New Dad. New Challenges.

Before engaging in this act of self-disclosure, I thought carefully about how it could affect or harm my position as a psychotherapist.  Will clients still want to work with me if they know that I, a so-called mental health professional, have also been depressed?  How am I supposed to help other people if I’ve suffered poor mental health myself?  But then from experience, I’ve also witnessed that sense of relief that a client will exude when I hint that I’ve suffered from depression before, or that I know what it’s like to have a panic attack.  I also believe that the only way to challenge the stigma surrounding mental health, and thereby encourage sufferers to feel more comfortable in seeking help, is to contribute to the conversation and be open about our experiences.  There is no shame in poor mental health.  So for what it’s worth, here is my story…

The experience of childbirth left me shell-shocked.  Our first child decided that she wasn’t content with the safety of the womb and decided to make an early dart, kicking my wife off into labour a whole 5 weeks early.  My introduction to this process was the sound of a torrent-like gush of liquid preceded by a swift but forceful splat coming from the bathroom in which my wife was.  The waters had definitely broken.  For the next 9 hours, I experienced the full range of emotions.  Joy, fear, frustration, confusion.  As I’m focusing here upon depression, I’ll spare you the more grizzly details, but I know I was traumatised by the experience.  Terrifyingly, for a childbirth layman like myself, the labour slowed down after 5 hours and contractions stopped.  My daughter was half-way to the exit, and her heart-rate was being monitored by a little antennae attached to her head.  I was watching the heart monitor intently looking out for any signs of danger whilst my wife squirmed in pain, sucking in futility on her gas and air.

After much discussion between consultants and midwives, eventually, things got moving again.  I remember seeing my daughter’s head crowning through a diamond of labial tissue for what seemed like an age, all the while with my heart in my mouth.  I had never felt so redundant, so useless.  In a final blur of activity, the midwives employing their craft and my wife pushing so hard the whites of her eyeballs turned red, out popped my little girl. 

She was a grey-blue colour and didn’t make a sound.  I feared the worst.  The mid-wives carried her over to this special observation unit (!?) and after a few terrifying seconds I could hear the first chirps of her voice.  Her skin soon adopted some pinkness and the fear begin to pass.  We were going to be ok. 

After the job was done, the midwife suggested I go and get a dampened towel to cool down my wife’s brow.  I fidgeted to the sink, moistened (drenched) a paper towel and shuffled back.  The midwife and my wife started laughing.  I’d got the towel bit wrong.  It was too wet apparently.  Just one thing I had to do and I’d messed it up.  The image I have in mind now is me standing there, being laughed at, with my limp, lifeless offering dripping from my hand.  I can’t think of a more effective metaphor for the de-masculated male.

The birth of my second daughter was slightly less terrifying, but significantly more gory (think of the film “Platoon”), and yet it didn’t seem to have the same effects upon my mood as the first.  As a therapist, I believe that I initially developed symptoms of a post-traumatic stress reaction in the months after my first child was born.  I had all the features:  vigilant for any sign of danger to my daughter, I became emotional and anxious whenever I thought about the birth, and I had adopted a number of unusual behaviours to minimise any chance of harm coming to her.  I used to check on her multiple times each night, sometimes accidently (deliberately) waking her up to make sure she was still alive.  I wasn’t comfortable with family members looking after her, and I would challenge them excessively if I felt they were doing anything which may, even remotely, cause her harm.  But being overly protective takes its toll.

Disturbed sleep, wanting to do everything and the need to be in total control, whilst also going to work full time was hard going, and I think the baby was the first person to pick up on how much I was struggling.  The general nervousness and lack of ease with which I nursed her made her more fretful and difficult to settle.  I personalised the crying.  Rather than recognising that there is very little in a baby’s repertoire of vocabulary with which to communicate her basic needs (I’m hungry, I’m wet, I’m lonely) other than bawling, I interpreted this at the time as evidence that I was rubbish at being a dad.  Not just rubbish actually.  Shit, useless, a total waste of space.  At around 1 month in to being a new dad, my depression had started.

In 2007 when all of this was going on, I was in my first NHS role training to be what at the time was called a Graduate Mental Health Worker.  This was before the Improving Access to Psychological Therapies (IAPT) initiative started by the Labour government in 2008, but the role was very similar to that of the current wave of psychological wellbeing practitioners, in that I was delivering low intensity, self-help type interventions to people with mild to moderate depression and anxiety disorders.  My daughter was born towards the end of the training course, so I knew that I had to spin all of the situational plates at the same time to pass the course and keep my job.  As such, I became proficient at problem solving – if there was something that needed doing, I would schedule it and get it done as efficiently as I could.  But babies don’t work like this.  Your work is not their priority, and they let you know this in no uncertain terms.  I was becoming increasingly frustrated and depressed with the situation, and instead of doing something about it (asking for extensions with the work, asking for more help with the baby from family), I started to withdraw into myself.

