Supernatural Energy

I have a background in psychology and social work, and I’ve studied mental health disorders. But all that factual data did nothing to help me when I started experiencing symptoms firsthand.

Even if someone had handed me a leaflet describing postpartum psychosis (PPP), I would’ve disregarded it because I don’t fit the typical description. I don’t have a history of mental health conditions like bipolar, major depressive disorder, and schizophrenia, nor does anyone in my family. Okay, fine, I did just have my first child, I was experiencing hormonal changes, and I was enduring serious sleep deprivation — but doesn’t every new mother go through this?

On the checklist of potential causes is also lack of social support, marital conflict, and stressful life events. “That’s not me at all,” I would’ve said at the time. But the fact is, all three applied.

The chances of developing PPP are slim — out of every 1,000 women, only one or two will develop symptoms after they give birth. As it turns out, I was that “one or two.”

I knew something was off about my behavior, and so did Gavi, but we didn’t talk about it. We just figured I was going through a range of emotions due to normal postpartum hormonal imbalances.

Around 72 hours after delivery, the first signs of psychosis started. I began to feel a whirlwind of emotions; my body literally felt like it was riding a roller coaster with towering peaks and cavernous lows.

I was easily triggered by what was going on around me. When my grandmother called to wish me mazel tov, it somehow came up that a person I barely knew passed away. I sobbed uncontrollably for at least an hour afterwards. Other times, I would be laughing hysterically, making jokes in a manic fashion.

I became a chatterbox, talking with friends on the phone constantly, with no filter. I would leave voice notes for friends whom I hadn’t spoken to in years, discussing personal post-birth traumas or sharing that I was eating stewed prunes and cold brown rice at four a.m.

The symptom that hit the hardest was the insomnia. Even when I finally had help with the baby, I could not sleep. Believe me, I tried. But sleep would not come.

At this point, my husband knew something was very wrong. He kept urging me to rest, but I was incapable of sleep, so his prodding accomplished nothing. Eventually, I felt so much hostility toward my husband that I couldn’t even stand the sight of him. He responded by staying out of my way.

The night before the bris, a friend offered to watch our baby so both my husband and I could sleep. She encouraged me to take a sleep medication, but it barely worked because I had already become manic.

The morning of the bris, I woke up at the crack of dawn after very little sleep, full of supernatural energy. I heard music in my head; it was as if my life had a personal soundtrack. I smelled things that were not there. I remember there was a foul odor in the room but when I asked if anyone else smelled it, they looked at me strangely.

I didn’t attend the actual bris ceremony because I was so clearly unwell. I was brought to a different room and only people who wouldn’t trigger me were allowed to enter. I remember talking for a while with the rabbi who was our sandek. I babbled on and on and probably said a lot of embarrassing things.

As soon as the bris was over, a decision was made to bring me to the hospital. My close friend brought me there, while my family stayed behind with my husband to care for the baby.

The Psychiatric Ward

I willingly went to the hospital as I understood there was something wrong with me. In my agitated, escalated state, I was forced to sit in the ER for hours on end, waiting to be seen. If not for my devoted friend who stuck by my side the entire time, I probably would’ve had a panic attack. Finally, a psychiatrist came in to evaluate me. He ultimately decided to keep me in the hospital on a psychiatric hold for my manic symptoms and insomnia.

The process of patient intake was traumatizing. I was instructed to wait in a cold, dark, gray room, rid myself of all my personal belongings, and change into a patient gown.

They wanted to take my hat. My favorite gray hat. The hat that I always wore when I wanted to be truly comfortable. The only element of my Yiddishkeit that I could hold on to. To this day, I am grateful to my dear friend: Because she had stayed with me, she was able to advocate for me to keep that hat.

I don’t remember much else from that first day in the hospital. I was placed on a regimen of different antipsychotics and mood-stabilizers, the combinations and amounts being adjusted with the advice of a psychiatrist. I do know that they gave me an injection to put me to sleep.

