By Lawrence D. Blum, M.D.

        [This article was published in the August, 2001, newsletter of Depression After Delivery, an organization dedicated to helping women suffering from post-partum disorders.]

        Few people are aware that the first modern treatment of a post-partum adjustment problem was carried out by Sigmund Freud in the early 1890's. Here is that forgotten story, which is closely related both to contemporary understanding of post-partum disorders and to Depression After Delivery's mission.

        A young woman gave birth to her first child, she was overcome by loss of appetite, vomiting, insomnia, and anxiety, and she was unable to adequately nurse the baby. After weeks of struggle, to prevent further risk to the mother and the baby, the baby was given over to a wet-nurse to feed (baby formula not yet having been invented.) Three years later, with the birth of a second baby, the same symptoms recurred. On the fourth day of frightful post-partum struggle, young Dr. Freud was called to see the young mother.

        Freud visited the young woman that evening. He hypnotized her and provided the typical hypnotic suggestion that from thence on everything would go well, her symptoms would disappear , she would eat well and nurse the baby readily. For half a day after Freud's departure, the woman ate sufficiently and nursed satisfactorily. A return visit that evening found the woman again overcome by her same difficulties. On this occasion, Freud provided a much more psychologically intuitive, different sort of hypnotic suggestion. "I told the patient that five minutes after my departure she would break out against her family with some acrimony: what had happened to her dinner? did they mean to let her starve? how could she feed the baby if she had nothing to eat herself?" Freud returned the following evening to find that everything was fine, with his patient eating well and with plenty of milk for the baby, although the husband commented that he had thought his wife's behavior after Freud's departure the prior evening to have been rather odd.

        What made this second treatment modern? Here is an intervention that for the first time takes into account the mother's mind, especially her emotional conflicts. Freud's intervention explicitly attends to the mother's own sense of needing to be taken care of, and her anger if she feels she's not being taken care of. Freud was well aware of the importance of biological factors, although hormones had yet to be discovered. But in this instance, while making observations that laid the foundations for the later development of psychoanalysis, he intuitively took note of the most important psychological factors in post-partum disorders.

        In my experience, the most frequent underlying difficulty in post-partum adjustment problems is mothers' concerns about whether they will be adequately taken care of while they are so consumed in taking care of others. If a mother starts to feel guilty about angry feelings toward her inevitably demanding baby, the problems are often compounded. My impression is that the biggest psychological risk factor for post-partum problems is difficulty asking for help, or the mother's dedication to proving she can do it without help, which is, of course, usually impossible.

        This is one reason why Depression After Delivery can be so helpful: it both provides assistance to those in need and also shows them that receiving help is a necessary and acceptable part of caring for a baby. When treatment is necessary, just as with Freud's case, sometimes a relatively brief intervention, to help a mother get over a struggle against receiving some help, is all that is necessary.