Low mood is not a bad thing per-se.  Evolutionary theorists suggest that the change in mood provides us with an emotional and physiological signal to retreat from punishing life events and to give us the opportunity to conserve our energy and heal our wounds.  In the early days of humankind, when the world was a more simplistic, yet infinitely more dangerous place, this signal served a vital purpose in enabling us to deal with our environment.  These days however, due to our use of language and thought, and our evolved capacity for problem solving, this retreat from the world presents an opportunity to not only escape from the punishment but also to engage in mental problem solving.  But to solve a problem, we need to ask the right questions and depression doesn’t tend to do this.  Instead of thinking “How do I solve this problem?”  we instead will think, “Why do I feel so bad?”  This powerful brain of ours will then rifle through the memory banks and come back with a million reasons for why you should feel bad.  “Why can’t I cope with this?”  Again, reasons as to why I can’t cope abound, making me feel worse in the process.  As we withdraw and isolate ourselves more and more we create more and more opportunity for us to try to think our way out of our depression, rather than take action on our environment to change it.  This cyclical process of depressive faux-problem solving is called Rumination and, in my opinion, is one of the most significant, yet deceptively pervasive, maintaining elements of depression.  I used to do it loads.  It’s a real bugger.

So there I was, modern man faced with a punishing environment, retreating to my cave to heal my wounds and to try to think my way out of my distress.  But it didn’t work.  I woke up every day with a sadness in my throat, feeling tearful whenever anybody spoke to me.  I had suicidal thoughts and the belief that my new young family would be better off without me being around.  But I couldn’t share this with anyone.  All I was hearing from people was “congratulations”, “how’s the baby?” “Is your wife doing ok?”  All meaning well, showing that they care, and I would answer them with platitudes, set responses of how I thought I was supposed to respond.  I struggled to share in the happiness.

Eventually, I took the plunge and sought some counselling from the occupational health service at work.  I’d like to say it helped, but it didn’t.  Being used to the active problem solving stance of CBT which I was delivering, counselling was a disappointment.  An elderly woman basically just listened to me moan for an hour then booked me in for next week, with no resolutions offered.  The most active thing that she did was refer me to the service doctor who suggested that I try the anti-depressant Citalopram. 

This stuff worked.  It worked lots.  I have a 'friend' (ahem) who dabbled in dance culture in the late nineties who likens the experience of taking SSRI anti-depressants with the experience of ingesting a quarter of an illicit dosed disco biscuit at a rave.  They do of course work in a very similar way, targeting the serotonin in the brain to facilitate an increase in positive mood.  They (SSRI’s, not ecstasy) don’t work for everybody, and I’m well aware of the arguments of their critics (e.g., Irving Kirsch) but anti-depressants worked for me and I’m an advocate for their use.  Sometimes, just that little bio-chemical pick up is enough to enable you to deal with the crap that’s out there in front of you.  They’re not the cure, but they’re an effective intervention.

So, very slowly, I started to get better.  The tablets calmed me down, made me feel less emotional, and as a consequence, I was more able to face the things which I had been struggling with.  I started to feel more comfortable with my daughter, and became more willing to allow others to help.  I had been so unhappy for such a long time and the change in my mood was noticeable.  I started to think that maybe I could be an ok dad, if I stuck with it, and today if I was to conduct a survey at home I think that most would agree, most of the time.

It was only when I completed my CBT training, that I started to understand depression in more depth and realised how to work with it effectively.  Looking at, and changing thoughts can be effective and is a good intervention for the problem, but changing patterns of unhelpful behaviour and avoidance, called Behavioural Activation, is massively effective, and can often get quick wins in a short space of time.  It works from the outside-in, encouraging the depressed individual to take small, carefully structured steps to respond to and act upon their environment, facilitating opportunities for positive reinforcement and thereby improving mood in the process. 

Male post-natal depression is not a clinical diagnosis, but there is growing evidence to suggest that there are psychological and biological changes which occur during this life period which leave men particularly vulnerable to depression,  the consequences of which being relationship breakdown, impaired life functioning, and that old chestnut that they don’t want us to talk about, suicide.  I’ve met people who will passionately deny the existence of male PND, and others who will vehemently disagree.  To be honest though, I think this argument is one of semantics and misses the point.  Do some men struggle with mood when they become a new dad?  Yes.  Do they get help?  Typically, no.  Having worked with a large number of men who have experienced depression or anxiety in similar situations to my own, and unimpressed by the lack of appropriate psychotherapeutic treatment available to me at the time of my depression, I have set up, with the aim of providing CBT based self-help and support for men within this group.

As it now stands, I’m doing ok with the Dad stuff.  In fact, I don’t want to speak too soon, but I think I might be better than ok.  I will still have the occasional days of low mood, but I treat them as a signal to do something different.  Write, get out for a walk, talk to my wife, meet my mates, wash a dish – anything which interrupts the pattern of withdrawal and rumination.  A mistake people can make in recovery from mental illness is that they view it as an either-or situation, well or unwell.  But the truth is that it’s all a matter of degree, and you have to work at recovery.  A good day doesn’t mean that you are better and need to stop trying, just as a bad day doesn’t mean you’re unwell and will never improve.  Stick with it, get help when you need to and don’t be afraid to make changes.  The bad times will pass.