When I woke up, I was in a completely different room, in a different section of the hospital. I had gone from being surrounded by my friends, family, and newborn son at the bris to being isolated in a strange place, with strangers, not knowing what was going on with me.

I wandered the halls of the psychiatric ward, talking manically to anybody who would listen. I had no filter and would share details about my birth story and my family with random people in the hall.

I started writing my thoughts in a notebook. I would write down my racing thoughts in the middle of the night when I couldn’t sleep and my mind was circling.

The timeline of events is blurry in my memory, but at some point, I began having delusions and obsessions. The most dominant obsession was about my son’s name. I had second thoughts about the name we had given him and desperately wanted to change it. I was also convinced that my son was Mashiach.

I had my siddur with me and I remember davening with tremendous kavanah. Everything in the siddur was crystal clear to me — all the words just made sense. (Even though I know I wasn’t in my right mind then, that memory is still very powerful for me.)

I believed I was the smartest, most famous person in the entire world. I started to become paranoid of others. I thought that I was in a conspiracy, that people were leaving me messages on the walls. Reality became upside-down. I became so agitated by one of my closest friends that I asked the nurses to refuse her entry to visit.

At one point, they took away my notebook and transferred me from the regular inpatient room to the PICU, a place meant for higher observation, for more dangerous and volatile patients.

Me. A frum young mother who, even in my heightened state, was never violent or aggressive, who never claimed to wish to harm myself or others.

My most vibrant memory of the PICU was waking up at dawn, pacing like a tiger in a cage. A tiger in a cage wearing a gray hat. I was starving postpartum, I had an insatiable hunger, and I wanted kosher food. At that early hour, they had nothing to give me that was kosher, so I waited, pacing back and forth, staring at the clock until the breakfast cart was brought around.

Being in the PICU was the most climactic part of my experience, where I suffered the most delusions and breaks from reality. I believed that I was living in a movie and that all my fellow patients were actors and actresses. I believed that I was a superhero who could freeze time.

I started writing on the wall in chalk, mostly because they had taken away my pen and paper, and that was the socially acceptable thing to do in that unit. I felt like a prisoner, locked in a place that I did not belong.

After several days, the medications began to work and my behavior normalized, so I was able to move back to the regular unit. With the help of sleep medication, my body finally recovered from the severe insomnia. The raging part of my internal storm had ended.

Recovering Me

The most severe, acute symptoms of PPP tend to last two to 12 weeks. For me, they lasted around six weeks — five of which I spent in the psychiatric ward. During those first initial weeks in the hospital, I was so out of it that apparently I wasn’t even asking about my son. It took a while to get back to reality.

Slowly, though, I began to recover my memory. I started to ask questions about my son and talk about him to anyone within earshot. I was given passes to see my husband, son, and parents for a few hours at a time.

Although my time in the mental health unit was difficult, it gave me the time and space I needed to heal. I was able to focus exclusively on my physical, emotional, psychological, and spiritual self.

When I finally got my pen and journal back, I wrote this down many times: “I need to be 100 percent better so I can care for my son.”

Once I was feeling more like myself, I began writing down a schedule of everything I needed to take care of myself, with the ultimate goal of being able to care for others. For the first time in a long time, I asked myself: “What do you need to be happy?” The list included things like eating well, davening, showering, exercising, and social activities. The next step was figuring out ways that I could practically work these into my daily schedule.

I had daily meetings with my doctor and psychiatrist to make sure I was doing everything I could to be healthy. Emotionally, I needed a tremendous amount of social support, which I got from the unit’s support groups and from visitors (mainly my husband, parents, and a friend who is a nurse).

There were also two public phones in the unit, which I used regularly to call family and friends. I felt compelled to talk and talk and talk about what I’d just lived through. It was the only way to process it.

