Postpartum Psychosis – The Last Taboo

From the moment little Mary Yates was born, her fate was sealed along with her siblings.

Much has been said, much has been written, and blame apportioned to drugs, doctors, and people about the events of June 20, 2001.

Yet nothing can undo the abominable and unthinkable tragedy of that day. It had, in fact, been a long time coming. Doctors had warned both Andrea and Rusty Yates. And steps had been put in place so that something like this didn’t happen. But on June 20, 2001, Rusty Yates went against that advice. It all took place in the space of one short hour. That was all it took.

Postpartum Psychosis-bathtub

Andrea Yates, first filled a bathtub, as she had previously done while in a psychotic state, and prior been hospitalized for. The Doctor had concluded incorrectly on that occasion the tub had been filled so that Andrea could commit suicide. Andrea had been released from the hospital following that event as their insurance prohibited a longer stay than ten days.

And so it was, on June 20, that being left unsupervised for an hour, she first drowned three of her children. She laid seven-year-old Noah, three-year-old Paul, and two-year-old Luke out on a bed. Then she drowned her baby Mary, whom she left floating in the tub. Then five-year-old John asked what was wrong, and she then drowned him after a struggle. Andrea then called the police for assistance and called her husband to come home.

Andrea had been suffering from postpartum psychosis, postpartum depression, and schizophrenia. Her husband Rusty had been warned by Dr. Saeed not to leave Andrea alone with the children. But Rusty felt that an hour on her own before his mother arrived to supervise her would help with her independence. Even before that, her previous psychiatrist Dr. Eileen Starbranch had counseled the Yates against having a fifth child as it would inevitably end in future psychotic depression.

Despite this, Andrea stopped taking Haldol and fell pregnant with Mary. So it was a catalog of failings that led to the death of these five innocent children.

Andrea was initially convicted of capital murder, spared the death penalty, and was given forty years with parole. Later in 2006, she was found not guilty because of insanity and detained in a high-security mental hospital. Then in 2007, she was moved to a low-security hospital.

Postpartum Psychosis mother

Postpartum psychosis: A devastating illness

The case is notorious and sheds light on just how devastating an illness postpartum psychosis is. It is a severe mental health condition that has been recognized for over a century. While many mental health conditions can and should be managed on an outpatient basis, postpartum psychosis should be treated by hospitalization. That’s because it carries a 5% chance of suicide and more terrifyingly a 4% chance of infanticide.

The illness itself is a legal defense. Infanticide by a mother is one of the biggest taboos society has. It is one of the most unspeakable acts we know of. Postpartum psychosis can twist the unconditional love of a mother into murder, and for this reason, along with maternal suicide, it is considered a medical emergency.

Many celebrities have happily come forward to say that they have suffered from postpartum depression (PPD), but few have admitted that they have had postpartum psychosis. Postpartum depression is a serious illness that can develop into postpartum psychosis.

This kind of terrible outcome is scarce, but it can be easily avoided. Postpartum psychosis is a treatable illness, and with the right care, women return to their normal selves.

Postpartum psychosis usually develops within the first two weeks after giving birth. For many mothers, this is a magical time of becoming a mother and bonding with their baby. Women who develop postpartum psychosis miss out on this, which they find very upsetting. It’s a period that as the illness develops, a woman finds it difficult to comprehend her feelings, thoughts, and emotions.

Postpartum psychosis symptoms

The symptoms of postpartum psychosis are numerous, A postpartum psychosis diagnosis includes one or more of the following:

  • Severe confusion
  • High mood and mania with a loss of reality
  • Delusions and strange beliefs
  • Hearing seeing or smelling things that are not there 

It can also include several other symptoms, including:

  • Feeling excited or elated
  • Depressed, anxious and confused
  • Irritable and changeable in mood
  • Being excessively talkative and sociable
  • Having a busy mind with racing thoughts
  • Trouble sleeping
  • Feeling energetic and restless with agitation
  • Behaving in a manner out of character
  • Feeling that the baby is connected to God or the devil
  • Feeling paranoid and suspicious
  • Feeling that things have unique connections such as stories on TV or the internet have personal meaning

Causes of postpartum psychosis are not known. It is thought that hormonal changes play a significant factor. Postpartum psychosis is more common in women with a diagnosis of bipolar when a sister or mother has also experienced postpartum psychosis when there is something wrong with the baby health-wise, and when there has been a difficult birth.

Postpartum Psychosis treatment

Postpartum psychosis treatment

It is unlikely that the woman herself will seek help. It is usual for a woman’s partner, friends, or family to notice changes and alert medical professionals. Treatment requires hospitalization. There are often mother and baby psychiatric wards set aside in many mental health facilities that are the perfect environment for women with postpartum psychosis to receive treatment.

Treatment includes:

  • Antidepressants to relieve the depression
  • Antipsychotics to relieve mania and hallucinations
  • Mood stabilizers such as lithium

Treatment also involves therapy and family therapy. Women that are pregnant and are at high risk of developing postpartum psychosis should have a postpartum psychosis plan set out. This consists of a meeting at 32 weeks with health visitors, obstetrician, and friends and family.

If a woman has had postpartum psychosis in the past, they are at extremely high risk of developing it when they have another child. For this reason, a care plan must be followed to the letter. While the Yates case is the absolute worst-case scenario, Andrea was indeed failed by many others, including her own poor judgment to have a fifth child. Lessons have been learned from the Yates case, including the drug she was taking. Effexor now has ‘homicidal ideation’ listed as a side effect.

There was certainly no need for the Yates children to have lost their lives, but it illustrates that postpartum psychosis should not be overlooked. Yet, at the same time, it also demonstrates that the illness can be effectively treated. If you or a loved one may be suffering from postpartum psychosis, call a crisis team immediately to get urgent medical help.