beginnings: Navigating Postpartum Disorders.  She testified yesterday in the Illinois Senate Criminal Committee.  HB 1764 just passed the Senate Committee and must next pass the full Senate.  Once the Governor signs off on it, it becomes Illinois law, making Illinois the first state to pass such a law!  Such a law has existed in the UK since 1922 when the Infanticide Act was put in place to ensure mothers receive psychiatric treatment and rehabilitation, rather than a death sentence or life in prison. Canada and several other European countries have also adopted similar laws.  It’s about time the US did too!

It’s due in large part to the following individuals that HB 1764 has made it thus far:  Dr. Feingold and Lita Simanis, LCSW who provided critical testimony, Bill Ryan (retired Assistant Deputy Director at the Illinois Department of Family and Child Services who regularly visited the Lincoln Correctional Center in Logan County, IL and heard the stories of numerous women serving long or lifetime prison sentences for crimes committed while sick with a postpartum disorder) who proposed the law and brought it to State Representative Linda Chapa LaVia (83rd District) who sponsored it, and Barry Lewis (Chicago Criminal Defense Attorney) who provided a written brief and expert testimony as to why this law is constitutional (in response to opposition from the State Attorney).

Click here for more information about postpartum psychosis and why this news is of such significance and a major stepping stone to what will hopefully be the passing of similar legislation throughout the U.S.   Cases of postpartum psychosis are rare and cases of ones leading to infanticide are even rarer.  But as the article states, all cases of postpartum psychosis are neurochemically caused.  Usually, women who are sick with postpartum psychosis don’t even know that’s what was wrong with them and their conditions go untreated, undiagnosed or diagnosed but not properly treated.  During trial, these women are not allowed to talk about their conditions or have them considered as mitigating factors in sentencing.  Although the idea of infanticide is truly tragic and unfathomable, try donning your empathy hat and imagine what it would be like if it were you (be sure to read up on what postpartum psychosis is and what it does to a person first) that was being controlled by  neurochemistry gone completely out of whack until tragedy strikes with an act you commit–one that you could not prevent or control due to your illness–that you will pay for dearly for the rest of your life enduring painful, unrelenting regret, many years or life in jail (or even face the death sentence), and with your illness never addressed or treated.

 

PPD Screening in NYC and Texas:
On May 18th, First Lady of NYC, Chirlane McCray, announced that NYC Health + Hospitals will screen EVERY new mother for maternal depression.  NYC Health & Hospitals provides healthcare services to more than 1.4 million New Yorkers in more than 70 patient care locations and in their homes throughout New York City.  Click here for the link to her Facebook page announcement.  Click here for more about NYC Health & Hospitals.

On my Facebook feed on May 23rd, I saw a link to an article that made my eyes pop wide open!  How exciting was it for me to read that, over in Texas, House Bill 2466 was passed for new mothers participating in federally-backed health care programs (for low-income families) like Medicaid to be screened for PPD when they bring their babies to see their pediatricians.  Yes, mothers who bring their babies in for their checkups can get screened for PPD by their babies’ pediatricians, and the screening would be covered under their children’s plan, like the Children’s Health Insurance Program. Research has shown that PPD is less likely to be identified and treated among low-income mothers, and this bill seeks to detect PPD through newborn checkups.  The rationale is–which I’ve blogged about previously and even wrote about it in my book–since mothers are not required to see their OB/GYN after childbirth unless there’s a medical issue that needs treatment, there is the opportunity at their babies’ 1-month checkup for the pediatrician to screen the mother.

