Growing up as a South Asian, you must have at one point in your life (if not multiple) heard “log kya kahenge?” (What will people say?) from a heart-in-the-right-place parent, aunty, cousin, friend. The “Log Kya Kahenge” syndrome amongst South Asians has many side effects but the most brutal of all is the stigma it has created around people suffering from any kind of mental health issues. A study conducted by WHO puts India at the top of the list of countries with the greatest burden of mental and behavioral disorders, with China and the USA following close behind. Couple that with the burden of not talking to anyone about it or seeking the help needed due to the stigma associated with it and you create a recipe for disaster.
Nima’s Story…
It was this recipe for disaster that took the life ofNima Bhakta, a vibrant, beautiful, successful Indian-American womanresiding in Califo
ia. Nima lost her battle with Postpartum Depression and committed suicide in July 2020. She leavesbehind a seven-month old Keshav who will only get to know his mother through the stories of her friends and family and a devastated husband Deven who is now on a mission to raise awareness around postpartum depression with the hashtag #BreakTheStigma4Nima. Nima’s last words are haunting and ring so true in our community “It was something you guys wouldn’t understand because the Indian society does not fully understand postpartum depression.”
When a woman gives birth, the baby is always the first priority, as it should be, but no one even looks to see if the mother is suffering. And, more times than not, the mother is afraid to reach out for help wondering what is wrong with her – she has a healthy, happy baby so why is she struggling? Given the stigma around depression of any kind in South Asians and the lack of women that speak out about their experiences, the woman may also feel that this is abnormal and something is wrong with her when the truth is that postpartum depression is common, affecting as many as 50-85% of new mothers. In the US alone, 1 in 7 women experience symptoms of postpartum depression and if those women happen to be South Asian and try to talk about it, they will be asked to keep it quiet, eat better, exercise more, concentrate on the baby because talking about feelings, especially negative is something that we as a societyjust do not do.
Those that recognize they have postpartum depression and need help have another uphill battle to fight. They will shy away from treatment because of a mother being idolized as the poster childfor sacrifice for her children. Just google “mother sacrifice child” and an unlimited lineup of motivational quotes come up, mostly along the lines of “A mother’s sacrifice is her child’s reward.” A new mother struggling with postpartum depression is also asking herself: What if I have to go on medication? Will the medication go through to my milk? Will I not be able to nurse? Because now you have moved on from the stigma around depression to the stigma around formula feeding. And none of these stigmas should be discussed openly because all we want to talk about are the happy thoughts and the celebration and the joy of motherhood!
We as South Asians must lea
to accept and openly talk about ALL feelings, not just the positive. We must also lea
to put equal significance to the health of the mother and the baby because giving birth to a child is a traumatizing experience and a mother is not just a vessel to deliver the baby – that child needs her to be healthy and happy so she can give the child all he/she needs. For Nima and for all those that have lost their battle with depression, I encourage everyone to start vocally sharing their stories of struggle, pain, depression, loss, hardship to make talking about the negative realities of life “normal” and “acceptable.”
A Medical Perspective by Dr. Supe
a Kundra
Postpartum Depression…
General information: 85 % of women during postpartum period experience some type of mood disturbance. Postpartum blues occur in about 50-85% of women during the first few weeks after delivery. Given how common this is, it may be more accurate to consider the blues as a normal experience following childbirth rather than a psychiatric illness. Women report mood changes, tearfulness, anxiety or irritability. These symptoms typically peak on 4th or 5th day after delivery and may last for a few hours or a few days, going away spontaneously within two weeks of delivery. Postpartum depression (PPD) typically emerges over the first 2-3 months after delivery but may occur at any point after delivery. It can occur in 10-20 % of new mothers. It is clinically indistinguishable from depression occurring at other times during a woman’s life. The symptoms of PPD include: Depressed mood, tearfulness, loss of interest in usual activities, feelings of guilt, feelings of worthlessness, tiredness, sleep disturbance, change in appetite, poor concentration and or thoughts of suicide. Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1-2/1000 women after childbirth. Majority of women with this develop symptoms within the first two weeks after delivery. Women with this disorder can have a rapidly shifting depressed or elevated mood, confusion and or disorganized behavior. Hearing voices that instruct the mother to harm herself or her infant may also occur. Risk for killing infant, as well as suicide, is high in this population.
