Ordeal of Postpartum Psychosis : Illness Can Have Tragic Consequences for New Mothers

Angela Thompson was unusually preoccupied the last week of August, 1983. She and her husband, Jeff, had friends over for dinner and she barely said a sentence. Sometimes she looked at Jeff across the table as if asking for a cue as to how to behave.

In the following days she cooked the meals, washed the dishes and cared for the couple’s 3-year-old daughter, Allyson, and their 9-month-old son, Michael. But Angela Thompson had the quiet air of someone making plans, someone with a secret mission.

. . . Angela means messenger of God . . . Jeff means God’s peace . . . so I am the messenger of God’s peace . . . .

When Jeff Thompson left for work the morning of Sept. 1, his wife was preparing stew for that evening’s dinner. She chopped, stirred and schemed:

. . . The baby is the devil. . . . If I kill the demon, my husband will raise the baby to life again in three days, and the world will know he is Jesus Christ . . . .

When Angela met her husband at the front door at 6:45 that evening, her eyes were glassy, her pupils dilated. Her expression, he said later, was like a pet dog who is unsure whether it’s done something good or bad--but is looking for approval anyway.

“Jeff, I have to say something,” Angela said. She was shaking. “Michael’s dead.”

Jeff searched his wife’s face to see if she could possibly mean what she’d said. Then he charged through the house, going first to his daughter’s room. Allyson was standing on her bed, looking perplexed.

Some impulse made him run outside. There, along the side of the house, he found his baby boy in a box, covered with a towel.

He picked the body up and hugged it to him. Then he went inside and dialed the police. He gave his address and said, “My son is dead.”

If the Thompsons had been living in England instead of Davis, Calif., at the time, Michael’s death would have come under the Infanticide Act of 1938, which states that in the first 12 months after she gives birth, a woman cannot be charged with the murder of her infant (she can be charged with the lesser offense of manslaughter).

The British law tacitly acknowledges the existence of a condition called postpartum psychosis: “The balance of (the mother’s) mind was disturbed by reason of her not having fully recovered from the effect of giving birth,” it reads.

According to two psychiatrists interviewed for this story, there is inadequate recognition of postpartum psychosis among medical professionals in this country. If diagnosed, the condition is readily controlled by hospitalization and drug or electroshock therapy, the psychiatrists said. Untreated, however, the psychosis can become so severe as to cause the mother to commit suicide or infanticide.

Caused by Hormonal Changes

The illness is a temporary condition that occurs in new mothers (the majority of whom have no prior history of mental illness) due to hormonal changes that are not yet completely understood, said San Francisco psychiatrist Dr. James Hamilton, who has treated more than 300 such cases.

He cautioned that when the illness is used as a defense for infanticide, “One needs to have a certain amount of evidence of some sort that this is indeed a psychosis. It would be a disservice to sick people if a lot of non-sick people who are just garden-variety child abusers got under this wire.”

Child abuse, not postpartum psychosis, was indeed the explanation that local newspapers gave for the death of Michael Thompson. Angela Thompson was charged with first-degree murder. (She drowned the infant in the bathtub; her psychotic reasoning for the act, as she described it in an interview, is spelled out in the italicized paragraphs above.)

In the months after Michael died, Angela was held in two different mental hospitals. She then was released to spend six months at her parents’ house in Salinas. (The $250,000 bail was reduced on the condition that Angela would leave town; she was at that time seen as a menace to the community, Jeff said.)

The charges were eventually reduced to manslaughter and felony child abuse. Angela was acquitted by reason of insanity. She was ordered into inpatient treatment at a halfway house for 90 days, then was allowed to go home as long as she met conditions set by the court. For as many as six more years, she must meet these conditions, which include regular visits with a psychiatrist.

Now that several years have passed since Michael’s death, Angela and Jeff Thompson said that they are working to alert new parents and health professionals that postpartum psychosis must be recognized and treated if future tragedies are to be averted. They are operating alone for the moment, they said, but hope someday to be part of a network of people concerned with postpartum psychiatric illness.

