What's your struggle?
“If I have postpartum depression, can you help me?” I, a recent psych grad, received this text from my 9-months’ pregnant cousin. She included the “crazy face” emoji.
I replied and said that I couldn’t be her therapist, but I could provide some online resources. Later that day, I told a family member about what we talked about, and they replied by informing me that my cousin’s cushy accounting job offered her 6 months of paid leave. There’s no way she would develop postpartum depression.
Why would they respond that way, when this struggle can strike anyone, regardless of circumstances?
Postpartum depression hasn’t been discussed in my Asian family before, and my older family members generally agree that having a child should be the happiest moment in a woman’s life.
Because of my cousin’s time off, they believed that she would have plenty of time to take care of her child, and would have no reason to be depressed after the baby’s birth.
I tried to explain to them that postpartum depression is more complex than that, but they didn’t seem to understand. I realized that social norms and expectations were a source of tension in the conversation, and I wanted to explore this conflict between intergenerational culture differences and the reality of postpartum depression.
What is postpartum depression (PPD)?
Postpartum depression (PPD) is a serious mood disorder that occurs after childbirth, characterized by feelings of depression that last longer than two weeks. Mothers experiencing PPD report symptoms such as anxiety, feeling guilty or worthless, self-blaming thoughts, mood swings, and fear of not being a good mother.
Research on postpartum depression isn’t as prevalent as research on major depression, yet the condition is common among women who give birth. According to a report by the CDC, about 1 in 8 women who give birth experience symptoms of PPD.
Although postpartum depression may be common, the condition is often underreported and goes undiagnosed. In a study that surveyed 78 women who were clinically depressed 6-8 weeks after childbirth, 97% of women recognized that they felt worse than usual, but only 32% believed they were suffering from postpartum depression. Over 80% of respondents did not report their symptoms to a health professional.
The onset of symptoms can be unpredictable. Signs of PPD can arise days or months after delivering a baby. Mothers who do not seek treatment may experience prolonged PPD, with symptoms that last between weeks or months.
Once a mother falls victim to PPD, through no fault of her own, she may enter a feedback loop of difficulty with parenting duties, depression and anxiety about these difficulties, and feelings of shame that further impede fulfilling responsibilities.
Why talk about postpartum depression?
Postpartum depression is a very real concern, because it impacts both the mother and the developing baby. It’s not the kind of struggle that can be prevented by a cushy job or simple gratitude – and talking about it can dismantle this cultural misunderstanding.
Many women with postpartum depression experience overwhelming guilt and judgement from others, because the condition can make them feel incapable of taking care of the child they brought into the world. Therefore, due to the stigma, postpartum depression may be underreported or even dismissed by close friends and family members, who believe that having a child should only bring immense joy, not sadness.
Some mothers have even more barriers (i.e. financial challenges, health complications, unstable families, lack of a partner) which make it even harder to cope with feelings of postpartum depression. These factors are not under the mother’s control.
What are the risk factors for PPD?
All mental health challenges are influenced by biological, psychological, and social factors in the person’s life. This is often referred to as the “bio-psycho-social” model of understanding mental health.
So what bio-psycho-social factors actually contribute to the development of PPD?
Throughout pregnancy, women’s bodies undergo significant changes that prepare the body for childbearing. Biological changes facilitate development of the fetus, promote labor, and prepare for breastfeeding. Changes in hormones such as estrogen, testosterone, prolactin, and oxytocin etc. have been reported to change due to pregnancy, but have also been found to be related to postpartum depression.
Social factors also contribute risk to PPD. A review found that among women who were surveyed after childbirth, women who had more stressful life events, catastrophic events, and more daily hassles also reported higher levels of postpartum depression symptoms than women who reported fewer negative life events.
Lastly, psychological factors have been coupled with the experience of postpartum depression as well. The review also suggests that women who report more parenting stress, chronic stress, and perceived stress are also more likely to experience postpartum depression than women with lower stress levels in daily life. These may be mothers who have difficult babies, or who have other prolonged stressors in their work or family life. These added stresses inevitably impact a new mother’s mental health.
Social and psychological factors can affect many women through no fault of their own, and biological factors inherently impact all women who deliver a child. It is not surprising that so many women are subject to experience postpartum depression.
However, people who don’t understand PPD may blame the individual or dismiss the condition altogether. This stigma may exacerbate the issue.
Cultural differences in understanding postpartum depression
According to the American Psychological Association, postpartum depression can affect any woman whether they had easy or difficult pregnancies; whether they were first time mothers or had multiple children; whether they were married or not; and regardless of income, age, ethnicity, or education.
