America’s Mothers Are Isolated, Anxious, and Depressed—Here’s Why
Then, she gave birth, and everything fell out of place. Nothing went according to her expectations, beginning with the actual delivery and how exhausted (to put it mildly) she found herself in its aftermath. “I emerged from the hospital feeling like I had been in an underground bunker for a year fighting a war,” she says. Things didn’t get easier from there. Jones struggled with a continued sleep deficit, a constant feeling of overwhelm, and physical pain. Really struggled. “I woke up on day four and was like, ‘The way I’m feeling isn’t normal.’ So, I dragged my husband to my OB and just cried. I was like, ‘I can’t do this. I just want to run away. This is not my life.’”
Jones’ obstetrician assured her that her feelings were normal—and to some extent, they were. “Eighty percent of all women have baby blues, which is a period of tremendous emotional instability that goes on for two to three weeks [after giving birth],” says Ann Smith, president of Postpartum Support International (PSI). “But it gradually gets better and it eventually resolves itself.”
"How am I really going to say, 'I want to run away from my baby, I want to run away from this house'? I’m not going to put that in the caption because people are going to call the police on me."
In Jones' case, however, things didn’t get better. That’s because she was suffering from postpartum depression (PPD), a mental illness that affects at least 1 in 9 new mothers, according to the Centers for Disease Control and Prevention (CDC). Smith puts the number even higher—at 1 in 7—and says the actual percentage could be higher still, at around 20 percent. Meanwhile, a recent study published in the Journal of the American Medical Association found that depression in young expectant mothers is 51 percent more common today than it was 25 years ago.
If you're surprised by these numbers, it may be because struggling mothers are difficult to spot among the perfectly curated images proliferating in Instagram's digital neighborhood. Like many other imperfect narratives, they've been filtered out in favor of flawless mommy-and-me portraits wherein everyone is smiling and there's no spit-up in sight. "Everything that’s portrayed on Instagram, even my own Instagram, is a lie," says Jones of the phenomenon. "How am I really going to say, 'I want to run away from my baby, I want to run away from this house'? I’m not going to put that in the caption because people are going to call the police on me."
Jones calls model and host Chrissy Teigen's essay on PPD for Glamour a life raft of sorts floating atop the shiny facade of motherhood in which she was drowning, proof positive more conversation is needed around this topic. And it's not just those struggling with PPD who could benefit from more realism—it's every mother.
Welcome to matrescence
One of the things Jones tells me she realized through the process of seeking treatment for PPD is that she's never really done well with change—and becoming a mother is one of, if not the, biggest changes to occur over the course of a woman's life. The transition is so consequential, in fact, that an anthropologist named Dana Raphael (the same woman who coined the term "doula," by the way) created a word to describe it: matrescence.
"Matrescence is not a condition—it’s a word to describe the period of time where a woman has a baby," says reproductive psychiatrist Alexandra Sacks, MD. If adolescence is a girl's journey to womanhood, matrescence is a woman's journey to motherhood.
Dr. Sacks explains that matrescence is different from pregnancy, which is described as the physical experience of growing a baby; it’s different from labor and delivery, which is described as the physical experience of giving birth to a baby; and it’s different from the postpartum period, which means many things, a lot of which are physical. "Matrescence includes a discussion about culture, a discussion about psychology, a discussion about relationships, money, sex," she says. "There's such a richness to this time in a woman’s life that I think it’s helpful to have a frame around the conversation that will inspire more support."
Dr. Sacks also hopes that spreading awareness of matrescence may help to lower rates of postpartum depression. To explain why, she again draws a parallel to adolescence, explaining that when you enter into that phase of your life, you're prepared for the changes that are about to occur. (As are the people comprising your support network: your parents, friends, and teachers.) The difficulties of transitioning into motherhood, by contrast, often catch women by surprise simply because there's little discussion of them prior to giving birth.
Plus, cultural acceptance of the concept of adolescence helps those experiencing its ups and downs be able to discuss it free of stigma, and she hopes education around matrescence will do the same. "I really want to encourage women to use the word as much as possible," Dr. Sacks says. "In creating a term to talk about the transition of motherhood, we’re remembering to talk about the mother's experience, which is so often put in the background and made invisible."
Alone with your phone
While the challenges that accompany matrescence aren't new, some factors could be making them more acutely felt in the modern world. One of these, speculates Smith, is that it's less common for women of this generation to have communities gather around them during their childbearing years. “Back in our grandparents generation, people saw other moms with babies," she says. "There was somebody in the apartment building above them or across the street or down the road. Their cousins lived nearby or their aunts and uncles lived nearby. They saw women breastfeeding. They watched how it all happened. Now, there’s this tremendous isolation." Often, she tells me, people who call or text or email into PSI report that they don’t know anyone else who has a baby. “I think that is really, really hard,” Smith says.
