THE deaths of 32-year-old Lisa Gibson and her two children may jolt a community to take a hard look at a mental-health issue that lurks in the shadows.
Or worse, it may only force women and families to hide or dismiss symptoms, especially for rare cases of psychotic behaviour in which new mothers are already paranoid and anxious.
"How do we raise awareness without pushing more women back in the closet?" said Karen Kleiman, the founder of Philadelphia-based Postpartum Stress Centre.
There is no easy answer. Kleiman, a licensed clinical social worker, wrote her first book on postpartum in 1994 titled, This Isn't What I Expected. It detailed the lack of awareness of postpartum depression (PPD) among health-care employees and mothers alike, and how the latter would often fear discussing symptoms with even close friends and family.
"Twenty-five years later and it's amazing how little has changed," Kleiman said. "Women still go to their doctor. He asks, 'How are you doing?' She says, 'Everything's fine.' Then she goes home and thinks about killing herself."
PPD has a range of symptoms: depression, feeling estranged from the newborn, lethargy and intrusive thoughts about harm coming to the baby. Those symptoms are said to affect as many as 20 per cent of mothers.
Cases of postpartum psychosis are more rare, ranging between 1-in-1,000 and 2-in-1,000 births. Sources said Gibson sought help for some form of postpartum mental illness, although there has been no confirmation of psychosis.
However, since the vast majority of women who suffered from PPD never harm their children, the working theory among experts remains psychosis, a break from reality in which mothers can be haunted by voices telling them to harm their children, who are possessed, or to save them by taking their lives.
"Trust me when I say these mothers believe they're doing the right thing," Kleiman said. "That's scary for all new moms, it's true."
The problem is diagnosing which scary thoughts are postpartum anxiety and which thoughts could be rooted in psychosis.
"There are tons of misinformed health-care professionals, and there are tons of misinformed mothers," Kleiman said. "Women with postpartum depression do not kill their babies."
Psychosis is believed to be triggered hormonally, with symptoms appearing as soon as 48 to 72 hours after birth, although the majority of episodes develop within the first two weeks after delivery, according to the PSC literature.
Kleiman said a woman suffering postpartum psychosis may hide her symptoms. Since differentiating between acute anxiety and psychotic symptoms is crucial, Kleiman suggested questions that should be asked of every postpartum woman who goes to the ER. They should be asked in front of family.
-- Does anyone in her family have a history of bipolar illness?
-- Is she talking or acting in a strange manner that is not characteristic for her?
-- Is she unusually quiet and withdrawn, or speaking rapidly with little concentration?
-- Does she claim to hear things or see things that others do not?
-- Is she suspicious of others or expressing concern others are out to get her and trying to harm her in some way?
-- Does she have a decreased need for sleep or food and/or exhibit a high degree of confidence or an exaggerated sense of her capabilities or self-worth?
-- Does she feel abnormally hyperactive with racing thoughts and/or behaviours?