Thursday, April 29, 2010

The Problem with no Name.

Basic Australian medical education is geared towards producing generalists, sort of jacks-of-all-trades in the practice of medicine. As such, I received little formal training on the subject of post natal depression. If my memory serves me correctly, we were told the the phenomena was incompletely understood but felt to be largely a hormonal problem, some factors predicted it and that when encountering a case, the patient should be referred to appropriate specialist care.

My medical training post medical school was extremely varied and broad. This was because I drifted through the medical profession becoming bored by the various specialties that I had undertaken training in. So when I started working in General Practice (Family Physician for my American readers) I was pretty green with regard to the subject of post-natal-depression. (PND)

One of the first things I did note was that certain personality types seemed to be more prone to the condition than others. Individuals who were more ordered, fussy and regimented in their ways seem to me to be more prone to it than carefree individuals. Career women seemed to be more prone to it as did the dogmatic/domineering lefty/righty types. It seemed to affect certain personality types more than others. Women who were determined to breast feed their children, no matter what, seemed particularly prone.

One of the common themes that seemed to run through these women was their utter incomprehension of how they came about to be depressed. Many of them felt failures as women, after all, what is more natural than motherhood? Isn't every woman supposed to be a natural mother? Their failure at motherhood proof that there was something "wrong" with them.Many of them felt failures, even though in real life they were highly successful professionals. Many of them had tried valiantly to overcome their feelings, only to come crashing down.

On the other hand, other groups of women positively thrived in motherhood. These women seemed positively enamoured of there state, many of them wanting to more children and saw themselves as professional mothers. Some of them were so overjoyed by the experience that they ditched high powered careers to stay at home with the kids. What frequently stopped them having more children was their spouse, who for a variety of reasons, did not want any more.

What clearly became apparent to me after a while was that there were three groups of women:

Group A, the professional mothers, who loved caring for babies,
Group C, the depressed mothers who were having a hard time caring for their children
Group B, Women who fell somewhere between the two.

When it came to motherhood, women were not the same.

What struck me about the Group C Women, was that many of them were temperamentally not suited to caring for children and that this temperament was innate. They had become depressed because of the situation they had found themselves in, or in other words, their post natal depression was a reactive depression; they were depressed because of their circumstances. Solution: Change their circumstances.

Now I have either been extremely fortunate or have only seen mild cases, but only a very few of my patients have required specialist care. ( One, I think) because I tend to manage these cases quite aggressively. The mainstay of my approach is:

1) Aggresive use of anti-depressants, usually for a short period.
2) Child care, to give the mother some breathing space.
3) Returning the mother to some form of part time work.
4) Counseling, by myself.

Of these, the most important are 2) + 3) followed by 4) followed by 1). The anti-depressants buy time to let 2)+ 3) work their magic. Nearly in all cases, the women got better, came off the anti depressants and many in fact are fine and loving working mothers.

I wish to explore this subject at depth in future posts and will expand on pertinent points later as I feel the forces that combine to produce PND seem to provide insights into the operation of the female mind, operations which render it distinct from the male and challenge the assumptions made by both Traditionalists and Feminists regarding female nature.

One of the first assumptions which I feel is wrong is the concept that all women are natural mothers. Making and popping out the baby really doesn't seem to involve much effort, looking after it does and the test of practical motherhood is to see how effectively a mother looks after the child. The fact that quite a significant portion of women have difficulty looking after a child means that motherhood does not come naturally to all women, or more importantly, there are a significant number of women who are not naturally endowed with the ability to rear children. The concept that all women are natural mothers is flawed and at odds with reality. Some women aren't meant to stay at home and look after the children.

It's interesting where other peoples research seems to confirm your own findings. Catherine Hakim, hated by feminists, has through a study of empirical data come to the conclusion that in British society, if given the choice, 20% of women would stay at home to look after the kids (Group A), 20% of women would work (Group C) and the rest would like a mix of the two (Group B). Her research would seem to correspond to to my observations.

The big problem with both Feminists and Traditionalists is that they assume that women are a homogenous group, especially when it comes to pushing their pet theories. The trads assume all women should be mothers, the feminists assume that all women should be workers. No one asks what the women want or what the women are suited to doing.

Disclaimer.The comments above should not be considered medical advice. The mechanics of post natal depression are complex and subtle and this post is a rough overview which could be misinterpreted. If any one should stumble upon this blog whilst Googling PND and feels that they may be suffering from post natal depression, I would strongly suggest that you seek professional help early and definitely do not manage your condition alone. Many women feel that they are alone with condition and are too embarrassed to speak to anyone about it. Rest assured, you are one of millions with the condition. The only dumb thing that you can do is not seek help. Seek help early, as treatment is easier and recovery more rapid than waiting till your condition is much worse.

Special treat:

Catherine lays the boot into the Feminists.
Stuff that people who believe in Game already know.