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While the Internet has been up in arms the past few weeks over the controversial aspects of Barzakh, the show has left me in shambles for entirely unrelated and unexpected reasons.

Before Zindagi decided to remove the series from Pakistan’s YouTube, my editor and I were planning a story on the show’s themes of mental illness and intergenerational trauma. But then, episode four dropped with possibly the most accurate, honest, and visceral portrayal of postpartum depression in South Asian cinema.

Barzakh brings the struggle of postpartum depression to life

The episode begins with Shehryar’s (Fawad Khan) wife, Leena (Eman Suleman), struggling with a breast milk pump. Shehryar tells her, “Let’s bite the bullet and move to formula.”

We then see Leena in the bathroom swallowing a large pill and then dunking her face in a sink full of water to muffle her screams.

In the next scene, the couple is seated on opposite sides of the sofa, heads in their hands, the telltale signs of new parenthood with exhaustion and sleep deprivation apparent on their faces. Their silence is interrupted by their shrieking baby, Haaris. Leena goes to soothe Haaris, but the only words to come from her mouth are a shushed string of “shut up, shut up, shut up.” Shehryar rushes in to take the baby away from her.

Some time passes. Haaris is bigger and needier now. Leena, with an unmade face and unkempt hair, has disappeared into motherhood. We watch her struggle to feed a still-shrieking Haaris while watching clips from her old life as a stand-up comedian. Haaris projectile vomits all over her face.

We then see Leena whisper words of farewell to her baby boy, swallow all the pills, and sink into the depths of the bathtub. Haaris, blissfully unaware as only a child can be, babbles and watches TV outside as his mother sinks to her death.

Maternal mental health: a slow unravelling

When a new mother grapples with the weight of depression and ultimately succumbs to it, her death isn’t immediate. It’s a slow unravelling, a death of several parts that occur one by one.

I know this because, five years ago, I became suicidal and was diagnosed with perinatal depression — which refers to prenatal and postpartum depression.

Since my diagnosis, I have researched and written about perinatal depression at length. Through my research, I have found more questions than answers — for example, why is this completely preventable and treatable medical condition still taking the lives of young moms? However, one thing I know for sure is that women like Leena don’t just wake up one day and decide to kill themselves. They erode. They become victims of biology and society.

I was six weeks pregnant when, seemingly out of the blue (but in reality, due to the havoc hormones cause on a woman’s body in the first trimester), I was overcome by an intense episode of prenatal depression, something I had never heard of until my diagnosis, and an overwhelming desire to end my life.

It felt like a switch had been turned off in my head. Overnight, I went from feeling the excited rush of pregnancy to sobbing in the shower, thinking it would be easier on everyone if I died.

My husband is a physician, which means I was lucky to have a medical professional hovering about in my home who was quick to notice me spiralling into a dangerous headspace. Within hours, my mother had moved in with us, and I was booked to see my obstetrician-gynecologist, who referred me to a psychiatrist.

The first psychiatrist I went to was a middle-aged desi woman. She asked me why I was unhappy. I told her I was there because I’d also been wondering the same. She told me what I was feeling was not normal and that women are usually ecstatic during pregnancy.

I left the clinic in tears.

The second psychiatrist I met was trained in maternal health, specifically prenatal depression. She brought me down from the mental cliff I’d been teetering on. She told me she personally knew women who’d suffered from severe anxiety and depression during and after their pregnancies. These women, like me, had contemplated suicide. And these women were now healthy with healthy children.

Not just the baby blues

A staggering 80 per cent of women will experience the “baby blues,” which is when new moms feel sad or moody for the first one or two weeks after giving birth. This typically resolves on its own. However, perinatal depression is a full-blown medical emergency.

Symptoms vary wildly from excessive tearfulness, worrying, and anxiety to an inability to care for one’s self and the baby, as well as morbid thoughts, including wanting to harm oneself or the baby.

Dr Sue Varma, psychiatrist and author of Practical Optimism, tells me she often hears female family members of depressed mothers say problematic things like, “What’s her problem? I never had help with the baby and had even more on my plate.”

These kinds of statements are not only unhelpful but extremely damaging because the new mother is already racked with guilt over how out-of-control she feels and because she is just trying to stay afloat.

Depressed moms: more common than you think

A 2018 Center for Disease Control and Prevention (CDC) study estimates that 1 in 8 women experienced postpartum depressive symptoms, and according to the Pew Research Center, from 2008 to 2019, about 1 in 11 women aged 15-44 who died by suicide were pregnant or had recently given birth.

These statistics are for American women. I couldn’t find anything comparable for Pakistani women except for three articles. One article, which was written over a decade ago, was aptly titled: ‘Postpartum depression in Pakistan: A neglected issue’ and pegged the prevalence rate of postpartum depression in Pakistani women ranging from 28-63pc — the highest in Asia. The second article, published in 2017, cited the same percentage and described pre and postpartum depression as one of the most common “complications” of pregnancy. The third article concludes that, in the UK, postnatal depression is more common in British South Asian women than in white women.

Poor maternal mental health is not just a depressed mother’s problem. It has consequences for the entire family, which is why spouses and even the elders in a new mother’s life would do well by paying attention.

“In severe cases, [perinatal depression] will threaten not only the mother but the baby’s life. It can also threaten the baby’s social, cognitive, emotional, and intellectual development. And it impacts the other parent. But when treated, it can create a 180-degree shift where the entire family thrives,” said Dr Varma.

According to Dr Varma, “Before us, every generation of brown folks prioritized the happiness of the entire tribe before themselves. But, the younger generation is more open to therapy and medication and the importance of health on an individual level.”

In my case, a focus on myself is what ultimately saved my life and that of my daughter.

Weekly therapy during and after my pregnancy, a lot of support from my loved ones, daily mental health walks, and a daily antidepressant not only got me through my first pregnancy but gave me the courage to consider a second pregnancy.

My girls are four and two years old now, and I’m currently trying to wean myself off of the antidepressants that gave me the mental fortitude to bring them both into this world.

Depressed mothers on TV

In the West, the topic of maternal mental health has gained traction thanks to famous mothers like Kylie Jenner, Adele, Chrissy Teigen, and Shay Mitchell publicly talking about their struggles.

However, in Pakistan, the medical community and the media are lagging behind, and admitting to ambivalence or struggling with motherhood is a very recent thing in our communities, and this is reflected on our TV screens.

In Pakistani cinema, I can only recall Baaghi, Dil Na Umeed To Nahi, and Udaari glazing over maternal mental health. In Indian cinema, Chhapaak and Pihu and Sam Chatterjee’s short film Cul-de-Sac depicted depressed mothers.

As someone who has been through the darkness and back — and felt the supreme shame of failing to have a ‘normal’ pregnancy experience — I cannot understate the social value of pop culture depictions of mothers and mothers-to-be struggling with anxiety and depression.

In a recent interview, Sarwat Gillani described how she found herself in the abyss of postpartum depression. And now, we have Asim Abbasi’s powerfully executed fourth episode of Barzakh, which uses a brutally honest depiction of postpartum depression as a plotline to propel its larger narrative.

If you’re reading this, chances are you have been or may know someone at risk of feeling what Leena from Barzakh feels. I’m living proof here to tell you: you don’t have to struggle alone.

In fact, you don’t have to struggle at all. Perinatal depression is absolutely treatable and needn’t be your permanent state of existence. With the right village, you can get better. Indeed, you deserve to get better so that you can be around not just to raise but actually enjoy watching your baby grow.