Thursday, April 29, 2010

The Problem with no Name.

Basic Australian medical education is geared towards producing generalists, sort of jacks-of-all-trades in the practice of medicine. As such, I received little formal training on the subject of post natal depression. If my memory serves me correctly, we were told the the phenomena was incompletely understood but felt to be largely a hormonal problem, some factors predicted it and that when encountering a case, the patient should be referred to appropriate specialist care.

My medical training post medical school was extremely varied and broad. This was because I drifted through the medical profession becoming bored by the various specialties that I had undertaken training in. So when I started working in General Practice (Family Physician for my American readers) I was pretty green with regard to the subject of post-natal-depression. (PND)

One of the first things I did note was that certain personality types seemed to be more prone to the condition than others. Individuals who were more ordered, fussy and regimented in their ways seem to me to be more prone to it than carefree individuals. Career women seemed to be more prone to it as did the dogmatic/domineering lefty/righty types. It seemed to affect certain personality types more than others. Women who were determined to breast feed their children, no matter what, seemed particularly prone.

One of the common themes that seemed to run through these women was their utter incomprehension of how they came about to be depressed. Many of them felt failures as women, after all, what is more natural than motherhood? Isn't every woman supposed to be a natural mother? Their failure at motherhood proof that there was something "wrong" with them.Many of them felt failures, even though in real life they were highly successful professionals. Many of them had tried valiantly to overcome their feelings, only to come crashing down.

On the other hand, other groups of women positively thrived in motherhood. These women seemed positively enamoured of there state, many of them wanting to more children and saw themselves as professional mothers. Some of them were so overjoyed by the experience that they ditched high powered careers to stay at home with the kids. What frequently stopped them having more children was their spouse, who for a variety of reasons, did not want any more.

What clearly became apparent to me after a while was that there were three groups of women:

Group A, the professional mothers, who loved caring for babies,
Group C, the depressed mothers who were having a hard time caring for their children
Group B, Women who fell somewhere between the two.

When it came to motherhood, women were not the same.

What struck me about the Group C Women, was that many of them were temperamentally not suited to caring for children and that this temperament was innate. They had become depressed because of the situation they had found themselves in, or in other words, their post natal depression was a reactive depression; they were depressed because of their circumstances. Solution: Change their circumstances.

Now I have either been extremely fortunate or have only seen mild cases, but only a very few of my patients have required specialist care. ( One, I think) because I tend to manage these cases quite aggressively. The mainstay of my approach is:

1) Aggresive use of anti-depressants, usually for a short period.
2) Child care, to give the mother some breathing space.
3) Returning the mother to some form of part time work.
4) Counseling, by myself.

Of these, the most important are 2) + 3) followed by 4) followed by 1). The anti-depressants buy time to let 2)+ 3) work their magic. Nearly in all cases, the women got better, came off the anti depressants and many in fact are fine and loving working mothers.

I wish to explore this subject at depth in future posts and will expand on pertinent points later as I feel the forces that combine to produce PND seem to provide insights into the operation of the female mind, operations which render it distinct from the male and challenge the assumptions made by both Traditionalists and Feminists regarding female nature.

One of the first assumptions which I feel is wrong is the concept that all women are natural mothers. Making and popping out the baby really doesn't seem to involve much effort, looking after it does and the test of practical motherhood is to see how effectively a mother looks after the child. The fact that quite a significant portion of women have difficulty looking after a child means that motherhood does not come naturally to all women, or more importantly, there are a significant number of women who are not naturally endowed with the ability to rear children. The concept that all women are natural mothers is flawed and at odds with reality. Some women aren't meant to stay at home and look after the children.

It's interesting where other peoples research seems to confirm your own findings. Catherine Hakim, hated by feminists, has through a study of empirical data come to the conclusion that in British society, if given the choice, 20% of women would stay at home to look after the kids (Group A), 20% of women would work (Group C) and the rest would like a mix of the two (Group B). Her research would seem to correspond to to my observations.

The big problem with both Feminists and Traditionalists is that they assume that women are a homogenous group, especially when it comes to pushing their pet theories. The trads assume all women should be mothers, the feminists assume that all women should be workers. No one asks what the women want or what the women are suited to doing.

Disclaimer.The comments above should not be considered medical advice. The mechanics of post natal depression are complex and subtle and this post is a rough overview which could be misinterpreted. If any one should stumble upon this blog whilst Googling PND and feels that they may be suffering from post natal depression, I would strongly suggest that you seek professional help early and definitely do not manage your condition alone. Many women feel that they are alone with condition and are too embarrassed to speak to anyone about it. Rest assured, you are one of millions with the condition. The only dumb thing that you can do is not seek help. Seek help early, as treatment is easier and recovery more rapid than waiting till your condition is much worse.

Special treat:

Catherine lays the boot into the Feminists.
Stuff that people who believe in Game already know.


Hestia said...

This was fascinating to read. I've volunteered with La Leche League as a peer counselor and serve as the leader for the Family Readiness Group (FRG--basically a support group) for my husband's unit and have seen and heard some heartbreaking cases dealing with PPD, the pressures women face to make decisions that aren't right for them, and the general problems that arise with new motherhood.

I've had several young women in my FRG who had babies while their husbands were deployed and they were far away from family. They were pressured intensely by friends to SAH, breastfeed, practice attachment parenting, and were pretty much told they were bad parents if they did not.

