THROWING BABY OUT WITH THE BATHWATER
Wendy, aged 26, was the self-possessed, dynamic theatre nurse of a nearby hospital who was married to a logging contractor. She was delighted with her first child delivered under our care. Over subsequent weeks she presented for help and advice at least weekly with her baby boy. There was some uncharacteristic irritation when we advised against circumcision. However, knowing her personality, I reassured her (and myself) that she would cope just fine.
Her husband rang me to say that he was concerned about Wendy because she had ‘lost interest in him, the household and sex’, among other things. She was also ‘bitchy and flying off the handle easily’. When I next saw Wendy, I discussed many of her problems and said I thought she had postpartum depression and should take medication in addition to counselling and support from myself. She dismissed her problems as simple ‘postnatal blues’ and said that she did not need, nor would she take any medication.
One week later Geoff rang to request a house call. When I arrived I found Wendy slumped on the kitchen table weeping while Geoff was holding the baby. ‘I came in to find her trying to drown the baby, and then she was going to slash her wrists,’ he said.
‘I’m just a failure as a mother and a wife. Everyone thinks I’m hopeless. I am hopeless,’ whimpered Wendy.
Wendy eventually responded to support, amitriptyline and electroconvulsive therapy. It took about 12 months for her to return to her normal, effervescent, coping self.
A classic case of postnatal depression had emerged under our noses and we were fortunate not to be answerable to a case of infanticide and suicide.
DISCUSSION AND LESSONS LEARNED
Depression, including postnatal depression, is potentially a deadly problem. Apart from the possibility of suicide, it can cause havoc in the home. I have encountered broken marriages and strained marriages through one of the partners being depressed.
Depression is a very real illness that affects the entire mind and body. It seriously dampens the five basic activities of humans, namely activity, sex, sleep, appetite and the ability to cope with life. Place this into a household and the ‘rotten apple’ effect can take over with relationships seriously affected.
We have a tendency to continue to treat people as we normally know them and tend to deny that they are mentally ill or rationalise that any deviant behaviour is but a passing phase. Experience has shown that doctors cannot take anything for granted with psychiatric illness, especially depressive illness.
Subsequent to this experience I have always searched for evidence of depression early in the postpartum phase and, if present, treated it aggressively.