Trigger Warning: This episode includes discussions about postpartum psychosis, infanticide, and suicide.
As the tragic news of the mother of 3 in MA who took the lives of her children and then attempted to take her own life has spread, there has been a great deal of misunderstanding in the media and on social media.
In order to prevent the spread of misinformation, I invited Paige Bellenbaum of the Motherhood Center to join me today to help clarify the difference between postpartum depression and postpartum psychosis, and offer psychologically-informed information to help people more fully understand maternal mental health.
While difficult, it is important to have these conversations, to understand the symptoms associated with perinatal mood and anxiety disorders (PMADs), to have compassion for those affected, and to know where to find support if you or someone you love is struggling with any form of PMAD.
Dr. Sarah (00:00):
Before we begin this week’s podcast, please be advised that the subject matter we’re going to be discussing today relates to postpartum psychosis and infanticide and is very disturbing. If you have little ones in earshot or if you are not able to tolerate hearing this content right now, please, please skip ahead to the next episode. It’s okay. Also, if you or someone that needs help, please contact the Suicide and Crisis Lifeline by calling 988. Check the show notes for links to that and additional crisis resources, or if you or anyone needs them. As the tragic news of a mother of three in Massachusetts who took the lives of her children and then attempted to take her own life. As this news is spreading, there has been a great deal of misinformation and misunderstanding about postpartum mental health. So to address this, I invited Paige Bellenbaum, who is the founding director and Chief External Relations Officer at the Motherhood Center of New York to join me today.
I really hope that this conversation with vetted, trustworthy and factual information can serve to increase awareness of PMADs, how to appropriately support parents who might be experiencing one, and also to make crystal clear how stigmatizing and in some cases, criminalizing these disorders, reduces women’s likelihood of reaching out and getting care, and just why that is so incredibly dangerous. I need to say this was a difficult episode to record, and I am sure that it will be a difficult episode to listen to, but it’s also a very important one. And before we begin, I want to acknowledge that neither Paige nor I are involved in the diagnosis or treatment of the mother that prompted this discussion. Our conversation today relates to perinatal mood and anxiety disorders as a whole and not in reference to any single person’s diagnosis or treatment.
Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.
Hi everyone. So today is a tough episode. This is not my typical topic of the podcast, but it felt really, really critical to do this episode today. And I am very, very grateful that we have Paige Bellenbaum here today to talk to us. She is the founder of the Motherhood Center in Manhattan. She knows a lot about postpartum mental health and so she’s here to talk to us today about some of the things that we’ve all been hearing a lot about and make some clarifying points and share information that we can really understand sort of recent events with a clear foundation in psychologically informed information. So thank you so much for being here, Paige. I really grateful for you to come on.
Oh, it’s a real pleasure. I’m so happy to be here and talk about such an important topic.
Dr. Sarah (03:38):
So for people who maybe want some context a recent tragedy happened where a woman of three took the lives of her three children. And I want to be really clear, Paige and I are not trying to diagnose or make any sort of clinical judgements on this particular case, but what’s happened as a result of it is there’s been so much noise in the media and just out and about, which shows a lot of confusion, I think, around perinatal mood and anxiety disorders, PMDAs. And so I was just hoping we could talk a little bit today about the difference perhaps between postpartum depression, postpartum anxiety, postpartum OCD, and postpartum psychosis, because I think it’s a really critical distinction to make, and not a lot of people know the nuance of these diagnoses.
That sounds great. I really can’t wait to clarify this for your audience and talk about something that is so important and really hit all of our hearts in such a heavy way. The way I like to describe perinatal mood and anxiety disorders as kind of a starter, a starting point is that PMAD is an umbrella and underneath it sits a number of diagnoses, many of which that you just shared with your listeners. And each one of those diagnoses have a grouping of symptoms that sit under the diagnosis. So as you mentioned the most critical and well-known perinatal mood and anxiety disorders or perinatal depression, anxiety, OCD, PTSD, and psychosis. And so for your listeners, perhaps some of who have experienced these symptoms in the past or are familiar with them, what we hear about the most is postpartum depression or postpartum anxiety.
