More Than the Baby Blues

While it is rare for a mother to kill her newborn, experts say 15 percent of all women feel depressed after pregnancy.

Many of us find it difficult, maybe impossible, to understand how any illness could cause such a horrific act — a mother, killing all five of her children. But “NBC Dateline” spoke to some women who say, while they would never do what Andrea Yates did, they do know some of what she was feeling. They understand, because they too have been there.

“AS I WAS changing my son on his changing table, an intrusive thought started running through my head, ‘What if I push him off the table?’” says Randy.

Stacey says, “If I just got up and walked out of the house and never came back again, I really believe that my daughter and my husband would be so much better off.”

Esther says, “I can’t live this way, this is hell. And I need to get some help.”

Karen says, “If a stranger comes in and abducts this child, am I going to cry? Because that means I love this child.”

These women know something about Andrea Yates that many of us do not. Their illnesses weren’t as severe as hers, but they say they understand the nightmare of postpartum depression.

They looked like a big happy family with four boys and a baby girl. But according to her medical records, Andrea Yates had a history of postpartum depression and psychosis. She had been hospitalized four times, most recently, last year in March and May following the birth of her youngest child, Mary.

On June 20, 2001 in a period of an hour, Andrea Yates drowned her five children in the bathtub of her home in a Houston suburb. She then called the police and her husband.

I said ‘Is anyone hurt?’ and she said ‘Yes,’ and I said ‘Who?’ and she said ‘The children,’” her husband, Rusty, said.

Many were shocked that a mother could commit such an unspeakable and inconceivable act. Yates’ lawyer says she was suffering from a very severe form of postpartum psychosis at the time of the killings.

While post partum psychosis is rare and extremely dangerous, postpartum depression — or PPD — is more common. In fact, experts say it affects up to 15 percent of new mothers.

CAUSE IS STILL UNKNOWN

There is no singular known cause of post-partum depression or psychosis. Some doctors think hormones might play a role, and experts agree that biological and social factors contribute to the illness. The biggest factor may be whether the mother or her family has a history of mental illness. The birth of a child could possibly act as a trigger for an underlying, pre-existing condition. Treatment involves drugs and therapy, and in severe cases, hospitalization.

These women say the depression they experienced was devastating, debilitating and very frightening.

“It still scares me that I got to that point,” says Karen.

As her family grew, Karen fell apart, and didn’t know why. Nine weeks after the birth of one of her children, maternal bliss dissolved into feelings of anger, guilt and depression.

Did Karen have any thoughts of hurting her children at any point? “One of my children, I did,” she says. “I would look at the baby and just say, oh, how vulnerable it is. I could put a pillow over the top of it. Its neck was so tiny, it could break so easily.”

She and her husband always wanted children so she couldn’t understand why she had those thoughts or where they came from and she was embarrassed to even admit she had them.

“I wanted to be the perfect mother, so therefore I was not going to show it to anybody,” saysd Karen. “I was too ashamed. I felt guilty.”

Karen says her depression got so bad, she couldn’t leave her bedroom.

“And I kept blankets on my windows,” she says. “And I kept a noise-maker in the room so I didn’t have to hear anybody. I was always curled underneath the comforters so I didn’t see any light.”

Randy, a mother of two, says she knew something was wrong when she had recurring thoughts of hurting her baby.

“After the thoughts started I sank into a deep, dark depression,” says Randy. “I was full of fear.”

What kind of obsessive thoughts? “Obsessive thinking — if I was going to hang a picture and I was holding a hammer with me I was frightened,” she says.

That she was going to hurt the baby with the hammer? “Yes,” says Randy. “I knew in my heart I was OK. I knew that I wasn’t going to actually harm him, but just the thoughts themselves were so frightening.”

But Randy says in the depths of her depression, the hopelessness was so overwhelming, she tried to harm herself.

“I was like starting to get suicidal thoughts at that point, and I was crying out for help and that’s when I took an overdose of the Tylenol PMS,” she says. “I just couldn’t live another minute at that point. I felt like I just wanted to sleep.”

For Stacey, the chilling signs of the depression began during her pregnancy.

“I would say, ‘Oh, we have to get clothes for it, and we have to get furniture for it,’” says Stacey.

She was really trying to distance herself in a way, and depersonalize the baby? “Yes,” says Stacey. “And then there were times that I said well, you know, if I had a miscarriage right now, I would be OK with it. So I cried throughout my whole nine months.”

Even though she said her husband was very supportive, three weeks after the birth of her daughter, Stacey started having paralyzing panic attacks — another sign, experts say, of postpartum depression.

“I was afraid to go to her bassinet and look at her,” says Stacey. “Because I had these weird, weird visions of her being blue and cold and stiff and dead in the bassinet.”

“It’s a very severe disorder that really needs very intensive treatment,” says Dr. Deborah Peel, a psychiatrist and psychoanalyst who is president of the National Coalition of Mental Health Professionals and Consumers, a group that opposes managed care for the treatment of mental illnesses.

Dr. Peel says the public needs to be better educated about this disease.

“Momentary thoughts towards someone that you love very deeply, momentary thoughts of wishing for their death are not abnormal. It’s when they’re persistent, and when they’re repetitive that you really need help.”

One thing that resonated during our interviews is the women are so ashamed of what they’re feeling.

“I think that’s not unusual,” says Dr. Peel. “Most of these women probably really wanted their babies so they may be even more puzzled that their feelings and thoughts don’t match up with their own expectations.”