Spiritually, I had my siddur and I davened when I was able to. Or I just spoke to Hashem from my heart. As the only Orthodox Jewish woman in the unit, patients turned to me as a “rabbinic” source. Because even when I didn’t know who I was, I was still attached to mitzvos — covering my hair, eating kosher, keeping Shabbos to the best of my ability. In the ward, I was known as “the girl with the gray hat” and it became part of my identity.

For my last Shabbos in the hospital, I hosted a seudah for my friends. I made Kiddush, sang songs just like I would at home, and even shared some of my food from Bikur Cholim. I was still the giving the person I’d always been, just in a hospital gown.

Before I left the ward, I identified three things I needed to be my best self: more friendships, more self-care, and more light.

I had been living in a dark basement apartment my entire marriage and the one thing I kept repeating to a friend when I was in the ER was that I couldn’t live there anymore, that I wanted to be in a place with light. Hashem answered my tefillos and, after recovering in my parents’ house for four months after my hospital stay, I moved into a beautiful, bright apartment.

Home At Last

The road to recovery was not easy. Just because I was out of the hospital didn’t mean I was cured. I was still on a high dose of medication, which caused me to feel exhausted during the day. After many weeks, I was finally able to reduce the dosage. I went off the medication entirely after a year.

I was so eager to leave the hospital that I didn’t anticipate how challenging it would be to come home. Instead of just focusing on me, I now had to reassume my roles as a wife and a mother, to factor in time to nurture my marriage and care for my baby.

The aftershock of PPP was perhaps more devastating than the psychosis stage. I had never dealt with mental health issues before and I couldn’t believe that someone like myself, who had always been firmly grounded in reality, could start hallucinating and having delusions. I was shocked by how easily it happened to me.

I dealt with postpartum anxiety for months and months afterward. (It typically takes six to 12 months to recover completely from PPP.) I remember feeling inundated by the responsibility of being a parent. The daily routine of motherhood was challenging for me, especially when we would reach new stages or milestones. Starting solid foods, for example — I felt like I spent my entire day feeding my baby and didn’t know what was considered normal. Little things that seemed trivial would trigger waves of anxiety.

Aside from the pharmacological help that I very much needed, the greatest source of healing came from the ability to speak freely without judgment and to be truly heard and validated — whether it was from my therapist, my husband, a family member, friend, or someone in the community who had been through a similar situation and could relate. I got a lot of chizuk from Chazkeinu, an organization that’s run specifically for frum women struggling with mental illness.

My therapist advised me to start a “joy journal,” where every day I would write down one thing that brought me joy. This daily practice grounded me and helped me see what I could be grateful for even on difficult days. Writing, in general, was an outlet for me — it helped organize my thoughts.

My experience with PPP permanently changed my identity.

It caused me to realize that I cannot neglect my own physiological needs, sleep being up at the top of the list. It taught me to tune in to my inner world, to focus on what my body is telling me, to advocate for my needs, and to reach out for support when I need it.

Being in the psychiatric ward with other “crazy” patients taught me that everyone is going through something, and everyone just wants to be heard.

Four and a half years later, I am a stronger mother and a deeper Jew. The trauma I went through taught me a foundational life lesson: I can endure intense amounts of pain — and still rebuild.

MY UNRAVELING, MY BECOMING

Miriam Simmonds

I lie there, cuddling my beautiful hours-old newborn son.

I had been dreaming of this moment since I found out I was expecting my first child. I had spent my pregnant days in a mesmerizing state of serenity and connection, meditating, talking to Hashem, talking to the baby in my womb. Sometimes I’d allow my mind to wander to the first beautiful moments with my future baby, to all his firsts, to those initial months full of newborn cuddles when I’d be able to revel in the explosive happiness of sharing the world with him.

But this, this I did not expect at all.

A torrent of terrifying and hysterical thoughts  scream in my head. My precious baby, he’s stopped breathing! Someone help me! I’ve lost him!

