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Action on Postpartum Psychosis
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I'm not a professional, but I need help to diagnose my wife

My wife gave birth 3 months ago. Since Thursday, she's been distracted, confused, paranoid, hostile/timid and delusional. Her maternity leave ended two weeks ago and it seems that she experienced some stress at work.

On monday, I picked her up from work early (in the morning) and informed them that she simply would not be able to come to work for the next two weeks. I'll deal with the repercussions of that later.

She's home, taking care of the baby now, but she's stopped generating milk. That doesn't help the situation.

She won't admit that she has a problem and refuses to go see a professional. She is even against me attending a support group (for caregivers of people with mental illness).

I want to do my best to diagnose her informally so that I can get an idea of the next steps. Should I be more forceful in prodding her to see a doctor? Should I just let her stay home and relax for these two weeks? Should I try to see a doctor on her behalf (without her consent)?

What is wrong with her?

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Hi Sitiposit,

You say "Since Thursday, she's been distracted, confused, paranoid, hostile/timid and delusional". That's quite a short time, but it is all the classic symptoms of PP. Has this been going on longer in hindsight? Has she been acting a bit off since the birth? Is she getting enough sleep? This is crucial. Also you say she returned to work after 3 months, this is very soon so understandable she is stressed juggling that and a small baby.

I think taking the pressure off her, letting her rest and helping look after baby eg. doing night feeds would be a great first step.

It is hard if she doesn't think she has a problem. Sometimes with PP women can be in denial they are ill, or unaware they are acting different. If you can get her to a GP I would and I would be insistent she see's a specialist perinatal mental health professional. She will need to be referred for that and not all areas have them.

Watch very carefully for a sudden, dramatic decline in her mental health. PP can come on very rapidly. For example, severe paranoia, VERY distressed/anxious, very unrealistic worries about baby and hyper mania. If she does experience these symptoms call 999, it is dramatic but PP is an emergency. At A&E you would need to talk to them about PP because unfortunately there is a lack of knowledge amongst SOME doctors/health professionals. If PP is diagnosed hopefully she will be admitted to a Mother and Baby Unit and she WILL get the help she needs.

Hope this helps, good luck, stay strong.

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Annanoosh,

I'd say that the severity level is not

"severe paranoia, VERY distressed/anxious, very unrealistic worries about baby and hyper mania"

but this weekend it was quite close. When I was much younger, a friend did too much LSD ("a bad trip"). I remember calming him down. It was quite similar: paranoia, confusion. This is worse because she is (my wife and) the mother of two small children.

Do you know if her early failure to produce breast milk is related? She is certainly not getting much sleep and no exercise. Generally lethargic.

I will try to convince her to see her regular doctor about the breast milk (she is very concerned about that, although I think that's the least of our worries). I will try to communicate with the doctor (I'll mention your suspicion of PP) beforehand about the situation. Perhaps they can make an appropriate referral.

PS I live in Houston, TX. I assume that they would know how to diagnose and treat PP. Am I wrong?

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I imagine they will know how to diagnose and treat PP, 1-2 in every 1000 women get it so there will be people out there who can help. In my experience my advice to you is be strong, stay calm, get help. She may just be delirious from tiredness/stress, best to get a professional opinion. Remember if it is PP it is very treatable.

I wouldn't worry about breastfeeding, like you say it's the least of your worries. Reassure her its ok, your baby will still be getting its vital nutrients in formula. PP can be related to hormones, so perhaps there is a link, but I am really not sure.

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Also just to say if she really won't see the doctor and you are still worried call your local Perinatal Mental Health Team for advice.

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Thanks for the response and the advice. I will try to contact a local professional for more, but I don't see anything happening if my wife refuses to admit that she's sick. When I confront her with the obviously fictional things that she said, things she knows she said, she gets agitated and deflects. I guess this is what they call denial.

Anyway, she's starting to act more calmly, but it so clear to me that she's just hiding the black hold in her mind that has been causing her such fear and anguish. Before she learnt to hide and deny it, I saw so clearly how much she suffered from it. It's like someone suddenly shut out some lights in her head. Who am I to force her to confront it?

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Hello sitiposit

Welcome to the forum. I’m sorry to hear your wife is suffering, it must be a very worrying time for you.

You’ve been given some really good advice by Annanoosh above - try to help your wife get as much rest as possible, be alert to her symptoms and any changes, and try to access professional support and advice. I don’t know if you’ve had a look at APP’s website, there is some really useful information and resources on there that might help you if you feel her symptoms might be postpartum psychosis - app-network.org/what-is-pp/ There is also a partners guide which might be helpful - app-network.org/what-is-pp/...

If your wife is unwell and doesn’t have insight she will need your support to get help as she won’t be able to ask for it if she doesn’t believe there’s anything wrong. I don’t know if others on this forum might have experience to share in how you go about this. I became unwell when our first child was 3 weeks old. I was very sleep deprived and anxious then stopped being able to sleep at all and starting acting strangely and saying odd things. My husband contacted the out of hours GP service as it was a weekend and the local maternity unit who agreed to see me - this was before I deteriorated quite rapidly into psychosis (which happened the next day) and I was sent home with reassurance - it can be hard to get help before approaching/ reaching crisis point.

