Three days after our son was born, my husband lay curled on the living room floor sobbing. I knelt beside him, trying to make out his words.
"Just tell Tyler... tell him it wasn't his fault," Rob gasped.
My stomach dropped in a sickening thump. Tyler was barely born, a sack of warm flour and red skin swaddled in blankets on our couch. My own body was stretched and raw from the birth, my mind slow to grasp what Rob was trying to tell me.
What wasn't Tyler's fault? And past tense... I tried to remember where Rob had been the past hour while I was nursing. How long had he been alone in the bedroom? The bathroom?
Long enough to swallow too many pills.
I shook his shoulders, panicked. "Rob, what did you do? Tell me!"
The world settled into slow motion. As if hovering above the scene, I noticed the splotches on my shirt where my swollen breasts had leaked, the dead fly on the edge of the window sill, pine needles scattered yellow on the wet street, the baby's bubbly breaths behind me.
Then time sped up and my brain raced into action: Call an ambulance, try to make Rob throw up, pack nappies for the hospital. I was reaching for my phone to dial 000 when Rob finally responded.
"Not yet," he said, almost too quiet to hear. "I didn't do anything yet."
My exhale lifted the hair on his temple. I didn't know I'd been holding my breath. "Are you going to kill yourself?"
I couldn't believe those words were coming out of my mouth. Or that I actually believed the answer was yes.
Three months before Tyler was born, Rob began suffering from insomnia, paralysing indecision and panic attacks. Neither of us had any previous experience with mental illness, and I didn't understand what was happening. My husband was always the even-keeled one, the one singing aloud in the grocery store and keeping his cool in crises.
I attributed Rob's symptoms to the fact that we were adjusting to returning to life in the United States after spending a year abroad, both of us stressed as we searched for jobs and prepared to become parents.
I dragged Rob to various doctors. One prescribed Ambien for sleep. Another recommended more exercise. Yet another gave him natural supplements to reduce stress. None of them seemed to recognize his mounting anxiety or the scale of his psychological pain.
I had hoped that everything would get better after the baby came, that seeing his son's face would reset the broken parts of Rob's mind. Instead, everything shattered into finer pieces - he became sullen and withdrawn, convinced that he was doomed.
Although Rob was eventually diagnosed with general anxiety disorder and severe depression, the psychiatrist never linked the illnesses to the changes associated with becoming a father.
Neither did I. I thought only women experienced mental illness related to childbirth and that it only happened postpartum.
But when I finally confided in my friends about Rob's mental illness, I learned that he was not alone: Other dads in our community had suffered from anxiety or depression during their partner's pregnancy or during their child's infancy. Yet, like us, these families kept their distress quiet, not sure what to name it or how to resolve it.
Expectations about how a new father should act do not include melting into a puddle on the living room floor. Yet research has found that 1 in 7 dads in the United States suffer from mood disorders during the perinatal period (the time before and after birth), which skyrockets to 1 in 4 dads in the three to six months postpartum.
If up to one-quarter of men are afflicted with paternal mental illness, why is it still under the radar?
"Because there's a stigma around mental health in general and an even heavier stigma around mental illness related to having a baby," explained Wendy Davis, the executive director of Postpartum Support International. At a time when Hallmark messages tell us we should be brim-full of joy and gratitude, any doubt or depression associated with becoming a parent is viewed as "a personal failure," she said.
Will Courtenay, a psychotherapist, expert in men's health concerns and founder of PostpartumMen, agreed: "There's a very powerful myth in our society that men don't get depressed."
Courtenay said entrenched cultural norms that men should be "emotionally strong" explain why even trained mental health clinicians are less likely to diagnose anxiety or depression in men than in women.
Another reason paternal mental illness is underdiagnosed is because it often appears differently from women. Depressed dads, Courtenay said, might act more frustrated, irritable and angry. Other red flags are emotional withdrawal, working constantly, complaining of pain with no cause, or an increase in risk-taking behaviours such as drinking, drugs, gambling or extramarital sex.