Angela, 31, is a registered nurse; Jeff, 33, is a lobbyist for the California Correctional Peace Officers Assn. Jeff is looking into the possibility of suggesting legislation along the lines of the British infanticide act, which would protect mothers who commit a crime under the influence of postpartum psychosis. Angela, currently studying for a master’s degree in nursing education at Cal State Sacramento, intends to inform physicians and mental health workers about the malady.

“We both feel like this happened to us for a reason,” Jeff said in a recent interview at the couple’s modern, airy home in a Sacramento suburb. “We tried to start a family and-- boom --did we ever hit a weird kind of body chemistry. We’re both in a position to educate, and that’s exactly what needs to be done.

“Doctors are literally ignoring mothers to death on this thing,” he added.

Although postpartum mental illness was observed as long ago as the 4th Century BC by Hippocrates, psychiatrist Hamilton said in a telephone interview that the term fell out of vogue in this country during this century because it didn’t fit neatly into a method of classification which categorizes mental disorders according to symptoms, not precipitating causes--such as giving birth.

The American Psychiatric Assn. mentions the disorder in the index of its Diagnostic and Statistical Manual of Mental Disorders, the menu from which mental health professionals select diagnoses, but it then refers readers to more general terms such as schizophrenia.

When postpartum psychosis as a separate ailment was expunged from the books, “research in this field died,” Hamilton said. “You can’t get research money for a non-existent illness, and American psychiatrists were darn sure there was no such thing as postpartum psychosis.”

Hamilton, a former associate clinical professor of psychiatry at Stanford University, said that medical students are often taught that some women became mentally ill after giving birth, but only because they were already disturbed and the birth trauma triggered a psychotic episode.

He said there is still professional debate over whether postpartum psychosis is an entity distinct from other psychiatric illnesses. Dr. Lewis Baxter, assistant professor of psychiatry at the UCLA School of Medicine, said the disorder could be a variation of psychotic depression.

‘A Vulnerable Period’

“It may be that the postpartum period is just a very vulnerable period for people with underlying disorders,” he said.

Hamilton contends, however, that postpartum psychosis is indeed a sickness unto itself, “with very definite hormonal changes involved.

“The whole thing is kicked off by the loss of the placenta, a giant factory for estrogen and progesterone,” he said. “When the placenta goes, there is a precipitous drop in estrogen and progesterone in the first 24 hours.” (While postpartum psychosis, as described by Hamilton, usually manifests itself in 72 hours to one week after a woman gives birth, doctors have observed psychoses occurring as long as a year later--as in Angela Thompson’s case. Doctors say this may be a continuation of an earlier, unrecognized psychosis, or it may be triggered by hormonal changes caused by the end of lactation or resumption of menstruation.)

As many as one in two women are afflicted by a mild depression commonly known as the baby blues after giving birth. This condition itself is not usually serious, but in rare instances it can become “rougher and rougher,” Hamilton said, until a true psychosis develops. The retired physician’s advice to new parents is to report any unusual behavior to their doctors. Doctors, Hamilton said, should “handle the baby blues with respect and observation.”

San Diego psychologist Susan Hickman sees postpartum psychosis as a particularly virulent form of a broader problem--the reluctance of new mothers to admit to difficulties and negative feelings about parenthood.

‘Big Taboo’

“The big taboo against talking about stress in motherhood needs to be swept away,” said Hickman, who works as a childbirth educator through UC San Diego Medical School. She has five children of her own.

Hickman facilitates a support group which is one of a handful of such groups around the country geared specifically to mothers suffering severe postpartum depression or psychosis. Hickman, 43, formed Parents Adjusting to Parenting after hearing about the suffering of her friend Susan Host, who experienced severe psychosis after giving birth nine years ago (more information is available by writing the group at 6635 Crawford St., San Diego, Calif., 92120).

