Postpartum depression (PPD) afflicts somewhere between 15 and 20 percent of all women who have recently given birth, and yet it is one of the most misunderstood and overlooked illnesses in American society. PPD is thought to be linked to the sharp drop in estrogen, progesterone and cortisol levels after childbirth -- hormonal changes that, in some women, trigger disastrous alterations in the neurotransmitters that govern mood. PPD has been documented in the medical literature for centuries. Yet, our cultural taboo against admitting that motherhood is anything less than unadulterated bliss is so profound that mothers are loathe to talk about it, and knowledge about PPD remains scandalously lacking in the medical profession.
Recent celebrity memoirs have helped bring PPD into the public discourse: singer Marie Osmond told her story in her 2002 book Behind the Smile: My Journey Out of Postpartum Depression, and last year actress Brooke Shields did the same with her book, Down Came the Rain: My Journey Through Postpartum Depression. (Note to file: look up whatever federal law it is that requires all depression books to have "journey" in the subtitle; lobby Congress for change.) But as valuable as these books are, celebrity memoirs can also be alienating. Most of us find it hard to identify too closely with somebody who has riches, fame and a personal makeup assistant. When it comes to having babies, women seem to have a genetically hardwired craving for the company and the stories of women just like ourselves.
That's what makes The Mother-to-Mother Postpartum Depression Support Book: Real Stories from Women Who Lived Through It and Recovered, by Sandra Poulin, such a welcome addition to the burgeoning canon of modern motherhood. It's a collection of candid interviews with over 100 women (about two-thirds of whom are from the United States, the rest mostly from Canada, Australia and Great Britain) who, as the title implies, have some motherwit to impart. In her introduction, Poulin calls it "the book I searched for when I had postpartum depression, but could never find."
Poulin's own story is typical, at least in some ways. A radio broadcast sales executive who lives in Dallas, Poulin had endured years of infertility treatments before she gave birth to her daughter, Rachel, in February 1996. Four months later, at a time when (as she told herself) she should have been blissfully enjoying her new baby, she found herself unable to sleep, jittery, disoriented, uninterested in food, crying constantly for no reason she could name and fighting off obsessive, terrifying thoughts of putting a gun to her head. She consulted the same doctor she had found helpful 10 years earlier during a brief period of depression, but this time he seemed oblivious to the seriousness of her situation and prescribed "relaxation exercises." Her family doctor prescribed sleeping pills, which didn't work either. Desperate, Poulin was on the verge of checking into a mental hospital when crucial help came from a fellow mom who had been through PPD, and who told her the exact anti-anxiety medication to ask for. "After two nights of medicated sleep, I had hope," Poulin writes. "I believe that anti-anxiety medication saved my life." From there, Poulin was able to find other kinds of help: family support, a nanny and antidepressants. Still, it took her a year to recover.
Poulin's story is atypical in one way: she sought medical help for her PPD, which is something that only an estimated one in three PPD sufferers ever do. What's typical about her experience, at least for American women, is the difficulty she had finding the right kind of medical help. A striking feature of this book is the accounts by women from Great Britain -- a place where medical recognition of PPD is at least a decade ahead of ours -- whose symptoms were recognized by their "health visitors " (a series of routine postnatal home visits provided by the National Health Service) or doctor fairly quickly. Likewise, women in the British Commonwealth countries of Australia and Canada also seemed to have, on average, a quicker and better response from their medical community than mothers in this country can expect.
The stories from the American women in this collection, on the other hand, vividly illustrate our society's sink-or-swim attitude toward new motherhood. There's Amelia, a 34-year-old California teacher, who was thinking of suicide as "a way to get away from the pain" -- and whose psychologist "didn't seem to comprehend the seriousness of my frame of mind." Families can be unsupportive: Emma, also from California, recalls, "I had to beg my mom to help." Glenda, a 34-year-old stay-at-home mom from New York, recalls how "everyone wanted me to pull myself together and snap out of this" -- right up to the point where she had a seizure due to sleep deprivation.
