Are we missing something by calling it “postpartum depression?” Or are we medicalizing a sociological pathology? Are we confusing a hormone problem with something else?
Comment on “Stigma Hinders Treatment For Postpartum Depression” reported on All Things considered 1 Aug 2011. I suggest that some of postpartum depression is misnamed, and actually reflects a rejection of the infant by the mother. By calling all “numbness toward the infant” PPD, doctors are ignoring a real sociological problem where the mother is just not ready to give birth to or care for an infant. Calling the symptoms PPD suggests a temporary problem probably due to the tremendous hormonal shifts that occur in the mother during and after pregnancy, when these shifts may have nothing to do with the problem. I discuss the different types of depression and how they have to be treated differently.
Updated: 4 Sept 2014
NPR Reporter Joanne Silberner interviews a mother, Heidi Koss, who “felt nothing” when each of her daughters were born, and was in danger of escalating that feeling to killing her newborn. She was diagnosed with postpartum depression (PPD), thought by most doctors to be “caused by” stress, genetics and hormonal changes. The report lists symptoms like changes in sleep or body weight or activity levels, accompanied by feelings of strong anxiety and a “lack of interest in life”. About 50% of PPD women also have thoughts of killing their babies. For many women with these feelings, the shame and stigma is so great, some contemplate suicide. The report also states that many obstetricians are not trained to handle PPD and many insurance companies do not reimburse for its treatment. Most of what this report states about PPD is based upon women who seek treatment for it. We have no idea of its actual incidence in the general population, nor can we state all of its symptoms. The report hints at some other problems with understanding PPD by showing us how cases of PPD have to be treated in Uganda, where the stigma of mental illness is so great.
My Comment Posted at NPR
Thank you NPR for addressing this little understood syndrome. However, this report barely makes a dent into what we need to know. Can we assume that all mothers who want to “get rid of their newborns” are in postpartum depression? Another mother’s depression may have started with the realization that she was pregnant and begs the question that it is “postpartum” at all. We assume that postpartum depression as being mainly due to the major hormonal changes that take place during pregnancy and after giving birth. That assumption is probably not too far from the truth, because we can actually measure hormone levels in the blood and find correlations. However, feeling nothing towards that infant because of problems with progesterone and prolactin is different from not wanting to bond at all with the baby because it will be too big a burden to carry. The latter is more likely to occur independent of hormonal state. I discuss this topic in more depth at my blog post “Postpartum Depression and Rejection of the Newborn” at https://marthalhyde.wordpress.com/2011/08/03/postpartum-depression-and-rejection-of-the-newborn/.
More of My Ideas
There are different reasons for each type of depression. We cannot lump all types of depression together and try to treat them in the same fashion. We need to distinguish the depression that is classic, the sadness and lack of hope for the future, from one that is very different–feeling “nothing” towards the baby and wanting to kill it. Heidi’s depression was shown to be hormonally linked, and medication helped her to “recover”. However, many mothers want to kill their newborns, not from mental illness, but from having no means, or hope of means, to care for them. “Dislike” changes to “kill” when they see the child as a true threat to the mother’s life. See my blog post on The Four Pillars of Support Affect Mothers’ Decisions.
Even true postpartum depression that results from hormonal imbalances, can have multiple causes for that imbalance. This type of depression and most of the classic types of depression that could happen in anyone can be examined differently from how most psychotherapists do now. Let’s think of depression as a natural emotion that comes from a repeated “lack of satiety” in brainstem (unconscious) neural programs that govern the body’s basic physiology, which can be corrected. (I discuss the integration of emotions with physiology in Emotional Representation in the Brain). The reasons for depression, regardless of its origin, will vary and most can be found with the use of mind-body medicine techniques of Muscle Reflex/Response Testing, Visualization (guided imagery), and Mindfulness. The reasons for a mother wanting to kill her infant will also become clear to her, if she doesn’t know already, using these techniques. Mind-body techniques are also preferable because a mother cannot breast-feed if she is on medication, but can if she uses these alternative methods for treatment.
