Is Postpartum Depression Normal?

Mental health awareness is intended to encourage people who need help to seek it and help others offer support to those struggling with mental illness. Sometimes, however, such awareness results in anxiety–both in those who have them and in their friends and family–about normal feelings, feelings that may be difficult to manage but that occur in the course of a normal, healthy life. The challenging transition to motherhood is one example.

The experience of becoming a first-time mother is so common that its extreme challenges are often marginalized. “Oh, of course, you’re tired, but these broken nights do not go on forever,” and, “Yes, getting out of the house is now complicated,” and, “You’ll soon learn how to soothe him,” are familiar utterances meant to reassure, but can leave a new mother feeling more alone, rather than understood.

Instead of focusing on the need she has for support and reprieve. She is often reminded of the joy, love, and excitement she, as a new mother, should feel: “He’ll be going to school before you know it,” and, “Did you ever believe you could love someone this much?” The theme of over-arching love, it is often suggested, trumps every other. Except it doesn’t.¹

Even if the baby has two parents, a new mother focuses on motherhood, not because only her nights are broken or because only she engages in new complicated logistics when trying to leave the house, but because she is more likely to experience these in ways that blend with some symptoms of postpartum depression.

These additional experiences involve tiredness that goes beyond anything “broken nights” suggests and can be highlighted by two excellent accounts of maternal fatigue in fiction. Alison Pearson in I Doesn’t See How She Does It discussed a mother’s “deep-sea-diver tiredness, voyage-to-the-bottom-of-fatigue tiredness.”

Celia Fremlin in The Hours Before Dawn described a mother juggling her baby, feeling “through her thighs, the tide of boredom rising within him,” and finds it “Harder–harder–it was like bailing out a boat when you know without a doubt that the water will win in the end.”

When we are tired, it is more difficult to process feelings, make decisions, and find efficient solutions to even small problems. Pearson’s reference to water, suggesting the sluggishness of movements through water, and Fremlin’s reference to an unstoppable flood, pinpoint the special sense of drowning in motherhood.

Fatigue and tedium are often said to induce “Baby brain fog.” A new mother’s brain is working hard and getting smarter about her infant, its needs, character, mode of communication, and the meanings behind those still inarticulate gestures, noises, and expressions. This very active brainwork registers the experience of what could be called “no choice responsibility”–the feeling that the baby’s needs are paramount. And this prioritizing of the baby’s needs, alongside the persistence and magnitude of those needs, puts a sense of self at risk.

This is the tipping point. Losing oneself is tantamount to dying, so it is not surprising that new mothers may feel isolated or frustrated to the point of tears when their ordinary exercise of agency–to go for a walk, to shop, to meet a friend, to jog or swim–is defeated by the plethora of small, practical negotiations with a dirty nappy or a leaking breast. It is not possible to bury the negative experiences of early motherhood with feelings of powerful love because these are connected. It is love that reinforces an overwhelming sense of responsibility, making it difficult to moderate fatigue and tedium.

A recent exchange on Twitter brought me back to my overwhelming experiences of early motherhood as love forcing a brutal change to my sense of self. The exchange began with articulate and touching posts by a new mother (a successful novelist) about her experiences of the slow burn of love, the fatigue, and the frustrations in her new life. Some posts also indicated a sense of alienation from the person she was before she became a mother, and some marked euphoria when she could enjoy former activities. She also discovered new vulnerabilities so that the apparent confidence of other new mothers left her feeling inadequate, and in response, she withdrew from group gatherings.

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Many responses to her posts raised the issue of postpartum depression. Surely, several respondents warned, she should be assessed for this.

I am not in a position either to suggest or rule out a diagnosis–nor is anyone else on Twitter. But these worried respondents ignored the layers of early maternal experiences. The responsibility is overpowering, as is the love. With this responsibility comes exhausting responsiveness–well known in psychology to be crucial to the infant’s well-being.

This also involves, for many mothers, a sense of losing their own identity, or as one woman once described it to me, “a shattered self.” Most mothers put the pieces together, gradually, with each reconnection resulting in euphoria. For some, it is experiencing the jogging, swimming, or singing that was so important to them before motherhood. For others, it can be as simple as fitting into their pre-maternity jeans.

If we are too quick to give difficult feelings a clinical label, we suggest that they can be avoided and pretend that new motherhood is not what it is–overwhelming, challenging, and life and self-changing. We also ignore the need for social support and shared care that allows new mothers to reconnect with and reconfigure their identities.