The awesome responsibility of caring for a newborn naturally warrants a heightened sense of vigilance. Sometimes this necessary state of watchfulness can be confusing. At every turn, a new mother believes a crisis is looming. Afraid of slipping and dropping the baby, she holds them extra tightly while she goes down the stairs. Afraid of a disaster in the night, she keeps herself awake to hear the silent sounds of breathing. If she falls asleep from sheer fatigue, she dreams of causing the baby harm through her own negligence.
Here are some reasons why postpartum women don't share these scary thoughts:
1. The ambiguity factor
One reason why postpartum women don't talk about the thoughts that are having is that they are not sure what is "normal" and what may be problematic. This is due to the overlapping experiences between women with postpartum anxiety or depression and women with no such diagnosis.
For example: fatigue, loss of libido, moodiness, weepiness, changes in weight, sleep disturbance, and low energy can all be attributed to anxiety and depression, yet they are also considered to be within normal expectations for postpartum adjustment. Because moods and other internal experiences are expected to fluctuate following childbirth, women sometimes decide it is best to brave any discomfort and hope it goes away by itself.
Unfortunately, scary thoughts are not easy to ride out. What's more, without proper assessment, a woman's worry about these thoughts can rapidly disintegrate from initial concern to panic.
2. The critical inner voice
The shame that can accompany upsetting thoughts is unbearable. What is wrong with me? How can I be thinking these things? Good mothers don't think such terrible thoughts. Often, the only explanation that makes sense to a mother who is trying to reconcile this disturbing experience is that there is something profoundly wrong with her, something is broken inside. Maybe she is close to insanity. Or maybe she is not fit to be a mother. Either option, or anything in between, is a nightmare. This nightmare stuns many women into silence. They hope that if they can just hold their breath and carry off this role-play, their awful thoughts will somehow go away. In some instances, the thoughts actually do go away. Usually, they do not.
Other women tirelessly try to push the thoughts out of their minds, but are distraught when the thoughts return in full force. Some women can express the horror of their thoughts along with the abysmal shame that accompanies them, but, for many, the actual articulation of the specific thoughts, the words they fear would somehow make the thoughts come alive, remain locked inside.
Women say they are embarrassed, ashamed, mortified, humiliated and guilty beyond description. They say they feel hideously exposed, naked, repulsive, raw, nauseous, ugly and sickened by their own thoughts. Some say they feel so appalled by the nature of their thoughts that they feel inhuman, as if only a monster could possess and admit such atrocities.
An important point here is that high level of distress indicates that the scary thoughts are ego-dystonic, or incompatible with the woman's sense of herself. Although it is never easy to experience such high levels of distress, there is considerably more concern when a woman expresses no such distress or displays no strong affect attached to this worry. Thus, a woman's agitation is often a signal that anxiety is the mechanism at work and not something more worrisome, like psychosis. Knowing this can reassure both the distressed mother and her healthcare provider.
Shame-based barriers to disclosing one's thoughts can be fueled by the critic inside one's own head. With regard to the critical inner voice, mothers report they are reluctant to reveal scary thoughts because they:
- Fear that they are the only mother who has ever felt this way and that no one could possibly understand.
- Believe that the thoughts they are having are an indication that something is terribly wrong.
- Worry if they admit this, they will indeed be crazy.
- Worry they will be locked up or institutionalized.
- Fear that saying it out loud will make the bad thought a reality.
- Believe that good mothers don't think these thoughts.
- Hate themselves for having the thoughts and remain stifled by intense shame and guilt.
- May not be comfortable talking about how they feel, in general.
3. The sentencing
Many women say they are extremely apprehensive about being labeled or diagnosed as mentally ill. Although it's true that a number of women diagnosed with postpartum anxiety or depression express relief in knowing that it is a real medical condition that is treatable, most continue to feel burdened by what others might think. Any stigma attached to motherhood presents as an oxymoron of sorts; it weighs heavily on the heart of a mother trying to do her best and impedes postpartum healing.
Common barriers related to what others might think are:
- Worry that someone will judge them.
- Worry that someone will label them as bad mothers.
- Worry that someone will take their baby away.
- Worry that their partner or family will deem them incapable of taking care of the baby.
- Don't think a health provider wants to know or can even help or may not trust them to understand and respond appropriately.
- Don't see mental health issues as part of their provider's job description.
- Have concerns about confidentiality and what may happen if they reveal what they are thinking.
The bottom line here is that if mothers are not careful, this propensity to condemn their thoughts or behavior in some way shifts the authority of these thoughts in the wrong direction, thereafter empowering the thoughts even more. Women need to speak on their own behalf, trust their inclinations to reach out for support, and worry less about what misinformed friends, acquaintances or healthcare providers might think.
4. The depression factor
Women with depression think negatively. Some theorize that biological factors influence negative thinking, which can lead to depression. Others claim that pessimistic or negative thought processes can contribute to the emergence of depression. Though this question of biology versus cognitive factors in depression is up for debate, experts agree there is a significant and constant correlation between the two.
