Podcast: Postpartum Psychosis Warning Signs
Having a baby is a wonderfully happy time, right? For many women, it certainly is, but estimates show that 1 in 5 women who give birth will suffer from some type of perinatal mental illness, such as depression, anxiety, OCD or psychosis. Chances are, this includes someone you know. In today’s podcast, Dr. Katayune Kaeni, a psychologist who specializes in perinatal mental health and a sufferer herself, discusses these often confusing and debilitating disorders, particularly postpartum psychosis, a more rare and severe form of perinatal mental illness.
Who is at risk? What does perinatal psychosis look like? And what is the treatment? Join us as we discuss an often misunderstood disorder.
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Guest information for ‘Dr. Kat- Postpartum Psychosis’ Podcast Episode
Katayune Kaeni, Psy.D., PMH-C, is a psychologist in private practice specializing in perinatal mental health. She was drawn to this specialty after going through Postpartum Depression, Postpartum Anxiety and Postpartum OCD with her first child.
Dr. Kat is involved with Postpartum Support International as a subject matter expert for PSI’s certification exam development, helped develop advanced training curriculum for PSI and is a board member and Chair of Education, Training and Certification. She also works with her local community to provide training and education about perinatal mental health.
Dr. Kat is the creator and host of Mom & Mind Podcast, which focuses on perinatal mental health and wellness. Through interviews with experts and people sharing personal stories of healing, the podcast raises the volume on issues to give information, reduce stigma and support families in the transition to parenthood.
About The Psych Central Podcast Host
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.
Computer Generated Transcript for ‘Dr. Kat- Postpartum Psychosis’ Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.
Gabe Howard: Welcome, everyone, to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Dr. Katayune Kaeni. She is the host of the Mom & Mind podcast, which focuses on perinatal mental health and wellness. Dr. Kat, welcome to the show.
Katayune Kaeni, Psy.D.: Thank you so much for having me. Glad to be here.
Gabe Howard: Well, I’m always excited to have a fellow podcaster because you know what we go through.
Katayune Kaeni, Psy.D.: Yeah, right. Yeah. It’s a thing.
Gabe Howard: It really, really is. Now, today, we’re going to discuss postpartum psychosis. And you were drawn to this specialty after you yourself went through postpartum depression, postpartum anxiety and postpartum OCD after the birth of your first child.
Katayune Kaeni, Psy.D.: Correct. Yes. There’s a lot of things that can happen in the postpartum period. I’m here to talk about one of the more severe conditions.
Gabe Howard: In the interest of full disclosure, I’m a 43 year old male. I’ve never been pregnant and I do not have children. I’m really, really entry level when it comes to understanding what postpartum anything is. So thank you so much for helping to educate people like myself. It really is an important topic.
Katayune Kaeni, Psy.D.: Yeah, it’s absolutely important and a lot of people have that same feeling. I don’t know anything about it. It seems like this weird thing that happens to other people. And chances are, you know, somebody who has suffered through some form of perinatal mental health condition, even if they don’t talk about it, which is very common, a lot of people don’t talk about it because there is so much shame around kind of not feeling well or not feeling yourself even during pregnancy or postpartum. There’s all these ideas out there that it’s this wonderful magical time and hopefully it is. But for a lot of people, it isn’t.
Gabe Howard: That’s one of the things that came up while I was trying to do research for the show so that I could talk somewhat authoritatively on this subject. I was shocked at how many times I Googled postpartum psychosis or postpartum anything, and the articles that came up were, Am I a bad mother? Am I a bad parent? Am I harming my child?
Katayune Kaeni, Psy.D.: Right, yeah.
Gabe Howard: That really kind of spoke to me like in a visceral way, this idea that you also have the illness and there’s all this stigma and shame surrounding it. Is that what you found working as a therapist?
Katayune Kaeni, Psy.D.: Oh, absolutely. I hear those comments all of the time. I feel like a bad mom. I’m not good enough for my child. Feeling the shame and the blame and confusion around why do I even feel bad? We are just not educated on what can happen. I think it’s a great disservice to everybody who goes through any kind of perinatal mental health condition because they’re mostly blindsided by it. Right? You’re like here I’m supposed to be having the best time of my life. This is like what my body is supposed to do, quote unquote. And here I am feeling like a failure.
