What Tully Gets Wrong About Postpartum Depression

Warning: This article contains major spoilers for Tully.

Before even being released in cinemas, Tully, Charlize Theron's new movie about parenthood, began sparking controversy — so much so that screenwriter Diablo Cody responded to the criticism on Wednesday, telling the New York Times that "the film is meant to be uncomfortable."

"I don’t want anybody to think that I sat down and thought, 'Oh, I’ll write a gripping and entertaining movie about something that I know nothing about,'" she said. "I would never presume to do that."

Cody was responding to criticism about Tully's portrayal of postpartum depression. In the movie, Theron's character, Marlo, is a struggling mom who decides to hire a night nurse named Tully (Mackenzie Davis) to help with her baby. Initially, Tully seems to make everything better, but as the big plot twist reveals, Tully is actually just a figment of Marlo's imagination, conjured up to help her cope with the messiness of motherhood.

The movie attempts to explain the twist by mentioning that Marlo has experienced postpartum depression, but as some have pointed out, her symptoms are more akin to postpartum psychosis, which is a very different disorder.

"Postpartum psychosis is a very distinct entity [from postpartum depression]. It represents a psychiatric emergency," says Marra Ackerman, MD, clinical assistant professor of psychiatry at NYU Langone Health. "Patients who develop this set of symptoms need to be taken to an emergency room and admitted psychiatrically almost 100% of the time, because it carries a very high risk of suicide and infanticide."

The symptoms of postpartum psychosis are pretty different from those of postpartum depression, Dr. Ackerman says. While they both can share depressive moods, postpartum psychosis involves hallucinations and delusional thinking, which Marlo goes through when she imagines Tully.

"People can have hyper-religious delusions or grandiose ideas. They really lose touch with reality and that’s a really important feature [of postpartum psychosis]," Dr. Ackerman says. "The biggest feature we have is the loss of reality, meaning someone has a really difficult time telling the difference between what is real and what is not real."

All that being said, postpartum psychosis is rare. Dr. Ackerman says that while postpartum depression occurs in about 10-20% of the population, only about 1% of the population experiences postpartum psychosis.

And while someone might experience both postpartum depression and postpartum psychosis, that's even more uncommon than postpartum psychosis itself.

"Sometimes, you’ll see patients who first present with postpartum depression, and then the symptoms change over time and become more severe, and it can go on to be postpartum psychosis, but that’s very unusual because it’s such a rare disorder," Dr. Ackerman says.

So it's possible that the film meant to show that Marlo's postpartum depression had evolved into something else, but for many people, Tully missed the mark by not actually addressing postpartum psychosis. Not doing so isn't just an inaccurate portrayal of postpartum illnesses, it also risks triggering people who've suffered from psychosis and weren't warned before watching the movie.

While Tully makes a sincere attempt at portraying the realities motherhood, this conversation shows that there are multiple faces of maternal mental illness, and we still have a long way to go in exploring and addressing what all those aspects might look like.