Understanding Postpartum Psychosis: Rachael Watters (Transcript)

Here is the full transcript of Rachael Watters’ talk titled “Understanding Postpartum Psychosis” at TEDxHieronymusPark conference.

Listen to the audio version here:

TRANSCRIPT:

This is a photograph of my family, featuring our four healthy, beautiful children. While the road to this picture was anything but an enviable process, the birth of my daughters Adeline, in my husband’s lap, and Chloe, the baby, found our family, myself and my well-being in particular, teetering on the edge of catastrophe. Today, I want to talk to you about postpartum psychosis. I am not a psychiatrist or an expert in the field of perinatal mood and anxiety disorders.

My Personal Experience

My experience with this condition is personal. I experienced postpartum psychosis after the birth of our second and fourth children. I hope that by sharing my experiences, I can begin to break down the stigma surrounding perinatal mood and anxiety disorders and bring hope and healing to those going through something similar. Our society paints this picture that the only acceptable feeling to have after the birth of a child is overwhelming joy.

And while for most, the first few months following the birth of a baby are filled with incredible joy, for many, including myself, this joy is abruptly interrupted by severe depression and anxiety. One in seven women experience a perinatal mood and anxiety disorder in the first year following the birth of their child. Let my story be the catalyst that allows each of you to reflect on your own stories. If I can bring hope to even one mother suffering in silence, then it gives purpose to the trauma that I experienced.

The Onset of Postpartum Psychosis

Our family moved to Montana when I was four months pregnant with our second child. At almost two years old, my son was still not sleeping through the night. So as I prepared for the delivery, I was already completely exhausted. A couple weeks after giving birth, I began to fear sleep because sleep brought vivid nightmares.

Overwhelmed and fueled by dread, I would lay in my bed at night. But this was more than just insomnia. As in wakefulness, the nightmares still found a way in. I began to lose touch with reality, but I didn’t tell my husband about the deeply disturbing thoughts I was having, because I was afraid that he would think that I was unfaithful to be around the kids if I did.

As my mental state declined, panic attacks, hallucinations, and delusions mounted. My son was possessed. There were demons in the bathtub. And all day long, I heard radio music playing in the background, and it was followed by the sound of glass breaking and the play gym crashing over and over.

All day long, I fought the voices, and I lived in fear. Remembering the next part of the story is like trying to recall pieces of a dream upon awakening. My husband and I were out for a run, and I suddenly stopped and turned to him and said, “I have to go home right now and say goodbye to the kids.” My husband said, “Why?” And I replied, “Because I’m going to kill them.”

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My husband, who is a physician, recognized that I was experiencing postpartum psychosis, and he immediately took me to the appropriate health care professionals, and a treatment plan was initiated. In retrospect, I am so grateful that he had this knowledge, and that he knew where to go to get the help that I so desperately needed. It is the unfortunate case that for too many women, their support system has no knowledge regarding postpartum psychosis, and they don’t know where to go to get the support that the woman needs before she takes her own life or the life of her child.

Understanding Postpartum Psychosis

So what is postpartum psychosis? It is one of six perinatal mood and anxiety disorders, including depression, anxiety, or panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, bipolar disorder, and psychosis. Although these disorders can occur at any time in a woman’s life, there is a marked increase in prevalence during pregnancy and in the first year postpartum.

Postpartum psychosis is a rare maternal mental health illness occurring in one to two out of 1,000 women who give birth. It is a potentially life-threatening medical emergency, generally requiring rapid intervention, hospitalization, and psychiatric management. Who is at risk for this condition? Postpartum psychosis is strongly and consistently associated with bipolar disorder. Most women who experience it have a history of bipolar disorder or go on to develop bipolar episodes outside of the postpartum period.

However, 50% or more of women who experience postpartum psychosis have no psychiatric history. Today, I’d like to talk about three risk factors for postpartum psychosis, the first being familial history. This will be a personal or familial history with bipolar disorder, schizophrenia, or schizoaffective disorder. Trauma is also a major risk factor, especially a childhood trauma of sexual or physical abuse.

