“Man Up?” Man Down Is More Like It

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“Man Up?” Man Down Is More Like It

Amie Newman

Postpartum depression in new dads? New research confirms it's a very real condition afflicting more men than previously known. For one father, it's a relief to know he's not alone and that his experience is "authentic."

Before it was fodder for every major, mainstream media outlet, before its “official” unveiling in the Journal of the American Medical Association (JAMA) as a male affliction as well, Joel Schwartzburg was told to “Man up!” when he expressed feelings of overwhelming anxiety and sadness after the birth of his son. But the diagnosis Schwartzburg received over ten years ago can now deliver a knock-out to that sort of belittling declaration. His condition?

Post-partum depression.

In April 2009, Schwartzburg wrote an essay for Newsweek detailing, according to him, his “suffocating depression” following the birth of his son.

I fell into a well of depression so deep I wasn’t even aware of it. It was only years later, after I spoke to a psychotherapist, that I learned I was experiencing male postpartum depression. It seems ridiculous on its face: men don’t do the hard work of carrying a pregnancy for nine months. We don’t have to bear the pains of labor. We never had an umbilical connection to our children. We just have to hang on tight. But giving my emotions a name, and an explanation, helped me feel less alone and better able to cut myself some slack. Before then, even calling it depression felt like an excuse for weak, pathetic behavior.

Sex. Abortion. Parenthood. Power.

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In May of this year, JAMA published the results of a meta-analysis undertaken at Eastern Virginia Medical School which essentially confirms that Joel Schwartzburg’s experience is not uncommon. The analysis looked at 43 studies involving thousands of incidences of postpartum depression (PPD) in males. The researchers found that up to ten percent of new fathers may experience prenatal or post partum depression and, according to a recent article in Time magazine, Postpartum Depression in New Dads: Fathers Get It Too about the study, the high rate was a surprise to the authors, 

“It is surprising and novel that the rate is much higher than most people would guess or expect,” says study author James Paulson. “This is a condition that is not recognized by many folks. Postpartum in men is an alien concept to most people.”

It was not, however, a surprise to Schwartzburg who says that,

“Many men I’ve spoken to share a similar story of struggling with depression when their children were first born, but they do so secretly, quietly, away from the dinner table. They understand that there’s no truly acceptable place or context for men to publicly reveal being challenged — much less rocked to the core — by what I call “sudden parenthood.”

Symptoms of PPD for fathers mirror the symptoms new mothers with PPD experience as well – feelings of emptiness, sadness, anxiety. These are feelings that go far beyond the so-called “baby blues.” As Dr. Richard Friedman, a psychiatrist who treats men with PPD, writes in a New York Times article last year about one of his patients,

A few weeks after the baby arrived, he had become uncharacteristically anxious, sad and withdrawn. He had trouble sleeping, even though his wife was the one up at night breast-feeding their new son. What scared her enough to bring him to my office was that he had become suicidal.

Schwartzburg tells one story of the first weeks following the birth of his son:

I couldn’t mask my sadness when my work colleagues asked excitedly about fatherhood. “It’s good … well, it’s OK,” I said. “Actually, it’s very, very hard.” By then, I was close to tears. We were all happy when the conversation ended.

What causes PPD in men – so we know what might help prevent it? Paulson offers what he’s found:

“…fathers are just as susceptible to factors that tend to trigger PPD in mothers — especially in first-time parents. In new moms, postpartum depression typically stems from feelings of stress and anxiety associated with fatigue, lack of sleep, changes in the marital relationship and concerns about finances and work. Fathers experience the same stresses and the same overwhelming emotions that accompany the life-changing event of becoming a parent…”

Many assume PPD arises, in new mothers, from intense hormonal changes. Hormonal shifts during pregnancy can certainly contribute to PPD but predictors or risk factors also include everything from marriage conflict to employment or childcare issues.  In fact, in one study, lesbian mothers were actually more likely to experience PPD than hetero mothers, with potentially “lack of support from family and society at large…to blame.” And while a major predictor of PPD in new mothers is previous depression, during pregnancy or prior to pregnancy, according to the Time article, “…if depression often goes undiagnosed and untreated in women during pregnancy, it goes doubly so for fathers, who are not often asked about their mental state during pre- or postnatal visits.” Dr. Friedman agrees,

Unlike women, men are not generally brought up to express their emotions or ask for help. This can be especially problematic for new fathers, since the prospect of parenthood carries all kinds of insecurities: What kind of father will I be? Can I support my family? Is this the end of my freedom?

The analysis also found a correlation between maternal and paternal depression. It is more likely for a father to exhibit symptoms of depression when his partner is depressed. Dr. Friedman notes that “fathers whose partners were also depressed were at nearly two and a half times the normal risk for depression.”

This does not appear to be a case of “one more thing to blame on moms.” The evidence does not suggest that new mothers are the cause of new dads’ depression after the birth of their baby. Dr. Paulson is clear:

“Our study found a clear, consistent moderate correlation between Mom’s depression and Dad’s depression, but what the study doesn’t say is what direction the causality might be,” he says. “There’s no clear pattern in the research we have so far.”

