Rachel Moran, ‘Making Sense of Postpartum Politics’: Blue: A History of Postpartum Depression in America

In the first of our guest blogs Associate Professor Rachel Moran introduces her path-breaking new book, Blue: A History of Postpartum Depression in America (Chicago, IL: University of Chicago Press, 2024), which explores the history of postpartum mental illness in 20th and 21st century America.

In 1930, writer Emily Holmes Coleman published a novel, The Shutter of Snow, partially based on her postpartum psychosis and institutionalization a few years earlier. When men at the time reviewed the book, they made no secret of their distaste for both Coleman’s artistic choices and her choice of subject. “The gentleman reader cannot fairly be expected to work up a professional interest” in this story of a woman’s insanity, one wrote. Another complained that “It is difficult to see the point” of such a book.[1] Around the same years, American psychiatrists showed only slightly more interest and a similar amount of skepticism about postpartum mental illness. They debated whether postpartum insanity differed from other insanity, whether it merited special attention and its own diagnosis. Most concluded it did not.[2]

Fifty years later, the situation was quite different. By the late 1980s, there was an organized network of self-help groups and a specialized organization for medical professionals interested in the postpartum. Psychiatrists sat next to mental health activists on television programs like Donahue and Oprah, introducing postpartum mental illness to the American public. The combination of mothers’ emotional stories and psychiatrists’ legitimizing explanations proved popular with 1980s audiences familiar with depression and primed to question American motherhood.

By the early 2000s, specials about postpartum depression required even less of an introduction in the United States. Celebrities, including Brooke Shields and Marie Osmond, published memoirs about their depressions.[3] Bipartisan legislation called for increased depression screenings for new mothers. Postpartum mental illness had arrived as a mainstream women’s health issue.

I set out to make sense of the last hundred years of American postpartum politics, and understand the forces behind these changes in how we think and talk about postpartum depression and psychosis. My new book, Blue: A History of Postpartum Depression in America (Chicago, 2024) considers this transformation in postpartum mental health between the early-20th to the early-21st centuries, with a focus on the period from 1945 onwards. The book engages with women’s and gender history, medical history and the history of the psy sciences.

Records of women’s postpartum mental health problems can be traced back much earlier than my focus, and historians (and activists) have made fascinating arguments about the postpartum mental illnesses of women in Hippocrates’ writings, or of a figure like Margery Kempe in the Middle Ages.[4] Other historical work considers the 19th-century diagnosis of puerperal insanity or lactational insanity, and its relationship to gender and medicine of the time.[5] There is no shortage of stories to tell about women’s suffering and the relationship between motherhood and madness.

For this book project, I was drawn to questions of how postpartum illness could move from taboo to mainstream between the mid-to-late-20th century, and how that trajectory related to other changes in American feminism, women’s health, and medicine. While the book covers earlier developments briefly, it begins in earnest with a discussion of the idea of the “baby blues” in the post-1945 period. The baby blues was a concept often wielded against women, it was dismissive of women’s experiences and borrowed from Freudian ideas about women’s immaturity and difficulty with role adjustment. At the same time, though, the articulation that American motherhood could be difficult offered an entering wedge for challenges to the institution in the coming years.

In the 1970s, feminists increasingly spoke of postpartum illness as evidence of problems in motherhood. If motherhood was women’s natural state, they argued, why were so many women unhappy? Why would women, occasionally, even kill their children? While some women’s health activists sought medical attention to postpartum illness, some natural birth activists argued depression was evidence of the problems of modern birthing and would not exist otherwise. Other feminists found that postpartum illness was most useful as a metaphor, not as a medical condition. No defined feminist stance of postpartum mental illness emerged.

It was only in the 1980s that postpartum advocacy took off in the US context (it emerged slightly earlier in the UK and Canada). Using oral histories with advocates and clinicians, I tell the story of how the idea of postpartum mental illness gained attention among fringe psychiatrists and psychologists in the early part of the decade, alongside (and often quite entangled with) women’s grassroots advocacy in the same years. The book looks at issues like the politics of diagnosis, the role of the mass media and television, and the relationship between postpartum psychiatric and psychological professionals and postpartum advocacy.

