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Babies in blue

There's Before Baby and there's After Baby, and they are two different lives. Why is post-natal depression not seen as the normal, commonplace result of coping with the earthquake? ask Aine Tubridy and Michael Corry

 

It takes a village to raise a child
— African proverb

 

The journey from the positive pregnancy test to the labour ward and beyond is akin to stepping onto a spaceship headed for Venus. First time voyagers agree that nothing could have prepared them for the experience. Whether it proves to be a smooth, uneventful trip, or the roller coaster ride to hell and back, this is influenced by variables too numerous to mention. It's fair to say that the medical community have had no success in attempts to identify clearly why this is so. The trip is independent of hormone levels, prenatal states, labour conditions, socio-economic factors: nothing serves to identify the mothers who will become post-natally depressed from those who will not.

mother & childThis is one area where the exceptions to the rule stand out: where, even in the face of extra-ordinary trauma or prenatal history, a mother's emotional reaction is not one of depression, against all the odds. Contrast this with the mother who was totally prepared and supported, who had an uneventful, healthy pregnancy, with the ideal context in place. It can be the greatest shock, out of the blue, when she finds herself in the grip of the last state she expected to feel, eclipsing and spoiling the joyous arrival of her much-wanted child.

 

The one-way ticket

Motherhood is irreversible. Although you could decide to give the baby away and aban-don your post, you can never erase the fact that you've experienced the birth process, an extraordinary event in its own right. Yet how many other monumental events are given so little time and space to be integrated, to be understood, and processed? For many mothers it is the most terrifying experience of their lives. Never is your body so out of control and taken over by a process which is supposedly ‘natural', yet feels anything but that, and from which there is now no escape. Far from being in the driving seat, you can find yourself a panicky passenger on a bus heading over a cliff. Catastrophic scenarios run through your mind as the intensity of the pain builds exponentially, stretching endlessly ahead. Many visualise their abdomen or pelvis bursting wide open, and ‘getting the baby out' by whatever means is the only sure release from their pain. For some the entire process is one unending panic attack and a life-threatening event, both for mother and child.

Physiologically, your body has major readjustments to make in the hours and days after birth. Blood loss, blood pressure changes, hormonal shifts, tissue repair, and breast milk coming in, are all being dealt with simultaneously. You may be still reeling from the shock, the overwhelming pain, or the exhaustion following a traumatic, protracted delivery, caesarian section, vaginal tears, or problems with urinating. Many women feel betrayed, conned, and deliberately kept in the dark about what they could expect. The experience of feeling bullied by the labour ward staff, and manhandled by their doctor, leaves many bitter and resentful. Home deliveries, with the best midwifery expertise, can be equally as turbulent: "Nobody ever told me it could be this bad."

After the delivery the baby takes centre stage, and from then on it's a juggling act. In between receiving adoring visitors and medical checks, you struggle to initiate breast feeding, bathe both of you, and attend to your own painful undercarriage, wondering if your gaping vagina, to you like the flapping sleeve end of a jumper, will ever shrink back to its original size. If sore nipples are a problem, it colours your view of the hungry little mouth approaching them, which you can't refuse. In the event of mastitis or your being unable to produce enough milk, your sense of failure grows, your confidence plummets: disappointed, and with your best-laid plans in shreds, you try to resist the bottle-feeding alternative but give in the end.

The moment of arrival of the baby, the birth, will have been coloured by the previous nine months. Factors such as a threatened miscarriage or blood pressure problems requiring bed rest, persistent vomiting, the pregnancy being an unwanted one — possibly even resulting from a rape or incest — or being a sole parent unsupported by the father or the rest of the family. Even a normal pregnancy is a state of dislodgement from a woman's former self and previous ways of thinking, feeling and behaving. Everything has changed : your body image, your confidence, your sex life, your sleep pattern, your posture, your pain threshold, the predictability of your emotions, your relationship to your partner, to your work life, and to life in general.

