Cindy Wachenheim was someone people didn't think they had to worry about. She was a levelheaded lawyer working for the State Supreme Court, a favorite aunt who got down on the floor to play with her nieces and nephews, and, finally, in her 40s, the mother she had long dreamed of becoming.
辛迪·瓦肯海姆(Cindy Wachenheim)是一个人们觉得不用为她操心的人。她是个头脑冷静的律师，在州最高法院工作；也是个受欢迎的长辈，能和甥侄辈的孩子玩个不亦乐乎；在40多岁时，她终于实现了长期以来的梦想，成为一个母亲。But when her baby was a few months old, she became obsessed with the idea that she had caused him irrevocable brain damage. Nothing could shake her from that certainty, not even repeated assurances from doctors that he was normal.
然而，在宝宝几个月大的时候，辛迪开始固执地认为，自己给孩子的大脑造成了不可挽回的损伤。任何事情，哪怕多位医生反复保证她儿子一切正常，都无法动摇她对那一点的确信。"I love him so much, but it's obviously a terrible kind of love," she agonized in a 13-page handwritten note. "It's a love where I can't bear knowing he is going to suffer physically and mentally/emotionally for much of his life."
“我很爱他，但这显然是一种可怕的爱，”她在手写的一封13页长的信中痛苦地写到，“这种爱，让我无法忍受知道他一生中的很多时候，都要饱受身体和精神/情感上的煎熬。”
On March 13, 2013, Ms. Wachenheim, 44, strapped her 10-month-old son to her chest in a baby carrier and leapt to her death from the eighth-floor window of her Harlem apartment. "I became so low," she wrote in the 13-page outpouring shortly before she jumped, "thinking that if I had unknowingly caused brain damage to my beautiful, precious baby, I didn't want to live."
2013年3月13日，44岁的瓦肯海姆用背带把10个月大的儿子绑在胸前，从哈林区八楼的公寓窗户跳楼身亡。“我变得很低沉，”她在那封跳楼前不久一口气写成的长信中写道。“想到如果自己在无意中给我漂亮、珍爱的儿子造成了大脑损伤，我就不想活了。”
Ms. Wachenheim's story provides a wrenching case study of one woman's experience with maternal mental illness in its most extreme and rare form. It also illuminates some of the surprising research findings that are redefining the scientific understanding of such disorders: that they often develop later than expected and include symptoms not just of depression, but of psychiatric illnesses.
瓦肯海姆的故事是一个令人心痛的案例，以最极端、最罕见的形式呈现了一名女性患上产后精神疾病的经历。这个故事也阐明了一些出人意料的研究结果，这些研究结果正在重新定义对这类疾病的科学理解：它们的发展通常会比预期晚，不仅包括抑郁的症状，还包括精神疾病的症状。Now these mood disorders, long hidden in shame and fear, are coming out of the shadows. Many women have been afraid to admit to terrifying visions or deadened emotions, believing they should be flush with maternal joy or fearing their babies would be taken from them.
如今，长期以来一直隐藏在羞耻和恐惧中的这些情绪紊乱，正在从阴影中走出来。很多女性一直害怕承认自己有可怕的念头，或是低落的情绪，认为自己应该陶醉在当母亲的喜悦中，或是害怕孩子会被夺走。But now, advocacy groups on maternal mental illness are springing up, and some mothers are blogging about their experiences with remarkable candor. A dozen states have passed laws encouraging screening, education and treatment. And celebrities, including Brooke Shields, Gwyneth Paltrow and Courteney Cox, have disclosed their postpartum depression.
但现在，关注产妇精神疾病的倡导团体正在涌现，有些母亲十分坦率地在博客中记述自己的经历。已经有12个州通过了鼓励筛查、教导和治疗的法律。波姬小丝(Brooke Shields)、格温妮丝·帕特洛(Gwyneth Paltrow)以及柯特尼·考克斯(Courteney Cox)等多位名人都透露自己曾患过产后抑郁症。Ms. Wachenheim's sister, Deb, is among those breaking the silence.
瓦肯海姆的妹妹黛布(Deb)便是打破沉默的人之一。"We did try to help her, but perhaps if we had been more knowledgeable about postpartum mood disorders, including the fact that postpartum depression is just one of an array of such mood disorders, we could have done something differently that would have maybe saved her life," she wrote in an email.
“我们的确尝试过帮她，但如果当时对产后情绪障碍有更多了解，比如产后抑郁症实际上只是诸多情绪障碍中的一种，我们或许就能以不同的方式做些事情，兴许就能挽救她的生命了，”她在电子邮件中写道。Cindy Wachenheim's experience defied the long-held belief among doctors and experts that symptoms emerge within a few weeks after birth. She seemed fine until her son was about 4 months old, said family and friends. And as a healthy, active woman, Cindy had no risk factors that would signal a mother likely to become delusional and suicidal.
