健康生活:產後精神病的悲劇

Cindy Wachenheim was someone people didn't think they had to worry about. She was a levelheaded lawyer working for the State Supreme Court, a favorite aunt who got down on the floor to play with her nieces and nephews, and, finally, in her 40s, the mother she had long dreamed of becoming.

辛迪·瓦肯海姆(Cindy Wachenheim)是一個人們覺得不用爲她操心的人。她是個頭腦冷靜的律師，在州最高法院工作；也是個受歡迎的長輩，能和甥侄輩的孩子玩個不亦樂乎；在40多歲時，她終於實現了長期以來的夢想，成爲一個母親。

But when her baby was a few months old, she became obsessed with the idea that she had caused him irrevocable brain damage. Nothing could shake her from that certainty, not even repeated assurances from doctors that he was normal.

然而，在寶寶幾個月大的時候，辛迪開始固執地認爲，自己給孩子的大腦造成了不可挽回的損傷。任何事情，哪怕多位醫生反覆保證她兒子一切正常，都無法動搖她對那一點的確信。

"I love him so much, but it's obviously a terrible kind of love," she agonized in a 13-page handwritten note. "It's a love where I can't bear knowing he is going to suffer physically and mentally/emotionally for much of his life."

“我很愛他，但這顯然是一種可怕的愛，”她在手寫的一封13頁長的信中痛苦地寫到，“這種愛，讓我無法忍受知道他一生中的很多時候，都要飽受身體和精神/情感上的煎熬。”

On March 13, 2013, Ms. Wachenheim, 44, strapped her 10-month-old son to her chest in a baby carrier and leapt to her death from the eighth-floor window of her Harlem apartment. "I became so low," she wrote in the 13-page outpouring shortly before she jumped, "thinking that if I had unknowingly caused brain damage to my beautiful, precious baby, I didn't want to live."

2013年3月13日，44歲的瓦肯海姆用揹帶把10個月大的兒子綁在胸前，從哈林區八樓的公寓窗戶跳樓身亡。“我變得很低沉，”她在那封跳樓前不久一口氣寫成的長信中寫道。“想到如果自己在無意中給我漂亮、珍愛的兒子造成了大腦損傷，我就不想活了。”

Ms. Wachenheim's story provides a wrenching case study of one woman's experience with maternal mental illness in its most extreme and rare form. It also illuminates some of the surprising research findings that are redefining the scientific understanding of such disorders: that they often develop later than expected and include symptoms not just of depression, but of psychiatric illnesses.

瓦肯海姆的故事是一個令人心痛的案例，以最極端、最罕見的形式呈現了一名女性患上產後精神疾病的經歷。這個故事也闡明瞭一些出人意料的研究結果，這些研究結果正在重新定義對這類疾病的科學理解：它們的發展通常會比預期晚，不僅包括抑鬱的症狀，還包括精神疾病的症狀。

Now these mood disorders, long hidden in shame and fear, are coming out of the shadows. Many women have been afraid to admit to terrifying visions or deadened emotions, believing they should be flush with maternal joy or fearing their babies would be taken from them.

如今，長期以來一直隱藏在羞恥和恐懼中的這些情緒紊亂，正在從陰影中走出來。很多女性一直害怕承認自己有可怕的念頭，或是低落的情緒，認爲自己應該陶醉在當母親的喜悅中，或是害怕孩子會被奪走。

But now, advocacy groups on maternal mental illness are springing up, and some mothers are blogging about their experiences with remarkable candor. A dozen states have passed laws encouraging screening, education and treatment. And celebrities, including Brooke Shields, Gwyneth Paltrow and Courteney Cox, have disclosed their postpartum depression.

但現在，關注產婦精神疾病的倡導團體正在涌現，有些母親十分坦率地在博客中記述自己的經歷。已經有12個州通過了鼓勵篩查、教導和治療的法律。波姬小絲(Brooke Shields)、格溫妮絲·帕特洛(Gwyneth Paltrow)以及柯特尼·考克斯(Courteney Cox)等多位名人都透露自己曾患過產後抑鬱症。

Ms. Wachenheim's sister, Deb, is among those breaking the silence.

