Postpartum mood disorders are more common than we realize: Up to 80
percent of new mothers experience mild depression within a year of giving
birth. If the "baby blues" persist, depression can escalate to dangerous
levels, influencing some women to experience psychosis and—in rare and
tragic cases—to kill their offspring.
During the first six weeks after giving birth, Jennifer Moyer was
grateful for her beautiful new son and supportive husband. Yet she wasn't
herself. She felt somewhat irritable and was having difficulty sleeping.
And just after her first postpartum physical checkup, things began to
unravel—and fast. The feeling that some unnamed harm was coming to her
son overwhelmed her; she became hyperprotective, not allowing anyone—even her husband—to hold the baby. One month later, after three
sleepless nights, anxiety and fear consumed her to a point where her son
had to be physically removed from her, and she was forcibly taken to the
hospital. Moyer was in the throes of postpartum psychosis.
The focus of a lot of media attention, this illness gained a voice
largely due to the story of Andrea Yates, the woman found guilty of
drowning her five children in a bathtub in Texas. Yates, who has a long
history of mental illness, confessed to jurors that Satan had ordered her
to kill her children. Though diagnosed with postpartum psychosis, she was
judged capable of discerning right from wrong and sentenced to life in
prison.
Despite considerable research into the nature of postpartum mood
disorders, there is still no clear medical consensus on what causes it
and how it should be treated. "Having grown up expecting motherhood to be
one of the best times of life, many women suffer alone, feeling miserable
but unaware that postpartum mood disorders have a name," explains Karen
Kleiman, M.S.W., founder and director of the Postpartum Stress Center in
Philadelphia.
Discerning Symptoms
As many as 50 to 80 percent of all women experience some degree of
emotional "letdown" following childbirth—the so-called "baby blues."
Fortunately, its more extreme sister disorder, postpartum psychosis, is
rare, affecting only about one in 1,000 new mothers.
The baby blues, though, are common for numerous reasons. The baby's
crying and the mother's interrupted sleep and soreness from
breast-feeding are enough to make any woman feel irritable, if not
overwhelmed and tearful. These feelings typically begin three to four
days after the baby is born, according to Kleiman, but normally dissipate
on their own within a few weeks.
If the blues last for more than two weeks, however, the new mother
may be suffering from a condition of intermediate severity, postpartum
depression (PPD), a mood disorder on par with clinical depression. Twelve
to 16 percent of women experience PPD, which results in feelings of
despondency, inadequacy as a mother, impaired concentration or memory
and/or loss of interest or pleasure in activities.
Some women, like Moyer, also become paralyzed with fear and concern
for the baby's safety. If such symptoms appear, it is important to seek
professional consultation to help differentiate PPD from other conditions
such as obsessive-compulsive disorder. Symptoms of anxiety are frequently
an aspect of clinical depression, but true obsessive-compulsive symptoms
signify a different disorder that needs proper diagnosis and
treatment.
Shoshana Bennett, Ph.D., a special-education teacher, began
suffering from these types of anxious feelings almost immediately after
giving birth. "I felt helpless and hopeless," Bennett says now. "I was so
afraid someone was going to hurt my baby that every day after my husband
went to work, I would place all movable furniture behind the front
door."
Though debilitating, the emotional reactions to being a new mom
that signify depression are not as severe as those associated with
postpartum psychosis, of which the predominant symptom is a "break" with
reality—a loss of the ability to discern what is real from what is
not. For instance, a woman with PPD may experience violent thoughts about
her baby but recognizes that those thoughts are wrong and potentially
dangerous. In that case, she will not act on them.
A woman with full-fledged psychosis, however, has temporarily lost
the judgment needed to make this assessment. Very often, a woman with
psychosis experiences a frightening sense of merging—she can't
differentiate between where she ends and where her baby begins. Psychotic
merger is so terrifying that she may try to avoid losing her sense of
self by either committing suicide or infanticide, also known as suicide
by proxy.
This was the case with Andrea Yates, whose suicide attempts ended
with the deliberate drowning of her children. Perhaps, in her mind, to
prevent the "loss of self," she was compelled to kill her children or
herself, or both.
Infanticide is a very rare phenomenon; only about 4 percent of
women who become psychotic kill their babies. Perhaps even fewer
tragedies would occur if proper education and treatment were more readily
available.
Researchers who study infanticide distinguish several different
groups of parents who murder their offspring. Some kill as a result of
psychotic delusions—the dread of parent-child merger or the belief
that the child is trying to harm or kill them. Others murder their
children out of profound depression and hopelessness. Often they carry
strong religious ideas that killing their child will enable them both to
enter an afterlife more peaceful than their current life. Susan Smith,
the South Carolina mother who attempted to drown herself and her children
by driving her automobile into a lake, may be an example of someone in
this group, although Smith ended up killing her children but not
herself.
