The Black Dog Wears Many Hats

PNDA story about postnatal depression…

Nadia finally realised she had a problem when she killed off the Wiggles.  Overwhelmed, she left three-year-old Alice and four-month-old Matthew with her husband and impetuously drove three hours north, turning up on my doorstep in tears.

“Yesterday I told Alice the Wiggles were dead.  She keeps begging to watch her Wiggles’ DVDs over and over and over.  They drive me crazy with their stupid grins, annoying songs and silly coloured shirts… always so bloody cheerful and moralising.  I tried hiding the DVD but that didn’t work so I made up some story about how they were driving in their big red car and that they were hit by an even bigger red truck and all killed.  I did it to buy myself some Wiggles-free time but the thing is that deep down I really, truly, wanted them dead.  What the hell’s wrong with me?

Her shoulders drooped and her body curled itself into the shape of a dejected question mark, mirroring her internal uncertainty.  It was as if someone had stuck a pin in her usual tall, erect, striking frame and deflated her.

What had happened to the proud, exuberant, compassionate Nadia I knew and loved; the woman who’d lit up every room she entered?  What had extinguished her flame?

As if to answer my thoughts, her fire unexpectedly rekindled.  She clutched my arm with an iron grip and looked me straight in the eye, her face a contorted mix of fear and desperation.  “I can’t go back home.  I can’t be alone with my kids right now.  I love them both with all my heart but there are times when I actually hate them, and I’m terrified that at one of those times I’m going to hurt myself or even, God forbid, one of them.”

A wave of panic rose inside me.  I didn’t want to hear this.  I didn’t want to know.  I felt it wasn’t fair of her to dump all this on me, especially considering what I’d been through, but I knew it was something I couldn’t ignore.  I also knew that her predicament was going to need far more than a cup of coffee and a reassuring chat with an old friend.

Nadia and I had been close friends at university but our lives diverged in more ways than just geographically.  Our frequency of contact dwindled slowly and then took a nose dive when her first child was born.  She’d entered the “baby zone” before me and her life revolved around nappies and naps.  Even when we managed a chat on the phone, our worlds were now worlds apart and we seemed to be going through only the obligatory motions.  “Buy milk – tick, wash towels – tick, phone old friend – tick”.

The disconnection was partly due to jealousy on my part, I’m ashamed to admit.  As two ambitious, intelligent, capable and confident women, our friendship had always had an undertone of competitiveness.  Being high achievers in different fields, there was no overt rivalry or envious feelings… until our reproductive discrepancies were revealed.

Nadia sailed through her first pregnancy, popped out a perfect infant without so much as a perineal stitch and took to motherhood like a duck to water.  Little Alice was angelic: sleeping, feeding and poo-ing like clockwork, with barely a cry to be heard.  Nadia attributed her good luck to good management, which added fuel to my already blazing resentment.

While she was gliding effortlessly through the motherhood pool, I was still at the starting blocks after a series of false starts.  By the time she became pregnant for the second time (exactly as she’d planned – when Alice was two), I’d had three miscarriages and was pregnant for the fourth time.  Our due dates were three days apart and for three joyous months Nadia and I were back in sync, our orbits having realigned in a most positive way.

At fourteen weeks of pregnancy my world was thrown off course with a fourth miscarriage, and Nadia was the last person on earth I wanted to see.  I heard second-hand that she’d had another trouble-free pregnancy and delivery and that, as hoped, had been blessed with a healthy baby boy.

I managed to send an e-card.

I had not spoken to her for over six months when she turned up out of the blue that summer’s day.

“I hate my life.  I shouldn’t hate it… I have two healthy kids, a loving husband, a comfortable home, no money worries… everything a girl is supposed to want out of life.  I don’t deserve to be bitter.”

I have to admit, part of me was thinking the same thing.  I was the one who had earned the right to be miserable, not her.  She had everything I wanted in life and I would have swapped my life for hers in a heartbeat.  However, as she continued to bare her soul, overwhelming feelings of sympathy and empathy pushed aside my complex set of emotions and washed away the tiny kernel of shameful schadenfreude  I knew I had to help.

I first phoned her worried husband and arranged for Nadia to have some “time out” with me for a few days.  When I’d asked her what she wanted to do about feeding Matthew, she merely shrugged and said, “I don’t care.  Chris can sort something out..”

From the breastfeeding zealot who’d fed her daughter for eighteen months, this spoke volumes.  Luckily I was able to get her an urgent appointment with my GP for the following day.  In the interim, we turned to the Internet.

An IT-savvy woman, Nadia had already consulted “Dr. Google” but found the experience disheartening.  “When I discovered that there were tons of risk factors for postnatal depression and that I haven’t got any of them, I felt more alone and that my feelings were even less legitimate.”

I tried to reassure her with platitudes but I was quite obviously out of my depth.

She ploughed on.  “I did just fine with Alice, better than fine, I positively thrived.  Why has it hit me this time?  Matthew’s a good baby, I have plenty of support… there’s just no reason for it.”

