Could postpartum depression represent a justifiable value judgement?

November 25, 2011

For a long-time I doubted the validity of most mental illnesses, viewing them as primarily social constructs. This wasn’t as the result of any particularly constructivist reasoning, or from exposure to Foucault, but more out of instinct. It seemed that suppressing unwelcome views or perspectives would be more likely, given the essential lack of imagination that most people have, than that the variety of mental illnesses existed out there in the world. Nor did it help that I can convince myself that I have most, if not all, mental illnesses, just by reading the diagnostic criteria and finding examples of how I exhibit these behaviors.

However, some experience I had with a narcissist have refined my view, to the point that I now believe that some mental illnesses must have a degree of truth in them. Basically, without those illnesses as a category, and without reading about the category, one is doomed to confusion in dealing with such persons. And so the question becomes how to distinguish between a constructed and a biologically valid illness, which would be real outside of a particular set of social norms.

I think a mental illness is meaningfully described if (1) it distinguishes a constellation of idiosyncratic behaviors or symtoms that occur with such collocative frequency that they form a seemingly organic whole, and (2) if at the same time the person is impossible to understand in the absence of that description.

I think that a mental illness, if it is to be a mental illness, must particularly fulfill the second criteria, because the first is more prone to manipulation (even given that we look at organic things like biological cohorts to the illness). The second criteria means that the disease must be all-consuming or all-explaining in reference to the victim. Here the DSM criteria of “interference” of the illness with life is critical. In other words, I am looking for wide-scope coverage for a variety of behaviors. This wide-scope coverage is what reacts upon the constellation of symptoms to give it the appearance of something seemingly improbable.

You can’t predict people’s behavior like a physical system. I would suggest that the psychological equivalent of a theory’s predictive validity is this wide-scope coverage of behaviors, which is also its utility. If a person were just opposed to social norms, it might well be that a description generated from within those social norms would provide strong descriptive validity in certain areas of friction with the system, but not in others. What I am asking is that a person’s behavior (as an organically improbable whole) make very little sense at all outside of a mental pathology.

I have no certainty as to whether postpartum depression meets this description. One thing we can be certain of is that it is defined as a transient phenemena, which means that it is happening in an otherwise well person. This alone should make us call it into question if there is another possible explanation.  

One hypothetical explanation which I will suggest (originally suggested here) is that in some cases postpartum depression might express a value judgement towards the baby’s life and the act of giving birth. This value judgement might be subject to various degrees of conscious recognition but it would be based upon real factors that would lead a rational decision maker to question giving life to the child.

In support of this idea, it is interesting to note that the incidence of post-partum depression (according to the A.D.A.M. Medical Encylopedia) correlates well with just such factors. All of the risk factors for post-partum depression would  also make a rational decision maker question giving the “gift” of life to a person who can’t consent, and isn’t asking to be born. Some of these factors (along with my explanation of their relevance to this theory) are:

being under the age 20

People under the age of twenty are less likely to have the financial resources or experience to really give a child a relatively good life and instruction.

Alcohol abuse, drug abuse, and smoking

If a person is a substance abuser, this is also likely to harm the child’s development.

The woman did not plan the pregnancy, or had mixed feelings about the pregnancy

If the pregnancy wasn’t planned, this increases the likelihood that there are probably very real reasons it wasn’t planned. A woman’s doubts about pregnancy also would have a more complicated role in the ontology of post-partum depression: very rational and deep seated apprehensions about giving birth might only attain to a threshold significance after the mother has been divested of the child, and the child has been externalized and is visible and vested with its categorical status as a “person”.  It is at that point that the child being committed to life strikes the woman as an ethical decision she has made for it. Even if the child has a life worth living, will it have a life that was worth starting?

Depression, bipolar disorder (for example, manic depression), or an anxiety disorder before pregnancy

A person with depression is more likely to pass on the risk of depression, thereby imposing life on someone who will regret being born. Even if this is not brought to consciousness (and our society usually will not protect future people from such risks, making the thought unlikely), nevertheless a depressive person may reason from their own experience and ask whether, in their experience, life would be worth starting all over again.   

The woman had a stressful event during the pregnancy or delivery, including personal illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or birth defect in the baby

An emergency delivery, premature delivery, illness, or birth defect are all likely to be stressful on the baby, possibly causing developmental defects, and all increase the likelihood of future suffering.

Have a close family member who has had depression or anxiety

The situation here is the same as above. A history of depression in a family would cause any reasonable person to wonder what the justification is for bringing a new depressed person into existence, and this might cause feelings of guilt.

Have a poor relationship with your significant other or are single

This bodes ill for the child in many obvious ways. 

Have financial problems (low income, inadequate housing)

Again this relates to the child’s future life and the prospects of getting a good job, etc.

