David Levin says the pivotal moment was when he imagined he had shaken his baby.
His son was two years old in 2013.
He laid him down in the playroom "a little rougher than it should have been," he recalls.
At the time, since he was not thinking logically, he was convinced that he had done it very rudely.
As a pediatrician, he knew that sudden movements can cause brain damage in a baby, even a fatal outcome.
He was horrified.
Levin's irritability and frustration increased after the birth of his son.
And his son needed time to get used to the outside world.
But it seemed to Levin that he was constantly crying.
"I took it personally, like I'm doing something wrong, I'm not doing the job right," he says.
"I started to feel like his reaction was directed at me - that my son was constantly crying because he didn't like me."
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Levin loved children.
Ever since he started working as a pediatrician in New Jersey, his parents would often tell him, "You're going to be a wonderful parent."
He was excited when his wife became pregnant and gave birth.
When she had problems with breastfeeding, and when he was able to help her with his professional experience, he felt that it was useful.
But then his role changed.
He was no longer supposed to be a pediatrician, but a father.
And when he started having problems with normal parenting tasks, like soothing a crying child, he felt guilty.
"Since then, the problems have continued," he says.
He insulted his son and shouted at him.
Scenes in which he physically abused both his son and himself appeared before his eyes.
He didn't know how to change things for the better.
"I would tell my wife that this is the end of our life together," he says.
"I saw nothing but hell in the future for our community."
During his practice, he had cases of mothers who suffered from postnatal depression (hereinafter - PND) - a type of depression that occurs in the first year after the birth of a child (it is better known as postpartum depression).
It is thought to affect only mothers.
Can fathers also suffer from it?
If they can, Levin didn't know about it at the time.
And he wasn't the only one who thought so.
PND, a psychological condition that includes constant feelings of despondency, apathy or even suicidal thoughts during the first year after the birth of a child, is a well-known phenomenon when it comes to women - although worldwide it remains undiagnosed and untreated, sometimes with tragic consequences.
It is less well known, even among doctors, that men can also suffer from PND.
However, many resources that could help prevent, diagnose and treat PND - from general questionnaires used by doctors, to support organizations such as parenting groups - are designed for women.
Even the symptoms that people associate with PND are more often associated with women than with men.
Add to that the stigma men feel when it comes to talking about mental health issues, and experts say it's not just mothers who suffer from PND that are being overlooked.
Millions of depressed fathers remain completely invisible.
A hidden disease
"Although the community's awareness of mental illnesses, such as postnatal depression in women, has increased, the fact that many people still do not associate this type of problem with men is a phenomenon," says Grent Blaski, head of the Australian Health Advisory Center.Beyond Blue".
And yet, it is estimated that about 10 percent of fathers suffer from depression during the first year after the birth of a child, and that percentage is twice as high if you look at the entire male population.
Some researchers believe that 10 percent is negligible; in the period of three to five months after the birth of the child, one of the fathers shows symptoms of depression.
According to the results of the research from June 2022, conducted on a sample of nearly 30.000 couples from 15 countries, among one hundred families in three cases there is a case where both mother and father go through postnatal depression at the same time.
This would mean that in America alone, more than 100.000 babies experience simultaneous PND in both parents.
Many fathers also suffer from anxiety, obsessive-compulsive disorder and post-traumatic stress disorder, says Daniel Singley, a San Diego-based psychologist and expert on men's issues.
However, only a few men from this group will tell anyone.
Moreover, they will not even be aware that they have a problem.
"According to my experience, it's interesting that even if you've graduated from university or practice medicine, there's still a stigma associated with mental health problems among men," says Blaski.
"And that can cause denial, not enough help-seeking, or feeling like you have to deal with it yourself."
In general, men want to avoid going to the doctor more than women.
In Canada, for example, experts have found that eight out of 10 men will not go to the doctor unless their partner convinces them to do so.
In this particular case, there is a particularly strong feeling that as men, even fathers, they will feel uncomfortable or embarrassed.
“[Men] never, never want to seek help from a psychologist, because it stigmatizes and feminizes them.
