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A Book Review By: Fern Sidman

A Jewish guide to prevention and treatment of postpartum depression

By: Rabbi Baruch Finkelstein, Michal Finkelstein, RN CNM and Doreen Winter, MSW

As far as Jewish lifecycle events go, there is no doubt that childbirth is the ultimate joy that a woman and her family can ever experience. A new Jewish life has entered this world through the kindness of G-d, and with great excitement and awe we revel in this incredible miracle. For some women, however, the days, weeks and months following childbirth can be a personally painful and daunting time, as they fall victim to unyielding hormonal upheavals that result in “the baby blues”, postpartum depression and in some rare cases postpartum psychosis.

In this recently published book entitled, “Delivery Form Darkness” (Feldheim Publishers 2009), the Jerusalem based authors, Rabbi Baruch Finkelstein and his wife Michal along with certified nurse-midwife and therapist, Doreen Winter, present a most sensitive yet pragmatic guide on the modalities of prevention and treatment of postpartum depression. Integrating both halachic and medical concepts, the authors make it abundantly clear that PPD and its related disorders are in no way reflective of a mother’s general mental state, nor does it serve as an ominous indication of her abilities to nurture her child, but rather they offer evidence that PPD needs to be cogently understood and addressed with concrete intervention. The taboo surrounding this most enigmatic of ailments often causes families a great deal of shame and guilt. In the forward to this book, renowned psychiatrist and author, Rabbi Avraham Twerski says, “Because the symptoms of postpartum depression are behavorial, many people think of them as being due to a mental abnormality. Given the stigma that this carries, the symptoms are often overlooked or explained away.”

The authors explain that while there are psychosocial components that make some women genetically pre-disposed to PPD, the major culprits are hormonal in nature that occur during pregnancy, along with both a thyroid and adrenal link as well. Family and communal support along with compassionate and educated health care professionals can make all the difference in the world in helping a woman and her family recognize that PPD is not an insurmountable obstacle on the highway to recovery. Addressing the issues of turmoil and pain that husbands often experience as a result of their spouses’ PPD, this book allows them to tell their stories in their own words, giving a personal face to the potential tragedy that can result if PPD is left untreated.

With 80% of all new mothers experiencing the “baby blues” and 15 to 20 percent being beset with PPD and in one in a thousand women being diagnosed with postpartum psychosis, the authors sound a clarion call to the Orthodox Jewish world to reach out with urgency and alacrity to those suffering. Mothers often experience daily bouts of anger, irritability, melancholia, moodiness and feel terribly frightened, agitated and distraught. An intense fear of death, or feeling as if one is going crazy and loss of control combined with suicidal ideations are also prevalent in some cases as the feelings of helplessness and hopelessness are all encompassing.

In salient detail, the authors describe the origins of hormonal shifts in pregnancy and the post partum period while also emphasizing environmental causes such as societally induced stress related factors. In some cases, medical treatments such as the use of anti-depressants have proven effective along with therapy, but the authors don’t stop there. They courageously suggest holistic approaches as well including Traditional Chinese Medicine, the use of herbs, vitamins and minerals as well as establishing a regime of the highest standards in nutrition and exercise.

Throughout this often arduous journey to recovery from PPD, we are consistently reminded by the authors that a woman’s connection to Hashem must be encouraged and bolstered as the most conducive trajectory to complete healing lies within a healthy spiritual mindset. Mothers are advised to, “Talk to Hashem out loud. Find time every day to talk to Hashem as if you were talking to a friend. Hashem listens. Tell Hashem everything. Tell Him how you feel about yourself, your family, your relationship with Him. Tell Hashem about your day, your plans, your moods. Tell Hashem your deepest fears and desires. This will be an enlightening and rejuvenating experience.” The cathartic benefits of the recitation of Tehillim will resonate in the hearts of women as we learn that they very same feelings of joy, sorrow, frustration, humiliation, anger, sadness and regret were also part and parcel of the life of the sweet singer of Israel, King David, who penned the words that we find here. Consulting rabbinic and halachic authorities on such issues as choosing the right therapist are earnestly discussed as well as sensitive issues such as the use of birth control.

The reader will be left with a sanguine conclusion as the authors offer the sagacious wisdom of Rabbi Nachman of Breslov who viewed depression as “very damaging” but also acknowledged depression as a “growth stage”. He said, “Know that all of the descents, breakdowns and confusion are required in order to enter the gates of holiness, and all the great tzaddikim went through them… All falls are necessary for the ascent.”