Is a Postpartum Depression Defense a Cop-Out?


A few of you who read my blog regularly and follow me on Twitter may remember a conversation I held with a woman who asked at her blog if Postpartum Depression is a cop-out defense when it comes to infanticide. This post is my response. It’s taken me some time to write due to research and the intense emotional aspect of this issue. The post below is lengthy. It is triggering. There are graphic descriptions beginning in the first paragraph. If you are easily triggered, go watch this video instead. Oh, and if you go watch the video? I’m not responsible for the ensuing addiction. (I’ve been listening to it almost non-stop for the past 36 hours.)

Humankind cannot bear too much reality.

T.S. Eliot

Since the dawn of time, humanity has grappled with parental induced deaths of infants and children. In Paleolithic and Neolithic ages, infanticide was an acceptable practice, one meant to preserve the balance of man and his immediately available resources. Later, in some cultures, infanticide grew to be gender-based with girls specifically sacrificed due to the cost of dowry required at marriage. Ritual sacrifice, unwanted birth, illegitimate birth, gender disappointment (including financial reasons such as dowry), birth defects or deformities, preservation of ecological balance, and a number of additional reasons peppered several cultures as legitimate reasons for the practice of infanticide.

Common early methods of infanticide included but were not limited to: exposure, suffocation or asphyxia, ritual sacrifice, brute force, blunt force trauma, and others. The most common method was exposure as this freed the parents from any direct involvement in their infant’s actual death according to societal belief. In fact, Romans often abandoned their infants with the hopes they would be raised by others, in which case they were referred to as “foundlings.”

Infanticide, the murder of a child older than 24 hours yet younger than 12 months, is carried out in our modern ages primarily by the mother and typically does not involve brute force or violent methods. The child is instead smothered, drowned, poisoned, or asphyxiated. Some cases do involve more force and more heinous methods.

Most mothers who commit infanticide are in a lower financial class and lack support from family and community. It’s also important to note many victims of infanticide are not first born but instead second or later born children.

Interestingly enough, not many fathers were cited in the research in regard to infanticide. In fact, only four known cases of infanticide with fathers at fault are present in current literature spanning the subject of infanticide. Fathers are far more prevalent in filicide cases which are cases involving children over 12 months of age. In these cases, the father is more likely to also harm the mother and himself in addition to any children involved.

In many infanticide cases involving mothers, a mental health disorder is cited as part of the defense or reason for the crime. Occasionally this directly relates to a Postpartum Mood Disorder, specifically Postpartum Psychosis. But for the mothers who use a Mental Health defense, is it a worthwhile defense or is it a cop out?

Postpartum Mood Disorders have been mentioned in literature since Hippocrates. Within the past several years, research and community awareness has exposed these conditions as real and palpable. While the true cause is not yet known or fully understood, researchers are working to expose the root cause and improve treatment for those affected. To date, we understand some physical roots but experts are still teasing out the specifics of these causes. Increasing social support surrounding mothers has proven time and again to be key to preventing and shortening the Postpartum Mood Disorder experience. Creating awareness and understanding of a less than Utopian postpartum experience lends a helping hand as well. Improving access to knowledgeable professional resources such as psychiatrists, therapists, and the like, also increases the potential for recovery success in families struggling with Postpartum Mood Disorders.

In many infanticide cases, the mothers and their families did not have adequate access to knowledgeable and compassionate personal, community, or professional help. If they did realize help was needed, they were either discouraged from reaching out for it via societal stigma (ie, the husband didn’t want his wife on medication, they were told to get “over it,” or there were religious beliefs preventing the necessary help) or there simply was not adequate sympathetic and knowledgeable care within physical or financial reach. That said, every infanticide case, as with every Postpartum Mood Disorder case, is different from the next. There are important basic factors from each which carry over into the next but the idiosyncrasies differ which make each case nearly impossible to successfully compare in entirety to the next.

From a legal perspective, choosing a Mental Health Defense is more of a crap shoot or a game of roulette. Postpartum Psychosis and Depression, while a real and experienced phenomenon, is not a guaranteed defense against the crime or action of infanticide. It is a transient defense at best, one wholly dependent upon the current legal status of mental health defense within the state and/or country in which the accused mother resides.