But what we know is that 50% of all cases originate during pregnancy, and the other 50% originate during postpartum, which is why we refer the to these as perinatal mood and anxiety disorders. So some just some very common ways that depressive symptoms can show up in the perinatal period, hopelessness, helplessness, crying, not enjoying the things we used to enjoy feeling down having suicidal ideation. That’s one grouping of symptoms. And then we have perinatal anxiety, which is constant worry, feeling like your mind is a hamster wheel, catastrophizing, jumping to conclusions, all or nothing thinking we’re jumping to the worst possible case scenario along with physical reactions, heart beating, fast panic attacks. And then you have the OCD grouping, which I think is really important as it pertains to postpartum psychosis. And one of the best known contributing symptoms to OCD in the perinatal period is scary, intrusive thoughts, which is this fear.
And sometimes these graphic images that can pop into a new mother’s head of harm coming to the baby, and more often than not, new mom causing that harm. So some examples of that are, I can’t get near the stairs because I’m afraid I’m going to throw my baby down the stairs, or I can’t get near the window because I’m afraid I’m going to throw my baby out the window or put my baby in the microwave, or a knife might jump into my hand. And unfortunately for those in the medical community that are not well versed in the nuances of PMADs, they might hear a new mother explain this scary intrusive thought and think, oh my goodness, this woman needs to be hospitalized. She’s a threat to herself and others. She’s experiencing psychotic symptoms. For those of us that specialize in this area of mental illness, we know that we can determine that in a very simple way.
Now, I don’t advise this at home, but as clinicians, we will say to that woman who’s having a scary intrusive thought, would you ever do this to your baby? And 99% of the time she will say, no, I would never do it. I’m so scared of it. I can’t believe that I could even be possible of having this thought. That is not a woman who’s experiencing psychosis. And then there’s PTSD, but then we get over to psychosis, which some important information about postpartum psychosis and notice how we use the term postpartum in front of this particular diagnosis because the majority of cases originate in the immediate postpartum. That means a few days after delivery up to a few weeks postpartum. That said, it can also strike a few months or even seven to eight months after the fact.
Dr. Sarah (08:33):
And there’s also, I think obviously the reason why people are more familiar with postpartum depression, and perhaps now because we’ve been talking about it more in the world, postpartum anxiety is because those are probably the two most commonly diagnosed p a s because they affect the most people and psychosis, postpartum psychosis is very rare. Approximately one to two out of every 1000 deliveries are approximately 0.1 to 0.2% of births result in postpartum psychosis. So while it’s very rare, it’s also usually associated with earlier diagnoses before having your child, whether it’s depression or bipolar disorder or schizoaffective disorder, some type of mental illness is often present, not always, but often. So I think there are sort of clearer, clearer boundaries around that diagnosis.
Absolutely. And so what we know to be due true about postpartum psychosis, yes, it’s incredibly rare and the statistics you gave one to two per 1000 births are correct. When we get into data points around perinatal mood and anxiety disorders, I always like to back that up with these are the cases that we actually hear about when we say one in five new and expecting mothers experience at PMAD. I always say, those of us who do this work know it’s really more like one in three, but the shame and stigma that surrounds maternal mental health keeps those numbers at a low, right? And when we consider that 80% of all cases go undiagnosed and untreated, we understand why one in five is wrong. I also share that because at the Motherhood Center, we treat a lot of postpartum psychosis, not directly. We have a lot of women who come to us that are psychotic and we refer to inpatient treatment, and we have a number of women that are coming out of inpatient treatment to us as a step down.
Yes. So we see psychosis all the time every day. So from where I’m sitting as a clinician who sees this daily, I’m seeing it a lot more than one to two per 1000 births, and I’m seeing a lot more since the pandemic. Now I do not. I am not a researcher that’s not quantitative, that is qualitative, but I just want to put that out for your listeners to know. The symptoms are very different than that of what we see in postpartum depression or anxiety or OCD cannot stress enough something that you mentioned. We know what to look for. We know who’s at risk of developing postpartum psychosis. Women who have a history of bipolar disorder or a member of their immediate family who has a bipolar diagnosis and women who have experienced a psychotic episode at another time in their life, these categories put women at a much greater risk.
