In the late 19th century, American writer and new mother, Charlotte Perkins Gilman, spoke of her experience of severe postpartum depression in her now famous short story “The Yellow Wall-Paper.” “The Yellow Wall-Paper” goes on to depict the well-meaning but ultimately harmful and oppressive efforts by her physician husband to alleviate the illness by mandating the “rest cure.” This comprised of bed rest, isolation in her bedroom, and strict prohibition of physical or mental stimulation, a common prescription at the time for upper class women thought to suffer from hysteria and other “nervous illnesses.” Gilman vacillates between attempts to assert her feelings and needs, and surrender to what her loving husband and the larger patriarchal society deem she should feel, need, and do in the face of distress as a new mother. She ultimately submits – after all, as she writes, “nobody would believe what an effort it is to do what little I am able.” Unsurprisingly, after a few months of this treatment, Gilman’s depression deepens and she feels, in her own words, “near the borderline of utter mental ruin.”
Gilman’s depression eventually lifted once she abandoned the rest cure, left her husband, and returned to writing. She became a staunch advocate for women’s rights and was a prolific author who insisted on a woman’s right to have her voice be heard.
There have been major, hard won changes in collective attitudes toward maternal mental health since Gilman published the “The Yellow Wall-Paper” in 1892. Perinatal depression and anxiety disorders are, for the most part, viewed as legitimate and serious health issues that warrant treatment. At the same time, this understanding is not uniformly expressed in actual medical practice. Still too many suffering women fall through the cracks and receive no screening or treatment. Moreover, timely access to quality, affordable mental health treatment remains a challenge, especially for low income women and women living in rural areas.
While progress has been made, many contemporary women experiencing symptoms of a perinatal mental health disorder echo Gilman’s 19th century sentiment that “nobody would believe” just how awful they feel. Their voice is not being heard. As a society, we are uncomfortable with the idea that a new mother can experience anything other than gratitude, love, and joy at her baby’s arrival. We continue to be trapped in the dichotomous territory of new motherhood: the mother is either good or bad, angel or monster. This shapes our expectations of new mothers and their own expectations as well. I have seen this play out hundreds of times; spouses, friends, siblings, even their own mothers grapple with, even resist, the reality that the woman who became a mother could feel such despair. A woman I met not too long ago shared with me that when she had to be hospitalized psychiatrically in the postpartum period due to the severity of her symptoms, her depression screening score was in the highest, most severe range. Her husband was immensely supportive of her and brought her to the hospital; as part of a research study, he was asked to complete the same screening questionnaire as though his wife was filling it out. The results? His score fell in the lowest, mildest range. She was stunned – how could he not see that things were so dire? She learned that he just could not reconcile the image he had of new mothers and his partner in particular: a strong, resilient, capable person, with the notion that she felt she was losing her mind. It was unthinkable.
And not just for him. Women afflicted by symptoms of depression or anxiety during the perinatal period understandably struggle to accept the reality of their distress as well. In fact, it often is the case that people closest to the mother sense that she is unwell and wish for her to reach out for help before she feels ready to do so. This is partly why it is common for partners to be placing the call to schedule the first appointment with the psychiatrist or therapist on the mother’s behalf. In those cases, the loved ones decided to act because they saw that the mother was dealing with an actual illness which has a name, scientific explanation, and can be treated by trained mental health professionals. For the mother, it is much harder to accept this explanation. She blames herself, she feels disappointed, heartbroken, often worthless, and incompetent, a “bad mother.” One of depression’s cruel tricks is that it makes a mother mistake what are symptoms of depression and/or anxiety for an actual aspect of who she is/who she has become – she doesn’t just feel like a bad mother, she believes she is one. The pressure of our one-sided, hyper-enthusiastic narrative of what entry into motherhood should feel like fuels the shame, and even more worryingly, often effectively silences the healthy part of her that knows she should speak out. Instead, she might pour the little energy she has into appearing okay.
The appearances. In our society, new mothers are applauded for appearing to be able to quickly resume their old lives with their normal routines, and ideally, pre-pregnancy bodies. She has barely left the hospital, her uterus has only started contracting from the stretching of the last nine months and her hormone levels just took the steepest dive of a lifetime, her milk might not even be in, and yet people around her comment enthusiastically on any perceived signs of restored normalcy. She, too, longs to feel normal. But the normal does not mean returning to what used to be. It has yet to be established. Where is a nuanced discourse about the massive nature of this transition that would be backed by community-wide efforts to provide support to new mothers, enshrined in helpful legislation and openly promoted by public figures and role models? It does not exist on the scale that would make a difference. As a result, many women feel it is wrong to struggle with their new roles, routines, bodies, relationships. This is not helpful at best and harmful at worst.
