I wanted to share this interesting exchange that occurred in the Comments section when I wrote this week about two recent, tragic instances of mothers killing their young children and the assumptions people make that every time a mother kills her child the act was related to postpartum psychosis or postpartum depression.

The first comment came from someone calling themselves GuideMD:

[according to a local article, the mother in Edmonton] "had shown signs of depression, but refused to get help" – not necessarily postpartum psychosis, but tragic when people don't want to get help for depression (for whatever reason).

Then, a response from Jeremy Condon, whose wife killed herself due to postpartum psychosis:

"Refused to get help" could be out of context and very misleading. My wife suffered from postpartum depression with postpartum psychosis and thought she was absolutely fine, even though she had a very strong family/friends support network with appropriate guidance. In fact, during a sort of manic phase of her illness, she had never felt better in her entire life. No person on earth would seek "treatment" when everything seems fine, much less when everything feels better than ever. You cannot blame the victim and assert that they take responsibility for their illnesses and just accept help/get over it/let someone fix them. Nobody wants to suffer. All human beings strive to move away from pain, no matter what. Treating these types of postpartum complications can be very, very complicated.

Firstly, women with postpartum depression don't kill their children. (Although, if they havepostpartum depression with psychotic features, as pointed out by the commenter "interested" below, they do have that potential.)

Secondly, women with postpartum psychosis very rarely cause harm to themselves or others. Enough of them do, though,that we must consider all women with postpartum psychosis of beingin danger if not receiving effective treatment (and sometimes even when they are receiving treatment, sadly, because the illness is just so pervasive), which is why we have to watch out for ALL of them so carefully.

Thirdly, if they do harm their children it's because they're SEVERELY ill and not in control of their actions and because those around them don't recognize they're in a dangerous situation. Or because everyone does recognize it and is trying to care for her but the woman believes she must take action in some way for some reason and finds a way to do so.

Fourthly (is there a fourthly?), there are women who kill their children who do not have any type of perinatal mood or anxiety disorder and never have.

Oneissue with postpartum psychosis is thatsome of thepeople who have it suffer from a lack of insight.Per Wikipedia on psychosis and insight:

The three kinds of insight that are most vulnerable to severe mental illnesses [they're referring in this instance to psychosis and schizophrenia] are the awareness:

• that a person is suffering from a mental disorder
• of the effects of medication; and
• of the social consequences of having a mental disorder.

If the mother in Edmonton had postpartum psychosis (and we have NO idea if that's the case), she may not have recognized she needed any help. And if she was suffering from paranoia, which can be a symptom of psychosis, the very fact that someone would have suggested she needed help could have led her to believe that people were simply out to get her or harm her. She would have run as fast as possible away from help. And, as Jeremy mentioned, the mania that some women with postpartum psychosis can experience makesthem feel as if they could conquer the world. Who wants to make that go away?

As Jeremy explains in his comment below, there are other women who know something is wrong. Some of them feel the only way aroundtheir illnessis to commmit suicide because it's so severe they want to protect everyone else, regardless of whether they are being treated or not.

I'm beginning to understand more and more how complex postpartum psychosis is. That's why it's so pernicious.

MDs/PhDs/MSWs etc. in the house — help us out here and add to this discussion …

P.S. Here's an interestinglittle articleon the complexities ofinsight.

P.P.S. Be sure to read the comments below because they are very insightful (no pun intended) from people who've been there and know what they're talking about.

Note: If you'd like to learn more about the symptoms of postpartum psychosis and postpartum depression with psychotic features, click here.