I wanted to write a little bit about PPD (post-partum depression) because I've had it (and didn't feel I could reach out for help because of the current simplistic cheerleading attitude toward it) and I've also been labeled as having it when I didn't have it at all, and both responses were detrimental.
But both situations also taught me that the well-intended portrayal of PPD as a purely hormonal blip and the attitude people must have toward it can actually cause problems.
I think that at least some PPD therapists realize the possible complexities involved in PPD and the variants in individual situations, but this doesn't seem to make it to the public.
First, I'd like to describe what it's like to be smacked with the PPD label when you don't have it.
But both situations also taught me that the well-intended portrayal of PPD as a purely hormonal blip and the attitude people must have toward it can actually cause problems.
I think that at least some PPD therapists realize the possible complexities involved in PPD and the variants in individual situations, but this doesn't seem to make it to the public.
First, I'd like to describe what it's like to be smacked with the PPD label when you don't have it.
Hostess-with-the-Mostess Depression
Years ago, we had a very difficult houseguest staying with us when my youngest was around 7 months old. (I agreed to this for reasons I cannot discuss, but the wrong decision resulted from my incorrect reasoning.) The houseguest was usually not around and came home late at night, and then I also saw him in the mornings. Overall, he had a pleasant personality, but he was too self-absorbed to live with.
Once, I found my baby with a mouth full of tobacco and hands full of chewed cigarettes in his hands (courtesy of the guest). Another time, I caught my baby just as he was biting into the foil wrapper of antidepressants (or antipsychotics? Again, courtesy of the guest.) He also used to sit up at night eating sunflower seeds and spitting the shells onto the Persian rug. Sunflower seed shells are a choking hazard and this meant that I needed to shoot out of bed in the morning before my 2-year-old climbed out of bed (the shells have a pleasant salty taste for 2-year-olds) and before I could put the baby on the rug, and thoroughly vaccuum, then inspect the surrounding floor for stray shells.
Yes, I told him to stop and I told him why. No, he didn't stop.
There were other stresses with him, but it's too much to say.
Anyway, I started feeling really frazzled and hopeless. In the course of talking on the phone with friends, they asked why I sounded so down. I said I didn't know why. And as strange as it sounds, I really didn't! Life had been stressful before the guest moved in with us, so I didn't consider that he was the cause. I thought I just needed to work on my middot and my attitude.
Immediately, I was told by every single person: "THIS is post-partum depression! It is TOTALLY normal and there is NOTHING to be ashamed of! And it can happen anytime during the first 12 months after birth! Do you want the name and number of the frum organization for post-partum depression? I'll be happy to give it to you!"
At that time, I was still strong on therapy being the answer to everything, so I appreciated their encouragement to get help. But I didn't feel this was PPD.
The problem was when I tried to tell them I really didn't feel this was PPD, but something else I couldn't figure out. I got interrupted or otherwise silenced every single time I rejected the PPD diagnosis. Why? Well, I must be in denial! Or simply reluctant to get help! That's part of PPD! (It is, BTW. A couple of the official symptoms are being afraid that people won't understand you or that your baby will be taken away.)
Pretty quickly, I started to get frustrated because I kept being told I had a problem I was sure I didn't have.
This made me feel even more frazzled and hopeless. Also, I had a tendency toward depression, so being bullied into seeing myself as depressed when I wasn't...well, it was depressing.
Finally, I decided to sit down and really think about what could be the source of my unhappiness. It didn't take long to realize that the guest was just too much for me. And despite how chessed and being compassionate is supposed to make you grow, I realized that what we were doing wasn't real chessed or compassion; it was "enabling."
So the guest was out by the next day. And I immediately started feeling better! At first, he was really angry at me for kicking him out, but then a year later, he called to sincerely apologize. He's actually a very good and likeable guy, and that period of depression and anger on his part were simply the results of his coming to terms with an upbringing that looked idyllic but was actually very dysfunctional.
But the whole thing got me thinking.
If your friend is down and isn't sure why, what ever happened to saying: "Do you want to talk about it?" or "Is there anything I can do to help?" or "I'm sorry to hear that. What's your name for davening? I'd really like to daven for you."
I know that friends can't be therapists. And how can they know what my real problem was or how to draw it out of me? They can't.
But denying a person's reality and insisting that his or her perceptions are wrong can drive a person crazy. Also, insisting that someone is depressed is also damaging. Being pressured to see myself as depressed aggravated an already desperate situation.
