It's crucial to understand that PPD comes as a spectrum and its effects can be far-reaching and long-lasting. While often associated with the immediate postpartum period, the reality is that PPD and its more severe form, Postpartum Psychosis (PPP), can linger for many years after birth.
For some women, the experience profoundly alters their baseline mental state, meaning they never truly return to who they were before childbirth. This explains why some individuals may suffer from psychosis or other severe mental health challenges even after their children are grown, decades after the initial onset of symptoms.
In 2020, an American woman, Melissa Wilband, was charged with murdering her four-month-old baby Lexi by violently shaking her when she wouldn't stop crying. It resulted in brain injury. According to neighbours, she had been "acting weird" days before the incident.
Melissa was jailed for 15 years, but experts familiar with the matter suspect she was suffering from postpartum psychosis. If true, hers would not be the first case, or the last, where mental illness collides with the law.
Attorney Winnie Odali, a women's rights lawyer who has represented women in similar circumstances, says these cases are more complex than the public often realises.
"When a mentally ill person commits a crime, particularly a woman harming her child, the reaction is usually anger," she says. "But very few people stop to ask, Was she okay? Had she been showing signs of illness? Did anyone try to intervene?"
Winnie explains that under Kenyan law, a person who commits a crime while mentally unfit can be found "not guilty because of insanity."
But invoking that defence requires a thorough psychiatric assessment, a competent legal team and often years of delay, all resources the average woman may not have.
"The reality is that women with untreated postpartum disorders are being jailed in this country, when what they need is urgent care," she says.
Jane was lucky; she didn't reach the point of psychosis, but she was close. After weeks of pretending everything was fine, she broke down during a routine clinic visit. A nurse referred her to a counselling centre that had just launched a maternal mental health program.
"It saved me," she says. "The first thing the therapist told me was, 'You are not a bad mother, you are just unwell, and we can help you.' That one sentence cracked open everything."
Jane was diagnosed with postpartum depression and began therapy and medication immediately. It took nearly six months before she began bonding with her baby. "I wish someone had warned me this could happen."
Anne was helped by a friend, a psychiatric nurse, who recognised the signs and suggested she might be exhibiting early signs of postpartum psychosis. "Just having a name for it helped me breathe," she says.
With support from a psychiatrist and her friend, she began to recover. "I still have moments of paranoia, but I no longer carry the shame."
Unfortunately, access to such help is limited in Kenya. Mental health services, particularly in rural areas, are scarce. Maternal mental health is rarely prioritised and many women don't even have the language to describe what they are experiencing.
Dr. Kiara notes that even among educated women, shame is a major barrier to seeking help. "A woman will say, 'I feel dead inside,' or, 'I can't stand my baby crying,' or, 'I hate my baby,' but she won't connect it to mental illness. She'll say she's weak, or lazy, or not praying hard enough."