医生和专家们长期以来认为，症状会在产后几星期内出现，但辛迪·瓦肯海姆的经历与这种观念相左。据辛迪的家人和朋友说，在儿子大约四个月之前，她看上去很正常。而且辛迪作为一个健康积极的女性，根本没有表现出这个母亲可能会产生妄想，甚至自杀的风险因素。"She loved life, she loved family, she was social," said her sister-in-law, Karen Wachenheim.
“她热爱生活，热爱家庭，也爱和人交往，”她的嫂子卡伦·瓦肯海姆(Karen Wachenheim)说。In fact, Cindy, long interested in women's issues and social justice, had, years earlier, identified postpartum depression in Karen. "Cindy would call at least once a day to check on me," Karen recalled. "She said, 'Maybe you have postpartum; I think it's past the baby blues.' " At Cindy's urging, Karen got therapy and medication, recovering quickly.
实际上，一直关注女性问题和社会公正的辛迪，多年前在卡伦身上发现了产后抑郁症。“辛迪每天至少会打一次电话，确认我没事，”卡伦回忆说。“她说，'你可能是患上了产后抑郁症，我觉得不只是生宝宝后情绪不好。' ”在辛迪的督促下，卡伦接受了治疗并服了药，很快便康复了。A Son Who Was 'My Heart'
“心肝宝贝”儿子Cindy grew up in Colonie, N.Y., outside Albany, where she was her high school's valedictorian. She attended the State University of New York at Buffalo and Columbia Law School. She valued public service and took a job doing research and writing for judges on the State Supreme Court in Manhattan.
辛迪在纽约州奥尔巴尼郊区的科隆尼长大，曾因成绩优异在高中时作为毕业生代表发言，并在纽约州立大学布法罗分校(State University of New York at Buffalo)和哥伦比亚大学法学院(Columbia Law School)就读。她重视公共服务，曾在位于曼哈顿的州最高法院工作，为法官做研究并撰写文件。When her mother became ill with leukemia, and later her father with lung cancer, Cindy would travel upstate to go to their medical appointments with them. When her siblings or their children had medical checkups, Cindy jotted the dates in notebooks, and called the night before to remind them to fill her in.
当母亲患上白血病，后来父亲又患上肺癌时，辛迪会去纽约州的北部，陪同父母就诊。当兄弟姐妹或是他们的孩子体检时，辛迪会在笔记本上记下日期，并在前一天晚上打电话，提醒他们要把最新情况告诉她。"I think she even kept all those books too, in a shoe box," said her brother, Ron. "People collect stamps; she collected that stuff."
“我想她甚至保存着所有这些本子，放在一个鞋盒里的，”哥哥罗恩(Ron)说。“别人集邮，她收集的却是这些东西。”She married at 40, and she and her husband underwent fertility treatment. She miscarried twice. But family and friends said that while mourning those losses and dealing with fertility hormones, she remained hopeful, noting that doctors said it was a good sign she had been able to become pregnant.
辛迪结婚时40岁，夫妇俩都接受过生育治疗。她小产过两次，但家人和朋友表示，尽管经历了流产之痛，还要调节生育激素，但她仍很乐观，还说医生表示，她还能怀孕就是个好兆头。"She just thought that she's going to keep trying and take each step as it came," said a longtime friend, Julie Knapp.
“她只是觉得要不断尝试，每次机会到来时都要抓住，”多年好友朱莉·纳普(Julie Knapp)说。Experts say little evidence links fertility treatment to postpartum mental illness; indeed, becoming pregnant may bring more joy than stress. Still, Wendy N. Davis, the executive director of Postpartum Support International, said some women experience cumulative stress from "fertility treatments, many losses, and the very, very high expectation she will enjoy this new baby."
专家称，鲜有证据表明产后精神疾病与生育治疗有关；的确，怀孕可能会带来更多的喜悦，而非压力。然而，产后支持国际组织(Postpartum Support International)的执行董事温迪·N·戴维斯(Wendy N. Davis)表示，某些女性会因“生育治疗、多次流产，以及十分十分期望自己会喜欢新生的宝宝”而导致压力累积。Eventually, Cindy was able to conceive and have an uneventful pregnancy, her only out-of-the-ordinary response being a tendency to be hyperaware of whether the fetus was kicking.
