The Fourth Trimester full transcript

JESSICA PIERSON: I dreamed of being a mom for so long. I was so excited to have that connection, but like, I couldn't control the things that were happening to my brain.

ALLISON BEHRINGER: This is Jessica Pierson. She goes by Jess. And eight years ago, something happened to Jess that she had never heard of before. No one in her family had either. 

It’s a mental health condition called postpartum psychosis. It occurs in about 1 out of 500 births, though some healthcare providers think it might be more common than that. When it’s not treated properly, the consequences can be disastrous and long-lasting. 

Over the course of reporting this episode, myself and the team spoke to over twenty people who’d had postpartum psychosis. And we heard the same thing over and over again: “I just didn’t know about this. How did I not know about this?”

Today, Jess shares her journey through illness and guilt, and her search for absolution within herself. 

From KCRW, this is Bodies. I’m Allison Behringer. And a heads up that this episode contains discussion of suicidal ideation and violent thoughts, and a description of involuntary commitment.

ALLISON: Jess always wanted to have a big family. She imagined the fun things she would do with her kids in the future, like taking them roller skating.

JESS: I am very much a kid at heart myself. It's actually hard to find other people like me because I'm very much a kid.

ALLISON: She planned to teach her kids sign language and take them to see plays with interpreters. Jess is completely deaf in her right ear, and severely deaf in her left – she wears a hearing aid in that ear. Jess teaches in the public school system, working with deaf and hard of hearing students to make sure they have the resources that they need. Her husband was the first and only person in her life to learn sign language fluently for Jess. They’re high school sweethearts.

When Jess and her husband found out Jess was pregnant with their first child, they were overjoyed. They picked out a name. They would call their baby Liyla. 

JESS:  Being pregnant was incredible. I loved that feeling of feeling her move and having a connection with someone that is partly you, you know, you're 50% that child. This is me and my husband put together in one person.

ALLISON: Jess painted Liyla’s room teal. She taught herself to sew so that she could make a rainbow pillow. She had the typical jitters of a first-time expecting parent, but she felt ready. In the final weeks of her pregnancy, the doctors discovered some potential complications and suggested that Jess schedule an induction. 

But on the day of the induction, the sign language interpreter that Jess had booked didn’t show up. Jess sat there hooked up to the pitocin, which made her contraction start, waiting for over 4 hours. Eventually, they decided to go forward without the interpreter. And Jess delivered her daughter. 

JESS: I was just in awe. I was just so excited and just wanted to share her with the world, like, this is my daughter, this is my daughter. And I just remember my mom coming. She was the first to come to the hospital. And she's like, oh my God, like, how do you have this much energy? I was up and about taking pictures, I just wanted to document everything of everybody holding her.

I just had all the energy.

ALLISON: When a mental health crisis happens, sometimes you can look back and find the early warning signs: tiny red flags that can only be spotted in hindsight. This high level of energy, it was the first flag. And over the next few days at the hospital, that energy shifted from elation to worry. 

In the beginning I thought, oh, this is just normal, like mom stuff, being a little bit scared about like, “Hey, I gotta keep this baby alive.” So normally in my daily life I take my hearing aid off to go to sleep, but as soon as she came, I refused to take my hearing aid off.

I was really afraid that I wasn't gonna hear her cry, and that my husband would not have woken up. And I needed to know she was okay. 

ALLISON: Jess gets home from the hospital. Everytime Liyla cries, Jess cries.

JESS: I had kind of had a hard time with breastfeeding and she wasn't getting the nourishment she needed. I was like, I'm a bad mom. I can't, you know, stop her from crying. So I remember bawling, like, oh my God, I'm not enough. 

For any first time parent, the first weeks at home can be a lot: You’re exhausted, you’re in the midst of a huge identity shift, you’re learning as you go.

But for Jess, her worries about breastfeeding soon took on a level of paranoia.

JESS: Then I had to burp her, and I was so afraid that I was gonna kill her just from burping her. Like, I have to make sure it's tapping just enough, ‘cause if I do it too hard, I could kill my baby.

ALLISON: Jess wasn’t acting like herself. Her family could tell something was off and so could Jess. 

JESS: I remember being like, where's Liyla? Where's Liyla? I can't find her anywhere. And she wasn't there. Like, she was not in her pack and play. And my husband had to be like, she's right there. Look, look, she's right there. Then I would see her. 

