Her beauty is smooth, warm, classic, in the vein of an Ali MacGraw. But her face is impassive, like an ancient Greek statue, expressionless. Her eyes quiver. I feel it right away as I enter the room, the smoky weight surrounding her heart.
I call her by first name, like an old friend. We do this to preserve confidentiality on the unit, but it must in part be habit, a way to plunge into informality with a stranger. “I will be your doctor here.”
She nods, the corners of her mouth trying to smile, but failing.
I take a seat and begin. “I heard a bit about what happened recently. Could you tell me what brought you here?”
She takes an uncomfortable moment of silence before speaking in a flat but determined tone.
“I don’t want him.”
“Don’t want who?” I ask, but I know exactly what she means. I’ve read the report from the emergency room where she was admitted before she was sent to us: 39-year-old married female, three weeks postpartum, first child, severe depression with insomnia and loss of appetite, passive suicidal ideation. Still, I want to hear it from her.
I am the chief on an all-female inpatient psychiatric unit dedicated to treating women in a protected setting. My patients on the locked ward are in various states of crisis; you get to stay here only if you have been deemed a danger to yourself or others. Most stay for a day or two, others for months. Every morning, I interview the patients. The new admissions who have arrived overnight come first.
Patient confidentiality prevents me from describing the new mom in more specific terms, and some details have been changed. I’ll call her Laura. She works with young children professionally and is from a close-knit family. It is all the more baffling that someone who devotes herself to children cannot bear to be around her firstborn child.
“I can’t take care of him. I can’t do it.”
“I made a mistake. He’s a mistake.”
Her honesty makes me wince. The nurses shake their heads. Those who work in a psych ward are no stranger to irrational, disturbing thoughts. But those who choose to work in a women’s unit tend to be maternal types. We’re a sisterhood helping others face the vicissitudes of the feminine gender role. Dealing with men, with motherhood, with work. Somehow still, postpartum depression—which affects between one and two mothers per 1,000 childbirths—is disproportionately jarring. It seems like the last feminine taboo, stronger than crack babies or neglect: a mother hating her newborn child.
My own mother was beatific in her devotion to me. There was nothing she wouldn’t sacrifice, and she spoiled me rotten. She was the same toward my father. She left delicious dinners waiting on the stove for when he returned from sleepless 36-hour shifts at the hospital where he, an anesthesiologist, kept furious watch over patients hovering in that precarious dreamworld between life and death.
He sometimes repaid her kindness by throwing her dinners across the room, plates shattering and food smearing the walls. The next day, she would clean those walls until they were spotless again.
Once, as a child, I leafed through an old photo album and saw a newspaper clipping of three women smiling proudly as they stared off into the distance, next to a Korean Air Lines logo. One was my mother, slim and trim in her uniform. After getting her nursing degree in the late 1960s, she worked for a couple years as a stewardess, dashing across the skies from one Asian metropolis to the next: Hong Kong, Tokyo, Bangkok.
After she got married, she didn’t work again. But she maintained her smile, perhaps by pouring her bottomless love into me and my sister, even as we pulled constantly at her skirts. Cut off from her family back in Korea, and discouraged from working by my father, she had nowhere else to go, nothing else to aspire to here in America. We were her everything.
I grew up singing “Someday My Prince Will Come” from Snow White and making lists of baby names—even hoping for boy twins named Christian and Sebastian. I used some of the names for characters in the little romance serials I would write and share with my friends in middle school.
On some level, I never outgrew it. As I got older, I kept men at arm’s length, in the realm of childhood fantasy. The reality of my parents’ marriage had been too terrifying—my father’s periodic rages, and my kindhearted, beautiful mother at his mercy. But when I went to college and met the textbook Korean dreamboat—Hwan, an Ivy-educated lawyer with a gentle voice, tall and well built, who loved German philosophers and Brahms quartets—my mother practically shoved me into his arms.
For the year and a half we were together, part of me was numb. Perhaps it was the fear, despite Hwan’s outward kindness, that I would end up abused like my mother or, worse, that I would dish out thoughtless cruelty like my father. I pulled away, and he knew it. I told him one day I didn’t love him, and he left me soon after.
I didn’t date anyone else for eight years. Once I hit 30, my mother began to panic. In her skewed traditional view, I was practically menopausal already. She tried desperately to set me up with the sons of various friends of friends. I shot them all down. Before I knew it, in the meantime, all my friends were married with children.
I was generous when I bought clothing gifts for each of my friends’ babies, as I played baby fashionista. Each one had a quirkier name than the last: Zane, Paige, Taylor. I would stare at these offspring, with their sticky, rosy faces, and they would stare back, glowy-eyed, equally curious. They would venture toward me, sometimes roll on my lap. I must have projected some sense of calm wonder. They would chatter, wanting more and more from me. More games, more dolls, strewn across the room in chaotic joy. But by day’s end, after all the noise, the incessant crashing and yelping of Nickelodeon cartoons in the background, I craved solitude, and felt the pang of confusion. Was this what I really wanted?