The legal definition of Postpartum Psychosis is not congruent with the medical definition. Both are based, at this time, officially on speculation. The DSM IV eliminated Postpartum Psychosis as a classification. The DSM III listed Postpartum Psychosis in the index but not as a separate illness. According to the DSM III, Postpartum Psychosis was thought to fall under: schizophreniform disorder, brief reactive psychosis, atypical psychosis, major affective disorder, and organic brain syndrome. Postpartum Psychosis occurs in 1 to 2 births out of every 1,000, or at a .1% rate. Postpartum Psychosis is considered a medical emergency with immediate treatment necessary. Onset is sudden and occurs within the first 4 weeks after birth, most often within the first 2-3 days. Postpartum Psychosis is the deadliest of the Postpartum Mood Disorders with a 5% rate of infanticide.

The legal definition of Postpartum Psychosis is no different than that of any other Mental Health Disorder as far as fault-finding and therefore subject to the same rigorous testing of any other Mental Health defense. In the United States, this is dependent on the state of residence. Some states abide by the M’Naughten rule while others abide by the A.L.I. test. In three states, Montana, Idaho, and Utah, the Insanity Defense has been abolished even though these states still admit evidence of mental status in cases.

Even with access to a state by state chart of current Mental Health Defense guidelines, it’s confusing at best to determine what your outcome would be in a court of law. In the United States, there is argument against setting a legal specification for Infanticide  as England did in 1922. The current argument against this specification cites lack of a true medical definition for Psychosis along with the potential for a growth of sympathy for mothers who kill and would then invoke the status.

If a mother who commits infanticide invokes a Mental Health Defense, she is not guaranteed freedom if not convicted of murder in the criminal sense but is instead found Not Guilty By Reason of Insanity (a conviction, by the way, not available in ALL states and very dependent upon which test your state uses to determine sanity at time of criminal action). She instead opens herself up to be remanded to a State Mental Institute more than likely with high security. This is not like going home after trial or heading off to a luxurious Club Med vacation. This is dark, gloomy, filled with meds, psychiatrists, therapy, and communing with a population who is equally if not more disturbed than the remanded mother. She is cut off from family, from friends, and from her life, just as if she were sentenced directly to jail. Also, she is continually judged by society, regardless of her convicted status as a psychiatric inmate versus a mainstream high security or possibly death row inmate.

Once remanded to a Mental Institution, the sentenced mother is at the hands of whatever governing body is responsible for releasing psychiatric inmates. This also differs from state to state. More often than not, it is the Court but a few states hand this responsibility to various agencies within their purview. She may also be sentenced to spend a specified amount of years at the Mental Institution despite therapeutic or rehabilitation status, thereby subjecting her to additional exposure to a less than preferable environment for years after conviction just as if she were a mainstream inmate.

The legal and medical diagnosis and defense of Postpartum Psychosis are at best subjective to the diagnostic technologies, sound judgment, and ethics of the medical and legal professionals privy to each individual case of infanticide, thereby further complicating the transient nature of this defense. Therefore a conclusion claiming Postpartum Depression/Psychosis defense as a “cop-out” is erroneous at best as this defense rarely guarantees the defendant the freedom to which she had access prior to her accusation and subsequent proceedings regardless of any legal outcome.

As David G. Myers stated in Social Psychology, “There is an objective reality out there, but we view it through the spectacles of our beliefs, attitudes, and values.” Infanticide has an objective reality in the courtroom. It is a crime. The precise charges depend upon the circumstances of the commission of the actual crime. The defense relies upon the knowledge of the psychological and criminal experts examining the accused. The prosecution relies upon them as well but relies heavier upon the requirements set forth by the law and the justice system to which they are bound. Society at large, meanwhile, is set free to judge, convict, and develop opinions not bound by the court. Our convictions of the accused mothers may be harsher, intrinsically darkened with our own emotions and experiences.

In the end, far more than one life is lost in every case of infanticide. Yes, one life moves on to eternity, but the lives of those surrounding the one lost will never recover. Infanticide is therefore not an incident captured in a vacuum but a ripple vacillating through families and communities like a tornado. Conversations must be held, action must be taken, and the stigma of asking for help signifying failure at motherhood must dissipate if we are to begin to battle the further destruction and loss of mothers, families, and infants to this crime.


