51. Postpartum Psychosis: The Signs Five Doctors Missed (Part 1)

A Terrifying Lived Experience with Aaisha Alvi 

In this episode of Nourished with Dr. Anikó, Dr. Anikó sits down with postpartum psychosis awareness advocate, writer, and author Aaisha Alvi for a powerful and deeply personal conversation about lived experience, advocacy, and the gaps in maternal mental health care that nearly cost Aaisha her life and her daughter's life.

Together, they explore what postpartum psychosis actually looks like from the inside, why it is so often missed by healthcare providers, and how a culture of misinformation and fear has caused this temporary and fully treatable condition to claim lives it never needed to.

This conversation also dives into the difference between intrusive thoughts and delusions, the bizarre behaviors that signal something is seriously wrong, and why "rare" is the wrong word for an illness that occurs at the same rate as Down syndrome and cerebral palsy.

00:00 – Content warning and crisis resources 

02:00 – Welcome and introducing Aaisha Alvi 

03:00 – Why Aaisha's book is a rare and detailed account of psychosis 

06:00 – Recovery and meeting Aaisha at her baseline 

09:00 – Why full recovery is possible even after delayed treatment 

12:00 – Why providers are sometimes afraid to name psychosis 

14:00 – Why PMADs are the #1 complication of pregnancy

24:00 – Psychosis as a progression, not a snap - where intervention is possible

 28:00 – Intrusive thoughts vs. delusions: how to tell them apart 

34:00 – Bizarre behavior as the most reliable outward sign of psychosis 

39:00 – When loved ones see something off and providers say it's fine

44:00 – A look ahead at Part 2

Important Resources Mentioned:
If you or someone you love is in a mental health crisis, call or text 988 (U.S.).

For maternal mental health support, the National Maternal Mental Health Hotline is available 24/7: 📞 1-833-TLC-MAMA

postpartum.net Postpartum Support International (PSI) — provider directory, provider-to-provider consultation line, helplines, and support groups for individuals and families

app-network.org - Action on Postpartum Psychosis — stories of recovery and educational resources for families and providers: app-network.org

A Mom Like That: A Memoir of Postpartum Psychosis by Aaisha Alvi — Aaisha's full account of both episodes of postpartum psychosis, with a foreword by Dr. Wendy Davis.

Follow Aaisha on Instagram for ongoing education and advocacy: @AaishaAlviWrites

Content note: This episode discusses postpartum psychosis in honest and sometimes graphic detail, including hallucinations, delusions, and homicidal and suicidal thoughts. Please listen thoughtfully and skip if it is not the right time.

Connect with Dr. Anikó:

Instagram: https://www.instagram.com/dr.aniko/

Website: https://www.draniko.com/

Thank you for listening to Nourished with Dr. Anikó! 

It would mean the world if you would take one minute to follow, leave a 5 star review and share with those you love! 

Your presence is truly felt and deeply appreciated.

Disclaimer:
The content of this podcast is for informational and entertainment purposes only and does not constitute medical advice, diagnosis, or treatment. The views expressed are those of the host and guests and do not substitute for professional medical advice. Always seek the guidance of your physician or other qualified healthcare provider with any questions you may have regarding your health or a medical condition. Never disregard professional medical advice or delay seeking it because of something you heard on this podcast.

Transcript

[00:00:00] 

Dr. Anikó: Hello everyone. This episode of Nourished may not be right for everybody because we are discussing postpartum psychosis in honest and sometimes very graphic detail. Some of the images and conversation topics in this episode may be disturbing for some listeners, and I do not recommend anyone with a recent history of postpartum psychosis.

Listen to this episode today. So please listen thoughtfully and feel free to set it aside [00:01:00] if this is not the right time to listen. But if it does feel like this could be nourishing for you, please listen with an open heart, and I really hope you find some nourishing information here. If you or someone you love is in a mental health crisis, please call 9 8 8.

And if you or someone you love need support in the maternal mental health space, the maternal mental health hotline is free, confidential, and is available 24 7. The number is 1 8 3 3 TLC, ma Ma. As a reminder, this podcast is for informational and entertainment purposes only, and does not constitute medical advice, diagnosis, or treatment.

Always seek the guidance of your physician or other qualified healthcare provider with any questions you may have regarding your health or medical condition. Never disregard professional medical advice or delay [00:02:00] seeking it because of something you heard on this podcast. Take good care y'all.Hello. Hello y'all, and welcome to Nourished with Dr. Aniko. Today's episode is part of our perinatal health and perinatal mental health series, and I'm so happy to have Aisha Alvi here with me today.

She's a postpartum psychosis awareness advocate, writer, and the author of a mom like that, a memoir of postpartum psychosis. She experienced postpartum psychosis twice. Once after giving birth to her daughter and once after a miscarriage. She was dismissed by five healthcare providers where she sought help before she got help from a sixth provider.

And because of that, her psychosis nearly claimed her life and her daughter's life. Her book details how exactly this illness claims the lives of moms and babies, despite the fact that it is a temporary and fully treatable condition. Welcome to [00:03:00] Nourished. 

Aaisha Alvi: Thank you so much Annika, and like I think you encapsulated that so well.

