Tokens of Affection

Reclaiming Your Marriage After Postpartum Depression

Karen Kleiman, Amy Wenzel

• Publisher: Routledge
• Year: 2014
• Print ISBN:
  9780415810456
• eBook ISBN:
  9781135093600
• Topic: Scienze sociali
• Subtopic: Salute mentale in psicologia

Postpartum depression is hard on a marriage. In their private practices, authors Karen Kleiman and Amy Wenzel often find themselves face-to-face with marriages that are suffocating, as if the depression has sucked the life out of a relationship that was only prepared for the anticipated joy of pending childbirth. What happens to marriage? Why do couples become angry, isolated, and disconnected? Tokens of Affection looks closely at marriages that have withstood the passing storm of depression and are now seeking, or in need of, direction back to their previous levels of functioning and connectedness. The reader is introduced to a model of collaboration that refers to 8 specific features, which guide postpartum couples back from depression. These features, framed as "Tokens," are based on marital therapy literature and serve as a reminder that these are not just communication skill-building techniques; they are gift-giving gestures on behalf of their relationship. A reparative resource, Tokens of Affection helps couples find renewed harmony, a solid relational ground, and reconnection.

1

Your Current Married State

What has happened to my marriage? I thought things would be better now. Instead, we are both irritable and more distant than ever.

—Support group participant

Just when you think things are finally starting to feel normal again, symptoms have resolved, everything seems to be getting back on track, everyone should be moving forward … suddenly both of you are stymied once again by an unforeseen obstacle.

If everyone is now feeling better, why does your marriage feel so difficult some of the time?

You’ve recently had a baby and you are both exhausted. Maybe it’s your first, maybe it’s your second or third. Maybe it’s your last, maybe not. Regardless, if the two of you have recently withstood the ravages of depression, you are in a far different place than you expected to be in at this time. Perhaps one or both of you are feeling relieved and hopeful. On the other hand, you might be angry and bitter. Or exhausted and unmotivated. Or anxious and uneasy. Or grateful and appreciative. Or perhaps you are feeling many or all of these feelings simultaneously.

One client said she noticed something wasn’t right soon after she told her husband she was starting to feel better. Before long, she was hesitant to tell him she was feeling better because she was afraid he had forgotten how bad she recently felt. She was afraid his expectations might change and she would fail to live up to them. For months, she has visited a therapist weekly, taken her medication as instructed, and learned how to cope with her ever-present intrusive thoughts that challenged her on a regular basis. At last, Nicole felt invigorated as she emerged out her period of “dark and daily devastation.” It was light again. The sun was shining again. She could breathe once more. She describes how her hard-earned desire to share this relief was short-lived as her husband impatiently and mistakenly concluded that everything would automatically return to normal, “We would now proceed as if nothing had happened; as if we should fall right back into line. You do your job, I’ll do my job, let’s have sex and oh, did I tell you I’m playing golf all day Saturday?”

It’s understandable that one or both partners yearn to return to previous behaviors and levels of functioning, partly fueled by denial but mostly because non-depressed spouses are eager to bring joy back into the household. However, recovery from depression does not happen overnight, thus, creating a lag between the crisis and a renewed sense of well-being. Anne Sheffield, author of several books on depression, calls this phenomenon and one of her books, Depression Fallout, describing overlapping stages of confusion, self-blame, demoralization, resentment, anger and the “desire to escape the source of so much unhappiness” (Sheffield, 2003, p. xv).