But everything Hashem does really is for the best and I got an insider's view of how attitudes were changing within the frum community, both in ways that were good and ways that were not so good.
Awareness is good, but simplistic thinking is not.
Yet that is what is pervading the mainstream media including the frum media: simplistic solutions to complex problems of the nefesh.
Once, I found my baby with a mouth full of tobacco and hands full of chewed cigarettes in his hands (courtesy of the guest). Another time, I caught my baby just as he was biting into the foil wrapper of antidepressants (or antipsychotics? Again, courtesy of the guest.) He also used to sit up at night eating sunflower seeds and spitting the shells onto the Persian rug. Sunflower seed shells are a choking hazard and this meant that I needed to shoot out of bed in the morning before my 2-year-old climbed out of bed (the shells have a pleasant salty taste for 2-year-olds) and before I could put the baby on the rug, and thoroughly vaccuum, then inspect the surrounding floor for stray shells.
Yes, I told him to stop and I told him why. No, he didn't stop.
There were other stresses with him, but it's too much to say.
Anyway, I started feeling really frazzled and hopeless. In the course of talking on the phone with friends, they asked why I sounded so down. I said I didn't know why. And as strange as it sounds, I really didn't! Life had been stressful before the guest moved in with us, so I didn't consider that he was the cause. I thought I just needed to work on my middot and my attitude.
Immediately, I was told by every single person: "THIS is post-partum depression! It is TOTALLY normal and there is NOTHING to be ashamed of! And it can happen anytime during the first 12 months after birth! Do you want the name and number of the frum organization for post-partum depression? I'll be happy to give it to you!"
At that time, I was still strong on therapy being the answer to everything, so I appreciated their encouragement to get help. But I didn't feel this was PPD.
The problem was when I tried to tell them I really didn't feel this was PPD, but something else I couldn't figure out. I got interrupted or otherwise silenced every single time I rejected the PPD diagnosis. Why? Well, I must be in denial! Or simply reluctant to get help! That's part of PPD! (It is, BTW. A couple of the official symptoms are being afraid that people won't understand you or that your baby will be taken away.)
Pretty quickly, I started to get frustrated because I kept being told I had a problem I was sure I didn't have.
This made me feel even more frazzled and hopeless. Also, I had a tendency toward depression, so being bullied into seeing myself as depressed when I wasn't...well, it was depressing.
Finally, I decided to sit down and really think about what could be the source of my unhappiness. It didn't take long to realize that the guest was just too much for me. And despite how chessed and being compassionate is supposed to make you grow, I realized that what we were doing wasn't real chessed or compassion; it was "enabling."
So the guest was out by the next day. And I immediately started feeling better! At first, he was really angry at me for kicking him out, but then a year later, he called to sincerely apologize. He's actually a very good and likeable guy, and that period of depression and anger on his part were simply the results of his coming to terms with an upbringing that looked idyllic but was actually very dysfunctional.
But the whole thing got me thinking.
If your friend is down and isn't sure why, what ever happened to saying: "Do you want to talk about it?" or "Is there anything I can do to help?" or "I'm sorry to hear that. What's your name for davening? I'd really like to daven for you."
I know that friends can't be therapists. And how can they know what my real problem was or how to draw it out of me? They can't.
But denying a person's reality and insisting that his or her perceptions are wrong can drive a person crazy. Also, insisting that someone is depressed is also damaging. Being pressured to see myself as depressed aggravated an already desperate situation.
But everything Hashem does really is for the best and I got an insider's view of how attitudes were changing within the frum community, both in ways that were good and ways that were not so good.
Awareness is good, but simplistic thinking is not.
Yet that is what is pervading the mainstream media including the frum media: simplistic solutions to complex problems of the nefesh.
Family-Induced Depression
In A Secure Base, John Bowlby described a case involving a first-time mother suffering from post-partum depression to the point that she experienced urges to harm her 6-month-old baby. And she felt terrible shame and fear about this. Despite her feelings, she really loved him very much. In Bowlby's eyes, she seemed like a very nice and normal person and her feelings didn't seem to go with her intelligent and caring personality.
So what was going on?
It turned out that these urges intensified after visits with her own mother.
Now, this woman felt like she had a good relationship with her mother and felt like her mother was helping her. But really, the mother was inserted all sorts of stuff under the radar that hurt and enraged the woman, which twisted around into feelings of rage at her innocent little baby.