"And they absolutely, absolutely do not want to do that during the postnatal period," says Signi.
He adds that heterosexual couples raising children are aware that pregnancy and childbirth are women's affairs.
Fathers often do not go to antenatal preparations, lectures or childbirth.
And even in cases where they are present, they are often told that their only duty is to provide support, regardless of the anxiety or fears they too may feel.
Those messages drive the masculine stereotype of "protecting, providing," Singley says, and ignore the bottom line: Fathers need to support mothers, but they need support, too.
Or, as one of them told an interviewer for the purposes of a study recently conducted in Britain: "When I look back, both the institutions and the family, together with me, we focused on how I should support the woman and the emphasis was on that that I should stay strong."
Watch the video:
"We should be like a rock"
Then, of course, there is the pressure of stereotyping masculinity.
If fathers are expected to be strong and supportive, how should we view them if they fall into depression?
One of the participants in the above-mentioned British study said that he felt that he had "fallen short, that he was not a real man".
Another asked himself: "What man feels depressed after the birth of a child?".
Some respondents blamed themselves for accepting the therapy.
One of them, who was given a leave of absence from work due to difficulties in adjusting to the new rhythm of life with a baby, depression worsened "because now I felt not only that I was not good as a father, but also as a husband".
Others mentioned concerns that their partners would leave them in the lurch.
"There are still many myths that predominate in the narrative of mental illness as a sign of weakness or something a man has to deal with on his own," agrees Blaski.
"Such myths can be reinforced by the understanding that a man needs to be strong during that big period of change for mother and baby."
As for Levin, he didn't open up to his wife about how severe his PND was until about a year later, when - after a PPD patient had spread the word about Levin - he was invited to talk about his experience on the TV show Charlie Rose.
"She didn't know I had depression. She didn't know that I had certain feelings for our son.
"She didn't even know I never told her, partly because I thought if I did, she'd think less of me," he says.
“Men don't talk about their feelings, do they? Our role is to be a strong support for women. I haven't found anyone to share it with.
"I was convinced that if I told her, she would leave me." And she's a wonderful person."
Postpartum depression is most often associated with women.
Therefore, men - or their environment, which may include doctors - find it difficult to recognize that they have its symptoms.
It is true that during the postpartum period, the partner giving birth is more likely to suffer from depression (in one study, it was reported that it is about 24 percent compared to 10 percent of fathers).
It has also been confirmed that hormonal changes in the brain, which take place at the time of child birth, are a common cause of postpartum depression in mothers.
In addition, the symptoms are different for men and women.
And while with postpartum depression we usually associate the image of a mother who cries and cannot get out of bed, fathers suffering from the same depression often avoid society and are prone to different types of escapism - they work longer hours or spend a lot of time using their mobile phones.
It often happens that they resort to the consumption of alcohol or different pills, as well as being indecisive, irritable or self-reprimanding.
"Sometimes [men] exhibit what we call a 'masked male depression presentation,'" which is different from our usual representation of depression, Singley says.
"When it comes to the male variant, there may be a tendency toward somatization," or feeling physical symptoms instead of emotional ones, such as stomach aches or migraines.
Some people believe that fathers cannot suffer from "real" postpartum depression and that it is classic depression.
That argumentation is based on the fact that it is more likely that fathers will suffer in the postnatal period if they were prone to depression before.
While there's some truth to this argument, it's misleading, says Michael Wells, a professor in the Department of Women's and Children's Health at the Karolinska Institute in Stockholm and a researcher of postnatal care and male PND.
Fathers are undoubtedly more likely to suffer from postnatal depression if they have dealt with depression in the past.
But the same goes for mothers.
"It's not just hormones," he says.
And not only that - recent research shows that fathers' hormones also change, and this process can start already in the prenatal period.
A father's testosterone levels may drop during his partner's pregnancy, for example, while estrogen levels rise until the end of pregnancy.
There is evidence that paternal PND influences this process.
