Post-partum depression” has been discussed as an identifiable, measurable, treatable disorder for 50 years now. Thresholds, scales, prevalence rates: everything seems clear, even reassuring.
But this binary model – it’s either depression or not depression – obscures a more subtle reality: new parenthood is disruptive, makes us vulnerable and places us all on a spectrum of distress.
The notion of post-partum depression was established in 1968, primarily because it responded to dual academic and medical requirements: to lend scientific legitimacy to the suffering of new mothers and to provide a clear and specific diagnostic framework for a particular period of life.
At the time, emphasis was placed on the atypical nature of this depression, which resembled an anxiety disorder. Its specificity was considered to be solely related to its symptoms, and the challenge lay more in its detection than in its management.
Minimising lived experiences
Furthermore, this specific characterisation made it possible to distinguish post-natal depression from the “baby blues” (sometimes called “chemical depression”) that occur in the form of brief depressive episodes linked to biological factors, particularly post-partum hormonal changes.
Since then, the debate has been confined to psychiatric classifications and screening tools. But that’s reduced a lived experience to a simple diagnostic category.
In a recent article published in the journal Neuropsychiatrie de l’enfance et de l’adolescence, we proposed, together with child psychiatrist Romain Dugravier, talking about perinatal relational distress rather than post-partum depression. Far from being unanimously accepted within the scientific community, our approach, which questions diagnoses and labels, attempts to view adjustments to parenthood beyond the sole prism of individual disorders.
A crisis of maturity
Becoming a parent means meeting the needs of a totally dependent child while reorganising your emotional, marital and social life.
For many, this experience is deeply formative. For others, it reawakens old wounds: emotional deprivation, loneliness or experiences of rejection. The arrival of a baby in that case can become disruptive by reawakening buried vulnerabilities.
Take the case of a woman who has her first child. More than fatigue, she is overwhelmed by the feeling of being trapped: someone who has always defined herself as independent and “not dependent on anyone” is suddenly confronted with an infant who is totally dependent on her.
This confrontation can reactivate the patterns of a childhood marked by the need to fend for herself. A diagnosis of post-partum depression does not address this history or the tension between dependence and independence.
Antidepressant treatment, which in our experience is sometimes prescribed following this diagnosis, will not address the cause of this distress, either. This is in contrast to a space where vulnerability is recognised and where the relationship with the child can be supported.
This leads to a loss of meaning: we diagnose “depression” when what we really need to understand are the interactions and upheavals inherent in the new parent-child relationship.
The scales used – such as the widely used Edinburgh scale (EPDS), a 10-item questionnaire designed to screen for depressive symptoms after birth – focus on the mother’s mood, neglecting the quality of the parent-child bond, social support or identity changes.
The result is that symptoms are assessed, but loneliness, family loyalty conflicts or difficulties in investing in the relationship with the baby are overlooked. Having “psychiatrized” the relationship, it is also difficult to treat it beyond medicating.
Rethinking the organisation of care
Our criticism is not only aimed at concepts, but also at the consistency of the various interventions with families. Perinatal care remains fragmented: between adult mental health, child psychiatry and social services, each speaks its own language and follows its own priorities, sometimes leaving parents alone to piece things together on their own.
Human-centred vision
Replacing post-partum depression with perinatal relational distress is not just a question of vocabulary.
It means refusing to limit ourselves to an approach that classifies disorders into diagnostic categories according to fixed criteria, to the detriment of a psychopathological consideration that views parenthood as a universal, relational and evolving human experience.
This is not about denying suffering or dismissing treatment when it is necessary. It’s a reminder that perinatal mental health cannot be limited simply to screening, prescribing and referring. It must also contain, connect and accompany. (The Conversation)