I am wondering if there's anything for me to add, 

Dr. Anikó: mean There's a lot for you to add, I think. I feel like yeah, there's a lot. Uh, you did write a whole book about it, so I feel like there's a lot to add. 

 I did wanna start, you know, by just saying that your book is so unique. You know, listeners, if you have not read it or heard about it, go out and get it.

It's so unique in that. I don't know that we have too many books about psychosis, much less postpartum psychosis where people are able to recall as much as you were able to remember. So with psychosis, often people don't remember once they've recovered, and then often people don't wanna remember, so they don't wanna go write it down.

But you not only wrote it down, you wrote it down in great detail, and you provide us with such an in real life account of the lived experience of psychosis, that I think it's so valuable just [00:04:00] both as, you know, people in the world and then also as providers to see like what it's like from the inside, and to really give us some insight and information and awareness about it that I don't, I don't feel like I fully had before reading your book.

Aaisha Alvi: Aw, thank you so much. for, for saying all that. I think, um, I, I tend to agree in, in the fact that a lot of people do, not have, Like a good recall of what, what happened to them. And I think part of that had to do with the fact that in most cases, fortunately, women are able to get help quite rapidly within days or within 24 hours or, or like two or three days of experiencing psychotic symptoms.

And in my case, I was left to have to endure those symptoms for a very prolonged period of time. And so even what is in the book, there are huge elements of things that, that I don't have, um, a recall of. And I think, especially when I talk about my first episode with [00:05:00] postpartum psychosis, I say in the book that there's one month that I have no idea.

Yeah, what happened to that one month? And the second time I experienced postpartum psychosis, because I couldn't really find books on postpartum psychosis after I had recovered, which was in 2006. My psychiatrist was like, why don't you write one? So I got everything down that second time in three months.

So, I mean, obviously it didn't look like the version that's out in the book. It was more like, this happened to me, that happened to me, this happened to me. But I was able to document all of it, like within three months of having experienced it. And so I'm really grateful. I don't think my psychiatrist really thought I would write a book.

He was just trying to, well, why don't you just write one? And I, and I was like, okay, why not? So I, I'm grateful between what I, what I documented. within those first, um, three months after recovering till it came out, there was 15 drafts in between. Wow. Yeah, so I am very grateful that I [00:06:00] was able, I, I did have a psychiatrist that suggested something like that, and I was able to put down the exact feelings I was having and stuff like that.

Dr. Anikó: Yeah. And was it that psychiatrist, was it the same psychiatrist who was that sixth provider 

Aaisha Alvi: Yes. 

Dr. Anikó: Well, that's very special. 

Aaisha Alvi: Yeah. and then read my first draft of the book that I was hoping to publish at that time, and she amended some things and she said, no, no, no.

This is what happened So I was like so grateful that I had, her helping me too. 

Dr. Anikó: Yeah. Fact checker. 

Aaisha Alvi: Yeah. 

Dr. Anikó: Well, and also it's so, you know, I, I kind of wanna start here, right, with where you are today, because in the book we accompany you through this very harrowing experience where you're starting to have hallucinations and delusions, you're becoming paranoid at one point, you're almost catatonic.

And so to hear you today, I feel like to me that's the take home message, right? Is that we don't need to fear postpartum psychosis. Obviously it can be a [00:07:00] scary situation, but the scariest part of postpartum psychosis is not recognizing it and not treating it because it's a temporary and very treatable.

Conditioned to the point that you are this very vibrant, very, you know, upbeat, talkative person to the point that, you know, I thought it was a really funny part of the book, where you're psychiatrist, you start to recover and she thinks you might be in mania. 

Aaisha Alvi: Yeah, yeah, yeah. So it was, it was because, um, at that point, because the version of postpartum psychosis that I had is, the version that was major depressive disorder with postpartum onset with psychotic features.

And that's because postpartum psychosis as an independent standalone diagnosis is not currently in the DSM, which is a diagnostic and statistical manual. So that being the case, in many instances, those that have postpartum psychosis usually have underlying bipolar condition, [00:08:00] or it's first onset of bipolar, um, depression, or it is postpartum psychosis with symptoms of bipolar like mania and stuff like that.

In, in my situation, I didn't have any manic symptoms. I didn't have a postpartum diagnosis from before. It wasn't first onset bipolar disorder, it was just. Major depressive disorder that developed psychotic features. And because of that, I was at, melancholic, super depressed, lost like 10 to 15 pounds in three weeks, couldn't eat, couldn't sleep.

Was so slow that my psychiatrist, the first time she met me, she thought I was developmentally delayed. And she asked my husband, is she always, you know, and I was very like, offended that she was asking this, but it was because I, was suffering from psychomotor retardation even so that mm-hmm. All my movements and my speaking was so, so when I got back to baseline, after I was properly treated, I was this person that's with you on the podcast.[00:09:00] 

My psychiatrist ordered that my husband have to come back. 'cause he used to come to the initial appointments but had stopped coming. And so she said, I need to see him in the next appointment. So he came and she was like, is this your wife? Because she couldn't believe, she thought I was going through like, mania, mania.

I was like, no, no, no. This is the woman that I married. This is her outside of the two times that she's had this condition. So it was like kind of funny because she thought like, what? I don't know what this woman's baseline is. So it was kind of funny in that way. 

Dr. Anikó: I mean, I thought it was funny and I was like, yeah, that makes sense.