ALLISON: Her family lived nearby and so her husband, sister and mom took shifts caring for Jess. They held the baby for her. They sat with Jess as she tried to breastfeed. They reassured her. They made sure she ate. And most of all, they kept trying to get her to sleep. But Jess still refused to take her hearing aid out. 

JESS: I would be laying in bed and the lights would be off. But my mind would never shut off. I would have these images of, is my daughter okay? I just wanted to protect her. I couldn't turn it off.

ALLISON: Jess went to her ob-gyn for her standard 2-week postpartum checkup. She told her doctor about the non-stop crying, the racing thoughts, how she couldn’t sleep. The doctor told her she had postpartum depression. 

Except, of course, the diagnosis was inaccurate.  

What the doctor could have done was to ask Jess if she had a personal or family history of mental illness. If she had done that, Jess could have told her that yes, she had an immediate family member with bipolar disorder. The doctor could have told her bipolar disorder puts an expecting birthing parent at extra risk for developing a condition called postpartum psychosis. She could have told her the signs to watch out for. 

But that’s not what happened to Jess, and it’s not what happens to many people in her position. Instead, the doctors gave Jess a prescription for an antidepressant and a recommendation for a postpartum depression support group.

Jess started going to the group immediately. But no one else was describing paranoia or anything like those times that Liyla would disappear from her vision. 

JESS: And they were like, yes, it does get hazy during postpartum depression. And, you know, they were kind of like validating some of my feelings, but it wasn't the same. I couldn't relate to people with postpartum depression. ‘Cause I'm like, this is not what I'm feeling.

ALLISON: The antidepressant did not help. Jess started to get disoriented. When she went for walks with her husband, she would forget the way home. When she tried to text on her phone, the words scrambled on her screen.

Her worries about breastfeeding morphed into an even scarier version. Her breast pump began to talk to her, in a deep, demon voice. It was telling her that it would be better if she died. 

The thing is, these breaks from reality would come and go, wax and wane. One minute she would be fine, the next minute she’d be overcome by images.

Jess didn’t fully understand what was happening to her. But she knew she couldn’t trust herself. 

JESS: ​​I was like, please do not let me be by myself. I didn't feel safe. And I didn't even wanna be in a bathtub by myself. That was definitely one of my suicidal ideations.

ALLISON: Her husband or mom would sit with her while she bathed, keeping her company and watching over her.

JESS: I had no appetite. I was starting to not dress myself. My husband was like, Hey, let me cheer you up. It's okay, you know? He brought me some mint chocolate chip ice cream. I love ice cream. Like, more than most things. And he brought that home and I was like, no, thank you. I don’t really want that.

ALLISON: Jess was nearly 4 weeks postpartum and she still hadn’t slept. She was exhausted, but her mind wouldn’t let her sleep. Like, during nighttime breastfeeding, she would drift off for 30 minutes or so, but then she’d jolt back awake from a hallucination about Liyla getting hurt. 

Eventually, her family convinced her to take a sleeping pill. 

That night, her mom and husband looked in on her. It looked like Jess was peacefully asleep, but what was happening inside Jess’ mind was anything but peaceful.

JESS: In my mind it was racing the whole night. There were voices from a demon, telling me that I was not good enough for my daughter, for my family, that I should just leave, end my life. Like, they were better off without me. In that same night, I had a dream, I don't know. I can’t even tell if it was a dream or racing thoughts, like very violent images. The images I saw was my funeral and I had taken my life. 

ALLISON: The next morning, Jess came out from her bedroom to her mom and husband waiting for her in the living room. She told them her dream. She could hardly talk because the hallucinations were so strong. She was hearing voices. Voices that were telling her to do horrible things. Voices that were telling her to harm her child. 

JESS: It felt like I was a puppet and someone was messing with my brain saying, you will think this and you will do it. I was like, I need help.

ALLISON: Right away, her mom and her husband took her to the ER. It was hours before a doctor saw them. 

JESS: And I was like, look, I am having these images of violently hurting my daughter. Please help me. Like, this is wrong. Something is wrong with me. The hospital sent me home and said, We're gonna sign you up for an anxiety and OCD outpatient program. You'll start with that anxiety OCD program on Monday.

