Chances are, you know someone with post-partum depression (PPD). Maybe she was someone in your pre-natal yoga class, someone you didn't see much after you both gave birth. Maybe she is a distant cousin, or the woman down the block with the double stroller, or someone you see on occasion in the grocery store. Maybe it's you. PPD is frighteningly common, affecting (according to some estimates) between 10 and 28 per cent of biological mothers (and, yes, it does affect adoptive mother and even fathers, as well). PPD is not the same as post-partum psychosis, which affects fewer than one in a thousand women, but it's certainly related: PPD sufferers may not kill themselves or their babies, but they think about it, and sometimes those thoughts become so overwhelming that they can no longer function normally.
Of course, it's hard to function "normally" when you've just had a baby. I remember a friend telling me about coming home with her daughter and weeping on the toilet as liquid leaked from every possible spot. How could this be "normal"? At the time I heard the story, I didn't have children; when I did, I remembered and finally understood. I didn't have PPD, but my doctor worried about my "affect" and called me in for an additional post-partum checkup (he didn't quite say if it was for me or the baby) a week after my first one, just in case.
I was lucky. Many doctors are not so alert for the signs, and many women come home from the hospital with little or no support. With so many women isolated in their homes (often their partners are already back at work), sleep-deprived, hormonally awash, and subject to bizarre demands on them at all times of day or night, it's almost surprising PPD isn't more common.
That seems to be what Marrit Ingman thinks, too. In her new memoir/essay collection, Inconsolable: How I Threw My Mental Health Out with the Diapers, she focuses on her own PPD and the socio-cultural factors that contributed to it, emphasizing the ways in which our culture's failure to support mothers (despite all our family-friendly talk) creates a situation in which PPD will develop. Brooke Shields, on the other hand, in Down Came the Rain: My Journey Through Postpartum Depression, focuses on telling her own story and emphasizes the hormonal and personal causes of her PPD. Between the two of them, a reader can gain a pretty good insight into PPD, learn a little about Brooke Shields's life (we all want a taste of celebrity gossip, after all), and even laugh out loud.
Ingman's Inconsolable is the more innovative book by far. A collection of essays all touching on her experience with PPD, Inconsolable offers up the fragmentary and confusing experiences of new motherhood with wit and humor. As with other recent memoirs of new motherhood, Ingman's goal is simple: "By sharing our voices," she writes, "perhaps we will all feel less alone" (13). As it was Anne Lamott's description of colic in Operating Instructions that finally allowed me to forgive myself for how I felt during my daughter's bout with it, perhaps Ingman's book will do the same for someone suffering from PPD. But even those of us who don't will find something of value here. Ingman, like Faulkner Fox (Dispatches From a Not-So-Perfect Life) and other recent mother-memoirists, is particularly aware of the disconnect between her expectations of motherhood and her reality. Of course, her reality may have been more difficult than most, starting with the unplanned c-section and carrying through her son's bouts with allergies, eczema, and reflux. It's hard enough to parent an "easy" baby the first time around; Ingman had my sympathy from the get-go.
Yet while I like Ingman's style -- she made me laugh out loud more than once -- I also found the book frustrating. Nowhere do we get a timeline of her PPD: "I came home from the hospital, I cried all day and all night, I saw a doctor." We don't know when it set in, when she sought help (or even at whose suggestion), how long her recovery took (though at times during the book she suggests she suffered for a year, or eighteen months). We do know that she'd been depressed before, that she had lost a sibling in childhood, that she was anxious and possibly depressed during her pregnancy, that she gave birth via c-section, and that her son had difficult medical conditions. I don't know about her son's conditions, but everything else listed did put her at risk for PPD, and one wonders if anyone told her so. It's hard to tell, reading her book.
Perhaps more significantly, Ingman seems to want to have it both ways when it comes to the causes of PPD. Early on, she laments (somewhat) that she's not a "political depressive," embracing "the One Flew Over the Cuckoo's Nest version of mental illness" -- that our culture is so crazy, insanity is the only "sane" response (20). But in fact her account of the etiology of PPD is highly political:
Maybe PPD isn't a malfunction of those mercurial female humors. Maybe it's more like a shitstorm parents endure because we are tired, frightened, isolated, confused, and apparently powerless. Especially if we live in some stupid suburban family domicile without a strong community around us; especially if we have learned the lie that a parent looks into a baby's eyes and somehow knows exactly what to do (3).