瓦肯海姆的妹妹黛布(Deb)便是打破沉默的人之一。

"We did try to help her, but perhaps if we had been more knowledgeable about postpartum mood disorders, including the fact that postpartum depression is just one of an array of such mood disorders, we could have done something differently that would have maybe saved her life," she wrote in an email.

“我們的確嘗試過幫她，但如果當時對產後情緒障礙有更多瞭解，比如產後抑鬱症實際上只是諸多情緒障礙中的一種，我們或許就能以不同的方式做些事情，興許就能挽救她的生命了，”她在電子郵件中寫道。

Cindy Wachenheim's experience defied the long-held belief among doctors and experts that symptoms emerge within a few weeks after birth. She seemed fine until her son was about 4 months old, said family and friends. And as a healthy, active woman, Cindy had no risk factors that would signal a mother likely to become delusional and suicidal.

醫生和專家們長期以來認爲，症狀會在產後幾星期內出現，但辛迪·瓦肯海姆的經歷與這種觀念相左。據辛迪的家人和朋友說，在兒子大約四個月之前，她看上去很正常。而且辛迪作爲一個健康積極的女性，根本沒有表現出這個母親可能會產生妄想，甚至自殺的風險因素。

"She loved life, she loved family, she was social," said her sister-in-law, Karen Wachenheim.

“她熱愛生活，熱愛家庭，也愛和人交往，”她的嫂子卡倫·瓦肯海姆(Karen Wachenheim)說。

In fact, Cindy, long interested in women's issues and social justice, had, years earlier, identified postpartum depression in Karen. "Cindy would call at least once a day to check on me," Karen recalled. "She said, 'Maybe you have postpartum; I think it's past the baby blues.' " At Cindy's urging, Karen got therapy and medication, recovering quickly.

實際上，一直關注女性問題和社會公正的辛迪，多年前在卡倫身上發現了產後抑鬱症。“辛迪每天至少會打一次電話，確認我沒事，”卡倫回憶說。“她說，'你可能是患上了產後抑鬱症，我覺得不只是生寶寶後情緒不好。' ”在辛迪的督促下，卡倫接受了治療並服了藥，很快便康復了。

A Son Who Was 'My Heart'

“心肝寶貝”兒子

Cindy grew up in Colonie, N.Y., outside Albany, where she was her high school's valedictorian. She attended the State University of New York at Buffalo and Columbia Law School. She valued public service and took a job doing research and writing for judges on the State Supreme Court in Manhattan.

辛迪在紐約州奧爾巴尼郊區的科隆尼長大，曾因成績優異在高中時作爲畢業生代表發言，並在紐約州立大學布法羅分校(State University of New York at Buffalo)和哥倫比亞大學法學院(Columbia Law School)就讀。她重視公共服務，曾在位於曼哈頓的州最高法院工作，爲法官做研究並撰寫文件。

When her mother became ill with leukemia, and later her father with lung cancer, Cindy would travel upstate to go to their medical appointments with them. When her siblings or their children had medical checkups, Cindy jotted the dates in notebooks, and called the night before to remind them to fill her in.

當母親患上白血病，後來父親又患上肺癌時，辛迪會去紐約州的北部，陪同父母就診。當兄弟姐妹或是他們的孩子體檢時，辛迪會在筆記本上記下日期，並在前一天晚上打電話，提醒他們要把最新情況告訴她。

"I think she even kept all those books too, in a shoe box," said her brother, Ron. "People collect stamps; she collected that stuff."

“我想她甚至保存着所有這些本子，放在一個鞋盒裏的，”哥哥羅恩(Ron)說。“別人集郵，她收集的卻是這些東西。”

She married at 40, and she and her husband underwent fertility treatment. She miscarried twice. But family and friends said that while mourning those losses and dealing with fertility hormones, she remained hopeful, noting that doctors said it was a good sign she had been able to become pregnant.