My mother leafed through one of my gift bags and casually said, “You shouldn’t spend so much on these gifts. They’re not your kids.”
Laura has been on the unit for three weeks when she asks to leave. “There’s nothing anyone can do. I want to go home.”
She has refused medication. She barely eats, still doesn’t sleep, and rage furrows her dark brows. Her sharp, uncharacteristic anger and paralyzing, ruminative guilt point to a depression more serious than our staff originally thought, one that bends into psychosis. It’s known to happen with postpartum mood conditions. In the worst cases, the afflicted mother can become floridly delusional, as in the tragic case of Andrea Yates, the Texas mother who drowned her children because she believed the devil had possessed them.
The new mom’s husband has left me several frantic messages, progressively angrier and more frustrated. “What are you going to do? No one is doing anything!”
The baby is staying with the new mom’s parents right now. I tell her, “Your family is very worried about you. Has your husband visited?”
Irritation flits across her face. “We hardly know each other anymore. We’re basically just roommates now. He doesn’t want him either. We’re both broke anyway. I can’t do everything. Everyone said it was what I should do; it’s what I always wanted. But I can’t do it. I just can’t.”
The nurses and I begin a round robin of positive thoughts to break into the shell encasing her mind. It’s hard, it’s not easy, but people do it, they survive, they pull through. You can get help.
Her family comes in for a meeting. Laura’s mother’s face is as hysterical as her daughter’s is withdrawn. “Please help her.” She grabs my arm.
Her family begs her to take her medications. She snarls at them like an angry teenager. “This is all your fault. Look at what you’ve done.”
The intensity of fury seems partly irrational, driven by her psychosis. But I wonder if there is also some underlying truth to her anger. Did her parents, like so many, pressure her with the usual expectation of having children that is drilled into many young girls’ minds from an early age? Did she fall for the idea, the fantasy, the duty of having children, while now being confronted with the tough reality: the responsibility, the anxiety, the endless chores and sleeplessness, the feeling that one’s life no longer belongs to oneself? And has she now become furious at her parents for that subtle and expected insistence, that she fell for it, only to find herself shattered?
Is she also enraged at her deteriorating relationship to her spouse, crouched by himself off in the corner, dressed in sweats like a wayward teen, at his own helplessness and regression when she needs him the most?
Laura’s parents are dismissive of him, as though their worst assumptions about him have been confirmed through all of this.
Out of the blue, he reveals a shred of resolve. “Take the meds, for heaven’s sake.”
She reluctantly agrees.
Her antidepressant dose goes up each day, but she refuses to increase the antipsychotic dose. She goes on like a broken record about nothing changing, nothing getting better. She says at times she wonders if the only way her son will forgive her wanting to give him up is if she is gone.
For the past three years, I’ve been dating a former colleague. I was his attending physician when he was a resident training under me. He was a rising star, with razor-sharp organizational skills and a strong sense of duty toward his patients. A year after I left that hospital, we met again on the outside. For a while I was gloriously happy. More than I had ever been.
Soon after we started dating, he told me that his parents were both dead. He grew up dirt-poor, neglected, in blue-collar New Jersey. His mother was a heroin addict who died of hepatitis C. His father was an alcoholic veteran who died of a heart attack. I wanted to help, to understand.
After we moved in together, the seams started to come apart. He piled everything on tables and couches, because he couldn’t let stuff touch the floor. He put his socks and his underwear into the garbage after each use. He asked me to carry everything, to cook everything, to clean everything.
I couldn’t tell my mother what is happening. I was supposed to get married now. My clock was ticking. But I was a mother already, of a very different sort.
Laura shows the faintest hints of recovery. A touch of calm starts to smooth her forehead. Moments of agreement suggest that our constant reassurance—You are not a bad person, you are not a bad mother, you have to do what is best, it isn’t easy—has started to sink in.
The Office of Mental Health is visiting for a hospital inspection. We cover the tables with white cloths and baskets of fake flowers. Laura walks into rounds and genuinely smiles. “You guys should always have inspectors coming,” she jokes.
When Laura is discharged, there is a final meeting with her parents. They insist that one day, after she gets better, she will raise her son. She has to be a good mother. They know she is.
She starts to whirl into the now-familiar circle of doubt. She is damned if she does or if she doesn’t. But we keep telling her there is a way out, a way to forgive herself.
Because I know what she means: it isn’t fair to make it black or white, to glorify or condemn what we do as women, as mothers. We can be good, we can try, but we can’t be perfect. We can’t be saints, especially not in the throes of a catastrophic depressive illness. Too often, mothers are expected to be perfect, all-sacrificing to their children. Anything less is viciously condemned by the public, and by loved ones alike, as selfish, evil. The weight of that expectation adds to the guilt, the horror when postpartum depression or psychosis leads to these uncontrollable negative, helpless thoughts, that love for one’s child isn’t happening in the oft-idealized way. Swallowing all these expectations, the mother’s rage can be worst against herself.
