Maternal Mental Health Is Having a Moment. What Is This Moment Asking Us to Pay Attention To?
Maternal mental health is having a moment.
The Lindsay Clancy trial has brought enormous attention to postpartum mental illness and forced a very public conversation about what can happen when a mother becomes profoundly unwell.
It has raised questions about postpartum psychosis, psychiatric medication, diagnosis, hospitalization, communication between providers, the role of family members, and whether our mental health system knows how to recognize when a mother is in serious danger.
These are important conversations and we need to have them. But I hope we don’t stop there, because most maternal mental health struggles will never look anything like the tragedy that happened in the Clancy family.
They look like a mother lying awake at 2 a.m. even though her baby is finally sleeping because her brain won’t stop scanning for everything that could go wrong. They look like spending hours researching sleep schedules, feeding, daycare, milestones or attachment because making the wrong decision suddenly feels incredibly high stakes. They look like irritability, rage, guilt, intrusive thoughts, perfectionism, loneliness, hypervigilance and exhaustion. And sometimes they look like a highly capable woman who is getting everyone where they need to go, doing her job, answering texts, making dinner and appearing completely fine.
I’ve spent more than 20 years working in maternal mental health, and I think this particular moment is asking us to widen the conversation.
Here are seven places I think we need to start.
1. We need more clinicians who actually understand maternal mental health.
This goes beyond therapists and psychiatrists. Every professional caring for women during pregnancy, postpartum and early motherhood needs training to recognize the nuances of perinatal anxiety, depression, OCD, trauma, bipolar disorder and psychosis—and to understand the psychological transition into motherhood itself.
These conditions don’t all look the same. They don’t carry the same risks. And they don’t require the same response.
A mother disclosing frightening intrusive thoughts, for example, is not automatically a mother who wants to hurt her child. Understanding distinctions like these matters hugely, because mothers need to be able to tell us what is actually happening inside their minds without fearing that simply telling the truth will make people afraid of them.
2. We need much better coordination of care.
One of the things maternal mental health has taught me over and over again is that having more providers does not necessarily mean having better care.
A mother can have an OB-GYN, primary care doctor, therapist, psychiatrist and other specialists involved in her treatment and still have nobody holding the whole picture.
Who knows what she was like six months ago? Who knows how much she’s sleeping now? Who knows that her partner has noticed a significant change in her behavior? Who is tracking medication changes? Who is noticing that she is getting worse rather than better? And, perhaps most importantly, who is making sure all of these people are talking to each other?
Mothers deserve care that sees the whole person, not a collection of symptoms divided among different offices.
3. We need to understand the difference between distress, intrusive thoughts and dangerousness.
This is particularly important in the wake of a case as frightening as Lindsay Clancy’s. If every disturbing thought a mother reports is interpreted as evidence that she may hurt her child, women will learn very quickly not to tell us what they are thinking. And that makes everyone less safe.
Intrusive thoughts can be super upsetting. A mom may be horrified by them precisely because they are so inconsistent with what she wants and who she knows herself to be. Clinicians need enough specialized knowledge to ask better questions, understand what they’re hearing and accurately assess risk.
Mothers need to know that they can tell us the truth.
4. We need to take maternal suffering seriously long before it becomes a crisis.
The overwhelming majority of mothers struggling with their mental health are not psychotic, they are not dangerous, and their stories will never make the news.
But they are suffering.
For years, I’ve worked with incredibly competent women who can run companies, care for patients, argue cases, lead teams and solve complicated problems, and then find themselves completely undone by the uncertainty of motherhood.
They can’t figure out why their baby isn’t sleeping. They worry constantly about whether they’re doing enough. They replay something they said to their child and wonder whether they’ve damaged them. They research until midnight trying to find the “right” answer. And they lose their temper and spend the rest of the day drowning in guilt.
From the outside, they often look fine.
We need to stop using visible dysfunction as the threshold for whether a mother deserves support.
5. We need to pay more attention to what happens psychologically when a woman becomes a mother.
Motherhood isn’t only the addition of a baby to an otherwise unchanged life. Your identity changes. Your relationships change. Your body changes. Your time changes. Your work may change. Your priorities shift. The amount of responsibility you carry can feel gigantic. Suddenly you are deeply attached to another human being whose wellbeing you cannot completely control.
That last part matters. Motherhood contains an extraordinary amount of uncertainty.
For women who have spent their lives becoming very good at planning, anticipating, organizing, analyzing and solving, that uncertainty can be deeply uncomfortable. Those abilities haven’t suddenly become problems; they are often part of what has made these women successful. But motherhood asks for additional capacities too.
Such as the ability to stay present when you don’t know. To tolerate discomfort without immediately needing to make it disappear. To notice what is actually happening before deciding what it means. To remain connected to yourself and your child when the moment isn’t going the way you hoped.
We don’t talk nearly enough about this part of maternal mental health.
6. We need to stop locating maternal mental health entirely inside the mother.
A mother’s mental health doesn’t exist in a vacuum. Sleep, childcare matters, money, work, her relationships, and her physical recovery from pregnancy and birth all matter.
Whether she has people she can call when she’s falling apart is incredibly important. As is paid leave, affordable, high-quality childcare, and all the expectations we place on mothers.
We can offer women therapy and medication when those things are needed while also being willing to ask whether the conditions in which we’re asking them to mother are actually sustainable.
Maternal mental health is both individual and systemic, and we need to be able to hold both.
7. We need a bigger definition of maternal mental health.
For a long time, much of the maternal mental health movement has understandably focused on identifying illness. We ask questions like, Is she depressed? Is she anxious? Does she need treatment? Is she safe?
These questions are essential. We definitely need better screening, better diagnosis, better treatment and easier access to specialized care.
But I want us to ask another set of questions too. Questions like, Can she stay connected to herself when things are hard? Can she tolerate uncertainty without immediately assuming something has gone terribly wrong? Can she trust herself to make a decision when there isn’t one perfect answer? Can she repair with her child after she loses her patience? Can she ask for help? Can she remain connected to the people she loves without disappearing herself? Can she experience motherhood as a full human being—with needs, ambitions, relationships, desires and an identity that extends beyond being someone’s mother?
Preventing and treating illness is imperative.
And helping mothers build the capacity to thrive in motherhood is imperative, too.
Let’s not waste this moment.
Three children died in the Clancy family tragedy. A mother became profoundly unwell. A father and an entire family experienced an unimaginable loss. There is nothing useful about trying to make something like that tidy or easy to understand.
But when a tragedy forces an entire culture to pay attention to maternal mental health, I hope we are brave enough to look at the whole picture.
We need better-trained clinicians. Better coordinated care. Better understanding of maternal psychiatric illness. Better support for families. Better systems surrounding mothers. And we need to start caring about maternal wellbeing long before a woman reaches a breaking point.
Mothers deserve more than our attention when something has gone terribly wrong. They deserve the support they need to be well while they are doing the incredibly demanding work of raising the next generation.
And our children benefit when they do.
What do you think we’re still missing when we talk about maternal mental health?
