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3/1/12-How Stigma Hurts Us

March 1, 2012 | Leave a Comment
A quilt including names of women, children, and family members who lost their lives due to postpartum psychosis, made and donated to Postpartum Support International

There is only one thing I follow more closely than articles that relate to Perinatal Mood and Anxiety Disorders (PMADs), and that is the comment section that follows these articles.

As I mentioned before in an earlier post about Sonia Hermosillo, articles on PMADs usually highlight recent cases of infanticide, which (contrary to popular belief) is more likely the result of Postpartum Psychosis than a Postpartum Mood Disorder. (Want to know what the difference is? Click here.)

This week, one of my colleagues forwarded me an article about Lorna Valle , a mother charged with infanticide in Los Angeles. While I was certainly pleased that the article forwarded to me was written with a great deal of sensitivity to the complex issues surrounding this tragic case, I was deeply troubled by the harsh judgments embedded in many of the comments.

Of course, I am sympathetic to the fact that infanticide is a topic that angers many people. Infanticide should infuriate us, because it doesn’t need to happen. What saddens me is that there are people whom, without thorough knowledge of Perinatal Mood and Anxiety Disorders and Postpartum Psychosis OR the circumstances surrounding specific cases would be so quick to judge the women and their family members.

Making judgments such as these without examining the details is a detriment to the families who are going through this awful tragedy, and also to women struggling with PMADs. Our lack of thorough understanding and persecutory attitudes towards women who are suffering with these horrendous illnesses contributes to the many thousands who suffer in silence because they are afraid to seek help.

While I am certainly not softening the reality of a child dying at the hands of a mother, I am suggesting we put all judgment aside and ask ourselves these important questions: Did the mother have a prior history of violence towards her children? (In most cases of Postpartum Psychosis, the answer is no). Did she  receive competent care from an expert in treating Postpartum Psychosis? (If not, there is no way to be sure that whomever was treating her was capable of recognizing the real risks and responding appropriately). Did she have a supportive spouse, friends, and extended family? (If not, it is unlikely that she would have had enough support to examine “other options” that many people mention in their commentary).

I am not making an excuse for anyone here, but I am saying that Postpartum Psychosis is an illness that, under specific circumstances, can cause ANY highly functional woman to take the life of her child. In many cases these are women who are described as healthy, outgoing, loving, responsible, social, professional, and are well-loved by many. These are women whose spouses and families would never, ever in their wildest dreams imagine that this could happen to them. Which is why competent care is important—Nobody could possibly estimate the risk unless they know EXACTLY what they are looking for. The symptoms of psychosis are often very subtle in these women.

I’d like to share some examples of the comments I found to be particularly troubling. Please note that I am in no way attempting to disrespect the commentators. I believe that everyone is entitled to their opinions, but I am simply highlighting the ways in which our statements, especially when uninformed, can be harmful someone who desperately needs help.

[Her husband] could have got her locked up in a mental hospital for (its 72 hours here) and gotten her checked out.

