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راهکارهای درمانی افسردگی بعد از زایمان

راهکارهای درمانی افسردگی بعد از زایمان

 

افسردگی بعد از زایمان و درمان آن

برخی از مادران ممکن است افسردگی پس از زایمان (PPD) را تجربه کنند

 

تولد یک نوزاد می تواند زمینه ساز شکل گیری مجموعه ای از احساسات قدرتمند، از هیجان و شادی تا ترس و اضطراب در مادر شود. اما تولد نوزاد می تواند به حالتی منجر شود که شاید انتظارش را نداشته باشید و آن چیزی نیست جز افسردگی.

نشانه‌های اصلی ابتلا به افسردگی پس از زایمان
احساس غم و اندوه در مادر مبتلا به افسردگی پس از زایمان می تواند چنان قدرتمند باشد که در توانایی وی برای مراقبت از خود یا خانواده‌اش اختلال ایجاد کند.

تولد نوزاد رویدادی در زندگی یک بانو محسوب می شود که اغلب با یک احساس شادی و خوشی فراوان همراه است. جان بخشیدن به موجودی جدید و ارزشمند می تواند انسان را به وجود آورد. این شادی با وجود تمام دشواری ها و چالش هایی که ممکن است پیش و پس از تولد وجود داشته باشند، احتمالا در طول زندگی مادر باقی می ماند.

اما همان گونه که اشاره شد، عوارضی پیش و پس از تولد نوزاد ممکن است شکل بگیرند. این عوارض می توانند فوق العاده دشوار، گیج کننده، خسته کننده و حتی خطرناک باشند. دشواری ها در طول بارداری و پس از زایمان می توانند به قیمت سلامت جسمانی و روانی مادر تمام شوند و گاهی اوقات به سطحی بسیار ناسالم برسند.

برخی از مادران ممکن است افسردگی پس از زایمان (PPD) را تجربه کنند که در این مطلب بیشتر به آن می پردازیم. به طور ویژه، بر نشانه هایی که از ابتلای مادر به این شرایط حکایت دارند، متمرکز می شویم. در ادامه با چهار نشانه اصلی افسردگی پس از زایمان بیشتر آشنا می شویم.

تفاوت بین افسردگی پس از زایمان و گرفتگی خلق
گرفتگی خلق ناشی از تولد نوزاد (Baby Blues) اصلاحی عمومی است که برای تشریح احساسات نگرانی، ناخشنودی و خستگی که بسیاری از بانوان پس از تولد نوزاد تجربه می کنند، استفاده می شود. بنابر ارزیابی موسسه ملی سلامت روانی آمریکا، ۸۰ درصد مادران گرفتگی خلق را تجربه می کنند. احساساتی که در این شرایط تجربه می شوند، خفیف هستند و به طور کلی پس از یک یا دو هفته از بین می روند.

افسردگی پس از زایمان نیز موجب بروز این احساسات می شود، اما درجه ای که افراد مبتلا به این شرایط تجربه می کنند بسیار بیشتر است. همچنین، نشانه های دیگری نیز اغلب پدیدار می شوند.

باید به این نکته توجه داشته که افسردگی پس از زایمان به عنوان یک بیماری روانی و پزشکی در نظر گرفته می شود و اگرچه شیوع آن کمتر از گرفتگی خلق است، اما شایع‌تر از آن چیزی است که ممکن است فکر کنید.

بنابر گزارش مراکز کنترل و پیشگیری از بیماری آمریکا، ۱۱ تا ۲۰ درصد از بانوانی که در هر سال بچه‌دار می شوند، نشانه های افسردگی پس از زایمان را تجربه می کنند. با در نظر گرفتن میانگین ۱۵ درصد، این تعداد تنها در آمریکا برابر با حدود ۶۰۰ هزار مورد افسردگی پس از زایمان است.