辛迪結婚時40歲，夫婦倆都接受過生育治療。她小產過兩次，但家人和朋友表示，儘管經歷了流產之痛，還要調節生育激素，但她仍很樂觀，還說醫生表示，她還能懷孕就是個好兆頭。

"She just thought that she's going to keep trying and take each step as it came," said a longtime friend, Julie Knapp.

“她只是覺得要不斷嘗試，每次機會到來時都要抓住，”多年好友朱莉·納普(Julie Knapp)說。

Experts say little evidence links fertility treatment to postpartum mental illness; indeed, becoming pregnant may bring more joy than stress. Still, Wendy N. Davis, the executive director of Postpartum Support International, said some women experience cumulative stress from "fertility treatments, many losses, and the very, very high expectation she will enjoy this new baby."

專家稱，鮮有證據表明產後精神疾病與生育治療有關；的確，懷孕可能會帶來更多的喜悅，而非壓力。然而，產後支持國際組織(Postpartum Support International)的執行董事溫迪·N·戴維斯(Wendy N. Davis)表示，某些女性會因“生育治療、多次流產，以及十分十分期望自己會喜歡新生的寶寶”而導致壓力累積。

Eventually, Cindy was able to conceive and have an uneventful pregnancy, her only out-of-the-ordinary response being a tendency to be hyperaware of whether the fetus was kicking.

終於，辛迪成功懷孕了，而且懷孕期間一切平安。唯一不尋常的反應似乎是，她常常極其在意胎兒有沒有在踢她。

Cindy gave birth normally and adored her son, often calling him "my heart."

辛迪順利生產，並且非常喜歡自己的兒子，常常稱他爲“我的心肝寶貝”。

"Not unlike a lot of high-achieving women, she was somewhat of a perfectionist, and she also wanted to be the perfect mother," Deb said. Still, she was pretty easygoing in the first months of her son's life, even when she had to introduce formula early because she produced too little breast milk, Deb said.

黛布說，“和很多優秀女性一樣，她有些完美主義，而且想當一個完美的母親。”但黛布表示，在生下兒子的最初幾個月裏，她還是很放鬆的，即便在因爲母乳不足，而不得不早早地給孩子喝配方奶粉時也一樣。

But when her son was 4 months old, Cindy emailed Deb that he was making "strange/jerky movements w/his right arm," almost "flapping like a wing."

但在兒子四個月大時，辛迪給黛布發電子郵件說兒子正在“用右手做些抽筋似的奇怪動作”，就像“在扇翅膀”。

The pediatrician said it was nothing to worry about, but Cindy scoured the Internet for diagnoses. She fixated on an instance a few weeks earlier, in August when, while washing clothes, she briefly left the baby on a play mat on the floor. He fell while pushing up, hitting his head.

兒科醫生說完全不用擔心，但辛迪卻在網上四處搜尋資料自行診斷。她對數週前發生的一件事耿耿於懷。那是在8月，在洗衣服時，她暫時把孩子放在了遊戲墊上。寶寶在往起爬時跌倒了，碰到了頭。

She believed this minor episode had caused him severe neurological problems: seizures, autism, concussion. She blamed herself for leaving the room, for placing the play mat on the hardwood floor. Other incidents alarmed her, and she decided he was more irritable, smiling less.

她認爲這次小小的意外給他的神經系統造成了嚴重的問題：癲癇、自閉症和腦震盪。她怪自己離開了房間，怪自己把遊戲墊放在了硬木地板上。其它一些事情也使她感到不安。她確信孩子變得更煩燥了，也笑得少了。

She visited two pediatric neurologists. Then she saw an expert in cerebral palsy because her son did not always exhibit the Landau reflex, a Superman-like pose babies make when held aloft, stomach-down.

