UK: New mums reject depression tag
New mums reject depression tag
Mothers diagnosed as mentally ill may simply be undergoing normal hormonal adjustments, claims book
Amelia Hill and Jo Revill
Sunday March 14, 2004
The Observer
In the first few days after giving birth to her second daughter, Trudie spent most of her energy trying to convince the hospital that she hadn't lost her mind.
'I couldn't sleep for days because the pain of having a second Caesarean was so intense and the hospital was not giving me enough morphine,' she said. 'I hated being on the ward and was on an emotional rollercoaster, crying at the drop of a hat.
'But my worst fear was that I would be diagnosed as being depressed, which I knew I wasn't. I knew my feelings were the result of external issues and natural upset, and that I would get over it.'
Trudie also knew that the health worker who came to see her every few hours thought she was suffering from post-natal depression (PND). 'She kept coming back, telling me I was suffering depression and asking these questions that almost forced me to agree,' she said.
'Post-natal depression was presented to me as something that would almost certainly happen to me, and that I should be completely open to it because when it pounced the full force of the medical establishment would swing into action with its drugs and intervention to take all responsibility away from me.
'If I'd been slightly less determined I would have been seduced by the pressure to be self-indulgent to an almost hysterical level,' she said. 'But I was determined, and within a few days after coming home I was fine. All that was left was the memory of that relentless pressure to make myself into a victim of PND.'
According to the Depart ment of Health, the months surrounding the birth of a baby carry the greatest risk for women of developing mental illness. The most common is PND, suffered by 10 to 15 per cent of all new mothers.
However, a new book on the subject is aimed at exposing some of the myths surrounding depression. Its author claims these figures are vastly exaggerated and include large numbers of healthy mothers suffering nothing more extreme than the natural post-birth hormonal shifts.
Sociologist Ellie Lee will present her views today at a debate held by think tank The Institute of Ideas. 'Once motherhood was a time of joy, but now many professionals seem to regard childbirth as a threat to the mother's mental health and child-rearing as hazardous to both mums and dads,' she said. 'What is happening now is that mothers are being misdiagnosed with PND by a medical industry intent on pathologising childbirth,' said Lee.
Andrea, who gave birth to her first child six months ago, felt a similar pressure to Trudie to admit PND. 'The health visitor kept asking me if I was depressed - she never asked if I was just sad or fed up,' she said. 'It alarmed me that, if I had these feelings, I would be encouraged to go down that road and give in.
'Parenting is so hard that you need to discover your own inner strength and resilience as well as building the community- and family-support networks that you need to cope,' she said. 'Blaming my mood swings on PND would have absolved me of any responsibility of overcoming it myself.'
For centuries, women who genuinely suffered depression following the birth of their child went undiagnosed. In the Fifties, it was not unusual for women to spend time in mental institutions if it was considered they could not cope with their newborn child at home. The emergence of new medications in the Sixties allowed doctors to give new mothers more help, although there has always been controversy about whether the condition is over- or under-diagnosed.
'Baby blues' is thought to affect a 90 per cent of new mothers, a state caused by changing hormones, exhaustion after the birth and rapid readjustment to a different way of life. It can make women very sensitive, prone to burst into tears and give them a sense of isolation.
PND, however, is a far more serious condition that lasts for longer than the first few weeks and can make it hard for a woman to bond with her child. Some experts believe it is the body's inability to adjust to the different hormone levels, and that the neuro-transmitters in the brain are affected.
Genetics plays a role, but women who have had previous psychological difficulties are known to be particularly vulnerable. The more social support that a woman has from parents or from a husband, the less likely it is that she will suffer PND.
Lee's contention that the psychological needs of parents are being blurred with mental illness - outlined in her book Abortion, Motherhood and Mental Health - is upheld by Brid Hehir, a former midwife who has worked in the NHS for 15 years.
'Because of the insistence that the welfare of children must come first, this is fertile ground for the involvement and intervention of health professionals,' she said. 'We have lower expectations of parents in the current climate. The notion that they can sort out their problems for themselves has become anathema.'
Screening now automatically takes place for PND six to eight weeks after a woman has given birth, using the Edinburgh Post-natal Depression Scale (EPDS) questionnaire believed to detect 90 per cent of cases. But Hehir criti cises the scale, which comprises a series of statements with four possible responses related to mood and feeling, through statements including 'I have been able to laugh and see the funny side of things' and 'I have felt sad and miserable'. A score of 14 or more out of a maximum 30 necessitates a referral to a GP.
But Lee's contention that scarce NHS resources are being spent by doctors searching out PND in women meets with an angry response from Kate Figes, author of Life After Birth.
'These claims underestimate the strengths of individual women; being given all the information and prepared for the worst does not mean that women will start believing the worst is going to happen,' she said.
'If a woman is grown up enough to have a baby and bring up a child, she is grown up enough to cope with the truth and decide whether or not she needs extra help and advice. It's ridiculous to claim that an under-resourced and over-extended health industry is spending time and money trying to exacerbate non-crisis cases.'
There are enormous social consequences for those who feel they cannot cope with a new child. Most marriages break up within the first year of parenthood.
'The mere fact that we have become much more willing to acknowledge that parenthood isn't all rose-tinted spectacles should be celebrated,' said Lisa Harker from the Daycare Trust, a charity that campaigns for more support for mothers.
'The curtains have been lifted at last on the experience of parenthood.'
http://observer.guardian.co.uk/uk_news/story/0,6903,1168916,00.html
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