Karen Kleiman MSW, LCSW

This Isn't What I Expected

Postpartum Psychosis: What You Might Not Know

It’s easier to miss than you might think.

Posted Oct 06, 2013

When most people imagine someone with psychosis, thoughts of unbridled madness come to mind.

But what does that look like?

How do you imagine insanity would reveal itself?

Are you convinced you would be able to identify someone suffering from a psychotic break?

We think so. We think we could use our very sane brains to decipher the mysterious process that underlies psychotic thinking. Surely we can identify it in our offices, assess it with reasonable accuracy and treat it with a reasonable degree of success. We have science and literature and research to guide us. Sure we will know it when we see it. Surely.

Postpartum psychosis is scary enough when you read about the symptoms and hear the catastrophic stories of women who have been trapped in the unforgiving vortex. The unpredictable behavior. The overwhelming confusion and strangeness that invades their lives. The paths of odd and pervasive thoughts, impulses and beliefs that stretch beyond the outer limits of what is known by most to be true.

But you know what’s really chilling about postpartum psychosis? It’s easier to miss than you might think.

For 0.1% of women who have just given birth to a baby, their lives are forever changed. While they suffer the unimaginable disconnect from themselves and the rest of the world, many desperately try to remain intact, to go unnoticed, to not ask for help. They might say “no” when asked if they hear voices. They might reply “never” when asked if they have thoughts that are not their own. It’s not hard to imagine that they would feel unable to adequately articulate or otherwise express the profound loss of self they experience along with other symptoms that simply make no sense; a lost soul, clinging to threads of reality in order to maintain the pretense of control.

Although postpartum psychosis is getting more attention, it remains poorly understood. We cannot begin to understand the tortured mind that propels some women into madness. It’s astounding, actually, how much effort some women exert to sustain their hold on the slippery slope between reality and unreality.

A woman with postpartum psychosis is not rocking in the corner complaining of bugs crawling all over her skin wondering if the shadows are out to get her. A woman with postpartum psychosis may be going to work, taking good care of her children, driving carpools, giving presentations and making dinner. She is rarely letting others know that in the course of merely getting through the day, she is coming unhinged. She may or may not have significant distress associated with this experience. Usually, she will not. There is, instead, an eerie complacency, Are my words making sense? What if I am making all of this up?, she may wonder to herself. She may wonder if her outrageous thoughts would seem bizarre to the outside world, or she may not. She may know she’s in trouble. Or she may not.

She may be having thoughts of hurting herself or her baby, but this is not always the case. One thing we do know is that the longer her brain wrestles with sensations of turmoil and distortions beyond comprehension—the more entrenched the symptoms become.

If we do not move past the stigma of mental illness and begin to discuss psychosis with the honest exploration and tender consideration that it deserves, we will continue to be stunned by tragic stories of moms who could not get the help they need.

If you have symptoms of depression, talk about your postpartum depression.

If you have symptoms of psychosis, talk about your postpartum psychosis.

If you are not sure, have an honest conversation with someone who knows the difference.

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