Labayit Women’s Magazine, in conjunction with Maaynei Hayeshuah’s Mental Health Centre – the first psychiatric hospital in the world for the Torah-observant community
Shortly after Sarah gave birth to her seventh child, she found that whenever she thought about her imminent return to work, she immediately became overwhelmed with the fatigue and exhaustion that had become all too familiar to her as of late. In truth, when she gave it more thought – yet another thing that was difficult for her to do these days – she noticed that she seemed to be perpetually tired and weak. She had started taking extra household help and stopped attending social events when she realized that they tired her too much, but all that did not seem to do much to alleviate her constant exhaustion. Finally, at her sister Miri’s urging, Sarah called the local medical clinic and scheduled an appointment with the family doctor to request an extended maternity leave. At the same time, she informed her boss that she will not be returning to work just yet. “Indefinitely, for now,” she muttered under her breath.
The appointment with the doctor took longer than usual. In fact, everything about it was different than the previous visits that Sarah recalled, which were always short and to the point. This time, the doctor seemed to have all the time in the world. She was thorough, patient, and completely focused and attentive to Sarah’s every word. When Sarah described the fatigue she was experiencing since her recent birth and her desire to extend her maternity leave, the doctor responded with empathy and sensitivity. She asked all kinds of questions about the fatigue and its manifestations, and wanted to know how the house was running and whether there were any activities that Sarah had stopped doing despite the fact that they had previously brought her pleasure. She inquired about Sarah’s sleep patterns, and Sarah was surprised to hear herself describe how she actually wanted to sleep and would generally turn in early because of her exhaustion, yet it usually took her much time to fall asleep, and she woke up many times at night despite the fact that her baby was relatively calm and slept through much of the night.
Throughout the conversation, Sarah suspected that the doctor was leading somewhere, but the fog that had become her constant companion lately – and which she had attributed to her tiredness – prevented her from defining to herself what it was that was in the air between them.
Sarah began feeling uncomfortable as the conversation progressed and she began wondering about the purpose of all these questions. At one point, she found herself rummaging through her pocketbook for a tissue through a haze of tears, and was gratified when the doctor gently handed her one. The pain washed over her, and she found herself crying to the attentive doctor. “It’s just so confusing and hard,” she unloaded to her. “I have no energy to cook, fold the laundry, clean up my house… I also keep crying and get upset over the stupidest things. I just cannot understand what is happening to me. Is it just because I’m still weak after the birth? I feel like I haven’t gotten back to myself yet. And the part that is hardest for me is knowing what my kids are going through. I hardly take care of them. My husband needs to do a lot of things instead of me. Sometimes he does cook something, but when he doesn’t have time for that, they eat whatever we have in the house, like store-bought soy patties and things like that. I just keep reassuring myself that they’re not hungry and that there’s nothing wrong with it. But when it comes to my baby, I know I’m not being a good mother. I have no energy for him.”
Sarah’s responses to the doctor’s questions revealed that her appetite had sharply decreased and that she was avoiding familial and social events that had been a regular and enjoyable part of her life before the baby’s birth. The doctor signed on a two-week extension of Sarah’s maternity leave in order to give her additional time to recuperate and gain her strength back. She also referred Sarah for some general blood work and recommended vitamin supplements to provide her body with more energy.
And then came the part that Sarah had secretly been afraid of.
“The symptoms that you described,” said the doctor seriously, “indicate that you are possibly suffering from postpartum depression. I am giving you a referral to the mental health clinic, and I want you to schedule an appointment there as soon as possible. Please make sure to do it as quickly as you can. It is extremely important that a specialist in this field will see you to determine the correct diagnosis. That way, you will be able to receive proper treatment, which generally includes medication and therapy. Postpartum depression is a very common phenomenon. About 31% of new mothers suffer from it and it may develop even up to a year following the baby’s birth. There is excellent treatment for it and it would be a shame for you and your family to suffer even one extra day when you can get help.”
Sarah took the papers from the doctor, thanked her with a weak smile, and slowly left the room. Her legs refused to move forward. She sat down on one of the chairs in the waiting room and waited for her sister to come and walk back home with her. Her sister Miri had been a lifesaver within the weakness and darkness that had been surrounding her. Miri listened to her, encouraged her, and was also the one who had convinced her to go to the doctor. Even now, Sarah felt that she needed Miri’s presence beside her. She knew that without Miri’s support, she will not be able to help herself.
