Eye on Fiction: The Babadook and maternal depression

If it's in a word
Or if it's in a look
You can't get rid of the Babadook
Mister Babadook

I have watched a lot of horror movies in my life. Apparently the first movie my father ever took my mother to when they were dating was Carrie (dir. Brian De Palma, 1976). If that's not definitive proof of the genetic basis for the heritability of such a character trait, I don't know what is. Since becoming a mental health professional, it's perhaps natural that I've become more attuned to depictions of mental health problems in the horror genre. Indeed, although horror films are often regarded as being of rather low cultural value, I've often found they depict complex ideas about psychological distress and mental health difficulties through the use of metaphors in a very accurate and non-stigmatising way. This contrasts starkly with the more literal, yet often inaccurate, depictions of people with mental health problems in highly lauded films. I'm sure I'm not the only mental health professional, despite a deep and abiding love for Jennifer Lawrence, to have been left cringing behind my popcorn during the Silver Linings Playbook (dir. David O. Russell, 2012).

A recent film that resonated with me much more was The Babadook (dir. Jennifer Kent, 2014). In the best of horror traditions, this is a relatively small-budget film with little-known actors turning in compelling and authentic performances. The film tells the story of Amelia, a single mother to her seven-year-old son Sam, who scrapes a living caring for elderly people in a nursing home. Amelia has been widowed under tragic circumstances, and although portrayed as a sympathetic and fundamentally kind woman, she is burnt out by the emotional demands of caring for her patients at work, and her emotionally and behaviourally disturbed child at home.

In The Babadook, as in all good horror films, the comfort and familiarity of daily rituals are perverted and hijacked by an increasing sense of dread and violation. One evening, after Sam and Amelia have completed the usual routine of checking for monsters under the bed and in the wardrobe, they settle down for a bedtime story. Sam requests his mother reads Mister Babadook, a pop-up book that has mysteriously appeared in his room. Needless to say, The Very Hungry Caterpillar, this is not. The Babadook is a prototypical monster – shadowy and indistinct, half-human, half-animal with a black hat and cape as ghoulish props. The book warns of the curse of the Babadook – how it will beg to be let in, and when it has got in, it will reveal its true terror to you. The final pages warn 'You're going to wish you were dead'. Needless to say, the book deeply disturbs both mother and son, so heralding the beginning of the Babadook's psychological and physical assault on the family over coming nights.

The haunting of Amelia by the Babadook is always set within the wider context of her being haunted by the death of her husband, and the impact of this on her ability to effectively parent her child. Bowlby's classic work on attachment theory highlights the importance of a baby forming a close emotional bond with a primary caregiver, which is usually (but not necessarily) the mother (Bowlby, 1969). The forming of an effective attachment relationship is dependent on the emotional availability and responsiveness of the parent. As the film goes on, we see Amelia display many classic depressive symptoms, including low mood, lack of energy, decreased activity and disturbed patterns of eating and sleeping. In mothers of babies, these depressive symptoms unfortunately disrupt the normal reciprocal social interactions vital to the development of emotional expression and regulation in the child, such as eye-contact, smiling and shared attention (for review see Alvarez et al., 2015). For Amelia, as the birth of her son coincided with the death of her husband, the film leads us to speculate that her bond with Sam was forged under the most difficult of circumstances. This adverse emotional environment has unfortunately persisted over the years, perpetuated in part by the social exclusion both Amelia and Sam experience as a result of their bereavement. This is portrayed starkly in one heart-breaking scene as Amelia is shunned by the other mothers at her own niece's birthday party for being without a husband. In a parallel scene, Sam is shown being openly taunted by his cousin for being without a father.

To be clear, it is always made clear that Amelia loves her son and wants to be a good mother. At the same time, she clearly isn't a saint or an angel. When Sam is screaming and shouting, when he disobeys her, gets into trouble at school, when he constantly wakes her up at night looking for reassurance, she is shown to be frustrated and angry towards her son; unacceptable feelings that she can only suppress and deny for so long. Later, when in the terrible grip of the Babadook, she shouts and rails at her son, saying cruel and rejecting things to him. These scenes are difficult to watch, in that they confirm the deepest fears both of Sam, that he is ultimately unwanted and unloved by his mother, and of Amelia, that she is a bad and inadequate parent.

These scenes also brought to mind the concept of ambiguous loss, a term first coined by Boss (1999). A child with a depressed or traumatised parent experiences an ambiguous loss, because the parent is physically present but emotionally absent. Ambiguous losses disrupt normal grieving processes and prevents any sense of closure, which can also occur in grief reactions in family carers for people with dementia or other degenerative disorders for example (Boss, 2011). Sam seems only too aware of the emotional unavailability of his mother during her darkest times, whilst also showing a wisdom beyond his years, in somehow being able to separate his mother from her affliction, saying 'I know you don't love me Mum – the Babadook won't let you'.

