So strong are stereotypes about the bliss of motherhood that the popular imagination allows little space for the lived reality of many women. Many women find themselves besieged by feelings of negativity - and the consequent guilt - after childbirth.

Postpartum depression (PPD) is the cause, says Dr Prathap Tharyan, Head of the Psychiatry Department in the prestigious Vellore-based Christian Medical College. In a British Journal of Psychiatry study that Tharyan and his colleagues carried out in rural Tamil Nadu and published in 2002, they found that 11 per cent of the pregnant women monitored had PPD.

Although there are no figures available for India, Planned Parenthood, USA believes that one in 10 women in the US suffer from PPD.

Unfortunately, says Tharyan, there is not enough awareness about this disease, possibly because psychiatry is not addressed adequately in medical colleges across India. While awareness levels among the general public are abysmal, even those in the medical profession are not well acquainted with PPD, he says.
PPD is a biochemical illness caused by changes in the brain chemistry. It might cause a woman to become deeply despondent and weepy; she might develop insomnia, anxiety or an aversion to touching her baby. She might feel 'out of control' and, more horrifying for her, develop a fear that she might harm her baby. A past history of psychiatric illnesses is a good indicator for PPD, but is not a prerequisite. And being from a 'good Indian family' is certainly no protection either!
In addition, Tharyan says, various factors - like bearing a female child when there was pressure to bear a male child, problems with in-laws, poverty, or a lack of help in the postpartum period - could result in PPD.

'Baby blues' is a milder, more common variant. (Planned Parenthood estimates that about 80 per cent women suffer from it.) The blues may cause a new mother to have mood swings - from an emotional 'high' of euphoria, to an emotional 'low' of being overwhelmed. She might also suffer from loneliness, sadness, loss of identity, irritability and decreased sexuality. The blues often resolve themselves without medical intervention. PPD however requires counseling and often medication.

According to Niloufer Ebrahim, a psychologist in Pune's Jehangir Hospital, soon after childbirth, hormone levels in a woman's body abruptly drop back to pre-pregnancy levels. Coupled with changes the body undergoes in order to prepare for milk production and the lack of sleep, a new mother is under immense stress. This could manifest as PPD. While the hospital's gynecologists do refer such women for pyscho-therapy, only about one in 20 of them actually seek help, says Ebrahim. "This is unfortunate because sometimes all it takes is for a qualified person to listen to the woman, take her seriously and validate her feelings."
Considering the high incidence of this illness, which makes it a public health problem, why are women not routinely educated about PPD in India? Dr Jyothi Unni, a gynecologist at Jehangir says that time constraint is a big factor. There are many issues, like nutrition, that she needs to cover in her brief sessions with each patient.

Tharyan believes the Indian doctor's mindset of 'preventing harm' to the patients is also a factor. "We interpret that to mean a situation of 'compassionate deceit'. For instance, we often don't inform our patients about the potential side-effects of the medicines. There are a lot of problems in communication between doctors and patients." So, PPD is left unaddressed.

Ebrahim says, "The word 'depression' is always associated with 'mental', and people don't realize that the mind is also a part of your body. No one's ashamed of going to a doctor for an upset stomach. People don't realize that being depressed is as much a physical medical condition as that, and as treatable."
Then there is the social and guilt factor. The new mother, Ebrahim explains, is asked questions like, "You've had a wonderful baby, why are you doing this to your child, to your husband?" It makes the woman doubt herself, because nobody is ready to believe in her.

Tharyan agrees. "The problem is the issue of depression is not very well recognised among clinicians, who say, 'this woman has a difficult pregnancy, so give her some time'. There is a tendency to naturalize a process that is going to be chemically disabling."

Ebrahim says mothers need to ignore well-meaning, conflicting advice and seek help from experts, be it for breastfeeding or getting the baby to sleep longer. What they also need is a good support system that validates their feelings. The new mother needs reassurance that it is natural to be confused and stressed with a newborn. "You should be getting positive inputs from your gynecologist, from your pediatrician - Oh! You're breastfeeding, wonderful!"

And to husbands, she has this to say: "If your wife seems to be happy one moment, crying one moment, she doesn't need to be told millions of women have been through this. Give her a hug, get her some juice; do whatever it takes to make her feel better."

A severe, though much rarer, manifestation of PPD is postpartum psychosis (PPP). Tharyan says that PPP might cause a woman to feel agitated, deluded or hostile. "There is no specific category of PPP per se, because people with PPP usually have a mood disorder, are bi-polar, or more likely, it could be an exacerbation of previous psychiatric illnesses." Without treatment, women with PPP may try to hurt themselves or those around them. Andrea Yates of the United States is an especially telling example - her church allegedly told her to ignore her psychiatrist's recommendations; lacking proper treatment and medication, she went on to drown all five of her children on June 20, 2001.

A Pune-based pediatrician had suggested that it is unnecessary to expose new mothers to "such things" that may "give her ideas". Ebrahim retorts sharply to this. "Nonsense! Just because you know a knife can kill someone, doesn't mean that you go run out and do it." In fact, knowing that her anguish has medical basis, and that many other women suffer from this, would serve the new mother better; along with psychotherapy and medication, of course