Healthcare coverage is a major issue in the United States right now and it has become the prime reason for Congressional turmoil. Experts in healthcare are telling us that not only is there inadequate care for those with medical needs, the situation is even worse when we consider various socioeconomic groups and those with mental disorders. Could this provide the answers to the "why did she do it?" people are asking about Miriam Carey's fatal car chase in Washington, DC? Everyone is speculating and yet no one will actually know, unless, of course, they do a psychological autopsy.
What's a psychological autopsy? I've taken part in them at psychiatric hospitals where patients had committed suicide and have seen it first-hand. Just as you would in the medical procedure, this type of autopsy looks at all the facts available. Everyone even remotely associated with the event is interviewed and the team attempts to piece it all together into something coherent. They look at what happened, what may have precipitated it, everything that is known about the deceased person and their past and most current history and it is multi-disciplinary. I would suspect that all of that is going on right now.
What do we know? We do know that at sometime during the morning of Thursday, October 3, 2013, Ms. Carey got into a car with a young child, drove to the White House area and attempted to crash through barricades placed there. During the ensuing hours, she engaged in high-speed care maneuvers, struck a police officer and her car was hit numerous times by bullets until it crashed. In the end, Ms. Carey was struck so many times that they had a difficult time identifying her, but the child was safe.
Who was this woman? From the available information, it appears that she was a pleasant woman who worked as a dental hygienist, graduated from a highly respected NYC college, had had a child. But she had also been fired from her job, started her own business, bought a condo and an expensive car and was a single mother who had suffered from postpartum depression.
The single most important clue here may be the postpartum depression for which she had received treatment. It appears to have been instrumental, perhaps, in some of her angry outbursts and difficulty with her employer that led, finally, to her firing. More clues related to this have been unearthed by interviews with family and friends. One indicated that she believed President Obama was doing something to her telepathy and there may have been other signs of impending mental instability.
Just how common and undertreated postpartum depression (with possible psychosis) is, unfortunately, isn't widely known. Some experts believe it is a hidden illness that is missed by medical professionals and seriously undertreated. One particularly horrific case of the disorder was seen in Texas where Andrea Yates in 2001 had repeated bouts with each of her pregnancies, had been placed on antipsychotic meds but, through a problem in continuing healthcare, she wasn't taking her medication and drowned her five children. One prosecution psychiatric expert called to provide testimony said she had followed a script on a well-known TV show at the time. It was proven to be incorrect because the alleged specific show never aired. I suppose he apologized, but the bell had been rung.
What are the signs? The symptoms include agitation or irritability, feeling withdrawn or unconnected, significant anxiety, suffering from insomnia, and fears of hurting the child, or thoughts not based in reality, even hearing voices or seeing things that are not there. The disorder can last for up to a year.
When postpartum is present at the first birth, it may not be severe, but if present, each pregnancy can magnify the disorder and require psychiatric medications and treatment. This was what happened in the Andrea Yates case according to trial testimony.
The statistics place postpartum depression between 1-6% of the population who suffer from the disorder, but it may be higher because of the missed diagnosis in many cases. Stress can add to the disorder and, in the case of Ms. Carey there were numerous stressors that could have been contributory factors.
Should the "baby blues" be dismissed? No, because it can be more serious than anyone suspects but the main problem remains adequate diagnosis and that is still missing from the equation.
Fired Up: A shrink's musings