Mental Health 101 is an ongoing series where I discuss a mental health concern that is common throughout pregnancy or early parenthood. I’ve previously written about “the baby blues,” the global prevalence of postpartum depression, and intrusive thoughts.
This week I talk about the relatively rare yet serious condition of postpartum psychosis, as well as how such experiences may be more relatable than you think.
Mental health difficulties can be thought of as manifestations of stress. This is obviously oversimplifying incredibly complex experiences, and, yes, biology and genetics play a role, but stress and other environmental factors arguably play just as large (if not larger) roles. This is one reason why giving birth (a very stressful experience) is associated with an increased risk of mental health difficulties, including psychiatric emergencies. Psychiatric hospitalizations occur when someone is experiencing a severe mental health concern, such as a mother wanting or trying to harm herself or harm her child. Especially for first-time mothers, there is an increased risk of first-time hospital admission for psychiatric reasons during the first three months after delivery. A population-based study that examined the records of over 2.3 million people in Denmark found that in the first three months after having a baby, 1.03 first-time mothers per 1000 births experienced a psychiatric hospitalization, compared to 0.37 fathers per 1000 births.1
One of the more common conditions that results in hospitalization is postpartum psychosis. Psychosis is a scary, loaded, confusing term for many people. To put it as straightforwardly as possible: Psychosis is a condition when someone has trouble telling the difference between what is real and what is not. They may see, hear, or sense things that are not there (hallucinations), believe things that are not true (delusions), start behaving in ways that may seem unusual to an outside observer, or have difficulties communicating or thinking clearly. Psychosis is associated with a variety of mental health diagnoses, including schizophrenia, depression, and bipolar disorder. It can also occur when someone takes psychedelic drugs, like LSD or ketamine.
Postpartum psychosis occurs in approximately 1-2 out of every 1000 deliveries and while it is more common in people with a history of mental health concerns, about 40% of people who experience it have no history of psychiatric illness2. Postpartum psychosis is most likely to happen soon after giving birth (within the first few weeks) and is often experienced as a rapid onset where symptoms become severe in a very short amount of time. A mother may suddenly start hearing voices in her mind telling her to harm her baby, or she may start believing that the baby is not hers or that some unknown force is going to take her baby away. However, not all mothers experience hallucinations or delusions that are specific to their baby - for a first-person account of postpartum psychosis, check out this piece by Lisa Abramson in the New York Times. Hospitalization and medication is usually necessary to help a mother recover, with recovery taking a few weeks to a few months. As you can imagine, this can be incredibly traumatic for mothers and their families.
Forde, Peters, and Wittowski (2020)3 conducted a “meta-synthesis” (i.e., a review of qualitative studies) of 15 studies where 102 mothers who experienced postpartum psychosis, along with 42 of their family members, discussed what the experience was like for them. The researchers identified common themes that arose across all of these studies, and while these experiences are in some ways unique to these mothers, I found myself relating to many of these themes. One theme the researchers identified across studies was “experiencing the unspeakable,” where mothers discussed feeling trapped inside their minds, feeling hopeless and alone, being unable to talk about their experiences with loved ones, and having trouble bonding with their baby. The researchers also identified a theme related to “loss and disruption,” including mothers and their family members feeling powerlessness and guilt (mothers missing out on a crucial time to bond with their baby, family members missing signs that something was wrong with their partner). The third theme was “realigning old self and new self,” where mothers discussed their recovery and trying to see their experience as something that made them more resilient and empathic towards others experiencing mental health struggles. Finally, the fourth theme was “social context,” including discussions around family, the healthcare system, and societal expectations of motherhood. Mothers discussed family members and health care providers as “double-edged swords” of both support and strain, facilitators and barriers to recovery.
One woman discussed how much shame she experienced, which I think is relevant for any mother who struggled after having their child:
It’s a double whammy. Not only the stigma of being mentally ill, you have got the stigma of being a mentally ill mother, a bad mum.
All of this is to say that, regardless of any mental health struggle you may have experienced, it’s easy to feel like you are living something unspeakable when you are experiencing difficulties with early parenthood. It’s important to remember that you are not alone in your struggles, parenthood is one of the most stressful life experiences there is, and there is help if you need it. For a variety of reasons outside of our control, some people experience psychosis as a result of that stress. Notably, it’s estimated that 40% of people who experience postpartum psychosis do not experience subsequent severe episodes, and for those who do, there are evidence-based treatments to help in one’s recovery.4
If you or anyone you know is experiencing postpartum psychosis, Postpartum Support International has a hotline (1-800-273-8255) and great resources on their website.
Munk-Olsen, T., Laursen, T. M., Pedersen, C. B., Mors, O., & Mortensen, P. B. (2006). New parents and mental disorders: A population-based register study. JAMA, 296(21), 2582-2589. https://jamanetwork.com/journals/jama/fullarticle/204395
Perry, A., Gordon-Smith, K., Jones, L., & Jones, I. (2021). Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain Sciences, 11(1), 47. https://doi.org/10.3390/brainsci11010047
Forde, R., Peters, S., & Wittkowski, A. (2020). Recovery from postpartum psychosis: a systematic review and metasynthesis of women’s and families’ experiences. Archives of Women's Mental Health, 1-16. https://link.springer.com/article/10.1007/s00737-020-01025-z
Gilden, J., Kamperman, A. M., Munk-Olsen, T., Hoogendijk, W. J., Kushner, S. A., & Bergink, V. (2020). Long-term outcomes of postpartum psychosis: A systematic review and meta-analysis. Journal of Clinical Psychiatry, 81(2):19r12906. https://pubmed.ncbi.nlm.nih.gov/32160423/