A Book Review - A Mouth Full of Air by Board Member Diane Cuff Carney, APRN, BC / www.depressionafterdelivery.com Heart Strings The National Newsletter of Depression After Delivery, Inc.

The principal character, Julie Davis, enters our lives as a young, slim, attractive, stylishly dressed, young wife and mother of an infant son.  Returning home from grocery shopping on the upper west side of Manhattan, she smiles as she thinks about how grateful she is supposed to be, to be alive.  A grateful house wife about to puree imported peaches for her sons first birthday breakfast, “she takes a mouthful of air, holds it, releases.” Just as Julie learned how to breathe in the hospital to distract herself form her physical pain, she now must direct her breath to distract herself form the emotional pain of Postpartum Depression.

This brilliantly written first fictional novel by Amy Koppelman, a PPD survivor herself, takes us on a harrowing journey through the mind, hear and spirit of Julie Davies.  She lets us in on the well- hidden, secret life of self- doubt that PPD creates.  We listen to the negative, self-deprecating thoughts, and feel the emotionally paralyzing fears, as Julie experiences them, recovering from a suicide attempt. 

We travel on her journey though recovery, step by painful step, as she tries to pull her life back together for herself and her husband, Ethan.  She struggles with how to look and feel normal in a world where appearance is everything and true connection seems impossible.  She walks us through the exhaustive pretense she must put in place every day to avoid the curious questions by family and friends.  The isolation that her shame creates blocks her ability to reach out to anyone for love and support.  She doesn’t believe that she deserves comfort when she is not living up to society’s expectations of selfless motherhood.

As a family therapist, I was struck by Ms. Koppelman’s understanding of Julie’s fragile state of being created in her family of origin by its disconnected members.  A sexually inappropriate father and an empty, stepfordsque mother explain how Julie never thinks she has a voice worth hearing.  Performance is what counts when pretending to love is the experience one has growing up in a family such as Julie’s.  Being real s too high an emotional risk for its members to take.  Vulnerability is not allowed.

In one of the most tender and moving scenes in the book, Ethan is holding Julie in bed, comforting her in her fearful state when she realizes she is pregnant again.  He reads a passage to her from her childhood book the Velveteen Rabbit.  “What does it mean to be real?” asks the rabbit.  “Real isn’t how you are makes… It’s a thing that happens to you.” another toy replies.  Julie’s postpartum depression is the most real thing that has ever happened to her, but she can’t get over it or forgive herself for it. 

Confused messages from her psychiatrist and obstetrician about the safety of Zoloft, during this second pregnancy, takes us on an emotional roller coaster ride toward a tragic ending that took my breath away.  Julie’s confusion about the safety of anti-depressant medications while pregnant and nursing, coupled with her ambivalence about her ability as a mother, creates a lethal dose of disaster from which she can’t escape.

I was sand and angry when Julie met her fate.  I wondered, “What would have happened to Julie and her family if DAD had entered her life after the birth of her son?”  I know that she would have been understood and helped like the countless women who have experienced PPD and found their way to health through our organization.  She wouldn’t have had to suffer in silence and isolations.  She could have been saved.

I highly recommend this book be added to your home libraries and sheared with your family and friends.  They will become truly enlightened about the painful experience of PPD and the havoc it can create for a family when it is not seen for what it is, a serious and potentially lethal state of existence. 

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