Legally insane mothers?

Before Andrea Yates was convicted of drowning her five children in a bathtub, the average person had not heard the term postpartum psychosis. “Baby blues” and “postpartum depression” were recognizable phrases, but not postpartum psychosis – not often anyway.

In past months, however, postpartum psychosis has worked its way into national news, showing its sometimes permanent effects.

PPP is a disorder that occurs in some women after giving birth and is characterized by a loss of reality and a desire to harm the baby. The onset of PPP is sudden and usually occurs within two or three weeks of delivery. While often associated with postpartum depression and baby blues, PPP has important distinctions from these diagnoses that make it much more severe and difficult to treat.

Postpartum depression and psychosis can be similar but are easily differentiable, said Cathey Soutter, SMU Coordinator of Psychological Services for Women.

“Postpartum depression looks like depression that occurs after the birth of a child,” Soutter said. “PPP is strange behavior, hallucinations, delusions, lots of really floored symptoms, so you know pretty quickly that something is up, depending on how good the mother is at hiding what’s going on.”

Harvard Medical School psychiatrist Deborah Sichel described the hallucinations as irrational, violent thoughts of a need to harm the baby.

“Women start to [think] the babies are bad; the babies are evil. It translates into an altered perception; a mood that for them starts to feel very real,” Sichel said. “What [normal people] would look at and say ‘that doesn’t make sense at all’ makes perfect sense to these particular mothers.”

Differences between the postpartum disorders could become a life or death issue for both babies and their mothers. Babies may be at risk if the mother’s disorder is left untreated and is severe enough for the mother to act on the hallucinations. The mother may consider suicide or, like Andrea Yates, commit murder.

The baby blues are a common reaction after giving birth. Symptoms include feeling let down, irritable and anxious, and crying without cause. Since symptoms are brief and usually disappear on their own, the reaction does not require medical attention. Usually the baby blues are nothing to worry about, as nearly three-fourths of all new mothers experience them.

Postpartum depression is a more difficult diagnosis, however, and has more negative consequences for the baby and the mother. The new mother may experience confusion, memory loss, over-concern for the baby, fear of losing control or intrusive thoughts. Ten to 22 percent of new mothers experience some kind of postpartum depression estimates New York University forensic psychiatrist Michael Welner. Symptoms may arise anywhere from a few days to a year after delivery.

Because of its substantial difference from baby blues, postpartum depression is recognized as a legal defense in 29 countries including Great Britain, Canada and Australia. In the United States, postpartum depression would generally be used in an insanity defense.

Postpartum psychosis, though, remains the most dangerous and critical postpartum disorder. The biggest hazard lies in the combination of the mother’s loss of reality and her ability to hide her symptoms.

“[PPP] is difficult to detect because symptoms fade in and out,” Sichel said. “[Mothers with PPP] are often able to hold it together and act normally when others are around.”

Although hallucinations and delusions may be difficult to detect, Sichel suggested that family members should be alarmed by suicidal thoughts, obsessions about the baby’s health or expressions like “the child would be better without me” and “I’m just not feeling myself.”

Although the psychosis’ causes are still unknown, researchers have reason to believe rapid hormone changes can cause postpartum disorders and that the disorders are treatable. Psychosis symptoms require immediate medical attention.

“We need to understand that these are brain illnesses,” Sichel said. “There is a very important part of the brain that is pushed into this sort of deregulated, abnormal state. [Researchers and doctors] believe there are women who are particularly vulnerable to the effects of hormonal shifts.”

Soutter added that hospitalization and medication have been used as treatment for postpartum disorders in the past but that hospitalization is becoming less feasible.

“It’s more difficult to get more people in the hospital for any length of time now because of managed care,” Soutter said.

Even so, Sichel recommended anyone who is suspicious that they may have symptoms of PPP seek medical attention immediately.