Below is the Afterword writted by the late Ilyene Barsky, pioneer in the field of maternal mental health. We will not forget her professional influence and her personal grace and fortitude.
As Amy and I proceed to work on the second edition of “Dropping the Baby and Other Scary Thoughts”, I feel compelled to bring Ilyene to the forefront of this process. She always did, and will continue to, provide inspiration for all of us in this specialized field.
This book is dedicated to
Whose words, wisdom, and infinite presence continue to inspire and heal postpartum women.
For the last twenty years, I have planned, promised myself, and intended to write a book about perinatal mood disorders. Karen Kleiman does not plan, promise, nor intend. Karen Kleiman writes books. She is, perhaps, the most prolific and most recognized writer on the subject. Karen and I have “known” each other for about fifteen years yet, we actually met just a few years ago. The bond was instantaneous. We’ve traveled many of the same paths. We can say, unabashedly, that we are pioneers within this “movement” of awareness, consciousness raising, training and educating the public of, what was once, an unrecognized, overlooked, and misdiagnosed illness. We figured out how to treat depressed and frightened moms at all levels of distress. We were there when the rumblings began. Barely perceptible. No Internet. No email. Slowly the connections and the weaving began. The rumblings grew louder and became stronger. Organizations began to emerge. We found Depression After Delivery (DAD) and Postpartum Support International (PSI). Newsletters and articles began to appear. We received them via snail mail.
Like most of us involved in the postpartum “movement”, I am a survivor. It was 1980. I was truly enjoying my pregnancy. Absolutely loved the attention and the movement in my belly. Strangers let you ahead of them on lines. They help with heavy packages. They give themselves permission to touch your belly. While some women object, I never minded that boundary being crossed. Somewhere around the eighth month of my pregnancy, reality hit. This baby has to come out of me. It truly was a different time. Painkillers were shunned upon as they would be harmful to the baby. The only way to go was “natural”. Some twenty-two years later, I read Naomi Wolf’s book “Misconceptions” and came across this African proverb:
Being pregnant and giving birth are like crossing a narrow
bridge. People can accompany you to the bridge. They can
greet you on the other side. But you walk that bridge alone.
This proverb, this metaphor, has stayed with me all these years. We all encounter bridges of various types, lengths, and strengths as we travel through our lives: Adolescence, leaving home for the first time, and marriage, to name a few.
I’d like to share with you three bridges I have crossed, and continue to cross. These three bridges are structurally quite similar. I imagine them to be primitive suspension bridges made of wood planks and rope. A pair of supports at either end (trees, stakes, or poles) secure the bridge. Wood poles are intermittently bored through the wood planks along the bridge to secure the length of rope which the traveler holds on to as he/she makes their way to the other side. Beneath the bridge lie sharp rocks and turbulent waters.
Back to my own personal experiences: Bridge number one, pregnancy, was rather fun. The bridge was sturdy. I walked across with great confidence. But as I got closer to the other side, thoughts of labor and delivery began to permeate my brain. I froze. I had nightmares of being sliced open. I had nightmares of a “natural” delivery. I had nightmares of dying on the table. There was no escape and the bridge began to wobble.
“The hell with Lamaze classes. This is going to hurt. A lot”. Of course I had the option of the much frowned upon painkillers, but that would make me a childbirth failure and a bad mother before even leaving the delivery room. Surely medication would harm my baby in some way. Could I ever forgive myself? What would others think? But I saw all those women on the other side of the bridge, supporting and encouraging me. Women since the beginning of time.
“If they could do it, I could do it”. And so, with the help of a shot of Demerol (took years to forgive myself for that one), and nearly 15 hours of labor (I think the number of hours get longer every year), I crossed that bridge with my son in my arms. I was greeted with excitement and joy. I was carried on their shoulders like the MVP after a football game. Then, I was back on the ground and they slowly drifted away. The fanfare was over. I quickly learned that labor doesn’t end in the delivery room.
My son was a preemie, born one month prior to his due date. His skin seemed nearly translucent and hung from his body like a raw chicken. Colic began within a few days. No respecter of day or night. It didn’t take long for it to reset my inner clock and for the insomnia to set in. I’m anxious. I’m depressed. I’m immobilized. I’m exhausted. I can’t seem to do anything right. My baby hates me.
No support whatsoever. My own undoing. I’m a master of disguise. Besides, I had a reputation of being strong and competent. I had an image to maintain. I told no one. You know the drill: shame, embarrassment, guilt, and fear. Obviously, my (ex) husband was aware of the insomnia and my uncontrollable crying. Each day he’d come home from work and see me in the same shapeless housedress. I engaged in little to no self-care and was totally isolated. My husband’s initial show of concern soon turned to annoyance. I’ll never forget the day he came home from work and pulled the dress off my shoulders and threw it in the garbage. He just didn’t get it. Neither did I. He became more and more distant and unavailable. Today, we recognize that men can have postpartum depression, too.
I approach bridge number two. I am surrounded by “seasoned moms” who have frequently offered me well meaning, but unsolicited advice. They contradict one another. They confuse me and add to my mounting sense of inadequacy. But now, everything is OK… I can see the sign as I stand before the bridge: “Motherhood Straight Ahead”. It is framed with cherubs and fluffy white clouds. It’s going to be a long walk, but when I squint, I can see all the beautiful, blissful mothers nursing, nurturing, and nuzzling their newborn babies on the other side. The babies are content and cooing sweetly. I want that.