افسردگی بعد از زایمان و درمان آن

اضطراب یکی از نشانه های اصلی افراد مبتلا به افسردگی پس از زایمان است

چهار نشانه اصلی افسردگی پس از زایمان شامل موارد زیر می شوند
ناتوانی یا عدم تمایل به تصمیم گیری
اضطراب یکی از نشانه های اصلی افراد مبتلا به افسردگی پس از زایمان است و اغلب از شدت بالایی برخوردار است. برای بانوانی که نخستین فرزند خود را به دنیا آورده اند، این اضطراب می تواند ناتوان کننده به نظر برسد و هر گونه تصمیم گیری را برای آنها دشوار سازد.

اما تصمیم گیری برای افراد مبتلا به افسردگی پس از زایمان اغلب شامل ترس نیز می شود. بانوی مبتلا به افسردگی پس از زایمان تا پیش از این در انتخاب های خود با دشواری مواجه بوده، اما زمانی که موقع تصمیم گیری درباره چیزی مرتبط با مراقبت از نوزاد (به عنوان مثال، تغذیه) می رسد، یک احساس ترس می تواند همه چیز را تحت تاثیر قرار دهد. بیشتر مواقع احساس ترس از انجام کاری اشتباه در این بانوان شکل می گیرد.

گریه یا طغیان های احساسی
هر فردی که افسردگی را تجربه کرده باشد با یورش ناگهانی احساسات منفی آشنا است. احساسات افسرده کننده در بانوان مبتلا به افسردگی پس از زایمان از شدت بیشتری برخوردار می شوند و از این رو، آثار آنها را تشدید می کند.

افسردگی شدید به طور قابل توجهی ساختار شیمیایی مغز از جمله ترشح سروتونین – یک انتقال دهنده عصبی مسئول تثبیت خلق و خو – را تغییر می دهد. برای مادران مبتلا به افسردگی پس از زایمان این تغییر شیمیایی در مغز – همراه با استرس اجتناب ناپذیر که مادر شدن در پی دارد – می تواند به هجوم احساسات طاقت فرسا منجر شود. این شرایط می تواند به گریه های شدید، خشم، طغیان های کلامی و دیگر رفتارهای نامنظم منجر شود.

خسته، اما ناتوان در به خواب رفتن
بانوی که به تازگی مادر شده است، اغلب از خواب کافی برخوردار نیست. تغذیه و مراقبت از نوزاد در طول شب یکی از روال های رایج است. در بیشتر شرایط، هنگامی که نوزاد خواب است مادر کمبود خواب را با به خواب رفتن جبران می کند.

با این وجود، با توجه به دلایل بی شمار، مادران مبتلا به افسردگی پس از زایمان اغلب ناتوانی در به خواب رفتن را گزارش می کنند که این شرایط به نام بی خوابی شناخته می شود.

هنگامی که مادر سرانجام به خواب می رود نیز کیفیت خواب اغلب ضعیف است. این چرخه ناسالم هرچه بیشتر مشکلات و عوارض موقعیتی که به خودی خود پیچیده است را شدت می بخشد.

افکار آسیب رساندن به خود یا نوزاد
اگرچه این نشانه احتمالا یک محصول جانبی از فعالیت غیر عادی مغز است، اما به واسطه استرس و اضطراب شدید بدتر می شود و از نظر متخصصان پزشکی شرایطی جدی در نظر گرفته می شود. متاسفانه، بسیاری از بیماران مبتلا به افسردگی پس از زایمان از این که در پی کسب راهنمایی برای مقابله با این افکار باشند، احساس خجالت و شرمندگی می کنند.

اما روانپزشکان و پزشکان بر این مساله تاکید دارند که دریافت کمک هیچ گونه شرمندگی ندارد. در حقیقت، بسیاری از مادرانی که کمک دریافت می کنند به این مساله اشاره دارند که طرح درمان می تواند به پشت سر گذاشتن این دوران دشوار کمک کند.

درمان افسردگی پس از زایمان
خوشبختانه، روش های مختلفی برای درمان افسردگی پس از زایمان وجود دارند. رایج‌ترین گزینه درمانی شامل گفتار درمانی، مشاوره، مصرف دارو، یا ترکیبی از هر سه است.

