Aged 12, I was a reluctant violin student. So great was my frustration with the instrument that I used to frequently picture throwing the violin against the wall and watching as the wood twisted and splintered into an unrecognisable mess. Despite the frequency and vividness of this mental image, I never acted on the thought. I also had no intention of ever doing so. The pictured action was merely an intrusive thought, born of feeling trapped in a situation that I had no desire to be in and felt powerless to change.

Twenty years later, I began to get a similar intrusive thought. But this time, instead of a violin, I’m picturing throwing my 3-week-old baby at the wall. As you can imagine, this was much more distressing and uncomfortable than the violin scenario. It also bolstered my increasingly strong conviction that I was a terrible mother and a worthless human being. These thoughts were accompanied by a constellation of other symptoms, such as low mood, lack of motivation, guilt, rage and irritability, the sum of which eventually equalled a diagnosis of postnatal depression.

At this point I feel the need to emphasise that, as with the violin image, I had no intention of ever harming my baby. I loved my baby deeply and did not wish to hurt him in any way. And yet my brain kept conjuring these images. Even, months later, when I came to the realisation that I was not well and sought help, I never told a health professional about these thoughts for fear that they would misunderstand and take my baby away.

I am by no means the first mother with postnatal depression to communicate a sanitised version of their experiences to health professionals. In fact, this is extremely common, and often prevents postnatal depression from being promptly identified and treated. Recent reviews of the research have found that mothers often avoid seeking help because they expect negative or stigmatising reactions from others; for example, unwanted social services involvement, difficulties with employment, or being labelled a ‘bad mother’.

Dr Anja Wittkowski from the University of Manchester is a clinical psychologist and an expert in postnatal depression. She and a trainee reviewed seventeen qualitative studies exploring women’s experiences of seeking and receiving psychological therapy for postnatal depression. Alongside fear of negative reactions, this research highlighted a number of additional things that prevented help seeking. Some women were reluctant to seek help because of previous negative interactions with health professionals in which their concerns had not been taken seriously; some simply lacked knowledge about postnatal depression and its symptoms; others were resistant to the idea that they might have postnatal depression because of the stigma attached to such a diagnosis. The review highlighted that mothers often sought informal help first rather than approaching health professionals; when they did eventually seek professional help, this was often prompted by family and friends. As Dr Wittkowski summed up, “Women only really seek help if in crisis”.

Organisations such as the PANDAS Foundation aim to reduce the stigma of postnatal depression and to inform the public about its prevalence and symptoms. A key way of doing this is to make mothers’ stories public. For me personally, despite working in mental health research and having seen several family members go through depression in the past, it still took months to realise what was going on. My symptoms didn’t seem to fit in a neat box and sometimes fluctuated wildly so that one day I felt relatively ok and another I felt awful. Although at times I suspected that I might be unwell, I tended to alternate between this and a deep seated belief that I was simply a terrible parent. One of the things that helped me most in realising that I had postnatal depression was reading first-hand accounts of other mums’ experiences. Although they weren’t systematic studies based on large datasets, these stories helped me realise that everyone’s experience of postnatal depression is unique. They helped normalise my experiences and ultimately prompted me to seek help and get well.

Given that roughly 20% of mothers develop postnatal depression in the three months after giving birth, identifying and treating this condition is clearly a priority. For every five mums sipping terrible coffee at your local toddler group, at least one has probably experienced postnatal mental health difficulties. Having gone through the pregnancy-birth-newborn process twice now (I had postnatal depression with my second child), it honestly surprises me that this figure is not higher. So many aspects of the early days with a newborn are comparable to effective torture techniques: sleep deprivation, solitary confinement and relentless noise, to name a few. But mothers are expected to cope with this. Ideally in an Instagram-worthy style.

However, even those mothers who do manage to project a perfect social media image of their #mumlife are unlikely to be quite as happy as they seem. A further study by Dr Wittkowski and a colleague provides some context for this. The authors investigated the experience of negative thoughts in non-depressed mothers. First, they interviewed women with postnatal depression and compiled a list of 54 negative thoughts that they reported experiencing. Reading through the list as I prepared this blog post was surreal: it felt uncannily like someone had gone back in time, to the point that I was acutely unwell, and had transcribed my thoughts verbatim. For example, some items on the list were intrusive thoughts like those I described earlier; some concerned the mismatch between the expectations and reality of motherhood; others expressed the feeling that “I should be able to cope but I can’t”.

It is not surprising that I could relate to these negative thoughts, but non-depressed mothers in the study could too. Between the 158 non-depressed mothers who were surveyed, the top twelve negative thoughts from the list were endorsed by more than half of the non-depressed sample, with all but one item endorsed by at least one participant. The authors concluded that the negative thoughts experienced by women with postnatal depression are on a continuum with the ‘normal’ experience of early motherhood. While noting that no-one should minimise depressed mothers’ experiences, Dr Wittkowski emphasised that this evidence may help to normalise some of the negative thoughts experienced by those with postnatal depression. This may, in turn, help to reduce stigma.

In terms of my own story, almost three years later, I consider myself fully recovered, though I do still take antidepressants and exercise regularly to stay well.

I have almost finished my PhD and both of my children are healthy and happy. I am glad to be able to live a full life again. I even get to the occasional music gig once the kids are in bed, although I tend to avoid anything featuring violins.

By Emily Eisner

Twitter: @an_emily_eisner