Tucked away in a Ziploc bag in Carol Blocker’s bedroom are 12 orange prescription bottles with her daughter’s name printed neatly across each one.
The labels have faded. The pain has not.
Melanie Stokes, Thiothixene, 5 MG. Melanie Stokes, Lorazepam, 0.5 MG. Melanie Stokes, Remeron, 30 MG.
Fifteen years after Stokes gave birth to the daughter she had named decades before, after she fell into a depression so profound doctors prescribed her the cocktail of pills, after she slipped away from her family to jump to her death from the 12th floor of a Chicago hotel, Blocker clings to the medication as a symbol of how little the world knew about the illness that claimed her daughter’s life.
Stokes’ public death, along with the suicides of three other women who gave birth only to take their own lives shortly thereafter, turned the spotlight on an illness that had been shrouded in mystery and stifled by stigma.
The past 15 years have proved to be somewhat of an enlightenment period for understanding postpartum depression and psychosis, though researchers and clinicians admit they still have a long way to go. The onset of smartphone technology and apps combined with more conventional hotlines and support groups have reached women who felt as though there was no way out of the darkness.
With increased awareness, the shame that for too long prevented countless women from reaching out for help is gradually receding.
Stokes, a pharmaceutical sales manager, and her husband, Sam Stokes, a doctor, had spent almost three years trying to have a baby. When Melanie realised she could be pregnant, she rushed to buy a pregnancy test and took it in the store bathroom. The joy carried through her pregnancy, but when Sommer Skyy was born in the winter of 2001, the postpartum psychosis took over almost immediately. Melanie was hospitalised three times in seven weeks before falling to her death.
Now 15 and soon to be a sophomore at a private school in Chicago, Sommer recently told the Chicago Tribune that she grew up understanding why her mother wasn’t around.
“I understood at a pretty young age that I didn’t have my birth mom and that I would never have a birth mom again,” Sommer said. “I understood that she died because of a disease, and I understood that other women get that disease as well.”
Postpartum depression affects 10 to 20% of new mothers and is believed to be linked to the sudden change in hormones after childbirth. The sadness, anxiety and mood swings are more intense and last longer than “baby blues,” which up to 80% of mothers experience. Stokes suffered from postpartum psychosis, the rarest and most severe of the disorders. It affects 1 to 2 of every 1,000 mothers and is marked by paranoia, hallucinations and delusions.
Sommer was still in elementary school when she learned that women should be screened for postpartum disorders after giving birth. Understanding the mental illness, she said, kept her from harbouring anger at her mother for leaving when she was three months old.
“I know she loved me,” Sommer said. “I don’t know the extent that she loved me, but I know that she loved me.”
In a lot of ways, Sommer’s life mirrors that of many of her peers. She speaks quickly, does well in school, plays the piano — though she doesn’t practise as often as her great-aunt Joyce Oates, with whom Sommer lives, would like. She’s obsessed with Harry Potter and cringes when she remembers just how infatuated she once was with One Direction.
With her high cheek bones, deep brown eyes and determined spirit, she is her mother’s daughter. Sommer’s father, who lives downstate, is a steady presence in her life. Blocker, the grandmother who has advocated for postpartum depression awareness and reform from the moment of her daughter’s death, is affectionately referred to as Sommer’s “protector.”
“I have a lot of love in my life,” Sommer said. “A lot of people helped raise me. Not having a mom is hard. There is no stronger bond than mother and child. But the heartache has helped me help other people.”
Melanie Stokes was one of two women featured in a 2003 Chicago Tribune series on postpartum disorders after a cluster of suicides in the Chicago area. Jennifer Mudd Houghtaling, whose postpartum depression led her to jump in front of a Red Line train nearly three months after her son was born, was the second.
Following Mudd Houghtaling’s death, the Mudd family made a donation to Evanston-based NorthShore University HealthSystem to create a perinatal and postpartum disorder programme that helped the health care system emerge as a leader in the field.
More than a decade later, the ripple effect of the family’s donation shows no signs of waning.
More than 7,600 women have called NorthShore’s free, confidential hotline, known as the MOMS line, which was funded through the donation and is staffed 24 hours a day, said Jo Kim, director of the perinatal depression programme.
“It’s still a one-of-a-kind resource,” Kim said. “We get calls from all over the US and all over the world.”
Kim was working the hotline in 2008 when she answered a call from Katie Karsten, who had given birth to her second child in two years.
Karsten remembers getting hit with a wave of sadness in the hospital after delivering her daughter, Annika, but she dismissed it and tucked away the flier from the social worker with the MOMS number. When she went in for her six-week checkup, she again shelved the hotline information.
“I was skeptical,” said the Arlington Heights mother, now 40. “I had never called a hotline before, and I remember thinking, ‘How is a person on the other end of a hotline going to help me? They don’t know me or my situation.’”
A week passed. Then one afternoon while her kids napped and the house was still, Karsten was overcome with panic, desperation and fear. She collapsed to the floor and began to sob.