I don’t know if making a note of your wife’s symptoms might help. Keep talking to her and asking her how she feels and if she thinks it’s normal - it’s so hard to know what’s normal with a young baby though isn’t it, it’s such an emotional time. I hope you can talk to her doctor and get some support. Postpartum International Support might be a helpful resource to you too - postpartum.net

Wishing you all the very best.

Take care.

Jenny x

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Hello sitiposit

I'm sorry to hear about your wife struggling and refusing to believe she is ill. I remember feeling the same during my PP episodes many years ago, thinking I was fine and everyone else had a problem! I was very challenging to my husband and family but with good medical care and treatment I fully recovered.

There have been some posts from the US on the forum. Recently skgerdes posted "Seeking input for U.S Postpartum Survivors ......." Although it relates to a survey and six women in the U.S who have recovered, perhaps you could make contact and they could signpost you to support? There is also a brilliant blog "PP Soup" at ppsoup.com with shared experiences and advice such as early symptoms and useful links.

Remember to take good care of yourself too as it must be distressing to watch your wife being so unwell. Congratulations on the birth of your baby :) Take care.

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Dear sitiposit, firstly you are being very supportive and responsible at a time when

Most people have expectations of a much easier time , which is so good to read . It’s hard to be so close to someone suffering PPP. Having had PP myself the most worrying aspect of crazy disturbing thoughts and fears is that no one said what I wanted to hear which was that in some women birth brings about a period of PPP and it’s going to get better . I was terrified of what was happening and never got reassurance so I suggest you do all you can to encourage rest and sleep , ( as sleep deprivation is a factor) , try to reduce her fears of “ being crazy and out of control”, contact your local support services e g GP health team , A and E if you are worried about harm to herself or baby , and most essential do look after yourself . If you have good friends and family let them help out with household chores , and be encouraging to your wife as much as you can . Medication is very helpful and your dr or obstetrician will advise . Denial is Very common but if you explain to your wife that this is a very well known syndrome and it will pass she may be more able to accept she needs help.

All best wishes Denise

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Thanks for your input Denise. The main obstacle I'm facing is her denial of her condition. I contacted her work and told them that she'd be staying home for two weeks for emergency health reasons (I didn't give any details, but she recently gave birth, so I guess they can figure it out). This morning, after a few days off and good sleep, she declared that she was going to work. She's not ready. She's still mentally unstable (believe me, I know). Still, she is not listening to me. She is not even appropriately dressed for work, but she doesn't heed my warnings, requests. I fear that she is headed for a humiliating and career damaging situation.

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Hello again . Although PPP is not yet well recognised I would consider discussing urgently with your drs( who attended her around the birth ? ) and ask him to give a med certificate . If your judgement is right she’s in a very vulnerable position and should receive medical help as extra stress will very likely make it worse. Who is caring for baby ? Is it you ? Is she still feeding baby ? That takes a lot of managing with expressing etc ? Please get professional help att this time . What options are in your area ? Thinking of you all Denise

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Please have another look at suggestions from others on this forum who have given valuable replies and advice . We are all here for you and wish you all the best in this difficult time . Denise

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Hi,

Your wife is VERY ill and is not rational so asking/expecting her to admit she is ill is probably not going to happen...if you can get her to talk to a mental health professional they should be able to see past her denial and get her the help she needs..

Please let us know how things are and if you have managed to get her help..

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Hi Sitiposit,

it must be such a traumatising experience for you with your wife being so poorly.

I was undiagnosed and somehow knew that something was wrong with me, but carried on to live in my little bubble without any sleep and completely stressed out about breastfeeding and looking after my new born child.

My partner was devastated as professionals did not recognise straight away that it was very serious. Apparently I managed quite well to role play and put myself together when the health visitor or midwife popped in. However, I was deteriorating quite rapidly.

Is there a possibility where you could arrange a professional to come to your home environment?

My partner invited a hair dresser friend, who just started chatting to me and trying to do my hair nicely and then we have had family friends popping by, the ones I trusted...then the midwife and crisis team...till I was ready to accept help and support...

Thinking of you and hope your wife will be cared for by a health professional (GP, Psychiatrist, midwife, health advisor....)

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Thanks Jasa. I think that you recognize the problem. That is, my wife refuses to acknowledge that she has a problem and certainly refuses to get any help.

The other day, she had a routine checkup with the same doctor that delivered our baby three months ago. I left a message for him that I suspected PP and asked him to refer her to a psychiatrist or what ever professional is appropriate for this kind of thing. I presume, being an obstetrician (or something like that) that he would be familiar with PP and related post partem conditions. The appointment was on Friday and I have had no indication from my wife that a conversion on the lines of mental health even took place.

