Genna and I sit across from one another at a cafe. We have each had hectic days and try to catch our breath before diving into the deepest conversation about mental health that we have ever had.

We’re sharing this post to grow awareness about postpartum psychosis and brainstorm some suggestions for anyone who is struggling with the question; “How can I support my friend who has postpartum psychosis?”

The following is about one lived experience of postpartum psychosis and support. Some of it may be difficult to read. The information here shouldn’t be considered medical advice. Call a crisis line or visit an emergency room immediately if you or someone you know is experiencing symptoms we discuss.

What is postpartum psychosis?

Genna explains to me that postpartum psychosis, while rare (affecting 1 to 2 out of every 1,000 deliveries), can also be very dangerous. When it emerges, usually in the first two weeks postpartum, it comes at a time when the birth parent, their baby and their supports are already vulnerable.

Symptoms

Postpartum Support International explains that the major symptoms of postpartum psychosis could include strange beliefs, hallucinations, extreme irritation, hyperactivity, inability to sleep or lack of sleep, paranoia, mood swings and difficulty communicating.

The first time I visited with Genna after her daughter’s birth I had heard that she had experienced something called psychosis, but I had no idea what that something was, and I assumed she had made a full recovery.

As we sat down for dinner the moment arrived for Genna and her partner to tell the birth story - a sort of rite of passage for new parents. Contractions, calling the midwife, heading to the hospital, surgery… all pretty standard bumps and hiccups and healthy birth stuff. I can’t remember if there was a dramatic pause in the room, but then Genna and her partner delved into their postpartum experience, and Genna’s psychotic episodes.

Genna’s strongest psychosis symptoms were related to seeing symbols and signs all around her. Colours vibrated, she foresaw the future. Genna was driven to express and document her revelatory episodes by writing, photographing and even recording video as the compelling thoughts and beliefs raced by.

Risk

Postpartum Support International explains that because the psychotic episodes feel so real and meaningful postpartum psychosis can be life-threatening, with a 5% suicide rate and a 4% infanticide rate associated with the illness.

Together in the cafe we revisit Genna’s most difficult memories. She reveals to me that in her scariest moment she felt an impending doom. She thought her breast milk had turned rancid and took action to dispose of it immediately. In a terrifying moment she saw a future where her baby girl was blue and not breathing. She had a panic attack and was rushed to hospital where she would begin her path to wellness.

Helping a friend who is experiencing postpartum psychosis

Genna describes this period of her life as helpless. During that first visit I had with her she had been out of hospital only a matter of days. She was stable, but she wouldn’t be able to be left alone with her daughter for another few weeks. It would take the better part of a year before she felt like herself again.

Through all of this I was so ignorant. I shudder now to say that I laughed at her stories of strange beliefs and hallucination. I laughed when she told me about insisting they buy Apple stock because apples are a symbol of life. I mean isn’t that so crazy?

I ask her what she remembers about my support and she graciously refers to a card which she has kept. With information and empathy I could have done such a better job of supporting her and her family.

But, when we know better, we do better. And now Genna is able to share with us all the helpful and not-so-helpful actions that were taken with good intentions in her service through postpartum psychosis. Hopefully some of these are helpful for you too:   

Be there: Genna was able to count on incredible support from her partner and their families through the crisis. Genna warns me that during my first visit as well as the hour-long checkup with her midwife she was able to hide her symptoms. Only those who spent a lot of time with her were able to see the changes over a matter of days.

Observe cues: Genna tells me that if a new mother is not able to sleep that is a huge sign that something is wrong. Other telltale signs include panic attacks and saying things aloud that seem irrational. We brainstorm some approaches that a friend could take if they’re concerned: “How are you sleeping? Are you able to get some rest?” is an understated way to learn how things are going and start a conversation.

Talk it through: When Genna’s symptoms started to surface, her family became worried, but were also unsure of what they were witnessing. In family meetings they wondered with each other if it was lack of sleep or the baby blues. It can be helpful to work through your doubts and do some validation with others. A crisis line is also a great resource.

Take action: Genna stresses that when it’s time to seek medical attention, it’s important that friends and family show confidence in the plan towards care and wellness. She underscores that it’s critical to encourage the person suffering to trust the advice and recommendations of the healthcare providers and to speak up clearly about your concerns and the symptoms you are seeing with professionals.

Once a crisis has passed, there is so much more we can do. Genna offers a few suggestions for longer term mental health allyship.

Check your language: Using terms like ‘looney bin,’ ‘crazy,’ or ‘whack job’ in passing hurts. Remember that most people around you at work, at school and in your neighbourhood have experience with a serious mental health challenge themselves or with the people they love.

Prevention: If you know someone who has mental health challenges and is pregnant, lend your support early, before they give birth. Genna mentions that she often wondered about how her mental health would be after she delivered, but felt brushed aside when inquiring specifically about postpartum psychosis. Genna sees an opportunity for prevention to start even before pregnancy. Looking back, she believes using cannabis in her youth helped trigger her illness. She's already brainstorming ideas to help her daughter avoid cannabis, especially because of her genetic predisposition. She recommends others with young loved ones think about doing the same.    

The drugs do work: During her episodes and to this day Genna hears well-meaning friends and acquaintances casually downplay the need for medication to address mental health disorders. ‘You’ll only need it for a little while.’ I’ll admit this is one I catch myself saying. Casting taking medication as a weakness is really, really unhelpful. Let’s not add that pressure to our friends and loved ones who are struggling.

Learn more: So many of us don’t know what to do in a mental health emergency. Genna urges everyone to sign up for mental health first aid courses often offered in workplaces and community.

Postpartum Support International concludes their info reminding us that postpartum psychosis is temporary and treatable. If Genna and her partner try for another baby  they can form an action plan and breastfeeding-friendly medication regimen in advance of delivery. While postpartum psychosis is an emergency situation which requires immediate help, it is something that you can recover from to enjoy life as an accomplished parent, professional, partner and friend.

It takes guts to rise against stigma and be open about such a difficult experience. Genna, I am so grateful for your voice and your leadership.