Sadie* was a smart, attractive 37-year-old woman, who had been married for 10 years. She was a kindergarten teacher who had always been particularly fond of children, but had been having some issues with infertility. Her traditional Italian Catholic parents kept asking her repeatedly why she wasn’t giving them a grandchild. She was excited when after several failed trials of in vitro fertilization, she became pregnant.

Janet was another successful 29-year-old mother of a 5-year-old daughter. After a brief but promising acting career, Janet stayed at home raising her daughter. She was married to a prominent older physician she had met at a fundraiser. She had been somewhat worried of late about not seeing her husband as often, given his long work hours. She was all the more excited then about her soon-to-be second child.

These two women were about to fall victim to some of the most disturbing types of mental illness: postpartum depression and postpartum psychosis.

Sadie gave birth to her son, with some complications. She survived with an emergency Caesarean section, and all seemed well afterwards. Yet despite her speedy medical recovery, Sadie was noted by her husband and family not to seem as excited and relieved as one would have expected. She seemed tired and irritable which was not her usual manner, and acted distant and forlorn regarding her new son. The condition rapidly worsened from there. She was able to breastfeed, but continued to refer to her child as “it” and showed little joy or interest in interacting with the new infant. Her close-knit family was more than willing to step in and help her, but they became concerned more and more about Sadie’s change in personality. To make matters worse, her husband had recently lost his job due to the bad economy.

Sadie spiraled into postpartum depression. She started to express hopelessness and felt the baby was a mistake. She stopped sleeping and eating. Despite attempts at treating her with medication, Sadie continued to ruminate about her unfitness as a mother. Her family seemed somewhat upset with her as well, not understanding how Sadie could not share in this joyous, hard-won event. Her husband seemed anxious and fretful about his inability to provide for the child. A few months after her son’s birth, Sadie attempted suicide.

Janet also was noted to act oddly after the birth of her second daughter. She became detached, and was also sleepless, and then began to report bizarre, frightening thoughts about her children being influenced by the devil, and her husband being the perpetrator. She felt she could save the children by spending all her time praying, and was often found in her room on the floor doing so. Unfortunately, she was, in the process, neglecting the care of her children, and had stopped eating. Her husband intervened and got her hospitalized. She gradually improved and was no longer psychotic. However, afterwards, she expressed a wish to return to work and admitted she was considering leaving the marriage, and giving up custody of her children to their father.

These women seemed to have had everything going for them, loving husbands and families, socioeconomic stability, good educations. They were picture perfect postcards for the modern American mother. Yet both fell prey to the tragedy of postpartum depression and psychosis.

These conditions have been well publicized of late, given several high profile cases, such as the Andrea Yates child murders, and Brooke Shields’ open debate with Tom Cruise over medications for postpartum depression. This greater awareness has been crucial to helping mothers with this condition get appropriate help. There remains more to be done though in understanding how the biological symptoms of this mental disorder intersect with the high societal expectations and standards regarding the “perfect mom.”

Do we as a culture tend to over-idealize the role of motherhood? Of course it remains a huge taboo in most societies for a mother to neglect or not take care of her child, a role that even little animals take on with aplomb. The detrimental consequences of maternal neglect on children are well documented. But lately, with celebrities losing their pregnancy weight in record times and parading their tots in public like fashion accessories, and whole social circles and yuppie obsessions centered around baby care in local neighborhoods, it seems that keeping up appearances surrounding maternity has reached an apex. It is hard for some of us to feel that we measure up to this effortless, fashionable mothering.

Perhaps because of the need to appear saintly and wholly self-sacrificing for one’s child, many women may not feel open to discussing the darker side of pregnancy and motherhood. With the additional modern pressures of juggling careers and relationships, these women may feel somewhat trapped and unable to express their fears, their doubts. The tragic overlay of postpartum depression amplifies these feelings.

There is no denying the intensity of raising a child: the hourly feedings, the sleepless nights, the crying and moodiness and noise, the overwhelming sense of responsibility. If one has an underlying vulnerability to a mood disorder, they can fall victim to this perfect storm of stress. Then any underlying worries begin to magnify, take on a life of their own. Maybe I can’t live up to being a good mother. Maybe I’m awful for thinking I don’t love my child. Maybe I can’t tell my family I’m not happy with my life anymore. Maybe I shouldn’t be alive.

In Sadie’s case, she suffered from some increased cultural expectations about the maternal role. In more traditional, family-centered societies, women are still primarily expected to give birth and raise children, and nothing else. Many are often expected to sacrifice everything, career expectations, social outings even, to stay at home and attend to the child. In turn the extended family may assist and provide help quite willingly. But this strong family focus on child rearing may backfire and be perceived as a guilt-inducing burden when a mother develops depression.

The contribution of the father may also be an important aspect to the support and stress mothers feel. Single motherhood is still all too common, and higher rates of postpartum disorders understandably exist when there is less family or spousal support. When the husband shows his own ambivalence or stress regarding his paternal role, the burden of childcare may fall that much harder on the mother’s shoulders. Also, if there are underlying unresolved marital conflicts, they tend to magnify under the stress of child rearing. Some couples in trouble think that a child will bring them together; if anything, the opposite may hold true.

The family-career balance also remains an important influence on how postpartum disorders affect women. Years of feminist debate still have not wholly resolved the issue of how one balances motherhood with careerhood. The hours conflict, income decreases, intellectual projects and promotions get put on hold. For someone whose self-identity has often rested on both foundations, the need to sacrifice one for the other can disappoint a mother’s expectations and dreams. Also, despite the difficulty of juggling these potentially competing interests, there are still strong stigmas against women who choose not to have children. There is often a quiet hostility towards the idea that not having children is a viable, respectable decision.

All in all, we need to be cautious in the pressures for perfection we place upon ourselves and other women entering motherhood. (And even those who decide not to pursue motherhood.) The range and extent of feminist writings and controversies over these issues point to the need for acceptance. Acceptance of all types of options and individual choices regarding motherhood, jobs, marriages.

To do so is not to ignore the significance of making sure children are well cared for and loved. If anything, this acceptance helps promote a healthier, more realistic view of motherhood, and more open discussion of these mothers’ particular needs. Accordingly, when these women feel heard, they can become better, happier mothers.

Postpartum disorders, thankfully, remain fairly rare. They do remain serious medical conditions that require immediate psychiatric intervention. But these types of depression and psychosis do not exist in a vacuum. We should continue to examine the wide array of sociocultural forces we face as modern mothers. We should broaden our tolerance for acknowledging the difficulties, as well as the joys, of motherhood. Blaming the mother is all too easy. 

(*Author's Note: Sadie and Janet are fictionalized composite vignettes of women with postpartum mental illnesses.)