What absolutely breaks my heart is when a woman with a history of bipolar disorder who is on antipsychotics and other to treat her illness is told by her PCP or OB/Gyn or general psychiatrist, you have to go off your meds because you’re pregnant and it’s going to have adverse impacts on the gestating fetus, right? Yes. Or mom decides without talking to anyone, she needs to go off because of the fear. And I cannot tell you every day we treat those women who are off their antipsychotics, who become actively psychotic in their pregnancy or immediate postpartum. So this is an advertisement for any providers who are listening use the PSI reproductive psychiatry hotline where you can speak to a reproductive psychiatrist to figure out what meds are safe and effective to take during pregnancy and don’t advise women to go off or Project TEACH, which is another great resource for New York based providers to speak to a reproductive psychiatrist because the alternative to going off your medication is that women become psychotic and in rare instances, tragedies can occur.
Dr. Sarah (12:59):
Yes. And it’s also important to mention that even if you are experienced in postpartum psychosis, the chance that you are going to act on some of your psychotic like delusions or hallucinations and actually hurt anyone isn’t like not everyone who has psychosis is going to hurt anybody, but we need to catch it at the beginning and make sure that we can help somebody be safe and get the effective treatment and immediate safety they would need to stabilize so that we can prevent tragedy.
Absolutely. A very, very small percentage of women with psychotic symptoms reached the level of what took place in Massachusetts this last week, what took place in New York City in Coney Island in the Bronx just a few months ago. It’s very rare that these tragedies take place. However the news captures these headlines and can really manipulate the outcome and the perception of these, of this illness. Yes. When the news automatically assumes that a woman was experiencing or struggling with postpartum depression, and that’s what led to this tragedy, what that says to other women that are struggling with postpartum depression or anxiety in fact, is I’m not going to say anything to anyone. I’m not going to tell anybody I’m having scary, intrusive thoughts of harming my baby, or that maybe I sometimes feel like I made a mistake or that I don’t want my baby anymore, or that I wish I could fall asleep and not wake up.
No, I’m not going to tell anybody that because they’re going to think I have this and that I’m capable of this. And so when the news keeps getting the diagnosis wrong, they reinforce the shame and stigma that surrounds the majority of perinatal mood and anxiety disorders and create even more of an obstacle. What was outstanding about this case in Massachusetts is that some of the news outlets actually referred to it as postpartum psychosis. I can’t remember the last time that I saw the actual diagnosis. And again, you started with neither you nor I diagnose this woman. We do not have all the facts, but with every infanticide case that I hear is a clinician, what I read, what’s reported unquestionably what’s being reported suggests that this is a woman who was not in her right mind, was operating under fixed false beliefs that led her and told her to commit the act. And in her mind, she thought she was doing the right thing because she was not in touch with reality and more often than not thought that she was taking measures to protect and save her children. Right? Yes. This is the impact of psychosis on the brain.
Dr. Sarah (16:04):
And a very important thing that I want to highlight that you just said is the distinction between an intrusive thought about hurting your child as a result of postpartum OCD and a false fixed belief that hurting my child will in fact save myself or my child. Or there’s some sort of delusional force cognitively going through a person’s psyche that is leading them to believe that this act is an okay and appropriate thing to do, maybe even critical or outside of their control, it’s going to happen. And that’s the difference between postpartum OCD and postpartum psychosis. That I think is super important to highlight because like you said before, one of the ways that when we are working with someone who is talking about intrusive thoughts about harming their baby is to always check that, right? To test reality testing, right? To say, is this what we psycho jargon is we call it ego syntonic or ego dystonic. Ego dystonic means, I don’t like this thought. I recognize it as coming from outside of myself. It’s disturbing to me. I don’t want to act on it. It’s causing me distress is when it feels aligned with our perception of reality in that moment. And that’s a real hallmark of psychosis because they cannot tell that this is a thought that’s not appropriate or based in reality.
