“Afraid her child would be taken away, Emilia told no one about the horrors in her head. She believed that by avoiding the triggers, she could keep the morbid images at bay”
Photo: Edvard March/Getty Images Not long after her baby was born, in February of 2016, Emilia began hiding the knives. She and her husband had a standard set — a serrated bread knife, a small paring knife, two larger ones — and she tried to avoid them altogether. Instead of cooking, she often asked her husband to pick up a pineapple pizza from Papa John’s or tofu curry from the nearby Thai restaurant.
Around this time, something else began to trouble her, something so distressing that she could scarcely acknowledge it to herself. If she caught a glimpse of a knife, in the drawer or left out on the counter, unspeakable images flooded her mind. She felt the presence of a “dark force,” she told me — a premonition that something was going to take over her body and she would stab herself in the belly and kill the baby. It felt like PTSD in reverse: a pre-traumatic flash-forward.
Afraid her child would be taken away, Emilia told no one about the horrors in her head. She believed that by avoiding the triggers, she could keep the morbid images at bay. The knives remained buried; she’d never give her son another bath. But she thought she might be going crazy. We tend to associate OCD with certain textbook symptoms, such as excessive hand-washing or lock-checking. But it actually takes a wider variety of forms. In some cases, it manifests primarily in intrusive thoughts of harm that are so unrelenting they become obsessions. The compulsions, in these cases, may be more internal, such as mental attempts to suppress the thoughts, or, as in Emilia’s case, avoidance of whatever seems to trigger them.
As an anxiety researcher, she was very familiar with the phenomenon. “We have kind of random thoughts all the time,” she says. “We only notice them when they carry some depth of meaning.” But she wondered how her reaction would have differed had she not happened to possess doctoral-level knowledge about the topic. Would she think she was a terrible mother, or worry that people would see her as a danger to her child? “Surely,” she remembers thinking, “there’s a way to turn this into a career.
But Abramowitz and Fairbrother saw it from a different perspective, through a cognitive lens. They perceived a logic to how OCD might develop postpartum even in the absence of hormonal chaos. Their hunch was reinforced by the fact that new fathers can experience OCD as well: Abramowitz co-authored case studies of several fathers with severe symptoms. One had images of shaking his baby violently; another had fears of losing control and harming his children when he was holding scissors.
But for parents who are predisposed to obsessional thinking — or perhaps, who have a hormonal susceptibility — the symptoms can become torture. One mother told me that she saw images of stabbing her daughter with scissors when the baby was on the changing table. “It just was going in a loop, over and over,” she said. “I felt like a monster.
Some mothers with frightening intrusive thoughts avoid their babies, which leads to a whole other obvious set of problems. But Emilia did not — on the contrary, she was more afraid that he would come to harm in someone else’s care than her own, and felt a compulsion to be with him at all times. “I felt like if I took certain steps, I would be safe and my baby would be safe,” she says. “But I couldn’t guarantee what anyone else was doing.
But, unbeknownst to Dr. Orlowsky, there was one thing Emilia kept to herself: her thoughts of harming her baby. She never even came close to bringing those up. Especially since she openly expressed her doubts about parenthood, what would people think? “You can’t go and tell anybody,” Emilia says. “You’re all alone.”
Emilia invited Fura to her home. In the living room, as her son played nearby, Emilia spoke about her anxiety and depression. After Fura put her camera equipment back in her bag, Emilia mentioned taking the metro. Fura said, “I could never have done that when I was pregnant. I would have thought, ‘What if I run on the track?’” Emilia looked at her. She told her that she had those kinds of fears, too.
To get to his office, she had to take a bus first, then a train, pushing her son in his gray UPPAbaby stroller. She was standing near the tracks, and a thought came, a ghastly vision. She could see herself pushing the stroller onto the tracks. “I could see people running to me and the police coming,” she says.
Emilia’s psychiatrist, Dr. Jeffrey Newport, told me that when mothers tell him about thoughts of harm to their children, “the thing that I look for is … how does she respond to them? If the thoughts are intrusive, unwanted, disturbing, she’s going to try to create some distance between herself and whatever that is.”
In January of this year, in Sacramento, a woman named Jessica Porten went to a postpartum checkup four months after giving birth to her second child. The next day she described her experience in a widely circulated Facebook post. “I tell them I have a very strong support system at home, so although I would never hurt myself or my baby, I’m having violent thoughts and I need medication and therapy to get through this.” Shortly thereafter, the police appeared.
Of course, better education could not only help distressed parents; it could also proactively prepare parents before birth. Abramowitz designed a prevention program targeted at women identified as vulnerable to obsessive-compulsive symptoms: those who exhibited certain cognitive biases such as equating thought with action. In a controlled experiment, the program was incorporated into a standard childbirth education class, helping participants to restructure their distorted beliefs.
Diana Wilson, co-founder of the U.K.-based nonprofit Maternal OCD, had severe OCD from an early age, and when she became a mother, her obsessions focused on harm to her children. After the birth of her fourth daughter, she finally sought help and participated in five sessions of cognitive behavioral therapy. “That was all it took to give me my life back after 26 years,” she told me.
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