Professionals, and often family members, tend to write off a new dad's symptoms as a normal part of the transition to parenthood, which is what Rob experienced. People kept saying he'd feel better if found a job. Or took a shower. Or got off the couch at all. When I felt the most overwhelmed by his flat stare and heavy silence (usually after a particularly rough night of tending to a colicky newborn by myself), I was guilty of saying the same unhelpful things - wishing out loud that Rob would "just get over it and stop moping around."
But a mood disorder is different from "moping around." A disorder can be diagnosed when a mental shift lasts longer than two weeks, interferes with daily functioning (including changes in sleeping, eating and physical performance), and creates a loss of identity. Rob was physically incapable of getting a job - he broke out in a cold sweat every time he had to leave the house. It was very obvious that the chemistry in his brain and body was off-kilter.
As with women, hormone changes can play a big role in a father's mood. Recent studies show that men's hormone levels fluctuate when their partner is expecting a baby, which is nature's way of priming dads to nurture their offspring. In general, when his partner is pregnant, a man's testosterone levels drop and he produces higher levels of estrogen, cortisol and even prolactin (the hormone that tells the body to make breast milk).
But if a man's hormonal shift is too big or too little, it can leave the father feeling stressed, aggressive or depressed. The hormonal changes can be compounded by lack of sleep once the baby arrives, which is known for its harmful effects on the mind and the nervous system.
Other countries are catching on that dads need more tools to cope with the sea change of becoming a parent. In Britain, dads are now screened if the mother is diagnosed with a perinatal mood disorder, because up to half of dads experience mental illness if the mother does, too. But we have a long way to go, said Andy Mayers, a psychologist at Bournemouth University in Britain.
"Recent research shows that we need to give dads early support so that it's less likely to escalate to the point of them needing medical intervention," Mayers said.
Mayers advocates universal perinatal mental health screening for both parents, as well as social groups specific to dads, such as online forums, monthly calls or community meetups.
I didn't know any of this five years ago when my husband was sobbing on our floor. I, too, bought into the fiction that men aren't as affected by having a child. I know better now.
During his year-long mental illness, Rob waged war every single day against an internal monologue that told him he was useless as a parent and as a partner, and that suicide was inevitable. One gray winter afternoon, he tattooed my name on one forearm and our son's on the other to remind him why it was worth continuing to fight a seemingly endless battle.
I fought hard, too, learning how to care for a helpless infant and an equally helpless husband. Someone was always crying in our house - sometimes all of us at once. Each time I walked through our front door, I swallowed hard, hoping like hell that I wouldn't find that Rob had lost the battle.
We navigated Russian roulette medical treatments that included two dozen different prescription drugs, breathing machines, behavioral therapy and even hypnosis. Then, inexplicably, one spring afternoon Rob decided to trim the maple tree in our front yard. The next day he went for a walk. A week later he patted my back in the kitchen after dinner, a long-absent touch that brought hopeful tears to my eyes.
Slowly, Rob came back to us. Slowly, our son learned that his dad could laugh. As the wounds started to heal, we began to talk about what had happened and how to prevent it from happening again - not just to Rob, but also to other parents who may be suffering in the dark.
Daniel Singley, a psychologist and founder of the Centre for Men's Excellence and PadreCadre.com, has studied what he calls the "dude to dad transition" for nearly a decade and says that connection is key for helping men navigate the transition to parenthood.
"Step one is having more conversations about the fact that it's not just women who experience perinatal mental health issues. Step two is providing men with a sense of community so they don't feel isolated," Singley said.
So here I am, starting a conversation: If your family is suffering, you are not alone. You are not a failure. You will get better. Don't be afraid to ask for help.
Sixteen months ago, Rob and I welcomed our daughter into the world. We made the decision to have another child with our eyes wide open to the potential pitfalls. This time, though, we managed to sidestep them, thanks largely to luck but also to the fact that we had shared our story with friends and family, creating a community better able to support us the second time around.
The Washington Post