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Everyone knows that motherhood is not always easy. The normal struggles of motherhood, like physical and mental exhaustion and loss of previous identity, are extremely challenging and they are discussed at length in Babies in Mind (the book). But postnatal depression is more than those everyday struggles that almost every mother has experienced from time to time. Postnatal depression is a dangerous, debilitating illness and it needs to be taken extremely seriously.

What does postnatal depression look and feel like?

According to the Diagnostic and Statistical Manual of Mental Disorders, this is what post-natal depression is:

  • feelings of sadness most of the day nearly every day for a period longer than two weeks
  • this depressed mood interferes with normal functioning
  • loss of interest or pleasure in anything
  • disturbances in appetite or eating
  • sleeping disturbances
  • fatigue and a loss of energy
  • poor concentration and memory 
  • feelings of guilt and worthlessness 
  • thoughts about harming the baby
  • anxiety and panic attacks
  • fears of leaving the house, fears of being alone or a feeling of impending doom
  • recurrent thoughts of death and dying 
  • thoughts of suicide

If you suspect that you might be depressed, get treatment without delay. An assessment by a clinical psychologist or a mental health professional who has training and experience in postnatal depression is essential. Medication may be indicated in which case a psychiatrist should be consulted. Other options are a postnatal support group or consultation with a parent-infant psychologist. The management of postnatal depression depends on the specifics of each individual case and it depends on the factors that have led to the development of the problem. Those factors need to be addressed. They might be associated with the environment (such as problems in the relationship with your spouse) or they might have more to do with things that are going on inside your own mind. These are called psychodynamic factors, and they probably stem from earlier on in your life.

Possible psychodynamic causes of postnatal depression
Every mother and every case of depression is unique, but there is one crucial factor that is often found lurking in the shadows of postnatal depression. This factor has to do with the way in which certain mothers process their own negative feelings during the postnatal period.

Your baby (in the normal course of events) projects his own fears and negative feelings into you because he does not yet know how to manage the intensity of these negative emotions. His mind is too young. So he uses an elusive, fascinating unconscious process called projective identification to get rid of his troublesome, negative feelings. He puts his intolerable feelings into you. You then are expected to carry or hold your baby’s hatred, rage or terror until he is able to taken them back and digest them for himself.

The problem with this is that maybe, because of your own past difficulties, current stressors or shaky internal resources, you might psychologically not be able to manage or withstand your baby’s negative feelings. In a similar way to your baby, your own mind will try a number of different things to get rid of the difficult emotions. These tactics that your mind might use in attempt to get throw out negative emotions are often not in the interests of mental health and they can make you feel quite mad, depressed and often very anxious too.

The negative feelings such as extreme fear, hatred and rage do not only come from your baby though. They may also be triggered in response to having had your life highjacked by the process of becoming a mother and the huge demands that are being placed on you. So you could be feeling intensely angry with your baby for causing you so much strain and trauma, but you will be trying not to blame your baby or let your feelings be known to him. You will be wanting to protect your baby from your feelings.

Where do your negative feelings go?
Your mind does not like the ‘bad’ feelings and it wants to get rid of them without doing harm to your baby. So perhaps your mind will try to project the feelings outwards onto the external world, into the nearest place it can find. This place or container could take a number of different forms. It could be a person such as the father of your baby. It could be some other unfortunate other person. Perhaps you have found yourself hating your spouse, or hating someone else.

Something that was previously quite benign in your own mind becomes bad. The badness has gone from you, gone from your baby and is now located in, for example, your mother-in-law. In your mind she becomes a wicked, horrible lady. Your spouse becomes insensitive and a bad, irresponsible father to your child. Watch out for these kinds of feelings. Even if they have some element of truth to them, they are probably more a reflection of your mind taking strain as a result of motherhood.

Anxiety and panic
Panic attacks are common in post-natal depression. They are linked to intolerable, undigestible, negative feelings. If you are feeling anxious, with or without the physiological effects such as dry mouth, racing or pounding heart and a feeling like you are going to die, you do need to see a psychologist or a psychiatrist. Anxiety and panic attacks are extremely unpleasant and they can become debilitating.

From a psychological perspective, when you feel intense hatred and rage and when you project those feelings onto some outside place, that place becomes filled with your own hatred and rage. That means that the place of your projections becomes, in your mind, exceedingly frightening and dangerous. That is why you feel anxious. You are afraid of the frightening and dangerous thing on the outside that actually originated from inside of you. You are afraid of your own destructive feelings.

When the negative feelings are turned on yourself
Your negative feelings towards your baby are not always projected onto the outside world. Sometimes they can find a home right inside of you. Instead of hating your baby or hating something or someone else, you could start to hate yourself. Your negative feelings are redirected inwards and so you begin to feel worthless, useless and guilty. Again, this is an unconscious process. You do not intend to put the negative feelings into yourself and you are not consciously aware that you are doing so. Your intention is honorable in that you are trying to protect your baby from your hatred. But sadly your baby is not protected in the end because babies do suffer when their mothers are feeling worthless and depressed.

Self-hatred can be a central feature of depression and it is linked to the feelings of guilt that are so common in post-natal depression. Feelings of self-hatred are often present when there are suicidal feelings. Just like you can hate someone so much that you want to kill them, you might also hate yourself enough to want to kill yourself. If any of this is feeling true for you, see a psychologist or a psychiatrist without delay. In addition to psychotherapy, medication can be prescribed for you which will help you to manage the powerfully destructive feelings.

You own vulnerability
Motherhood can be particularly challenging if you yourself were very poorly mothered years ago. You will not have learned first hand about how to be a sensitive, loving mother because you did not have a good role model. More importantly, you will also be reminded in the most intense way of your own vulnerability and emotional pain (stemming from your childhood) when you interact with your baby. Being so closely connected to a defenseless and dependent baby could throw you back into that same fragile mental state you were in as an infant all those years ago.  

Being a new mother has its challenges and its losses. It can challenge the relationship between you and your spouse as well as other relationships in your life. You can and probably will temporarily lose aspects of your own identity, like your career and the time to pursue your own interests. Your child suddenly occupies a huge part of your mind. Your physical life and all other aspects of your life are relegated to the back seat. Although the full-time and all-consuming aspect of this decreases after the first few months, you might not be able to pick up on your life in an undistracted way for a long time. Everyone knows that babies are a lot of hard work but some people are not aware of the fact that the process of taking care of a baby can put considerable strain on the psyche of the mother. Look for support within your own community. It will offer you a chance to connect with others and to feel valued, supported and understood. Above all, take special care of yourself during this extremely important, precious but difficult time.

An adapted version of an extract of Babies in Mind (Juta)
by Jenny Perkel