Human mind is a strong and strange thing.
It can have immense control over our bodies and actions and reactions. I can recall times when I have marched through a full blown influenza infection with a mask worn over my mouth and continued to work for full days, and I can also recall times when I have received a two line letter from hospital informing that one of my patients has ended up in hospital due to worsening depression and inability to cope, and I have simply waited for my next day off work and then have allowed myself to be unable to drag myself out of bed even to perform simple necessary tasks like taking a shower or eating, feeling immeasurably sad and a little closer to the human being who had gone through this similar despair, but not for a day and not at a time when convenient to do so but over and over again, every single day, every single moment of their hopeless and tired days, and sleepless and tearful nights.
What I have described above is empathy. It’s an emotion that we can feel, that we have some control over and it’s something that our mind allows us to to feel, sometimes even makes us feel, so that we can adjust to the sadness that the suffering of others has caused us. So I experience the sadness of my patient for the day but then wake up the next day and have the energy to greet the new day. I am open to relating to the joy of my next patient who has just come out of hospital after their hip replacement and are in much less pain and are ecstatic that they can once again walk to their bathroom without crippling pain! The sadness for the other patient still remains but is balanced by the joy of the new one. And the cycle of this balance goes on, allowing me to get on with my work whilst maintaining my sanity.
But depression is very different. All of us have some sort of balance in our life – of joy and sadness, of hope and despair, of successes and failures, of wishes and needs, of restlessness of passions and satisfaction of achievements, of yearning for what we want and being at peace with what we have, of the burden of having expectations laid on us and the tranquility of knowing we have done our best. Depression breaks this balance.
Depression is something that our mind doesn’t have control over. In fact, oftentimes our consciousness tries to not to allow us to feel it, it tries to make us not feel it.
Generally we all like to have some degree of control over things around us, most of all over ourselves. But depression is very disempowering. It takes away our control. Hence the fight of the mind against acknowledging it.
These are the times when our mind and body can have a disconnect – we go through what I wrote about a few weeks ago – adjustment disorder. We don’t recognise that we are going through depression but our bodies tell us differently. We feel unnecessarily tired all the time, we don’t find much joy in activities we loved previously, we find everyday chores an enormous burden and struggle to get through them day after day. Our friends, acquaintances, work colleagues and even family, who were our constant companions in some way almost on daily basis, may start to seem overbearing and intrusive and judgemental. So we start decreasing our contact with them on one pretext or the other.
And as we don’t really understand what is happening with us, we start being unsure of ourselves. This unsurity tends to be the cause of anxiety, stress, irritability. Its not uncommon to take out these feelings on our closest ones. These are all cries for help, but hidden under the bitterness of arguments and fights, they become a source of further distancing from the very poeple who will most likely help the most, if only they knew or understood that help is needed.
There is no other time in a woman’s life when this is more true than the first few days after giving birth. In the first few days after giving birth the likelihood of some imbalance in emotions is quite highly likely and peaks at about 4-5 days after giving birth.
It’s a whole mix of things – hormones, going through the marathon physical effort of giving birth, exhausted body, sleepless nights and neverending demands of breastfeeding and diapering and looking after a little thing which is quite fragile looking (so causes a huge amount of worry and anxiety about whether you are doing the right thing and handling it correctly) and in the first few days, seems almost completely unresponsive to this slavery like care!
But thankfully we have something we call instincts which kick in pretty fast and together with the support of our social network, we start to get it all in our stride in about 10-12 days after birth, after which it’s generally a smoother sailing in terms of persisting emotional problems. This period is known as postpartum blues and is almost a natural phenomenon as it emphasises that you are just human, dealing with some expected adjustment issues and eventually its going to work out fine for you and your baby. What causes worry is postnatal depression.
The reality is that out of every 100 women who give birth, about 13 will experience postnatal depression. These mums will experience an ongoing period of low mood, lethargy, tearfulness, hopelessness, perceived inability to cope, broken sleep pattern, excessive worrying about the baby, focus on baby’s ‘imperfections’. But have we ourselves not experienced most of these emotions when we are new mums? Who hasn’t either experienced themselves or had a friend describe the new motherhood as sheer physically exhausting experience, sleep deprivation, constant tiredness from not getting enough rest, worrying about whether we are doing the best by our babies and questioning ourselves and seeking reassurances from friends and family and medical professionals (oh, not to forget the grandmaster – Mr Google) about whether ‘we are good enough mums’?
Due to these reasons women and their families, and sometimes their doctors too, fail to recognise when some of these mums have crossed over to the realms of depression. But a separating factor can be that in postnatal depression these symptoms generally fall outside the expected norm e.g. the excessive worry about baby: some examples can be – ‘it’s too colicky’,’its so prone to eczema’, ‘it just never seems to settle’, ‘it just doesn’t feed’, ‘it doesn’t digest food properly’ – all these worries persist despite reassurances from older members of the family, partners, medical professionals. Quite often this can also leads to a degree of resentment towards the baby as it may be seen as the cause of much despair for the mum. This is then followed by feelings of guilt and self deprecation, further accentuating her unhappiness.
As these new mothers are fraught struggling with the overbearing problems in their baby and their own helplessness to deal with them, they are too distracted to worry about their own health or emotions. Due to these reasons postnatal depression is quite often picked up by medical professionals, family and partners. But sometimes even picking it up doesn’t help as there may be a feeling of shame for the patient as they feel a failure at something ‘that should have come naturally to them, like it does to everyone around them’, particularly their social circle such as mothers/mother in laws/sister/sister in laws/best friends etc. This feeling may lead to denial or poor acceptance of offers to help in the initial stages.
If postnatal depression goes undetected or unaccepted then it may lead to quite serious consequences. Families have broken due to this, children have been neglected, self harm has occurred and in extreme cases even suicide when the woman feels such despair that she sees no way out. Even in less severe cases, there is evidence to state that children of mothers with undetected and unaddressed postnatal depression tend to have developmental delays. So its a very real problem with quite serious consequences. Look out for this around you – yourself, your friend, your relative, your colleague, your neighbour – anyone can be affected and sometimes just reaching out in some way is all that is needed to set them on the way to recovery.
There is treatment available for all stages of depression – from mild to severe. There is counselling, family support, psychotherapy and medications. In some advanced cases, where either the depression has progressed to severe stages due to lack of recognition or if it hasn’t been addressed due to poor patient acceptance or lack of social support, there is provision for inpatient treatment. Best practice now dictates that mothers requiring admission for depression are admitted to a specialist mother and baby unit, unless there are specific reasons not to do so.
In most cases though simple and empathic counselling is all that is needed, as it helps in development of problem solving skills, basic restructuring of thought process, breathing exercises and stress management.
Interpersonal psychotherapy is also used quite successfully as it lays focus on woman’s interpersonal relations in her family and her changing role, and it allows woman to improve her social adjustment so that she can return to being a ‘happy worrier’ – a mum who continues to fuss over her child but is able to enjoy their smiles and soft cuddles and is able to experience the exhilaration, along with the worry, that only comes with being a mum.
She gets the balance back in her life.