终于，辛迪成功怀孕了，而且怀孕期间一切平安。唯一不寻常的反应似乎是，她常常极其在意胎儿有没有在踢她。Cindy gave birth normally and adored her son, often calling him "my heart."
辛迪顺利生产，并且非常喜欢自己的儿子，常常称他为“我的心肝宝贝”。"Not unlike a lot of high-achieving women, she was somewhat of a perfectionist, and she also wanted to be the perfect mother," Deb said. Still, she was pretty easygoing in the first months of her son's life, even when she had to introduce formula early because she produced too little breast milk, Deb said.
黛布说，“和很多优秀女性一样，她有些完美主义，而且想当一个完美的母亲。”但黛布表示，在生下儿子的最初几个月里，她还是很放松的，即便在因为母乳不足，而不得不早早地给孩子喝配方奶粉时也一样。But when her son was 4 months old, Cindy emailed Deb that he was making "strange/jerky movements w/his right arm," almost "flapping like a wing."
但在儿子四个月大时，辛迪给黛布发电子邮件说儿子正在“用右手做些抽筋似的奇怪动作”，就像“在扇翅膀”。The pediatrician said it was nothing to worry about, but Cindy scoured the Internet for diagnoses. She fixated on an instance a few weeks earlier, in August when, while washing clothes, she briefly left the baby on a play mat on the floor. He fell while pushing up, hitting his head.
儿科医生说完全不用担心，但辛迪却在网上四处搜寻资料自行诊断。她对数周前发生的一件事耿耿于怀。那是在8月，在洗衣服时，她暂时把孩子放在了游戏垫上。宝宝在往起爬时跌倒了，碰到了头。She believed this minor episode had caused him severe neurological problems: seizures, autism, concussion. She blamed herself for leaving the room, for placing the play mat on the hardwood floor. Other incidents alarmed her, and she decided he was more irritable, smiling less.
她认为这次小小的意外给他的神经系统造成了严重的问题：癫痫、自闭症和脑震荡。她怪自己离开了房间，怪自己把游戏垫放在了硬木地板上。其它一些事情也使她感到不安。她确信孩子变得更烦燥了，也笑得少了。She visited two pediatric neurologists. Then she saw an expert in cerebral palsy because her son did not always exhibit the Landau reflex, a Superman-like pose babies make when held aloft, stomach-down.
辛迪去见了两位儿童神经科医生，后来还去看了一位大脑性麻痹领域的专家，因为儿子并不总是能做出兰多反射(Landau Reflex)——被腹部朝下抱起时，婴儿通常会做出这个像超人一样的姿势。In October 2012, when her son was 5 months old, she emailed a doctor she had seen that day: "When you said babies can't injure their brains from even several floor-level head hits on a wooden floor, did that include hits even if they are turning and hit back or side of head on the floor?"
2012年10月，儿子5个月大，她给当天见过的一名医生发电子邮件询问：“你说，宝宝哪怕是头在木地板上磕了好几下也不会伤到大脑，这种情况包括他们在转身时后脑勺或脑袋两侧撞到地板上吗？”The doctor replied: "That's right. Little bumps on the head at floor level that a baby may cause themselves in the course of normal spontaneous movements would not cause any injury. Babies are really very hardy (thank goodness)!"
医生回复：“是的。宝宝在地板上自发进行正常活动时，可能会导致头部受到轻微碰撞，但这不会造成任何损伤。宝宝真的很结实（谢天谢地）！”Cindy sent the doctor a video of her son, noting that "he almost always moves the right hand when holding a toy, reaching to grab something, etc."
辛迪又把儿子的一段视频发给了那名医生，称“他在拿玩具、伸手抓东西或做其他事情时，几乎总是用右手”。The doctor responded: "All of his movements look like normal, age-appropriate movements to me."
医生回复：“在我看来，你儿子的所有举动都很正常，都和他的年龄相符。”Her siblings assured her that their children had made similar movements, but she was implacable. Without telling her sister, Deb called the pediatrician, who said she was also concerned about Cindy. Deb said Cindy's husband worried too, although "part of him said: 'Maybe she's right. She is smart and was with the baby all the time.' "
辛迪的兄弟姐妹安慰她说，他们的孩子也曾有过类似的动作，但这还是无法缓解辛迪的忧虑。黛布瞒着姐姐，偷偷给那名儿科医生打了电话。医生表示她也对辛迪有所担心。黛布说，姐夫也有忧虑，不过“他同时认为：'或许她是对的。她很聪明，而且时刻都和孩子在一起。'”Still, both Cindy's husband and siblings urged her to seek therapy.
但辛迪的丈夫和兄弟姐妹还是敦促她接受治疗。"I just really want you to see someone," Deb emailed Cindy. "You cannot continue like this, for your sake and for his sake."