Ingman, like Shields, gets conflicting advice in dealing with her PPD: wait it out, keep nursing, stop nursing, get help now, wear your baby, let him cry it out, etc. We've all been there, I believe, but Ingman is particularly sharp about the ways in which an isolated new mother is vulnerable to the declarations of the advice-givers. Dr. Sears comes in for special criticism (there's a chapter called "Fuck Dr. Sears"), but really her anger encompasses anyone who purports to give parents (usually mothers) one best way to parent, anyone who "prescribes" rather than "endorses" certain parenting practices, practices at which we are likely to fail at one time or another. And here again her account of PPD turns overtly political:
Parents -- especially mothers, for reasons of socialization as much as biology -- who carry this great bilious load of unattainable expectations are punching a one-way ticket to Crazy Town. If our baby isn't content and approvingly silent, like a neonatal customer service supervisor, we have failed. It sounds risible on paper -- of course we haven't failed -- but when you're sleep deprived and suddenly isolated for long stretches of time, whereas you used to be the star system administrator in the networking team or you used to discuss Proust with your book group, you can quite literally go fucking insane (96).
Shields's take on her PPD is, not surprisingly, quite different. Down Came the Rain is a straight memoir, moving chronologically from Shields's fertility treatments, miscarriage, pregnancy and unscheduled c-section through her first year of parenthood, when PPD hit her without warning. Unlike Ingman, Shields had no history of depression, yet she too was unknowingly at risk because she experienced fertility treatments (the hormonal manipulation can exacerbate post-partum hormonal imbalances), the death of her father three weeks before her baby's birth, a move into a new apartment in late pregnancy, and an unscheduled c-section after a long and difficult labor. Unable to "bond" with her baby right away, Shields found herself disoriented, tearful, and frightened:
I was afraid to let Chris [her husband] sleep, because I was scared to be alone. Even though we were in the same apartment, if he was sleeping and I was awake, I thought I might try to escape or wouldn't be able to stop myself from swallowing a bottle of pills. I even thought that I'd welcome being kidnapped. These were strange, irrational fears that still felt real to me (68).
Shields clearly (if somewhat awkwardly) chronicles her slow awakening to the fact that she's depressed. Friends talk to her about PPD and she thinks it's irrelevant to her:
Postpartum depression was a crazy person's affliction, and I associated it only with those people who harmed their kids by doing things like driving the car into a lake. I was certainly not in that category. I had no intention of ever harming my baby, although I also didn't seem to have any intention of becoming attached to her, either. I was a healthy-minded and capable woman who simply shouldn't have had a child. Postpartum depression was plainly not something that affected someone like me. It hit only those people you read about in the news (83).
At times, Shields's lack of self-awareness is stunning. Who does she think she is, after all, if not one of "those people you read about in the news"? As someone who's been in the public eye since she was herself a baby, she's keenly aware of her image, to the point of stage-managing her exit from the hospital in pearls and pumps. That image, however, comes in conflict with the reality she's portraying here, and at times it's difficult to tell whether she's concealing the facts or simply not fully aware. This makes the memoir frustrating to read at times: her father's death, her relationship with her mother, and even her relationship with her husband all clearly play into her depression, but she makes only glancing efforts to analyze these. It's finally a tale of triumph, of how a good baby-nurse, a sympathetic therapist, a couple of perceptive friends and strangers, and a prescription for anti-depressants combined to pull her out of depression and into a more balanced, happier motherhood. Her story is familiar now, of course, to those who have followed her public debate with Tom Cruise over the use of anti-depressants and the "reality" of post-partum depression. I read the book before Cruise's infamous appearance with Matt Lauer, but the public dust-up actually proved the point both she and Ingman make: post-partum depression is still a taboo subject, one that needs further public discussion.
And these books provide it. Both books do the great public service of providing bibliographies and resources for PPD in their final chapters, and both are equally helpful in simply raising awareness of the issue. Ingman's anger may put some readers off, as may Shields's clunky prose (surely her publisher could have provided better editing -- did she reject it?) and her failure to reflect deeply on her experiences. One wonders if Ingman can ever be happy, while applauding her for telling the truth; conversely, after reading Down Came the Rain, I can rejoice in Shields's hard-won happiness while wondering if she knows quite what destroyed it during that traumatic first year. There's also, in Shields's book, the vexing issue of product placement: we hear in detail about her photo shoot for Bright Beginnings formula, her constant wearing of the Baby Bjorn, etc., leading at least this reader to wonder if they are sponsors of the book in some way. And yet both Ingman's anger and Shields's honesty are refreshing -- each will speak to different readers; both have told important stories. I'm glad these books exist, but neither one is the last word on PPD for me.