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We've seen Tully—and we've got some real concerns

Spoiler alert: This is about the entire movie, not just the trailer. Additionally, this article contains information and opinion about maternal mental health and may be upsetting for some individuals.

When the trailer for Tully first came out, I was beside myself. Finally, a movie about what motherhood is really like. I couldn't wait to see it.

In Tully, Charlize Theron plays Marlo, a mom of three who hesitantly accepts the help of a night nanny to get through the famously rough fourth trimester, after her youngest daughter is born. The movie is named for the night nanny, Tully, who is played by Mackenzie Davis.

Tully depicts an image of motherhood never before seen in a movie like this. Marlo has leaking breasts, a postpartum belly and a messy house—definitely not the glamorized version of motherhood we are used to seeing. We also see a lot of very familiar scenes, such as when Marlo accidentally spills a bag of freshly pumped breast milk, and the pure heartache that ensues from that.

Marlo's husband, played by Ron Livingston, is a fine husband and dad—definitely present and "trying" but certainly not as engaged or aware as we'd like him to be.

So far, I was on board with the plot.

Enter the night nanny, who comes into Marlo's life and starts making everything better. She connects with the baby right away, helps Marlo get her house organized and eventually becomes her confidant and friend.

Things take a turn for the huh? though, when Tully sleeps with Marlo's husband—while Marlo is watching and "telling her what he likes."

The climax of the movie comes when Tully and Marlo go out for a night and find themselves drunk in a bar in Brooklyn. Tully tells Marlo she can't work for her anymore, which greatly upsets Marlo. They end up driving back home together, but Marlo is drunk and falls asleep at the wheel—and they get into an awful car accident.

When Marlo regains consciousness, she is in the hospital, with her husband by her side. We learn from a doctor that Marlo has been suffering from postpartum depression.

We also learn that Tully is not real. Tully is actually Marlo's younger-self, who Marlo has imagined into an actual walking-talking person. The movie ends with Marlo's husband stepping up and helping around the house a bit more, and it is unclear if Marlo receives treatment—the movie definitely does not show her doing so.

I am not a movie critic, so I can't speak to the cinematography and acting—though from a non-expert POV I thought that was all really good. The actors all did tremendous work, and I was really impressed.

I am, however, a midwife. And as a maternal health provider, I have some very real concerns about Tully.

Postpartum depression is mentioned in the movie (once when we find out Marlo had it after her first baby was born, and once at the end when the emergency room doctor asks her husband if she's had a history of mental health issues).

The problem is that Marlo does not have postpartum depression—she has postpartum psychosis.

Postpartum psychosis (PPP) is rare, impacting about one or two out of 1000 women. Symptoms include:

  • Delusions
  • Hallucinations
  • Periods of extreme activity
  • Anger
  • Paranoia
  • Trouble communicating

As with all mental illness, it's essential that we do not make any blanket statements about women with PPP because everyone's story is different. That said, postpartum psychosis "can lead to devastating consequences in which the safety and well-being of the affected mother and her offspring are jeopardized," according to Dr. Dorothy Sit and colleagues.

From hallucinating a personified version of her younger self (including "helping" her have sex with her own husband), to nights filled with frantic cleaning and cupcake baking, to a spontaneous night out where she ends up driving home drunk, Marlo exhibits many of the signs of PPP.

I am not sure if this was intentional, or if the film-makers did not realize that the character they created had PPP. Since they acknowledge that she has postpartum depression, though, I am surprised that they seem not to have consulted with a therapist to ensure that the topic was handled appropriately, whatever their intention was.

My issue with the movie is not that it is about a woman with postpartum mental illness—indeed we need many, many more movie about postpartum mental illness.

My issue is that in not addressing the fact that Marlo has a postpartum psychosis, the rampant problem of unaddressed maternal mental health concerns is perpetuated.

The reason that people are so excited about Tully is because they feel like it is the first time that true motherhood is being portrayed on the big screen—but this is not true motherhood. Motherhood is hard, yes, but it is not this. This is mental illness. Brushing aside her mental illness again refuses to give it the attention it deserves.

Marlo needs immediate mental health treatment, and there is no direct acknowledgment in the film that she is getting it. Yes, a doctor tells her husband that she has PPD. Perhaps we can assume that means she's getting help?

Here's the thing though—all too often in mental health we assume that someone is fine and getting the care they need. So we don't do anything or say anything.

We need to create a culture that is done assuming and starts ensuring.

My strong concern here is that this movie which presents itself as validating the experience of motherhood is sending the message that these symptoms are normal. They are common yes. But they deserve to be respected and attended to, not dismissed.

Twice in the movie, Marlo talks about suicide. Once in the beginning when she says (to her entire family), "I want to kill myself," and her husband tells the kids that she's only joking, "like a clown." And then later Tully jokes that Marlo wants to murder her—since Tully is really Marlo, murdering her means killing herself.

In neither of these instances does anyone do anything to help her. Yes, this is a movie—but real women are suffering from this very real problem. Normalizing suicidal ideation is simply not okay.

Carolyn Wagner, a maternal mental health therapist based in Chicago told us: "The reality of postpartum psychosis is that it is extremely serious and presents a grave danger to mom and infant. It does not involve fantastical imagined friend and caregiver, and it is certainly nothing to be made into a plot twist.

"Additionally, I am concerned about the impact the storyline will have on postpartum mood disorder survivors who are not aware before going into the movie what they are going to see. The promos do not even hint at the twist, so moms are likely to be caught totally unaware which can be really upsetting and potentially damaging."

I find myself wondering about responsibility. Does the film industry have a responsibility to address mental illness appropriately? I'm not sure that they do.

But I see such a missed opportunity in Tully. Had the movie been just a bit longer, perhaps they could have shown Marlo receiving help—how amazing would it have been to see Hollywood take on the stigma of maternal mental health and turn it on its head? Instead, we leave with the notion that this is just "how it is" for moms.

So for what it's worth, to anyone out there suffering, please know it doesn't have to be like this. You have done absolutely nothing wrong, and you are not alone. There is very real help available to you.

You are so worth it.

If you're experiencing feelings or thoughts that concern you, contact your medical provider or a therapist who can help you find the right treatment plan. If you want to hurt yourself or your child, please call 911 or go to the emergency room where they can help you. For a description of postpartum mental illness symptoms, please visit Postpartum Progress.

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