Postpartum Depression

The birth of a child is often accompanied by the appearance of psychopathological symptoms in its mother. The most common emotional change (in 50-75% of women) is a kind of melancholy with intense emotions; often after the birth of her child the mother breaks into tears (albeit mainly of joy) but this disappears after the first six months. The second most frequent condition is postpartum depression, which affects 15-20% of women and with which we will deal in more detail in this article, and finally puerperal psychosis, which is the most serious condition, affecting 3% of women.

Επιλόχειος Κατάθλιψη

Postpartum depression is that which affects mothers about three days after giving birth, while lately the term has been extended to cover both parents, as quite a few dads develop similar symptoms.

However, we will focus on postpartum maternal depression, as its consequences on the mental state of the child are more important than any depression its father may be experiencing in this stage of the child's life.

Postpartum depression can keep as long as a year. It is noted by an absence of joy for the baby but also, more generally, by strong feelings of guilt and self-blame, intense stress associated with a feeling of inadequacy, often crying, abstinence from the usual sources of joy and interest, including sex, mental fatigue and a desire to stay in bed.

 

Its appearance is associated with many factors.

There is a biological factor, which is associated with hormonal disturbances experienced by the woman's body during childbirth, especially with the sharp change in progesterone levels. Of course, this happens in all women, so we have to look at other psychological factors that are combined with this biological change.

Any change in one's body always brings a person face to face with narcissistic problems and the outcome of this meeting depends on how its psyche and history are structured. Narcissistic deficiencies or trauma aggravate the consequences of any physical change, as the body is inextricably tied to the concept of identity and the person feels that its overall identity is affected.

Another reason is the great change that takes place in one's life with the birth of a child. This change does not only concern the management of everyday life but also identity as a whole. The woman now acquires a new parenting role, noted for its particularly extensive responsibilities.

There are many cases where a child's birth coincides with a loss. Unfortunately, in this case, the joy for the birth of the child will be accompanied by mourning for the loss of a loved one. This combination joy and sorrow decisively effects the relationship created between the mother and child and characterises their emotional transactions.

Other causes that could be linked to the occurrence of mental problems after childbirth are the experiences of meaningful relationships with those close to her, especially with her partner, but also the experience that the woman had with her mother. The chances of maternal postpartum depression seem to increase dramatically if her mother also experienced the same problem at her birth.

Financial and other difficulties are less important but can, however, contribute to amplifying a mental vulnerability. It also seems that women who have a child at a young age are more vulnerable.

The effects of postpartum depression in children are important and leave a permanent mark on their psyche.

The relationship between mother and infant in the first months of its life is symbiotic. In this sense, we mean primarily that the infant does not see itself as a separate individual yet. On the other, the mother (more than any other adult) is able to intuitively understand the needs of the infant and what it is asking for when it is crying. Thus, this symbiosis is experienced equally by both (mother-infant) and is essential in the first months of its life. Is a key relationship, because it helps the child to adapt to new conditions of existence, outside the womb, where its basic needs are not automatically covered any more, and it must face the feeling of deprivation caused by hunger, thirst, etc.

Maternal depression greatly disrupts this perception of the mother for her baby. She cannot understand it, feel empathy to understand why it is crying and therefore shall cannot console it. This feeling of inconsolability and absolute weakness may accompany tomorrow's adult forever, even if they may not realise its causes.

Mothers with postpartum depression usually do what they have to do, but it is all done mechanically, without emotional investment.

Thus, she will feed her child, care for it, clean it. But there is a huge vacuum. This depressive vacuum is like a big black hole. The vacuum of depression is the result of a real or imagined loss. If it is imaginary, it may concern the loss of her girlhood, her sexual identity (the change from the archetype of Eve to that of the Virgin Mary), her carelessness, her career etc.

This vacuum is transferred to the relationship between mother and child and is manifested as an absence that largely determines its development. When she is feeding it for example, she may put on her breast (at best) or not, but her mind will be elsewhere, or devoid of representations. Thus, her milk is given unaccompanied by the love imparted by her gaze, touch, speech or singing.

Today, we know the importance of caresses, embracing and physical manifestations of the psyche of infants. A mother suffering from postpartum depression who recognizes her condition may try to fill the gap with forced actions. For example, she may hold her baby tighter than she should. However, the baby is able to recognize what is not good, that is more or less than what it needs, and reacts strongly, exacerbating the mother's feeling of inadequacy and leading to a vicious cycle.

The same happens with other things, such as diaper changes, bathing etc. A depressed mother does not play with her child. She does not speak and sing to it, does not sing it lullabies.

The importance of the maternal gaze is crucial. The baby seeks its mother's gaze, which is its first mirror. The look of a depressed mother is empty. It does not offer the valuable reflection the child needs. It feels great discomfort, as in reality it is confronted with nothingness.

Furthermore, its cognitive functions do not find fertile soil to grow. Playing, a source of joy and learning, is lacking. Speech, which provides meaning, is also largely absent. On the other hand, the mother's alertness in making sense of the baby's first word, for example, does not function as it should, leading to a delay in speech. The development of symbolic thinking is the result of interpersonal contact. This is why it is termed sym-bolic. The other (the mother) should fill a random word or act of the infant with meaning.

Fortunately, however, postpartum depression does not last forever. The mother will recover at some point and her relationship with her child will be restored later. But an important stage in its development will bear the marks. It is very likely that this baby may be later described as a "difficult" child. It is often grumpy (grumpiness is a behaviour associated with a primary need that is not reciprocated). It is not easily consoled. It often feels weak. Its representational system is often deficient. If it is a girl, as a woman, she will be more likely to repeat her experience she had with her mother with her own baby.

And of course the child is not responsible for the onset of any mental disorder. The birth of a child is just the trigger. The cause lies in the mother's pre-existing vulnerable personality structure and her history.

Of course, everything can be changed through therapy, regardless of the mother's age, if she is willing.

Certainly however, everything will be easier for the child, and for the entire family, when postpartum depression is diagnosed and treated on time. Here too, significant others (her partner, parents, friends) can motivate the mother to consult a mental health specialist. The benefits of such an intervention are permanent and are enjoyed by all members of the family and especially the child.

 

 

Dimitra Stavrou

Psychologist / Dramatherapist

Research Associate SEC

SEC - Self Esteem Center