Post Partum Depression and Mother-in-Law Issues

We live in an age where there is an abundance of information and awareness about so many aspects of our emotional lives. One of those is regarding "post partum depression" (PPD), a type of depression that can occur following the birth of a child - sometimes appearing within days of the birth, and sometimes not until months later. The new mom, often overwhelmed with the hormonal and emotional changes, may find herself lost and afraid, unable to cope with the added responsibilities and expectations. PPD can appear in many degrees, from mild to severe. Usually there is the added guilt of feeling so low when she "should" feel joyful for the miracle of birth and a healthy baby. Needless to say, this condition often wreaks havoc on family harmony.

Such was the situation with Chaya who came into my office with her husband, Moshe, to seek help for her depression. They had 3 children under 5, the newborn being 2 months old. She reports that since the baby's birth, she has not "gotten back to herself" - indeed, she finds herself crying a lot during the day; feeling like she has to "walk through molasses" to complete even a simple task. Everything seems to be a struggle. Even praying, which used to be a source of comfort and strength, now is difficult. Indeed, she feels afraid, misunderstood and, in her words, "abandoned by G‑d."

Moshe is frustrated with his wife's struggle. Although he tries to be sympathetic, he often feels it's "all in her head" - and he wishes she could just somehow "snap out of her bad mood." He reports that they have just moved into a beautiful new apartment. She has everything to be grateful for. And he simply can't understand why, with this child, her recovery is taking so long. In an effort to help his wife feel better, and on the advice of well-meaning friends and relatives, he encouraged Chaya to see a psychiatrist and get some medication. Chaya was upset about having to take pills, and is despondent over the fact that this birth was so different than the other two.

In helping this couple cope with the present crisis, I first stressed the importance of understanding what PPD is all about. I emphasized that fact that although Chaya had not experienced PPD with her other two children, every birth is different. And that PPD is not only a normal human response, but actually quite common. However, because it causes such guilt and self-blame, it often goes unreported and untreated, until, in severe cases, medication is warranted. It makes sense that Chaya would feel "abandoned" – but her reaching out for help, and her willingness to find answers, were already the beginning of the healing process.

Sometimes PPD is purely a result of the enormous chemical changes in the body, and in some cases medication is certainly recommended. However, as we talked about their marriage, I sensed that there were some underlying issues that might help us examine what is making Chaya so vulnerable this time. She expressed admiration for her husband, and love for her children and great satisfaction in being a home-maker. But, when I asked her what has been the greatest pain in her life - she quickly responded, "my mother-in-law." When I asked, "How long has this been going on?" She answered, "Since day one!" She seemed surprised and embarrassed at the quickness of her answer, and certainly Moshe looked surprised as well. Not only did he not know this information, he did not see the connection to what is going on now.

Chaya was quite reluctant to share honest feelings with Moshe for fear of "hurting him." After all, he's a good husband and provider, and a very caring father. However, with a little assurance and encouragement from both Moshe and myself, she proceeded to talk about how she felt her husband was pulled between his mother and herself. Chaya never felt comfortable with her mother-in-law's demands and her "nosiness." She gave several examples of such incidents. Although Moshe validated these examples, he never realized how deeply Chaya had been affected. He smiled and wondered if perhaps she was "too sensitive" and took everything "too seriously." His judgments made her retreat into herself further, alternating between self-blame and anger at him for not understanding her.

That, of course, led to a discussion of various personality types. Although the topic is quite complicated, because of all the variances, most people can, indeed, see themselves as defined by descriptions of introvert/extrovert, sensing/intuiting, feeling/thinking, and spontaneous/organized. In addition, we can describe those who are more "head" oriented, and those who are more "heart" oriented. Some are naturally more sensitive and dramatic. Others are more thinking types, and, still others, seem not to react too much altogether. We are born with these differences, and our strengths and weaknesses which eventually constitute our "repair work" – tikkun – in this world. The Torah's account of Jacob's 12 sons are a classic example of such personality types. Each son was a world unto his own, defined and acknowledged in the blessings they were given before their father's death. Perhaps we can apply the well known saying, "Maa'seh avot siman l'banim" – the deeds of our Fathers are a sign(post) for the children." Utilizing this knowledge helps us enhance and refine our relationships. A knowledge of the personality types will help to move us towards greater tolerance, forgiveness and appreciation of ourselves and others. (To educate yourself regarding the basic personalities, please see "The Enneagram Made Easy" by Baron and Wagele, "The Wisdom of the Enneagram" by Don Riso, or "Awareness" by Miriam Adahan. This information can be life-changing!)

In this case, we can see a clear example of a few factors that can trigger depression, or depressed/lowered feelings:

A) Lack of honesty in a relationship - having to "depress" the truth - usually for fear of "hurting" someone. In this case, Chaya's lack of communication with her husband for fear of "hurting" him actually ended up hurting both of them.

B) Not "knowing" oneself - "depressing" the intuitions and instincts that are built into our personalities. Chaya had been discounting herself since the beginning of her marriage. She, herself, had not understood the profundity of her pain. She never learned to acknowledge herself or "take herself seriously." And therefore, Moshe was not able to understand her either.

Once this major issue was "put on the table" - Chaya felt a great sense of relief. She was grateful that she was able to deal with the fear that her husband would never understand or accept her feelings. Moshe, despite his initial lack of empathy with Chaya's strong response to his mother, was finally able to accept his wife's feelings without resentment. We spoke about "safety" in the relationship - making each person feel heard and validated.

As Chaya and Moshe continued to work through their issues, Chaya felt increasingly supported by Moshe, and developed greater trust in his ability to stand with her as a strong unit. When there was any pressure from outer environment, especially his mother, they were able to successfully negotiate an approach which felt "safe" for both. As the situation improved and Chaya's depression lifted, the psychiatrist agreed to wean Chaya off the medication. And the "icing on the cake" came a few months later when Chaya volunteered to work on a hotline for women who were going through PPD.