June 18, 2014 7:29 AM   Subscribe

"Postpartum depression isn’t always postpartum. It isn’t even always depression. A fast-growing body of research is changing the very definition of maternal mental illness, showing that it is more common and varied than previously thought." ‘Thinking of Ways to Harm Her’ and "After Baby, an Unraveling".

One of the journal articles listed in the "Harm Her" piece is available for free online: "Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings." Abstract for the second is here: "Obsessive-Compulsive Symptoms During the Postpartum Period: A Prospective Cohort"

The Times has a page devoted to post-partum depression. It also put together a list of Resources for Maternal Mental Illness which includes:
* Postpartum Support International
* Postpartum Progress
* The Postpartum Stress Center
* For Fathers: http://postpartumdads.org/
* For Providers: MedEdPPD
* Federal Resources: National Institutes of Health MedlinePlus
* U.S. Department of Health and Human Services: "Depression During and After Pregnancy"
* Information in Multiple Languages

A detailed list of links, including blogs, foundations, and information for medical professionals and for family members, can be found here.
posted by zarq (58 comments total) 55 users marked this as a favorite
Trigger Warning: Many of the links in this post discuss depression and its related symptoms and side effects as well as suicide and suicidal thoughts. The "Unraveling" article is a case study of a mom whose depression and fear for her newborn overwhelmed her. I found it difficult to finish.
posted by zarq at 7:34 AM on June 18, 2014 [2 favorites]

Oh my god. Nothing prepared me for the last line of the second article. Fantastic post.
posted by Mchelly at 7:43 AM on June 18, 2014 [26 favorites]

Came here to say exactly that, Mchelly.
posted by Melismata at 7:45 AM on June 18, 2014

My wife went through this with our second child. It was terrifying. Also terrifying was the visit from the home health nurse. I was sure she would call a social worker and that would be it.
posted by KokuRyu at 7:48 AM on June 18, 2014 [2 favorites]

Those two articles were both tough reads, but I'm glad the issues are getting more attention.

The second article had this line:
they [postpartum illnesses] often develop later than expected and include symptoms not just of depression, but of psychiatric illnesses.

When did depression stop being considered a psychiatric illness or mental illness? It's a little baffling to me, especially given how deadly severe depression can be.
posted by jaguar at 7:50 AM on June 18, 2014 [12 favorites]

I've been sitting on a draft of a "what can I do to avoid/minimize PPD?" AskMe question for a little while, so this has been weighing heavily on my mind. Thank you for this post.

I have a history of depression and OCD, and the only good thing I can say about either condition is that I have an idea of what to look out for. They can sneak up and pull you under.
posted by Metroid Baby at 7:53 AM on June 18, 2014 [6 favorites]

Slate's XX Factor blog on the NYT stories.
posted by zarq at 7:54 AM on June 18, 2014

Aw fuck. I stopped reading the second article before I got to the last sentence. Thanks for pointing that out.
When did depression stop being considered a psychiatric illness or mental illness? It's a little baffling to me, especially given how deadly severe depression can be
I think it's very poorly phrased, and what they mean is that it can manifest not just as depression, but also as another psychiatric illness. At this point people are often on the lookout for symptoms of depression in new mothers, but they might not think about postpartum illness if a new mother starts having delusions or hallucinations six months after the baby is born.
posted by ArbitraryAndCapricious at 8:08 AM on June 18, 2014 [4 favorites]

When did depression stop being considered a psychiatric illness or mental illness?

I'm about halfway between what Arb&Cap said (perhaps that was supposed to be "other psychiatric illness") and the idea that there's still a connotation in the wider world that "depression" is just "the blues" and isn't as bad as "psychiatric illness."
posted by Etrigan at 8:11 AM on June 18, 2014

I feel so sad for everyone - the moms, the kids, the families.

I wonder, how much does lack of sleep and social support factor into severe PPD? Are there any studies which talk about rates of PPD being different in different countries and/or cultures? I think that having to cope alone, or with just a partner's support, and not having extended family or friends able or willing to come in and help out, is so hard on new parents. And lack of sleep after going through labor and birth has got to be the worst.

Sometimes things just go wrong - Cynthia, in the article, appeared to have everything going for her. Some people are just more susceptible, just as others are more susceptible to depression no matter how rich their lives are. But with Emily, at least, I wonder how much better her outcome would have been if she had social support and some sleep.
posted by Rosie M. Banks at 8:21 AM on June 18, 2014 [5 favorites]

From "Unraveling":
Many women have been afraid to admit to terrifying visions or deadened emotions, believing they should be flush with maternal joy or fearing their babies would be taken from them. ...

“Not unlike a lot of high-achieving women, she was somewhat of a perfectionist, and she also wanted to be the perfect mother,” Deb said.
The toxic conjunction of vulnerability, stress, fatigue, depression, shame, silence, and unachievable standards can lead to such awful outcomes. These articles are so hard to read, zarq -- but thank you.

"Be kind, for everyone you meet is fighting a hard battle."
posted by MonkeyToes at 8:22 AM on June 18, 2014 [9 favorites]

Reading those two NYT articles filled me with terror and dread.
posted by Narrative Priorities at 8:23 AM on June 18, 2014

I was terrified about PPD when pregnant with my son. I have Bipolar II and had to go off my meds to conceive (one by personal choice because there weren't enough studies to prove it was safe, the other was known to cause birth defects). I was fine through my pregnancy and kept waiting for the bomb to drop. And then other than one really low day (when my family all left and my husband went back to work and I went from tons of help and support to none, overnight), I never had a real issue. And I had an awful birth experience and a baby with a shallow latch who tortured me throughout the year of nursing. If anyone was a likely candidate, I was.

I really thought that prior mental illness and depression = automatic PPD, especially without meds. Apparently not always. And meanwhile many perfectly mentally healthy women are affected so awfully. The more we can learn about this, the better.
posted by my left sock at 8:27 AM on June 18, 2014 [9 favorites]

I found it difficult to finish.

Total understatement.
posted by Pudhoho at 8:33 AM on June 18, 2014 [1 favorite]

Intrusive thoughts. I could write a god damn book on the things. They sent me to a PHP program because I didn't understand them and they scared the living shit out of me. I would get an impulse or a thought and immediately start going into a panic attack. If I saw a knife it would immediately attract my attention and I'd get a surge of adrenaline then the panic would set in. Fourteen of the longest god damn months of my life so far.