In that moment, she picked up the phone and heard Kim’s voice. The clinical psychologist listened, took down Karsten’s insurance information and set up an appointment with a doctor within the week.
“She didn’t make me feel ashamed,” Karsten said, her eyes welling with tears all these years later. “She said I wasn’t strange. I wasn’t a bad mother. She said they weren’t going to take my kids away.”
She began seeing a therapist regularly. Every year on her daughter’s birthday, Karsten sends Kim an e-mail of gratitude. “I don’t know what would have happened if I did not call,” Karsten said. “I can’t say for sure I would be here today.”
She feels a similar appreciation toward the Mudd family, which declined comment for this story. “It saved my life, and I’m sure it saved others,” she said. “I thank them wholeheartedly.”
Chris Beer also credits the hotline for saving her life four years ago. Her husband, Matt, made the initial call when he saw the radical change in his wife, a successful trader accustomed to leaving her Wilmette home every morning to catch the 5:40 train into the city.
“When you look at it from the outside, I had a great husband, two healthy kids and a great job, and you ask, ‘Can’t she snap out of it?’” said Beer, 34. “I couldn’t just snap out of it. I was holding it all together but I was pretty fractured on the inside. It’s not as easy as it may look in the Pottery Barn catalogue.”
Beer, who grew up in a working-class family on Chicago’s South Side, said she felt guilty that she had everything she wanted but could not stop the flood of tears. A perfectionist, Beer found herself waking up at 2:30am to slice fruit for the kids and fold laundry into neat piles. She couldn’t sleep. The anxiety was crippling. When she looked down at her baby girl, her heart did not warm with compassion.
After her husband dialled the hotline, he handed her the phone and she began to describe her despair. The social worker who took the call created an action plan for Beer, followed up with phone calls and set up doctor’s appointments.
Beer took a break from work and entered an intensive outpatient programme for eight hours a day, five days a week, for two months. Getting better became her new job.
In addition to therapy and medication, she incorporated exercise as a major component to her treatment. She still does barre and yoga four times a week and takes frequent walks throughout the neighbourhood. She’s back in the trading pit at the Chicago Board of Trade.
When she looks at her daughter, Kate, now, she is awestruck.
“She is happy,” Beer said. “She is loving. She is funny. She completes our family.”
While the diagnosis and treatment of postpartum disorders have evolved markedly since Stokes’ death, the past five years in particular have included dramatic advances. Through technology once reserved for games and coffee orders, researchers have connected with tens of thousands of women. At the University of North Carolina at Chapel Hill, Dr Samantha Meltzer-Brody aided in developing an app to help her study the possible genetic component of postpartum depression in hopes of understanding its causes and risk factors.
The app, PPD ACT, launched in March, and 10,000 women signed up by April, said Meltzer-Brody, director of UNC’s perinatal psychiatry programme. The app screens women for postpartum depression, refers them for treatment as needed and helps identity women for follow-up DNA testing.
“Using technology and social media is really going to be a critical and very powerful tool for reaching people in ways we haven’t before,” she said. “You get a very different section of the world. When you’re using technology, you can reach any person, anywhere.”
NorthShore’s Kim also recognised the limitations of pen-and-paper screenings. Her group teamed with a University of Chicago statistician to develop a mobile health initiative that can electronically screen women for postpartum disorders and then follow up with supportive text messages. Texts might suggest things such as “plan one pleasurable activity for you and your baby to do tomorrow” and “no mom is perfect.”
With the passage of a state law in 2007, Illinois became one of only a handful of states that requires women to be screened after they deliver. That marked the start of routine postpartum depression screenings at many hospitals including Chicago’s Stroger Hospital, where the majority of patients are low-income, said Dr Andrew Segovia Kulik, chairman of psychiatry for the Cook County Health and Hospital System.
While not all screenings are done electronically, they are frequent. Women typically are assessed at least four times, beginning with their 20-week prenatal appointment, then after delivery, during the baby’s appointment with a pediatrician and again at six weeks after labour, Segovia Kulik said. We’ve come a long way,” he said.
Mothers at Edward-Elmhurst Health, which includes Elmhurst Memorial Hospital and Naperville’s Edward Hospital, also are screened multiple times and encouraged to attend the Nurturing Mom support groups, said Linda Huelke-Pfleger, behavioural health integration co-ordinator. Like many in recent years, Huelke-Pfleger has shifted from the term “postpartum depression” to “perinatal mood disorders,” which encompasses the period before and after birth and goes beyond depression. That’s important because anxiety often shows up during pregnancy, not just after, she said.
“It’s a hard time to have a family,” Huelke-Pfleger said. “Since the recession of 2008, lots of dynamics have changed. There are more single parents, more economic stresses, and women are not staying home anymore.” — Chicago Tribune/TNS
MEMORIES OF ANOTHER DAY: Katie Karsten plays outside with her kids at their home in Arlington Heights. Karsten suffered from postpartum depression after having two children within 20 months of each other in 2008. She reached for the helpline and was subsequently cured of the condition.