Jill Di Donato, writing on Huffington Post, addresses the potential for the blame-game and quickly dispels the notion:

As feminists, it’s tempting to let reports like this rub us the wrong way. But we need not take this as an indictment suggesting the sanctity of a family’s mental health rests on mom’s shoulders. Studies like this one point us in the direction of an inclusive family model – one that recognizes a variety of experiences for each member. Moreover, studies like this can help women and men alike recognize risks and take additional steps to prepare for the mental, emotional, and existential changes that come with the birth of a child.

But if it looks like PPD and it feels like PPD, is it really PPD if it isn’t a woman experiencing it? It seems as if women have had to fight tooth and nail for post-partum depression and other post-partum mood disorders to be recognized as clinical, valid and very real medical conditions in order to begin to receive necessary help. Di Donato traces a general history of PPD:

The Women’s Movement of 1970s brought an increased interest in the study of mothering, and over the next two decades, when public anxiety about the breakdown of the family mounted, research into postpartum depression grew at an unprecedented rate. In 1994, the condition was officially added to the (DSM-IV). The new millennium saw postpartum depression grow into a high profile public concern. From the 2001 Andrea Yates case to the 2005 feud between Tom Cruise and Brooke Shields, postpartum depression drew media attention and became fodder for debate.

It’s only in the last few years that PPD has really made it onto the radar screen of many new mothers and even many health care providers. In 2007, in an article on the importance of raising awareness of PPD among both new mothers and providers, Stefanie Pistole-Mangum, a first-time mother and volunteer for Postpartum Support International’s (PSI) Washington chapter, told me:

“Postpartum depression wasn’t even on my radar screen before I became pregnant. I didn’t know what PPD was. It’s not something I even thought about. If I would have thought about it though, I probably would have said Tom Cruise is right – people shouldn’t take drugs. I would have told a new mother who told me she was depressed to go get a pedicure or listen to some happy music.”

With the help of dedicated advocates helping to raise awareness in order to increase resources to identify and treat PPD, the condition even garnered special attention in health care reform legislation through the passage of the Melanie Blocker Stokes MOTHERS Act:

With this long sought federal mandate, states will find more support for PPD programs, researchers will find funding encouragement to continue their search for etiology and cure, and communities will harken to respond to this unmet need. Grants will be made available to fund a variety of entities and programs charged with caring for women suffering from postpartum depression.

Katherine Stone, blogger for Postpartum Progress, “the most widely-read blog in the U.S. on postpartum depression & other mental illnesses related to childbirth,” admits that after the initial reports about the condition in men, many refused to believe it:

“I saw several tweets on Twitter with people saying they didn’t believe it for a second.  One tweeted that male postpartum depression “sounds like a good SNL skit”.  Men can’t have postpartum depression!  They don’t have the babies!  They don’t have baseball-sized hemorrhoids!  They aren’t leaking from their head-of-lettuce-sized sore breasts!  They aren’t still bleeding and exhausted from childbirth!”

But she is quick to offer that, as I wrote above, the research suggests that PPD for men is caused by the same factors that seem to cause PPD in women. It makes sense, then, that PPD would pop-up in couples – couples experiencing similar external conditions:

They also can experience sleep deprivation.  They also can worry when their children are born with health problems or when their wives have traumatic births.  They also can have dreams about what having a baby will be like, and then must face when the reality doesn’t live up to those dreams.  Why wouldn’t they be susceptible?

And, as Di Donato notes,

“Overall, this is a good thing. Interest in paternal postpartum depression speaks to a wider range of experiences that fabricate the modern family. Respectively, getting to know the “sad dad” deepens our understanding of the psychosocial issues parents confront without necessarily minimizing the seriousness of postpartum depression in mothers…”

As a mother who experienced post-partum depression after the birth of my first child, without – intially – fully understanding how it came about or why, I certainly empathize with anyone who experiences anything similar to the painful, sometimes traumatic, symptoms. Increasing awareness of the existence of post-partum depression in new fathers means we’re increasing awareness of post-partum depression in new mothers. And while the rising attention must not result in the siphoning of necessary resources away from addressing the condition in women, of course, the more we call attention to why mothers and fathers may experience PPD, the better we can be at addressing specific risk factors and eradicating this condition completely.

It’s hard to argue with the fathers who know, undeniably, that what they feel is real. Schwartzburg, writing on coming to terms with his own experience and the recently-released research is unwavering:

I hope this can be a starting point for discussion of the unique pressures sudden fathers feel. At the end of the day — and days are never longer than when you’re a new parent — “manning up” should include expressing feelings of vulnerability, depression, and personal need, not just burying them. In my experience, that’s the only hope of truly overcoming.

I feel lucky to have children, but with every Father’s Day I now feel even more lucky to be a real dad, an authentic-to-me dad. I wish the same for all fathers.