Here's Why Postpartum Depression Is Even Harder When You're Not White
Five women talk about why it's so hard for new parents of color to get the treatment they need for postpartum depression and other mood disorders, and how to make it better.
Postpartum mood disorders are far from rare. Statistics show that up to 1 in 7 women may experience postpartum depression, anxiety, or obsessive compulsive disorder. These disorders make it hard for parents to get through the day, and seriously affect their ability to take care of themselves and their families. They do not discriminate and can affect any new caregiver, regardless of income, age, race or ethnicity, culture or education. And yet new parents of color, in particular, often face a host of unique stigmas and barriers when it comes to assessing and treating postpartum mood disorders.
This is an online conversation between five parents of color about the challenges they faced in identifying and treating their illnesses, and what we can do to make it better.
Before we get started, who are you?
Pooja Makhijani: I am an American expatriate living in Singapore. I write children's books, essays, and articles; develop educational media and curricula; and have written about my mental health for WashingtonPost.com. My writing has also appeared in the New York Times, The Rumpus, Quartz, and elsewhere.
Sharline Chiang: I am a Berkeley, California–based writer, editor, book coach, public relations strategist, and maternal mental health advocate. I have written about my PPD experience for Mutha and Hyphen. I have also written for BuzzFeed, OZY, and Center for Asian American Media.
Tyrese L. Coleman: I am a writer, wife, mother, and federal employee living in Hyattsville, Maryland. Because I’m not busy enough, I’m also a student in the writing program at Johns Hopkins University and fiction editor for District Lit. My writing has appeared in PANK Magazine Online, BuzzFeed, the Doctor T.J. Eckleburg Review, the Tahoma Literary Review, and elsewhere.
MK: I am a Vietnamese-American scholar, teacher, and writer on race and religion, queer of color politics, mental health, and Asian-American motherhood. (I'm going by my initials for privacy reasons.)
A’Driane Nieves: I am a United States Air Force veteran, writer, artist, speaker, and postpartum depression and anxiety survivor living with bipolar disorder. My writing has been featured on BlogHer, Upworthy, EverdayFeminism, and Postpartum Progress. I am the founder and creative director for Tessera Collective, an online platform and nonprofit dedicated to empowering women of color in their mental health.
The actual experience of a postpartum mood disorder is different for everyone. How and when did yours manifest itself? What was it like?
Makhijani: I alternated between boredom and rage. One minute, I would be staring out the window as my infant rolled around on her play mat; the next, I would feel the urge to throw things and scream. I snapped at my husband a lot, I admit. I also was consumed with intrusive thoughts that always involved blood and gore and, ultimately, death. Images of her — of us — impaled or decapitated would flash before my eyes all the time. It was terrifying and anxiety-inducing.
I imagined often what would happen if I ran away. I made plans, I made maps, I planned bus routes. At first I decided that I would first give up my daughter to my parents (or whoever else wanted her), and then I would just run away so no one could ever find me to give her back to me. Then I made plans to take both our lives. But, ironically, I couldn’t make good on any of those plans because I was so unmotivated and anxious all the time. I just didn’t have the energy to step out the door.
Coleman: I also thought about blood and gore — all the bad things that could happen to them, all the bad things I could do them. I remember being on the miniature trains in Oakland, California, holding one of my babies. We were winding through the woods up very high in the mountains. I looked over and thought, What if he fell over? What if I threw him over? The shame and guilt I immediately felt! And yet it still didn’t occur to me at the time that those thoughts were happening because I was dealing with PPD. I just told myself to stop, to never think that again. It was terrifying to have those kind of thoughts and not know where they were coming from.
Nieves: I knew the first night in the hospital that something was wrong. I remember holding my son and feeling as though I wanted to break out of my skin and run away. Lack of sleep and his constant crying (or his older brother whining) were my top two anxiety triggers. I coped by trying to keep everything neat and organized. I spent so much time on my bathroom floor, trying to cool my body down from the sweats my anxiety triggered. It was relentless and would come in waves, leaving me exhausted and shaking. I had moments of sadness, but they were usually triggered by guilt over the detachment I felt toward my son. Bonding with him was difficult. I also experienced rage that would catch me off guard. I remember screaming one time after my oldest spilled some milk, and while I was screaming I was saying to myself, “What the hell is wrong with me? Who am I right now?”
