When a mother is ill, it affects not only her, but also
- her immediate family, including her partner
- her friends and acquaintances
- her functioning at work and at home
This is easy to understand with most physical illnesses, such as a broken leg. The effects are predictable, and usually the time-scale of recovery is defined. There is usually no stigma attached, and people are able to discuss the situation openly.
With a psychological or psychiatric illness this is usually not the case, and both the sufferer and those close to her find it exceptionally difficult to be honest about what is happening. They often feel embarrassed, always feel helpless, and that it is hard to believe that it is nobody’s fault.
What follows is an attempt to give you a better understanding of Postnatal Depression, and to give you some ideas for coping with its effects.
There are three forms of postnatal “mental” illness.
- The “Baby Blues” (40-80% of all mothers)
- Postnatal Depression (0-30% of all mothers)
- Postnatal Psychosis (0.1 -0.2% of all mothers)
The three disorders may be considered as lying on a continuum from least to most severe.
The “Baby Blues”
This affects the majority of women following the birth of a baby. The new mother becomes weepy, tense, anxious and very emotional on about the third or fourth day after delivery. Often this is baffling for an unprepared new father, who cannot understand what is happening to his normally happy wife, who has just produced a beautiful, healthy baby.
The “Blues” are thought to be due to one, or a combination of the following factors:
A sudden change in hormone levels following birth.
Further hormonal changes as breast-milk is established.
The arrival of a long-awaited baby, and the realisation that life will never be the same again.
Whatever the cause, the “Blues” are likely to be short-lived. The reassurance that this is “normal”, and that it is the result of hormonal changes, is usually enough to help the mother (and the family) cope with it.
Postnatal Depression affects 10-30% of all mothers, and may appear as a continuation of the “Blues”, or may develop slowly over the months that follow the birth. (It is also extremely likely to be found in women who have been depressed during pregnancy.)
It is thought to be caused by the interaction of:
- Biological/physiological factors
- Social factors
- Personality factors
- Psychological factors
The mother often becomes increasingly angry, weepy, tired, anxious, panicky, and generally overwhelmed. She may be unwilling to leave the house, afraid to be alone. Her moods are likely to be unpredictable; she loses enjoyment of life and of her usual interests, including sex. Her confidence disappears; she can’t sleep normally; her eating patterns change. She feels that her life is out of control; she may want to harm herself or her baby; she may contemplate, or even attempt suicide.
Although she feels trapped, and utterly at the mercy of a demanding baby, she may also feel unable to accept help in caring for the infant, because of feeling guilty, or because she is unable to trust anyone else with the task. She may be overwhelmed with conflicting feelings or love for and resentment towards the baby, and other people around her.
She may perceive her partner and her family and friends as uncaring and unsupportive. She may resent the fact that the baby’s father’s life is continuing as usual, apparently unaffected by the birth. His attempts to help her may be unacceptable and rejected. She feels abandoned when he goes to work, resentful when she has to prepare meals and take care of the home, and, at the same time, feels guilty because she knows that she is not being a good enough wife or mother. She may, in fact, be so overwhelmed that she is unable to continue to take care of herself, her home or her other responsibilities. If there are other children, the depressed mother may behave resentfully, angrily, and unfairly towards them.
But this is not her fault. She cannot help it. She is ill with Postnatal Depression, and it is nobody’s fault.
While the following section is directed at the partners of PND sufferers, suggestions may be useful for other people close to the depressed mother.
The depressed mother is in a state of helplessness, isolation and confusion, and those close to her will probably be experiencing these feelings too. The family is living with a mother who is irrational, weepy, often bad-tempered, and ungracious about accepting help. Although she may be unable herself to keep up with domestic chores, she often feels too guilty to thank those who try to assist her, and withdraws into angry silence, or loses control.
Living with a depressed mother is likely to cause depression in her partner. (In fact, PND has been found to occur in fathers with the same frequency as it does in mothers, even if the woman, herself, is not depressed.) The new father often cannot understand his partner’s feelings. He thinks she ought to be happy, particularly if it is a “wanted” baby. Where previously she was his lover, companion and best friend, his wife now seems to reject him, and is unavailable to him. He tries to tell her “Pull yourself together”, but she apparently cannot, or will not, hear him.
Like the mother, the new father is probably not getting enough sleep. Unlike her, if she is a stay-at-home mother, he has to perform well in his work each day. When he comes home, he may find the house in chaos, and no dinner. He may have to undertake household chores and take care of the children, in addition to his normal workload.
Like her, the partner of a depressed woman may feel guilty and inadequate. He is probably socially and sexually frustrated. Many men feel unable to discuss intimate personal problems with other people, and so carry their burdens without support. He may also feel embarrassed because his wife is “mentally ill”; he may feel that it is somehow his fault. He may draw away from his friends and usual recreational activities, or he may look for reasons not to go home, because it is so unpleasant when he is there. He may feel that discussing his partner’s condition with other people is being disloyal. He, too, may be depressed, because he cannot help his partner or because he is making his own adjustments to new responsibilities.