Giving up BACON for Mothers & Babies


Bacon Sacrifice Campaign for Postpartum Progress

To donate via credit card:

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To donate via paypal, click on over to Postpartum Progress.

KevinMD guest post misses the mark about Mothers


This evening I happened upon a guest post over at KevinMD by Dr. Srini Pillay, MD, an author and an Assistant Clinical Professor at Harvard Medical School. KevinMD has been a site I read more and more these days. I enjoy the insight offered by his knowledgeable guests. Today’s post, however, has me shaking in anger.

Dr. Sirini Pillay’s post is entitled “What a psychiatrist learned in therapy sessions with mothers.” It’s also posted at Pillay’s other blog, Debunking Myths of the Mind under the title “I love my children but hate my life: Solutions to Dilemmas Mothers Face” with the subtitle of “A balm for all guilty mothers.”

(Please note: All text below in italics and bold is directly from Dr. Pillay’s article)

 

Dr. Pillay pontificates a few reasons for the psychological issues/stress mothers experience during their lives. With every one of them, his explanation (in my opinion) places even more guilt upon the already exhausted and stressed out mother rather than offer true solutions for her success as a mother. Perhaps most glaring  in his examination of the trials and tribulations of motherhood is the omission of any mention of a Postpartum Mood Disorder as the source for the points upon which he offers his expert insight. I find it impossible to believe, given the statistics of Postpartum Mood Disorders (1 in 8 new mothers), Dr. Pillay has never seen a mother with a Postpartum Mood Disorder or is unaware of the additional issues a Postpartum Mood Disorder brings to the dynamic of Motherhood, especially if said Postpartum Mood Disorder goes untreated. It is both appalling and irresponsible to me for a Psychiatrist to fail to mention such a glaring issue in the face of addressing issues faced by Mothers.

First up, Dr. Pillay mentions Perfectionism. “New mothers often expect to be perfect rather than the best that they can be,” Why does the mother expect to be perfect, Dr. Pillay? Is it because SHE has placed those ideals in her head? No. It is because society has placed these ideals in her head. We are absolutely expected to be pristinely Stepford in our execution in the assigned task of Motherhood while Fathers are expected (also unfairly) to be aloof idiots. What Dr. Pillay fails to mention is that those of us who are obsessive perfectionists are at a higher risk for developing a Postpartum Mood & Anxiety Disorder. What he fails to mention is that, in order to overcome this “Peril of Perfection” society must also change their view of Motherhood. Instead, Dr. Pillay perpetuates the stigma and tells Mothers “you can always strive to be better by making small changes. Holding yourself to a standard of perfection can lead to burnout in all areas of life, because you are constantly striving for something that does not exist.” I agree, Dr. Pillay. But the same society fails us when they perpetually hold us to a standard of perfection, for which when not reached, we are then automatically judged and crucified.

Next up, burnout. Burnout is a direct result of perfectionism. It’s also the direct relation of attempting to care for an infant while struggling with the depths of a Mood Disorder. Study after study has proven the adverse effect of Postpartum Mood Disorders on sleep. Have a Postpartum Mood Disorder? You won’t sleep as well when you do sleep. Sleeping less and lower quality of sleep are both symptoms of a Postpartum Mood Disorder. Yes, everyone knows new mothers don’t sleep much. But moms with a Postpartum Mood Disorder sleep even less and achieve a lower quality of sleep when we DO sleep. Another kicker? Our children sleep less and at a lower quality as well. So now you have an exhausted dyad attempting to live up to an impossibly high societal standard which is now even further out of our grasp. Need more ammunition here? We’re also told to snap out of it if we seek help. Stigmatized. Made to feel guilty. Not allowed to have the “time” to be depressed because by God we have an infant to raise which is what we were bred to do. Failure is not an option. So we stay silent, we suffer, we weep, we wail, we dry our eyes in the face of the public realm because we’re not allowed to have emotions other than those seen in Johnson & Johnson or Pamper’s commercials. Everything is to be picture perfect. If it’s not, we’ve failed. Dr. Pillay’s suggestion here? “So rather than force themselves to think and feel differently, addressing the burnout can help many problems all at once.” I would have loved to have addressed the issue of burnout. I attempted to address the issue of burnout with each one of my children. I asked for help. I begged for a night nurse from the pediatrician once our second daughter came home after nearly a month in the NICU after being born with a cleft palate. His response? “Why do you need a night nurse?” I had a toddler. Two dogs. A husband who worked 70+ hours a week. I was exclusively pumping every three hours and running a Kangaroo pump on the same schedule. I had to clean my daughter’s PEG site and jaw distraction sites a total of 4-6 times a day on TOP of everything else. Sleeping would have been a gift from the Gods. Yet I was denied and landed in a Psych Ward less than two months after my daughter’s birth through no fault of my own. No amount of forcing myself to think and feel differently would have helped. But I tried to address the burnout. That too, failed.

