Tech + Health

08.05.14

Postpartum Stigma: Why My Patient Committed Suicide

The pressure—from family, friends, society, doctors—to be a ‘perfect’ parent can be overwhelming. When a new mother suffers from postpartum depression, that pressure can be fatal.

Mothers don’t have to be perfect. Yet it seems everyone—people out on the street, family members, media, and parenting “experts”—are ready to pounce at a moment’s notice, ready to judge if they feel Mommy isn’t doing a good enough job.

The problem is that this kind of pressure can have toxic consequences. People on the outside sometimes forget that mothers undergo pressures that are internal, external, social, hormonal, financial, physical, mental. Immense pressures. The greatest of which is probably their own guilt at not being able to do it all, and worse, when they are incapable of doing it all due to the throes of severe postpartum mental illness.

Sometimes, that intense social judgment, that expectation of saintly loving maternal perfection, can destroy a mother.

I had a patient once, a beautiful, intelligent, goodhearted woman, who decided to have a baby. Tragically, she developed severe postpartum depression, crippling her with near-psychotic ruminations, anger, and guilt. She could not feel attached to her child; she could not handle the crushing weight of responsibility, the insomnia, the constant anxiety.

Despite all we did, she committed suicide.

There were a multitude of complex factors, but my gut also tells me that her paralyzing guilt was magnified by social expectations: the insinuations from traditional cultural family expectations and from legal court expectations (a judge allegedly refused to allow her to give up custody of her child), that she needed to grow up and deal and be supermom, no matter what. Even though her brain was broken.

A postpartum psychiatry expert who discussed her postmortem case admitted that when she met with some of these patients, she would think to herself, “Great, another mom who doesn’t want her baby anymore.” I was shocked to hear even someone like that throwing in social judgment. Other psychiatrists also said the case was hopeless due to “personality disorder” issues despite the obvious presence of primary mental illness. What a convenient excuse.

The selfish mother is one of the most condemned cultural tropes in our modern society. The media goes into a frenzy when egregious examples of bad mothers occur, like Susan Smith or Casey Anthony. Certainly, such crimes are beyond unconscionable and horrifying. But they are rare. And in a case like Andrea Yates’, social judgment can be wrong.

There were a multitude of complex factors, but my gut also tells me that her paralyzing guilt was magnified by social expectations.

Andrea Yates drowned all five of her children in 2001, even chasing after them when they tried to flee. But according expert opinion and the case details released to the public, she was also floridly psychotic and delusional. She had stopped her antipsychotic medication, and her husband, despite the psychiatrist’s advice that she not be left unattended, ignored that advice in order to build up her independence. (Yates’ brother alleged during a 2005 Larry King interview that the husband once said to him, “People with depression need a swift kick in the pants.”) She felt her children were “tormented by Satan” and must be saved. Despite her clear insanity, the Texas jury voted her as criminally liable and even considered the death penalty for her, though she was given life in prison. On appeal in 2006, she was found to be not guilty by reason of insanity and remanded to a psychiatric hospital.

People are quick to blame mothers for any wrongdoing. I’ve read a couple of recent essays, such as Kim Brooks’ June 3 article where she briefly left her child in a car for five minutes running an errand, and ended up in legal trouble for over a year, and Marie Myung-Ok Lee was verbally chastised and ganged up on at a supermarket for trying to calm down her autistic son’s loud tantrum. Neither incident was of a child-abusing Mommy Dearest, and yet, people had their trigger fingers on 911 and were ready to jump in like a lynch mob.

Aside from random strangers, family members themselves can be the worst source of pressure. Traditional families tend to highly value the maternal role above all else, and sometimes expect that mothers sacrifice everything about themselves. Sharline Chiang in a November 2013 Hyphen Magazine article wrote a vivid portrait of coping with her traditional Asian parents’ intense maternal expectations while suffering from postpartum anxiety. This rings true to me; my own Asian mother gave up any personal career to become a full-time mother, but leaving me with ambivalence about whether I could ever measure up to that standard as a career woman, wondering at age 40 about having kids.

Of course people need to protect children above all else, and neglect and abuse should not be tolerated. But parenting is such a complex and individual matter, and when people are quick to jump on their high horses about circumstances and situations they don’t fully understand, it just adds to the intense self-pressure mothers already put on themselves every day. It is also interesting that fathers usually don’t get pulled into these public situations and discussions as often—or with the same amount of vitriol (even though men are far more likely to be the perpetrators of domestic violence).

It is very encouraging that several famous women, like Brooke Shields, have openly discussed their struggles with postpartum illness. Postpartum depression and psychosis and related conditions can be particularly complex and difficult to treat because of the intense hormonal triggers and swings involved, the additional natural stress of childrearing and lack of sleep, and the concerns about breastfeeding and medications. Aside from the neurobiological issues, several research studies have also noted that socioeconomic pressures such as income status, spousal relationship stress or partner absence, and/or lack of social support have been shown to worsen the risk for postpartum mental conditions.

Parents, family members, and clinicians need to be open-minded and highly vigilant about any warning signs, since some cases can quickly progress into very dangerous territory, such as in Pam Belluck’s New York Times article, where the mother, tormented by obsessional delusions, strapped her baby to herself and jumped off a building. The baby fortunately survived.

Notably, in response, you can still find ignorant drivel like this recent Above the Law post right after the mother’s death was reported, which classically illustrates your typical mom-shaming, hateful, angry viewpoint.

On a Freudian level, this social stigma against bad mothers reflects a deep-seated anxiety about maternal relationships. Mom is the centerpiece of your life when you are born. She is a large, overwhelming presence, who you are wholly dependent upon for food and survival, before paternal influences come into play. At the stage when you are a helpless baby, Mom is, literally, everything. Mom can be terrifying if she isn’t happy or healthy. On some preconscious level, we never outgrow this expectation or fear about our omnipresent mothers. Our deepest fear is that Mom will somehow subsume and destroy us, even as we depend on her for everything. So she has to be perfect and self-sacrificing to the point of self-annihilation.

But this time, we are the ones who need to grow up and take responsibility. Mothers are regular human beings, flawed and ordinary. Their love is legendary, powerful, and unique, but not invulnerable. We are increasingly honest about the difficulties of childrearing, especially in the modern post-feminist era, about having to juggle the multiple demands of careers, marriages, and the nonstop neediness and frustration intermixed with the joy of children. We cannot keep judging mothers by a primitive, antiquated, simplistic standard.

In particular, if a loved one is exhibiting signs of postpartum mental illness, it is crucial to engage them in a nonjudgmental, supportive manner, and not to foist societal expectations upon them. This hysteria about bad mothers only exacerbates the depressive ruminations and guilty obsessions that can accompany these illnesses. Fatigue, sadness, or psychosis is not about choice or laziness or selfishness. It is about unfortunate biological mechanisms gone awry, compounded by the real stress of motherhood.

So stop judging mothers so harshly. Your words can kill.