Causes of Postpartum Depression:
Rapid shift in the hormonal environment. within the first 48 hours after delivery, estrogen and progesterone concentrations fall dramatically. Some women might be more sensitive to the hormonal changes that take place after delivery which is thought be one of cause for postpartum illness. Marital discord, limited support systems, stressful life events occurring either during pregnancy or near the time of delivery, Women with histories of major depression or bipolar disorder are more vulnerable to PPD, and women who develop PPD will often go on to have recurrent episodes of depression unrelated to pregnancy or childbirth. Age of pregnancy, younger patients have higher chances and patients living alone.
The type of treatment selected is based on the severity and type of symptoms patient presents with. Evaluation of patient generally includes a thorough history, physical examination, and routine laboratory tests and ruling out any medical causes of mood disturbance. Non-medication therapies are useful in the treatment of postpartum illnesses. Women with more severe postpartum illness may choose to receive medication treatment.
South Asian Communities and Postpartum Depression:
South Asian community is notorious about not discussing sensitive topics. There is a huge pressure on women about how being mother is expected to be most joyous time of her life. Women feel the pressure to be perfect mother. It is almost abnormal to feel down or depressed during that time. We tend to have huge support system but struggle with transparency in relationships at times. Pregnancy and childbirth bring a lot of change inte
ally and exte
ally for women. Changes in her body during pregnancy, lack of sleep, being away from work, friends and some other things which she could use prior to pregnancy as coping mechanisms are not available, complications during pregnancy can make things harder for her, gender preference in child can all contribute to difficulties in this jou
ey of child birth. She might not feel comfortable expressing complex emotions she is feeling during pregnancy, labor and after childbirth. Lack of strong support system for her, lack of sleep, lack of exercise, hormonal changes, complications during pregnancy, labor and in post-partum period, special needs child can all push her into deep dark hole.
Screening for perinatal disorders in OB visits and pediatric visits have become common occurrence in US but largely relies on women truthfully reporting mental health symptoms on scales used to screen. Families can make it a point to have women share their inte
al feelings comfortably with them. More transparency in family relationships is needed. It is important to break the stigma about mental illness. It is not weak or abnormal to have mental health symptoms. Mental health issues are real, postpartum period is vulnerable time for most of women. If family members notice mental health symptoms in women, it needs to be brought into attention of them and provider taking care of her and or baby. Depression can make a person feel alone in deep dark hole, which can eventually progress to where ending life is the only way to get out of that hole. Making sure a family member does not end up going into that deep dark hole, if they are sliding, holding their hands, helping them get out of that hole is very important.
I tell my patients, “We all want to be perfect mothers, as a mental health professional I think perfect mother does not exist. We all just need to be good enough mothers”. Healthy mother= healthy baby. Taking care of mother is as important as taking care of baby. Yes, becoming mother is expected to be the most joyous time of our life, but we are most vulnerable during that time. It is important to be aware of risks of perinatal disorders we are all prone to have. If perinatal disorder sets in, it is important to recognize it.
Discuss with medical professional about that. Discuss treatment options. They don’t have to be medications all the time. Yes, breast feeding is very important for baby, but having healthy mom who is going to be there for that baby long term is more important.
LET’S BREAK THE STIGMA. It is time to accept mental health is as if not more important any physical health for all of us. Let’s spread the awareness so we don’t continue to lose more precious lives.
Resources:
National Alliance on Mental Illness -www.nami.org
National Suicide Prevention Lifeline (1800-273-8255) – -www.suicidepreventionlifeline.org
Postpartum Support Inte
ational-www.postpartum.net
About Dr. Supe
a Kundra
Dr Supe
a Kundra is an outpatient psychiatrist that works for the Department of Veteran Affairs in Surprise, AZ. She is a clinical assistant professor at The College of Medicine-Phoenix. She moved to US after completing her medical school in India from JJM Medical college. She completed her MD from He
epin county Medical center, MN. Dr. Kundra worked at a perinatal clinic as part of her practice prior to moving to AZ in 2014 and assuming her current position. During her current work, she helps female veterans with perinatal issues.
Asia Today thanks Dr. Supe
a Kundra for the medical perspective she has provided about postpartum depression. We will continue to share personal stories related to postpartum depression or any other mental health issues with the hashtag #BreakTheStigma4Nima to support Deven Bhaka’s cause for promoting awareness around mental health issues in the South Asian community. If you have a story to submit, please send it to editor@asiatodayaz.com
