We Should Not Need a Courtroom: Part Four

This is Part Four of a four-part essay. Start with Part One.

Part Four: We still do not know enough

The country had a version of this conversation in 2002, during the Andrea Yates trial. More than twenty years later, the research has not moved nearly as far as the outrage has.

Postpartum psychosis does not have its own diagnosis in the DSM. In October 2025, an international group of experts published a consensus statement in Biological Psychiatry arguing that it should be classified as a distinct condition within the bipolar disorders, with specific timing and criteria, so that it can be studied and treated as what it is. It still has no diagnosis of its own.

More research is needed, and it is needed for reasons that go beyond any single case. While the public was focused on the rarest outcome there is, the more common danger got almost no attention. Mental health conditions, including suicide and overdose, account for nearly a quarter of pregnancy-related deaths in this country, according to data from state maternal mortality review committees compiled by the CDC. That is where women are actually dying, and it is largely preventable.

Fear-based messaging makes this worse. If the only thing a new mother hears about postpartum illness is danger, she is less likely to tell anyone when something feels wrong, because she is afraid of what will happen if she does. What helps is women and families knowing the signs, and knowing that these conditions respond to treatment.

The most useful thing anyone can do with all of this is ask the new mothers in your life how they are really doing, and ask the people around them what has changed, because family often sees what a short appointment cannot. And if what you hear worries you, help her get to someone who specializes in this.

I say that as a woman who went through postpartum depression three times, and as a psychologist who refers perinatal care out every time.

If you or someone you know is struggling after a birth, call or text the National Maternal Mental Health Hotline at 1-833-852-6262, or 988 in a crisis.