Even when I’m holding my son close, I’m gripped with panic. Is he breathing? Check. Is he still breathing? Check. Is he still breathing? Check.

Later, in the recovery room, I doze off. When I awake, I panic. Where is my baby?! He’s gone, he’s not here anymore! He’s been taken!

It is unhesitating, unstopping, constant. This was not part of the dreamy newborn stage I’d heard of.
A nurse knocks on the door. She’s here to take my baby to the nursery for six hours and feed him because I’m struggling with nursing. “Now you can catch up on sleep,” she says warmly.

Inside, I fall apart. He’s not feeding, he’s starving. He’s dying. I’m doing this to him! And now look — they’ve taken him. They’ve swapped him with another baby. He’s gone, he’s gone!

In this postpartum state, I am at my rawest, most sensitive, and most primal. Every new terrifying thought breaks me, suffocating any hint of joy. I am drained physically, drained mentally.

But I don’t vocalize my intrusive thoughts. I am too consumed with postpartum pain and figuring out how to take care of a newborn infant. My husband and I feel helpless. We are first-time parents, living in Israel, far from our family in England.

I’m supposed to sleep when my baby does, but instead I’m on high alert. The anxiety pulsing through my body robs my body of much-needed sleep. I look around the hospital room in a state of complete shock. What has happened to me? Outside the window, people are walking around as if nothing has changed.

 Oh, no! An armed man is making his way toward the hospital! It’s a terrorist attack, my whole world is about to explode!

 Every single moment brings another wave of destruction, opens a whole new world of danger. Rationale tells me that my fears are statistically highly unlikely. The panicked voice in my brain, however, I completely believe. Logic makes no difference to my new reality.

A Deafening Voice

As the days turn into weeks, my intrusive thoughts only grow wilder and more imaginative, steadily manifesting into my whole life. Everything around me has suddenly become dangerous, potentially lethal. Every single day I truly believe will be my last, since my brain repeatedly tells me so.

It isn’t a quiet voice whispering in my head; it’s deafening, all-powerful, insistent. It feels so real, so terrifyingly clear, that I don’t even consider the idea that we might all be okay.

Finally, time to sleep. But when you open your eyes again… you’ll be blind.

And that was the last time you’ll see your son’s smile.

Did I lock the door? I hear footsteps…  Someone is coming in and making their way directly to my sleeping baby….

I live with a constant, insurmountable fear that I, my husband, and my baby are in grave danger. There’s no break from my brain, not a single second to breathe and refocus. Every moment is simply catastrophic. I’m seized with terror for our lives, welfare, and happiness.

This is the last time you’re seeing your husband’s face; this is his final day in this world.
My son’s heart has stopped beating! I’ve neglected him, killed my own baby! The police are on their way to take me for questioning, as they should.

This obsession with our safety is followed by compulsion. I must keep my son safe, so I check the door many times to make sure it’s locked. I’m desperate to hear the “click” of certainty that it’s truly closed. I check to make sure no cars are outside of our home waiting to kidnap my family, and then I check again, and again. Danger lurks everywhere and I’m the only one who can keep my family safe.

Move the chair to the left! Run, quickly! Otherwise, your family will die. And it would be all your fault.
I needed constant reassurance that we were safe. I would repeat to myself again and again, “It’s okay, he’s alive. My baby is alive.” I flooded my husband with questions about the baby’s welfare: “Is he okay? Is he hungry? Do you think he’s too hot? Too cold? Do you think he’s in a safe sleeping position?”

I started saying “chas v’shalom” at all times, even when it didn’t make sense. I’d whisper it under my breath repeatedly like a ritual.

I couldn’t understand what was happening to me. Why did having a baby make my brain malfunction and explode?

Panic became the new norm, and the soft beat of my life morphed from a calm steadiness into a chaotic, unstable din. My head was a noisy, frenzied place to live in, and without a moment of quiet, I was drowning.