Into this void enters social media—Instagram and beyond—where women are greeted by the inhumanly ideal and insanely judgmental best friend they never asked for, and against whom they could never measure up. In a November 2017 cover story, Time coined a term to describe this ubiquitous portrayal of perfect motherhood. "Call it the Goddess Myth, spun with a little help from basically everyone—doctors, activists, other moms. It tells us that breast is best; that if there is a choice between a vaginal birth and major surgery, you should want to push; that your body is a temple and what you put in it should be holy; that sending your baby to the hospital nursery for a few hours after giving birth is a dereliction of duty. Oh, and that you will feel—and look—radiant," the story read.
"I hear a lot from moms that when they set the bar too high, they inevitably feel like if they don’t reach it, they’re failing." —Alexandra Sacks, MD
Thirty years ago, mothers of course knew some things were bad for baby (e.g. smoking), but they definitely weren't bombarded with such an array of often-confusing and conflicting information. Plus, they didn't necessarily have to contend with such a visible army of crusaders for the various causes—natural birth, breastfeeding, vaccines (or, no vaccines), and on and on it goes. My mother, for example, had three Cesarean sections out of necessity and thought nothing of it. But today's mom might know that there's evidence linking C-sections to compromised gut health in baby and worry. She may also watch glowing woman after glowing woman after glowing woman describe her magical home birth on Instagram and feel less than by comparison. Hello, depression, anxiety, and all the rest.
In a data vacuum—the Goddess Myth's effects on modern-day moms have not yet been studied—Time conducted its own surveys and found, among other things, that 70 percent of participants felt pressured to mother in specific ways and that over 50 percent felt guilt and shame when things didn't go according to plan. "Pressure to be perfect makes everything harder," Dr. Sacks responds when I ask her if she thinks the phenomenon is making motherhood more difficult. "I hear a lot from moms that when they set the bar too high, they inevitably feel like if they don’t reach it, they’re failing. And that’s just an incredibly shameful thing if somebody worries that they’re failing their own child."
A perfect storm for postpartum depression
As mentioned above, facing difficulty adjusting to life as a mom is not the same as experiencing PPD. To understand the difference, it's important to first understand what the latter even is. Postpartum depression falls under the umbrella of perinatal mood and anxiety disorders (PMAD), which includes postpartum depression, postpartum anxiety, postpartum obsessive compulsive disorder (OCD), and postpartum psychosis. And it's also important to understand, Smith says, that these disorders don't just appear for new moms after they give birth—for one-third of mothers, onset of PMADs occurs during pregnancy.
PMADs differ from transitional difficulties in that they're debilitating, says Smith. Patients may feel flat, like they can’t enjoy life, aren’t looking forward to anything, and that they’ve lost themselves (a la Jones). They may also feel like they can’t bond with their babies. This is postpartum depression. Or, they may instead feel a crippling anxiety, which Smith says comes in two forms. “One is a formless anxiety, a fear of fear itself,” she says, describing postpartum anxiety disorder. “Then there are people who have anxiety that is specific—they’re frantic about the baby stopping breathing, they’re frantic the baby is going to get some kind weird disease,” she explains. The latter is part of what’s known as postpartum OCD. Around 1 percent of mothers may experience postpartum psychosis, which differs from the above disorders because it requires psychiatric hospitalization due to risk of suicide and infanticide. Mothers with this condition—like Adele's good friend, Laura Dockrill—may experience hallucinations, delusions, paranoia, insomnia, and mood swings.
When I ask Dr. Sacks what causes PMADs—if it’s mainly a biological response to stimuli like hormonal shifts or if life circumstances play a significant role—she tells me that this question is like asking what causes depression. The short answer? No one really knows. “Science doesn’t have a confirmed answer of what aspects of depression are purely biological versus what aspects are psychological and influenced by life stresses,” she explains. “In psychiatry, we appreciate that it’s usually a combination of factors.”
It’s common, she says, for women who are hormonally sensitive (who’ve had prior issues with premenstrual dysmorphic disorder or intense premenstrual syndrome, for example) to also suffer from a PMAD; however, there are also women whose experience is primarily influenced by social factors, such as limited familial support. "Generally, postpartum depression is kind of the perfect storm," Dr. Sacks says. There's social stress and behavioral stress caused by your new schedule: "[There's] lack of sleep. It’s probably harder to exercise and get out of the house and get exposure to sunlight. It’s harder to engage in self-care, it’s harder to see your friends." These are all things, according to Dr. Sacks, that are protective against depression.