Gabe Howard: And just to be clear, none of this is true. You are an excellent parent. This is just sort of the illness and society’s misunderstanding of the illness taking hold in an unexpected way.
Katayune Kaeni, Psy.D.: Oh, for sure. This is a very treatable and very temporary condition. If you get the right help and if you get it as soon as you know, even if you’re getting it a little bit later down the road, you still can feel better. And there’s not a huge impact throughout the life course of you or your child. However, again, in the more severe cases that are not treated, there are some long term effects. And I know that might sound really scary to people. So I want to dispel the myth that if you have a condition, you’re going to be like messing up your kid in some way. Like I said, this is very treatable. And also, when it’s very, very severe, there can be really life-threatening consequences.
Gabe Howard: So let’s talk about postpartum psychosis. What is the definition of postpartum psychosis?
Katayune Kaeni, Psy.D.: Typically, a postpartum psychosis is very rare. One to two out of every one thousand deliveries, and it is not postpartum depression or postpartum anxiety. The onset of these symptoms are usually in the first two weeks, but certainly can show up a little bit later. There’s a really rapid onset meaning symptoms start quickly and it is characterized by the mind is kind of going off on its own, in part because of hormonal changes, in part because of your own mental health history and in part because of sleep deprivation. So people who are experiencing postpartum psychosis are having rapid mood swings. They are potentially having delusions or strange beliefs about themselves or their child or people around them. They may be having hallucinations. Feeling very, very irritated. The difficulty to sleep or inability to sleep. Sometimes paranoia and what’s really hard about postpartum psychosis is that the symptoms wax and wane, meaning they come and go. So sometimes people can sort of be and feel like themselves and appear to be like their normal selves. And then sometimes people around them might observe that they don’t look like themselves or sound like themselves. So it can come and go for quite a few people. And then for some people, the symptoms, once the onset is there, just continue. So I know all that probably sounds pretty scary and serious and it actually is pretty scary and serious. Like I said before, it’s very rare. And people who have a history of a bipolar disorder are at a high risk, or if there’s bipolar disorder in the family, they’re at higher risk. Oftentimes psychosis in the postpartum is an undiagnosed bipolar disorder.
Gabe Howard: So let’s talk about that for a moment. I myself live with bipolar disorder. And I understand psychosis from a lived experience perspective because I have experienced psychosis. Is it the same? Is postpartum psychosis, and for lack of a better phrase, “Gabe Howard” psychosis, is this a similar thing or is it completely different?
Katayune Kaeni, Psy.D.: There’s certainly some similarities in terms of symptoms of psychosis are the same. But what’s very different here is that there is a new baby involved. And sometimes the delusions or hallucinations are in relation to this new child. This new very vulnerable child. And also the perinatal person is also very vulnerable. They’ve just given birth. They’ve had massive changes in hormones, both during pregnancy, at delivery and then in the postpartum there are really, really rapid kind of swings in the hormones during that time. And the sleep deprivation is, you know, when it’s sort of like just you quote unquote, you have capacity to possibly sleep. In these cases, there’s a baby involved. And babies cry and they wake people up. And that’s what they do and that’s what they’re supposed to do. But for somebody who needs sleep and isn’t getting it and can’t get it, it adds a whole other layer of complexity into into the life and into the symptoms, because you’re in relation to a baby while having psychosis for some time. That means that there’s like a hyper vigilance around the baby. Like it’s really hard to not be around them or to let anyone else support them. Or sometimes it’s like a kind of a total disregard. Like people in some psychoses, they will kind of forget that the baby is there. So it brings a whole other level of danger and complexity also. Then there’s this additional layer that people around them are thinking, oh, well, she’s had baby. She’s not quite herself or giving some other explanation for odd behaviors, the strange behaviors. And it kind of puts people in a more of a dangerous situation because symptoms are explained away because they’re not understood and it’s not expected that these kind of symptoms will show up.