Now we move into “The best balance.” This paragraph’s opening sentence really captures judgment of mothers across the world: “When women feel overwhelmed, they essentially need to ask themselves why they expect something impossible from themselves.” Again, he’s absolutely right. Yet again, it’s society which has trained us to expect the impossible from ourselves. Dr. Pillay goes on to suggest “The reality is that if a woman has a need to work and have a baby, she needs to find a best balance that is right for her and her family.” Again, I agree. But if a woman has a Postpartum Mood & Anxiety disorder, she is already wracked with guilt. Attempting to find balance in her life is not achievable until she has begun to heal from her fragile mental state. A woman with a Postpartum Mood & Anxiety disorder can barely survive her day let alone find balance in her life until her mental health issues are addressed. Any health professional or anyone I knew mentioning to me all I needed to do to improve was to “find a best balance” in my life when I was in my darkest days would have heard an earful. We’re barely able to keep our own heads above the fray – how are we expected to balance too?

“There is no one-size-fits-all type of mother, and different types of mothering produce different positive and negative outcomes.” Amen. And yet, society expects Sally to parent like Suzie and Suzie to parent like Bethany and Bethany to parent like Rebecca and Rebecca to parent like Jody and Jody to parent like.. well.. you get my drift. It’s the whole Stepford thing. Again, society does not allow for this sort of flexibility. Mothers with Postpartum Mood Disorders parent far differently than any other mother on the planet. We realize the value of self-care because it’s necessary for our survival. For some of us, it’s necessary for our children’s survival. We are judged for how we parent. How we HAVE to parent. We are judged for expressing our frustrations, for choosing to formula feed, for choosing not to go the attachment parenting route, for letting our little ones watch TV because we’ve had a tough day. Yes, we heal from a Postpartum Mood Disorder but when you’re in the thick of it and family members or random people in public are judging us, we have a harder time letting it go and then BAM. Hello guilt. Hello Xanax. I love the idea, I love the theory of “no one -size-fits-all type of mother,” I do. But it doesn’t work in the real world and certainly doesn’t work when the public thinks of mothers with Postpartum Mood Disorders. A mother with a Postpartum Mood Disorder is a horrible mother to most – we’re stigmatized and in addition to overcoming the every day normal judgmental issues which accompany motherhood – we must also overcome the additional perception of our “bad mother” rep.

The final paragraph recognizes that “It’s not all you.” It’s not. It’s genes. It’s how our child is wired to react. But guess what? Kids of depressed parents are more at risk for issues like ADHD. They sleep less. Their quality of sleep is less. Dr. Pillay says, “Parents who take on all the responsibility of this often distort this, feeling as though they are fully responsible for how a child turns out.” Wait a second. Aren’t we? What about Parents who are arrested for the behavior of their children? Parents who are judged because their child isn’t yet sleeping through the night or wets the bed or isn’t getting good grades in school? Or Parents who have infants who are not yet eating solid foods even though they keep trying? Yet, Dr. Pillay’s solution is for PARENTS not to blame themselves when their child doesn’t “lean on their own sense of responsibility.” He also goes on to add this gem: “Also, mothers who are alarmed by their own mistakes set a challenging standard for their children who may grow up to learn that mistakes are “bad” rather than inevitable but not a reason to give up.” Let’s say a mother has a doctor for her Postpartum Mood Disorder who keeps telling her she’ll get better with every therapy they try. Instead, she continues to worsen. Eventually she’s convinced the fault lies within her. That SHE is the problem. Some of these mothers may even give up and just live out the rest of their lives without trying any more therapy because they are the issue, not the therapy. So of course she will raise a child to believe mistakes are bad as opposed to inevitable. Of course she will raise her child to believe once a mistake is made more than once that giving up is the proper course of action. Or even worse yet, let’s say mom doesn’t get treatment at all (which is the case with most mothers struggling with a Postpartum Mood Disorder, by the way), this issue will spill over into how she raises her child and no amount of pulling herself up by the boot straps will change her thinking. She’s leaned on her own distorted sense of responsibility and it didn’t work for her. Why should she then expect it to work for her child? Why would she not consider herself fully responsible for her child’s behavior when society does just that on a daily basis?

