One in 10 women suffer from postnatal depression, but what is little known is that new fathers can suffer from the debilitating illness just as often. Kathy Evans reports.

Kham Sirimanotham’s slow descent into mental illness began with the butterflies. Every morning they would begin their fluttering, a thousand wings beating silently and helplessly in the drum of his stomach. But his mind wasn’t listening.

As a new father, his sense of duty towards his new family was paramount. His wife had been diagnosed with postnatal depression, so he was the one who did the shopping, made decisions and cuddled the baby when his wife was too listless to care.

With little family support, he juggled the intense needs of his wife and baby with his job as a civil servant. As the milestones passed and his daughter grew into a toddler, Sirimanotham found it increasingly hard to cope. Anxiety gnawed at his stomach, he lost weight and became inert: ”In my darkest days all I could think of was going to sleep and hoping it would go away. But then I couldn’t sleep.”

It was Sirimanotham who had first picked up that his wife had PND and persuaded her that she needed help. Finally it clicked that he, too, was unwell. Two years after his daughter was born, he visited the GP and was given anti-depressants.

After a few weeks on medication he was feeling worse. Trying to manage the raw needs of his daughter, along with the constant worry he felt towards his wife, left him feeling hollowed out.

As his symptoms worsened, his GP referred him to the psychiatric wing of a hospital in Sydney’s west, where he spent three weeks learning to listen to what his body was trying to tell him.

With plenty of rest, relaxation and cognitive behaviour therapy he began to feel like a whole person again. He returned home and went back to work, renegotiating his job so that he could spend two days a week working from home, to support his wife and child.

”I discovered I had a threshold,” he says. ”When I get near my threshold I know now that it’s my turn to say ‘stop’. I need to look after myself so I can look after my family.”

Postnatal depression is a largely unrecognised problem in new fathers. While there is increasing recognition of the incidence of PND in women – with close to one in 10 mothers diagnosed with the condition – an Australian study shows that depression actually hits fathers and mothers equally in the first year of a baby’s life.

The study, conducted by nine academics including Professor Jan Nicholson of the Parenting Research Centre in Melbourne, was published in December 2012 in the journal of Social Psychiatry and Psychiatric Epidemiology. It also notes that 30 per cent of fathers who have problems in the first year continue to report ongoing mental health issues as their children age.

But because postnatal depression is traditionally associated with women, it is not picked up, or taken seriously, in men. (As one British newspaper columnist grumbled ”can’t females have anything just for themselves without men barging in, not even a foul debilitating condition directly related to the physical act of pregnancy and childbirth?”)

”I don’t think people have recognised that men get depressed at this time,” says Professor Philip Boyce, head of the Perinatal Psychiatry Clinical Research Unit at Sydney’s Westmead Hospital. While he puts the figure of affected men slightly lower than 30 per cent, he nevertheless believes it is a health issue that is poorly recognised or understood.

He concurs that labelling the man’s experience as PND is something of a misnomer, though he says only in a very small proportion of women is the condition related to changing levels of hormones. In the vast number of cases it is caused by stresses such as fatigue, isolation and the huge demands of a newborn – factors that also affect men.

Women and men in poor relationships are particularly vulnerable, as are fathers under 30, and those with sparse social networks and support systems.

However the biggest risk factor for men is having a wife or partner with PND, in which case they are 50 per cent more likely to develop it themselves. Despite its sudden appearance in the spotlight, it is not a new phenomenon.

Says Boyce: ”Men deal with stress in a very different way than women. Traditionally, it has often been by drinking too much or working too hard instead of speaking about their feelings.”

It is also hard to diagnose because depression, like its evil twin anxiety, doesn’t fit into pigeon holes. There are no purply eruptions, suspicious swellings or identifying itchy rashes. Sometimes it appears trapped behind a wall of rage – in a blank face, reckless behaviour or a flat, monotone voice.

According to Howard Todd-Collins, psychotherapist and director of Melbourne-based Men and Relationships Counselling: ”What I would see as depression, some guys would talk about in terms of feeling out of control, being more agitated, or angry. Or they may say they feel lost and want to hide or withdraw.”

For Todd-Collins, depression in new fathers is often triggered by being emotionally unprepared. In the months before birth, the imagined baby reigns supreme – prospective parents are encouraged to stroke it, sing to it, play Mozart and avoid smoky atmospheres.

Bookshelves groan under the weight of pregnancy manuals; catalogues

and shop windows pander to parental fantasies with frilly bassinets and ergonomically designed prams. Then the baby is born, its perfection suddenly tainted. An eerie silence descends when it comes to discussing the inevitable insurrection of identity that has taken place in the homes of newborns everywhere.

Says Todd-Collins: ”A lot of the work I do with men is around emotional awareness that comes with things such as loss of freedom, lack of sleep, sex and so on … all the things they took for granted before. Some dads just aren’t prepared and it becomes very difficult.”

In his award-winning memoir, The Scent of Dried Roses, British author Tim Lott describes depression as ”the illness of identity”, ”of those who do not know where they fit, who lose faith in the myths they have painstakingly created for themselves”.

