The case of Lindsay Clancy, a Massachusetts mother accused of killing her three children, has put postpartum psychosis at the center of debate in the United States.
Clancy’s defense has argued during the trial in Plymouth Superior Court, Massachusetts, that this condition and the lack of adequate medical care led her to commit these acts. Postpartum psychosis affects up to two in every 1,000 women after giving birth.
To help better understand this condition, Noticias Telemundo spoke with psychologist Edith Shiro.
What exactly is postpartum psychosis?
It is a diagnosis given to people who, after giving birth, go through a stage, a diagnosis of postpartum depression. It can end in a psychotic episode, which means that the person is out of touch with reality.
It generally manifests itself with hallucinations, delusions, paranoia, some voices, some visual auditory sensations that cause the person to perhaps behave and react or say or do things that are out of touch with reality. Generally this lasts a short time, a few moments, that is, it lasts a few hours, a few days, but it is not a chronic situation of days, weeks and months.
After giving birth we also hear terms like baby blues and postpartum depression. How is postpartum psychosis different from these two conditions?
This is an extremely important distinction to make when a person gives birth because of the hormonal change, because of the differences between how the body manages itself to breed, for a baby to develop inside the womb. There are hormonal changes, there are psychological, emotional, physiological, social changes, which happen not only at the level of the person’s body, but at the level of the environment.
So, it is very common for most people who are pregnant when they give birth. Have what we call baby blues It can last one or two weeks, where you feel like crying. You are a little sadder. It’s like a hormonal variation that happens in most people. Now, if these types of symptoms last over time for weeks and months and even years. This is what becomes a diagnosis of postpartum depression.
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This happens when the person feels unmotivated, anxious, depressed, that they have no desire to live, that they do not connect with the baby…, they feel that they have no social, emotional, or family support. This is a diagnosis that is very important to attend to. It has medical treatment, psychological treatment, it happens in some cases, it is a recognized diagnosis and it has a solution. Now, very rarely there can be psychotic episodes within this postpartum depression. They are specific moments where the person loses contact with reality and has hallucinations and auditory or visual illusions that cause them to react without having control of what they are doing. That can happen but it is quite rare. So it is important to make these diagnostic distinctions in the person.
What are the main warning signs of postpartum psychosis that a woman and her family should take into account?
The issue of diagnosing postpartum psychosis is a moment of emergency. That is, the person enters an episode where their biological, chemical, physiological, emotional, and mental balance is out of control in the sense that there is a lot of imbalance and it has to be addressed immediately. I say that as postpartum psychosis or psychosis of any kind. That is, there are other diagnoses such as some types of bipolarity, schizophrenia, where the psychotic episode has to be treated immediately because the person can harm themselves, they can harm others because they are not in contact with reality.
Signs include talking things that don’t make sense, behaving in ways that don’t make sense. Not functioning on a day-to-day basis the way anyone else might. I mean, it’s pretty obvious when a person is psychotic.
Is there a period after giving birth when a woman’s risk is highest?
Beyond the period that is at risk. (you have to see) what antecedents there may be. I think it is very important to recognize that a person who is about to give birth has had major physiological changes. On top of that, you bring a baby into the world, you need social support, family support, and a lot of times that’s not the case. The levels of stress, anguish, anxiety, worry are quite high on an economic level, on a social level, on an emotional level and this can affect the development of postpartum depression. But be careful, that (occurs) along with genetic, physiological and social factors. It is a confluence of variables.
Does a woman experiencing postpartum psychosis always show obvious symptoms or can she have moments when she appears to be functioning normally?
Psychosis is a very particular and specific moment that lasts a short time. Postpartum depression can last for months and years. So, it is important to make that distinction. Postpartum depression isn’t necessarily identified as quickly because you can say, well, the person is worried, they’re stressed, and it’s a little bit harder to diagnose, especially when you’re not paying attention to that. That usually happens many times when you’ve already had a baby and then you have another, and usually the reaction is this postpartum depression. It may be that once it happens it will happen again.
Postpartum psychosis is a moment in time, it is an episode, so it is quite identifiable and should be treated immediately. That is, it is not that it lasts over time, but rather it is a quite concrete and specific moment.
When we talk about losing touch with reality, what does that mean in practice?
