Nature Versus Nurture in Relation to PPD

I am going to preface this post with a quote from Tracy Thompson’s The Ghost in the House: Real Mothers Talk About Maternal Depression, Raising Children, and How They Cope  (pg. 135): “There are two basic ways in which depression is handed down from one generation to another: by the genes parents pass on to their children, and by the behaviors parents model for their children.”  She also goes on to say (on pg 150) “You do not ‘give’ your depression to your children; rather it’s the attitudes they learn from you that provide ‘fertile soil’ for depression to grow.” 

Why do some women get postpartum depression (PPD) and others don’t?  Despite the research that has been performed over the years, no one is 100% sure what causes PPD and why some women get it and some don’t.  What we know is that both genetic and environmental factors come into play.  There is a genetic link, as depression tends to run in families and an individual’s personality will, in large part, determine his/her susceptibility.  Many studies have shown—and it absolutely makes sense—that children of depressed parents are more vulnerable to a wide range of psychiatric disturbances including major depression, anxiety disorders, and alcohol and substance abuse.  There is also an environmental link, as your experiences—in large part those of your childhood—can also play a role in whether you are prone to depression or not.  Socially well-adjusted women with a cheerful outlook, easygoing personality and a large circle of friends will be less likely to develop PPD than someone who has always had difficulty trusting others, establishing close relationships, and are more prone to worrying about things.   I can remember being fascinated during my high school days with the interplay between heredity and environment, just as Darwin’s theory of evolution and the survival of the fittest fascinated me.  Well, now I get to write about it! 

Role of Genetics/Nature

Depression is generally an inherited trait, just like there is a genetic link in terms of alcoholism, diabetes, heart disease and cancer.  I always wondered how alcoholism could be hereditary.  I always assumed people drank a lot by choice to forget their problems, and it gets out of hand.  But what I’ve learned is that there is a correlation between depression and use of alcohol and/or drugs as a form of self medication.  Depression increases the tendency to drink heavily because people want to escape their pain, their thoughts of hopelessness.  For individuals who choose to self-medicate, alcoholism or drug addiction often results when these people rely on these substances to escape their moods on a short-term basis without realizing that, over the long term, they only serve to worsen depression and/or anxiety, impair memory, and not to mention, cause addiction.  Worst case, a person seeking an escape from their depression out of desperation runs the risk of mixing up a dangerous cocktail of drugs (and alcohol) that can kill.  Look at what happened to Heath Ledger.  I’m not saying he was depressed and he was mixing drugs to escape his pain.  No one confirmed (probably because no one really knew) he was depressed at the time of his death.  But his death was ruled as due to an accidental overdose of a mixture of different drugs.  I can remember how much his death hit me.  It affected me for a couple of weeks.  What a shame that such a talented actor’s life ended when his brilliance as an actor was only just taking off.  He should’ve received an Oscar for his role in Brokeback Mountain!  Sorry, didn’t mean to digress…..

I’ll never know if depression runs in my family.  I was never 100% sure whether I suffered from depression as a child.  I often felt unhappy and tended to hide in my bedroom from the world that I felt was so cruel.  It is completely normal to experience sadness and cry in reaction to something negative that happens.  Depression, however, is an illness – experienced by men, women and children – that can be debilitating to the point of no longer being able to carry out normal functions.  Depression is characterized by the following:  inability to appreciate anything that used to bring you pleasure/interest, insomnia or oversleeping, quick appetite/weight loss or gain.  Depression is more than just a feeling of sadness.  And nothing bugs me more than people innocently, and all too liberally, using the word “depressed” to describe how they’re feeling in reaction to something when the words they should really be using are “sad” or “down.”  Since I now know what it’s like to be depressed, I know that all my past periods of unhappiness weren’t episodes of depression.  I was unhappy with my life, but not debilitated and unable to function day-to-day.  I was able to sleep and eat. 

Role of Environment/Nurture

I am going to start off by mentioning some fascinating research findings discovered by researcher Stephen J. Suomi of the National Institutes of Health, which Tracy Thompson mentions in her book (pages 124-125).  His findings, while working with monkeys, showed that experiences occurring early in life can alter the course of genetics. What he learned was that monkeys with the depression-prone gene—as long as they were able to form secure attachments as infants to foster mothers lacking that gene and raised in a caring and secure environment—did not exhibit depressive behavior as adults.  On the other hand, monkeys with the depression-prone gene that were “peer-raised”—or the equivalent to a human child’s experience of growing up in an orphanage—tended to exhibit depressive behaviors as adults. 

