The trial concerning the murder of Lizzy Glancy in Massachusetts drew attention to postpartum psychosis, raising complex questions about maternal mental health and the consequences of untreated severe mental illness.
Lizzy Glancy, who previously worked as a nurse in an obstetrics and gynecology department, is accused of murdering her three young children in January 2023. Her defense claims she suffered from severe postpartum psychosis and was not criminally responsible for her actions, but the prosecution disputes this version.
As the jury remained deadlocked after six days of deliberation, the case reignited discussions about postpartum mental health. Currently, Lizzy Glancy is under investigation for the murder of her three children. The jury is set to reconvene on Friday, and no verdict has been reached yet.
However, for new mothers and their families, a broader lesson extends beyond a single court case. Postpartum mental health issues exist on a spectrum. 'Baby blues' are common and usually short-lived. Postpartum depression is more serious and requires treatment. Postpartum psychosis is rare but constitutes a medical emergency.
What is postpartum psychosis?
Postpartum psychosis is a rare and severe mental illness that can develop shortly after childbirth. It affects approximately one to three women per 1000 births and typically begins suddenly, often within the first two weeks after delivery.
Symptoms can include hallucinations, delusions, paranoia, severe confusion, unusually elevated or agitated mood, rapid speech, and a sharp decrease in need for sleep. A mother experiencing postpartum psychosis may believe untrue things or perceive things that others cannot. Furthermore, she may have very little understanding that she is ill.
This is what distinguishes postpartum psychosis from more common emotional changes that can occur after giving birth. It is not something that can be waited out at home; a woman exhibiting signs of psychosis requires immediate medical evaluation. The American College of Obstetricians and Gynecologists describes postpartum psychosis as requiring prompt medical attention. Postpartum psychosis is a medical emergency.
'Baby blues' are common
'Baby blues' differ significantly from postpartum psychosis. Many new mothers experience mood swings, tearfulness, irritability, anxiety, or feelings of sadness in the first few days after giving birth. Hormonal changes, physical recovery, sleep disruption, and the massive reorganization of newborn care can all play a role.
Generally, 'baby blues' start in the first few days after birth and pass within about two weeks. They are not considered a mental illness. The important point is what happens next: if low mood, anxiety, or other symptoms persist longer than two weeks, become more severe, or begin to interfere with daily life, professional healthcare should be sought.
How is postpartum depression different?
Postpartum depression, also known as postnatal depression, is more than just tiredness or emotionality after having a baby. It can involve persistent sadness, frequent crying, loss of interest in things the woman usually enjoys, feelings of guilt or worthlessness, appetite changes, sleep problems, and difficulties bonding with the baby.
Postpartum depression can develop gradually, but not always on a predictable schedule. It can arise during pregnancy or within the first year after delivery. Unlike psychosis, depression is usually not associated with a loss of contact with reality. However, severe depression can occur alongside psychotic symptoms, which is another reason why professional assessment is crucial.
Treatment may include psychotherapy, medication, or a combination thereof, depending on the individual's circumstances. It is extremely important to understand the difference between these conditions.
What about frightening intrusive thoughts?
This area deserves special attention because intrusive thoughts can frighten new mothers. Some women experience unwanted mental images or thoughts that something bad might happen to their child. These thoughts can be deeply distressing precisely because they are unwanted.
Having an intrusive thought does not automatically mean the mother wants to act on it or that she has postpartum psychosis. This distinction is significant. A person experiencing an intrusive thought generally recognizes it as unwanted and distressing. A person experiencing psychotic delusions, however, may accept the false belief as true.
This does not mean that intrusive thoughts should simply be ignored. If they are frequent, distressing, or interfering with daily life, a doctor or mental health specialist can help. Experiencing an intrusive thought itself does not mean the mother wants to act on it.
What causes postpartum psychosis?
There is no single cause for postpartum psychosis. Research has found a strong link to bipolar disorder, and childbirth can trigger the first episode of mania or psychosis in some women with underlying vulnerability. Sleep deprivation can also contribute to the onset of severe mental symptoms. Hormonal and biological changes after childbirth are also studied, but postpartum psychosis cannot be reduced to a simple explanation related to a sudden drop in hormones.
This is one reason why families may struggle to understand what is happening. A woman may have no prior history of serious mental illness and still develop postpartum psychosis.
Can postpartum psychosis happen again?
Experiencing postpartum psychosis once increases the risk of a recurrence, especially after a future pregnancy. A systematic review and meta-analysis from 2020, including six studies involving 645 women, showed that 43.5% had a course of illness limited to the postpartum period. In the remaining women, the first episode was succeeded by severe mental episodes outside the postpartum period.
Other studies have shown that relapse after a subsequent pregnancy can be high, particularly among women with a history of postpartum psychosis linked to bipolar disorder. This does not mean that future pregnancy is impossible; it means planning is essential. A woman with a previous episode should discuss future pregnancies with her doctor or psychiatrist before delivery to consider medication, sleep, support, and early monitoring.
What should families look out for?
The people closest to the new mother may notice changes before she does herself.
Warning signs can include:
- Surprisingly long periods of wakefulness without sleep, despite exhaustion
- Severe agitation or restlessness
- Rapid or unusually tense speech
- Severe confusion
- Hearing or seeing things that are not there
- Persistent beliefs that seem detached from reality
- Increasing paranoia or suspicion
- Behavior drastically different from the person's usual behavior
If such symptoms appear, one should not wait to see if it will pass. Postpartum psychosis is a psychiatric emergency. A woman exhibiting signs of psychosis requires urgent medical evaluation and should not be left to handle the situation alone. One sign to watch for is when a person does not sleep for a long time despite extreme fatigue.
How can families support a new mother?
Support begins before a crisis develops. Partners and family members can help by ensuring the mother has opportunities to sleep, sharing childcare duties, and observing significant changes in her mood or behavior. It is also important to create an environment where discussing mental health is not perceived as an admission of failure.
A new mother may be reluctant to admit she is struggling because motherhood is often portrayed as something women should instinctively control. This pressure can make asking for help difficult. If a mother seems confused, detached from reality, or highly agitated, arguing with her about what is likely untrue will not help. Calmness must be maintained, trusted family members should be involved, and professional help should be sought immediately.
Most importantly, a postpartum mental illness does not reflect whether she is a good mother. New mothers need all possible support. The case of Lizzy Glancy is an extreme and tragic example of why postpartum psychosis should be viewed as a serious medical condition, not just another form of 'baby blues'. For most new mothers, difficult emotions after childbirth do not escalate into psychosis. But when a woman's behavior changes abruptly or she begins to lose touch with reality, recognizing warning signs and getting help quickly can be critical. If you or someone close to you is experiencing difficulties with postpartum mental health, speak with a primary care therapist, obstetrician, gynecologist, or mental health specialist. In an emergency, go to the nearest hospital emergency room or call emergency services. The South African Depression and Anxiety Group (SADAG) can also provide mental health support at 0800 567 567.
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