The Weeping Mother
____ From movie “The Story of the Weeping Camel” to postpartum depression
"The Story of the Weeping Camel" is a 2003 German film about the nomadic life of Mongolians. The life of a nomad is hard! In the movie, it is in winter. The landscaping is desert-like: the grass and trees are dry; the sand is everywhere and will fill the air when the wind blows. After the sandstorm, a thick layer of sand is left on the Mongolian yurt. No TV, no computer, no electricity. Water resources are also scarce. Who can survive under such harsh conditions? The hard-working nomads and their camels, sheep, and dogs.
The nomads depend on the Camels and sheep for surviving. Camels are their friends and partners.
The film documents the life of a nomadic family, and a large part is about the mother camel and her baby calf. With the help of the whole nomadic family, the red camel mother experienced two days of painful delivery and gave birth to a rare white camel calf. However, the camel mother rejects her baby; she does not let the calf be close and refuses to breastfeed the calf. The nomads keep pushing the calf towards her, but she keeps on dodging. The condition worries the nomad family. In order to change the mother camel's mind, they did two things:
First, they organized a prayer ceremony, inviting people to pray together loudly at a dedicated location with blue ribbons hanging high up. Unfortunately, this praying ceremony was unsuccessful, and the camel mother was still very stubborn in rejecting the little camel.
Then they tried the second method. The father and the son rode the camels to a community center to invite a musician for help. The musician arrived as scheduled and brought his beloved horse head fiddle on that day. After the greeting, they started the ceremony. First, they tied a blue ribbon to the instrument. Then, they hung the instrument on the mother camel's hump, and when the camel calmed down, they took off the instrument from the camel and gave it to the musician. The mother starts to sing while caressing the camel. Then the musician starts his play. In the open space of the desert, the beautiful song and music seem to stop the time! At first, the mother camel resists the baby camel, but gradually, she becomes quieter and less repulsive to the little camel, and then tears come out of her eyes. Was she crying? Finally, she allowed the little camel to eat her milk! On the vast winter grassland (more like a desert), the mother and the calf cuddle with each other. In the sunset, both of them are standing like a beautiful picture!
The camel mother finds her mother's love, and the little camel can grow up under her mother's wing.
The musicians and the whole family walk back to the Mongolian yurt at sunset. They drink, play the instrument, laugh, sing and revel freely at night.
Why does the camel mother reject her baby? What is the importance of building a mother-child bond? She cannot talk, and we may guess some possible reasons; one of them might be that the camel mother suffered from postpartum depression or psychosis.
Postpartum depression or postpartum psychosis, as the name suggests, is the symptoms of depression or psychosis that develop after giving birth to a child. This article will mainly focus on postpartum depression. In the latest DSM-V (American Psychiatric Association, 2013), there is no diagnosis of postpartum depression but "perinatal depression." However, since many people still prefer to use the term postpartum depression, this article will continue to use this term as a description of a phenomenon, not as a diagnostic term.
Postpartum depression is also different from "baby blue." Baby blue occurs within a few days after giving birth. It is generally thought that postpartum hormone change is the cause of baby blue. The women who have the baby blue will experience bad moods, crying, and irritability. Baby blue usually disappears after a few days. If baby blue goes beyond a few days, the baby blue may develop into postpartum depression. Therefore, postpartum depression (PPD) is a relatively persistent state with similar symptoms to major depressive disorder. The women who suffer PPD may experience (all or some of ) the following: depressed mood or unable to feel happiness, sleep disturbances, low energy (not only caused by postpartum physical weakness or exertion, of course, constant stress and exertion can be a contributing factor to depression), loss of interests, hopeless, and suicidal thoughts or attempt, thoughts of harming children or ideas of infanticide. Some postpartum depressed women may also experience hallucinations or delusions—for example, some infanticide fantasies related to command hallucinations or delusions that the ghost possesses the baby (psychotic symptoms). If the psychotic symptoms are dominating, it is called postpartum psychosis.
Postpartum depression is a mental illness that needs to be taken seriously; ignoring or delaying the treatment of postpartum depression is detrimental to both the child and the mother.