Ruta Nonacs in her book (pg 22) A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years indicates how research has shown that “the seeds of depression are sown early in life,” and mentions how Sigmund Freud was the first to indicate a critical link between childhood events and a predisposition for depression.  Freud argued (supported later by the research findings of Stephen Suomi) that the key to raising a child free of depression is providing a nurturing and loving environment.  Freud believed that exposure to stressful life events (e.g., death of parent, abuse) at an early age, while the brain is still developing, can permanently and significantly affect brain functionality by “[inducing] an oversensitivity to stress that persists into adulthood.  Later, when these individuals are exposed to stress, the HPA axis, which dictates how we react to stress, is too responsive: the body is sent into a flight-or-fight response with little provocation and produces higher than normal levels of stress-related hormones.  When the brain is exposed to high levels of these stress hormones, certain [physiological] changes may occur.….At the time of birth, one possesses certain genes that play an important part in determining predisposition to depression later in life.  Superimposed upon that genetic inheritance are the earliest experiences of childhood.  By adulthood, one’s vulnerability to depression is almost predetermined, a by-product of genes and early experiences.  The missing ingredient is a trigger, some event that uncovers this vulnerability and allows depression to manifest.”  For many women who suffer from PPD, it seems that that event is childbirth and the resulting biological changes (i.e., huge hormone shifts)—not to mention life changes–that come with it.

Genetics plays a role in determining such traits as personality and temperament, which in turn play a role in determining how an individual responds to stressful life events.  It’s safe to say that worrywarts, pessimists and those prone to anxiety or nervousness will probably not deal with stress as well as someone who is easygoing and optimistic.  Add worrywarts, pessimists and anxiety-prone individuals to Type A personalities, perfectionists, and high- or over-achievers—or those who think they should be able and/or want to handle everything themselves the same way they always did before baby came along—to the list of traits with a greater risk for developing PPD.  These individuals will learn, probably the hard way, that this is an unrealistic expectation indeed.  This is why therapy to correct certain attitudes and behaviors in certain situations is recommended.  Though it is, as they say “hard to teach old dogs new tricks,” learned behavior is not completely set in stone.  With practice and help of a professional, negative behaviors and thinking can be adjusted, which helps minimize negative reactions to stressful situations, which cuts down the likelihood for a mood disorder to be triggered. 

It’s how parents handle stressful situations and express anger, their overall attitudes about life, and even the way they recover when they make mistakes that ultimately sets the example for the next generation. Children will observe and mimic, perhaps not intentionally, their parents’ reactions to stress, as well as overall attitudes and behaviors. When they are young, children look to their parents as role models. Parents, whether they intend to or not, set the stage for their children’s behavior and outlook on things. Parents cannot serve as role models for optimism, perseverance, and resilience if they are unable to keep going when faced with a negative situation. Parents cannot inspire self-confidence and self-esteem if they put themselves down, blame themselves for things that aren’t their fault, and fail to give themselves credit when they’ve accomplished something. 

On the other hand, a child whose parents are role models for a positive attitude, optimism, self-confidence, and ability to deal with issues head on and in an effective and confident manner will more likely adapt a similar outlook, attitudes, and behaviors. The child who is exposed to such positive traits, in addition to nurturing role models who are loving, supportive, and encouraging, will more likely develop assertiveness and self-confidence. If the parent(s) of a child genetically predisposed to depression is too overwhelmed with his/her own issues and/or is too depressed to provide positive reinforcement and a nurturing environment, there will be a greater likelihood for the child to develop negative behavior and thought patterns that will open the doors wider for depression to develop. 

Thompson (pg 158) also delves into the behavior referred to as perfectionism, which she refers to as “a sense of failure despite high achievement.”   Usually the roots go deep in childhood when expectations/standards are set so high and positive feedback, acknowledgement, praise, and nurturing are lacking.  What results is a child that, no matter how smart, pretty or talented she is, will never be happy with herself or believe in her own abilities.   For these perfectionist kids, the only thing that matters is being the best—whether it be in sports, school or appearance.  Setting high and unrealistic expectations on themselves ultimately sends them into a vicious cycle of disappointment and other negative behavior and thought patterns that may lead to depressive behaviors.   Along with these behaviors come eating disorders (e.g., bulimia, anorexia) and low self esteem, to name a few.  Thompson goes on to say (pg 159) that “[If] your expectation is perfection, it doesn’t matter how many successes you have, they will never exceed your expectations.”

