"Is it postpartum depression?" she asked me.
She did not have quite the features of depression. But then these psychological concepts when used to complain about one's problem are so difficult to form a judgment upon. Depression is after all a word and words are shorthand for complex phenomenon. And while words convey information they can only approximate to what the other person has in mind and cannot evoke the exact image in the hearer. Every individual experiences his or her mental misery somewhat uniquely and they all get lumped under the rubric of depression. Of course there are certain features which frequently cluster together, and gives the core of what we clinically understand as depression, but sometimes there may be none of those core symptoms and patient can still be not doing well and may be having what should be looked upon as depression (which is best defined as a general inhibition of functioning).
What exactly she meant by she cannot bond with her baby?
She described it as that while as a mother she does take care of the baby, she does it mechanically. She is not drawn to the baby as the baby's father and baby's two grandmothers are, who get so excited when with they are with the baby, and cannot wait for their turn to have it because they get so much pleasure out of cleaning, feeding and playing with her, and go into raptures if the baby smiles or does something that they were not expecting her to do.
Then the patient wondered if the baby will develop autism because of this lack of bonding with her (mother).
While I agree that the etiology of autism may have similar origins, where the baby's caretakers are not quite in tune with the baby's emotional needs and may deal with the expressions of its emotions, especially aggression, without proper feel for it, suppressing instead of allowing them to blossom into age appropriate forms, forcing the baby's psyche to shove the manifestations of these aggressive drives back upon its own self, which will eventually find expression as autistic behaviors.
I assured her that most likely the baby will not have autistic traits because she seems to be getting enough acceptance and nurturance from her father and the two grandmothers.
"And you you may be overestimating your lack of emotional attachment to the child," I tried to be supportive.
Then I asked the patient if she was breastfeeding the baby.
It turned out she was not. She blamed it on some nutritional expert in the hospital who just after delivery came to teach her about breastfeeding but on hearing she was on Suboxone and Xanax immediately declared that it was not an option because Suboxone and Xanax will pass through the breast milk and will harm the baby's brain.
I felt sorry for the mother and the child who were harmed for life because some expert, based upon a single variable that Suboxone goes into the breast milk, had ignored all the other benefits of breastfeeding which easily outweigh the little opiate going into the baby's system. It is better to be ignorant than to have half-baked knowledge.
I asked her if she really wanted the child?
She was not sure if she did. She had known the baby's father for just six months before she got pregnant. They were living together but not because of any strong bond. They just moved in without thinking through and because they could never plan anything beyond what was right under their nose. They both were good looking, so there was physical attraction. But the biggest thing in common was their opiate dependence and addicts like to do drugs together as if they seek courage from others doing the wrong thing. Their partnership had persisted in trying to give up opiate abuse too and both were in treatment with me getting Suboxone, and supporting each other to remain abstinent.
There were couple of other points which held them together. She admired him as an exceptionally good tattoo artist, which he really was, and he once was flown in to Florida from Michigan to tattoo a famous basketball player and had been feted while he was doing the job by that celebrity, which had made her really proud of him, but overall she did not think of him as a husband material. She claimed he worked only when he felt like - which was not very often - and feared when married they will be more broke than secure. They were living together more for convenience in her mother's basement than anything else. Then she got pregnant and lacking decisiveness allowed the pregnancy to proceed till she had no choice but to go through the delivery.
Then both of them dropped out of treatment.
Six months later the girl's mother came for her own session to my office and told how her daughter was back doing drugs, and raising Cain. She was stealing, partying and hanging out with all wrong men.
For all practical purposes she had abandoned the baby.
So the lack of bonding with the child had a motive. If she had gotten really bonded to the child, it would have been a powerful counter motive to return to drugs and party all the time. With the child latched on to her, she could not have abandoned herself entirely to fulfilling her these pregenital primitive selfish drives.
So what looked like a spontaneous failure of bonding was not all that spontaneous. There was a cause, a hidden motive, the pull of living wild, with no restraints on one's basic animal urges.