“我真的想让你去看看医生，”黛布给辛迪发邮件。“为了你自己，也为了你儿子，不能再这样下去了。”Cindy agreed, but insisted that she had no postpartum mental illness. She told her family she was simply depressed because of the harm she had done to the baby.
辛迪同意了，但坚称自己没患产后精神疾病。她告诉家人，只是因为给宝宝造成了伤害而觉得郁闷。"You can hardly imagine how it feels to strongly believe he has brain damage and that I caused it," she emailed Deb. "It must be one of the top one or two nightmares for any parent. iloveyou, cindy."
“你几乎想象不到这种感觉是什么样子，我强烈地觉得他有大脑损伤，而且是我造成的，”她给黛布发邮件说。“对任何父母来说，这肯定都是数一数二的恶梦。爱你的辛迪。”Consumed With Worry
忧心忡忡Experts say such breaks from reality are likely symptoms of postpartum psychosis, which affects only one or two in 1,000 mothers. About 4 percent of those hurt their children; about 5 percent kill themselves. Flagrant cases usually emerge soon after birth; women may hear voices or feel compelled to inflict harm, like Andrea Yates, who drowned her five children in a bathtub in 2001, or Dena Schlosser, who in 2004 cut off her infant's arms. Both women were ultimately found not guilty by reason of insanity.
专家表示，这类与现实的脱节，很可能是产后精神病的症状。产后精神病的发病率只有千分之一到千分之二。在那些患病的母亲中，约有4%的人会伤害自己的孩子；大约5%的人会自杀。骇人听闻的案例通常出现在母亲生下孩子后不久；产妇可能会出现幻听，或者有去制造伤害的冲动，比如2001年将自己的五个孩子淹死在浴缸里的安德烈娅·耶茨(Andrea Yates)，以及2004年砍掉婴儿双臂的德娜·施洛瑟(Dena Schlosser)。这两位母亲最终都因精神失常被判无罪。"More subtle forms of psychosis are going to be picked up later," said Dr. Katherine Wisner, a professor of psychiatry and obstetrics at Northwestern University. These women "tend to have prolonged delusional thinking: 'there's something really wrong with my baby.' "
西北大学(Northwestern University)的精神病学和产科学教授凯瑟琳·威斯纳(Katherine Wisner)说：“不那么典型的产后精神病会较晚出现症状。”这些女性“往往会出现长期错觉：'我的孩子真的有问题'”。Most other maternal mood disorders do not involve such unshakably unrealistic convictions; most women know something is wrong, and although they fear they will harm their children, they rarely do.
大部分其他产后情绪障碍都不会出现这类不切实际到不可动摇的坚定想法；大部分女性知道出了问题，而且尽管害怕自己会伤害到孩子，但她们很少真的那么做。At Thanksgiving in 2012, Cindy's family gathered at her brother Ron's home outside Albany, and Cindy, normally outgoing, seemed consumed with her son's supposed problems. She told Deb she had thought about suicide, saying "How can you go on knowing that you've ruined your baby's life and it was your fault?" Deb was stunned. She and Cindy's husband discussed the situation, hopeful that therapy would help.
2012年的感恩节，辛迪的家人在哥哥罗恩(Ron)位于奥尔巴尼郊区的家中聚会。通常颇为外向的辛迪，似乎一心想着她所谓的儿子的问题。她告诉黛布她想过自杀，说“知道因为自己的错误而亲手毁了孩子的一生，你还能活下去吗？”黛布大吃一惊。她和辛迪的丈夫讨论了这一情况，希望治疗会有所帮助。Later that visit, the baby rolled off a low bed. It was one of several times that Cindy panicked and took him to the emergency room, where doctors pronounced him fine.
那次聚会后，宝宝从一张矮床上滚了下来。辛迪惊慌失措地把孩子送到急诊室，但医生却说宝宝一切安好。这样的情况发生过好几次。The next month, Cindy began seeing a psychiatrist, who prescribed Zoloft, an antidepressant. She briefly visited other counselors for talk therapy. Friends offered support and company.
接下来的那个月里，辛迪开始看精神科医生。那名医师给她开了左洛复(Zoloft)，一种抗忧郁的药物。她还短暂地去其他几名咨询师那里接受过谈话治疗。朋友给了她支持与陪伴。One January weekend at Ron's house, she seemed more engaged, smiling more. When Deb asked, she acknowledged still having thoughts of suicide, but said her psychiatrist had told her it was not too worrisome "as long as they're not getting more frequent," Deb recalled.