The worst thing is that outside of specialist therapists in OCD nobody really understands them or what they really are. I saw a therapist before going into the PHP program and she didn't have a clue what was going on. Even in the PHP program they couldn't tell intrusive thoughts apart from serious threats and in psychiatry you treat everything as serious. Which just compounds the problem because you literally think you either are crazy or going crazy. You worry that you're a psychopath or a sociopath and you're just waiting to snap. But it's all bullshit in your mind and you realize that after the "human" part of your brain regains control from the emotional "lizard" part of your brain.

If you do an fMRI while someone with OCD is having an intrusive thought and the aftermath you watch the Orbitofrontal cortex it's working overtime. People who are afflicted with bad reactions to intrusive thoughts are so worried about them coming true that you can literally see their impulse control center going into hyperdrive to make sure they won't actually do it.

Part of it is just plain thought-action fusion. You think you'll do something, or that something you think is as bad as actually carrying out the action. Because we think bad thoughts we immediately assume we're bad people. But things don't work that way. Otherwise we could literally think ourselves to wealth by imaging a pot of gold appearing in front of us and it actually happening.

But we can't control our thoughts any more than we can control the weather. Your brain is a machine that has parts working in the background iterating through every conceivable situation for your convenience in survival. Sometimes when it comes across something that it thinks is bad it draws it to the attention to your prefrontal cortex with "I wouldn't do that shit if I were you" but our prefrontal cortex, culturally conditioned by millenia of religious overtones completely antithesis to actual brain functioning ("thinking impure thoughts? DEVIL PERSON!"), immediately doesn't understand the context and jumps straight to "why the fuck did I think that? I must be evil".

Of all the things to suffer from, intrusive thoughts are some of the scariest shit you'll ever encounter. Thankfully most people respond well once they encounter a therapist with a clue but the stigma behind impure thoughts and people's complete misunderstanding of what they actually mean makes a god damn nightmare to even admit that you need help. A lot of people just suffer in silence, allowing these obsessive intrusive thoughts to become compulsions like our ass-dragging-down-stairs new mother. All because they're worried some ignorant asshole will react with "you're crazy. Give me your child and get the fuck away from it".
posted by Talez at 8:39 AM on June 18, 2014 [24 favorites]

I wonder, how much does lack of sleep and social support factor into severe PPD?

For me, having a lot of family support really helped. I had really distressing intrusive thoughts about child abuse (not the urge to hurt my child, just thoughts about all of the really horrific child abuse stories I've heard over the years). The fact that I had my mom (who also experienced it when she had my brother and me) coming over to let me have a nap everyday and friends to talk to reduced the scariness of the thoughts to something that was distressing but manageable.
posted by echolalia67 at 8:42 AM on June 18, 2014 [2 favorites]

Oh God, that "Unraveling" piece is just...words fail me. I think in those circumstances I'd have been inclined to just never tell that kid the truth about how his Mom died. Although, I suppose eventually he has to find out. But oh dear lord, what a thing to carry with you.
posted by yoink at 8:46 AM on June 18, 2014 [1 favorite]

I have a question about the story of Benjamin's mother in the first article. I want to tread carefully here because I'm not a mother and I haven't experienced mental illness first-hand, but that story seemed like an outlier to me. In contrast to the other women who were profiled, Benjamin's mom did not want to give birth to him. The article doesn't directly suggest that she was coerced - either by her doctors or by her husband - into giving birth when she very clearly wanted was an abortion, but I couldn't help wondering about that possibility.

I have a hard time imagining any thing more traumatic that being forced to carry a child to term against one's will, and then being forced to care for that child without adequate social support (it sounds like her husband was deployed for at least part of the time.) Under those circumstances, the woman's desire to give the child up for adoption, or to drop him at the fire station, seems like a profoundly rational wish. While fantasies of harming a child are certainly stressful, they don't necessarily strike me as a sign of mental illness, and neither does a lack of affection for a child, as socially unacceptable as that might be. Day after day of caring for this child under incredible pressure pushed her to the breaking point, but the husband's line about how they just have to find the right medication that would make her love her son struck me as chilling. I'm glad she got the help she needed, but I can't help but recoil at the implication that a mother must love a child, even an unwanted one, or else be branded mentally ill...and I have a hard time imagining a father who'd failed to bond with his son being pathologized in quite the same way.
posted by pretentious illiterate at 8:55 AM on June 18, 2014 [28 favorites]

I am too afraid to RTFA at the moment, but my left sock, thank you so much for coming in and saying that. Just because I also have BPII, and even though I probably have another 3-5 years before I REALLY have to worry, the thought of what may happen during a potential pregnancy and motherhood absolutely terrifies me. I also assume that serious preexisting mental illness = automatic PPD. Yours is literally the first first-person story of someone with bipolar disorder and had a baby that doesn't end in some version of "and then I crashed into crisis and had to go immediately back on potentially harmful meds/wound up going inpatient/lost my child/everyone agrees this was a Bad Idea that we should never have tried." It's good to know that there is at least some small possibility that things will go well.

And I agree, the better we can understand PPD, the better off so many people will be. I do also wonder how much of this is a social/environmental issue because of the devastating lack of support for new mothers, but either way, more information is better.
posted by bowtiesarecool at 9:06 AM on June 18, 2014 [1 favorite]

That second article hit even harder than I was expecting. My 3-month old is currently snoozing on my chest, and just a few days ago I was scouring the internet for one of the symptoms Cindy Wachenheim was worried about and reading article after article saying the same thing: brain damage, brain damage, brain damage.

I don't think my baby has brain damage - there are no other signs and more likely (and less serious) explanations. But my initial reaction was still: of course it's the worst possible scenario, of course I have somehow failed to protect her during pregnancy/birth/infancy.

It was only brief, and it didn't take long to think "nah, that's irrational, baby's fine." But if I could jump to that conclusion despite having no depressive symptoms, I can see all too disturbingly clearly how much easier it would be to get there, and stay there, if depression or psychosis are already starting to take hold.

