Taking Action
Postpartum Depression: The Convergence of Media Coverage and Community Activism to Influence Health Policy
Mary V. Muse, John T. Carlsen and Vanessa D. Newsome
“The media’s the most powerful entity on earth.”
—Malcolm X
Introduction
The media can exert significant influence on social and public health issues, and it can reach the public through many means, such as print media like newspapers, billboards, and magazines, and electronic ones like television, radio, and the Internet. Through all of these, the media has the ability to encourage action, stimulate thinking, and propose solutions. This chapter examines a particular health problem—postpartum depression—and how, in one instance, the media played an influential role in addressing it. The chapter will present the story of Melanie Stokes, a young woman who suffered from postpartum depression and psychosis. She eventually committed suicide as a result of the disorder. The history of postpartum mood disorders, policy development, and the role that media played in focusing attention on the problem will be described.
In the past, the popular media’s involvement in highlighting postpartum mood disorders has been limited. The focus has generally been on criminal events associated with the disorder, with less attention to the causes or management of the symptoms. Postpartum mood disorders can be debilitating if left untreated. When inadequately or not appropriately treated, they can lead to serious outcomes for the mother, child, and family. However, if these disorders are identified early and the mother receives appropriate treatment, postpartum depression and psychosis can have better outcomes. In the case of Melanie Stokes, the media played a valuable role in influencing policy change surrounding postpartum depression.
One Media Portrayal of Postpartum Depression
In 2009, the daytime television drama General Hospital featured a story line on postpartum depression. The character of Dr. Robin Scorpio (Robin) is portrayed as a married, respected physician. In this story line, Robin gives birth to her first child. Following the delivery, Robin becomes detached from her husband and her new baby. Her personality changes from focused, confident, and driven to withdrawn and disconnected from her family, child, and work. Robin does not bond with her baby and prefers that someone else care for her. She comments: “My baby doesn’t like me.” Robin is encouraged to get psychiatric help, but she is reluctant. She returns to her practice but refuses to take her medications and misrepresents her participation in therapy. After Robin’s husband learns that she has not been seeing the psychiatrist, he arranges a family intervention. The intervention concludes with Robin and her husband in agreement to seek family therapy. The story line concludes with Robin’s receiving treatment and, over time, she begins to engage with her husband and new baby. This media portrayal of postpartum mood disorder, although created as entertainment, provided an accurate glimpse into what can happen in a family’s life when a postpartum mood disorder occurs.
Background on Postpartum Depression
Baby Blues
Current literature identifies three categories of postpartum mood disorders: “baby blues,” postpartum depression, and postpartum psychosis (Harris, 1994). “Baby blues” is a time-limited experience that women might experience shortly after delivery of a baby. It can be a period of anxiety, and the new mother may experience a sense of feeling overwhelmed. It is considered normal because many women experience a period of anxiety and fatigue following delivery. This is usually associated with adjustments by the mother to the baby’s feeding schedule and adjustments to the new baby. “Baby blues” usually peaks in 3 to 5 days and subsides within 2 weeks. For some mothers, anxiety and sleep disturbance extends beyond 2 weeks.
Postpartum Depression
The symptoms of postpartum depression and postpartum psychosis are much more severe than those of baby blues. When depression lasts 2 weeks or longer, the symptoms are categorized as postpartum depression. Postpartum depression can affect new mothers within 2 weeks to 1 year after delivery. Women experiencing postpartum depression are frequently anxious and experience crying that lasts throughout the day. These women may develop feelings of inadequacy or detachment from their babies. Although these symptoms appear similar to those of “baby blues,” the difference lies in their intensity, frequency, and duration. Women with postpartum depression worry that they cannot properly care for their babies or that they may hurt their children. The mothers may have appetite changes and sleep disturbances, difficulty concentrating and making decisions, fatigue, psychomotor agitation, and anxiety. Women displaying five of these symptoms should be considered to have postpartum depression (Gjerdingen & Yawn, 2007; WebMD, 2008). Women with postpartum depression may also have thoughts of suicide, death, feelings of worthlessness or guilt, and a frequent focus on the child’s health (WebMD, 2008). These symptoms may also be associated with postpartum psychosis.
Postpartum Psychosis
Postpartum psychosis is the most severe form of postpartum disorders. While it usually develops around 3 weeks after delivery, it can occur earlier or up to 1 year after delivery (WebMD, 2007). Mothers with postpartum psychosis lose touch with reality; they become delusional and have distorted thinking. Hyperactivity, mania, hallucinations, disorganized speech, or disorganized behaviors are also features of the illness (WebMD, 2007).
Magnitude of the Problem
Postpartum mood disorders affect about 800,000 women annually (Menendez, 2010). A literature review found that 10% to 20% of women experience postpartum depression; the numbers most frequently reported are 15% to 20%. Postpartum psychosis is considered a medical emergency, affecting 0.1% and 0.2% of women (Joy, Contag, & Templeton, 2010; Gjerdingen & Yawn, 2007). The cause(s) of postpartum mood disorder and psychosis are not easily understood. There appears to be consensus among researchers that hormonal changes, stress, fatigue, anxiety, and sleep disturbance are factors that are likely to contribute to postpartum mood and psychotic disorders. A review of the literature finds research studies that have examined effects of hormones on mood, sleep disturbance, fatigue, mental illness, and prior history of depression. The findings from these various studies suggest that there is a sharp decrease in hormones following delivery, poor sleep is found to be associated with depression, and fatigue (not necessarily stress or depression) is a better indicator of postpartum mood disorders. Research also shows a link between a prior history of mental illness, depression, or anxiety and these disorders. The research also finds that women with a history of bipolar disorder are at risk for postpartum psychosis. Additional research shows that the risk of psychosis for mothers without a previous psychiatric illness (hospitalization) increases when the mother’s age is at least 35 (Cassels & Murata, 2009). Despite the magnitude of this illness, its devastating effects on the mother, child, and society, and its recognition as a major public health issue, little attention has been paid to it by the general public. In 2001, an event raised awareness of the problem by capturing the attention of a local community and the nation. It was the death of Melanie Stokes.
Melanie Stokes’ Story
On June 11, 2001, Melanie Stokes jumped to her death from a hotel in the Lincoln Park neighborhood of Chicago, Illinois. According to her mother, Carol Blocker, Melanie had every reason to live (personal communication, June 11, 2009). In 2001, Melanie was a successful pharmaceutical sales manager, was married to a physician, had a supportive family, and was expecting her first child (Figure 100-1). Mrs. Blocker, who was extremely close to her daughter, described Melanie as a beautiful and radiant woman who was excited about her new baby and looking forward to motherhood.
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