Within hours of giving birth to her first son in 2003, Carla O'Reilly began hearing voices.
She heard the word "smother" over and over again. She could envision violent images of herself harming her infant boy.
O'Reilly was blindsided by fear.
"It came out of nowhere," she said. "It was terrifying, it was terrible, it was traumatic."
It was postpartum psychosis, which can occur in up to 1-in-1,000 births. O'Reilly was fortunate, she said, in that she recognized immediately the severity of her condition and notified the doctors in postnatal care. She was given medication that dealt with the psychosis.
O'Reilly's tale of her postpartum psychosis gives a hint of what 32-year-old Lisa Gibson was dealing with Wednesday morning.
O'Reilly said she struggled with obsessive-compulsive disorder issues and suicidal thoughts for the next four years.
"It was like a prison sentence," O'Reilly recalled. "It was like the most terrifying movie going on in your head. It's like a black hole when you're down there."
She reached rock bottom after a suicide attempt, only to be saved by a close friend who also suffered from postpartum depression (PPD), who looked O'Reilly in the eye and said, "You're going to have to fight through this."
"That's when I knew I had a choice," O'Reilly said. "My choice was I was going to choose my son and my family and I was going to choose to be an awareness advocate. That's when the healing started."
O'Reilly is co-author of the book, Smiling Mask: Truths About Postpartum Depression and Parenthood. Ten years later, she travels the country speaking about PPD to spread awareness and education about an illness that remains unfathomable to most of society. In Moose Jaw, Sask., where O'Reilly lives, she regularly lectures parents at prenatal classes.
O'Reilly remembers PPD coming up in her prenatal classes, too, for about 10 minutes. She never paid any attention.
Then the voices came.
"I want people to know if they're suffering from PPD, first, don't be ashamed," O'Reilly said. "Get help right away. There are supports available. There can be a quick turnaround. The family can remain healthy, happy and resilient."
Unfortunately, O'Reilly noted PPD often only gains prominence in the case of tragedy, when a young mother jumps in front of an oncoming subway train while holding her infant, or a mother drives her and her four children into a lake. These are jarring, seemingly unnatural incidents that garner national headlines.
But in most cases they begin with a woman, such as O'Reilly, who suffers from depression following or prior to giving birth. The mother can suffer from extreme sadness, not wanting to bond with her child, crying excessively, suffering from panic or anxiety attacks. These are considered symptoms of PPD, which according to various studies can affect as many as one-in-five mothers.
Cases of psychosis are more rare (1- or 2-in-1000) and involve hallucinations, delusional thoughts or hearing voices, such as demands to kill the children.
"A postpartum psychosis doesn't necessarily mean the children are at risk," noted Dr. Carrie Lionberg, a clinical psychologist with the Manitoba Psychological Society. "It's far, far less that you ever see something that ends up with the death of children."
Some women are reluctant to admit to either PPD or psychosis due to the stigma of mental illness. And some family members are reluctant to believe them, even if they open up.
"The other thing is the myth and cultural expectation that pregnancy and those early days of mother-infant bonding are supposed to be serene and totally fulfilling and loving. In soft focus, so to speak," Lionberg said. "In reality it's a very challenging period. When experiencing this stress they (women) may feel ashamed, they may feel guilty... when they're supposed to be happy."
Some cases of PPD may require hospitalization. Some require medication. All require some form of professional mental-health intervention, Lionberg added.
Risk factors include a history of bipolar disorders or depression. However, it's possible for mothers, especially in first deliveries, to suffer PPD without any risk factors at all.
Many of the more notorious cases of filicide -- where parents kill their own children -- involve suicide.
In such cases, experts cite that parents can come to believe the world isn't safe. "To prevent them from being hurt I'm going to end their life and the thought of living without them is so much that I have to end my own life as well," Lionberg said. "A person who's hearing command hallucinations, the auditory hallucinations may direct the woman to kill herself as well. (But) we don't know this because we can't interview anybody who's successfully committed suicide. But these are some of the possibilities."
Lionberg believes awareness and understanding of postpartum depression is increasing, although that education still has a battle with the "cultural myths" of child birth.
Regardless, O'Reilly said mothers who experience PPD need to take care of themselves, expectations or not.
"We believe that mothers need to forgive themselves, that they need to be aware of their role as a mother and how powerful it is," she said. "So we talk about self-awareness, self-love and self-acceptance. Anyone suffering with any sort of depression struggles with those sorts of things, especially mothers. The most important thing is to say, 'I had postpartum depression, I struggled, but I love my child.' "
But forgiveness for what?
"To say to somebody I had thoughts of harming my son," O'Reilly replied. "So I used to beat myself up early in the illness. Why would you think that? You're a monster. You're horrible.
"Now I recognize those thoughts were scary but they weren't me."