That poor family, all of them.
posted by Catseye at 9:08 AM on June 18, 2014 [3 favorites]

I've had intrusive thoughts since giving birth to my twin boys a little over 19 months ago. I have no other symptoms of depression, anxiety, OCD, or any other condition, yet every time I walk downstairs carrying one of my boys, I see myself falling down the stairs and killing or severely injuring my child. I once read an account of a child who died in a hot car and for weeks afterwards, I'd get a vision of one of my sons suffering the same horrid fate. I can't watch a zombie movie without obsessing for days afterwards about how terrible such an event would be for my sons. I saw three doctors about this issue and the first two were dismissive. The first one said that it was normal for parents to have these thoughts and they never went away. The second one said that it was due to stress and I should try meditation. The last one gave me zoloft, which helps considerably, although I hate the side effects. I'm currently looking for a therapist who can help me deal with them on my own, but it's very difficult to find someone who will take me seriously. I mentioned this in a group of mothers I am close to and at least 1/5 of the women in that group had experiences similar to mine. Of the ones who sought help, all but one of them were also told that it was normal and they would just have to live with it.
posted by PrimateFan at 9:12 AM on June 18, 2014 [13 favorites]

Oh my god. Nothing prepared me for the last line of the second article.

Was doing fine until that point and then that damn sand in my eye.
posted by Behemoth at 9:15 AM on June 18, 2014

I wonder that they didn't push for in-house treatment with repeated suicidal threats and a vulnerable infant at home. I have had to do the in-patient protocol for suicidal ideation for family members and I'm unsure why it wasn't done here because it's pretty standard in my area for suicidal threats. On the other hand, I can imagine that would make someone fake it rather than risk parting with their child when they're in the headspace of needing to protect the child at all costs too.

And PrimateFan, your doctors are ASSHOLES. They're lazy and careless assholes. You're awesome for trying again and again, that is incredibly strong. Keep asking and make your partner or a trusted family friend do the calling around for a good referral if it's exhausting you.
posted by viggorlijah at 9:15 AM on June 18, 2014 [3 favorites]

These stories make me want to usurp an enormous chunk of the US military budget and redirect those wasted dollars to women's health care.
posted by Pudhoho at 9:16 AM on June 18, 2014 [3 favorites]

PrimateFan, (and any other people afflicted with intrusive thoughts) find a therapist who (and I can't stress this enough) *specifically* deals with OCD and/or anxiety with intrusive thoughts. Too many therapists list a laundry list of crap because they're generalists who use a specific therapy to attack many problems. Call them up, ask them "do you know how to work with intrusive thoughts" and if they say "what?" immediately wish them a good day and move onto the next person.

Keep in mind that you'll never get rid of intrusive thoughts. They are normal. The essence of the problem isn't that you have them but mental illness causes an overreaction to it. It's treatable and you can work through it.
posted by Talez at 9:19 AM on June 18, 2014 [8 favorites]

I suffered from depression, on and off, for over a decade before getting pregnant and having my first child. I was super-worried about PPD but -- almost magically -- after a miserable and relatively emotional pregnancy, I was calm and centered and "un-depressed" after he was born. (I believe some of this is because my depression tended to feed itself when I over-focused on myself and my own emotional states and get stuck in circular thoughts about how much I suck, and once I had a child I spent a lot less time thinking about myself.)

So even though I knew intellectually that PPD can hit you after any pregnancy, I was not prepared for the ridiculously bad case of PPD I developed with my second one. I felt "safe," I guess. I again had a difficult and emotional pregnancy, which I in hindsight I can see involved prenatal depression, not "just" exhaustion and hormone-emotions, but at the time it seemed like "just" my miserable pregnancy to me and everyone around me. In the few months after his birth I had a series of shocks (death in the family, job loss, rabies exposure), and I had an extremely active two-year-old, and I just went down and down and downhill and by six months I was a barely-functional, very sad robot who just breastfed and changed diapers and cut up toddler food all day. I never had intrusive thoughts (well, except for the six months I couldn't sleep because I was obsessively checking the house for bats and constantly googling rabies symptoms in infants), but I was constantly depressed and in a fog and it's hard to REMEMBER a lot of that year.

I finally started getting treatment when the baby was about a year old and the toddler had been diagnosed with a developmental issue and I just fell completely apart and the developmental specialists were like, "Hey, a lot of times when we see kids with problems we see moms who are worn out from dealing with these issues unsupported and maybe have some post-partum depression?" It took seriously a year of treatment after that to really get the depression under enough control that I felt like myself again.

One of the things that was hardest about my PPD was that I felt so isolated all the time (stuck at home with two small children) but I also wanted to be by myself and have nobody touching me or talking to me or needing anything from me ever again. Being alone made me more depressed because I was so lonely and isolated, but being with other people -- even just adults-only, with good friends -- was absolutely overwhelming and left me exhausted and drained and depressed.

It was also incredibly hard on my relationships with other people -- my friends, my family-of-origin, my husband -- who went through basically two years of me being a withdrawn, sad, angry, tired, needy basket case. They were all extremely supportive, in both practical and emotional ways, but it's like I was lost and missing for two years and those relationships have to be repaired.

viggorlijah: "On the other hand, I can imagine that would make someone fake it rather than risk parting with their child when they're in the headspace of needing to protect the child at all costs too."

I would absolutely have refused treatment -- refused to even go back to a doctor -- if being removed from my child for treatment had been on the table. And there were supports I rejected (like the local crisis nursery) because I was absolutely positive it would get me on a DCFS list and if I didn't get "cured" quickly enough, they'd take my children away. I was absolutely paralyzed with fear about telling people how bad I felt because I couldn't bear the thought of losing my children, or them losing me. I know some of that is illogical, but I am choking up with tears of fear just thinking about it two years later. This is not an uncommon reason for women to minimize symptoms and refuse treatment.
posted by Eyebrows McGee at 9:20 AM on June 18, 2014 [26 favorites]

Oh and some of my resources, this saved my sanity. His website is absolutely spectacular for explaining what's going on. Also, Lee Baer's "The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts" was also absolutely fantastic for more information.
posted by Talez at 9:25 AM on June 18, 2014 [5 favorites]

the young rope-rider: I haven't read all the comments yet, but fwiw, for some parents co-sleeping and breastfeeding actually means *more* sleep. The only reason I'm still pumping at work (I hate pumping) is to keep my supply from dropping because it is so much easier to roll over and offer my baby a boob at night then it would be to pick her up, maybe get a bottle ready, etc. Usually I fall back asleep within a few minutes. But I've always been a light sleeper and waking up a few times a night -- as long as I don't come fully awake -- has never been an issue (the worst was actually late in pregnancy and having to get up to pee multiple times a night because that always woke me up all the way).
posted by R343L at 9:25 AM on June 18, 2014 [4 favorites]

More on topic to the articles ... I could only read the first one and now I have to stop. I don't think I hit any thing clinical but I certainly had moments of extreme frustration, crying and hopelessness when my daughter was in the 1-3 month period. This is on top of just crying over "nothing" the first two months after birth (in scare quotes because I would read things normally I had no issue with and start crying).
posted by R343L at 9:27 AM on June 18, 2014

What do you do with a secret so shameful you don't feel you can tell a soul? You tell Metafilter.

