The myth of male postnatal depression
Dr Ellie Lee picks apart the social and media construction of a biological impossibility.
Is there an epidemic of postnatal depression in fathers? Recent headlines in the British national press seemed to think so. ‘Depression hits one in five men after they become fathers, claim top scientists’, reported the Daily Mail. ‘Fathers get postnatal depression too’, reported the Guardian, as ‘a new study reveals that it’s not just women who get postnatal depression’.
At first sight this finding seems bizarre. Though specialists would admit that the causes and symptoms of postnatal depression (PND) are not completely understood and are contested, there has been a general consensus that PND has something to do with the act of giving birth. So how is it possible that fathers can have postnatal depression at all – let alone that one in five of them now allegedly suffers from this illness?
The headlines were reporting on a study published in September in the Archives of Paediatric and Adolescent Medicine. Doctors working at the Medical Research Council and at University College London had analysed patient records from 1993 to 2007 to assess the incidence of depression in parents. The study looked at information about diagnoses of depression and prescription of anti-depressants to mothers and fathers from the birth of a child to age 12, and found that ‘rates of depression were highest in the first year after birth’.
For women, diagnoses of depression were in line with rates identified in ‘a meta-analysis of maternal postpartum depression [which] found rates to be 13 per cent’. For men, they were in line with those of a ‘large population based-study [which] found the prevalence of post-partum depressed mood among fathers to be four per cent’. It was also found that after the first 12 months, the incidence of depression declines in both men and women. The authors did, however, find that large minorities of mothers and fathers (39 per cent and 21 per cent respectively) had experienced an episode of depression by the time the child was 12, with the median length of ‘an episode of anti-depressant prescribing’ being 105 days.
In lay terms, the study could have been understood and reported in a number of ways. It confirmed, for example, that the large majority of mothers and fathers are not depressed in the first months after a baby is born. It found that a small proportion of fathers (less than five per cent) and a larger proportion of mothers do experience depression during this time, and that a large minority of mothers and fathers experience an episode of depression at some point in the 12 years following a child’s birth.
This finding is not, in itself, surprising, given the high rates of depression diagnosed in the general population (often put by advocacy groups at the level of ‘one in four’). Indeed, given the likelihood of any individual having a diagnosis of depression in the course of 12 years of his or her life, it would be more surprising if mothers or fathers were immune to this malady. The study gives no basis for assuming that parenthood causes depression, or that parents are more depressed than non-parents. Furthermore, the study’s authors noted that the increase in the incidence of depression in fathers found between 1993 and 2007 ‘may reflect, in part, a trend in increased prescribing of anti-depressants by general practitioners’. So the ‘one in five’ depressed-fathers finding may be more reflective of changed prescribing practices than a new mental health crisis.
How did we get from these findings to claims about the major problem of postnatal depression in dads? Look no further than the Medical Research Council’s press release. Headlined ‘Depression affects a fifth of all fathers’, its first point was: ‘A fifth of fathers and more than a third of mothers experience depression before their child turns 12 years old.’ The release also gave journalists their ‘action point’: ‘Scientists are calling for greater awareness of the occurrence of depression not just in mothers, but also fathers.’
It is significant that a large-scale study by an organisation with the standing of the MRC has led to the endorsement of the idea that paternal depression is a serious social problem. The publication of this study comes shortly after an article appeared in the prestigious Journal of the American Medical Association, which also argued that research endorses the notion that men as well as women suffer from both ‘prenatal and postpartum depression’. ‘Male PND’ has, it seems, ‘come of age’.
But it hasn’t come out of nowhere. My research suggests that the concept has a history of about 20 years. Up until the early 1990s, postnatal depression (PND) was widely considered a specifically female condition. From this point onwards, numerous studies have been published claiming that men may also suffer from PND. Journalists have been strikingly uncritical about the idea that dads are newly suffering from depression in a way unknown to their own fathers, and self-styled ‘experts’ on contemporary fatherhood have bolstered the claim in the media coverage.
Claims-makers have demanded that policymakers must take action to warn prospective mums and dads of the risk of mental-health problems and more must be done to encourage dads to visit health professionals and get medical treatment. Some health professionals have developed pioneering schemes to encourage dads to be more ready to talk about being a father and seek help if they experience emotional difficulties.
Is this a problem? A cursory examination of messages posted by fathers and mothers in response to the most recent discussion of male PND indicates that the contemporary experience of parenthood is certainly disturbing and emotionally destabilising for some. But the discussion about ‘paternal PND’ promotes a medical-sounding metaphor for the experience of new fatherhood. This approach medicalises and pathologises a normal – if sometimes difficult – part of life.
