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Thursday, October 13

Postpartum Depression in the 1950s, my Grandmother's Story (or A Short History of Postparturm Depression, from 1950-Now)

In 1951, after giving birth to her first child, my grandmother developed postpartum depression. She was diagnosed as having a "nervous condition". Her treatment took the form of electroshock therapy.  She was twenty years old at the time. Separated from her family she was sent to a mental hospital in St. Thomas, many miles away from her home. In the meantime my grandfather was left to watch over his newborn daughter. He moved back in with his parents, and did what he could to take care of the baby, while also holding down a full-time job. Each and every weekend he made the four hour drive to visit his wife in the mental hospital.
Young couple on the riverbank in 1949.
My grandparents circa 1949.

Finally, after almost a year my grandmother was pronounced cured and was released to return to her family.  She went on to have two further children without incident. Everything seemed to be going fine until she reached menopause.  The hormonal changes combined with the damage that had been done to her brain during the electroshock therapy worked together to cause her to have a second nervous breakdown. She began seeing a psychiatrist and was to be on psychiatric drugs for the rest of her life.

I didn't learn this story all at once, but in bits and pieces as I grew older. I knew, from when I was a teenager on, that my grandmother had some mental health problems. Sometimes she forgot or refused to take her medication and suffered bouts of paranoia. The sort that would have her demanding that she needed to change all the locks in the house because the neighbours were sneaking in and stealing her Harlequin romance novels.

Then at the age of 80 my grandmother had a mild stroke.  It was such a mild stroke it slipped by unnoticed, but what it did do was again change the chemical balance in her brain so that the dosages for her medication were now off. She slipped into bizarre and paranoid behaviour. It took months for us to figure out what was actually going wrong. Once they realized she'd had a stroke and adjusted her medication, she was in a much more balanced state. Again the doctors mentioned that this was likely a side effect of her earlier treatments. The after effects of her postpartum depression, in particular the after effects of the electroshock therapy, were to remain with my grandmother for her entire life.

It is a sad story, but unfortunately not an uncommon one.  I originally thought that my grandmother must have been a very extreme case in order to have been treated as she was.  I thought perhaps she had suffered from  postpartum psychosis, a far rarer and more intense version of postpartum depression.  I started reading up on it, and I was shocked to discover that my grandmother was far from alone. Though not always separated from their families for such long periods of time, many woman during the 40s, 50s and 60s received electroshock therapy to help treat "nervous conditions", a catch all phrase used to cover everything from postpartum depression to mild psychosis. It was a very common treatment choice for the time.

I was aware of electroshock therapy, but thought it was something they stopped using at the turn of the century.  After a bit of research I discovered that it actually wasn't introduced until 1938. The doctors who developed the treatment were even nominated for a Nobel prize.

I was surprised and disgusted to find out that it was the popular treatment of choice in the 1950s. I was even further surprised to discover that electroshock therapy is still in use today.  A CBC news article from 2008 opens with the line, "Despite protests calling for a ban in the treatment, electroshock therapy is frequently used by Canadian psychiatrists to treat severe depression."

Though apparently it's a bit different then the treatment my grandmother would have received in 1950. Now a days they sedate the patient, and give them a muscle relaxant, so it's a slightly more humane experience - though overall the effect upon your brain remains the same. There are some differences between pioneer and modern electroshock therapy that I don't claim to understand, such as the change over from unilateral sinisoidal current to constant current brief pulse. Unilateral was used by some doctors in the 1940s and early 1950s, and I don't know if my grandmother received unilateral or constant current electroshock therapy. 

But the purpose of this article isn't to bash electroshock therapy. It's to highlight the differences in how postpartum depression is treated today vs. how it was treated in my grandmother's time.  In the 1950s there was no acknowledgement of postpartum depression as a valid medical condition.  A women, like my grandmother, who had a bout of postpartum depression was described as having a "nervous condition" or "bad nerves". All of this was hushed up and never really spoken of.

I have my grandmother's copy of Every Woman's Standard Medical guide from 1948. The chapter on pregnancy and birth, which covers up to six weeks post-birth, makes absolutely no mention of postpartum depression, or any of the normal feelings or anxieties you may experience post-birth. .  There are however two entire chapters dedicated to "Nervous Tension" in women. When going into reasons that women develop "bad nerves" it mentions that "Arrival of a new baby may be a signal for the beginning of nervous tension in the sensitive, anxious woman." Far from reassuring, it places the blame back on the woman for being too sensitive or anxious.

