Does A Maternal Mental Health Diagnosis Always Help?
After giving birth, you might feel any number of emotions: Euphoria and joy at meeting your baby, for one. Or completely exhaustion, wanting nothing more than to sleep for days. You might feel disconnected to your baby. You might even feel resentful. These feelings can fluctuate throughout the postpartum period, and oftentimes they’re just par for the course. Other times, these moods might indicate a more serious situation. Many struggling new moms avoid seeking help due to the stigma surrounding mental health issues— but what if there were a way to reduce it? When it comes to maternal mental health, are labels always necessary, or could they cause more harm than good?
The answer is more complex than a simple yes or no. The MGH Center for Women’s Mental Health in Boston states that roughly 50 to 80 percent of all new mothers experience what’s often called “baby blues.” That is to say, most new moms face psychological and emotional challenges (shocking, I know). But according to the World Health Organization, only 13 percent of new moms experience a mental health disorder worldwide. This tells us that only a small percentage of new mothers will likely need a specific diagnosis beyond the usual struggles (like sleep deprivation, potential for malnutrition, general stress, etc). There are certainly times when a proper diagnosis can help an individual obtain proper treatment, whether it be through specific therapies, medication, or both. The fact remains, however, that according to the National Alliance on Mental Illness, nearly 60 percent of adults living with a mental illness did not seek help in the past year — and that includes new moms. These statistics indicate that we are in dire need of a shift in order to get help to all mothers in need (whether they have postpartum depression or simply need someone to talk to while they adjust to their new lifestyle).
Take for example 30-year-old social media strategist, Nikki Harmon. Before becoming a mother, Harmon was feeling better than ever in terms of her mental health. She had only been treated for depression once before, brought on by birth control pills she needed to treat her endometriosis. Once she had surgery for her condition, she was able to leave her meds behind as her depression subsided. Then she had a baby, and found herself feeling inexplicably angry at everyone except her son. Harmon struggled with these emotions for months before they finally tapered off. She then battled constant anxiety and intrusive thoughts after the birth of her daughter, who spent some time in the NICU.
“I kept worrying that she would be the child to suffer the worst possible childhood illness, or her body would just stop functioning. She was a healthy and vibrant baby... Even so, it was an obsessive, scary screaming voice in the back of my head,” Harmon says.
While she now believes she may have been experiencing varying levels of postpartum depression and postpartum anxiety, she never once sought help from a mental health professional.
“Mental health issues have been highly stigmatized in my family, which is probably one of the biggest reasons I haven’t reached out,” the Florida-based mother of three says.
Harmon isn’t alone. I spoke with several other mothers who shared similar concerns, like 24-year-old Holly Perkins. The Denver-based mom has struggled with depression and anxiety at various points in her life, and recognizes that stigma kept her from getting treatment, including medication she later realized she needed.
Many mental health professionals tend to pathologize what are pretty standard experiences — especially for new moms.
“People don’t want to be labeled 'crazy' or have to depend on pills to exist in life. It’s seen as weak. I think it’s ridiculous now, but I definitely had similar thoughts,” says Perkins.
“I have this ... irrational fear that a label will be something used against me when it comes to parenting my children. Like it will become a weapon. That fear is why I have never sought out a diagnosis,” Harmon adds.
Fortunately, mental health care professionals are beginning to examine the problem with mental health stigma more closely. Take behavioral psychologist Dr. Lara Fielding, for example. Author of Mastering Adulthood: Go Beyond Adulting to Become an Emotional Grown Up, Dr. Fielding believes that while labels and diagnosis certainly have their place, they may be causing a disservice to both those who seek help and also to those who are still suffering in silence.
“Diagnostic labels are an important shorthand for communicating,” she says, noting they can be necessary for insurance purposes. However, Dr. Fielding stresses that many mental health professionals tend to pathologize what are pretty standard experiences — especially for new moms.
“Categorical labels lump individuals with a certain number of symptoms (five out of nine, usually) into the same group, and receive the same treatment,” Dr. Fielding says. This means that someone who only has certain indicators of a condition like postpartum depression will receive similar treatment to someone who is exhibiting every symptom — someone who might require more aggressive treatment. Conversely, someone with few symptoms might end up overmedicated or misdiagnosed (they may, for example, be prescribed antidepressants when what they need are mood stabilizers).
We over-identify with the label as if it is us, rather than an experience we have in a moment, or series of moments.
Once the supervisor psychologist at UCLA’s Department of Psychology Clinic, Dr. Fielding prefers a more individualized approach for her patients. Moreover, she warns against quick diagnosis due to what she refers to as “over-identification with the conceptualized self.” This is when an individual gets stuck on the labels they are given, such as referring to oneself as being “anxious” or “depressed.”
“We over-identify with the label as if it is us, rather than an experience we have in a moment, or series of moments,” say Dr. Fielding.
Because so many individuals end up taking their label as a major part of their identity, those who are still not getting help due to stigma often remain avoidant. They might believe that getting help will mean they will also have to publicly announce their diagnoses, or that they will immediately be lumped in with anyone else who is dealing with anxiety, OCD tendencies, and so on. The reality, though, is that a label is just that: a label. If having the label helps a patient better relate to and treat their symptoms and condition, that's fantastic. But a person who is living with anxiety or depression will continue to do so whether or not they are given the label, and it's more important that they seek and get help, diagnosis be damned.
Dr. Alexandra Sacks is a reproductive psychiatrist whose work involves stepping away from pathologizing new mothers’ experiences in order to ensure that all mothers can find the support they need. She refers to the postpartum period as “matrescence,” a time of significant mental, physical, and emotional change akin to adolescence. The growing pains of new motherhood can sometimes point to a larger mental health issue, but mothers don’t always need a diagnosis to help get them through this period.
"When I explain to [patients] what I understand and experience are the main pillars of matrescence, they feel tremendous relief and their symptoms go away often," Dr. Sacks told the crowd at a panel hosted by Plum Organics last year. There are many cases, then, where a specific diagnostic label can alienate the 80 percent of mothers experiencing a normal, but fluctuating, range of moods, and discourage them from seeking help.
It’s clear that most new mothers could use a little help. While the reasons new moms don’t seek out or obtain mental health help vary (accessibility is a whole other elephant in the room), those who are able to are still resisting receiving any kind of help due to societal stigma.
Some mental health providers, including The Motherhood Center of New York, have moved away from explicit labels like postpartum depression and toward all-encompassing terms like "perinatal mood and anxiety disorders" (PMADs) to reduce the fuzz. Perhaps if we start reframing the way we look at maternal mental health, putting less onus on labels unless necessary and more emphasis on getting care no matter what, we might just start to help moms (and babies) get a shot at thriving in those first few months.
If you or someone you know is experiencing antenatal or postpartum depression or anxiety, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.