(BTW, this kind of relationship in very common with a personality disordered parent. If a Narcissist mother crowns you as the "golden child," then you might go around thinking that you and your parent have a great relationship and even say things like, "My mom is best friend!" But really, all sorts of unhappy stuff is roiling underneath the surface and you can come away from get-togethers feeling bad about yourself. In a nutshell, a harmonious relationship with a personality disordered person can only occur on their terms. So an adult child who has unconsciously adapted to those terms may think the relationship is harmonious when really, it's very one-sided against the child's needs.)
Anyway, once Bowlby helped the woman to see how her own mother was making things worse (and that the mother was the cause of the post-partum depression), he then was able to work with the woman on dealing with the real issues at hand and also limiting time spent with her own mother.
There were more details that I can't remember, but the story had a happy ending and the woman went on to heal from these feelings and enjoy a loving relationship with her baby boy.
(Although I can't help wondering whether, if she were treated today, the real cause of her extreme feelings would be missed in favor of a round of antidepressants. I think it would depend on the insight of the therapist.)
In fact, before I ever heard of Bowlby, I noticed that a lot of post-partum depression seemed compounded by other people, particularly the husband. Yes, of course, there is hormonal flux going on after birth. Combine that with a traumatic birth (even a normal "easy" birth can be traumatic, depending), stressful events or environment (even normal ones, like upcoming holidays or happy events or coming home with the baby to young and dependent children still in diapers or not sleeping through the night themselves), serious sleep deprivation, and so on, then it's a wonder that most women don't break down after birth!
And I want to stress that there are many cases in which the woman's surrounding family and family background is really good yet she suffers PPD anyway. This is completely realistic and as I said, it's a wonder that not every woman suffers PPD after birth!
We should not jump to condemn her family members when a woman suffers PPD.
But if you compound all the above "normal" stuff with family members who are stressed out, critical, selfish, demanding, narcissistic, or uncaring (and these could be the husband, older children, parents, parents-in-law, or adult siblings/siblings-in-law), then you could have a recipe for a serious overload on the woman's already overtaxed body and nefesh.
True Story #1
A very famous letter circulated throughout the frum community from a husband whose wife suffered PPD. It was very good that he brought awareness from the husband's side. The interesting thing is that when he described how he initially responded to his wife's difficulties, he really sounded strange. For example, 3 months after birth, a baby is usually not sleeping through the night.
Think about that: Birth is a emotionally and physically grueling event. But you don't get to rest and recover from it. Even if you go to a mother-baby rest center and sleep through the night there, it's usually only for a few days and you still need to do lots of babycare yourself (like feedings and soothing a crying baby). Then you come home (maybe or maybe not fully recovered) and deal with waking up several times a night.
Some women feel worse 3 months after birth than they do immediately after the birth.
Furthermore, the woman in this case was dealing with older children who were still very young and helpless, plus work, and so on. And the husband was actually getting angry at her for being exhausted and overwhelmed! (That's how I remember him describing himself).
I really don't think you need your wife to be diagnosed with PPD in order to behave with compassion toward a wife who is seriously sleep-deprived and overworked.
But apparently, he eventually did teshuvah and that is really good. And it's good that he publicized his experience in the letter. (My only problem with it, if I remember it correctly, is that he kept emphasizing how he should have been more sympathetic and supportive because her overwhelm resulted from PPD, and not that he generally needed to be sympathetic and supportive when his wife was going through a rough period.)
True Story #2
I personally know, just off the top of my head, 2 women who were initially diagnosed with post-partum depression, then never recovered. Both were calm, competent types, and one I always thought of as being particularly mature for her age when she was a teenager--a very good solid head on her shoulders. You know the type?
And last time I saw her (a couple of years after birth), she was still medicated and paranoid with no end in sight. Her husband seems like a very good guy and has been sticking by her, but I know that her parents are very dysfunctional people and some of her siblings are also problematic (read: mentally ill), one of whom was living with her and her husband for a few months before she gave birth...coincidence?
The other woman had a real jerk of a husband. But she kept pretending everything was fine. But everything hit after the birth of her second child. Eventually, her husband got fed up with living with a depressed wife and they're divorced now with the kids in his custody. Allegedly, he and his mother turned the older child against the mother and when the baby was five, the husband sued for (and won) custody of him too. During the that whole period, the mother lived with an elderly aunt (between hospitalizations for mental illness).
