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How much suffering does it take to warrant fixing? How broken do you have to be?
THE FOG

Why I didn’t get help when I fell into depression during pregnancy

Jessanne Collins
By Jessanne Collins

Contributor

The thing I remember most clearly about my first pregnancy is the moment the fog lifted after it was all over.

It was a Monday night at the end of January, in an Upper East Side hotel room, where I was having an entire glass of wine. I’d given birth to my daughter two days prior, after, no joke, walking to the hospital in a record-setting blizzard.

The blizzard hadn’t been the most dramatic thing about her birth: She’d arrived with an unanticipated complication that would require surgery almost immediately and we’d spent that day enduring a hospital transfer and a battery of tests. So, suffice to say it hadn’t been the very best time so far. But, finally showered and fed, I felt fantastic. Despite the fact that my daughter couldn’t be with us; that in a few days she’d go through a procedure more serious than anything I’d been through in my life; that, at the moment, there were a lot of unknowns about her future.

I missed her, though I barely knew her. I was exhausted, overwhelmed, anxious, and in pain. But what I wasn’t, for the first time in nearly nine months, was depressed.

***

My daughter was an anomaly in the NICU; an otherwise healthy full-term baby with an extremely rare but benign medical condition is a best-case scenario, especially at a teaching hospital. She was a little superstar, a highlight of the rounds, and, especially after the successful surgery, a happy story in a place of mostly uncertain ones. Over those first few days, I was interviewed by countless specialists about my pregnancy, as they sought to understand if there had been any indicators of her condition. There wasn’t much to share, other than morning sickness and back pain, which seemed par for the course.

But in that hotel room, once it was all over, I realized that the most debilitating symptom, worse than puking and pain, was the fog that had settled in my brain sometime around week six. Depression doesn’t, in my experience, equate as much with sadness as it does with being numb. Fog is the best metaphor I have for it, the thick Bay Area variety that rolls in a way that seems slow from a distance but is on top of you before you know it. Sylvia Plath famously likened depression to a bell jar, my colleague Corinne Purtill called it “a musty shag carpet wrapped around your brain.” It muffles, suffocates, stamps down. It saps you of energy, and worse, the basic ability to enjoy things. That was why I noticed that baseline-level feeling of “hey, this is not bad” that was suddenly washing over me as I clicked through the hotel’s shockingly inadequate selection of Direct TV channels.

Depression doesn’t, in my experience, equate as much with sadness as it does with being numb.

This feeling—my surprise at a wash of quiet satisfaction, happiness even, at nothing in particular—was familiar. I have a clear memory of feeling it at least once before, at 22, a few weeks after I started an SSRI regimen for the first time. I was sitting on a stool behind the counter at the bookstore where I worked, coffee in hand, and I looked up and thought, “This feels … nice.” I couldn’t remember having ever felt that way, at least not in many years. Only a few months prior, before I’d been convinced to go to the doctor, I’d sat on a park bench expressing disbelief to a friend that “happiness” was an actual thing, not a convenient construct of late capitalism. (¯_(ツ)_/¯)

The contrast of what I felt in that moment in the bookstore with what I’d felt for so long prior was so jarring it stuck with me for years: It was like a light had gone on in my mind. Things looked brighter. My chest felt lighter. Nothing special was happening at all, I just felt fine. Not to bring up puking again, but it felt like the emotional equivalent of that moment right after you puke, when your body feels simply amazing just by virtue of being not actively vomiting.

But by the time I became pregnant, I hadn’t used medication to control my depression in a decade, and it certainly hadn’t occurred to me to start again then. While I was well-schooled in the risk of postpartum depression, I hadn’t yet learned the statistic that depression affects up to 15% of women while they are pregnant, or that perinatal depression (encompassing both pre- and postnatal depression) is considered the most common pregnancy complication in the US. Just this week, in fact, the American Academy of Pediatrics issued an updated recommendation that women should be routinely screened for depression during and after pregnancy, citing research that half of women who experience it go undiagnosed and untreated.

My experience bore out this statistic: No doctor had assessed me for symptoms while I was pregnant. But in the hotel room down the street from the hospital, almost as soon as the hormones started shifting in my body, suddenly, unmistakably, the light went on again.

***

Looking back, I do hazily recall telling a friend while I was pregnant that I wondered if I was depressed. It was hard to tell because the physical symptoms of pregnancy are, in a lot of ways, a manifestation of what depression can feel like: intense, skin-crawling fatigue, constant queasiness, the sensation of something pushing all your organs into your lungs. Suffocation. So I guess there were times I wondered whether what I was feeling might not just be physical; almost nightly I cried in bed. Why was I crying? I would wonder, and sometimes ask aloud. Wasn’t this supposed to be a happy time?

I stopped doing all the things I love doing. The very fact of being pregnant stripped away a lot of the things that bring my small doses of daily joy: Coffee, wine, food. But other habits dissipated as well. For three years I’d been keeping one of those “line a day” journals, jotting down tiny notes from my luxurious pre-child universe: went for a walk in Bryant park, had drinks with so-and-so, worked late again. Six weeks into pregnancy, for the duration, the lines go entirely blank.

Why was I crying? I would wonder. Wasn’t this supposed to be a happy time?

Typically, I’m reading about six books at once, but I abandoned reading altogether. I stopped writing, except for the bare minimum required to do my job; stopped meditating, as I couldn’t bear to focus on my body or the next uncomfortable breath; stopped yoga, since I couldn’t get through a class without almost or actually puking. I didn’t enjoy hanging out with friends all that much, and even eventually abandoned Scandal and the other guilty pleasure TV I’d taken up while couch-ridden with nausea.

