In the modern tellings of the fairytale Hansel and Gretel, a wicked stepmother leaves the children in the forest to starve. But a friend told me recently that in the original version, it's their mother, not their stepmother, who abandons them. Maybe we changed the details because we just can’t imagine a mother harming her own children. But the Lindsay Clancy trial has forced us to face the unthinkable.
Although mothers rarely murder their children, when catastrophes do happen, they awaken us to the potentially dire consequences of the maternal mental health crisis in this country. Are we ready to face that reality now? And are we finally ready to talk about postpartum psychosis?
In my practice, I specialize in postpartum mental health. And I can tell you from the front lines that our country is failing moms. We’re suffering from a maternal mental health crisis that's reactive rather than proactive: We wait for serious problems to arise and then ask exhausted, overwhelmed new mothers to figure out how to get help.
The Clancy trial should be a wake-up call. But if we’re going to talk about postpartum psychosis, we first need to understand what it is — and what it isn't.
Postpartum psychosis is a medical emergency and the most severe perinatal mental health condition. Symptoms of postpartum psychosis can involve a break from reality, including delusions or fixed distorted beliefs, hallucinations or hearing things other people can’t hear, and seeing things other people can’t see. Its typical onset is within 3-10 days after birth, and women are most vulnerable in the month following birth, but it can still happen beyond the first month.
It can also be challenging to definitively diagnose because it’s often comorbid with other postpartum mental health conditions, like bipolar and depression. What many don’t understand is that symptoms of psychosis can also wax and wane. A new mom can appear fine one moment, and psychotic the next. In addition, during episodes of psychosis, a mother can still act in practical ways, even with a completely disorganized reality. And often, we hear survivors of postpartum psychosis talk about not sharing their symptoms, for fear that they'll be viewed as unfit or have their children taken away.
Postpartum psychosis requires hospitalization, but the good news is that it's temporary and very treatable. And postpartum psychosis that leads to infanticide is exceedingly rare, occurring in .00004% of the population.
It's also important to understand what postpartum psychosis isn't. Intrusive thoughts, for instance, occur in 90% of new parents. What if I harm the baby?, or What if I drop the baby? are terrifying thoughts to experience, but they are not postpartum psychosis.
That distinction matters when we look at some of what Clancy wrote in her journal before the deaths of her children.
“I feel like I'm drowning every day,” she wrote.
"I have crazy brain fog... I just live moment to moment, waiting for the next nap time," she wrote in another entry.
“I feel completely disconnected with my baby."
I said (or thought) some of those same words during the early weeks with my newborn son, when I felt alone and adrift. What new mother hasn’t felt similarly overwhelmed? Brain fog is common from lack of sleep and increased mental load, as your brain adjusts to the unending responsibilities of taking care of a dependent being. And bonding often happens over the course of months — rather than the idyllic "falling in love with your baby straight out of the womb" phenomenon that's often shown on screen.
But when mothers experience a disconnect, they often think that they're failing — and that something is wrong within them. And many mothers, especially high-functioning women, have trouble being beginners at something, when they're used to being experts in their lives or careers.
Mothers grappling with postpartum depression may find it difficult or impossible to problem-solve. But our system asks them to find help when they’re in the thick of the crisis. That's like trying to teach someone to swim in the middle of the English Channel.
I know firsthand how critical it is to have help when you need it most: I’ve faced postpartum obsessive-compulsive disorder twice in my own life. Even though I’m a clinical psychologist specializing in postpartum mental health, I couldn’t sleep for five days straight, riddled with anxiety. Postpartum OCD left me shaken and humbled. No one was more surprised than me when I realized that I was not immune to postpartum mental health complications. Luckily, I had my treatment team in place well before giving birth, which allowed me to get treatment and relief and ultimately propelled me to feeling better than ever within two months.
That experience only underscored something I now tell prospective mothers: Mental-health preparation should be an essential part of prenatal care. Ideally, a prospective mom would find a therapist and prescriber who are perinatal specialists. The provider can assess a woman's personal medical and psychiatric history, explain any unique risk factors, and establish a plan long before symptoms might emerge.
Just as importantly, mothers need a postpartum mental health team long before they're due. They should know that intrusive thoughts are common, that bonding doesn't always happen instantly, and that depression, anxiety, and OCD are treatable. One day all of this may be streamlined as part of OB-GYN care, but currently it’s not.
The broader truth is that the developmental phase of becoming a mother, known as matrescence, comes with prolific neurological and hormonal changes that make mothers more vulnerable to experience perinatal mental illness. We acknowledge the massive physical changes that take place during pregnancy, but too often ignore what's happening in a mother's brain.
Maybe those original fairytales tried to warn us — to make us face the reality that tragedies do happen in early family life. But we shouldn't just be preparing for the worst-case scenarios. We can't prevent all tragedies, but we can give women facing mental health challenges during childbirth and matrescence the care they need.
Some stories about motherhood do end in the darkest part of the woods. Let's rewrite future ones, to make sure mothers don't have to find their way out alone.
Nicole Amoyal Pensak, Ph.D., is a Harvard and Yale-trained clinical psychologist, author of Rattled: How to Calm New Mom Anxiety with the Power of the Postpartum Brain, and speaker, and researcher specializing in treating anxiety, OCD, and depression, and specializes in postpartum mental health. Dr. Pensak provides evidence-based treatment and serves on the Expert Review Board for Parents magazine and Welcome Baby USA.
