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There are those that say depression is a choice. There are others that say depression is a medical illness with biological triggers and treatments. Still others argue depression is a result of negative thinking as opposed to those who say negative thinking is actually a result (or symptom) of depression. One can make the case for any one of these theories, depending on the individual or the particular set of circumstances. We know there is no single explanation. When postpartum depression sets in, there is much variation in terms of which influences play the biggest part in any one mother's experience. Experts agree, however, that depression is indeed an illness. I believe it is an illness with a purpose.
When women get depressed after having a baby they can be faced with any number of symptoms for any number of reasons as a result of any number of factors. This is why each woman we treat is a unique constellation of her own history and present experience which merge together in the fabric of her story. But when we listen carefully we can hear common themes emerge, words that echo one another and tears that feel familiar.
Women are weary. Many of the women I see tell me they just can’t do it all anymore. Of course, they aren’t doing it all, but it feels like they are. There can be many reasons for this. Perhaps they were parentified as a child and asked to do more than a child should do and they haven’t yet slowed down. Perhaps they have been trying for thirty years to gain their father’s approval or their husband travels weekly for business and they are on their own for too much of the time. Or perhaps they are driven by some internal force that keep them spinning and working and cleaning and organizing and proving something to themselves or to someone or no one and it’s never enough and it’s never quite right.
Whatever the reason, they are tired and depleted. They typically have strong caretaking tendencies and are most comfortable being in control of their lives and their relationships. Some of these women are good at expressing what they need. Most of them are not. And those that are not tend to keep their feelings, needs and desires in check, inside, very deep inside. It is well known what happens to feelings when we suppress them. Sometimes they disintegrate into oblivion but more often they morph into some unwelcome beast roaring for attention.
So when we see one of these women in our offices she carries a burden in common with many others. Regardless of what her story is or how she got here—she has shut down. Her body has shut down, her mind has shut down and her spirit has shut down. In this way, the depression speaks on her behalf, as if to say, “That’s it. I’m done. I cannot do this anymore. I’m tired. I’m weak. I’m completely done. I need to sleep. I need others to take care of me. I cannot do this by myself anymore.”
Thus, depression can be viewed as an adaptive protector of sorts. If we consider depression as a voice that serves to protect the core self, it may be the only way her system can respond when she’s overwhelmed.
When the symptoms get bad enough, hopefully, intervention takes place. Husbands and families mobilize, healthcare providers get involved, and in an ideal scenario, she is scooped up and surrounded by loved ones who continue to care for her throughout her recovery. It doesn’t always follow this idyllic model, but this is what we hope for.
The reason this concept is relevant to treatment is that ultimately, one of the goals of treatment is for her to learn how to be mindful of her areas of vulnerability so she can intervene at an earlier point, before symptoms set in if possible or as soon as they emerge.
She needs to learn:
How to listen to her bodily cues if she is overwhelmed or exhausted.
How to stop pushing herself when she is depleted.
How to dial down her expectations.
How to keep perspective on what others need and want from her.
How to express what she needs to those who are close to her.
How to give herself permission to slow down, rest, relax, do nothing.
How to stop feeling guilty when she learns how to take care of herself.
How to recognize her own symptoms of depression so she can respond without delay.
How to engage her partner in this process so he can join forces with her or initiate the necessary steps to get help.
Those of us who are in position to help her, must do so with compassion and intention. We want to keep her well. We want to help her become more resilient.
Ask her what you can do to help.
Adapted from "Therapy and the Postpartum Woman" Karen Kleiman (Routledge)
