What is postpartum psychosis? Rare condition is in the spotlight after the killing of three children in Massachusetts - NBC News

A Massachusetts woman accused of killing her three children has put a spotlight on a rare condition that mental health advocates say is shrouded in shame, often preventing mothers from seeking treatment.

Postpartum psychosis is an illness in which hallucinations and delusions alter a person's sense of reality after giving birth, sometimes driving them to harm themselves or their children.

The condition is treatable, but it requires emergency psychiatric care, experts say.

It is not clear whether Lindsay Clancy, the 32-year-old mother from Duxbury, Massachusetts, had postpartum psychosis. Family members did not respond to calls and emails from NBC News on Monday and authorities have not said whether mental health was a factor when she allegedly strangled her kids before attempting to kill herself last week. 

According to NBC Boston, Clancy suffered from postpartum depression, a form of depression that can interrupt a mother's ability to bond with her baby. Postpartum depression affects about 1 in 8 mothers, the Centers for Disease Control and Prevention says.

It's one of several mood disorders that can happen after childbirth. Another, postpartum anxiety, causes anxiety so crippling that it disrupts new moms' ability to function. Estimates of its prevalence vary, with the advocacy organization Postpartum Support International reporting it occurs in 10% of mothers. 

Postpartum psychosis is the most extreme mood disorder after having a baby, and it's also the rarest — happening in 1 or 2 out of every 1,000 deliveries, according to Postpartum Support International. The onset of symptoms is sudden and usually happens within the first few days or weeks after childbirth, though they can show up later.

In addition to hallucinations and delusions, postpartum psychosis symptoms include insomnia, irritability, paranoia, restlessness and rapid mood swings.

Thoughts of self-harm or harming others, particularly one's children, can also be part of the condition but are less common. Among mothers suffering from postpartum psychosis, about 5% will attempt suicide and 4% will commit infanticide, said Michele Davidson, a postpartum psychosis expert and board member of Postpartum Support International.

When these mothers kill, it is often done under the false notion that they are keeping their children from an even worse fate.

"In nearly all the cases that are true postpartum psychosis, there really is not malicious intent," she said. "It's basically these women trying to save their babies or take their babies with them to heaven."

Barriers to treatment

Asking for help can be difficult, said ​​Dr. Phillip Resnick, a professor of psychiatry at Case Western Reserve University.

"Women who have a baby are expected in our society to love that baby immediately," he said. "If someone has postpartum depression or postpartum psychosis, they may not feel the natural maternal feelings, then they feel guilty and are reluctant to even tell their husband or their obstetrician or pediatrician about their feelings."

"Women who have a baby are expected in our society to love that baby immediately."

Dr. Phillip Resnick, professor of psychiatry at Case Western Reserve University

And when patients do bring their symptoms to doctors, they don't always get an accurate diagnosis, experts say. 

Resnick has spent decades studying parents who kill their children and testified for the defense in the case of Andrea Yates, the Texas mother who stunned the nation when she admitted to drowning her five children, one by one, in the family's bathtub in June 2001. Her children ranged from 6 months to 7 years, and Yates' attorneys said she was suffering from postpartum depression and postpartum psychosis when she decided that killing her children would save them from going to hell. 

"The first time I saw her, three weeks after the homicides, she felt justified and that she had done what was best for her children," Resnick said. 

Months later, after being treated with antidepressants and antipsychotics, Resnick said, "she recognized that she had earlier psychotic beliefs, and of course had terrible regret and severe depression over losing her children."

Yates was initially convicted of murder before that conviction was overturned and she was found not guilty by reason of insanity in 2006. 

She is currently receiving treatment in a mental hospital and has declined annual hearings to determine her eligibility to leave the facility. 

In Massachusetts, Lindsay Clancy has been charged with two counts of homicide and three counts each of strangulation and assault and battery. 

In a statement released Saturday, her husband, Patrick, said his wife was struggling with an unspecified condition and asked for forgiveness for her after the deaths of their 5-year-old daughter Cora; 3-year-old son Dawson and 8-month-old son Callan. 

"The real Lindsay was generously loving and caring towards everyone — me, our kids, family, friends, and her patients. The very fibers of her soul are loving," he wrote. "All I wish for her now is that she can somehow find peace."

Yates' then-husband, Rusty Yates, blamed the killings of his children on mental illness — a response that is not unusual from the partners of postpartum mothers who kill their children, said Cheryl Meyer, a professor in the school of professional psychology at Wright State University who has co-authored two books about women who kill their children.

"These men are not on the whole saying, 'I want her punished to the fullest extent.' They're saying, 'This is not my wife,'" she said. 

Preventing postpartum psychosis

Pregnant people can discuss ways to lower their risk of developing postpartum psychosis by planning ahead with their obstetrician-gynecologist.

While postpartum psychosis is rare, women with a history of certain mental health conditions are at increased risk for it. A 2006 study published in the Journal of Women's Health suggests that 72% to 88% of women who develop postpartum psychosis immediately after childbirth have bipolar or schizoaffective disorder. 

If friends or family suspect a new mother has postpartum psychosis, getting immediate emergency medical care is critical. The illness is temporary, and in addition to antipsychotic and antidepressant medications, electroconvulsive therapy has been shown to be an effective treatment.

Support is also available from Postpartum Support International online, by phone and through volunteers across the country.

Resnick said the best way to help women who are struggling after they give birth is by letting them know it's OK to ask for help. 

"I think the first step is to reduce the stigma of it," he said. "It doesn't show a decreased maternal capacity or shameful behavior."

If you are pregnant or a new mother and you are in crisis, the National Maternal Mental Health Hotline provides free, confidential support 24/7 in English and Spanish. Call or text the hotline at 1-833-9-HELP4MOMS.

If you or someone you know is in crisis, call 988 to reach the Suicide and Crisis Lifeline. You can also call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.

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