On the Epistemology of Postpartum Depression

With respect to the epistemology of perinatal mood and anxiety disorders, we follow the rules of the road. When I say we, I mean all of us. We collectively look at the different formulations of objective truths about PPD and agree that it is what we say it is, lead by the language of science. With good intention, yet limited success, science attempts to reinvent new ways of knowing, measuring or treating PPD that correct errors in the previous models. We collectively agree that science is the objective observer—looking at the woman, the womb, and the world of PPD from a clean disengaged, rational distance. The nature of the positivist/postpositivist epistemological venture is to get the world to look at PPD differently, more clearly–to use empirical science to present the knowledge about PPD to us, and to use the scientific method to produce all knowledge about it, including how to diagnose, treat, and prevent it. How is that going so far? Have we nailed down what it is, where it is, when it is and how to fix it? Given that the same science describes prevalence rates remaining as high as 60% in developing countries and as high as 20% in the US, I would argue that we could use an alternative perspective. I have been researching perinatal mood and anxiety disorders for over a decade. The reality presented in the scientific literature and by the stories of women I interview is the same reality my mother experienced 52 years ago. How can we shift our strategies of knowing to get at the core of what underlies this phenomenon, postpartum depression?

Phenomenologists would suggest that we might do better to try to examine the lenses through which PPD is constructed into reality by empirical science. The ontological nature of PPD should take its place within the world of knowledge about a disorder labeled by science and carried by women. Maybe mothers need to examine all of the words and methods used to treat us, the years of education that confirm a concrete reality in the minds of providers about who we are, what our bodies do, and what is and is not abnormal.

Consider an OBGYN who is technically a surgeon, given the responsibility of detecting symptoms of PPD and referring to appropriate care providers, or treating the symptoms herself. She completed a residency for x amount of years and had one 6-week rotation in psychiatry. Before that, she attended medical school where she spent 6 years studying biology, physiology, anatomy, chemistry. Before that, she attended a four-year university where she studied biology, physiology, anatomy, chemistry. Before that, she attended high school where she studied the same biology, physiology, anatomy, and chemistry for four years. Before that, she attended an elementary and middle school where she learned biology, physiology, anatomy, and chemistry.

So, on this day, a perfectly well-meaning, highly trained woman looks at another woman. They look at one another agreeing to use the thick lens of nearly 25 years of education on biology, physiology, anatomy, and chemistry. The reality created by those lenses is that one woman is a doctor, one woman is a patient. One is well, one is potentially sick. They have come together that day for the doctor to determine the normal (healthy) from the abnormal (potentially unhealthy) of the patient through a visual examination and laboratory testing protocol designed by biology, physiology, anatomy, and chemistry. The doctor and the patient believe the reality of the findings, as they are based on scientific evidence. Yet, with all of the evidence, when it comes to women’s mental illness, the arrangement between the doctor and the patient fails miserably, and predictably.

Are we so habituated to the familiarity of science that we co-create a reality about PPD that is by its very nature flawed? 

Instead of trying (and failing) to get the evidence of this thing right, maybe we would discover more about it by looking critically at the methods of getting the evidence. If we know, for example, that a set of questions can predict the presence of disease, yet the disorder remains at a consistently high prevalence—may be an examination of the questions themselves, the language, the history of how they came to be used, and by whom would show us where we got it wrong. What would happen if we unpacked the reasons that we have identified something as abnormal and thus created concrete ways that abnormality is realized? We create the reality of PPD as it exists through the lenses of science. And we still don’t get it right! 

Without the lens of science, what would exist?  What would we know more clearly? How would we come to know it differently? If the essential nature of the phenomenon were allowed to be revealed, what words would we put to it and what meanings would those words take? What dimensions of experience would it offer? Would there be any disorder at all? Or is the disorder actually our disordered habit of hailing objective science as empirical?

The phenomenon is not a score of 13 or higher on the EPDS. It is not the soul-crushing self-loathing experienced over sleep-deprived nights and bloody, cracked nipples. It is neither the personal anguish nor the diagnosed disorder. The entity, the phenomenon of PPD has yet to be revealed.

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