At the time, we were living on a small moshav away from family and friends, so we didn’t have a built-in support system. My husband tried to help, reassuring me as much as he could, not realizing that this just fed the obsessive-compulsive behavior even more. He reached out to whoever he could for assistance, not quite knowing where to turn.

As my world fell apart around me, I watched other women become mothers and seem to bounce back to themselves in no time. Why am I struggling so intensely to keep up? What’s wrong with me? Am I simply incompetent?

The smallest tasks become like Everest to me. I was incapable of making even the simplest decision. Something as inconsequential as choosing a parking spot would have me panicking. In fact, the smaller the decision, the more uncertainty I felt because the outcome didn’t matter that much.

I began to torturously obsess over my imperfections and shortcomings.  He needs a perfect mother. You’ll never be that!

My brain simply couldn’t coexist with incompletion, in any form. If someone sang the alphabet to me, but only up until X, I would’ve had a meltdown because you didn’t complete the Y and Z.

I didn’t sleep much. How could I? I had to be on high alert to protect my family. Every moment was about survival, and this fixation consumed my time, energy, and will. My house was in a state of disarray. I was barely able to care for my basic health needs. I cut my hair short simply because I couldn’t look after it.

The smallest trigger set off very real and terrifying birth PTSD. I spent my nights having to convince myself that I wasn’t in the delivery room anymore, that I wasn’t in labor, that it was all over, my son was born! I’d feel my empty stomach and start internally shouting, you’re home! You’re home! This is your room. You’re not pregnant anymore! Somehow, my now obsessive mind had led me to believe otherwise.

Hanging on to Hope

Finally, finally, after three months of debilitating mental anguish, I heard about Nitza, an organization that provides help for postpartum women.

I called immediately and began a dialogue with one of their representatives, who thought my symptoms sounded more like obsessive thinking than anxiety. I hadn’t considered this, and my initial response was doubt and confusion.

Isn’t obsessive-compulsive disorder just another way of saying someone is incredibly clean and hygienic? Surely my messiness proves that I’m not OCD!

It was only when I started researching OCD that I realized I ticked almost every box for having an obsessive disorder. Incessant checking (to confirm the oven gas is off, etc.)? Yes. Asking for reassurance? Always. Repeating words in my head? Regularly. Thinking neutralizing thoughts to counter my obsessive ones? Every minute. Avoidance to prevent fears from actualizing? Yes. We lived on the second floor, but I avoided walking down the stairs with my son unless it was absolutely necessary because I was terrified I’d trip and he’d fall, bang his head, and die.

It took another three months before I was finally seen by an OCD specialist. Three months of unstopping, intrusive thoughts, and images that were suffocating me. Three months of hanging on to hope because even though I couldn’t see Hashem in all the pain, I trusted Him and knew He was holding my hand.

The OCD specialist in Jerusalem referred me to a psychiatrist, who diagnosed me and put me on a treatment plan of exposure response prevention, alongside medication, to help me recover fully. For the first time since birth, I felt relief. Finally, someone understood what I was going through and knew how to help me.

During that first session, everything was explained to me. OCD is a hereditary, neurological disorder that, in some cases, can lie dormant until pregnancy or birth. I discovered that OCD is something I’ve always had, just very subtly so I was unaware of it. Now, it had ignited.

Contrary to popular belief, OCD is not a character trait or quirk. It’s a misconception that one “can be a bit OCD.” It is a truly debilitating disorder that manifests into a person’s whole life. It’s a world where logic doesn’t apply, where you’re convinced that every deplorable, terrifying fear will actualize if you don’t do something to stop it.

It’s an incessant, relentless fear. You check to make sure the door is locked, but then feel compelled to check it again. And again. This constant checking temporarily relieves the anxiety you feel, but as I began to learn, it also feeds it.

The only way to combat my fears was to go through the torturous process of exposure therapy. I had to sit with my obsessive thoughts and feelings and leave them “exposed” so I could dwell on them. Then — and only then — would they dissipate.

