edit: I’ve got a bank of drafted/half-drafted posts that I’ve just decided to try to either post or delete. This one was written 30/07/09
This question, “Are we medicalising unhappiness?” has come up in two separate programmes I have listened to recently. I’m going to talk about one, from the Radio 4 series Am I normal? The specific programme was on Post-natal Depression. You’ll find a link to the programme (programme number 2) here.
This radio programme looked at the experience of giving birth and asked whether we are over-diagnosing PND. It notes that it’s now commonplace for new mothers to have visits from a health worker after the birth and that they are given forms to fill in with questions and tick-boxes. Don’t we all just love a tick-box questionnaire? Ahem. However, some of the questions are along the lines of “Have you ever felt overwhelmed in the last seven days” alongside the more serious questions of “Have you thought about harming yourself or your baby?”
The problem with such forms is that a new mother is very likely to answer ‘yes’ if you ask her if there are times she’s felt overwhelmed, if you ask her if she’s doubted her ability to cope with the new baby, if you ask her if she’s lost some enjoyment from life. She’s likely to answer ‘yes’ because most new mothers at some point are likely to feel sleep-deprived, anxious, weepy and exhausted, unless they have exceptional support networks i.e. are Madonna or Angelina.
Whilst it’s a given that new mothers should be monitored for signs of not coping, it seems that we are jumping in a little too quickly to offer treatment for PND (which would probably be an SSRI and/or talking therapy). The thing is, we’ve all heard the cautionary tales of women who’ve been unlucky enough to suffer a bout of Post-natal Depression, perhaps with psychotic features, that has resulted in their babies being harmed or killed. So it makes sense to have a means of monitoring any potential signs of this condition, catching it as early as possible.
It seems to me that the problem with the aforementioned questionnaire approach is that it is all about how the midwife or health visitor explains it. Some women might be within the parameters of normal post-baby stress e.g. feeling exhausted at times, emotions up and down, worrying a lot, but looking at a set of questions that list a lot of their negative feelings could be quite scary, unless they are reassured that most women experience such feelings and that, for most people, these feelings will pass within the (probably variable) period of post-birth adjustment.
I’m not convinced that anyone veering towards psychotic depression would answer a question like “Have you had thoughts of harming your baby?” truthfully, as there is probably a feeling of shame attached to having those thoughts.
These are just some musings I had whilst listening to the programme. Perhaps there is a high success rate, using questionnaires and medical experience, for separating ‘normally stressed’ new mums from dangerously depressed women. I don’t know. I do, however, suspect that Post-natal Depression, as well as ordinary Depression, are now over-diagnosed, and I can’t help thinking that what most new mothers need is probably time, time, time, support and encouragement and…time.
I am not a mother so this is nothing more than my response to an interesting issue raised in this radio show. I’m quite happy to accept I could be talking out of my arse because I have neither a baby nor medical training. The topic for the show happened to be Post-natal Depression, but the underlying question “Are we medicalising unhappiness?” remains an interesting debate.