Many women go through a few weeks of “baby blues” during the months after childbirth. Estimates vary from 40% to even 70% of all mothers having had such a temporary emotional setback. Usually a combination of very different causes can contribute to this: specific physical after-birth problems such as incontinency or sore nipples, the daily burdens of new responsibility, doubts if you’re an adequate mother, lack of sleep due to the baby’s crying, hormonal changes, sometimes a certain disappointment because actual motherhood turns out to be different from idealized motherhood, and so on.
For some, these fairly natural “baby blues” can worsen and instead of fading away again, will grow into a more persistent postnatal depression. Depending from how exactly you define “postnatal depression”, according to modern research roughly 10% to 15% of all mothers develop a more or less serious depression in the year after giving birth. One of the many things that play a role here, is that a case of simple “baby blues” can get worse by itself: this can happen if you start worrying about it, feeling guilty for not being as completely happy as a good mother is supposed to be.
Postnatal depression was already known thousands of years ago; we can clearly recognize it in some old Greek and Roman stories. Since the 19th century, it has gradually got more attention. Today, there are many websites offering background information on causes, symptoms and therapies. So I will not try to do here what many others have already done better. Just find yourself an informative website, preferably one by a trustworthy non-profit organization. Try for example the Postnatal Depression pages of the British National Health Service.
As you may know I’m not particularly fond of simple online depression tests. I think they are too superficial and often misleading. The standard short 10-question test for postnatal depression is the 1987 Edinburgh Postnatal Depression Scale.
If you really want to, you can do this EPDS test online (select your answers and click “add up score” for a result). Just remember that the outcome, whatever it is, is not a hard fact but only a very rough indication.
If for whatever reason you think you have postnatal depression, you should seek professional help. Without proper attention and treatment, a postnatal depression can take a long time. It will mean a difficult time anyway. But with the right treatment, you will get over it. And although it can be a terrible and maybe even terrifying experience, it is not necessarily dangerous.
Postnatal Psychosis
In a few exceptional cases, about 0.1% (so only one in a thousand), something can happen that is worse than postnatal depression, and in fact is something different: postnatal psychosis (also known as “puerperal psychosis”). The first one who really systematically discerned this, was the German gynecologist/obstetrician Friedrich Benjamin Osiander. In 1797, he gave an extensive description and analysis of postnatal psychosis in his book Neue Denkwürdigkeiten für Aerzte und Geburtshelfer (“New Memorable Facts for Doctors and Obstetricians”).
Postnatal psychosis can make you not just very depressed, but also very agitated, and often you lose any clear judgment of your own situation. You can get distorted or delusional ideas, start to act in strange or desperate ways. In the most extreme cases you can become a danger to both yourself and your child.
But something like this will happen only to a tiny minority, and within that little group, the group where such a danger really becomes acute, is even smaller. Perhaps, to put things into perspective, will it help to visualize things here a little? In the diagram below, the group with postnatal psychosis is in fact so small that to show it in proportion, we should have made it completely invisible.
Still, in the few cases where it comes to postnatal psychosis, this can end in catastrophe. Some of these cases are so tragic that they get much publicity – and this publicity can make us think such tragedies happen more often than they actually do.
Two examples of high-publicity cases: the one of Melanie Blocker-Stokes, who after she had given birth to a healthy daughter developed delusions, began to behave strangely, and a few months later killed herself. And the much-discussed tragedy of Andrea Yates, who in a postnatal psychosis killed all her five children by drowning them in a bathtub.
Paper gown
Although postnatal psychosis does not happen very often, research indicates that the people who already have a past of depression (especially bipolar disorder) are relatively more vulnerable.
This may (or may not) be illustrated by another high-publicity case. In 1994, Susan Smith drowned her two children (a 3- and a 1-year old) by letting her car, with the children in it, roll into a lake. Just like later with Andrea Yates, there was heated discussion about whether Smith should be seen as a perpetrator, or as a victim.