1月的一个周末，在哥哥罗恩家，辛迪似乎精神更集中了，笑容也多了。黛布回忆，当她问起时，辛迪坦言依然会有自杀的想法，但她说，精神科医生告诉她不用太担心，“只要这些想法没有变得更频繁。”Family and friends wonder now if she was feigning feeling better. "Now I think maybe she was backing off so everyone wouldn't think she was crazy," Karen said.
家人和朋友现在揣测，她当时是不是假装感觉好些了？“我现在觉得，她那时候是退了一步，这样大家就不会觉得她疯了，”卡伦说。Experts said postpartum psychosis symptoms can fluctuate. Sometimes women are "lucid and not delusional," said Dr. Davis of Postpartum Support International. "Then they slip back into delusions more easily than with other types of psychosis."
专家表示，产后精神病的症状可能会出现波动。国际产后支持组织的戴维斯博士说，病人有时候“头脑清晰，不会产生错觉。然后，她们会比患其他精神病的人更容易陷入错觉中去”。The mixed signals from Cindy continued into March. She discussed returning to work and finding day care. On a visit to her mother-in-law on Long Island, she called Deb while strolling by the ocean and sounded good. But the next day, Sunday, the baby fell while pulling up on a chair in his grandmother's kitchen. Cindy considered it another disastrous "head hit."
辛迪表现出来的复杂情况持续到了3月。她说起回去工作，并找家日间托儿所。去长岛探望婆婆期间，她一边在海边散步，一边给黛布打电话，当时听上去挺好的。但第二天是星期日，在奶奶的厨房里，孩子碰到椅子上摔倒了。辛迪把这看作是另一场灾难性的“撞头事件”。On Tuesday, Cindy uncharacteristically canceled her psychiatrist's appointment, citing rain. On Wednesday, as she sometimes did, Cindy asked her husband to come home from work. When he arrived, she said their son's morning had been rough, but that she was feeling better. After a few hours, he returned to work.
接下来的周二，辛迪以下雨为由，反常地取消了和精神科医生的预约。周三，与之前偶尔出现的情况一样，辛迪把丈夫从公司叫回了家。丈夫到家后，她说儿子一上午都过得不顺，不过她感觉正在好转。几个小时后，丈夫回去上班了。That afternoon, with her baby snug to her chest, she jumped.
当天下午，辛迪把孩子捆在自己胸前，跳下了楼。"I am so unbearably sorry, which I know does nothing to undo the evil I have done," her farewell note began. "I wanted to be a mother so badly and I hoped to be a wonderful one, and instead I have become the worst of the worst."
“我特别特别愧疚，我知道这无法弥补我犯下的恶行，”辛迪在遗书开头写道。“我非常想当母亲，想成为一位优秀的母亲，然而，我却成了差到不能再差的一个母亲。”Searching for anything to blame herself for, she described minor, harmless moments: tucking a light blanket over his face for warmth, letting him suck a leaf, briefly putting a dime in his mouth and immediately removing it. "These things I did were horrible," she wrote.
在找一切理由责怪自己时，她说到了一些没造成什么伤害的小事：为了保暖把薄毯子盖到了宝宝脸上、任由他吮吸一片树叶、短暂地把十分钱硬币放到宝宝嘴里又马上拿走。“我做的这一切太可怕了，”她在信里写道。She was sure her son would never walk, and said she believed his most recent fall caused a concussion. "I'm so so sorry, but I can't bear for him to suffer more and more."
她确信儿子永远都不会走路，还说她认为最近那次摔倒造成了脑震荡。“真的非常非常对不起，但我无法忍受他越来越遭罪。”She said she knew others would see her suicide as a result of "postpartum depression/psychosis." But, she said: "I know I am right that I mistakenly harmed him. I'm not claiming a voice told me to do this."
她还说自己知道，其他人会把她的自杀归咎于“产后抑郁症/精神病”，但她说：“我无意中伤害到了儿子，我知道自己是有理由这么想的。并不是说有个声音让我这么做。”She even chastised herself for crumbling emotionally, saying she made her son a less happy baby.
她甚至苛责自己情绪不稳定，说她让儿子没那么快乐。"I don't know if there is a hell," she wrote, "but I hope so."
“我不知道是否有地狱，”她写道，“但我希望有。”Cindy Wachenheim would never know that in her last act, her body cushioned the fall for her son and saved his life. Weeks later, the healthy little boy took his first steps.
辛迪·瓦肯海姆永远不会知道，她生命的最后一刻，自己的身体为儿子从高处摔下来时提供了缓冲，救了他一命。几个星期后，这个健康的小男孩迈出了人生的第一步。