The Postpartum Psychosis Circus Is In Town

It’s in the news again. Postpartum psychosis (ppp) with a dreadful outcome. I feel caught in a murky riptide of misinformation and hot takes.

I experienced my first episode of ppp 20 years ago. The second just over 16 years ago. I began writing and speaking about it 14 years ago. I’d earnestly hoped writing about my experience would help shift the stigma around this illness.

Things have changed, but I am not convinced much has shifted.

In the beginning, the traditional media almost never resisted the almost pornographic pull of describing the women who succumbed to ppp as demonic.

The way we consume our news and entertainment has evolved or devolved depending on your point of view. Either way, 20 years ago the internet was younger and social media didn’t exist.

Today many more people know about the American woman standing trial for murdering her three children whilst allegedly in the throes of ppp, than they would have 20 years ago.

If you click on just one post the algorithm will vomit everything that is current about ppp, mostly based on this case, into your eyeballs.

Is this a valuable acknowledgement of this rare, devastating condition? And will it reduce some of the stigma it is steeped in?

Yes and no.

The positives are that in the wake of the talk and comments about it, women who have survived ppp have felt safe enough to post about their experiences.  They look into the camera, cradling their babies, like a million other new mothers on social media. In doing so they show ppp has many different faces, that it can happen to anyone, and that it is possible to look normal while your thoughts are lying to you.  

Plenty of women who have experienced perinatal depression (pnd) and perinatal anxiety (pna) are also voicing their stories of being trapped in the dark, airless corners of motherhood.

Many have fallen through the cracks of a mental health system too.

They say: ‘That could have been me.’

Yet, invariably every ‘That could have been me’ is followed by a powerful caveat: ‘Except for the outcome’, which means ‘That could never be me.’ 

The incidence, degree of stigma around, and treatment of pnd and pna and ppp is different and conflating them is misleading.

All of these conditions carry a risk of suicide, but the risk of infanticide due to pnd alone is so low it lacks a statistical percentage. For women who experience ppp the risk of infanticide is about 4% if left untreated.

In the context of this court case any woman with lived experience of a perinatal mood disorder has earned the right to step into this discourse or to give it a wide berth.

Beyond lived experience posts and a handful of reputable professional sources, it mostly feels like a circus out there.

Content creators are virtually camping outside that court room in America and are creating a freak show to slaver over, greedy to extract every salacious morsel they can out of a broken woman’s agony.

There are posts from alleged mental health professionals doing a to camera piece on how scary it is to be in a room with a patient with ppp, centring the experience solely on them.

Psychiatrists, other medical professionals, and lawyers pick over the bones of this case, and a woman’s sanity on Instagram. It may be well intentioned, but it is also for the entertainment of their followers.

There are lawyers, nurses, and content creators dressed for a picnic or book club meeting, sometimes including a pet, with a glass of red wine or an iced latte in hand giving us their hot take on this case and the people involved.

They remind me of the women knitting by the guillotine during the French Revolution.

I have been diving in and out of comment sections in the last few days.  My exchanges have generally been respectful. They have also thrown up interesting questions. Sharing my thoughts on one iced coffee wielding content creator’s page prompted them to ask me ‘Would you rather we didn’t talk about it at all?’

It is a double-edged sword. Yes, it needs to be discussed. But is all publicity good publicity? 

I responded by asking how they would feel if only the worst one-dimensional views about their demographic were being picked over and posted by people who had not lived it?

The years of writing about my experience of early detection and appropriate treatment of ppp, of surviving with my family intact feel like I have been shouting myself hoarse into a widening void.

Survival is boring. Having happy, healthy adult and nearly adult children is boring. Not facing life imprisonment is boring. Good outcomes are not click bait.

And yet for women who have experienced ppp, or who are experiencing it, the most important thing for them to know is not that this condition could end their lives, their children’s lives, that their experience could end up being torn apart by vultures on social media, but that devastating outcomes are not a foregone conclusion of postpartum psychosis.

The most important thing for them to know is that there is hope.

Below is a sample of some of the other writing and speaking I have done about postnatal psychosis:

Guilty Of Postnatal Psychosis

Media-Made Monsters

https://www.abc.net.au/listen/programs/conversations/conversations-anita-link-rpt/9009148

Guilty Of Postnatal Psychosis

(Content Note: suicide and infanticide are mentioned in this post)

Who am I?

I am a veterinarian.

I had my first baby at 32.

I developed postnatal psychosis after the birth of that baby.

I had no history of mental illness before that.

I have a perfectionist personality.

This is me.

But given this information, you could mistake me for Melissa Arbuckle.

If you’ve read even just the headlines this week, you will know Melissa’s baby Lily died in horrific circumstances, as a direct result of Melissa’s undiagnosed postnatal psychosis and depression.

Melissa’s story is an important one. But I have yet to read a story by a journalist who gets the narrative of postnatal psychosis (or any form of psychosis) right. Journalism around psychosis, even decent journalism, focusses on the sensational.

But despite the inevitable sensationalism, in this case the journalists got one thing right. They investigated the lead up to this horror story. And that shows us the number of times this horrific outcome could have been prevented.

Melissa’s baby was born in April 2021.

The Age reports ‘Maternal health notes showed that as early as May 19 the new mother revealed she was having difficulty coping and became teary, later telling a lactation consultant she felt ‘out of control’.

According to News.com ‘Victoria’s Supreme Court heard that in the weeks leading up to Lily’s death, Ms Arbuckle had been ‘really down’ and she believed she injured her baby after rocking her bassinet too vigorously.’

She hadn’t injured her baby at that point, but her thoughts (believing she had injured her baby) were delusional, for weeks before her daughter’s death.