ALLISON: At this point, the flags were everywhere, big bright red flags. She was in the ER on a Thursday. Monday was four days away. 

The very next day, the postpartum psychosis took a dangerous new turn: Jess became delusional. She was in her bedroom when her husband walked in. But in Jess’s mind, her husband and baby had suddenly transformed into something else entirely. 

JESS: I thought my husband was the devil and I thought my baby was the devil and I refused to feed her, because, if I fed my daughter, then I would be feeding the devil. So I remember her crying and crying. My husband was like, you need to feed her. And so I had just let her cry and cry. My husband was like, oh my gosh, we need to get help. He called my mom and my sister and was like, she needs to go to the hospital asap.

ALLISON: Suddenly her sister and mom were there, packing a bag for her, getting her dressed and trying to get her in the car. Jess was confused, her head was spinning. She didn't want to go wherever they were taking her. Her family had to physically force her into the car. She tried to jump out. Her sister sat in the backseat with her, pinning her arms down.

When they got to the ER,  the hospital staff immediately transferred her to an in-patient psychiatric ward. Her delusions had convinced her that she had died. And she thought the psych ward was either hell or purgatory.

JESS: They were like, you need to take your hearing aid off and lock it behind the medicine cabinet, because of safety reasons. Because I had suicidal ideation, they were worried that I would swallow the battery and they didn't wanna be liable for that. So they made me lock it at night

And I remember waking up and having people draw my blood, and take my vitals and people are touching my body without any permission because maybe they asked, but I'd never heard 'em.

ALLISON: Jess was separated from Liyla. She wasn’t allowed to have her baby with her, which is standard practice in general psych wards. During the first couple days, Jess, under supervision, pumped her breast milk, so that her family could pick it up and take it home for Liyla. 

And then, the psychiatrist put Jess on anti-psychotic medication. And they told her that Liyla might have side effects from drinking Jess’ breast milk. So, there are some antipsychotics that are available that do not impact the baby. But this information wasn’t available to Jess. She stopped pumping her milk. 

JESS: That was the only thing I had still with me to remind me that I was a mother and to remind me of Liyla and that she needed me. I remember taking a shower and feeling my milk dry up and just sobbing. ‘Cause I felt like that was my fault. Yeah. Yeah. I still have so much guilt about that.

ALLISON: Jess was going in and out of reality, in moments, not even sure if she was alive.

One day, she was sitting on the floor. And the social worker assigned to her came over and gave her a handout, printed front and back on a piece of paper. It was titled: “Postpartum Psychosis, in plain mama English.”

JESS: I read it to myself and was like, “What?” And it had every single symptom that explained me to a T.  Oh my gosh, this is what I have. 

ALLISON: After all of these weeks, this was the first time that Jess heard the words "postpartum psychosis".

She read: “You know that something is terribly wrong and you don’t understand it.” She also read the other main symptoms: confusion, paranoia, hallucination, thoughts of harming self or others.

JESS: And I was just like, this is a real thing. This is an illness. It’s not in my mind. Maybe this hospital really is real. Maybe I'm not in hell. Maybe I can get better. 

ALLISON: Postpartum psychosis can happen to anyone and researchers don’t know exactly what causes it. But there’s a few things that put a person at higher risk: a personal or family history of bipolar disorder, a lack of social support, experiencing a stressful or traumatic birth and sleep deprivation. It’s also more common to have it with a first born.

Postpartum psychosis usually appears in the first 2 weeks after birth, but sometimes it can appear up to a year after birth and sometimes it can occur during pregnancy.

Perhaps most of all, Jess read that postpartum psychosis is reversible and treatable.

JESS: Being away from Liyla, during the time in the hospital was the most excruciating pain. 

She was a part of me for nine months, you know? It confused me even more because this huge identity piece had just been introduced. Like, okay, you're a mother now, but I'm gonna take away, I'm gonna take away your daughter.  I kept asking like, can I see her? I wanna see her. I'm her mom, like I need to be with her.

ALLISON: But the staff kept telling her no, it wasn’t safe for her to be around her child. Jess didn’t feel like she had any power to protest or negotiate. She was trying to do everything right. 

JESS: I understand why they didn't feel that I was safe with her, but I don't understand why I couldn't be safe with her with supervision. It made me feel so broken, you know? All of those violent images that were happening in my mind, like I never wanted that. I never asked for that. 

