June 26, 2001
Yates case draws attention to new moms' mental healthBy CLAUDIA FELDMAN
She might cry when she realizes her midsection more closely resembles her bed pillow than her once-svelte figure.
She might wail when her husband speaks to her with an edge in his voice.
She might scream when she changes a third diaper in five minutes or realizes the baby can't go anywhere, which means she can't either.
Experts say that up to 80 percent of all new mothers experience brief bouts of the postpartum blues. By day 14, however, most women are back on an even keel. Their hormones have adjusted, they have found new coping skills, and they are full of love for the newest member of the family.
Friends and family should intercede, however, if the tears don't stop, and a woman spirals beyond the postpartum blues to level two of the mood disorder -- postpartum depression -- or level three -- postpartum psychosis.
The entire nation has been fixated on the rare postpartum psychosis after a Clear Lake woman, Andrea Yates, told police she killed her five children, ages 6 months to 7, by drowning them in a bathtub. She has been charged with capital murder and could face the death penalty.
The drownings occurred Wednesday. Talking to reporters Thursday, Russell Yates said his wife suffered from severe postpartum depression after the births of Luke, 2, and Mary, 6 months, and grieved intensely when her father died in March.
According to neighbors, proof that the mom already was overwhelmed was her 1999 suicide attempt.
Here and around the country, obstetricians, gynecologists and psychiatrists struggle to put the Yates case in perspective. They don't want the public to think that every new mother with the baby blues is suicidal or homicidal. But, they say, more attention should be paid to the mental health of new moms.
After giving birth, a woman's hormones, electrolytes and fluids are in flux -- those are the biological reasons for the mild depression, doctors say.
There are practical reasons, too. New moms find themselves tied to home and hearth, like it or not, and they face new financial challenges, new family dynamics, new worries about their appearance and competency.
Usually the blues pass quickly, with no treatment needed beyond the requisite empathy and understanding. If, however, a simple case of down-in-the-dumps evolves into a more lasting depression, the mother may need much more support, including antidepressants and therapy.
Too often, postpartum depression -- which affects one in 10 new moms -- is underrecognized, undertreated or missed altogether, says Dr. Lucy Puryear, an assistant professor of psychiatry at Baylor College of Medicine.
It resembles any other kind of depression, Puryear says. "The new mom may be tearful, irritable, unable to sleep, with a poor appetite, decreased energy, and no interest in her usual activities. All those symptoms interfere with her ability to get out of bed and take care of that baby. She thought she would be ecstatic after the birth. Instead, she feels miserable."
None of those feelings, Puryear says, are easy to discuss. "The rest of the family is excited. There are gifts in the mail. But she is thinking, `This isn't what I thought, maybe I wish I hadn't had this baby.' The thoughts are so painful, she doesn't tell anybody."
In rare cases -- one in 1,000, Puryear says -- depressed mothers become psychotic.
"When it's so severe, women may hear voices, they're delusional and their thoughts are very confused. In those cases, there's excessive worry about the children and thoughts of harming them."
It's a reasonable guess, Puryear says, that Yates suffers from postpartum psychosis. Dr. Jay Tarnow, another Houston psychiatrist, agrees. "With psychosis, people are paranoid, they're out of touch with reality, they hear voices -- they may even hear God telling them to do something.
"Didn't God tell Abraham to tie up his son, Isaac, to slay him as a sacrifice?" Tarnow asks. "Then God said, `OK, get the ram instead.' I'm not saying Abraham was psychotic. But I am saying that if people are God-fearing and think they hear God telling them to do something -- sometimes they will do it."
While the baby blues disappear without treatment, and postpartum depression can usually be handled with antidepressants and therapy, postpartum psychosis usually calls for antipsychotic medication and hospitalization.
Before doctors focus on treatment, Tarnow says they should spend much more time on screening and prevention.
"Obstetricians, pediatricians, nurses have to look for postpartum problems," Tarnow says. "Mothers aren't going to say, `By the way, I'm feeling horrible, and I don't want to bring my baby home from the hospital.' They feel so guilty they can't ask for help."
Tarnow suggests that new moms have someone in the house -- a grandmother, mother or aunt -- who can help the new mother catch up on sleep, assure her of her competency, and also be on hand to spot signs of depression.
He also suggests health professionals create an atmosphere that allows women to talk about their true feelings and deepest fears.
That's essential, says forensic psychologist Geoffrey McKee, a professor at the University of South Carolina School of Medicine and associated with the South Carolina Department of Mental Health. "When a woman, a mother, comes in with depression and suicidal ideas, the therapist or whoever is treating her needs to ask: `What plans do you have for your child?' "
McKee says he first heard the question posed by Dr. Phillip Resnick, a forensic psychiatrist at Case Western Reserve University Medical School in Cleveland.
"The clinician is giving the patient an opportunity to voice her unthinkable thoughts," McKee says. "If she has contemplated killing herself or her children, she is certainly not going to volunteer that without being asked. But real people do have those thoughts."
Events just this month bear him out.
In early June, Calgary police arrested a 23-year-old Japanese woman, Rie Fujii, and charged her with failure to bury her 15-month-old son, Dominic, after his body was found in a vacant apartment.
Police still are searching for the body of Fujii's 3-month-old daughter, Gemini, believed to be wrapped in plastic bags and in the Bow River.
Fujii is currently undergoing a 30-day psychiatric assessment while the medical examiner's office continues to hold Dominic's body as evidence. Police say the current charge against her may be elevated.
On June 11, Melanie Stokes fell to her death from the 12th floor of a Chicago hotel. Her death, ruled a suicide, came three months after the much-heralded birth of her daughter, Sommer Skyy.
Stokes had wanted a child for years and underwent fertility treatment to become pregnant. When the baby arrived, however, she could not fight her way out of the ensuing depression and psychosis, even with family support and psychiatric treatment.
In hindsight, Houstonians can see that Andrea Yates was overburdened, did cry for help and did receive help, though it was inadequate.
One more take-home message, says Dr. Michele Curtis, associate professor of obstetrics and gynecology at the University of Texas Health Science Center, is that local mental health services are overloaded, underfunded, yet regularly cut instead of bolstered.
It doesn't make sense, she says.
"This case raises a lot of questions that need answers."
Copyright 2001 Houston Chronicle