Exactly. That’s exactly right. And other symptoms that go along with postpartum psychosis. And like all PMADs, although this is very different, but I say this generally about all PMADs, it’s like when you are struggling with any PMAD, whether it’s perinatal depression or anxiety, and in particular postpartum psychosis, you oftentimes have no idea what’s going on with you. You’re not sure how to help yourself even more so in a psychotic state. But this is why it is so critical for family members and friends to know the symptoms and warning signs so that they can throw the life preserver to that woman who is drowning in the sea because her symptoms are so great. So this is for everybody to really listen to and take in these signs and symptoms. So to your point, women that are experiencing any kinds of hallucinations or delusions, auditory, visual sometimes or often hearing auditory commands being commanded by a higher power to harm themselves or their children or someone else.
Oftentimes with a religious undertone either speaking to hearing or seeing God or Satan or some kind of religious higher power, feeling incredibly paranoid thinking that people are out to get them. You might often even hear about the CIA or the NYPD or another government agency that is following them, tapping their phones, this flavor of paranoia, or it could be closer to home, my husband is plotting against me, he’s having an affair. These things that are so not typical to how this person usually presents or shows up or processes information, feeling very irritable, aggravated, feeling confused, or having a difficult time communicating. Oftentimes when you’re talking to someone who’s actively psychotic, they are all over the map. Their thoughts are not connecting. They’re having pressured speech, they’re not making any sense. It’s very hard to redirect them.
And another thing that’s important about postpartum psychosis is that it can, there’s this waxing and waning process that happens, and I share this because an incident that took place in the Bronx not long ago of a woman who also sadly took the lives of her children in a psychotic state, she had spoken to her father one hour prior, and based on his account, he said she sounded fine. She sounded like myself. And then one hour later, this tragedy took place, and psychosis can wax and wane, meaning somebody can go from one moment to the next, appearing very lucid, easy to comprehend to the very next second, staring blankly into space without an expression or acting manic or hyper-manic. So can be very tricky, but it’s odd behavior. It’s out of place behavior. And when we see these symptoms, we need to act immediately. This is a 9-1-1 call.
This is immediate visit to the emergency room. We want to keep this person safe because they’re in an altered state of reality and they are believing the state of reality that they are in. There is no way we can talk them out of it. This is something that is happening in their brain. The sooner we can get them to treatment, the sooner we can ensure safety and stability. And what I really want everybody to know about in regards to psychosis, it is clearly a very difficult illness for the person in the family and the community and everybody that’s impacted by it. And it’s totally treatable. Women who experience postpartum psychosis go on to live healthy and productive lives. Sometimes they have a long course of medication. Some women don’t have to be on medication forever. Some women just have psychotic episodes after birth and they never have another sign or symptom of any kind of bipolar disorder for the rest of their life.
It’s different for everyone, but it doesn’t mean that their life is going to be altered in a negative way forever. These illnesses are treatable and they’re not to be criminalized. And I know that’s really hard for some of your listeners and society in general to entertain, but what I always say about postpartum psychosis is no mother in her right mind would whatever take the lives of her children, she wouldn’t. It is in this altered state that these tragedies happen, and without treatment and without the appropriate support and intervention, this is what can take place. But unfortunately, because of what’s perceived as an atrocity, what kind of person could commit such a crime or an act, we criminalize this behavior and women spend years and years and years in prison when the person who really ultimately suffers the most is her. When she does receive medication and she does return to her baseline and has to live for the rest of her life with this reality of something she probably doesn’t even remember right doing.
Dr. Sarah (23:40):
And the data and the science backs this up, we know by the many, many women that have been successfully treated for postpartum psychosis that when looking back upon even just, I mean, if they never acted on it, but if they received adequate care, can say, I don’t remember. I, they can recognize that that was out of their sense of self and their volitional behavior. And so it’s not hypothetical. We have a lot of data on this, but I think it’s very few people really know what it’s like. I think you’re in a very unique position having, like you said, worked with a, you kind of get the a disproportionate perspective because a lot of people walk through your doors are actually experiencing it.
