It is my sincere hope that women feel strong and encouraged by their doctors and their families the INSTANT they feel uneasy, and more importantly, it is absolutely vital to have strong support systems in place.
I can still feel my mother hugging me so tight and repeating, “You’re going to get through this.” I can feel the tears rolling down my cheeks over and over again. Nonstop.
My name is Amanda, and I am a continuing survivor of postpartum OCD.
THE LIFE AND DEATH OF RUTH RHODEN CRAVEN AND THE BIRTH OF POSTPARTUM SUPPORT CHARLESTON
The Life and Death of Ruth Rhoden Craven and the Birth of Postpartum Support Charleston
Editor's Note: This is part three of a four-part series, airing every Friday, that retells the origin of our organization. (Read part one here and part two here.) Some of the content may be disturbing, as it is a story of maternal mental illness, gun violence and suicide. If you find that you need to talk to someone about it, please reach out at firstname.lastname@example.org.
According to the discharge summary of the hospital’s psychiatrist, he wrote: “The patient is a 33-year-old white female with no previous psychiatric history admitted for depression and suicidal ideation. The patient had her first child on 9/20/99 after a normal pregnancy. Since then she has had a decreased mood, increased anxiety, and significantly reduced sleep. The patient took an overdose of 8 Ambien prior to admission. She denies psychosis, use of alcohol or drugs. She was started on Zoloft 50 mg two weeks prior to admission but that was recently increased to 100 mg. The patient’s medical history is significant for being postpartum, otherwise, unremarkable.”
Ruth Rhoden Craven was admitted on Oct. 10, 1999, to the adult psychiatric unit in Columbia, S.C. She continued to take Zoloft and was given medication to help her sleep, which seemed to improve her mood, according to the psychiatrist’s notes. “During the hospitalization,” the notes state, “she continued to deny any suicidal ideation and was noted to have brighter mood and affect. By 10/14/99, she had improved sufficiently for discharge home.”
But according to the records obtained by Ruth’s family, Ruth conveyed to her caretakers in the inpatient psychiatric unit that she was still unsure of her ability to be a mother.
On Monday, Oct. 11, the notes say that she was very tearful, saying that it was the first time she had really cried about her situation. She had feelings of guilt that others were having to take care of her baby. The staff offered reassurance, according to the notes, and talked with her about how to receive adequate sleep while rearing an infant. On Oct. 12, the notes indicate that Ruth vented feelings of incompetence about taking care of her son. Others thought it was “no big deal,” but she said she was left feeling insecure. Ruth said she was still stressed out about Andrew having to be re-hospitalized shortly after his birth due to jaundice. At that point, though, Ruth reported feeling more well-rested and more competent.
On Oct. 13, Ruth said she was feeling a little better about her competency as a mother, but she wasn’t sure she was ready to be discharged from the psychiatric unit. On Oct. 14, the day of her discharge, she received a dose of Ativan for anxiety and stated that she was not ready to leave the unit. She reported that she was still apprehensive about her ability to mother her child but acknowledged to the unit’s staff that she would have a lot of support at home.
Upon her discharge that day, Ruth’s mother said she and Joey Craven, Ruth’s husband, met with a hospital counselor on how best to support Ruth moving forward. Helena Bradford complained that the institution was ill-prepared on how best to help her daughter. “They didn’t know anything about postpartum depression,” she said. “Other people [in the psych unit] were just dealing with regular depression. And that’s what all their questions were about. And so I said, ‘You know, what can we do to help her with postpartum depression?’” Helena said the hospital’s staff could not find anything about postpartum depression in their library. Helena tried to do her own research online and was dismayed by what she found. “What I found [online] was stuff like, take her off on a vacation, let her go buy a new dress... And so, even after she died, I had no clue what postpartum depression was. What had killed my child?”
Knowledge and information about postpartum depression, and the rest that fall under the spectrum of perinatal mood and anxiety disorders (PMADs), has evolved greatly in the past 20 years. “Regular” depression can present at any time during a person’s lifespan. It’s more common in women, and the median onset is 32.
For PMADs, it is often linked to a woman’s hormones associated with pregnancy, childbirth and breastfeeding. A clinical diagnosis of perinatal depression is identical to “regular” depression, except she may be pregnant or has recently given birth. A PMAD like postpartum depression usually presents within four to six weeks of giving birth, although most women are not diagnosed until at least three months postpartum. Symptoms can occur even in pregnancy.
Diagnosing a PMAD can be difficult though. Moms may deny their feelings, in the hopes of waiting it out. They may fear that someone is going to take their child away. For women like Ruth, having a baby and suffering from a PMAD can be overwhelmingly challenging.
