08/05/2026
⚠️Postpartum psychosis is a psychiatric emergency. It is also exceedingly unpredictable. Delusions can fluctuate, creating brief moments of lucidity marked by profound fear and fleeting awareness that something is terribly wrong. In those passing moments, can she ask for help? Perhaps. But we cannot assume she can. Psychosis often robs a woman of the very insight she would need to recognize her own suffering, let alone name it. Her silence may not be fear or shame. It may be that the illness itself has taken the words and the awareness along with it.
That is what makes this illness so dangerous. We cannot count on disclosure. We cannot rely on her to tell us. And if a lucid moment does arrive, and she does find the courage to speak, will we be prepared to respond with the knowledge and confidence to get her help at once?
We cannot know what has not been revealed, and psychosis may make revealing impossible. But we can become more attentive to what is only partially shown: a subtle shift in her manner, a comment that doesn't quite fit, a silence that feels different from ordinary exhaustion. We can become more curious. We can ask the hard questions anyway, not because she is certain to answer, but because sometimes, in a passing window of clarity, she might.
Here are some of the hard questions to ask EVERY perinatal woman in distress and just as importantly, to ask those who are with her, since she may not be able to answer for herself.
- Does she or anyone in her family have a history of bipolar illness or previous psychosis?
- Is she talking or acting in a strange manner that is not characteristic for her?
- Is she unusually quiet and withdrawn, or speaking rapidly with little concentration?
- Does she claim to hear things or see things that others do not?
- Is she suspicious of others, or expressing concern that others are out to get her or trying to harm her in some way?
- Does she have a decreased need for sleep or food, and/or exhibit a high degree of confidence or an exaggerated sense of her capabilities or self-worth?
- Does she feel abnormally hyperactive, with racing thoughts and/or behaviors?
She may not be able to tell us what is happening to her.
That is not a reason to stop asking.
It is the reason we must keep asking.