Yeah. They walk into our door mean, again, people, women that are actively psychotic, we get into inpatient treatment, right? That’s the most important thing. But when they do come to us after they’ve started medication and they responded to medication and have sealed over a bit, which is the term we use they do come to us. And every single woman that we’ve ever treated who has experienced a psychotic episode in the perinatal period gets better. They get better, and they return to their baseline. A sense of normalcy treatment works for all of these illnesses and including postpartum psychosis. And what does that mean for them in the future if they decide to have children? Again, it means we watch it really closely. It means that we make sure, I can’t tell you how many patients that we treated in the day program who had a psychotic episode, experienced treatment, got better, went on to decide they wanted to have another child. We just create a very structured outpatient treatment team that’s watching them managing their medications titrating as they gain more weight and move along in their pregnancy so that the amount of medication they’re on is appropriate. Bring it back down after they deliver, right? Yes. When they’re followed, we can stave off the likelihood of another episode transpiring in the immediate postpartum. And so many women go on to have children again because they’re being watched. They’re being watched by experts and specialists in the field who know how to treat this.
Dr. Sarah (26:28):
Absolutely. And as we talk about this, I want to be mindful of the fact that while there is incredible support out there, not everyone has access to this type of care.
The healthcare system has a long way to go. So I just want to up the fact that there are obviously systemic problems that need to be addressed, and that’s frankly a different conversation. But something it would be remiss not to acknowledge when we’re talking about maternal mental healthcare. And the other piece though that I wanted to bring up was that we need this type of support for all PMADs beyond just postpartum psychosis. Everyone who have other PMADs right who have postpartum depression or postpartum psych anxiety or perinatal depression, and who also could benefit from appropriate treatment throughout their pregnancy, throughout their postpartum period, that sort of clinical scaffolding that will make the experience of the symptoms less and the impact of those symptoms on that person’s life significantly less profound. Everyone deserves this. Everyone deserves to have an appropriate diagnosis and an appropriate treatment if they have a perinatal mood and anxiety disorder.
And when we are afraid to talk about it, when women don’t have the information to understand and recognize one, something doesn’t feel right, and two, what can I do when people around the mother don’t know how to spot these things and step in and say, let’s get you some support, then they go undiagnosed. The symptoms get potentially out of control. And the impact on that person’s life is profound, even if it nev. And that’s not talking even about postpartum psychosis, just any of these disorders. And so it’s just so critical, one that people know the difference between them, but two, that people can talk about it out loud in the world and that we are immediately responding not with shame or judgment or dismissal, but with a lot of knowledge and support.
I mean, we’ve created this construct in American society and in other societies and cultures as well that paints this picture of motherhood being romanticized and glamorized. It’s the thing that completes us. It’s what we do as women and birthing people. We become mothers, and it’s this beautiful, amazing, blissful experience. And when they put the baby on our chest and we see them for the first time, we feel this unconditional love and the heavens part and the angels come out and it’s like, this is life. This is what it’s all about. This is purpose. And I always tell moms, I mean, maybe some people have that experience. I haven’t met them, but I’m sure they’re out there. The rest of us after we give birth, feel exhausted and want to be in a room by ourselves for a week eating hamburgers in the dark and just sleeping.
I don’t know who came up with that storybook example of what it is to become a mother. But unfortunately, that’s what we’re propelled into. And when we have even the slightest difference of experience, we blame ourselves. We think there’s something wrong with us. We compare ourselves to others or what we think of others, especially in this field of social media that presents this picture of what I described, that romanticized glamorized version of motherhood. So all of these things put place pressures on women not to come forward and talk about how hard this is just on its surface or to talk about these more acute symptoms that they’re experiencing that might very well be related to a pma. And it is all of our jobs who are committed to this work in this field to talk about maternal mental health as much as we can to normalize it, to give women permission to struggle and talk about how hard this is to make it safe and normal and to come forward and ask for the support and care and treatment that every single new mother and expecting mother and birthing parent needs and deserves to feel better.
But it’s still very stigmatized and it’s why 80% of all cases go undiagnosed and untreated. And what I would say to that is there’s a lot of adverse impacts that transpire to the lack of treatment that impact not only the mother, but the gestational fetus, infant, toddler, child, adolescent. Not treating PMADs can have long-term health and mental health implications on both mother and child if untreated. And so the sooner earlier the intervention is, the more productive and effective it can be for that dyad. Not only that dyad, but the experience of both of those individuals in the world with their partner, family, friends, everyone. And it has generational positive impacts too. So normalizing this experience for new and expecting mothers and expanding access to care are the two ways that we’re really going to be able to make it dent is what I consider to be a crisis.