Certain populations are also statistically at higher risk than others. At the top of this list is those who’ve had experience with a PMAD in a prior pregnancy. Next is women who’ve had a history of mental health issues prior to conception. “Fifty percent of all women who get a perinatal mood disorder have a [non-pregnancy related] mental health history,” Smith says. Also on the list are teen mothers, single mothers, mothers of multiples (e.g. twins), those in the military or who have military spouses, those in troubled or abusive relationships, those who had troubled childhoods, those with sick babies or babies who spend time in the NICU, women who dealt with infertility prior to conception and, as mentioned above, those who are hormonally sensitive. This doesn’t mean, notes Smith, that all women who fall into these categories will experience a PMAD—some will, some won’t. And some women who don’t fall into any of these categories, like Jones, will struggle with a PMAD regardless.
The alarming statistic no one's talking about
Here's the good news about PMADs: They're treatable. "Basically, 100 percent of women can get well," says Smith. Here's the bad news: The majority of people don't get treated. "I will give you a shocking statistic," Smith says. "Only 30 percent of women who should be treated are, and only 10 percent are treated to remission." She tells me that this is due in large part to flaws in the mental healthcare system, from a lack of trained physicians who can diagnose and treat PMADs to a lack of mental health providers, period, who take insurance.
PSI is endeavoring to remedy this from multiple fronts. They offer a PMAD training program for mental health professionals, which has educated around 9,000 people over 20 years. Since this is only a "drop in the bucket," as Smith puts it, however, they're also rolling out Frontline Provider Trainings, which will work to train OB/GYNs, family practitioners, nurse practitioners, and the like. "If those people know how to screen, diagnose, and begin treatment, you can get a lot of people helped," she says. Finally, PSI plans to offer a consultation line for untrained doctors to call when they're unsure of which steps to take with a patient who exhibits signs of a PMAD.
"There’s a stigma about getting help, there’s a stigma about psychiatrists, there’s stigma about therapists, and there is tremendous misunderstanding about what medications are and what they do." —Ann Smith, president of Postpartum Support International
All of the above will be a great help for patients who seek and follow through with treatment, but unfortunately, stigma may still prevent a number from doing so, says Smith. "There’s a lot of stigma about the illness—about any mental illness. There’s a stigma about getting help, there’s a stigma about psychiatrists, there’s stigma about therapists, and there is tremendous misunderstanding about what medications are and what they do," she says.
Jones is a perfect example of this. She mentions several times that because the women close to her were "perfect mothers," she felt there was something wrong with her for not embracing the role as easily. And when she finally did speak up, her mother told her what she was experiencing was normal and that it would pass. This dismissal—well-meaning as it was—delayed treatment for Jones. And once she did get help, she had to hide the medications she was prescribed from her mother, who did not approve. It's a good thing she took them in secret, however: They helped.
When to reach out
Dr. Sacks tells me that people often ask her how to know if they’re suffering from a PMAD or are just going through a rocky patch. Her response? It doesn’t really matter. “Any woman who has any concerns about her psychological health should just tell any doctor,” she says. “You can even tell your pediatrician.”
As with “regular” depression, Dr. Sacks explains, it can be difficult to navigate resources and advocate for yourself—especially when you add in the enormous burden of care for the baby—so it's important to enlist the advice, guidance, and expertise of professionals. Plus, she points out, there’s little to lose. “Worst case scenario is that you’ll feel reassured and best case scenario is you’ll get treatment for postpartum depression [or another disorder],” she says. Besides, she adds, you don’t have to have a PMAD to seek out psychological support. “Plenty of women benefit from being able to talk about their transition even if they’re not experiencing an illness,” says Dr. Sacks.
It's clear that, for Jones, our conversation is helping serve this purpose; it's a stand-in therapy for what she's experienced and is still experiencing. "I think society has a lot of expectations that make being a new mother really hard, and people need to work on being more accepting and more forgiving," she says. "Now, [my daughter] is 10 months old and she's great, so there is a light at the end of the tunnel. But in the moment, you really feel like it's never going to get better."
If you're struggling with feelings of anxiety, depression, overwhelm, or other mental-health symptoms while pregnant or after giving birth to a new baby, call the Postpartum Support International hotline at 800-944-4773 to be connected to someone who can talk you through your experience and connect you with treatment in your area.
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