This was the closest my grandmother's medical book came
to hinting at the existence of postpartum depression.

When my mother gave birth to me in 1975 and later my baby brother who was born in 1978, no one spoke to her about postpartum depression. No one explained to her that it was normal, something that one in four women experience. She described to me her feelings after my little brother was born, "I knew something was wrong with me, but I had no clue what it was."

By the time my mother gave birth to my sister in 1983, there had been a change in the medical scene. This time she was provided with information on postpartum depression by her family doctor and the hospital.  It was at this point that she had the ah-ha moment and realized what she had been going through back in 1978 was perfectly normal.

Today, and I am speaking from my personal experiences after having gone through two pregnancies,  today we are bombarded with info about postpartum depression. I was handed pamphlets throughout each stage of my pregnancy. There were posters hung on the wall in the O.B. and midwife's office. Every pregnancy or baby book you pick up has a chapter devoted to the topic. I'm not sure if this is the same across Canada, but here in Windsor, after being released from the hospital the local health nurse calls, and even visits your house, to check in with you and see how you are doing. Every post-birth appointment I had with a doctor or midwife they would gingerly ask, "How are you feeling?" and I would have to reassure them that I was fine.  I was lucky in that I never went through postpartum depression personally.  I will freely admit my hormones were out of whack after giving birth, and I remember having crying bouts within the first few days after having each babe, but nothing serious and sustained. It was actually a bit overwhelming to have people constantly checking on you, and sort of expecting you to snap.

But then compare it to the alternative, where no one talks about postpartum depression, or is willing to admit that it is a real and serious condition.  I think we as women are lucky to live in a time when postpartum depression is recognized as a valid medical condition, and we are also lucky that electroshock therapy is no longer considered the treatment of choice. Now a days postpartum depression is treated through a variety of methods, including psychotherapy, support groups, and medication.

But when did the change over in public perception occur?  I don't believe there was one defining moment when the public perception shifted, I think it was a gradual shift over time. From what I've read, starting in the 1970s, amid renewed scientific interest in mental illnesses in general, postpartum depression began to gain new recognition. Though even then, most women struggled with the illness on their own.

I decided to write about this, and share my mother and my grandmother's personal stories with you, because I think it is important to know just how lucky we are with the way things are right now, with the fact that postpartum depression is a widely recognized medical condition, and one that is treated humanely.  I also think it is terribly important to not let it slip from the public mind. It needs to keep being talked about. The support needs to be there for the women who are suffering, for the women who are pregnant and need to know what they may be coming into. Even the mild depression and wacky hormonal stage that I went through after child birth, or the Baby Blues as it's usually termed, could be terrifying if you didn't know it was a normal phase of your body adjusting post-birth.

I don't want the story of what my grandmother went through, what many women of her time went through, to be lost. In twenty-some years time when my daughters are becoming mothers, I want them to receive the same, or better, level of care and support that we are seeing today. I don't ever want postpartum depression and it's discussion, it's acknowledgement,  to slip into a dark and secret place again.

The following definitions and stats are taken from the Public Health Agency of Canada's Family Centered Maternity and Newborn Care: National Guide Lines

Postpartum blues, or baby blues, are experienced by 45 to 80 percent of postpartum women. Common symptoms are insomnia, sadness, mood changes, tearfulness, fatigue, headaches, poor concentration, and confusion. These symptoms are usually transient: beginning on the third or fourth day after birth, they last one to two weeks and then disappear without treatment.
Ten to twenty percent of women experience postpartum depression during the first year after birth. Usually, it begins within two weeks to six months of birth. Although a form of clinical depression, it is not psychotic in nature. Common symptoms are periods of excessive crying, feelings of despondency and guilt, emotional lability, anorexia, insomnia, feelings of inadequacy, poor self-esteem, inability to cope, social withdrawal, and concern about "not loving the baby." The many physical symptoms include impaired concentration, irritability, poor memory, and fatigue.

I was selected as one of the Summer 2011 recipients for Mom Central Canada Blogger Grant, and received compensation for the above post.  Mom Central Canada's Blogger Grant Program provides financial aid to Canadian bloggers in the Mom Central Canada network who have a compelling story to tell and who want to help make the lives of busy moms and their families better.
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