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Tuesday, September 14, 2010

Treatment Tuesday - Postpartum Psychosis

This week's ultra awesome character assessment (meaning, the character was awesome, not necessarily the assessment) is courtesy of Steena. Her character works at a car dealership as a receptionish. She's a tad overweight, cheerful, friendly, always optimistic, and bubbly. She doesn't have close friends, but many acquaintances. Everyone believes she lives for her two children, a boy and a girl, age 4 and 3.

What they don't know is that her children are dead. Their bodies reside in a beautiful wood chest in a padlocked room in her house. But in her mind, her children, who died within days of being born at home, are the age they would be in the present day. She drives a minivan with 2 car seats. She's got toys all over her house and yard, 2 bedrooms, and kiddie clothes galore. Her neighbors often compliment her on how quiet her children are - they never see or hear them. She's got large shrubs that shield her backyard from people looking in.

Steena wants to know: Would it be right that she is dealing with postpartum psychosis? She carries pictures of 2 beautiful children on her, takes sick days for them, talks about them all the time...and at home she carries around 2 beautiful dolls. Can you help me with her?

[rubs palms in delight] Looking forward to this one, Steena!

What you've described sounds like the extremely rare Postpartum Psychosis...but according to the Diagnostic and Statistical Manual (4th edition, text revision), the actual technical name for that is Psychotic Disorder Not Otherwise Specified. She doesn't meet the more usual criteria for Brief Psychotic Disorder, postpartum onset, because of the time line her symptoms for 4 years. Nor does she fit with the Major Depression, postpartum onset, because of her cheery disposition and demeanor.

This disorder is very rare, usually considered to occur in about 1 of 1,000 births. The general mode of treatment would be antipsychotic medication administered until the symptoms subside, and then regular counseling. usually psychosis is accompanied by severely disorganized behavior, thought, and speech. Your gal doesn't have this (I assume), so one more reason to put her in the Not Otherwise Specified category.

My first question is why have one child 4 and the other 3? I assume you have the same medical problem that caused their death for each? Did she pretend the boy was alive during that first year? Or did she all of a sudden believe they were both alive after she lost the 2nd one? For reasons I go into further detail below, I'd consider twins. 

I'd want to know if she actually sees the dolls as her children and talks to them at home as if they were alive. The skeletal remains were surely placed there and venerated by her, so my first question to you is whether she actually knows they are dead. If she actually sees the dolls as her real children, believes they are sitting in the empty seats in her minivan, and converses with them and hears their responses, then she's having full-on hallucinations. She wouldn't fit for Schizophrenia, though, because she would need other symptoms to go along with the hallucinations, and she doesn't have them. She is described as a high-functioning person.

You mentioned you were thinking of having her married or a single mother. I think it would make for a more interesting backstory if you had her married. When couples experience the death of a child, either through a stillborn or SIDS or some other health problem, it causes a tremendous strain on the marriage. The mother's body has all these hormones present to enable her to connect with a baby who is not present. The grief can be overwhelming.

It was be more than feasible that the husband could have left her due to her ongoing psychosis regarding the lost child....but that would only really work for the first child, I guess. This is why I would consider twins and her losing them both at the same time. But regardless of how you figure it out, adding that layer of a failed marriage would make her psychosis that much more believable. Her way of handling his deflection could be to hang on to these children with a fierceness.

One of the best Law & Order: Criminal Intent episodes I ever watched that you are definitely going to want to check out was from Season 4. "In the Dark" features a woman who believes her child is still alive, but the child actually is still inside her womb as a "stone baby," also called a lithopedion. Such an interesting phenomena, and of course very sad, but pretty much what you are describing as far as belief your character's belief that the child is alive and well. Check it out at this link.

This character sounds fascinating. If I had a blog award for one the coolest character I've done, you'd get it. Hmm...that sounds like a good idea! Maybe I'll work on that. Thanks for writing in!

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist (at) hotmail (dot) com.

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Stina said...

This sounds great! I can't wait to read Steena' book (I'm one of her beta readers). :D

Steena Holmes said...

Jeannie - thank you!!! I've been wresting with her character because I'm not sure if she's believable or not. What if she were a high-level exec who has complete control at work but then falls apart at home and believes her child/ren are still alive? Would that be more believable? In my head, I have her carrying her a doll around at home, conversing with it, taking care of it - perhaps even speaking with her dead/left husband ... things start to fall apart at home (she expects dinner to be ready, dishes done - they aren't) as well as at work - her normal in control, tight run ship starts to unravel ... would that make more sense? More believability than a bubbly, overweight receptionist?

I'm off to watch that episode! Thanks!

Nicole Zoltack said...

Wow, what a concept! How horrifically sad. I love kids so much so this really is like a nightmare to me. You might want to watch The Others with Nicole Kidman, Steena, that might help you as well. Good movie too.

Jeannie Campbell, LMFT said...

steena - you nailed it i think. that's the part that probably bothered me the most, but i didn't want to be too discouraging. if other aspects of her life were dysfunctional, and her inability to function became more apparent in other avenues, then you very well could have her wandering into the world of schizophrenia.

watch that episode and come back to the blog and let me know what you think. fascinating stuff.

Jeannie Campbell, LMFT said...

and nicole - i'll have to check that movie out myself. thanks for the recommendation and for stopping by!

Hannah said...

I agree with Nicole, The Others is a great movie! And it would definitely give you some additional insight. You should also check out The Orphanage.

Steena Holmes said...

Between Hannah and Nicole, I'm going to end up with nightmares!!

Jeannie - so I need to do a tad it of research into schizophrenia then ... I don't see a good outcome right now for her other than locked away in a room.

Vicki Rocho said...

Hidy ho...first time visitor came to eavesdrop on the couch session. Fascinating stuff! Adding you now....

Jeannie Campbell, LMFT said...

hi hannah and vicki! glad to have you! you can let the receptionist know if you are in need to schedule an appointment. :)

Jeannie Campbell, LMFT said...

steena - there are people with schizophrenia who operate just fine between medication and talk a locked room doesn't have to be her fate. but essentially she's got psychotic symptoms if she's behaving the way you envision her to be. she'd probably have some sort of breaking point which might land her in a psychiatric would be interesting to see her go to the emergency room with one of her dolls....she'd get a psych evaluation faster than you could snap your fingers. she'd probably be monitored, etc., and stabilized on meds at some point. if you need to talk further about it, drop me a line.

truly one of the most fascinating assessments i've had the pleasure of doing! i really should design some character assessment award. if i did, would you put it on your blog? i did create a new button that anyone can grab...but maybe something more unique?

Steena Holmes said...

I have questions - so I'll email - but I'd gladly accept the award ;) I'm glad you found my character fascinating!

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Both comments and questions are welcome. I hope you enjoyed your time on the couch today.