The Age also reports ‘The night before the incident, Arbuckle told her husband she was having suicidal thoughts, but assured him she could never go through with it.’

Lily died and Melissa nearly died after being struck by a train on the following day, July 11 2021.

Melissa was diagnosed with postpartum depression and psychosis the day after her daughter died.

When I think of all the points on this timeline that Melissa’s and Lily’s odds could have been dramatically improved, anger steals my breath.

Regarding the Maternal health notes made in May 2021:

‘Maternal health notes’ imply a nurse or midwife assessed Melissa at some point and, aside from making some notes about her difficulty coping and being teary, did nothing.

Midwives and nurses need to be taught: The baby blues and mild anxiety are not always the cause of a teary mother who is having difficulty coping. They need to know when and how to refer a new mother for assessment with a psychologist, psychiatrist, a mother baby unit, or at least a GP. And they need to err on the side of caution!

I am not surprised a lactation consultant didn’t know what to do with a mother feeling out of control. Lactation consultants tend to be laser focussed on getting breast milk into babies at all costs. But again – educating lactation consultants to look far enough beyond ‘latching issues’ and ‘milk supply’ to consider referral to qualified mental health care professionals when red flags are raised, would be a good idea.

In the weeks before Lily’s death, when Melissa is described as ‘really down’ – these were the weeks that preceded the night before Lily’s death.

The night when Melissa told her husband she was having suicidal thoughts.

From my standpoint and lived experience, I struggle to give Melissa’s husband much benefit of the doubt here. I understand (based on the article in The Age) that her husband lost his own father to suicide as a teenager. So, there is possibly a barrier of unresolved grief and trauma that prevented him from reacting appropriately to his wife’s symptoms.

But presumably he noticed Melissa being ‘really down’ for those weeks. Did he attempt to get help for her? And if not then, what was stopping him when she expressed suicidal thoughts to him on that night? The fact that she claimed she wouldn’t act on those thoughts? Did he not consider the amount of mental pain one needs to be in just to have suicidal thoughts?

For everyone reading this: If anyone ever expresses suicidal thoughts to you, PLEASE ACT! Even if there is no option but an ambulance to the nearest hospital. And if the person experiencing suicidal thoughts tells you they won’t act on them, not only are they too unwell to make that assessment, they are also suffering intensely and need help!

Yes, our public mental health system needs a lot of improvement, and there are nowhere near enough public mother baby units available. But even if the ideal of a private psychiatric hospital with a mother baby unit, was not available or an option for Melissa and Lily, a public hospital might have given them a fighting chance.

Back for a moment to the journalists reporting on psychosis. They tend to give all the characters surrounding the person living the horror of psychosis a voice, even if some of those voices are irrelevant and add to the stigma psychosis is already steeped in.

In Melissa’s case that person is her baby’s great aunt. In The Age article, this great aunt doesn’t want to be named, but she does suck up more than her share of oxygen. She has publicly expressed that she thinks Melissa’s actions were ‘catastrophic’ and ‘cruel’.  Catastrophic – absolutely. But ‘cruel’ implies the malicious intent of someone whose mental health is totally uncompromised. She used the words ‘Melissa’s actions’ but what she communicates is ‘Melissa is a cruel woman, and that is why she killed her baby.’

To that great aunt, I would say this:

If people like you didn’t perpetuate the stigma surrounding illnesses which feature psychosis by giving uninformed stigmatising quotes to journalists, then Lily’s father may have had some clue about what to do when presented with the symptoms of severe mental illness that were obvious in his poor wife for months before they led to such unbearable pain for everyone. If you want to blame something, blame this horrible illness, in the same way you might blame cancer for taking loved ones too soon.

News.com reports ‘The case has revealed just how quickly the 32-year-old’s life spiralled out of control after she developed severe major post-partum depression and psychosis following the birth of her daughter in April 2021.’

Melissa’s life didn’t spiral out of control quickly. She developed a life-threatening illness, the symptoms of which were either ignored or not acted on for months, until it was too late. Reporting it was quick, implies it was too quick to do anything about.

My postnatal psychosis set in by day 6 of first-time motherhood. By days 7 and 8 I was completely detached from reality, denying knowledge of my baby and my husband.

And when I was accurately diagnosed with postnatal psychosis in the safety of a mother baby unit in a private psychiatric hospital, my husband asked what he should have done if this had happened at home. This is what he was told:

‘Call an ambulance. Postnatal psychosis is a psychiatric emergency, but it is treatable.’

My greatest sympathy and compassion go out to Melissa. She was failed at so many points.

My memoir Abductions From My Beautiful Life was published last year and (among many other events) includes details of my experiences with Postnatal Psychosis. You can find an excerpt here: Book and it is available to buy online, including at Booktopia, Fishpond, and Amazon. If you are Brisbane based, you can also buy it at Avid Reader and Riverbend bookshops and Ruby Red Jewellery at 107 Romea St. The Gap.

If buying a new book is not in your budget, Abductions is also available to borrow from the Brisbane City Council Library Catalogue.

Other Thought Food posts that may interest you are:

My Sliding Doors Encounter With Our Public Mental Health System

Welcome To Motherhood

Lifeline 13 11 14

Media-Made Monsters

SV400601
Day six

(Confronting Content Ahead)

I don’t dwell on what might have happened had I been sent home on day five after my daughter was born. But whenever the news throws up sensational stories reporting murder, infanticide, or suicide, and there is even a slim possibility the perpetrator might have been psychotic – then I think about it. Because that could have been me.

Continue reading “Media-Made Monsters”