By Sarah R. Fields
May/June 2007 - Issue 142
She's so fragile. I could kill her without trying. I realized this when my daughter, Anna, was born. Such innocence and utter dependence! Two years later, the arrival of my son, John, brought a return of the same fears. What if I dropped him down the stairs? Becoming a mother brings a sense of reverence and holy fear, in the face of the awesome responsibility of caring for a tiny little life. Sometimes, when a mother loses touch with reality, those fears come true.
When I learned, from one study, that one in 25 mothers with postpartum psychosis kills her child, I was overwhelmed with a feeling of gratitude.1 Postpartum psychosis affects only one to two women per thousand in the first year after giving birth, but when my son was six months old, it happened to me. No harm came to either of my children while I was psychotic, thanks to close supervision and quick intervention by my husband and my parents. But I realize now that it could have.
The problem began with a bout of depression, due in part to social isolation and in part to grief: We were living in a new community, and my father-in-law was dying of Alzheimer's. I was able to cope as long as Carl, my husband, was home from school for the summer, but when he returned to teaching in the fall and left me home alone during the day with two-and-a-half-year-old Anna and five-month-old John, I found myself swinging from inexplicable sorrow to blinding rage and back again. I lost my appetites for food and sex. After a month or so of skipping breakfast, I also stopped eating lunch, and found myself tandem-nursing two children on one meal a day. Even when I tried to sleep at night, I couldn't relax. Carl would wake in the wee hours to find me reading a book by a tiny night-light as the children dozed beside me.
I felt a sense of impending doom, and was plagued by severe guilt that I could neither explain nor escape. That feeling of guilt was the worst part of my depression: I felt as if I carried the weight of the world in my soul. When Katrina struck a thousand miles from our house, I felt as if the hurricane had barreled through my body and left me drowning in its wake.
A series of shocks left my frayed nerves totally jangled. We were struck by a drunk driver in a hit-and-run accident, and just days later, in a hotel, we were awakened at three in the morning by a security guard, who asked us to leave because the hotel management thought we hadn't paid for the room. After that, I didn't sleep for four nights. My next sleep would come in a psychiatric hospital.
Over the two days following the hotel incident, I became increasingly delusional and suspicious of my loved ones. My behavior was strange: I ran into a convenience store hollering about abortion; I refused to feed my daughter during the day; I asked my neighbor to leave my house because I was convinced she was trying to kidnap the children and make them part of a cult; I accused Carl of having affairs with all our friends. By the second day, Carl realized that I could not be left alone, and drove me to my parents' house, two states away. I wandered down the highway by their house in sub-freezing temperatures with no coat, convinced I'd seen a friend from home who was there to rescue me from the imaginary cult. I scanned magazines because I believed they were full of codes placed there just for me. Clues in the everyday world pointed to my theories: When Mom loaned me a coat with a cassette tape in the pocket, I took this as evidence that the FBI was tapping my phone calls.
The day after we arrived at my parents' house (still no sleep), we went as a family to see a psychiatric nurse practitioner. During the appointment, I couldn't sit still. I frantically cleaned her office while my parents and husband talked with her. I decided that the nurse practitioner was actually the lesbian lover of my 90-year-old grandmother (who lived with my parents), and accused her of trying to dominate me. She told my family that the hospital didn't have a free bed until the next day, and sent us home to wait. During the night, convinced that my grandmother was going to swallow all her pills at once to kill herself, I placed myself on "suicide watch." I screamed for hours as Carl and my father physically restrained me so that I wouldn't keep jumping in bed with her to keep her from killing herself. Twice that night I called the police to tell them I was guilty of murdering my grandmother because I couldn't prevent her suicide. Grandma took out her hearing aids and went to sleep, but I was sore and hoarse for three days. The police did come by twice in the night to check on the house, and Mom asked them to come back the next day to help get me into the car to go to the hospital. They did.
