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April 27, 1984

'Rip van Winkle period' ends for puerperal psychiatric problems

JAMA. 1984;251(16):2061-2067. doi:10.1001/jama.1984.03340400003001

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A young woman gave birth to her first infant in a fairly routine delivery but five days later started having delusions, hallucinations, and nightmares. Soon afterward, she grew extremely depressed.

Days passed, and delirium alternated with depression, accompanied by weakness, excessive sweating, and, weeks later, menstrual irregularities. To the relief of her perplexed physician, however, after several months this new mother suddenly recovered, completely resuming all normal activities.

That happened in 1858. If it had happened today— and similar scenarios do—the obstetrician might well have referred the woman to a psychiatrist. Although the French physician Louis V. Marcé wrote a treatise on madness after childbirth in 1858, and physicians since Hippocrates have noted similar behavior, official medical recognition of specifically puerperal psychiatric problems went into the deep freeze years ago, and only now have some psychiatrists begun thawing it out.

"For three quarters of the 20th century, psychiatrists lay down