Stigma and the Language of Mental Health in Mothers
This is an article I submitted as part of a series titled, “Mental Health: The Missing Piece in Maternal Health.” It's a blog series co-hosted by the Maternal Health Task Force and the Mental Health Innovation Network at the London School of Hygiene and Tropical Medicine, as well as Dr. Jane Fisher of Monash University. Find the original article on the website of the Mental Health Innovation Network here (it was also cross-posted to the website of the Maternal Health Task Force).
How do we talk about mental illness in pregnancy?
Well, we don’t.
Not that we don’t know about it at all; pregnancy-related mental illness, for the most part, is well-recognised culturally. But it’s not what mothers talk about while they work and watch their children play.
The commonest maternal mental health problems are mood disorders, with more than half experiencing “baby blues” and one in ten women having full-blown depression. Psychotic illnesses are even more serious, but a thankfully much smaller number experience this.
Together with their partners (where partners are supportive), new mothers struggle to come to terms with symptoms they themselves can barely articulate. Both the women and their partners feel alone, while unknown to them, similar experiences within their own circle of friends and family members might well abound.
And that, if nothing else, needs to change.
The reasons for this silence on maternal mental health issues are not far-fetched. Childbirth is a greatly celebrated event, which makes any feelings of remorse at this time highly stigmatized. In many low- and middle-income countries (LMICs), a child is considered a token of divine favour (especially if the child is male), and cements a woman’s place in her husband’s home (especially if it is polygamous).
However, the opposite holds true, too: the inability to have a child is often seen as a sign of disfavour, or even a curse. (Such women, typically described as “barren,” are sometimes tagged as witches.) Not only that, but anything that differs from perceived childbirth norms is potentially stigmatising. For instance, the stigma associated with childbirth via caesarean section is easily observed in the way we talk about it. Women talk about having their children “normally” (with the implication that anything other than vaginal delivery is abnormal), or “by themselves” (which contains a subtle hint at weakness in those who require the “assistance” of surgery).
Given such beliefs, it is not hard to understand a woman’s reluctance to admit to anything—like negative feelings surrounding childbirth—that would cast criticisms and shame on her as being out of favour.
Among such shame-casting problems, those of mental health might well loom largest. Again, the language we use illustrates the problem: for instance, among the Yoruba culture in Nigeria, a common description of mental illness is as a “spiritual attack.” If childbirth is a divine gift, mental health problems are the diabolical corollary, and, therefore, the only help recommended is spiritual.
This stigma does not only affect the mother, however. A mother with mental health problems is likely to be considered unfit to breastfeed by her family, especially her in-laws, which poorly affects her health and the health of her child. In addition, children may well grow up to stigmatise their mothers, bringing it all full circle.
If we are going to change maternal mental health outcomes in LMICs, we need to change the way we talk about mental health in pregnancy within our communities—even the way we talk about pregnancy as a whole.
We need to figure out how to use language to capture mental health problems in pregnancy as part of the range of possible health problems all women can experience. The language doesn't have to work against us; we can make it work for us. We can use it to change the perception of pregnancy as something that must occur in a certain way. Pregnancy and childbirth are gifts, whichever way they occur: with or without pain, with or without surgery, with or without mental health problems.
With a better understanding of our languages, we can learn to communicate that.
Check out other posts in the Mental Health: The Missing Piece in Maternal Health blog series.
Photo: “Lekki-Peninsula, Lagos” ©2007 Seattle Globalist, used under a Creative Commons Attribution license: http://creativecommons.org/licenses/by/2.0/