In our book A Womb of Her Own (Routledge, 2017) author Kristin Reale writes as follows: After further investigation (Blum, 2007) it seems that the strongest evidence of a biological cause of post partum depression is what the literature refers to as “mood reactivity”, meaning that women who have had premenstrual dysphoric disorder (PMDD) may be predisposed to postpartum depression (Bloch, Rotenberg, Koren, & Klein, 2005). However, this view sees women in a biological vacuum, and begs the question as to what other psychoanalytic forces could also exist in conjunction with premenstrual dysphoric disorder.
While we know that there are certain external and psychosocial factors that have been concretely stated that predispose a woman to be at risk of PPD including: prior depression, prior postpartum depression, an unwanted pregnancy, depression or anxiety during pregnancy, low levels of social support (especially in the marriage), lack of sleep, and the experience of stressful life events during pregnancy or the early postpartum period (Robertson et al., 2004), these factors have unfortunately not been researched through the lens of maternal psychology. Noting that there has been an incidence of adoptive mothers who have also suffered from postpartum depression — as well as documented cases of fathers — we must call into question the focus of PPD having been framed as a mostly biological or only psychosocial causation. (Blum, 2007)
Furthermore, while a great amount of research has been done on the psychological needs and ideal mental outcomes of the baby (Bowlby, 1978; Beebe, 2010; Beebe & Lachmann, 2002; Schore, 2000; Schore, 2010), very little attention has been focused on the new mother’s intricate maternal psychological needs while in the face of this incredible physical and emotional demand of the infant. Through the well branded notion of the idealized mother, and arguably even through the lens of the much lowered bar of the “good enough mother”, it has been assumed that women can “naturally” and “instinctually” fulfill the immense needs of an infant 24 hour, 7 days a week — as if the new mother has been in some kind of training for this new roll for years. When in reality, the new mother has had zero training, except perhaps how she was taking care of an infant herself. The literature of Schore, et al only takes into consideration the absolute needs of the baby while neglecting the immense demand this research puts on mothers.
Thankfully, although on a minimal basis, there does exist some psychodynamcially driven postpartum literature noting Blum (2007) . He investigates a far more psychoanalytically minded view of post partum depression and calls for the biological framework to be challenged. Blum (2007) notes that there is a kind of “trifecta” psychodynamically that leads to postpartum depression. This causal “trifecta” includes women who have difficulties in expressing their own anger, unmet dependency wishes and needs, and a very conflictual relationship with their own mother (Blum, 2007). The dependency conflicts typically take on a unique counterdependent form: over-compensatory ways of being may have been adaptive for the mother’s life and survival pre-baby, but she finds herself undefended against and exposed to her overwhelming own needs to be taken care of in the face of a newborn. Interestingly, counterdependence is noted to be a common trait found in health and mental health professionals who are consciously and subconsciously used to taking care of others and sidelining their own needs. (Blum, 2007) This brings me to my own story and how I am a wonderful example of the counterdependent new mother who suffered in the midst of the misunderstood postpartum experience, crumbling under the pressure of the idealized mother and the pressure to perfectly hold.
Beebe, B., Jaffe, J., Markese, S., Buck, K., Chen, H., Cohen, P., Bahrick, L., Andrews, H., & Feldstein, S. The origins of 12-month attachment: A microanalysis of 4-month mother-infant interaction. Attachment & Human Development, 2010, Jan 12 (1-2), 1-135.
Beebe, B., & Lachmann, F. (2002). Infant Research and Adult Treatment: Co-Constructing Interactions. Hillsdale, N.J.: Analytic Press.
Bloch, M., Rotenberg, N., Koren, D., & Klein, E. (2005). Risk factors associated with the development of postpartum mood disorders. Journal of Affective Disorders, 88, 9 –18.
Blum, Lawrence D. Psychodynamics of postpartum depression. Psychoanalytic Psychology, Vol 24(1), Jan 2007, 45-62.
Bowlby J. Attachment theory and its therapeutic implications. In: Feinstein SC Giovacchini PL, eds. Adolescent psychiatry: Developmental and clinical studies. Chicago: University of Chicago Press, 1978.
Bowlby, J. (1958). The nature of the childs tie to his mother. International Journal of Psychoanalysis, 39, 350-371.
Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26, 289 –295.
Schore, AN. Relational trauma and the developing right brain: The neurobiology of broken attachment bonds.Chapter in T. Baradon (Ed.), Relational trauma in infancy (pp. 19-47). London: Routledge, 2010.
Schore AN. Attachment and the regulation of the right brain. Attachment & Human Development 2000; 2: 23-47.