Law & Order Shines A Light On Postpartum Illness In This Week’s Episode

Never afraid to address real topics, the latest episode of Law & Order, “A Perfect Family,” tackles an often stigmatized issue facing new mothers and their families: postpartum illness. Ahead of the episode’s release this Thursday, Rick Eid, Executive Producer/Showrunner of Law & Order, sat down with Dr. Cathy Birndorf, Founder and CEO of The Motherhood Center, to chat about what it was like for her to consult on the show, and how they attempted to dramatize this important issue. 

Rick Eid: First off, it’s important to know that Cathy and I are friends. The idea for “A Perfect Family” was inadvertently hatched over dinner. Cathy had just confessed that she’d never watched a Law & Order episode in full, which prompted me to explain the show’s enduring allure: probing polarizing, topical issues from all directions. Cathy, being Cathy, then immediately suggested — demanded? — that we do an episode about postpartum, her area of specialty. I wasn’t interested at first. It felt too depressing, we’ve seen it before, blah, blah, blah. But when we started talking about the husband’s role in postpartum, it suddenly got very interesting. In short, the husband didn’t believe in mental illness and was an obstacle to the mother getting the help she needed. Have you ever dealt with “skeptical” partners before?

Cathy Birndorf: Yes, of course.  When a mother has any mental illness, the whole family suffers with her. Partners and other family members are typically the ones who have the best view — they can see what’s happening first hand and have the history to know if something is wrong. Under ideal circumstances, the partner or family member reaches out for help and a trained professional diagnoses and treats the illness. Many people, like Melinda’s husband in this episode, don’t “believe in” mental illness and see it as a weakness or a moral failing. But mental illnesses are medical illnesses, and the people who have them deserve proper care.

RE: What advice do you have for partners of those struggling with postpartum illness?

CB: Our society purports to revere mothers, yet expects them to be perfect and able to do it all. This becomes part of what makes it hard for mothers to say they aren’t feeling well — the stigma and shame around not finding motherhood easy and enjoyable is daunting. If you see something wrong or know something is off with a loved one, please speak up, and ask them how they are actually doing. So many women I have worked with over the years suffered in silence because of fear they would seem like monsters, so it’s helpful to be someone who can listen without judgement. 

RE: What do you wish more people understood about postpartum mental health? 

CB:  My hope is that people will understand that the perinatal period (pregnancy and postpartum) is a challenging time for mothers — physically, hormonally, and mentally. Becoming a mother can be wonderful, but if the only message out there is that it’s a blissful time, we are hurting women and families. Most expecting and new moms experience ambivalence, many feel distress, and in 20% of cases, will have a PMAD, or a Perinatal Mood and Anxiety Disorder. This umbrella term encompasses illnesses like depression, anxiety, obsessive compulsive disorder, PTSD, bipolar disorder, and psychosis. Another key thing to mention is that it can affect partners — it’s estimated that 10% of fathers experience Postpartum Depression, especially if their partner is suffering. 

RE: What struck me during our various conversations is how treatable this illness can be. The difference between getting treatment and not getting treatment can be so severe, and that is what we tried to dramatize in this episode: if the mother suffering with postpartum, Melinda, had just gotten treatment, this tragedy could have been avoided. In that vein, how treatable are postpartum illnesses?  

CB: As Mr. Rogers famously said, ‘if it’s mentionable, it’s manageable.’ And that is so true of PMADs. If we stop insisting that becoming a mother is easy, we can start talking about the hard parts, so that it becomes commonplace to recognize and diagnose these disorders that are very treatable.

RE: Tell us about your experience consulting for this episode. What was it like to work with the Law & Order team?

CB: Helping to shape this episode to sympathetically portray a mother with severe mental illness has been a true highlight of my medical career. Having the opportunity to help shine a light on such a serious, potentially lethal and yet treatable illness like postpartum psychosis, knowing that millions of people will be watching, was amazing. Not only that, it was so much fun to be on set! Your amazing co-writer for this episode, Jennifer Vanderbes, took incredible care of me, making sure I knew the daily call times, had a script with a pencil for edits and headphones with fresh batteries, and made introductions to the cast and crew.

RE: Melinda’s experiences go a step beyond postpartum depression, as she suffers from postpartum psychosis as well. How common are both postpartum depression and postpartum psychosis?

CB: It is suggested that Melinda suffered from postpartum depression with her first or second child, but what she experiences after the birth of her third child in this episode is quite different. Psychosis, or loss of touch with reality, can include symptoms like experiencing hallucinations (hearing voices or seeing things that are not real) or having delusions (fixed false beliefs). It can wax and wane, and can be missed entirely because the person isn’t always acting unusual — in fact, they may seem quite “normal” at times. Postpartum psychosis occurs in 1-2 per 1000 women, and 4% of those will commit infanticide and 5% will die by suicide.

RE: We talked a lot about trying to make the character of Melinda feel “real.” What are some ways you see these conditions portrayed inaccurately in media? What did this episode do differently to get it right?

CB: The media has not always been kind to mothers with mental illness. When you and I were talking about this project, it was most important to me that we portrayed the mom as sympathetic and unwell, and that there was no mistaking her illness for evilness. I was thrilled to speak one on one with Allison Miller, the incredible actor who played Melinda, about what someone with postpartum psychosis would look and feel like. Everyone involved in the making of this episode took the subject matter seriously and acted respectfully, and it shows. 

RE: What resources are available for new parents who may be struggling?

CB: One of the most respected and oldest non-profit organizations, Postpartum Support International, for whom I previously served as a Board Member, provides facts and resources for patients and families struggling with PMADs. Additionally, New York City has The Motherhood Center, which I co-founded and currently run as the CEO and Medical Director. As a reproductive psychiatrist, I saw a giant gap in treatment options between traditional outpatient care and inpatient hospitalization. I started the Center to provide a Perinatal Partial Hospital Program where pregnant people, new moms, and their babies could come during the day for intensive treatment. We work with their partners and families to educate about the illnesses, and in some cases, help get them the care they need as well. 

Watch “A Perfect Family” on Thursday April 3rd at 8/7c on NBC, and stream the next day and catch up on all episodes of Law & Order on Peacock.

Visit Postpartum Support International and The Motherhood Center for more information about postpartum illness.