You know, if you went from super slow talking, barely talking to mm-hmm. Who you are today, I too would be worried, you know, in the context of psychiatry and how wonderful that you were able to really like fully recover. I mean, you have fully recovered. 

Aaisha Alvi: Oh yeah. Yeah. I would have to say like, for a while after I recovered, I was always, wondering if certain things would still trigger me and [00:10:00] I can say, no, no, they don't at all.

There was a time in my life, like a couple of years and that whole experience where there would be small things that would still kind of be like, oh my gosh, that reminds me, but I'm not there anymore. I, I have fully resolved everything to do with that experience and, and this is despite the fact that.

Both my experiences with postpartum psychosis were allowed to go on for so long. Right? Yeah. And, and got to such a severe level that I was homicidal and suicidal and to think that despite, you know, that that psychosis having impacted my brain. 'cause we do know the psychosis does impact a person's brain, right?

It does. it harms your brain. But, you know, even though I was allowed to be psychotic the first time for four months and I never got help that time, and the second time it was allowed to progress for one and a half to two months. 

Dr. Anikó: Mm-hmm. 

Aaisha Alvi: Um, you know, recovery, full recovery is possible. And that's why, [00:11:00] like you said, the worst aspect of this illness is the fact that.

When healthcare providers and the public don't know about it, and you're forced to suffer from something that is so, so treatable, so easily treatable. 

Dr. Anikó: Mm-hmm. And not even don't know about it. They're like afraid to see it for what it is. Like, I feel like they were points in your journey where you were coming in saying, I'm hearing voices.

Mm-hmm. And people are like, mm-hmm. Which is a hallucination, right? That's an auditory hallucination. And, and then providers are saying, well, aren't they just thoughts though? You know, it's almost like they're trying to talk you out of it at points. Right, right. And again, I also wanna just name that this is the, basically the definition of Monday morning quarterbacking.

Like, I'm coming in knowing the end of the story, being like, how could they have missed it? Like, there's so much nuance, I just wanna be empathic and, and generous and just say like, I'm coming in knowing, knowing what happened. So it's very easy for me to comment on it. [00:12:00] Um, but there, there does seem to be a way that not only is it a lack of information, it's like a fear.

It's like a fear that, oh God, I don't want it to be this. Either because the idea of having psychosis is so scary or of someone you love or, or treating. Having si psychosis is so scary. And then also, um, recently I did an episode with Dr. Kara Brown and she said something that I just keep repeating. 'cause I think it's so true and, and kind of funny as well, where if you don't know what to do with psychosis, you also don't wanna diagnose it, you know?

Mm-hmm. So she, she says, you know, if you don't, you don't wanna open a can of worms if you don't know what to do with worms. Mm-hmm. You know, so it felt like even more than not knowing the signs, it felt like being too afraid to see it. Mm-hmm. And then maybe even being like, I don't even know what to do with this if it is that, you know?

Aaisha Alvi: Yeah, a hundred percent. I, I, I totally agree with that. It was like, and also something that Wendy Davis included [00:13:00] in, in the Forward that she wrote to my book is that like. If you can, like, you know, all these doctors knew what my day job is. Um, and they were like, if this woman who seems so normal and has just seems like me can be suffering from this condition, then what does it say about me?

What does it say about my sister, my brother? I mean anybody. You know what I mean? And so mm-hmm. In that level too, there's that like, no, no, no, no, no. This doesn't happen to people that are educated, can be articulate. All that kind of stuff. Because I remember when I went back and read, uh, my reports, 'cause I'm like an advocate, so I was like, I am going to take these doctors through the ringer.

But I, when I went back to my look at my notes, it was like, I was like surprised because they're commenting on all these different things that I didn't know that doctors comment on, which is like, uh, you know, like how I'm dressed, how I look, if I'm articulate, if I'm, you know, and they're making notes on all these kinds of things, but I'm like, wait a second, how come it doesn't [00:14:00] say.

I said, I'm hearing voices. And the thing is, I, I myself ha did, if I did not have witnesses to the fact that I was saying these things, I might have my gaslit myself and been like, did I even say that? But everybody that was with me at these appointments were like, yeah, you did say that. You did ask to be hospitalized.

You did say, I'm feeling like doing bad things and I don't want to. But meanwhile, all of these things were left out of the report. So it was almost like, like they themselves did not wanna acknowledge what they were hearing. Mm-hmm. They only wanted, mm-hmm. Acknowledge that kind of stay safe. You know what I mean?

Dr. Anikó: Mm-hmm. Well, yeah, they kept saying like, get rest, exercise. And then you began exercising compulsively to escape these thoughts and voices that were, you were kind of starting to drown in. Mm-hmm. Um, you lost all this weight. I mean, it really, I mean it, and I will say that as a physician you do notice, you know, if somebody is dressed well as taking care of [00:15:00] themselves, like those are all things you do comment on, especially if you're worried about psychiatric conditions and wellness and competence and all those things, but you don't then not include that they're hearing voices, you know?

Aaisha Alvi: Yeah. 

Dr. Anikó: Um. And, and how wonderful that you had witnesses. 'cause it would be really easy for somebody to convince me, especially in that state of mind that I hadn't said it. It's like, oh, well then maybe I just thought I did. So, yeah, I mean, it's wonderful that you, that you did all your, you know, essentially kind of not necessarily due diligence, but you really looked through it and said, how did we get here?

