On Suicidal Ideation and Psychosis


Psychosis, Suicide, and Infanticide mentioned.


I’ve gotten some push-back on my post that discusses whether Sasha Hettich was suffering from psychosis when she completed suicide on Christmas Day, 2015. We discussed this idea briefly together as a group a few weeks ago but the therapist present kind of shut down that conversation, saying that it didn’t really matter because we won’t ever know. She is right that we won’t ever know for certain, but I think she is wrong that it doesn’t matter. It does. Or why else do I feel this need to “prove” that it was not psychosis, whereas at least four different women adamantly disagree with me. If we all care this much, I would think that it matters! It matters to us.

But why? Why does it matter? I’ve been thinking about that quite a bit. I understand both sides of the argument much better now that I did at first. I think we want to blame psychosis because none of us want to believe that Sasha would deliberately make the choice to complete suicide. It’s just too awful. As Cody said in his interview, “A healthy Sasha wouldn’t do this.”

Another friend of mine said that she felt that all suicidal thinking was a form of psychosis. If that’s true, that puts an entirely different spin on my own experiences with suicidal ideation at various points in my life. I spent upwards of a year battling suicidal thoughts and obsessions—not once, but twice; does that mean I was in a psychotic state for almost two years? I will have to keep thinking on that.

I guess I come at Sasha’s suicide from the opposite direction, where I don’t want it to be psychosis because if that were the case, then her decision was completely out of her control. I want it to be a severe case of depression that led to her deliberate decision to complete suicide because that gives all of us the power to make a different choice.

So I did what I do best. I spent a lot of time with my good friend, Google. I also reread almost the entire Postpartum Depression for Dummies book. I have compiled a whole bunch of research on postpartum psychosis that I am happy to share with anyone interested but I won’t share it here because it’s pretty boring and repetitive.

I can say with a good deal of confidence that Sasha was not suffering from Postpartum Psychosis. (Stay with me for a minute…)

The timing is all wrong. Postpartum psychosis typically begins within the first few days following delivery, which overlaps the baby blues period. More than half of all cases of postpartum psychosis begin the first week, and more than 75 percent begin within the first two weeks. (Postpartum Depression for Dummies, page 60)

This was corroborated by every source I found, and one source said 99 percent of cases occur within the first six weeks. Odds are that this was not postpartum psychosis.

In fact, the psychosis Sasha experienced after Ember was likely not postpartum psychosis either (in my admittedly unprofessional opinion). She had started taking an antidepressant the first day I saw her, and it was over the next few days that she deteriorated into full-blown psychosis. This is exactly what happened to me when Becca was three months old. Same med. Same psychosis. And the more I share my story, I am meeting more and more women who all had psychotic episodes after starting this particular drug.

(I hesitate to mention this medication by name only because many women do SO well on this antidepressant, and I don’t want to discourage women from trying it as it may be their saving grace to beating back this darkness. Just be sure to have your support team read the warnings and be on the lookout for any drastic changes in mood or behavior whenever you start a new medication.)

What Sasha could have experienced, however, is what is called psychotic depression. I did not know this existed before researching this. This makes sense because we are gradually learning that many of the causes of psychotic depression were present in Sasha’s life:

The cause of psychotic depression is not fully understood. What we do know is that there’s no single cause of depression and it has many different triggers. For some, stressful life events such as bereavement, divorce, serious illness or financial worries can be the cause. Genes probably play a part, as severe depression can run in families, although it’s not known why some people also develop psychosis.

It is gradually coming to light that things were not going well for Sasha. Her marriage was faltering, she hated her job, money was tight, and on top of that she was dealing with postpartum depression. Someone mentioned the other night that they believe something triggered Sasha and that threw her into psychosis. Based on my research, that is a very real possibility!

I wholeheartedly agree that something triggered Sasha to make the choice to pull the trigger; however, I still don’t believe it was psychosis, personally. There are two primary symptoms to psychosis—any form of psychosis—that we have no evidence were present: hallucinations and delusions.

I think the confusion comes because the simplest definition of psychosis is a “break from reality,” and I think all severe depression and the suicidal thoughts that follow could be considered a break from reality—or maybe even a delusion. It doesn’t make sense for Sasha or for me to believe that our families would be better off without us. That is deluded thinking, for sure. In that sense, I suppose all severe cases of depression include a break from reality because we cannot objectively see our reality any more.

But this is not exclusively a symptom of psychosis. Suicidal ideation is very common in any form of depression, and it is not the same as psychotic depression. Psychotic depression still needs those two elements—hallucinations and delusions—and the delusion that my family would be better off without me is not the kind of delusion we are talking about.

For Sasha, her delusions from psychosis in 2012 came in the form of paranoia: she thought her husband and the staff at Pine Rest were trying to kill her. Similarly, in July of 2011, I thought that every airplane that flew over my house (which is a lot because I live in the flight path) was CPS spying on me. They knew I was an unfit mother, and they were coming to take my kids away.

I never learned what other delusions or hallucinations Sasha experienced because we never did have the date we had planned to swap war stories about psychosis and Pine Rest. But I can share some of mine.

Some of the hallucinations I experienced were that I was falling into my closet, which kept growing bigger and darker and was trying to swallow me whole. I closed my eyes, but I could still feel the darkness creeping up my skin, like a swarm of spiders crawling up my entire body and ready to devour me. I saw the hand of a skeleton clawing at the window above my head, trying to get in. Trying to kill me.

I remember rocking back and forth in the armchair, clutching Becca with all my might because the couch across the room was just waiting for me to fall asleep. If I closed my eyes for even a second, it was going to pounce and tear Becca to shreds, like a lion.

Yes, my couch.

And there were thoughts to harm Becca, even as I was protecting her from other predators. I obsessed all day about how to do it. I had even decided how I was going to do it. The only reason I did not act on it was because I couldn’t decide how I was going to kill myself to make sure I didn’t survive. It was my indecisiveness that saved our lives. That and a phone call to my husband that I don’t remember making.

That, my friends, is psychosis.

It is possible that something triggered psychosis in Sasha that day. I won’t rule it out. Perhaps she was on medication and stopped taking it, as withdrawal symptoms can also cause psychosis. Perhaps something terrible happened between her and her husband that triggered it. We will never know. I won’t rule psychosis out. If that helps you to cope with what happened, I will no longer disagree with you, because it absolutely could have happened that way. I can’t say because I wasn’t there.

I will say, though, that I do not believe that I was suffering from psychosis when I was admitted to Pine Rest on suicide watch in December of 2011, five months after my psychotic episode (for which I was not hospitalized but absolutely SHOULD have been). Just as we suspect something triggered Sasha, something triggered me too. It’s almost humorous now, but it was almost deadly at the time; it was PMS. I did not know that I was three days away from getting my first postpartum menses. I have struggled with Premenstrual Dysphoric Disorder since I was 14, so it is no surprise that severe PPD with suicidal ideation combined with PMDD was enough to push me over the edge.

It’s almost eerie now. I got my period on Christmas Day. Sasha killed herself on Christmas Day, four years later.

Blood gave me new life. Blood spilled brought her death.

But for me, there was no psychosis. I was not hallucinating. Even though I thought my family would be better off without me, I was not deluded; I was depressed. Very, very depressed.

Depression does scary things too. It can lead us to make decisions we otherwise would not have made. That is why we need to take it so very seriously and fight like hell to beat this thing, or at least manage our symptoms.

But I still had the power to choose. I chose not to jump. Sasha chose to pull the trigger.

Our stories are both so similar and yet so very different. We have so much in common in our experiences between 2011-2012. But that’s where our similarities stop.

I cannot relate to all that she was dealing with in 2015. She was dealing with so much more than just PPD, and I think we need to acknowledge that too. Her circumstances were devastating, even without PPD thrown into the mix. I confess that if I were in her shoes, based on what little we know, I think I would have made the same choice.

But that decision—at least for me—did not come from a state of psychosis.

Is that awful? It’s easy to want to rationalize that away because of the awfulness of it all. To contend that it was something else that caused me to make the decision that suicide was the best choice. I suppose you can even blame the PMDD if you want. But I think it was all me.

It’s not a decision I would have made if I were healthy, no. But I was not psychotic.

And if I had so many things that Sasha did not have—a supportive husband, an amazing family, financial semi-stability, a job I love, and most importantly, Jesus Christ himself—and yet I still nearly made the same choice?

Sasha’s choice makes perfect sense to me, no psychosis necessary.

And that is important to me, because that gives me (and anyone else reading this who is not suffering from psychosis—which is highly doubtful if you have the ability to read this blog) the power to choose. It gives me the power to choose differently. To choose something better.


I can’t say anything with certainty about Sasha, but it did not take psychosis to make me suicidal. Because as horrible as that is, that means I was able to choose differently when I found myself struggling with those same thoughts again after Lizzy was born.


You cannot choose to not have psychosis. That is outside of your control. And the choices you make in a psychotic state are also outside of your control, sometimes with devastating consequences. But outside of psychosis, you can choose to complete suicide—or NOT complete suicide. The choice is yours.


And I think that matters.



About kneumair

Karen Neumair is a lover of God and a lover of words, especially when those two things come together. She has experienced multiple depressive episodes in her life, most severely after the birth of her second daughter, but is overwhelmingly thankful for how God has used her depression to teach her more about Who He is (and who she isn’t). Wife to Chris and Mommy to Hannah, Becca, and baby Lizzy.
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One Response to On Suicidal Ideation and Psychosis

  1. Pingback: On Suicide and Who You Are | karenneumair

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