On the way to the hospital, Carl sat beside me in the back seat of my parents' van and held my hand, fearing I might try to jump out of the moving vehicle. During check-in, I threatened to sue the hospital. A nurse tried to gather my medical history from me and my dad as the psychiatrist interviewed my mother and husband about my background and symptoms. Mom, a retired La Leche League Leader, explained in no uncertain terms that I would want to continue breastfeeding. The nurse brought me a breast pump, but neither she nor I could figure out how to use it.
Carl left with my parents, taking the children, and I was alone. I thought I recognized many of the patients there, and called them by the names I thought were theirs. I was sure we were in a concentration camp, or in hell. The hospital staff took away my shoes and removed the hangers from the closet, for fear I would hang myself, and locked up the bag Carl had packed. I had nothing of my own.
I accused the psychiatrist of trying to rape the patients, and insisted that a female nurse be present during my first meeting with him. I spoke in an accusatory tone about conspiracies, lawsuits, and codes, but was able to momentarily "hide" my psychosis when I wanted to—for instance, when I spoke about breastfeeding. I told the doctor that I wanted to nurse, and asked him to go to La Leche League's website for help in allowing me to do so. I quoted a friend, La Leche League Leader Pam Ahearn, who said that "healing begins at the breast." I suggested the doctor read Dr. Thomas W. Hale's book, Medications and Mothers' Milk, as he considered psychiatric drugs for me. When he came back the next day with the book, I began to accept him.
That first evening in the hospital, I trusted the patients more than the staff. I followed one patient—an elderly woman with an eye infection who spoke nonsensical phrases over and over—sure that she was my long-dead paternal grandmother. When she needed help in the bathroom, I tried to break in, now sure that the nurses were going to rape her. As I yanked on the bathroom door, five gloved security guards grabbed me and pinned me down on the bed in the isolation room. As I screamed "You're killing me! I can't believe you're killing me!" a nurse pulled down my pants and gave me an injection in the butt. I put my head down to die. It was the first sleep I'd had in four days.
I woke at four in the morning and asked for my son. We had never been separated before, and my breasts were so full they felt as if they would explode. Carl arrived with John, who nursed contentedly after having cried all night and refused formula. What a relief to hold my baby again, to feed him in my arms and be soothed by his presence as he was comforted at my breast.
That morning, the psychiatrist gave permission for John to stay in the hospital with me, as long as Carl stayed, too, to take responsibility for the baby's safety. We pushed two hospital beds together to make a "family bed" in the locked-down psychiatric ward. The doctor asked where John would sleep. Although I knew John would be in bed with me, and although I wasn't sure what it was, I asked for an isolette. (I knew it was some type of hospital baby bed.) The nurse wheeled into my room a twin bed with a cage around it—a giant crib. I was convinced that the hospital was going to remove my vital organs and deposit my corpse in this terrifying contraption. Instead, it served as a makeshift dresser for the nine days we spent in the hospital.
We then fell into a rhythm, as I began to make up for lost sleep and missed meals. I devoured as much food as the hospital kitchen sent up to my room. Every hour during the night, a nurse would peek into our room—the lights were never completely switched off—to check on me. The psychiatrist prescribed one dose per day of antipsychotic medication instead of two, to be taken just before bed so that the levels would peak in my bloodstream—and in my milk—as John and I slept. My parents and my daughter, Anna, visited me each afternoon. Anna nursed when we were together—it was hard to reconnect so briefly. She coslept with my parents at night, but it would be months before she felt relaxed and happy again. For those months, she worried about my becoming sick again and returning to the hospital.
I was released on a pass for six hours on Thanksgiving Day, and the following Saturday I left the hospital. The medicine left me sleepy, and I walked around stiffly, holding my arms in front of me, like a zombie. I ate every meal as if it were my last. After two weeks at my parents' house, we went home, and Mom stayed with us that first week. Then friends from church took turns coming by every day for a few weeks.
After I returned home from Wisconsin in December, I contacted Dr. Karl Robinson, a homeopathic physician, who treated me with a constitutional homeopathic remedy. For the first time in months, I was able to relate to people without fear, to be alone without feeling panic, and to renew the bond of family with my children and husband. While conventional psychiatric medicine helped me to sleep at first, I believe it was homeopathy that brought me true peace and healing. The constitutional treatment gave me the power to pursue dreams and ambitions that had been buried by self-doubt and inertia.