However, misinformation regarding the above facts may be perpetuated along cultural lines. Cultural differences in understanding postpartum depression can make it harder for suffering mothers to receive necessary care and support.
Asian mothers are less likely to report psychological experiences of depression
A literature review examining the experiences of PPD cross-culturally found differences in the way women expressed their symptoms. The review found that mothers of Asian cultures tended to express their depression more in terms of physical symptoms such as headaches, and feelings of worry about the baby instead of themselves. Mothers who were European or American expressed their depression in terms of emotional difficulties. In the Nigerian culture, women reported nausea, feelings of guilt, and insomnia as symptoms they experienced after child birth.
The impact of intergenerational culture differences
The cultural differences in how people of different cultures perceive depression could have contributed to the disconnect between my views of depression and my family members’. My cousin and I are Asian American, but most of the older adults in our family hold views that are more representative of native-born Asian women. They believe that having time off from work reduces stress and creates more time for child care, thus preventing “depression headaches” and worries about resources for childbearing.
Having intergenerational conversations with family members about the uncontrollable onset of postpartum depression can help to dismantle stigma. Being informed about the experience of PPD can be the first step in equipping a person who wants to break down such stigma.
Social media allows asian mothers to de-stigmatize their struggle
To demystify the circumstances around postpartum depression and break the stigma, many women who experienced PPD have used social media to share their stories and find their communities.
Karen Yeung, a beauty and fashion Youtuber shared her story about how her mind and body changed after giving birth. She said, “When I first had the baby I felt like I was happiest I have been in a really, really, really long time… but it all hits you when you have sleep deprivation, your hormones are changing constantly… I felt so alone, I felt like no one could understand me.”
She overcame her postpartum mental health challenges after learning about her friend’s postpartum depression and realized she needed counseling. In the comments of her video, other pregnant women and mothers commented to say that they related to her struggles. Her story helped educate people about symptoms of postpartum depression and how to seek help for it.
Social media also highlights existing stigma
Polly, an artist known as pastelpolly on Tiktok, creates stickers, shirts, and temporary tattoos that illuminate mental health awareness. She is known for her tattoos, which she uses as coping mechanisms for self harm (the line art can be colored in with markers). She shared her postpartum depression story on Tiktok with the aim to break down stigma around the topic and start a conversation. In this video, she said:
“My postpartum depression almost killed me and barely anyone noticed. To this day it still irritates me when I hear people say ‘I wish they spoke up, Why didn’t they ask for help?’ Because there’s a high chance that they did speak up, and they did search for help, and they fell on dead ears. (It happened to me).”
Asking the question “Why didn’t they ask for help?” or offering other quick fixes and uninformed advice is not an effective way to help an individual with serious or chronic mental health challenges. Rather, it can lead to the individual feeling like their illness is their fault and that they are not seen or heard.
Polly also mentioned that during her postpartum depression, she had times where she felt like she didn’t want to be around her newborn son. Unfortunately, due to Polly’s candor, Tiktok deleted her video due to the “minor safety” violation. She described Tiktok’s decision to take the video down as perpetuating stigma around postpartum depression on the internet.
She reposted the video, but it was not able to reach a large audience. Still, many people commented and said that her video helped them feel less alone. They appreciated that Polly shared her experience and art to raise awareness of mental health issues.
What can be done?
People who experience postpartum depression have several options that can help, some of which do not require seeking professional help (which some mothers are reluctant to pursue because of the stigma associated with seeking therapy). If those around you misunderstand your struggle due to an intergenerational culture clash, consider:
- Talking about your feelings with people around you who will support you, and not judge you (partner, friend, relative…)
- Joining a support group on social media to connect with moms and people who are going through or have gone through the same thing.
- Accept help from an understanding relative or friend, whose help isn’t likely to compound your feelings of guilt, and can help take care of the baby so that you can rest and take breaks
- Take care of your health: get enough sleep and exercise, maintain a healthy diet
- Know that you can overcome postpartum depression, it is a temporary challenge, and that your depression does not define you
- Help educate friends and family members who knowingly or unknowingly stigmatize mental health awareness and postpartum depression
- Remind yourself that you do not deserve your illness and that your illness is not your fault
All mental health challenges are filtered through the lens of culture and social norms, sometimes in ways that make it very hard for an individual to seek help and have the support of their friends and family. Being educated about the false beliefs and thought patterns that stigma places us in can help us break stigma and reach people who need help healing right now.