I will never be able to express how grateful I am to this community for being here when I needed you. Never, ever.

I do still also struggle with intrusive thoughts: mine primarily focus on thinking about what it must have been like for [group of mothers] when [horrible thing happened], and putting myself entirely in that headspace, but fortunately I'm able to cope with them by mentally developing action plans in the unlikely event that a zombie apocalypse/tsunami/fascist state/etc. invades my lovely city. But I can totally relate to the woman who jumped. I've been there. I understand her.

I cannot imagine what the baby's father will tell him when he's older. Cannot imagine.
posted by anastasiav at 9:29 AM on June 18, 2014 [18 favorites]

This is why I am less than enthusiastic about exclusive breastfeeding, cosleeping, never letting a baby cry, and any number of other tenets of attachment parenting.

Eh, I don't think it's quite that simple - there's evidence to suggest that exclusive breastfeeding means more sleep, for one. I feel like for my family, everybody gets more and better sleep where night feeds don't involve anyone preparing a bottle, even though the night feeding falls 100% on me. Obviously there are other families where the opposite is the case, and they should be doing what works for them accordingly - I just don't think it's quite as straightforward as "parenting philosophy X means you get more/less rest than parenting philosophy Y", when everyone's babies and situations are so different.
posted by Catseye at 9:34 AM on June 18, 2014 [5 favorites]

(Aaaaaand I didn't preview in time to see your last post, the young rope-rider. Looks like we're in agreement after all!)
posted by Catseye at 9:36 AM on June 18, 2014

I cannot imagine what the baby's father will tell him when he's older. Cannot imagine.

If it was me? "Your mother was ill. She was so ashamed from incorrectly thinking that she had hurt you, the one she held most dear in the world, in some, way shape or form that she couldn't bear it. She loved you so much that her last act was to save your life from her then terminal illness."
posted by Talez at 9:38 AM on June 18, 2014 [3 favorites]

I think we're in agreement. :) I agree that women shouldn't feel pressured to do all those things at the expense of their mental health, etc. (my partner made sure I could shower regularly early on because it's so important to me emotionally). But there's certainly a damned-if-you-do, damned-if-you-don't aspect here to how we portray this culturally. One side tells you you're going to damage your kid forever if you don't do all the AP crap. Another side is OMG YOUR CHILD WILL DIE IF YOU CO-SLEEP!!!! I'm definitely in the "whatever works" camp.
posted by R343L at 9:43 AM on June 18, 2014 [2 favorites]

For anyone reading this who feels like they are not making it but is scared to seek treatment because they fear they'll be separated from their child: Go. Get help. In December of 2007, when my daughter was 14 months old, I sent my husband an email at work that said "Do you know, in order to get a bed in the psych ward, do I have to actually hurt myself or can I just threaten?" He wrote back "Don't joke like that" and I responded "I am 100% not joking." He contacted his work EAP line, who said "omg your wife needs to see someone BEFORE THE SUN SETS TONIGHT." He came home, we bundled up the kid, got burgers and books to read, and headed for the local ER.

I was treated with enormous kindness at the ER. On admission, my blood pressure was 165/105, and the triage nurse asked "Are you under a lot of stress?" I said "Yeah, you could say that." He said "Thinking of hurting yourself?" and I said "Don't want to, will if I have to." They brought all three of us back to the ER room, and I was seen by a social worker and a psychiatrist. At no point did anyone suggest that I was anything other than a good and loving mother who was just experiencing more stress than I currently had the capacity to manage. And, I mean, I told them that I was so exhausted that I had considered throwing my baby across the room into the wall to get her to stop crying so I could sleep, and that this scared me so badly because she was so precious to me but I just didn't know what to do.

After they saw me -- and they spent a lot of time talking to me and my husband, both together and separately -- they came to the conclusion that whatever other issues I had going on, my immediate problem was sleep deprivation to the point of psychosis because my daughter was still nursing every two hours around the clock, and had been for more than a year. They told my husband point blank that we could go home IF AND ONLY IF he could personally guarantee that I could get ten uninterrupted hours of sleep for the next three days, and that otherwise they would admit me just so that I could sleep. They asked me if I wanted to be admitted anyway. And they set me up with an appointment with a crisis shrink the next day.

It was such a positive experience. It may have saved my life. And yes, in my case getting enough sleep gave me the resources I needed to get the rest of my cognition on track, but they were very much geared to making sure I was in touch with professionals even after the sleep situation resolved. We got phone calls at home for several weeks afterwards checking in. I can't stress this enough -- I showed up at my worst, I told them the things I was most terrified for them to hear, and they treated me with compassion and dignity and did what was necessary to get me back on track, and nobody even made a noise about taking my baby away, ever.
posted by KathrynT at 9:43 AM on June 18, 2014 [82 favorites]

I think sometimes people get hung up on general best practice vs individual best practice. Breast feeding has health benefits but lot's of other things have health benefits, and having a depressed pained mom can be damaging to babies health.

So it's about balancing a lot of different complicated needs around differing factors of benefit or detriment. And when one beneficial thing doesn't happen to work out, you can buffer that by choosing other health promoting or bonding activities. No one generates children in utopia, we're all coping with alterations to "the perfect model" and an overall commitment to wholesome choices when possible and graceful accommodation when specific desired wholesome choice doesn't work out for whatever reason will lead to an over all balanced environment.

It's not that the variables don't matter because they do, but that you can find other positives to make up for areas you can't do the ideal.

To me, this all sort of fits in a model of harm reduction. Seeking best practice when possible, accepting alternative ways of handling specific difficulties that come up and require a less ideal but still acceptable solution, and simply minimizing the impact of that through other means.

Also: I admitted a friend for sleep deprivation- she was delusional and incoherant and had been working a night shift drinking redbull all night while watching her daughter during the day. She was literally not sleeping more than a few hours a day. I told them my concerns about this on admission and they came to the same conclusion KathrynT. She stayed there and rested until she was coherant and was ableto go home (and quit her job and got more rest and follow up counseling).
posted by xarnop at 9:51 AM on June 18, 2014 [3 favorites]

for some parents co-sleeping and breastfeeding actually means *more* sleep.