After all, significant changes in our lives are eased by collective recognition that a transition is occurring. As we move from one stage of life to the next, widely recognized rites of passage replete with symbols and involving our community, reflect back to us that change is taking place, create opportunities for preparation and receiving guidance, and help us set expectations. Take marriage, a transition that is nowhere near as massive and disruptive as entry into motherhood. From shopping for a ring, to engagement parties, showers, rehearsal dinners, the wedding itself and the honeymoon, the couple’s new status is celebrated long before and after they say “I do.” What about new parents? What are the rituals that focus specifically on them and not the baby, helping them embrace their new identity as parents, and providing guidance and support along the way? In our mainstream American society, there aren’t any. It is not surprising then that wanting to feel normal and good about themselves, many postpartum women believe that the sooner they can function like they used to – autonomously, without having to rely on others for much help – the better. Negative feelings, the experience of struggle and turmoil, is seen as wrong. While depression and anxiety in the postpartum period are not part of the normative adjustment, the presence of struggle, doubt, frustration, confusion, and ambivalence about the new role, is.
What a terrible bind! To really thrive in their new role, women actually need to be able to express all of their feelings; they need a robust community of support, and not to feel that flying solo signals that they are rocking at motherhood. Mothers need to be able to rely on others and not feel bad about doing so – which in essence asks them and those around them to loosen the culturally conditioned belief that pull-yourself-up-by-the-bootstraps, self-sufficiency, and autonomy in all things signifies the highest level of success. In this country we say it takes a village to raise a child, but do we really act like we believe it?
Support is about so much more than a family member holding the baby when the parent takes a shower. Some of it needs to be pragmatic – helping with errands, cooking, cleaning, burping the baby or looking after the older siblings. Much of it requires willingness to exercise a different muscle altogether: that of the heart. What women need is friends and family who “get it,” with whom it is possible to be real in all the messy ways that being real entails, who are not afraid of the many juxtapositions of feelings in motherhood that are as multifaceted and changeable as images in a kaleidoscope (I’m mourning my old life and I wanted to become a mother more than anything else; I want my old life back and I would not trade my child for anything; I am tired and hate all this today and I hope to be in love with my life tomorrow). Sadly, if the new mother’s supports make no space for any of this, her emotional needs will not be expressed or met, creating a fertile ground for depressive symptoms to grow in.
So many women come to psychotherapy months or even years after they first started to feel badly and share that they never sought help because they thought that feeling this way was how motherhood is supposed to feel, that their symptoms were just part of the ongoing, unending adjustment process. When I hear that, I cannot help but wonder about all the other people in the life of the woman who has spent months or years struggling: did no one see? Did no one hear her pain? Did no one share their experience to help empower her to realize that if she doesn’t feel okay, it’s not okay? To help her distinguish what is to be expected as part of the transition from what is not? Was she judged and unsupported? That is unfortunately all too common. Or did she keep the pain to herself so much that no one could have noticed? But if so, why did she? As I have learned again and again in my psychotherapy practice: sometimes the meticulously applied makeup and the stylish outfit represent desperate efforts to camouflage the pain that she actually feels. The pain is hidden for a good reason; she does not feel safe to share it with the world.
We must change this status quo. It is already changing – culture is fortunately anything but static. Women need to feel they can speak up about their feelings and needs as mothers. There will always be countless perspectives and much difference of opinion, but agreement is not the point – having the dialogue, feeling heard and seen, is. Paradoxically, in the very vulnerability that we so often fear and judge lies our greatest source of strength.
If you don’t feel okay, this does not mean you are failing as a mother or in any of your other roles. Reach out. Most women who have done so before you will attest that seeking support and help was the most difficult step. Sometimes being real and feeling accepted is all it takes to feel better. At other times, seeing a mental health professional might be needed. Remember: you deserve to thrive, and with the right supports, you will. It does take a village (and not just any village).
You can read “The Yellow Wall-Paper” here