Many factors can affect postpartum depression, both its cause and progress. Biological and genetic factors, postpartum hormone changes, family mental illness history, prenatal depression, premenstrual syndrome are all risk factors of postpartum depression. The genetic factors mainly increase the susceptibility to PPD. Studies have shown that there is little difference in the incidence of depression in people with and without genetic susceptibility in the absence of stressful events. However, the likelihood of having depression will significantly increase in both genetically susceptible and non-susceptible populations under stressful conditions (Kendler et al., 1995). For a woman, few other events have had a more significant impact on her life than having a child for. Not only does she have to go through the pain and danger of childbirth, but after the child is born and before her body has recovered from the pain and weakness, she has to start caring for a completely helpless baby. The baby will bring a 180-degree change in her lifestyle and role. No wonder the incidence of postpartum depression is high (who can replace the mother? A woman who gives the infant's birth will have to take the role no matter how difficult it is?) The incidence of postpartum depression is about 10-15%, depending on the population participating in the study (range 3.6% to 23%) (Blum, 2007)!
Whether the process of pregnancy and delivery is smooth and whether the mother suffers birth complications or whether the infant is healthy also affect the mother's postpartum mood. It is only human instinct to stay away from and reject the things that make her suffer, physically or mentally, such as the baby who causes the delivery pain and trauma. However, another part of the instinct and the superego tell the woman that she should love the baby, which will inevitably lead to the intense inner conflict in the mother, and the resulting love-hate intertwining, self-blaming, and guilt. Sometimes, perhaps, the instinct of staying away may surpass maternal instincts. For example, in "The story of the Crying Camel, does the camel mother's rejection of the baby camel relate to the pain she experienced in dystocia? Fortunately, with the efforts of the nomad's family, she regained her motherly love so that the baby calf could grow up under the nourishment of their mother's milk and enjoy the accompany of his mother.
The social support system is also important, e.g. the quality of the marital relationship and relationships with other family members. For example, the conflicts between husband and wife and mother-in-law and daughter-in-law are frequently encountered in treating postpartum depressed clients even though the causes may be objective or subjective. Either way, they may relate to past psychological trauma, relationship with their own parents, and their internal model of being a parent/child. In terms of social or family support, the cultural custom of "postpartum confinement" practice in China and in the Chinese community overseas (the actual practice of postpartum confinement might be different from place to place and time to time) maybe not only beneficial to the physical recovery of the mother but also the preventive to the new mother from developing postpartum depression. However, because the woman in postpartum confinement is mostly taken care of by the mother or mother-in-law, the mother & daughter or mother-in-law & daughter-in-law relationship is important.
The influence of psychological factors is multifaceted. First, as mentioned earlier, genetic factors and stressful life events greatly impact the susceptibility to depression. Depression, including postpartum depression, is closely related to past trauma such as loss and abusive experience. The loss could be the loss of a parent during childhood or adolescence, long-term separation from a parent, a parent's divorce, a previous miscarriage or abortion, or a child's death. The past abusive experience could be childhood abuse (physical, mental, sexual) and past sexual assault or harassment. Having a child of herself may activate the memory. Loss and trauma in early life can increase a person's neurological, biological, and psychological sensitivity and even cause structural changes in the brain, such as a smaller hippocampus. The hypothalamic-pituitary-adrenal axis is more active in these people, and when a stressful event occurs, more stress hormones are secreted. This neurological adaptation is intended to protect the traumatized person, but it may overact during stressful situations. If a person was traumatized in childhood, he will: (1) In fear of being traumatized again, she might choose to distance himself from others. Then she might be more likely isolated from others. Therefore, she might have a weaker social support system. (2) Because her needs of intimacy and being loved and cared for are never being met, she would idealize others once in the relationship. Because ideal others never exist, she would become deeply disappointed. Feelings of abandonment, anger and fear related to her old traumas would be reactivated. The internalized aggressive object may turn to attack the ego. Self-blaming, guilt, and low self-esteem may also appear. It will not be a surprise if she becomes depressed.
To understand the emergence of depression, psychoanalysts offer different explanations, probably because of the different cases they analyzed.