If we leave the physiological causes aside, both mothers and fathers face numerous changes after the birth of a child: "adjustment to the baby, changes in the relationship, changes in the sex life of the partner, new responsibilities, struggle with stress and financial pressure felt by the partner", says Blaški. from "Beyond Blue".
"On a more general level, it can be a time when we question our own identity, and many men can worry about having to take care of a baby."
Certain risk factors may also predispose to PND.
One of them is the partner's psychological health; the risk of the father succumbing to PND is more than five times higher if the mother already suffers from it.
And if the father has PND, there is a high probability that the mother will also suffer from it.
Other risk factors include not having a steady job, unplanned pregnancy, a relationship that does not fill partners with satisfaction, lack of information about pregnancy and childbirth, lack of social support, lack of sleep and unrealistic expectations of fatherhood.
Interestingly, research involving Wells shows that, despite popular belief, this depression isn't just about new parents; many fathers suffer from PND after having other children, too.
However, the fact that people like Levin, who have stable jobs and marriages, no history of mental health problems, and vast medical knowledge of pregnancy and babies, can suddenly experience strong PND shows that it can affect anyone.
As for Levin, he believes that the reason for PND flare-ups lies in not realizing that parenting can be very difficult, or what normal newborn behavior is.
He didn't realize that many babies wake up frequently or cry.
He took the blame on himself.
Watch the video:
"My personality has changed"
Much of this sounds familiar to Mark Williams of Britain's Fathers Helping Each Other, a support group that has since become a lobbying organization.
When his child was born in 2004, Williams, who lived in Wales, worked from home.
He expected to return to work in two weeks. But nothing went according to plan.
First, his wife's birth was traumatic.
"I had a panic attack in the maternity ward, and the doctor told me my wife had to go to the operating room 'for a necessary C-section,'" he says.
While she was in the hall, no one told him what was happening.
He thought his wife and child would die.
From that traumatic situation, Williams faced the challenges of life with a baby, all the while feeling pressure to return to work because of "the lack of money and the loan he was paying off."
His wife also suffered from severe postnatal depression.
"I started drinking to avoid various situations. My character has changed," he says.
He felt anger and aggression.
At one point, he punched the couch, breaking his arm.
He learned about male postnatal depression through a casual conversation with someone who went to his gym: their wives suffered from it, and it turned out that they both felt the same way.
When Williams tried to find out what kinds of support existed for fathers, such as groups for mothers, he realized that there were none.
Over the years, he managed to overcome depression with the help of cognitive behavioral therapy, medication and family support.
He was also diagnosed with attention deficit disorder.
And he wanted to make sure that if other fathers overcome the stigma of male postnatal depression and ask for help, they will be able to find it.
"At that moment, there was nothing. Nobody talked about it," he said.
In 2012, he started the organization Fathers Helping Each Other, which connected fathers and offered support and advice in the field of mental health.
In the meantime, the organization disbanded and became a lobbying group, due to "a lack of money," Williams says.
Soon, not only fathers, but also mothers were contacting him.
"They said, 'My husband is really struggling, his behavior has changed since the beginning of the pregnancy and since the baby was born,'" he said.
Williams devoted himself to supporting other fathers, but also to campaigning.
He has spoken at conferences, worked with academics, written a book, founded International Fathers' Mental Health Day and lobbied the UK government to provide mental health screenings for fathers if their partner feels they have a mental health disorder. , which was successful.
Awareness of mental health in general and male postnatal depression has improved, he says.
But not enough.
"The situation is much better, but the problem is not recognized," he says.
"No one mentions fathers in the national recommendations to improve health and care in England.
"The World Health Organization only provides information to mothers, not fathers.
"It is necessary to talk about this topic in the whole country, or at least for some famous person to start talking about it in public."
An additional problem, Wells says, is that since PND has long been classified as a women's mental health disorder, the screening tools that doctors use, usually a questionnaire that a patient fills out before making an appointment, are designed for women.
This means that doctors are unlikely to be able to see the key signs of postnatal depression in men and be able to diagnose them.
Even some medical professionals think PND is a woman's problem, Wells says.
