Postnatal Depression (PND) – A counsellor’s perspective
By Jill Thompson
I am a relationship counsellor specialising in postnatal depression.
I have been working with sufferers of PND for over a decade now and my aim in this article is for readers to understand that motherhood is an intense emotional roller coaster of a ride and some of us are not as well equipped as others to manage this intensity for a variety of very understandable reasons. I would like to promote connectedness between well mothers and those suffering from PND and hopefully help increase understanding and reduce the sense of isolating shame.
PND like any depression is complex, each individual is unique; the causes and symptoms are many and varied, but there are discernable patterns. Predominantly women feel they cannot cope. Life is a terrible effort. Fears range from not being able to look after the baby, not feeling a good enough mother, to fantasies about actually harming the baby. There are profound feelings of failure. Often there is intense anger and resentment. There can be a general lack of interest in anything and definitely in sex. Sometimes there is an absence of feeling bonded to the baby or an inability to separate. There can be disturbances in sleep and eating patterns (not directly to do with baby) and lots of crying.
As well as depression, there can be anxiety. Women feel tortured by all the terrible things that could happen to this new attachment: death, illness, the effects of their depression on the happiness of their child.
The anxiety sometimes manifests itself as a need to become obsessive about tidiness and/or cleanliness, or women may become agoraphobic or suffer from panic attacks. Some will self- harm. In short, it is hell!
As a parent, no doubt you will be identifying with some of these feelings, at least some of the time, because I believe as a parent in our society it is impossible not to.
So, what makes one person more vulnerable to PND than another?
Essentially, I think women and couples have to be fairly robust to come through the experience of parenthood relatively intact. Ideally you need a good supply of internal and external resources to achieve happiness as a new mother. The official figures are one in ten mothers will become postnatally depressed. Anyone working with families with young children will tell you this is a gross underestimate. Many women suffer in silence and never get into official statistics.
When women realise there are good reasons to feel the way they do, then the process of recovery can begin.
I think everyone has difficulty with the intense, overwhelming feelings that go along with motherhood.
Women who become depressed blame themselves and their capacity to manage these feelings is then further impaired.
Our internal resources are undermined by many things; a combination of social, biological and psychological factors. Some researchers believe hormones have a part to play.
Difficulties in pregnancy and/or the birth experience itself can get you off to a bad start. Lack of a supportive partner or family, illness in the mother or the baby, a recent bereavement can all increase vulnerability to PND. Loss of mother or carer in childhood or a previous history of depression are two very significant factors.
There are also the general losses that motherhood inevitably involves e.g. reduced income, work identity, friends, couple time, mobility (especially with twins), independence, libido, previous body shape not to mention the great restorer of sanity, SLEEP!
Being fortunate does not automatically offer protection from depression. Well-off women with nannies feel they should be grateful and therefore have no business being depressed.
Women who have struggled to conceive feel they have what they always wanted; they are so lucky and so have no right to feel so unhappy. Women with supportive partners and family can be convinced nobody could possibly love this new depressed person that they themselves do not recognise and feel hateful towards. The full extent of the depression has therefore to be hidden.
What is usually out of people’s awareness is how being in a mother-infant coupling resurrects previous unresolved attachment issues for all of us, including the wealthy and the fortunate.
Issues that happily went on the backburner, as we entered the world of work, autonomy and the independence of adulthood, often resurface in parenthood.
You are thrown back, whether you like it or not, into that first relationship with your own mother/carer (and father). The child’s cry reminds you of your own cry as a child and how you were managed (or not). The world of dependency is emotional and intense. It is easy for mothers to feel extremely stressed and vulnerable at the same time as their access to soothing ,replenishing activities is usually diminished. Apart from having to manage on much less sleep there now seems precious little opportunity for having an uninterrupted conversation with someone who cares about you or to watch a good movie or get lost in a great book. New parents are often too exhausted to take up their previous sex lives therefore missing out on the close intimacy and sense of connectedness that sex can bring.
Everyone suffering from depression needs understanding and support.
Guilt and shame need to be reduced. Openness and acceptance encouraged. We have to talk openly about how tough motherhood can be as well as how wonderful. Women with PND hide away and become further isolated because they see their depression as their failure.
It’s hard to say how it really is. We all fear being judged especially when we are already judging ourselves so harshly. I also believe most of us thrive on a sense of connectedness and belonging. Women with PND don’t feel their experience connects with other mothers. PND groups allow those connections to take place and women start to feel better. However, they are a scarce resource.
If you are suffering from PND you can get help and information from the contacts listed at the end of this article. If you can’t reach out yourself, tell someone you trust and ask them to help you get the support you need. If you are enjoying motherhood, be aware that someone you are socialising with may not be having such a good time. PND sufferers feel extremely ‘thin skinned’ and comments can easily bruise. If you are not enjoying motherhood, be aware that other mothers are going through similar experiences, but like you thinking only they are feeling that way. However isolated you feel, use the contacts below and get connected, you are not alone, and that’s official! Your GP and/or health visitor will be able to advice you.
Many GP practices now have counsellors or will be able to refer you to an appropriate service.
Other Useful Contacts:
APNI: Association of postnatal illness Help line 020 7386 0868
Samaritans 08457 90 90 90
Parentline: 0808 800 2222
MAMA: Meet a Mum Association Help line 0845 120 3746 Evenings 7.00-10.00 Mon-Fri.
Netmums www.netmums.com has a noticeboard where mothers suffering from PND can send exchange messages
ARC: Association of Relationship Counsellors
Web address: arc-relationshipcounselling.co.uk
Tel. 020 8299 0155
(A local South East London network of relationship counsellors also working with PND)