In his "Mourning and Melancholia" article, Freud (1917) pointed out that melancholia symptoms, such as self-depreciation and self-blam, appear when the anger to the early loss turns to inward attacking the part of the self that identifies with the lost object. In "The Ego and the Id" (1923/1961), he added the harsh superego as one of the causes of depression, which makes people feel guilty for their aggressive behaviour.
Abraham (1924) further developed Freud's loss and melancholia theory thinking loss in childhood seriously damages the child's self-esteem. New loss or disappointment in adulthood activates previous pain, resulting in depression.
Jacobson (1971) also further developed Freud's idea and combines the effects of object loss and the conversion of the internalized lost object into the superego. The person will become a victim of his own superego, the helpless, powerless child. On the other hand, Mania arises as to the magical union of the ego and the superego, transforming the harsh object into a loving, forgiving, and flawless. This perfect object is projected into the environment expecting a perfect ideal relationship while blind to all the flaws through the denial mechanism. This relationship is closer to the relationship pattern of patients with borderline personality. When this defense fails, depression emerges. Jacobson's interpretation is close to Klein's explanation below.
Klein (1940) argues that to overcome the pain of loss, the child, in desiring and longing the lost object, may develop manic defenses, such as omnipotence, denial, contempt, and idealization. Moreover, the desire for triumph leads to self-blame, guilt, and depression. Klein's explanation is beneficial for understanding bipolar disorder. However, in clinical work, we can also see that even unipolar depression patients have idealization, omnipotence fantasies and denial and the failure of these manic defenses. So it is also helpful in understanding depression.
Bibring (1953) believes the realization of the difference (tension in ego) between ideal and reality causes depression. He thinks that people have three highly invested narcissism-related aspirations: to be worthy and loved, to be strong or superior, and to be good and loving. When the ego realizes that it is impossible to measure up its aspirations, a sense of helplessness and powerlessness appears. He believes that anything that harms self-esteem can lead to depression. Unlike Freud, he does not think the inward-oriented aggression or superego are causes of depression. He thinks narcissistic vulnerability plays a crucial role in causing depression. It does resonate in many depressed patients. Sandler and Joffe (1965) think depression develops when something essential is lost, but the ego cannot do anything about it. The loss to Sandler and Joffe includes not only the loss of a real or imagined love object but also the loss of well-being (health, well-being) - called "Paradise lost". Specific to postpartum depression, the well-being of postpartum women is repeatedly threatened during pregnancy and childbirth. It is not uncommon that pregnancy and childbirth cause diseases (e.g. diabetes) and injuries from childbirth or long-term physical discomfort due to childbirth. The changes in body shape, appearance, and the mother role may further affect their lifestyles, personal income, social roles, self-experiences and self-esteem.
Arieti (1977) looked at depression from another angle. He observes that many depressed persons have a typical pattern of not living for themselves but the dominant other. The dominant other could be a person, e.g. a spouse, an organization, an institution, or an ideal. Depression may occur when the person fails to gain the approval of the dominant other or feel unable to achieve their ideal.
Attachment theory is familiar to many therapists. John Bowlby (1969) believes that mother and child will develop a pattern of attachment during the first few years of the child, and it is crucial to the child's mental health in the future. In a secure attachment relationship, the child feels loved, safe, and relaxed. If a child loses his mother or has an insecure attachment relationship, the child will feel abandoned, unloved, unworthy of love, and helpless. Death is not the only condition that interferes with a mother's love. Prolonged separation from the mother, depression or disease of the mother, or other conditions (e.g. a very busy mother) can interfere with the mother's capacity to love her child and interfere with attachment development. In the future, when the child encounters some loss, such as the breakup of a friendship or a love relationship, divorce, children leaving home, relocation of a close friend, Etc., it may reactivate the sense of abandoned and unloved, helplessness and powerlessness, i.e. the melancholic state. c
Developing a secure attachment relationship is closely related to the mother's condition. Depression will compromise the mother's ability to build a relationship with her child. Therefore, providing support and treatment to the postpartum mother is crucial. It benefits both the mother and the child and the child's offspring because mentally healthy parents are more capable of bringing up a mentally healthy child; a mentally healthy child is more likely to grow up becoming a mentally healthy adult.