Because for nine days after her children’s disappearance she’d kept pretending that they had been kidnapped, and because she was in love with a man who didn’t want children, some saw her simply as a devious, scheming, heartless murderess.
On the other hand, others pointed out how very likely it was she had been suffering (and acting) from postnatal psychosis, also in view of her past: her father had committed suicide when she was 6, her stepfather had sexually abused her, and she herself had already made two suicide attempts, at age 13 and 18.
In the end Smith was convicted to life in prison. But still the tragic story of her and her children kept appealing to many, even got something like an emblematic dimension. Do you know the 2008 album Lantana by the wonderful folk singer (country-ish folk singer) Caroline Herring? Her song Paper Gown is directly inspired by this tragedy. In fact, in this song, Herring is trying to give a voice to Susan Smith.
See the official Caroline Herring website for more of her music (she’s really worth a click). – UPDATE: I just found out her site has now gone offline for a redesign, temporarily redirecting to her Facebook page. So maybe you’ll have to try that instead.
Anyway, here she is with Paper Gown, singing about how Susan Smith came to kill her children:
(click the “Play” button – if it does not work, install Flash)
Meanwhile, do you notice how even I could not resist focusing here on this extreme, dramatic, terrible, but relatively rare aspect of postnatal psychosis? While in fact I was planning to focus on the much less rare, but also less spectacular, more drab aspect of postnatal depression?
Common postnatal depression is also a terrible ordeal, sure, but usually it will not lead to suicide or killing your children. With some help and support from others, you will be able to overcome it. So let’s conclude with a few basic tips.
Tips:
1. Having the “baby blues”: in the first months after childbirth this is fairly normal, and certainly nothing to feel guilty about. Instead of blaming yourself for not living up to expectations, try to pinpoint what specific causes are making you sad or unhappy at times. Talk openly about this with others.
2. If you continue to feel really very unhappy and inadequate for at least several weeks on end, then you should begin to ask yourself if you’re developing a postnatal depression. Ask for advice; do not hesitate to seek professional help. Maybe you need some kind of temporary therapy. Perhaps even, for a while, a little medication: not all antidepressants are incompatible with breastfeeding.
3. If you have had serious depressions in the past, in the form of bipolar disorder or otherwise, then you may run a slightly higher risk than others to develop postnatal psychosis. Even though the risk will still be very small, in this particular case you should ask the people around you expressly and beforehand to keep a close eye on you: just as an extra safety measure.
• footnote 1: For a little more background info, see this Psychology Today article: Moms Who Kill, by Mark Levy (2002).
• footnote 2: Though largely forgotten now, Friedrich Benjamin Osiander (1759-1822) was an interesting man, and not just because of his pioneering role in the recognition of postnatal psychosis.
As a professor he wrote many books; another one of them (1813) was Über den Selbstmord, seine Ursachen, Arten, medicinisch-gerichtliche Untersuchung, und die Mittel gegen denselben. Eine Schrift sowohl für Polizey- und Justitz-Beamte, als für gebildete Aerzte und Wundärzte, für Psychologen und Volkslehrer.
My translation of the title: About Suicide, its Causes, Kinds, Medical-Juridical Investigation, and Means of Prevention. A Book for Police- and Court Officials, trained Doctors and First-Aid Medics, Psychologists and Teachers.
This 1813 book by Osiander is the only one of his works that is online at Google Books: if you can handle German text in the old-fashioned Fraktur script, it makes a fascinating (but occasionally also very moralistic) read.
• footnote 3: Fathers having postnatal depression? Yes it happens, and while not exactly the same, this is beginning to be recognized a little better. But I didn’t want to make this post more complicated than it already is. So, some other time.
You probably know Florence Nightingale as the “The Lady With The Lamp”: the almost mythical, near-saintly nurse who in the 1850s saved many wounded soldiers by setting up the first modern hospital for them. In many ways, she laid the foundations for professional nursing.
In the next two years, she managed to turn herself around. She returned to Kaiserswerth and from there wrote in a touchingly reassuring letter to her mother that she felt no longer suicidal: “I find the deepest interest in everything here and am so well in body and mind… I really should be sorry now to leave life. I know you will be glad to hear, dearest mother, this.”