How did this happen? Because I feel like that's one of the. Best things about your book really is that you do illustrate how somebody, and you didn't have any risk factors, right? You didn't. You didn't, you don't drink, you don't smoke, you don't use drugs. You had tons of social support. So all of these ideas that we have of like the kind of mom this happens to, didn't apply to you and obviously isn't true.

Like they can increase your risk, but it doesn't mean if you don't do those, you have no [00:16:00] risk. Mm-hmm. And also, you know, and we've talked about this before, but you know, this is something that everybody needs to know about psychosis. Postpartum psychosis is rare, but PMAD, so perinatal mood and anxiety disorders of which postpartum psychosis is sort of the most extreme and severe.

PMA DS is the number one complication of pregnancy. Mm-hmm. So the fact that we as a culture don't know how to recognize the signs of it and that the medical community doesn't, not that everybody know needs to know how to treat it. Mm-hmm. But they need to know how to recognize it and where to send people for appropriate treatment.

And one of the things that I feel like I talk about a lot, because it's something that I just think is absolutely like unacceptable, is that reproductive psychiatry and perinatal psychiatry and that, that being a specialty, like I love that people are devoting themselves to it and say, I only wanna do this.

Mm-hmm. But the fact that there are psychiatrists out there who know nothing about [00:17:00] PS is not acceptable. 

Aaisha Alvi: No. Yeah. A hundred percent. Hundred percent agree. Is there something that I can, I can just make a comment about onco that, um, I just wanted to point out, I do not like the word rare with respect to postpartum psychosis.

Dr. Anikó: Sure, 

Aaisha Alvi: yeah. And reason for that is because although you're completely right, it is the most extreme out of all the Ps it actually occurs at the same instance as down syndrome and cerebral palsy. And we have posters like where I live, we have posters in like subways about Down syndrome and cerebral palsy.

And yet still nobody. Like even doctors don't know about postpartum psychosis. And I think it's because when we, when we, when we call it rare, we kind of mentally make a note that it's not something that we need to be aware of. So that's like one of my biggest pet peeves. I just wanted to just, I know people still use it, but I just wanted to point out that I hate the word rare because I always feel like that word is why none of the doctors, [00:18:00] um, bothered to make space for it in their brain, you know?

Because one of the things my psychiatrist was saying was like, oh my gosh. Like what more, aside from self diagnosing yourself, could you have done with these doctors you went to, you know what I mean? So, 

Dr. Anikó: mm-hmm. 

Aaisha Alvi: Yeah. I just hope that we can get, get to the point where we can not call it rare anymore, because the reality is that it isn't rare, you know?

Yes, it is. I, I like to say less common. 

Dr. Anikó: Mm-hmm. Yeah. The least common. The least common of PMM A Ds. 

Aaisha Alvi: Yes. 

Dr. Anikó: And I agree. I love, I love the. I love that you pointed that out and I, and I love that you pointed that out in the context of it. It prevents us from thinking of it as a possibility. It's not just like a pet peeve 'cause you're like, I hate the word rare.

It's that like the fact that people think of it as so rare 

Aaisha Alvi: Yes. 

Dr. Anikó: Means that people are not allowing themselves to consider it for their loved ones or [00:19:00] their patients because there's this idea of like, oh, it's so rare. This could never happen to me. So I love the context of Down syndrome and cerebral palsy because we all know somebody who has cerebral palsy.

We all know somebody who has Down Syndrome. We all know somebody. Now all of our listeners know somebody who has had postpartum psychosis twice. 

Aaisha Alvi: Yeah. And, and the funny thing was that I, I remember like when I went back to one of the providers that had, um, you know, dismissed me and sent me home, she later said, you know, I'm really sorry, but in my 30 years of practice, you were the first person with postpartum psychosis I ever came across.

And I was thinking, well, maybe not. 

Dr. Anikó: Mm-hmm. 

Aaisha Alvi: You know, maybe not, maybe you just didn't recognize it, like you didn't recognize it with me. Right. 

Dr. Anikó: That's 

fair. 

Aaisha Alvi: Yeah. So I just think that just like, you know, the, the language that we use is important in the way that we frame something and then the way we frame it.

Determines how, like where it gets [00:20:00] filed in our brain, right? 

Dr. Anikó: Mm-hmm. Mm-hmm. Yeah. And, and sort of a along kind of the same lines of what we were talking about, about PMAS being so common that to make it be a niche thing as opposed to like a baseline thing that everybody else needs, that everybody needs to know about also impacts us.

'cause when you say like, it only affects pregnant people to, like, it is the number one complication of pregnancy that changes people's view of it. Right. And even to say only affects pregnant people. I mean, that's crazy. So many people become pregnant. It's a huge proportion of our population. Um, and it sounds like in your book.

This is a leading question because I know the answer to this, but I know you were really trying to share. 'cause you know, when, when something deeply and like tragic doesn't even, it's not even a big enough word, when something as like heart shattering, soul shattering, um, mind shattering happens like what happened with Andrea Yates or Lindsay Clancy.