Recently, he says, "I was talking to a nurse and I asked her if they do screening for fathers, and she said, 'No, fathers can't be depressed.'"
"In her mind, it's caused by hormones and has to do with childbirth. Therefore, men cannot suffer from it."
Help for fathers
The cost of not treating it can be high.
Men in Western countries are four times more likely to commit suicide than women (not of course, just because of PND).
There are consequences for entire families.
Fathers play a key role in children's early development; the findings of one study are that in the case of a father's depression in the first few years of a child's life, there is a greater possibility that there will be behavioral problems, weaker development and a general worse state of personality in the child in the fourth or fifth year.
One of the solutions for noticing postnatal depression and solving it, according to experts, is to control the mental health of parents who have not given birth, not only mothers.
For example, Wells found in research that when fathers received more support from midwives, nurses and partners, they were less likely to develop depression.
"A parent who has not given birth to a child is usually not dealt with by doctors or nurses," says Levin.
"You are sending a message to families that the mother is the most important parent and the father is secondary. And that is not true.
"My wife didn't suffer from postnatal depression, it was me. But my depression could have caused her PND as well.
"Or if she suffered from depression, there was a 50 percent chance that I would have that problem as well." And no one tells you that.
"Pediatricians, the only doctors who see two parents at the same time, are not in the business of screening the whole family."
Singli adds that it is very important to explain to fathers that they will need support.
It can be an address to friends who are fathers.
Or they could be fathers' groups, where men gather to discuss the challenges of parenting.
These activities can be held within the community or online, such as the counseling held by the organization International PND Support of the Americas (Postpartum Support International) or the British band Panda (pandas).
This means that men have to talk more openly about problems.
Only by talking about mental health issues can we succeed in de-stigmatizing it, enabling men who need support to get it, Levin, Singley and Wells agree.
Better conditions for maternity leave, that is, changes in business culture so that fathers who take leave to care for a child are praised rather than stigmatized, would also help, they add.
Fathers do not recover from childbirth, but they also need to adjust.
Paternity leave can make fathers feel empowered and involved in decision-making, which reduces the possibility of postnatal depression.
When Levin's son turned three months old, he decided to apply for maternity leave.
"Those three and a half weeks I spent alone with him at home had a huge impact on me, because I was the only one who cared for him, I was responsible for him and I gained confidence as a parent," he says.
"From feeding him to dressing him, putting him in the car and meeting my wife in town or driving him to my parents or meeting a friend for lunch, that's when I realized I could do it all.
"It had a huge impact on my confidence."
Rejecting the Big Lie
More broadly, people need to be honest about parenting, says Levin.
He often tells people about something he calls "the big lie," which is the idea that we can have it all.
That you can work full time, be a parent after that and everything will look like the great photos of perfect children's rooms with smiling babies on social networks.
When thinking about this, most often the term is associated with women.
However, it can also refer to men, who suffer additional gender pressure to provide for the family financially.
"And then when everything doesn't turn out the way we imagined, we pathologize that problem and say 'the problem must be in me, I must be the one who is wrong in everything, because all my life I have been watching how people deal with it,'" he says. he.
"We shouldn't be ashamed to admit that parenting is hard, it's fun, but it's very hard, especially in the beginning."
For Levin, the fear of admitting he was struggling lasted several weeks and, with encouragement from his wife, he sought help.
He talked to a therapist at the place he worked.
A postpartum depression specialist, who understood that men can suffer from this type of depression, admitted to him that she had never met a male patient before.
He started cognitive behavioral therapy.
With the advice of the nurse who helped with the baby at night, he started to sleep better.
Currently on the board of an organization called PND Support International, founded in 2018, Levin speaks about male postpartum depression at pediatrician seminars.
He shares his own experiences with every parent who turns to him for help.
His mission is to destigmatize the PND.
He is very aware that things could have been different.
"Having gone through this experience, if I hadn't been a pediatrician, if I hadn't worked where I worked, I might not be talking to you right now," he says.
"Something terrible could have happened."