MK: I don’t remember very much from the first year of my daughter’s life. In hindsight, I think I battled depression on and off for the first few months, and then really hit the lowest point around nine months postpartum, when my daughter’s sleeping “regressed.” Sleep. So much of my experience revolved around sleep, the lack of it, the management of it — how much has she slept, when will she need to sleep again, when will I get to sleep again, did I just miss my window, why is she awake and crying already? Nursing her to sleep, rocking her to sleep, holding her while she slept so that she wouldn’t wake, wouldn’t cry, crying while she slept, crying when she woke. My life was just an endless, exhausting cycle of care for her. I wanted to run away; I wanted to die.
I remember lying in bed, wishing I could die and resenting so much that I couldn’t. Dreading the next hour, the next round, the never-ending cycle. I remember looking at my baby and feeling nothing but despair. I remember thinking, Why can’t I do this? How come other moms don’t feel this way? What is wrong with me? So I picked up the phone and texted my husband, "I think I need help." Then I went online and ordered a book on postpartum depression.
Chiang: I was deeply exhausted from the birth on, and sleep deprivation leveled me. I was often too tired to eat, and too hungry to fall asleep. The messages around me told me it was part of being a new mom. I didn’t feel like I had permission to stop breastfeeding, so I assumed I would never have a real chance to rest — ever. Soon into the second month, I stopped being able to sleep and was in what I now understand to be panic attack mode 24-7. I became unhinged. I became OCD — couldn’t stop washing and rewashing bottles and pump items, cried when I had to wipe a tear off my child’s face because I was sure I would infect her and make her blind. I was so tired I felt like I wanted to die, just so I could rest. I started talking loudly to myself. I had trouble connecting thoughts. It was like the real me was watching this new “crazy” me take over.
I had images of killing my child and myself, images that felt often like urges. All day long I felt like jumping out of moving cars, out of buildings, grabbing knives, grabbing strangers. I fantasized about cutting off my breasts so I could stop breastfeeding, about running away and hiding out in a hotel or getting on a plane. I wondered how to buy a gun so I could take myself out. I was sure everyone would be better off without me. I had no idea that I had PPD, or that it could manifest as all these symptoms. I thought PPD meant you had to feel sad, or to cry. I didn’t feel sad; I was just exhausted, unhinged, and terrified. I just thought I was very flawed, a failure at being a mom, and very weak.
How did race and culture play into your postpartum experience? Were there expectations or stigma specific to your community that made it harder to get the acknowledgement or treatment you needed?
MK: As a Vietnamese-American, war and refugee displacement form the context in which sacrifice, family, motherhood, and daughterhood are understood in my community. The second generation, within the Vietnamese diasporic community but perhaps also of immigrant communities more broadly, struggles deeply with how to articulate its suffering next to the immigrant generation’s. What is motherhood compared to the collective suffering of a people who have been killed, displaced, exiled, forced to rebuild from the ashes so that future generations may live?
Coleman: I just never thought it was anything people talked about. I considered all moments of despair, ineptitude, and struggle to be things you dealt with privately, because black women already have so much of the world against them that you cannot give the world yet another reason to doubt you. That’s with everything: work, school, relationships. Everything has to be perfect. It's even hard for me to admit it now, because I don’t want to lift the mask of the “Strong Black Woman.”
Nieves: Tyrese, I struggled with that too — that Strong Black Woman archetype that tells us we have to be silent about our pain and deal with it privately, or that what we’re experiencing isn’t a big deal. What added another layer of shame for me in my experience was the stigma surrounding mental illness in the church, which is also a very patriarchal institution. I was an active member of my church, but had no one to talk to about what I was dealing with. When I tried, I was basically told my struggles were a direct result of my “not living right.” I was an unwed single mother of two. I was told that I needed to get married and to be a better Christian, pray harder, serve more. I had no support from the other women and mothers in my church, and my family wasn’t supportive either. They don’t discuss mental health issues, despite a prevalent history of mental illness, so I couldn’t even talk to my mom.
Makhijani: So much shame, fear, and secrecy surrounds mental illness in South Asian communities! I've heard the word "psychiatrist" uttered in hushed tones and death by suicide straight-up lied about. On top of that, new South Asian mothers are made to feel that a child is the pinnacle of achievement, and the only appropriate feeling on the birth of a child is joy. We’re expected to perform a certain femininity: to nurture and transmit traditions, to uphold honor. And in Hinduism, our goddesses are often worshipped for their unwavering devotion to their husbands and children. I thought I was a feminist, but this sort of socialization runs deep, and it absolutely affected me.
Additionally, since 2010 my husband and I have lived in Singapore, where there is a tremendous stigma surrounding mental illness. Quality mental health care is scant and expensive, and Singapore is very patriarchal and paternalistic. I found it difficult to find a mental health professional who "got" me culturally here; several private therapists I met with were utter misogynists, and exhorted me to "shake it off" as my "duty" to my family.