افسردگی پس از زایمان به طور کلی طی شش ماه با دنبال کردن درمان مناسب برطرف می شود. همانند دیگر بیماری های روانی، ادامه درمان برای مدت زمان تجویز شده حتی در صورتی که احساس بهتری دارید، ضروری است.

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  157. L’UFCM a constaté depuis quelques mois l’accroissement des tromperies à la « roqya ». Les témoignages de personnes victimes de ces pratiques se multiplient et présentent les mêmes caractéristiques : « Une personne vous appelle et vous propose une séance de « roqya » gratuite. Cette personne vous propose de rappeler un numéro prétendu gratuit, souvent un numéro commençant par 0 800… » Mais, dans les faits, cette prestation est loin d’être gratuite, puisque la conversation est facturée à vos frais et à votre insu. Au-delà de l’aspect juridique qui est traité à ce jour par le pôle juridique de l’UFCM[1], ce procédé soulève la problématique de sa conformité au Coran et à la Sunna. En effet, la « roqya » peut se définir comme une thérapie qui permet de soigner les actes de sorcellerie, de mauvais œil et également de se protéger contre ces derniers. Par conséquent, est-il possible de la pratiquer par téléphone et quelles sont les exigences édictées par le Coran et la Sunna ? Nous présenterons ainsi successivement les conditions liées au soignant (I), les exigences relatives à l’environnement où est réalisée la « roqya » (II). Nous aborderons ensuite la question de la gratuité de la prestation ou de sa contrepartie financière et enfin les conditions dans laquelle elle est réalisée (III). I- Les conditions liées au soignant Souvent la « roqya » est perçue comme une pratique dispensée par un tiers. Or, il est essentiel de rappeler et de souligner un fait important : la meilleure des « roqya » est celle que nous dispensons nous-mêmes à travers le « dhikr » et la récitation du Coran. Ainsi, pour se prémunir des maux liés au mauvais œil ou à la sorcellerie, il convient régulièrement de lire le Coran et faire des invocations notamment celles du matin et du coucher, de réciter régulièrement la sourate « La vache », de renouveler son intention, de placer la certitude dans son cœur, d’effectuer ses prières etc., et surtout de demander à Allah la meilleure des protections. Toutefois, dans certaines conditions, il est nécessaire de recourir à un soignant. C’est à ce stade qu’il convient d’être vigilant. Il ne suffit pas de se rendre auprès d’une personne qui se présente avec la qualité de cheikh ou d’imam pour accepter de lui confier cette pratique. Comme pour tout procédé et encore plus lorsque cela relève de considérations religieuses, il est important de bien choisir son soignant car ce dernier est tenu de posséder des qualités bien affirmées. La maîtrise du Coran et des traditions prophétiques en la matière est une condition sine qua none, mais insuffisante. La personne doit également avoir des notions de psychologie afin de déterminer la part de sorcellerie et celle de troubles psychologiques fréquents chez les patients. La personne doit posséder une bonne hygiène de vie, notamment spirituelle puisqu’il n’est pas inutile de rappeler que le succès de la « roqya » dépend de Dieu. Ces critères sont difficilement évaluables, surtout par une personne qui est affectée par un mal-être, quelle que soit sa source. C’est pourquoi les proches doivent accompagner la personne dans la recherche d’un soignant qualifié et reconnu comme tel par des référents religieux de la localité (imam, responsables associatifs, etc.). De manière générale, le soignant doit posséder des qualités déterminées que nous pouvons synthétiser de la manière suivante. Il doit : être en capacité de lire le Coran, croire avec certitude au Coran, être empreint de piété, connaître les pièges et les caractéristiques du diable et des djinns, connaître la méthode prophétique de la « roqya », disposer de connaissances de base en psychologie, avoir la conviction que le succès de sa thérapie dépend de Dieu. A l’exception de la première exigence, il