It is difficult for him too, in that even where medical advice has been sought, experts are usually unable to predict how long this disabling condition will last. Anti-depressants, Support Groups and therapy are all useful treatments for the woman, but there is no quick cure. It is also important that the partner takes care of himself too, and seeks similar help for himself, if necessary.
HOW YOU CAN HELP A PND SUFFERER
- Consult a doctor, psychiatrist or psychologist who is interested in PND.
- Make sure that medication is taken as prescribed.
- Encourage the mother to join a Support Group if possible. Isolation exacerbates depression.
- RE-ASSURE THE MOTHER THAT SHE WILL GET WELL.
- LISTEN TO AND ACCEPT THE MOTHER’S FEELINGS.
- RE-ASSURE THE MOTHER THAT YOU WILL NOT ABANDON HER
Here are some other practical ways in which you can help:
- Take care of the baby, and encourage the mother
- To have a long, hot bath
- To go for a walk
- To visit or call a friend
- To take a nap
- To help her with FATIGUE
- Help her plan a schedule for handling a few simple tasks.
- Assist and encourage her in arranging child-care.
- Encourage joint activities, even though she may resist. Suggest going out for dinner, watching a TV programme together, going for a walk together.
Recognise that what she may need is sleep. Encourage her to rest without allowing her to feel guilty. But even though she is probably exhausted, the depressed mother may be unable to sleep. She may be helped by:
- A warm bath before going to bed.
- A snack, or warm, milky drink.
- Avoiding exercise or excitement before bedtime.
- A loving massage.
- Listening to gentle music.
To help her with ANXIETY and TENSION:
- Massage her neck and shoulders.
- Encourage her
- to walk, swim, go to gym, or yoga classes.
- to do deep breathing exercises.
- to listen to relaxation tapes, or to music.
- to apply moist heat to her neck and shoulders.
To help her with IRRITABILITY and DISTORTED THINKING:
- Depression, tension, fear and anxiety may cause her to become
- Hypercritical of herself and those around her.
- Unreasonable, hypersensitive and resentful.
- Understand that she is unable to control these feelings, and that, although you may be the apparent target of her unreasonable feelings, you should not take this personally. Women with Postnatal Depression often appear quite bright during casual social contacts, and then collapse into misery, rage or silence when they are alone with their partners.
- Try not to take her criticisms personally. She is really angry and frustrated with herself.
- Encourage realistic thinking, but don’t be drawn into an argument at this time. She cannot help her negativity.
- Direct your own feelings of anger and frustration at her illness, not at her. She is doing the best that she can.
- Talk to an understanding counsellor or doctor yourself. You also need support.
- TAKE ANY TALK OF SUICIDE VERY SERIOUSLY, AND CONSULT A PROFESSIONAL IMMEDIATELY.
- HELPING THE OLDER CHILDREN
Not only the baby, but the older children too, will be affected by a parent’s Postnatal Depression. Their mother will not be as available to them as she was previously; she may be making unreasonable demands on them. They may also feel that their father, too, is cut off from them by his worries. They may be left for long periods with friends and relatives; their social and emotional behaviour may change as a result of the ongoing family stress, resulting in bed-wetting and misbehaviour. Coping with the older children may be an additional burden on the father.
Try to find someone who can talk to the older children in an empathic way, and who can explain to them that their mother’s illness is not their fault, re-assuring them that she will recover. The children need someone skilled, who will listen to, and help them to express their feelings.
This extremely serious condition is relatively rare, affecting 1 or 2 new mothers per thousand. Here the mother loses a sense of reality, may hallucinate, hear voices and think in a bizarre manner. She may believe that people are trying to harm her, that she has given birth to a monster. She may become manic, out of control and very excitable, alternating suicidal with homicidal thinking and behaviour.
The mother needs urgent psychiatric help, usually involving hospitalisation. She may be dangerous to herself and those around her, and will certainly need medication and professional supervision. The mother may have to be separated from the baby, which is difficult for everyone. Treatment is usually very successful.
HOW EVERYONE CAN HELP
- Do remember that Postnatal illness is nobody’s fault.
- The mother needs non-judgmental, encouraging companionship, and both practical and emotional support and understanding.
- All members of the family need help and support.
- Re-assure the mother that she will recover.
- Re-assure the mother that she is not alone in feeling like this.
- Listen to the mother; do not judge her.
- Be patient.
- Encourage the mother to seek professional help.
- Encourage the mother to join a Support Group.
- Re-assure the children that their mother will recover.
- Re-assure the children that the illness is not their fault.
- Don’t let your own feelings of helplessness get you down.