When a mother is afraid to tell you

This essay discusses the deaths of children and postpartum mental illness, without graphic details. Urgent help and support resources are below.

There is a particular kind of loneliness in being asked how you are doing after having a baby and realizing that the most negative version of that answer they are equipped to hear is, "Tired but good!"

They're excited about the baby, and excited to share that with you. They're being so kind and helpful, checking in on you after all, and you feel guilty saying it is still not enough. And you are usually the person who knows what to do, and you cannot imagine how to explain that you no longer feel like yourself. The whole exercise seems exhausting, and likely with little reward. An uncomfortable lull in conversation, maybe a "you're... you know.... okay, right?" So you begin to edit. You're so tired but full of love, you say. It's been a big adjustment. The baby is wonderful. And all of that is true.

How to Hate a Baby

In Winnicott's famous article, “Hate in the Counter-Transference,” he makes room for something mothers are rarely encouraged to say: loving a baby does not prevent us from sometimes hating the demands that baby makes on us, or even feeling hatred toward the baby. His emphasis is on being able to acknowledge and bear that feeling without retaliating against the child.

I take from this a possibility for both parent and child. A mother who can recognize her anger has something she can think about, bring to another adult, and seek help with. The baby does not need to hear that they are hated or become responsible for making their mother feel better. Over time, a child can experience a relationship in which frustration is survived, care continues, and ruptures can be repaired. There is room to learn that anger can be felt and worked through without becoming an attack or destroying love. This is a way of thinking about emotional development, not a claim that children need to be hated.

But a case involving the deaths of children can make that space for thought feel terribly precarious. The distinction between feeling and action can collapse in the frightened reader's mind: if something this devastating happened in another family, what does my own anger mean? It would be a mistake to assume that ordinary maternal anger explains Clancy's actions, or that intrusive thoughts are steps toward violence. Yet the fear of that connection can make both everyday ambivalence and a developing psychiatric crisis harder to disclose. A mother may become more careful about how she sounds at precisely the moment she needs help describing what is happening.

The Lindsay Clancy case has made these conversations more urgent, and in some ways harder. I am not Lindsay Clancy's therapist, and I have no special insight into her or her actions specifically. But I do want to think about the mother reading this coverage at home, already frightened by the mix of feelings inside her, and the questions this case has brought up: Am I like her? How do I know I'm not? Would someone be able to help me if I were? How do I share that I'm struggling without sounding dangerous?

“You’re doing great” can end a conversation

I understand the wish to reassure. Someone is suffering in front of us; we want to offer relief. And sometimes reassurance is exactly right. But there is a difference between helping someone feel less alone and helping them stop telling us something we find frightening.

A mother says she does not feel like herself. We tell her everyone feels that way after a baby. She says she can't sleep. We tell her this stage will pass. She says she is frightened by her thoughts. We tell her she loves her baby. Even we clinicians can make assumptions - both overly negative and overly positive, depending on what we "need" to hear - about what that means, before we even ask.

In my recent article about AI and therapy, I wrote about turning to ChatGPT after my son was born, desperate for a schedule that would help us sleep. I repeatedly described my exhaustion and my concern about my own mental health to it, and it kept offering a "better schedule" that would magically make my weeks-old baby sleep through the night, while never asking about my own mental health. Looking back, what strikes me is how easily a response can feel attentive while missing the thing that most needs attention.

People can do this too. Therapists included. We can become so invested in being helpful that we hurry toward the answer we know how to give. Meanwhile, the person in front of us may need us to slow down and be open to the chaos and confusion they really feel inside.

The thought is not the whole story

One distinction deserves particular care: an unwanted, frightening thought about harm is not the same as wanting to cause harm.

In postpartum OCD, a parent may have intrusive thoughts or images that horrify them precisely because they conflict with what they want. They may check repeatedly, avoid caregiving tasks, or keep asking for reassurance. The thought itself becomes something to fear. The International OCD Foundation explains these patterns. An intrusive thought alone does not establish intent, and it is not, by itself, evidence of psychosis.

Postpartum psychosis is different. It can involve losing touch with reality, severe confusion, hallucinations, delusional beliefs, or a markedly elevated or agitated mood. Symptoms can change quickly. It is a psychiatric emergency that needs immediate medical assessment, not something to wait out until the next therapy appointment. The NHS describes the warning signs and urgency of care.

These distinctions are not a self-diagnosis checklist. Being frightened by a thought does not, on its own, settle every question about safety; symptoms can overlap. It takes clinicians with specialized expertise to understand the whole picture, including intent, behavior, sleep, changes in thinking, etc. to determine the correct diagnosis and the next right step.

Postpartum depression and anxiety deserve attention in their own right. Persistent sadness, loss of pleasure, hopelessness, or overwhelming worry should not have to become a catastrophe before they count. Perinatal depression is treatable; care may include therapy, medication, or both.

What I would want to understand

If you told me you were afraid of what was happening in your mind, I would want to hear more. Not because I had already decided what was wrong with you, but because those words can mean very different things.

Does the thought arrive uninvited and leave you horrified? Does it feel true, or like something you are being instructed to do? Are you worried you might act on it? Can you sleep when someone else takes over? Have you begun to feel unusually energized, confused, or unlike yourself? Who knows how difficult this has become?

I realize these questions sound very direct, and they are, especially about a topic that is very sensitive. I don't think warmth requires us to be vague. I would want you to understand exactly why I was asking and what I was thinking about your answers. I would not want you studying my face for evidence that you had said "too much." Someone bravely sharing what they're going through, looking for answers, deserves transparency - even if the transparent answer involves a recommendation they don't prefer (spanning everything from therapy to medication or even hospitalization).

I also would not want the assessment to swallow the person. What has becoming a parent cost you? What have you gained that you are afraid to lose? What happens between you and your partner when you ask for help? Are you allowed to be angry, disappointed, or exhausted without immediately having to prove how grateful you are?

Trust is not something I can ask you to assume

It would be easy to end here with “just tell someone.” But that little word, just, skips over a great deal. Perhaps you have told someone before and been dismissed. Perhaps you are afraid of what will happen to your family, your privacy, or your work. Perhaps you do not yet have words that feel accurate.

I cannot honestly promise that asking for help will never lead to an urgent evaluation or a higher level of care. Sometimes that is necessary. I can say that needing protection is not a moral failure, and that careful assessment should involve explanation, respect, and as much collaboration as circumstances allow. You can ask a therapist to explain confidentiality and its safety-related limits before discussing what worries you.

In my work, I want there to be room for you to correct me. To say that my reassurance has missed the point, that a question felt frightening, or that I am moving too quickly. Trust develops partly through discovering what happens when we do not immediately understand each other. Can we notice it? Can we talk about it? Can I revise my understanding when it does not fit you?

Sometimes the next step is ongoing therapy. Sometimes it is a psychiatric consultation, specialized treatment for OCD, or urgent medical care. Sometimes practical help needs to happen alongside treatment: another adult taking over, someone making the call with you, a plan that does not depend on your managing everything yourself.

You do not have to present your suffering neatly to deserve help. You can begin with what you know, even if all you know is that something feels wrong. The work is to understand it together, clearly enough that we can decide what is needed next.