SAD DAD: ABOUT POSTNATAL DEPRESSION IN MEN
A longread about a psychotherapist's view on postnatal depression in fathers
This is a chapter from Olivia Spencer's book Sad Dad: An Exploration of Postnatal Depression in Fathers. Her book explores many approaches to the condition, and this chapter is simply one view of the causes and prevention of postnatal depression in men. To read the book in full, you can buy it here, and scroll to the bottom to see a list of resources if you or anyone you know needs help with postnatal depression.
Adam Jukes is the founder and director of the Men’s Centre in London where he works as a group analyst and analytic psychotherapist. It was Europe’s first dedicated treatment centre for abusive men, but it also provides treatment for men with most other kinds of personal problems. Over the past twenty years he has published several books examining men’s relationships with, and attitudes towards, women.
The behaviour of men, and the reasons they behave the way they do are something like his ‘specialist subject’.Through years of work he has encountered many men, with many problems, and he maintains that depression, not to mention perinatal depression, manifests itself very differently in men than in women, and it is this that we need to address more than anything else.
Jukes claims that every patient he sees has a history of depression, but since men are generally less self-reflective than women and less likely to go to a doctor, they may not have realised this. Men who are depressed tend to exhibit symptoms such as anxiety, sleeplessness, weight changes, manic episodes, and risky, self-destructive behaviour, such as adultery, gambling, or excessive drinking. This sort of thing is not uncommon; it’s just that we don’t always notice it enough to remark on it unless it happens to us.
Jukes tells me about one patient in particular who was depressed; he was a married man with young children,who started seeing prostitutes. The father believed that the prostitutes were providing him with everything that his wife couldn’t, and would see the same one for a while, but would then have to find another woman after a time because he’d ‘fall in love’. He would get to know them and they would tell him their story – sooner or later, his morals would get in the way. He would have learnt that many of them were very young, from damaged backgrounds, immigrants in a strange country – and he’d start to see them as people, thus rendering him unable to maintain the sexual objectification needed to have sex with them, and so he would have to find another prostitute, and the cycle would start again.
In addition to seeing prostitutes, the man started drinking heavily and watching masses of porn on the internet, masturbating frequently.The man already had a history of all this sort stereotypically ‘male’ behaviour – it was not a cause for alarm when he was single and unmarried. – so no one remarked on it. Even now, as a married father, the drinking, the porn, the anger and masturbation are all seen as typically male behaviour, and so, as is often the case, go under the radar. What was not seen behind all this ‘maleness’ is that he was completely split off, mentally, from his wife and children as if they were not there. This can ultimately be a strong indicator of depression in men, who are more likely than women to act out with risky, self-destructive behaviour.
Throwing himself into his work after his child was born was also something that Jukes’s patient did. Work is seen as acceptable and necessary for men, so that even working overtime is not particularly controversial, since it can fulfil the traditional expectations of man as provider. If questioned, working overtime can be explained away, but in some cases a man might be finding it too difficult to be at home with a new baby – no longer a priority for his wife – and so escapes into the office with the pretence of fulfilling his role as provider for his family.
This notion of ‘escape’ is also mentioned by Michel Odent , who talks about new fathers who take themselves away from the family unit after the birth – to work or to the golf course, or the computer game console – because they had to get away in order to protect themselves.
The expectations of fathers have changed significantly in the last fifty years or so, with post-feminism and what one might call the ‘natural male response’. Social pressures now dictate that a father should be involved with childcare and housework as much as a mother. Fathers are expected to get up during the night with their newborn, taking it in turns with their partner, perhaps, and to help out with washing, cleaning, etc. The main pressure, says Jukes, is to be responsible. Fathers are expected to provide for the child, not only materially but also emotionally; there is a pressure to provide a protective environment for the mother and child unit.
So, while a father is often at work all day, they may come home to a highly educated, intelligent female,who may have once had as good a job as he; who is frustrated and angry after a day caring for a baby and using so little of her intellect. It is undeniably very difficult for a father to work all day and to come home and care for his child, since his partner is so often the primary carer and is more practised and knowledgeable than he. This can produce feelings of anger in a father, since he cannot meet the expectations of his wife or society, despite going out to provide for them on a daily basis.
Often, according to Jukes, feelings towards a new baby stem from one’s own childhood – this is usually very complex, and many people don’t realise these connections unless they have been through therapy or counselling, but these connections are a significant and useful way of understanding what happens to men after the birth of their children.
Jukes argues that some men experience conflicted feelings towards their baby because of unresolved conflicts with their own mother, and what occurs between a man and his baby is very similar to a sibling rivalry, since they are both competing for the affections of the same mother. He tells me about a booklet produced by his centre for abusive men, which addresses how such men might deal with their pregnant partners. Much domestic abuse begins during pregnancy, so a leaflet like this would hope to mitigate that by helping men identify some of the negative feelings that might be associated with it.
