Research Paper on "Postpartum Depression and the Yellow Wallpaper"

Research Paper 7 pages (2000 words) Sources: 8

[EXCERPT] . . . .

Postpartum Depression

Past and Current Understanding of Postpartum Depression: Comparative Analysis of "The "Yellow Wallpaper

Postpartum depression (PPD) also referred to as postnatal depression, is defined as a form of clinical depression which may affect women, and to a lesser degree men, subsequent to the birth of a child in most instances. Recent empirical studies report prevalence rates among women from approximately 5 to 25%; however methodological differences in the studies make the actual rate of prevalence unclear (Kinnaman & Jacobs 2006). Common symptoms associated with postpartum depression include irritability, sadness, guilt, low self-esteem, inability to be comforted, emptiness, social withdrawal, feelings of inadequacy with regard to caretaking of the baby, changes in eating and sleeping patterns, anxiety, and fatigue, episodes of crying and decreased libido. Although a number of risk factors have been associated with the onset of postpartum depression, the cause of PPD still remain not well understood (Cox, Holden, & Sagovsky 1987).

"The Yellow Wallpaper" by Charlotte Perkins Gilman (1892) is a first person description of her own experiences as articulated in her journal and narrated by her. Gilman is reported to be suffering with some form of 'nervous depression' (Knight 1997); however, literary scholars have determined her condition to be postpartum depression. Her husband and doctor John, who is described as a highly qualified physician, is described as minimizing Gilman's condition as well as her suspicions regarding the homestead that he elected to use for her rest-cure prescription. Gilman's treatment from her husband, and seconded by her brother, who was also a physician, was to avoid doing anything that would make her tire, the basis of the rest cure prescription purportedly indicative of the time; including refraining from writing or work of any kind. Although she feels that being active, working and writing would help her to feel better, it is strictly prohibited (Knight 1994).

The understanding of and treatment the narrator in "The Yellow Wallpaper" was subjected to and the level of understanding and the treatment many women suffering with postpartum depression are vastly different. There are a number of scientific and empirical studies and peer reviewed scholarly literature in support of the notion that postpartum depression is a treatable condition using a variety of methodologies.

Current Understanding & Treatment of Postpartum Depression

The caregiver infant relationship has been described as one of the most significant relational units nested within a complex paradigm of interacting individual, ecological, and societal factors that are assistive in shaping developmental outcomes (Goodman 2007, p. 107).

Quality maternal infant emotional bonds and the attachment security provided form the basis for infant mental representations of the self and others, socio-emotional, cognitive, moral and self-regulatory development, as well as promote the optimal developmental trajectory from childhood through adolescence (Goodman 2007, p. 108).

The effects, then, of postpartum depression on infant-maternal attachment, maternal attunement, and the development of maternal infant synchrony are significant (Goodman 2007, p. 110). Many of the intervention approaches in the past have targeted either maternal depression or the mother infant attachment and interaction with limited effectiveness. Because of the increased levels of understanding with regard to the maternal infant connection and the significant impact postpartum depression has on the relationship, the call for more comprehensive treatment and intervention have been posited. Moreover, such interventions would necessarily consider the ecological factors such as socioeconomic status that may well serve to exacerbate the effects of maternal or postpartum depression on infant development as well as restrict or impeded access to effective psychosocial care (Thompson & Fox 2010, p. 250).

Mothers are at increased risk of developing depression when they have infants that are of low birth weight, high risk pregnancies, prematurity, poor motor functioning, and neonatal irritability (Besser, Priel & Wiznitzer 2002, p. 394). Additionally, the characteristics of depression that so significantly impact on maternal interactions with her child, other factors are important to be considered, which aid in the understanding that has been developed and is developing with regard to postpartum depression. If the mother has been diagnosed with depression pre-pregnancy, she is more significantly predisposed to relapse during the pregnancy. As much of the traditional treatment for depression is medication, this risks increases substantially if the use of anti-depressant medication is discontinued because of the pregnancy (Besser, Priel & Wiznitzer, 2002, p. 395). Depression during pregnancy not only has adverse consequences for the infant, they exist for the mother as well. The ecological factors, including socioeconomic status, combined with increased risks associated with higher numbers of life events, low self-esteem, high levels of stress, low family income and low satisfaction derived from the social support system or the absence thereof, play a significant role in the development of postpartum depression (Thompson & Fox 2010, p. 252).

