A lonely struggle

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Nine mothers from around the globe share their mental health struggles during the happiest period of their lives.

Daniel Egneus: Illustrations

'I felt bad for not feeling the way I was told to feel.

Anyone can be affected by mental disorders during pregnancy or the first year following birth, even if they have never had any prior problems.

According to the National Health Service of UK, 1 in 5 women will experience a mental disorder during the perinatal phase. These disorders can range from common ones like anxiety and depression to rarer ones such as postpartum schizophrenia.

A lack of awareness, deeply embedded stigma, and gender and economic inequalities mean that, according to estimates, millions of people go undiagnosed and untreated every year, whether they live in high-, middle- or low-income countries.

Alain Gregoire is a perinatal psychiatrist, honorary president of Maternal Mental Health Alliance and a perinatal psychiatrist. The experience of profound trauma during a critical period in life is one that women, children and their families around the world share.

Scroll down to listen to nine women from different parts of the world. They will give you a glimpse into what it's like to live in these conditions and how poverty, inequality, or a lack support can affect these outcomes.

The accounts of these people have been edited to ensure clarity and conciseness.

The nine mothers' bases

This article is divided into five sections:

How it feels

Motherhood: Expectations and expectations

Inequality and its impact

Women's Status

No one to turn to

How it feels

The entire reality of a woman changes during pregnancy, childbirth, and motherhood. This includes hormonal and physical changes as well as a new role at home, in the community, and in the workplace.

Zebunisa pathan and Daniela pinate discuss their struggles with mental health in this period of intense change.

No one understood me.

Zebunisa was severely sleep-deprived five days after her birth and began developing severe symptoms of postpartum psychosis. She was sent to a mother and baby unit located more than 30 miles from her home, in the UK, because her nearest hospital lacked this facility. She was there for 3 months.

Pathan describes the experience in detail.

Zebunisa Pathan, 29

Leicester, United Kingdom

From day one to ten, I showed all the symptoms a woman would show with postpartum schizophrenia. The list includes: inability to sleep, hallucinations and delusions.

All the criteria were met. My personality was ten-times my personality. I was hyperactive, overly enthusiastic and had verbal diarrhoea.

When it came to taking me to the Mother and Baby Unit, I refused to let them take me.

From day 5 to 10, I was unable to understand anyone. Nobody was listening. You're not paying attention, I told everyone. I may have raised my voice to everyone.

I was exhibiting bizarre behavior. In one instance, I was so thirsty that I threw a whole jug over my head. I also did a lot of other bizarre things. My body was hurting so I poured an entire bottle of oil on myself.

The logic of what I did was sound, but my behavior was bizarre.

I had never heard of postpartum schizophrenia. I felt a little frustrated and confused. I didn't trust anyone, I didn't understand why I was in the hospital. I knew I was sick, but didn't realize how ill I really was.

I was in the room and all I could think about was how I didn't wish to have my baby taken from me. I was suffering from separation anxiety. Even though I was ill, it seems I still took care of my baby well.

They told me at the beginning that I would get worse, then better. That's the way it is. That's what happened.

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'I feel like I'm drowning.'

Daniela Pinate developed postpartum depressive disorder shortly after giving birth to her daughter in Ecuador a year earlier. She described feeling like a zombified zombie, and that her feelings were blocked. She also felt guilty about being the worst mother on the planet.

Pinate shares her entries from a journal she kept as a way to get through the difficult time.

She speaks Spanish with English translation.

Daniela Pinate, 36

Olon, Ecuador

I still have the same fears. The time passes. I'm not feeling 100%. I'm not feeling 100%.

I see and understand everything around me, but I cannot internalize it.

I am blessed to have a wonderful man at my side. I also have an amazing daughter, who is healthy and beautiful. A family network that is second to none.

But I'm not feeling well. At times, I experience fear, anguish and shortness of breathe.

I don't know how I will survive this.

I don't even want to consider trying to end my life again. It is a thought I have that keeps coming back to me.

I am very sad. This is not going to change.

I am in a deep, dark and gloomy hole.

All of this makes me want to cry. I feel like everyone is judging me, yet I also see that everyone around me is so normal. I know that these are just my thoughts.

I'm a beast. This is how I feel. I'm a Wolf. This is how I feel. I feel like the most miserable person in the entire world. I'm not sure what to call it anymore. I know that it is postpartum depressive disorder, but I want to get rid of it as soon as possible.

My God, I have no idea why. I don't even know how to continue on this path, which suffocates, overwhelms, and steals my sleep.

It makes me nervous. I don't wish to be a crazy person who lives on pills.

I know that I am not crazy. I know I am just a mom who is depressed.

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What are the most common maternal mental disorders?

The National Society for the Prevention of Cruelty to Children, a UK children's charity, divides perinatal psychiatric illness into six categories. Estimated numbers of women in England affected by each category are as follows. There are few global statistics on these disorders.

Source: UK National Society for the Prevention of Cruelty to Children.

Distress and adjustment disorders

Struggling with pregnancy or motherhood.

Affects between 150 and 300 mothers out of 1,000

Mild to moderate depression or anxiety

The symptoms of depression include persistent sadness, fatigue and loss of interest. They can also include uncontrollable worry, panic attacks, and obsessive thinking.

100-150 mothers out of 1,000 are affected

Post-traumatic Stress Disorder (PTSD)

An anxiety disorder that is caused by stressful events such as childbirth.

It affects 30 mothers out of 1,000

Severe depression

Depression that is severe and persistent.

It affects 30 mothers out of 1,000

Postpartum psychosis

Some symptoms include confusion, paranoia and hallucinations.

Two out of every 1000 mothers are affected

Mental illness is a serious condition that can be chronic.

