One Mother's Story
Postpartum Psychosis: Rare, Frightening and Treatable

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Shelley Ash

After narrowly conquering her own bout of postpartum psychosis, Shelley Ash became a health professional so she could help others with the disorder.
Photo: Dan Ash

Feb. 18, 2002 -- Today in Houston, a jury will begin hearing testimony in the murder trial of Andrea Yates. She's accused of drowning her five young children last June. Her lawyers have said she'll plead not guilty by reason of insanity, citing her history of postpartum depression with psychosis. For Morning Edition, NPR's Joanne Silberner reports that the condition is rare, frightening -- and treatable.

When Shelley Ash of San Jose, Calif., was pregnant five years ago, she read all the baby books she could. She never came across the term postpartum psychosis. Then she gave birth to her son.

"I knew right away something was wrong," says Ash. She sensed she was watching the delivery from above. She was terrified. Hospital nurses told her the feeling would pass. It didn't, even after she and her baby went home.

Ash says was pacing all the time, and caught in a horrible depression. She was constantly crying, couldn't sleep and couldn't eat.

Symptoms of Postpartum Psychosis

Postpartum psychosis is a more rare and severe disorder than postpartum depression. It affects about 1 in 500 to 1,000 new mothers. Onset is severe and quick, and should be treated as a medical emergency. Symptoms include:

Delusions, or false beliefs.

Hallucinations -- hearing voices or seeing things that are not real.

Thoughts of harming or killing the baby.

Unwillingness to eat or sleep.

Frantic energy.

Severe depressive symptoms.

This wasn't the "baby blues," a temporary anxiety and depression that hits about three-quarters of mothers. Nor was it the postpartum depression that afflicts one in 10 new mothers. As Ash eventually learned, she was suffering from postpartum psychosis, which hits about one in 500 to one in a 1,000 mothers within three months of birth.

"Postpartum psychosis is condition in which the person loses touch with reality," says Dr. Ralph Wittenberg, who runs a postpartum screening project in Washington, D.C. Mothers hear voices, see things and feel an irrational guilt that they've somehow done something wrong, he says. Without treatment, women may try to hurt themselves or those around them.

What was happening to Ash was beyond her control. Postpartum psychosis sometimes develops out of postpartum depression, or hits women who've had previous psychiatric problems. Sometimes, as in Ash's case, it shows up out of the blue. Psychiatrists aren't sure what causes such a sudden and powerful break with reality, but they believe the changing hormones and stress of childbirth are somehow involved.

Symptoms of Postpartum Depression

About 70 percent of new mothers get the "baby blues" -- feelings of anxiety and irritability that can hit three or four days after delivery, but disappear quickly. Postpartum depression, which can appear even a year after giving birth, is more severe and can last for months, if not treated. About 1 in 10 new mothers experience the disorder. Symptoms include:

Severe sadness or emptiness; emotional numbness or apathy.

Withdrawal from family, friends or pleasurable activities.

Constant fatigue, trouble sleeping, overeating or loss of appetite.

A strong sense of failure or inadequacy.

Intense worry about the baby or a lack of interest in the baby.

Thoughts about suicide; fears of harming the baby.

Ash knew she was getting worse. The midwife in her obstetrician's office told her to call a psychiatrist. But that was the last thing Ash wanted to do.

"I was terrified," says Ash. She was having delusions and was afraid that if she told anyone about what she was thinking or seeing in her mind, they would take her son away.

But after one episode, she became desperate.

She remembers watching David Letterman drop watermelons from high places on his television show. "But that turned into my son," she says. "I kept imagining how it would be to drop him out of his bedroom window and he would go splat on the pavement below and shatter into a million pieces."

The image was too much for her. Ash went to her bathroom cabinet and took an overdose of painkillers she had been prescribed for a previous back injury.

Her husband came home from a run to find her on the floor in the front hall, babbling, and he rushed her to the hospital. That pattern isn't unusual, says Dr. Nada Stotland, who specializes in women's health. Stotland says women with postpartum psychosis tend to know that something's wrong, but like Ash, they're often terrified to let anyone else know. Health professionals and family members need to recognize that delusions and really erratic behavior are sure signs of trouble, and that hospitalization and medication are needed, says Stotland.

Ash was hospitalized for a few days. She then spent 18 months on anti-psychotic, anti-depressant and anti-anxiety medications. Her son is now 5 years old and healthy. Ash got a graduate degree in public health so she could educate people about postpartum psychosis. She couldn't be happier now about her own health, or the health of her son. But she's not having any more children.

It's not worth the risk of getting sick again, she says. There's a 10 to 20 percent chance that without treatment, she would, according to British research. But Stotland and others say that with treatment at the first sign of a problem, women with a history of postpartum psychosis can safely have more babies. And while neither psychiatrist would comment on Andrea Yates -- the woman who killed her five children -- both say that the tragedy whenever a case of postpartum psychosis ends badly is that most likely it could have been prevented.

Join the Discussion

Postpartum depression and psychosis often go unrecognized and untreated. Weigh in with your thoughts or experiences with the disorders at NPR's discussion board.

In Depth

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Other Resources

Postpartum Support International is a nonprofit resource and support center sponsored in part by the Indiana University of Pennsylvania. Visit its Web site for listings for support groups worldwide, online chat rooms and bulletins, book recommendations and information on postpartum illness.

• Read a factsheet on postpartum illness, provided by the Office on Women's Health.

• Visit Depression After Delivery, Inc., a national, nonprofit organization, for other resources, including telephone support and referral services for women and families coping with mental health issues associated with childbearing.

• Search through the National Library of Medicine's resources on postpartum depression.

• Read the American Psychiatric Association's factsheet on postpartum depression. (Adobe Acrobat Reader required)

• Browse through Postpartum Support International's list of Web sites dealing with postpartum illness.