Now that I’m a tenured professor at Harvard, young women newly pregnant or recently back from maternity leave often ask me for advice.   They stare at me eagerly, wide-eyed, asking, “How did you do it all? Get tenure at Harvard, while being a mom?” As if I hold some secret knowledge.  I respond lightly, “Getting tenure at Harvard is easy compared to being a parent.”

What I don’t tell them is that four months after giving birth to a healthy baby boy, I decided to kill myself.   

It’s 9:00 am on a sleepy Thursday morning in July.  I am 39; my son is almost four months old. I am widely regarded as a rising academic star at Harvard – in the field of mental health. I’m at home in Cambridge, curled up in a fetal position on the couch, anxiously listening to the baby monitor. My son, L, is in his room settling down for his morning nap. Once he falls asleep he will not wake for two hours.  My mother will be coming over in an hour.  She has the key, so she’ll let herself in.

I review the plan:  I’ll walk out the back door, enter the not quite two-car garage; close the garage door; get in my 1993 red Toyota Corolla; turn on the ignition; wait. The carbon monoxide will deprive my brain of oxygen. I’ll fall asleep and die. 

My friend’s mother killed herself this way in college. Relatively painless, no messy clean up.  I feel no fear. Just relief.  I’ll be free from pain, from despair and from failure.  I know my husband, Shaun, and L will be better off without me.  We need a new car anyway.

Harvard gives me thirteen weeks paid maternity leave. By week ten, most of the women in the mother-infant group I attend move beyond looking disheveled and shell-shocked.

Meanwhile, I am invisibly slipping, slowly at first and then more and more quickly, into a deeper and deeper post-partum depression.

As an expert in mental health, I know one in seven women experience depression after childbirth.  I also know how to hide mine. I catch a nasty stomach virus after giving birth, which, combined with breast-feeding, means I am back to my pre-baby super thin body within a month.  I look fabulous. I shower, dress, and blow-dry my hair, which is still thick and lustrous from pregnancy. I cheerfully answer emails from colleagues, return responses to grant reviews even though I’m on leave. I breast feed on demand.  Within eight weeks, my son is smiling and on a fairly regular sleeping schedule.  He is the classic ‘easy’ baby. I join mommy and me groups, and smile when strangers come up to complement me on my beautiful boy. 

I lose my appetite.  I cannot sleep, even when L sleeps through the night. I fear equally his waking up crying and his not waking up. I dread the nights. But the days are worse.  Shaun goes back to work after two weeks.  Daily, desperately, I beg him to stay home with me.  Daily, he leaves, unable to escape fast enough.  I am completely alone. Trapped.

The problem: I am terrified. Constantly. I, who worked as a Peace Corps volunteer in Niger, West Africa, rode a broken-down lorry through rural Pakistan, flew a small plane, and gave speeches in front of hundreds of people.  While other women seem to ease into motherhood, I feel only fear. L’s vulnerability terrifies me. Crib death. Choking.  Smothering. Drowning. Falling. If I let my guard down for a minute, he could die. 

At thirteen weeks, I go back to work.  Everyone says I will feel better.  “It’s boring being with a baby all day.  At work, you will be back to your old self.”

At work, I spend most of the day alone, in my office at Harvard, lying on the floor, sobbing.

I knew something was deeply wrong with me. I had years of training and experience treating anxious and depressed women, had published books and a hundred or more articles on mental health. I still had not seen the depression coming. Now, once it was here, I both knew what worked to treat depression and had access to the best care.  I tried everything: Individual cognitive behavioral therapy, mother-infant groups, yoga, exercise, meditation, focused breathing.  I tried Zoloft. I saw two psychiatrists, experts in women’s mental health themselves, who prescribed Celexa, Klonopin and Wellbutrin. Nothing brought relief. I was helpless in depressions’ wake.

Each day drove me further and further into the abyss.  My brain was on its own track.  I gave up.

It’s time. I walk to the back door, intending to go outside to the garage. 

Even after all these years I still don’t know what made me stop.  I like to think that I heard L cry out.  But my memory is fuzzy. I know I call Susan, my individual therapist.  When she answers, I say, “I need to go into the hospital.  Mclean. Today. Now.” 

Shaun and I leave L with my mom. McLean looks more like a New England college campus than a hospital.  Admission is as competitive as getting into an elite private school. The prize: admission to a locked inpatient ward.

Shaun and I tour the unit.  The patients move in slow motion. Many are lying in bed in a fetal position. Shaun repeats, like a mantra, “These people are crazy. You don’t belong here.”  But I know I do.  I am crazy.  I fear my child. And myself.  I have tried everything. I am out of options. I am defeated. I have failed.  I am admitted.

On Sunday, I see the psychiatrist and am proscribed olanzapine, an atypical anti-psychotic usually given to patients with schizophrenia. The psychiatrist heard reports it helps some women with severe post-partum depression. I hesitate; olanzapine “seems extreme” in my case.  But then I think “I have a four-month-old baby and am a tenure-track professor at Harvard, being in an inpatient unit is extreme.” I take my first pills that evening.

I sleep deeply that night, for the first time since L’s birth.

I spend a week at McLean, the days quickly taking on a rhythm. Meals. Medication. Group meetings. Art therapy.  Individual therapy. Medication. Supervised walks.  Like an adult summer camp, but one where community is made out of pain and suffering. Free of decisions and with minimal responsibilities, I am finally able to breathe.

I am released on a rainy Friday afternoon. What if I can’t handle life outside?

But I also feel something else: hope, and even excitement, to see my son, to hold my happy baby boy in my arms, to kiss his chubby cheeks. To absorb his unique scent.

We arrive home. “Will he remember me?” L looks at me, smiles, and gurgles. I take him in my arms, cradling him against my chest. I know I am his mother. 

Olanzapine and Mclean saved my life.  The medication reduced my fear and Mclean provided a structured environment that enabled me to begin to grapple with how vulnerable motherhood made me feel.  I was then able to use other tools to fully recover. Two years of mother-child attachment based therapy. Individual therapy. Psychiatric consultation. Couples therapy.  Yoga. Acupuncture. Meditation.

Seven years later, L comes into my room after having a nightmare.  He falls asleep, an arm and leg both draped across me.  As we walk hand in hand to school, he talks endlessly about the eternal questions: Who would win a battle between Star Lord and Darth Vader? How much should he and Tobias charge for the invisibility potion they’re creating?  Can Duncan come over for a Nerf fight this weekend?  As L talks, I quietly thank God: for olanzapine, McLean, and for saving me for this life.  

But when younger women laugh nervously and ask for advice, I don’t tell them about Mclean, or olanzapine or how thankful I am every day to have been saved.  I smile, provide reassurance, and give some practical advice about childcare or setting priorities at work. 

I don’t tell them that what motherhood required of me was death. My brain, unbalanced by hormones, dysregulated neurotransmitters, and lack of sleep convinced me that this meant physical death.  But, in fact, what was required was death of the woman who thought she could achieve anything with the right amount of knowledge, discipline and hard work. I had to surrender to the vulnerability of motherhood. Living every day, in a dangerous world, with every parent’s greatest fear – that something terrible could happen to one’s child. And despite the danger, the fear, and the vulnerability, deciding every day to stay.


  • Karestan Koenen

    Professor of Psychiatric Epidemiology at the Harvard T. H. Chan School of Public Health and Associate Member, Broad Institute of MIT and Harvard Massachusetts General Hospital