The Postpartum Depression Screening Wars: Is PPD “Real”?

As a pediatrician who has been involved in this issue, both from a clinical and a policy perspective, for many years, I find myself unsettled by the intensity of the conflict that has erupted around the issue of PPD screening, that followed on the heels of the new recommendation by the US Preventative Services Task Force that all women be screened for depression in pregnancy and in the postpartum period.

It all began when Marianne Williamson, who I had not heard of but according to her Facebook page is a public figure (she has a number of photos speaking alongside Bernie Sanders) author,and spiritual leader wrote in a FaceBook post that this screening was a ploy to sell drugs, that the hormonal changes of pregnancy are normal, and that this is a disease of society rather than a disease of women. She made a reference in conversation with followers to the lack of paid parental leave in this country.

Almost instantly she mobilized the entire community of strong advocates for PPD screening to unite against her. This includes the large and influential organization Postpartum Progress led by Katherine Stone.There was a call for a “virtual pushback” on twitter with #Meditateonthis and Facebook Postpartum Depression is Real.

Before I enter into the fray with my view on this issue, I would like to call attention to a central fact.
depression is different from other forms of depression because it exists in the context of caring for a new human who is completely helpless, or to use the words of pediatrician turned psychoanalyst D.W.Winnicott, absolutely dependent.

Having worked with many new mothers and fathers, I have no doubt that the wide range of serious emotional disturbances that new parents experience, are real. Certainly in mothers, hormonal changes that result from pregnancy play a role, though other explanations are in order for fathers, and for the increasingly well-recognized phenomenon of post-adoption depression.

There are ways in which both sides of this debate are “right.” PPD must be identified and treated. Medication has a role to play and may in some circumstances be lifesaving. But to effectively treat the problem we should be able to address the issue in its full complexity, as I address in my forthcoming book
The Silenced Child
, from the outset.

This calls for acknowledging the massive biological and psychological shifts of motherhood, the reorganization of the relationship between parents, the role of the baby, as well as the normal ambivalence that accompanies this developmental phase. All this may be distorted in the setting of social isolation, severe sleep deprivation, and unrealistic expectations of rapid return to pre-pregnancy function.

This critically important issue has been woefully neglected in our culture for a long time, to the detriment of parents, infants, siblings, whole families. It has significance not just for mothers but for the future of our society. I am hopeful that all who feel passionately about supporting young families can find a way to come together on common ground.

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