The primary purpose of the bio-psychiatric-pharma faction is to expand turf and sell more drugs. This is a multi-faceted endeavor, one component of which is disease mongering. This consists of using marketing techniques to persuade large numbers of people that they have an illness which needs to be treated with drugs.
With regards to postpartum depression, it is an obvious fact that some mothers do indeed experience a measure of depression in the period after giving birth. The term postpartum depression has in the past been generally understood to mean that the problem had something to do with hormones. Today brain chemicals are blamed.
In the old days (pre-1950) postpartum depression was rare. But perhaps back then things weren’t so difficult. Most women were in stable relationships and did not work outside the home. Extended families were usually close by, and for the most part, babies were born at home.
Today it’s very different. Many women react negatively to the loss of autonomy they experience in a hospital setting. And when they come home, they are often overwhelmed by the extra work, the sense of isolation, and by the lack of sleep. In this context, it’s very easy to start doubting oneself, and young women in particular can become very susceptible to the psychiatric-pharma pitch.
Over the years, I’ve worked with a good number of postpartum women who were depressed. In my view their major needs were: someone supportive to talk to (not necessarily a mental health worker), some practical help with childcare and chores, and sympathetic, non-judgmental encouragement.
For years psychiatry/pharma has been promoting the idea of universal screening for postpartum depression, i.e. that all postpartum women should be screened for depression. They’ve made a great deal of progress in this area, and in the US we may be fairly close to universal screening already.
Screening, however, is a very insidious concept. It sounds so benign. “We just want to check to see if you’re sick.” Who can argue with that? But the reality is that the thresholds are set ridiculously low, and the “screen” is simply a “patient” recruiting tool.
The new mother is vulnerable and perhaps lacking in confidence, and is an easy sell. Any resistance on her part is countered by the assurance that getting “treatment” is the best thing she can do “for the baby.”
The marketing pitch doesn’t stop with depression. Postpartum Progress lists the other “illnesses” that the postpartum mother needs to be aware of (link here):
- Antenatal Depression
- Postpartum Anxiety
- Postpartum OCD
- Postpartum Panic Disorder
- Postpartum Post-Traumatic Stress Disorder
- Postpartum Psychosis
Nor does it stop with the mother. Check out Postpartum Men! And why not? An untapped market is like money going down the drain. Perhaps next we should have postpartum screening for the baby’s siblings, so we can get big brother and big sister on drugs too. It makes sense. The arrival of a new baby inevitably precipitates some negative feelings. Left untreated, who knows where this could lead? And what about the baby him/herself? Enough.
Fortunately there are some sane voices out there also. Evelyn Pringle has written some great critiques of the postpartum marketing. Dyan Neary (here) addresses the issue of pregnant women being prescribed psychotropic drugs. Paula Caplan weighs in energetically here. All good reading.
Last month (March 2013) an article by Katherine Wisner MD et al appeared in JAMA. It was titled Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings. You can see the abstract here.
In the study, 10,000 women who had recently given birth were screened for depression using a 10 item questionnaire. Fourteen percent screened positive for depression, and of those, 98% were found on interview to have a DSM “diagnosis.”
The study is methodologically flawed. James Coyne PhD has written an excellent critique titled Time to screen postpartum women for depression and suicidality to save lives? (From the title you might get the impression that Dr. Coyne is advocating screening – but note the question mark. It’s a critique.)
By the way, Dr. Wisner has ties to Eli Lilly. Stephen Wisniewski PhD, one of the other authors of the JAMA article, consults for a number of pharmaceutical companies.
This is another example of spurious research being used as a marketing tool.
Postpartum depression is not an illness. Nor is it a function of hormones or brain chemicals. It stems from the fact that some new mothers feel isolated, vulnerable, unsure of themselves, and overwhelmed. In some cases, they have had a difficult or unpleasant birthing experience. These problems can only be addressed through human contact, reliable support, sympathetic encouragement, and practical help.