Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Friday, December 12, 2014

Dads and Postpartum Depression: A Reframing

Recently I worked with Susan, a new mom who was struggling terribly with feelings of depression. Her doctor had recommended medication, but she hesitated.  Susan's depression lifted when her husband Tom started attending a new dads group.

How can we make sense of this? In today's culture, where mothers are usually the primary caregivers, fathers are often relied upon to be breadwinner and caregiver, as well as primary and often sole source of emotional support for a mother.

A colleague of mine, Ed Shapiro, pointed out a potential vast disparity between a mother's and a father's experience of life with a new infant. A mother usually feels taken care of when her husband takes care of the baby. In contrast, a father, whose spouse may also be his sole source of emotional support, may feel alone and abandoned when a mother is- in a natural and healthy way- preoccupied with the baby.

In addition, many mothers may give mixed signals, asking for help while conveying, in both words and actions, that they know better how to read the baby's signals.

Putting all of these together with the helpless infant who requires care 24-7, and both parents may be physically in the same house but feeling terribly alone and disconnected. Depression, for both mother and father, is an understandable outcome.

A new dads group has the potential to address all of these issues. Similar to a moms group, dads can share with others who are having similar struggles. With the baby present, they have the opportunity, in a safe, supportive environment, to learn to read the baby's cues and connect with the baby.

When in turn, a father feels an increased sense of competence, he may be more available, both physically and emotionally.  A mother may feel less alone and isolated and be more available for both baby and spouse. A positive cycle of connection may be set in place.

In my previous post,  I offered a re-framing of postpartum depression in mothers, pointing to social isolation and unrealistic expectations that contribute to the experience. While the response of readers was in general positive, many readers reacted with the criticism that I was implying postpartum depression wasn't "real."

Having worked with many new mothers and fathers, I have no doubt that depression is real. What I am interested in is a deeper exploration of the cause of the depression.  Certainly in mothers, though not in fathers, hormonal changes may play a role. Feelings exist in the realm of the mind/brain. Medication may help to alleviate the symptoms.

But to discover the cause of the depression, and in doing so to intervene with effective treatment, we need to look beyond the individual to the social context. The way our society does and does not offer support and services to new families is intimately intertwined with the occurrence of postpartum depression in both mothers and fathers.

Perhaps a reframing, from a disease model, that proposes "there is something wrong with you and I will fix it" to a wellness, or resilience, model is in order. Listening and meaningful connection regulate our physiology. Being heard and understood promotes growth and healing.

Offering new parents a space to be heard, held and supported is integral to the treatment of postpartum depression, in both mothers and fathers. This may mean mobilizing of family and friends, individual therapy, dyadic therapy with parent and infant together, parent-baby groups, or some combination of these. Support around sleep, crying and feeding, as well as yoga, mindfulness and meditation may also have a role to play, Ideally these interventions occur in the first three months, when not only is the infant most helpless, but also the brain is rapidly growing.

The early weeks and months with a new baby should be a time of joy, bliss and love. When it is not, as a society we owe it to both parents and babies to see that it is. As another colleague Mara Acel-Green wisely pointed out, treatment of postpartum depression ( as well as anxiety and other perinatal complications) always works. Identifying underlying causes while thinking creatively about treatment is essential.

Susan, Tom and the new dads group offer a case in point.

3 comments:

  1. "Certainly in mothers, though not in fathers, hormonal changes may play a role.".

    Surely you realize reality is a bit more complicated than that. Though of course you're also right about the importance of the social context.

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    2. Yes you are right. I only meant it in the most basic sense that men are not actually pregnant. Oxytocin plays a very important role in both mothers and fathers, particularly in the developing relationship with the baby.

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