Um, [00:21:00] and it's, it's notable, and you've noted this as well, that the, the public's response to Andrea Yates back in like the early two thousands compared to Lindsay Clancy, um, I think it was 2024 was different. And that is wonderful, you know, seeing somebody, um. Fall victim to postpartum psychosis and their children fall victim to postpartum psychosis is a very different lens than seeing that person as a monster.

You know? So in that sense, it does feel like we've evolved. Yeah. But, you know, in both cases it seems like people are like, how could this have happened? How could this have happened? How would, how would this even happen? You know? Mm-hmm. And then you write a book about how this even happens. Mm-hmm. And then what did the publishers say?

Aaisha Alvi: Well, I, so this book, the first draft of it came out in 2007, so it was like 16 years in the making. And I mean, I, I first wanna be entirely honest, that draft maybe didn't sound as great. [00:22:00] Like it was more kind of like. You know, not as narrative in style, but still, I did have interest from publishers, but the publishers said they wanted me to tone down the violence.

They said, this is very jarring in terms of what we think of motherhood and what you are writing about. And they asked me to tone down some of the violence in it and I said, no, I'm not gonna do. And they, because they said that they would give a, a second reading and I said, I'm not interested in doing that because people always want to know how these tragedies happen.

And yet here when I'm offering like an a window into that experience, you're asking me to tone it down. And no, I want to be truthful and honest about exactly how this happens. And so, you know, I was like, no thanks. I instead, I took the feedback that I got about like narrative writing it in a more narrative manner and stuff like that.

And I took that and I said, okay, maybe you know, the world is not ready for something like this because, you know, maybe we don't have such a great [00:23:00] understanding of mental health. And I don't, I don't blame anybody. Like I was a psych major and I was still under this perception of like, oh no, all mental health problems can be solved without medication.

You know, just therapy is enough type of thing. So like, I mean, if I was like the average person, I could see why maybe what I wrote could be so jarring to people. But then over time I just found that the landscape, uh, I was doing advocacy work around the area of, perinatal mental health and stuff.

And I could see that the landscape was changing. And COVID was great for that because I completely, um, decided to revamp my book and. Resubmitted it to publishers. And so I'm, I'm grateful to COVID. I mean, I hated that time, but it gave me the time to really work on it and revamp it. And I think at that time, society was more open to the idea of like, seeing the fact that, you know, all, all of motherhood is not the roses and all that kind of stuff we try to paint it with, right.

There's a [00:24:00] reality to motherhood that we need to face. And some of that is very ugly and some of it is very frightening, but at the same time, even this most extreme condition is treatable and doesn't need to be allowed to progress to the level of, of harm that it causes, you know? 

Dr. Anikó: Mm-hmm. Well, and I would argue, you know, I, and also like I, I am in the.

The world of truth. Like I feel like medicine is figuring out the truth. Science is figuring out what's real, right? Like I don't wanna shy away from things that are scary or unpleasant. Mm-hmm. I just wanna dwell in the truth so I can help, because the only place we can help is in reality, you know?

Yeah. But you know, I would argue that, you know, having somebody see the level to which it can progress and, and you know, you thankfully got treated before there was actual homicidal action, although there was command hallucinations around that as well. but people need to recognize that the scary thing is the progression and the lack of [00:25:00] treatment.

That's right. Not the, not naming it, not the being like, oh, you have it. Mm-hmm. It's not scary. I mean, it can be a scary experience to have it, of course, but that's not the worst outcome. The worst outcome is the not treating it. 

Aaisha Alvi: Yes. And and for sure. And that's the other thing that people. I have to, um, that I hope that people would understand from reading my book is that my first experience with postpartum psychosis, although people would still consider that severe, because I did experience delusions that my husband wanted to molest my daughter and my family wanted to harm my daughter and things like that.

And those are pretty serious delusions. Um, it was nothing compared to what happened to me the second time. 

Dr. Anikó: Yeah. 

Aaisha Alvi: And, and the thing is, um, it, it, like nobody wakes up with postpartum psychosis and picks up a knife and feels ordered to, you know, slaughter their family or anything like that. It's like there is a progression to these illnesses.

There are [00:26:00] like, like my psychiatrist said to me, there was a lot of things going wrong with you and that people were seeing, but they were not understanding or recognizing. And that's the important thing. Like I think sometimes people just think like some postpartum mom who was associated with tragedy, like she just woke up out of bed one day and, and decided to like, you know, take the lives of all her children.

No, that is not how it works. There were so many points at which, um. Intervention was possible, right? Mm-hmm. For this not to have progressed to the point that it progressed to, and my psychiatrist explained to me, she said it was, in her opinion, she said it was the fact that you were completely untreated for four months with your postpartum psychosis the first time.

That's why your psych like, it was almost like, you know how we talk about like the plasticity of the brain? 

Dr. Anikó: Mm-hmm. 

Aaisha Alvi: And how we have these like pathways that are set. So she said it was almost like there was this groove to that part, if [00:27:00] we can call it a proverb, proverbial land of psychosis.

That path was set. And so even though you did not carry to term, and you were only 14 weeks pregnant when you miscarried, that was already so ingrained in your brain from not having been treated, that your mind just ran immediately to that place that it recognized. Mm-hmm. And that's why you got. I so fast, so quick, you know?