ALLISON: Finally, on the 10th day of not seeing her baby, Jess started to show enough improvement that her husband was allowed to bring Liyla to the psych ward. They sat together in a small private room and her husband placed Liyla in her arms.

JESS: My body felt numb. My body felt completely numb while holding her. And it was like, just this, what is wrong with me? Why am I not feeling anything in my heart? It was the scariest thing. I thought that feeling would never go away. 

ALLISON: On the 12th day, Jess was released from the psych ward. Her psychiatrist recommended continued treatment, so for a month, she went to an outpatient center, Monday through Friday, 9-5.

Postpartum psychosis is a medical emergency and it requires inpatient treatment. Her stay in the psych ward and outpatient program were crucial to her recovery. But her time away from Liyla had wiped away her confidence in being a mom. 

She felt more pressure than ever to succeed.

JESS: I had to prove myself as a mom from there on out. You know? Obviously, I felt everybody doubted me, didn't think I would, could do it. I’d failed as a breast feeder. I’d failed as a mom because I was hospitalized instead of taking care of her. I had to be super mom, you know? I had to do better than everyone else just to prove like, Hey, don't, don't take her away from me. Please don't ever make me go in the hospital again.

ALLISON: The most severe symptoms of postpartum psychosis can last anywhere from 2-12 weeks, but it can take up to 12 months or more to fully recover. For Jess, the whole first year was dark and hazy. She stayed on the antipsychotic medication for 12 months, which made her very tired. She had PTSD-like symptoms, like flashbacks to the darkest moments of her psychosis. She was haunted by the voices and the images. 

Jess was still afraid to take a bath on her own, out of fear of what she might do to herself.

And Jess also couldn’t help but feel incredibly jealous of her husband and how Liyla always seemed to prefer him, even if she was right there.

JESS: She would always be like, oh, you know, Daddy. She always wanted to be with him and wanted to be with Daddy instead of Mommy. I very much internalized that this happened because I got sick.

ALLISON: After the break, hope, community and a better way to care for people with postpartum psychosis. 

ALLISON: And we’re back. 

Postpartum psychosis is treatable, but it’s very serious. The two biggest risks are the parent killing themself, which happens in about 4% of cases, or killing their child, which happens in about 5% of cases.  

The condition is life and death, but there’s a big gap in knowledge among healthcare providers and new parents. It’s not in the manual that psychiatrists use to diagnose mental disorders. And since postpartum psychosis sits at the intersection of OBGYN and psychiatry, there aren’t enough health care providers with expertise on it. So despite the evidence, doctors are still incorrectly advising pregnant patients to go off bipolar medication – even though some have been proven to be safe and decrease the risk of a psychosis episode. 

NIRMALJIT DHAMI: There are so few resources. There are so few treatment centers, there are so few psychiatrists that are willing and able to treat this condition.

This is Dr. Nirmaljit Dhami. She’s a psychiatrist who has been treating people with postpartum psychosis for 15 years. She’s also the medical director of Inpatient Perinatal Psychiatry Services at El Camino Health in California, which has one of the country’s only psychiatric units that prioritizes the mother-baby relationship. 

DHAMI: Why should we separate a woman from her baby for 30 days as she recovers, and then throw her back into her outside environment and tell her to function? When we treat patients, you can't treat them in a vacuum. You have to understand their life before they came into the hospital and what they're gonna face when they leave and support them in their journey.

ALLISON: Dr. Dhami designed the program at El Camino based on observations she made across the world.

DHAMI: I had actually visited a couple of mother-baby units in different parts of the world. I visited one in India in Nimhans, Bangalore, and that is unique because they admit the mother, the baby, and a close family member.  

And it really touched me that women were getting this really highly specialized care along with her baby. And as she was treated and recovered from her serious mental health condition, she was supported in her role as a mother by the staff.

When I first visited the unit in France, I just stood there, awestruck, and I was thinking, wow, we spent so much money on healthcare. Why can we not do this in our country? Why are we not able to give these women the care that they need?

ALLISON: The United Kingdom, for example, has over 20 mother-baby units for postpartum mood and anxiety disorders, including postpartum psychosis. The babies get to stay with the moms around the clock. 