Dr. Sarah (31:56):
Yeah, I agree. And I think obviously the Motherhood Center is an phenomenal resource for women in New York. And I think if you’re listening and you’re in New York and someone who is expecting or who has a child, a new child in that bubble of risk for a PMAD, right? Check in with them. First of all, it doesn’t matter where you are, but if you’re in New York, know that that’s a resource, the Motherhood Center. But then outside of New York, well, everywhere Postpartum Support International is the best possible resource we have for the world. Actually, the best possible resource we have available to us right now. You can go on there and get information. There are free groups, support groups for the birthing parent, the family members of the birthing parent. There’s a directory that you can type in your zip code and find a provider who is certified in perinatal mood and anxiety disorders, who’s been trained to understand what is going on and how to effectively treat it by region so you can find someone close to you who can treat you. What other resources can do of that we can share with people if they’re curious.
I mean, I think mean you named it PSI is really the epicenter of anything and everything PMAD related, whether it’s education or a advisement or support group or training. Here in New York, certainly The Motherhood Center is at your disposal. There’s also the Postpartum Resource Center of New York, which is another fabulous resource for people living in the New York State area. They have a warm line that runs, I believe, from 7:00 AM to 7:00 PM where you can speak to a peer support person who can help you navigate treatment and resources. And you know what? We’re starting to see a real shift. We’re seeing more and more people enter the perinatal mental health space because finally, women’s mental health is starting to matter. And the need is so acutely there. I tell anyone who will listen, we’re in a maternal mental health crisis right now. I have the honor of sitting on New York City’s Maternal Mortality and Morbidity Review Committee, and so many cities and states across the US that are finally paying attention to maternal mortality rates.
We here in New York City review all maternal deaths and figure out what the cause was, what are the primary causes and what we can do to prevent them. And unbeknownst to what most people perceived as obstetric complications as a primary contributing factor, mental illness and substance abuse are the leading causes of maternal death in this country. And I share that because I think that’s one of the things that’s led to an impetus in creating more conversation and attention to maternal mental health. And because of it, more people are getting their PMHC, they’re getting training and treating perinatal mental health disorders. We’re seeing more reproductive psychiatrists come on the scene. We’re seeing more intensive outpatient programs, partial hospitalization programs. So it’s good that the clinical field is responding, and yet there’s still a really long way to go.
Dr. Sarah (35:32):
Yeah. And the work that you’re doing is obviously having a really important impact. And I’m so grateful that you took the time out of your busy schedule to come and share this. For those of you listening, I emailed Paige this morning and it was like, can you make this episode happen today? And she was like, done, I’m in. And thank you.
You’re so welcome. I thank you for paying attention to these important issues because this is a part of changing the conversation and it starts here. And so I’m just really honored that you asked me to be on.
Dr. Sarah (36:11):
Yeah, thank you. Thank you. I think amplifying clear, psychologically informed information right now is the best thing that we could possibly do because there’s so much noise and there’s so much stigma. And I really feel like if you can walk away from this episode feeling like you understand at least how to get your own mental health support as a woman, as a mother, or help another mother get mental health support in appropriate way without passing any judgment, without making it be about fear, but about safety and support, I think then that is all I can really hope for.
Dr. Sarah (36:53):
Thanks so much.
Thanks for having me.
Dr. Sarah (37:01):I sincerely hope this episode added some context for you to this tragic situation and helps everybody understand a little more about maternal mental health and perinatal mood and anxiety disorders. If you walk away from this episode with one thing, just one thing, I sincerely want it to be the fact that if you or someone experiences a PMAD that you know it is not your fault, you did not cause it, and it is treatable, please go to Postpartum Support International’s website postpartum.net to get connected with the best resources available based on your geography. And if you are in New York State, you can also connect with The Motherhood Center or Upshur Bren Psychology Group for treatment and resources. And if you want more information about PMADs and the different diagnoses and symptoms under that umbrella, you can also listen to episode 13 of this podcast. In short, I know this is a lot of resources, check the show notes for a link to everything, and thanks for listening. And don’t be a stranger.
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