Warning: this may trigger readers who are struggling with attachment trauma.

For my entire professional life as a psychiatrist, I have been in the minds of mothers—or at least tried to be—when things have not gone smoothly. As a perinatal psychiatrist I have worked with women in my office in weekly visits, and daily with inpatients; I have run focus groups asking questions like “why did you not seek treatment earlier?” and run groups. Groups like the one which appears in my novel, The Long Shadow.

Since the establishment of self help groups like PANDA in the 1980’s which gave a voice to mothers, allowing the unspeakable to be spoken, and beyondblue’s ground-breaking postnatal depression program which put depression screening on the national agenda in 2008, we have now become familiar with postnatal anxiety and depression and its impact on some 10-15% of women giving birth, and their families. We are less aware of the most severe illness—postpartum psychosis—which affects 1 in 600 women giving birth. In both depression and psychosis, women’s minds are often full of the myths of motherhood that they feel they have fallen short of. They may tell family and friends stories to hide their greatest fear; not just that they are mentally ill, but that they are also bad mothers.

Mummy bloggers, podcasters and Chick-Lit authors fill pages with the trials and tribulations of motherhood. The fears of not being good enough, of ruining our children’s lives…all common amongst mothers, but also shared by those whose fears cripple them and take over their minds. But why them? How is it that a majority of mothers—and fathers—manage to keep perspective and balance their fears, anger and exhaustion with joy, adoration and perseverance? What is going on in those other minds? If evolution wants those children to continue the cycle and have families of their own, why isn’t doing a better job of helping mum along?

The short answer is that evolution is doing fine. Child deaths from abuse and neglect in Australia are relatively low—0.8 per 100,000. These children generally survive. But what this doesn’t take into account are the long term impacts—the elephant in the room when it comes to maternal mental illness. What is the long term impact on the child?

There is already far too much mother blaming and more than enough guilt for mother’s with a mental illness to deal with, so the tendency is to—and rightly so—laud women for accessing treatment and supports. But this should not be at the expense of ignoring the child.

Most children are resilient and most, certainly whose mothers had milder depressions where support and treatment was forthcoming, have no long term consequences. But the risk factors for postnatal depression include lack of support, a past and family history of mental illness—and a history of the mother being abused as a child. Women with these risk factors, especially the latter, may need extra help—as do their children. These are the 400,000 or so families each year that Protective services deal with daily—complicated combinations of mental illness, addiction, poverty and violence.

What is in the mind of mothers whose own experience of being parented is dominated by memories of fear? The fear may be downplayed as an adult, but it still leaves a scar—and the fear need not be of beatings or sexual abuse. A child needs a safe environment and reassurance, and any situation where that isn’t provided—because the parent is using drugs or drinking, fighting or absent—creates fear. And if this occurs for substantial periods of time, the child reacts to the stress just as we all do as adults when stressed—our adrenaline shoots up and we feel anxious. The issue for children is that this may alter their stress reactions permanently—predisposing them to later depression and anxiety (and potentially other conditions they are genetically prone to eg autoimmune diseases).

We know adults subjected to stress can develop post-traumatic stress disorder (PTSD). For children this is occurring at a time when their neurological development is accelerating and then in late adolescence, pruning off what isn’t needed. Their personality is forming around fear and stress and how they have learned to deal with it. This child, then an adult, having their own child is exposed to a unique stress—on call twenty four seven, motherhood myths and social media pile-ons—as well as a constant stirring up of their own unmet dependency needs. In short, every time their baby cries—needs protection—some deep inner part of them is back when they were two or three, reliving the terror of their own childhood.

There is no—at least yet—magic pill to help this (intranasal oxytocin, the “love hormone”, is being researched). But for the intergenerational pattern to shift—for this woman whose mind is full of guilt, desperate to be a better mother than her own was—attachment cannot be ignored. Most mothers love their babies—and the first postnatal year, before negative attributions are placed on the child, is an ideal time to make changes. Women with drug and alcohol addictions, often cease or go onto methadone to help their infant’s outcomes. But if we want to help them protect their child—provide the Circle of Security’s* “bigger, wiser and kind” parenting that promotes secure attachment and decreases the chances of later mental health problems—then we have to help them understand their own minds. In doing this, in putting their own attachment issues to one side they can see their own child’s needs and respond, rather than reacting through the lens of their own attachment trauma and recreating the same problems for their children.

Acknowledging and treating depression and anxiety postnatally is critical. The stigma is much reduced by talking about it, having celebrities like Brooke Shields and Jessica Rowe share their personal stories. But now we need to go further into the minds of mothers, and understand the ambivalence and anger and fear that occasionally leads to tragedy, more often underlies abuse and neglect, and is labelled as “bad”. No one sets out to be a bad mother, to create a fearful environment for their child. But if they live in fear themselves, a mother cannot create safety for their infant. We need to help and support rather than stigmatise and demonise a mother that is struggling to love or protect her child.

Want help with attachment security? There are a number of individual therapists who work with attachment theory, and many maternal child health centres run attachment focused groups such as the Circle of Security (also see *circleofsecurity.org )The Long Shadow is a rural crime thriller, set around a postnatal depression group. The secrets that the women are hiding threatens their own ability to attach securely to their child, as well as putting lives at risk.