Cindy Wachenheim was someone people didn't think they had to worry about. She was a lawyer, a favourite 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.
But when her baby was a few months old, she became obsessed with the idea that she had caused him irrevocable brain damage – even though doctors tried to convince her he was normal.
"I love him so much, but it's obviously a terrible kind of love," she agonised 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."
On March 13 2013, Wachenheim, 44, strapped her 10-month-old son to her chest in a baby carrier, then leapt to her death from the eighth-floor window of her New York apartment. "I became so low," she wrote shortly before she jumped, "thinking that if I had unknowingly caused brain damage to my beautiful, precious baby, I didn't want to live."
Wachenheim's story provides a 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 also of psychiatric illnesses.
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, fearing their babies would be taken from them.
Wachenheim's sister, Deb, is among those breaking the silence.
"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.
Cindy Wachenheim's experience defied the long-held belief that postnatal depression symptoms emerge a few weeks after birth. She seemed fine until her son was about four months old, said her family and friends.
A son who was ‘my heart’
Cindy 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.
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 foetus was kicking.
Cindy gave birth normally and adored her son, often calling him "my heart”.
"Not unlike a lot of high-achieving women, she was somewhat of a perfectionist, and she also wanted to be the perfect mother," her sister Deb said. Still, she was pretty easygoing in the first months of her son's life.
But when her son was four months old, Cindy emailed Deb that he was making "strange/jerky movements w/his right arm" and that it was almost "flapping like a wing."
The paediatrician said it was nothing to worry about, but Cindy scoured the internet for diagnoses. She fixated on an instance a few weeks earlier, when she briefly left the baby on a play mat on the floor. He fell while pushing up, hitting his head.
She believed this minor episode had caused him severe neurological problems: seizures, concussion. She blamed herself for leaving the room, for placing the mat on the floor. Other incidents then alarmed her, and she decided he was more irritable, smiling less.
She visited two paediatric neurologists, then she saw an expert in cerebral palsy because her son didn’t always exhibit the Landau reflex, a Superman-like pose babies make when held aloft, stomach-down.
In October 2012, when her son was five 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?"
The doctor replied: "That's right. Little bumps on the head at floor level that a baby may cause themselves … would not cause any injury. Babies are really very hardy (thank goodness)!"
Her siblings assured her that their children had made similar movements but she was implacable.
Cindy's husband and siblings urged her to seek therapy. Cindy agreed but insisted she didn’t have a mental illness; she told her family she was simply depressed because of the harm she thought she’d done to the baby.
"You can hardly imagine how it feels to strongly believe he has brain damage and that I caused it," she emailed Deb.
Consumed with worry
Experts say such breaks from reality are likely symptoms of postpartum psychosis, which affects only one or two in 1000 mothers. About 4 per cent of those hurt their children; about 5 per cent kill themselves. Flagrant cases usually emerge soon after birth; women may hear voices or feel compelled to inflict harm.
"More subtle forms of psychosis are going to be picked up later," said Dr Katherine Wisner, a professor of psychiatry and obstetrics. These women “tend to have prolonged delusional thinking: 'there's something really wrong with my baby'", she said.
Most other maternal mood disorders don’t involve such unshakably unrealistic convictions; most women know something is wrong, and although they fear they will harm their children, they rarely do.
In 2012, Cindy's family gathered at her brother Ron's home, and Cindy seemed consumed with her son's purported 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?"
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.
The next month, Cindy began seeing a psychiatrist, who prescribed an antidepressant, and she briefly visited other counsellors.
One January weekend at Ron's house, she seemed more engaged, smiling more. She acknowledged still having thoughts of suicide, but said her psychiatrist had told her it wasn’t too worrisome "as long as they're not getting more frequent”.
Experts said postpartum psychosis symptoms can fluctuate. Sometimes women are lucid, but can then slip back into delusions.
The mixed signals from Cindy continued. She discussed returning to work and finding daycare; then one day, the baby fell while pulling up on a chair in his grandmother's kitchen. Cindy considered it another disastrous "head hit".
One Tuesday, Cindy uncharacteristically cancelled her psychiatrist's appointment. On Wednesday, as she sometimes did, Cindy asked her husband to come home from work for some company. When he arrived, she said the morning had been rough but that she was feeling better. After a few hours, he returned to work.
That afternoon, with her baby snug to her chest, she jumped.
"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."
She was sure her son would never walk, and believed his most recent fall caused a concussion.
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."
"I don't know if there is a hell," she wrote, "but I hope so."
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.
This is an edited version of an article that first appeared in The New York Times.