How my therapist missed my diagnosis: a patient’s experience of PND

South Africa · CPD courses & CPD points · Health Professionals

It’s easy to miss the signs. I told myself that the listlessness and inability to focus on anything was just porridge brain. I passed off the debilitating inertia as first-trimester fatigue. The inexplicable, overwhelming rage was legitimate irritability caused by (alternately) preggy hormones and my annoying family. I convinced myself that nervousness and anxiety were completely normal effects of pregnancy. All pregnant women worry, right? Don’t we all worry about the baby, the future, the household products that are probably giving our entire family cancer, the starving homeless people at the traffic lights, being attacked and raped in the night by unknown assailants? I passed off the twisted, obtrusive thoughts as my simply being a perverted person and who should not have been allowed to become a mother. Not for a second did it occur to me that I could have been suffering from Peri-Natal Distress (PND).

I’d been seeing a counselling psychologist for a while, mostly about work-related stresses. I’d developed a good relationship with her and I trusted her judgement. Eventually (towards the end of my first trimester) I confided in her that I didn’t “feel myself lately”, but I had trouble verbalising the extent of it. My therapist responsibly completed a questionnaire to analyse my symptoms.

Difficult to diagnose

The trouble is that many of the signs of PND could easily be mistaken for “normal” symptoms of pregnancy. Mood-swings and tearfulness are common in pregnant women, often brought on even by healthy hormonal changes. Overwhelm in social and professional settings can be rationalised by this as well. Most pregnant women experience changes in their appetite and/or sleep patterns, and weight gain is obviously expected so excessive comfort eating or lassitude may be missed too. Many tired or queasy pregnant women don’t make time for personal grooming or hobbies.

The most dangerous signs of all, however, are the ones that can’t always be seen from the outside: the anxiety, the dark thoughts, the suicidal ideation.

I told my therapist that I wasn’t keen on taking drugs, especially being pregnant. Because of this – and because she knew that in my previous pregnancies the worst of my symptoms had eased significantly as I cleared the first trimester – she suggested giving it a few more weeks before reassessing the situation. She responsibly took my preferences into account. But she missed the signs. Just a few weeks later, I was hospitalised to be psychiatrically treated for PND.

Denial and shame

If we hadn’t missed the signs, my condition may not have deteriorated so drastically. If we had intervened earlier, perhaps I would have been spared the months of drugs, panic attacks and voices in my head. But the truth was I knew this was different to my other pregnancies. As I wrote in my diary (later published as Through the Window: How I Beat PND):

I agreed with her that I should give it some more time. I told her that these were probably just the normal ups and downs of pregnancy. I didn’t tell her that the downs were much worse than I’d ever experienced in my life and were starting to terrify me. I didn’t tell her that I was petrified of being diagnosed with depression because I don’t want there to be something ‘wrong’ with me. That I’m terrified that the world will judge me. That I will judge myself.

A diagnosis feels like such a formal, ongoing undertaking. Depression is a big deal. And it makes my ‘problem’ seem like a big deal. And that’s scary.

I loved and respected my therapist, and I still do. I do not blame her for missing the signs, because I missed them too. If I’m brutally honest with myself, I hid their severity from her. I misled her – and myself.

Professionals need to be aware of this and look deeper into a patient’s responses before excluding the possibility of PND. Anyone who works with pregnant women or news mothers should be on the look-out for possible cases of PND. That means not just psychologists and psychiatrists, but also gynaecologists, obstetricians, paediatricians, GPs, nurses, pharmacists, clinic sisters and social workers. Take every single possible sign very seriously.

Understanding what it’s like

The best way to truly understand another person is to empathise with them, and this cannot be done if you do not know what they have been through. This is why I wrote Through the Window: How I Beat PND – to give readers a look into what it is like to live with and through PND.

The book is endorsed by the South African Depression and Anxiety Group (SADAG) and features a foreword and afterword by Cape Town psychiatrist and mother Bavi Vythilingum, as well as footnotes and resources to help the reader to identify symptoms and treatment options.

Through the Window: How I Beat PND is available at www.laurenshapiro.co.za/books