Baby blues: I second that emotion

If postnatal depression has a hormonal cause, how come men get it too? Oliver Bennett reports
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Indy Lifestyle Online
Major life events - however happy they are meant to be - can be crucibles of mental stress. In this respect the birth of a child is no different. Indeed, the arrival of a new infant, often supposed to be a time of unalloyed joy, can often be the opposite, with all kinds of new tensions and anxieties floating to the surface.

Post-natal depression is one unfortunate manifestation of new parenthood and the unfeasibly high-maintenance baby regime enforces the parents into a grim, dutiful round; sleepless, joyless and resentful. But whereas PND was considered exclusive to mothers, men have been found to be susceptible as well.

Typical male "me-too-ism", some women might say. To paraphrase Woody Allen, if a woman's got a headache, a man's got a tumour. But whether male PND is a new phenomenon, or something we have only just noticed, it is starting to rank highly on the men's health agenda. "Little empirical research has studied the prevalence ... of depressive disorder in post-natal fathers", said a paper in the British Journal of Psychiatry in 1994. Meanwhile, a recent article in the International Review of Psychiatry reads: "The occurrence of psychiatric morbidity amongst fathers during the postnatal period is often attributed to the change in gender roles which have occurred over the last 30 years."

There may be nothing necessarily specific about female PND, says Clive Ballard, senior lecturer in Psychiatry at the University of Newcastle. "Men seem to display exactly the same symptoms of PND as women - in fact, there's no real evidence that female PND is hormonal." Ballard believes that PND in both sexes is similarly "psycho-social" in origin, though he adds that there is a possibility that male PND may have a contemporary factor due to "role confusion" in dads.

Ballard found that 10 per cent of men and 20 per cent of women had experienced PND, with no significant peaks or troughs with age or number of children. The worst-afflicted fathers were those that were unemployed and doing a lot of babycare, and those with a depressed partner. But men are still less likely to report symptoms than women, and one upshot of Ballard and his peers' research is that post-natal care is beginning to take in the whole family, not just the mother.

It might seem perfectly obvious why a new father would be depressed: his position as the mother's love object has been usurped, he may be sexually rejected and is no longer the privileged end of the genetic line. There are masses of practical demands on him, but he is excluded from the core mother and child unit. A spokeswoman for pressure group Families Need Fathers says of the post-natal period: "Society discourages the involvement of fathers with children, and the marginalisation starts here." Current orthodoxies - such as men being present at the birth - can have ill-effects. "Men are bullied into the room and some react negatively," says the spokeswoman, who reports that a common response from fathers is "they feel guilt for causing the pain".

Part of the cause of male PND could lie in poor preparation for paternity, says child psychiatrist Sebastian Kraemer. "Part of the problem for new fathers is that their lives are very different; it is a shock and a surprise, like being an older sibling and watching someone new take your place. And if men are not prepared for parenthood it does not help." In these circumstances, some form of male retreat is evident.

There are psychoanalytic undertones to male PND; one theory centres around castration anxiety. Some, like Nikki Bradford, author of What They Don't Tell You About Being A Mother and Bringing Up Babies (HarperCollins), remains pragmatic: she believes that a major factor of PND in both sexes is sleep deprivation. But most acknowledge a raft of psycho-social reasons for PND.

There is an Association of Post-Natal Illness in London, and while many men still call on behalf of their female partners, the awareness of male maladjustment to parenthood is looming larger each year. Claire Delpech, secretary of the Association, thinks that part of the problem may be that father's roles are poorly defined. "One of the things that we feel strongly is that fathers are asked to fulfil too many roles," she says. "These days we live in isolated units, away from the extended family, and the male partner is expected to do everything. We expect too much from new fathers."

This can lead to relationship break-ups. Malcolm George, a physiology lecturer who has written papers on male PND, cites the "demand/withdraw" pattern of marital interaction - whereby women tend to demand, men tend to withdraw - creating a vicious conflict that is "very prescriptive of relationship breakdown. Depression is about sadness, but also hostility. She will often be hostile at this period, and he will return it".

George also cites research showing that husbands tolerate wives with a mental health problem more than the reverse; and that studies using the Beck Inventory - a psychological test for depression - show that men are under-diagnosed as depressed, whereas women are over-diagnosed. Men, you see, aren't meant to get depressed. "Depression in a man is seen as incongruous with his role, which should be self-sustaining and autonomous," says George. "In women it is seen as acting out the character."

One interesting facet of male PND, according to the marriage and partnership research agency One Plus One, is that "new" men are said to be more likely to suffer than the unreconstructed. Psychoanalyst Joan Raphael-Leff has called these different types "participators and renouncers": the former being actively involved in the whole birth process; the latter being older-fashioned chaps who reject the idea of being in the birthing room.

Yet even the most hard-nosed renouncer, if he is to slip a disc, will somehow manage to do it in the post-natal period. For if men cannot express their depression, it will emerge in other ways. Michel Odent of the Active Birth Centre and author of Primal Health (Century Hutchinson), says that he has noticed it particularly with the home-birth families with whom he has dealt. "Two or three days later (after birth), I found the mother active and the man in bed," he says. "There was always a reason: flu, a backache, whatever."

Odent says that the absence of couvade - a French word, literally "hatching", given to the sympathetic birthing rituals that were once part of paternity - may have much to do with it. "The last example of couvade in this country was earlier this century, when the man was instructed to boil the water during birth," he says. "Though it had no application, it was a way to channel the emotional energy of the father. Now that we have this participatory doctrine, we have lost these ritual aspects, and male PND is a new result of this loss." The way forward, he says, is to be more aware of the father's role; for "the father needs to be in good shape after the birth".

Paternal parenthood is being taken more seriously, and part of the agenda is preventing the likelihood of PND. Labour's proposals for a campaign of "preparation for parenthood" are a start, as is the burgeoning impact of paternity leave: Kraemer notes that the Swedish car manufacturer Volvo now actively prefer to employ men who've taken paternity leave.

Such vigilance will surely have good effect, though it may be that fathers need to regain a secure sense of their role, as something more than a "supportive" cameo. We cannot truly know what we are letting ourselves in for, but we can at least be better prepared.

Association for Post Natal Illness: 0171 386 0868