In addition to these normal post-natal adjustments, many mothers have the added burden of grave concerns over a sick or premature baby, where its life hangs in the balance, or of surgery or a disability appearing on the horizon. Visits to the neonatal intensive care unit, fraught with anticipation of further bad news, are tension-ridden experiences, and utterly contrary to the happy scenario you had imagined. You can feel helpless and out of control: fear, sadness, weeping and disillusionment is the norm. Partners, too, are shattered.

 

The eclipse of your original self: for life?

Life is sexually transmitted, and the role of mother is the means through which this is achieved: an awesome archetype to inhabit. Every construct in your makeup which relates to nurturing, both giving it and receiving, begins to surface. Unresolved issues around your own parenting and nurturing experience inevitably emerge. Your own parents are the only models you have experienced at close quarters, and your expectations of yourself and your partner rest on that.

‘Good' mothers are able to meet their child's every need, put a smile on their face and never complain, have no needs of their own, and are adept at juggling the needs of the entire household in spite of the profound exhaustion resulting from sleepless nights. ‘Bad' mothers are those who fail to be so perfect, who sometimes feel like screaming at the baby if it won't settle, who may want to throw it down into its cot, who at times wish it would disappear in a puff of smoke, who think they'll crack up at the invasiveness of having someone hanging out of them constantly even during their sleep, and who lust for time on their own. The incessant proximity of your baby and its insatiable, all-consuming appetite for your energy is a fact which, when it dawns that it is inescapable, can be an overwhelmingly depressing realisation.

All normal mothers occasionally feel such inclinations, and since verbal expression of theses feelings is often taboo, a mother can find herself in the isolated position of not having an avenue by which to ventilate them and be offered reassurance. As a result, guilt and feelings of inadequacy erode their self-esteem and can sow the seeds of depression.

The grieving for the old you who has permanently disappeared can be profound; for the you who was in control of her energy, body, sleep, time, social life, work identity and had a rewarding sexual and emotional relationship with the child's father. Since the baby's arrival, the future will have to be made up as you go along, with nothing taken for granted any more, no assumptions, and no guarantees. Life is now being lived by the seat of your pants. For some this is a joyous process, and, happy to set aside their own lives, they embrace the adventure eagerly. For others, the time away from your own calling, now a fait accompli, can seem to stretch into the future like a life sentence, depressing them.

Why do some mothers take to the role like a duck to water? Even yearning to repeat the process long after they've hung up their ovaries, eagerly awaiting the arrival of grandchildren to partake in the process even at one remove. Some seem to transcend the difficulties and turn the whole experience into a joyful one, as if was second nature to them, as if they'd done it thousands of times before. Against all expectations some mothers, having had no role modelling and working in a busy career, find that the baby is the ‘making of them' and effortless. Some men, likewise, if they had breasts, would make better mothers to their baby than their wives, so natural and familiar does the role seem to them.

Some spiritual healers and energy workers have another take on this. Accepting the notion that we have previous incarnations as well as this life, some of them would say that, in terms of past lives, it probably is the second time around for the 'effortless' mothers, or the hundredth or the thousandth. The more female and mothering lifetimes under your belt, the less overwhelming and awesome the task must seem this time. By the same token, they would ask could this lack of prior experience and ‘know-how' account for some post-natal depressions? And it appears that many women, mystified by why their post-natal depression is so severe, derive benefit from this possibility and find it helps them to cope.

This notion incorporates the idea that the animating principle in males, the animus, and that in females, the anima, are entirely different in their modus operandi, their way of being in the world. Tackling tasks male-style means identifying what is to be done, bringing your energy to bear on the job, and completing it, packaging it away. Tasks are discrete things with beginnings and endings. In the female psyche tasks can be interwoven, one flowing into the next without punctuation in between. ‘A women's work is never done' never more truly applies than to housework, feeding babies, shopping, cooking, and so on. In short, nurturing is never over as long as those dependent on your energy have needs. This dynamic can hugely frustrate a woman whose 'prior lifetimes' have mostly been male ones, and who struggles therefore to comprehend the never-ending tidal wave of demands, each one of which, when seemingly under control and completed is instantly replaced by the one following! Depressing to the male-oriented psyche, unused to such chaos and mayhem, for those experienced in female lore, this is just ‘the way it is', and is celebrated as part of the great flow of life.