My absolute favorite part of Dr. Pillay’s piece is the closing paragraph:

“Thus, when mothers find their relationships thrown into disarray, they may want to re-examine their own standards and relax their judgments toward themselves as they allow themselves to be more human and the very best that they can be without needing to be perfect.”

Sighs.

If only society would let us, Dr. Pillay. If only society would let us.

I’d like to add though should a mother finds her relationships thrown into disarray, she should not immediately blame herself for the fault of the disarray. Yes, she may truly be at fault but the other party may be at fault. She may be struggling with a Perinatal Mood Disorder or another type of mental illness. There are many additional reasons for the fault of relationships to be at fault other than the internal (yet societal driven) standards imposed on Mothers today. Perfectionism is imposed, not perceived. Failure to achieve perfection is perceived yes, but the standards we fail to reach were, at some point, imposed upon us by society. If we truly want to help mothers overcome the perception of succeeding by not being perfect, we need to first change society’s view of mothers, not mother’s view of themselves. The standards we try to reach our not our own… they are the fences between which we are forced to live. Until these barriers are removed, we will never succeed.

Saturday Sundries: Is Postpartum Depression only tears?


Happy Saturday, y’all!

It’s been grey here all day. Within the past hour, we have had torrential downpour, thunder, no lightning, and the sky is now a bright white instead of a dark lingering grey. I have been down for the count since Thursday night with Strep. I’m on the mend though, and managed to go for a drive this morning to escape the house. I ended up in a little town named Good Hope. Lately it seems to be where my car likes to take me when I need to get out and breathe. You can read more about my journey there at The 3six5 Project tonight at 8:00p.m.

There has also been an air of tension over my hometown for the past few days. The situation has resolved as of early this morning and we are all breathing much easier today. I’m not disclosing the reason because I would hate to trigger anyone inadvertently. All that matters is that it resolved without any further tragedy and all is well once again.

Today I am grateful for local law enforcement, tylenol, ibuprofen, and antibiotics. And I cannot wait until I can hug my children close again!

As always – the answer below is not meant to be complete or professional in any sense. Always seek a professional’s opinion in regard to your own situation. Everyone does not always have the same experience.

Today’s Question: Is Postpartum Depression only Tears?

No. It’s not.

Sure, tears may be involved somewhere. But they may not be involved at all. I have had so many mothers share with me that they didn’t think they had PPD because they were not crying lumps. Thing is, there are many different Mood Disorders on the Postpartum Spectrum. These include but are not limited to:

  • Postpartum Depression
  • Postpartum Anxiety
  • Postpartum Obsessive Compulsive Disorder
  • Postpartum Post Traumatic Stress Syndrome
  • Postpartum Psychosis

You’ll notice that I did not include the Baby Blues in the above list. It’s not there because it’s not considered a psychiatric disorder. The Baby Blues happen to many mothers – up to 80%. When the blues last longer than a few weeks and/or go beyond simply weepiness or moodiness, it is time to get checked out by your doctor.

Postpartum Psychosis is a medical emergency. Postpartum Psychosis has a fast onset. It may involve hallucinations (both auditory and visual), an incapability of making decisions for oneself, and delusional thinking. A mother with Postpartum Psychosis should NOT be left alone either by herself or with an infant. This means not even in the next room – someone needs to be with her at all times. She should also be admitted to the ER as soon as possible.