One called me crying in the middle of the night one night as she was completely overwhelmed, exhausted, and wasn't sure how she could last the rest of the deployment. I went over to get her, bringing her and her baby back to my house for the night, and as we stayed up talking, I was just sick about what she had told me. Her baby was six months old and waking up all night to nurse. A friend told her to co-sleep with the baby, nurse more, never let the baby alone while crying, and on and on. This poor girl was barely taking showers and eating as result of the advice.

She was also struggling with her husband's deployment and was having a hard time not caving under the stress of having him in harm's way.

Over the next few weeks, myself and the Major in rear detachment helped her access services and got her in contact with some veteran army wives/mothers who could encourage her in making the best choices for herself and child without judgment. Part of this included weaning her child from the breast and putting the baby in a safe place and taking a shower every day, even if baby whined and cried. She also used three hours of respite care in the base child care center every week so she could have some time to herself and the time necessary to go to doctors appts. She really thrived after this and it was so nice to see her doing well, having a smile on her face, and enjoying her precious baby!

I've helped many other military wives get help or make better choices on many occasions. Part-time work or volunteer work (paid employment can be scarce in may military towns) is often a welcome blessing for many of these women. It's amazing to see the difference not only in the mothers but their children as well.

During my husband's last deployment, I had a teenager from the local homeschool co-op come once or twice a week to look after my daughter while I did my business books or worked on projects that my daughter could not help with. She and the helper would play together, do a craft project, or read books and she really seemed to enjoy spending time with her "friend". My daughter also enjoys/ed going with me to the farmers mkt when I was running my booth there. She helped collect the money and loved talking to all the different people who came by. A good situation for all I think!

Jonathan said...

Interesting post. Lots of food for thought there.

I've heard whispers of evidence suggesting that sometimes postpartum depression may be related to nutritional deficiencies. Particular nutrients I've heard cited include DHA, EPA, and the fat-soluble vitamins (K, D, A). If the mother was deficient to begin with, the fetal demand for these nutrients might make the deficiency really bad. I wonder if you have any experience that might support or refute this hypothesis. (Of course, I'm not suggesting this is a factor in every case.)

Thursday said...

You might be interested in the work of Sarah Blaffer Hrdy. Justin Martyr has a nice summary of the relevant bits here. Her big book is called Mother Nature.

The Social Pathologist said...


In My experience, organic issues;hormones, diet, exercise etc seem to play a very small role in the condition. I imagine there are some women were this may be an issue, I always arrange a basic series of blood tests to exclude common organic pathology, I've actually never found one that has had an organic basis to her disease--that's not saying that its not possible, it just that it has not happened in my experience.

One of the big big issues which I have with the "Americanisation" of medicine, is trying to find an organic problem for maladaptive behavioural response. There seems to be this presumption that there is an organic basis for all pathologies, when in reality many of our modern lifestyle illnesses are based on bad choices or bad cultural ideas. But more on this later.

She really thrived after this and it was so nice to see her doing well, having a smile on her face, and enjoying her precious baby!

A lot of these women make fantastic mothers when they develop a style of mothering that suits their personality. Some women simply aren't suited to staying at home alone, looking after a child. The other big issue is the bullshit programming women get from their "friends", media, psychologists and so called child care experts. These women are taught "skills" which are guaranteed to set them up to fail.

My point with regard to this post, is the assumption, made by Traditionalists especially, that a woman's natural place is in the home caring for children. Unfortunately this does not stack up with the reality of human nature. Many women(not all)are simply not wired up to be stay at home mothers. (But I'll be writing more about this in the next few posts).

The Social Pathologist said...


Thanks for the link. This is from the link.

As Sarah Blaffer Hrdy points out in Mother Nature that the career versus children dilemma is hardwired into females.

Blaffer is looking at the problem the wrong way. For some women, child care is a career, it's the chosen profession that they are suited by temperament to take. I know lots of "high status women", i.e lawyers and doctors who have given up their profession to stay at home with the kids because they love it. Indeed, one of the major problems with the Australian medical workforce is that there has been a massive under supply of doctors in this country. Training numbers were based on the assumption that women would work as many hours as men when they graduated, when in reality, after they had children, many women chose not to return to work full time, even though most of them could afford deluxe childcare. Women, when given choices, tend to chose career paths which accord with their temperaments. Both traditionalist and feminists societal conceptions don't recognise this.

The childcare/work dilemma comes about mainly as a result of economic circumstances and personality factors. Hakim's middle group of mothers would work for a pittance just for a chance to get out of the house for a bit, get dressed up and have some adult contact for a while. Work is a legitimate excuse to get away from the kids and get some psychological breathing space. The psychological breathing space required tends to determine the amount of work a woman wants.

Hughman said...

"Basic Australian medical education is geared towards producing generalists, sort of jacks-of-all-trades in the practice of medicine."

Story of the UK medical education system, with some regional variation. (traditional universities focusing on academic medicine, medical schools with strong dentistry departments have a lot of focus on surgery. My own is becoming a massive focus of medical administration, leadership and management)

Medical students on entry tend to poll at 10-20% wanting to become GPs. But half of students need to become GPs to cover our needs.

From what I can tell this change happens because the 'alpha-female' power-grrrrls become broody and want a simple life to allow them to have a family. Being a GP allows for that: part-time or locum work is pathetically easily to get. Disruption to training pathways isn't a big issue. Take another point: 60% of females that start surgeon training are expect to retrain or drop out of medicine totally.