 

Alexis Joy D’Achille Center for Women’s Behavioral Health:
In my Facebook feed today, I spotted an article about a new center like The Perinatal Mood and Anxiety Disorder Center at Monmouth Medical Center, which celebrated its grand opening on May 5th.  Click here for my blog post about this first of a kind center in New Jersey.  Due to open this fall, the the Alexis Joy D’Achille Center for Women’s Behavioral Health will offer comprehensive maternal mental health care at West Penn Hospital in Bloomfield, PA, in partnership between Allegheny Health Network and the Alexis Joy D’Achille Foundation.  This new facility will offer a wide range of treatment, including weekly therapy, an intensive outpatient program and partial hospitalization for women with more severe forms of PPD.  The Alexis Joy D’Achille Foundation was founded by Steven D’Achille in memory of his late wife who at the age of 30 lost her battle against the severe PPD that hit her after she had her daughter in August 2013.  The article about this new center talks about the work it has done to benefit new mothers since 2015, and the work it plans to do once the facility is completed.

 

Personal Success Story: If You Only Ask – by Jordan Reid
Being your own advocate by being informed about postpartum mood disorders, knowing your risk, and being prepared for the possibility – unfortunately, you have to for self-preservation purposes because there aren’t enough resources to catch the moms who fall through the cracks of doctors failing to diagnose, treat or even refer maternal mood disorders. The post reflects the main steps I suggest in chapter 5 of my book, which delves into risk factors and coming up with a prevention plan.  I also touch on being prepared in a previous blog post by having a therapist lined up, just in case, if you think you are at high risk for postpartum depression (PPD).  I’ve also blogged about risk factors for PPD.

 

Postpartum Support International (PSI):
The annual PSI conference is coming up in Philadelphia!  Register by May 8th to take advantage of early bird rates for its PMD certificate course from 7/12-13, as well as for the regular 2-day conference from 7/14-15).

Additionally, PSI has just announced its partnership with the University of North Carolina-Chapel Hill (UNC-Chapel Hill) School of Medicine to expand the PPD ACT.  The PPD ACT is an iPhone app previously released in the U.S. and Australia to study PPD, which is now expanding its reach to iPhones in Canada and to Android phones in the U.S. and Australia.  The app was designed to help understand why some women suffer from PPD and others don’t, in the hope of improving the ability to minimize risk and find more effective treatments.  Women with the app can participate in surveys and DNA testing to study the genes of those suffering from PPD.  This study is the first of its kind.  Last year, approximately 14,000 women enrolled in the study.  Many women who participated were successfully treated for PPD. Ultimately, the hope is to be able to expand the study across the globe.  To download the app or learn more about the study or PPD, click here. For more information about the PPD ACT, click here to access the UNC-Chapel Hill announcemen, here for a HuffPost Canada post announcement, and here for a Mom.me post titled “Find Out If You Have Postpartum Depression Without Leaving Home” by Claudiya Martinez on May 15, 2017.

 

National Coalition of Maternal Mental Health (NCMMH):
And last and most definitely not least, please have a look at how you can participate in Maternal Mental Health Awareness Week (May 1-7) led by the National Coalition of Maternal Mental Health (NCMMH).  Click here to see how you can partner along with other organizations, blogs, authors, mental healthcare providers, etc. in the awareness initiative by becoming a social media partner (like me) to NCMMH.  Help spread the word about the #1 complication of childbirth on Facebook and Twitter by changing your profile pictures and cover pictures, as well as re-tweeeting/re-posting digital messages from the NCMMH’s Twitter and Facebook accounts from May 1-7.

 

Postpartum Bipolar Disorder: The Invisible Postpartum Mood Disorder

In response to my blog post from February 3, 2016 titled “15%-21% of Moms Suffer from a Perinatal Mood Disorder” in which I mention yet another mother who suffered from a postpartum condition that resulted in tragedy, fellow maternal mental health advocate Dyane Leshin-Harwood left me a comment that prompted me to offer her to explain why it’s so crucial to know the difference between postpartum bipolar and postpartum psychosis.  I explained to her that I haven’t seen much out there on a comparison between the two, and of course, the more we speak up about these conditions, the better off we all are!  These are illnesses that are extremely misunderstood, which can result in unnecessary stigma, mothers not getting the help they need because they don’t know who to go to for help, doctors not necessarily knowing how to properly diagnose and/or treat these mothers……and sometimes leading to tragic circumstances.