During those weeks before Christmas, Dr. Brian McGuckin, our family chiropractor, tested my blood for nutrient levels and found me very deficient, especially in iron and calcium. He prescribed 15 different vitamins and minerals in high doses, to allow my adrenal glands to rest, and to nourish my cells. The supplements calmed me and brought color back to my skin. Within a week I felt more energetic and able to cope.
In January, at a local domestic violence shelter, I began attending a series of support-group meetings for survivors of sexual assault. While attending college overseas almost a decade before, I had been raped. Sexual abuse can be a risk factor for postpartum mood disorders, and I realized that I had never resolved the feelings of shame and guilt stemming from the assault. Over the next nine months, I was slowly weaned off the medications.
Music has always been a source of nourishment for my soul, so I began singing again. I wrote letters and made phone calls to old friends. Finding support in those who had brought me comfort in my childhood and early adulthood satisfied a deep need for connection with others. I joined a playgroup for mothers and children and am now active in encouraging mothers in my town to consider practicing attachment parenting, as they in turn teach me about tolerance of mothering styles that differ from mine. I reawakened an interest in writing, and joined a writers' group to learn to let my heart sing by telling stories and writing poems, and making a record of my memories.
Just this year, I started a local mother-to-mother support group for mothers diagnosed with perinatal mood disorders, including postpartum depression and psychosis—because while I was healing, what most helped me was talking with women who had been there, and who promised me that I would be well and would soon feel like myself again.
Psychosis was terrifying for me and for my family, and healing took months. Finding an outpatient psychiatrist who would allow me to continue nursing my son was a challenge, but I insisted on protecting our nursing relationship. I am very grateful to La Leche League for the publications, philosophy, and people who provided me with the courage to continue nursing despite the obstacle of a psychotic episode. Nursing kept my babies safe when I became psychotic, because even when my mind was scattered to the four winds, my body remembered how to do what mothers do. Even when my mental state was chaotic, my heart guided my arms and breasts to surround, nurture, and protect my children. They are alive today because my body remembered how to care for them, and took over for me.
It is over a year now since I became psychotic, and I have had no relapse in symptoms. We found out last Christmas that we are expecting our third child, and I am overjoyed with the news. I feel confident that by maintaining good nutrition and sleep habits, implementing preventive measures, getting comprehensive blood work done by my health care provider, and remaining under the watchful eye of my family and midwife, psychosis will not happen to me again. If it does, I'm ready with a treatment plan, care providers, well-informed friends and family, and the wisdom that comes from experience.
Sarah Fields sings, writes, and mothers in Hobart, Indiana, where she lives with her husband, Carl, and their children, Anna (4) and John (2).
FOR MORE INFORMATION
Health Research Institute and Pfeiffer Treatment Center, 4575 Weaver Parkway, Warrenville, IL 60555-4039; 866.504.6076; 630.505.0300; www.hriptc.org.
Postpartum Support International (PSI); PSI Postpartum Depression Helpline: 800.944.4PPD (4773); www.postpartum.net.
Karl Robinson, MD, homeopath, 713.621.3184.
Bennett, Shoshana S. Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression. Moodswings Press, 2006.
Hale, Thomas W., PhD. Medications and Mothers' Milk, 12th Edition. Hale Publishing, 2006.
Pfeiffer, Carl C., PhD, MD. Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry. Healing Arts Press, 1987.
Poulin, Sandra. The Mother-to-Mother Postpartum Depression Support Book: Real Stories from Women Who Lived Through It and Recovered. Berkley Publishing Group, 2006.
1. J. Davidson and E. Robertson, "A Follow-Up Study of Post-Partum Illness, 1946-1978," Acta Psychiatrica Scandanavica 71, no. 5 (May 1985): 451-457. Cited and discussed in detail in Kathleen Kendall-Tackett, Depression in New Mothers: Causes, Consequences and Treatment Alternatives (New York: Haworth Press, 2005), 28-32.
Photo provided by the author.