Chiang: Mainstream — and maybe by that I mean majority-white — society is only still at the beginning stages of talking about PPD, and that’s largely thanks to highly visible, mostly white female celebrities coming forward with their stories. So of course the Asian-American community is lagging in really understanding that PPD is a medical condition. We are raised to believe that you should keep your problems to yourself and be careful not to “shame” your family by making it known that you have a mental health struggle. To this day, my parents do not know I had PPD. They’ve talked openly about how they don’t believe in therapists.
There is also the model minority myth, which affects the way others, like medical experts, see us, as well as how we see each other and ourselves. I had gone to see many medical professionals over the first three months and remained undiagnosed until one psychiatrist finally confirmed that I had PPD. She said she could see why no one thought I had PPD, because I looked too “together” — I wasn’t falling apart in front of them the way I was at home.
Many of you have said elsewhere that hearing about others' experiences carried you through difficult times. How does being a person of color make a difference in how those stories are shared?
Coleman: What’s funny is that it wasn’t necessarily other women of color who made me recognize that something was going on. I belong to a pretty tight-knit Facebook group of mothers who share the same birth month as my boys, and the vast majority of them are white. My own feelings had been bottled up for so long, and these women were discussing how they had experienced the same feelings, openly, without filters. I started to recognize that I needed to seriously examine this; that maybe all of the lies I was telling myself to cope weren’t actually working. It took white women sharing for me to come that realization, because women of color do not open up in the same way. But we have to. We need to.
Makhijani: I, too, belonged to a private Facebook group of (mostly) white, middle-class women who were very open about their therapists and their medication, in a matter-of-fact, nonjudgmental way, and what many of them described (and named) was familiar to me. I agree: Women of color are not so open. This is the culture in which our bodies exist, and there is great danger in communal silence.
Nieves: Since I had so little support in my family and church community, I turned to the internet and found blogs from other women detailing their experiences, and found community support through #PPDChat on Twitter. But my experience was similar — all but two of the women I found online initially were white, and only one of those two could “risk” being so open about their struggle in #PPDChat. It was very hard to find women of color who would open up privately, let alone in public online spaces. I agree, there is danger in that silence. It kills.
Chiang: When I was having my worst symptoms and still didn’t know what was wrong with me, I did find articles and essays online by other women who had survived or were surviving PPD. But they were all white, so I thought that I must have something else. I just couldn’t relate. Only after reading one anonymous piece on Postpartum Progress by an Asian-American woman did I feel a sense of relief and comfort and say to myself, “OK, maybe I am not alone in this experience. Maybe this is a thing.”
For me now, capturing and sharing stories of women of color PPD survivors is one of my most important missions. I have had another woman of color tell her friend that an essay of mine saved her life. I’m not saying this to brag. I know that A’Driane Nieves’s work, for example, was a huge part of my recovery. We can save one another’s lives.
If you did find resources and spaces to share those stories, particularly for women of color, where was it? What resources should there be that don't exist?
Chiang: I joined a PPD therapy group in Berkeley for a month that helped me by surrounding me with five other women every week who made me feel less alone. They were all white, but I was grateful to have that safe space to talk, cry, and vent. I also started writing about my experience for MUTHA and Hyphen, and the response to my pieces was overwhelming. Women were dying to talk about their experiences. What I learned is that we are, globally, just at the tip of the iceberg in terms of understanding PPD, how widespread it is, how silenced it is; how to screen for it, manage it, talk about it. I wish there were a website dedicated just to families of color around PPD.
Nieves: The only space I found to talk about what I was experiencing 4.5 years ago was #PPDChat on Twitter. And the only other woman of color I found who consistently wrote about her experience was Alexandra Rosas, who shared her experiences with PPD on Postpartum Progress and on her blog. Postpartum Progress’s blog was a huge resource for me in terms of just finding factual information on postpartum mood disorders, and other mothers’ stories of recovery.
Makhijani: The essays I found online by women with postpartum mood disorders were either by celebrities or white women. And while I truly appreciated these new parents shedding light on these issues, I never found a mirror to my experience. Until very recently, the gatekeepers of such spaces have overlooked the vast diversity of writers and storytellers.
Recently, in writing about my own experiences, I found very little scientific research specifically about postpartum depression in South Asian women, save for a 2007 study in the Journal of Obstetrics and Gynecology, which found that 24% of Indian-American women (mostly recent immigrants) experienced major postpartum depression symptoms, and that symptoms differ and are often misdiagnosed. Our communities need these sorts of resources, too.