Your partner meanwhile has taken on the mantle of fatherhood. You look at him through a lens tinted with your own past conditioning combined with your very real present-day needs, and the reality of whether or not he is meeting them. This period of time has the potential to generate a conflict between the father you want him to be, and the one he is portraying. Like the female of all species, you unconsciously assess him on his ability to be a ‘good provider', a protector who backs up the main act, you and your baby, with an extra pair of hands, compassion and tolerance. Unsuspecting, he is sitting an exam he doesn't even know he's taking, and you don't know you're setting. Without any prior experience, he now finds himself facing the challenge of sharing the responsibility for two extremely vulnerable people.

The mother's over-riding drive now, immediately after birth, is to do very little, adopting a virtually passive role, needing to rest and be fed, so that she can build the reserves necessary to meet the demands of the baby which are 24/7, and possibly other children who may become clingy at this time. If the father is unable or unwilling to provide the hands-on backup she needs, then this task becomes inescapably hers, and dependent on the often unreliable and patchy substitute support of family. Some fathers recoil from the responsibility, perhaps having been bachelor husbands, and now predictably go on to be bachelor fathers, their life going on undisturbed. They find the trade-off worth it — arguments wash over them, as does having to move out of the bedroom. The status quo is maintained at all costs.

 

Binding contracts

It's part of the human condition to have contracts with yourself and others with whom you are conducting a relationship. The terms of some of these are implicit, such as the agreements and promises you have unconsciously made to yourself: to fulfil your potential, to express your creativity, to honour and respect your needs, to care for your health, to make your life meaningful, and to endeavour to find happiness. Should you ignore or fail to fulfil these, there is a gnawing discontent, a sense of guilt, a feeling that you have somehow betrayed a higher purpose, that you've let your soul down. In some, this existential disquiet expresses itself as depression. One of the difficulties in articulating this feeling stems from the fact that the contract is non-verbal, has never been clearly stated, that it ‘goes without saying' and may even be unconscious.

On the other hand the explicit contracts, those with others, are conscious and binding. The mother-child relationship may start even before the pregnancy, if the conception was planned. In essence the mother is inviting in an unborn spirit, and promising to nurture it. When the child comes in, this contract deepens, and her relationship to her partner changes, as he becomes the father. Three contracts are now happening concurrently for the mother: the one with herself, the one with her child, and the one with her partner. Ideally, they're confluent, and don't conflict with each other. However. this is often not the case, and much confusion and turmoil results.

 

Caroline, a 31-year-old journalist, had felt driven to write all her life. A vivacious, lively story-teller, her short stories were acclaimed for their unique colourful style and she held the position of sub-editor of a weekly newspaper. When she became pregnant, she fully embraced it; watching her diet, going to yoga, and planning with her partner to have the baby at home. The delivery went normally, but she found it a nightmarish experience. Terrified by the intensity of the pain and the panicky, out-of-control feelings, she thought it would never be over. It took her some days to recover from the exhaustion of the experience, and in spite of plenty of hands-on support, she found it hard to rally. As her energy plummeted and she become increasingly anxious, she began to dread having to handle things on her own when her partner went back to work, and became progressively disheartened and disillusioned.

Her depression changed in nature over the weeks and months. Initially she felt hopeless and trapped by the endless feeding and caring schedule, and the sleep deprivation. Sometimes she referred to the baby as her ‘Buddha' so much had it taken overshadowed their lives.

Living life as a mother was difficult, even having to do the most basic things. Everything seemed insurmountable, from cooking to cleaning. And a worrying shift was occurring between her partner and herself, where she felt so wrapped up with the baby that it was often a strain for her to relate to him, as if she could only make room for one intimate relationship at a time. It concerned her that sex no longer interested her and that doing ‘couple things' had become another chore, and she felt guilty about neglecting him. The months dragged on, and she became plagued by a growing irritability about never having time to write, although her mind was always feverish with ideas. This frustration she called ‘the pressure of the uncreated creation' and hated it.

