Feminist perspectives on PND

[qumquat]

I saw a thread on this years ago before I had DD and now can't find it. It was something like 'how much of PND is a rational response to intolerable circumstances?'. I'm well past my PND now but it still makes me angry that the standard response was 'it's your hormones dear', rather than being alone with a screaming child 12 hours a day while in agony (painful breastfeeding which I couldn't bring myself to give up), and then not sleeping at night. The whole 'its your hormones' seemed reminiscent to me of he old beliefs in hysteria and I wondered how much if any research had been done into how much of PND is biological and how much circumstantial. Does anyone know of any? I feel I'm far enough past it now to face delving into it. I've suffered from depression on and off most of my life so I found the focus on hormones odd, no-one has ever suggested my hormones had anything to with my depression at other times of my life.

I also have a friend who posts a lot on FB about her PND (which is of course good if it helps her), but I have to sit on my hands a lot to stop myself responding that if her useless DH did any parenting she would probably start to feel a bit better.

Sorry I'm working now so if anyone responds please don't think me rude if I don't respond today.

Hi qumquat,
For those first few months, I had a weird thing where I was flooded with happy hormones like I'd taken drugs even though it was really difficult. I wonder if it is more a case with PND that the hormones haven't kicked in to disguise the intolerable circumstances?

I'm with you qumqat and think PND is very situational. It's a drastic change to life for women. It frustrates me too, the disconnect sometimes, between a woman's circumstances and experience and a diagnosis of PND. It's almost as if their experiences don't matter. It devalues what they are trying to cope with.

Was it this thread? www.mumsnet.com/Talk/womens_rights/1786967-How-much-PND-do-you-think-is-a-rational-reaction-to-awful-circumstances I posted on it at the time under another name, when I was in the throes of sleep deprivation with DD.

I haven't had pnd but know many people who have and still remember my first months with ds now 3.
I think feeling "depressed" is often due to lack of sleep and the natural overwhelming impact of having a baby on most lives in this century (i.e. We haven't grown up in extended families, don't live with older generations, husbands work away from home rather than coming in for lunch etc etc).
But, pnd is more than just depression isn't it? It's got all kinds of facets involving any combination of fear of hurting the baby, lack of bonding, feeling not good enough, manic perfectionism... loads of things that are different to the more basic "I'm really not enjoying this".

In contrast to Guardian, I had awful post-natal hormones with both my DC, but I knew I wasn't depressed. (I've been depressed before fwiw.) I knew it was hormones making me upset and weepy and moody and angry and awful, I knew I could get through it, and underneath it I was fundamentally ... can't think of the right word but maybe satisfied/content? that I had had a baby.

By contrast with depression I didn't have a sense that I could probably cope, and I didn't have the fundamental feeling of rightness underlying it.

So while I have no idea about any research, I do feel "it's your hormones" would have been the right answer to me (sorry). Which of course is not to say that it should be used as an excuse not to investigate further with someone who may have PND.

I absolutely believe my 'diagnosis'* of PND was incorrect and I was actually suffering PTSD following an incredibly traumatic birth. I had all the hallmarks of PTSD. Of course I had many symptoms of PND but that doesn't mean anything as they are so broad it renders the diagnosis all but meaningless.

I have only ever considered this in context of my own experience but a couple of thoughts spring to mind from what you have said -

A brief look at the list of symptoms makes me think it comes dangerously close to pathologising basically all* "new" mothers.
*It potentially hinders identifying other factors that may be causing these things. Outside of other illnesses it could also cause professionals and family to ignore signs of DV for instance.

*I put diagnosis in quotations because it isn't on my medical records. I rocked up the the GPs explained my symptoms and was told I had PND and should go to the seaside for the weekend could have ADs if I wanted but shouldn't because it might be bad for the baby even though I wasn't breastfeeding. Years later I released my medical records for a job and had disclosed this in the occy health form. I was told that this wasn't on my records so there was no need to disclose it.

So while I have no idea about any research, I do feel "it's your hormones" would have been the right answer to me (sorry).

