Bathtub Scene in “Homeland” Stirs Discussion on Postpartum Disorders

Friends were calling; clients were bringing it up in our therapy session. “What did you think of ‘Homeland,’ they asked, each of them turning to me, expecting praise or derision.

The popular Showtime series is in its fourth season and it stars Clair Danes in the central role of a CIA operative who, in addition to a dangerous job, struggles with bipolar disorder. If that weren’t intrigue enough, the writers throw into the mix a baby from an affair with a character that was killed off in season three.

In the Oct. 5 episode, Carrie Mathison has been part of a bungled operation and is forced out of her post in Islamabad and returns home. While stationed there, her sister has cared for the baby.

But, as Hayley Krischer writes in Salon, “Carrie doesn’t want to be home. She doesn’t miss her baby. She runs when she hears her baby cry. And it’s not because Carrie can’t occupy those two spaces—can’t be both a strategic, ruthless CIA agent and a mother: it’s because Carrie clearly is struggling with post-partum depression, or maternal mental illness.”

Carrie’s struggle is vividly described in a disturbing scene — one that engendered all of the calls for my opinion. She gives her daughter a bath, with the camera lingering on the baby in the bathtub, shifting back and forth from the innocent child to Carrie’s haunted face. The baby slips for a moment and those of us watching hold our breath to learn if she will go so far as to let the baby sink.

Gratefully, Carrie doesn’t go any further, instead lifts and comforts her daughter. But she recognizes the possibility of her being a danger to her child, so she maneuvers to get sent back to Kabul, where no offspring are allowed.

As disturbing as this scene was, I’m glad the writers brought into the open the issue of postpartum mental illness, or what we often refer to as perinatal mood and anxiety disorders. But as often the case when the media or TV present these issues — often for shock value — they leave the public slightly more educated but largely more confused.

So in an effort to set the record straight and inform the public, let’s talk about two different possibilities of what form of postpartum illness Carrie has. There are many women with postpartum depression and anxiety who have obsessive thoughts, which take the form of hurting their baby or someone else hurting their baby. When these symptoms are the predominant problem, we call this postpartum obsessive-compulsive disorder.

Women who have these obsessive thoughts experience intense distress, anxiety, guilt, and shame. This is an ANXIETY disorder and it can also lead to feeling more depressed, with panic, anxiety and self-doubt about their own love for their baby, and uncertainty about their sanity and ability to trust themselves.

Postpartum obsessive-compulsive disorder is the most misunderstood perinatal illness in which women suffer — often in silence. It is the most secretive of the postpartum disorders, as the women themselves realize their thoughts are “crazy thoughts” and fear that someone may take their child away if they only knew.

To set the record clear, these are not the women who hurt their babies or commit infanticide. But they are so afraid of their own thoughts and filled with self-doubt, that they often avoid being alone with their babies. The risk is this can affect attachment and the mother-baby bond. In addition, it’s difficult to get more comfortable and competent as a mother when you avoid taking care of your baby.

There is another type of postpartum illness that is exceedingly rare, called postpartum psychosis (PPP). This affects 1-2 out of 1000 new mothers and has been correlated with bipolar disorder. Women with psychosis are at risk for harm to themselves and/or their babies (although it is rare for them to hurt their babies, they can), as they often have delusions, and/or hallucinations, impaired reality testing, and impaired judgment. These women with PPP need immediate hospitalization for their own, and their baby’s safety, until they are stable and non-psychotic.

It’s unclear which of these disorders Carrie has. Is Carrie having postpartum obsessive thoughts, or by her behavior, is it more likely that she is having psychotic symptoms that wax and wane, in which her judgment is impaired, but then realizes what she’s doing and snaps back to reality?

While we’ll have to wait for more episodes to hopefully learn the answer, I’m grateful “Homeland” has opened this topic up for discussion.

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~ by ppdsus on October 16, 2014.

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