One wonders too if postpartum depression does not just arise out of vacuum but has some similar hidden motive behind the profound dip in mood. If we go deeply into the psychology of Oedipal Phase of the female sex, one is left with no choice but to conclude that the compensation for the lack of penis, which at that age the little girl suddenly realizes will relegate her to second class status in affairs of the world all through life, is having an exclusive possession over her own baby child when she has one. What she was denied - the male genitals, which are so strikingly obvious in her male siblings and playmates - and the absence of which was most acutely felt during that phase was handled by fantasy of getting compensated on growing up via having a baby of one's own who will be completely dependent upon oneself. But in some women, rather in all women to different degrees, their birthing and having a baby over which one has complete possession is not felt as adequate compensation. The original penis envy and continued search for it through direct competition with men, which is manifested in all kinds of inexplicable behaviors which puzzles us to no extent, like entering into relationship to trick/cheat him into giving what he has to her (the woman's attitude on this matter is best explained by the saying, "What is mine is mine and what is yours is mine too", or through destroying him out of jealousy, often after falling in love with them and then once he becomes her life partner turning the relationship into a constant criticism of all his behaviors, or making his life miserable, governed by the illusion - unconscious of course - that this will hasten his destruction which will be equivalent to her getting what she has always envied and desired.
Girls who are into wild partying instead of settling down with a mate and seeing the purpose of life in having and raising children are really into this alternate lifestyle. The motive being to steal from some unsuspecting man - in the chaos of wild relationship - the penis that is so badly desired. Women's love for clutter, confusion and goofiness in conversation also owes to the same complex: in the disorder and turmoil to steal what one so badly wants. The tumultuous relationships, the modern generations are having, prior to settling down - for they are brought up with so much indulgence with all their desires immediately satisfied so they want everything - also owes to the young girls not giving up the desire to have the penis directly by stealing from a man through a deceptive relationship than through having a child by him and postponing that wish to the next generation.
And behind postpartum depression lies the same complex. "Let me kill this baby for it has not gotten me true parity with men and let me seek what I want not through marriage and playing with my child (the penis substitute) but through indulging in wild chaotic existence and changing places with a man. Even when these women come from socioeconomic backgrounds in which leading a wild sexual lifestyle is out of question just the fantasy of indulging in polymorphous perversions may act as sufficient counter motive to not take care of the baby to the point of even killing it; done under the delusional cloak of protecting him from evil (the evil itself being mother's own infanticidal tendencies).
Does a lack of instinctive understanding of the aggressive tendencies of the child who has disposition to develop autism on part of the mother also arises from some counter motive?
It is interesting that in the modern times as more and more information is being fed to people on how to be ideal parents paradoxically we are producing more and more obsessive/autistic children. It appears that more full of education, sophistication, and upper class one gets, greater is the chances for the child to turn autistic.
Why this paradox?
Perhaps all this acquiring of knowledge happens at a cerebral level and perhaps much of it as an overcompensation for lack of feeling of natural motherly bond between oneself and one's child. In olden times women had children in their teens and twenties, when they were nearer to being child themselves and thus instinctively understood their babies and could instinctively identify with their children's drives. They did not need any Dr. Spock's books or Child Protective Services manuals and parenting classes on how to be a good parent. They did take care of the child instinctively and did not see themselves as separate from the baby. Mother and child were a unit. Of course, they neglected and ignored the child much more than they do today and the child was exposed to dangers and harm far more than nowadays. Today the child is infinitely more protected and safe from physical dangers. But in earlier times while they had little time for their children, the time they did spend had far more emotional warmth and understanding than nowadays. And what the mother could not give emotionally, there were always siblings around picking up the slack, and acting as surrogate parents. Now with only one or two children in household, this substitute parenting role of siblings has disappeared.
Nowadays the parents are full of knowledge of how to raise a child but the counter motive to be drawn by other demands of life: their career, their friendships, their hobbies, their need to excel with peers, their social obligations which are far more ingrained in them for these distractions were practiced late into their twenties and thirties, with childbearing postponed to the limits of one's biological clock, they all act against bonding with the child as the unsophisticated mothers of the past could instinctively do.
Once I was severely castigated by a neurologist for suggesting that inadequate parenting may be responsible for autistic children not finding proper outlets for their aggression. She insisted that of what she see of the parents of autistic children they are more attentive, more concerned, and more devoted to their child than ordinary parents.
I agreed with her but added that they may be more devoted and may be spending more time and may be doing everything as the book says they should do. But it is done more cerebrally than instinctively and spontaneously. Trying to heal problem of the heart with the carefully thought out solutions by the head often fail. These older aged mothers, who often become quite narcissistic, by postponing marriage and becoming androgynous for living by themselves rather than with a partner, try to bring up their children through doing everything right by the book instead of feeling emotionally one with the child.