Grieving the Joy That Wasn’t: Healing from Perinatal Mood Disorders

A lightbulb went off for me recently when I spoke to another mother about her experience with perinatal mood and anxiety disorders (PMADs). There is an aspect of PMADs that is seldom talked about: grief. When I began to feel better after the arrival of each of my girls, I mourned the idealized time of new parenthood filled with complete joy over smiles and giggles.

The mother I spoke to is participating in a study I’m conducting with my research team at New York University to examine birthing and non-birthing parents' experiences with PMADs. This is a passion project for me in many ways, as I experienced perinatal mood disorder with both my daughters—one whom I gave birth to and the other whom we adopted. Despite being a psychologist myself, I was still unprepared for the experience.

I had longed to be a mother for many years before getting pregnant with my first and again before adopting our second. I had suffered a late-stage miscarriage and we had multiple adoptions fall through at the last minute.

I wanted these children more than anything in the world. So why was I so anxious and sad when they arrived? And once I felt better after getting support for my PMADs, why did I feel such a sense of grief?

I was unable to identify my grief until I spoke to the other mother who experienced PMADs. She said “I feel really sad. I feel like I'm grieving that time period of my life because I didn't enjoy it. I have a hard time remembering it. I really didn't get to soak in those newborn moments just because everything was so traumatizing. I feel like now I'm grieving that time period because I didn't get to experience it in a way that I would have liked to.”

How does my experience, and that of our participants, relate to those of others?

The transition to parenthood is often portrayed romantically as a time of unending joy and fulfillment. However, for many birthing and non-birthing parents, this time is marked by PMADs. PMADs are prevalent yet often misunderstood conditions affecting a significant proportion of new parents, with an estimated 10 to 20 percent of birthing parents and up to 10 percent of non-birthing experiencing one.

Grief following PMADs may seem paradoxical, as it mourns a time that was not necessarily happy. Yet it is a very real and valid emotion.

The psychological theory of "disenfranchised grief" (Doka, 1989) sheds light on this phenomenon. This theory suggests that grief that is not socially recognized or validated can be particularly difficult to process.

In the case of PMADs, the grief for a happy time may be disenfranchised because it doesn't fit the traditional model of grief, which is typically associated with the loss of a loved one. Parents may feel guilt or shame for grieving a time that should have been joyful, further complicating the grieving process.

The grief for a happy time can also be understood through the lens of other psychological theories. Bowlby's attachment theory (1969) highlights the importance of early bonding experiences for healthy child development. When these experiences are disrupted by PMADs, it can lead to feelings of loss and grief.

Additionally, cognitive theories of depression emphasize the role of negative thought patterns and distorted beliefs in perpetuating feelings of sadness and loss. Beck's cognitive triad (1976) suggests that individuals with depression hold negative views about themselves, the world, and the future. In the context of PMADs, these negative views can extend to the past, leading to grief for the missed opportunities and experiences.

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The transition to parenthood is a significant life event that can trigger an identity crisis, and PMADs can exacerbate this by hindering the integration of the parental role into one's self-concept. The theory of stress and coping (Lazarus & Folkman, 1984) can help explain the grief experienced by parents with PMADs as well. The stress of adjusting to parenthood, coupled with the challenges of PMADs, can overwhelm an individual's coping resources, leading to feelings of helplessness, loss, and grief.

While the grief for a happy time can be intense and overwhelming, it is important to remember that it is a natural and necessary part of the healing process. By acknowledging and honoring their grief, parents can begin to integrate their experiences into a broader narrative of resilience and strength.

Seeking support is crucial in this journey. Therapy, particularly cognitive-behavioral therapy (CBT), has been shown to be effective in treating PMADs (Sockol et al., 2011). Another promising approach to support is through telehealth, making access to mental health practitioners more accessible for caregivers for whom leaving the house is a barrier to treatment.

Support groups can also provide a safe space for parents to share their experiences and find solace in shared understanding. Additionally, engaging in self-care practices such as mindfulness, exercise, and creative expression can promote emotional well-being and facilitate the healing process.

Still, the burden of seeking support shouldn’t fall solely on the shoulders of caregivers. When you’re already struggling with a newborn and with your mental health, the prospect of finding a therapist can be overwhelming. It’s vital that caregivers are screened—more than once—and promptly connected to care.

Through grieving, parents can gain a deeper understanding of themselves, their vulnerabilities, and their strengths. They can learn to forgive themselves for the perceived shortcomings during their PMADs experience and cultivate self-compassion. Research indicates that grief for a happy time can ultimately transform into a catalyst for personal growth, empowering parents to embrace the present and create a future filled with joy, connection, and resilience.

As someone only now acknowledging these periods of grief (my daughters are 15 and 4), I do feel stronger and better able to give myself grace. Let’s put grief on the radar of new parenthood and normalize this experience.