Yeah. But even, even though I got so ill so fast that second time, I also got better incredibly fast 

Dr. Anikó: Well, and you also, like you said, um, it's not like you snapped one day or anything like that. Mm-hmm. Or it's not like anybody snaps one day, which is very good news.

You know, that's very hopeful and encouraging and exciting. 'cause that means there are so many places to intervene if the truth about psychosis or at least postpartum psychosis or that there's no signs, you just snap one day and you know, kill your children. Well that is a much scarier situation where we can't do much [00:28:00] about that.

But actually there are so many early signs where we can intervene. Um mm-hmm. And so can you share some of those, like your progression, those points where, you know, you look back and you're like, that was a sign that was a thing. So that our listeners, you know, some of whom who have read your book, some of whom have not yet.

Um, but so that they can sort of have some information about like, oh, here, here's something to notice if you see in your loved one. Because ultimately I know that one of the things you're really passionate about is advocacy and education so that the public, you know, can start to recognize this and start to help one another.

Mm-hmm. And, um, and your mom's already started doing that, but we can get to that in a little bit. Um, but so what were some of these sort of signs of progression that, that people could have recognized as, this is really strange, this is, this is something we need to notice. Um, but kind of didn't. 

Aaisha Alvi: Yeah. So I would say, um, one of the, so, so basically in, in both my [00:29:00] experiences with postpartum psychosis, I initially started off feeling depressed and anxious.

And that is very common to a lot of women's experiences, whether because you're experiencing the baby blues, which is a completely normal, you know, transition kind of phase where you're feeling these kinds of, um, emotions because of, of the new life, that new role that you've taken on. So that's normal and depression and anxiety and intrusive thoughts, which is it okay if I define that for 

Dr. Anikó: absolutely sure.

Aaisha Alvi: In thoughts are kind of like random thoughts associated with anxiety that can occur in people that are depressed or anxious or any of the PMA ds and they're random, um, unwanted thoughts that can just manifest as mental images. Or they could be like, what if? Mm-hmm. So what if my baby drowns? What if my baby falls.

Insert any number of awful things into the what if. Okay. Like even it could be like, what if I accidentally sexually molest my baby? It could. Mm-hmm. It could be all these kinds of random thoughts. And you know, a lot of [00:30:00] times people sometimes are like, oh no. They get confused by like, wait, is that an intrusive thought?

Is that a hallucination? I've had people, you know, share their intrusive thoughts and think that they're hallucinating or think that they're have postpartum psychosis. And it's really important that we don't frighten people about intrusive thoughts because intrusive thoughts are something that 90% of parents, both moms and dads experience.

And we don't want 90% of parents thinking that they're psychotic. Right, 

Dr. Anikó: right. 

Aaisha Alvi: So, um, intrusive thoughts are completely normal, especially in the postpartum period. And they're like more a symptom of anxiety. Right. And I did have intrusive thoughts now, the symptoms that were kind of. And at that point I was not, psychotic.

What kind of showed that I was psychotic was when I started to believe strange things. Right. And, and of course it's hard for other people, outsiders to know if you're believing strange things. 'cause they're things that are in your head. I'm gonna give a tip that I think is useful. so the beginning of psychosis for me [00:31:00] was the be beginning of believing strange thoughts.

And by strange thoughts, I mean like, I started to think that my family was at risk of acting on the thoughts in my head. No normal person would be like, oh yeah, this person's gonna act on the thoughts in my head. That's a strange belief. I did not think it was strange at the time, but as you can see, that would qualify as a strange belief.

And then I had other ones, like I thought that my baby wasn't a baby, but a grown adult pretending to be a baby. And then other ones like that, my husband was having an affair that he wanted to molest my daughter. Now. How can we tease that apart from intrusive thoughts as somebody that's has lived experience of both?

The way that I would kind of, um, separate the two is that, first of all, intrusive thoughts. Feel like they're a product of your mind, or they're in your mind, or, you realize at some level they're, they are not real and it's, you're just thinking it. Okay. But delusions and psychotic [00:32:00] thoughts can be very bizarre and illogical in nature.

So like, the fact that I'm thinking that other people are at risk of acting on the thoughts and my head, nobody would say, yeah, yeah, I've experienced that too. Like, that'd just be like, that's bizarre man. Why are you thinking that? Right? And for me to be like, my baby's not really a baby. Like, I don't think there would be anybody that would say that.

That is not a bizarre thought. Whereas if some mom said, I'm scared that my baby could drown in the bathtub, I think like 90% of parents would say, yeah, I've had that thought. Like, you know, so. Psychotic thoughts, um, tend to be more bizarre and illogical in nature. They don't make sense, right? But I mean, to that person, they might make sense at that time.

 or it might not be that it makes sense, but they believe it and they believe it because, um, they have proof of what they're thinking. So it's a fixed belief. It's not like a temporary, random thing that comes up. It's a very fixed belief. So I'll give an example. Like when, um, I was thinking that my family was at risk [00:33:00] of acting on the thoughts in my head.

Believe it or not, I have evidence of it. I mean, the evidence is gonna sound foolish, but I, I remember when my mom was trying to deny that she wanted to harm my daughter, I was like, no, 'cause my mom kept telling me to go with my daughter on walks. And for me that was like proof what she was actually saying.