辛迪去見了兩位兒童神經科醫生，後來還去看了一位大腦性麻痹領域的專家，因爲兒子並不總是能做出蘭多反射(Landau Reflex)——被腹部朝下抱起時，嬰兒通常會做出這個像超人一樣的姿勢。

In October 2012, when her son was 5 months old, she emailed a doctor she had seen that day: "When you said babies can't injure their brains from even several floor-level head hits on a wooden floor, did that include hits even if they are turning and hit back or side of head on the floor?"

2012年10月，兒子5個月大，她給當天見過的一名醫生髮電子郵件詢問：“你說，寶寶哪怕是頭在木地板上磕了好幾下也不會傷到大腦，這種情況包括他們在轉身時後腦勺或腦袋兩側撞到地板上嗎？”

The doctor replied: "That's right. Little bumps on the head at floor level that a baby may cause themselves in the course of normal spontaneous movements would not cause any injury. Babies are really very hardy (thank goodness)!"

醫生回覆：“是的。寶寶在地板上自發進行正常活動時，可能會導致頭部受到輕微碰撞，但這不會造成任何損傷。寶寶真的很結實（謝天謝地）！”

Cindy sent the doctor a video of her son, noting that "he almost always moves the right hand when holding a toy, reaching to grab something, etc."

辛迪又把兒子的一段視頻發給了那名醫生，稱“他在拿玩具、伸手抓東西或做其他事情時，幾乎總是用右手”。

The doctor responded: "All of his movements look like normal, age-appropriate movements to me."

醫生回覆：“在我看來，你兒子的所有舉動都很正常，都和他的年齡相符。”

Her siblings assured her that their children had made similar movements, but she was implacable. Without telling her sister, Deb called the pediatrician, who said she was also concerned about Cindy. Deb said Cindy's husband worried too, although "part of him said: 'Maybe she's right. She is smart and was with the baby all the time.' "

辛迪的兄弟姐妹安慰她說，他們的孩子也曾有過類似的動作，但這還是無法緩解辛迪的憂慮。黛布瞞着姐姐，偷偷給那名兒科醫生打了電話。醫生表示她也對辛迪有所擔心。黛布說，姐夫也有憂慮，不過“他同時認爲：'或許她是對的。她很聰明，而且時刻都和孩子在一起。'”

Still, both Cindy's husband and siblings urged her to seek therapy.

但辛迪的丈夫和兄弟姐妹還是敦促她接受治療。

"I just really want you to see someone," Deb emailed Cindy. "You cannot continue like this, for your sake and for his sake."

“我真的想讓你去看看醫生，”黛布給辛迪發郵件。“爲了你自己，也爲了你兒子，不能再這樣下去了。”

Cindy agreed, but insisted that she had no postpartum mental illness. She told her family she was simply depressed because of the harm she had done to the baby.

辛迪同意了，但堅稱自己沒患產後精神疾病。她告訴家人，只是因爲給寶寶造成了傷害而覺得鬱悶。

"You can hardly imagine how it feels to strongly believe he has brain damage and that I caused it," she emailed Deb. "It must be one of the top one or two nightmares for any parent. iloveyou, cindy."

“你幾乎想象不到這種感覺是什麼樣子，我強烈地覺得他有大腦損傷，而且是我造成的，”她給黛布發郵件說。“對任何父母來說，這肯定都是數一數二的惡夢。愛你的辛迪。”

Consumed With Worry

憂心忡忡

Experts say such breaks from reality are likely symptoms of postpartum psychosis, which affects only one or two in 1,000 mothers. About 4 percent of those hurt their children; about 5 percent kill themselves. Flagrant cases usually emerge soon after birth; women may hear voices or feel compelled to inflict harm, like Andrea Yates, who drowned her five children in a bathtub in 2001, or Dena Schlosser, who in 2004 cut off her infant's arms. Both women were ultimately found not guilty by reason of insanity.

