Reducing Stigma Around Postpartum Psychosis: Infant Risk, Self-Blame, and Treatability

In this video, Mena Mirhom, MD, FAPA, a board-certified psychiatrist, professor of psychiatry at Columbia University, and Psychiatric Times section editor, described 3 drivers of stigma around postpartum psychosis and how clinicians can address them.

Fear of Losing a Child

Mirhom said the first important point is unique to this condition: the infant. Few other psychiatric conditions place a vulnerable person at the center of the conversation, and mothers face a real fear of having their children taken away. That fear can stop a mother from saying she is having trouble with her mental health or frightening thoughts about her baby.

To counter this, Mirhom advised clinicians to tell new mothers plainly that disclosure will not lead to automatic removal of their children. The goal of an open, normalizing conversation is for the medical community to support the mother, not to punish her for what she is experiencing.

Self-Blame

The second barrier is internalized blame, which is seen across mental health but is especially painful here. Mothers may ask themselves what is wrong with them for having harmful thoughts toward their own baby, or may conclude they are broken.

Mirhom said clinicians can take this apart by explaining the biological and genetic factors behind the illness. "This is not simply somebody who is choosing to have negative, hurtful, or painful thoughts," she said. Explaining the biology moves the conversation away from fault.

Highly Treatable

Mirhom called the third point the most important: postpartum psychosis is highly treatable. "The only way that this can not be treated is when it is in isolation, in the darkness, with no support," she said. With support from clinicians and experts, patients can do very well. Evidence supports this, with most women reaching remission under structured treatment, including lithium-based approaches.^1,2

Clinicians also have several treatment options to draw on, including more than one medication and more than one form of therapy. Mirhom said that stressing how treatable the condition is gives patients hope and reduces stigma, which encourages them to come forward early.

Dr Mirhom is past president of the New York County Psychiatric Society, an assistant professor of psychiatry at Columbia University, a Forbes contributor, and chief wellbeing officer at Athletes for Hope.

References

1. Bergink V, Burgerhout KM, Koorengevel KM, et al. Treatment of psychosis and mania in the postpartum period. Am J Psychiatry. 2015;172(2):115-123.

2. Bergink V, Rasgon N, Wisner KL. Postpartum psychosis: madness, mania, and melancholia in motherhood. Am J Psychiatry. 2016;173(12):1179-1188.