Most of the current treatment for postpartum depression includes pharmacological treatment combined with psychological intervention. These approaches can include non-directive counseling and psychodynamic approaches, as well as cognitive behavioral intervention (Thomas & Fox 2010, p. 253). However, experts in the field have determined that singularly targeting the mothers' symptomology is not nearly as effective as a combined maternal child relationship intervention. The interventions that include both the mother and the child directly include the child in the intervention and attempt to restore order in the mother infant dyad. These may include mother-child psychodynamic psychotherapy, Watch Wait and Wonder and parent toddler psychotherapy, all contingent on the psychodynamic principles that where the mother is "encouraged to understand the influence of prior relationships on her current relationship with her infant, the mother child dyad will improve" (Thomas & Fox 2010, p. 254).

These kinds of therapies effectively serve to link the mother's present parental concerns to her own childhood conflicts, with the expectation that additional insight will promote greater competency and maternal functioning in the current dyad. The Watch, Wait and Wonder and Toddler Psychotherapy options also incorporate attachment theory wherein the mother is provided with support and guidance through specific instructions that are focused on increasing her sensitivity and responsiveness as well as inhibiting her intrusiveness with relation to her child (Thomas & Fox 2010 p. 254). Therefore, the mother aids and empowers the infant to work through core relational struggles with her, providing a greater sense of efficaciousness and mastery within the mother child interaction. According to researchers, these methodologies and approaches have resulted in marked improvement of maternal symptomology of depression, greater reciprocity, competence in the role of parent, decreased maternal intrusiveness in interactions and an enhanced parent child dyad.

Comparative Analysis with "The Yellow Wallpaper"

The kind of care the woman in the short story received was really no medical care at all; nor was there any psychological intervention provided as is typically with cases of postpartum depression today. Scott (2006) in her iteration regarding "The Yellow Wallpaper" maintains that the slightly hysterical propensity in which the main character is afflicted and displays as well as the fact that the narrator is required to acquiesce to societal pressures and adjust her condition to her circumstances is described as aversive by Scott (Knittel 2006). The prescribed course of treatment was for the woman to rest and deal with her own feelings of sadness, guilt, inability to manage the parent child interaction, left her in a position to 'let her imagination wonder'. Scott suggests the room in which the narrator was kept (trapped) bespeaks the preindustrial ideal setting that Gilman imaginarily constructed in her work "The Nervous Breakdown of Women" (1916). Because there was little to no understanding of the cause of postpartum depression (as there remains no clear cut causal factor today), no inclination from the medical community toward pharmacological intervention, and limited resources for cognitive intervention, women were left in asylum like institutions until the depressive symptomologies dissipated.

Scott's discontent with the nervous condition with which the narrator suffers is exemplified when she writes, "she begins to heal, at least in the eyes of those who observe her and look for nervousness" (2009). The fact that the narrator moves to an obsessive state with regard to the wallpaper is described as bizarre fascinations and the directing of excess energy toward an understanding and appreciation of the wallpaper and the room that contains it. Scott reduces the extravagant and detail description of the wallpaper by the narrator to "irritating ornate imaginations of the beholder."

Because the woman in the story was the product of her own time, socioeconomic status, and circumstances, she never described her situation as a prison or something she should openly fight against. Maybe she was fortunate because her husband and brother were both doctors that she did not have to wait out her symptoms in a much more depressive public institution. Her socioeconomic status afforded her the opportunity to go to a summer home to wait for the symptoms of postpartum depression to dissipate. It is interesting that at no time was there any direct information provided in the storyline as to the status of the child. Maybe the hand maiden that was so readily available to her,… READ MORE

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