One thing the leaflet highlights is the loss of the breast – the breast is a symbol of food, nourishment, comfort, and affection – and how they might feel when faced with the loss of such things that they may have been getting from their wives or partners. This reaction is dependent on a father’s early relationship with his own mother – if this was a good relationship the sense of loss is mitigated and the father is able to delight in the presence of his child, which will bring about a positive association and there will be no jealousy.
Jukes says that men are bad at metabolising and dealing with disappointment; they don’t always acknowledge it as something they are feeling – it’s easier, and, therefore, more common, to just get angry and blame someone else for the situation. A man may get angry and blame his wife for not keeping the baby quiet at night, or for getting pregnant in the first place, but may never ask himself about the root of this rage.
In facing the pain of disappointment, says Jukes, we are confronted with reality – things are not as we want them to be. Jukes talks about Melanie Klein, who suggests that we must reach a ‘rapprochement’ with the world. The world, according to Klein, will never be how we want it to be, but we must find ways of dealing with it and dealing with the pain. We must either re-evaluate our expectations and come to terms with the way things are, or we must make ourselves more effective in the world so we can shape situations to how we want them to be, without resorting to hostility, anger, murderousness or theft – which would be symptomatic of failing to reach this ‘rapprochement.’
Jukes has experienced many patients who cannot articulate their disappointment. If they are asked what has made them angry they will never say that it is because they feel disappointed, but will instead lay the blame on the situation itself.
Jukes also talks about Freud and his paper ‘Mourning and Melancholia’ to give a deeper understanding of the anger and resentment some fathers feel towards their baby and their situation. The father has lost his old life, the object, and the part of his old life that he loved he identifies with and tries to become like it and recreate it so as not to lose it. But he still feels rage towards the thing he has lost, and so the superego (the part of our unconscious that controls our sense of right and wrong) takes the rage and becomes angry and strong, attacking the good parts of the thing that has been loved and lost. Everything in your life has been identified with what you have lost, and so you are left with only damaged things, or‘objects’. A person (in this case the father) then feels guilty about being angry with what he has lost, and this triggers depression.
This is part of Freud’s theory in very basic terms – to put it in context, perhaps consider it like this: a new father feels sad that his life is no longer how it was before he and his partner had a baby, and so he tries to hold on to it by doing some of the things he used to do, such as playing golf all weekend, or working late. But he is still angry that he doesn’t really have this kind of life any more, and this anger infiltrates everything, since everything is now associated with his new life as a father. He must always think of his child and partner when before he didn’t have to, and so all the time he is feeling angry.
But the new father feels guilty that he is angry and that it is this situation that has made him angry (whether this is a conscious acknowledgement or not) and so he begins to feel more and more depressed about the whole thing. Jukes says this produces all sorts of problems for a man – he loves his partner, or he knows he should love her, and their union has produced a child (an object) and he knows he should love the child too; it is what is expected, and so when a man feels anything other than this, the guilt can be overwhelming.
Often these feelings are worse if the baby was unplanned – in the worst instance a man may feel conned by his partner, thinking she made him get her pregnant.This heightens the conflict between love, rage, and jealousy, at a time that is already known for being difficult for couples and their relationship. A first pregnancy and birth is the time when men are most likely to abuse their partner, and the time when some marriages start to fail, but this can also occur during a second or subsequent pregnancy.
In his book, Is There a Cure for Masculinity?, Jukes writes about a man who came to him after he was physically abusive towards his wife during her second pregnancy. His wife had given up her career as a teacher and as a consequence the man had to work harder to earn more money, while at the same time helping out more and more around the house. His wife, he said, had stopped cooking meals, wasn’t interested in him or in sex, and was constantly berating him for his lack of contribution. He felt overwhelmingly that this was a terribly unfair situation, and would spend his session with Jukes complaining of his wife’s inadequacy as a wife and mother, and had terrible and paranoid things to say about her and their two-year-old child, who he believed was colluding with her mother to get him out of the house.
Jukes was unable to help this man enough to make his presence at home acceptable for his wife and children, but he did continue to see him once he had moved out of his marital home and into his parents’ house. Through further sessions, Jukes explored the man’s history, and discovered that he had experienced an intense rivalry with his younger sister, feeling rejected by his mother – and then his new sister, as his bullying made her nervous towards him and unaffectionate.
Jukes is sure that the man’s wife represented his mother and his child the younger sister – this is an example of ‘transference’ – the unconscious projections of feelings onto other people. Jukes maintains that this transference is not unusual, but is very complex, and, almost certainly, this man would never have made these connections had it not been for the therapy he sought because of his violent behaviour.
It is clear in most people’s minds that perinatal depression is, historically, a female problem. But what does masculinity and femininity have to do with being a parent? And what is the difference between men and women that makes this sort of depression apparently more common in women than men?
Jukes says there are no essential differences. There has been lots of research into what makes a man a man and a woman and woman (apart from the very obvious physical attributes), but the fact is that men differ more from other men than they do from women. The same can be said of women, too, but if we want to explore masculinity and femininity, a look at behaviour is a good place to start.