Almost a year later, continuing to breastfeed, she persisted in trying to be the best mother she could be, which she felt was the baby's due. Now working freelance from home, she found that her writing was frustrated by her inability to ‘get a good run at it', so constricted was she by the baby's schedule. Her partner, a patient and supportive man, hated to see her like this, and encouraged her to return to her job. She resisted, but he insisted that this wasn't benefiting anyone, and even the baby was picking up her distress. She decided to find a psychotherapist, and gradually over the following months was able to put words on her confusion, and learn to balance the conflicting demands.

 

Joseph, a 40-year-old laboratory technician, was married for ten years to Janet, a successful event promoter. Having tried for years they had given up on the idea of ever having children. The marriage had cooled, and Janet had become absorbed in her work. When they had met, she had been a French teacher, and at that stage they had both shared a yearning to work in the third world, to ‘give something back'. However, as her new career took off she lost interest in their initial plan. Opportunities overseas came and went, a fact which frustrated Joseph, and since the marriage no longer seemed worth salvaging, he privately considered leaving and pursuing his dream. When the next temporary contract came up, one in Uganda with the WHO which involved setting up a laboratory there, he considered it seriously.

Although sex was now a rare event between them, it happened spontaneously on the night of an after-party following a highly successful concert she had handled, and they were both shocked to find that she had become pregnant. Although Janet was delighted, this news threw Joseph into a tailspin. He no longer loved her, but now felt a growing sense of responsibility towards the child. At the same time he was painfully aware that he was facing a dilemma. It would be wrong for him to jump ship now and renege on his duty as a father, but at the same time it would be inauthentic to go on with the pretence of their life as a married couple, and depressing for him to live trapped in the life they had.

He decided to see Janet through the pregnancy and gauge how he felt after the baby was born, hiding his confusion and ambivalence from her. Following the birth, which went smoothly, Joseph was moved to find himself deeply attached to the child. Intense inner turmoil followed. He was now more trapped than ever, but couldn't tear himself away, however strong his calling was to leave the dead marriage and start a new life. Stuck and hopeless, he grieved for the future he would have to let go of, and feeling numb inside, found it increasingly difficult to motivate himself for work. His only solace was his time with his son.

When Janet stopped breastfeeding and returned to work, more of the primary care fell to him, dropping and picking the baby up from the creche, doing the night-feeds and minding him on the weekends. For a brief time the novelty of this new role as house husband and ‘mother' sustained him, but as the months wore on he found himself doubting whether the price was too high. Often too tired even to enjoy the time with the baby, he started to feel depressed.

Joseph had reached a crunch point where nothing seemed to be working; his job was now meaningless to him, his relationship was empty and unrewarding, and the future held only more of the same. He went on Prozac in the hope it would give him a boost. When it didn't, he negotiated with Janet that in the interest of the baby and his disenchantment with his job, that he'd take temporary leave of absence. He resigned six months later. His depression continued, although he went to great lengths to hide it from his growing son.

 

Wendy, a 31-year-old mother of a two-year-old boy and a ten-week-old girl, began to experience mounting anxiety and panic attacks soon after the second birth. Her husband held a junior diplomatic job which meant weekly travel to Brussels, and very soon after the birth, she found herself having to manage alone for several days at a time. Each day began with palpitations, difficulty breathing, dizziness, and a knot in her stomach, even before she left the bedroom. Being a paediatric nurse, specialising in the neonatal area, she was mortified at the thought of admitting to her husband that she felt such fear, and hid the panic from him. On the days of the week when he was home, the anxiety was much less. It was her thoughts which concerned her the most. They predicted every possible catastrophe happening that day relative to her caring for the children. She worried that through some oversight of hers they would come to harm, that she might not have paid enough attention to whether the fire was on or off, whether they were wearing enough clothes, or if she was spending enough time with her son. The responsibilities, and her probable shortcomings as their mother, constantly plagued her. This also confused her, for, as a neonatal nurse, she very capably cared for as many as 20 babies in the nursery without the slightest hint of hesitation.

