Jerusalem murders shine light on postpartum depression sufferers

When sirens blared repeatedly on Jerusalem’s Hebron Road on the late afternoon of Sunday, January 1, residents knew something was terribly wrong.

But it wasn’t a terror attack, as locals often fear when hearing clusters of sirens and cars racing down the six-lane street.

Instead, it was a tragic, inconceivable occurrence, as firefighters found four children, ages 9, 7, 2 and 11 months, dead in a locked room set ablaze, and their 36-year-old mother hanged to death on the adjacent balcony.

Little is known about the circumstances surrounding the tragedy of the French family, who reportedly immigrated to Israel more than a decade ago and lived comfortably in this enclave of southern Jerusalem that is home to many French- and English-speaking immigrants.

Following an autopsy of the two older children, it became clear they had been strangled prior to being locked in the room that was then set on fire, and officials suspect the two younger children were strangled as well.

As details began emerging, one salient detail mentioned was the mother’s repeated bouts of postpartum depression, a type of clinical depression that can take place after birth. The dangers of the depression were driven home again on Wednesday, after a mother apparently killed her 6-year-old son before taking her own life in the northern city of Acre.

“I don’t understand how this happened,” said Dror Schussheim, the lawyer of the father in the Jerusalem killings, quoting his client. “There were no warning signs. There were problems after the birth and I knew she was in poor spirits like in the past. I figured it would pass and we would get over it. But nothing would lead me to believe that she would do a thing like this.”

According to the Israel Hayom daily, the mother was receiving daily psychiatric treatment, and the grandmother had spoken with her on the morning of the tragedy and offered to come and help her, but the mother said there was no need.

The Jerusalem municipality said the mother had telephoned her local social welfare center three months ago asking for information about babysitting services.

She was told the municipality does not provide babysitters, but the staff person suggested that she come into the center to learn about services available to her. That never happened.

It’s the kind of event that “makes us all wake up,” said Professor Ruth Pat-Horenczyk, who teaches social work at Hebrew University.

“It’s an extreme case, very rare, and we will never know what went through her mind,” said Pat-Horenczyk. “It was a moment of insanity, and I wouldn’t put this under mental illness or depression because many people who suffer from that are very functional.”

Some 30 percent of the population will develop depression at some point in their lives, but it’s treatable, said Pat-Horenczyk, as “it should be.”

“You can’t learn a lot from such an extreme case,” she said. “But be sensitive, be involved if you see stress.”

According to posts on Facebook, friends and acquaintances of the distressed mother were reaching out to try and help during the last six months.

For Sue Freedman, a Jerusalem social worker with 35 years of experience working in local branches of the Social Welfare Ministry, the question is where was the larger community in the tragic story.

“Did someone miss something?” asked Freedman. “Where were the red lights and the people that should be watching a family in distress?”

If there was a sense that the children were in immediate danger, they would have been taken out of the home, said Freedman.

“Asking for help taking care of the kids was a cry for help,” said Freedman.

What’s necessary following a tragedy of this nature and scope is to understand how postpartum depression happens, and how pregnancy, labor and birth can affect the central nervous system, said Rachelle Oseran, a Lamaze-certified childbirth educator in Jerusalem.

According to Oseran, postpartum depression (PPD) occurs in 13% of the birthing population and more than half of sufferers go undetected and undiagnosed, partly because mothers are often unwilling to reveal how they’re feeling to their partners, family, friends or doctors.

“There’s that cultural expectation of being a good mother, and what that represents,” said Oseran.

The immigrant connection

In a place like Jerusalem, where immigrant families, some with many children, are the norm, the absence of an extended tribe dashes the expectations of creating a large, warm family.

“The saying ‘It takes a village’ is so true, and to think that we can just do this within only the nuclear family is insanity,” said Oseran.

Sharon Zimerman, a local birth and postpartum doula — a non-medical professional trained to serve families before, during and after birth — who works with the English-speaking population in the greater Jerusalem area, noted that immigrating to Israel can create and exacerbate tensions within the family unit.

“People who make aliyah — it’s similar to divorce and death, it’s a huge life change, and it can affect men as well,” she said. “It changes our identities, our social standing. No matter how smart you are, you may not know how to say ‘pacifier’ in Hebrew. You may be a PhD and not know.”

There are expectations for people to “just love” the onslaught of parenthood, said Zimerman.

“The assumptions are huge,” she said. “The combination of aliyah and having a bunch of kids is crushing.”

And there is the eshet hayil concept as well, said Zimmerman, referring to the familiar Hebrew term used to laud the perfect Jewish wife.

“I hear hayil” — also the Hebrew word for military force — “and there is a whole army backing up a soldier, but a mom is completely abandoned,” she said. “She’s got to look good, feel good, make the sandwiches and show up for the school play.”

Doulas, said Zimerman, can’t diagnose or treat or advise, but can bring expertise, companionship and emotional support, which can be vital for immigrants who often don’t have the support system necessary after the birth of an infant.