Existing mental illness, such as schizophrenia or bipolar disorders, can resurface during pregnancy or worsen after childbirth.

Two out of every 1000 mothers are affected

Motherhood: Expectations and expectations

Motherhood is a period of great joy and happiness. It's a natural part of womanhood. Experts warn that this period can be exhausting and challenging.

60%

Some mothers who have emotional concerns are embarrassed to talk about them or worry that the health care professional will think they're not capable of caring for their baby.

Note: In March 2017, NCT asked 1,012 women with children under two years of age in the UK about their experiences of the six-week postnatal check.

Source: UK National Childbirth Trust

Gregoire said on CNN that there is a fantasy-like world. For most parents, becoming a parent is a joyous experience, but there are also many stresses, worries and traumas. It's a thing that almost all cultures are not prepared for. It's the hardest thing we do in our life."

Women in the UK are afraid to admit that they're struggling, because they think it will make them look like a failure mother.

Gregoire says that this is the most common fear. The fear that I will be judged as a parent is almost universal across cultures.

Catherine Cho and Analia seria share their feelings of guilt and shame at not being able to live up to the societal expectations for motherhood.

If it doesn't seem natural, that doesn't mean we are failing as mothers.

Catherine Cho, a Korean-American who lives in the UK, is a member of the Korean-American community. Her and her husband's Korean families share certain cultural traditions about motherhood. For example, they practice the tradition of keeping mothers indoors after birth for a period ranging from 21 to 100 days.

The couple decided to break with tradition, as they already had plans for parental leave. When her son was just two months old they took a long trip to the US to see family. Cho, who had her baby around three months prior, developed postpartum schizophrenia during the trip.

She shares her experience and the realization that motherhood is not what it seems.

Catherine Cho, 36

London, United Kingdom

I had no idea what would happen to me mentally, or how the mental transition from being a woman to a mother could be.

Our society speaks about motherhood as if it is all about being a selfless mother. It's also about giving endlessly.

You can feel like you are a failure if you do not feel this way or act in a certain way. You may feel like you are not a good mom. This can be very isolating.

What I didn't expect was that, by becoming a mom, I would also have to lose part of myself.

It's suddenly not only you. You're someone else in relation to another.

It was a heavy feeling, especially after a physical experience like childbirth and labor, that you didn't have the time to reflect on what this transformation meant.

It is rare to experience postpartum psychosis, but the feelings and struggles I experienced are universal.

I believe that part of the stigma and shame surrounding postpartum mental illness is because it breaks down that ultimate taboo. I am not only a danger for myself but also to my child.

I have lost all senses of time. I lost my sense of time. I thought I was Dante's Inferno and was in a computer-simulated hell.

I thought my son's eye looked like those of the devil. By the time my husband brought me to the hospital I had stripped off my clothes and was attacking the nurses. I was screaming that we all were in hell. I was kept away from my son in a general mental ward and given antipsychotic medications.

I was separated from my child for about 10 days, then released with a prescription and no instructions on how to care for him.

It also leads to the idea that motherhood should be a natural thing. It should be natural, but I don't believe that to be true.

We have to learn it and if it does not feel natural then it does not mean we are failing as mothers.

When I gave birth to my son, the labor was very difficult. I would often end by saying, "but it was worth it." I believe this is a phrase we use a lot.

It may also diminish the importance of giving birth. What it means to be a mother.

It's amazing how much wisdom is in the Korean tradition that focuses on mother's care and health. I overlooked it because I didn’t know what that meant. It's actually that, as a mom, you should also take care of yourself and give yourself some time to focus on yourself.

You can be so focused on your baby and making sure it is healthy that you neglect to take care of yourself, both physically and mentally.

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"Nothing happened the way I imagined it in my mind."

She was pregnant with no problems and she approached the birth with some apprehension. However, she had the firm belief that, whatever the outcome, this would be the most happy day of her entire life. She had high hopes and expectations, but nothing came to pass.

She explains how she felt and how, when she returned to work later, she was torn by being both a mother and a woman. She began to question if she could ever fill a certain role. She tried to end her life.

Sierra was diagnosed with postpartum depressive disorder, but it took months for her to receive a proper diagnosis. She recovered with the help of the right therapy and treatment.

She speaks Spanish with English translation.

Analia Sierra is 46 years old.

Buenos Aires, Argentina

During my pregnancy, the obstetrical checkups always focused on my physical condition, and that of my baby. I never got asked about how I feel, or how I am doing, or how well I sleep at night.

The day arrived for delivery. The day of delivery arrived.

These idealizations have a huge impact on women, and they can cause them to feel guilty, because they don't feel the way they should, they are unable to solve problems as they should, or they lack that maternal instinct everyone thinks they must have.

After 11 hours, my son was born. My first concern was that the moment they placed my son on my chest, there was no sign of that perfect moment they had described about love and connection at first sight.

In fact, I was exhausted, confused, and guilty. Before I left the delivery room I felt guilty because I didn't feel what they told me I should, that I wasn't completely satisfied and happy to have given birth.

I can remember leaving my son on the crib, and then starting to cry constantly while sitting on the bed. I was overcome by anguish I couldn't control or understand.

No apparent cause or reason was given for the distress. My husband comforted by telling me that this was a hormone issue that was bound to happen. The famous baby-blues.

As the days passed, I became more and more distressed. My feelings were getting worse. My crying continued. The memory of the lack of attention.

Simple things like choosing what to wear. They were too difficult for me.

This panorama included breastfeeding. A second, important issue. It didn't happen the way I imagined it. It was far from an act out of love. It felt more like a fight and torture each time I put the baby on my chest.

In this chaotic environment, I am going to return to work. I had no memory.