It’s December 2015. On Thursday, Meghan Cliffel, a Lakewood native who was living in New York City, was a typical working mother with two daughters, one who was 8 months old. On that Friday, she became convinced everyone around her was part of a vast conspiracy to recruit her and her children into a dangerous cult. By Saturday, she was involuntarily admitted to Bellevue Psychiatric Hospital in the throes of a full psychotic break.
Cliffel did not know it at the time, but she was suffering from postpartum psychosis (PPP), a highly dangerous condition where a new mother experiences a rapid onset of symptoms including hallucinations, paranoia, delirium and a complete preoccupation with untrue beliefs. In a short amount of time, a new mom can become completely separated from her own reality. Symptoms manifest in as little as one day, and most often appear within a few weeks after a baby is born. Other times it can correlate to hormonal shifts, for example when a mother stops breastfeeding.
“I often say when I’m teaching that postpartum psychosis is the most serious, most emergent condition psychiatrists will ever see,” says Dr. Susan Hatters Friedman.
Friedman is a perinatal psychologist and the director of forensic psychiatry at University Hospitals. She has extensively researched and written about PPP and has partnered with Cliffel to raise awareness of this devastating condition through writing, teaching and speaking engagements.
“The big risks we think about acutely are suicide and infanticide,” Friedman says. “A good and loving mother begins having these false beliefs that seem so true, and they think they are saving their baby [acting on these beliefs]. Even if they aren’t trying to kill their baby to save them from these delusional beliefs, the confusion can be dangerous.”
Cliffel remembers feeling “not like myself,” but her overworked, overstretched life didn’t seem out of the ordinary for a working mother in the United States.
All of this changed in 24 hours. She felt unusually distracted as she got ready for work, and found herself narrating all of her tasks in order to complete them. Throughout the day she laughed more frequently, and as she left work to meet friends from out of town, she felt that her coworkers were covertly talking about her. On the subway, her suspicions increased.
“While I noticed a few weird things throughout the day, when I stepped on the subway, that’s when the floor dropped out,” she recalled. “I started to notice everyone’s eyes on me. I think, ‘They’re all looking at me because I have this orange hat on,’ but then people are meeting my eyes and immediately looking back to their devices and I believed I was being surveilled.”
Her fear and certainty intensified throughout her night. “I felt like everyone was out to get me. I tried to lose people, take off the hat, change trains and train cars. I started to realize a cult was after me for some reason, and my brain starts to knit every little detail into this new reality it created.”
As the night wore on, Cliffel believed everyone, from old friends to even her husband, were implicated in a plot to trap her and her children. After another sleepless night, there was no escape. In her mind, the only way to save her children was to pledge her allegiance to this nefarious cult, even if that meant running to the roof of her building to show she was willing to jump.
Fortunately, Cliffel’s husband was able to restrain her and called 911.
“The thing I would stress to a partner, or the mom’s own mother, is the importance of telling the doctor what’s going on,” Friedman says. “If the doctor just speaks to the mom briefly and she doesn’t want to say anything is wrong, they may not be convinced. The partner needs to speak up. In their delusions and fear, women may hesitate to be forthcoming. A trusted family member or friend can provide critical information to the care team, which can lead to a faster diagnosis and more immediate treatment.”
PPP is highly treatable, but not often recognized.
“The problem is a lot of people don’t know about this,” Friedman adds.
Despite its severity, its prevalence throughout history, and recognition in countries around the world, PPP is not listed in the Diagnostic and Statistical Manual of Mental Disorders, considered the gold standard in the United States for the diagnosis of mental disorders. It is often misdiagnosed, misunderstood, or simply missed until it’s too late.
“Researchers in the UK have been looking at the genetics of it at a chromosomal level. We are decades away from tests like that for diagnosis here. So, what we look at is, does this person have a personal or family history of bipolar disorder, a personal or family history of postpartum psychosis,” Friedman says.
However, she points out that while the presence of bipolar disorder can indicate an increased risk this is not always the case. Furthermore, bipolar disorder often becomes symptomatic in women in their 20s, around the same time many are having children.
It wasn’t until after a couple of months of her experience that someone told her she had PPP. It changed everything. “Once someone named what it was, it made it workable. I no longer felt I was fundamentally lost or flawed,” she says.
This knowledge was a major step forward, but her road back to herself was still long.
“The journey back was terrible. I was terrified,” Cliffel recalls. “Once you experience this, feeling like your brain can suddenly tell you this disastrous story, you feel like you can’t trust yourself. Couple that with my shame around addressing mental health at the time, it was terrible. I didn’t have any confidence in myself. Everything in my apartment was a trigger, and I couldn’t tell if I was believing it again or remembering it.”
Cliffel knows now that while PPP can’t always be prevented, existing in a culture that does not prioritize maternal mental health has a devastating impact.
She feels the lack of paid family leave; the absence of support systems; little awareness of dangers for mothers both within and outside of the medical community all contribute to conditions like PPP, postpartum depression, postpartum OCD and postpartum anxiety.
Together with Friedman, Cliffel has dedicated her time and energy to connecting with other mothers who have had similar experiences, writing and speaking about maternal mental health, and raising awareness about resources available to new mothers and their families.
University Hospitals also has a team of professionals offering support in both perinatal behavior health and reproductive psychology. Postpartum Support International provides support groups, expert education, peer mentorship, and a database of care providers for women to find the medical help they need.
Cliffel advises women to be proactive about knowing what resources are available, and whether or not they seem necessary. She also knows how important it is to prioritize maternal care, something that gets lost in the focus of new babies, readying nurseries, and balancing the demands of the outside world.
“We deserve our own care,” she says. “We must see centering our own wellbeing as critical and generous work, build a system around it, because it’s also centering our family’s wellbeing.”