But for now, Laura smiles when she leaves the ward. She nods that she will be okay. I see a flicker of relief in her, to be leaving.
Over the last year, the strain at home had been taking its toll. I would fly into rages, desperate to free myself from my boyfriend’s imaginary prison of germs and contamination. He finally accepted help; I found him a therapist, and he got better.
But once he improved, he didn’t need me anymore. He wanted to live the childhood he never had. He began wearing leather jackets and started a band. He would go out into the wee hours of the morning with his coke-addicted high school pal. He gained 30 pounds from uninhibited munching and boozing.
I felt a bit like Dr. Dick Diver in F. Scott Fitzgerald’s Tender Is the Night. Diver marries his fragile patient Nicole, and once he cures her, she leaves him and he descends into obscurity. “The case was finished,” writes Fitzgerald.
There has been a setback. Laura has been admitted to another hospital, one of our sister facilities. There was a hearing, where a judge refused to let her sign over custody of her son to her family, and he reprimanded her. She fell apart.
I hear faint murmurs through the grapevine about how she is doing at the other hospital. Apparently not well. She has been there a long time. I feel guilty because I am partly relieved she is there and not here. But I also wonder if the providers there are making the right decisions in her care, if they are giving up on her.
My boss is a political type who has in the past brushed off my staff and me as a hysterical women’s team when we complained about insufficient security and patients violently attacking us on our unit. He says the administration has discussed Laura and that they think she is a “borderline personality” case who will likely end her life regardless of what we do. They say she is better for now and is being discharged home.
I am horrified by his indifference. He has written her off as a deluded, personality-disordered, selfish mother. What more heinous crime could there be?
The director of the day hospital where Laura went in between hospitalizations approaches me in the hallway. His expression betrays him, and I know right away. Our patient is dead. He pats me on the arm.
A couple months later, I go to a dinner party, and a couple arrive at the last minute; they were able to find a babysitter for their twin sons.
“Wow,” I say to the mother, “that must be a handful.”
Grateful for the acknowledgement, she sighs. “Yes.”
“It’s like two for one though,” another friend chimes in. “Isn’t it easier?”
I shake my head no. I’ve heard several patients tell me otherwise. She nods in agreement with me.
“I would much prefer one at a time,” she says. “So you deal with depression?”
“What causes that, a chemical imbalance?”
“It can be.”
“Does exercise help?”
We bond a little over not liking Manhattan’s Upper East Side, where I used to live and where she and her husband currently live. She doesn’t care much for the intense “mommy scene” there, the competition it breeds.
“I don’t want to be like one of those mothers who just expects her kids to be perfect at everything,” she confides. “Like my mom, she wanted us to be straight-A everything.”
I agree. “If I had kids, I would let them do whatever their talents led them to. But it must be hard being a mother.”
She looks at me wide-eyed, as though I’ve opened a door she is tired of trying to hide. Motherhood is our joy but also our burden, and we should not be excoriated for acknowledging that truth, that ambivalence. Laura had felt excoriated, both by biological illness and societal forces, and the guilt destroyed her.
“I hear those stories sometimes, about those mothers who end up killing their babies,” she says. “God forbid—I love my kids, there’s nothing I wouldn’t do for them. But sometimes there are days where I understand the feeling. How a mother can just … snap.”
“It isn’t easy. People don’t talk about that.”
She looks relieved.
I do understand. How women are not supposed to be saints or whores or Madonnas or witches. How much stress everyone puts on us to fulfill our one bit of evolutionary purpose, without question and with perfection. There isn’t enough empathy for the complexity, the mixed emotions, the burden of responsibility, the crushing guilt when you aren’t Supermom. And nobody is or has to be.
Burnt out from various pressures and office politics, I have decided to leave my job at the hospital. My boyfriend is moving out soon. For now, he sleeps on the couch; he stays out all day and night. Abruptly he has turned cold, become a stranger.
Having grown up in the shadow of my mother’s sacrifice, confusion has been my companion. I saw how motherhood held her captive, but also gave her hope. How she nurtured me but also overprotected me. On some level, I wanted to be different. I wanted an independence my mother never had, by trying to be a powerful career woman. Instead I ended up becoming my boyfriend’s surrogate mother, even a surrogate mother to all my patients. Because I also wanted to care, to love, to help. Perhaps I could not escape my own maternal instinct. Not having children yet didn’t spare me the double binds that mothers face.
I don’t know what the future holds for me, as I move into my late 30s. I also don’t know if motherhood is in the cards or if it is something I even want anymore. If it is okay that I am confused. And I wonder if our collective refusal to acknowledge that confusion killed Laura.