But you knew that, and would have told that anyone who asked, right?

If a woman says she just feels terrible after giving birth and doesn't know why, then all potential causes should be investigated.

Thanks for linking the thread Lord Wimsey, that was it! And no need to apologise Giraffes! It's interesting to hear other experiences. For me because being depressed was a very familiar feeling, I was struck by the different way it was responded to by professionals. The one time it seemed entirely rational (as opposed to when I was a popular high achieving 17yr old who wanted to die) was the one time it was assumed to be entirely physiological.

I also think about the way Valium used to be prescribed to bored miserable housewives. Pathologising the woman rather than responding to the circumstances. I'm torn because obviously I want PND to be taken seriously, but I worry we often end up treating the symptoms rather than the cause. E.g. if I had received adequate support for breastfeeding I may not have got into such a desperate state.

I don't think that we can look at PND without considering the parlous state of mental health care more generally.

Interesting question. I'm currently taking Sertraline for pnd, which I've been taking since dd was about 4 months old (she's 11 months now).

In my case, I had a very difficult pregnancy - hyperemesis, and awful flashbacks from a sexual assault I suffered, which was treated with shocking lack of sympathy by the hcps I told. I fully expected that when dd was born I would feel entirely different and better, both physically and emotionally. And to begin with, I did. I felt instantly bonded to dd and I was very relieved that the pregnancy was over and we had both come out the other side healthy.

I'm not sure exactly what triggered my pnd, although for me it manifested as anxiety. My dh is very supportive and has always been on hand at night as well as when he's here during the day. But he does travel a lot with work and he works long hours. My mum has been a wonderful source of support but she lives quite far away. Dd is on the face of it a pretty 'easy' baby, but yet I still have pnd. The pp who said that it was ptsd made me wonder if that is the case for me too - caused by the pregnancy in my case, rather than the birth.

All that wittering on to say, I don't know exactly what caused my pnd, but I agree that 'just hormones' is a cop out.

But, pnd is more than just depression isn't it? It's got all kinds of facets involving any combination of fear of hurting the baby, lack of bonding, feeling not good enough, manic perfectionism... loads of things that are different to the more basic "I'm really not enjoying this".

I had PND with my eldest, and it was all of those things.

I have bipolar & have experienced 'ordinary' reactive depression & hypomania - PND was nothing at all like it in my experience.

I had the opposite experience to what your OP suggested - I was not diagnosed with PND until about 4 months afterward, I had lots of 'it's just a reaction to the circumstances' in the time leading up to being diagnosed.

I feel my PND and the psychosis I suffered was due to my partner and lack of support in general coupled with a horrid birth and my baby being hospitalised for 7 weeks. So a number of things. But mainly my partner to be honest. He wasn't there emotionally even if he was physically. And that made a big difference I feel. And the sleep deprivation...absolutely no good especially if you are prone to poor mental health already. It was exhausting. And two and a half years later it is still affecting me due to the resentment I feel about it

I'm in IKEA at the moment but want to come back to this.

Hmmm, interesting. My HV concluded I didn't have pnd based on the fact I don't feel dreadful every single day. My feelings definitely correspond to how much sleep I get. There are days I just cry and feel I can't cope. Luckily baby occasionally has a good night (3 hours of sleep in a row is good!) Wish I had family so I could occasionally hand over baby, but I don't. The only people who seem to get it are two mums from older DDs school who've offered to have her for a couple of hours while I sleep but I'm too ashamed by messy house to take them up on it. I would say that my low moods are entirely down to lack of sleep, but the lack of sleep is brutal, and I wonder how long it has to go on before it permanently changes my brain chemistry....

But, yeah, it seems to me you're much more likely to get pnd if the circumstances are intolerable.....so no family support, bad birth, bad recovery, poor sleeping baby, problems feeding, reflux etc etc have there been studies on this? e.g. Incidence of pnd among women with / without family support with good / bad birth / postnatal experiences

This is a very interesting question. I think it may be both hormones and also a natural reaction to circumstances.