Masculinity is what men do, often according to cultural expectations, and so it is easy to spot differences in men if you look at how they behave. When Jukes talks about how men deal with their anger following the birth of their children, it is an example of how men can be very poor at dealing with their emotions. Traditionally, men do not talk about their feelings; the idea of sharing innermost thoughts to a trusted friend might well be considered a ‘girly’ notion.
Times are undoubtedly changing, but there will still be many men who feel awkward about admitting how they feel if it is not what is typically expected of them as men. Another example of changing times is the introduction of paternity leave within the last twenty years or so. Now a father is expected and often encouraged to take time off work to be at home with his partner and newborn baby, but, as mentioned, no thought is given to how men might feel during this period; the focus is generally on a mother and how she is coping, emotionally and physically.
Of course anxiety is something that affects both mothers and fathers: it is undeniably a very stressful time for both partners when a new baby arrives. Jukes suggests that women are probably better at dealing with anxiety than men, who, Jukes says, tend to act out in the same ways that depression might cause them to – by doing risky things and setting up dramas because they can’t talk about their feelings. For instance, a man might begin sleeping with other women and become anxious that his wife will find out, but will continue, regardless, in order to avoid having to explain to himself why he feels like he doesn’t want his new child or hates his wife.
Again, this is an example of a man, apparently unconsciously, creating a way to get out of his new situation as a father. Jukes sums this up with this statement: 'the most common precipitant for divorce is the birth of the first child'.
In his book Is There a Cure for Masculinity?, Jukes puts forward another reason for men choosing to act out, other than to alleviate extreme anxiety surrounding pregnancy and birth. He suggests that these sorts of behaviours enable a man to feel in control and hold on to an ‘unravelling’ sense of masculinity, bolstering his independence, toughness, and potency. A man may feel helpless when faced with the task of parenting, and there is little wonder that this is the case since so much advice and help is directed solely at mothers.
I asked Jukes how useful he thinks leaflets about domestic abuse are to men on the cusp of fatherhood. On the whole they would be useless, he says, and wouldn’t be read. I can see how that would certainly be true until more men prioritised mental health as something to be aware of during the pre-and postnatal period. The fallout from abusive situations is extreme, so it would be dismissive, says Jukes, to say that leaflets would be a waste of time if it ultimately helped to prevent just one case of abuse.
Jukes tells me about a project he set up some time ago to help men deal with the enormity of becoming fathers. So much work had been focused on the mother and child, and while important, it left out the other important figure in all of this – the father. He devoted much time to the project; writing papers, talking to ministers and the directors of locally-run organisations, and other charities – all of whom were very supportive and interested in the initiative. It was suggested that a structured programme of support group sessions could be run specifically for men about to become fathers for the first time. This would have enabled and encouraged men to face their feelings while their wives and partners were pregnant so that they could articulate what was going on for them emotionally which would help them to prepare for what they were going to have to deal with.
However, Juke’s project was met with such strong resistance and disdain when they tried to get it off the ground – from both the people who would be running the sessions and from fathers who would have attended - that the project was abandoned. Jukes is adamant that this sort of system would have been cheap to run, since fathers themselves could have been trained to lead the sessions, while being able to refer any cases they couldn’t deal with to the local mental health trust.
Would this be the kind of group new and prospective fathers would attend? Clearly, something needs to be done in communities and at that level – perhaps in the same sort of settings as women go to for similar classes. Antenatal classes, which often are directed at couples, could perhaps be encouraged to include fathers in more in what they cover, in addition to birth and the first few weeks. I feel it is unlikely to be something men would actively seek out. But, as discussed in other parts of this book, the research is there telling us that support groups for men are effective.
Fathers may feel like they don’t have time, or that they don’t need any help and that a support group, or even any fathers group, isn’t something ‘conventional’. While it is clear that changes do need to be made,and funding needs to be secured in order to make those changes, this needs to be accompanied by a change in attitude in fathers themselves.
Jukes ultimately maintains that dealing with the anxiety and anger surrounding pregnancy and birth would be relatively easy – but the problem remains that men very rarely present themselves to GPs or other health-care professionals with the problem of paternal perinatal depression.
Unfortunately, unless there is a change in the way outreach for mental health problems is seen, PPND will only present itself in the divorce courts. Work has to be put in by couples to engage in regular, honest dialogue in order to break the cycle of acting out, which may have become the default response to dealing with difficult emotions.
USEFUL LINKS AND GROUPS FOR SUFFERERS OF POSTNATAL DEPRESSION AND THEIR FAMILIES
(taken from Sad Dad by Olivia Spencer)
postpartum.net - Postpartum Support International – based in Oregon, but a worldwide organisation.
acacia.org.uk - Raises awareness and provides support for families suffering from pre and postnatal depression. Based in Birmingham.
Bluebellcare.org - Based in Bristol. A charity for mums, dads and families affected by pre and postnatal depression.
The Marcé Society - Swansea based group dedicated to supporting research and assistance surrounding prenatal and postpartum mental health.