The disabling aspects of postpartum depression
The disabling aspects of postpartum depression: a social history of medicine approach
Medical historian Michelle Walker highlights the historic tension between society and medical support for the disabling effects on mothers of postpartum psychiatric illness.
A female commentator asked in 1927 why New Zealand (NZ) society ‘differentiate[s] between one disability and another—between tuberculosis and puerperal insanity? Why stigmatise the latter and let the former go scot free?’[i] The answer to why puerperal insanity, the 19th-century term for what is now commonly understood as postpartum psychosis, was viewed not only as a disability but assigned societal stigma, is, of course, complicated.[ii] As a medical historian of postpartum psychiatric illnesses (PPI), I am interested in how the past understood ideas about motherhood and mental illness.
Today, medical literature distinguishes between three categories of PPI, distinguished by the level of ‘disability’ on the mother. At the mild end of the spectrum is the ‘third-day blues,’ affecting up to 75% of new mothers, often not requiring medical intervention.[iii] On the other end, doctors agree that around two in every thousand women experience psychotic or manic symptoms in the first four weeks after childbirth.[iv] Considered the most serious disorder, ‘postnatal psychosis’ greatly disrupts one’s ability to go about usual life activities.[v] Symptoms include hallucinations, delusions, confused thinking, and severe mood swings. In between these extremes is ‘postpartum depression,’ estimated to affect anywhere between 10% to 22% of new mothers.[vi]
Historically, medical responses to PPI varied depending on the severity of symptoms. Mothers who experienced milder symptoms were typically treated at home or recovered unsupported. For example, Annis Hammerton showed observable signs of mental and behavioural deterioration after childbirth in 1864 and was treated for puerperal insanity with medical support in her family home. She recovered quickly.[vii] Women whose PPI symptoms were life-threatening typically received care in mental institutions. Isabella Watt experienced debilitating symptoms after each of her 13 children was born, and received respite in the local mental asylums between 1868 and 1906.[viii]
My research also found that shame and secrecy were common themes intersecting cases involving severe PPI symptoms, especially when coupled with illegitimate births, suicide, and infanticide. These events could be catastrophic, subjecting mothers and their families both to legal and social “disability.”[ix] Research has concluded that some families experienced the stigma of mental illness for generations, and that shame had a profoundly negative impact on the lives of those who did not conform to the prescribed norms of motherhood.[x]
Medical responses encouraged support for the disabling effects of PPI throughout the 19th and 20th centuries. By the 1960s, doctors became increasingly vocal against societal shame related to PPI, focusing on the need to better support all ranges of PPI symptoms. Some doctors stated, ‘when these feelings become a disability and begin to interfere with daily life, then we can put a name to it… By this time the person needs skilled help.’[xi] In 1980 an international group addressed strands of research in puerperal mental disorders at a conference, which resulted in the establishment of the Marcé Society. To this day the Society fights to improve healthcare for the disabling effects of PPI through research, education, mentorship, and training.
Despite advances in support, the director of NZ’s Mental Health Foundation declared in 1982, depression in new mothers was ‘of epidemic proportions’ and ‘an epidemic of suffering.’[xii] Today, current public knowledge about PPI remains vague, inaccurate and clouded by stigma regarding historic psychiatric institutional care.[xiii] For this reason, PPI remains an urgent topic for conversation, and society must consider how to better support new parents experiencing the disability of mental illness.
References
[i] Anonymous, “Views of a Correspondent – Letter to the Editor,” Nelson Evening Mail (3 March 1927), 2.
[ii] Postnatal, Postpartum and Puerperal were used interchangeably in the twentieth century and all mean ‘relating to childbirth or the period immediately following.’ Most groups used ‘postpartum’ until the 1980s: “Puerperal,” in Concise Medical Dictionary (Oxford University Press, 2010), https://www.oxfordreference.com/display/10.1093/acref/9780199557141.001.0001/acref-9780199557141-e-8429 (accessed 20 October 2019).