So, without further ado, I’d like to share Dyane’s story and important information about postpartum bipolar disorder.  Thank you, Dyane, for all the work that you do as a maternal mental heath advocate!

Postpartum Bipolar Disorder: The Invisible Postpartum Mood Disorder

Like father, like daughter: I grew up close to my father, a professional violinist who had bipolar disorder. In this photo I was eight months pregnant, and I never suspected that childbirth would trigger my bipolar disorder.

Like father, like daughter: I grew up close to my father, a professional violinist who had bipolar disorder. In this photo I was eight months pregnant, and I never suspected that childbirth would trigger my bipolar disorder.

By Dyane Leshin-Harwood 

Bipolar disorder, postpartum depression and postpartum psychosis have recently made media headlines. Katie Holmes stars as a lovestruck poet with bipolar disorder in the film Touched With Fire. The British hit television show EastEnders featured a postpartum psychosis storyline that gained national attention. Last January in a landmark decision, the U.S. Preventative Task Force called for screening for depression during and after pregnancy.

While the greater awareness of postpartum mood disorders is promising, postpartum bipolar disorder, the mood disorder I was diagnosed with, is virtually unheard of. Postpartum bipolar is also known as bipolar, peripartum onset, and it’s arguably the least known of the six postpartum mood and anxiety disorders.

It might seem unimportant to publicize an obscure mood disorder, but every mom’s postpartum experience counts. Many medical professionals are unaware that postpartum bipolar exists. Some postpartum and bipolar organizations are unfamiliar with postpartum bipolar or they’re unclear about its definition.

When I was pregnant, my obstetrician didn’t question me about my mental health or my family’s mental health history. My father had bipolar disorder, but before and during my pregnancy I didn’t show any signs of mental illness.

When I went into labor, my life changed overnight.

We went to the hospital and I stayed up all night in pain. When my daughter Marilla was born the next day, I became hypomanic. I was exuberant and talkative (both signs of hypomania), but I appeared relatively normal. My baby attracted most of the attention, and no one noticed that I was in trouble. Exhausted, I sensed something was off, but I kept my fearful feelings inside.

Within forty-eight hours I had hypergraphia, a rare condition in which one compulsively writes. I wrote at every opportunity, even during breastfeeding, when I should’ve been resting and focusing on my baby. I could barely sleep as my mania escalated, and poor Marilla didn’t gain enough weight because I didn’t breastfeed her sufficiently.

A month postpartum, I knew I was manic; after all, I had witnessed mania in my Dad. I frantically searched the internet about postpartum mania, but my search only yielded postpartum psychosis statistics. During Marilla’s six-week checkup, her observant pediatrician heard my racing voice and pressurized speech (symptoms of bipolar) and blurted out “Dyane, I think you’re manic!”

I burst into tears. While I felt ashamed, I was relieved that he realized what was happening. It was clear I needed hospitalization, but leaving my newborn was agonizing. I admitted myself into a hospital’s psychiatric unit where I was diagnosed with postpartum bipolar disorder.

After years of hospitalizations, medication trials, and electroconvulsive (ECT) therapy, I’m stable and doing well. While bipolar disorder ravages many relationships, my husband and I have stayed together, in part, thanks to the guidance of counselors and psychiatrists. Life will always be a challenge, but my two daughters inspire me to take care of myself.

While chances of postpartum bipolar are low, it can affect any mother. Obstetrician and Perinatal Mental Health Lead Dr. Raja Gangopadhyay of West Hertfordshire Hospitals NHS Trust, UK, explains,

“The risk of developing new-onset severe mental illness is higher in early post-childbirth period than any other time in women’s life. Family history, pre-existing mental health conditions, traumatic birth experience and sleep deprivation could be potential risk factors. Bipolar illness can present for the first time during this period. Accurate diagnosis is the key to the recovery.”

