[orthodoc]

The advent of PET scanners has done a great deal to move our understanding from theory to observable, reproducible information, as has our understanding of neurotransmitters and neuroanatomy/neuropathology. It's true that psychiatric diagnoses remain clinical, but so do many 'physical' diagnoses, such as carpal tunnel syndrome (EMGs don't make the diagnosis; they just provide information regarding the extent of neural disruption), MS, and most of the degenerative neurological diseases. Many, many diseases are identified by direct observation.

Postpartum depression is a particularly malignant form of depression, with a higher prevalence of psychotic features than many other forms. Any woman who suffers from it needs aggressive treatment, support, and frequent assessment. The presence of any psychotic symptoms is a huge red flag indicating the need for immediate evaluation and probable admission.

Could others have noticed differences in the days leading up to the crisis? Possibly, if she had shared any delusions or hallucinations. Could they have gotten help for her? It's fairly unlikely. If she even had a policy that covered mental health, the criteria for admission are so stringent that unless she vocalized direct threats to herself or others she would not be admitted. Being psychotic on its own does not get you admitted. Even then, insurers will force discharge the moment the direct threat appears to have settled, even though the person is not stable.