Let’s say I heard a regular sound, like footsteps. My brain would immediately tell me that someone was coming to hurt or kidnap my baby. My instinctive response to this obsessive thought was to try to control, dismiss, or fight it — like lock the door (a physical compulsion) or reassure myself again and again that my son was safe (a mental compulsion). I couldn’t turn to my husband for reassurance anymore because my psychiatrist had explained to him that giving me reassurance was essentially enabling me.

Now, I had to learn to shrug and say, “Hmm, it could happen. Someone could harm or take my child. I can’t be sure that’s not true.” Then I had to sit with the fear — the terror for my baby, the uncertainty of his wellbeing, that nothing in life is guaranteed. These feelings would consume me, and I’d agonizingly wait for them to dissipate. And eventually, they would.

By repeating this process again and again, with every single obsession, I slowly rewired my brain back to regular function. Gradually, the deafening voice in my head became less frequent and less clear, like a distorted radio. It grew quieter and less believable.

Bit by bit, I healed. The weeks turned into months, and I slowly started to breathe again. The more energy I put into exposure therapy, the more results I saw. I began to enjoy being with my baby. I had moments where we were playing undisturbed by intrusive thoughts. These moments became longer and more frequent. I smiled again, laughed even.

Until now, I’d never parted with my baby for the fear that I would be killed, and he wouldn’t have a mother to raise him. But now I was ready to try taking a walk by myself. Those first few solo walks were unbearable. I’d come home hysterically crying, on the verge of a panic attack because of the fatal, harrowing scenes that would play out in front of me, taunting me, dancing nightmarishly across my vision.

Eventually, the terror and panic that unwaveringly washed over me became a stream rather than a raging river. Once a week, I’d go on a walk, and after pushing past the initial shock, I saw that exposure therapy truly, undoubtedly works. I discovered that if I ever had reassurance, whether it was from myself or others, the doubt or thought would just reappear, and keep doing so after being fed reassurance yet again. By taking away this compulsion and treating the actual obsession, the obsessions gradually came to a stop.

The work of exposure therapy was unsparingly brutal. I didn’t feel brave; I felt terrified. In those moments, I had complete bittur to Hashem to heal me. And He did. Beautifully. Hashem was my source of comfort and warmth, of stability and love at a time of real struggle. Our relationship deepened as I surrendered to Him.

In therapy, I delved deeper into my brain, uncovering hidden, subtle obsessions and compulsions that had been controlling me my whole life. I learned about the many faces of OCD, which can be entirely invisible to the untrained eye — people-pleasing, perfectionism, ruminating, and hoarding.

The less anxious and fearful I became, the more space there was for love and joy; for my carefree self to live again. I started being kinder to myself, accepting and even embracing my shortcomings and imperfections. I stopped running from my birth story. I started talking, and hearing of others who also struggled deeply through postpartum. I opened myself up, began to express, to succumb to the beautifully terrifying embrace of true vulnerability. My confidence was growing, building strength, building momentum.

But I learned that the journey of recovery is not a linear one; there will inevitably be bumps along the way.

Like during the rocket attacks last August, when my husband and I felt the ground rumble beneath our feet. My brain told me that we were going to die, but I did nothing to reassure myself or check my family’s wellbeing. I just sat with the fear. Another rumble. My husband pulled out his phone and rushed outside, where there was a view of central Israel. Rockets were being fired from Gaza. Booms and shakes could be heard in the distance as red alerts came flooding in.

I, however, stayed inside. Exposure therapy was so deeply ingrained in my being that I was surprised by my husband’s reaction. Isn’t checking not allowed? It took me a few moments to catch up and understand that this wasn’t an imaginary fear in my head — this was really happening.

