Surviving PPP Death-Free (but not Color-Blind}: Two Book Reviews by Carl Blumenthal

Ayana Lage, Missing Me: A Memoir of Postpartum Psychosis and the Long Road Back (New York, Worthy Books, 2026, 186 pages}

Aisha Alvi, A Mom Like That: A Memoir of Postpartum Psychosis (Toronto, Dundurn Press, 2024, 251 pages)

Postpartum psychosis (PPP) occurs in one or two of every thousand women who give birth. Due to delusions and hallucinations, about 4% of these women will kill their babies and 5% will kill themselves. With approximately 3.5 million births in the U.S. each year, about 150 mothers commit infanticide and 175 commit suicide annually as a result.

But if not for such high-profile cases as Adrea Yates’, who drowned her five children in 2001 and Lindsey Clancy’s strangling of her three kids in 2023, Americans wouldn’t know the differences between PPP and other forms of mental illness.

In addition, the few women who receive media attention are primarily white. Is this because journalists, who are predominantly Caucasian, especially in management, hold white women to a higher standard? Or are mothers of color simply invisible to them when not denigrated as welfare recipients?

Ayana Lage, an African American journalist, who just published Missing Me, and Aisha Alvi, an Indian immigrant and psychology graduate, who authored A Mom Like That, suggest that invisibility might be the answer, given that they are both middle-class. They document that women of color are twice as likely to experience PPP. And they are not only less likely to seek help but more likely to be ignored by their largely white doctors when they do.

Two of the risk factors for PPP are previous mental illness, especially bipolar disorder, and a prior episode of PPP. Other possible causes are hormonal changes, sleep deprivation, and a family history of mental illness and PPP.

Since childhood, Lage was plagued by anxiety, depression, suicidal thoughts, and an eating disorder worsened by stereotypes of overweight Black women. She only experienced PPP in 2020 after the birth of her first daughter. Before her daughter was born in 2001, Alvi was mentally well. But she also experienced PPP after a miscarriage five years later.

Unlike many women with PPP, they both got help. Due to a previous hospitalization for suicidal thoughts, Lage knew enough to hospitalize herself when overpowered by dire thoughts about herself and her baby. Although Alvi waited out the symptoms of her first PPP, she only found the right doctor the second time after five attempts because the previous providers didn’t think grief could turn into psychosis. Both women also had supportive husbands who approved of their wives’ treatments.

Given that Lage was a practicing, if sometimes skeptical, Christian for most of her life and Alvi a knowledgeable Muslim, delusions and hallucinations about God and the Devil were prominent features of their conditions, along with fears that others would harm them and their children. But each takes a different narrative approach to their experiences, in part because Lage kept detailed journals while Alvi relied on her vivid memories.

Lage travels back and forth in time since childhood to chronicle her ups and downs, including quotes from those journals during her postpartum inpatient stay and from her hospital records. It’s as if she wants the reader to be as unsettled as she was throughout her life. Although the book is partly subtitled “and the Long Road Back,” little space is devoted to her recovery, except that her second daughter was born without incident. A mental health advocate previously, apparently Lage views publication of this book as sufficient to promote better perinatal mental health.

Alvi’s two episodes of PPP are described in chronological order, building gradually to her final recovery. They are bracketed by her before-and-after crisis intervention of another Indian American mother with PPP, mirroring Alvi’s experiences, except she convinces this new mom to go to the hospital. Thus, she learned from her own challenges about the emergency, but temporary nature of the condition. Ironically, her previously fine mental health and psychology training didn’t protect her. Although Alvi doesn’t dwell on her role as a patient advocate for the last 20 years, she provides enough information about PPP in an Afterword to prove she now knows her stuff.

For further information, see Ayana Lage on the Oprah Winfrey show about Lindsey Clancy’s trial: