An undated handout photo of Cindy Wachenheim, a lawyer who had dreamed of having a child, and seemed fine after the birth of her son, until he was about 4 months old, when she became obsessed with the idea that she had caused him brain damage

Cindy Wachenheim was someone people didn't think they had to worry about. She was a levelheaded lawyer working for the state Supreme Court, a favorite aunt who got down on the floor to play with her nieces and nephews, and, finally, in her 40s, the mother she had long dreamed of becoming.But when her baby was a few months old, she became obsessed with the idea that she had caused him irrevocable brain damage. Nothing could shake her from that certainty, not even repeated assurances from doctors that he was normal."I love him so much, but it's obviously a terrible kind of love," she agonized in a 13-page handwritten note. "It's a love where I can't bear knowing he is going to suffer physically and mentally/emotionally for much of his life."On March 13, 2013, Wachenheim, 44, strapped her 10-month-old son to her chest in a baby carrier and leapt to her death from the eighth-floor window of her Harlem apartment. "I became so low," she wrote shortly before she jumped, "thinking that if I had unknowingly caused brain damage to my beautiful, precious baby, I didn't want to live."Wachenheim's story provides a wrenching case study of one woman's experience with maternal mental illness in its most extreme and rare form. It also illuminates some of the surprising research findings that are redefining the scientific understanding of such disorders: that they often develop later than expected and include symptoms not just of depression but of psychiatric illnesses.Now these mood disorders, long hidden in shame and fear, are coming out of the shadows. Many women have been afraid to admit to terrifying visions or deadened emotions, believing they should be flush with maternal joy or fearing their babies would be taken from them.But now, advocacy groups on maternal mental illness are springing up, and some mothers are blogging about their experiences with remarkable candor. A dozen states have passed laws encouraging screening, education and treatment. And celebrities, including Brooke Shields, Gwyneth Paltrow and Courteney Cox, have disclosed their postpartum depression.Wachenheim's sister, Deb, is among those breaking the silence."We did try to help her, but perhaps if we had been more knowledgeable about postpartum mood disorders, including the fact that postpartum depression is just one of an array of such mood disorders, we could have done something differently that would have maybe saved her life," she wrote in an email.Cindy Wachenheim's experience defied the long-held belief among doctors and experts that symptoms emerge within a few weeks after birth. She seemed fine until her son was about 4 months old, said family and friends. And as a healthy, active woman, Cindy had no risk factors that would signal a mother likely to become delusional and suicidal."She loved life, she loved family, she was social," said her sister-in-law, Karen Wachenheim.In fact, Cindy, long interested in women's issues and social justice, had, years earlier, identified postpartum depression in Karen. "Cindy would call at least once a day to check on me," Karen recalled. "She said, 'Maybe you have postpartum; I think it's past the baby blues.'" At Cindy's urging, Karen got therapy and medication, recovering quickly.Cindy grew up in Colonie, New York, outside Albany, where she was her high school's valedictorian. She attended the State University of New York at Buffalo and Columbia Law School. She valued public service and took a job doing research and writing for judges on the state Supreme Court in Manhattan.When her mother became ill with leukemia, and later her father with lung cancer, Cindy would travel upstate to go to their medical appointments with them. When her siblings or their children had medical checkups, Cindy jotted the dates in notebooks and called the night before to remind them to fill her in."I think she even kept all those books too, in a shoe box," said her brother, Ron. "People collect stamps; she collected that stuff."She married at 40, and she and her husband underwent fertility treatment. She miscarried twice. But family and friends said that while mourning those losses and dealing with fertility hormones, she remained hopeful, noting that doctors said it was a good sign she had been able to become pregnant."She just thought that she's going to keep trying and take each step as it came," said a longtime friend, Julie Knapp.Experts say little evidence links fertility treatment to postpartum mental illness; indeed, becoming pregnant may bring more joy than stress. Still, Wendy N. Davis, the executive director of Postpartum Support International, said some women experience cumulative stress from "fertility treatments, many losses and the very, very high expectation she will enjoy this new baby."Eventually, Cindy was able to conceive and have an uneventful pregnancy, her only out-of-the-ordinary response being a tendency to be hyperaware of whether the fetus was kicking.Cindy gave birth normally and adored her son, often calling him "my heart.""Not unlike a lot of high-achieving women, she was somewhat of a perfectionist, and she also wanted to be the perfect mother," Deb said. Still, she was pretty easygoing in the first months of her son's life, even when she had to introduce formula early because she produced too little breast milk, Deb said.But when her son was 4 months old, Cindy emailed Deb that he was making "strange/jerky movements w/his right arm," almost "flapping like a wing."The pediatrician said it was nothing to worry about, but Cindy scoured the Internet for diagnoses. She fixated on an instance a few weeks earlier, in August when, while washing clothes, she briefly left the baby on a play mat on the floor. He fell while pushing up, hitting his head.She believed this minor episode had caused him severe neurological problems: seizures, autism, concussion. She blamed herself for leaving the room, for placing the play mat on the hardwood floor. Other incidents alarmed her, and she decided he was