image001America seems to own the market of mistreating people with mental health problems.  Whether Tasering 12 year olds in Chicago or shooting disturbed people in just about any circumstance, we just don’t care enough to make health services available to stop the carnage.

As a long time volunteer CASA guardian ad-Litem working with *tortured children (about half the fifty children removed from their homes in my caseload had been sexually abused), I’m really sensitive to how lack of treatment, sporadic treatment, and the use of psychotropic medications on five year olds is filling prisons and damaging schools with our troubled youth.

16 year old Jeff  Weise’s father committed suicide a few years before Jeff started writing about his homicidal and suicidal thoughts and listening to his mother’s wishes that he had never been born.

A few months later he shot dead his grandfather and 14 other people before killing himself.  Talk about warning signs.

The year after the carnage, Red Lake found 3 million dollars to fund a mental health facility for the community.

Michael Swanson’s mom (an educated and very capable person) worked for years to find mental health services for her tragically disturbed boy before he drove to an adjacent state and murder 2 convenience store clerks for shits and giggles.

My friend adopted 4 children from a county that assured her they came from fairly normal backgrounds.  If being sexually abused at very young ages is normal, then the county did not lie.  Here family fought for years to find any mental health services for the children.

20 years later, the mental health issues this family still endures make me hate our institutional habits of obfuscating and lying.

When it is your family or friend that is visited by violence or other forms of insanity the sensation is unbelievably painful.  Until then, let’s just not care about affordable health care.

Yesterday, Miriam Carey died after being shot by police following a car chase between the White House and the US Capitol building. Carey is reported to have tried to ram through barricades at the White House, hitting at least one officer as well as a squad car. She then drove her vehicle into barriers in front of the Hart Senate Building before being fatally shot by law enforcement officers. She was unarmed. A child identified as her daughter — a little more than one year old — was in the car the whole time.

Today, news outlets are reporting that Carey had a history of traumatic brain injury and postpartum depression, the latter of which may have been severe enough to send her to the hospital at some point in the past year. Nobody knows what, if any, effect this may have had on what happened yesterday. But it’s led to plenty of speculation, and the spread of bad information that stigmatizes women suffering from an incredibly common mental illness.

For instance, on NBC’s Today Show this morning, psychologist Jennifer Hartstein declared that “postpartum depression has led mothers to kill their children” — a statement that conflates PPD with a different disorder AND overstates the risk that other disorder poses to kids.

Over the next few days, we’re all likely to hear a lot of discussion about postpartum depression. As you absorb that news, keep the following facts in mind:

1. Postpartum depression is a spectrum and it affects a lot of women 
It’s not entirely clear exactly how many women get postpartum depression. Partly, that’s because there’s not a universal screening system in place (we’ll talk more about that in a minute) and partly it’s because depression isn’t a binary on-off switch kind of thing. It’s a collection of symptoms. If you have enough of the symptoms for long enough (and you have a personal support system and financial/healthcare access to back it up) you’ll get diagnosed. But there’s a lot of grey area — especially considering the fact that caring for a newborn can be incredibly exhausting, isolating, anxiety inducing, and all-around stressful. On the low end of the spectrum, you might just feel a little overwhelmed and sad for a couple weeks. At the high end, you could be having problems that interfere with work and relationships for months. A survey done by the Centers for Disease Control and Prevention found that between 8 and 19 percent of women reported frequent symptoms of postpartum depression. But as many as 75 percent of new mothers experience milder “baby blues”.

Point is: Postpartum depression isn’t some super-rare disorder that only affects mythical “other people”. It’s common enough that you could even consider it part of the range of normal human experience following the birth of a child. That doesn’t mean women with postpartum depression should just “suck it up” or anything like that. It simply means that PPD is real and it’s not something you brought on yourself. Most importantly, it’s not something you should feel embarrassed or ashamed about having, any more than a new mother would feel ashamed of, say, having torn her perineum during labor. (Oh, and men get it, too.)

2. Postpartum depression is different from postpartum psychosis 
The average woman with postpartum depression does not have hallucinations. A very small minority, however, experience a much more serious disorder called postpartum psychosis, which can cause you to hear, see, or smell things that aren’t there (as well as causing paranoia, mania, or catatonic states). Only about 1 in 1000 women get postpartum psychosis and their symptoms tend to kick in quickly, often within a couple of days after birth. Postpartum depression, on the other hand, can occur up to a year after the birth of a baby. These are very different disorders. As different as depression is different from severe bipolar disorder. If you conflate the two, you’re going to miss very real cases of postpartum depression and you’re likely to blame events (like, say, a young mother leading cops on a car chase through Washington DC) on postpartum depression when other forces are at work.

It’s also worth noting that even women with postpartum psychosis shouldn’t be thought of as flailingly irrational and inherently dangerous to the people around them. Neither postpartum depression nor postpartum psychosis can be described as making you want to kill your children. The biggest risk for women with postpartum psychosis is that they will kill themselves, not their kids or anyone else.

3. For such a common disorder, screening and treatment of postpartum depression aren’t handled very well
Only 15 percent of women who meet the criteria for having postpartum depression get treated for it. That’s a big deal because, while some people’s symptoms lessen over time, you can’t rely on postpartum depression just going away on its own. In fact, it can get worse. Again, you can be a year out from having a baby and still be struggling with the effects of postpartum depression. And there’s no reason that should happen to anyone. Between medication and therapy, this is a very treatable illness. It’s something that you absolutely can make better. But it takes having access to financial and healthcare resources necessary to receive treatment. And it takes getting diagnosed in the first place, which isn’t always easy. There’s still a lot of misinformation out there and the doctors that postpartum women are most likely to deal with on a regular basis — pediatricians — aren’t well-trained in spotting it. On the other hand, at least the American Academy of Pediatrics recommends doctors screen all new their new moms. The same can’t be said for the American Congress of Obstetricians and Gynecologists. So, even if you have insurance, there’s a decent chance of falling through the cracks when it comes to diagnosis — especially if you don’t immediately recognize the symptoms in yourself, or if your doctor is inclined to write those symptoms off as “no big deal”.

Some resources
 Postpartum Progress — a blog and community with lots of great information and support
• Postpartum Support International — which will help you connect with local treatment, diagnosis, and support options.

Image: depression, a Creative Commons Attribution No-Derivative-Works (2.0) image from loop_oh’s photostream

 

1 Comment

  1. The City of Portland, Oregon, has been found by the DoJ to be using police to violate the constitutional rights of those perceived to be in mental health crisis. This blog post explores a new force that may begin targeting this vulnerable population. The public does not yet know the power about to accrue to care providers, as mandatory insurance provides an incentive to fill hospital beds.
    http://consulthardesty.com/2013/07/18/detention-without-trial

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