Nothing interested me; nothing mattered.

Not even having a baby. The single piece of writing I produced during this period, titled “37 weeks and one day,” which I found in my Google Docs much later but have no memory of creating, contains this telling passage:

“My husband asks each day if I’m excited for the baby. He’s checking on me, worried about those minutes (hours?) I spend in inexplicable tears. He’s looking for assurance but instead it puts my ambivalence into stark relief. Of course I am. Of course I’m not. Today it’s more fear than excitement, today it’s more dread. Today it’s more that I want to get it over with already. Today it’s that I simply cannot imagine it. That’s every day, actually. I feel like Adele. ‘Hello from the other side!’ No answer. Just a big, empty, unfathomable space.”

***

Of course, some measure of ambivalence is normal in pregnancy. It’s a weird in-between time when your entire life is no longer what it was and is not yet what it will be. The other side is unfathomable, even to a healthy mind.

But reviewing the scant material evidence I have of my pregnancy—that draft, those blank journal pages, the very few photos I Instagrammed, or allowed myself to be the subject of—I can see clearly that my mind was not healthy.

It didn’t occur to me to ask for help, even though I wasn’t shy about asking for help with other symptoms. I enlisted my husband for foot rubs, got weekly massages that helped with the back pain, took prescription medicine for the nausea.

How much suffering does it take to warrant fixing? How broken do you have to be?

Maybe I was wary of the possible side effects of SSRIs, unable or unwilling to weigh the pros and cons, the hypothetical risks versus potential upshots. Maybe I was unconsciously swayed by the stigma around maternal depression, wary of being labeled one of the “women who fail at joy,” as described by Andrew Solomon, author of The Noonday Demon: An Atlas of Depression.

Maybe I’d convinced myself I wasn’t suffering enough to need an intervention; after all, I wasn’t desperately unhappy. I wasn’t a danger to myself. I just wasn’t anything at all.

That was the same mindset that had prevented me for years from getting help the first time; it’s the reason most of high school and all of college is pretty much colored in the same gray tint. How much suffering does it take to warrant fixing? How broken do you have to be? If you think you can survive, should you just power through? Or do you deserve something more: Feeling good, or at least ok?

These are questions that seem to weigh particularly heavily on women as they navigate the terrain of mental health, perhaps because women in particular are trained to consider appearances. It’s not just a matter of how you feel versus how you could feel. Unwritten, unspoken, most of the time is a question about how you should feel; does what’s going on in your mind match the situation as it appears objectively?

This calculus is compounded when that woman is a mother, or about to be. How much hypothetical risk are you willing to tolerate? How much of yourself do you think you can sacrifice? The pressure to make the right decision—every right decision—is magnified because it’s not just about your life anymore. The sense that there is a right or a wrong decision, or more than one of these, knits into a kind of impossible tangle.

***

This year, I found out I was pregnant for a second time. I mentally set a doomsday clock, counting backwards from the moment at which, I feared, I would be temporarily erased.

There was quite a to-do list. I had a few weeks at best, I figured, to finish all the creative projects I had on my plate, eat all the things I loved eating, spend time with the people I enjoy spending time with, and appreciate the daily details of living life with the child I love. Soon, so soon, I thought, it will all be out of my reach. I will be underwater, in retreat. It will be like going into hibernation for the winter; I’ll come out next summer on the other side with little memory of what’s transpired in between, just the lingering sensation that it was so very hard to breathe.

From the inside, the fact that my depression was temporary was extremely hard to see.

As I started mentally preparing myself, furiously checking things off my list, I realized the instinct, while understandable, was coming from my expectation that pregnancy, for me anyway, necessarily equates to depression. For a second time, I saw my first pregnancy in a clear light; and wondered if this time it could be different.

Becoming a mother is disorienting. I, at least, was fearful that it would turn me into someone I wasn’t, that it would cost me the things I had worked hard to be. From here I can safely say that becoming a mother didn’t change me, at least not in the ways I feared, at least not permanently. I’m still here. I still love coffee and wine, and writing and reading, and travel and real estate—or at least reading about travel and real estate in the New York Times on Sundays.

But being pregnant did cost me those things, and that self, albeit temporarily. From the inside, the fact that my depression was temporary was extremely hard to see. I had no evidence that I would emerge into something recognizable as myself. I assumed I had been erased, subsumed into a mass of cells that served as a shell for another mass of cells.

But the advantage of what happened during my first pregnancy is that I can prepare for the possible scenario in which it happens again. So rather than just wait for depression to wash over me like a wave, I’ve started thinking of ways I might attempt to tread water this time. The friends I’ve talked to about what it was like last time, who I can ask to check in on me. The therapist I’ve since gotten to know, who’s just down the street. The knowledge that if necessary, medication is something I’m willing to consider. The idea that actually, it might be smart to go ahead, while I’m still feeling awake and alert, and make a contingency plan that my future self could follow, in the event that the fog rolls in.

I’ve also made a list of little things that make me feel content in my regular life. Again, already, I can’t stomach wine or coffee. But there are other things I should be able to manage, like reading, if not six books at once, at least the New York Times on the weekend, having tea parties with my daughter, and creating small things, like muffins.

This time, the day I do one of these things and don’t feel at least okay about it will be the day I ask for help.