Misery in Motherhood [Preview]

A deep despair mars the first year of motherhood for as many as one in five women. Without treatment, postpartum depression can weaken critical bonds between a mother and her child

The psychologist smiles at Manuela, a new mother in her late 30s. “Please play with your baby for two minutes,” the therapist instructs her and then leaves the room. Two video cameras film Manuela (which is not her real name) and her three-month-old daughter. In the next room, a split-screen monitor shows the mother's profile on the left and her infant in a baby chair on the right.

At first, Manuela appears to be at a loss for what to do. Then, her face noticeably stiff, she begins to talk softly to her baby. Her baby fidgets, briefly makes eye contact and then turns away. Manuela eventually stops talking and stares into the distance, unsure again how to act. She absentmindedly strokes her baby's foot with one hand. The psychologist knocks on the door; the videotaping is over. The new mother is now on the verge of tears.

Manuela is undergoing therapy at the Clinic for General Psychiatry in Heidelberg, Germany, for postpartum depression, an ailment that has strained her relationship with her baby. Although the vast majority of mothers experience periods of crying and irritability, along with concentration lapses and exhaustion, these so-called baby blues disappear within a few hours or days of delivery. But 10 to 20 percent of women in the U.S. develop, in the first year after childbirth, the more disabling despair that afflicts Manuela. These mothers succumb to a deep sadness that, if untreated, may persist for months to years.

Manuela frequently feels exhausted and emotionally empty. When her baby cries, she sometimes wants to flee or hide. She is wracked with guilt because she cannot show love to her daughter. Mothers with symptoms of postpartum depression [see box on page 96] are often overwhelmed by the feeling that they might harm their babies. Although they rarely cause any outright harm, depressed mothers may have difficulty caring for their infants—and that fact can heighten their distress.

These emotional problems plague women worldwide. A 2006 review of 143 studies in 40 countries documents that postpartum depression is especially common in Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea, with prevalence rates as high as 60 percent in some countries.

The causes of the disorder are not fully known, but the dramatic hormonal fluctuations that occur after delivery may contribute to it in susceptible women. A bout of previous depression is a huge risk factor for the postpartum variety, new research shows. Whatever its cause, depression can weaken the nascent bond between a mother and her child, studies suggest, and thereby make a toddler more passive, insecure and socially inhibited—although a child's intellectual development usually remains unimpaired.

Thus, in addition to treating the mother's depression, psychologists and psychiatrists increasingly focus on strengthening the relationship between the mother and her child—for example, by using a video camera to record and analyze their interactions. “We need to change the unfavorable behavioral patterns that develop between mother and child during depression,” says University of Heidelberg psychologist Corinna Reck.

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