Where Does Stress End and Mental Illness Begin?
Where Does Stress End and Mental Illness Begin?
By James Porter
As I write this, a jury in Massachusetts is considering the fate of Lindsay Clancy, a former labor-and-delivery nurse accused of killing her three young children. Her defense argues that she was suffering from postpartum psychosis and was not criminally responsible for her actions. The prosecution argues that she understood what she was doing. After two days of deliberation, the jury has not yet reached a verdict and is expected to resume deliberations Monday. (AP News)
I don't know what happened inside Lindsay Clancy's mind. Neither do you. That is precisely what the jury is being asked to determine. But the case has brought me back to a question that has fascinated me throughout my 45 years of studying stress: Where does stress end and mental illness begin?
I first encountered the term postpartum psychosis about five years ago while reading Veronica O'Keane's remarkable book, A Sense of Self: Memory, the Brain and Who We Are. She begins with a patient she calls Edith, who had recently given birth and was admitted to a psychiatric hospital in London. Edith had stopped caring for her baby, wandered aimlessly and appeared distressed and preoccupied, but could not—or would not—explain what was troubling her. O'Keane described her as being in an "altered consciousness," as if she had been removed from the world.
That phrase stayed with me.
Because postpartum psychosis isn't simply an especially severe case of being stressed or depressed. It is a rare but profound psychiatric illness that can involve hallucinations, delusions, confusion and a loss of contact with reality. It typically requires immediate psychiatric treatment. Current estimates suggest it affects roughly one or two women in every thousand births. (The Guardian)
And yet the boundary between ordinary distress and serious illness has been troubling us for a very long time.
In the second chapter of O'Keane's book, she discusses Charlotte Perkins Gilman's famous 1892 short story, The Yellow Wallpaper. Gilman had herself experienced a serious illness after the birth of her daughter and was subjected to the nineteenth-century "rest cure," which prescribed isolation and enforced inactivity. She eventually transformed that experience into one of the most disturbing stories ever written about a mind gradually losing its grip on reality.
What strikes me is how little medicine understood about these experiences at the time.
And how much we still don't understand.
We have become much better at recognizing postpartum depression. We understand that sleep deprivation, biological changes, psychiatric vulnerability and overwhelming life circumstances can interact in complicated ways. And we now know that postpartum psychosis is a medical emergency—not a failure of character or motherhood. (Reuters)
But the larger question remains.
When does a person who is overwhelmed by stress become a person who is ill?
And perhaps an even more practical question is: How do we recognize that transition while it is happening?
Those questions don't belong only in psychiatric hospitals or courtrooms.
They belong in our homes.
And they belong in our workplaces.
Because every day, managers, HR professionals, coworkers and EAP professionals encounter people who are struggling. Someone who was dependable suddenly isn't. Someone who was engaged withdraws. Someone who seems merely "stressed" begins behaving in ways that are completely unlike themselves.
We don't expect a manager to diagnose mental illness.
But perhaps we should expect all of us to become better at recognizing when ordinary stress may have become something more.
In the next installment, I'll take that question into the workplace—and look at the difficult line between an employee who is simply under too much pressure and one who may need something more than another wellness tip, a vacation day or a reminder to "manage their stress."
Erica Tuminski
Author