Where Postpartum Depression Meets Adoption: Looking Beyond Hormones in Maternal Mental Illness

Several days ago, I read, reread and then read again the New York Times article Thinking of Ways to Harm Her, the first of a two-part series about women and maternal mental illness, with a focus on postpartum depression.

In this excellent article, which explores both antenatal and postpartum depression, Pam Belluck reports:

A complex interplay of genes, stress and hormones causes maternal mental illness, scientists say. “Hormones go up more than a hundredfold,” said Dr. Margaret Spinelli, the director of the Women’s Program in Columbia University’s psychiatry department. After birth, hormones plummet, a roller coaster that can “disrupt brain chemistry,” she said.

One of the most agonizing manifestations of postpartum depression can be intrusive thoughts, as described by Belluck in her piece:

“Jeanne Marie Johnson, 35, of Portland, Ore., had a happy pregnancy, but she began having visions right after her daughter, Pearl, was born. She said in an interview that she imagined suffocating her while breast-feeding, throwing her in front of a bus, or “slamming her against a wall.”

She said she was horrified at the idea of hurting her baby, and did not carry out the acts she envisioned. Yet while overlooking a shopping mall skating rink, “I pictured myself leaning over the bridge and letting her fall and bust like a watermelon,” she said. “I was actively thinking of ways to harm her.”

I read this story with my heart in my throat, remembering the short period of time when I had intrusive thoughts after bringing home my oldest daughter.

But here’s the catch:

My daughter was adopted.

In the absence of childbirth, what happens to the brain of a mother that can account for these terrifying thoughts?  If a plummet in hormones has not occurred, what is the explanation?  And how many adoptive mamas experience this devastation?  What do we do to help them?

If I let myself think about it, the day I started experiencing intrusive thoughts feels like yesterday.

I was sitting on the couch holding K.  She had been home with us for about six weeks.  One minute, we were just sitting there together, and all was quiet.  She was sleeping in my arms.  I glanced out the window of our 18th story condo, and I suddenly had this horrifying image of her falling to the street below.

Boom!  Out of f*cking nowhere, I was in the throes of a massive panic attack.  Sweat slicked down my brow.  On shaking legs, I jumped up from the couch and began pacing.  My husband was at work.  I started to cry, trembling and heaving.

I stuffed K into the Baby Bjorn and rode down 18 floors on the elevator.  I had to get away from the windows, the balcony, the terror.  What the f*ck was happening?  I walked in the numb freezing Chicago cold, letting the icy wind cool my sweat and slow my pulse.  After an indeterminate length of time, I felt ready to return to my apartment.

As soon as I stepped off the elevator and walked down the corridor to our unit, my heart began racing again.  I could not go inside.  My warm and cozy home, the place where I had been joyfully nesting only that morning, was now the scene of terror.  This is how phobias are born.

I called my husband at work and did something I never do.  I cried and asked him to come home.

I hadn’t asked him to come home a year earlier on the day that I walked three miles from my office to my apartment, leaving work without so much as a word, after running into a former colleague who saw my flat-again belly and asked how the baby was doing, and I stared at him and said, “dead” and flinched at my own bluntness and walked out without even putting on my coat.

I hadn’t asked him to come home when I learned six months later that the birthmother we had been making an adoption plan with was actually fake, that she wasn’t even pregnant.  I had already put in for maternity leave and had spent hours upon hours talking with her on the phone, and then the truth came out.  I cried for two weeks straight; I was furious and vulnerable and betrayed, but I was still grounded.

But this.  This was more than I could bear alone.  I didn’t know what to do or who to talk to.  I didn’t have a clear cause or an enemy to point to; there was no reason to explain why I was suddenly unable to breathe.

It was exactly the opposite.  I had everything I wanted.  I finally had my baby.  The foster care nightmare was over, and we had gained custody of K.  She was safe.  This was supposed to be the happiest time of my life.  I was in the midst of my maternity leave, with hours and hours alone each day to dote on my baby.