When thoughts are distorted, perceptions become darker, scarier, and magnified out of proportion. Nerves are exposed, leaving women feeling hypersensitive and thin-skinned. This feeling of over-exposure can create a sense of mistrust in the outside world; women can grow suspicious of how others might respond to knowing the "truth" about what they were thinking and feeling.
Depression is a very self-absorbing illness. It can rob women of their desire to seek appropriate care and can interfere with any effort to even try. Depressive thinking can inhibit attempts to deal appropriately with scary thoughts by distorting or exaggerating the possible outcomes of disclosing. Making a good decision on one's own behalf is stymied when everything is perceived through the lens of depressive thinking.
5. The propaganda factor
There are tons of misunderstandings and misperceptions surrounding this phenomenon of scary thoughts during motherhood. This lack of knowledge spans from woman to woman, to healthcare professionals, and to society as a whole. Postpartum women frequently find themselves at the mercy of well-meaning, but often misinformed, family and friends. Family and friends can be incredible sources of support, but they can also unwittingly sabotage a mother's recovery with false information.
In addition, dedicated health care professionals are not always correctly informed and can react in ways that cause further difficulties for a struggling mother. Generalizations that are splashed in print or other media outlets may not be pertinent to a mother who is suffering, or, they may be totally irrelevant or erroneous. Internalizing more negative information can reinforce the inherent resistance to seek help. It is best not to place too much emphasis on unsubstantiated statements and always check out the sources of information that may be potentially agitating.
6. The community factor
The stigma of mental illness is pervasive. It remains steadfast, in spite of current wisdom and widespread attempts to inform and enlighten women and healthcare providers across cultures. Although we must be alert to specific cultural expectations that can impose high standards for mothers to meet, we cannot ignore the research literature, which consistently demonstrates that communities with strong social support provide shelter and yield lower rates of postpartum depression.
This dichotomy can send mixed messages to the mother who is trying to juggle her desire to comply with expectations from all directions. The message to new mothers should be for her to prioritize her social support, regardless of the pressure she feels from either a perceived stigma or cultural mandate. In many cases, and in many cultures, women claim that, despite ongoing and abundant support, the expectation to only express positive feelings attached to the mothering experience remains high.
The tendency for women with acute distress to suffer in silence persists, reinforcing the concern that social support systems, though crucial to postpartum healing, remain inadequate to some extent. Perhaps the greatest menace is the inability to accept the presence of negative thoughts and feelings during this time. Only when this takes place can we expect postpartum women to speak from their heart and break through their reluctance to disclose.
7. The 'what if' factor
The best way to summarize the anxiety-drenched roadblocks to disclosure of scary thoughts is to view them in terms of "what ifs." All or any of the previous-mentioned barriers culminate to create this ultimate deterrent: What if something bad happens as a result of my disclosure?
When you are in, or expect to be in, a potentially anxiety-provoking situation, such as disclosing your scary thoughts, you might respond by focusing on imaginary dangers. This is referred to as anticipatory anxiety which is typically characterized by what-if thinking patterns.
- What if they take my baby taken away?
- What if they call Child Protection Services?
- What if they think I'm a bad mother?
- What if they don't like me?
- What if they think I'm crazy?
- What if they put me in a hospital?
- What if they think I could really hurt my baby?
- What if I really do hurt my baby?
- What if this means I really AM crazy?
- What if my husband leaves me?
- What if I never get better?
- What if I can't really trust this person?
- What if they can't help me?
- What if they can help me, but I am labeled for life?
- What if my friends/neighbors find out (and think I'm crazy)?
- What if my mom (parents, family) think I am not a good mother?
- What if someone at my other children's school finds out, and this affects my other children?
- What if people at work find out, and it affects my career?
- What if letting someone know how I feel makes it more real somehow.
- What if I will always feel and think this way?
Imagine if we put all of this anxiety to good use!
It is possible, conversely, to have a list of what-ifs with a positive spin:
- What if I talk about what I'm thinking, and I get the help I need?
- What if my husband (family, friend, doctor) reassures me, and I am comforted by my decision to talk about this?
- What if by talking about this, I get relief, and I feel less guilty?
- What if talking about it frees me up to make room for other feelings, such as joy or serenity?
- What if I trust myself and the people around me and take a leap of faith that I will get help or reassurance?
- What if I discover that what I am feeling and thinking is not so bizarre and that lots of other women feel this way?
- What if it's true that the way I am feeling is a common response to motherhood?
- What if I believe this can and will get better?
Generally speaking, it appears that postpartum women appreciate being able to talk to a sympathetic and supportive listener, allowing them to express their fears and unburden themselves. Intervention at this level rests with efforts to increase awareness of their irrational fears, while establishing a context in which women can feel safe to express what they think and feel. Once this begins, women will learn to feel more confident about the process and will be better equipped to restructure some of their thinking patterns and begin to heal.