Prameela looks down at her one-year-old baby boy as he breastfeeds, his face concealed amongst the folds of her turquoise sari. She’s cooing softly, rocking him back and forth as she whispers to him in Karnataka, the local language of Bangalore, they are sitting on a hospital bed in India surrounded by pink and blue striped walls.
Prameela, 22 is one of the many women in India diagnosed with postpartum schizophrenia. Together with her husband Lalu Prasad, 28 and her baby boy Hemanth Kumar, she is receiving treatment at the mother-baby unit (MBU) in Bangalore. The centre is focused on helping new mothers overcome postpartum psychiatric illness and includes both the husband and the infant in the recovery process.
MBU is located at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, NIMHANS is the largest mental health facility in India and the MBU, consisting of only 5 beds, is the first and only of its kind, having been established in 2009 by Dr Prabha Chandra, the head of psychiatry at NIMHANS and a champion in women’s mental health.
Before coming to MBU, Prameela believed she was possessed by a ghost, she thought she was going to die and ran away with her baby to the local temple for safety.
“After my pregnancy, a ghost entered my body and kept talking to me bad things that disturbed me, so I would run away to sleep at the temple with my baby and it made me feel better. The ghost made me scared,” she said.
The World Health Organisation reports one in five mothers in India will develop postpartum psychiatric disorder within two weeks after birth. In Australia, one in 10 women will experience depression during pregnancy and increases to one in seven in the year following pregnancy. In India, new mothers often struggle to grasp what is happening to them and will try to conceal what they are feeling out of fear and confusion.
Rural communities often have no access to mental health facilities, with the community at large having limited mental health literacy.
Dr. Sundarnag Ganjekar, the head consultant at MBU, says it’s common for women to feel extreme pressure to be a perfect mother and wife. He says dowry payments play an important role in triggering mental health problems, as women are sold into arranged marriages and are expected by society to behave in a certain manner.
They are often scared to inform people of their rising mental health symptoms due to fear of the husband and husband’s family being unhappy with the marriage arrangement. In the past women have been subjected to dowry burnings when the husband becomes unhappy with the payment of his bride.
“Many times, the families of the mother try and conceal early on that there are health problems in the woman out of fear she will not be married off and become a burden on the finances of the family,” he said.
Shanbagh Vandita one of the head nurses working at MBU says the gender of the baby is one of the main triggers for postpartum depression and anxiety. In India, it is illegal for the sonographer to inform the expectant parents of the gender of the unborn baby.
“Women in India still have a desire to have a male baby. Often it’s not just the mother it’s the pressure from the husband and the mother-in-law to have a baby boy” she said.
Ms. Vandita says some of the most commonly reported factors contributing to a prevalence of postpartum psychiatric disorder is domestic violence, the gender of the baby, discrimination against women and a reluctance to admit they are suffering due to social stigmas associated with mental health.
Postpartum schizophrenia or postpartum psychosis (PP) is a severe mental illness commonly affecting women directly after giving birth. During labour, the woman’s body experiences an abrupt decrease in levels of progesterone and estrogen following the expulsion of the placenta. This sudden drop of hormones can go on to trigger severe psychosis in new mothers, with estrogen imbalance affecting important neurotransmitters; serotonin and dopamine in the brain.
In India, psychiatric illness is often taboo and village people living in rural areas will seek the help and advice of religious leaders. The husband and family members often encourage women to attend temples for care, this has devastating effects on the new mother and many times the patient goes undiagnosed and becomes more unwell.
Lalu Prasad, Prameela’s husband never knew about mental health before coming to MBU. However, he was afraid of what would happen to her if he took her to the local medicine person in his tribe outside of Bangalore.
“You are supposed to go to the village elders, our village elders often use chants and mantras and beat up such people with a ghost with their shoes or with their hands or other things to get rid of the ghost inside of them,” he said.
Lalu is being taught about postnatal illness at MBU and now has a better understanding of what is happening to his wife. He receives counselling as part of the program and is encouraged to help his wife with the care of the baby.
Prameela is still recovering from post-natal schizophrenia at MBU and has a long recovery ahead of her as she undergoes daily injections of antipsychotic medication but hopes to get better soon so she can go home with her husband and baby.
“Before coming to this ward, I was afraid of dying, now I take my medication every day and I don’t feel as afraid,” she said.
The author travelled to India as part of The Foreign Correspondent Study Tour, a University of Technology Sydney (UTS) programme supported by the New Colombo Plan (NCP) mobility grants.