Nowadays, we also realize the importance of the father's role. The marital and family relationship is more likely harmonious and warm if the father is stable and loving, providing a favourable environment for the child. It will be helpful for the child to develop a sense of security and the development of self-esteem. Father love and father's childcare involvement can also provide an extra dimension and psychological space out of the mother-child relationship. Freud thinks the father's love is most important in the Oedipus complex development.
Talking about the mother-child relationship and postpartum depression (and depression itself) cannot avoid the insights of Winnicott, the British child psychiatrist and psychoanalyst, especially his insights in "Primary Maternal Preoccupation" (1956) and "The Theory of the Parent-Infant Relationship" (1960).
Primary maternal preoccupation refers to a state that the mother gradually developed during pregnancy, reaching the peak at the end of pregnancy, then fades away within several weeks after the infant is born. Then the state will be "forgotten" by the mother. During this period, the mother develops a high degree of identification with the baby and is extremely sensitive to the baby's needs. She would know the baby's needs as clearly and accurately as knowing her own needs. He wrote:
"It gradually develops and becomes a state of heightened sensitivity during, and especially towards the end of, the pregnancy. It lasts for a few weeks after the birth of the child. It is not easily remembered by mothers once they have recovered from it. I would go further and say that the memory mothers have of this state tends to become repressed."
Winnicott argues that primary maternal preoccupation or identification with the infant is "conscious but deeply unconscious." Mentally healthy mothers can achieve this state naturally during the third trimester and postpartum. In this state, the mother can best meet the baby's needs. When his needs are met fully and timely, the baby does not need to fear the environment ("fear of annihilation"). Winnicott also believes that healthy mothers can achieve this state naturally and can come out of this state after a few weeks postpartum naturally. She can gradually allow the infant to influence the outside world (e.g., crying), to react and to cope. Some mothers cannot achieve this primary maternal preoccupation state or are unable to achieve it fully and naturally for various reasons. First, they will feel guilty about their failure. Second, they will desire to compensate (consciously & unconsciously), so they cannot let go (let the child face the world) when they should. Such a mother will continue to pay attention and meet all her child's needs or spoil the child as if he is still a newborn. She may feel that she loves her child, but Winnicott believes she is doing therapy for herself instead of being a parent ("They do therapy instead of being parents.—Winnicott, 1956.)
Why is the mother's strong identification with the infant, i.e., the primary maternal state of cohesion, so important? Because Winnicott believes that only when the mother naturally reaches this state can she give the baby a "good-enough environmental provision" to reach the state of "live-on-being." The baby will feel the real existence, and then his natural development tendency can unfold naturally; makes the baby's self (self) appear and develop naturally, and develops a healthy ego-function, laying a solid foundation for life. If the mother does not provide such a good enough environment at the earliest stage, the baby will not be able to exist in a relaxed way, the sense of realness will be disturbed, and his development of self will be interfered. In the absence of maternal support (ego support), the ego function will also be interfered. Winnicott argues that every human has both true self and false self, originating from the earliest stages of life. In a normally developing infant, the false self only works when being interfered in order to buy time. A non-normally developed baby will be stuck in a false self. Put it into another way, the baby will be in constant anxiety, unable to relax.
In "Primary Maternal Preoccupation," Winnicott discusses and explains the infant's earliest needs and the mother-infant relationship, and the impact of this particular mother-infant relationship, as well as the primary maternal preoccupation, on the infant's mental/mental health. In "The Theory of the Parent-Infant Relationship," Winnicott continues to emphasize the importance of the early mother-infant relationship, arguing that holding is not just physical holding but also the holding of the three-dimensional holding that the mother provides for the child, including psychological holding. In my opinion, the quality of psychological holding affects the quality of physical holding. Likewise, the mother's mental health affects the quality of both psychological and physical holding. After the birth of the infant, the health of both mother and infant, the mother's mental health, and the support that the mother gets all affect the mother's capacity to provide holding space. Winnicott also thinks that some mothers have the ability to hold the baby, and some mothers do not. The mother who cannot provide maintenance will soon make the baby feel insecure, further affecting the later development period and the formation of object relationships and the attachment building (secure or insecure). Furthermore, the mother's ability to provide ego functional support and the quality of object relations affect the child's ego function. Going further, these are the cornerstones of a child's future mental health, well-being, and even life/career success.