Yup. We all do whatever we need to do to get by. Whatever works!

OTOH, as a former co-sleeper, sling-wearing, cuddle-at-first cry attachment parent, it just now occurs to me that trying to follow all of the AP recommendations is a precarious proposition for women who are going through PPD. How can you get it right, and feel the things you are (culturally speaking) supposed to be feeling, when your intrusive thoughts are driving you in the opposite direction? That's self-serve guilt on top of fear and doubt, heaped on to a baseline challenging situation. I remember those "shoulds" as being so very loud in my own mind, and how they competed with the inner voice of criticism, and the endless self-messages of not being enough, and oh God, why did I ever think I could be a mother, stupid, stupid, stupid, and how I would sit at storytime and look around at the happy mothers and wonder what it would be like to just...stop being. Needing so badly to hear an understanding voice and at the same time sealing myself away because I was afraid to say what I was thinking. Or showing up and not being able to connect with the mothers who seemed to be doing OK (who am I kidding, they showed no signs of mothering being an effort), because I was so not OK inside about whether I was a good enough mother.

I'd like to thank the commenters here for being so open about their own experiences. It helps. I have you here, now, when I'm doing better and have the luxury of being annoyed about my kids' clothing on the floor instead of beating myself up in isolation. Thank you for helping me stay better.
posted by MonkeyToes at 10:02 AM on June 18, 2014 [11 favorites]

So, does everyone have a NYT subscription now? I've been paywalled out.
posted by kinnakeet at 10:11 AM on June 18, 2014

If you're using Chrome, right click on the link and choose "Open Link in Incognito Window"
posted by desjardins at 10:14 AM on June 18, 2014 [3 favorites]

**Trigger warning; personal PPD story**

Andrea Yates saved my daughter. She really did. When I was pregnant with my youngest, I already knew she had a chromosome disorder, a kidney disorder, a heart defect. It wasn't until she was born that she presented us with colic and insomnia. I was determined to do everything I could for this poor, broken baby.

So I didn't sleep. I didn't let anybody else take care of her. I didn't take a break. I obsessed over what was wrong with her, and what else might be wrong with her. Crying while carrying her, crying while nursing her... sometimes I would put her in her cradle and let her cry while I cried in the bathroom.

I remember coming back after one of these jags, and looking at this poor, broken baby and thinking, "It would be so easy to smother her. Then she wouldn't ever suffer."

Then I remembered Andrea Yates. Whom I had judged fiercely-- I mean, I would give her killing one baby from PPD, but five? In a row? My best friend and I had been pregnant at the same time, and we'd talked about the case endlessly. But in that particular moment, I suddenly understood.

I looked up a social worker and called her. She got me in to see my doctor that day. It was an intrusive, embarrassing visit where he asked if I had harmed anybody, if I had harmed myself. But he medicated me, and gave me sleeping pills, and ordered me to let my husband take care of the baby sometimes.

After a while, the fog lifted and things were better. Still, when it came time for us to move, I found a box of old baby pictures of my daughter. I was surprised at how beautiful she was. That's not how I remembered her. Not at all.

I'm glad I have that back now. I'm glad I have a glorious, hilarious twelve year old tumbling around my house at full volume, all the time. I wish I had more to offer, but I thank Andrea Yates for her every day.
posted by headspace at 10:22 AM on June 18, 2014 [25 favorites]

Yes, open an icognito or private browser window. Will allow you to view past their metered paywall.
posted by zarq at 10:22 AM on June 18, 2014

I think that rearing children in isolation is really hard on mothers-- being alone with a baby all day while sleep deprived and exhausted is HARD.

"Both teen and adult mothers were approximately five times more likely to experience PPD if they received no support or minimal support after the birth of the baby"

This is one of those situations where often we come up with complex pathologies and clinical diagnosis/medicines for something that could be easily remedied in many cases by using what we already know about human health needs.
posted by xarnop at 10:50 AM on June 18, 2014 [9 favorites]

I have a question about the story of Benjamin's mother in the first article. I want to tread carefully here because I'm not a mother and I haven't experienced mental illness first-hand, but that story seemed like an outlier to me.

I don't think it's right to say imply that if someone is in a shitty situation, then they're not depressed because it's logical to be bummed out in a shitty situation. There is a pretty vast difference between being upset/bummed and being depressed. I would say the vast majority of people I know who experience depression, including myself, can point to environmental factors like stressful situations as triggers or contributors to their depression, but that doesn't mean our thoughts/actions while depressed are rational responses to the trigger. For example, getting fired from a job is very stressful and upsetting, but cocooning myself in my room and never leaving is not helpful. Neither is suicidal ideation.

Yes, Ms. Guiellermo's story has an extra layer of tragedy because the circumstances of the birth were more complicated, but that doesn't invalidate the fact that Ms. Guiellermo was depressed, and that she might be able to get some relief from that depression with environmental changes, therapy, and medication.

While fantasies of harming a child are certainly stressful, they don't necessarily strike me as a sign of mental illness

There is a huge, huge difference between "I do not love this baby" and "I am fantasizing about harming this baby and myself." I also think that it's uncharitable to read that anyone wanted to force Ms. Guiellermo to love Benjamin, rather than deal with the fact that she was both suicidal and on the brink of killing her baby. These are not logical, rational, or helpful responses to the situation of an unwanted baby.
posted by muddgirl at 11:06 AM on June 18, 2014 [1 favorite]

At 32+ weeks pregnant, feeling blissfully content when I'm not in some sort of pain or discomfort, I'm still basically waiting for the PPD to hit. I'm hoping the baby's many needs will fill the "letdown time" that hit after I got married, but I also have a gallbladder surgery to schedule and a very limited amount of paid leave. Oh, and a not particularly strong network of in-person help.

This waiting is so hard. It's like playing on the beach while you see a storm approaching. There's a house just a few feet away, but you're not sure if it will protect you or collapse directly on your head.
posted by Madamina at 11:09 AM on June 18, 2014 [5 favorites]

Searching for anything to blame herself for, she described minor, harmless moments: tucking a light blanket over his face for warmth, letting him suck a leaf, briefly putting a dime in his mouth and immediately removing it. “These things I did were horrible,” she wrote.

