As part of Guardian Media’s ongoing focus on postpartum depression, Caroline Ravello writes about the need for T&T to become more sensitised about this debilitating perinatal illness which affects a significant number of new mothers and their babies. Look out for Caroline’s weekly column on Wednesday when she tackles other mental health issues.
There is a line in the movie In The Line Of Fire which, for me, captures the terrifying experience of clinical depression. Mitch Leary (John Malkovitch) an ex-CIA assassin taunts Frank Horrigan (Clint Eastwood) the agent, who is investigating a threat to the current US president and is determined not to let the history of John F Kennedy, of which he was a part, repeat itself.
Leary is intent on killing the current president and plays on the debilitating fears and failures that haunt Frank. In one of Leary’s teasing, torturous phone calls he says: “Tell me Frank, when you are alone and the demons come, what do you see?”
It has long been the line that would describe for me the depth of depression and the inherent aloneness one experiences, which can be so overwhelming forcing an individual to weigh death above life.
Postpartum depression (PPD) and suicides have dominated media this past week. PDD is a perinatal illness which carries all the symptoms of clinical depression including feelings of being overwhelmed, intense anxiety, frequent crying or weeping, irritability or anger, pervasive sadness, fatigue or low energy, feelings of worthlessness, hopelessness, or guilt and changes in sleeping or eating habits.
PPD manifests in mothers with a high and acute level of anxiety, with the added burden of feeling of inadequacy, negative thoughts of, and fears of harming the newborn. Anxieties for a new mother takes many forms and include intrusive, frightening thoughts that are overpowering.
While those feelings run in high percentages among new mothers, researchers say this sometimes dreadful disorder called PPD actually affects 6.5 per cent to 12.9 per cent of women in the first year postpartum.
Postpartum psychosis is another similarly occurring perinatal illness marked by high mood (mania), depression, confusion, hallucinations and delusions that occur. This is considered a psychiatric emergency.
About predisposition, researchers say: “The most common risk factors for PPD are antepartum depression, personal psychiatric history, family psychiatric history, poor social support, and poverty.”
The longer a woman is incapacitated by PPD, the more she is at risk for lifelong and recurrent depression and suicide, and that untreated PPD may seriously damage the mother-infant relationship.
Quite often it is a partner or relative who recognises the symptoms. The question for T&T is: “How many partners or relatives know or think they need to know the signs and how many, including and especially fathers/partners are part of pre- and antenatal care?” Or further, “How many pre- and antenatal healthcare providers and clinics present this as a real possibility to expectant and new mothers?
Do doctors unfailingly forewarn patients about PPD so the patient could approach the doctor with less trepidation?
What if husbands and relatives/family members were trained as part of antenatal care?
What if we were to engage and embrace the discourse on despair daily?
What if the issues of mental health were easier to accept because we were more educated and sophisticated in our thoughts and approaches to this globally prevalent issue that nations and individuals are talking openly about for decades now?
The sentiments and or emotions associated with grief are similar to that of depression. What if we were able to differentiate grief from depression or depression (a disease or disorder) from sadness (an emotion)? What if we were being taught continuously that to be affected by a mental disorder is no different from any other physical illness or ailment?
What if we were committed as a family, community, health sector, and national citizenry to openness about mental illnesses and disorders?
We have changed the dialogue over cancer, HIV/Aids, LGBTI issues, and others that were/are taboo, what if we realised that the illness of the mind could be the illness of everyone with a mind?
Depression—major, minor, PPD—has a zone of darkness, a yawning chasm almost which sometimes seemingly offers more comfort in death than life. That hopeless darkness is a more common occurrence in T&T than we are ready to accept. But the fact is, suicide, suicidal ideation, and attempted suicide exist among our family and friends, with our without a history of depression.
For T&T, a 2014 World Health Organization report says that suicide rates here are “higher than regional and global averages.” That report gave T&T’s 2012 rising suicide rate as 13 per 100,000 inhabitants. We are surpassed by Guyana only in this hemisphere.
Suicidal thoughts or suicidal ideation, are thoughts about how to kill oneself, which can range from a detailed plan to a fleeting consideration. It does not include the final act of killing oneself. Most people who experience suicidal ideation do not follow through with a plan or action.
Though ideation and actual suicides are prevalent among us, we give no consideration to these matters on a daily basis as we ought to do. Death is what moves us. But what if instead T&T was sensitised to depression with the same compassion, tears, and receptivity, not as the after-the-fact emotions but as a real commitment to saving the lives of those who live with or experience depression?
Stigma and discrimination perpetuate the shame and guilt about these feelings. It causes us to rationalise what we see (depression) to what we can accept (sadness, grief) and so limit our response to the real need to our own detriment.
Tell me, if we become more progressive in our daily commitment to reducing the incidence of depression—clinical, postpartum, major or minor, and curbing suicides: “When the demons come what would we see?”