"Living in isolation, weakness is not encouraged or tolerated, so you just didn't talk about it. Then, after so many generations, if you do talk about it, what's wrong with you? Especially if you're talking about it to outsiders."
"You talk about having struggled with depression prior to giving birth. When did you first recognize what it was?"
"I initially went to a psychiatrist in Austin because I had to fly and I could not get on a plane. Even the vague idea of getting on a plane would leave me in a corner, huddling and whimpering. We started to talk about family background, and she went through this checklist for depression and asked if I had ever exhibited any of these signs. I realized I had, and that I thought it was normal.
"So, she helped me with my immediate issue, which was getting on the plane. (The answer to that is lots and lots of Xanax!) Then, we started looking at the larger issues, and it dawned on me how depressed I'd been off and on for as long as I could remember."
"Are there recognizable triggers that lead to depression in your case?"
"I wish there were, because then I'd have something to avoid. It seems to be random, but I have to say that being institutionalized really gives you a wake-up call. I joke that going to Tower 4 was one of the best things and one of the worst things that ever happened. I never want to do it again, but at the time it was exactly what needed to have happened.
"Over the past four or five years, recognizing the depression for what it really is, it's a lot easier to deal with. I'm no longer shy about asking for help."
"Do you think society is getting better in its attitude toward and understanding of depression?"
"I don't know. I would like to say that all of the world has become like Brooke Shields, 'Yes. Mental illness exists.' But my suspicion is that it's more like the Tom Cruise response where the feeling is that it's just the pharmaceutical companies selling medication and that there's really nothing wrong with you. 'If you try Scientology, you'll feel much better.' Or, 'try whatever brand of Christianity.' I think it's getting better, but we're not there yet.
"Depression and mental illness have always been labeled a women's issue. I don't think the numbers bear that out, but I think that's how it's viewed. The general societal response is, 'Suck it up girlie, and do as you're told.' I don't think larger reactions to mental illness will change until that attitude changes.
"Two-thirds of the people on the psych ward where I was were women. The guys who were there were mentally ill, but it was a different kind of thing. The women were depressed, but the men were..."
"Yeah, really crazy. Depression, you can kind of live with for awhile, but something like bipolar disorder or schizophrenia -- you look at that and say, 'Wow. You're crazy.'"
"At the end of the book you leave us with the announcement that you're pregnant again. What was the aftermath of that birth like for you?"
"Well, forewarned is forearmed. Having done it once, the unknown of giving birth was known, and that helped quite a bit. It also helped having an OB who knew my history. At every appointment we talked about it. After giving birth she made it very clear that I was to call her no matter what, day or night, even if I thought it was nothing.
"There were a couple days where I thought it was happening again. Things started to feel like they were spiraling out of control, but I did call and we dinked around with my medications and that seemed to work.
"We also called in my husband's mom early. She lives just a couple hours away."
I wondered if her family was nervous that the postpartum depression would recur with the second birth. "Was your family on pins and needles?"
"If they were, they didn't say anything. I think everybody was calling to take my mental temperature. Though, they did that when Maddy was born too. I'm very good, after so many years of not wanting the world to know that I was having mental and emotional issues, at saying that everything is fine. With the second baby, they called my husband, Scott, and asked him how I was doing."
"You counsel women to not become invisible if they are experiencing depression after giving birth, and yet the inclination to hide those feelings is so strong. Do you have any tips for women for how to overcome that reticence?"
"I think the biggest thing that helps is finding a group of moms. I think the same holds true for people with mental illness. Nobody wants to sit around in a circle and say, 'Oh, let's talk about our feelings.' Really, what you want is just someone who can ask you if you're having a rough day, or someone who's willing to hold the baby for a half hour so you can take a shower, or to invite you out for coffee and a chance to get away for a few minutes.
"You would be amazed how small gestures make it all so much easier. The day that I checked out of the psych ward and came home, my house was full of food that people had baked. For the next two weeks, someone brought dinner to us every night. Often they didn't even stop long enough to talk, they just dropped the food off. That was huge, and it made me feel so cared for."
As our conversation winds down, I share that my youngest daughter is just about to deliver our first grandchild. Having read about Ms. Martini's postpartum depression I am, understandably, nervous for my own daughter. "What should we look for as signs that 'the baby blues' have evolved into something more serious?"
"For the first two weeks, I suspect every mom's head is spinning. But, after that, if she says she's not sleeping and not eating, then there's something wrong. You are so tired during that time that if you're not sleeping there has to be something else going on."
Free Press, 2006, $23, 221 pages.