We've got to stop promoting this disastrous idea that someone out there is doing it 'perfectly.' That there is a perfect way to be in this world. Cus there isn't.

The thing is, it is true that children are extremely impressionable and that childhood environment can have lifelong effects. So parents are not wrong in being concerned and a little obsessive about that.

But look, you can't protect a kid from everything, you can't protect them from being alive and you can't protect them from their own karma. Sometimes shit happens. Sometimes there are bad seeds. You can do everything perfectly and still not every kid is going to be Mozart. You can't control everything. Kids have their own journey to make too.

imo the best thing you can do for kids is to make yourself a strong, healthy and positive person with good boundaries & communication skills. The rest will take care of itself.

Studies show time & time again the things that impact kids' futures the most are: 1) attachment style of the mother/primary caregiver 2) education level of the parents 3) economic background of the family. Nowhere does it correlate to quantity of leaves sucked or boogers eaten.

Life: everyone's doing it fine.

Yes maternal mental health comes into play, but so does this cultural obsession with status/achievement and thus pressure on mothers to be perfect.
posted by St. Peepsburg at 11:31 AM on June 18, 2014 [5 favorites]

Oftentimes, I feel the MF experience-sharing can be a bit much. Though it is so lovely too.
But in this case, I hope we can help those young mothers who are far too isolated. It takes a village. It really does.

One of my childhood friends had a pp-phychosis. This is something you would not want to happen to your worst enemy, and I will not go into detail, the second article in the OP gives a vivid and terrible account. My friend and her baby survived, because of our village and her husband, who grew from being a lazy bro-type into a caring dad and husband. But when it was going on - the intense and terrible horror is beyond what I can describe.

I had severe depressions during both my pregnancies. First time, it disappeared at the very moment my daughter was born. But the second time, it was the hospital care that brought me over on the other side, so I know exactly how the ppd feels. I only really met my daughter the third day after she was born. Those first days were terrible, and she only really started eating normally when she was almost three. Today, I love her beyond myself. She is the most wonderful and magical person.
What I am trying to say is that whatever happens during pregnancy and birth can be reversed. With my first daughter, it was love at first sight, with my second daughter, love grew on me, but both loves are endless.

This is all important to me because I know for a fact that my gran had a severe postpartum psychosis when she had my aunt, and never resolved it. And I suspect my mother had a postpartum depression when she had me, and only partially resolved it.

I'm rambling now, I know. Because this is difficult stuff, and some of us need to live with it and get over the pain. What I have learnt is that in our day and age, there is help, and it works.
posted by mumimor at 12:29 PM on June 18, 2014 [1 favorite]

R343L: The only reason I'm still pumping at work (I hate pumping) is to keep my supply from dropping because it is so much easier to roll over and offer my baby a boob at night then it would be to pick her up, maybe get a bottle ready, etc.

Catseye: I feel like for my family, everybody gets more and better sleep where night feeds don't involve anyone preparing a bottle, even though the night feeding falls 100% on me.

I often hear people claiming that only women can feed the baby easily in the middle of the night because making a bottle is such an ordeal. This doesn't need to be the case!

To bottle feed a baby while maintaining sleep inertia: make a bottle in advance (with pumped milk if you are only using breast milk) and put it in a little cooler next to your head. When the baby wakes up, pull out the bottle, prop your arm so you are feeding them in a comfortable position and doze just like a breastfeeding mom would.

Sleep is unbelievably important. I so appreciate all the time my husband spent doing this very thing, because, even if you are able to doze while breastfeeding, doing all the night feedings can really grind a person down.
posted by insoluble uncertainty at 12:53 PM on June 18, 2014 [3 favorites]

My twins refused to latch, so my wife wound up pumping to bottles from day one. We eventually switched to formula.

She would pump and take care of the kids throughout the day when I was at work. I'd come home and take over feedings. Usually until at least 2 or 3 in the morning. Preparing bottles and feeding two babies is a snap once you get into a routine. Assuming of course that they aren't fussy, cranky or colicky. I had a system. For the first few weeks, they would feed every 2 hours. For the 11:00 feeding, I'd pull a milk bag (or prepared bottle) out of the fridge/freezer, warm it up in a bottle warmer, test then retrieve a child. Kid would slurp 2oz in anywhere from 20-45 minutes balanced either in the crook of my elbow or against my chest. Cuddle, burp (them, not me) wait for them to pass out. Slip them into the pack and play or later, a crib. Return to the kitchen, repeat with other child. Rest. Start all over around an hour later.

The practical upshot of this is my wife slept for at least a few hours most evenings and into the night those first few weeks once we got a routine going. She could shower in peace while I took care of things. Later, she could get out of the house. She didn't realize at first how much she needed that. It's not just the lack of sleep and exhaustion that take their toll. It's the fact that when you do sleep, you're never able to sleep deeply and just relax. One ear is always pricked up, listening for a crying child. It's not ever restful.

So, the best advice we were given with the kids was "put them on a schedule and keep them there." It's not for them. It's to preserve your sanity. To hell with letting them sleep and feeding on demand. Especially with preemies. We'd have been more nervous wrecks than we already were. I didn't truly understand how profoundly sticking to a set schedule was keeping my house from descending into total chaos until one of them became ill and the schedule fell apart. Holy cow. Two babies, screaming their heads off for food at 4am, and you're totally sleep deprived and scrambling and panicking to get everything just so.

We leaned on each other. We had no choice. And my wife had to learn that she couldn't do it all herself and that it was okay to ask for help and say, "I'm overwhelmed." Something I had no problem with because I was scared I'd screw up.

I think we had this image in our heads of how parenthood was supposed to be. What being a good mother or father meant. But even under the best of circumstances, taking care of a baby can be unbelievably stressful and lonely. Taking care of two can be terrifying. Add hormones, sleep deprivation, fear and worry into the mix and yes, that can be truly overwhelming.
posted by zarq at 1:30 PM on June 18, 2014 [9 favorites]

Some links and a different perspective to add here. I hope it interests some of you enough to justify the screen space I'm about to take up. (Apologies in advance.)

I'm with jaguar (above) in having reservations about the language "symptoms not just of depression, but of psychiatric illnesses," not just because of the weird depression-vs.-illness implication but also because it's an insufficient nod to what I believe is the real takeaway of this piece: Screening for PPD is fairly standard at this point, but there's a whole world of *other* perinatal mood and anxiety disorders that need to be considered when a mother experiences or shows signs of emotional distress surrounding the birth of a baby.