Gabe Howard: I’m kind of assuming that the way that postpartum psychosis is played out in the media as well as how motherhood is played out in the media, those two things combined. Because like you said, we want to defend new parents. We don’t just want
Katayune Kaeni, Psy.D.: Right.
Gabe Howard: To throw every new mom under the bus and say, oh, well, you have a serious mental illness. That’s the problem. But of course, this can be dangerous because it lacks care. I suppose my specific question is, how is postpartum psychosis played out in popular culture?
Katayune Kaeni, Psy.D.: It’s actually in very dangerous ways. So in ways that further stigmatize the perinatal period. So mostly what we’re seeing in the media, what you see on the news, is that postpartum psychosis that has led to infanticide and this is a really, really hard topic for people to hear about. And also, this is a very real possibility with postpartum psychosis. Out of that 1 to 2 percent of people who have postpartum psychosis, 4 to 5 percent of those mothers will kill their children. They kill their baby. It’s really, really a hard reality to hear. And what I want people to know is that when this happens, women are not in their right mind at all. They are not themselves. They do not know what they’re doing. They are often being told by their delusions to do something. Sometimes there are delusions that the baby is possessed. So they can’t be here. Although this might not make any sense, but most of the time it’s really out of love. A lot of love, like the world is too harsh for this child. So they have to go. And this is a very severe departure from reality. The moms who are in this situation do not know what they have done. If they come out of it and get the medication that they need, they can’t even fathom what has happened. People think and say, oh, what a horrible person. I can’t believe she has done this. I would never do this to my child. And the thing is, is that if she were in her right mind, she wouldn’t either. So what we’re seeing in the media is usually the moms who have done something like this and who are being handcuffed or going on trial. So this most severe, this is the most severe consequence of perinatal mental health condition. Postpartum psychosis and infanticide is how postpartum psychosis is viewed. Most people with postpartum psychosis are experiencing hallucinations or delusions or some kind of waxing and waning symptoms that does not reach that level. Typically, they may need hospitalization and medication, but it’s not always that people go on to hurt their children in this way.
Gabe Howard: It’s very interesting what you said there, because, of course, when something as terrifying and scary as infanticide happens, we say, oh, I would never do that as a mom. I can’t believe that a mom would do that. I mean, we have a lot of like really fear-based reactions.
Katayune Kaeni, Psy.D.: Yeah.
Gabe Howard: Because it’s terrifying. But then when we hear about somebody getting help for mental illness after the birth of a baby or not being excited about the birth of a baby, which is very common, we also say that exact same thing. Well, I would never do that as a mom or, oh, my whole
Katayune Kaeni, Psy.D.: Mm-hmm.
Gabe Howard: Family was excited or I just can’t imagine not loving. It’s the same reaction and it stops people from getting help.
Katayune Kaeni, Psy.D.: Oh, totally. It absolutely does. Yeah. This is the stigma. And when you are feeling as bad as you might be feeling in the postpartum period, even if it’s not psychosis, you’re dealing with depression or anxiety or OCD or PTSD or even a bipolar disorder in postpartum. You being the one who’s not well, also have to sort of fight against people around you who don’t want to think that you’re not well to advocate for yourself to get help. And sometimes it’s with the medical providers, too, who unfortunately in their training don’t get a lot of education on this. So getting to the point where as a person who is suffering to also be in charge of finding the help that you need when you don’t know what’s going on is an incredible hill to climb. I see it all the time. I see it all the time. People who come in not wanting to say out loud how badly they feel. And they finally get to help. And then they get to learn about how common this is and how preventable or treatable. And all of that. There is an amazing amount of strength in people who are dealing with a mental health complication while pregnant or having a newborn. It is phenomenal.
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Gabe Howard: We’re back discussing postpartum psychosis with Dr. Kat, the host of the Mom & Mind podcast. To switch gears a little bit, we know that you’re an accomplished therapist and you understand this, of course, from the medical side and helping people. But this is also something that you went through personally.
Katayune Kaeni, Psy.D.: Oh, yeah.
