Postpartum OCD

The Laundry Chute

The house had a laundry chute.

 “I know what this is!” my husband exclaimed from the bathroom, the day we moved in. My daughter, at nine, was delighted at the efficiency- no more lugging dirty clothes around. My five-year-old was also thrilled, and he immediately sent underwear, paper balls and cars down to the floor below.

The only one not excited about the laundry chute was me. 

Because I knew I was going to drop my baby down it.

Each time I passed it. I could picture opening the door and gently sliding her into it. I could see her little body hitting its metal sides as it slid. I could hear her land in the cupboard in the laundry room, silent.

When I walked by the chute,  the Thoughts would start: “You are going to do it. You are going to do it. You are going to put her down there.”

I would squeeze my eyes shut, and tighten my grip on her to the point where she would let out a little, confused gasp. But the Thoughts would hit harder, come faster.

“See?” the Thoughts would say as I held her tightly, “you want to hurt her.” “You are going to throw her down there.”

Then They would show me horrible images of her falling, to the point where I would let out an audible “No!”, sometimes startling the baby awake in my arms.

It was tempting just to avoid the chute altogether, and maybe just to use a different bathroom completely. We could board it up, or I could pad the sides and the bottom, just in case. Maybe I could seal the cover, much to the disappointment of my family.

But I didn’t.

I didn’t because I knew those things would make it worse. I knew that because the Thoughts had a name. I had postpartum obsessive compulsive disorder.

Actually, I probably had all-the-time obsessive compulsive disorder. Since age 6, my overdeveloped imagination has expertly combined with hereditary anxiety to tell me horrifying stories. For example, when I was young, the Thoughts would tell me that my mom, two minutes late home from shopping, had died in a fiery crash. I sobbed hysterically in the corner while my sisters enjoyed some extra TV time. My sisters, ever the empaths, would look at me with disdain: “You’re nuts, Katie!”

Before bed, the Thoughts would say that I needed to look at the hill out my window six times to keep my family safe. I dutifully complied, certain that everyone else was doing something similar as their bedtime routine.

As I aged, the Thoughts got less frequent. They cropped up now and again; telling me that my boyfriend’s plane had crashed for example, showing me what my imminent slow death from cancer would look like. But I got therapy, learned about anxiety, managed them as best I could, moved on.

After babies, however, the Thoughts were back in force. With my first daughter, we lived above the street car line in San Francisco, and boy did they have a field day. I shut all the windows and obsessively checked their locks, rather than risk tossing her out.

With my son, I’d have visions of pushing his stroller onto the busy San Francisco streets. I’d clutch it tighter until my hands sweat, and then, worried it would slip from my sweaty fingers, I’d wrap the hill strap around my wrist, even in the flat Richmond district.

And here we were with my third baby and, in a morbid twist, the laundry chute.

I can write about these horrible, terrifying thoughts in such a flip way, because I’ve learned that treating them with irreverence takes away their power. How long did it take for me to figure that out? About seven years of graduate school.

Indeed, after realizing that I probably had OCD, I became a psychologist, and after my first postpartum OCD experience, I focused on treating perinatal OCD specifically.

The Thoughts are so powerful, they convince you that if you tell anyone what you are thinking, that they would be appalled, you might be locked up, everyone would know you were a horrible person. So not only do people like me suffer, they do so in silence and fear.

And sometimes OCD can be confusing even to providers. If I went to the hospital and said “I’m constantly thinking about throwing my baby down the laundry chute, “ they indeed might consider placing me on a hold. But it would be hard to explain that my thoughts about hurting my baby are different from someone experiencing postpartum psychosis, someone who may be having actual (often scary and confusing) command hallucinations telling her to do something. Instead the Thoughts are telling me the most terrifying thing my brain can conjure up, purely to horrify me. I have no actual intention of acting on them; it’s the last thing I would do. And if I were placed on a hold, it could inadvertently reinforce the Thoughts’ assertion that I am dangerous and that the Thoughts are real intentions.

But how do providers know the difference? I’ve been now, many times, in the position of deciding whether or not a patient needs to be placed on a hold. It’s tricky enough. OCD can make it even more difficult. Providers have to know to ask some hard, uncomfortable questions: “How do you feel about throwing your baby down the chute? Is someone telling you to do that? How close have you gotten? What do you do when you have that thought?”

So as I learned about perinatal OCD, I realized that it was much more common than I thought, and that both providers like myself and patients like myself might benefit from reading others’ experiences with it.

Which brings me back to the laundry chute. Instead of sealing it up, or padding it, or using another bathroom, I practice skills from exposure and response prevention, the gold standard treatment for OCD (which I’m happy to report, does not take 7 years, more like 7 months).

 I make myself walk by the laundry chute daily, and I make sure at least half the time I’m holding my baby. Sometimes I’ll call out the thoughts out loud as they come “No thanks, Thoughts, not going to toss her down today!” I notice that if I’m extra sleep deprived or sad or anxious about something else, the Thoughts are louder, the images more vivid. When I see something terrifying, I respond to it in kind: “Yikes! Whoah! What an imagination!”I say.

I talk back to my thoughts so that they don’t have control. I watch the images with much less fear.  And I share all of this with my therapist, who listens alongside me, to my Thoughts about my laundry chute. When I go through a period during which I have trouble managing my reaction to the thoughts, I take SSRI medication to help.

And I’m happy to report,  I’ve yet to toss my baby down the laundry chute, or even come close.