Every few minutes, the ground would shake and my mind would pounce. I mentally made strategies of survival for my husband and baby and calculated how far the run was to the bomb shelter. I mentally checked every detail over and over. I saw the worst, over and over. The intense anxiety and panic were so familiar to me by now that it was somewhat comforting that this time, I wasn’t alone.

But whereas everyone else regrouped relatively quickly, I did not. I stopped sleeping, and felt like I was spiraling downwards, unable to keep up with the exposures. After 24 hours passed, I finally managed to sleep. Not even half an hour later, there was a resounding boom that rattled the windows by my head. I jumped up and ran to my baby. My husband quickly reassured me that we were okay — the Iron Dome had intercepted a rocket that was just over the valley from us, but we were okay.

I almost believed him before OCD drowned out his voice. I panicked. My body was shaking uncontrollably. I felt like I was suffocating and struggled to breathe. My hands flew to my neck to release the rope that was tightly wrapped around it, but they found nothing.

I spent the next few hours outside on the balcony, breathing in the fresh air and the starry night sky. I was in a state of panic, and my husband’s support was the only thing keeping me from completely losing control. Gradually, I was able to withhold from succumbing to reassurance and desperately trying anything to feel better. To truly put an end to the thoughts, I knew what I had to do.

With bated breath, I turned around and opened up to absorb all the doubt and uncertainty the universe could possibly contain. I encouraged it, stoked the flames, fully, uncompromisingly submerging myself. OCD was my battleground, and I was walking into the center and taking off my armor. True exposure.

And it dissipated.

Free of Fear

When my baby was 10 weeks old, I remember being told that I’m going to recover, I’m going to be happy again. I shook my head, unable to speak. I couldn’t see the light at the end of the tunnel; I couldn’t even imagine it.

Not even a year later, my baby is a huge source of joy rather than anxiety, of love rather than fear. I honestly didn’t know my heart was capable of this much love and happiness.

I no longer need to avoid triggers, because I can feel the distress and be okay with it. I can finally experience everything I dreamed of but was too terrified to do. Simple things, like taking my baby to the beach, to his first swimming lesson, or for a walk in the forest. I’m now able to leave him with a babysitter so I can go to the gym or see friends. For every single fearless moment, I am deeply grateful to Hashem.

My mind, once a terrifying cacophony of sounds, has grown silent.

I revel in the quiet.

The writer can be contacted through Mishpacha.

IS THIS NORMAL?

Ariella Schiller

M

ost new mothers feel hormonal, weepy, overwhelmed, or anxious during the newborn stage, so how does one know if what they’re experiencing is par for the course — or something to be concerned about?

“The more difficult thing about diagnosing perinatal disorders is that they’re not definitive,” says Mindy Karmel, director at Yad Rachel, an organization in Lakewood, New Jersey that offers a comprehensive program for women who are suffering from or at risk for perinatal mood disorders. “It’s not A plus B equals C. Some women have A and B, some have A and F, and some just have one pervasive symptom, and they can all be suffering from a prenatal or postnatal reaction.”

Mindy clarifies that, today, disorders are not categorized as “postpartum” because they sometimes begin during pregnancy, which is prenatal. Together, they’re called perinatal mood and anxiety disorders.

The list of possible symptoms for perinatal disorders is long and varied (see chart). “Not everyone can articulate exactly what they’re feeling,” says Mindy. “Some just say there’s this bad feeling in the pit of their stomach or they lack the vibrancy they once felt. Since symptoms ebb and flow, women can sometimes assume they’re imagining it or making a big deal out of nothing. And that prevents them from reaching out.”

When people hear of postpartum issues, they usually think of depression. “But perinatal disorders can also present as anxiety disorders,” says Mindy. “Women will call me and say, ‘I’m going crazy, I’m going to be taken away.’ Because anxiety can honestly make you feel like you’re losing your mind.”

What if you’re unsure whether your symptoms require further concern? “Our motto is: Speak up,” says Mindy. “If you feel something, say something.

