On 13th March 2013, a 44-year-old New York woman named Cynthia Wachenheim took her own life and attempted to take the life of her 10-month-old son.
Fortunately, baby Keston survived.
She thought those falls may have led to seizures and she thought that would affect her son for the rest of his life. “I love you. I’m making you suffer,” she wrote in the 13-page letter.
Wachenheim’s friends and family were shocked by the lawyer’s death. They described her as a “highly educated, socially conscious woman who had been active in a women’s group in her synagogue” who was on leave from her $120,000-a-year job as an attorney.
So what was it that made Cynthia change so suddenly? What would make the first-time mother want to take her own life and that of her son?
Investigators now believe Cynthia was suffering from a mental health condition called postpartum psychosis (also known as puerperal psychosis). Postpartum psychosis is an incredibly rare illness that occurs in one in every 1000 women who give birth. Usually those who suffer lose touch with reality and start believing things that are not true.
Postpartum psychosis can occur in women of any age and, while it is more common with a woman’s first baby, it presents itself almost randomly. It’s only if a woman has had a previous episode of postpartum psychosis that she has about a one in three chance of getting it again with another baby.
Unlike postpartum depression (more commonly known as post natal depression), which affects around 13 per cent of mothers usually in the first three to four months after they give birth, postpartum psychosis usually occurs in the first month and receives very little attention in the media. It’s usually only when the stories are incredibly horrific, like that of Cynthia or that of Andrea Yates (the woman who drowned all five of her children in the bathtub of her Texas home) that people take notice.
But more often than not, the stories of women who suffer from postpartum psychosis but do not to take extreme actions like taking the lives of their children or themselves are rarely told.
Hayley* is one of those women.
When Mamamia ran a story about Wachenheim earlier this year, we were contacted by 23-year-old Hayley who had recently recovered from postpartum psychosis.
Hayley contacted us in the hope that she could tell her story and help make other women aware of the illness that had consumed her life for more than a year.
It all started for Hayley just a day after her daughter Lillian was born via caesarian section on 21 October, 2011.
“The day after she was born, I just started getting very giddy and very happy,” Hayley says, adding that she was “talking a lot more” and that she wanted to talk to “anybody and everybody that (she) could find in the hospital”.
“I think day three I started escalating,” Hayley says. “I was bouncing around the hospital; this is after major abdominal surgery. I wasn’t feeling any pain. Then it started getting worse and worse from there, and what happened was I started not getting any sleep,” she says.
During her five days in hospital, Hayley only slept on the first night after her C-Section.
“I just could not rest, I could not sleep. I just got more and more manic, the thoughts really started to pick up and they started to race. I was like ‘what is going on? I’m just too happy’.”
“Day four came along and they were preparing to discharge me from the hospital. And I asked the staff ‘is there something wrong, am I meant to be this happy?’ They said ‘Yeah Darl, you’re a new mum. This is normal. It’s all normal’.”
“And it’s like ‘okay great! The nurses say I am fine. The doctors say I’m fine’.”
At the time, Hayley put it all down to being a new mum. She was discharged from the hospital and went home with her husband Matt*, now 23, to live with some of Hayley’s family.
The first night at home, Hayley slept. But after that point, she says “things started to go south.”
According to Marie-Paule Austin, who is Professor of Perinatal and Women’s Mental Health at St John of God Health Care and UNSW, postpartum psychosis can present itself in a number of forms.
There’s the manic psychosis where a women might be elevated in her moods and believing incredibly positive things have happened when they haven’t. There’s a paranoid psychosis where “you start to think that everybody’s out to get you or they’re out the baby or that something awful is going to happen to you because there are evil forces out there so you can’t trust anyone anymore”.
And then there’s a depressive psychosis where “the mother starts to believe that it’s just a bad world to bring her child in, that there’s no future, everything is hopeless, so she may as well end her life and that of the child because what’s the point anyway?”
For Hayley, it was a manic psychosis and it truly started presenting itself in the days after she arrived home from hospital.
Hayley said she started acting very impulsively. She was waking up at 4am and cleaning the house or exercising obsessively.
“I got out the bathtub one night and I just had an insane urge to clean the shower. So I was cleaning the shower in my underwear and scrubbing. No top, pretty much nude, scrubbing. My brother walked past and he saw it. That was when my family started to think something’s not right,” she says.
“I started getting weird feelings of if my house wasn’t clean then I wasn’t a good mum. If there is dust on top of my TV, then I’m not a good mum. I started to get these obsessive thoughts that I had to prove to everyone that I was a good mother. So from then on, it just got worse and worse.”
Hayley says she was “ridiculously energetic”.
Her speech was rabid; the words were “falling out of (her) mouth.”
“It started getting worse and my husband was starting to get really confused at this point,” Hayley says. “At no point was my child at risk, but I found myself slipping further and further away from being able to take care of her.”