Gabe Howard: I imagine that these myths and misconceptions from both society and whatever lived in your brain made the treatment and the acceptance of it very, very difficult.
Katayune Kaeni, Psy.D.: Oh, my gosh. It really did. So I was already a psychologist. I had a full time job. You know, I was helping other people and I got pregnant. Pregnancy was fine. Birth was fine. But very quickly, like day one, after my daughter was born, anxiety was there. I was so hyper vigilant. Not your normal checking on the baby. Like I could not not watch her because I was so afraid she was going to die. And she was fine. Physically, she was fine. Looking back on it now. That was the first sign. I want to say, before I go into the rest of this, is that I was a therapist and I didn’t know what was going on. It took me a full year to figure it out. And I myself have a history of depression. But it felt different in part because of those myths that you mentioned. It was crying all the time. I felt really alone. I felt like I didn’t know what I was doing. Everything that I was doing was wrong. I started having intrusive thoughts that something bad is going to happen. And I had them all the time. But because I had this idea of motherhood, or maybe like an incorrect idea of motherhood, I thought to myself, well, I guess this is what it’s like. I guess this is normal. I guess this is what I’m supposed to be experiencing.
Katayune Kaeni, Psy.D.: And it didn’t fully register to me until later that it was depression and anxiety and then OCD. And it went on for a year, a good year. I felt horrible the whole time until I figured out what was happening. I had read about one of my symptoms in a book and immediately had immediate relief like, oh my God. It’s not just me. And then I started researching a little bit more and realized there’s this whole world of mental health conditions that I had never learned about in grad school. I never learned about in any of my training anywhere. Maybe there was like a one page in one book that described it, but really no actual education on it. So I didn’t even know that postpartum anxiety was a thing. Certainly not postpartum OCD. I had heard about postpartum depression, but I thought, oh, no, no, no, no, not me. I’m a therapist. I’ve gone to therapy. I’ve done a lot of work on this stuff. So that’s not what this is. And looking back on it now, I can see how and when I started and all the factors that contributed. But at the time, when you’re in it, it just feels horrible and it just feels like it’s only you. And it’s incredibly embarrassing and filled with shame.
Gabe Howard: When did you finally realize something was wrong and what steps did you take to get help?
Katayune Kaeni, Psy.D.: Yeah, it was about around my daughter’s first birthday. It was almost like after I made it to that year, something just cracked in me and I knew something was wrong for sure. So, again, I was a therapist. I was working in a major medical system and we give out the PHQ-9, a ten item questionnaire, which is a mental health depression screening. And I said, OK, I’m going to take this and I’m going to be honest so that I can see objectively really how bad off I am. Mind you, I had taken this PHQ-9 several times in just regular doctor’s visits and in my postpartum visits. And I lied. I lied on those. I did not want to be as bad off as I was because I was like, I know what this is asking. I know. Like, nobody else needs to know about how I feel. So anyhow, that day where I just sat down and had an honest conversation with myself and that was the turning point. Again, it was around a year. So I went back to my therapist and I talked with her about what I thought was going on. And unfortunately, she didn’t have training in this. So she disagreed with me that I was having postpartum depression. So I started doing my own reading and really learning as much as I could. And then that helped a lot. I wish I would have known at the time to seek out a specialist who could know what I was talking about. But yeah, I went to therapy. I did a couple of other things, like I went to get my thyroid checked out and I started a bunch of supportive types of things to help me get back. So I took that kind of a route. I had taken antidepressants in the past, but again, I didn’t really know enough about antidepressants during this period of time to feel okay about it. But knowing what I know now, I know that they’re largely safe. So I did go to therapy. I did reading and I sought out whatever kind of supportive things I could.
Gabe Howard: And you’ve described it as very scary, and as you pointed out, you’re a mental health professional.
Katayune Kaeni, Psy.D.: Mm-hmm.
Gabe Howard: If a mental health professional is scared to seek mental health treatment after the birth of her child, what are the odds for the rest of us? Which brings me to my next question. What are the odds for the rest of us? And that’s kind of an all encompassing question. How many people have postpartum psychosis that never get help? And I guess it naturally goes away or of course, something bad happens. Once you get help, what percentage of people get better? I know it’s kind of a big question, but what’s the prevalence rate of postpartum psychosis?