That means that the person’s awareness of understanding what is happening in their surrounding context is not there. So, what you are perceiving with your senses is not working in the same way as you and I may be seeing it. So I can be standing here looking at you. But when a person has psychosis, they do not see that, but rather they see a hallucination, that is, reality is distorted, they are disconnected. What lights up is another part of the brain that begins to have visual or auditory stimulation. You start hearing voices. Maybe there are people who are more paranoid, there are people who see things and people who hear. There are people who feel things on their skin. Maybe they have religious hallucinations. It’s like being (using) psychedelics, for example. In other words, it is very similar to that experience of using psychedelics where you disconnect from reality and are in a slightly more fantasy world, outside, in another dimension. I know it’s hard to explain, but pretty relatable. When a person is psychotic it is quite obvious.
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Are there women who are more predisposed to postpartum psychosis? For example, does having previously suffered from anxiety or depression increase the risk after giving birth?
I think they are genetic variables, social variables, family variables and I think that the greatest prediction for knowing that a woman can develop postpartum psychosis is that she has had it before. So if there was that trend before, the probability of it happening again is greater. I don’t know how predictable it is in general, because sometimes it’s a combination of several factors that makes this happen. We can’t always predict when it happens.
In some Latino families there is a lot of stigma around mental health. How might that affect a mother who begins to experience symptoms after giving birth?
Look, that’s a good question. Many times mothers have lived not only the baby bluesbut this postpartum depression very isolated, very alone and without support, perhaps with a very big stigma that ah, well, if you have a baby, if you are a mother you have to be very happy, very grateful or celebrating this.
It is important to identify that there are ways to intervene, to care for and to help and improve postpartum depression and that it can be something that can be managed so that it is not a problem for mothers or for the family in general. Part of what we have to take into account is more social support, more family support. Understand that a child is raised. In other words, the support of an entire village is needed to raise children, this is not the responsibility of a single person. You have to pause and address these symptoms and seeking professional help is essential.
What if a partner, family member, or this same person notices signs that could point to postpartum psychosis, what should they do at that time?
Note, postpartum psychosis is more difficult to predict for the person experiencing it and for the people around them. But postpartum depression, especially if you have experienced it before, you should know that you (should) seek professional help. (Make sure that) you are taking the necessary medication, that you are getting the necessary family support, that you are getting people around you and strategies that can help you with the newborn baby, with the other children in the house, with household chores, with basic needs.
Once an episode of postpartum psychosis is identified, how is it treated and what is the recovery process typically like?
Psychosis, like any psychosis, the psychosis of depression, schizophrenia, and bipolarity is treated with medication and is an emergency that must be immediately treated. The person is under observation for a couple of days, a couple of weeks, until the medicine takes effect. There has to be psychological support where there is also therapy and where the emotional and psychosocial part is worked on. If these instructions are followed and these interventions are performed, the person can return to fairly good functional stability. Yes, professional, medical and psychological intervention is necessary.
Do you think a case like Lindsay Clancy’s can drive changes in the way maternal mental health is cared for in the United States?
I always love to see how specific cases open up dialogue and conversation. And I am very grateful that especially since the pandemic, the issue of mental health has taken a position at the forefront and has become an important priority. So for me that is a huge advance in our society and in our Latin culture as well, where more and more people are open to therapy.
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It’s about talking about emotions, recognizing how important it is not only for adults, but also educating children as well. So opening a conversation about postpartum depression is very important. (…) Because many times what is given is a stigma. What is your problem? Because you are sad, you have to go to work, take care of your children when in reality this diagnosis of chronic depression is real and prevents you from having the motivation, the desire, (and brings) hopelessness, anxiety, lack of motivation. (It leads you to) say that life has no meaning and you don’t have the energy and strength to move forward. That is very important to recognize, address it and support the people who are experiencing this.
What would you say to a mother reading this interview who feels like something is not right after giving birth, but is afraid or ashamed to ask for help?
Well, first I want you to understand that it is normal for a mother after giving birth to have the baby blues. It is normal for the body to regularize itself. So, you have to give time, patience and care to the body, mind and emotions.
After giving birth, you have to seek a lot of social and emotional support to be able to move forward. If you feel that you are having these symptoms of depression, that they are lasting longer than is really expected, that you have been feeling this way for months, (you must) have the strength and courage to talk about it, say it, seek help. Help is necessary, important and will help you feel accompanied and move forward, so that you can fulfill your roles as a mother, wife, daughter and woman, which you need at this moment.