While I wholeheartedly agree that there are times in which involuntary hospitalization are necessary to protect mom and baby, there is no compassion in the language used here. “Locking someone up in a mental hospital” implies two things. First of all, it implies that a woman who is struggling with mental illess is “crazy” and should have her freedom taken away. Second, it implies that hospitalization by itself can cure, fix, or solve the problem.
Hospitalization can* be useful when a woman needs to be stabilized. It can help her get caught up on sleep, and can provide a safe environment in which medications can be stabilized. But I have never, ever seen a woman walk out of a hospital cured of a PMAD. She still requires medication, therapy, and loving support from family and friends long after her hospital stay.
Why would any parent let a mentally ill parent near their kids alone?
If 1 out of every 5 people has a mental illness, then it’s guaranteed that there are a lot of “mentally ill parents” out there doing a perfectly fine job parenting.  Frankly, it worries me that there are still people out there who believe that simply having a mental illness warrants having  human rights taken away.
Seriously, I work in a doctors ofc and i swear nine out of ten women who walk thru the door seeking antidepressants are white women, i don’t get it [.]
The woman mentioned in the article is from Guatemala, therefore I am assuming that this commentator is referring to the fact that in many cases, Caucasian women are far more likely to reach out for services.  While all women are at risk of developing PMADs,  PMADs are more prevalent among Hispanic and African American women, and/or women of lower socioeconomic groups. Women are more/less likely to seek services because of cultural attitudes and access to resources, which we know can be limited among women in lower socioeconomic groups.
I’m so sick of the I was depressed so I hurt/killed my kids. Hope they provide some help for you in jail because no matter what is wrong with you…you’re a murderer plain and simple.
Depression does not cause women to kill their children. Postpartum Psychosis, coupled with inadequate or inaccessible treatment/support can and does. There is a major distinction between women who kill their children because of Postpartum Psychosis, and women who kill because of underlying sociopathic tendencies. All women have a right to be examined and judged based on every single circumstance of her case.
Women who commit infanticide because of untreated or ineffectively treated Postpartum Psychosis ARE victims. As a professional in this field, I know how difficult it is to find competent care when you’re struggling with such a serious and largely misunderstood affliction. It is not as simple as “getting help” because in many cases, specialized help literally does not exist. These women and children ARE victims, because they are falling through the cracks, plain and simple.
If the father knew the wife was depressed and needed help (which sounds like he did)  he should have never left the children with her alone.  He is as much to blame as anyone.  It is like giving a depressed person a gun.
Unless a mental health professional A) Recognized the seriousness of her illness, and B) Clearly instructed her husband and other family members to make sure someone was with her at all times, there is NO WAY this man could be held accountable for his wife’s actions. He is obviously not a trained mental health professional, and although he was concerned about his wife’s behavior and wellbeing, there is no way he could have known how to appropriately respond to the situation without the guidance of someone well versed in this illness.
I’m so tired of hearing how all these people are victims…victim is an excuse. She could’ve walked away. She could’ve did a million other things than what she did.
Neither you nor I know the circumstances surrounding this woman’s life, so we cannot even begin to presume what she (probably in a state of psychosis) could or could not have done. However, it seems to me that her husband did seek help on her behalf. Since we do not know any of the details of what treatments were tried (and we should not assume), there is no way of knowing from our vantage point who is to “blame.” That being said, if she is anything like many of the hispanic women I see in my office, it is possible that she truly had nobody to turn to.
[P]eople who think she is victim because of postpartum depression, you are as guilty as her.
Denying that inadequately treated Postpartum Mental Illness can cause such a tragedy is the only crime here. If we acknowledge that roughly 20 percent of ALL postpartum women become victims of these illnesses, and we resolve to do something about it (screening at postpartum and well baby visits, and referring to specialists), we won’t need to argue about who is guilty.
One of my greatest wishes is that one day, women will not have to be afraid of seeking help. And when they seek help, they will be met with the expertise, compassion, and support they so desperately need to be well again. When a woman is out of control because of a mental illness, she cannot possibly be fully responsible for herself, which is why it is OUR responsibility to educate ourselves and do everything within our power to provide care that will truly make a difference.
If you are concerned that you or someone you love may be experiencing a Perintatal Mood or Anxiety Disorder, contact Postpartum Support International. They can help you find experts in your area who can help you or your loved one recover. If you are in the Chicago Area, contact the Postpartum Depression Program at Healthcare Alternative Systems at 773-292-4242.

*Shortly after publishing this post, my phone started ringing. A former client of mine  had read the post, and  called to ask me to make an important point on her behalf. She reminded me that her own (multiple) hospital stays were not helpful to her in the least. Fraught with what she calls an “overwhelming feeling of adrenaline,” she was unable to sleep for months during her pregnancy and after her baby was born. What would have helped her, she said, was being allowed to “catch up on sleep” at the hospital. However, she said that she was awoken every morning at 6:30am, and was expected to participate in activities and groups all day, which only increased her anxiety and dread. As a strong self-advocate, she would say to each new professional she met at the hospital, “I have Postpartum Depression. What experience do you have with this?” Of those direct care providers she encountered in the hospitals, not one claimed to have any experience with treating Perinatal Mood and Anxiety Disorders.

She wanted me to highlight this point because my post struck a chord for her. When I said that competent, specialized care is vital, this is exactly what I meant. This is a woman who struggled with Postpartum Depression for almost a full year, despite the fact that she sought services from the early stage of her pregnancy, and had excellent support from family and friends. Unfortunately she was met again and again with professionals who were unclear about her diagnosis and appropriate treatment, and were therefore unable to provide her with the care that might have liberated her sooner. Thankfully, she has made a full recovery, but she is still haunted by certain aspects of her experience.

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