The first time I went through post-partum depression, I spent gloomy months in an emotional soliloquy trying to figure out what was wrong with me and how to get back to normal. When I became depressed again after the birth of my second child, I decided to scathe depression the best way I know how: writing my final academic psychological paper on its causes and therapies. Part of me wanted to thoroughly understand what was affecting me so deeply. But more than that, I felt touchy about the discourse I was hearing on postpartum depression in magazines, birthing classes, fictional TV shows, and right down to my son’s playgroup.
To put it simply, I was getting some feminist heebie-jeebies hearing postpartum depression discussed in language reminiscent of the old diagnosis of “hysteria.” Like a werewolf under the light of a full moon, women with “hysteria” were transformed by the powerful force of their uterus, causing an excess of emotion. Interchange that moon for a baby, and you’ve got postpartum depression — a woman’s disease. A condition a woman can’t control because of her femaleness, the vehicle being her female balance of hormones.
While I sometimes heard sleeplessness and changes in lifestyle mentioned as sideline contributors, a schema prevailed in which a woman with postpartum depression is a victim thrown about by chemical changes in her body and brain. I felt like I was hearing a very old tale: once again, women are the hapless, lone riders on waves of their emotions, while men are left out of the emotional picture. But the woman-as-emotionally-fickle stereotype wasn’t the only problem I saw in the culture surrounding postpartum depression.
First, I will out myself as a believer in family therapy. I feel one-on-one therapy is tricky when the person seeking help returns to a family with an ingrained set of healthy and unhealthy behaviors. Asking one person to change while the rest of the world stays the same is a huge challenge. I am also a believer that families function like an ecosystem, with all the booms and busts, seasons, and natural checks and balances that metaphor implies. So when something as life-altering as the birth of a child enters the family ecosystem, I had a hard time buying the woman’s disease viewpoint. In this perspective, the woman-only perspective was analogous to a highway cut through a rainforest, with everyone insisting only the milled trees were affected.
In the end, research supported my hunch. Several studies looking at the demographics of postpartum depression show high, independent correlations to economic, social, and interpersonal factors. A woman’s relationship to her family, her partner and her peers are all related to her likelihood of becoming depressed and her outcome thereafter. The health of the baby and quality of medical care can be correlated.
Households with a depressed mother often had another depressed or otherwise psychologically suffering member. In one study, family-centered or couple-centered therapy showed greater efficacy than traditional single-patient therapy. All in all, my new vantage of postpartum depression was much more like that rainforest in reality: while some members of the ecosystem are more obviously affected, shockwaves travel throughout.
I even learned that the condition is technically called postpartum onset of depression and not considered a separate diagnosis from major depression in the official psychological manual, the DSM. Those extra two words remove the implied cause-and-effect relationship between postpartum and depression. The term seems to imply a time state of the whole family instead of a physical state highly associated with the mother. Maybe this is mincing words, but as someone labeled by those words, it makes a difference to me.
Let me be clear: I am not trying to discredit hormones and physical changes as factors in postpartum depression, or even as primary factors in many cases. Instead, I worry that the woman-centric view of postpartum depression has overshadowed other research-supported causes and the subsequent opportunities for a family to understand one another and heal. The woman’s disease perspective undermines the beneficial power of relationships while the stressful aspects continue to exist. To me, these lost opportunities are more important than my feminist ideology or my drive to disseminate false information.
I’m encouraged by recent news coverage of a study declaring an increase in postpartum depression in men. No, I’m not thrilled to hear men are depressed; I am just happy to see a little fracture in the woman’s disease discourse. I’m even happy to hear researchers theorizing a connection between greater involvement of men in parenting and the rise in male postpartum onset of depression. No, not in a “welcome to the club” sort of way.
Instead, as a mother of two sons, I feel hopeful because such a theory could only arise in a society allowing men and women psychological and emotional equality. If we’re going to laud society for gains in equality between men and women, along with gains in equality for same-sex parents, then we have an obligation to recognize and support the struggles of every type of family member during the wonderful but difficult postpartum period.
If you have academic database access, here are relevant studies published in peer-reviewed journals.
Barnes, D.L. (2006). Postpartum depression: Its impact on couples and marital satisfaction. Journal of Systematic Therapies.
Burke, L. (2003, August). The impact of maternal depression on familial relationships. International Review of Psychiatry, 243-255.
Clark, R., Tluczek, A., Brown, R. (2008, September-October). A mother-infant therapy group model for Postpartum depression. Infant Mental Health Journal.
Johnson, S., Jacob, T. (1997, February). Marital interactions of depressed men and women. Journal of Consulting and Clinical Psychology, 15-23.
Misri, S., Kostaras, X., Fox, D., Kostaras, D. (2000, August). The impact of partner support in the treatment of postpartum depression. The Canadian Journal of Psychiatry, 554, 556-557
Page, M. (2008, September). Postpartum daily stress, relationship quality, and depressive symptoms. International Journal of Family Therapy. Retrieved from
Shlulz, M., Cowan, C., Cowan P. (2006, February). Promoting Healthy beginnings: A Randomized Controlled Trial of a Preventative Intervention to Preserve Marital Quality During the Transition to Parenthood. Journal of Consulting and Clinical Psychology, 12-15.