Pathways to psychosis - one mother's story
Andrea Yates was a young mother of 37 when she killed her five children. The oldest was only seven, the youngest six months. She has been in a mental hospital ever since and has no wish to leave.
Yates declined a hearing last month that would have determined whether she was competent to be released from the hospital. Under the terms of her conviction, Yates is eligible to undergo a review each year. She has repeatedly declined to be assessed.
Yates was almost certainly psychotic at the time of her crimes, and while her story is horrifying, she is hardly the only mother to have taken her children’s lives while in an altered mental state. Studies suggest that postpartum psychosis occurs in 1 to 2 women per thousand, and that of those, around five percent of mothers commit suicide while four percent kill their children. These figures suggest that many of us will know at least one mother who “went through a difficult stage” after having a baby, although the details will probably have been hidden, out of shame.
Mothers and maniacs
Supposedly, society has moved a long way from a hundred years ago or more, when normal female emotions were ridiculed as “hysterics” in contrast to more stable male states of mind. Back in 1922, the United Kingdom passed the Infanticide Act, which automatically commuted a murder charge to manslaughter if the perpetrator was a mother who had killed her child at a time when she “had not fully recovered from the effect of giving birth to such child, but by reason thereof the balance of her mind was then disturbed.” Certainly women have been killing their unwanted children for millennia, before and after birth, and many if not most of them deserve to be convicted of murder. But there is a minority, peopled by mothers like Andrea Yates, where their actions run contrary to their maternal instincts and far from continuing their lives happily unencumbered by the “punishment” of a baby, they feel that they have nothing left to live for.
How does Andrea Yates fit within the public perception of madness? The “raving lunatic” in popular imagination is someone utterly out of control who could do literally anything, a danger to society who should be locked up with the key thrown away. The truth, as the statistics mentioned above attest to, is that most people, even in the grip of psychosis, do not pose a danger to anyone. Nonetheless, infanticide as a result of postpartum psychosis is not so rare that there is no urgent need to investigate it and do our utmost to prevent it. And the most compelling reason to understand why it happens is for the sake of the mothers themselves as well as their children.
Can ‘thinking good thoughts’ overcome anything?
Six months after her fifth child (in seven years) was born, Andrea Yates was exhausted both mentally and physically, caring for all her children, homeschooling them, and also helping with her elderly father who had Alzheimer’s dementia. She had suffered crippling depressions after the births of her third and fourth children, and she was prescribed sedatives on these occasions. She had also attempted suicide several times. She refused to take antidepressant drugs but was eventually given antipsychotics.
Several months after her youngest child was born, her father died. Andrea began having paranoid delusions, believing that she was being watched via video cameras hidden in her home. When she became catatonic, totally retreating into her inner world, she was admitted to a psychiatric hospital where she was given antipsychotic drugs.
Just ten days later she was discharged, sent back home to her family. Her psychiatrist decided to wean her off the drugs, and when she began to decline, her husband asked the doctor to resume the dose — but he refused, saying that the drugs were “bad medicine” and that Andrea just needed to “think good thoughts.”
Less than a week later her five children were dead and Andrea’s life was effectively over.
‘They had to die because I was a bad mother’
Later, Andrea would tell investigators that she couldn’t have been depressed because she had “never cried.” She recounted how voices from the television would tell her to do bad things to her children, over a period of years. She had clearly resisted the voices, many times, but eventually succumbed to “Satan’s command” to kill them, because she “was a bad mother who couldn’t bring them up to save them from sin.”
Expert witness for the prosecution psychiatrist Park Dietz would use her words to argue that she was clearly sane at the time of the killings, as she knew she was doing wrong if she was “obeying Satan.” He dismissed any notion that she was psychotic or delusional, saying that she merely had “obsessional intrusive thoughts.”
The expert witness for the defense, Dr. Phillip Resnick, disagreed.
In my opinion, even though she knew it was against the law, she did what she thought was right in the world she perceived through her psychotic eyes at the time.
Yates’ attorney, George Parnham, said later that the case “opened the nation’s eyes to mental illness.”
I had no earthly idea before I got this case what was meant by postpartum.
Fixing disturbed brains
Postpartum psychosis means various things depending on one’s perspective. One hundred years ago in the UK, women who committed infanticide were of “disturbed mind.” Today, the prevailing view in the western world is that such women are of “disturbed brain,” and that the answer is chemicals (or electrocution, ECT) to rearrange the brain cells and “fix” what went wrong.
As Dr. Lucy Puryear, a psychiatrist who saw Andrea after the drownings, told The Lancet,
I see women with postpartum disorders all day long. They get diagnosed, they get treated, and they get well.
But Andrea Yates was treated. She didn’t get well. What went wrong?
One step beyond normal
Around one in ten women experience what is called postpartum depression, as opposed to postpartum psychosis, in the Western world in recent times. The symptoms of this depression include feeling “down,” having low energy levels, anxiety, disturbances of appetite and sleep, feeling guilty about being an inadequate mother, obsessing about the baby’s safety, and possibly thoughts of suicide.
Aside from suicidal ideation, all the other symptoms of this “disease” are easily recognizable by many woman who have given birth as normal, as long as they do not become all-consuming. This is why psychiatric diagnoses depend on the number of symptoms and the length of time they are experienced — because it’s all a matter of degree.
Many woman who have given birth will also readily admit that most of these symptoms can be eased by having practical help with the baby, reassurance that she’s doing just fine, and enough time to eat and sleep. Coming home from the hospital to a house full of young children needing to be homeschooled, as well as an elderly father with dementia, isn’t likely to help a young woman recover from the stresses of childbirth.
Andrea Yates had been warned after her third and fourth children that future births would likely be followed by more bouts of severe depression. But Andrea wanted more children. So did her husband.
Religion or delusion
Deb Vickers also went through postpartum psychosis, not just once but twice, after her first and second children. She is a devout Christian and described how her faith impacted the way both she and others were treated by the medical profession:
My Christian faith was a double-edged sword. Because religious grandeur can be part of psychosis, I don’t think I had hallucinations, or believed I was something else; but my spirituality was definitely heightened. I found it difficult in the public-health system when I was asking for a chaplain, or I wanted a Bible given to every patient at Christmas. I think it was a heightened version of my normal self, but clinicians saw it as a warning sign.
Deb related how her faith was treated with “suspicion” and that when she approached another postpartum mother in the hospital where they were being treated, asking if she would like to pray with her, the other mother said she would, adding, “Please don’t tell the staff.” Religion, in the doctors’ minds, was a sign of mental instability. The mothers wanted to appear sane, so that they could be discharged and return home to their families. So they hid their faith.
Should a psychiatrist not be able to distinguish religious fervor from psychosis? Mania from nervous excitement about being a new mother? Clinical anxiety from the natural worries of caring for a helpless infant? The problem starts when psychiatrists (not all, but many) see any emotional upheaval as a sign of instability, the “unbalanced mind” diagnosed by doctors a century ago. If mental illness is a matter of degree, then even the slightest degree could increase until it crosses the dividing line between health and “disease.”
Which factors can push a new mother over that dividing line, and is there anything that can be done to pull her back from the brink?
To be continued...
The information contained in this article is for educational and information purposes only and is not intended as health, medical, financial or legal advice. Always consult a physician, lawyer or other qualified professional regarding any questions you may have about a medical condition, health objectives or legal or financial issues.
If you are struggling with suicidal thoughts, you can call a qualified free mental health helpline or seek help from a qualified therapist.