The various above-mentioned psychoanalytic interpretations of depression all refer to love and loss. So it must be true that early childhood trauma has a lasting effect on people. Postpartum depression could be one of the manifestations of trauma. And, when a mother is depressed, it could be a loss/trauma to the infant. What he loses is part of his mother's love, the mother's partial capacity to provide the love to him (it does not mean the mother does not love him.)
Why do we only mention mother here? Because in the initial stage of an infant's life, the infant does not yet know the existence of the father and other people. All the people who provide care to the child is experienced as "mother." Therefore, the "mother" here could be anyone who provides the care to the infant and the mental health of all of them will similarly affect the infant.
Blum (2007) summarized three common psychological conflicts in mothers with postpartum depression: (1) dependency conflict, (2) anger conflict, (3) motherhood/motherhood conflict). She believes that all patients with postpartum depression have at least one of these three conflicts.
Blum believes that for a mother to take good care of her baby, she needs to feel that she is taken care of, and everyone has the need to be taken care of. However, some women who experienced frustrations or traumas before in relying on others, such as being repeatedly rejected or belittled (e.g. "You suck!"), may become defensive about relying on others, forming an attitude of asking for nothing (I can do it. I can take care of myself. I need to take care of myself.) This counter-dependent adaptation stance is generally not a problem. However, this adaptation will fail to work if too many things are taken care of (such as taking care of a newborn) or limited ability (e.g. after episiotomy or C-section). If she can accept help from her family or friends or hire someone (nanny, nurse), her need to be taken care of could be met, it will be beneficial for the prevention and recovery of postpartum depression.
As mentioned above, the mother has one-month postpartum confinement in Chinese culture. During the period, the mother does not go out, and the family steps in to take care of the mother and provide help in baby care. Because this is a social custom, the mother can accept the help with peace of mind, guilt-free. Therefore, despite there being controversial aspects in postpartum confinement, help from the family should be helpful in preventing postpartum depression if the process goes well.
Of course, as mentioned earlier, postpartum depression relates to multiple factors. To meet one aspect of needs does not solve all the problems. When providing help to the new mother, psychological support should not be neglected. Postpartum confinement could be a difficult period. Because usually, the mother or mother-in-law is the primary helper. The conflicts between mother and daughter and mother-in-law and daughter-in-law are pretty common due to the unsolved preexisting conscious and unconscious issues. Many unconscious things may be reactivated and manifested during this period, such as envy and past object relation trauma (this article will not detail it here.) However, young mothers living abroad, influenced by the Western culture, may not want to conform to the postpartum confinement custom on the one hand, and they may also have little family support resources on the other. During the Covid-19 pandemic, due to the travel restrictions, I encountered cases where young couples could not go back to where their family were to give birth to the babies as planned, or their family members could not come to Canada to help. In these cases, their sense of helplessness directly relates to the occurrence of postpartum depression.
After the child's birth, that small life brings earth-shaking changes to the mother's life. The new mother's life revolves around the baby; the endless feeding, diaper changing, pain, fatigue, sleep deprivation, etc., are tiring and despairing. The sagging belly and excess fat, the unfamiliar self in the mirror, estrangement from friends and previous social circle are saddening and may affect the self-esteem of the new mothers depending on some of the cases. Furthermore, the change of couple routine may also reactivate the sense of insecurity of the mother in the relationship. Depending on the object relation history of the mother, her husband, her mother/mother-in-law, etc., old object-relation trauma could be activated in this interaction field. Living with an "evil mother-in-law/evil mother" could be painful. Many women fear expressing their grievances because they "learned" that mother love is great, selfless, unconditional, and requires sacrifice. And, in the Chinese culture, a good daughter/daughter-in-law must be filial piety and forgiving. Therefore, she feels guilty for having un-filial thoughts/feelings. Therefore, her anger may direct inward to herself or project to the infant because he gets the attention and care she does not get (as a child and now). She may envy the baby (unconsciously) as well. Therefore the idea of hurting the baby or infanticide. The causes of infanticide ideas are mostly suppressed with the denial or dissociation mechanisms into the unconscious, so even the patients cannot understand why they have these thoughts.
