Everyone has different feelings about the movie Tully’s portrayal of a mother’s emotional breakdown after the birth of her third child (and believe me, people have FEELINGS about this movie). But I think we can all agree that postpartum mental health issues don’t get nearly the amount of attention that they should, and the fact that Tully brings these issues to light—with a whole lot of raw, dark, and often disturbing realness—can only be a good thing.
And while the movie never formally diagnoses the main character Marlo’s mental health issues, several experts agree that she exhibits many signs of postpartum psychosis — a rare, but very serious postpartum mood disorder. Without giving away too many spoilers, Marlo appears to be experiencing the mania, hallucinations, suicidal ideation, and impulsive behaviors characteristic of the disorder.
When I began to do research on the disorder, one thing that struck me was how little information is out there about postpartum psychosis, as opposed to other postpartum mood disorders like postpartum depression, anxiety, and OCD. Part of the reason for that is that postpartum psychosis is a relatively rare disorder, affecting 1-2 out of every 1,000 women giving birth, whereas something like postpartum depression is more common, with 10-13% of mothers experiencing it.
But even though postpartum psychosis is quite rare, 1-2 out of every 1,000 mothers actually amounts to thousands of new moms each year. And it can’t be emphasized enough that the disorder is very serious, not something that should be glossed over or ignored for one second. In fact, when a mother begins exhibiting signs of the disorder, it is considered a “psychiatric emergency,” according to American Family Physician.
Women exhibiting signs of postpartum psychosis can be a danger to themselves or their babies, and need to receive treatment right away. As the Journal of Women’s Health points out: “[T]he combination of frank psychosis and lapsed insight and judgment in PP [postpartum psychosis] can lead to devastating consequences in which the safety and well-being of the affected mother and her offspring are jeopardized. Therefore, it is critical to quickly identify and treat the symptomatic patient.”
What’s more, another troubling characteristic of the disorder is that because of the mother’s state, as well as the stigma attached to psychiatric disorders in the first place, the mother is rarely able to self-diagnose herself, which means that it is imperative that anyone who is close to or cares for a postpartum mother should know about the signs, symptoms, and warning signs of the disorder.
It’s a disturbing subject to talk or think about, but one that we all really need to familiarize ourselves with.
The first thing you should know about postpartum psychosis is that it generally comes on very suddenly. The Journal of Women’s Health explains that symptoms usually begin within 2-4 weeks after giving birth, but in many cases, they show up even more quickly than that. “The onset of PP is rapid,” they describe. “As early as 2–3 days after childbirth, the patient develops paranoid, grandiose, or bizarre delusions, mood swings, confused thinking, and grossly disorganized behavior that represent a dramatic change from her previous functioning.”
Let’s talk a little more about those symptoms. It’s especially important to be able to differentiate between postpartum psychosis and other postpartum mood disorders. While other disorders are equally troubling and deserve as much attention, postpartum psychosis has its own set of unique characteristics—and again, requires rapid action and medical care.
The Royal Colleges of Psychiatrists from the U.K. explains that postpartum psychosis is a “more severe illness” than postpartum depression, characterized specifically by symptoms of mania as well as depression, or a mixture of the two. In postpartum psychosis, “symptoms can change very quickly from hour to hour and from one day to the next,” they note.
Other significant symptoms of the disorder may include feeling high or “on top of the world,” a decline in energy, moodiness, anxiety, confusion, agitation, uncontrolled thoughts, unusual behavior, loss of inhibition, excessive talking and/or being very social or withdrawing from socializing, not being able to sleep, paranoia, delusions, and hallucinations.
It’s common to hear voices, or feel as though you are being commanded to do or think things by a force outside of yourself. “For example, you might believe you have won the lottery,” explains The Royal Colleges of Psychiatrists. “You may think your baby is possessed by the devil. You might think people are out to get you.”
These symptoms obviously make it very difficult for a mother to care for her baby, which is one of the reasons why the disorder is considered a medical emergency. And although suicide and infanticide are less common, it is estimated that if untreated, postpartum psychosis has a 4% risk of infanticide, and a 5% risk of maternal suicide.
All of this and more is why awareness, treatment, and support is so important—and why mothers and their families need to know that treatment is out there, and usually quite effective. Treatment generally involves initial hospitalization (often babies can be admitted with moms), treatment with psychiatric drugs, and ongoing follow-up treatment.
The good news is that with treatment, most mothers will make a full recovery, though the process does take time. “It can take 6 -12 months or more to recover from postpartum psychosis,” says The Royal Colleges of Psychiatrists. “The most severe symptoms tend to last 2 to 12 weeks. The vast majority of women will recover fully.”
Moms who have experienced postpartum psychosis need abundant support, not just from the medical community, but from their families and friends. Postpartum mood disorders, especially psychosis, are cloaked in stigma and shame. Motherhood can fill you with self-doubt to begin with, which is why moms who have experienced psychosis need to know that their illness does not make them a bad mother, that they will get better, and that they are stronger than they realize.
Perhaps most importantly, all of us need to do our part to support any mother suffering from a postpartum mood disorder. We need to be be willing to listen, learn, take action when needed, and care for that mother generously and without judgment. And finally, we should all become educated about the disorder so that we can recognize any potential symptoms in our loved ones—and help them seek necessary treatments promptly, and with love.
One of the things Tully did not do (and I feel strongly that it should have) is offered resources for mothers who are experiencing a mental health crisis postpartum. So please, pass this along:
If you or someone you know is having a mental health emergency, please call 911 immediately. If you are currently having suicidal thoughts, please call the National Suicide Prevention Hotline: 1-800-273-TALK (8255). Non-U.S. citizens can visit IASP or Suicide.org to find help in your country. If you think you or a loved one is suffering from postpartum psychosis or another postpartum mental health issue, visit Postpartum Support International for resources and support.