Reducing the Stigma of Postpartum Psychosis

In the United States, an estimated 13 percent of women experience symptoms of postpartum depression, and as many as 80 percent are affected by “baby blues” – two forms of maternal depression that many have come to accept as both common and treatable, thanks to recent progress in the medical community to destigmatize these conditions through public education, clinical research, and patient outreach.

However, another form of maternal depression – known as postpartum psychosis (PPP) – has remained largely excluded from these awareness-raising efforts, contributing to a dangerous, misinformed stigma that will continue to drive poor maternal and infant health outcomes – unless we speak up.

PPP is a rare but serious condition in which postpartum women experience a break from reality. It occurs in approximately 1 to 2 out of every 1,000 deliveries – a similar incident rate to Down syndrome – and can include symptoms like delusions, hallucinations, hyperactivity, sleeplessness, paranoia, and difficulty communicating.

While the exact causes of PPP are not yet known, certain factors have been associated with increased risk for the condition, including having a personal or family history of bipolar disorder or having experienced a psychotic episode in the past.

While PPP is a medical emergency – and should be met with the same urgency as a heart attack or stroke – it is often not treated that way. Too many mothers remain unaware of the signs and symptoms to look for, preventing many of them from seeking early treatment to mitigate the severity of the condition.

In fact, because PPP is not discussed as a potential condition some pregnant people may experience, many mothers know nothing about it outside of the sensationalized incidents of infanticide – which only occur in about 4 percent of cases but receive a disproportionate amount of media attention. Many mothers may experience PPP symptoms and never even share what they’re going through for fear of how they may be perceived, adding to the stigma and shame surrounding this condition.

As medical providers and mental health professionals, we must work to correct this.

Too often, women in my practice are led to believe that because a condition is “rare,” it doesn’t apply to them. Unfortunately, for the very few who do exhibit symptoms of PPP, it can also make them less likely to talk about it with friends, loved ones, or healthcare providers.

Therefore, as mental health professionals, we must do more to ask questions of our patients, educate them on the signs and symptoms, and assure them of their safety if they ever exhibit these feelings. PPP symptoms can be confusing and make those experiencing them feel vulnerable and alone.

To turn the page on how this condition is discussed and treated, we must first talk openly about it, sharing the early warning signs of PPP and symptoms one might be feeling. Second, we must provide resources to individuals so they know they are not alone, and if these symptoms arise, they have a better understanding of who to call for help. Finally, as medical practitioners, we must get curious about our patients, asking questions that may pull back the curtain and reveal how someone is truly feeling.

Too often, illnesses like this are allowed to live on in the shadows, and as medical professionals, we can put an end to that.

In July, I attended the 35th Annual Postpartum Support International Conference here in New Orleans and listened to several talks that I found extremely interesting, educational, and thought-provoking. However, the one that impacted me most was a presentation given by Teresa Twomey, J.D. – a survivor of PPP, a maternal health advocate, and the author of Understanding Postpartum Psychosis: A Temporary Madness.

Teresa experienced PPP in 1998 very unexpectedly, as she had no history of mental illness prior to her postpartum period. Even after so many years, I could see how difficult it was for her to stand up in front of a packed room and relate the horrible pain she felt from this traumatic experience with PPP. Still, she bravely chose to share her story with us, from start to finish – because she wanted to bring awareness to PPP and break down the stigma.

The medical community must build on the efforts of survivors and advocates like Teresa. We need to do our part to raise awareness around PPP, provide more education and awareness opportunities, and underscore that this is a treatable condition and that folks experiencing it are not alone. However, none of that is possible without first educating ourselves – the medical community – about the signs and symptoms of PPP and learning best practices for how to approach an open and supportive conversation with a patient who might be at risk.

Postpartum Depression Essential Reads

Supporting Your Postpartum Partner

New Treatment Option for Postpartum Depression

As mental health professionals, we must remember that a lack of knowledge and resources can lead to fear and avoidance, which, for this acute condition, in particular, is not a good formula.