And suddenly I felt like I was crawling out of my own skin.

Help, I whispered, choking on my sobs.

I believe in you, he told me.  But I can’t help you on my own.  Call Susan, he said, and she can help.  Susan was the grief counselor who worked with us when we lost Matthew.  Week after week, we would speak with her, often on the phone via conference call, as she coaxed us through our misery.  And when we found ourselves tangled up in a foster care adoption, it was Susan who spoke with me each week and reassured me that even if the adoption fell through, I would survive.  I was a survivor, she helped me to see.  I survived Matthew and I would survive K, if need be.

But I didn’t have to survive K, because it worked out and she came home to us.  All the terror and uncertainty of the past 14 months was done.  Why was I now brought to my knees with a gaping nameless fear?

I called Susan at home at 9 pm on a weeknight and she answered.  I explained what was happening.

It makes perfect sense, she mused.  Up until now, you have been going a million miles an hour, barely stopping to absorb the magnitude of your stresses and loss.  Just think, she reminded me, of how you channeled your grief and anxiety into the adoption process.  You barely acknowledged the one-year anniversary of losing Matthew, because you were in the middle of taking custody of K.  For all these months, you have been working a heavy schedule and traveling and moving through a highly stressful adoption, and now everything has stopped.

Don’t you see? she asked me.  The fear of K falling over the balcony is about your fear of attachment.  This tiny fragile person is completely relying on you, and it terrifies you.  You couldn’t save Matthew from his illness, and now you are afraid that something will happen that will prevent you from saving K.  Without work to distract you, there is time and space for your mind to dip into the places it has been afraid to confront.

It made sense.  So much f*cking sense.  I told her about the nightmare that had awakened me the night before.  I had dreamed that K was in the bathtub, and the water was running.  The phone rang, and I stepped out of the bathroom to grab the portable phone.  But the bathroom door locked behind me, and K was alone in the tub, with the water rising, and I couldn’t get to her.  I banged on the door, screaming, knowing she would soon be submerged.  When I jerked awake, it had taken me a long time to stop shaking.

Yes, Susan said softly.  You were afraid that you couldn’t save her.  You are processing the traumas of the past year.  That is why you are having panic attacks.

Talking with Susan was my lifeline.  I do not know if I could have survived that time without her steadiness.  But I did.  And I learned about the phenomenon of Post Adoption Depression, which in my case was Post Adoption Anxiety.  It feels like a secret burden you have to bear, because nobody understands how you can possibly be unhappy now that you finally have what you have wanted for so long – a baby.

The good news?  It gets better, oh so much better.  Within a few weeks, I had clawed my way back from the edge.  Within a few months, the waters receded, and I was joyfully standing in the sun, my baby strapped to my body, my arms outstretched reaching for the sun.  K and I basked in the warmth and security of the spring.

For me, it wasn’t about a hormone change triggered by birth.  It was about attachment, specifically the fear of attaching to my new daughter.  It was about isolation, because I spent all my time alone with the baby.  It was about trauma and grief and exhaustion, after losing Matthew and losing my way in the world.   When I addressed those issues, the intrusive thoughts and the terror dissipated.

If you are an adoptive mom and you are blindsided by these feelings, reach out.  It’s okay to talk about it.  It’s okay to ask for help.  My little K is almost 11-years-old now.  I went on to have two more daughters after her.  I live for my girls in a way that is inexplicable.

Maybe it is due to all the pain and suffering that went into building our family, but I literally think each of my girls is beyond amazing.  Sure, they can be impossible and difficult like all kids, but I cannot love them enough.  Every little thing they learn to do brings me crazy amounts of joy.  If I had known it would end up this way, it would have made the beginning so much easier.  Stay with it, all you struggling mamas.  You can do this.  But ask for help, because you don’t need to do it alone.

Check out Carrie Goldman’s award-winning book Bullied: What Every Parent, Teacher, and Kid Needs to Know About Ending the Cycle of Fear

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