Pause for a moment and consider how you feel about your partner right now. Where are you both in terms of your relationship? How close do you feel? Do you feel loved? Do you feel listened to and understood? Next, think about how you felt about your partner before the baby. Before the depression. Before your life changed so dramatically. How did you envision your life together at this point? How did you think you’d be act and feel as a couple? It’s quite possible things feel good, but if you are reading this book it is likely that you feel something is missing. There may or may not be high degrees of conflict in your marriage. Good, solid marriages can experience periods of time when one or both partners feel discontented. Undoubtedly, life has become enormously hectic and it may seem as though the two of you are rarely in the same space at the same time. The experience of having a baby and depression is a volatile combination. Although statistics vary, the worldwide estimate for the prevalence of postpartum depression (PPD) ranges from 5% to 25% (Gaynes et al., 2005) and about 10% of men (Paulson & Baze-more, 2010). Unfortunately, these numbers are likely to be on the low side because postpartum depression is generally under-recognized and under-treated in both men and women. The prevalence rates (up to 26%) have been noted to be higher in some urban women with low incomes (Hobfoll, Ritter, Lavin, Hulszier, & Cameron, 1995). (Note that this book refers to postpartum depression and depression to include all postpartum mood and anxiety disorders, including anxiety, panic, obsessive-compulsive disorder [OCD], and post-traumatic stress disorder [PTSD].)

It would be a mistake to presume that the volatility of depression would not take a toll on the marriage. If the impact of the depression is ignored, the couple might conceal true feelings of resentment, disguised by bickering, criticism, irritability, and generally unpleasant dispositions. Although these are normal reactions to such a series of shockwaves to the marriage they are nonetheless certain to make things worse instead of better. A marriage in gridlock can result in a downward spiral of anger, blame, and isolation.

Postpartum Depression Is Hard on a Marriage

No one expects to be blindsided by depression after the birth of their baby. Although it’s true that increased awareness is enabling more couples to better prepare for the possibility and thereby reduce its impact, still, when it happens, it doesn’t matter how well you’ve prepared. You feel cheated. You are cheated. Even later, after symptoms have improved and healthy coping skills begin to emerge, remnants of the earlier ambush can, and will, create various degrees of turmoil in your marriage.

The early postpartum weeks and months divert couples away from themselves and invariably diminish the time they have for each other. More specifically, it diminishes the time a woman has for her partner, which can reduce his marital satisfaction (Barnes, 2006). Studies show that depression has been linked with “marital problems” (Whiffen & Gotlib, 1993) and poor “marital adjustment” (Whiffen, 1988). Do poor marital relationships cause postpartum depression or does postpartum depression cause poor marital relationships? Both are true, depending on the circumstances, but there is no clear causal association that would hold true across the board. Without a distinct definition of poor marital relationships, it’s difficult to generalize, but it’s interesting that despite the research which supports this, many couples exhibit a consistent, though frustrated, effort to settle what has been disrupted during the crisis. In fact, many women report after the fact, that their relationships were strong and their partners were particularly supportive. I have been witness to countless numbers of women and men who fight tirelessly to regain the love temporarily lost in the shuffle of emotions.

In 2011, The Postpartum Stress Center distributed an informal questionnaire in preparation for this book, exploring the impact of depression on the marital relationship. Ninety-five percent of the 55 respondents were women. Of these women, 93% identified themselves as the depression sufferer in the relationship. By far, the majority of participants reported that their marital relationship suffered but continued to be loving and strong. While only 7% responded “No,” they were not in the slightest worried about their relationship, 62% said they were “not really worried, but postpartum depression did take its toll on the marriage,” and some were “a bit worried” but trusted in the strength of the relationship to help them navigate the rough waters. Consequently, more women than not, were hopeful that their relationship could withstand the tumult caused by the depression. It seems that many of the couples continue to put forth great energy and effort toward the marriage, and may do so despite, or because of, the extraordinary strain. This apparent incongruity speaks volumes in favor of the incentive to repair the connection during depression’s aftermath.

Taking a look inside your relationship is probably the last thing you feel like doing right now. It may even feel like a waste of time. Digging into your marriage just when you have recovered from the tumult of postpartum depression, may present a hardship for which you simply cannot muster the energy.

But you should.