The United States has only three facilities like this, including the one that Dr. Dhami started at El Camino Health, where new parents can get treatment for postpartum mood and anxiety disorders. Due to insurance reasons that are specific to the United States, the baby cannot stay overnight. But the baby can come during the day to visit, under the supervision of health care professionals.

DHAMI: I have personally seen a lot of women show a significant decrease in their symptoms, specifically suicidality when you begin to involve the baby in the treatment. ‘Cause then it is a reason for them to live. Their role is irreplaceable in the life of the baby.

ALLISON: In addition to the in-patient psychiatric hospital, El Camino has an outpatient unit where parents can attend with their babies, after they’re discharged. And so patients in the hospital also get to spend time with these newly discharged parents who are on their way to recovery, which Dr. Dhami says is a huge source of hope for them. El Camino also creates a discharge plan that includes that family and collective roles. 

DHAMI: Having family that supports you, having someone help with the baby so the patient can have protected sleep. And then just having family that supports you through the process should you require hospitalization is so critical and so crucial to good outcomes.

ALLISON: In many other countries this focus on community isn’t such a revolutionary idea. This “fourth trimester” is acknowledged as a critical time for new parents to receive care. Like in China, the month after birth is called zuo yue zi (坐月子) which means “sitting the month.”  

It’s meant to restore the body after giving birth. And the new parent is expected to eat healing foods and limit physical activity. Meals are prepared in advance by the family and community.

But in the United States, this postpartum period is not protected: there are no mandated mental health screenings, and since there’s no law guaranteeing parental leave, new parents may have to work during this time. 

Not only is a close-knit support system helpful for someone recovering from postpartum psychosis. It's also integral to preventing some of the most tragic and extreme outcomes. Since the person may have lost touch with reality, the onus can’t be on the person experiencing psychosis.

DHAMI: Typically it's the family. And the family will notice that the person who's just delivered a baby is getting more and more confused, more disorganized, or is making random statements that don't make sense.

ALLISON: The early warning signs are a person appearing “odd” or “strange” or “off” – and these are signs that really only the people closest to the person can pick up! 

New parent culture in the United States tends to be ultra-individualistic, with parents expected to take care of their newborn in a bit of a bubble. For single parents this can mean a bubble of one. 

And this isolation makes it difficult for anyone to catch those warning signs of psychosis.

During Jess’s first year postpartum, friends and family brought meals and kept her company.

JESS: I think about what would I have done if I didn't have my mom, my husband, my in-laws, my friends, there to support me. I think about that all the time. 

ALLISON: At one point, she got a visit from some childhood friends. Jess told them about what she went through. And she was trying to explain this other personality that seemed to come over her during the episodes, and one of her friends came up with an idea.

JESS: Why don't you name that other like, quote unquote personality. And I decided to name it Jeff, J-E-F-F. 

The reason for that is because when I was younger, I would always go up to the front of the classroom. When the teacher was like “Jeff,” and Jeff and Jess sound almost the same to me, ‘cause I'm deaf, right? But I would always come up and try to collect my paper and they're like, no, we said Jeff, J-E-F-F. 

That really, really helped me to use humor, to look back on things. Like, “Hey, that wasn't you. That wasn't you, that wasn't your fault. You didn't do this.”

ALLISON: As hard as Jess’s experience was, she considers herself one of the lucky ones. Jess spends a lot of time thinking about all the people out there who fall through the cracks in our healthcare and legal system. The people who never got proper treatment or support. 

JESS: As a person who speaks English and a person who has insurance, as a white person, I'm very aware of that privilege that I have  because there is such inequities in the U.S.

ALLISON: As it is in this country with just about every health condition, a person’s experience with postpartum psychosis is impacted by race and class. Like for example, Medicaid provides coverage for pregnancy, but in most states, that coverage ends after 60 days postpartum.

And we’ve heard from several people we interviewed and experts that people of color are especially hesitant to seek out help, fearing that child protective services would interpret them unfit to parent and take custody of their children. Research also shows that people of color are more likely to have their children taken away.

Jess was getting a little better. Liyla was two and half now, and their bond was getting stronger. She and her husband wanted another kid, but she still didn’t feel like herself – she was still feeling depressed. And she was still feeling so guilty and ashamed for being away from her daughter for so long.