Postpartum Obsessive Compulsive Disorder, the disorder with which I struggled, involves what are called intrusive thoughts. These thoughts often include visualizations of harming our children or ourselves, but unlike Postpartum Psychosis, we are immediately repulsed by these thoughts as soon as they flit through our heads. We struggle to control them and often will create a blizzard of IT’s with no end in sight as we get lost in the ever expanding tunnel of negative “what-if” thoughts. I recently wrote a post about whether or not these thoughts go away. They fade and get easier to control but they never really go away, a difficult reality for many to face. I am a little over 5 years past my last PPOCD episode. I still have the occasional thought but I am able to stop them quicker and they do not happen nearly as often.

Postpartum Post Traumatic Stress Syndrome can be triggered by a negative birth experience or anything within the birth/newborn process which is perceived to be traumatic by the mother. The worst thing you can ever say to a mother with PP PTSD is that she’s silly for being so upset over such a small thing. Clearly, if it is causing her issues to the extent that it interferes with her daily living, it is not a small issue for her. Mothers with PP PTSD will avoid the place at which the triggering event took place – such as the hospital, doctor’s office, midwife’s office, etc. She may also struggle with graphic triggering dreams, intense anxiety, panic attacks, hyper-vigilance, and flashbacks. It is important to note that PP PTSD can occur in conjunction with any of the other mood disorders, and may even be the triggering point for the development of other disorders such as Anxiety and Obsessive Compulsive Disorder. This is my own opinion because I believe I had PP PTSD with my first and second daughters which then led to my OCD. My first birth was very traumatic and my second birth led to a month long NICU stay for our daughter.

Postpartum Anxiety is marked by constant worry about things which don’t need to be worried about, hyper-vigilance, overwhelming sense of doom, inability to sit still, racing thoughts, and possible physical symptoms such as dizziness, hot flashes, and nausea. There is help available for Postpartum Anxiety and you are not alone in struggling with this.

Postpartum Depression, while involving symptoms of crying and sadness, also involves feelings of anger and irritability. Not many people think of depression being angry, but for many, this is how it manifests. You may also become overwhelmed with feelings of shame, sadness, and guilt. Motherhood is supposed to be a happy time for us mothers. For those of us who develop a Postpartum Mood Disorder, we become ashamed for not feeling how society expects us to feel. We struggle to ignore these feelings, leading only to a more serious and urgent situation down the road.

Bottom line, Postpartum Depression is not just tears. It might be anger, irritability, anxiety, intrusive thoughts, hallucinations, flashbacks, panic attacks, shame, guilt, and hyper-vigilance. Just because your wife isn’t weeping her way through her postpartum period does not mean she does not have a Postpartum Mood Disorder. There are so many varied ways in which this can manifest.

Please also remember that Postpartum Thyroiditis may masquerade as a Postpartum Mood Disorder. It is important to get your thyroid levels checked to rule this out as if it is Postpartum Thyroiditis, an entirely different type of medication will need to be used to treat the condition. In fact, anti-depressants may make things worse if a thyroid issue is the root cause.

Don’t tell her to snap out of it. Tell her these things. Tell her you love her no matter what. Be there for her. Let her cry on your shoulder if she needs to do so. Encourage her to see a doctor but know you can’t force her to do this UNLESS she is a clear threat to herself or to others (ie, threatened suicide or harm to others). Recruit help for housework. For childcare so she can rest. Having a baby is hard work. Raising one while struggling with a Postpartum Mood Disorder is hell. We need all the help we can get. She may not say thank you immediately but one day, in the future, she will be ever grateful for all you did for her when she needed you most. She will say thank you. One day.

Postpartum Voice of the Week: @HeatherColeman’s Ignite DC speech


Ignite is an awesome concept. They organize gatherings which give ordinary people like you and me just 5 minutes to get up in front of a bunch of people with the goal of “igniting” them to action.

Not too long ago, Heather Coleman shared her story anonymously over at Katherine Stone’s blog, Postpartum Progress. Heather’s story is intense as it involves details of a Psychotic Break. But it’s also inspiring because people stopped to help her as she struggled during the darkest moments of her life.

I am glad Heather has grown bolder in sharing her story as it is an important story to share. I applaud the courage it took to get up in front of a room full of strangers to tell her story.

Thank you for walking to the front of that room, Heather. Thank you for sharing your journey with them. And with us. You rock.

Go watch her amazing video here. But first, get some Kleenex.

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