I’m angry!

I’m feeling really angry at the moment. The newspapers are often full of troubling headlines about inadequate mental health services. But a recent report touched both a personal and professional note for somebody who, more than twenty years ago, suffered herself from postnatal depression. (1)

I can now make the professional observation that the medical model of treatment for PND is not appropriate and actually risks lives.

The story which disturbed me was that of a young mother who jumped from the top of the multi-storey car park just a few months after giving birth to 2 healthy babies.

Claire Turpin was let down by our society and let down by a mental health system ill equipped to identify and offer effective support and advice about how to get over depression for a woman who was in desperate need.

Mail Online Sunday, Mar 02 2014

”A mother of twins who had longed to have children committed suicide because she thought she was an inadequate parent.

Claire Turpin, 42, had struggled to conceive, eventually succeeding after lengthy fertility treatment. But she went on to become acutely depressed even though she was caring well for newborns Jack and Eliza.

Three months after their birth, the married former hotel manager jumped from the top of a John Lewis multi-storey car park.

An inquest heard Mrs. Turpin had been referred to a mental health team and became ‘paranoid’ about social services wanting to take her babies away. Her mother Kath Sugden criticised the medical support she was given, telling the hearing:

‘All that happened was that Claire went to the doctor and came home with another batch of tablets.

I was expecting things to move a little bit faster. She should have had more and quicker help from the agencies. I saw her deteriorate over these few weeks day by day…..’

The SAFE SPACE lens

Post natal depression can start from two weeks to several months after delivery. It often develops slowly, sometimes making it difficult for doctors to diagnose and hard for the mother herself to recognise.

There are various theories about what causes the problem. Biological, psychological and social factors can all play a role.

But, viewed through the SAFE SPACE (2) lens, it is easy to recognise how post natal depression can occur for the very same reasons that all depression occurs. – Unmet emotional needs.

If you suspect that you (or someone you know) may be suffering the effects of PND, check out which of your emotional needs is not being met by your current lifestyle.

Safety and security

It is common to lose confidence in your abilities as a mother. Emotional distress can lead to a feeling of being unsafe. Both mind and body can seem unpredictable and almost outside your control.

Some mothers have troubling thoughts that their babies may be taken away. they are wary of opening up to doctors or health visitors as they are frightened of being viewed as an unfit mother.

Attention

Depression interrupts the ability to give and receive attention. The severely depressed person becomes ‘selfish’ inasmuch as they are focused on self and internal processes. This can lead to further feelings of guilt and inadequacy.

Fun, family friends

For a new mother at home with two small and demanding babies, it can seem that life is all work and no play or relaxation.

This contrast is all the more difficult for those mothers who have previously been fully engaged in a work environment which is both sociable and intellectually stimulating.

Emotional connection to others

Both emotional and physical isolation impacts well-being. The isolation of being in the home all day with only a small and demanding baby for company can, in itself, be the source of depression.

Status and feeling valued

We all love a pat on the back for a job well done. But being a good mother or good home maker is often not appropriately valued by our society. People tend to notice when it’s not being done well but do not notice and offer praise or affirmation for a job well done.

For this reason, mothers and housewives can feel invisible. The contrast between the work environment and home environment could not be more stark. Status is a significant unmet need.

Privacy

There is very little room for privacy, or time to relax and unwind with two new babies.

Sleep is also interrupted and in short supply which can have a dramatic effect on well being and the ability to cope.

Achievement

We all love to have a sense of achievement and women who are high achievers are often perfectionists.

But anyone who has had the job of looking after small babies will understand the incompatibility of perfectionism and childcare.

Anything less than perfect may feel unacceptable. But ‘less than perfect’ is the realistic option. Donald Winnicott’s (3) notion of the ‘good-enough’ mother is more achievable for most.

Control

Autonomy and control fly out of the window where childcare is concerned. It is impossible to totally control babies who can seem unpredictable at best, chaotic at worst

Engagement

The isolation of a new mother, both social and psychological can have a huge impact. Sadly, an early reaction to depression is the tendency to retreat. Less social support simply compounds the problem.

How to get over depression

Having identified which of your essential human needs are not being met, you might now have more clarity about why you are feeling so low.

Take action. Ask for help. Do whatever you need to bring a better balance into your life.

Many people say they will do x or y when they feel better. But it’s the doing that makes you feel better

Take proactive steps to readjust your life and get back on track:

• Practise relaxed breathing for ten minutes twice a day to calm anxiety and promote better quality sleep. A relaxed mum often equals a relaxed baby.

• Get enough full spectrum light to raise your mood by getting outdoors every day for at least twenty minutes. This will also be very good for your baby. Daylight helps to regulate the body clock for you both.

• Take practical steps to adjust to your new circumstances and seek as much support as you can from friends, family and professionals.

Finally, cut yourself some slack and set aside the idea that you have to be perfect.

Babies also have their needs.

Having a high-achieving, super-slim mother and designer home are certainly not amongst them!

The Fusion Model approach to resolving post natal depression involves:

• Staying solution focused

• Accessing the neuroplastic brain for change management

• Active breath work to calm anxiety and promote better quality sleep

• Full spectrum light work to elevate mood. getting outdoors every day for at least twenty minutes

• Restoring hope by positive and structured sessions with weekly achievable tasks

• Putting a fence around worries by learning to ‘worry well’. Having fifteen minutes a day set aside ‘just for worrying and problem solving.’

• Take practical steps to readjust to new circumstances. Seek support from friends, family and professionals

• Use of the holistic life wheel to notice areas of challenge and acknowledge all the positives through scaling

• Super future pacing and preferred future

• Harnessing the reticular activating brain mechanism for future focus

• SMART goals and tasks

• Motivational support

• Using the STOP System for pattern breaking

• Use of The Rewind technique for resolution if traumatic birth is part of the picture

• Using appropriate poetry, story and metaphor to reframe and shift focus

• Staying within a prescriptive five session format where possible to focus

• Refer to the Matrix of Interventions for other appropriate interventions such as the CBT hot cross bun technique

• Sleep management

• Client psycho education for personal empowerment