DEPRESSION VERSUS PSYCHOSIS

When does someone know if they are suffering from postpartum depression? “If a woman feels very depressed, has trouble sleeping, concentrating, loses weight, has trouble having any energy for a period of two weeks or more, that’s serious enough to think of getting an evaluation from a mental health professional,” says Dr. Peel.

When does it become postpartum psychosis? And what’s the difference between that and just depression? “Well, psychosis means a disordered way of thinking,” says Peel. “A person might believe they heard voices or even heard God speaking to them. These thoughts can be very compelling, and powerful, and very, very disturbing.”

Andrea Yates was diagnosed with post-partum psychosis, and was in and out of psychiatric hospitals for almost two years before she killed her children.

According to her medical records, four months after the birth of her fourth child, Luke, in 1999, Yates took an overdose of anti-depressants. She told the doctor at a hospital she “... just wanted to sleep forever.”

Less than a month later, Andrea’s husband, Russell Yates, took her to another hospital. Yates admitted she was not taking her medicine, and was diagnosed with postpartum depression and psychosis.

She told the doctor she heard a voice, and then she saw an image of a knife. And something telling her “get a knife, get a knife.” Then she had a vision of “a person being stabbed.”

One of the doctor’s observations was chillingly prescient: “Apparently patient and her husband plan to have as many babies as nature will allow! This will surely guarantee future psychotic depression.”

SHOULD INSURANCE PAY FOR TREATMENT?

But why was Andrea Yates continually allowed to leave the hospital, even though, according to her doctors, she was not well?

Here is a note from the end of her first hospitalization. The doctor discharged Yates, not because she was better but “... because of insurance restrictions.”

She was discharged from the hospital because their insurance wouldn’t pay for it.

“We have what amounts to drive-by hospitalizations,” says Dr. Peel. “In other words, the amount of time she spent in the hospital really may not have been enough for the severity of her condition.”

Peel says though managed care advocates would say that improved drug therapy and outpatient care have reduced the need for long hospital stays, she maintains that the time authorized by most managed care plans, often just 10 days in a hospital, still isn’t nearly enough.

“Managed care selectively and deliberately cut the funding and the benefits for people with mental illnesses and addictive disorders in this country,” says Dr. Peel. “It’s deliberate corporate practice.”

Peel says it’s no coincidence that Texas, where Andrea Yates lives, ranks near the bottom in the U.S. for mental health care.

Six months after her fifth child Mary was born, and after two more hospitalizations, Andrea Yates drowned her children.

A jury found her competent to stand trial. If convicted, she could face the death penalty. Andrea Yates’ lawyer has entered a plea of not guilty by reason of insanity.

BUT IS DEPRESSION AN EXCUSE?

But some people don’t buy it. They believe Andrea Yates knew exactly what she was doing when she killed her children.

“I don’t think the fact that Andrea Yates was suffering from mental illness excuses her from accountability for her crime,” says Nancy Pftonhauer, president of the Independent Woman’s Forum — a conservative group that lobbies for gender equality and personal responsibility

“Society is coming close to anointing a politically correct rationale for killing our children,” she says. “And the idea that the thing we would anoint is a parent killing a child, when a parent should be held to a higher standard not a lower standard, it’s really appalling.”

And many find the death of 7-year-old Noah Yates particularly hard to fathom.

Andrea Yates reportedly told police she chased him down the hall and dragged him into the bathroom before drowning him.

“It’s unimaginable,” says Dr. Peel.

It’s almost unspeakable. “Yes,” she says.

She had these children and then she just took their lives. You can understand how angry people are at her?

“Absolutely,” says Dr. Peel. “It’s so horrific, I really understand what would make you feel that way. But if you, or if we, had a chance to understand what was in her mind, what she was feeling like, it might make a difference. If five dead babies and this tragedy don’t show us that our nation needs to have effective, real mental health care available for everyone, I don’t know what will. I don’t know what will.”

The women “Dateline” spoke to say they were horrified when they heard what happened that Wednesday morning outside of Houston, but they say they can understand how it might happen, and have sympathy for Andrea Yates.

“When I had postpartum depression, I was not myself,” says Mirium. “So I can fathom the fact that someone can do that to their children not because they want to, but something has taken over them. They are not in control.”

“I cried for the father, I cried for the children and I even cried for the mother,” says Stacey. “Because you know, I hope to God that she’s getting treatment now, but she’s going to have to live with this for the rest of her life, the thought she — knowing that she killed her children.”

These women also say they know from personal experience how much this mental illness is misunderstood. Some people might be saying, “Oh, please.”

“Oh, they are,” says Karen.

It’s the sentiment of, “These are just a bunch of whiny, neurotic mothers. Oh, please.”

Karen says, “I wish. I wish we were. Stand in our shoes and you try to go through what we went through,” says Karen. “It is the hardest thing to go through. That’s what I tell them.”

And they say their biggest comfort has been the support of their families and other women who have been there.

“I feel like I almost made like a promise to myself when I was going through it that I was going to get the word out,” says Randy. “It’s so important to let people know how real that this disorder is. It’s serious, and to encourage people to get help and get the right help.”

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For more info on depression, visit the HealthyPlace.com Depression Community. On the left-hand side, read through the sites and conference transcripts. On HealthyPlace.com Radio, we've done several shows on depression and anxiety. Listen to them in our 2002 and 2001 archives. Our specific show on postpartum depression aired on September 7, 2002. And if you have some comments to share right now, post them on our bulletin board.