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Postpartum Psychosis: Is It Real?

“I don’t remember too clearly,” says Sarah, 40, now divorced. “There was a rat. It was black and silky, the size of a cat, and it ran across the closet from one side to the other. I was terrified it would bite the baby if it had burrowed into the walls, so I pulled all the shoes out to the center of the closet, searching for it, or for the hole where it had to be hiding. It had to be there — I had seen it, and I could smell it: like damp and oily rags.”

She loses the thread of her broken memory, recounting her then husband’s confusion at her behavior, irritated, telling her to come back to bed, there wasn’t a rat, it was a dream, turn off the damn light. So she did, and though the baby woke several times that night, as he always did, she got up, and cared for him as she had done since the day she brought him home. A bright, blue-eyed boy, a lightning bolt of infant activity. When he grew sleepy the next morning, she laid him in his crib, and returned to bed, restless and unwell.

Through the monitor, she heard him scream. Agonizing, a sound of pain that took her back to the videos of babies born addicted to drugs and their haunting cries of withdrawals. She leapt from the bed, down the hall to the crib. He slept, peacefully, the little back rising and falling with easy breath. She stared at him, waiting for him to stir, but he slept on.

“It was strange,” she says, “But there were children playing outside. I thought maybe it had been one of them. I just went back to bed. Then it happened again. The same cry, the same peaceful child, sound asleep. Just a nightmare, I thought.”

“Then there was a third cry. Deeper and different. When I went to him, I was nervous. From the doorway, I could see the strange, grey lights, like blades, stabbing into sparkling air above his small body. He looked asleep, but the cry came from inside him, from deep in his belly, and the lights around him were greyish, and sinister. The cries turned to laughter, and indistinct voices like scraping metal on metal. I backed away. I didn’t know what to do.”

Frightened, confused, she called her mother.

“Later, she told me that she thought I had killed him, that I said, over and over, ‘He’s asleep, but he’s still screaming. Please help me.’ She was a thousand miles away. She called a local friend, who came to the apartment to see us. She must have been terrified of what she would find. But the baby was fine. I was a wreck.”

Sarah pauses in the telling, eyes wet, though it has been long enough that the infant in question is now preparing for college, no worse for the wear. I let her gather herself, and she smiles.

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“She sent me to bed, and took the baby monitor. I don’t know how long I slept, but someone must have called my mother and reassured her.”

She stops talking and looks out the window. I wait, expecting to hear the end of the story.

“That’s it,” she says. “The next day it was as if nothing had happened.”

She shrugs.

“You’re thinking I should have gotten care, gone to the hospital, someone should have come to help me. But none of that happened. And no one talked about it again, ever. You’re right, of course. I needed help. But I wasn’t sure what had happened. I don’t really remember the next six months of his life. I must have done what was expected of me.”

“The thing is, if everyone around you acts as if nothing has happened, you wonder if it did, especially when your mind fails you in that way. I remember seeing and hearing vague sounds and voices, and thinking, ‘Is it real?’ I’d decide it didn’t matter, and go on about the day. If you’re doing what you should be doing, aren’t you alright?”

She shakes her head, lets her gaze fall to her shoes.

“Years later, I described the incident to my doctor, after another bout of depression. Her eyes got wide. ‘That’s psychosis,’ she said. ‘You should have been hospitalized. Someone should have taken care of that boy for you.’ I’d never had that word attached to me, and I laughed. Of course I wasn’t crazy. ‘Crazy isn’t a great word. If you are seeing and hearing things that aren’t there, that’s psychosis,’ she said. ‘A sign that you really need help. Why didn’t they help you?’”

Sarah sighs and admits there wasn’t anyone to help her. Her family and friends were a thousand miles away, her husband had to work to keep them fed. And her face turns sad when she admits it might have been for the best. She still worries all these years later that someone might find out about what happened. Her career is such that a label of ‘psychosis’ would likely end it.

“The stigma attached to it is so powerful. An involuntary commitment would have marked me as unfit to do my job.”

While privacy laws protect medical records, licensing boards for several careers in most states ask questions regarding mental health treatment, and the consequences for reporting are unknown. The Americans with Disabilities Act should protect people who are under mental health care, but, it becomes a grey area when it comes to the public service sector. Whether a doctor, lawyer, nurse, or police officer is “fit” for duty after having been hospitalized for mental health issues remains a topic of debate, even years after the incident, and even if the incident was so clearly tied to a particular event.

“If something went wrong, even if it wasn’t my fault, something like that on my record might be enough to push a jury to blame me. It was years ago, but that might not matter. So I just don’t report it. I was never hospitalized. I’ve had colleagues through the years who refused to seek treatment for depression, even with mental health coverage, for that exact reason. Especially if the policy comes through their jobs. Sure, HIPPA protects people. Until it doesn’t.”

She smiles again, and says it feels good just to tell the story. She asks to see it when it’s finished, ostensibly out of curiosity, but also to make sure her identity is properly disguised. The stigma of mental illness weighs heavily on her, as it does on any society that prevents its public servants from seeking out the help they need to continue to serve. Sarah has received awards from her superiors for her hard work and dedication. She is an exemplary employee. Thousands like her are not seeking treatment because of stigma and miseducation, when they might serve their communities better with treatment, and offer a unique perspective on those members of the public who are themselves struggling with mental illness. That is the reality.

Postpartum Psychosis: Is It Real?

Erin O'Shea

APA Reference
O'Shea, E. (2018). Postpartum Psychosis: Is It Real?. Psych Central. Retrieved on August 15, 2020, from
Scientifically Reviewed
Last updated: 8 Oct 2018 (Originally: 21 Jul 2017)
Last reviewed: By a member of our scientific advisory board on 8 Oct 2018
Published on Psych All rights reserved.