semble difficile de vérifier les autres conditions dans le cadre d’un entretien téléphonique avec une personne que nous n’avons jamais rencontrée, même si elle se présente sous le titre de « cheikh » ou d’un imam. Par conséquent, ces conditions soulignent une première limite quant au recours à la « roqya » par téléphone. Par ailleurs, à l’instar de tout médecin, le soignant doit, avant de prodiguer des conseils ou une médication, procéder à une consultation. Ainsi, un environnement adéquat est indispensable pour la réalisation d’une « roqya ». Il est enfin inconcevable qu’un médecin puisse vous affirmer par téléphone connaître votre maladie et attester pouvoir vous guérir. Vous auriez plus que des doutes sur ce prétendu médecin. II- Un environnement propice et la réalisation d’une consultation préalable à la réalisation d’une « roqya » Il est intéressant de noter que, dans son ouvrage « Comment se protéger des djinns & satan », Wahîd ‘Abdussalâm Bâli évoque l’importance du climat pour réaliser une roqya[2]. Ainsi, il expose les points suivants : « ۱٫ Préparer le climat adéquat en faisant par exemple sortir les images et les statues de la pièce où on va soigner le malade, pour permettre aux anges d’y entrer. 2. Débarrasser le sujet de tout ce qu’il peut porter sur lui comme talismans ou amulettes et les brûler. 3. Éteindre tout ce qui peut émettre le son de la musique et des chants. 4. Vider le lieu de tout ce qui comporte une infraction à la shari‘a à savoir, par exemple, la présence d’un homme qui porte de l’or ou une femme qui ne porte pas le voile légal – al-hijab. 5. Donner au malade et à sa famille une leçon de dogme de façon à ce que leurs cœurs ne soient pas attachés à un autre qu’Allah. 6. Leur faire savoir que la façon de soigner est différente de celle des sorciers et des charlatans et que le Coran recèle guérison et miséricorde, comme l’a informé Allah le Puissant et le Majestueux. 7. Diagnostiquer son cas : pour cela poser des questions au malade pour s’assurer de la présence de tous les symptômes (…) ». Or, dans les témoignages communiqués, l’interlocuteur qui se présente comme soignant ne pose aucune question aux personnes. Il débute ainsi la « roqya » directement par une récitation du Coran. En outre, il est intéressant de souligner que dans l’un des témoignages communiqués à l’UFCM, l’interlocuteur demandait à la personne de remplir successivement des verres de lait, d’huile, d’eau etc. et de les poser par la suite sur la table de la salle à manger. Au point que la personne s’est retrouvée avec une multitude de verres posés sur la table. Le comble est que la personne ignorait ce qu’elle devait en faire lorsqu’elle a pris conscience de la tromperie. Nous constatons par conséquent qu’une « roqya » ne peut être réalisée dans un environnement quelconque. En effet, une procédure de diagnostic est essentielle. Nous pouvons à titre d’exemple faire le parallèle avec un rendez-vous chez le médecin ; ce dernier ne peut vous prescrire une ordonnance sans au préalable vous avoir ausculté et interrogé sur les différents symptômes que vous ressentez physiquement. A défaut, au lieu de guérir vous allez aggraver vos maux. Cette attitude vigilante du médecin traitant doit se retrouver lorsque nous envisageons le recours à une « roqya ». Pour illustrer ce propos, nous citerons l’exemple de l’anthropologue, spécialiste de l’islam européen, Farid El Asri, chercheur associé au Centre Jacques Berque, qui nous rapporte une situation alarmante suite à une « roqya » : « Une jeune femme en Belgique (…) est morte suite à une tentative d’exorcisme. Pendant les séances, les fkihs (imams) utilisent normalement de l’eau « coranisée ». Pour cette jeune femme, prétendument stérile, les exorcistes ont carrément plongé son visage dans l’eau et quand elle tentait d’en sortir pour respirer, les guérisseurs estimaient qu’il s’agissait du jinn qui l’habitait et ils replongeaient son visage dans l’eau. Pendant le procès, la famille de la défunte s’est présentée