Many women with postpartum depression have problematic relationships with their mothers. Perhaps it is because they felt that their mothers were not interested in them or were unwilling to take care of them when they were young (e.g., internalized patriarchal ideas). Their mother did not have a loving and caring relationship with them. When they become mothers, they do not have a good internal model for reference. Even though some of them had sworn to be different if they had children, they swore never to let their children experience the pain they experienced as children. Often, however, they are unaware that the mother is their only internal model (a person has one mother or one primary caregiver only). Often, they did not realize how similar they were with their own mother until talking with their therapist.
Of course, some women are overcompensated "successfully;" they make sure that they are the opposite of their own mother. For example, if her mother is a neglectful mother, they would do everything to meet the needs of her children. If her child is out of her sight for a moment or a small need of her child she did not meet, she would feel very guilty and anxious and blame herself harshly. Again, such a mother is not being a parent but doing therapy for herself. She is healing the wounded child inside. At the same time, she is blocking the natural development tendency by being over devoted. In this sense, she is actually similar to her mother--not attuning to her child's need; her mother by neglecting, she by suffocating her child.
The first half of this article lists many factors related to postpartum depression to illustrate the importance of the mother-infant relationship. The mother's mental health is closely related to the child's psychological development. Therefore, postpartum depression brings mental distress to the mother and affects the mother-infant relationship and infant development. The three conflicts Blum suggested come from his observations of adult postpartum depression patients. It is helpful in guiding postpartum depression treatment. These conflicts also indirectly reflect these patients' past mother-infant/parent-child relationship problems, which resonates with the psychoanalytic trauma mentioned above as the cause of the conflicts.
Since postpartum depression is so significant to mothers and their babies, women with postpartum depression should seek help as soon as possible. Family members should also provide physical and psychological support to them. Treatment of postpartum depression includes psychotherapy and medication. Considering the issue of breastfeeding, Psychotherapy should be considered and tried first. Of course, if postpartum depression is severe, drug intervention or hospitalization should also be in place in time. Short-term or long-term psychotherapy can help clients understand the underlying issues and are the therapy worth promoting.
In "The Crying Camel," the efforts of the nomad family to rebuild the bond between the mother camel and the baby camel are absolutely good for the baby camel's survival. If camels also have mental/mental health (I believe they do), they are helpful to their mental health and the baby camel's psychological development as well.
Reference
American Psychiatric Association, 2013. Depressive disorders. In: Diagnostic and statistical Manual of mental disorders fifth edition (DSM-5). 155-188. American Psychiatric Publishing Inc.: Washington DC & London England.
Blum, L. D. (2007). Psychodynamics of postpartum depression. Psychoanalytic psychology. 24(1): 45-62.
Gabbard, G. O. (2005). Affective disorders. In: Psychodynamic psychiatry in clinical practice (4th edition). 213-247. American Psychiatric Publishing Inc.: Washington DC & London England.
Kindler, K.S, Kessler, R. C., & Prescott, C. A. et al. (1995). Stressful life events, genetic liability, and onset of an episode of major depression in women. American Journal of Psychiatry, 152: 833-842.
Winnicott, D. W. (1956/2018). Primary maternal preoccupation. In: Through Paediatrics to Psychoanalysis. 300-305. London and New York: Routledge.
Winnicott, D. W. (1960). The theory of the parent-infant relationship. International Journal of Psycho-Analysis. 41:585-595.
The Story of the Weeping Camel. https://www.facebook.com/mongoliantravelcompanies/videos/%D0%B8%D0%BD%D0%B3%D1%8D%D0%BD-%D0%BD%D1%83%D0%BB%D0%B8%D0%BC%D1%81-the-story-of-the-weeping-camelthe-story-of-the-weeping-camel-mongol/2082719828500944/
Francy Wang 王方
January 25, 2022, 1:16 am
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