When Motherhood Doesn’t Feel Like You Thought It Would: Postpartum Depression, Intrusive Thoughts, and Why We Need to Talk About It
The Lindsay Clancy case has been difficult to watch. As a therapist, I find myself thinking about the mental health questions surrounding the case; postpartum depression, postpartum psychosis, medications, intrusive thoughts, and what happens when a mother’s mental health deteriorates after childbirth.
But I’m also watching it as a mother. And that part hits differently.
While my postpartum experience was very different from the circumstances being discussed in this case, I know what it feels like to become a mother and suddenly not recognize yourself. I know what it feels like to love your baby and still feel like you are failing at motherhood. And I know how scary it can be when your own brain doesn’t feel like a particularly comfortable place to live.
I Was a Therapist. And I Still Struggled.
When I had my daughter, I was living in Los Angeles, thousands of miles away from my family in Florida. We didn’t really have friends in LA who had children. There wasn’t a built-in group of women dropping by who understood what it was like to be awake half the night with a baby and then somehow be expected to function like a normal human being the next day.
I was isolated and exhausted. My daughter didn’t sleep much. And in one of motherhood’s crueler jokes, even when she didsleep, I couldn’t. People would say, “Sleep when the baby sleeps.” Excellent suggestion. Perhaps next you could tell me to “just relax.”
My body was exhausted, but my nervous system seemed to have missed the memo. I couldn’t shut down. I couldn’t rest. I was constantly alert. Underneath all of that was this growing feeling that I wasn’t doing motherhood correctly.
I felt like a failure.
There were times when I almost felt as though I were watching myself from above. Watching this woman go through the motions of being a mother. Feeding the baby. Holding the baby. Doing the things mothers do. It felt like I was playacting at being a mom rather than actually being one.
That feeling was incredibly unsettling. It was also incredibly lonely.
The Thoughts We Are Afraid to Say Out Loud
One reason the conversation surrounding the Clancy case matters is that it is forcing us to talk about experiences that women often keep secret. Postpartum mental health problems don’t always look like a mother crying in bed saying, “I’m depressed.”
Sometimes they look like anxiety, insomnia, hypervigilance, or feeling disconnected from yourself or your baby. Sometimes it’s being convinced that everyone else knows how to do this except you. Sometimes it’s wondering whether you’ve made a terrible mistake. And sometimes it’s having intrusive thoughts that scare you so badly that you become afraid to tell anyone about them.
Intrusive thoughts are particularly important to understand. An intrusive thought is an unwanted thought, image, or impulse that can appear suddenly and feel completely inconsistent with who you are or what you want. New mothers can experience frightening thoughts about something terrible happening to their babies—or even images of accidentally or intentionally causing harm.
For many women, the thought itself isn’t the only frightening part. It’s what they think the thought means about them. What kind of mother thinks something like that?
So, they don’t tell anyone. Because what if their partner thinks they’re dangerous? What if their therapist thinks they’re dangerous? What if someone takes their baby away? What if saying the thought aloud somehow makes it more real?
That silence can leave a woman alone with a frightened, exhausted brain trying desperately to convince herself not to think the very thought she is terrified of thinking. Anyone who understands intrusive thoughts knows how well that strategy tends to work.
Intrusive Thoughts Are Not the Same as Wanting to Harm Your Baby
This distinction matters enormously. An unwanted, distressing intrusive thought is not automatically an intention, desire, or plan. In fact, people experiencing postpartum anxiety or obsessive-compulsive symptoms are often horrified by their thoughts precisely because those thoughts conflict so deeply with what they value.
But postpartum mental health exists on a spectrum, and some conditions require immediate intervention. Postpartum depression, postpartum anxiety, postpartum OCD, and postpartum psychosis are not interchangeable terms.
Postpartum psychosis, in particular, is a psychiatric emergency. It can involve hallucinations, delusions, severe confusion, paranoia, dramatically altered behavior, or a loss of contact with reality. We need mothers, and the people who love them, to understand the difference. Not so that families can diagnose someone at the kitchen table, but so they know when something is wrong and feel empowered to say, “We need help. Now.”
I Got Help
My story got better. Not because I tried harder or finally figured out the perfect swaddle, sleep schedule, feeding schedule, or whatever else we were all supposed to be mastering.
I got help.
I went on Zoloft. Eventually, I was able to move back to Florida, where I could be closer to my mom and have the kind of family support I desperately needed. Slowly, I began to feel like myself again.