Todd-Collins agrees it can be a stasis in the struggle to adapt to radical change and acceptance of loss. All births are accompanied by a death of the old self, as men and women metamorphose into parents. Yet cultural and social conditions can make it hard for men to adapt.

Melbourne photographer Chris Morgan* has spent many years struggling to come to terms with his children’s existence. The birth of his daughter, now a teenager, came at a time when he was enjoying the peak of his career in the advertising industry.

”Career was No. 1,” he says. His wife, a lawyer, was also ambitious and he found himself resentful when his job ended up on hold. ”I got really depressed about not being able to do what I wanted to do. I expected the baby would fit in with our lifestyle somehow. It was an immature way of thinking about it.”

Morgan also struggled to cope with the changing relationship with his wife: ”It was totally different when the baby came along. There was now a third party which took all the attention away from us. I felt like I was on the outer.”

Feeling disgruntled and angry, he visited the doctor and was given anti-depressants and therapy. And then, unexpectedly, his wife became pregnant again. Morgan was so enraged he left home. Eventually he moved back in but found himself in a similar situation as before; alone at home with a baby and a toddler and again depressed.

It is an irony not lost on him that the advertising world in which he craved to belong was also partly responsible for his mental turmoil. ”In advertising, the emphasis is on how good you will feel if you buy a product. It presents everything as something you deserve.”

Advertising doesn’t just sell products, it conjures up ideals. In 1987, a monochrome poster called Man and Baby, depicting a shirtless male model with an admirable six-pack holding a baby, became a global sensation. The juxtaposition of a rugged bloke tenderly cradling a helpless newborn had instant heart-twang appeal and heralded the arrival of the sexy but sensitive New Man.

Now he’s ubiquitous. Says Todd-Collins: ”The glossy photos you find on the cover of parenting magazines, of strong men holding all these kids up with one hand while pushing a shopping trolley with the other are strong images. Even though people recognise that they are unrealistic, the underlying message for some guys is that they should be able to cope.”

Men feel under pressure to be Superman; as Boyce points out, babies often arrive at the same time in a man’s life as when they are furthering their careers and jostling for promotions, which require long hours in the office. At the same time they are also needed at home.

In previous generations less was expected of both mothers and fathers. Children passed through lives, predominantly cared for by women. Now the demarcation lines are much fuzzier. These days, parents invest much more financially and emotionally in their offspring, armed with encyclopaedic knowledge on all aspects of their care and development.

The classic guy response to stress, Todd-Collins says, is to bottle up feelings. But hiding emotion is toxic to intimacy. ”When there are problems, they become more distant or they can be become cut off emotionally. They disregard whatever kinds of feelings they have, or they don’t trust them in some way. Some men don’t see their emotional life as very manly.”

For men like Morgan, whose own upbringing was difficult, fatherhood opens up old wounds. ”Without realising it, you find you are reliving the way you were in childhood,” he says.

In therapy, he found it hard even to say the word ”family”. ”The very word just sent shivers through me; I was putting myself in the same situation that I’d had so many bad thoughts about growing up.”

While Boyce applauds the work of organisations such as the Post and Antenatal Depression Association (PANDA) and beyondblue, he says there needs to be more education programs and campaigns to raise awareness of the impact of childbirth on men. Given that there are, on average, 300,000 babies born annually in Australia, and the condition is often unrecognised in men, that leaves, potentially, a lot of fathers experiencing untreated mental illness.

In his darkest hours, Morgan had suicidal thoughts. While he never acted on them, other fathers do; in Australia suicide is the leading cause of death in men under the age of 44.

Dr Nicole Highet, founder of the Centre of Perinatal Excellence, has been active in lobbying the government for the screening of all women in the public centre for PND during pregnancy and in the postnatal period. Antenatal classes are an ideal place to educate men, she says. ”Unfortunately very little attention is given to mental health and when it is, it tends to focus on the women.”

Experts agree that depression is very treatable. Even without help, some 50 per cent of cases will spontaneously remit after about six months as men adjust to the new stress levels, says Boyce. However, it can become chronic.

What is worrying is that emerging data shows the illness can have an effect on the child’s development, particularly boys, leaving them prone to social and emotional problems.

Morgan, who divorced his wife when his eldest was nine, believes his children have been affected by his condition: ”I don’t think I had a good relationship with either of them until I left. In the end I found having kids very rewarding but it took me a long time to learn that. You go from being very selfish at the beginning to learning how to be selfless. That’s the transition.”

The internet is a good place to find help initially, says Boyce, with websites such as MoodGYM offering first-line treatment and strategies. ”A very small minority of men may need some medication; the majority would benefit from counselling or cognitive therapy.”

These days Kham Sirimanotham is in a good place. ”I eat well, I stay in routines. I do meditation. If I ever feel sad or depressed I take it seriously. It’s hard for guys because there is still a stigma around mental health and you worry about being seen as weak. But I don’t care what other people think. I’m proud to say I had it, I got help and I’ve recovered. It feels like a real achievement.”

Says Todd-Collins: ”The striking thing for me is how many men are willing to talk about it. Once they begin to speak about their feelings and know they are not going to be judged, but supported, I think they see it as a big relief.”

*This is a pseudonym.

This article first appeared on ‘The Age’ on 11 June 2014.