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.
Katherine,
I agree that these types of postpartum disorders are becoming sensationalized (everyone who kills a baby must have PPP!), which is ironic, considering the miniscule media attention of PPP not too long ago. The more sensationalized “news” becomes, the more inaccurate it becomes—for example, using the word depressed and psychotic interchangeably in the papers.
On “our side”, however, it’s also popular to say that “hardly anyone gets PPP (“only” 1 in 1000)”, and “even fewer of those people kill their babies or themselves.” Infanticide and suicide due to PPP are, horribly, real symptoms, however rare. These symptoms cannot be minimized. They happen to enough women to warrant attention, without a doubt.
My wife Jennifer was aware that she was sick. Her family and friends were very aware that she was sick. We were also very aware that she was in a dangerous situation, and we did everything imaginable to try to help her. She was receiving treatment. Due to her disease, she believed that she was doing an altruistic thing by committing suicide. She was completely in control of her actions, but her perception of reality was extremely distorted by her psychosis. This is why PPP is difficult to treat. The person with PPP may or may not know she is sick, and their illness defines their reality.
Read it again and see if it makes more sense now.
interested,
“Postpartum Depression with Psychotic Features” was my wife’s official diagnosis, partly because she had no previous bipolar or schizophrenic condition. I am understanding it more and more each day. Thanks so much for sharing.
Jeremy
Important discussion… however, a clarification if I may…which actually shows how right you are when you note how complex posptartum psychosis is.
Women with postpartum depression can end up killing their kids – if they suffer from postpartum depression with psychotic features.
This too is a form of postpartum psychosis but the formal diagnosis you get when your postpartum psychosis is unrelated to bipolar or an underlying schizophrenia.
As you probably know, in many cases, postpartum psychosis can occur as first episode bipolar or because of a preexisting bipolar or schizophrenic condition.
However, in some women (like me)postpartum depression can quickly develop psychotic features(and become postpartum psychosis). The reason for noting the difference is because it necessitates a different concoction of drugs to alliviate it (no lithium for manic symptoms).
Anyway, hope this sheds more light on the complexity of this illness and clarifies why everyone needs to know about it since it can really affect anyone out there.
Thanks for all you do to create understanding of postpartum illnesses.
Another excellent point. Thanks for clarifying the differences between the two and the fact that both are so dangerous.
I wonder how an MD can tell whether it's postpartum psychosis or postpartum depression with psychotic features. Is it if someone has all the symptoms except mania?
Yet some people actually find out they did have bipolar all along and just didn't know it. So they did actually have postpartum psychosis even though they had no prior diagnosis. So I'm curious, as I commented above to interested, as to how a doc differentiates between the two.
I know this is probably just my own stupidity, but I am confused. To be honest, this is all really new to me as I had only heard PPD mentioned a few times before I was diagnosed with it. All I really know is my own experience, but I really don't think I had PPP, but I was definately suicidal. I felt like I was in a constant battle with myself trying to keep from killing myself. It was like there were voices in my head that just kept pushing me. Even when I first went on medication, my husband had to bring the bottle to work with him everyday, because every time I saw it, all I could think about was downing the whole bottle. So, I guess I am just surprised to hear you say that suicide is not very common in PPD or PPP because I was under the impression that it was–but like I said I know very little about all of this, so I would appreciate any clarification.
I feel I have to point out that the mother in Edmonton has NOT been convicted of the murder of her children.
Just as we should not assume she suffered from PPD/PPP, neither should we assume that she is guilty of this crime.
You are not stupid. I've been doing this blog for five and a half years and there's still SO MUCH stuff I don't know or don't understand. As patients and sufferers and survivors, we are all figuring this stuff out together.
But for clarification, there is a big difference between thinking about killing yourself, wanting to kill yourself and actually doing it. When I say suicide isn't common, I mean the incidence of actually going through with it is rare. Thinking about it and even wanting to do it (but not doing it) is a symptom among ALL of the perinatal mood and anxiety disorders. Does this make sense?
Check out this piece: http://postpartumprogress.typepad.com/weblog/2009…
Yes. Absolutely. You are quite right.
And before I get in trouble, when I say that going through with it is rare, I DO NOT mean that it doesn't happen often enough that we don't need to pay very close attention to ANY and EVERY person who expresses thoughts about harming themselves. I want to be extremely clear on that.
The reason I bust my ass working on this blog every day is so that it doesn't happen EVER among moms-to-be or new moms. I realize that may be expecting too much, but it's certainly worth a try.
Great clarifications Jeremy. I will amend my post to make it clearer.
From what my psychiatrist told me about the whole difference, this is it in a nut shell:
The general protocol is that psychiatrists are always to assume that a woman experiencing postpartum psychosis has an underlying bipolar condition or is experiencing postpartum psychosis as a first episode bipolar. It has to be viewed this way to make sure it doesn’t lead to a dangerous situation –I’ll explain further later.
After first viewing it this way, they need to rule out bipolar as the underlying condition by taking a careful case history, which can rule out both pre-existing bipolar and schizophrenia. If after a careful examination of current symptoms experienced, there is no indication of manic symptoms, then and only then should they conclude that it is postpartum depression with psychotic features.
The reason for such a thorough analysis is because a woman with ppp- underlying bipolar, must have her cocktail of medication include a mood stabilizer. This is because only going on anti-psychotics and anti-depressants will cause the manic symptoms of a woman with ppp- underlying bipolar to sky rocket.
If you read Suzanne O’Malley’s book on Andrea Yates, you will see this is what happened to Yates. She was diagnosed as having postpartum depression with psychotic features, when she in fact had the bipolar version. Hence, being on only anti-psychotics and anti-depressants – without a mood stabilizer – sky rocketed her mania and may have contributed to the tragedies by giving her the overwhelming energy necessary to carry out her delusional beliefs about needing to kill her children.
Hope this sheds some light on the issue.