Looking back, I can see how much my environment mattered. We tend to talk about postpartum mental health as though it exists entirely inside a woman’s brain. And of course, biology matters. Hormones matter. Sleep matters. Previous mental health history matters. But so does support.
Human beings were probably never designed to have a baby, close the front door, and figure the whole thing out alone while simultaneously answering texts asking whether we’re “enjoying every minute.”
No. We are not enjoying every minute. Some of the minutes are terrible.
And saying that does not mean we don’t love our children.
What I Hope Comes From This Conversation
As I watch the Lindsay Clancy trial unfold and see the enormous amount of discussion surrounding it, I keep thinking about the women watching from home. The mother scrolling through videos at 2:00 a.m. while feeding her baby. The woman who hasn’t slept properly in days. The mom who keeps having a thought that terrifies her. The woman who loves her baby desperately but privately wonders why she doesn’t feel like herself anymore.
I especially think about the woman who recognizes some small piece of herself in conversations about postpartum mental health and immediately thinks, I can’t tell anyone.
She is the person I hope we are thinking about.
Because if the public conversation about postpartum mental illness only leaves mothers more frightened of admitting what is happening inside their heads, we have failed them. We need to create the opposite response. We need women to know they can say, “I’m not okay. I’m having thoughts that scare me. I don’t feel like myself. I can’t sleep even when the baby sleeps. I feel disconnected. I’m afraid of what is happening in my brain.”
And our response should not automatically be judgment or panic. It should be curiosity, careful assessment, compassion, support, and appropriate treatment.
Sometimes that may require urgent psychiatric intervention. Sometimes it may mean therapy, medication, sleep, practical support, or simply having someone knowledgeable enough to recognize what is happening. But we cannot help women who are too afraid to tell us the truth.
We Have to Get Better at Taking Care of Mothers
I have been a therapist for more than 20 years. I understand trauma. I understand the nervous system. I understand mental health.
And I still struggled.
Knowing what is happening intellectually doesn’t necessarily protect you when you’re exhausted, isolated, hormonal, overwhelmed, and trying to care for a tiny human who apparently has strong objections to sleep. What helped me was getting treatment and getting support.
That is what I want other women to know.
You can adore your baby and hate how you feel. You can be grateful and miserable. You can be a good mother and need medication. You can have a frightening thought without being a frightening person. You can need someone else to hold the baby while you sleep. And you can say that motherhood is not feeling the way you thought it would.
None of those things should have to be whispered.
If anything, good can come from the painful conversations happening around this trial, I hope it is this: we start asking mothers better questions, we listen more carefully to their answers, and when a woman is brave enough to tell us that something inside her doesn’t feel right, we make sure she doesn’t have to figure out what to do next by herself.
When to Get Help
One of the problems with postpartum mental health is that new motherhood is supposed to be exhausting, emotional, and overwhelming. So where is the line between “having a newborn is really hard” and “I need help”?
You do not have to wait until you are in crisis to reach out.
Consider talking with your OB-GYN, primary care provider, therapist, or another mental health professional if anxiety, sadness, irritability, guilt, hopelessness, or feeling disconnected from yourself or your baby is persistent or interfering with your ability to function. The same is true if you cannot sleep even when you have the opportunity, feel constantly on edge, are experiencing intrusive thoughts that frighten you, or simply keep thinking, Something about this doesn’t feel right.
Intrusive thoughts themselves deserve compassionate assessment rather than automatic assumptions about what they mean. Having an unwanted thought or image is different from wanting to act on it. A clinician familiar with postpartum mental health can help determine what you are experiencing and what kind of support or treatment would be appropriate.
There are also symptoms that should be treated as urgent. If a postpartum mother seems confused or disconnected from reality, is experiencing hallucinations or delusions, has become extremely paranoid or unusually agitated, is behaving in ways that are dramatically unlike herself, has gone for an extended period with little or no sleep while becoming increasingly activated, or believes she or her baby must be harmed, she needs immediate psychiatric evaluation. Thoughts of suicide or thoughts of harming the baby that involve desire, intent, planning, or feeling unable to maintain safety also require immediate help.
And perhaps most importantly: you don’t need to know what diagnosis you have before asking for help.
You don’t have to decide whether it’s postpartum depression, anxiety, OCD, trauma, sleep deprivation, or something else.
You can simply say:
“I don’t feel like myself, and I need someone to help me figure out what’s happening.”
That is enough.