I imagine that he didn't recognize the symptoms (or maybe he didn't appreciate or receive my request). In any case, besides her calming down in the last few days, nothing has changed. That is, she is mentally unwell and is not being treated. Although we don't plan on another baby, I expect this illness will manifest again in the not to distant future ... possibly in a more severe fashion. For now, I'm just too frazzled with the whole experience to pressure her more than I already have for fear of another relapse. I guess that means I'm going to do nothing for a while. What other option do I have?

dan

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Hi mate. Have you tried calling your local early intervention team? I had a similar situation with my wife who also refused to admit she was ill. Even went so far as her leaving me and were almost divorced until the point when she had a proper breakdown and was sectioned. I tried everything to get her help, but if I had known what was going to happen (won't go into the details) I would have been a lot more forceful with the authorities about getting her help. My advice is try the early intervention and keep trying. Also, if you can get some others to help you to get through to her, then give that a whirl. Good luck. Hit me up if you need to talk.

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Hey dado, thanks for the tip. Truth is, I am afraid of the shitstorm that will drown our already fragile marriage if I make any suggestion that she's not mentally healthy. She doesn't have anyone that she trusts (including me) and I suspect that she's scared of what might happen (to her career, her custody of the kids etc) if she is labelled mentally ill. I don't want to push her into a corner.

I imagine that this can go two ways. Either she has another episode/breakdown (which I can only guess would be worse than the recent one) or she stabilizes enough that I can speak will her about it without fear of triggering more hell.

dan

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It's a tough one man and only you know what's best really. From my own experience I also thought she might snap out of it at some point, but it just got worse and worse. That said, I completely understand how frustrating it is and powerless you feel. Wish you all the best.

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Hello sitiposit

It must be very difficult to find support for your wife in the U.S. We are fortunate in the UK that mental health is now coming out of the shadows and there is help available. I'm sorry that the doctor didn't recognise how unwell your wife is. Is it possible that you could contact him / her voicing your concerns?

I'm sure you must feel overwhelmed but with respect I feel that doing nothing for a while is not an option. Your wife needs immediate attention, although she seems calmer now. Here in the UK if there is a mental health issue you can be seen in the Accident and Emergency department by a specialist team? Do you have something similar in the US? Perhaps you could find a way to go to the caregivers support group as you really need someone to signpost you to the help you need for your wife and your own sanity. Did you reach out to the Postpartum Support International as mentioned earlier?

I'm sorry it must be very difficult for you trying to cope with your baby too. My delusions and hallucinations were all very real and frightening. In the midst of what I now know was psychosis, I stayed for a while with my parents and my GP would not visit as I was out of his area and my parents' GP would not visit because I wasn't his patient. So it must have been so overwhelming for my husband and family as I wasn't sleeping and heard voices. After a traumatic episode I was eventually admitted to hospital via A & E and sectioned.

Do you have family support so that someone can be with your wife and baby while you can find the support you need? I did relapse during recovery from my second PP but this was due to reducing my medication myself, without supervision, and I quickly went downhill. I did eventually fully recover but it took a long time for me to find my place. So as hard as it is for you, I think your wife needs to access medical support and treatment as soon as possible. Please take care and keep writing here if it helps.

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Hi Sitiposit ,

thank you for your response.

My partner cared and loved so much and was absolutely devastated, -

being confronted with an unknown situation whereby I was not only struggling, but suffering so much and then obviously having to care, feed and love for our new born child had put enormous pressures on my partner. He was absolutely amazing in trying to find ways and convincing the medical health team that our little new nuclear family was in crisis and needed attention straight away.

Please, do ask for help, you need urgent support for your family!

I let you digest Lilybeth response, who also highlights some very good options.

Maybe you can find a very diplomatic way of approaching your wife, so that she is ready to get help.

We are listening and thinking of you.

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Hi mate. Do not take no for an answer until your wife has been diagnosed and has the correct care plan. My wife was not cared for quikly enough and I regret that very much.

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Try to be patient with your wife and understand that not having insight into her sickness is part of the illness. When I had my postpartum episode I thought my delusions of witches were real and part of it was that I couldn't tell anyone about it. It was like I was living inside an entirely different reality than everyone else. I live in the US also and understand how difficult it is to get help for mental illness for another person. Perhaps you could get her to do a psychiatric evaluation at a local psychiatric hospital. Another option may be that there is a crisis team of some sort that you could call and they would come to the house to talk it out. I did this once for an ex boyfriend who refused to get psychiatric help after a suicide attempt and the crisis team was able to convince him to go to the hospital. In the US it is not possible to force someone to get psychiatric help unless they are a danger to self or others and even then it would involve either getting them to an emergency room or a psychiatric hospital for a psych eval or calling the police. Typically, they can then be held for 3 days and the doctor can renew the hold if he feels the person is not well enough. You are doing the right thing by getting your wife some help. My heart goes out to you and your family at this difficult time.

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Hello sitiposit

I hope the replies here have been helpful in what must be a very difficult time for you seeing your wife so ill. Have you been able to find support for yourself to move forward, e.g. family or friends?

Take care .... we are all thinking of you and your family.

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Yes, like Lilybeth I hope that help is on its way for your wife.

We are thinking of you sitiposit.

Take care

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