Beyond the Blues

Behind the congratulations, welcome gifts and newborn smiles, there is sometimes a different reality.

A new mother may be exhausted and overwhelmed. She may feel hopeless. She may have terrifying thoughts she doesn’t want — or begin hearing voices and believing things that aren’t real.

To an untrained eye, they may look like different versions of the same struggle.

They aren’t.

Postpartum depression, postpartum OCD and postpartum psychosis fall on very different points of the maternal mental health spectrum — and knowing where one ends and another begins can be lifesaving.

The stakes are clear in the ongoing Massachusetts trial of Lindsay Clancy, where postpartum psychosis and criminal responsibility are central issues.

When Sadness Stays
The baby blues are common. Hormonal changes, sleep deprivation and the adjustment to caring for a newborn can leave a new mother tearful, anxious and overwhelmed.

But when those feelings persist or become severe, they may signal postpartum depression (PPD). Affecting approximately 1 in 8 women, PPD can bring persistent sadness, hopelessness, exhaustion, anxiety and difficulty bonding with the baby.

A mother may desperately want to feel happy but instead feels numb, disconnected or as though she is failing.

For generations, women were told to simply endure. Today, we know PPD is a treatable medical condition — not a sign that someone is failing as a mother.

Intrusive Thoughts
Postpartum OCD can turn a mother’s own mind into a source of terror.

She may suddenly imagine dropping her baby or causing harm. The thoughts are vivid, and intrusive. She doesn’t want these thoughts — they frighten her.

She may repeatedly check the baby’s breathing, avoid certain situations or seek constant reassurance.

Yet many mothers stay silent, afraid someone will mistake a frightening thought for an intention.

Broken Reality
Postpartum psychosis is rarer than PDD or OCD but far more severe, affecting about 1 to 2 women in every 1,000 after childbirth. It can cause hallucinations, paranoia, confusion, and delusions — and requires immediate medical attention.

A mother may hear voices telling her to kill her baby, convinced that obeying them is necessary to protect the child.

Unlike OCD, where frightening thoughts are unwanted, psychotic beliefs can feel completely real.

From Judgment to Care
For generations, severe postpartum mental illness was misunderstood, leaving women judged rather than treated.

The 2001 case of Andrea Yates helped change that conversation. After drowning her five children during a severe psychotic episode, Yates was initially convicted of capital murder. At a 2006 retrial, she was found not guilty by reason of insanity.

More than two decades later, the ongoing Massachusetts trial of Lindsay Clancy, who is accused of killing her three children in January 2023, is raising many of the same difficult questions. Her defense argues that she was experiencing postpartum psychosis and was not criminally responsible; prosecutors disagree.

Other countries — including the United Kingdom, Canada and New Zealand — have laws that specifically recognize childbirth-related mental health issues in cases involving maternal infanticide.

But the biggest lesson may have little to do with the courtroom.

Responsibility to Recognize
A mother in crisis may not know she is in crisis. Family and friends can notice changes and encourage help, but they shouldn’t have to diagnose a psychiatric emergency.

Healthcare providers need to look beyond the baby blues, recognize the warning signs and ask the next question.

Sometimes, the person who needs to see the crisis isn’t the patient. It’s the person trained to recognize it.

Happy reading,
Suzanne Daniels, Ph.D.