“My brain was just going a hundred miles an hour and I could barely have a conversation with anyone. I couldn’t think properly. I was doing too much, I was too over motivated to do things,” she says.
Hayley soon started spending money that she didn’t have, buying things for her baby that she really didn’t need. At the height of her psychosis, Hayley says she thought she was worth millions. She thought she owned charities. She even convinced herself that she owned one of Australia’s largest and most-profitable supermarket chains.
“I started thinking that I was a multimillionaire, that I could rid poverty, these sorts of things. I started thinking these really big delusional thoughts – that if everything were free then we could give people things for free. I started trying to employ people for my charity.”
“I contacted friends on Facebook saying can you work for me. I started thinking about name badges and how they’d get to work. How would they come to my house, send people things and approach businesses, the whole lot. After that, I checked my bank account,”
“There was about a $1000 in there, but I thought there was $1 million in there. That was when my brain just snapped, from that point on, I was just out of control. I started thinking I was a millionaire”.
Looking back, Hayley describes the situation as incredibly scary.
“It’s quite funny now. I look back and I laugh, don’t get me wrong,” she says.
But there was a point for Hayley’s family when they realised they had to intervene. One day, Hayley went to a local supermarket (the same one she thought the owned) and tried to “buy some stuff for (her) charity”.
“I went to the self-serve check out and I thought I’d paid, I was having hallucinations at this point, I thought I had paid but then I realised I just wanted to take the stuff. I just frantically searched through my bag for the key card, and I didn’t have any money so I just walked out of the store,” she says.
Staff stopped Hayley and confronted her, asking her to pay the money. But Hayley assured them that she’s paid.
“I couldn’t leave and people were staring at me, people were looking at me funny. Asking what’s wrong,” Hayley says.
“They asked me to contact somebody to come and get me, and to pay for what I had taken. I called my mum because I couldn’t remember my husband’s number, I couldn’t remember my house phone number. I could barely remember where I lived. At this point I was really getting into full blown psychosis,” she says.
“Nobody really knew what the hell was going on with me, and I didn’t know what was going on. I just had completely lost it.”
The next day, Hayley’s family took her to hospital and it was there that she was eventually diagnosed with postpartum psychosis. She was transferred to a psychiatric unit where she says her symptoms just got worse.
“I started having full blown hallucinations – that people were plotting against me, that I was friend’s with Julia Gillard, that Barack Obama was my friend – then I started having hallucinations and delusions that the government was trying to assassinate me because I hold the key to ridding poverty. Because of all of these things I was saying, I was put into involuntary care.”
Hayley was sedated on and off few a few days, before she eventually started to respond to medication.
After 13 days in hospital she was released into the care of her husband and mother – but was continually checked on by perinatal nurses at home.
“The psychotic symptoms were still there for quite some time, I think about six months,” Hayley says. “There was nothing wrong with me, but seeing something that wasn’t there occasionally. The really severe psychotic symptoms were knocked on the head by a month of treatment.”
Professor Austin says sufferers of postpartum psychosis are usually treated with a combination of counseling and drugs.
“They will need those anti psychotics usually for several months after the episode …. and then they need post-monitoring to make sure that things remain well and they often do need quite a lot of counselling,” she says.
A year and a half later, Hayley says shes 99 per cent recovered. But she says it took a long time for her and her family to get over the trauma of postpartum psychosis. During the psychosis, Hayley’s husband had to give up his job to care for their daughter and Hayley says it took her eight months to build a bond back with her daughter.
But now she wants to tell her story so that other women and their families know what to look for.
“I am doing this because if I knew the signs and the symptoms, I would have been put straight in the hospital and I wouldn’t have had to go through any of that,” Hayley says.
“Somebody might read (this article) and have a baby and think ‘I remember that article I read about post partum psychosis’,” she says.
“Hopefully it will inspire people to get help and give them hope that their life isn’t over.
“It’s just temporary madness.”
Professor Marie-Paule Austin says the important thing when it comes to postpartum psychosis is to seek help earlier rather than later.
In terms of what people would be looking for, Prof Austin says family members would notice that the mother “would start to behave oddly”.
She said the mother might look distracted, she might not be able to follow through on simple tasks “because she’s preoccupied by her internal thoughts”.
“So she’s looking disorganised, vague, confused, she may be fearful because she’s frightened that there are people out there who are wanting to do nasty things. Or she may be a bit euphoric, a bit too happy. Or she may become very deeply depressed and completely uncommunicative,” Prof Austin says.
Prof Austin recommends taking the mother to a GP as soon as possible if you suspect postpartum psychosis. “It’s not something that should be allowed to just go for a few days,” she said.
She also recommends looking into admission to a mother/baby unit such as the Mother Baby Unit in Burwood, Sydney (02 9715 9200). And there are similar facilities in most capital cities.