Postpartum Psychosis (PPP) is a life-threatening mental health issue that affects a small percentage of mothers. Causing delusions, hallucinations, and paranoia, PPP is a mental health emergency that puts babies’ and mothers’ lives at risk.
With proper treatment, including inpatient care, PPP can resolve within a few weeks. However, left untreated, PPP can persist for months, and tends to worsen in severity over time.
While PPP is rare, many women struggle with their mental health in the postpartum period, with shifting hormones, sleep deprivation, and the overwhelming responsibility of caring for tiny human taking a toll on their emotional wellbeing.
Acclaimed novelist Jodi Picoult explores trauma and postpartum psychosis in her latest book, Hollow Bones, and offers readers a narrative look at a mother’s experience of PPP.
HRA: Your latest novel, Hollow Bones, centers around the lasting trauma of characters whose lives were changed by the terrorist attacks of September 11, 2001. In what ways do you notice our society continuing to be impacted by the collective trauma of this event?
Jodi Picoult: It’s the 25th anniversary of 9/11 this September, and I think if you were alive at the time of the attacks, you carry a memory of that with you, still. Everyone knows exactly where they were when the planes hit the Twin Towers. In that sense, every reader is bringing his or her own story to this novel, too.
As for the survivors of the victims — there are so many families who are still waiting, after all this time, for remains of their loved one to be identified. I also think there’s a psychological dissonance that feels very relevant at the current moment: 9/11 was also the last time that the whole world stood with America in the wake of a crisis. This country and the feelings it inspires worldwide are very different now, and that goodwill — and the reasons for its loss — are unsettling.
HRA: One of the characters in your book struggles with postpartum psychosis, a rare but debilitating maternal mental health issue. What inspired you to write about this topic, and what surprised you most in your research on postpartum psychosis?
Jodi Picoult: One in 500 women suffer from postpartum psychosis (PPP), a mood episode with psychotic elements like paranoia and auditory hallucinations. Those who suffer from PPP can hurt themselves or their children. More than half the women who have PPP have no previous psychiatric issues. Untreated PPP leads to a 4 percent chance of infanticide and a 5 percent chance of suicide. A person who has PPP may believe that the only way to save herself, and her child, is through death.
Although this clearly is a medical emergency, it is not listed in the DSM-V as its own diagnosis. Diagnosis is difficult — in part because the woman’s concerns can be dismissed by doctors as “new mother worries”, in part because one of the hallmarks of PPP is that a woman might be psychotic one moment and completely rational the next — which also makes it hard to defend from a legal standpoint.
The Lindsay Clancy trial has brought this condition front and center. What shocked me the most is that the way most PPP is diagnosed is that a woman who is suffering from it is misdiagnosed as having postpartum depression, is given an SSRI — and if she feels like she is being burned from the inside out and her thinking gets even more disordered, then she is diagnosed with postpartum psychosis instead. In other words, we make these women suffer even more to be diagnosed correctly.
Most PPP manifests between 1.5 months postpartum and 12 months postpartum, exactly when postpartum OB visits end; when a woman has likely not seen her PCP for a year; when ERs are equipped to handle crisis, not long-term care; when there is a four-month wait to see a psychiatrist — in other words, the system is set up in a way that fails women who are struggling. In a time when medical research grants are denied simply for having the word “woman” in the title of the study, this feels like gender discrimination in health care — one that begins with puberty and the onset of menstruation and continues through fertility, perimenopause, and menopause.
When I was researching this, I received a letter – out of the blue – from a woman in jail awaiting trial for the altruistic homicide of her child while she was suffering from postpartum psychosis. Believing that Satan was telling her to kill her child, she smothered her daughter, then left her wedding ring and a note for her husband reminding him of a pediatric appointment for their other child had the following week. She then tried to kill herself and did not succeed. She is white, educated, upper-middle class. She is hardly what we imagine when we think of a monster. Joelle (not her real name) asked me to be her voice. I know this book will raise a lot of awareness about postpartum mental health, and I’m glad for that. I just hope I did Joelle justice.
HRA: How does trauma shape this story, and how do your characters ultimately overcome it?
Jodi Picoult: Trauma is a hallmark in Hollow Bones, most notably in the main character of Molly Fitzgerald. She was 2 months old when her mother went to a doctor’s appointment on 9/11 and never came home. When we meet her 25 years later, she is the director of Emergency Preparedness and Response for the state of Rhode Island. She literally shaped her adult life around making sure others don’t have to feel what she did, in the wake of disasters.
HRA: What do you hope readers take away from spending time with Hollow Bones?
Jodi Picoult: That we lose people in our lives…but we also find ways to carry them with us.
