The silent struggle of postpartum depression

The silent struggle of postpartum depression (Photo: iStock) When Jane gave birth to her daughter, she expected to feel the wave of joy and love that everyone told her would come naturally. Instead, all she felt was fear, rage and confusion. "She wouldn't stop crying," she says now, nearly four years later. "And I couldn't sleep. I hadn't eaten or bathed. I would look at her and feel nothing. Worse than nothing, I actually felt disgust. Then guilt for feeling that way. I hated myself. I hated my baby." At the time, Jane couldn't say those words out loud. When she finally confided in her aunt, the response was unforgiving. "She told me I was selfish and ungrateful. That I should be thanking God for giving me a child while other women cry and pray for years to conceive. That I needed an exorcism. I shut down after that." For Anne, the joy of childbirth quickly turned into a nightmare. "I loved my baby, but I was terrified of myself," she says. "I kept imagining and hearing voices ordering me to do terrible things to my baby. Dropping him, shaking him when he cried and smothering him, even though I never wanted to." The intrusive thoughts left her feeling like a monster. When she told her husband, he dismissed it as hormones. Jane's and Anne's stories are not unusual. But they're rarely told and when they are, they are met with moral outrage and backlash. Society's expectations of motherhood leave little room for nuance: the image of the nurturing and glowing mother is so deeply embedded that anything outside of that is treated with suspicion, even hostility. But experts say the two women's experiences are more common than most people think and far more dangerous when ignored. Dr Violet Kiara, a Nairobi-based psychologist, says the myths around maternal mental health are some of the hardest to break. "There's this belief that a mother will always love her child immediately. That she will cope, naturally and instinctively," she says. "But the reality is that childbirth is a massive physical, emotional and psychological upheaval. For some women, it triggers serious mental health disorders, including postpartum depression and worse, psychosis." Postpartum depression (PPD) can begin anytime within the first year after childbirth. It goes beyond the "baby blues", the mild mood swings and weepiness many new mothers experience due to hormonal shifts. PPD is deeper, longer-lasting, pervasive and more impairing. "It's characterised by persistent feelings of hopelessness, anger, sadness, irritability, fatigue, guilt and in many cases, detachment from the baby," Dr. Kiara explains. "A mother might feel like she's failing, like she made a mistake having a child, she may feel a 'hatred' for the child, or like her baby would be better off without her." Research shows that 10-20 per cent of women globally experience postpartum depression. A landmark meta-analysis of 291 studies involving almost 300,000 women from 56 countries estimated that approximately 17.7 per cent of mothers experience postpartum depression worldwide, which is consistent with the commonly cited prevalence range of 10-20 per cent. If left untreated, PPD can escalate to postpartum psychosis, a condition that affects approximately 1 to 2 out of every 1,000 births. In these cases, mothers may experience both visual and auditory hallucinations, delusions, paranoia and exhibit bizarre behaviour, often centred around the baby. It's crucial to understand that PPD comes as a spectrum and its effects can be far-reaching and long-lasting. While often associated with the immediate postpartum period, the reality is that PPD and its more severe form, Postpartum Psychosis (PPP), can linger for many years after birth. For some women, the experience profoundly alters their baseline mental state, meaning they never truly return to who they were before childbirth. This explains why some individuals may suffer from psychosis or other severe mental health challenges even after their children are grown, decades after the initial onset of symptoms. In 2020, an American woman, Melissa Wilband, was charged with murdering her four-month-old baby Lexi by violently shaking her when she wouldn't stop crying. It resulted in brain injury. According to neighbours, she had been "acting weird" days before the incident. Melissa was jailed for 15 years, but experts familiar with the matter suspect she was suffering from postpartum psychosis. If true, hers would not be the first case, or the last, where mental illness collides with the law. Attorney Winnie Odali, a women's rights lawyer who has represented women in similar circumstances, says these cases are more complex than the public often realises. "When a mentally ill person commits a crime, particularly a woman harming her child, the reaction is usually anger," she says. "But very few people stop to ask, Was she okay? Had she been showing signs of illness? Did anyone try to intervene?" Winnie explains that under Kenyan law, a person who commits a crime while mentally unfit can be found "not guilty because of insanity." But invoking that defence requires a thorough psychiatric assessment, a competent legal team and often years of delay, all resources the average woman may not have. "The reality is that women with untreated postpartum disorders are being jailed in this country, when what they need is urgent care," she says. Jane was lucky; she didn't reach the point of psychosis, but she was close. After weeks of pretending everything was fine, she broke down during a routine clinic visit. A nurse referred her to a counselling centre that had just launched a maternal mental health program. "It saved me," she says. "The first thing the therapist told me was, 'You are not a bad mother, you are just unwell, and we can help you.' That one sentence cracked open everything." Jane was diagnosed with postpartum depression and began therapy and medication immediately. It took nearly six months before she began bonding with her baby. "I wish someone had warned me this could happen." Anne was helped by a friend, a psychiatric nurse, who recognised the signs and suggested she might be exhibiting early signs of postpartum psychosis. "Just having a name for it helped me breathe," she says. With support from a psychiatrist and her friend, she began to recover. "I still have moments of paranoia, but I no longer carry the shame." Unfortunately, access to such help is limited in Kenya. Mental health services, particularly in rural areas, are scarce. Maternal mental health is rarely prioritised and many women don't even have the language to describe what they are experiencing. Dr. Kiara notes that even among educated women, shame is a major barrier to seeking help. "A woman will say, 'I feel dead inside,' or, 'I can't stand my baby crying,' or, 'I hate my baby,' but she won't connect it to mental illness. She'll say she's weak, or lazy, or not praying hard enough."

The silent struggle of postpartum depression

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