The blood test results showed no obvious medical reason for Sarah’s fatigue, other than a somewhat low hemoglobin count, further reinforcing the doctor’s presumptive diagnosis of postpartum depression.
Sarah’s symptoms indicate possible PPD. She is experiencing fatigue and lack of energy. She has lost interest in things that once gave her pleasure – shopping, social events, and family gatherings. She lacks the desire to initiate simple activities and has a hard time falling asleep (or remaining asleep for a long stretch of time), even while the baby is sleeping. Sarah is finding it difficult to focus on activities such as cooking or housework. She has poor appetite and does not enjoy foods she once enjoyed. She is experiencing feelings of disappointment with herself and guilt for “not being a good mother.”
Sarah tried to explain away all the symptoms through different excuses and to convince herself that “everything is fine,” that it is only natural to feel this way after the birth of a child, and that sometimes it simply takes longer to recuperate. Yet this, too, is another symptom of PPD, preventing the motivation and cooperation so vital for the treatment. Sarah’s sister, Miri, needed to work hard to persuade her to reach out to the doctor, and even needed to be personally and practically involved in Sarah’s visit to the doctor. Miri’s presence in Sarah’s life served as a significant, positive factor in identifying the problem and referring Sarah for treatment.
“Postpartum depression has become very common over the last few years. The good news is that it is highly treatable. Many women receive treatment in the clinic – a combination of medication and psychotherapy. Consistency is an imperative factor in the success of the treatment. At the same time, it is crucial to understand the importance of a solid support system: friends, family, husband, or parents. This is when they all need to gather strength, tolerance, and patience, and to believe in her ability to heal. No one should ever blame the patient. When a patient tells us, “I can’t,” and the family says “She doesn’t want to,” the professionals say “She is unable to want – her ability to “want” is impaired.”
Restlessness and difficulty remaining seated in one place, excessive worrying that affects the patient’s peace of mind, feelings of despair and no pleasure in life, frequent bouts of sadness, feeling that everything is done “robotically,” caring for the baby “because that’s what needs to be done” without joy or pleasure, difficulty making decisions, disorganization and forgetfulness. These are all basic changes that are important to check out in order to rule out PPD.
The sharp mood decline, sometimes developing into anxiety surrounding the baby’s care and safety, are a result of a significant deficiency in serotonin – the chemical produced by the brain which is responsible for normal, happy mood. Any negative change to the serotonin levels will affect the mood. A slight decrease is typical in the postpartum period, but a healthy diet and rest should encourage the body’s return to normal function. Poor appetite and insomnia may disrupt the biological life cycle and inhibit the postpartum mother’s weak body’s return to normalcy. Something in the self-healing process ceased, initiating an overall decline that is characterized by frequent crying spells, feelings of guilt, and fear of harming the baby. A tremendous difficulty in emotional regulation develops. The continuation of this decline then develops into depression. If the patient exhibits many of the symptoms described, a visit to the family physician is necessary to consider referral to a mental health clinic.
The people in the patient’s immediate environment are in a crucial place in identifying the problem as well as in taking an active role in addressing it. A new mother who is not feeling well, has a hard time falling asleep, has frequent crying spells, poor appetite, and so on, is certain that this is all part of the recuperation following the birth. Her low energy levels prevent her from taking initiative and doing what she needs to do in order to heal.
The process leading to depression begins with fatigue, decreased motivation and desire to act, and exhaustion. As time goes on and the symptoms continue, additional symptoms may appear, such as bouts of sadness, crying spells, or excessive irritability and anxiety. These symptoms may appear even as late as a year after the birth, and if there was a trigger event at that time, you may link it to the preceding birth.
I would like to urge all family members, and especially the fathers/husbands who are shouldering the burden and seeing the symptoms described in the beginning of this article:
Parents and other close family members, please note! A weak mother who does not find enough energy within herself to run her home – a mother who drops the reins because “she has no energy” – is a precarious situation for the entire family. If there are young children at home, they currently have no mother. If there are also older children who need to fill in for the mother’s role instead of her, they are experiencing a tremendous privation, and their emotional development, as well as social and cognitive development, are at risk. Please, fulfill your moral obligation to the family and make sure that the mother receives proper treatment from a licensed physician.
In the last week of November 2019, Professor Rael Strous, the South African-born medical director of Mayanei Hayeshua’s Mental Health Centre, and professor of psychiatry at Tel Aviv University’s Faculty of Medicine, was in London for a busy round of meetings and events organised by the British Friends of Mayanei Hayeshua.