The promotion of male PND first of all encourages a confusing picture of contemporary experience. When there is significant enthusiasm for the project of gaining recognition for the medical problem ‘male PND’, advocates of this diagnosis are obliged to define its causes. Obviously, PND in men cannot possibly have a biological cause – indeed the concept manifestly severs the conventional association between PND and hormonal changes associated with pregnancy and birth. So a raft of alternative explanations is offered.
According to Professor Irwin Nazareth, one author of the MRC-funded study, depression is ‘caused by extra pressures that come from having children, such as loss of sleep and increased responsibilities’. Bridget O’Connell of the mental-health charity Mind contends that men are depressed because of ‘sleep deprivation, changes in lifestyle, changes in their relationship and new responsibilities all at once’.
Such commentaries boil down to the message that being a parent makes life different, and so more difficult. As such they seem to draw more upon the larger cultural zeitgeist surrounding parenting than any expert or specialist insight arising from training in psychiatry. Such generalised and one-sided accounts tell us nothing about how we might distinguish ‘depression’ in parents from other mental states, or why taking on new responsibilities or experiencing changes in one’s relationships should, apparently, be experienced so negatively by some.
They are not so much evidence-based explanations for illness as they are ‘health warnings’, advising us all to be fully alert to risks and dangers that may lie ahead when we become parents. Indeed Rob Williams, chief executive of the Fatherhood Institute, argues: ‘We are missing a golden opportunity to forewarn new parents of the challenges they might face once their baby arrives. Parents need to be told about the risks of depression for both mothers and fathers and they should also be told about the signs which they should be looking out for in their partner.’
The second problem arising from the medicalisation of fatherhood is the relationship it encourages between parents and the medical profession. Those diagnosed with depression, or the extremely serious mental illness postnatal psychosis, need professional help and medical treatment. In the latter case mothers need access to specialised psychiatric and other assistance, which is currently badly underfunded.
The dynamic currently set in place, however, is routinely to encourage parents into medical settings to discuss their experiences with doctors. So Professor Steve Field, chairman of the Royal College of General Practitioners, argues: ‘Men who are adapting to the new duty of parenthood while continuing in their job are under stress, and many do not go to see their GP to talk about any fears and worries they may have.’
But what could a GP actually do to resolve negative emotional experiences associated with becoming a parent? An article in the Guardian purported to illustrate the growing problem of male PND using firsthand accounts included the story of an ‘Edward Davies’. This father sent the following to the online comment page about his experience to clarify some matters:
‘…As the Edward Davies above, I wasn’t clinically depressed as the article may give the impression, I just found the first six months of both children brain-meltingly hard - something I suspect a lot of dads go through… [A]fter those initial baby months of doom, I have come through the fug and absolutely love the relationship I have with them, much of which was probably (somewhat ironically) inadvertently forged in the horrors of trying to get them to sleep at 3am.’
By Edward’s own account, his struggles with new fatherhood were less about ‘depression’ but something far more existential: a kind of identity crisis. It seems highly unlikely that his experience could have been improved by the intervention of a doctor. Perhaps most importantly, his problems were also transitory and were soon replaced by ‘love’. The danger of pathologising parental experience through viewing it in the framework of depression is that experiences that have no lasting detrimental impact are re-cast as illnesses, increasing their significance and undermining the resilience of those diagnosed.
The most powerful driving force of all behind the medicalisation of fatherhood is the perception that ‘depressed dad’ will damage his child. For the Fatherhood Institute’s Rob Williams, there is a problem with the focus on maternal depression, as ‘in reality, the impact of a father’s poor mental health on his children is also powerful’. Liz Wise, PND counsellor and adviser to the National Childbirth Trust, believes that ‘the sad thing is that men are even less likely than women to come forward for help….and what that means is that it’s the next generation who will be picking up the pieces – because parental depression has a huge knock-on effect.’
It is telling that a study which found that depression in parents can only be considered widespread where the measure is a single episode during a 12-year period could generate comments such as these. Are we supposed to seriously believe that children are harmed by parents who take anti-depressants for a few months? Should we be persuaded by the idea that we risk leaving our children to ‘pick up the pieces’ if we decide not to call the doctor or psychotherapist when we find being a mum or dad emotionally tough? The suggestion that this is the best way to think of ourselves as parents is really something to worry about.
Dr Ellie Lee is senior lecturer in social policy at Kent University. She is the director of Parenting Culture Studies and author of Abortion, Motherhood and Mental Health, Medicalizing Reproduction in the United States and Great Britain. (Buy this book from Amazon(UK).)