Note: The following essay includes descriptions of violent thoughts and hallucinations which some readers may find troubling or triggering.
“Do you want to harm others?” asked the doctor, peering over her notepad at me.
“No,” I said, my eyebrows knitting together. I recalled the urges I felt earlier in the week to stab my 4-year-old daughter. But even still, I knew I was telling the truth. I didn’t want to harm her. I was actively trying my best not to hurt her — or anyone else. These thoughts and urges I was experiencing were not my own. Then again, how could this doctor know that?
“Do you want to harm yourself?” the doctor asked.
“No,” I replied. I needed her to understand that I didn’t want to do any of the things I was feeling compelled to do. Since my miscarriage a few months earlier, I seemed to have no control over the terrible feelings I was experiencing. It was like I had no choice.
I wanted to live, see my little girl grow up, graduate, and get married. But if taking my own life was the only way I could stop myself from giving in to the incessant commands to harm her or anyone else, I would do it.
It appeared she didn’t believe me.
“I’m very concerned that your mind is starting to play tricks on you,” she said. “I’m going to start you on some new pills.” She leaned forward and showed me a notepad with the word Seroquel scrawled on it. “I need you to take this, to stave off a dangerous psychotic episode.”
With those three sentences, my road to recovery finally began.
A miscarriage can be traumatizing for many reasons. Mine triggered the most severe of all postpartum mood disorders: postpartum psychosis. On the spectrum of postpartum mood and anxiety disorders, it is considered a true life-threatening psychiatric emergency. Though there is greater awareness about some of the other conditions on this spectrum, including postpartum depression and postpartum anxiety, postpartum psychosis is an entirely different condition. It is still shrouded in ignorance and many people do not recognize it. Characterized by hallucinations, delusions and bizarre thoughts, research has shown it carries a 5% suicide risk and 4% infanticide risk.
Less than a week after my miscarriage, I stumbled into a place devoid of feeling and emotion. I couldn’t laugh or smile. It was as though my face had been Botoxed and the muscles left incapable of doing anything, including lifting the corners of my mouth.
Having studied psychology as an undergraduate student, I suspected I was suffering from depression. So, I paid a visit to my doctor. Within minutes it was determined that I was grieving over the loss of my pregnancy.
I wasn’t so sure.
For the next week, I sat in darkened rooms wishing that my emotions would return. From there, it only worsened. Anxiety came to replace the emotional numbness. It took the form of relentless repeating thoughts nagging me to organize my house. Dull and nonsensical at first, my thoughts grew more insidious as time passed.
Then, a more horrifying symptom emerged. I found myself thinking my daughter needed to die. I didn’t want her to die, but strange as it may sound, it was like my mind was trying to convince me of it. It was a truly bizarre thought, and I couldn’t understand where it came from.
The anxious thoughts in my mind were also oddly beginning to feel like a voice. They had developed a sound-like quality. I began walking around cradling an old Walkman with the volume on high, desperate to drown them out.
Was it normal for thoughts to have volume? Three weeks into my waking nightmare, I could no longer recall what normal thoughts were like.
“Your husband is going to leave you,” the voices screamed at me. It went on 24 hours a day, seven days a week. The shrieking even prevented me from sleeping. I began pacing around my house. Besides blasting the Walkman, walking felt like the only way to hush the incessant noise of the voices.
In a little less than a month, I had effectively gone from a functioning person to a walking zombie, so my husband dragged me to yet another doctor ― it would be the fourth in two weeks.
The first doctor had dismissed my issue as grief over the miscarriage. The second told me I was experiencing “ruminating thoughts,” while the third doctor told me it was “intrusive thoughts.” None of these were true or complete diagnoses, but the doctors were satisfied enough to send me home.
Nonetheless, it was evident to me and everyone in my family that I was progressively worsening. The voices told me things I didn’t want to know: that my husband was going to leave me, that I was going crazy, and most disturbingly, that I shouldn’t go near my daughter.
Now at my fourth doctor, I confided to her that I was hearing a voice telling me terrifying things.
The reality is that postpartum psychosis is a medical emergency. Anyone in the postpartum period experiencing hallucinations or delusions should be immediately hospitalized. This ensures that both the person afflicted and their child (if there is one) are safe while the mother is able to get treatment. In my case, this didn’t occur. Even when I told the fourth doctor about my auditory hallucinations, I was sent home.
