With postpartum depression, empathy, not judgment, is needed

"This morning, I killed my own child."

The statement is unfathomable to us — the lucky ones who never have experienced postpartum depression.

While Shwe Htoo, 22, of St. Paul, had not been diagnosed with this form of mental illness when she spoke these words, I can't imagine that her actions were the result of anything else.

So, to the haters suggesting on social media that Htoo was a "piece of crap" mother who should have killed herself, I hold out hope that you will stay with me here, and learn something. Because you just never know when someone you love might face the same formidable — but treatable — mental health challenge.

Postpartum depression is not the short-lived "baby blues" that as many as 80 percent of new mothers experience within the first few weeks of giving birth. For that, treatment is not necessary, but emotional support and extra hands to allow Mom to sleep are exceedingly welcome.

Postpartum depression is more serious and long-lasting, affecting one in five new mothers and one in 10 new fathers. Symptoms include feeling overwhelmed, irritable and guilty, the latter due perhaps to a lack of interest in the baby and difficulty experiencing pleasure or joy.

In rare cases, a parent plunges into postpartum psychosis, which can lead to suicidal thoughts or bizarre beliefs about harming the baby. FBI data show that, on average, 450 children are killed annually by their parents. Mothers are most likely to kill newborns, and to do so on impulse. They tend to be younger themselves, most commonly ages 20 to 22.

According to the Ramsey County attorney:

On Nov. 17, Htoo prepared a mixture of baby formula, sweets, three sleeping pills and substances for killing bedbugs. She fed the mixture to her month-old baby. Later that night, she drank another preparation of the mixture herself. When morning came, and mother and child were still alive, Htoo covered her baby's mouth with both hands until he stopped breathing. The cuts on her neck, she told an officer, were from a kitchen knife she used to try to cut her own throat. When she didn't die, she got into her car and intentionally slammed it into a light pole.

I attended what was to be Htoo's first court appearance 10 days ago, but she was still hospitalized. I'm guessing the delay was not due to the knife cuts or even the car crash.

"We don't know anything about her mental health history and, possibly, there were other things going on that we don't know about," said Crystal Clancy, a licensed marriage and family therapist and co-director of Pregnancy and Postpartum Support Minnesota (PPSM).

"But her baby was about 5 weeks old, which is the most crucial and dangerous time. She was likely feeling very overwhelmed."

Clancy points to Andrea Yates of Texas, who drowned her five children in a bathtub in 2001, believing that she was saving them from Satan. Yates was diagnosed with "psychotic major depression" and has been in a psychiatric hospital since 2007.

Clancy fully appreciates that, for those of us looking in, "it is very hard to understand this."

Fortunately, understanding of postpartum depression is growing. PPSM was founded in 2007 by seven mental health providers, many with firsthand knowledge of the disorder. The website (­ppsupportmn.org) offers resources, education about risk factors, one-on-one peer support and a free help line.

"Sometimes, we'll just ask mothers to tell us their story and the other stuff comes out," Clancy said. "We'll say, 'You sound like you're feeling kind of overwhelmed.' A lot of times they'll cry. They'll say, 'Yes, that's true.' "

Most of her clients, she said, "need extra hand-holding, sometimes medication, sometimes a doula or yoga. Mostly they're looking for reassurance that they're not alone in feeling this way. And that this is going to get better."

"Within a couple of months, they're usually back on their feet, feeling more like themselves. A couple of years later, if they decide to get pregnant again, they come in and say they want to try to prevent postpartum depression this time around. That's a very rewarding part of working with this population."

Immigrant populations, however, may face added barriers and challenges to recovery, noted Sia Her, executive director of the Council on Asian Pacific Minnesotans.

Her also has been following the story of Htoo, who is a member of the Karen (pronounced Ka-REN) community, an ethnic group from the mountainous border regions of Myanmar (formerly Burma) and Thailand.

"My first thought was that she might be experiencing postpartum depression," said Her. But different cultural practices, fear of being ostracized and language barriers often keep young mothers from getting the help they need, she said.

"A sufferer might not even know that she is experiencing what we know as 'anxiety' or 'depression,' " said Her, who helped to coordinate a large mental health research project in 2004 and 2005 tracking a wave of Hmong refugees from Thailand.

In addition, many in Minnesota's immigrant communities fear the stigma attached to mental health challenges.

"They would try to explain it away," Her said. " 'It's nothing.' 'It's just me.' 'I can cope.' "

Like Clancy, Her sees progress in her communities' efforts to crush the stigma too long attached to mental health issues. "We have come a long way since 2004," said Her, whose state agency advises the governor and Legislature on issues of importance to the Asian Pacific Minnesotan communities.

"Stakeholders are much more aware of the specific challenges that refugee and immigrant communities are facing," she said, noting the work of community organizations such as the Wilder Foundation, the Ramsey County Crisis Team and the Center for Victims of Torture. "They're working diligently to chip away at the mental health barriers we see."

Still, Her has a wish list. More licensed mental health providers from cultural communities. More community leaders stepping up to say, " 'We can do better,' starting with learning to let go of the belief that someone with mental health needs is less than a whole person."

"I hope she gets the help she needs and in a sustainable manner," Her said of Htoo. "I hope we start asking ourselves, 'What is our role in minimizing the chances that unnecessary tragedies will occur again?'

"I hope that, when we talk about mental health issues, we recognize that that's not all there is to the person who is suffering," Her said. "We need to help them believe that there is hope."