“Have you read…?” She paused, shaking her head incredulously and chuckling softly to herself. “No, of course you haven’t. So, there’s this obscure gothic short story called –“
“—The Yellow Wall-Paper”, I interrupted. I looked over my shoulder at my husband who stared back at me with his eyebrows raised, his lips pursed into an impressed smirk as he nodded his head approvingly. He has heard me reference this story throughout the years.
I went to an all-girls Catholic high school, you see. And, if I remember correctly, this story was assigned reading in my Honors Literature class taught by a young female teacher. This story made such an impression on me. It was about a woman losing her mind in the confines of a room covered in yellow wallpaper, wasn’t it? I loathe the color yellow and felt some kinship with this addled woman in the story. I would draw parallel to her descent into madness in an attempt to explain to my husband when I felt claustrophobic or stifled or antsy in any one of our series of small San Francisco apartments, all of which, coincidentally were painted yellow. No one ever knew what story I was referencing. None of them had read it, much less heard of it.
So here I sat, on video chat with a new-found comrade in the battle of postpartum depression that is being waged in both our minds and our families, connecting over a story I first read more than fifteen years ago. I nodded when she laughed incredulously that I knew the story too, that I related to the story too. I nodded because I thought I knew. Yes, we both feel like we have lost our minds and no one can help us. Yes, this whole process is maddening. Yes, no one understands. But I didn’t know. I didn’t know that this story was a semi-autobiographical account of the author’s own postpartum depression.
Scanning my bookshelf, home to mostly old high school and college reading, I found it: Great Short Stories by American Women. The edges of the pages are turning brown and the inside page bears the inscription: Rachel Teixeira, c/o 2004, HR 115. And in between the pages of this old paperback, archived between a faded cover adorned with purple and blue flowers, this story has lived on my bookshelf this whole time, for over 15 years. My eyes widened with excitement as I opened the musty pages to discover its margins heavily annotated with my adolescent scrawlings. Some in green glitter gel pen, no less.
I flipped through the pages, and as I scanned my notes and the passages marked with neon pink highlighter, I thought to myself: there is no way this could be about postpartum depression. Nothing from my notes points to this. At all.
“She is trapped by how society (her husband, etc) has categorized her… b/c if she is told that she is “ill” in this certain way, if she wasn’t b4 she is made to think that she is...develops “illness” on own”.
Next to the highlighted passage: “Personally, I believe that congenial work, with excitement and change would do me good. But what is one to do?” I had scrawled: “complacency”.
The pink highlighter showcases a story about a woman who is dramatic. Attention-seeking. Histrionic. We would discuss assigned stories such as this one in class and my pencil annotations are likely capturing that discussion. Not once did I write down anything remotely to do with depression. My notes are not compassionate. They mention nothing of healthcare, or stigma. Nothing about the baby. Nothing about postpartum.
The introduction to this story was hidden on the back of the first page. This page was not annotated. This page explains the context of the story, calls it out clearly: “Suffering from what was most likely postpartum depression…”. But this is not what I remember of the story; I remember that it was about a woman losing her mind. Going insane. Despite everyone’s best efforts to help her. She was crazy. And devious. And manipulative. And she was this way because she deliberately undermined everyone’s efforts to help her.
Puzzled, I turned to the beginning and re-read the story.
And I cried.
I could have written this. A friend could have written this. Any of my mother contemporaries could have written this.
“I get unreasonably angry with John sometimes. I’m sure I never used to be so sensitive. I think it is due to this nervous condition.”
“It is fortunate that Mary is so good with the baby. Such a dear baby! And yet I cannot be with him, it makes me so nervous.”
“I cry at nothing, and cry most of the time.”
“You think you have mastered it, but just as you get well underway in following, it turns a back-somersault and there you are. It slaps you in the face, knocks you down, and tramples upon you. It is like a bad dream.”
This story was published in 1892.
The candor and rawness - this doesn’t read like a dusty old Victorian short story with wildly archaic and flowery language. Charlotte Perkins Gilman’s words ring so true that her pain, her truth, her suffering calls out from the pages clear as a bell even after all this time. Even after one hundred and twenty seven years.
One hundred and twenty seven years later and the system is STILL BROKEN.
One hundred and twenty seven years later and the stigma is STILL THERE.
One hundred and twenty seven years later and this is STILL in the shadows, dismissed and vilified in the same breath. One hundred and twenty seven years. Hundreds, thousands, hundreds of thousands, MILLIONS of women. GENERATIONS of women.
One hundred and twenty seven years later and we STILL do not have a diagnosis.
“If a physician of high standing, and one’s own husband, assure friends and relatives that there is really nothing the matter with one but temporary nervous depression - a slight hysterical tendency what is one to do?”
“I don’t feel it is worth while to turn my hand over for anything and I’m getting dreadfully fretful and querulous. I cry at nothing, and cry most of the time. Of course I don’t when John is here, or anybody else, but when I am alone. And I am alone a good deal just now.”
“John says if I don’t pick up faster he shall send me to Weir Mitchell in the fall. But I don’t want to go there at all. I had a friend who was in his hands once, and she says he is just like John and my brother, only more so!”
