Having reasoned discussion of a social problem is especially challenging in this new media age, which may highlight what is sensational rather than thoughtful. A recent book called attention to the problem this created in thinking about child abuse. The same issue may apply in attention given to postpartum depression.
One way of attracting attention to any issue is to link it to a celebrity or movie star. In recent years the renewed interest on the part of women in motherhood after years when working and careers were in the limelight, was promoted with magazine covers of pregnant movie stars. Pictures of “belly bumps” of the famous were followed along with speculation about whether they showed pregnancy.
In the same way, celebrities are now speaking out about their postpartum depression. This is all good if it leads to a meaningful educational response to address the problem. In the past, attention has been called to the issue through extreme examples from which women and others may distance themselves. Cases like that of Andrea Yates who drowned her five children in a bathtub are so clearly a sign of mental illness that new mothers have a hard time identifying themselves with the problem.
Now recent research has indicated that postpartum disorders may include symptoms not just of depression but of psychiatric illnesses. Mood disorders that may come to the fore after childbirth have often been trivialized or dismissed as “baby blues.” Yet, there are good reasons that the possible seriousness of such symptoms are missed given the emotional upheaval as well as the reality that often emerges after the birth of a baby.
Aside from hormonal factors at play, there is the well known fact of sleep deprivation to which any new mother will attest. The total dependency of an infant can be overwhelming. The birth of a first baby in particular turns a couple into a family, which involves adjustments between parents, grandparents and many new issues with which to deal. If not the first child, questions about and between siblings arise. In short, it is a time of major life adjustments.
The psychoanalyst Daniel Stern, a pioneer in infant research, also studied and wrote about what it means to become a mother. In his book, “The Motherhood Constellation”, he describes a particular mind-set that emerges during pregnancy and may last for months or even years. This mind set, influenced also by culture and individual personality, is one in which a mother’s primary preoccupation is with her baby’s well-being and her own connection to the baby.
Stern, writing about the tasks of new motherhood, describes the mother’s need to show first and foremost her ability to protect her child and to keep him alive. The stress involved in the baby’s dependence and her feeling of responsibility requires an environment in which she feels validated, encouraged and supported. Unhappily, in today’s world, these are needs too often unmet.
Stern believed that the mother’s preoccupation with her child’s well-being as part of the “motherhood constellation” should not be confused with symptoms of a psychiatric disorder as it is a normal developmental stage. This adds another layer of questions that must be considered when thinking about postpartum depression and whatever symptoms are a matter of concern.
One case that received a great deal of attention was that of an educated, professional woman who became convinced that her son had suffered brain damage in a fall resulting from her neglect. She was so sure that he was doomed to an abnormal life that she jumped out of the window with the baby strapped to her body.
Without questioning the fact that such extreme behavior was a result of a serious disorder, it does focus attention on the mind-set and emotional preoccupations of new motherhood. One aspect is the degree of responsibility that mothers feel for their children’s well-being. A second is the degree to which mothers blame themselves for anything perceived by them or others to be wrong.
A third factor, which applies beyond children’s infancy, relates to a mother’s connection to and knowledge of her child. Mothers, generally, know their children better than anyone else. During years of work with mothers, over and over again I have seen situations where mothers felt that something was wrong with a baby or growing child, had their concerns dismissed and ultimately were found to have correctly sensed something amiss with their child.
What complicates the matter further is that often mothers attribute questions of abnormality to behavior that is within the developmental range or that touches some particular personal or family worry. Behavior that is an expression of a child’s feelings, concerns or temperament may be confused with a disorder.
Ultimately, what stands out is the importance of listening to mothers. Their perceptions should be trusted rather than dismissed. To accurately judge the significance of those perceptions requires that mothers feel that they are being heard.