‘Thinking of Ways to Harm Her’
New Findings on Timing and Range of Maternal Mental Illness
By PAM BELLUCK
Postpartum depression isn’t always postpartum. It isn’t even always depression. A fast-growing body of research is changing the very definition of maternal mental illness, showing that it is more common and varied than previously thought.
Scientists say new findings contradict the longstanding view that symptoms begin only within a few weeks after childbirth. In fact, depression often begins during pregnancy, researchers say, and can develop any time in the first year after a baby is born.
Recent studies also show that the range of disorders women face is wider than previously thought. In the year after giving birth, studies suggest, at least one in eight and as many as one in five women develop symptoms of depression, anxiety, bipolar disorder, obsessive-compulsive disorder or a combination. In addition, predicting who might develop these illnesses is difficult, scientists say. While studies are revealing clues as to who is most vulnerable, there are often cases that appear to come out of nowhere.
As public awareness has grown, often spiking after a mother kills herself or her baby, a dozen states, including Illinois, New Jersey, Texas and Virginia, have passed laws encouraging screening, education and treatment, and New York and others are considering action. The federal Affordable Care Act contains provisions to increase research, diagnosis and care for maternal mental illness.
Sometimes cases are mild, resolving themselves without treatment. But a large analysis of 30 studies estimated that about a fifth of women had an episode of depression in the year after giving birth, about half of them with serious symptoms.
Jeanne Marie Johnson, 35, of Portland, Ore., had a happy pregnancy, but she began having visions right after her daughter, Pearl, was born. She said in an interview that she imagined suffocating her while breast-feeding, throwing her in front of a bus, or “slamming her against a wall.”
She said she was horrified at the idea of hurting her baby, and did not carry out the acts she envisioned. Yet while overlooking a shopping mall skating rink, “I pictured myself leaning over the bridge and letting her fall and bust like a watermelon,” she said. “I was actively thinking of ways to harm her.”
Most women experiencing such “intrusive thoughts,” as experts call them, never hurt their children. Some take extreme measures to protect their babies. One woman “scooched downstairs on her butt for months because she’d imagined throwing her baby downstairs,” said Wendy N. Davis, the executive director of Postpartum Support International.
But studies indicate that maternal stress may undermine women’s ability to bond with or care for their children, and that children’s emotional and cognitive health may suffer as a result.