As Rebecca stepped over the threshold to my office, her 9 week old son slept soundly in his car seat. “He looks so angelic doesn’t he?” she mumbled. I smiled sensing that Rebecca’s statement carried much insinuation. “You mean, I asked…as compared to how he is at home?”
This introduction gave way to Rebecca’s lamenting about her fatigue, his colic, sleep deprivation, and difficulties adjusting to being a new mom. These and other stressors led this 26 year-old woman as a referral to my practice for therapeutic support to address her postpartum depression (PPD).
For the uninitiated PPD is a mood disorder similar to other forms of depression and/or anxiety. But, depression that occurs post childbirth and endures longer than the “baby blues” and that often accompanies childbirth, is referred to as PPD. Underlying causes of PPD vary; perhaps due in part to hormonal changes in pregnancy and childbirth. Perhaps due to other risk factors and causes including but not limited to:
- A personal history of depression or another mental illness
- A family history of depression or other mental illness
- A lack of support from family and friends
- Anxiety or negative feelings about the pregnancy
- Problems with a previous pregnancy or birth
- Marriage or money problems
- Stressful life events
- Young age
- Substance abuse
Rebecca’s life. She filled out the 10 question, Edinburgh Postnatal Depression Scale (EPDS). This is a self reporting scale developed to help primary care health professionals assess mothers struggling with postnatal depression.
Early on in our sessions we attended to Rebecca’s life stressors; built healthier coping skills, and worked on her struggles with bonding to her newborn. Her husband accompanied her to several sessions expressing his support for Rebecca and their mutual parental struggles.
And yet, despite all that was going “right” for Rebecca, she verbalized personal disappointed in her inability to connect with her son. She became critical of family, of herself, and began rejecting friends like soiled diapers. In fact, it became apparent that despite all the support she was receiving, Rebecca was experiencing deterioration in her ability to cope. One crisis followed another and our sessions took on the role of managing crisis after crisis.
From the beginning, I suspected that in addition to the expected postpartum depression that brought Rebecca to my office, she might also be dealing with unresolved feelings of detachment, resentment, or even jealousy; in other words, issues regarding insecure attachment in her own childhood.
“I keep waiting for his real mother to come and take him off my hands, like I’m some babysitter or something. But then I realize, I am his mother and no one is coming to save me!”
Until we addressed the more immediate depression, Rebecca could not have successfully addressed her fundamental issue; childhood experiences of insecure attachment. These unresolved issues had lay dormant for years and were only now surfacing with the advent of the birth of Rebecca’s first child. As is often the case, many of these “buried or forgotten” issues do not surface until a life change flushes them to the surface.
The inevitable question arises as to why a new mom might not bond to, or feel detached from, her infant? And the question is better served by looking back in time.
history revealed that she has struggled with depression and anxiety at different times in her
Bonding and attachment are cornerstones of our early development. And while the two terms are often used interchangeably, bonding addresses trust and attachment addresses affection.
In an emotionally healthy mother/child dynamic, an infant’s basic needs are addressed and the mother is responsive to the child on an otherwise consistent basis. The infant ultimately learns that his/her needs are met and the infant comes to experience the world as safe.
When there is injury brought to that early bonding experience the fundamental attachment does not cultivate a trusting, safe foundation upon which all other relationships will ultimately grow. The infant, turned child internalizes a learned pattern of insecure attachment, shame and/or disconnection with/from others.
Put another way, in the experience of secure attachment that child turned adult learns to develop stable relationships with others, experience confident identity and self-esteem, and regulate feelings and emotionally connection with others.
A number of risk factors contribute to attachment issues:
- Extended or repeated separations from mother/father during the first three years (hospitalizations, incarcerations)
- Mental illness in the family
- Multiple changes in living location
- Substance abuse (Addictions) within the family dynamic
- Significant family loss
- Parental neglect and/or abuse; physical, sexual, emotional
- Emotional dysregulation between caregiver and child
- Intergenerational patterns of maternal insecure and avoidant attachment
Rebecca’s own childhood experiences with her family revealed a history of maternal depression, verbal and physical abuse of Rebecca by her father and brother, and her personal depression and anxiety that predated her pregnancy. Most significant, however, was Rebecca’s retelling of how she watched her mother “go through the motions” with her younger sister.
“I can’t remember what life was like for me, but I do remember my mother seemed like she was on autopilot with my sister. She was there for us, you know, but not for anything emotional—that was just normal.”
Fortunately, Rebecca took action and was willing to look deeper and back in time to her own experiences of childhood. She availed herself of help and learned healthier more adaptive skills to “reparent” her inner child; and therefore bond with her young baby. It wasn’t until this crisis that Rebecca came up against her unresolved issues.
Our early childhood years cannot be recreated. Unlike Rebecca, some people may have experienced more serious breaches to their early parental bonding and attachment. If there are more serious and enduring violations to this early construct, one can experience more fundamental personality changes that lead to Complex Post Traumatic Stress and other disorders.
It is important to remember—when we can no longer cope in the here and now, reach out for support. Albeit by way of outpatient therapy, residential treatment (if appropriate) and/or other supportive resources, there is a path toward fulfillment and [dare I say] happiness.