We came across two excellent websites: and .  The most helpful part for her was taking the self-test on the Black Dog website.  Returning a score of 27, the worst possible, she looked at me and said, “I really have a problem, don’t I?”

Trying to lighten the mood I replied, “That’s you all over – when you do something, you do it properly.  No half-assed attempts at anything for our Nadia.”

She didn’t smile.

Over the following 24 hours, she didn’t talk much either.  She didn’t do much of anything actually – didn’t eat, didn’t sleep, didn’t cry.  It was as if she’d expended all of her energy getting to where she felt safe and had nothing left in the tank.  I watched on helplessly as, like a wind-up toy that needed re-winding, she slowed almost to a standstill.

The following day Nadia was hospitalised, as there were grave concerns about her risk of self-harm.  I have to admit that I felt a huge sense of relief to have the responsibility for her care lifted from my shoulders.

After two weeks of antidepressants she started to improve in leaps and bounds and was discharged, although it took at least another month before she started to regain her maternal confidence.

After that there was no stopping her.  The exuberant, capable Nadia was back.  Two years later and off medication for six months, her glass has remained very much half full.

She’s been strengthened by the experience, as a woman and as a mother, and yet still feels a sense of shame.

“I would rather have had breast cancer,” she admits.  “At least then I might get sympathy without judgement.  When people hear I had postnatal depression I get comments like, “‘But you’re a great mother,’ and ‘I’m surprised – you don’t seem like the type.’”

If I hadn’t been personally involved, I might have made similar comments.  Instead, thanks to my encounter with Nadia and some self-education, I came to realise that I too was suffering PND after my miscarriages.  The black dog wears many hats.

Just as there are many different manifestations of PND, a one-size-fits-all treatment approach doesn’t work.  For Nadia, the key to recovery was high-dose antidepressant medication.  She didn’t find psychological therapies or self-help strategies particularly helpful.  The opposite was true for me.

I think it would have helped each of us had we known earlier that postnatal depression is not indicative of bad parenting or a sign of failure; knowing that while there are risk factors, it can happen to anyone who’s had a pregnancy.  It can be unpredictable and has the ability to cripple even the most confident, capable and resilient.

It happened to Nadia.  It happened to me.  It could happen to any of us.

(This story is fictional)









Male Postnatal Depression – a sign of equality or a load of nonsense?

Storylines on popular TV dramas are a great way of raising the public’s awareness of a disease. They’re almost as effective as a celebrity contracting an illness.

For example, when Wiggles member Greg Page quit the group because of postural orthostatic tachycardia syndrome, I had a spate of patients, mostly young and female, coming in with self-diagnosed “Wiggles Disease”. A 30% increase in the number of mammograms in the under-40s was attributed to Kylie Minogue’s breast cancer diagnosis. The list goes on.

Cast of Desperate Housewives

Cast of Desperate Housewives

Thanks to a storyline on the current season of the TV drama Desperate Housewives, I’ve recently received questions about male postnatal depression from local housewives desperate for information:

“Does it really exist?”

“I thought postnatal depression was to do with hormones, so how can males get it?”

“First it’s male menopause, now it’s male postnatal depression. Why can’t they keep their grubby mitts off our conditions?”

“It’s like that politically correct crap about a ‘couple’ being pregnant. ‘We’ weren’t pregnant, ‘I’ was. His contribution was five seconds of ecstasy and I was landed with nine months of morning sickness, tiredness, stretch marks and sore boobs!”

One of my patients, a retired hospital matron now in her 90s, had quite a few words to say on the subject.

“Male postnatal depression — what rot! The women’s liberation movement started insisting on equality and now the men are getting their revenge. You know, dear, it all began going downhill for women when they started letting fathers into the labour wards. How can a man look at his wife in the same way if he has seen a blood-and-muck-covered baby come out of her … you know? Men don’t really want to be there. They just think they should — it’s a modern expectation. Poor things have no real choice.”

Before I had the chance to express my paucity of empathy she continued to pontificate.

“Modern women just don’t understand men. They are going about it the wrong way. Take young couples who live with each other out of wedlock and share all kind of intimacies. I’m not talking about sex; no, things more intimate than that, like bathroom activities, make-up removal, shaving, and so on.”

Her voice dropped to a horrified whisper. “And I’m told that some young women don’t even shut the door when they’re toileting. No wonder they can’t get their de facto boyfriends to marry them. Foolish girls.

“Men need some mystery. Even when you’re married, toileting should definitely be kept private.”

I have mixed feelings about male postnatal depression. I have no doubt that males can develop depression after the arrival of a newborn into the household; however, labelling it “postnatal depression” doesn’t sit all that comfortably with me. I’m all for equality, but the simple fact of the matter is that males and females are biologically different, especially in the reproductive arena, and no amount of political correctness or male sharing-and-caring can alter that. Depressed fathers need to be identified, supported and treated, that goes without saying, but how about we leave the “postnatal” tag to the ladies?

As one of my female patients said: “We are the ones who go through the ‘natal’. When the boys start giving birth, then they can be prenatal, postnatal or any kind of natal they want!”

Published in Australian Doctor on 28th April, 2011:  On Male Postnatal Depression