At a time when I still did not have periods due to breast feeding, I found my mood became even more terribly depressed around the time when the period would have been there. But also lack of sleep, probably not eating enough, and trying to do too much, losing all the life I'd had before, the feeling of not mattering and a heightened sensitivity to everything made it terrible.

I don't think people were designed to be alone with a baby. In a perfect world there would be a bevy of people around to look after the mother and the baby and the house, with no loneliness.

I also think there may be subconscious difficult memories surfacing related to one's own time a a baby which begin to have an effect.

Really interesting thread. My PND was in large part due to a hugely traumatic birth and painful complications which are still ongoing; limited support ; recurrent mastitis; colicky baby etc. I think the pnd was a reasonable response to a really awful time. I've also read that in other cultures where the mother is able to really rest for several weeks, pnd rates are far lower.

As Kinddogs says I don't think we're designed to look after babies solo, and where there is trauma/illness other factors, pnd is maybe to be expected? Plus of course very little support for mother's with PND.

I think that actual PND is quite rare. In most of the cases I have encountered, it has been situational or misdiagnosed PTSD.

Post natal psychosis with hallucinations and extreme effects must be a different thing again.

I had prenatal depression and anxiety
caused by infertility and IVF that morphed into PND through a traumatic birth I spent the first few months of my dd's life in a dissociated state.

I now after several months can see how ill I was (we've actually been talking about it this evening.) I'm not better but not as ill as I was.
My PND is not hormonal, neither is it caused by being at home for 12 hours a day with the baby.
I'm mentally ill, it's not a feminist issue it's a human issue, I have a chemical imbalance not a hormonal one.

I think the clinical focus is more on risk factors rather than the question 'how much is due to hormones vs how much is due to circumstances'. After all, all women have hormonal changes during and after pregnancy. Similarly giving birth and being a new mother with a newborn is always a massive general stressor. I'm sure its no coincidence that of the two, its the hormones that society focuses on as 'the' causal factor in something affecting only women. Although I suppose to be fair, the 'chemical imbalance' explanation is frequently used for depression as a whole so sort of fits in with that line of explanation.

PND isnt thought of as different from other depression in terms of symptoms, nor that it is a separate illness. Puerperal psychosis does often look a bit different. The other thing I wonder that might be relevant is that it is difficult to distinguish any depression from the normal response to stressful life events and the bigger the event, the more difficult it is to detect even more severe forms of depression. So this is always a difficulty in diagnosing pnd. It is also a similar difficulty in assessing for depression in severe physical illness but I think people tend focus more on the 'stress' rather than the physical possibilities as 'the cause' here. If hormones are relevant then cortisol is probably the most likely option and that changes in both men and women under conditions of stress (such as physical illness) as well as in the post partum period for women.

There is lots of evidence about lack of support both from partner but also wider network and other life stress or loss being significant risk factors. Previous history of depression and depression or anxiety in pregnancy are also major risk factors. There is also evidence on tempermental characteristics of babies eg colic and birth trauma or problems increase risks and any number of other, quite logical risk factors.

I think in terms of treatment then the current thinking for all depression is that because the causes are probably all multifactorial in most cases then you should look at all treatment options and individualise, starting with basic, practical support, self help, psychological approaches and adding in antidepressants for more severe forms or later if the first measures haven't worked. Unfortunately the reality is that mental health is poorly funded so these options are not always there. For PND then an particular focus on prioritising women with PND, a recognition of their particular needs and a lower threshold for access to help including specialist perinatal services would be what I would want to see as the difference between treatment for pnd and other depression.

Meant to say Puerperal psychosis looks a bit different to other forms of psychosis - it looks completely different to depression!

I also agree with KindDogs - there is something psychologically about having a child that reminds you of your own childhood experiences and that can be really hard for women with bad experiences in childhood.

I think this article is pertinent to this thread. Huffpost

I wonder to what extent the low rates of women describing their care as "satisfactory" or lower, despite the high numbers of people who have reported having fairly obviously pretty atrocious care is because women simply expect to be treated in these ways?