This as-told-to essay is based on a conversation with Dr. Sarah Oreck, founder of Mavida Health. It has been edited for length and clarity.
As a reproductive psychiatrist, I’m focused on the way that female reproductive hormones impact mental health in unique ways. I’ve been interested in that since I was a tween, watching my mom struggle with depressive symptoms during perimenopause.
In the 10 or so years that I’ve been practicing, I’ve seen the field take off. Women, especially millennial women, are demanding that doctors take them seriously.
I meet most of my patients during their pregnancy or in the postpartum period. Many struggle with postpartum depression or postpartum anxiety, which are very common. But I’ve also treated about 20 people with postpartum psychosis.
Here’s what I’ve learned about the condition.
Postpartum psychosis not as rare as we’d like to believe
It sounds reassuring to say that this condition only affects one or two in 1,000 birthing moms. And yet, I don’t like to use the word “rare,” because it makes people think they or their loved ones will never experience postpartum psychosis. The truth is that about 4,000 women in the US experience postpartum psychosis annually.
This is a condition that should be on every new mom’s radar, and their family’s. That’s especially true given how disastrous it can be.
Violence is rare, even when psychosis occurs
Cases like Lindsay Clancy’s highlight the worst-case scenario of untreated postpartum psychosis. Even among the women who have this condition, hurting or killing a child is exceedingly rare. Research shows that about 1% to 4% of women with the condition kill their children. Any violence is too much, which is why early intervention is so important.
Moms with the condition can look and act fairly normal
When people hear psychosis, they think about depictions of schizophrenia and other psychotic conditions — the caricature of the “crazy” person on the street.
The truth is, people with psychosis often don’t look like that—and that’s especially the case with postpartum psychosis. The women I’ve treated aren’t talking to themselves or constantly disconnected from reality. The psychosis can wax and wane, and sometimes they seem quite lucid.
Getting help can be really hard
About 75% of the women I’ve treated have tried to get help, only to be turned away. Sometimes, that’s because they don’t look ill. There are also biases at play — if you’re white, well-groomed, and have a supportive family, some doctors are happy to send you home to be with your baby.
Psychosis is very different from intrusive thoughts
Many, many new mothers experience intrusive thoughts, like thinking about dropping their baby on the stairs. This is normal and — I believe — has biological roots. If you’re worried about dropping your baby, you’ll hold her tighter. Our brains are wired to recognize risk to our newborns, so we can protect them.
Intrusive thoughts are ego dystonic, which means they clash with who you really are. That’s why they’re so horrifying to many new moms.
Psychosis is defined by a break with reality. Thoughts of violence can become ego-syntonic, meaning they match what a person feels at their core (due to their psychotic symptoms). A patient might no longer be horrified by thoughts of violence.
Almost everyone recovers
Most people with postpartum psychosis recover to where they feel like who they were before. The best course of treatment is inpatient hospitalization, ongoing therapy, and antipsychotic medications for at least a year.
Of course, my patients have become mothers and have been through a very traumatic experience, which changes them. And yet, most of them can live the lives they imagined.
The rare, rare exceptions are cases like Lindsay Clancy’s, where the consequences of postpartum psychosis are so life-altering that they’re hard to imagine living with.