It is notable that the height of the women’s health movement was a modest time for postpartum mental health activism, while it thrived in the more politically conservative 1980s. I wanted to make sense of this tension, and to think about what it says about the past and present of postpartum health. Was the rise of this advocacy in the 1980s a surprising triumph for women’s reproductive concerns against a backdrop of anti-abortion organizing and retrenchment? Or was it actually a conservative containment of motherhood, a way of medicalizing anything that challenged the idealization of motherhood? Was calling women’s suffering “hormonal” a way of getting attention and treatment, or a way of trivializing it?[6]

I argue that in the 1980s and 1990s, advocates often adopted biology-focused, politically neutral explanations of women’s mental illness. This was in part a reaction to a conservative political climate. It was also in part a reaction to the failure of earlier feminist activism to agree on how to conceptualize postpartum illness. And, in many ways, it was simply a natural consequence of the most invested individuals often also being medical professionals themselves, who took women’s suffering seriously through the language of medicine.

In the book, I consider the way this construction of maternal mental illness was implemented, and its success in allowing for a broad, medicalized acceptance of postpartum illness. But I also think about the limits of the approach, especially in the final chapter. The imagination of “good motherhood” damaged by mental illness often focused on a middle-class white motherhood that made coalition building across race and class difficult. It also limited opportunities for some of those earlier feminist projects of using maternal distress to critique motherhood. When so much energy went into explaining that mothers with postpartum distress were still “good mothers,” it often reinforced ideas about what good motherhood meant.

As I wrote the book, I struggled with telling as complete a story as I wanted to while still making it compact and readable. I think of so many interviews I did with amazing people, where I only used one sentence, and of so many rabbit holes I went down and then had to cut everything I wrote out. This is a familiar story for all writers, of course, but was hard when there is limited writing on the history of postpartum depression in the US out now.[7] I am proud of all I believe Blue brings to this conversation, and also inspired by the idea it will be joined by all kinds of work currently underway. There is so much at stake in the study of women’s postpartum mental health, and so many angles to still be explored.

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ENDNOTES

[1] Carmen Callil, “Introduction,” Emily Holmes Coleman, The Shutter of Snow, Virago Modern Classics (New York: Virago Press, 1986).

[2] Edward Strecker and Franklin Ebaugh, “Psychoses Occurring During the Puerperium,” Archives of Neurology & Psychiatry, 15 (1926): 239–52; Gregory Zilboorg, “Malignant Psychoses Related to Childbirth,” American Journal of Obstetrics and Gynecology, 15 (1928): 145–58.

[3] Brooke Shields, Down Came the Rain (New York: Hyperion, 2005); Marie Osmond, Behind the Smile: My Journey out of Postpartum Depression (New York: Warner Books, 2001).

[4] P.R. Freeman, C.R. Bogarad and D.E. Sholomskas, “Margery Kempe, A New Theory: The Inadequacy of Hysteria and Postpartum Psychosis as Diagnostic Categories,” History of Psychiatry, 1 (1990), 169–90.

[5] Hilary Marland, Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (Houndmills: Palgrave Macmillan, 2004); Nancy Theriot, “Diagnosing Unnatural Motherhood: Nineteenth-Century Physicians and ‘Puerperal Insanity,” American Studies, 30 (1989): 69–88.

[6] Amy Koerber, From Hysteria to Hormones: A Rhetorical History (University Park, PA: Pennsylvania State University Press, 2018).

[7] Critical, must-read exceptions are: Rebecca Godderis, “Motherhood Gone Mad? The Rise of Postpartum Depression in the United States during the 1980s,” in Body Subjects: Essays on Gender and Health 1800–2000, ed. Tracy Penny Light et al. (Montreal: McGill Queens University Press, 2014), 303–18; Rebecca Godderis, “A Tricky Object to Classify: Evidence, Postpartum Depression and the DSM-IV,” Journal of the History of the Behavioral Sciences, 49 (2013): 123–41; Rebecca Godderis, “Iterative Generation of Diagnostic Categories Through Production and Practice: The Case of Postpartum Depression,” Culture, Medicine, and Psychiatry, 35 (2011); N. Dubriwny, The Vulnerable Empowered Woman: Feminism, Postfeminism, and Women’s Health (New Brunswick, NJ: Rutgers University Press, 2013).