Dr. Silas Mitchell is lauded as the father of modern neurology for his work in identifying phantom nerve pain in Civil War amputees; a crucial advancement in the field of pain management and specifically for veterans. However, he is also the doctor referenced in this tragic story for a rest cure that was a common treatment employed to women of that time who could afford a private specialty physician. These affluent women were subjected to strict bedrest for six to eight weeks, fed on a diet of milk and rich food until they gained pound after pound. The less affluent women who undoubtedly suffered the same mental illnesses have no well documented story that survives to be retold today; their cries are relegated to echo in the long forgotten halls of insane asylums; institutions which were not ever known for compassionate care but rather as places for unregulated unfettered experimentation – think lobotomies ala “One Flew Over the Cuckoo’s Nest”.
Women’s health continues to be poorly researched and at the mercy of a patriarchal racist health system. In 1892, women were diagnosed with “hysteria” – a catchall for the female condition. And even today the language we use around pregnancy and postpartum mental illness is dismissive, diminutive, and sexist. “Mood disorder”. “Miscarriage”. “Hostile Uterus”. Women continue to be told their bodies are not enough. That if something is wrong after birth it must be their fault.
I have read contemporary commentary on this story that writes off this illness as a convention of the times, accusing women of playing into this convention to gain a type of notoriety for suffering such ills. This accusation disgusts me. But it is really no different than commentary on contemporary postpartum mental illness. Self care! Have you tried yoga? Have you steamed your yoni to release all the negative energy? You need to sleep. Sleep when the baby sleeps! You are depleted and you need to replenish yourself! How’s your self care? You need to get outside.
And what if I did yoga? What if I steamed and shoved a jade egg up my vag and went outside and slept while my baby slept - and just left my toddler to his own devices because synchronized nap schedules are Holy Grail of parenting - and... and what if I did all these things and I still am not better? You know how that makes me feel? Like I failed. Like I wasn’t trying hard enough - if I really wanted to get better that I would be.
“He says no one but myself can help me out of it, that I must use my will and self-control and not let any silly fancies run away with me. “
I speak from a place of privilege: I am white. I have a college degree. I own a home. I have a good job. I have insurance. I am medically savvy. I am pretty close to the best case scenario and I still have suffered. I have access to resources and support that many others do not. Yes, perinatal and postpartum mental illness have complex biological, social, and environmental contributing factors. Of course. But I would like to point out that a quick literature review will show that this is the case for health in general. This is the case for diabetes. And schizophrenia. And heart disease. Researching, diagnosing, treating these other medical conditions is not a reductionist scientific exercise. Nor is it for women’s health issues such as perinatal and postpartum mental illnesses* which are the most common complication of childbirth.
Some statistics show that the incidence of maternal mental illness is greater than that of breast cancer, cervical cancer, and stroke combined. Combined.
Medical diagnoses are important. Having formal diagnostic criteria is important. It is how providers distinguish one condition from another and formulate an evidence-based treatment plan. Take diabetes, for example. Do you know how many different diabetes diagnoses there are?
*In your best Bubba Gump voice*
Type 1 diabetes.
Type 2 diabetes.
All of these have diagnostic criteria. Because all of these manifest from different complex biological processes and, dare I say, contributing social and environmental factors. The treatment plans are different. If the medical community said” “why bother diagnosing these things differently? It’s all diabetes anyway! We will just figure out each case as we go. Hope that works out!”. Do you know what would happen? PEOPLE WOULD DIE. They would die because without standardized diagnostic criteria each provider would be starting over each time with each patient trying to figure out what to do. Giving insulin for diabetes insipidus isn’t going to get you anywhere fast. Except maybe the morgue.
Sound familiar? It should. Because mothers - and fathers, but mostly mothers - are DYING. We are dying because there is no standardized treatment plan. There are no parameters to distinguish postpartum anxiety with postpartum depression. There are no parameters to distinguish postpartum OCD with postpartum post-traumatic stress disorder. Without these parameters, these diagnostic criterium, there can be no evidenced-based treatment plan. And untreated, undiagnosed, shamed to figure it out for ourselves, we are dying. The United States does not currently collect data regarding suicide as it relates to maternal mortality but in the countries that do like Britain and Japan, it is the leading cause of maternal mortality.
What are we going to do about this? We can share our stories, sure. That is an important piece of destigmatizing and educating and building community. But we’ve been sharing our stories publically for at least the last one hundred and twenty seven years. If the American Psychiatric Association (who authors the DSM) is calling for research to prove that postpartum mental illnesses are unique distinct disorders, then let’s give them the story. Let’s share and collect and quantify our stories. Let’s raise our voices together so loudly that they will be heard forever in the black and white pages of history. It is time for the next step. It is time to make history. It is time to take action.
Please join us is taking action by completing and sharing this survey.
*Also, can we agree that Perinatal Mood and Anxiety Disorders is a misogynistic and dismissive term? Mood?They are not moods. They are mental illnesses. Join me in properly referencing these conditions.