Nieves: That is largely what drove me to participate in those spaces during and after my recovery. I needed that kind of community from other women of color, but I couldn’t find it. So I became an advocate. I talked openly online about my experience, hoping that if another woman of color could find my story, she’d feel less alone and be encouraged to seek treatment.
Postpartum Progress offers Plain Mama English Guides that detail the range of symptoms that show up in different postpartum mood disorders, and its blog features stories from women who have gone through it. During my time as a contributing editor there, I made it my mission to center and amplify our particular experiences as women of color, with writing by people like Dr. Lekeisha Sumner and Divya Kumar. Women of color still need more research, access to culturally competent treatment providers and outreach services in our communities, and support groups (on- and offline) that exist specifically for us. That’s why I run a peer-to-peer private support group on Facebook called Tessera Collective, and conduct chats on Twitter, where women of color can talk openly about what they’re experiencing and get support from each other.
We’re finally seeing the mainstream media pick up on how postpartum mood disorders impact women of color and the barriers to treatment we face, but we still have so much more work that needs to be done. I don’t want us to see only white faces staring back at us, and see only those white faces getting validation and support.
What was your turning point to better health?
MK: I asked for help, and I restructured my life. My husband used all his vacation time and took off several weeks to be at home with me. My in-laws came to take a short shift every day. I stopped night duty so that I could finally get a full night’s sleep. I made sure to nap every day. I listened to my body, forced myself to rest when I felt my energy dwindling. I went to individual therapy. My husband and I went to couple’s therapy. After his leave ran out, my husband worked from home for a few months until I felt ready to be alone, and then he slowly transitioned back to working in the office. My husband literally saved my life.
Makhijani: My mother-in-law identified my difficulties on Skype, essentially, and flew to Singapore for five weeks to support my husband and me. She encouraged me to get professional help, and, most important, shared her own struggles with mothering and motherhood, and those of others in our families (sisters, aunts, etc.). She’s a really radical woman in many ways. This is not to say that her care led to immediate healing; it took nearly two years for the proverbial fog of depression to lift. But her attention to my illness was the moment when I saw a sliver of light.
Nieves: The turning point for me was when I was diagnosed with rapid cycling bipolar disorder type 2, after I was again experiencing worsening symptoms and suicidal ideations. I started a course of treatment (medication and therapy) that saved me and helped me recover from my PPD in the process. I lost many relationships within my family and church community during that time, and my illness put a significant strain on my relationship with my partner; we broke up more than once. What helped me work toward recovery while navigating that was my online community. Writing about what I was going through on my blog, #PPDChat, and the friendships I developed with other women through that were my lifelines.
Coleman: I never received treatment, and never received support other than from my husband. It has been two years, coming up on three, and although the anxiety and fear have lessened in intensity, they’re still there. It is now that I’ve decided to share my story that I am considering seeking treatment, and still, I am so very hesitant. People think it takes strength to cope with mental disorders, but I am finding it takes even more courage to seek treatment. For me, it's so much easier to write about my feelings and experiences than it is for me to open up to someone in person. I’m scared about what this will reveal about me, and who I am. I have to say that having this conversation, hearing about others and admitting my own problems, has helped me tremendously. But I know the work has just started for me.
Nieves: I agree, Tyrese — it takes a significant amount of courage to seek treatment. Letting go of that fear and risking vulnerability is incredibly hard. But having this conversation and acknowledging what you’re facing takes courage as well. I know the journey isn’t over, but recovery will happen. Having a postpartum mood disorder changes parts of you, but it isn’t the end of you, I promise.
Sharline Chiang: The psychiatrist I mentioned earlier connected me with one of the top PPD experts in the nation, Jeanne Alexander, who is also in Berkeley. She saved my life. I was very judgmental and against medication at the time, but she got me on the right meds, which worked right away. I also had enormous help from my husband, in-laws, close friends, and a full-time child care provider. That plus therapy, not working, resting, getting exercise, eating well, writing, meditating, going on “dates” with friends, and connecting with other survivors of color like A’Driane — and then actually getting back into my career, which helped boost my self-esteem — all helped me on the road to recovery.
The thing to keep in mind, and I try to remember to be grateful for this, is that my recovery was directly due to my privilege as someone who could afford the supports that let me get better. Most women do not have the resources for or access to medical care like I did, let alone all the “extras” like child care, house cleaning, time off work, organic food, etc.
Makhijani: Exactly. I recently told a friend that the reason I’m a survivor is “because I have money.” I had the luxury of taking time away from paid work, and I have access to medical care, health insurance, child care, and leisure time. One of the reasons I was motivated to share my own story publicly is because I know that others can’t. Never once has it been implied to me (cisgender, heterosexual, married, college-educated) that I am a “bad mother” and deserve to have my child “taken away.” Not everyone who battles a postpartum mood disorder has these privileges.