Confusion abounds regarding postpartum bipolar and postpartum psychosis. While the two conditions can present together, postpartum bipolar isn’t always accompanied by postpartum psychosis. Perinatal psychologist Shoshana Bennett Ph.D., co-author of the bestselling classic Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression and Anxiety says,

“Many women I’ve worked with had been previously misdiagnosed with postpartum depression. I always make a point of discussing this during my presentations. In addition, postpartum bipolar disorder deserves its own category separate from postpartum psychosis.”

Mental health screening during pregnancy would be of immense value to every mom. Women with a family history of bipolar disorder could be observed postpartum, and if symptoms manifested they’d be treated immediately. It’s imperative that doctors and other caregivers assess women not only for postpartum depression but also bipolar symptoms.

Everyone who lives with a stigmatized illness deserves a chance to find support and empathy from others who understand her experience. Through connecting with those who can relate to our mood disorder, we may not find a magic cure, but virtual support can be profoundly helpful. Postpartum Support International recently created online support groups in English and Spanish led by trained facilitators, while the Postpartum Progress website offers moms a private forum to interact with one another. I’ve never personally met another mom who has postpartum bipolar and I yearn to do so. If you or someone you know is or might be suffering with postpartum bipolar disorder please reach out — I’d love to hear from you!

Kona

My daughters Avonlea, Marilla and husband Craig stood by me through the roughest times.

Dyane’s bio:

Dyane Leshin-Harwood holds a B.A. in English and American Literature from the University of California at Santa Cruz. A freelance writer for over two decades, she has interviewed luminaries including Madeleine L’Engle, Dr. Kay Redfield Jamison and SARK. Dyane was diagnosed with postpartum bipolar disorder (bipolar, peripartum onset) in 2007. Dyane was selected as an International Bipolar Foundation Story of Hope and Recovery, and a PsychCentral Mental Health Hero. She’s raising her daughters Avonlea and Marilla with her husband Craig and serves as women’s postpartum mental health advocate. Dyane founded the Santa Cruz, California chapter of the Depression and Bipolar Support Alliance (DBSA) and facilitates free support groups for moms with mood disorders. She’s a member of the International Society for Bipolar Disorders and Postpartum Support International. Dyane’s memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder will be published by Post Hill Press in 2017. Dyane is a Huffington Post blogger. Visit Dyane’s blog Birth of a New Brain at: www.proudlybipolar.wordpress.com and find her on Twitter: @birthofnewbrain

15%-21% of Moms Suffer from a Perinatal Mood Disorder

For the longest time they were saying between 1 out of 8 women suffer from a perinatal (before, during or after childbirth) mood disorder.  Then, they said between 1 out of 7.  And more recently, literature indicates it’s now approximately 15%-21%, which is anywhere between 1 out of 5 and 1 out of 6, with 21% experiencing a postpartum mood disorder.

If you are suffering from a perinatal mood disorder, you can see from these numbers and in many places online–from a multitude of Facebook support pages, blogs and on Twitter–and in newspapers that you are not alone.  For example, in today’s Upworthy, my friend Heidi Koss shares her experience after the birth of her daughters.  She is a PPD survivor and now helps other moms suffering from perinatal mood disorders.  Her story was also mentioned in an NPR article a week ago today.

You need to know when you need to get help from a doctor and/or therapist.  Get it early.  Know the facts.  Know the difference between postpartum blues and postpartum depression (PPD).  Know the difference between PPD, postpartum anxietypostpartum OCD and postpartum psychosis.  Click here for helpful information that can help you.

You need help for you.
You need help for your baby(ies).
You need help for your family as a whole, including your significant other.

