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“Postpartum depression” has been discussed as an identifiable, measurable, treatable disorder for over 50 years. Limits, scale, prevalence rates: everything seems clear, even reassuring.
But this binary model – it’s either depression or not depression – obscures a more subtle reality: the new parenthood It is disruptive, makes us vulnerable and puts us all in a state of crisis.
postpartum conception Depression was established in 1968, primarily because it responded to dual educational and medical needs: to provide scientific validity to the suffering of new people mothers and to provide a clear and specific diagnostic framework for a particular period of life.
At the time, emphasis was placed on the abnormal nature of this depression, which resembled an anxiety disorder. Its uniqueness was considered to be related only to symptomsAnd the challenge lies more in detecting it than managing it.
diminishing lived experiences
Furthermore, this specific characterization has made it possible to distinguish postpartum depression from the “baby blues” (sometimes called “chemical depression”), which occur as brief depressive episodes associated with biological factors, particularly postpartum hormonal changes.
Since then, the debate has been limited to psychiatric classification and screening tools. But this has reduced a lived experience to a simple diagnostic category.
In a recent article published in the journal Neuropsychiatrie de l’enfance et de l’adolescence, we, together with child psychiatrist Romain Dugravier, proposed to talk about perinatal relational crisis rather than postpartum depression.
Far from being unanimously accepted within the scientific community, our approach, which questions diagnoses and labels, attempts to view adjustment to parenthood beyond the sole prism of individual disorders.
maturity crisis
Becoming a parent means meeting the needs of a completely dependent child while reorganizing one’s emotional, marital and social life.
For many people, this experience is deeply formative. For others, it reopens old wounds: experiences of emotional deprivation, loneliness, or rejection. In that case the arrival of the child can be disruptive by reawakening suppressed vulnerabilities.
Take the case of A Woman Whose first child is this. More than fatigue, she is overwhelmed by a feeling of being trapped: someone who has always defined herself as independent and “not dependent on anyone” is suddenly faced with an infant who is completely dependent on her.
This conflict can reactivate childhood patterns involving the need to protect the self. The diagnosis of postpartum depression does not address this history or the tension between dependence and independence.
Antidepressant treatment, which in our experience is sometimes prescribed after this diagnosis, will not address the cause of this distress. This is the opposite of a space where vulnerability is recognized and where the relationship with the child can be supported.
This leads to a loss of meaning: We diagnose “depression” when we really need to understand the interactions and turmoil inherent in the new parent-child relationship. The scales used – such as the widely used Edinburgh Scale (EPDS), a 10-item questionnaire designed to screen for depressive symptoms after birth – focus on the mother’s mood, neglecting the quality of the parent-child bond, social support or changes in identity.
The result is that symptoms are assessed, but loneliness, conflicts of family loyalties, or difficulties in investing in the relationship with the child are ignored. Once the relationship has been “psychopathized”, it is also difficult to treat it beyond medication.
dependence, independence
Our article offers another explanation, this one inspired by attachment theory: the tension between the child’s dependence and the parent’s independence.
Parental freedom is not always synonymous with autonomy. This may be a survival strategy learned in childhood, when trusting others proved too risky. However, becoming a parent brutally confronts the individual with the newborn’s complete dependence: he or she must be with them at all times, unconditionally. For those who have never learned to never owe anyone anything, this experience can be jarring.
This relational explanation helps us understand why perinatal distress cannot be divided into two groups – depressed or not – but forms a gradient: from normal fatigue to severe anxiety and depression, including feelings of loneliness, loss of self-confidence and inability to parent.
Prevention and continuation
Unlike a hierarchical approach, which can be restrictive, attachment theory opens up new perspectives. It is based on two essential principles: prevention and continuity.
Prevention: First and foremost, visit Guardian A place where their feelings are welcomed without judgment, to help them understand what they are experiencing. Interventions such as parent-child interaction therapy or relational interventions with video feedback suggest that confidence and security can be restored by valuing existing parenting skills rather than correcting perceived deficiencies.
Continuity: Often, parents move from one professional to another, having to repeat their story and experiencing interruptions in continuity. careBut it is important to deal with issues consistently across time (from pregnancy to the early years of a child’s life), in terms of space (maternity ward, home, health services) and in terms of language (between medical, social and psychological disciplines), Ensuring a range of relational security means avoiding assistance that is limited to isolated, one-off interventions without any common thread,
Rethinking the organization of care
Our critique focuses not only on the concepts, but also on the sustainability of various interventions with families.
Perinatal care remains fragmented: between adult mental health, child psychiatry and social services, each speaking its own language and following its own priorities, sometimes leaving parents alone to piece things together on their own.
About the author
Thomas Delavarde-Saos is Professor of Psychology at the Université du Québec à Montréal. This article is republished from Conversation Under Creative Commons license. read the original article,
We advocate a relationship-centered approach to health care: training teams in attachment theory, creating accessible postpartum spaces, and providing key figures to support families through the transition. Because if there is “no such thing as a child” then there must be no such thing as an alienated parent.
human centered vision
Replacing postpartum depression with perinatal relational crisis is not just a question of terminology. This means refusing to limit ourselves to an approach that classifies disorders into diagnostic categories according to fixed criteria, to the detriment of a psychodynamic view that sees parenting as a universal, relational and evolving human experience.
It is not about denying suffering or rejecting treatment when necessary. This is a reminder that perinatal mental health cannot be limited to just screening, prescribing and referring. It is also important to be involved, connected and together.
In short, it is time to move away from a logic focused on individual disorders toward an approach that treats the parent-child bond, not just the symptoms. Prevention and care should be organized around families, not around diagnostic categories.