“Look inside,” she advises. “Do you feel off? I don’t mean tired or hungry — do you no longer feel like yourself? Does something feel different for you? That’s a key point.”

Ask people around you for input, too. “Don’t try to be the sole judge of your own condition,” says Mindy. “There is such an awareness of postpartum issues today that chassan teachers and roshei chaburah discuss it with young husbands, and very often, it’s the husbands themselves who call up.”

Sleep, or lack thereof, can be a red flag. “As soon as you notice a change in your ability to fall asleep and stay asleep when the baby is sleeping, call your OB. There are organizations in our community waiting to help like Yad Rachel, Nitza, and Tikvaseinu. Even Monmouth Hospital has a program they designed after ours,” says Mindy.

Experts in the field typically look for three things: the frequency, intensity, and duration of a woman’s symptoms. The more frequent, the more intense, and the longer the symptoms last, the more urgent it is to get help.

Baby blues are short-lived, typically lasting up to two weeks (compared to up to a year for perinatal disorders), so if symptoms aren’t fading after two weeks, or they’re getting worse, that’s a sign to get help.

Early intervention is best. “After birth, symptoms of both baby blues and postpartum disorders can develop. So, if you’re not sure if what you’re experiencing is normal, reach out. For example, if you feel empty during normally pleasurable experiences, that can be an indicator that something is off.

“Every woman of childbearing age should be aware of perinatal disorders, but not afraid,” says Mindy. “These conditions are treatable and manageable. Women who are struggling should know that there is help, you’re not alone, and you will get better.”

THE STATS:

While baby blues are common — impacting around 85 percent of women — perinatal mood disorders are less frequent: one in every seven women may experience a perinatal mood change. Estimates vary, but according to the National Institute of Mental Health, postpartum depression occurs in approximately 15 percent of births. Postpartum psychosis and postpartum OCD are rare and present in just .002 percent of births.

ADVICE TO NEW MOMS FROM THE FRONT LINES:

“Motherhood can be an overwhelming time, especially for first-time moms. There’s a quote, ‘We shouldn’t call first-time moms “expecting” because they have no idea what to expect.’ I feel like this applies to motherhood in general.

It may look like everyone else has it all together and knows what to do, especially today where people are putting their best picture forward. But what you see on the outside generally doesn’t depict reality.

At a professional training, the presenter showed a picture of what postpartum is advertised to look like: white hotel sheets, mom in silk pjs with baby relaxing peacefully next to her. The reality picture: rumpled sheets, mom in spit-up stained pjs, didn’t shower in two days with a crying baby in her arms.

We need to adjust our expectations and recognize that it’s okay to sometimes feel overwhelmed with our responsibilities. Remind yourself that you’re doing your best and that ‘good is good enough.’ Practice self-care, send up a tefillah in your own words, and reach out for help. Being open and honest with other moms is a good way to put things into perspective. It can also be helpful to speak to kallah teachers, rebbetzins, or anyone you feel can be supportive.”

BE PROACTIVE:

There’s no way to prevent perinatal mood disorders, but you can be proactive.

*During pregnancy and after, make sure you’re getting adequate sleep and proper nutrition

*Prioritize self-care that leaves you feeling fuller

*Arrange for support and professional care as needed

*Arrange childcare for your other children

*Accept help from others, whether it’s meals, babysitting help, or more

WHAT I WISH WOMEN STRUGGLING WITH A PERINATAL DISORDER KNEW:

“You will get back to yourself one day. This is a process, a temporary one, and what you’re feeling right now is just symptoms of a mood reaction. This condition may make you feel different, but you are still you even if it doesn’t feel like it. Keep reminding yourself of your character strengths and who you were before this happened. You will be back there, im yirtzeh Hashem soon. Also, when you speak to other women who went through postpartum issues, remember that no two stories or circumstances are exactly alike. The idea is to support each other, not compare treatment plans.”

(Originally featured in Family First, Issue 856)