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When It's NOT Postpartum Depression

Updated: Dec 6, 2021

Do you escape to the bathroom and cry behind a locked door years after giving birth?

You may wonder if it could possibly be Postpartum Depression (PPD) even though your instincts tell you it’s not. And you’re probably right. PPD typically subsides within the first 18 months after giving birth, and yet for many moms, an ongoing depression remains. Is it the workload, all the new details related to caring for a baby, or the realization that life will never be the same on so many levels? A fly on the wall might suggest it’s the all consuming workload that’s part of your everyday experience or the constant demands that are put upon you. I know it can be hard to keep up with the details that call you day in and day out. But, does this explain away that deep ache inside, those conflicting feelings that come and go, or your need to cry more often than you think is “normal”? Maybe. And maybe not. There could be more to your feelings and the depression you’re trying so hard to keep at bay, or hidden from the people around you. I know. I’ve been there, and after conducting dozens of focus groups I’ve come to believe that something more is going on, something deep and significant to moms’ overall mental health.

Consider this.

Maternal Intrapersonal Anxiety (MIA). And no, it’s not a coincidence that the acronym is the same as “missing in action” because that’s kind of how it feels — like you’re missing from your own life, but you still get up every morning and have a pretty regular routine of chores, obligations, and activities; from preparing meals to changing diapers, cleaning the house to playing in the park, shopping for meals to putting the kids to bed at night. You do what must get done all the while feeling a disconnect from your “self” as though you don’t recognize the person looking back at you in the mirror. You look at that person and hear a voice within you ask a simple question, “who am I?” and you don’t have an answer that feels complete. You know you love your children. You know you don’t regret becoming a mom. In fact, you know you would do it all over again, if asked. You are mom. That's who you are. But is that enough? Is that all you are? Is that all you want to be? It may be, and that’s wonderful. Or, you may feel the way the majority of moms feel; like you are more than mom, miss the “old you,” and don’t understand what’s going on, how to adequately describe it or how to help yourself out of it.

"I think I'm MIA"

That’s why I coined the term Maternal Intrapersonal Anxiety (MIA). I wanted to give language to a complex set of feelings. MIA is intended to make it easy for moms to talk about their experience, share their feelings, and be clearly understood by others. “I think I’m MIA” says a lot in the fewest words possible, and moms get it, instantly. In brief, MIA is the unrecognized and unacknowledged grief (yes, grief) that manifests when mothers perceive any undesirable change in their appearance, lifestyle, mood, income, relationships, personal goals, and self-esteem (or any other change) as a loss of something that was formerly valuable to them. Key concepts being perceive, undesirable, change, loss, and value. Strung together and it’s easy to see how grief could (and does) manifest, but we’ll get to that later. First I want you to know that I coined this term after years of reading about transition, studying clinical concepts and modalities, bouncing my ideas off of several professors, and interviewing lots of moms, mostly SAHMs coming from a variety of backgrounds, cultures, personal histories, and income levels. I figured my experience alone wouldn’t convince everyone. I knew I needed more “proof,” even if anecdotal. I tried to get the broadest range possible to get feedback that might explain a phenomenon I knew was real for me and so many moms.

Maternal Intrapersonal Anxiety made sense. Let me tell you why. Maternal represents you, mom. It identifies the motherhood experience. Intrapersonal simply means within the person rather than between persons as in the word interpersonal. In MIA, moms experience the loss of a pre-child identity (and the aspects of their lives associated with that identity); it’s an internal processing of change, all the changes related to becoming mom; an internal experience that perceives a familiar image lost as the demands, sacrifices, and responsibilities of motherhood expand. It does not in any way involve the loss of a significant other person. But it does involve the loss of something significant: the “old me.” As for my use of the word, “anxiety,” it represents the core experience of grief. This anxiety is intended to highlight the relation between the many symptoms moms experience and grief as understood in a grief theory known as Grief as a function of Separation Anxiety introduced by David Switzer, a pastoral theologian. This theory maintains that anxiety is the underlying emotion in grief. Symptoms of grief (e.g., fatigue, anger, guilt, depression, social withdrawal) are not separate from this anxiety, but rather relate directly to it. From Switzer’s perspective, anxiety exists at a primal level and is evoked when something of value is lost. Losing a valued person, image, idea, object, place, or construct (e.g., sense of self) can all elicit grief.

To be clear, MIA is not related to Postpartum Depression (PPD), a condition that occurs during childbirth or the period immediately following the birth of a baby. The symptoms of PPD include depression, guilt, and anxiety; however, hormonal fluctuations that follow a birth contribute largely to the symptoms that new moms experience during this time, and the symptoms usually subside within eighteen months. In contrast, MIA is not hormonally driven and typically exists after the eighteen-month “honeymoon period.” It continues in the years that follow when moms are inundated with a long list of ongoing chores, responsibilities, details, and challenges related to caring for and raising children. These challenges typically leave little time or energy for moms to care for the self within them that gives shape to any identity apart from that of “mommy.” That is, moms rarely pay attention to and nurture the elements of their lives that had meaning to them prior to motherhood, elements that speak to the person they had been, the self within that still seeks expression; the self they feel they lost once they became moms.

Not all moms experience the “loss of self” and the ensuing grief that I describe. I’m not assuming I have perfectly identified what you may be feeling, thinking, or experiencing. Some moms may miss certain aspects of their pre-child identity, but they may not perceive change as loss, and will therefore not grieve. Many factors contribute to a mom’s experience, such as community support, marital status (and the quality of that relationship) age, and cultural influence. Other moms will see themselves in this blog post, recognize MIA, understand its relevance, see how it relates to their lives, and feel comfort in knowing that they are not alone, and their feelings make more sense than they ever thought.

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