Okay, this is long, but in a nutshell my question is, now that my little sister has come out of her first episode of acute postpartum psychosis, what should we be doing to help her? How much space should we give her? And her husband? If she doesn't want to talk about it, is that normal and okay? Is there anything we can say to help her realize this is an illness outside her control, not a personal failure to be ashamed of? Is there anything we can say to help her accept she needs to be on medication for a while? I've done so much research and learned so much about the condition, I want to talk about it with her and help her, but she's unwilling to talk right now - and I think somewhat unwilling to accept her condition and treatment.
Here's the long version:
My intelligent, wonderful little sister (who is an R.N., tends to be somewhat sensitive or high anxiety in general, and likes to be in control) had her first baby 4 months ago, and showed clear signs of postpartum depression/anxiety afterward. It was apparent to everyone but her, but she would evade attempts to talk about it saying "I don't want to label it," "those are serious labels," "I just need to work on my anxiety levels and trusting God" etc. Her doctor noticed something was wrong, too, but she avoided treatment.
Then there was a snowball effect as high anxiety caused sleep deprivation and sleep deprivation caused high anxiety (I think). A month ago, others saw signs that she was becoming paranoid and drawing odd connections between things, but it wasn't totally obvious yet. Last Thursday, she began experiencing full-blown psychotic delusions (all persecutory in nature). She thought she was under surveillance, being poisoned, being watched, that her incredibly sweet and devoted husband was an enemy, that everyone was out to get her. The family took her to the hospital and, at the hospital, she was put in a 5150 (involuntary) hold but then released because she "snapped out of it" shortly after the hold began.
Back in her right mind for a few hours, she agreed to trust her family members and recognized that the delusions had been false. But then, in the middle of the night, they started again. By the next day, she was totally non-functioning with paranoid delusions. But, even in the middle of them, she agreed to trust us (we were able to coach her to just "let go" "trust" "remember you decided you would trust no matter what") and she DID! We were so impressed by her fortitude in the middle of that terror. We got her to go to the E.R. voluntarily with us. She was very delusional (the hospital was a terror camp run by communists, they were going to euthanize her, they were going to sterilize her, everything was terrifying and most of her delusions surrounded medical issues of various kinds. She was extremely adamant she did not want medication. She threw water at one nurse in terror about something or other).
Unfortunately, the doctor at the hospital, without telling ANYONE, put her on another 5150 hold - even though she was voluntarily complying at that point. We did not know this. We were told she was being transferred to another hospital with a mental health unit. I rode with her in the ambulance, holding her hand, helping her with deep breathing techniques, coaching her to "trust," "let go" "focus on the simple things" "focus on breathing." Somehow she powered through it and did not lose control despite her obviously sky-high anxiety and delusional levels.
Then, to our horror, the ambulance stopped at a locked, mixed-population mental health unit, where my sister was carted into a back room behind locked doors. They announced we could not follow and she would be unable to see us except 1 visiting hour per day, and unable to see her baby at all. We (the family) just about lost our minds with the agony of this. We had been the lifeline she was clinging to. Within minutes, not surprisingly, they had to forcibly sedate her. It was just heart-wrenching, especially after she had been doing so well trusting and complying despite every urge in her to the contrary. The pain of that experience is still very fresh.
Later that evening we got our "visiting hour." She was restless and anxious but heavily sedated. We helped her into bed and tried to sing her to sleep. That night was agony as we wondered how she was faring. But in the morning, it turned out she had slept and felt much better. She was still having paranoid delusions, but not so bad.
Over the weekend, she kept improving (even before she was medicated). Then they put her on Risperdal and Depakote Sprinkles. Ultimately, they discharged her to us this Tuesday. Supposedly she was going to immediately begin an IOP (intensive outpatient program) which Kaiser, the HMO here, is apparently not starting until Friday (tomorrow).
In the meantime, life has become suddenly and bizarrely normal. My parents are doing a one-week remodel of part of their house for my sister and her husband and baby to move into so they'll have extra support. And the baby is staying overnight with my mom so my sister can sleep at night. And her husband is staying home from work so she has someone with her 24-7.
But otherwise, it's like this never happened. She and her husband are acting that way, anyway. All the books I bought and read, all the psychiatrists/endocrinologists I contacted, all the resources and ideas, are going by the wayside. She is just focusing on sleep and time with her family right now. We are overjoyed that she seems more like herself (I didn't know if we'd ever see her back to herself again). There are no delusions, she just seems tired. So in a way this is all wonderful. But I would HATE for this to recur. And she's talking about getting back to breastfeeding (i.e., off the medication) soon. And I know she's pretty anti-medication and doesn't want to be labeled as having a mental illness. There are hints that she and her husband think this was just a sleep deprivation thing and nothing more. She has also indicated she's embarrassed or traumatized in a way that prevents her from talking about it. When someone says "how are you doing" she responds "let's talk about you, let's not focus on me." I'm hoping Kaiser will give her sound advice and she will be treatment compliant, but who knows. She's deflected every attempt to talk about it.
So, bottom line: Should I just be happy for her, sit back and give her space, hope the professionals at Kaiser say all the right things, and stop intervening? Or should we try to draw her out, and try to help her see this is a real illness that she should not be ashamed of? Did anyone else experience this? Did you just need space? What was able to help you with your denial? Or your feeling of embarrassment? Why can't she realized that it's as if she just had a heart attack from our perspective - we love her and want her to accept our help and our celebration of her recovery too?
Also, is it normal to expect she might get off medication soon (as she clearly expects) or is it closer to 12-18 months like I've read so often? Thank you so much in advance.