How do you continue to care for yourself now?
Makhijani: As Audre Lorde said, self-care “is not self-indulgence, it is self-preservation, and that is an act of political warfare.” I make sure I have time alone — no child, no partner, no family and friends — and silence, with minimal distractions. Yes, this alone time often takes place in the dead of the night, but I can’t function without it! Too many social obligations, on top of family and professional obligations, also make me anxious, and I’ve become much better at saying no since I became a mother.
Coleman: Sadly, I am still trying to figure that out. I’ve made a promise to one of my closest friends to find a therapist and I mean to do that. I will start there.
Nieves: That Lorde quote is what pushes me to make my health and wellness my top priority — especially on the days I want to quit. I take medication and see a psychiatrist regularly. I chart my mood and symptoms in my journal and on apps (Clue and iMood Journal). Doing that helps me identify my triggers. I paint and write. I hula hoop; I take breaks from my kids and husband. I definitely have gotten better at saying no as well, Pooja.
Chiang: I try to remind myself that four years ago, when I had my PPD, is not that long ago, and I still have to watch my stress levels and energy output. I attend one writing retreat a year, which feeds my soul and reconnects me with people who make me feel like my old self again. I try to get eight hours of sleep each night. I try to get massages once a month. I try to go out with girlfriends about twice a month, for drinks and dinner. I write here and there. But I know I could be and should be doing a lot more self-care. I tell new moms who are struggling all the time, “Put your own mask on first,” and yet I struggle with it myself.
MK: I take care of myself by constantly evaluating my capacity, my energy levels, my feelings. I try to listen to my body; I let myself take breaks. I allow myself to do less, to not be perfect — to never see my limits as failures but simply as the boundaries of my capacity. “Weakness” does not make you ill; bearing beyond your capacity does. Recognizing that has been life-changing, life-saving. Self-care is respecting your own limits, even as you strive to grow and stretch your capacity. It’s loving yourself enough to know you are enough, even as the world tries to tell you otherwise.
What's the one most important thing you wish someone had said to you — or that you now would tell yourself — when you were a new parent?
Coleman: I wish someone had told me what to expect. I wish someone had talked about what they went through, or directed me toward finding out what other women went through, so that I didn't feel so utterly crazy. And I mean all of it — everything we are talking about here. Because I think if I knew that, yes, this can happen, yes, you will think about doing harm to yourself and your children, and that this is symptom of something deeper that you will need help for, maybe I would not have been so closed up and afraid. Or at least wouldn’t have felt so alone. And maybe I would have had more courage to seek treatment.
Nieves: I wish someone had said “I believe you” when I told them about my struggles. I wish others had been willing to listen and had been aware enough of what postpartum mood disorders are to tell me I wasn’t imagining it all, and that I was going to get better — I just needed the right help. Like you, Tyrese, I felt so alone in it early on. It was completely terrifying at times. But if I had known earlier what it was, and that experiencing it didn’t make me a monster of a mother, I would’ve given myself more grace.
Chiang: I wish, first of all, that someone had told me as soon as possible, “Hey! You have PPD! It’s a medical condition and treatable.” I wish someone had told me that my anxiety and symptoms were very common — that even if you are not crying all the time, but you feel that something is terribly wrong, you could have PPD. And then I wish someone could have called me every day, another survivor of color, to say, “I know how hard it is. It feels like hell. And it sucks. But chances are you will live through this. Medication can help stabilize you. Therapy will help hold you. And then the rest is a matter of time and taking everything off your plate and asking for help. No one will judge you. OK, maybe that’s not true, but really, most people will not judge you. And nothing matters except your health and well being. You are not alone and we won’t let you go through this alone.”
MK: Yes, yes, yes. I wish someone had told me that I didn’t have to go through this alone. I wish I had been told to build out a (better) support system from the start. And I wish, at the worst moments, that someone had told me that there is a way out, because I couldn’t see one on my own. It took a book promising me that there was a way out for me to blindly work towards that, on faith and hope alone.
Makhijani: Apart from all said above, I wish someone had told me that this wasn’t my burden to bear alone. That mental illness was not a personal failing, that misogyny is what continues to keep women's stories silenced, and that capitalism could not survive without the unpaid caring work of women. Many forces are invested in keeping women, and especially women of color, quiet and compliant.
Always consult with your doctor about your personal health and wellness. BuzzFeed posts are for informational purposes only and are no substitute for medical diagnosis, treatment, or professional medical advice.
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