Identifying Postpartum Depression

Misconceptions and myths

prevent mothers from seeking help

 

 Postpartum depression often becomes a catch all phrase for the mood disorders that some women experience after delivery or when a pregnancy ends. Sometimes, it is misapplied to the baby blues, (a benign and self resolving condition) and other times used to describe the extremely rare (less than .2% of women) postpartum psychosis. This misunderstanding can lead to confusion, under diagnosis and increased apprehension among the very mothers who would greatly benefit from a variety of supportive treatments.

 

While research and clinical practice indicate the enormous variation of symptom presentation across many diagnostic categories, the stereotype of postpartum depression remains – the scarlet letter of the 21st century. In  news stories and whispered tales in communities across America, the mother with postpartum depression is often depicted as an out of control, non functioning and seriously ill woman who cannot be trusted with her child.

 

 Recently, much has been written about the media’s implication that postpartum psychosis is interchangeable with postpartum depression. We have lamented this clinically erroneous sensationalism for its increase of  stigma, fear of social judgment and condemnation. Just last week, ABC’s Private Practice website featured a damning poll questioning whether the psychotic  mother depicted on the show had the right to even see her child.  How could this possibly encourage women to seek help? The prospect of hospitalization, steady decline into madness and potential loss of one’s child could discourage the very mothers who may  desperately need relieving treatment.

 

 But there is another group of mothers disserviced by these regretful misrepresentations. These are mothers who may have a pregnancy related mood disorder but think that because their symptoms do not equal the extreme drama portrayed in such stories, that they do not have postpartum depression or another affective pregnancy related disorder. They may conclude that their suffering is insufficient to warrant intervention and compassion. These are the mothers who know that something is wrong, but compare themselves to these extremely rare depictions and think they are just “blue” and attempt to tough it out – week after hellish week. So months of silent anguish continue and the potential joy of motherhood is lost to the woman, her infant and her family.

 

  “Thank God that’s not me”  such a mother might think while making such comparisons, even as her own nights are sleepless, her heart empty and the person and dreams she once knew have disappeared. “I couldn’t have postpartum depression”, she thinks, “because I am able to get up and work and take care of my baby”. Never mind she is a shadow of her former self, she assumes the joylessness of her relationships, even that with her child, are her own fault. She concludes that she has failed, that motherhood has found her lacking, that she is unworthy of compassion and assistance.  “After all” she thinks, “women who are really ill with postpartum depression are in bed aren’t they? Or in the hospital, or running away from their families, hearing voices and thinking of ending it all?”

 

 She does wonder how this emptiness came to be and if it will ever end as she plows through each isolating day, crying to herself and hiding the extent of her disability from those she loves and even from herself.  She lives in an airless limbo of frustration and despair. This mother does not think she has postpartum depression because she is functioning.

 

These mothers can suffer for months, blaming themselves and feeling unworthy of help because they do not know that postpartum depression, postpartum anxiety, postpartum OCD and other diagnostic variations can manifest in many ways  - allowing a mother to function but separating her from herself and causing intense mental anguish. She no longer recognizes the person she has become - but if she is able to work, doing the grocery shopping and going through the motions of caring for her child, she feels she merits no special notice. This is the sentence of guilt she must accept.

 

 Clinically, we associate major depressive disorder with lethargy, exhaustion, poor or increased appetite, hypersomnia or insomnia and intense feelings of guilt and hopelessness. And these symptoms may indeed be present and indicate the need for rapid intervention. But often in the postpartum period, the depression is agitated masking the feelings of despair with activity and hyper vigilance, causing mothers and loved ones to doubt that depression is present. Such activity and pseudo competence may give the illusion of health, obscuring the suffering that deadens each day as guilt increases with self-blame. Family and friends look at the busyness, the meals on the table and the lack of tears and think, “she’s fine, maybe a little tired, but fine”. So she drives herself to meet these expectations.

 

 Ladies and friends, if you or a pregnant or new mother you know seems agitated or unlike herself, even though the dishes are done and the baby is thriving, please approach gently and ask those important questions. How are you doing?  Every week family members and friends ask me what they can do to help? Offer to listen, offer to help, let her know you  have noticed, that it is NOT supposed to be this hard, that every expression of depression is different. Give her books to read, websites to visit and numbers to call of support groups and professionals. And most of all, lend your ear and heart without judgment…as this is often the turning point which leads to treatment seeking and eventual recovery.

 

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