專家表示，這類與現實的脫節，很可能是產後精神病的症狀。產後精神病的發病率只有千分之一到千分之二。在那些患病的母親中，約有4%的人會傷害自己的孩子；大約5%的人會自殺。駭人聽聞的案例通常出現在母親生下孩子後不久；產婦可能會出現幻聽，或者有去製造傷害的衝動，比如2001年將自己的五個孩子淹死在浴缸裏的安德烈婭·耶茨(Andrea Yates)，以及2004年砍掉嬰兒雙臂的德娜·施洛瑟(Dena Schlosser)。這兩位母親最終都因精神失常被判無罪。

"More subtle forms of psychosis are going to be picked up later," said Dr. Katherine Wisner, a professor of psychiatry and obstetrics at Northwestern University. These women "tend to have prolonged delusional thinking: 'there's something really wrong with my baby.' "

西北大學(Northwestern University)的精神病學和產科學教授凱瑟琳·威斯納(Katherine Wisner)說：“不那麼典型的產後精神病會較晚出現症狀。”這些女性“往往會出現長期錯覺：'我的孩子真的有問題'”。

Most other maternal mood disorders do not involve such unshakably unrealistic convictions; most women know something is wrong, and although they fear they will harm their children, they rarely do.

大部分其他產後情緒障礙都不會出現這類不切實際到不可動搖的堅定想法；大部分女性知道出了問題，而且儘管害怕自己會傷害到孩子，但她們很少真的那麼做。

At Thanksgiving in 2012, Cindy's family gathered at her brother Ron's home outside Albany, and Cindy, normally outgoing, seemed consumed with her son's supposed problems. She told Deb she had thought about suicide, saying "How can you go on knowing that you've ruined your baby's life and it was your fault?" Deb was stunned. She and Cindy's husband discussed the situation, hopeful that therapy would help.

2012年的感恩節，辛迪的家人在哥哥羅恩(Ron)位於奧爾巴尼郊區的家中聚會。通常頗爲外向的辛迪，似乎一心想着她所謂的兒子的問題。她告訴黛布她想過自殺，說“知道因爲自己的錯誤而親手毀了孩子的一生，你還能活下去嗎？”黛布大吃一驚。她和辛迪的丈夫討論了這一情況，希望治療會有所幫助。

Later that visit, the baby rolled off a low bed. It was one of several times that Cindy panicked and took him to the emergency room, where doctors pronounced him fine.

那次聚會後，寶寶從一張矮牀上滾了下來。辛迪驚慌失措地把孩子送到急診室，但醫生卻說寶寶一切安好。這樣的情況發生過好幾次。

The next month, Cindy began seeing a psychiatrist, who prescribed Zoloft, an antidepressant. She briefly visited other counselors for talk therapy. Friends offered support and company.

接下來的那個月裏，辛迪開始看精神科醫生。那名醫師給她開了左洛復(Zoloft)，一種抗憂鬱的藥物。她還短暫地去其他幾名諮詢師那裏接受過談話治療。朋友給了她支持與陪伴。

One January weekend at Ron's house, she seemed more engaged, smiling more. When Deb asked, she acknowledged still having thoughts of suicide, but said her psychiatrist had told her it was not too worrisome "as long as they're not getting more frequent," Deb recalled.

1月的一個週末，在哥哥羅恩家，辛迪似乎精神更集中了，笑容也多了。黛布回憶，當她問起時，辛迪坦言依然會有自殺的想法，但她說，精神科醫生告訴她不用太擔心，“只要這些想法沒有變得更頻繁。”

Family and friends wonder now if she was feigning feeling better. "Now I think maybe she was backing off so everyone wouldn't think she was crazy," Karen said.

家人和朋友現在揣測，她當時是不是假裝感覺好些了？“我現在覺得，她那時候是退了一步，這樣大家就不會覺得她瘋了，”卡倫說。

Experts said postpartum psychosis symptoms can fluctuate. Sometimes women are "lucid and not delusional," said Dr. Davis of Postpartum Support International. "Then they slip back into delusions more easily than with other types of psychosis."

