Transcript<\/p>\n
[MUSIC PLAYING]<\/p>\n
EMILY KWONG: You’re listening to Short Wave from NPR.<\/p>\n
NATHAN ROTT: Hey, Short Wavers, it’s Nate Rott, here with doctor and freelance science journalist Angela Zhang.<\/p>\n
ANGELA ZHANG: Hey, Nate. It’s good to be here. So I have been really deep in the weeds on this Lindsay Clancy trial.<\/p>\n
ROTT: Oh, yes, I have heard about it. But honestly, Angela, I’ve been kind of trying to avoid it because as a newish parent, it’s really sad to read about. Because she was being tried for the murder of her three children, right?<\/p>\n
ZHANG: Yeah, it’s this really horrible situation. And at the center of the case is this question– was she sane when she strangled her children in the basement?<\/p>\n
[AUDIO PLAYBACK]<\/p>\n
SPEAKER 1: This was not a woman in the throes of psychosis on January 24, 2023. This was a woman who acted intentionally, rationally, and swiftly to accomplish a very specific goal– to kill.<\/p>\n
ZHANG: Or was she, as her defense argued, too mentally ill to be found guilty of murder?<\/p>\n
SPEAKER 2: This is a woman that did not get the medication, did not get the medical treatment that she so deserved. This is a woman that was suffering from psychosis.<\/p>\n
[END PLAYBACK]<\/p>\n
ZHANG: It was a pretty contentious trial. And now this whole thing is being dragged out. A mistrial was declared last Friday, when the jury was unable to come to a unanimous decision.<\/p>\n
ROTT: Yeah, and to be clear, Angela, in this whole case and trial, we’re talking about postpartum psychosis here, not postpartum depression or the baby blues, both of which are, like, far more common, right?<\/p>\n
ZHANG: Yeah, you’re right. Postpartum psychosis is different. After giving birth, parents will have these really huge mood swings– so much bigger than in the classic, quote, “baby blues” many parents might have. They might be really irritated, or they might even have tons of energy, unlike in postpartum depression.<\/p>\n
ROTT: I mean, it almost sounds more like bipolar disorder to me.<\/p>\n
ZHANG: Yes, it’s much more similar to bipolar disorder. Also, the parent’s sense of reality changes. They can have hallucinations, paranoia, among other things. And they’re at risk for harming themselves or their kids.<\/p>\n
ROTT: Ugh, it’s sad.<\/p>\n
ZHANG: It is really sad. But that’s usually all people know because this condition is so under-researched. I learned a little bit about postpartum psychosis in medical school, but not much, which is surprising because it’s not particularly rare. It happens around one or two out of every 1,000 births, which is almost the same prevalence as something like multiple sclerosis in the US.<\/p>\n
ROTT: Oh, wow.<\/p>\n
ZHANG: But some experts were not surprised when I mentioned how little I knew, like Veerle Bergink. She’s a psychiatrist and director of the Women’s Mental Health Center at Mount Sinai. She says that when she started taking care of patients with postpartum psychosis over 20 years ago now, there was really nothing in the literature. Patients had so many questions, and she just couldn’t answer them.<\/p>\n
VEERLE BERGINK: Why did I get so sick? We didn’t see this coming. And what triggered it? How long should I continue this medication? And can I safely have a second baby? Am I at risk for a severe mental illness?<\/p>\n
ZHANG: So, really good questions and, to be honest, the questions that I had, too. So we’re going to try to answer some of those today.<\/p>\n
ROTT: Awesome. OK, so today on the show, we do a deep dive into postpartum psychosis. Why does it happen? How do we treat it? And why don’t we know more about it? I’m Nate Rott. And you’re listening to Short Wave from NPR.<\/p>\n
[MUSIC PLAYING]<\/p>\n
ROTT: So Angela, right off the rip, why does postpartum psychosis happen?<\/p>\n
ZHANG: Well, the short of it is, we don’t totally know. And we’ll get more into why later. But what we do know is that it can happen really suddenly, like in the first few weeks, or even days, after giving birth. You can compare that to postpartum depression, which tends to happen more slowly. We also know that people are more likely to get postpartum psychosis if they had bipolar already or had psychosis in a previous pregnancy. But Veerle Bergink, the psychiatrist we heard from earlier, she says that that doesn’t mean that others aren’t at risk.<\/p>\n
BERGINK: It doesn’t matter if you’re old or young, you’re rich or poor, or higher educated or not, or the color of your skin, what kind of personality you have. It can happen to everyone, to you, to me.<\/p>\n
ROTT: Oh, and what do people who have experience say it’s like?<\/p>\n
ZHANG: At first, one person I talked to said that she felt fine– honestly, even great.<\/p>\n
SPEAKER 3: After I gave birth, I felt incredible. I felt euphoric. I felt like the life of the party, like the funniest person in the group chat. Like, I was just, like, on top of the world.<\/p>\n
ZHANG: This is [? Ayana ?] [? Lage. ?] I talked to her while reporting this story. [? Ayana ?] says that her husband noticed she was acting more animated than usual, but chalked it up to having just given birth. After all, they were first-time parents, and it’s so hard to know what to expect after such a life-changing experience, as I’m sure you’re aware, Nate. [LAUGHS]<\/p>\n