Was that, don't leave your baby with me because I will harm her. Mm-hmm. So see for me, I had evidence of that thought when I believed that my husband wanted to molest my daughter, it was like, it was in a moment where I had wanted to go shopping and, um, my baby was crying. And so he was like, no, you go window shopping and I'll take her home.

And all of a sudden it was like, oh my God, here's the proof. He's literally trying to get me out of the picture so he can molest her. 

Dr. Anikó: Mm-hmm. 

Aaisha Alvi: So that's why delusions are believed by the people experiencing them because they have, quote unquote evidence proof that this is happening. Right? 

Dr. Anikó: Mm-hmm.

Aaisha Alvi: And [00:34:00] intrusive thoughts like I was having intrusive thoughts of my, uh, baby drowning, my baby, falling my baby.

I had no evidence that was gonna happen. That was just like a random thought that would pop up in my head, right? Mm-hmm. But meanwhile, a delusion and psychotic thoughts have like a story behind it like, oh, my mom wants me to go take my baby with her 'cause she's saying that she's gonna harm my baby if I'm not there.

Dr. Anikó: Right? It's like a sense that like, this is the truth. And as you said, most parents have them. I mean, and they can even be like, oh God, what if I, you know, you see a knife block and you're like, oh God, what if I stabbed my baby? Like, it's not logical and you're not like, oh, here's the evidence that I will, it doesn't become like a belief system.

 sometimes they're also images, but they're not hallucinations. No. And you're certainly also not being like, well, here's the proof that I'm gonna drop my baby down the stairs. That's, you know, set in stone. Now it doesn't become a belief in the way that, um, delusions do. 

Aaisha Alvi: Yes. And, and the way that you can tell, like [00:35:00] even though I had all these, like if you went back and asked my family, wow, did you ever think Aisha was delusional?

They'd be like, no. Did you ever think that she was hallucinating? They'd say no. But if you asked them if I was behaving bizarrely, they would've said a hundred percent. And that's the thing, somebody might never tell you the beliefs that they have because especially like, I'm not gonna tell my husband, I think you're gonna molest her or you're gonna like, kill my daughter.

I'm not gonna tell anybody that those are cards I'm keeping close to my chest. But boy was I acting bizarre because I believed those things. I was not letting my family have access to my daughter. Um, there's a scene that I narrate where I was literally punching my husband in the head 'cause I was so angry and disgusted that he would even think to, to want to molest my daughter.

So like that's the thing, like you'll see unequivocal bizarre behavior In response to delusions and hallucinations, when I was hearing the voices, I was sticking my fingers in [00:36:00] my ears and like running down the street. 'cause I didn't wanna hear the voices That's why I always tell people, like, if you witness bizarre behavior in the postpartum period, never ignore it.

Dr. Anikó: Mm-hmm. 

Aaisha Alvi: That definitely needs to be checked out because for that person, there is a reason why they're doing what they're doing. Right? Mm. 

Dr. Anikó: Mm-hmm. 

Aaisha Alvi: in my second experience with postpartum psychosis, when I thought. The devil was in front of me I was literally out of the bed trying to kick and punch and it must've looked so bizarre to my family 'cause they're seeing me punch thin air and kick and scream at thin air.

But for me it was because I was seeing the devil in front of me, right? 

Dr. Anikó: Mm-hmm. 

Aaisha Alvi: So that's why if you ask my family, they would say, wow, we never knew she was delusional. We never knew. But boy, they could come up with like a thousand different ways that I was acting bizarre. And that's the same with all of those women that have had tragic outcomes to their stories.

I'm a little bit of a stalker on PPP stories, because I always find that news stories don't give a full [00:37:00] picture. You have to read like a gamut to get little facts from all the different coverages. 

The family will always say that, oh, this person was doing this bizarre thing. That bizarre thing. But they kind of just like, kind of shook it off. Like, you know, like, like my husband shook it off like I was punching him in the head and I asked him after like, well that is so not my baseline. Like, why weren't you like, like crazy concerned about that behavior?

And he said, well, I knew the postpartum period's hard. It's a different change. Like, he was cutting me a lot of slack, but, and which is nice. I'm, I'm very happy that he was giving me a wide birth. But you know, like something that is so, so off the person's baseline. I'm not saying go and have them admitted into the psych ward because, you know, may, they may seem to be demonstrating a bit of rage, but how have that looked into.

Dr. Anikó: Have them give them some support. At the very least, have them checked out. Of course. And I love that distinction. It's not like we're like, well now, now you're in the inpatient psych ward. It's like, no, you just need to go get them checked out. But [00:38:00] I will say, you know, in defense of your husband's kind of blase attitude and loving wide birth attitude towards your punching him, 

You had also been reassured by multiple providers. So there was also a period of time where, and I think you're also doing such a good job of being so generous with your family as well, because there are points in the book where I'm like, geez, like I'm upset with your dad, or I'm upset with your husband.

But you know, they keep being told that there's nothing really wrong. She just needs rest. She just needs exercise. Mm-hmm. And I can only imagine the fear in them of seeing you act bizarrely, but they're being told that it's fine. And there's just this, this desire to kind of like, just shake it out of you, like, stop acting like this.

 and so that. Also a very difficult position to be in as a family member, to be seeing this bizarre behavior and being told that it's fine. Mm-hmm. And I think, you know, another take home message is like, you know, your loved one the best. Mm-hmm. So if you are seeing bizarre behavior and [00:39:00] people keep telling you it's fine, then find a specialist, who's seen this before, because even, and you've said too.