專家表示，產後精神病的症狀可能會出現波動。國際產後支持組織的戴維斯博士說，病人有時候“頭腦清晰，不會產生錯覺。然後，她們會比患其他精神病的人更容易陷入錯覺中去”。

The mixed signals from Cindy continued into March. She discussed returning to work and finding day care. On a visit to her mother-in-law on Long Island, she called Deb while strolling by the ocean and sounded good. But the next day, Sunday, the baby fell while pulling up on a chair in his grandmother's kitchen. Cindy considered it another disastrous "head hit."

辛迪表現出來的複雜情況持續到了3月。她說起回去工作，並找家日間託兒所。去長島探望婆婆期間，她一邊在海邊散步，一邊給黛布打電話，當時聽上去挺好的。但第二天是星期日，在奶奶的廚房裏，孩子碰到椅子上摔倒了。辛迪把這看作是另一場災難性的“撞頭事件”。

On Tuesday, Cindy uncharacteristically canceled her psychiatrist's appointment, citing rain. On Wednesday, as she sometimes did, Cindy asked her husband to come home from work. When he arrived, she said their son's morning had been rough, but that she was feeling better. After a few hours, he returned to work.

接下來的週二，辛迪以下雨爲由，反常地取消了和精神科醫生的預約。週三，與之前偶爾出現的情況一樣，辛迪把丈夫從公司叫回了家。丈夫到家後，她說兒子一上午都過得不順，不過她感覺正在好轉。幾個小時後，丈夫回去上班了。

That afternoon, with her baby snug to her chest, she jumped.

當天下午，辛迪把孩子捆在自己胸前，跳下了樓。

"I am so unbearably sorry, which I know does nothing to undo the evil I have done," her farewell note began. "I wanted to be a mother so badly and I hoped to be a wonderful one, and instead I have become the worst of the worst."

“我特別特別愧疚，我知道這無法彌補我犯下的惡行，”辛迪在遺書開頭寫道。“我非常想當母親，想成爲一位優秀的母親，然而，我卻成了差到不能再差的一個母親。”

Searching for anything to blame herself for, she described minor, harmless moments: tucking a light blanket over his face for warmth, letting him suck a leaf, briefly putting a dime in his mouth and immediately removing it. "These things I did were horrible," she wrote.

在找一切理由責怪自己時，她說到了一些沒造成什麼傷害的小事：爲了保暖把薄毯子蓋到了寶寶臉上、任由他吮吸一片樹葉、短暫地把十分錢硬幣放到寶寶嘴裏又馬上拿走。“我做的這一切太可怕了，”她在信裏寫道。

She was sure her son would never walk, and said she believed his most recent fall caused a concussion. "I'm so so sorry, but I can't bear for him to suffer more and more."

她確信兒子永遠都不會走路，還說她認爲最近那次摔倒造成了腦震盪。“真的非常非常對不起，但我無法忍受他越來越遭罪。”

She said she knew others would see her suicide as a result of "postpartum depression/psychosis." But, she said: "I know I am right that I mistakenly harmed him. I'm not claiming a voice told me to do this."

她還說自己知道，其他人會把她的自殺歸咎於“產後抑鬱症/精神病”，但她說：“我無意中傷害到了兒子，我知道自己是有理由這麼想的。並不是說有個聲音讓我這麼做。”

She even chastised herself for crumbling emotionally, saying she made her son a less happy baby.

她甚至苛責自己情緒不穩定，說她讓兒子沒那麼快樂。

"I don't know if there is a hell," she wrote, "but I hope so."

“我不知道是否有地獄，”她寫道，“但我希望有。”

Cindy Wachenheim would never know that in her last act, her body cushioned the fall for her son and saved his life. Weeks later, the healthy little boy took his first steps.

辛迪·瓦肯海姆永遠不會知道，她生命的最後一刻，自己的身體爲兒子從高處摔下來時提供了緩衝，救了他一命。幾個星期後，這個健康的小男孩邁出了人生的第一步。