Tuesday, April 27, 2010

Postpartum Depression: A Silent Killer

by Katherine Scardino

I was horrified to hear in the local news that Houston is home to another mother who has killed her baby. Najres Modarresi joins Andrea Yates as another Houston mother who is now accused of the capital murder of her two-month-old son, Masih. As someone who grew up in an area and during an era where psychological issues were just not allowed, it has been an education for me to learn how serious postpartum depression can be for some women.

Hearing the facts of the Modarresi case, any rational person would be initially enraged. Ms. Modarresi first lied to police and accused “two black men” of accosting her and kidnaping her baby. This led Houston police on a wild goose chase for a couple of days, even to the point of issuing an Amber Alert for little Masih. Ms. Modarresi eventually led police to a muddy stream and pointed out where her infant lay buried in the dirt and muck. Autopsy results showed the baby's lungs contained mud and other particles, which means he had been buried alive.

It wouldn't be difficult for any normal person to wish Ms. Modarresi the maximum punishment for this crime. However, we have to remember all that our society learned during and after Andrea Yates’s two trials. Initially, Ms. Yates was found guilty of murdering her children. Then, after an appeal and a reversal, she was retried and found not guilty by reason of insanity in 1996. Andrea’s case had national appeal, and everyone seemed to have an opinion about her state of mind when she drowned her children. Observing the progress of the Yates case taught me about the seriousness of postpartum depression. I learned that there are four levels of depression: mild, moderate, severe and psychotic. It appears that a person can bounce into a depression at any one of those four levels at any time. The question a lot of people had about Andrea Yates had to do with her treating psychologist. Why didn't he see the severity of her condition?

It was reported that Ms. Modarresi was prescribed mood-altering prescription drugs. So apparently she also has a doctor who is, or should be, fully aware of her condition. How can this disease overcome a mother who is under medical treatment?

It is surprising to learn that around 50 to 80 percent of all women experience some degree of emotional problems following childbirth. Only about one in 1,000 new mothers graduate to the most extreme and rarest disorder, postpartum psychosis. The mildest form of postpartum depression, more commonly known as “baby blues,” usually lasts only a few weeks. If the moodiness lasts longer, the new mom may be suffering from a more severe condition, a mood disorder called postpartum depression. If a new mother experiences the more severe condition, she may lose her connection to reality. The break is debilitating and known as postpartum psychosis. There is no logic to this psychosis. The mother doesn't know right from wrong nor the consequences of her actions. She may feel that she is “saving” her child by killing him.

So back to the question of how the treating physician can fail to recognize severely depressed and psychotic patients. It's possible for the depressed mother to go to sleep slightly or moderately depressed and wake up in a psychotic state. This shift can happen quickly and be deadly.

If a new mother suffering from this type of depression doesn't get to a doctor before her symptoms escalate, it becomes more and more likely that a tragedy like the Modarresi case will occur. Then the mother is charged with murder or capital murder. Capital murder is applicable when the victim is younger than two years old; conviction carries the possibility of the death penalty. By the time she is sitting in front of a jury of her peers, the mother looks and sounds sane. She's been under psychiatric treatment for most likely a year or two. The jury looks at her and finds it hard to believe that this defendant was insane at the time of the offense. Insanity is a hard defense. But there is no doubt in my mind that at the time of the murder, Ms. Modarresi knew neither right from wrong nor the consequences of her actions. Unfortunately, nothing we do now can bring back this two-month-old baby boy.

The good news about the Yates case and now the Modarresi case is that women today are much more aware of the symptoms of postpartum depression. They can express themselves and explain their feelings candidly to their doctors without feeling ashamed and degraded, like they are the scum of the earth. These cases have given credibility to this dreaded disorder.

There is also hope for the future in recognizing and preventing postpartum depression. The Melanie Blocker Stokes MOTHERS Act was recently passed into law as part of President Obama’s healthcare reform bill. This act provides for research, education and screening for postpartum depression and related mood disorders. Hopefully, it will lessen stigma attached to maternal mood disorders and get more women the help they so desperately need before more young lives are lost to this disease.


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Anonymous said...

This was really a good article. It made me think about the case. I'd read about it in the Houston Chronicle. Thank you for putting it in context with the Yates case.