Natasha Mauthner is Professor of Social Science Philosophy and Method at Newcastle University. She is interested in how feminist philosophy should be applied in the social sciences. Her work has contributed to a range of fields including gender, work and family; the intersection between technology and society; data sharing and big data; perinatal mental health; qualitative research; and research ethics.
We talked all about postnatal depression questionnaires and why they should matter to feminists.
So, why is measurement of postnatal depression a feminist issue?
It’s a feminist issue for two main reasons: it takes a social and political problem and makes it the responsibility of individual women, and it pathologises women who don’t conform to an ideal.
Individualising
Measurement asks about and measures individual emotional states, so it will ask a mother whether she's feeling down or depressed, hopeless and tired, whether her appetite, her sleep, or her concentration are disturbed.
The act of filling in the screening device reinforces the idea that there is something wrong with the woman. I can't sleep. I can't concentrate. I can't eat. I'm feeling down. I feel like a failure. There's a problem with me and the questionnaire is confirming that notion.
But what these screening questionnaires are not asking about are the broader conditions of women's lives that might be contributing to their feelings of depression. So, for example, whether the women have social support from their partners, their families, their friends. Whether they're experiencing domestic violence, what their living conditions are like, what their levels of income are, or the impact that unrealistic cultural expectations of mothers are having on them.
Postnatal depression measurement devices are not innocent, they’re not just objective means of coming up with a diagnosis. They have assumptions embedded within them about depression, about motherhood. They portray motherhood and depression as individual conditions.
Assuming postnatal depression is a problem of the individual and ignoring those broader social, political, economic, cultural, material contexts in which women and mothers live is a feminist issue.
The act of asking different questions would be consciousness raising- planting a seed for the woman filling out the questionnaire that maybe it’s not an individual failure on her part.
Maybe there is a broader context.
Maybe the level of support and safety and stability she’s experiencing has an impact.
But we’re choosing not to ask those questions. We overlook the broader context and treat these questionnaires as objective, neutral instruments and tools rather than something subjective, culturally situated and historically embedded.
Pathologising
The second thing is that measurement pathologises women's experiences. So if we think about mothers’ mental health and well-being as encompassing a wide range of feelings and emotions, then what screening questionnaires and measurement is doing is dividing off one end of the spectrum and turning those feelings and emotions into something that's problematic: a disorder, an abnormality that we then call postnatal depression.
Measurement is pathologising feelings and emotions that don't conform to the idealised and romanticised portrayals of motherhood that are really very, very deeply embedded within so many aspects of our culture.
Measurement implies there's something wrong with mothers and their feelings, rather than allowing us to ask whether the problem lies with the cultural expectations and norms surrounding motherhood.
Recognising the value of a diagnosis
Having said all this, one thing I did want to say is that it is really important to recognise that women who are experiencing postnatal depression will often find these questionnaires beneficial because they can lead to a diagnosis. So in my own research, I did find that the majority of women really valued having a diagnosis and a label for their condition.
I think this is because it really helped them make sense of their experiences and really importantly, I think it also alleviated their feelings of guilt and responsibility so they could really see postnatal depression as a recognised medical condition, as something that happens to women after they've had a baby rather than a personal and moral failure on their part.
So it's a bit paradoxical because the questionnaires present it as an individual kind of pathology but somehow it's also something ‘out there’ that you catch, a bit like the flu.
And of course, for many women the diagnosis also helped them think about treatment pathways and a lot of women did find medication was helpful. It helped them get out of that really deep, dark hole that they were in to a place where they could begin to have talking treatments and therapies and counselling and so on. Whereas when they were in the depths of the depression, they just couldn't really engage with those treatments.
We might come in as academics and critique and deconstruct some of what's going on within the medical profession. I always think it's important to hear and listen to what women themselves are saying. Sometimes those things seem contradictory. But I think they are different parts of the story, and it's very important to approach it in that holistic way where we understand these different perspectives.
Can you tell us a bit about the research behind your book: The Darkest Days of My Life ?