more irritable, smiling less.She visited two pediatric neurologists.Then she saw an expert in cerebral palsy because her son did not always exhibit the Landau reflex, a Superman-like pose babies make when held aloft, stomach-down.In October 2012, when her son was 5 months old, she emailed a doctor she had seen that day: "When you said babies can't injure their brains from even several floor-level head hits on a wooden floor, did that include hits even if they are turning and hit back or side of head on the floor?"The doctor replied: "That's right. Little bumps on the head at floor level that a baby may cause themselves in the course of normal spontaneous movements would not cause any injury. Babies are really very hardy (thank goodness)!"Cindy sent the doctor a video of her son, noting that "he almost always moves the right hand when holding a toy, reaching to grab something, etc."The doctor responded: "All of his movements look like normal, age-appropriate movements to me."Her siblings assured her that their children had made similar movements but she was implacable. Without telling her sister, Deb called the pediatrician, who said she was also concerned about Cindy. Deb said Cindy's husband worried too, although "part of him said: 'Maybe she's right. She is smart and was with the baby all the time.' "Still, both Cindy's husband and siblings urged her to seek therapy."I just really want you to see someone," Deb emailed Cindy. "You cannot continue like this, for your sake and for his sake."Cindy agreed but insisted that she had no postpartum mental illness. She told her family she was simply depressed because of the harm she had done to the baby."You can hardly imagine how it feels to strongly believe he has brain damage and that I caused it," she emailed Deb. "It must be one of the top one or two nightmares for any parent. iloveyou, cindy."Experts say such breaks from reality are likely symptoms of postpartum psychosis, which affects only one or two in 1,000 mothers. About 4 percent of those hurt their children; about 5 percent kill themselves. Flagrant cases usually emerge soon after birth; women may hear voices or feel compelled to inflict harm, like Andrea Yates, who drowned her five children in a bathtub in 2001, or Dena Schlosser, who in 2004 cut off her infant's arms. Both women were ultimately found not guilty by reason of insanity."More subtle forms of psychosis are going to be picked up later," said Dr. Katherine Wisner, a professor of psychiatry and obstetrics at Northwestern University. These women "tend to have prolonged delusional thinking: 'there's something really wrong with my baby.' "Most other maternal mood disorders do not involve such unshakably unrealistic convictions; most women know something is wrong, and although they fear they will harm their children, they rarely do.At Thanksgiving in 2012, Cindy's family gathered at her brother Ron's home outside Albany, and Cindy, normally outgoing, seemed consumed with her son's purported problems. She told Deb she had thought about suicide, saying "How can you go on knowing that you've ruined your baby's life and it was your fault?" Deb was stunned. She and Cindy's husband discussed the situation, hopeful that therapy would help.Later that visit, the baby rolled off a low bed. It was one of several times that Cindy panicked and took him to the emergency room, where doctors pronounced him fine.The next month, Cindy began seeing a psychiatrist, who prescribed Zoloft, an antidepressant. She briefly visited other counselors for talk therapy. Friends offered support and company.One January weekend at Ron's house, she seemed more engaged, smiling more. When Deb asked, she acknowledged still having thoughts of suicide but said her psychiatrist had told her it was not too worrisome "as long as they're not getting more frequent," Deb recalled.Family and friends wonder now if she was feigning feeling better. "Now I think maybe she was backing off so everyone wouldn't think she was crazy," Karen said.Experts said postpartum psychosis symptoms can fluctuate. Sometimes women are "lucid and not delusional," said Davis of Postpartum Support International. "Then they slip back into delusions more easily than with other types of psychosis."The mixed signals from Cindy continued into March. She discussed returning to work and finding day care. On a visit to her mother-in-law on Long Island, she called Deb while strolling by the ocean and sounded good. But the next day, Sunday, the baby fell while pulling up on a chair in his grandmother's kitchen. Cindy considered it another disastrous "head hit."On Tuesday, Cindy uncharacteristically canceled her psychiatrist's appointment, citing rain. On Wednesday, as she sometimes did, Cindy asked her husband to come home from work. When he arrived, she said that their son's morning had been rough but that she was feeling better. After a few hours, he returned to work.That afternoon, with her baby snug to her chest, she jumped."I am so unbearably sorry, which I know does nothing to undo the evil I have done," her farewell note began. "I wanted to be a mother so badly and I hoped to be a wonderful one, and instead I have become the worst of the worst."Searching for anything to blame herself for, she described minor, harmless moments: tucking a light blanket over his face for warmth, letting him suck a leaf, briefly putting a dime in his mouth and immediately removing it. "These things I did were horrible," she wrote.She was sure her son would never walk and said she believed his most recent fall caused a concussion. "I'm so so sorry, but I can't bear for him to suffer more and more."She said she knew others would see her suicide as a result of "postpartum depression/psychosis." But, she said: "I know I am right that I mistakenly harmed him. I'm not claiming a voice told me to do this."She even chastised herself for crumbling emotionally, saying she made her son a less happy baby."I don't know if there is a hell," she wrote, "but I hope so."

© 2014, The New York Times News Service

Cindy Wachenheim would never know that in her last act, her body cushioned the fall for her son and saved his life. Weeks later, the healthy little boy took his first steps.