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Afterword
For the last 20 years, I have planned, promised myself, and intended to
write a book about perinatal mood disorders. Karen Kleiman does not
plan, promise, or intend. Karen Kleiman writes books. She is, perhaps, the
most prolifc and most recognized writer on the subject. Karen and I have
known each other for about 15 years; yet, we actually met just a few years
ago. Te bond was instantaneous. Weve 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 on
what was once an unrecognized, overlooked, and misdiagnosed illness.
We fgured 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 e-mail. Slowly, the connections and the weaving began.
Te rumblings grew louder and became stronger. Organizations began
to emerge. We found Depression Afer 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 survi-
vor. It was 1980. I was truly enjoying my pregnancy. I absolutely loved the
attention and the movement in my belly. Strangers let you ahead of them
in lines. Tey help with heavy packages. Tey gave themselves permis-
sion to touch your belly. While some women objected, I never minded that
boundary being crossed. Somewhere around the eighth month of my preg-
nancy, it reality hit: Tis baby has to come out of me. It truly was a difer-
ent time. Painkillers were shunned because they would be harmful to the
baby. Te only way to go was natural. Some 22 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. Tey can greet you on the other side. But
you walk that bridge alone.
Tis proverbthis metaphorhas stayed with me all these years. We
all encounter bridges of various types, lengths, and strengths as we travel
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through our lives: adolescence, leaving home for the frst time, and mar-
riage, to name a few.
Id like to share with you three bridges I have crossed and continue to
cross. Tese 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 to which the traveler holds as he or she makes
his or her 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. Te bridge was sturdy. I walked across with great conf-
dence. But as I got closer to the other side, thoughts of labor and deliv-
ery 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. Tere was no escape and the bridge began to wobble.
Te hell with Lamaze classes. Tis 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 mesince the
beginning of time.
If they could do it, I can do it. 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 afer a football game. Ten, I was
back on the ground and they slowly drifed away. Te fanfare was over. I
quickly learned that labor doesnt end in the delivery room.
My son was a preemie, born 1 month prior to his due date. His skin
seemed nearly translucent and hung from his body like that on a raw
chicken. Colic began within a few daysno respecter of day or night. It
didnt take long for it to reset my inner clock and for the insomnia to set in.
Im anxious. Im depressed. Im immobilized. Im exhausted. I cant seem
to do anything right. My baby hates me.
Tere is no support whatsoever. My own undoing, Im a master of dis-
guise. Besides, I had a reputation of being strong and competent. I had an
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image to maintain. I told no one. You know the drill: shame, embarrass-
ment, guilt, and fear. Obviously, my (ex) husband was aware of the insom-
nia and my uncontrollable crying. Each day hed 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 husbands initial show of concern soon
turned to annoyance. Ill never forget the day he came home from work
and pulled the dress of my shoulders and threw it in the garbage. He just
didnt get it. Neither did I. He became more and more distant and unavail-
able. Today, we recognize that men can have postpartum depression, too.
I approach bridge number two. I am surrounded by seasoned moms
who have frequently ofered me well meaning but unsolicited advice. Tey
contradict one another. Tey 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 cher-
ubs and fufy white clouds. Its going to be a long walk, but when I squint,
I can see all the beautiful, blissful mothers nursing, nurturing, and nuz-
zling their newborn babies on the other side. Te babies are content and
cooing sweetly. I want that.
I take my frst tentative step. Baby in one arm, hand of the other grasp-
ing the rope. Clearly, this is going to be a challenge. Tis bridge is not
the same as the frst. Te slats are faded and worn. Te links connecting
the slats are rusted. Te ropes are frayed. Tis bridge wobbles and sways
as the wind whips up. Te water below is turbulent. In addition to 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 minds
eye. Other thoughtsintrusive thoughts, each one more horrifc than the
lastleave me shaken and gasping for air. I would never harm my child.
Te depression deepens and the anxiety turns to terror; I am thoroughly
exhausted. I am holding on to that rope for dear life. I take that fnal step
of 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. Im diferent. Tere is some-
thing wrong with me. I am as unsteady and as unstable as the bridge I just
crossed. I need to sit and rest. I fnd a shady tree. Propped up, baby on
my arm, I close my eyes. At last, some respite. I drif of. But not for long.
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Here come those images again. Tey are vivid, tragic, and revolting. I am
startled into awareness; I sit up abruptly and, once again, I am gasping for
air.
Te jig is up, the mask is of, and I am desperate for help. I fnd 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 depres-
sion, given a prescription for an antidepressant, and sent on my way. Te
medicine did work. Sleep did come and, with time, the thoughts began to
drif away.
Some 4 years later, by a sheer luck, I come across an article in a maga-
zine about postpartum depression (PPD). I call the author (founder of
Depression Afer Delivery) and fnd enormous relief. I was never really
alone. I sufered in silence like hundreds of thousands of women in the
United States every year. Tey, too, did not come forward due to shame and
embarrassment. (Note: By now, my son is 4 and my daughter is a newborn
by the grace of God, the PPD following her birth was mild in comparison.)
Te networking began. Te New Mother Syndrome, by Carol Dix, was
published in 1988, 8 years afer my trauma. Te book was informative
and validating. As a social worker 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 Te Center for Postpartum Adjustment, and the moms begin
to trickle in for counseling and psychotherapy. I am fying by the seat of
my pants because there is no script or manual for treating this population.
I am my own frame of reference. Te common threads begin to emerge:
the symptoms, the myths, the unrealistic expectations. We discuss grief
and loss associated with becoming a parent. Teir normal negative feel-
ings are validated. I learn to ask the hard questions: Do you think you
will harm yourself or your baby? Are you having scary thoughts? Tey
know they are safe and accepted.
Its been 30 years. I am 56 years old. I have treated thousands of women
and have been blessed with a wonderful reputation in a very large commu-
nity. Ive got my treatment techniques down pat: cognitive therapy, inter-
personal therapy, and Ilyene Barsky therapy (aka gut feeling). Tanks to
Karen Kleimans new book, Terapy and the Postpartum Woman, clini-
cians now have a how to manual. I am also the longest standing member
of Postpartum Support International, a worldwide organization working
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toward the eradication of ignorance surrounding perinatal mood disor-
ders. I have been their Florida coordinator and volunteered in numerous
capacities for many years. I have lived to see this illness in scholarly jour-
nals and books, in TV plots, and as the subject of public service announce-
ments. I have lived to see women routinely screened by their medical
providers and the passage of Te Mothers Act. I am enormously proud of
the role I have played. I will be leaving my footprint.
I just learned 6 months ago that I am standing in front of my fnal bridge.
Many other bridges have come and gone, but it is this third bridge Id 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. Te 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 fair. Gavin, now 30,
and Monica, now 26, allow me to go on this fnal journey with peace. Tey
are college grads, working on their careers, and will be self-sufcient. Tey
are genuinely good, warm, caring people. Te best part of my life? Being
their mother. In fact, despite turbulent beginnings, I have been an awe-
some 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. Tey 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 of this aferword?
Despite the oxymoron, I am a survivor.
Kol haolam kulo gesher tsar meod v haikkar lo lefached klol (Hebrew)
Translation: Te entire world is a narrow bridge. Te main thing is not
to fear.
Ilyene Barsky, MSW
Te Center for Postpartum Adjustment