ROTT: For sure, uh-huh.<\/p>\n
ZHANG: But then she started to have these different, even scarier thoughts.<\/p>\n
SPEAKER 3: I start to feel paranoid and think that no one is safe for my baby but me. Like, I can’t trust anyone with her. No one can hold her. No one can feed her. I just want to be around her. And I just kind of had a thought of, like, this is how moms feel toward their children. Like, it’s supposed to be animalistic. It’s supposed to be primal.<\/p>\n
ZHANG: And her husband started to get really worried about [? Ayana’s ?] behavior. She was lashing out at her family and being so protective of her baby in a way that just didn’t seem normal. And then she started hearing voices.<\/p>\n
SPEAKER 3: I heard what I called the voice of God and told my husband that we were going to start a church. My daughter was Jesus, that I was a special prophet.<\/p>\n
ROTT: Oh, wow. So things took a turn.<\/p>\n
ZHANG: Yeah. And before her pregnancy, [? Ayana ?] was already seeing a psychiatrist for depression. So her husband called the psychiatrist, and they advised him to take her to the emergency room. By this point, her symptoms were so bad that she was seeing things that weren’t there. She even thought that her daughter was a figment of her imagination. So [? Ayana ?] ended up hospitalized for 17 days in a psychiatric ward.<\/p>\n
ROTT: This just sounds like such an overwhelming experience, especially as a new parent, where everything is a little overwhelming. Like, how do you treat postpartum psychosis if that’s what you get diagnosed with?<\/p>\n
ZHANG: Well, the good news is, is that postpartum psychosis can actually be pretty easy to treat. We have great medications for it. Remember, it’s similar to bipolar disorder. Here’s Veerle again.<\/p>\n
BERGINK: The best treatment is lithium, often combined with antipsychotics. And we see, you know, in some women, the psychotic and manic symptoms disappearing within days, others within weeks. So that is a really optimistic message.<\/p>\n
ROTT: Yeah, it is.<\/p>\n
ZHANG: Yeah, and getting better means that the parents can get back to bonding with and parenting their baby. Veerle has actually studied this bond and what that means for the baby. She says that when the parent is treated successfully, their attachment to their child is the same as parents who didn’t experience postpartum psychosis. And– good news– the kids grow up to do just fine.<\/p>\n
ROTT: Oof. That is a relief to hear. Is that what ended up happening with [? Ayana? ?] Did she go on to have any more kids?<\/p>\n
ZHANG: Mm, yeah. So thankfully, [? Ayana ?] was treated successfully and recovered, although she says it probably took up to a year to feel totally herself again.<\/p>\n
ROTT: Yeah.<\/p>\n
ZHANG: But she had another baby four years later.<\/p>\n
SPEAKER 3: I’d prepared as much as I could mentally, but I also knew, if this happens again, everyone in my life knows the warning signs. Like, they’re watching me like a hawk. It will be caught within literal minutes if I start to act bizarrely or not like myself. And my psychiatrist will be, you know, on speed dial.<\/p>\n
ZHANG: And so with all of this, [? Ayana ?] did well with her second baby and didn’t have any psychosis.<\/p>\n
ROTT: Aw. I’m so glad to hear that she was able to experience parenthood again without having that cloud over her. Sounds like she also had a really good team in her corner.<\/p>\n
ZHANG: Yeah, that’s really important. In some ways, [? Ayana’s ?] case was the best-case scenario. She had an extremely attentive partner and family who sought medical attention as soon as they realized something was wrong. She had a pre-existing psychiatrist who actually called ahead to the hospital and prepared them for her arrival. [? Ayana ?] is Black, and we know that Black women experience racism in medicine. But having people advocating for her, [? Ayana ?] says that made a huge difference.<\/p>\n
ROTT: I’m curious– what are some of the barriers to treating postpartum psychosis effectively? I mean, it sounds like not every case turns out as well as [? Ayana’s ?] did.<\/p>\n
ZHANG: Yeah, some barriers are around early and accurate diagnosis. Parents may not know about postpartum psychosis or know how to get help. And even if they do, they may not be able to see a mental health provider. They may not even want to, because they’re scared of being judged or separated from their baby. And patients with postpartum psychosis encounter doctors from all specialties, not just psychiatrists. So it’s important that all types of doctors know more about it.<\/p>\n
ROTT: OK, so if a parent does get to the doctor, they are diagnosed quickly, then, are there still barriers?<\/p>\n
ZHANG: Unfortunately, so. Veerle mentioned that lithium is one of the best treatments for postpartum psychosis. But there’s been a big decline in lithium prescriptions for many reasons.<\/p>\n
BERGINK: Lithium is a very cheap treatment. It’s a salt. So there is no money to be made there.<\/p>\n
ZHANG: Lithium can’t be patented, so pharmaceutical companies aren’t going to spend money to advertise it. So it usually gets looked over in favor of other newer drugs. And lithium can have a lot of side effects. So there’s some issues with the medication. And then there’s also issues with how we care for these patients in the hospital. Where Veerle trained in Europe, she took care of patients with postpartum psychosis who could actually keep their baby with them under tight supervision. Here in the US, we don’t really have those types of units.<\/p>\n