You, you weren't announcing your hallucinations, you weren't saying, I'm hallucinating, I'm having delusions. And that's pretty rare as far as, psychosis goes. just in practice people will deny hallucinating. People will deny their delusions. You'll ask them, do you believe strange things or whatever.

Um, and they'll say no. Or maybe they don't think it's strange, but as you're saying, they are often behaving. And I think bizarre is the perfect word because it's bizarre. You know, it's not just like off, it's not just like, oh, it's a little weird for them. You're like, this is genuinely bizarre. Like, they'll be looking around and doing weird things.

Yes. And like talking to people like through the side of their mouth that like, you don't see anybody. So there are clues. if you're expecting your loved one to come and be like, hello everybody, I'm hallucinating and having delusions.

I think I'm in psychosis. Like that's not what the reality looks like. [00:40:00] 

Aaisha Alvi: No. And even though, like, um, earlier on in my, um, second episode with postpartum psychosis, when the doctor had asked like, are you hearing voices? And I was like, wait. Yeah, I like, it does sound like a voice. Like even though I had initial awareness, by the time I saw the sixth provider, which was a psychiatrist, I now had a new delusion that I was in this apocalyptic battle between God and the devil.

And I was like, oh, can't share it with her because you know, I'm of Muslim faith. And I, at that point I was like, I can't share it with somebody who's not Muslim. 'cause they will think I'm delusional, which I was, but I had this kind of thing going on. But, and, and the point that you say about like the, the behavior.

So at that point when I saw my psychiatrist, I was not telling her anything. I was like practically for two reasons catatonic ish at that point. And also had this delusion that I couldn't share anything with her. And yet she was the one who suspected I was experiencing postpartum psychosis. And [00:41:00] later I went back to her and I said, how did you know?

Because I was so like tight-lipped at that point. Sure. The other doctors should have known, but you were the one who diagnosed me, yet I wasn't being like loose lips at that time. And she said, it was just that every time I asked you something,I could just see it in your face your head. Was not in the game, it was in a different game. Mm-hmm. And so I'm so grateful to how, this speaks to the fact that you need to be in the hands of the right care provider. And I'm not saying, I'm not trying to like dis other care providers, but it's kind of like know your lane.

There is a place for therapists in postpartum, but that usually comes after that acute phase, right? 

Dr. Anikó: Mm-hmm. 

Aaisha Alvi: Like your job when you notice these kinds of things is to hand that person off. If you are having a difficult time discerning whether or not this is intrusive thoughts or a thing, and you're kind of in the middle.

Don't worry about it. There's other people who do know how to detect that difference, [00:42:00] don't try to be like, I have to solve this. No. That's why we have different people with different specializations. sometimes in the awareness work that I do sometimes when I say, you know, this is an emergency and medication is the fastest way, then you know, sometimes therapists will come on and they'll kind of be offended and they'll be like, well, therapy is important too.

And I say, yeah, but in that acute moment when it's a medical emergency. You need a medical practitioner that is not to discount the service that you can provide for this, but it is just that it comes after. 

Mm-hmm. 

Aaisha Alvi: And that's not a dis or, or a disrespect or anything. It's just saying that know your lane.

And it's important to stay in that lane because that's when harm can happen. When somebody feels like, oh, I know what's happening. I dunno enough about postpartum psychosis, so I'm not gonna diagnose that, but I'll just assume it's this thing that I can manage. 

Dr. Anikó: Mm-hmm. Mm-hmm. Yeah. I mean, one of the most dangerous qualities in [00:43:00] a healthcare provider is somebody who doesn't know what they don't know.

You know? And I, and I understand the pride involved in saying like, I don't know this or something, but you know, we're not in this work for pride. We're in this work to help folks. And, knowing that limitation saves lives, and, and we'll get into PSI, um, in a little bit postpartum support international, where you've done a lot of work, both supporting individuals and then also supporting the evolution of what providers are trained.

Um, but PSI provides, you know, provider directories, provider to provider consultations. So if you find yourself in a situation where you're like, I'm in over my head 

Aaisha Alvi: mm-hmm. 

Dr. Anikó: Reach out, you know, there's places to reach out for that. And I also think you do a really good job of talking about how the inpatient psychiatric unit was what you needed, you know, and, and you were so grateful for it.

 And that like, sometimes we're too [00:44:00] scared. Even doctors feel terrible about, sending somebody to inpatient psych. and it's a big deal, So it's appropriately, we're appropriately, um, careful with it because you're essentially, I mean, your case, I know that you were asking to be sent to the hospital, but in some cases you're going against somebody's will.

Mm-hmm. You're forcing medical treatment on them that they are not consenting to. It is a big deal. Yeah. And it can be the exact thing that people need to save their lives. 

Dr. Anikó: We're going to pause our conversation here this week, but join us next week for part two of our conversation with Aisha Alvi. Next week Aisha will walk us through what her recovery actually looked like, the medication, the therapy, the unexpected phobias, and how she was able to fully recover from two episodes of postpartum psychosis.

So looking forward to talking to y'all next week and take good care.[00:45:00]