Motherhood began cruelly for Joanna Baranauskas. For the )) first 2 1/2 years of her daughter's life, Baranauskas was trapped in another world, a gloomy, colorless land in which she tried to dodge the dark clouds that engulfed her with evil, monstrous thoughts.
The thoughts dealt with her baby's death, and they cut through Baranauskas like an icy rain. What if she dropped the infant out the window, or flushed it down the toilet? What if she took a knife and? . . .
The fantasies were so gross they made her vomit. Her baby was beautiful; why would she imagine it dead? Afraid for her child, Baranauskas rushed into the kitchen of her north Baltimore rowhouse and hid all her knives -- not from her daughter, but from herself.
Several miles away, on a quiet residential street in Ruxton, Dawn Baynes lived a similar nightmare. Giving birth gave rise to the same black clouds, enveloping Baynes' mind and destroying her first Kodak moments of motherhood. Hard as she tried, all she saw were the negatives.
"People would say, 'You have such a happy baby, you must be a wonderful mother,' " says Baynes. "I thought, my God, if only they could get inside my head."
Baranauskas and Baynes suffered from what doctors call a postpartum disorder, a potentially debilitating form of mental illness believed to be triggered by the hormonal changes of childbirth and exacerbated by psychological stress.
Childbirth can send a woman's hormone levels plummeting from record highs to record lows, precipitating neurochemical changes in the brain and creating anxiety and depression in new mothers. Experts say personal problems and pressures only add to the depression.
"Giving birth is one of the most high-risk periods for mental illness in women," says Dr. Ray DePaulo, director of the Affective Disorders Clinic at Johns Hopkins Hospital.
DePaulo himself has treated 200 victims of postpartum depression, yet says that science remains largely baffled by the disease. "We don't yet know the mechanisms, and there aren't any blood tests for it," he says. "But some of these women can become very, very ill and unable to care for their children or themselves."
Too often, say experts, the early rumblings of serious postpartum depression are ignored or misdiagnosed. And, because the typical victim is a new mother with no psychiatric history, she is generally too ashamed -- or too busy -- to seek professional help.
"One of the great tragedies is that [mothers] often are not recognized as being ill soon enough," says DePaulo. "This is a medical disease, like pneumonia."
Recent studies show that as many as 80 percent of new mothers experience "maternity blues," a mild, transitory form of melancholy marked by crying and fatigue. Perhaps 10 percent of these affected women, including Baranauskas and Baynes, fall into a more severe and persistent postpartum depression within several weeks of delivery. Signposts include loss of appetite, despair and fleeting negative thoughts toward the baby.
Rarer still is postpartum psychosis, a family's worst nightmare whose symptoms strike one of every 500 mothers and put them at risk of harming themselves, their spouses or their children. Studies indicate, however, that only 1 percent of women who get the psychosis attempt to act on their delusions or hallucinations.
In 1989, a 30-year-old Catonsville woman on trial for killing her two young sons in a Western Maryland motel room the previous year was found not criminally responsible for their deaths. Lawyers for the woman held that she suffered from postpartum psychosis. She was sent to Clifton T. Perkins Hospital at Jessup and is recovering.
Women who have experienced the intermediate form of maternal sickness call it the mother of all depressions.
"Depression is a wimp of a word for what I went through," sayBaranauskas, 32. "I've been to hell and back."
For 18 months, she struggled inwardly to cope with her private demons. Hiding the knives helped. But often when she tried to cuddle her daughter, Anna, the pervasive clouds rolled in, blanketing Baranauskas in a mist of morbid thoughts.
The impulses toward infanticide were so strong, says Baranauskas, that she forced herself to draw away from Anna, recoiling from the nursery until the fog lifted.
"I would put her in the crib, leave the room and stay away from there," she says. "When the thoughts eased up, I'd return.
"I did everything I could to save my baby from me."
Baranauskas never acted on her thoughts. Eventually, with the support of her husband, she sought medical help, went on medication, recovered and began enjoying motherhood.
Anna was nearly 3 years old.
The frightening experience with baby Anna in 1981 -- and a similar ordeal following the birth of her second child -- prompted Baranauskas to join a national postpartum support group, Depression After Delivery. She now helps run the Baltimore chapter.