Assuming the predisposition for depression is passed on to you through your genes, whether those genes are expressed, or turned on, depends on the following:

1)      your experiences during childhood and adolescence

2)      the overall environment in which you live during those years

3)      the severity of stressors with which you are confronted early in your life

4)      how much nurturing (support, positive role modeling and positive reinforcement) you get from your parents

I have no real pleasant memories of my childhood and adolescent years, which were characterized by constant moving and finally settling down in N. Caldwell, NJ only to experience prejudice from being the only Chinese girl in a high school class of over 300 students and with zero friends.  My adolescent years were marked by hatred of everyone in my school class and even my own family.  So many times, I wished I could just blink myself out of my life as if I were a genie.  My parents’ strict discipline of me and my brothers managed to keep us from getting into trouble, managing to raise us to be honest and hard working.  Grant it, I realize now that my life could’ve been so much worse compared to others out there.  But I received very little in the way of nurturing, support (someone to talk to about my feelings/emotions/issues, etc.) and positive reinforcement.  I had no one that could provide comfort when I needed it.  No one to understand or listen to me.  No shoulder to cry on.  No close friends.  I couldn’t even confide in any of my family members.  I felt like whatever I did was never quite good enough for my parents.  That’s not because they kept pushing for A’s.  Rather, it’s because whatever I did never seemed to earn any sort of praise.  That and the fact that the only time I ever really communicated with my parents was through arguments.  All of my negative experiences led to low self-esteem and a self confidence level I’ve been trying all my life to improve.  My family life was characterized by anger that got out of hand way too many times and loads of misunderstandings and fights.  Sure, all this made me into a survivor, if in fact I was able to survive at that point in time.  I’m surprised I survived my high school years, I really am.   Looking back, I’m amazed that I never once touched a cigarette or any drugs.  Heck, I didn’t even have a beer until I was in college (didn’t like the taste anyway).  So, I obviously didn’t self medicate to escape my issues.  I definitely could’ve used an understanding and non-judgmental therapist, though.

This is why it is important we provide consistently positive feedback/interaction, love, and nurturing to our children.   If we want to keep our children free of depression, nurture them, love them, encourage them, and spend quality time with them.  Minimize the stressors that they face within reason, especially as they go through adolescence.  Be aware and supportive of your children’s school experiences and activities, and help them with any challenges they face.  If you want your children to grow up with self confidence, a positive outlook, honesty, being hard working and well-grounded overall, then serve as their role model for all these traits.  Lead by example.  Be there for them.  Listen to them.

Role of Reproductive Events

Every woman is unique in terms of her genetic make-up, as well as any traumatic events she may have experienced.  It is entirely feasible for someone vulnerable to depression to live most of their life without ever exhibiting any signs of depression, only to succumb to it with a certain combination of physical (i.e., drastic hormonal fluctuations, prolonged sleep deprivation) and psychological (i.e., high anxiety) factors.  The huge shifts in hormone levels and accompanying emotional/mood changes inherent for those who are genetically predisposed—coupled with the fact that the postpartum period is particularly stressful (remember, even positive change leads to stress)—may be the reason why cases of depression surface during the postpartum period. 

What all women who want to have children should know is that no woman is completely immune from PPD, and what would be of tremendous benefit at a time when you’re transitioning to motherhood is plenty of practical and emotional support.  To determine whether you are at risk for PPD, consider your past history and family history carefully.  You should also keep the following in mind:

 Genetics + Life Events + Reproductive Events = Increased Risk for PPD

Was I genetically predisposed to depression and/or anxiety?  I will probably never know the answer to this question.   As I mentioned earlier, I am not aware of experiencing depression while growing up.  I firmly believe my PPD was triggered by the following chain of events:  childbirth complications + 7-day stay in hospital + concern for baby’s health + possibility of SIDS + baby’s bad case of eczema and cradle cap + my hair loss + my daily hive outbreaks on legs, arms, butt and mouth (some up to 2” welts) + baby’s one-week colic.   The huge shift in hormones probably tipped the scale in favor of PPD.   Given the tough life I had while growing up and how I survived all those years, I felt I could handle the challenge of taking care of my brand-new, helpless and completely dependent baby despite the non-stop series of events I faced.  But that series of events put my body in such a heightened state of anxiety at a time that my body was at its most physically vulnerable (i.e., loss of 4 units of blood during surgery to remove my uterus, huge drop in hormones, lack of sleep), that my body couldn’t find a way to turn off that anxiety switch.   Hence, the insomnia that started me down my PPD journey.  I will write more on the topic of Risk Factors in my next post.

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2 thoughts on “Nature Versus Nurture in Relation to PPD

  1. Pingback: Nature Versus Nurture in Relation to PPD | Maternal Mental Health | Scoop.it

  2. Hey Ivy- I literally just sent off an email to a suffering mom suggesting The Ghost in the House! It is a great read on maternal depression and in my opinion is very inspiring to get good treatment for your children’s and your own benefit. Thanks for all you do to advocate and educate!

    Amber
    http://www.atlantappdmom.blogspot.com

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