The Essential Meaning Structure of Postpartum Depression. A Qualitative Study

Abstract

Postpartum depression (PPD) is a fairly common yet often unidentified disorder which not only affects the mother, but may also have an adverse effect on the cognitive, emotional and social development of her baby. The nature of PPD and whether it may be qualitatively different from non-postpartum depression (NPPD) is still disputed. The main aim of this thesis is to explore the phenomenon of PPD from the first person perspective. In order to deepen our understanding of PPD we compare it with the phenomenon of NPPD. The methodological approach towards this aim is descriptive phenomenology as outlined by Giorgi. The participants are 4 PPD and 3 NPPD women who were interviewed in-depth two to three times about their experience of depression.<br> The findings of this thesis are presented in three separate papers. The first paper “Two ways of living through postpartum depression” presents two identified essential meaning structures of PPD: 1) The looming threatening world and 2) Loss of primordial my-ness. In “the looming threatening world” we describe how mothers after birth may experience themselves as anxiously thrown into an alienated and threatening world in which their inhibited body is perceived as an obstacle for their attunement to their baby. The baby becomes a catalyst for feelings of guilt and shame, and they tend to withdraw from others into loneliness. In “loss of primordial my-ness” we describe how a mother experiences a fundamental feeling of unreality and disconnection both in relation to self, the baby, and the social and material world. She experiences a basic loss of ownership of her own perceptions, feelings, thoughts and actions. In parallel, the world is perceived as unreal, colorless, strange, and robbed of its meaning. Unbearable anxiety accompanies this overwhelming feeling of depersonalization.<br> The second paper “Incest and postpartum depression intertwined” is a case study which explores how incest experiences in the past constrain perceptions, thoughts, emotions and actions in the present. We describe how the birth of a baby girl may reactualize and throw a mother into a world of incest where she is overwhelmed by intruding fantasies of men who abuse her children. Constantly on guard, she actively seeks information about abuse of other children in the media, which in turn feeds her anxious vigilance and fantasies.<br> The third paper “Engulfed by an alienated and threatening body: The essential meaning structure of depression in women” describes the essential meaning structure of NPPD. We described how NPPD women initially feel entrapped in a personal mission that has gone awry. Experiencing her lack of personal resources to resolve the situation, the NPPD woman crumbles under the perceived disapproval of others. She doubts her own judgments and experiences others’ negative emotions almost as if they were her own. Excessive feelings of responsibility are coupled with strong feelings of shame and guilt, which lead her to overwork or over-involve herself. In the process she ignores her embodied emotions, which gradually become alienated and threatening and in which she is ultimately submerged.<br> This qualitative study suggests that the most striking difference between PPD and NPPD is that PPD mothers felt in essence disconnected and alienated from the world and others (the baby), and in the case of one mother, also in relation to self, whereas in NPPD the problem was rather an experienced heightened sensitivity to others’ distress or negative judgments. Thus, there may be a difference in the development of PPD and NPPD which seems to be centered around two opposites; heightened sensitivity versus disconnection. We conceptualized the alienation in PPD as existential depression and anxiety, and the increased sensitivity in NPPD as a more relational type of depression and anxiety.