What could be worse than feeling like you are failing a baby?
This feeling is just one of the possible features of perinatal depression and anxiety (PNDA); there are others, but I think this one alone can be agony enough.
As a perinatal psychiatrist providing mental health care in pregnancy and early family* life, I often wonder: How much could new parents’ agony be reduced if our society dealt with gender issues in better ways? What if – in some ways – we are all failing a baby?
So much about having a baby is gender-unequal. Women’s bodies nurture the growing infant and are pushed to extremes; even with Western medical care, childbirth is still one of the most dangerous times in a woman’s life. In the first year of life a baby’s primary carer is usually her or his mother, requiring the sacrifice of body, career and pre-parenthood identity (among other things).
From the outside at least, life may not appear to have changed nearly as much for the men. So we can retain high expectations of them at work as well as in their new lives at home, and all the while the enormous internal changes of new fatherhood can go under the radar. We routinely screen new mums to check their emotional wellbeing, but often no one asks – how is dad going?
These situations are clearly unequal. Are they unfair? Plenty of men and women I hear from, at work and outside work, seem to feel that way.
Both dads and mums can feel that things are unfair – albeit in different ways.
Both dads and mums can get PNDA – if again, in different ways.
It is getting safer to come out and say ‘I have/had a mental illness’. Elephants in rooms are being named and looked after. However, the presence of a baby as well as the gender issues of motherhood and fatherhood add extra dimensions to PNDA as a mental illness. It’s not quite an elephant in the nursery; it’s a different beast.
Perinatal Anxiety and Depression Australia (PANDA) receives calls from distressed new mums and dads every day. I asked National Helpline and Programs Manager Jenni Richardson about gender patterns in PNDA. She said:
“Both mums and dads speak of not wanting to ‘add more of a burden’ to their partner by sharing their internal world of distress…this is commonly rooted in a concern for the other…”
Here there seems to me a strong wish to be fair-enough to the other parent. But what about your own burden in a situation like this? What if a part of you is crying out ‘it’s not fair!’ – what then?
“Many of our mums speak of anger and irritability, even rage… strong and scary emotions that are unfamiliar and not associated with the image of the caring, all-loving mother. These can be primary symptoms of perinatal anxiety and depression…”
Sometimes the diagnosis of illness can seem to render moot the questions of fairness, as if you can’t be both ill and having understandable experiences of unfairness. This can be the case for dads as well as mums:
“Pressures for dads include needing to both be there for family and hold down a job; feeling uncertain what their role is; huge discomfort with experiencing vulnerability…”
Many dads will say to me that they are working so hard to provide for their family financially, and it seems they feel their efforts are not fairly recognized. Meanwhile:
“Pressure can mount for a mum to ‘be a good mother and manage on my own’ when ‘I can’t get him to come home to be with me’. Everyone is trying so hard but …no-one feels like a winner.”
A natural and healthy response when you don’t feel you are winning is to wonder if the game is being played fairly. If you are depressed you are more likely to assume it’s all your fault, which is both unrealistic and very unhelpful for sorting out a way forward. I wrote about this regarding Male Shame – men turn inwards, blaming themselves and seeing no point in asking for help. On this, Jenni adds:
“Shame is not a concept that is only of the male domain. Shame is alive and well in mums who speak of distressing thoughts or feelings around suicide or urges that place baby at risk. Shame delays help seeking for both men and women.”
You could think of PNDA as like an unwelcome extra guest that came home from the hospital with the baby. Like a panda, it’s quiet, relying on isolation and a lack of engagement from the outside world for its survival. Like a panda, PNDA isn’t really just inside Mum or Dad, even if one has more symptoms of illness than the other. It’s in the room, with Mum, Dad and Baby.
For a family with PNDA, what’s needed is to name it, to find a way to approach and care for the panda in the room. That includes helping the family find its place in our society in helpful ways. Jenni says:
“As a society we need to engage in a dialogue about the emotional and mental wellbeing of both mum and dad as a part of universal care.”
I think that for society, PNDA is a warning sign to us all. So many families reach breaking point under pressures that we all contribute to; our problems with gender equity open the nursery door and invite the panda in. Well into the 21st century we still live with so many assumptions about what men and women should and shouldn’t do, what mums and dads can and can’t do.
Babies need adults to fight for fairness, not sameness. They need us to fight alongside one another, not with each other. If we descend into gender wars, pandas take refuge in nurseries. In gender wars we are all failing our babies.
It doesn’t have to be this way. But more on that next time.
PANDA Perinatal Anxiety and Depression Australia www.panda.org.au 1300 726 306
BeyondBlue 1300 224 636
Lifeline 13 11 14
Mensline 1300 789 978
*I am aware that this piece is heteronormative and assumes cisgender identity. I have worked with and very much respect same-sex and transgender parents, and I hope to write in future about these issues in new parenthood.