All of us know that the body undergoes major changes in physiology, and even anatomy, when we become pregnant. We certainly must understand that once pregnancy, labor and giving birth are finished, the body doesn’t start the change back to normal, since motherhood demands physical changes to promote the survival of a newborn. Because physiology has to change drastically during pregnancy and again after birth, it stands to reason that some of the body’s systems are less capable of making an easy change than others. Because of this, the brain will register lack of satiety at some point. It will continue to signal dissatisfaction to the point that it brings that unconscious status to the conscious level by triggering depression. With the very rapid change that needs to take place immediately after birth, it only makes sense that the onset of depression could also take place very rapidly.
A practitioner should not stop at finding a hormonal imbalance. Why is there is an imbalance in the first place? After all, we all are capable of the same mechanisms, so if some people have an imbalance that doesn’t self-correct, then the mechanisms must be messed up. Just replacing missing hormones does nothing to solve the problem. The same is true for taking anti-depressant drugs for the more classic cases of depression. Unfortunately, most patients need to change medications often, and usually having to take medication for the rest of their lives.
This is not a cure. The brain will just create workarounds concerning the medication because the medicine is treated as a toxin by the body and it tries to get it to the liver to break it down, throw it out or sequester it somewhere else. Our bodies change so much during life, as we suffer emotional and physical traumas, that the act of sequestration never becomes a permanent solution. Stress tends to cause whatever is sequestered to be released. This means that periodically, the sequestered drug gets released, messing up what the person thought was a balanced physiology, and a repeat of symptoms appears.
If classic depression results from local tissue problems, then local tissue upsets will be even more obvious in a pregnant woman, setting her up for depression if her nutritional needs are not satisfied. In addition, tremendous hormonal changes have to occur to accommodate a foreign tissue, the growing baby, and these can cause temporary problems with chemical balance in the body, contributing to depression. However, maternal hormonal changes also can be disrupted as the brain “remembers” previous traumas, causing a different type of depression.
I strongly suspect that in the case of Heidi Koss, something happened at the births of her two children that triggered “body memory” of some childhood trauma, and the mother is completely unaware of its significance to her physical and mental symptoms. That would come out in the usual psychotherapy sessions, but answers could be gotten much faster if Muscle Reflex/Response Testing were used, especially if the therapist realizes that all “mental” conditions reflect physiological conditions.
In Heidi’s case, it is likely that cells in the hypothalamus responsible for causing the release of prolactin and progesterone are being blocked from secreting. Blocks can be put on neurons at any level in a hierarchy of circuits from posterior medulla to cerebral cortex, and often are with emotional traumas. The brain finds them and removes them when it can figure out what it needs to do, but obviously cannot always do this. Psychotherapists help their patients in many ways to remove these blocks, and usually do so without realizing the precise neuronal changes that will occur in the brain as a result. I talk about how practitioners can treat patients in Using MRT: Recovering From Trauma.
It is clear from this report that there are cultural differences that must be addressed in treating PPD anywhere in the world. In Uganda, they call depression “the worries” so that most people there do not think of it as mental illness. Even in this country, most people would be surprised that mental illness can include symptoms that are the emotional equivalent to a sore throat. Most of the time these brief episodes of mental illness, such as sudden, unexplained anger at someone, are processed by the brain as we search for explanations for our sudden change in behavior, and we figure out the cause, and learn how to control that emotion the next time.
Sometimes we are so bothered by our response that we search for more answers over a longer time, not unlike how the body has to recover from a fall down the stairs and mend a lot of bruises. Just the act of thinking about some troubling event can heal the brain. We do this all the time when we reach a point where we can “let it go.”
The more we understand the physiology of depression and other mental illnesses, the more likely we are to accept that it should not be feared, even the weirdest cases of it, where we think the individual needs to be hospitalized. When we become educated enough about mental illness, it will cease to be the stigma that it is now.
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© Copyright 2014 by Martha L. Hyde and https://marthalhyde.wordpress.com.