Many women inherit depression from their mothers

Motherhood and depression share a long-common border, author Tracy Thompson observes in "The Ghost in the House" (HarperCollins, $24.95), her exploration of the often-overlooked mental health problem. The book blends memoir with research on the topic.

Thompson's focus is not the more-familiar postpartum form that can follow the birth of a baby, but the longer-term illness that affects an estimated 12 million American women, many of them diagnosed in the prime childbearing years between 25 and 44. In Thompson's view, unrealistic expectations about motherhood may be increasing the risk of depression in women who feel they can't measure up.

A former Washington Post reporter who chronicled her battle with suicidal depression in her 1995 book "The Beast," Thompson explores the legacy of an illness that is often passed from grandmother to mother to daughter. She discusses ways the intergenerational link might be broken, based on insights gleaned from her own history and interviews with some of the 400 mothers whose accounts of depression she collected over several years.

Following are excerpts from a recent question-and-answer session with the author:

Q. What do you mean by maternal depression?

A. Maternal depression, the way I define it, is depression that is created or exacerbated by the stresses of being a mother in this culture at this time.

It can be transmitted from mother to child via genetics, environment or through learned behavior - or more likely a combination of all three things. It's depression as it intersects with motherhood, with the lifetime job of rearing a child.

We as a society give lip service to what a wonderful thing motherhood is, but at the same time (we) act as if any old mammal can do it. I'm not trying to dis fathers here, but I'm not writing about dads. I'll leave that to someone else.

Q. What are the stresses associated with contemporary motherhood that in your view contribute to depression?

A. If you go back to "The Feminine Mystique," the classic 1963 book by (feminist movement founder) Betty Friedan, and substitute the word "motherhood" for "housework," it's amazing. (Friedan wrote about the tyranny of housework and the all-consuming, never-ending and unpaid nature of what was then called "women's work.")

I think these days instead of starching and ironing bedsheets once a week, we've transferred that energy to our kids. Our kids are a measurement of how well we're doing. There's this attitude that a mother's constant presence is necessary to ensure her children's emotional health.

At the same time we're supposed to be doing all the other things women are supposed to be doing - like working and going to the gym and keeping the home computer free of viruses and having hot sex with our husbands and looking good. There are a lot of inflated expectations for mothers in this culture.

There is no downtime in being a mother. And there's no easy way to share supervisory duties, which was the case for mothers when I was growing up. These days, if I send my kids out to play, no other kids are out there because they're in after-school care or camp or taekwondo or soccer. Lots of women cope with these pressures admirably and don't let it get to them. But if you are a person who's going through life without shock absorbers, which is the way I think of myself - if you're someone who has a history of depression before you had kids - this is likely to affect you at some point.

Q. What are the characteristics of maternal depression?

A. One is certainly withdrawal - the inability to get out of bed or hiding in your room away from your kids. There is a mother in my book who would just go into her bedroom and lock the door, and her kids would slip notes under it to try and communicate with her. One of them was so young he couldn't write; it was just scribbles. It was heartbreaking.

Another characteristic is chronic irritability - yelling at kids and having inappropriate expectations of what they should be doing or how they should act. It's often a vicious cycle, because these women then fall back into the withdrawal pattern.

Another pattern of behavior that emerged is this compulsive busyness. It's almost like running away from the illness: You get into the car and you just go. You find things to do because if you were ever to stop and think, it would be crushing, because you would realize how bad off you are. But that endless round of activities doesn't foster closeness with kids.

Q. How do you apply what you've learned with your two young daughters, especially the older one, whose diagnosis with depression at age 5 is chronicled in your book?

A. One of the hallmarks of depressive thinking is this all-or-nothing attitude: If I don't ace this test, I'm stupid. If I can't do something perfectly, I'm worthless. I have certainly felt that.

What my mother would have done when I said that is to say, because she didn't know any better, "Well, I love you anyway, Sweetie."

What I try to tell my own kids is, we don't expect you to be perfect. Perfection is not required. Love is not conditional on performance or on good grades.

I tell stories about myself - funny stories - and I point out ways in which (my kids) are getting better. You try to give kids concrete, specific feedback about what they're doing and how they're improving. I might say, "A year ago, you couldn't have glued all those sticks together and now look, you just did it."

My older daughter is now 10. She's on medication for ADD (attention-deficit disorder) and anxiety, but she made the honor roll last semester and has a pet-sitting business and friends. She's doing great.

I also realize I can't control her life, and I can't live it for her. And I don't know what the future holds.

Q. What advice would you give mothers struggling with depression?

A. First, take yourself seriously, which I think mothers have a hard time doing. Your health is vital to the functioning of your family and to how well your kids are going to do. And when you realize that, then it becomes much more logical to say, "I need to take care of myself," and not just be in martyr mode or on autopilot.

Mothers need to understand that this is a chronic illness, and they have to devise their own regimen that works for them. It's likely to include regular exercise, a decent diet, sleep - you can't skimp on it - and maybe some kind of spiritual practice - it could be yoga or meditation.

Another component is medication, when it's appropriate. But it isn't always indicated.

The other thing I would say is that engaging in the struggle with depression can make you a better mother. You end up modeling for your kids something that is really important for them to know: that Mom is a person worthy of respect and care, not just the family drudge.

If you're struggling with an illness and from time to time you're not going to be there all the time, then it teaches your kids that they are not the center of attention, that they don't have to be always receiving care, but sometimes they can be giving care. Of course, the one thing you don't want to do is turn your kids into your caretaker.

Inside a world on edge

From "The Ghost in the House":

"Leave me alone, my mother always said during her bad times.

"The craving for isolation lies at the heart of the experience of depression. Isolation is a prison cell, but at least there you can lie down under your crushing burden. ... Motherhood is simply incompatible with solitude. You may crave it, but what you get is another 'Mommeee!' scraping the surface of your brain like a rusty razor. Unlike ordinary depression, maternal depression is a war fought on two fronts: against the depression itself, and against children's competing demands for nurture, guidance and reassurance. The barbed-wire boundary between self and others must be painfully navigated every day, several times a day. It takes enormous energy, and that struggle was evident in comments from many mothers I heard from."