It was around this time that Jess found Postpartum Support International. It’s an advocacy and support organization dedicated to perinatal mental health, like postpartum depression and anxiety and psychosis. 

They were having a conference and so Jess went, hoping that maybe they’d be other postpartum psychosis survivors – she had never met anyone like her. She went to a panel on postpartum psychosis, where two survivors spoke. After the conference, the three of them went out to dinner together. 

JESS: And I remember asking them so many questions. And those two survivors just sat and talked with me and, you know, telling me, “Gosh, it's gonna get so much better. And there is light, there is hope in this world. You can have more kids if you want to. You just need to have a good, safe plan.”  and know these things. 

ALLISON: It was late when they finally left dinner. The two women walked Jess back to her hotel. They exchanged numbers and promised to keep in touch. Jess walked up to her room, filled with hope for the future. And she decided she was going to take a bath, alone, for the first time since Liyla was born. 

JESS: I sat in the bathtub and, you know, plugged up the plug and I was like, you know, I'm gonna trust this. Like, it's all gonna be okay. And I was like, just thanking the universe for everything that I had and how much I'd grown and for these two women and for my beautiful family. 

I took the plug out and like all the water drained out. And in my mind, all of those fears I just was like, no more, no more. And it just kind of drained from me too. When I get back, I wanna try for another baby. Let’s do it, but let's do it safely.

Like let's make sure I get on medication. Let’s make sure I protect my sleep. Everybody in my community knows what to look for. So it just felt so much more safe to go with this decision.  

ALLISON: Four years after the birth of her daughter, Jess got pregnant again. 

JESS: I decided, you know what, I'm gonna write myself a letter in the event that I might have psychosis again. And it was basically me telling myself like, Hey, when you had Liyla, you got really, really sick. You didn't trust your husband or your daughter. But this is part of the illness. It does get better with help.  And you can trust everyone around you, you will get better.

ALLISON: The pregnancy and birth of her second child all went beautifully – and this time the sign language interpreter showed up. They named their son Griffin. She was able to safely breastfeed him on her antipsychotic medication. Her husband took care of all the nighttime feedings so that Jess could sleep, hearing aid on the bedside table.

JESS: It felt magical to be present and not manic and not super overly anxious, I just got to be with him. But I feel like the second time around I held him so much tighter knowing that this could be taken away from me at any moment.

ALLISON: Jess was on maternity leave with Griffin for about 6 weeks. And just as she was getting ready to go back to work teaching, she started to feel her mental health get shaky. She was like, okay, I need to get help right away, and so she went to see a psychiatrist. 

JESS: And for the first time ever, a psychiatrist had really, really sat down with me and asked me questions about my history, asked me questions about my personality. And he was like, after, I think it was probably like a two hour discussion, he was like, oh, I would definitely diagnose you with bipolar. Like, no question about it. 

ALLISON: About 85% of people who get postpartum psychosis also have an underlying condition of bipolar disorder, oftentimes undiagnosed.

JESS: And he said, you're gonna probably wanna manage this with an antidepressant and a mood stabilizer. This is medicine that you're gonna be on lifelong, but if you take it right and you manage this right, you will feel like yourself again.

And I was like, “Wait, what?” And like the idea of ever feeling like myself again, like pre-pregnancy, I thought that person was gone. I thought, no way am I ever going to feel that way again.

ALLISON: But sure enough, two months later…

JESS: Oh my gosh, I think I'm starting to see that person again. I'm starting to feel more like myself again. and I didn't meet that old person that was pre-pregnancy, but I ended up meeting a much better person, like a person that was stronger than the person that was pre-pregnancy cuz nothing scared me anymore.

ALLISON: It’s now been almost 8 years since Liyla was born. 

And in that time, Jess, like many other postpartum psychosis survivors we spoke to, has dedicated herself to spreading the word. And whenever someone has a baby, she always checks in on the parent first. 

JESS: Everybody that hasn't been through this usually is like, oh, how's the baby? Let me see. Oh, it's so cute. And they only talk about the baby, but I'm like the very opposite. I'm like, oh, cute baby. How are you doing? I'm like, if I do it, I'm like, how are you feeling? Is there anything I can help you with? Can I come over and, you know, can I cook you meals? Like, do you need me to come over? Is there anything that you're scared about? 