All this, and the tremendous successes that followed, did not mean that for the rest of her life she was entirely free of depressions.
Please don’t worry. This is not going to be some kind of dumb rant against pills or the pharmaceutical industry. I just want to show you how what was considered normal in psychiatric health care 50 years ago, is seen a very different light by us today.
And by implication, how what we now think is normal, may be considered weird 50 years from now.
Frankly – Frankensteinly – I think those people in the future will find this way of treating children just as unbelievable and weird, as we find this old Nembutal advertisement.
No doubt you’ve noticed that it happens quite often that a celebrity dies prematurely from a drugs overdose (or, like 
Of course the same thing can happen to ordinary people too: but they don’t make the headlines. A celeb’s death just gets much more attention.
One of the best known and still intriguing deaths-by-overdose from history is the one of Elizabeth Siddal, in 1862, in Victorian England. Even today, her life and her death still get a lot of attention. Even today, she still has devoted fans. There are books and websites about her; I especially recommend Stephanie Pina’s excellent blog 
Siddal had become very depressed after having given birth to a stillborn daughter, and in 1862 (at age 32) an overdose of laudanum was fatal to her.
But – suicide or not – can depression and death ever be a matter of glamor? I cannot help thinking that the actual tragedy is that, in her own sadness, to herself, Elizabeth Siddal already must have lost her glamor before that cold February day when this overdose took her life. Depression is ugly; and so is death.
Of course depression has always interested doctors – in fact, since the earliest times. In the 1st century AD, the prominent Greek physician 
But I digress. The real process of “illnifying” depression began much later, in the second half of the 19th century. It has accelerated significantly since about 1900. Gradually, pharmacists, psychiatrists and hospitals discovered that there was big business in treating common mental health problems – including depression.
The question that arises here is, haven’t we pushed the borders far enough by now? Aren’t we beginning to overdo it?
Maybe that’s where we should draw the border line between illness and non-illness again. And, resisting commercial impulses, stop further illnification.
Many of us have at one time or another visited some historical landmark with the intention of meeting such ghosts. Such as a carefully restored old Illinois 
Since ancient times, it is known as the “Duivelsberg” – meaning “Devil’s Mountain”, even though it’s nothing but a knoll. From September 1944 to March 1945, this hill was a strategic point in the frozen front line between Allied and German forces. Marked as Hill 75.9 on Allied army maps, the Duivelsberg changed hands several times before the Allies finally managed to break through. Eight miles to the south is an army cemetery where over 2,500 Canadian soldiers now lie forever. *
Our personal life is also full of such “historical landmarks”. And just like with official landmarks such as Lincoln’s log cabin or my Duivelsberg, it is our knowledge (in this case, our own memory) that gives these personal landmarks their special, ghosts-evoking power.
Example: any old, nondescript, chipped coffee mug can work as one of your personal history landmarks if it happens to have been the favorite mug of your mother, or of a long-lost lover. For you, when you chance upon that mug in a corner of your cupboard, it can have the power to suddenly conjure up a face, a smell, a voice, a conversation, a row.
This becomes even more problematic if your depression has some of it roots in traumatic experiences from the past. Then, just seeing some common object may keep reviving for you, in that ghostly landmark way, memories of those traumatic experiences. Along with all the associated negative feelings of panic, fear and what not.
Identify as much of those personal landmarks as you can, things like that coffee mug, that photo album, that old favorite music CD, whatever. If possible, if this is about small objects, then stuff them into a box (I mean this literally) and temporarily stow it away. Try to remove them from sight for a while. Archive the most poignant reminders of your own past. Reduce the possibility of stumbling upon such Landmarks again and again.
From my own experience I do know that something trivial like rearranging the furniture in your living room and redecorating the walls can sometimes really help to fight depression. Repaint that Landmark in a fresh new color, and it may become much less haunting to you.
June 19, 1783 –