Two weeks after her discharge, on Oct. 28, she had her postpartum checkup with her OB. According to his notes, her postpartum exam was normal and that her “postpartum depression was under control.” Ruth had been experiencing high blood pressure throughout the month of October and was advised to keep an eye on it.
After this time, the family said that Ruth improved, but not enough to return to the job that she loved. Helena said that Ruth was triggered whenever her son cried, not knowing how to soothe him. The crying would send her into a panic.
It is common for women who are working toward recovery from PMADs to have bad days despite any progress that they’ve made. This is a time where family members should be vigilant, even when the mother seems to be doing well, and take precautions to remove potential weapons from the home and keep tabs on medications. Recovery from PMADs is measured in months or years, and not weeks or months. Moms who are struggling do not want to hurt themselves, but sometimes they convince themselves that it’s the only way to save themselves or their children when they experience a bad moment.
Unfortunately, suicide is one of the leading causes of death for postpartum women, according to a 2015 study in the Journal of Psychiatric Research. The authors determined that the women likely resorted to suicide because of the low rates of seeking mental health treatment and inadequate assessment by their health care providers of risk or illness severity for mood disorders.
When women have access to resources, are educated about their risk for PMADs, have proper medical management and guidance of their medication, if necessary, and know that they will be welcomed into a community, the chances of them resorting to self-harm or suicide will decrease.
On the night of Sunday, Dec. 5, Ruth’s best friend, Mary Anna Mullinax, was decorating her Christmas tree when she felt suddenly stricken by sadness.
“We had just moved into a new house, and I love Christmas,” she said. “I love Christmas more than anything. And while we were decorating, I just got so sad. And it was just overwhelming, and I went up to my room and cried. And there was no reason, but I was just so sad. I thought I just needed to get this out, whatever I’m feeling. And I came back down, and I got the phone call right after that.”
That day, while Joey was working and she was home alone with her 2.5-month-old infant, Andrew, Ruth fetched her handgun -- which her husband had given back to her because she had started to feel better -- from her car’s glove compartment. When Joey arrived home from work that day, he discovered his wife in her vehicle with a self-inflicted gunshot wound and his baby inside their home, alone. Joey then contacted the authorities and Ruth’s younger brother Mark, who also lived in Lexington. Word moved quickly to Ruth’s mother and her friends that she had committed suicide.
“I think she was having intrusive thoughts,” Helena said. “I think she was afraid she was going to do something to hurt [her son], and so she shot herself instead. She meant business, that last time.”
Helena said she and her second husband, Buzz, drove up to Lexington immediately to be with Joey and Andrew. Elaine Earl, a friend of Ruth’s, said she screamed when she received the news in a phone call. She said that, to this day, she still regrets trying to help Ruth with breastfeeding. Elaine said she had trouble dealing with her grief and knowing what to say or how to act in the days after Ruth’s death.
People who knew Ruth say that she would be the last person you would think would resort to suicide.
“We had a group friend who had committed suicide earlier in our lives,” said Mary Anna, who was a co-founder of the Ruth Rhoden Craven Foundation. “And I remember at his funeral, all the friends had gotten together sort of in a circle, and she was one of them. And everybody sort of made a vow that if anything were to be getting to us that bad that we would reach out to others. She never did. She would be the one that everyone would reach out to. You would never think that it would be her…
“She was very forward thinking,” Mary Anna recalled. “I remember there were times where she thought Joey might get a new job. ‘Well, when Joey gets this job, I’m going to do this, this, this and this, and then, you know, we’ll have it all worked out.’ And I remember thinking, you don’t do that with a baby. You can’t plan like that. And that’s what always struck me with her death. That I knew it had to be something instantaneous because had it been planned, she would’ve had that child’s life planned out. She would’ve had Joey’s life planned out...She would’ve had casseroles in the freezer for the next three months. That would’ve been her just preplanning everything.”
The next day, on Monday, Dec. 6, Joey called Ruth's OB. “Patient’s husband called today to state that Mrs. Craven took her life last night with a gun,” her OB records state. “She had an appointment today for an IUD placement. On her last discussion with me about how she was feeling, she stated that she was much improved and her psychiatrist had decreased her Zoloft to 50 mg. Her husband was disappointed with the psychiatric evaluation and care of his wife and wanted me to call her psychiatrist and let him know of the news. I expressed my condolences to Mr. Craven and told him that I would be in touch with her psychiatrist and let [him] know of her demise.”
The visitation for Ruth’s body was on Tuesday, Dec. 7, with the funeral taking place at the Cravens’ Lutheran church in Lexington the next morning. Family and friends would then travel to Mount Pleasant later on the 8th for entombment at Mount Pleasant Memorial Gardens on Mathis Ferry Road.
Read Part 4 here.