Katayune Kaeni, Psy.D.: Prevalence for postpartum psychosis specifically is 1 to 2 percent, which is very low.
Gabe Howard: Very rare.
Katayune Kaeni, Psy.D.: Yeah. Very rare, but for postpartum depression and anxiety, it’s in around 20 percent, a huge number. So one in five people will deal with a perinatal mental health condition. So I’m talking about like the umbrella of things that can happen. 20 percent is a lot. And when you put that out into like the population of the United States, we’re getting into the hundreds of thousands of people every year who are dealing with this. So it is super treatable. And there are a lot of people who now are specializing in this area, perinatal mental health. So when people get help, symptoms resolve relatively quickly. All of these conditions are treatable. So if we can get somebody who is at risk for postpartum psychosis into the right psychiatrist and the right therapist or the right support team, then the symptoms can resolve relatively quickly. But the longer it goes on, the harder it is to heal and recover. So the sooner that we can get people in and seen, the sooner it will resolve and people go on to be fine. Absolutely fine. And also people who come in for therapy, sometimes there are some underlying things that have contributed to the anxiety or the depression or the OCD. And if people are getting the right kind of help, I really hear sometimes that they’re better off than they were before because they’ve caught something and gotten help for something that was actually had been bothering them for years. Let’s say anxiety for instance, a lot of people just live with anxiety and don’t specifically know that they have it. But if there’s a peak in symptoms during this period of time and it’s finally bringing them in for help, then we’re able to help them not only in the postpartum period, but also just help them with life skills that can benefit them for years.
Gabe Howard: It sounds to me like while postpartum psychosis is scary, it is treatable and it’s most treatable if you get help immediately. And one of the reasons that people aren’t seeking help immediately is because of a lot of, you know, myths and shame that isn’t really relevant to the disease that you have, the illness that you have, the disorder that you have. And then we’d be in a much better position if people got it checked out before it became, you know, bigger and bigger and bigger or before the worst case scenario happened.
Katayune Kaeni, Psy.D.: Absolutely. The sooner you get in, the better. And I’m also a really big fan of prevention. So if you are planning on getting pregnant or get pregnant and you know that your family has a history of any mental health conditions, I would say just find somebody who specializes in perinatal mental health. Go talk to them about your concerns and develop a plan. I think really when we can get ahead of it, it’s even better. So there are things that we know how to do, like protect sleep and negotiate that within the family to help with the baby and have meals brought in. There are so many things that we can do to help prevent this. And also sometimes it’s not completely preventable, but we can help reduce the intensity by quite a bit if we’re ahead of it. So although I know people kind of don’t want to think or believe that these kinds of things could happen and therefore sometimes don’t get preventative care, I would highly recommend to do that because it will make your experience so much better.
Gabe Howard: Dr. Kat, thank you so much for being here. I can’t thank you enough. And I hope that everybody checks out your Mom & Mind Podcast. Do you have a Web site where people can find you easily?
Katayune Kaeni, Psy.D.: Yes, www.momandmind.com.
Gabe Howard: Again, Dr. Kat, thank you so much for being here. Do you have any last words for our listeners?
Katayune Kaeni, Psy.D.: Thank you for having me. I would just like to say to anyone who’s listening, who is concerned about these symptoms, you are definitely not alone. There is help. And with the right help, you will be well.
Gabe Howard: Thank you so much. And remember, everybody, wherever you downloaded this podcast, I just need you to do a couple of things. Give as many stars as you feel comfortable giving. Hopefully it’s all of them. But no matter what, use your words. Tell people what you like or tell people what you don’t like. You can always e-mail [email protected] and let me know what kind of shows you would like to hear. And remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. And we’ll see everybody next week.
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Central Podcast, T. (2020). Podcast: Postpartum Psychosis Warning Signs. Psych Central. Retrieved on July 14, 2020, from https://psychcentral.com/blog/podcast-postpartum-psychosis-warning-signs/