Grieving not Forgetting

August 25, 2015

We are heartbroken after learning yesterday about the death by suicide of PSI member and friend Naomi Knoles. Naomi was a remarkable person who seemed to radiate gentleness, light, and kindness. She had a combination of vulnerability and strength that simply taught all who met her. Naomi suffered from postpartum psychosis after the birth of her daughter Anna. She served 10 years in an Arizona prison following Anna’s death. After learning from her own tragedy, her support system, and her own research, she was compelled to help other mothers after her release. Everyone she touched learned from  her. At the PSI Conference in June, she quietly and honestly touched so many of us. Our understanding and inspiration were deepened through her blog and advocacy in Arizona and beyond.

It is so difficult to grieve after suicide. We all ask what we could have done to prevent it, how we might have better helped. We must turn those questions into our next steps, toward real efforts for all who are suffering. When someone has truly made the final decision to end their life, it is like a speeding train, nearly impossible for somebody on the outside to stop its rush forward. We want to impart to those in such despair that things will improve, that we are here to help, that “life holds you in its hands and will not let you fall.”  (Rilke) Please don’t give up, please stay. We will always endeavor to call the train of despair to stop, to find the switch to halt its speed. Most times we will succeed. You can find more about dealing with loss after a suicide on our website. If you need help now, do not hesitate to reach out for immediate support, or call our warmline 1-800-944-4773 for a supportive ear and local resources.

It is also very important to understand the differences between postpartum depression, anxiety, obsessive intrusive thoughts, and psychosis. Please read our section on postpartum obsessive compulsive symptoms to learn about the troubling anxious symptom of repetitive, intrusive thoughts and images. When present without psychosis or disordered thinking, this is an anxiety disorder and not a sign of psychosis or seen as a risk of harm. Many postpartum moms and dads experience this symptom and are frightened when they don’t know it is a symptom of anxiety. It is crucial that we understand the differences, and that those struggling with anxiety and intrusive thoughts are not frightened or ashamed to reach out. Call our warmline and talk to one of our volunteers for more information.

What do we learn now? How do we comfort her family and one another? Our hearts break in pieces for her husband and her whole family. Rivers of tears are being shed for this beautiful woman and her family’s grief. We know without a doubt that their love was profound and steady, and she felt it. It was not for lack of love or support that Naomi ended her life. It was her own private pain and despair. Despite love, her wisdom, and her faith, she decided to end her life. We imagine she followed a lethal path that she believed would lead her to unification with God and her daughter.

We also cry because so many of us know her pain and suffering, either as survivors of a perinatal mental health disorder, as family members, or as caregivers. Inside our perinatal mental health circle of support, we understand and are making strides to understand more and include the subject of postpartum psychosis, infanticide, and suicide in our conversations. But we know, painfully, that outside this circle of understanding modern society judges, fears, and harms the very people who most need help.

Here are the facts about postpartum psychosis, and you can read more on our website Get The Facts section on postpartum psychosis.

Postpartum psychosis is an illness that is unique to the perinatal time, and if treated appropriately and quickly, is temporary and treatable. Research suggests that psychosis occurs in 1-2 per thousand births, and of that number, a very small percentage complete infanticide — perhaps 4-5% of those who have psychosis. Although statistically rare compared to the more common postpartum depression, psychosis is the most extreme and serious perinatal disorder, and requires swift and experienced medical intervention. Unlike other psychiatric conditions with chronic and persistent symptoms, postpartum psychosis is temporary and treatable with psychotropic medication and intervention.

We have to understand this: When women with postpartum psychosis injure or kill their children, they are under the influence of uninhibited, irrational, compulsive action driven by delusional beliefs, confusion, and exhaustion. Women with postpartum psychosis do not hurt or kill their children because they are unhappy mothers or want to remove the child as a barrier. Please read our statement about crimes committed during postpartum mental illness for more understanding.

We understand that for the woman in the grip of psychosis the shadow-land of her distorted thoughts became more real and more compelling than any other reality, any other message from her family or moral code. We have to understand the internal chaos the psychotic woman is living through when she acts on what others call “the unthinkable;” that in the disordered thinking of a postpartum psychosis, she might believe that it is her imperative as a loving mother to end her child’s life so that the baby will go right to heaven, be saved from a dreadful life on earth, or in some cases “save the world.” It is not a rational state of mind; it is not a choice, it is compelled by internal, distorted beliefs.

What we have learned from women who have lost their child at their own hand during a postpartum mental illness is profound. We have learned in surprising ways about the depth of maternal love from women who have to survive infanticide; we grieve to feel the pain of the mother who was not able find her way without danger. We cry with families who have lost their daughters and grandchildren and we want them to know that they are not alone. Today I felt the support and virtual embrace of our PSI community and friends across the globe; I felt the strength and empathy in that support and want all who suffer to feel the same.

When we have lost such a mother it seems sometimes we can only cry, pray, and grieve, and comfort each other. Through our tears, we look up, we find one another, and we keep the work alive. Every mother is important, every family should have help when they need it, support before they slip. We might not be able to prevent the loss, the tragedy, but in the memory of those we have lost, we will certainly work in their names to do so. We send Naomi’s family, and all who have been wounded by this illness, great love. We are with you.

We will hold a special training “Maternal Mental Illness and the Law” seminar in New Jersey on October 23, with a dinner on October 22nd. Please consider joining us, and PLEASE let any attorney, judge, or law enforcement officer know about it. We have to improve — we have to help the criminal justice system do better, so that there is swift assessment and compassionate treatment. That is the kind of swift justice we need. Please contact me at the email below for more information about the seminar.

Wendy N Davis, PhD
PSI Executive Director