Anne Buist, MBBS,MMed,MD,FRANZCP
Professor Women’s Mental Health, Austin Health, University of Melbourne; Director of the beyondblue postnatal depression program 2001-5; author of The Long Shadow and the Natalie King trilogy.
Sophie is one of those women who dominates mothers groups—the supermom who’d be sipping Sav Blanc and giving Róisín you should lose that baby weight looks. Róisín wouldn’t say much, not turn up next time and you’d soon forget her.
As a perinatal psychiatrist, I am lucky. I get to see these women and delve beneath the superficial. Mother’s seem to all start out on a level playing field—all the cliches about motherhood not coming with an instruction manual but mother knows best—yet just like in life, some people get a head start. Over thirty years I have worked with hundreds if not thousands of women like Róisín and Sophie, who start from behind. They are two of six fictional women—mothers—in a therapeutic group that features in The Long Shadow, a psychological thriller set on background of motherhood, loss and how the early relationship with our primary carer—known as attachment—shape our lives.
Sophie’s parents were high achievers—and expected her to be as well. When she developed an eating disorder in her teens it was in part because food was the one thing she could control…until it controlled her. She had to be “best” even at losing weight. Now she has a six month old son, Tom, and she wants to be the perfect mother. Her perceived lack of success has resulted in depression.
Róisín’s mother was depressed and anxious and her father was a bully. Anxious herself, she has withdrawn from the world. She wants the best for her two year old daughter, Bella, but is rarely able to leave her house.
When I started as a perinatal psychiatrist in 1990, I would have treated Sophie and Róisín with SSRI antidepressants and referred them to a psychologist for cognitive behavioural therapy. Because SSRI’s had only just become available, the recovery often seemed miraculous. It was a heady time for a junior therapist—and seeing mothers start to enjoy their infants, to fall in love, reassured me I’d made a good career choice.
But when I did my doctorate, following up women I had treated four years later, I was dismayed at the number who had relapsed, never fully recovered and who were still on antidepressants. And whose children had behavioural problems. My thesis was on the influence childhood abuse—including neglect and having parents who just weren’t emotionally available—had on the transition to parenting, and for some, it seemed it did. But how to improve outcomes for these women and their children?
From John Bowlby’s work in the 1960s, we know this is a critical time when attachment occurs—a foundation for confidence and ability to make sense of the others’ points of view in future relationships. And it is associated with better mental health outcomes. Mother’s issues—depression, anxiety and even more so, the patterns they learnt as a child, can get in the way of providing the child sensitive care. That is, seeing their child’s needs without the filter of their own. And dad’s haven’t been picking up the slack in most cases. What we know now, is that treating the illness isn’t always enough; for Sophie and Róisín I would now also look at attachment, as does my fictional psychologist.
Sophie’s positive interactions are around Tom’s success. Sophie beams when he puts blocks on top of each other, and is quick to dismiss behaviour seen as needy, even his basic need for comfort, because it evokes memories of her own unmet emotional needs. She is already teaching him to squash down his emotions just as she learned to squash her own.
‘You can tell Bella really loves you,’ one mother tells Róisín, ‘but she looks kind of anxious whenever you leave her (in childcare).’ Bella is anxious—because she has been relying on her mother’s map of the world. When Bella first learnt to crawl, she kept interrupting her exploration to check in with her mother. Sophie would have beamed reassuringly, but Róisín’s look conveyed fear: the world is a scary place. Róisín needed to keep her daughter close—to keep her safe, but also because she needed her to bolster her own sense of self. Róisín’s inability to “take charge”—that is, provide boundaries and limits, to say ‘no’ to her child—means this is also a disorganised attachment.
In my groups, women like Róisín and Sophie spent sixteen weeks looking at videos of each others interaction with their babies, asking the question ‘what is the baby trying to say?’ They were given no instructions about changing their behaviour, but when they were videoed again, there were changes in their behaviour —often changes so dramatic that the group would laugh and cry. Light bulb moments.
I’ve seen women like Róisín who, in the initial video, had been too worried about risking their child’s love to ask them to pack up their toys. In the second video they’ve firmly laid down the rules and, in doing so, given the child confidence that someone was in control—and they pack up! A woman like Sophie learns to see her child’s quivering lip before they smile to please her, and respond with more reassurance, a longer cuddle.
Once a week for twenty weeks is not long in the world of psychotherapy but I’ve found the approach remarkably effective, particularly in providing insights that lead to change in a reasonably short timeframe—important when we’re dealing with babies in a crucial stage of their lives. And just as rewarding—these mother’s start to enjoy being a parent, and stop seeing the baby they were and truly fall in love with the baby they have.
Want help with attachment security? There are a number of individual therapists who work with attachment theory, and many maternal child health centres run attachment focused groups such as the Circle of Security (also see circleofsecurity.org ) and CHUGS (ask your maternal child health nurse or see piri.org.au). Some parenting books (eg Good Enough Parenting by Andrew Wake) work from an attachment theory base.
The Long Shadow, out April 28th, is a rural crime thriller, set around a postnatal depression group. The women’s past and the town’s secrets threaten their relationships to their child…and put lives at risk.