She had experienced overwhelming insecurity after the first birth also, but put it down to first-time motherhood, and the fact that they were living in Britain for many months. Whenever her mother came to visit, since the responsibility was shared she had felt less anxious. Although the nervousness lingered for at least a year, it had eventually passed. While she found the waves of anxiety troubling, it was the mental symptoms which really undermined her confidence in her mental stability. Losing control was her worst fear. Sometimes, as the panic swept over her, she would get images flashing in, where she would see herself hurting the baby, flinging her against the wall, or suddenly getting the urge to push her head under the bath water. Secretly she feared admitting these thoughts to anyone in case a mental illness would be diagnosed, and the social services called, resulting in her children being removed from her care.

However hard she battled the thoughts, they persisted. Increasingly, by the end of each day, she found herself tearful and depressed. Putting on a brave face in front of her husband, she would feign tiredness and go to bed before him, often crying herself to sleep. Eventually she consulted her family doctor, telling him that she felt drained of energy and motivation, and he recommended she try an antidepressant. This cemented in place her conviction of being mentally ill, and her anxiety escalated. She tried them for a week but, too frightened to continue, stopped them. Instead she sought out a psychotherapist, saying she was taking a parenting class.

Wendy's father had died when she was 12, leaving her mother to raise five young children. In telling her psychotherapist about that time, she remembered her mother trembling with anxiety, and holding her forehead in despair many times, muttering "what'll I do, what'll I do?'. Small upsets easily became unmanageable for her distraught mother, and she remembered always leaving for school in a state of disarray, often without a lunchbox or her homework done. Being able to cope with her own children had always been a priority for Wendy and she dreaded letting them down, like she felt her mother had with her. Her depression gradually lifted as she learned how to handle the anxiety attacks, and to realise that the thoughts of harming her baby were common expressions of feeling out of control, not of a mental illness.

 

Re-writing the contract

Joseph's dilemma is more complicated than Caroline's. He is caught between honouring the contract to himself, and upholding the one with his son. His was a no-win situation, damned if he did and damned if he didn't. The cost of such a predicament was a continued sense of entrapment, expressing itself as depression. He arrived at an uneasy truce, to some degree having to accept that there was no solution and to go on ‘biting the bullet'. Although traditionally regarded as the preserve of the mother, and moreover as hormonally driven, Joseph's depression reaction to the baby's birth was legitimately post-natal. The predicament he faced is typical for countless numbers of mothers who have learned to live making great sacrifices, remaining in intolerable, sometimes violent relationships, at huge personal cost ‘for the sake of the children'. Tragically, sometimes contracts with oneself cannot be re-drafted until the child is grown.

Caroline, by contrast, although juggling three conflicting contracts managed to find a way to reconcile them. The breakthrough came when she re-examined her idea of how ‘good mothers' fulfil the role. Finding the middle way, she learned to redefine her mothering role so that it was no longer so all-consuming, no longer completely eclipsing her own personal needs.

Wendy's difficulty, following on her own experience as a child, centred around her absolute dedication to the idea of mothers always, and in all circumstances, being able to cope. She had to learn to make allowances for the difficult circumstances she was facing: a husband who travelled, leaving her the full brunt of responsibility for much of the week. Her conditioning had taught her to fear, unnecessarily, the responsibilities of motherhood, and in therapy she was able to draw distinctions between her mother's desperation as a widow with no support whatsoever, facing many financial burdens, and herself, an experienced neonatal nurse. Her depression lifted once she began to share more of her concerns with her husband, overcoming her fear that her intrusive thoughts were an indication of some serious illness which would render her children motherless, her worst fear.