In the 90s I interviewed about 40 women, half of whom had postnatal depression. In the end, my research was a deep dive into the accounts of the women who had experienced depression and I also interviewed some of their partners. What I was interested in at that time was primarily to actually just listen to their stories and give voice to these women and their experiences. It doesn't sound revolutionary now but it was back then because at that time most of the research was very much done within a medical model, a medical framework, and there was no interest in actually hearing about women's own subjective accounts of their experiences.
I did research in the UK and then I spent a year in the States and I followed that up with research which looked specifically at the role of self-help groups because it became very clear to me that social support amongst mothers was really critical. I spent about six months going to a support group for new mothers who had been experiencing depression looking at how it helped them and what the process was.
One of my findings was that what the women actually found the most helpful of everything was to talk to other women because it was by talking to other women and realising they were not alone, realising there were a lot of other women out there who were experiencing exactly what they were experiencing, that normalised their feelings and made them feel less alone. Connecting with other people made them realise, “there isn't something wrong with me, there can't be something wrong with me, otherwise, all these other women wouldn't be experiencing exactly the same thing that I'm experiencing”
When I was doing my research, I often felt that if only women could get to that point earlier, you would bypass that need for medication and even diagnosis and full blown depression.
It was the isolation and the expectations of being the perfect mother that was the really toxic cocktail so I often thought if you could somehow get right in there, intervene right from the beginning to normalise those feelings then it would sort of diffuse all of these other problems that can develop later.
Twenty years on, many new mums still feel like isolated failures. Is this just an inevitable part of the process of becoming a mother for some people?
I think that what is inevitable is that women will respond to motherhood in many different ways. We have different reactions to similar situations in life. We're all different, so it's not surprising. Interestingly, if you look at prevalence rates of postnatal depression across the world, there are also differences between countries.
But does that mean that this sense of failure and isolation are inevitable? Well, I think it's yes and no.
Yes, because we live in a society that really glorifies motherhood and sees it as this natural, instinctual and joyous state of being and these ideas are really, really deeply rooted in our culture and they go back centuries. So we can see them in art. We can see them in literature, religion, laws, policies and so on. And if our own feelings of motherhood don't conform to this really powerful imagery, then it can leave us with a sense of loneliness and shame.That's where social media is also playing a really important role- Tiktok, Instagram, Facebook- they can all contribute to creating these unrealistic and idealised expectations and images of supposedly perfect motherhood, parenthood, family life. And that can really leave women feeling inadequate.
So that's one sense in which we could say that this is inevitable but I'm also saying no, because we know that feminists have been challenging these kinds of ideas for at least half a century. So there are many, many other images and narratives about motherhood and in fact Motherhood Uncensored is a great example of this. There are also many online communities where mothers share their experiences of motherhood and depression. If mothers can tap into these alternative stories about the lived realities of motherhood and if they can connect with other women who share similar difficulties and feelings of ambivalence then I think this helps and it can help normalise their own feelings and accept that motherhood encompasses a range of experiences and emotions.
I remember a really insightful comment made by a mother I interviewed years ago- she said there's a difference between what she called feeling low and feeling really bad about feeling low. For her, it was the feeling bad about feeling low that led to postnatal depression.
If we can normalise the feeling low part, then the sense of isolation and failure that can flow from that to depression may not be inevitable. If there was a consciousness raising movement that helped people understand feeling low as part of the rich tapestry of motherhood- something that we can talk about, share and embrace- then there’s an extent to which that can stop us sinking into a much deeper stage of guilt and shame.
I think the title of your organisation, Motherhood Uncensored, captures this so well because there’s so much censoring going on- on a cultural level but also at an individual level and within families.
I remember the many stories women told me about their partners or their families not being able to deal with the fact that they were feeling down about having had a baby especially, for women who'd been trying to have a baby for a long time and had such high expectations. And so we censor those more negative feelings, feelings of ambivalence that go so deeply against the cultural grain of what motherhood is meant to be, and has been portrayed to be for centuries. We've had feminists fighting this fight for 50 years, but we have centuries, if not millennia of this other imagery, and so undoing that is difficult. It's deeply rooted within our psyches as well as within our culture. It's very difficult to dislodge that.
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