Depressing Middot
Finally, PPD can be brought on because of the mother's negative middot.
For example, if a woman is narcissistic and on the lazy side, the routine acts necessary to keep a baby alive may cause her overwhelming resentment. Having said that, babycare is stressful even with the most easy-going baby, so a normal woman can also experience resentment or overwhelm at times. But someone who is truly narcissistic and isn't up to doing much in the best of times (especially for anyone but herself), she can get depressed after birth. But it isn't hormonally induced depression (although hormones can contribute to her negative feelings). It's just that life has overwhelmed her middot. And medication will not help with that root cause.
So what was going on?
It turned out that these urges intensified after visits with her own mother.
Now, this woman felt like she had a good relationship with her mother and felt like her mother was helping her. But really, the mother was inserted all sorts of stuff under the radar that hurt and enraged the woman, which twisted around into feelings of rage at her innocent little baby.
(BTW, this kind of relationship in very common with a personality disordered parent. If a Narcissist mother crowns you as the "golden child," then you might go around thinking that you and your parent have a great relationship and even say things like, "My mom is best friend!" But really, all sorts of unhappy stuff is roiling underneath the surface and you can come away from get-togethers feeling bad about yourself. In a nutshell, a harmonious relationship with a personality disordered person can only occur on their terms. So an adult child who has unconsciously adapted to those terms may think the relationship is harmonious when really, it's very one-sided against the child's needs.)
Anyway, once Bowlby helped the woman to see how her own mother was making things worse (and that the mother was the cause of the post-partum depression), he then was able to work with the woman on dealing with the real issues at hand and also limiting time spent with her own mother.
There were more details that I can't remember, but the story had a happy ending and the woman went on to heal from these feelings and enjoy a loving relationship with her baby boy.
(Although I can't help wondering whether, if she were treated today, the real cause of her extreme feelings would be missed in favor of a round of antidepressants. I think it would depend on the insight of the therapist.)
In fact, before I ever heard of Bowlby, I noticed that a lot of post-partum depression seemed compounded by other people, particularly the husband. Yes, of course, there is hormonal flux going on after birth. Combine that with a traumatic birth (even a normal "easy" birth can be traumatic, depending), stressful events or environment (even normal ones, like upcoming holidays or happy events or coming home with the baby to young and dependent children still in diapers or not sleeping through the night themselves), serious sleep deprivation, and so on, then it's a wonder that most women don't break down after birth!
And I want to stress that there are many cases in which the woman's surrounding family and family background is really good yet she suffers PPD anyway. This is completely realistic and as I said, it's a wonder that not every woman suffers PPD after birth!
We should not jump to condemn her family members when a woman suffers PPD.
But if you compound all the above "normal" stuff with family members who are stressed out, critical, selfish, demanding, narcissistic, or uncaring (and these could be the husband, older children, parents, parents-in-law, or adult siblings/siblings-in-law), then you could have a recipe for a serious overload on the woman's already overtaxed body and nefesh.
True Story #1
A very famous letter circulated throughout the frum community from a husband whose wife suffered PPD. It was very good that he brought awareness from the husband's side. The interesting thing is that when he described how he initially responded to his wife's difficulties, he really sounded strange. For example, 3 months after birth, a baby is usually not sleeping through the night.
Think about that: Birth is a emotionally and physically grueling event. But you don't get to rest and recover from it. Even if you go to a mother-baby rest center and sleep through the night there, it's usually only for a few days and you still need to do lots of babycare yourself (like feedings and soothing a crying baby). Then you come home (maybe or maybe not fully recovered) and deal with waking up several times a night.
Some women feel worse 3 months after birth than they do immediately after the birth.
Furthermore, the woman in this case was dealing with older children who were still very young and helpless, plus work, and so on. And the husband was actually getting angry at her for being exhausted and overwhelmed! (That's how I remember him describing himself).
I really don't think you need your wife to be diagnosed with PPD in order to behave with compassion toward a wife who is seriously sleep-deprived and overworked.
But apparently, he eventually did teshuvah and that is really good. And it's good that he publicized his experience in the letter. (My only problem with it, if I remember it correctly, is that he kept emphasizing how he should have been more sympathetic and supportive because her overwhelm resulted from PPD, and not that he generally needed to be sympathetic and supportive when his wife was going through a rough period.)
True Story #2
I personally know, just off the top of my head, 2 women who were initially diagnosed with post-partum depression, then never recovered. Both were calm, competent types, and one I always thought of as being particularly mature for her age when she was a teenager--a very good solid head on her shoulders. You know the type?