 

Access contracts

Post-natal depression should be seen as transcending clinical definitions, gender, and time-span. This is self-evident where relationships break down and custody and access battles rage. Estranged parents can be plunged into depression and unspeakable torment which can last a lifetime. The adversarial legal process involved can cause parent alienation and destruction of such magnitude that desperate measures such as child homicide and suicide occur. In the hysterical emotional climate generated by the ‘wronged' parent's indignation, every card in the pack is played with ruthless intent. The children become unfortunate pawns, used as instruments to inflict wounds, or avenues to convey anger. Everything from protection orders, barring orders, accusations of sexual abuse, unfaithfulness, neglect, addictions, and psychiatric instability are used to fabricate a profile of the other parent as someone to whom access to their children should be denied, limited or supervised.

Solicitors and barristers, untrained in family therapy, and therefore lacking psychological knowledge of human dynamics, have turned family law into a thriving financial industry. Some behave not as legal eagles but as vultures, hovering over the battlefield looking for easy pickings. As each side fights it out, in an atmosphere of mounting distress and time urgency, enormous fees change hands, usually crippling both the ‘loser' and the so-called ‘winner'. Frequently children find their homes sold over their heads to pay legal costs, in the name of indulging one hurt parent's thirst for revenge. No ‘good counsel' is given to such a parent, cautioning them to reign in their anger in favour of prioritising their ‘beloved' children's needs.

Suddenly, parents who were until then considered safe and adequate now find themselves considered a danger to the same children, an unfit parent. They find themselves being assessed by some willing psychologists and psychiatrists, acting as hired guns, providing reports as to their suitability as parents, blatantly favouring the paymasters. How judges can be expected to make just rulings in the fog of such a war is a miracle, faced as they are by a tide of skilfully presented, sanitised and carefully selected facts, backed by the evidence of ‘expert' witnesses. In fact, the rise of legal lying in the name of the ‘truth' is now commonplace.

A parent's image is systematically destroyed in the name of proving him or her to be rotten to the core, when in fact it is their failure as a husband or wife which is the issue, not their parenting. Somehow they must be made pay, and the cost is the children's alienation from them, which can be lifelong. When the battle is over and the spoils divided, devastation is the legacy. Most regret that they allowed themselves to be taken advantage of by the unscrupulous legal profession in this way. Some realise, too late, that they were manipulated and bullied into taking positions from which there was no coming back. ‘Let's take the bastard to the cleaners', ‘Let's teach the bitch a lesson', ‘Let's get every penny'. (It is not uncommon practice for a legal team to ‘try on' the issue of custody and access in straightforward separation and divorce cases, in order to up the stakes, and ‘put the frighteners' on the other side. The agenda is to generate as much fear and conflict as possible, a side-effect of which is more fees).

 

God is on everyone's side… and in the last analysis, he is on the side of those with plenty of money and large armies
— Jean Anouilh

 

Emotional chaos can possess the parent who has been obstructed from fulfilling their private contract to their children. In a climate of overplayed adherence to timing of visits, slamming down of phones, awkward silent Sunday afternoon meals in fast-food restaurants, tearful departures, Christmas Days spent apart, and threats of further legal action, depression, hopelessness and despair thrive. Now with nothing to lose, with no purpose to their lives, feeling totally alone and consumed with mental and emotional turmoil, irrational actions can be embarked on. Some fathers sever all contacts, some commit suicide, while some mothers kill their children and then themselves. One father recently resorted to pouring petrol over himself in a solicitor's office, setting himself on fire, such was his frustration at his distress at not being taken seriously. These tragedies fill our newspapers and should be seen for what they are, travesties of justice instead of the result of an illness. Such medicalisation allows society to shirk its responsibility and avoid putting in place a truly humanitarian system of justice. Good legislation works. Models exist in other countries, in particular New Zealand, where the orientation is towards the wellbeing of the children.

 

Looked through the paper.
Makes you want to cry.
Nobody cares if the people
Live or die.
And the dealer wants you thinking
That it's either black or white.
Thank God it's not that simple
In my secret life.
— Leonard Cohen


 

More on depression

 

Disease? A red herring
In the first chapter of their latest book, Michael Corry and Aine Tubridy examine the roots of false thinking about depression, and its dangers
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Anti-depressant response

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