I take my first tentative step. Baby in one arm; hand of the other grasping the rope. Clearly this is going to be a challenge. This bridge is not the same as the first. The slats are faded and worn. The links connecting the slats are rusted. The ropes are frayed. This bridge wobbles and sways as the wind whips up. The water below is turbulent. Besides my baby, I am carrying all the symptoms I had before I embarked upon this new journey.
However, there is now a new dimension: “What if my baby falls from my arm?” “What if he is swept away by the waters below?” “What if he is crushed by the rocks?” “What if we both topple over?” I can see it all in my mind’s eye. Other thoughts, intrusive thoughts, each one more horrific than the last, leave me shaken and gasping for air. I would never harm my child. The depression deepens, the anxiety turns to terror. I am thoroughly exhausted. I am holding on to that rope for dear life. I take that final step off that bridge and am now surrounded by the serene and peaceful images I saw when I squinted at the beginning of this journey.
“I made it!” But not really. I am not like them. I’m different. There is something wrong with me. I am as unsteady and as unstable as the bridge I just crossed. I need to sit and rest. I find a shady tree. Propped up, baby in arm, I close my eyes. At last, some respite. I drift off. But not for long. Here come those images again. They are vivid, tragic and revolting. I am startled into awareness; sit up abruptly, and once again, I am gasping for air.
The jig is up, the mask is off and I am desperate for help. I find an older, kindly, female psychiatrist and tell her about my depression, anxiety, and worst of all, insomnia. No mention of intrusive thoughts and how they exacerbated my sleep disturbance. I am diagnosed with “Major Depression”, given a prescription for an antidepressant and am on my way. The medicine did work. Sleep did come, and with time, the thoughts began to drift away.
Some four years later, and by a sheer luck, I come across an article in a magazine about “postpartum depression” (PPD). I call the author (founder of Depression After Delivery) and find enormous relief. I was never really alone. I “suffered in silence” like hundreds of thousands of women in the U.S. every year. They, too, did not come forward due to shame and embarrassment. Note: By now, my son is four and my daughter is a newborn (by the grace of God, the PPD following her birth was mild in comparison). The networking began. “The New Mother Syndrome”, by Carol Dix, was published in 1988, eight years after my trauma. The book was informative and validating. As a social worker, and in the helping profession, I knew I had to enlighten others. My “lectures” began in the living rooms of childbirth instructors, then hospitals, and then large organizations. By now, I have established The Center for Postpartum Adjustment and the moms begin to trickle in for counseling and psychotherapy. I am flying by the seat of my pants as there is no script, no manual for treating this population. I am my own frame of reference. The common threads begin to emerge. The symptoms, the myths, the unrealistic expectations. We discuss grief and loss associated with becoming a parent. Their “normal negative feelings” are validated. I learn to ask the hard questions: “Do you think you will harm yourself or your baby?” “Are you having scary thoughts?” They know they are safe and accepted.
It’s been thirty years. I am fifty-six years old. I have treated thousands of women, and have been blessed with a wonderful reputation in a very large community. I’ve got my treatment techniques down pat: Cognitive Therapy, Interpersonal Therapy, and Ilyene Barsky Therapy (AKA…gut feeling). Thanks to Karen Kleiman’s recent book, Therapy and the Postpartum Woman, clinicians now have a “how to” manual. I am also the longest standing member of Postpartum Support International, a worldwide organization working toward the eradication of ignorance surrounding perinatal mood disorders. I have been their Florida coordinator and volunteered in numerous capacities for many years. I have lived to see this illness printed in scholarly journals and books, woven into TV plots, and been the subject of Public Service Announcements. I have lived to see women routinely screened by their medical providers and the passage of The Mothers Act. I am enormously proud of the role I have played. I will be leaving my footprint.
I just learned six months ago, that I am standing in front of my final bridge. Many other bridges have come and gone, but it is this third bridge I’d like to share with you. It is strong and sturdy.
My husband, Mark, has seen to it that this bridge is safe. He has replaced the old slats with new ones. No more rusty links. The rope is taut and secure. I am sad, but not afraid. I look behind me and see my greatest legacy of all…my children. I have lived to watch them cross their own bridges with style and grace and their own personal flair. Gavin, now thirty and Monica, now twenty-six allow me to go this final journey with peace. They are college grads, working on their careers, and will be self-sufficient. They are genuinely good, warm, caring people. The best part of my life? Being their mother. In fact, despite turbulent beginnings, I have been an awesome mother!
I do believe that my own mother and father will be there to greet me on the other side. I know they have been watching over me and are proud of me, too. I hope my beloved childhood dog is with them. I believe we will all appear to each other as we were when we were last together, but before we became ill. I suspect I will be tired by the time I reach them and will want to rest. I remember, as a child, falling asleep in one room and waking up in another. They carried me. I am still their child and they will carry me again.
I do not know how long it will take me to cross this bridge. Who does? But I will be ok. Remember what I said at the beginning? Despite the oxymoron, I am a survivor.
“Kol haolam kulo gesher tsar meod v’haikkar lo lefached klol” (Hebrew)
Translation: The entire world is a narrow bridge. The main thing is not to fear.
Ilyene Barsky, MSW
The Center for Postpartum Adjustment
April 25, 2010