While I do believe that we are making strides in greater public awareness of perinatal mental ill-health, this is a recent development and, unfortunately, as a result, people sometimes assume that postnatal depression (or anxiety or psychosis) is a new phenomenon. A distressing side effect of this is that people can blame the sufferer, as if everyone was fine after having a baby up until the 1990s and so any problems must be self-inflicted, a result of modern lifestyles or weak character.
This couldn’t be further from the truth. Postnatal mental illness has always been around, even though no one necessarily understood it. The ancient Greek physician Hippocrates wrote about the subject around the fourth century BC, proposing that lochial discharge from the uterus could travel to the brain, causing agitation which he termed ‘puerperal fever’. (See Perinatal Mental Health: A Guide for Health Professionals and Users, by Jane Hanley) He is often assumed to be talking about septicaemia or infection, but this could equally be a psychiatric disturbance. Speculative study of postnatal mental ill health continued over the centuries. The best summary I have found is in ‘Sadness and Support.‘
I would add to that essay, however, the case of Margery Kempe in the fifteenth century. Margery is known as a mystic and a general ‘character’, but she was also a vowess, the author of the first autobiography in English and a sufferer of postnatal psychiatric difficulties. She begins her startling memoir by writing about herself (in the third person) during the time after the birth of her first child, when she was about 21 years old. (All quotations fromThe Book of Margery Kempe, trans. Barry Windeatt (Penguin, 1985, repr. 2004)) She says that “what with the labour-pains she had in childbirth and the sickness that had gone before, she despaired of her life, believing she might not live.” This anxiety led her to seek her confessor, the man to whom she would relate her sins and be prescribed penitential acts in order to receive forgiveness from God. She began to confess that she had not always confessed her sins in the past but instead had dictated her own penance. The confessor interrupted her and began telling her off, so that she failed to finish confessing. She was then caught between the fear of his rebuke and the fear of damnation. She writes that, because of this, she “went out of her mind and was amazingly disturbed and tormented with spirits for half a year, eight weeks and odd days” (a long-winded way of saying around eight months).
Margery’s description is what she suffered is vivid, terrifying and sadly familiar to some of us. “She saw, as she thought, devils opening their mouths all alight with burning flames of fire, as if they would have swallowed her in, sometimes pawing at her, sometimes threatening her, sometimes pulling her and hauling her about both night and day…” These devils called upon her to renounce her faith, her family, her friends and all goodness. This she did. “She slandered her husband, her friends, and her own self.” She became suicidal and self-harmed: “She would have killed herself many a time as they stirred her to…. she bit her own hand so violently that the mark could be seen for the rest of her life. And also she pitilessly tore the skin on her body near her heart with her nails, for she had no other implement, and she would have done something worse, except that she was tied up and forcibly restrained…” After months of this, she called on Jesus and was instantly delivered. Margery’s understanding of her experience was completely entrenched in her religious beliefs, which may seem bizarre to us, but probably would have seemed reasonable to her contemporaries. She went on to have another thirteen children before eventually convincing her husband to take a vow of chastity so that she could do the same.
Postnatal psychiatric difficulties are too common to have escaped the notice of medical professionals or laypeople. My great-aunt described to me how, as a new mother in the 1950s, she kept the windows closed for fear that she would throw her baby out of a window. And my mother has written here about her experience of postnatal depression in the late 1980s. ‘Sadness and Support’ details how a handful of medical professionals grappled with the problem over the centuries. The DSM (The Diagnostic and Statistical Manual of Mental Disorders) nodded briefly to it in 1968 but even the latest version, published in 2013, fails to accept the widely-known fact that it need not commence in the early weeks after delivery. The UK equivalent on the DSM, the ICD (The International Classification of Diseases) is similar in this.
In summary, then, postnatal mental illness is not a new phenomenon and it is not newly-recognised. It is, I fear, simply that few people have been genuinely interested in the well-being of mothers and have recognised the potential consequences. The media and the internet have empowered more mothers (and fathers) to tell their stories, and hopefully people are finally beginning to listen. There is still a lot of stigma and ignorance flying about but I believe we are making strides. And, rest assured, that this illness, exacerbated as it may be by circumstances or by social isolation or by the shock of becoming a parent, is as old as time. It is not weakness or a reflection upon the sufferer as a person. The sooner everyone catches up with that, the better.
If you would like to read more from Laura, please visit her blog at Keeping It Eclectic.