As details from Sunday’s tragedy came to light, an image of the protagonist emerged — an individual generally known to be a caring mother as well as a chic, elegant, well-dressed woman who had become very depressed since the birth of her fourth child, an 11-month-old daughter.

“There are such expectations of women,” said Oseran.

Facebook groups for new mothers, she said, can fuel the feelings of despair and depression.

“There’s the baby-wearing group and the new mother’s group and it all sounds like women have their stuff together,” she said. “A woman can feel embarrassed how family or friends look at her, or scared that they will take her baby away from her.”

Oseran said that one-third of women giving birth in Israel have symptoms of PTSD — post-traumatic stress disorder, and noted that working with a childbirth educator or doula can lower the potential for birth drama — when a woman feels that she has lost control in the decisions made during the birth experience.

“Women hold on to that birth experience,” she said. “We are in a prime position as childbirth educators to have pregnant women and partners be all ears — so that they and dads know how to help and know what to do — and to talk about social norms and expectations.”

Postpartum symptoms

The symptoms for postpartum blues and the continuum of postpartum disorder is a long list that includes mood swings, weepiness, mild anxiety, fatigue or low energy, worry, and mild sleep disturbances. The warning signs can appear from four weeks up to one year following the birth, said Oseran.

There is also insomnia even when the baby is asleep, extreme emotional upheaval, over- or under-eating, increase in depression or irritability, thoughts about hurting oneself or the newborn, becoming socially withdrawn, not interacting with the baby and feeling inadequate as a mother, anxiety or panic attacks, symptoms of mania, hyperactivity, and psychotic or delusional incidents.

Postpartum depression can affect men as well, said Zimerman.

While psychosis is very rare, the spectrum of postpartum depression should raise all kinds of red flags, she said.

“It takes many forms and we mustn’t be quick to judge,” she said. “It’s also important to know that having a mental health issue doesn’t mean you’ll kill your kids.”

Oseran recommended looking at the Edinburgh Postnatal Depression Scale, created to help new mothers detect whether they are suffering from postpartum depression.The test should be given by the presiding obstetrician at the six-week checkup, although that could be too early if the onset comes later, said Oseran.

Women and men also need to know where to turn for non-judgmental help, said Oseran and Zimerman.

Oseran recommended new mothers’ groups that meet in person, and not just on Facebook. Her own childbirth classes meet five times for three hours each, and are sometimes partially covered by local health funds, with a reunion after all the babies have been born.

“It’s a great opportunity for me to notice anything out of the ordinary,” she said.

“Nothing can make up for that real-life, person-to-person connection,” she said. “There are such feelings of isolation and loneliness. You’re on maternity leave and your partner is back to work and especially with immigrants who don’t have support — they should go out and be with other mothers.”

Who can help?

There are several organizations in Israel and the greater Jerusalem area that provide support to new mothers, including Mom to Mom, a grassroots group founded 17 years ago by Marsha Kaitz, a professor in the psychology department of Hebrew University who studies the mother-infant relationship and maternal behavior.

Kaitz modeled her group after the Visiting Moms project that is part of the Jewish Family and Children Services in Boston.

“Postpartum depression is only one consequence of amazing stresses that mothers and families can go through before, during, or after birth, whether it’s the first or second or 14th,” said Kaitz.

Kaitz said she views postpartum depression as a bucket that fills up with stresses over time, and the question is whether or when the bucket is going to overflow. Mom to Mom, a volunteer home visit organization, is meant to offset that bucket of stresses.

She founded Mom to Mom while on sabbatical, and was looking to create a project that would help families get off to a good start.

“I wanted to be there as a hug,” she said, “just a partner that’s on your side.”

The organization now has 25 branches across Israel, has trained 700 volunteers and worked with more than 700 mothers. They recently partnered with the Israeli prison system to help mothers returning home after serving time.

There are other services in place for mothers, including Nitza, The Israel System for Maternal Health, which has a hotline, and Metiv, Trauma and Crisis Treatment Center, another Jerusalem-based organization. There are also psychological services provided by the national health clinics and and the Briut Hanefesh Network of Israeli mental health professionals.

Oseran also pointed to PostPartum Support International, a global website providing postpartum information and support.

“There’s no time limit to needing support,” said Zimerman, who charges NIS 110 an hour, (most local doulas take NIS 80 to NIS 160 an hour, she said). “People plan for having a baby, choosing names and strollers, but I’m saying save money and get a postpartum doula and some diapers rather than any fancy stroller.”

People are more aware than they once were about postpartum depression, but the government hasn’t been forthcoming with the necessary services, said Kaitz. Mothers are screened six weeks before and after for postpartum depression, but if they call the clinic for help and there’s a waiting list for a psychologist, the mother and baby can’t wait.

Organizations like Mom to Mom have become a kind of stopgap system for social services, she said.

“What we really need is a huge basket of services that can service all mothers,” she said.