And last time I saw her (a couple of years after birth), she was still medicated and paranoid with no end in sight. Her husband seems like a very good guy and has been sticking by her, but I know that her parents are very dysfunctional people and some of her siblings are also problematic (read: mentally ill), one of whom was living with her and her husband for a few months before she gave birth...coincidence?
The other woman had a real jerk of a husband. But she kept pretending everything was fine. But everything hit after the birth of her second child. Eventually, her husband got fed up with living with a depressed wife and they're divorced now with the kids in his custody. Allegedly, he and his mother turned the older child against the mother and when the baby was five, the husband sued for (and won) custody of him too. During the that whole period, the mother lived with an elderly aunt (between hospitalizations for mental illness).
Depressing Middot
Finally, PPD can be brought on because of the mother's negative middot.
For example, if a woman is narcissistic and on the lazy side, the routine acts necessary to keep a baby alive may cause her overwhelming resentment. Having said that, babycare is stressful even with the most easy-going baby, so a normal woman can also experience resentment or overwhelm at times. But someone who is truly narcissistic and isn't up to doing much in the best of times (especially for anyone but herself), she can get depressed after birth. But it isn't hormonally induced depression (although hormones can contribute to her negative feelings). It's just that life has overwhelmed her middot. And medication will not help with that root cause.
Honest instead of Simplistic
So there is a lot more to PPD than just hormones.
Unfortunately, in the current environment of psychology, these observation are ignored in favor of relating to PPD is if it's just a virus that needs rest, chicken soup, and maybe some Prozac.
And that's where the tricky part lies.
Many people mean to be helpful. But like with all the sciences, money and personal bias/agendas tend to determine the solutions and treatment of the problems.
For example, I would say that the reason why most episodes of treated (with rest, nourishing meals, and other people taking on her household and childcare responsibilities until she recovered) PPD go away (including those treated without medication) and never recur is because the mother received the support she needed. Now it was embedded in her subconscious that she is not alone and that she had nothing to fear because the community met her needs.
I have no proof for this, but it makes sense based on my observations and reading.
I really hope we can move past simplistic thinking when it comes to anything on the spectrum of mental illness, even regarding a disorder that really is sparked by biology beyond our control, as is the case with PPD.
_______________
BTW, I am not trying to discourage anyone from getting help for PPD.
PPD is a nightmare to deal with. (The one time I had it, I hid it from my husband and children so they wouldn't know how I was really feeling.) and I'm sure there are genuinely insightful and experienced therapists who can help someone get to the root of their PPD and recover from it. (Although I emphasize the word "help." Therapy is only ever help. Ultimately, a person can't skip steps. Deepening your relationship with Hashem needs to be part of it.) The superficial attitude permeating popular culture right now (and pushed by some psychologist and psychiatrists) is not indicative of every single therapist. I wish I'd known that when I had it.
Unfortunately, in the current environment of psychology, these observation are ignored in favor of relating to PPD is if it's just a virus that needs rest, chicken soup, and maybe some Prozac.
And that's where the tricky part lies.
Many people mean to be helpful. But like with all the sciences, money and personal bias/agendas tend to determine the solutions and treatment of the problems.
For example, I would say that the reason why most episodes of treated (with rest, nourishing meals, and other people taking on her household and childcare responsibilities until she recovered) PPD go away (including those treated without medication) and never recur is because the mother received the support she needed. Now it was embedded in her subconscious that she is not alone and that she had nothing to fear because the community met her needs.
I have no proof for this, but it makes sense based on my observations and reading.
I really hope we can move past simplistic thinking when it comes to anything on the spectrum of mental illness, even regarding a disorder that really is sparked by biology beyond our control, as is the case with PPD.
_______________
BTW, I am not trying to discourage anyone from getting help for PPD.
PPD is a nightmare to deal with. (The one time I had it, I hid it from my husband and children so they wouldn't know how I was really feeling.) and I'm sure there are genuinely insightful and experienced therapists who can help someone get to the root of their PPD and recover from it. (Although I emphasize the word "help." Therapy is only ever help. Ultimately, a person can't skip steps. Deepening your relationship with Hashem needs to be part of it.) The superficial attitude permeating popular culture right now (and pushed by some psychologist and psychiatrists) is not indicative of every single therapist. I wish I'd known that when I had it.
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