Book Review: Little Voices by Vanessa Lillie

I’m a therapist trained in post traumatic stress disorder (PTSD) and perinatal mood disorders. I treat survivors of traumatic birth, so the women-centered content of Little Voices is very powerful for me. This story deeply describes the unique female psychological experience of traumatic childbirth, perinatal mental illness and recovery. The opening scene is Devony’s traumatic birth experience. Many women come into my office sharing a story much like hers.

I love mystery thrillers. It is one of my greatest joys when a book absorbs me so much I forget the world around me. Little Voices does just that. Read it right through, stayed up all night to read it!

Although Little Voices, by Vanessa Lillie, is a mystery thriller about the murder of a young woman in a quaint New England town, Little Voices is also about the onset of, and recovery from, postpartum psychosis (PPP). The main character, Devony, is a close friend of the victim, and an investigative lawyer. She’s determined to find her friend’s murderer.

I’d like to share some background about postpartum psychosis. It is a rare and extremely serious mental illness that occurs in .1% – .2% of births.

Postpartum psychosis is a medical emergency. A woman experiencing PPP must be treated immediately. If you think that you are with someone who is experiencing PPP, move quietly and gently. Don’t agitate her by challenging her delusions. Instead, listen to her and gently join with her in her delusion, and immediately call 911.

Women who experience postpartum psychosis experience an actual break from reality. They have delusions and hallucinations. The hallucinations and delusions can take different forms. Often the delusion is an insistent voice: harshly critical of the mother in all way, as a mother, as a wife, as a person. Sometimes there are also auditory and visual hallucinations; such as believing she sees a child hiding in a corner or believing she hears insistent crying. Sometimes the delusions take the form of violent commands of self harm or even, sadly, infanticide. The violent forms are rare. However, any delusion must be taken seriously.

These postpartum delusions and hallucinations are most often completely out of character for the woman experiencing them. Postpartum psychosis is not always indicative of an underlying, permanent mental illness. But women who have pre-existing mental health issues, such as bipolar disorder, might be predisposed to PPP. In addition, woman who have experienced abuse or trauma in their lifetime might be predisposed to PPP. With treatment, including medication and counseling, most women recover and never experiment such episodes again.

Back to Little Voices…Intertwined with Devony’s murder mystery investigation is the emotional journey of the her recent pregnancy, traumatic birth and postpartum psychosis, and the accompanying anxiety and depression…and her recovery from mental illness back to mental health.

Devony’s traumatic birth is the book’s opening scene. She is bleeding profusely and is in excruciating pain. We experience the pain and near death experience (NDE) that occurs during Devony’s traumatic birth. As she floats between life and death, Devony thinks about how she worked on her birth plan, about all the beautiful outfits she has ready for her baby and the nursery she and her husband set up in anticipation of greeting her newborn baby. Shockingly, nothing happens as she planned. She is in the middle of a medical emergency. She also wonders if she has done anything wrong…has she walked too much, has she eaten too much sugar? She wonders…Is it my fault? Am I a bad mother? A bad person?

As Devony drifts into unconsciousness, she thinks she hears the news on the radio saying there’s been a murder and the victim is her friend, Belina. Devony is hospitalized for eight weeks after her near death experience.

This is a remarkable book, with two story threads intertwined. It’s a tale of Devony’s devastating postpartum psychosis. We learn in bits and pieces about Devony’s disordered thought processes and delusional emotional state. And also how important that the people around her…her husband and her best friends…join with her and support her in her journey back to mental health. The fourth semester is indeed an important incubator of mental health.

It’s also a tale of a young woman’s murder and Devony’s persistent and intelligent investigative abilities. It’s a tale of powerful political alliances, the drug trade, betrayal, sexual jealousy and murder, with riveting twists and turns.

Despite Devony’s extreme anxiety and crippling fears sparked by postpartum trauma and hormonal upheaval, she doggedly pursues evidence to find Belina’s killer. She is an experienced and persistent investigative lawyer. She makes powerful enemies along the way. And she also has a network of powerful political connections. As she digs into the evidence, she finds shocking criminality beneath the veneer of monied political society.

Intertwined with her work is her struggle with mental illness and her journey towards wellness. She is a survivor of childhood abuse, which leaves her vulnerable to depression, anxiety and a propensity towards obsessive-compulsion that interferes with her life in some ways, yet helps her in others. Th obsessive -complusiveness drives people away and sometimes cause her to be totally absorbed in her work. But Devony is not defined by her mental illness. This is a well-developed and interesting character; she is also mature, well-educated, and has a potent intellect. She has a good solid marriage and she is well connected in political society.

Ms. Lillie accurately and compassionately depicts the symptoms of postpartum psychosis: the anxiety, the paranoia, the delusions, the excruciatingly critical command voices, the crippling self doubt, the fear, and the shame.

Devony has a relentless critical voice in her head, telling her she ought to be dead, she is a terrible mother, her baby hates her. Devony thinks: “I fear the truth…This child hates the look of me, my smell, the taste of my treat refused by her tiny, perfect mouth…” (p. 9). The voice tells her her husband is getting ready to leave her. “You don’t belong here. He’ll realize you’re trash and dump you..you never deserved him…he thinks you’re fat, you’re repulsive… ” (p. 10). The self doubt and personal anguish is crippling, and a real symptom of PPP.

And yet, Devony has good legal and investigative skills: her specialty is working with accountants to identify and prosecute fraud. She was good at her job because she would delve into the psychology of the fraud: the why, the financial necessity and the criminal rationalization. She has personal tenacity, an obsessive attention to detail, the desire for justice, and the intellectual capacity to translate financial crimes into legal arguments.

Little Voices is well worth the read. Ms. Lillie educates about postpartum psychosis and also writes a great thriller that gave me my fix for an escapist read!

You might be interested in:

Are You There Alone? The Unspeakable Crime of Andrea Yates

Janet the Laundress Postpartum Psychosis Story

Differential Diagnosis on the PPD Spectrum

Part One: Recovering from Birth Trauma

Part Two: Recovering from Birth Trauma

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