Have little support from family, friends, or your significant other

It is difficult to raise a child without such support systems, hence the outlook for the child decreases even more when there is no support for the pregnancy.

It seems to me that all of these factors which influence the mother’s quality of life can be tied directly to the child’s well being. If they are present, a woman would naturally feel guilty. Otherwise, what kind of person would she be? All of these risk factors are in fact things that would make a woman question the wisdom of childbirth.

My question is this: could postpartum depression be a justifiable value judgement toward the pregnancy? Could it be that after the child has been born mothers begin to take account of the commitment they have not only made for themselves, but that they have made, in proxy, on behalf of the child, by conceiving it and bringing it into the world?  PPD is the inverse of “survivor’s guilt”, under this conception. It is guilt about starting life. It is “birther’s guilt”.

A person talking with these new mothers, and who listened long enough, would not be in a position to validate such concerns under the present taboos in favor of evaluating reproduction positively. After all, you can’t turn back time. Therapists would be in the position of framing such issues in terms of the mother’s present responsibilities, and might well be right to do so. The woman brought the child to term, has given birth to it and now (in our legal system’s realm of black and white thinking) the child must be taken account of as a person with interests seperate from hers, though dependent on her. Why should the woman not just get over such ideas, and do the best for the child now that it is already born?

This sounds reasonable, but it probably doesn’t correspond to the mother’s felt reality. To the mother, the baby’s new independent reality is not so easy to distinguish, or is perhaps multidimensional. With the horror of modern hospital birth– the lack of intimacy, the clinicizing of the body, the blood, the screams, the agony– the independence, dependence, and causal dependence of the baby on the mother might cut across the mind in myriad ways. The child holds a liminal status with real and suddenly apparent value of life concerns but with an undiminished relation to maternal autonomy. Though it is assumed that time will heal these psychic scars, at bottom there may be, after such an undeniably traumatic introduction to the world, the haunting question of why: why bring a child into the world?

Those who work with PPD could probably bring out many anecdotes about women who are priveleged and fall into none of the classes above, and so have no reason to think their child’s life will be anything but charmed. But how exceptional are those cases? And what elements of truly valid pessimism are revealed in therapy with other women, who do fall into these classes, and who might feel a valid sense of birther’s guilt for having handicapped their children from the beginning?

Post-partum depression seems to incoporate elements of such birther’s guilt for having imposed life on an unconsenting being who was not asking to be born. And with PPD we are also looking at the number one complication of childbirth, which means, under this interpretation, that anti-natalist sentiment could be far more prevelant than anyone would at first believe. Could postpartum depression (at least in those cases) be a social-construct, similar to homosexuality as a mental illness, or any of the other fictional mental illnesses that have been invented in the past to justify the inflication of harm? 

The infliction of harm on future people is not something our society has made a priority. Underprivelaged children of teenage mothers, like those I see a profile of in the data about postpartum depression, are exactly what our pro-natalist society requires for cannon fodder and cheap labor. Under such a system, would it be any surprise if women who felt a justifiable sense of remorse for functioning as breeding machines for unconsenting have-nots were branded as mentally ill and then medicated?

One of the more interesting effects of postpartum depression is that mothers are ideating about harming or killing the baby. It’s important to note that this is exactly what that baby’s future self would want, considering the chances that (if all of the above true) they are saddled with a miserable life from day one. As we know, once a child has passed outside of the vaginal canal he or she receives their legal package of humanhood, which makes infanticide wrong. Post-partum depression appears to be, at least in this hypothetically extreme case, the desire to right the wrong. If mothers were only allowed to listen to their maternal instincts, how many children would be strangled to death in the cradle?


4 Responses to “Could postpartum depression represent a justifiable value judgement?”

  1. Great entry. I have to agree with you that PPD would be better interpreted as strong, perhaps unconscious guilt. Also, I support infanticide, although I daresay it’s not a popular position at all… 🙂

  2. By the way, thank you for linking to my blog. I returned the favor.

  3. JR Says:

    Glad you like it. I’ve been reading you for a while. I also consider myself a libertarian socialist.

    There’s a book on PPD that looks interesting here:

    “…guilt about childrearing is typical in postpartum depressions. Of particular interest here is that questionnaire addresses the topic of guilt in terms of feelings the mother has about the child. The content of guilt in these depressed mothers is primarily determined by a feeling of doing harm to the child, as we see in clinical reports from three mothers with postpartum depression.” (Postpartum Depression and Child Development pg. 250)

    I especially like this (p.g 187): “At the 24-month interview, Mrs. Z reported residual guilt and fatigue, but she noted that she had “finally adjusted” to her toddler and was getting some pleasure FROM HER.” (emphasis mine)

    That pretty much says it all.

  4. “Glad you like it. I’ve been reading you for a while. I also consider myself a libertarian socialist.”

    Fo shizzle! Glad to meet another AN anarchist. That makes two of us. 🙂

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