Over the next 24 hours, the situation rapidly worsened. Whatever remaining insight I had began to disappear, and I grew convinced that the voice plaguing me belonged to the devil. It suddenly all made sense. I wasn’t going crazy ― this was a spiritual crisis, with the devil controlling my mind.
And so, my husband took me to the doctor for the fifth time in two weeks.
Unrelenting commands to stab my daughter suddenly overtook me. Over and over again, I experienced demands to hurt her and saw visions of exactly how to do it. Panic gripped me. I felt like I had no choice but to comply. It was fortunate that my daughter was safe with my parents and nowhere near me.
As I walked toward the clinic with my husband, I was overwhelmed by new commands and urges to shove people around me into oncoming traffic. It was unfathomable and uncontrollable.
Tears streamed down my face as I struggled to hold myself back from being propelled toward them. I tightened my grip on my husband’s hand.
“Kill yourself so you don’t kill anyone else!” I heard a voice in my head saying. Who this was from, I didn’t know anymore.
As I sat before the newest doctor, I tried to explain what was happening.
“I feel like doing bad things to people and because I don’t want to, I feel like doing bad things to myself,” I said, tears splashing onto my hands. “Because of this, I want to be hospitalized.”
“What kind of bad things?” the doctor asked gently.
“They’re evil,” I said, shaking my head. How could I even put those evil ideas into words?
“Hmm,” she said, thinking. “Well, I think you can go home, and I’m going to give you some medications.”
I left clutching a prescription for the tiniest possible dose of an antidepressant and some anxiety medications, as well as a referral to see a psychiatrist.
It’s ridiculous that the doctor thought I was safe to go home. But this scenario occurs too often, and this is exactly how tragedies can happen.
With the command hallucinations and violent urges I was experiencing, it is a miracle that I was somehow able to keep it together until my psychiatric appointment. Even though I had only been prescribed medication for anxiety and depression, the side effects made me lethargic. This reduced the likelihood that I would be able to act on any commands. Not everyone in this position might be that lucky.
By the time I finally met the perinatal psychiatrist, I was so far gone into my delusions that I could not accurately communicate what was happening to me. Despite this, she suspected that I was experiencing postpartum psychosis. This is why she prescribed me Seroquel, an antipsychotic. For this reason, I was not hospitalized at the time. As I recovered and relayed more of what I had experienced, my psychiatrist acknowledged that I should have been admitted to the hospital for care.
Nevertheless, I will forever be grateful for this doctor’s insight. She also spent time supplementing my medication management with talk therapy, something many psychiatrists don’t do. I don’t want to think about what could have happened if I had not been seen by this doctor and received antipsychotic medication.
People who have never experienced this illness cannot comprehend what these hallucinations and delusions feel like. Instead, they are quick to assign hatred, vitriol and blame. I understand this — I myself believed that I was evil and wanted to take my own life.
But postpartum psychosis is a medical condition, not a moral failing or shortcoming. It can strike anyone who is postpartum, including those who have experienced pregnancy loss (though there is frustratingly and dangerously little research or information about PPP after a miscarriage). Like me, two-thirds of those who experience it have no prior psychiatric history.
Nonetheless, I blamed myself for the heinous feelings. But when I received antipsychotic medication, the symptoms completely resolved. This swift recovery, which was achieved after I was medically treated, is further proof that postpartum psychosis is likely primarily a devastating biological condition.
After three months, I was weaned off the antipsychotics. Since being treated for postpartum psychosis, I have never experienced any of those feelings or symptoms again. I went back to working full time and have been able to see my daughter grow and graduate high school.
My experience with postpartum psychosis was terrifying and prolonged. The unfortunate reality is that it did not need to be. When properly diagnosed, postpartum psychosis is a temporary, highly treatable condition. It occurs in 1-2 out of every 1,000 deliveries, which is similar to the incidence of cerebral palsy and Down syndrome. When so many are affected, it is a mystery to me why society and health care professionals continue to be so ignorant of it.
Had the doctors who saw me been better informed, I am confident I would not have suffered and placed myself and those around me in danger. It is only increased awareness of postpartum psychosis that will ensure that the tragic deaths of children and mothers due to this illness are a thing of the distant past.
If you or someone you know is or may be struggling with postpartum mental health issues, contact a medical profession and visit postpartum.net or call the Postpartum Support International HelpLine at 1-800-944-4773.
Aaisha Alvi is a pseudonym used by this author to protect her privacy. She is a survivor of postpartum psychosis and an advocate and is currently working on her memoir,“ The Secret We Keep: How Postpartum Psychosis Kills.”