BERGINK: And that is a problem if mothers cannot be admitted together with their baby. Because as soon as they can, they want to go home. So their doctors, they feel a pressure to treat them very fast. And what I see happening a lot, that women get a lot of medication, like, really, in a few days, all kind of combinations.<\/p>\n
ROTT: Oy.<\/p>\n
ZHANG: Yeah, so the parents really want to go home, and then our psychiatric system is overwhelmed. And so between all of that, sometimes the parents go home when they’re safe, but not totally better. And of course, the fear is they’re still at risk for harming themselves or their baby.<\/p>\n
ROTT: Yeah, like what we’ve been hearing about with the Lindsay Clancy trial and case.<\/p>\n
ZHANG: Mm-hmm, exactly. And so what’s so interesting about the Lindsay Clancy trial is that, now, a lot of people want to know more about postpartum psychosis.<\/p>\n
BERGINK: People are talking about it. And that is understandable, because it’s so horrible.<\/p>\n
ZHANG: But Veerle thinks that some of the attention is harmful misinformation, too.<\/p>\n
BERGINK: We should also realize that it’s really rare. Even in the US with not good diagnostic system or care system, the actual risk of women actually, you know, harming their child, that is extremely rare. Unfortunately, the risk of women losing their own life is not so rare. And that happens a lot as well. But that doesn’t make it into, you know, the front pages of the news.<\/p>\n
ROTT: Ugh. That’s hard to hear. But it’s also interesting because this isn’t the first time postpartum psychosis has really been in the limelight, right?<\/p>\n
ZHANG: Yeah, so that’s another thing. The more I researched this case and postpartum depression, the more I was pulled into another from 25 years ago. In Texas, in 2001, there was a similar case with a woman named Andrea Yates, who drowned her five kids in a bathtub at their home after months of hearing voices. And she thought doing so had saved them from Satan. I brought this case up to Veerle, and she pointed out that across all that time–<\/p>\n
BERGINK: There is no progress. There has been zero progress with regards to postpartum psychosis. It’s scandalous.<\/p>\n
ZHANG: And, you know, it’s maybe not surprising because there’s still a huge stigma around mental health. A lot of people judge Lindsay and Andrea because they think it could never happen to them or someone they know. At the same time, there’s also been no progress on how much we know about postpartum psychosis, or even how many people are getting sick from it. Postpartum psychosis isn’t even defined in the DSM-5.<\/p>\n
ROTT: Which, for those of us that aren’t doctors, is what?<\/p>\n
ZHANG: Yeah, so the DSM-5 is this psychiatric dictionary of sorts that helps people have a standardized definition, that helps you, you know, know what you’re taking care of and know how to research it.<\/p>\n
ROTT: OK, so, Angela, what can we do about this going forward?<\/p>\n
ZHANG: Veerle says that having a formal definition of postpartum psychosis would really help researchers. It could also help doctors make guidelines about how best to diagnose and treat it. She’s hopeful that if we do this, we can make the same kind of progress that we made in postpartum depression. So with postpartum depression, there’s actually formal screening tools. And interesting fact– I actually used them a lot during my newborn visits when I was a pediatric resident. And I was able to get a lot of parents mental health resources just by asking them the questions.<\/p>\n
ROTT: Yeah.<\/p>\n
ZHANG: And so one lesson here is, doctors should ask their patients about any symptoms of mania or psychosis.<\/p>\n
ROTT: I mean, that’s great if people can get care at the doctor, or their doctor asks them questions about their psychological well-being. But what about, you know, like, husbands, like me, or non-doctor friends or family? Is there anything that we can do to help people out?<\/p>\n
ZHANG: Yeah, so in some ways, the people that are around the parent are the most important ones. You could pay attention to and support the postpartum parents in your life. If you notice that a new parent is acting just really different from their normal self, Veerle recommends taking some extra precautions. So maybe you don’t let the new parent be alone with themselves or the children. Or if you’re really worried, like in [? Ayana’s ?] case, maybe you call their doctor or take them to the emergency room to get help.<\/p>\n
ROTT: That is great advice, Angela. Thank you so much for talking to us about this trial in this case and this condition.<\/p>\n
ZHANG: Yeah, thanks, Nate, for having this really important conversation with me.<\/p>\n
[MUSIC PLAYING]<\/p>\n
ROTT: This episode was produced by Arun Nair and edited by Rebecca Ramirez. Tyler Jones checked the facts. Robert Rodriguez was the audio engineer. I’m Nate Rott. Thanks for listening to Short Wave from NPR.<\/p>\n
[MUSIC PLAYING]<\/p>\n
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