In the end, Sam helps his mother to find the strength to fight back, along with a timely appearance by their kindly neighbour Mrs Roach, who comes to check on them during the darkest of their nights. Prior to this point, Amelia's bereavement has remained a taboo; a mark of social stigma, something not to be spoken about or even admitted to. Even her sister suggests after so many years, shouldn't she perhaps be getting 'over it?' The elderly Mrs Roach, who has known the family for many years, recognises the futility of ignoring the anniversary of her husband's death, saying to Amelia:
I know this time of year's terribly difficult for you and I know you don't want me to go on about it, so I won't, but I just wanted you to know I'd do anything for you and Sam. I love you both.

Amelia's refusal to grant Mrs Roach admission to the house, even after this heartfelt offer of support, symbolises her inability at that time to let anyone in to her internal world, to be able to recognise that she is not, as feared, all alone in her struggle. However, Sam and Mrs Roach's declarations of unconditional love and support for her are in fact the turning point for Amelia, in that they allow her to gather her own resources to go into battle with the Babadook.

The worse part of a curse is often that you can't get rid of it, as Mister Babadook repeatedly warns. In the same way, the worse part of depression is perhaps that it is characterised by negative and hopeless cognitive themes – nothing ever works, things will never get better, there's no point in even trying. These thoughts often result in unhelpful behavioural responses such as avoidance and social withdrawal, which maintain the vicious cycle of depressed mood by reinforcing such negative thoughts, according to Beck's classic cognitive theory of depression (Beck, 1967). Cognitive therapy works by encouraging active reappraisal of such negative cognitions, and in many cases acting against such thoughts, by deliberately re-engaging with valued activities which help to improve mood (Beck et al., 1979). Is this also the Babadook's final trick then, its ultimate deception, to convince you that once you've let it in, you can never get rid of it? If so, Amelia's 'solution' is pretty original, as the curse is not simply broken by passing it on to someone else (as is often the case in horror movies, such as The Ring franchise). Given that depression is a highly recurrent disorder (e.g. Judd, 1997), a lot of people describe learning to live 'with' depression, staying well and managing episodes as best they can. This process is skilfully depicted at the end of the film, after Amelia's big show-down with the Babadook, in which she manages to somehow tame the monster, and banishes it to the basement of the house.

The Babadook cannot be simply ignored or shut up for ever, though – further care and attention is needed. In the closing scenes, we see Amelia presenting food to the Babadook in the basement, in a surprisingly tender way. In an interesting role reversal, the Babadook appears to be the one who is scared and roars back at Amelia. She recognises its fear and pain, and responds not by retreating, but instead approaching the monster with soothing words and gestures in an effort to comfort it. This is a rather moving scene, and seemed consistent with the work of Paul Gilbert and colleagues on compassion-focused therapy, which encourage us in part to try to befriend our inner critics and demons and to understand the messages they are bringing us, rather than fruitlessly battling to eliminate them altogether (Gilbert, 2009).

In conclusion, although The Babadook explores some rather dark themes, it is a strangely uplifting film. The great screenwriter Nora Ephron famously said 'Above all, be the heroine of your life, not the victim', and Amelia's character certainly embodies this notion. Despite cautionary evidence that persistent maternal depressive symptoms are related to higher levels of emotional and behavioural problems in the children of affected parents (van der Waerden et al., 2015), likewise there is much cause for optimism for good outcomes for both parents and their children if they receive timely help and support. For example, a recent meta-analysis of nine randomised-controlled trials concluded that not only were psychological therapies an effective treatment for maternal depression, there was also a knock-on beneficial impact on the mental health of their children (Cuijpers et al., 2015). As the wise old neighbour Mrs Roach might say, it's good to talk.

- Dr Pamela Jacobsen is a NIHR Clinical Doctoral Fellow at the Institute of Psychiatry, Psychology & Neuroscience, King's College London. [email protected]
@pamelacjacobsen

References

Alvarez, S.L., Meltzer-Brody, S., Mandel, M. & Beeber, L. (2015). Maternal depression and early intervention. Infants & Young Children, 28(1), 72–87.
Beck, A.T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row.
Beck, A.T., Rush, A.J., Shaw, B.F. & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Boss, P. (1999). Ambiguous loss. Cambridge, MA: Harvard University Press.
Boss, P. (2011). Loving someone who has dementia: How to find hope while coping with stress and grief. San Francisco: Jossey-Bass.
Bowlby, J. (1969). Attachment (Vol. 1). London: Hogarth.
Cuijpers, P., Weitz, E., Karyotaki, E. et al. (2015). The effects of psychological treatment of maternal depression on children and parental functioning: A meta-analysis. European Child & Adolescent Psychiatry, 24(2), 237–245.
Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 15(3), 199–208.
Judd, L.L. (1997). The clinical course of unipolar major depressive disorders. Archives of General Psychiatry, 54(11), 989–991.
van der Waerden, J., Galera, C., Larroque, B., et al (2015). Maternal depression trajectories and children's behavior at age 5 years. Journal of Pediatrics,