Postnatal psychosis, an extrememe psychiatric form of postnatal depression, occurs after birth in a small percentage of women. Many recover, but some do not.
Postnatal psychosis, an extrememe psychiatric form of postnatal depression, occurs after birth in a small percentage of women. Many recover, but some do not.
Cindy Wachenheim was someone people didn’t think they had to worry about. She was a levelheaded lawyer working for the state Supreme Court, a favourite aunt who got down on the floor to play with her nieces and nephews, and, finally, in her 40s, the mother she had long dreamed of becoming.
But when her baby was a few months old, she became obsessed with the idea that she had caused him irrevocable brain damage. nothing could shake her from that certainty, not even repeated assurances from doctors that he was normal.
On March 13, 2013, Cindy, 44, strapped her 10-month-old son to her chest in a baby carrier and leapt to her death from the eighth-floor window of her Harlem apartment. “I became so low,” she wrote shortly before she jumped, “thinking that if I had unknowingly caused brain damage to my beautiful, precious baby, I didn’t want to live.”
More Than The Blues
“We did try to help her, but perhaps if we had been more knowledgeable about postpartum mood disorders, including the fact that postpartum depression is just one of an array of such mood disorders, we could have done something differently that would have maybe saved her life,” Deb, Cindy’s sister, wrote in an email.
Cindy’s experience defied the longheld belief among doctors and experts that symptoms emerge within a few weeks after birth. She seemed fine until her son was about four months old, said family and friends. And as a healthy, active woman, Cindy had no risk factors that would signal a mother likely to become delusional and suicidal.
“She loved life, she loved family, she was social,” said her sister-in-law, Karen Wachenheim.
In fact, Cindy, long interested in women’s issues and social justice, had, years earlier, identified postpartum depression in Karen. “Cindy would call at least once a day to check on me,” Karen recalled. “She said, ‘Maybe you have postpartum; I think it’s past the baby blues.’” At Cindy’s urging, Karen got therapy and medication, recovering quickly.
A Son Who Was “My Heart”
Cindy married at 40, and underwent fertility treatment with her husband. She miscarried twice. But family and friends said that while mourning those losses and dealing with fertility hormones, she remained hopeful, noting that doctors said it was a good sign she had been able to become pregnant.
Experts say little evidence links fertility treatment to postpartum mental illness; indeed, becoming pregnant may bring more joy than stress. Still, Wendy. Davis, the executive director of Postpartum Support International, said some women experience cumulative stress from “fertility treatments, many losses and the very, very high expectation she will enjoy this new baby”.
Eventually, Cindy was able to conceive and have an uneventful pregnancy. Her only out-ofthe-ordinary response being a tendency to be hyperaware of whether the foetus was kicking.
Cindy gave birth normally and adored her son, often calling him “my heart”.
Beginnings Of A Problem
But when her son was four months old, Cindy emailed Deb that he was making “strange/ jerky movements with his right arm,” almost “flapping like a wing”.
The paediatrician said it was nothing to worry about, but Cindy scoured the Internet for diagnoses. She fixated on an instance a few weeks earlier, in August when, while washing clothes, she left the baby on a play mat on the floor. He fell while pushing up, hitting his head.
She believed this minor episode had caused him severe neurological problems: Seizures, autism and concussion. She blamed herself for leaving the room, for placing the play mat on the hardwood floor. Other incidents alarmed her, and she decided he was more irritable, smiling less.
She visited two paediatric neurologists and then an expert in cerebral palsy because her son did not always exhibit the Landau reflex, a Superman-like pose babies make when held aloft, stomach-down.
She also emailed another doctor she had seen about her son’s possible brain injuries. The doctor assured her that her son was fine, “All of his movements look like normal, ageappropriate movements to me.”
Consumed With Worry
Experts say such breaks from reality are likely symptoms of postpartum psychosis, which affects only one or two in 1,000 mothers. About four percent of those hurt their children; about five percent kill themselves. Flagrant cases usually emerge soon after birth; women may hear voices or feel compelled to inflict harm, like Andrea Yates, who drowned her five children in a bathtub in 2001, or Dena Schlosser, who in 2004 cut off her infant’s arms. Both women were ultimately found not guilty by reason of insanity.
Most other maternal mood disorders do not involve such unshakably unrealistic convictions; most women know something is wrong, and although they fear they will harm their children, they rarely do.
At a Thanksgiving family gathering in 2012, Cindy, normally outgoing, seemed consumed with her son’s purported problems. She told Deb she had thought about suicide, saying “How can you go on knowing that you’ve ruined your baby’s life and it was your fault?” Deb was stunned. She and Cindy’s husband discussed the situation, hopeful that therapy would help.
The next month, Cindy began seeing a psychiatrist, who prescribed Zoloft, an antidepressant. She briefly visited other counsellors for talk therapy, and friends offered support and company.
Cindy seemed to be getting better. One January weekend at her brother, Ron’s house, she seemed more engaged, smiling more. She discussed returning to work and finding day care.
On a visit to her mother-in-law on Long Island, she called Deb while strolling by the ocean and sounded good. But the next day, Sunday, the baby fell while pulling up on a chair in his grandmother’s kitchen. Cindy considered it another disastrous “head hit”.
On Tuesday, distraught and worried about her baby, Cindy uncharacteristically canceled her psychiatrist’s appointment, citing rainy weather as a reason. On Wednesday, as she sometimes did, Cindy asked her husband to come home from work. When he arrived, she said that their son’s morning had been rough but that she was feeling better. After a few hours, he returned to work.
That afternoon, with her baby snug to her chest, she jumped.
“I am so unbearably sorry, which I know does nothing to undo the evil I have done,” her farewell note began. “I wanted to be a mother so badly and I hoped to be a wonderful one, and instead I have become the worst of the worst.”
Cindy Wachenheim would never know that in her last act, her body cushioned the fall for her son and saved his life. Weeks later, the healthy little boy took his first steps.
I wanted to be a mother so badly and I hoped to be a wonderful one, and instead I have become the worst of the worst
– Cindy, in the note she wrote before she committed suicide
More than just the baby blues
Postnatal Depression (PND) is a medical illness commonly mistaken for the postnatal blues. however, while the blues last about two weeks and don’t require treatment, PND is a more severe and longer-lasting condition that should be treated.
1 UNUSUALLY LOW MOOD
This means having a “low mood through most of the day on most days,” says Dr Cornelia Chee, director and senior consultant at the women’s emotional health Service, NUh.
2 EXHAUSTION
Mothers may feel “very tired or low in energy levels, and have sleep problems – either the inability to sleep even when the baby is asleep, or conversely, oversleeping”, notes Dr Chee.
3 NEGATIVE THOUGHTS
“worrying about your baby is natural,” says ho Shee wai, director and registered psychologist at The Counselling Place, “but if you feel uncontrollable anxiety or are afraid to be alone with your baby something more may be amiss.”
4 FEELINGS OF HOPELESSNESS
“Mums often report feeling overwhelmed and not up to the multiple tasks of looking after the baby,” says Dr Chee.