Host, also of San Diego, said in a telephone interview that her psychosis was recognized by doctors when she became delusional, convinced that the devil was hovering around her baby. She recalls the six-month hospitalization that followed as a time of great isolation; she had a malady that no one seemed to know about. Host, 38, said she helps out with Hickman’s groups “so other women feel they’re not alone in this.”

Host was fortunate in that her condition was diagnosed and treated; Hickman said that too often when new mothers report symptoms ranging from tingling hands and other peculiar bodily sensations to hallucinations, doctors are likely to dismiss them with, “You need to get some sleep.”

Host agreed: “People who don’t experience it (postpartum psychosis) think it’s not real. I’ve talked to obstetricians who say, ‘Gee, I don’t see that in my patients,’ or, ‘There’s less of that now that fathers are involved with child care.’ ”

There are other resources for those experiencing postpartum problems, including Carol Dix’s book, “The New Mother Syndrome” (Doubleday and Co. Inc., 1985). Dix discusses the symptoms and treatment of postpartum depression and psychosis and lists where to go for help throughout the country.

A Santa Barbara group called Postpartum Education for Parents operates a 24-hour “warmline” staffed by volunteer mothers. The number is (805) 964-2009. Director Jane Honikman said that it’s important to acknowledge that no one gives birth without making some sort of adjustment.

While postpartum psychosis affects only about one in 1,000 mothers, the figure jumps to one in three after one bout of pregnancy-induced psychosis. “You have a real bad Russian roulette if you’ve had it before,” Hamilton said.

The odds caught up with Sharon Comitz, a 29-year-old mother who is serving an eight-to-20-year sentence at Muncie State Correctional Institution in Pennsylvania. According to her husband, Glenn, she was found “guilty, but mentally ill, of third degree murder,” in the murder of the couple’s 1-month-old son (she dropped him off a bridge).

Sharon Comitz, like Angela Thompson, had suffered a psychosis following her first pregnancy.

Glenn Comitz said in a telephone interview from his home in Osceola Mills, Penn., that if the couple had understood the chances of a second episode, “We would have thought twice about having a second child, or have taken precautionary measures to control the situation.” (Their first child, Nicole, is now 6.)

As it was, not only did they not think twice, they didn’t even hear the term postpartum psychosis until six months after the death of the baby, said Comitz, a design drafter for the DuPont Corp.

Initiating Appeals

Armed with information about postpartum psychosis, Comitz is initiating appeals in his wife’s case.

The sequence of events following Angela Thompson’s first round of postpartum psychosis illustrate how such a problem develops, and how difficult it can be to handle if the parents, friends and family are not aware that such a condition as postpartum psychosis exists.

Angela was one of four siblings. She was the peacemaker, the family mediator. As a young woman, she took her faith (Catholicism) seriously. She was sociable and athletic, a member of the swim team at Salinas High School. She was in the honor society and served as the first female senior class president at her high school.

When she met Jeff Thompson--he grew up in the small agricultural town of Gonzales, 16 miles south of Salinas--both were eager to be parents. They only had to agree on how many kids they wanted. (Angela said six; Jeff said two.)

The problems started when Allyson was several months old. Early in 1980, Angela began to have trouble sleeping. Soon she was getting by only on brief naps during the day.

“I began to get manic,” she remembers. “I thought I didn’t even need sleep.”

She began to have hallucinations with a religious theme. She would switch on all the lights in the middle of the night (“I was afraid of the dark and of evil”), turn on all the water faucets in a baptismal frenzy, and sing hymns in a robust voice.

As Jeff Thompson said in retrospect, no one would have thought to suggest that motherhood itself might be causing the problem. So they looked elsewhere--for hidden stresses, for religious guidance. Jeff took Angela to see their pastor at Davis Evangelical Church.

The pastor performed what Jeff describes as an exorcism. Jeff said he and Angela went then to the home of a church member who was also a physician. Jeff remembers praying some more while a pack of dogs howled ominously outside.