ALLISON: Why is it that you think that postpartum psychosis isn’t something that more people know about? Like what's behind kind of the lack of awareness?

JESS: I think that a lot of people don't bring it up during pregnancy because they're afraid they're gonna scare the mom. I do talk about my experience openly. Here's the alternative.

If I don't mention it, the much scarier result is that there could be a tragedy and maybe that person that could have like maybe a little bit scared during pregnancy is no longer there. Or maybe their families are harmed or maybe they're not getting the care they need.

I'd rather scare them a little bit, because I don't want them to think this is rare and that it will never happen to them because it's not a rare thing. And I think that use of that terminology of saying that it's so rare has been very harmful because it's caused people to be like, “That won't happen to me.” There's people dying from this.

It makes me so angry. It infuriates me that the only time anybody ever hears about postpartum psychosis, it is only when a tragedy occurs. And like the first person to blame is the mom.

ALLISON: When postpartum psychosis reaches its most tragic possible outcome and someone harms or kills their child, the court cases often come down to whether the defendant can prove they are, quote unquote, “insane” at the time of the crime. In these cases, race and class are a big determinant of who gets convicted, because without a documented health history, it’s very difficult to prove, quote unquote, “insanity.” And if the defendant didn’t have access to mental health services to begin with, it’s unlikely that they’ll have any documentation to support their case. 

And this “insanity” versus “sanity” designation doesn’t take into account that the condition waxes and wanes. There’s only one state, Illinois, that factors postpartum psychosis into sentencing when there is a homicide.

Guilt is a thick, sticky emotion. It can harden over time, and stay with us, despite our best efforts to wash it down the drain. For as many times as Jess has told other survivors: it’s not your fault, she continued to struggle for years to peel off all the layers and fully forgive herself. 

It was just this past year that Jess felt like that final layer of guilt was scraped away, in a conversation with Liyla.

JESS: We had this conversation and she repeated something from her teacher, and she's like, if you have a really, really bad memory, my teacher says, hold onto it like it's a balloon or something. Hold onto it and then let it go. Let it go into the sky. And for me, I imagined all the guilt and all the shame and all of that, that I had bottled up about not being enough. 

I just took her advice and I let it go. And just had so much gratitude for her being my daughter and that bond that we have no matter what, we went through hell and back together. 

We made it. We survived. 

OUTRO

ALLISON: Thank you, Jess, for sharing your story. During our reporting process, we spoke to a lot of postpartum psychosis survivors and so we’d also like to thank all those people who shared their story with us. 

If you or anyone you know is struggling during pregnancy or postpartum, you can call the National Maternal Mental Health Hotline at 1-833-TLC-MAMA, that’s 1-833-852-6262. The number for the Suicide and Crisis Lifeline is 988.

Again, postpartum psychosis is a medical emergency that requires immediate hospitalization. 

If you are a medical provider and you have questions related to the mental health of your pregnant or postpartum patients, you can book a free consultation with a psychiatrist with expertise in perinatal mental health disorders by calling 1-877-499-4773. 

As always, you can find this information on our website, KCRW.com/Bodies, along with additional resources as well as a link to a survivor-led project where people can submit stories  about their experience with postpartum psychosis You’ll also find a transcript of this episode and a link to the Bodies facebook group.

You can follow Bodies on Twitter and instagram at @bodiespodcast. And if you like Bodies, tell a friend about this show, send ‘em a text right now!

CREDITS

This episode was reported and produced by Lila Hassan and me, Allison Behringer. With additional reporting by Kalaisha Totty. Our story editor is Mira Burt-Wintonick. Additional story editing and advising by Cassius Adair, Sharon Mashihi and Caitlin Pierce. Original score by Hannis Brown. Mixing by Nick Lampone. Theme music and credit music by Dara Hirsch. 

Transcription help from Nisha Venkat. Tape sync by Julie Conquest. Special thanks to Camila Kerwin, KalaLea and Kristen Lepore. Episode art by Neka King. Cover art by Sarah Bachman. 

Bodies is supported and distributed by KCRW. Our executive producer at KCRW is Gina Delvac. Thank you to the whole KCRW team. I’m Allison Behringer, host and executive producer of Bodies. Thanks for listening. See you next week for our 6th and final episode of season 4.