Abstract
Moran deftly uses oral history methodology to reconstruct a chronological account of postpartum activism from the 1970s onwards. Readers become familiar with the stories and perspectives of thirty-five individuals who significantly contributed to grassroots activism, advocacy, psychology, and psychiatry, thereby making postpartum depression a widely known umbrella term for a range of postpartum mental illnesses. These personal stories are presented in conjunction with the analysis of traditional archives and materials (e.g., letters, photographs, cassette recordings of meetings, conferences, news clippings) shared by the interviewees. This historical account seamlessly coalesces the voices of interviewees, Moran's own voice as a feminist historian who, herself, lived through postpartum emotional difficulties, and the dominant voices of whiteness, American family values, and neoliberalism.
The book makes a significant contribution to our understanding of the power dynamics embedded in activism focused on postpartum depression. Most of the grassroots advocates and activists embraced biomedical explanations of women's postpartum suffering. They worked in partnership with psychiatrists to make it evident that postpartum depression is a real illness and mothers need treatment to recover from it. Many women have entered the fields of psychology, psychiatry, and obstetrics and contributed to the further medicalization of postpartum suffering. By the mid-2010s, postpartum activism metamorphosed from a peer support movement into an expert-driven organization offering training and certificates to promote perinatal mental health. Eventually, postpartum professionals and activists engaged in “pragmatic politics” and contributed to the passing of bipartisan legislation that was pro-woman and pro-family (p. 227). Furthermore, whiteness, racism, and heteronormativity within mainstream professional organizations were challenged by Black, Brown, Indigenous, Asian-American, trans, and queer women who have worked to reshape the spaces of professional and lay activists.
While some advocates and activists acknowledged the impact of social stressors on motherhood and postpartum depression, they did not advocate forcefully enough for the transformation of cultural ideals about motherhood, the de-centering of nuclear families, or the reduction in the social isolation of suburban life. Neither did postpartum activism focus on changing social policies to address the lack of paid maternity leave and subsidized childcare in the United States of America. Moran reflects on this aspect of the movement by stating “offering a diagnosis could make one's suffering legible but also risks confusing a person's emotional distress with problems arising from social and political issues” (p. 7). Moran argues that the postpartum activists and advocates reproduced existing power structures by distancing themselves from the women's health movement, claiming political neutrality, and seeking medical legitimacy.
The book clearly provides evidence of the hegemony of the medical model. It also demonstrates how grassroots activists and advocates may harness the medical model's power to reduce women's suffering without unsettling the heteropatriarchal norms that make up a vital part of the social, cultural, and structural fabric of society. Moran aptly says that this is a story of women grappling with what motherhood meant in the late twentieth century, a story of supermoms and career women, a story of conservative family values and post-feminism, of adaptation and professionalization and a kind of moderate activism deeply reflective of its moment. (p. 9)
Despite the medicalization of women's postpartum suffering, postpartum depression is not recognized as a distinct illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Moran skillfully articulates the reasons for this paradox. First, it is difficult to determine whether postpartum depression originates from biochemical imbalances or the demands of motherhood. Second, there is a lack of a consistent definition of postpartum depression across research studies. Third, the DSM committee privileges empirical research evidence over any clinical, consumer, or popular understanding of illness. Within the domain of empirical research, controlled experiments are considered to produce the most objective and scientific evidence as opposed to clinical case studies and personal stories. Due to the lack of quantitative evidence, postpartum depression is not considered a distinct illness. The scientific community often regards women's personal narratives as less significant sources of data than research studies with large samples, a preference which results in mothers’ anecdotal perspectives being underrepresented within the psychiatric field's accepted knowledge base.
In the book, Moran earnestly integrates biomedical and structural perspectives to uncover the strengths and limitations of postpartum depression activism. However, the discourse remains confined to the language afforded by the white-patriarchal-neoliberal matrix of powerholders. There is no recognition of the limitations of a human-centric episteme underlying this matrix. As a result, certain questions remain unanswered. For instance, how does a health care provider determine what is real or fictitious in a postpartum mother's expressions of distress?
Furthermore, Moran does not present narratives about postpartum emotional suffering and healing rooted in maternal epistemes. Readers are not made aware of any action emanating from “other ways of knowing and being” that continue to co-exist in the United States of America. These “ways” may not align with the medical model's ideas of mainstream culture, counterculture and marginalization. Therefore, further questions remain about what constitutes history, who holds the power to construct history, and who gets invited to participate in this construction. Lastly, one wonders if it is possible to write a history of postpartum suffering and healing that includes the recognition of women's bodies as cosmic space containing infinite potentiality and inner wholeness not yet understood or valued within human-centric power structures.