Here’s why: As far back in 1957, LeMasters reported that 83% of new parents experience moderate to severe levels of crisis during the transition into parenthood. Although initially disputed, other researchers have validated this high degree of distress during the transition to parenthood (Stamp, 1994). In fact, one study shows that marital quality decreases sharply for 40% to 67% of couples during the first postpartum year (Shapiro, Gottman, & Carrère, 2000). When we factor in postpartum depression, the picture is even bleaker. Research shows that husbands of women with postpartum depression report less satisfaction in their marriage and feel less capable as parents compared to husbands of postpartum women who are not depressed (Zelkowitz & Milet, 1997). Additionally, there is evidence that women with postpartum depression report inadequate communication with their partners (Paykel, Emms, Fletcher, & Rassaby, 1980) and, specifically, that they feel less able to talk openly about problems with their partners than postpartum women who are not depressed (O’Hara, 1986). In summary, there is (a) a high degree of distress during transition to parenthood (without depression), (b) a decrease in marital quality during first postpartum year, (c) less satisfaction reported by husbands of women with PPD, and (d) inadequate communication with spouses reported by women with PPD. Additionally, lesbian couples, who conceived a child through artificial insemination, showed an increase in relationship conflict after the birth of their baby (Sayer & Goldberg, 2006).

Another reason why you should rally around this effort is that research shows that couples therapy reduces depression, especially in women. This is partly based on the finding that women tend to use emotion-focused coping, and blame themselves for marital problems, which puts them at greater risk for depression. It follows, then, that if couples learn to attend to the relationship with effective tools, this could conceivably relieve depression or likely protect from relapse (Beach, Fincham, & Katz, 1998).

Thus, we see that the impact of postpartum depression on the marriage has striking implications and can potentially damage the relationship. This is true whether it is the mother who has suffered from depression or whether depression affects the father. Do not make the mistake of minimizing the impact, regardless of who suffered from depression. As one woman told me, “Postpartum depression changed my marriage. It actually made it better in some ways, I think. We learned things about each other we never knew. But it crushed our spirit and it hasn’t been a smooth road home. It rocked our foundation.”

If you are the depression sufferer, right about now, you might be feeling guilty about how the depression affected your marriage. Not only will that not help, it will keep you locked into some of the old distorted thinking patterns that emerged during or, perhaps, triggered your depression. I know, first you felt guilty about the depression and now you feel guilty about the state of your marriage. Right now, it’s important that you exercise the ability to ignore your temptation to feel guilty about this. Do not blame yourself. Save your energy for this work you have ahead of you. If you are the non-depressed partner, it will be helpful if you can remind your partner that they are not to blame and that the two of you are on the same team here, working on making things feel strong again. Note that if your marriage feels either too fragile or too volatile, self-help measures will not be sufficient. In those instances, you should seek professional assistance for further support.

In my clinical practice, I find myself face-to-face with recovering couples who appear to be suffocating by each other’s fumes, as if the depression had sucked the life out of a relationship that was best prepared for the anticipated joy of pending childbirth. Couple after couple report an agonizing new married state; one that emerges after the acute depression has resolved; at a time when joy is expected to permeate the demands of this life transition. Even without depression, the postpartum period challenge each and any marriage with stressors of unprecedented proportion. You already know how sleep deprivation, unpredictability, idealistic expectations, and a new baby can combine in combustible fashion! When we factor postpartum depression into the mix of two individuals trying to make sense out meeting each other’s needs, it can get pretty messy, pretty fast. All systems are interrupted and abruptly forced to recalibrate.

Whether or not depression has interfered with the family dynamics, partners do not always understand what the other one wants. This happens, from time to time, in every marriage. Sometimes it is due to poor communication. Other times it may be the result of a misperception. Still other times, it is because one or the other may...

Table of contents

• Cover
• Halftitle
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the Authors
• Foreword
• Introduction
• 1. Your Current Married State
• 2. When Depression Descends
• 3. The Connection
• 4. Secrets of a Successful Marriage? The Tokens
• 5. Connection Strategies
• 6. Token of Esteem
• 7. Token of Collaboration
• 8. Token of Compromise
• 9. Token of Selflessness
• 10. Token of Sanctuary
• 11. Token of Expression
• 12. Token of Tolerance
• 13. Token of Loyalty
• 14. Bumps in the Road
• 15. What’s Next?
• References
• Index