One month before I got pregnant with my son, I was diagnosed with bipolar II disorder. My husband and I had been trying to conceive since our miscarriage the year prior. But we were supposed to have paused the baby-making to focus on finding a fix for my brain.
When I told my therapist and my psychiatrist that I was pregnant, their faces fell. I would have to stop trying out medications and hope that the lowest possible dose of the safest possible antipsychotic would be enough to sustain my mental health through my pregnancy. While some pregnant people are able to stay on antidepressants, doctors said they were off-limits for me. In fact, Zoloft was what confirmed my suspected bipolar disorder when it launched me into “a mixed state”—simultaneous mania and depression.
“I’m afraid I will lose my mind when the baby is born,” I told my therapist.
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“Well, that’s a valid fear,” she said. According to a study in Brain Sciences, a meta-analysis published in the American Journal of Psychiatry found that as many as 1 in 5 people with bipolar disorder who give birth experience a postnatal psychotic or manic episode.
“What if I hurt him?” I asked.
“The very fact that you’re asking this question means you’re more equipped than most parents to make sure you don’t hurt him,” she said.
As my fetus grew from a pear to a coconut to a honeydew melon, I studied news clip after news clip about mothers dealing with postpartum psychosis who were eventually pushed to do unthinkable harm to their children or to themselves. In addition to painting our nursery and mastering the swaddle in our infant-care courses, I tested my husband regularly with worst-case scenarios: “If I so much as joke about wanting to throw the baby out the window, what do you do?”
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My therapist promised I would be monitored carefully—by her, by my psychiatrist, by my husband. But once the baby was born, it was impossible for anyone to watch me all the time so I was alone with him for so many hours each day.
And I was not OK. On top of my bipolar II diagnosis, I had been diagnosed with complex PTSD (CPTSD) from years of physical and emotional abuse as a child. It manifested mostly in the form of daily flashbacks, nightmares, and inarticulable fear. I screamed in panic, for example, when my son was 6 weeks old, and my husband climbed a step stool to install a ceiling light. Sobbing, I begged him to come down as my concerned in-laws tried to reason with me. When I proved inconsolable, my 71-year-old father-in-law eventually installed the light by himself because my brain couldn’t handle the remote possibility that my baby’s father might fall off that fourth step and die.
But sometimes, the CPTSD showed up as intrusive thoughts. This baby is completely helpless, the thoughts would say. You could crush the life out of him. If you dropped him now, you could kill him. I was terrified of my power. Terrified that being a “good mom” wasn’t an automatic reaction. It was a choice. I couldn’t stop thinking: “the distance between him alive and him dead / is how well I am.”
Of course, I would never intentionally hurt my son. I love my child. To the moon and back, just like the best of them. But when I read about Lindsay Clancy, the Massachusetts mother accused of murdering her three children, my first thought, as horrified as I am by her alleged crimes, was not “How could a mother do such a thing?” It was instead: “That could’ve been me. Thank God that wasn’t me.”
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I thought childbirth was supposed to flip on the switch of sacrificial, maternal love, but I have lost count how many mom friends have admitted they were disappointed not to have had that magical moment when the baby was placed in their arms after labor and delivery. Hormones fritzing, body reeling from the bludgeon of pregnancy and childbirth, many of us were shellshocked. It turns out that “What am I supposed to do with this now?” is a more common reaction to holding your newborn for the first time than I thought.
Having a safe space to confess my most disturbing thoughts and sort out what is and isn’t “a common reaction” is what ultimately helped me most during those trying months. In addition to my mental-health team, I was fortunate to have two close friends, former roommates, who gave birth to their first babies around the same time as I did. One of them made us take the postpartum-depression quiz at least once a month. We could joke with each other about wanting to run away, which made us better equipped to stay.
Still, during that excruciating first year, I fantasized about dying or leaving more times than I admitted even to my best friends. But I had the good fate of avoiding postpartum psychosis. The worst thing I did was leave the apartment once with the baby still inside. I didn’t go far. I stood outside our building and stared up into the baby’s bedroom window. And with the Nest camera feed of him sleeping in his crib open on my phone, I smoked half a pack of years-old cigarettes I’d found in a sweater drawer and cried. When I texted the group thread and told them what I’d done, the other moms said they were glad I got some air. They were glad I came back home.
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The idea of harming our own children is probably one of the worst scenarios imaginable to the healthy human parent brain. And the idea that it’s possible not to have control over our own brain while we commit harm is even more alarming. Our instinct here is to distance ourselves from this possibility. We want to believe this could never happen to us.
But while we may feel safer this way, “othering” people with mental illnesses only increases our susceptibility to this danger. It perpetuates the false idea that mental-health help is something only some people require when what we actually need is more access to mental-health care. For everyone. It’s true that people with preexisting mental illnesses are more likely to experience postpartum psychosis, but it’s also true that 1 in 5 Americans experiences mental illness every year. That’s a whole lot of moms.
When our kids were toddlers done with breastfeeding, one of my happiest, most “well-adjusted” mom friends with no history of mental illness and a very loving family of origin confided that she thought every mom experienced suicidal ideations during milk letdown. When the other moms and I looked bewildered, she told us about her experience with dysphoric milk ejection reflex (D-MER), which she described as the feeling of Harry Potter-esque dementors descending down upon her every single time she breastfed or pumped. Her mood would plummet just before her milk released, then the momentary depression would vanish after a few minutes of torture.
There is so much that moms don’t talk openly about. Sometimes we stay silent because we, like my friend, assume our suffering is so normal that it’s not something we’re allowed to complain about. Other times, we stay silent because we worry no one else is struggling and that our suffering might make us appear unfit to parent. Either way, our silence comes from shame. And we are ashamed because of continued stigmas against mothers with mental illnesses, against mothers with histories of trauma, or against the average struggling mom and especially the average struggling BIPOC mom.
When I considered whether to have a second child, I did a deep dive into maternal-mental-health studies before making the difficult choice to stick with one. One 2019 Australian study published in the Journal of Marriage and Family found that while maternal mental health decreases after the first baby, it eventually finds its way back up. But after two babies, it’s much more likely for maternal mental health to go down and stay down.
I have nearly every privilege in the book. A loving, supportive, hands-on spouse. The kind who can be a solo parent when I have a bad day. Plus money to pay for regular visits with both my out-of-network therapist and my psychiatrist, and to afford my medication. And still, I’m not so sure I have the hardware to be able to handle two kids, let alone three. This is not to say it’s impossible. I happen to know several mothers with well-controlled mental illnesses who parent their multiple children with enviable grace.
But when I see a mother falter—or worse, do harm—I see a mother whose pain and illness outweighed the resources she had to manage that pain and that illness. The circumstances don’t excuse harmful behavior, but they do, at the very least, put the behavior within our own realm of human possibility. Most of all, they expose how ill-equipped we are to support and care for mothers who find themselves in that unique hell, which the rest of us escaped by sheer luck of the draw.
If you or someone you know may be experiencing a mental-health crisis or contemplating suicide, call or text 988. In emergencies, call 911, or seek care from a local hospital or mental-health provider.