I just found out tonight about the fate of Carol Coronado about whom I blogged in May 2014.  She suffered from postpartum psychosis (not PPD as some newspapers allude to), didn’t get the right help and was just sentenced to life in jail.  Carol, her babies, and her husband were failed by the system.  The same system that failed to ensure she got help is punishing her for their failure.  Sound fair to you?  No!  Her case sounds similar to Andrea Yates case nearly 15 years ago.  I pray for Carol and her family.  She has suffered enough and does not need to spend the rest of her life in jail.  I saw a Facebook comment about Carol that triggered me to write this post.  The coldness and lack of understanding are a reflection of just how close-minded people can be.  It amazes me, really.  It’s really hard to beat down stigma when you have such barriers in the way.  But don’t let any of that deter you from getting help.  YOU are important.  Forget these clueless people.  Get the help you need.  Don’t delay!

Whenever you read about these stories in the news, please remember the facts.  Get information from the right resources (links above would be great place to start).  And don’t let stigma and ignorance steer you away from understanding and compassion.  Don’t let stigma, ignorance, and the close-mindedness of people (those who choose not to understand and would rather continue their misogynistic, super hokey, religious extremist mindset in which women are second class citizens) steer you away from getting the help you need to be well again!  Stay strong!  There is help out there!  Reach out to me.  Reach out to the Postpartum Support International Facebook page (closed group) for support.

Thank You, New York Times, for Your Recent Coverage on Maternal Mental Health

These past couple of weeks have been a blur of work and plans for celebrating a couple of milestones in my life.

A little behind, as I usually don’t blog about such meaningful news relating to maternal mental health a couple weeks after they occur, here I am today, taking a quick break from what I am working on right now to applaud the two-part New York Times focus on maternal mental health, the first of which was titled “Thinking of Ways to Harm Her: New Findings on Timing and Range of Maternal Mental Illness” and appeared on June 15, 2014 on the front page and the second part titled “After Baby, an Unraveling:A Case Study in Maternal Mental Illness” appeared the very next day.

Kudos to Pam Belluck, the reporter who wrote the articles and ensured they received such prime spots in such a major newspaper.   Ms. Belluck interviewed three mothers for the first article, and the second article featured the story of Cindy Wachtenheim, who after battling postpartum psychosis, ended her life on March 13, 2013.  Both articles mention Postpartum Support International (PSI), the organization I joined back in 2006 in my search for answers and information as I endeavored to write a book about my own experience with postpartum depression (PPD), which began in January 2005 and ended a few months prior to the first PSI conference I attended in June 2006.

A week ago, on June 23, 2014, an article appeared on HuffPost Parents titled “What the New York Times Got Right and Wrong About Maternal Mental Health” in response to the NY Times articles.  Very good points made by  Christiane Manzella, PhD, FT, supervision director and senior psychologist at the Seleni Institute including how, even though this two-part series in the NY Times was a step in the right direction, it was still a missed opportunity to educate the public on the common misconceptions of postpartum mood disorders.  For example, many cases of postpartum mood disorders actually begin during pregnancy (i.e., antenatal or antepartum depression) or up to a year after and is not strictly limited to the first weeks postpartum.  Also, the spectrum of postpartum mood disorders covers not only PPD, but postpartum psychosis as well, which is still not being diagnosed/treated correctly in all too many cases today…and unfortunately the disastrous outcome hits the news, like in the case of Cindy Wachtenheim.

I also wanted to highlight the June 21, 2014 Letters to the Editor submitted in reaction to the two-part series on maternal mental health.  Note the first letter written by Karen Kleiman, MSW, LCSW, founder of The Postpartum Stress Center.

Thank you, Pam Belluck and the NY Times for making these articles happen and putting them in the spotlight to bring more awareness about perinatal mood disorders to the public.  For too long perinatal mood disorders have been lingering in the shadows, remaining a topic that has evaded the understanding by medical/mental health practitioners and the public alike.

Every mother deserves to understand what perinatal mood disorders are, as well as how to know when to get help and who to go to for help without fear.  Fear of stigma.  Fear of any potential repercussions. People need to put aside these fears because things can get very bad very quickly if a mother does not seek help in a timely fashion, or gets the wrong diagnosis and/or treatment.

