Postpartum Psychosis: The Birth of a Nightmare

By Michelle Visser, LMHC, CEIS

“You just had a baby a week ago, it’s okay to rest,” my friend said.

“No need, I have so much energy! I’ve done all of the laundry, prepped meals for the week, and wrote thank-you cards for all of the gifts. I still need to check all of the locks on the doors and windows again, just in case they come for her.”

“You’re speaking so quickly; I can hardly understand what you’re saying. In case who comes?”

“Thank you for your visit, but I really just need some space.”

After my friend finally left, I was able to think more clearly despite my mind still racing. There was that voice again. “It’s time. No more waiting. You know what you need to do.”

“Yes, yes. I know. I hear you.” The voice just wouldn’t stop. It grew more and more urgent. I looked at my baby lying in the bassinet. I must protect her. I must do whatever it takes to keep her safe. Everything around me felt so intense, overwhelming. The sound of the cars outside was a reminder that at any moment, it would happen. They would come for my baby. There was nothing I could do to protect her. And then it happened, I saw them looking in the windows, their eyes staring right at me. I heard them talking, but couldn't understand what they were saying.

 “Now!” the voice screamed. “If you really love her, you’ll do it.”

I knew the voice was right, I had no choice. I grabbed my baby.

*The above is not a description of an actual event, though it is an accurate portrayal of how Postpartum Psychosis can present. *

Postpartum psychosis 

Postpartum psychosis affects 1-2 mothers per 1,000 births. Among these mothers, there is an approximate 5% suicide rate and approximate 4% infanticide rate. Those who are most at risk have a history of Bi-Polar Disorder, a family history of Bi-Polar Disorder, or a previous psychotic episode. It typically presents within the first 2 weeks postpartum but can happen at any point during the postpartum year.

Many who experience psychosis never become violent or have violent delusions. It is not uncommon for the delusions to be religious-based. For example, many report hearing the voice of God telling them what to do. Lack of violence does not make the condition any less serious. Psychosis tends to present suddenly and can be extremely unpredictable, which is why immediate help is necessary.

Symptoms can include:

• Delusions or strange thoughts
• Hallucinations
• Extreme irritability
• Hyperactivity
• Decreased need for sleep
• Rapid mood swings
• Paranoia or suspicion
• Trouble communicating

Seek emergency help

When someone is showing any of these signs, it is important to seek emergency help. This can include mental health crisis hotlines (more information below) or 911. Calling a doctor or, worse, waiting until the next scheduled appointment is not appropriate for possible psychosis. A person in this position needs immediate help from a trained professional.

Hospitalization and medication are almost always needed. During the stay, the patient will be fully assessed and observed and not released until they are no longer a threat to them self or others. Even after a hospitalization, patients often need ongoing therapy until recovered.

The good news is that recovery is absolutely possible. Most patients who receive timely and appropriate care recover and return to their previous selves. They go on to parent their children and live normal lives.

Talk, Ask, Listen, Watch

No matter who we are, there are 4 important things we can do when interacting with new parents: Talk, Ask, Listen, and Watch.

We can talk about our own mental health challenges (when appropriate) to lessen the stigma. It’s much easier to admit that you’re struggling when you hear that others also have. If you’re a provider, have information about mental health clearly visible and available in the place you practice. Talk about how common mental health challenges are during the perinatal period.

Ask. If you’re a professional, you must screen ALL of your patients. Giving them a survey in the waiting room isn’t enough. Take the time to ask deep questions, even if they make you uncomfortable. Practice with a colleague if you need to. If you’re a friend, partner, sister, mother, or co-worker, take the time to check in on those who recently had a baby. Keep this up even after the newborn stage. Ask them how they’re doing, don’t just coo over their baby.

We must listen in a way that truly welcomes any answer. We must be prepared for what we invite. This might come as a surprise, but listening requires being silent and giving space. The act of listening doesn't include sharing our personal experience or giving advice. Truly listening is one of the best gifts we can give others.

We must also watch. Do your patients, friends, loved ones seem like themselves? Is their behavior what you’re used to? Does it seem odd? Are you noticing any of the symptoms listed above? Trust your gut. It will tell you when something just doesn’t feel right. If that happens, you don’t have to have the answers, you don’t have to be sure, you just need to lead them to someone who is trained to help.

No one's fault

As with all mental health conditions, Postpartum Psychosis is no one’s fault. You don’t need to wait until all symptoms are seen to get help. If you suspect that you or someone you care about might be suffering from Postpartum Psychosis, please seek help immediately.

Don’t wait, time is a precious thing, and so are mothers.

For more information and help

Postpartum Support International (Postpartum.net)

• Free online support groups, information for parents and providers, helpline
• Call or text 1-800-944-4773

Crisis Text Line (Crisistextline.org)

• Free hotline via texting for a variety of crises
• Text HELP to 741741

Suicide & Crisis Lifeline (988lifeline.org)

• Hotline for general crises as well as specific to maternal mental health
• Call 988

National Maternal Mental Health Hotline (mchb.hrsa.gov/national-maternal-mental-health-hotline)

• Free hotline for expectant and new moms
• 1-833-9-HELP4MOMS

References

1. Postpartum Support International. (2020). Postpartum Psychosis. Link to Postpartum Support International

About the Author / Michelle Visser, LMHC, CEIS

Michelle Visser is a Licensed Psychotherapist and Certified Early Intervention Specialist. Michelle’s career has included in-home and private practice therapy. Working with individuals as well as groups, she has assisted those struggling from perinatal mental health challenges, unexpected outcomes of pregnancy and childbirth, and general adjustment to parenting. Currently, Michelle creates and facilitates training for non-mental health professionals and parents on perinatal mental health. Current offerings can be found at Link