This is HUGE (though, sadly, not at all new) news, and it's news that not only the general public but mental health service professionals need to receive and recognize ASAP. Unfortunately, that's a lesson I learned the hard way when I sought care for what I assumed was PPD after birthing my third child last fall. I identified my symptoms as PPD because, well, what else could it be? Even after obsessive Web research in my own attempts to learn about what was happening to me (a symptom of PP-OCD, by the way, which will become relevant later), it remained the only PPMI I was aware of besides postpartum psychosis--which my symptoms clearly did not indicate.

Unlike some of the experiences described above, wherein mothers sought help and received positive and appropriate treatment that allowed them to work with their families and support systems to improve their condition under the general supervision of sensitive and well informed doctors, _I_ was immediately labeled a threat to myself and others (specifically, my own children) and involuntarily committed to a high-security mental health facility over an hour from my home and anyone I knew. I was reported to my local child welfare agency, who had the right to immediately place my kids in foster care. (Luckily, after viewing my home and meeting the kids, the rep who received the report was so skeptical about the veracity of details therein that she allowed them to remain home with my husband. Otherwise, we might still be fighting to get them back.)

The kicker? While I was tortured by a "general fear that I'd do something" that would hurt my kids, I never expressed a desire to harm my kids. I had no plan, no visions, no formulated ideas. Just a general sense that I was "unsafe." I expressly noted that I had no desire to commit suicide. I was exhausted but fully functional--hadn't missed a day of work or even a deadline since returning to my 3(!) jobs after my son's birth. But I'd started having terrifying panic attacks along with fierce crying jags that shook my whole body.

I'll spare you any more details. You get the drift.

It would be nearly 3 months before I was released from one form of (compulsory) state-supervised treatment or another...and yet ANOTHER 2 months before I finally encountered a doctor who had the knowledge and experience to properly diagnose me: I had PP-OCD, a condition described in mental health literature as early as 1993 (D. Sichel, L. Cohen, J. Rosenbaum, J. Driscoll. Postpartum onset of obsessive-compulsive disorder. Psychosomatics, 34 [1993], 277–279) but very rarely diagnosed--often to the detriment of the victim:

"A questionnaire regarding a case marked by filicide obsessions was emailed to psychiatrists and psychiatry residents. Respondents provided their preferred and differential diagnoses, reporting their perceptions of risk and optimal case management. Of the 43 respondents, only 62 percent considered OCD in the differential diagnosis. Those considering OCD in the differential diagnosis assessed risk of harm as being lower than did those who did not consider it (3.7 versus 6.6; F(1,36) 12.18; p.005). Despite this result, the majority of respondents included involuntary admission (60%) and reports to child welfare authorities (68%) among their preferred management strategies. This survey supports our contention that greater awareness of OCD and understanding of management strategies is needed among psychiatrists and trainees. As well, a greater awareness of the low risk of violence associated with this population is necessary to avoid penalizing individuals with OCD-related aggressive and infanticidal obsessions." [Taken from the abstract: Booth, B.D., Friedman, S.H., Curry, S., Ward, H., Stewart, S.E. Obsessions of child murder: Underrecognized manifestations of obsessive-compulsive disorder. Journal of the American Academy of Psychiatry and the Law. Volume 42, Issue 1, 1 March 2014, 66-74.]

The misdiagnosis of my condition cost me 14 days in a locked psych ward, 2 additional months of misguided treatment, nearly cost me my children, and, due to the very existence of the child services investigation (details are sealed as the report was determined unfounded, but the fact that an investigation happened is a matter of record), could impact my future career if I ever try to work with children. These are not small things.

So getting back to my original point, I wish the articles had done a little more homework. If they had, I think they might have taken the profession more directly to task for not doing enough to help properly diagnose and treat women with perinatal mood and anxiety disorders other than PPD and postpartum psychosis.

Finally, it was interesting that one of the articles seemed to me to imply that the State of NJ had particularly progressive policies in place to help mothers and families suffering from PPMIs because that happens to be where all this happened. While the screeners were originally intended to help more patients in crisis find community-based (rather than inpatient) care, this 1993 article written by a professor at Rutger's Institute for Health, Health Care Policy, and Aging Research demonstrates that a combination of factors and pressures from national, state, and disciplinary agencies provide no incentive for doctors or screeners to recommend community-based care over institutionalization: thus, "Screening centers may become 'gate openers' instead of playing their expected role as 'gate keepers.'" [Note: This information applies to all mental health cases in the state, not just those involving PPMIs.]

Caveat: This is ONE horror story out of many great successes reported here. Please don't take this to mean that you should be afraid to seek treatment if you need it. The point I'm trying to make here is that these articles, and the ensuing discussion here, are important steps toward making sure that all new mothers AND HEALTH CARE PROVIDERS are educated in the full scope of PPMIs. Until these disorders make it into the standard cannon of knowledge surrounding both pre- and postnatal care, cases like mine will continue to wreck unnecessary havoc on already-suffering families.
posted by MamaA at 1:50 PM on June 18, 2014 [14 favorites]

Once, she forcibly shut Benjamin’s jaw when feeding him. During several baths, “I held the water over his face until he started to flail, he could not breathe,” she said. “I was hearing a voice saying, ‘Do it and he will stop crying. He’s not going to wake Christopher from his nap.’ ”

I haven't gone through all of these articles yet, but I'm so grateful for the bravery and honesty of these women. These are horrible things to admit out loud, they risk damaging how people see them by saying them, and yet they're doing it and it will help people.
posted by A Terrible Llama at 2:12 PM on June 18, 2014 [3 favorites]

That second article is right out of the Twilight Zone or Alfred Hitchcock Presents.

“We did try to help her, but perhaps if we had been more knowledgeable about postpartum mood disorders, including the fact that postpartum depression is just one of an array of such mood disorders, we could have done something differently that would have maybe saved her life,” she wrote in an email.

This is heart-breaking because I think we always think there may have been a "right" answer even when you try your absolute best. I remember this case a long time ago, of a young psychologist who did the same thing -- she was trained to spot something like this, yet never saw it within herself. No one event can throw a person's biochemistry and life askew than giving birth -- it's like an internal and external tsunami plus you are left with a helpless life completely dependent on you to boot.

Thank you for the links...
posted by Alexandra Kitty at 2:58 PM on June 18, 2014

Oh my god. Nothing prepared me for the last line of the second article.