[iii] “Baby Blues and Postnatal Depression,” New Zealand College of Midwives (blog), https://www.midwife.org.nz/women/postnatal/baby-blues-and-postnatal-depression/ (accessed 28 January 2024); C. Hunt, “When Baby Brings the Blues: Family Therapy and Postnatal Depression,” Australian and New Zealand Journal of Family Therapy, 27:4 (2006): 214-220.
[iv] “Postpartum Psychosis,” PADA - Perinatal Anxiety & Depression Aotearoa (blog), https://pada.nz/postpartum-psychosis/ (accessed 28 January 2024); American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed. (Arlington: American Psychiatric Association, 2013); C. Hunter, “Postpartum Psychosis: A Foucauldian Analysis of Women’s Experiences of Living with This Diagnosis” (PhD in Clinical Psychology, University of East London, 2013); M. Abbott and M. Williams, “Postnatal Depressive Symptoms among Pacific Mothers in Auckland: Prevalence and Risk Factors,” Australian and New Zealand Journal of Psychiatry, 40:3 (2006): 230–38; I. Brockington, “Postpartum Psychiatric Disorders,” Lancet, 363:9405 (2004): 303–10.
[v] M. Abbott, Postnatal Depression (Mental Health Foundation of New Zealand, 1982), 5.
[vi] S. Weeks, Mothers Cry Too: Recognising and Coping with Postnatal Depression (Penguin Books New Zealand, 2013); G. White, “A Comparison of the Postpartum Depression Screening Scale with the Edinburgh Postnatal Depression Scale,” New Zealand College of Midwives Journal, 39 (2008): 1-28.
[vii] F. Porter et al., My Hand Will Write What My Heart Dictates: The Unsettled Lives of Women in Nineteenth-Century New Zealand as Revealed to Sisters, Family and Friends (Auckland University Press & Bridget Williams Books, 1996), 376.
[viii] M. Walker, “Aotearoa’s Postpartum Psychiatric ‘Problem’: Exploring New Zealand’s ‘Hidden Epidemic of Suffering,’ 1850-1980” (PhD, University of Otago, 2024), 57-96.
[ix] D. Cohen, Family Secrets: Living with Shame from the Victorians to the Present Day (Viking, 2013), xiv.
[x] E. Clark et al., “Stigma, Shame and Family Secrets as Consequences of Mental Illness in Previous Generations: A Micro-History Approach,” Health, 28:1 (1 January 2024): 74–89; R. Godderis, “Motherhood Gone Mad? The Rise of Postpartum Depression in the United States during the 1980s,” in Bodily Subjects: Essays on Gender and Health, 1800-2000, eds. P. Light, B. Brookes, and W. Mitchinson (McGill-Queen’s University Press, 2015), 310.
[xi] H. Freeman, “Time to Consult a Psychiatrist,” New Zealand Family Doctor (1 August 1966), 14.
[xii] Abbott, Postnatal Depression, 2.
[xiii] M. Wicks, “Horrible histories: Auckland’s dark and seedy past,” Newshub (8 March 2018) https://www.newshub.co.nz/home/new-zealand/2018/03/auckland-s-horrible-histories.html (accessed 10 April 2024); L. Fisher. “The Story of Seacliff, the most haunted place in New Zealand,” Spinoff (13 February 2021) https://thespinoff.co.nz/society/13-02-2021/the-story-of-seacliff-the-most-haunted-place-in-new-zealand (accessed 10 April 2024); E. Haynes, Motherhood and Mental Illness: A Relational Treatment Approach (Routledge, 2022), 25.
Dr Michelle Walker holds a doctorate in History and Preventive and Social Medicine from Ōtākou Whakaihu Waka/Otago University, New Zealand. Her research explores maternal mental health, medicine, and psychiatry, focusing on women’s experiences in NZ. She seeks to understand the inequalities of postpartum psychiatric healthcare that some groups of mothers’ experience. You can learn more about her research here: https://orcid.org/0000-0001-9658-7640.