The couple took turns describing the following events:

As Angela became increasingly agitated, the doctor said they had better call an ambulance. Angela was taken to Woodland Memorial Hospital where she was kept on a 72-hour hold. While she was there, Angela said, a psychiatrist told her: “This does happen to women after childbirth”--that was the closest anyone came to explaining postpartum psychosis to her.

When she returned from the hospital, she seemed to be more herself, but the psychosis had not yet played itself out.

Jeff drove Angela to the river for a day of sunbathing and rock collecting to take her mind off her worries one hot day. As they were driving over a bridge, Angela jumped out of the car. Jeff stopped the vehicle, holding up traffic behind him. Clinging to a trestle underneath the bridge, Angela had a look that her husband described as “a wild pony kind of style--attentive, agitated, excited. She looked up (at Jeff),” he said. “She smiled, dropped.” Angela fell 30 feet to the water. She was picked up by some fishermen and rehospitalized.

Angela was released after another 72-hour hold. Being treated with various medications as an outpatient, she gradually returned to normal. The couple made a pact never to bring up the frightening episodes again. They wrote a contract to that effect, signed it and filed it away.

When Angela became pregnant a second time in 1982, she remembers telling her nurse-midwife that she had jumped off a bridge after her first pregnancy and she was worried that something strange would happen to her again.

“She (the midwife) cried, I cried,” Angela recalled. “She said, ‘You just don’t have to worry about it happening again.’ ”

The Thompsons have filed suit against the obstetrics group and two psychiatrists who saw Angela on an outpatient basis. These doctors, they charge, did not adequately advise them that postpartum psychosis was likely to recur.

Karen Chauncey, a certified nurse-midwife who saw Angela during her second pregnancy, said that she believes postpartum psychosis is adequately addressed in the training of both midwives and obstetricians, and that lack of understanding on the part of these health professionals is not a significant problem. She said it’s standard practice to advise women of a variety of problems that might follow giving birth. “Whether she (the mother) hears that is another thing,” Chauncey said.

Although he could not comment on Angela Thompson’s case specifically, Dr. Leon Schimmel, an obstetrician with the Davis group named in the Thompsons’ suit, said that postpartum psychosis “is a known entity, and has been for a long time. It’s something you work to prevent with all of your patients.”

By taking the mother’s history and inquiring about previous pregnancies, Schimmel said, they provide “anticipatory guidance” to deal with the malady.

At first the Thompsons shielded their daughter from the facts of her brother’s death. But then one day Allyson was in the bathtub with her mother when the child said, “Mommy, you did it, huh? You killed the baby.”

Angela and Jeff have endeavored since to make Allyson understand that Angela was “very, very sick,” when the event occurred, and that her actions were not intentional.

Allyson, now 7, is a dark-haired girl who most closely resembles her father. (Michael was blue-eyed and blond like Angela.) While her parents were being interviewed, Allyson entertained herself within hearing of the conversation, interrupting only to ask her father to play football on the living room rug with her.

By May there should be a new brother or sister for Allyson to play with. Angela is 4 1/2 months pregnant. Both she and Jeff admit to being somewhat apprehensive about undergoing yet another pregnancy. But they have faith it will be better this time. Angela is monitored by the court and attends regular meetings with her psychiatrist. Her psychiatrist will work together with an obstetrician to manage any psychiatric symptoms that may occur during this pregnancy.

“Now it (the illness) has a name, it has a treatment,” Jeff Thompson said. “We’re going to get around this monster.”

SYMPTOMS OF BIRTH-RELATED PYSCHOSIS Syptoms of postpartum psychosis can occur up to a year after childbirth, said San Diego psychologist Susan Hickman, who cited the symptoms listed below. She said women experiencing these or other unusual signals should seek professional help. Inability to sleep for days at a time, even when the baby is quiet or asleep Suicidal thoughts or fearfulness while handling the baby. Crying for more than 15 or 20 minutes on two or three consecutive days. Religious precccupations that are not normally expressed. “Funny thinking,” such as fear of household utensils, food, medicine, water. Chronic feelings of not wanting the baby. General fear of anxiety.