Was doing fine until that point and then that damn sand in my eye.

Seriously. I've been/am suicidal (no plans or ideation at the moment, no need to call 911) so I can totally empathize with where she was, the mental space she was inhabiting.

But the tragic irony of her last act actually saving the baby... The father can never, ever tell the kid how Mum really died because that kind of guilt can crush you forever. I don't envy him having to hold that secret.

On the other hand, Google. So, catch-22 there.

Once again, we need two things: 1) better funding for mental healthcare, and 2) to stop being dismissive when women say they are experiencing problems.
posted by feckless fecal fear mongering at 3:06 PM on June 18, 2014 [2 favorites]

I have a two month old daughter and articles like these are absolutely terrifying. I feel fine and they make me wonder if I'm nothing but a ticking time bomb.
posted by lydhre at 7:06 PM on June 18, 2014

I think that's what parenthood is, though: a constant series of time bombs that you simply have to ignore most of the time, for fear that they will drive you crazy... except that you really do have to keep remembering they're there.

Just one of the many balancing acts we need to keep up.
posted by Madamina at 7:40 PM on June 18, 2014 [2 favorites]

Someone asked if there had been studies about sleep deprivation and links to depression. I only know of one - a local one, in my case, but the link between lack of sleep and depression was a strong one.

Which is not surprising to me at all. The chronic, weeks-turning-into-months sleep deprivation is an astonishing and unique type of torture.

I was very nervous (my partner to a lesser degree) that we would get sucked back into the terrifying vortex with our second. The sleeplessness, the perfectionism, the baby's constant crying, my own blind ignorance of both baby-rearing and its demands, the fucking baby books that insist if you just do x, y, z that the baby will stop crying and start sleeping - and if it doesn't you are doing it wrong. Fuck those books, and the judgment that goes with them and the fucking baby forums, jesus. The huge sense of judgment you get from strangers, from friends, from family. The feeling of isolation. The terrible advice that everyone has.

But it wasn't like that at all. Baby was easy going, hardly cries at all. I took six months off work, my partner recognised when to ask for help and we all kept an eye out for opportunities to help.

But man, PPD, is so hard, and people who haven't spent much time mental illness in general, and 'difficult' babies in particular really just have no idea. It's like another world.
posted by smoke at 10:24 PM on June 18, 2014 [5 favorites]

I had really bad PPD 20 years ago. I am/was an extremely private/loner introvert, but during that time whenever anyone asked me how I was, my response was essentially 'Hell. I'm in hell. I don't know what's happening. Please help me. Please help me.' And yeah, I was terrified of having my baby taken away, so I couldn't ever really describe the problem. I got lucky with a combination of therapist and other support, but I was hanging on by a tiny sliver of Human left in my brain preventing the worst.

I'm not going to click on the links - the comments here already have me crying. I just wanted to thank zarq for posting this and everyone who's commented. Also a general shout-out to metafilter for being awesome, because until a post within the last year or so that was about OCD (ah. this one.) , I never knew that what I was going through was 'intrusive thoughts' and OCD would never have crossed my mind as being one of the options to look at and seek help for.
posted by you must supply a verb at 1:56 AM on June 19, 2014 [5 favorites]

the fucking baby books that insist if you just do x, y, z that the baby will stop crying and start sleeping - and if it doesn't you are doing it wrong.

Ugh, yes. I bought a Baby Whisperer book when I was pregnant, forgot all about it, then picked it up again when the baby was two months old and just laaaaaaaughed at how comprehensively we were doing everything wrong wrong wrong and messing up the baby to boot. So glad I didn't read it in the earlier weeks, when I'd have been more inclined to believe it.

The toughest thing for me wasn't the sleep deprivation, although it did and does indeed suck (I think I was hallucinating on our second night in hospital, unless there actually were three people in white doing solemn formation dances in the courtyard). It was the overwhelming worry that hit when she was a couple of days old and took over my brain. I couldn't stop imagining all the awful things that could happen to her, in vivid vivid detail. Couldn't look at the stairs without imagining tripping and dropping her down them, couldn't let anyone hold her while I napped in case they fell asleep and she suffocated in the sofa cushions... It was awful and it was overwhelming, it was literally all the time and I could not get these images out of my head.

I felt like I was falling apart and didn't know what to do about it. The midwives warned me about postnatal depression but I didn't feel depressed, and I didn't want to bring up all the worrying because... I don't know, really. Maybe because I didn't want to hear that this was just normal now, and I equally didn't want to hear that there was A Problem. So I just ignored it.

It went away by itself after a couple of weeks (mostly), so I was lucky. I wish I had told someone about it at the time, though, just to hear that they had my back if nothing else. It scares me to even think back to how I felt at the time.
posted by Catseye at 3:26 AM on June 19, 2014 [4 favorites]

Former PPA turning into PPD for over two years. It was horrible. I never had any thoughts about harming my son. It was quite the opposite. I was full out obessed that he was going to die (he was born apgar 1 and then at 6 weeks he had RSV so bad that he was hospitalized for a week and then repeatedly got sick afterwards that required nebulizers, predisone and other drugs to keep his lungs clear). I never was religious but you better darn believe that I was "praying" and begging deeply while crying and desperate not for anything to take my child away. I could not sleep thinking that if I did, I would wake up to find him dead in the crib. When he was sick, I would sleep on the hardwood floor next to his bed obsessing with him breathing. Then about a year into it, my anxiety turned into depression. I knew it was bad when I took him to the zoo by myself and couldn't wait to go home. I did not enjoy one aspect of being out with my son as a new mother. It nearly tore my marriage apart. I finally got my shit together and got on Prozac. It was only then that I felt better. I've always had major depression and was unmedicated pre and post pregnancy so I was at very high risk for PPD/PPA. My ob just triaged it as in "so you depressed?" When I'm OCD PPA, no I'm not depressed. I get out of bed and take care of my son. I also don't have intrusive thoughts about harming him so I'm fine, right???

Needless to say I was not right at all. But it shook the shit out of me so badly that I only have one child. I couldn't go through that again and have my son witness that.

There needs to be more education for mothers and more support for them to realize that PPD isn't always not getting out of bed. There are HUGE ranges of symptoms that can affect your thinking and feeling normal. I'm sorry to hear that women feel that murder/suicide is the way to effectively manage their pain.
posted by stormpooper at 11:08 AM on June 19, 2014 [1 favorite]

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