The American mothers in these stories had to blunder around finding help any old way they could: from a drugstore walk-in clinic, the Internet, a supportive sister or girlfriend or (if they were lucky) a new mothers' group. Many had to overcome the active resistance of their doctors before getting appropriate treatment. Audra, for instance, a 30-year-old mother from New Jersey, suffered from crying fits, insomnia and constant thoughts of hurting herself. She finally saw a therapist when her thoughts turned to hurting her baby. "Big mistake," she wrote. "He grilled me on all my family relationships, drug and alcohol use. After making me feel totally insane, he said I didn't have PPD."
The most striking example of how differently American and British doctors deal with the same kind of medical emergency comes in back-to-back stories in the section of the book Poulin devotes to postpartum psychosis -- an extremely rare and serious complication of childbirth sometimes preceded by, but not to be conflated with, PPD. (Andrea Yates, the Houston mother who drowned her five children, suffered from postpartum psychosis.) Jessie, a 34-year-old mother from Great Britain, went "straight from the maternity ward to the mother and baby unit on a psychiatric ward" when she showed signs of the disorder.
Yet, one page later, we hear from Miranda, a 33-year-old Kentucky mother who was planning to kill both herself and her baby son after suffering for four months from sleep deprivation, an inability to eat and thoughts of hurting her baby. A hospital emergency room intern wanted to admit her, but was overruled by Miranda's insurance company, which "didn't think ...[she]...needed it." National health insurance, such as Canada and the United Kingdom have, surely has its limitations, but they can't be any worse than the hopeless jumble of employer-subsidized plans that the U.S. has now.
Poulin has organized this book intelligently, in short chapters devoted to the different contexts in which PPD plays out -- PPD whose main feature is anxiety, PPD induced by sleep deprivation, mothers with unsupportive spouses, single mothers, mothers with multiples, etc. Within each chapter are individual stories, and within most stories there are boxed suggestions and thoughts ranging from the practical (get a headset telephone) to the profound ("Feeling guilty is not the same as being guilty"). I was a bit confused by the number of stories from women who were from other countries: while their stories are certainly gripping, the differences in health care and attitudes toward PPD in the United States are so uniquely American -- for better and for worse -- that Poulin runs the risk of devoting a lot of space to information women in this country won't find useful. (How many American women will have the option of contacting the Association for Post-Natal Illness, a British organization?)
In other ways, though, Poulin does an admirable job of collecting a diverse socioeconomic group: single mothers, older mothers, mothers of multiples, artists, stay-at-home mothers, high-powered New York magazine editors, nurses, cashiers, speech pathologists. One minor quibble: being from the Deep South myself, I was on the lookout for women from my neck of the woods, and didn't find any. I'm curious as to why, but I don't think their absence affected the overall quality of the book. Another minor quibble was the number of Bible quotes, and the fact that a handful of stories came from a distinctly Christian perspective -- a fact that some readers may find off-putting.
The stories told in The Mother-to-Mother Postpartum Depression Support Book are recounted in workaday prose; none of these women are wordsmiths, and nobody tries to be fancy or self-consciously literary here. For me, that was a good thing; reading these vignettes was like reading letters from an old friend, or maybe a sister, just letting you know How It Was. "I would hold my screaming baby and sob, crying as I walked with her," writes one mother; another reports: "Couldn't nap with the baby, couldn't sleep at night, and when I did, I had nightmares." Experiences like those more than speak for themselves.
Minor quibbles aside, this is a terrific book, designed by a woman who knows what it's like to have only five minutes at a time to read. But in those five minutes, women who pick up this book are likely to find help, companionship, information (there's an extensive list of resources, websites and phone numbers in the back) and comfort. If you have PPD, and you're not lucky enough to have a beloved mother, sister or girlfriend at your side, The Mother-to-Mother Postpartum Depression Support Book ought to be on your bedside table. And when the day comes that you no longer need it, pass it on to a friend.