In this piece for ZMag.org, Dr. Bruce E. Levine examines the state of modern psychiatry, with its over-reliance on potentially hazardous medications and the blurred ethical line between doctors and pharmaceutical companies, and poses the question: If the US has a 10–25% rate of post-partem depression, while places like Fiji and China have far lower rates, is there really something wrong with you—or could it be there is something fundamentally wrong with American society?
Postpartum depression among women in the United States occurs at a rate of between 10 to 20 percent, but it is rare in several cultures where new mothers routinely receive structured social support following childbirth. Yet, currently Congress is legislating increased medical treatment for postpartum depression rather than confronting its societal roots.
In the United States, one in three doctor’s visits by women involves an antidepressant prescription, 11 percent of women take antidepressants, and a 2007 study of pregnant women enrolled in Tennessee Medicaid revealed that antidepressant use during pregnancy increased from 5.7 percent in 1999 to 13.4 percent in 2003.
With respect to children not “fitting” into standardized schools, U.S. doctors have been heavily encouraged since the early 1980s to diagnose them with attention deficit hyperactivity disorder (ADHD)—and to prescribe Ritalin, Adderall, and other amphetamines. Today the practice of drugging “difficult-to-manage” children continues, augmented with more serious psychiatric diagnoses and more powerful drugs. The diagnosing of children with bipolar disorder in the U.S. has increased 40-fold from 1994 to 2003 and bipolar-labeled children are now the fastest-growing part of the approximately $12 billion U.S. market for antipsychotic tranquilizing drugs such as Zyprexa and Risperdal.
In 2008 Congressional investigators began paying attention to the financial relationships that drug companies have with both individual psychiatrists and the American Psychiatric Association. Though this Congressional investigation has been covered by the corporate press, they do not make clear that Big Pharma has virtually annexed every major mental health institution from which U.S. doctors and the general public receive their mental health information. The corporate press most certainly does not report why increasing numbers of Americans are having emotional difficulties.
Postpartum Depression: Cultural Disorder?
Official American psychiatry repeatedly states that postpartum depression occurs in 10 to 20 percent of new mothers. The truth is that postpartum depression occurs in 10 to 20 percent of American mothers—not all mothers. A 2004 cross-cultural review in BMJ (formerly the British Medical Journal) reported that postpartum depression is rare in Fiji and in traditional African and Chinese populations. BMJ authors concluded that “structured social supports after childbirth are described in groups of women with low rates of postpartum depression.”
Medical anthropologists Ann Becker and Dominic Lee in “Indigenous Models for Attenuation of Post Partum Depression” (a chapter in the World Mental Health Casebook, 2002) report that postpartum depression in Fiji occurs at a rate of 1 percent. For Fiji women after childbirth, there is mandated extended relief from domestic responsibilities such as laundry and cooking (for three to four months) as well as relief from work on the family farm (for one year). Given that a Fiji woman’s daily life consist of exhausting physical labor, this relief represents a serious commitment by the household and the culture to the new mother’s well being. In addition to this extended relief, a caretaker (often the woman’s mother or sister-in-law) is designated to assist in the caring of both the new mother and her infant.
In traditional Chinese culture there is the postpartum custom called peiyue, which means attending. Peiyue requires an elder female relative to help the new mother with domestic duties for a month. Becker and Lee report that in one Hong Kong study, women who did not observe peiyue were four times more likely to suffer postpartum depression than women who observed peiyue.
Structured social supports for women after childbirth are decidedly missing from U.S. culture. On a modest level, social supports would mean universal paid maternity and paternity leave. On a deeper level, it would mean rethinking our cultural priorities. However, the U.S. Congress and psychiatry officialdom have chosen a different kind of assault on postpartum depression.
In 2007 the U.S. House of Representatives passed the Melanie Blocker-Stokes Postpartum Depression Research and Care Act and sent it to the U.S. Senate, which renamed it the Mothers Act. In 2008 the Mother’s Act was included in the omnibus bill “Advancing America’s Priorities Act” (that has not yet passed).
In the “Findings” section of the Mothers Act we are told that postpartum depression is a “devastating mood disorder” and that “postpartum depression is a treatable disorder if promptly diagnosed by a trained provider.” The stated goal of the Mothers Act is to “ensure that new mothers and their families are educated about postpartum depression, screened for symptoms and provided with essential services and to increase research at the National Institutes of Health on postpartum depression.” Critics of the Mothers Act, such as those at the International Center for the Study of Psychiatry and Psychology (not funded by Big Pharma), believe that the Mothers Act will merely ensure that federal dollars are used to increasingly diagnose, often unreliably, depression in pregnant and postpartum women—and then convince them that antidepressants are safe and effective.
In the Mothers Act official findings, several inconvenient truths about postpartum depression are omitted. Not many in Congress would vote for legislation that stated the U.S. could eliminate much of postpartum depression by transforming American values, culture, and economics. The Mothers Act findings neglect to mention, for example, a 1996 British Journal of Psychiatry article that reported postpartum depression is associated with unemployment of the mother (no job to return to), unemployment of the head of the household, not breast-feeding, and unplanned pregnancies. The Mothers Act findings also omit relevant truths about Blocker-Stokes, the woman for whom the initial House bill was named. Blocker-Stokes was a pharmaceutical sales manager who began suffering severe symptoms of depression after the birth of her child. She was hospitalized three times in seven weeks, given four combinations of antipsychotic, anti-anxiety, and antidepressant medications, and underwent electro-convulsive therapy (electroshock). But despite her psychiatric treatment—or because of it—Melanie Blocker-Stokes jumped to her death from the 12th floor of a Chicago hotel.
Pregnant Women on Antidepressants
A study “Increasing Use of Antidepressants in Pregnancy,” published in the American Journal of Obstetrics and Gynecology in 2007, is an analysis of the medical records of 105,335 pregnant women enrolled in Tennessee Medicaid from 1999 to 2003. Among the group of 13.4 percent women who took antidepressants at some time during pregnancy in 2003, 10 percent took antidepressants during the first trimester, 6.4 percent used them during the second trimester, and 5.9 percent used them during the third; white women were four times more likely than nonwhite women to have used antidepressants during pregnancy.