And finally, insomnia. Sleep deprivation can cause a psychotic break, and there’s evidence to suggest that severe sleep deprivation may be a trigger for postpartum psychosis.

So what are the symptoms that a woman experiencing this condition may display? There may be delusions, often religious in nature, visual hallucinations, like seeing someone else’s face in the place of your baby’s face. For me, I saw my face morph into my mom’s face, morph into my grandma’s face. There may also be auditory hallucinations or hearing voices. This would be the radio music that I experienced. There might also be catatonia in following a psychotic episode.

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My husband said that after I threatened to kill our kids, that I had a very distant look on my face, as if I wasn’t even aware of what I was saying. There may also be a disorganized thought process. Leading up to my manic break, I was aware that I was losing touch with reality, and I was trying to make sure that what I was thinking made sense, which it didn’t.

But I would ask my husband if he saw what I saw or heard what I heard.

After my manic break, I tried so hard to think myself back to the realm of normalcy, and I blamed myself a lot. I constantly asked how long am I going to feel this way, and when am I going to feel better? My husband didn’t have the timeline that I was so desperately grasping for, but he assured me that I would recover. A woman may also have strange beliefs.

I thought that everything that I read on billboards and books and magazines were direct messages telling me what to do, and I also felt like I had this divine power to affect the universe. The symptoms may present in a waxing and waning fashion, which means that the woman can appear normal and lucid in between the psychotic symptoms. Postpartum psychosis is treatable. A treatment plan usually includes medications, sleep aids, short-term psychiatric hospitalization, and counseling.

The Importance of Support and Awareness

The tragedy of postpartum psychosis is when women don’t share the true thoughts and images going through their minds because they fear the negative repercussions that may come from doing so. What if they take my kids away? What if they lock me up?

After I recovered from my first episode of postpartum psychosis, I became aware of an incredible resource called Postpartum Support International, or PSI. They are the leaders in education, treatment, resources, and current research on perinatal mood and anxiety disorders. PSI’s universal message is, “You are not alone. You are not to blame. And with treatment, you will get better.”

This message is vital to women experiencing perinatal mood and anxiety disorders because there is so much shame, blame, and stigma surrounding maternal mental health conditions. Speaking these words is life-giving to women that may be struggling with their condition completely alone out of fear of judgment or the negative consequences of sharing those true thoughts running through their head.

So what are the consequences of untreated postpartum psychosis? Suicide is the leading cause of paternal death up to one year postpartum. In women with postpartum psychosis, 5% commit suicide. Infanticide is also a very severe consequence of not treating the disorder. A third of women hospitalized for postpartum psychosis express delusions about their infants. And sadly, 4% kill their child.

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In the height of a manic episode associated with postpartum psychosis, women may also commit other acts that cause them to spend years in mental hospitals or even in prison. We must break down the stigma surrounding postpartum psychosis and other maternal mental health conditions.

Women who may never have told anyone about their true thoughts and feelings after the birth of their child need to know that they are not alone. Everyone in this audience who is a mother, who knows a mother, and who one day may be a mother need to be aware of the reality of perinatal mood and anxiety disorders.

Conclusion

Break the epidemic of silence and allow women to feel safe sharing their true thoughts and feelings in the postpartum period without passing judgment, without labeling them as crazy, and instead guide them to the resources available to provide hope and healing. If you are a health professional that works with women who are pregnant or in the postpartum period, seek out continuing education on perinatal mood and anxiety disorders, how to treat them, and how to recognize them.

If you know a woman who has just had a baby, seek her out. Ask her if she’s sleeping or if she’s having any kind of thoughts or images that she’s been afraid to share with anyone. If we do this, and the woman that may be listening to this right now feeling like there’s no hope, that she will feel crazy forever like I did, I want to speak to you and say you can make it through this and you can take care of your child again. You can take care of four children.

And we all have days where we feel like we’re losing it. But if we can support one another as a community, if we as friends and family members and community members recognize the vulnerability of women that bringing a child into this world can create, then we can foster healthy mothers and we can support women in their greatest time of need. It is time that our society pay as much attention to the mother as the adorable baby that she was responsible for bringing into this world.