Down dropped the asimon

It has been a little over a year. I wrote these lines a few weeks ago; the feelings had come back. Was it what psychologists call the “Anniversary Effect”? Or the cloudy and rainy days in Jerusalem dampening my mood? think seasonal affective disorder (SAD)…

They tell you, You look great and those dark circles under your eyes, well, you’ve delivered not long ago, what do you expect? They tell you Your broad smile cheers up the whole neighborhood when you walk around, your new bundle of joy wrapped up against your chest. They tell you You’re such a wonderful mother, of course, it is with poise and patience that you manage the arrival of number four! Right?

And you nod and you grin, but deep inside, your heart bleeds and your soul is screeching.

Because they don’t know that what keeps you up all night is not just your baby who has called for you twice or thrice. They don’t know that if you don’t manage to get enough food in your stomach for days on ends, it is not simply because your newborn is stuck to you 24/7. They don’t know that the time of day you actually look for is when you can get out of your house – baby in tow, of course – to get a breather before the sun sets for another night and other days without rest.

What’s wrong with you, really? Aren’t happy, don’t you feel blessed?

* * *

In May 2016, the Center for Women’s Health Studies and Promotion at the Ben Gurion University in the Negev  issued new guidelines for treating perinatal mood and anxiety disorders, which include, among others, what is commonly known as postpartum depression. According to the study supporting these guidelines, while millions of women in the world are affected by such disorders, only a third of them get treatment.

Three years earlier, an article in Haaretz reported that the Israeli Health Ministry launched a program aimed at detecting and treating women who suffer from depression during or after pregnancy. Questionnaires were to be administered in HMOs — Kupot Holim — and well-baby clinics — Tipot Halav — to women at the end of the second trimester of pregnancy and during their baby’s’ regular one- and two-month checkups. A pilot program was already in place in Jerusalem.

A year and a half ago, the already overworked nurses at the Tipat Halav in my neighborhood weren’t working in regular conditions — in cramped offices elsewhere while their building was undergoing renovation — and by the time they remembered to ask me about postpartum depression (PPD), my baby daughter was already 6-months-old. “But you don’t have it, for sure!” they said, assuming, from my usual happy-go-lucky smile, that I was that blissful mother every women would like to be, especially when her growing family is endowed with a princess after three little princes. “Oh, I have it, big time!” I answered, my smile broadening.

Had I been living in an Anglo environment, I may have been told early on that what I was experiencing had a name, and that it wasn’t just the “baby blues”, which, as a French female comedian puts it, sounds so trippy you almost want to have it. I may have been told earlier about Marie Osmond’s Behind the Smile or Brooke Shields’ Down Came the Rain, accounts of these celebrities’ journey out of postpartum depression. Or I may not have heard about it and all this has a reason.

It was only a month before my visit to the Tipat Halav that I was told about seeking treatment. And even then, I didn’t know what for… It seemed like no-one wanted to say the word…

It isn’t uncommon for a woman to experience mood swings right after birth. Your hormones are all over the place, your baby needs all of you, and so do your other children – and if you have a family “blessed with children”, which isn’t uncommon in this part of the world, well… you can go through cyclic feelings of elation and depression several times a day. That malaise, which often comes right after birth, lasts for a few weeks and goes away. PPD is different.

Postpartum depression is a medical condition, with specific symptoms, which can occur early on after delivery or even several months later. A few of the symptoms – which range in intensity – include fatigue; feeling sad, hopeless, overwhelmed; having trouble sleeping and eating; losing interest in things you enjoyed; withdrawing from family and friends; displaying no interest in your baby and/or having thoughts of hurting yourself or your baby. PPD is one form of disorders that a woman may experience after birth but the spectrum include, among others, postpartum anxiety, postpartum panic disorder, postpartum obsessive-compulsive disorder, postpartum post-traumatic stress disorder, and the most severe but also the most rare form of PPD, postpartum psychosis.

PPD can be treated. Treatment may include medication. Learning that depression had in part to do with chemical imbalance in the brain lifted a big weight off of my chest. And how should the following be understood? Was it merely the placebo effect? After taking medication for a few days, my head started clearing up and I realized that the fog that had invaded my mind for the past few months was starting to lift away. And that my inner little sun was rising again: “Hello, myself! Where had I been all this time?” It took me a bit longer than a few days to get all my strength and energy back, but experiencing quasi-immediate relief helped me see the light through the tunnel.

Psychotherapy. It helps. Kupot Holim have good therapists; private – and costly – therapists also exist. Typically, a mother may contact her Kupat Holim to make an appointment with a psychologist who will evaluate whether and what kind of treatment she needs. The first session may come with a fee but, at least in my kupa, psychotherapy is free and isn’t limited in time.

There are other resources, which don’t target women with PPD only but help any woman after birth. One of them is NITZA – The Israel Center for Maternal Health. Based in Jerusalem, this organization that runs by donations offers services to all women and their families in Israel. The Mom to Mom (Eml’Em) organization was also set up to help new mothers cope with their first year as parent, with the mother’s psychological well-being in mind. Those two organizations exist in Jerusalem – but not only – and they may be contacted via local Tipot Halav. Additional organizations exist elsewhere in the country.

PPD isn’t a character flaw or a weakness. Yet, expectations about motherhood often dwell on our minds like mantras. If we can’t function (because of depression), we may feel that we are “bad mothers”. In Israel, women’s participation in the workforce ranks fourth worldwide. At the same time, while the country’s fertility rate isn’t among the highest, it still ranks among the hundred top countries. Large families, strong working women, and the ideal image of the “Jewish mother” always on top of things create expectations about motherhood that may make you feel inadequate if your own behavior falls short of any of them.

Stigma is another foe. When you hear, a year after suffering the hardest episodes of PPD, this kind of sentence – “Oh, I just heard that so-and-so also suffered from PPD, can you believe it, she is the example of the perfect mother!?” – you cringe. You cringe because PPD has nothing to do with parenting ability. It has nothing to do with your intellectual abilities, your morals, your ability to love your baby and raise your children. But somehow, many women – and I was one of them – integrate stigma and expectations, unconsciously turning those against themselves.

Motherhood and mental health have unfortunately been brought to the fore in the past week. I had wanted to complete writing this post earlier but work and studies got in the way. It seems to me that I should postpone it no longer. At the same time, this post shouldn’t be taken as a commentary. No situation is the same and no one can understand every facet of a tragic event.

But… down dropped the asimon. If it took me so long to get help, I shouldn’t wait until Mental Health Awareness Month in May to raise awareness and share the information I have collected since then, if it can help.

May we hear only good news.