Every mother deserves to receive the right treatment and not be afraid to seek it.  As in my case and in all too many other mothers’ cases, time is of the essence in getting the correct treatment.  If I had gone much longer with my insomnia and panic attacks without the right combination of medications to treat them, I am not certain what would have happened.  I was in a very bad place for a few weeks, and I am ever so grateful for only losing a few weeks of precious time with my baby.  The outcome could have been so much worse.

Stigma and Ignorance…Go Hand in Hand and a La Dee Da Dee Dum

I was on my way home from work today and thinking it wasn’t such a bad day…that is, until I stumbled across a post on Facebook.  This post made it clear there was yet again an ignorant comment(s) made about perinatal mood disorders.  I went to Twitter to see what the ruckus was about.  Someone–and I’m not going to say who it is because I feel no need to advertise her blog post and give it any more attention than it may have already gotten–put up a blog post today that poses the question of how it is that moms with postpartum depression (PPD) can use their illness as an excuse, a get-out-of-jail card, for killing their babies……okay, then…right.

[WARNING:  I realize that there are moms out there suffering from a postpartum mood disorder that should not be reading articles that will only cause them further distress.  So, if you are currently suffering from a postpartum mood disorder, you should probably wait until you are feeling more strong before reading the following post.]   

Yep, here we go again.  Another case of stigma and ignorance skipping along, hand-in-hand, with the mindset of an innocent child, with limited maturity, experience, and know-how.   A case of instinct to judge, label, hate and turn a blind eye.  The primitive reflex of wanting to see justice done regardless of what the circumstances truly are.   I could picture this blogger (and someone else who posted a comment in her favor)–and just about everyone else who is as ignorant as her and chooses to stay that way–picking up stones and wanting to hurl them at any mom whose circumstances may follow that of an Andrea Yates–who had postpartum psychosis.  Remember the recent cases of women getting stoned to death over in the Middle East?  How we were all horrified at the injustice of it all.  And yet here we are judging and passing on guilty verdicts, regardless of circumstances?

Here’s the comment I posted on the woman’s blog:

Firstly, let me just say that everyone is allowed to wonder things, especially when you don’t have any personal experience with an illness such as postpartum depression–or in the cases you cite (Andrea Yates, Otty Sanchez), postpartum psychosis–AND you’re not a medical/mental health professional.  But let’s just get something straight here.  There is a HUGE difference between postpartum depression (PPD) and postpartum psychosis.  I blogged about this very thing back in Sept ’10 when certain comments–comments made out of ignorance– rubbed me the wrong way.  It’s not through your fault or the public’s fault that there is not a whole lot of knowledge about perinatal mood disorders out there.  But it’s the lack of awareness that is causing the general population to have misconceptions, which can be very dangerous.  Dangerous in that mothers who suffer from a perinatal mood disorder suffer the consequence (e.g., fear of getting help, fear of being labeled another Andrea Yates when in fact Andrea had postpartum psychosis, far rarer than PPD). And that really pisses me off.  These misconceptions cause a vicious cycle of ignorance and incorrect generalizations and assumptions–such as moms deliberately setting out to use PPD (not even the right term illness) to escape punishment for killing their babies.  Before you go running around proclaiming that the mother who is devastated by a horrible illness such as postpartum psychosis and in rare instances may kill her baby deserves to be put to death herself, become knowledgeable about postpartum psychosis.  So, please read the article by Katherine Stone (that link was provided via a tweet today), and please read this: https://ivysppdblog.wordpress.com/2010/09/17/postpartum-psychosis-know-the-facts-and-stop-judging-based-on-ignorance/

 There is a whole lot more to it than you think.

We need to open our eyes.  Really know the facts before we start labeling, judging, and hating. 

Postpartum Psychosis – Know the Facts and Stop Judging Based on Ignorance

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.

 

Andrea Yates

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.