comme musulmane et a accusé ces pratiques d’être extérieures à l’islam quand les guérisseurs estimaient qu’ils avaient simplement fait ce qu’ils pouvaient. Le fait de recourir trop systématiquement au fkih risque également de faire passer une crise d’épilepsie, par exemple, pour une crise de possession. »[۳] Nous allons aborder enfin la dernière problématique, celle relative aux honoraires du soignant. III- Les honoraires du soignant Le Prophète, bénédictions et salut sur lui, « a agréé les Compagnons qui ont été payés pour la roqya ». Il est dès lors autorisé de rémunérer un soignant en contrepartie d’une prestation. Toutefois, cette rémunération doit être raisonnable et surtout clairement définie avant le traitement. En outre, nous ne pouvons que souligner et rappeler que, si la roqya est réalisée dans un cadre sérieux, il convient de procéder à toutes les déclarations administratives. Comme pour tout contrat, vous devez exiger un document écrit et le praticien doit préciser quels sont ses engagements exacts afin d’éviter tout litige postérieur. Malheureusement, tous les témoignages transmis à l’UFCM soulignent que l’interlocuteur insiste à plusieurs reprises sur la gratuité de la prestation. Or, dans les faits, cette dernière est payante puisque le coût de la communication est surtaxé. Ainsi, l’une des victimes qui nous a contacté, s’est retrouvée avec une facture téléphonique (hors forfait) de 1800 euros. Par conséquent, nous constatons que ces « roqyas » gratuites sont fondées sur la technique dite du « call-back » qui consiste à amener une personne à rappeler un numéro surtaxé, information qui lui est bien évidemment dissimulée. Une « roqya » peut être payante à condition de respecter un cadre prédéterminé, fondé sur l’information et la transparence des honoraires. En conclusion A la lumière des développements susvisés, l’UFCM appelle d’une part à une régulation du métier de la pratique de la « roqya », d’autre part, à la vigilance de chacun à ne pas céder à la tentation d’une « roqya » qui ne serait pas réalisée dans les conditions requises et qui pourrait produire des effets inverses. Au-delà du cadre spirituel ou juridique, les divers témoignages reçus et étudiés par l’UFCM ne peuvent pas nous laisser indifférents à la question suivante : pourquoi des personnes sont-elles amenées à accepter aussi facilement une « roqya » par téléphone ? Est-ce la gratuité qui a déterminé leur choix ? Certes le mal-être produit par cette société est de plus en plus grand. Nous vivons une époque où les êtres sont de plus en plus coupés des signes de Dieu et vivent un rythme de vie effréné. Ces affaires sont révélatrices des maux les plus profonds qui touchent la communauté musulmane. Par ailleurs, comme l’ensemble des rites islamiques (hajj, halal, pompes funèbres) censés nous rappeler les limites qui déterminent la voie vers Dieu, nous constatons que leur marchandisation trahit de plus en plus leur vocation première. Suffit-il qu’un interlocuteur se présente à nous comme un « cheikh » ou un imam et qu’il nous propose une « roqya » gratuite pour l’accepter aussitôt Ne devrions-nous pas tous nous interroger sur le fait qu’il y ait des musulmanes et des musulmans aussi isolés et aussi ignorants de leur propre religion pour être trompés aussi facilement ? Sommes-nous devenus si dépendants des Hommes que nous en oublions de nous adresser directement à Dieu pour solutionner nos malaises ? Autant de questions que chacun d’entre nous a la responsabilité de se poser. En effet, aucun de nous ou de nos proches ne sont à l’abri d’une telle tromperie. Il convient enfin de rappeler que la « roqya » est un remède précis et qu’elle ne peut se faire que sous certaines conditions et surtout qu’elle demeure l’exception à la règle, qui est de toujours s’adresser directement à Dieu. Avant de recourir à une « roqya », il convient de faire une introspection sur ses propres pratiques cultuelles et de revenir.

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