Q. I have a grandfather client who is concerned about his daughter-in-law's angry and threatening demeanor towards her 3-month-old daughter. She screams at her for not going to sleep, for crying and not stopping, and she is neglectful. She leaves many of the comforting tasks to the father.

She has not, to anyone's knowledge, physically abused her child, but this is the fear that everyone has. The grandfather wants to intervene but he wants to do it knowledgeably, so he has asked me for information on mothers who have such a strong negative affective relationship with their babies. Do you have any information on this topic?

A. The rubric "negative affective relationship" covers a lot of ground, as you know. It would be important to learn whether the alleged neglectful behaviors (I assume you have no direct evidence of the behaviors) represent a sudden change in the mother's behavior, whether this has been accompanied by depressive symptoms, psychotic features, etc.

One would certainly consider either postpartum depression or postpartum psychosis in the differential diagnosis, if these features were present. Frankly, if you believe the mother is truly behaving in an angry and threatening way toward her 3 month old daughter, I would not waste time doing a research project.

If you have credible evidence this is the case, you may have a professional obligation to report this to your local department of social services as possible child abuse. (This is a legal issue on which you may want to seek counsel).

You do not mention how the father of the child is involved in this--but the best course may be for your client to speak directly with the child's father immediately, in order to get the mother into professional treatment ASAP.

For general information on postpartum depression and psychosis, I would recommend the book, "Women's Mental Health", by Burt and Hendrick, published by American Psychiatric Press (Concise Guide Series, 1997).

November 2003

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