By Andrea Johnson
I. Definition
Postpartum depression (PPD) refers to the intense sadness women sometimes experience after giving birth.[1] It must occur within the first four weeks of giving birth and last for a period of two weeks or longer.[2]
II. Secular Perspective
The DSM IV was the first resource to place postpartum depression under the category of major depression. Therefore, PPD is viewed/treated similarly to major depression, with the exception of the use of medication, because some anti-depressants are not recommended for mothers who are breastfeeding. PPD has a prevalence of 13% amongst new mothers[3], and it generally self-resolves within two weeks to three months. PPD often disrupts the mother’s interpersonal relationships, and can even harm child development.[4]
Those who are a part of the feminist camp do not approve of PPD being a specific category at all. PPD is offensive to them because they do not want women to have a specific disorder that does not pertain to men, as this would cause women to potentially appear weak. They argue that because men do not have a specific label for any hormonal or emotional imbalances, neither should women.
Secular treatment for PPD includes interpersonal psychotherapy, short-term cognitive behavioral therapy, pharmacotherapy, hormonal therapy, and in extreme cases, psychiatric hospitalization.
III. Biblical Perspective
Postpartum depression affects both the inner and outer man. Body and soul are distinguished, but they cannot be separated (2 Corinthians 4:16). PPD affects the woman as a whole – her physical body is experiencing hormonal changes, lack of sleep, shock to new motherhood, and physical pain due to childbearing, meanwhile her thinking, attitude, motivations, desires, and reactions are all being affected. Where there is a physical problem, there will also certainly be a spiritual problem.[5] Therefore, a woman who is experiencing PPD should care for both her physical body and her inner heart. 1 Corinthians 6:19-20 says that our bodies are the temple of the Holy Spirit. So the woman experiencing postpartum depression should be cared for as a whole person, both the physical outer man and the spiritual inner man.
Depression/anguish is not seen as a sin in and of itself in the Bible. We see this in the examples of David (Ps. 42, 2 Sam. 12:15-24), Job (Job 2:9, 4:9), and even Jesus (Isaiah 53:3, Luke 22:44). Postpartum depression means that a woman is experiencing real pain that is both physical and spiritual, and she should be cared for equally in both areas.
IV. Evidence of the Problem
Common themes and patterns for women experiencing PPD are lack of sleep, transitional shock, hormonal withdrawal, and previous depression[6]. Common expressions of PPD are crying spells, insomnia, depressed mood, fatigue, anxiety, poor concentration, lack of interest in daily activities, increased or decreased appetite, hypersomnia, phychomotive behavior, feelings of worthlessness or inadequacy about being a mother, guilt about being depressed, and recurring thoughts of death regarding either her or the baby.[7] Women experience these expressions in varying degrees ranging from mild (i.e. the “baby blues”) to severe (i.e. postpartum psychosis). There are several risk factors that greatly contribute to a new mother’s chance of experiencing PPD[8]. These include previous depression, prenatal depression, prenatal anxiety, life stress, poor marital relationship, lack of social support, child care stress, and temperamental or sick infants.
There are consequences for both the mother and the infant that can arise from the presence of PPD, such as behavioral and cognitive development in the child[9], disrupted mother-infant bonding, disruption of interpersonal relationships for the mother, and disruption to the mother’s marriage[10].
V. Examining the Heart
It is important to investigate each scenario to find out what each woman is struggling with individually. PPD is looks different for different women, both physically and spiritually. Sinful heart themes that may be present are: pride in the unacceptance of physical weakness, a wrong view of motherhood, false expectations for motherhood, resistance to connecting with the local church/asking for help. Women who are new mothers may want to prove to themselves and others that they are a capable mother. In addition, their view of “capable/good motherhood” may not be biblical. This may contribute to a depressed state because women will never live up to an unrealistic and unbiblical standard of good motherhood. Motherhood must be learned, it is not simply known. Women experiencing PPD will often ignore their own physical pain in an attempt to focus on their child, when they should also be caring for themselves physically, and asking for necessary help. Sleep deprivation has been found to be one of the leading factors of depression[11], but women are often not aware of the implications of their sleep deprivation and other physical stress they are experiencing. This could be rooted in the pride of not wanting to accept their physical limitations, and not wanting to look like an incapable mother by asking for assistance.
VI. Biblical Solutions
A woman experiencing PPD must ensure she has a biblical perspective of motherhood, humbles herself to admit her physical weakness, and ask for help from the local church. She also needs to understand that it is good to take care of her physical body, as this will impact her inner soul as well. Heath Lambert and Stuart Scott recommend that a woman with PPD should seek help from her husband/friends/the local church, so that she is able to tend to her immediate physical needs of sleep and food. She should study Romans 5:1-5 to be encouraged that her suffering is not pointless, and she has the opportunity to see the Lord’s hand through her depression. She should confess sins of pride and any unrealistic expectations she has placed on herself. Finally, she should gain a biblical understanding of motherhood by learning from other women who have gone before her, as Titus 2:3-5 commands.
Homework would include prayer, studying Romans 5:1-5, meeting with an older woman from church, and setting a daily schedule. Setting a schedule will help the new mother ensure that she is getting rest, food, and daily tasks accomplished, and will help her to find out what areas she specifically needs help in (i.e. meal prep, laundry, house cleaning, etc.)
Recommended books include: Overcoming Fear, Worry, and Anxiety by Elise Fitzpatrick; Women Counseling Women by Elise Fitzpatrick; Depression: Looking Up from the Stubborn Darkness by Edward T. Welch; and Lies Women Believe by Nancy Lee DeMoss.
BIBLIOGRAPHY
Anderson, Gary R. 2017. Postpartum Depression: Prevalence, Risk Factors and Outcomes. Health Psychology Research Focus. Hauppauge, New York: Nova Biomedical. http://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=n ebk&AN=1453453&site=ehost-live&scope=site&custid=s8898283.
Andrews-Fike, Christa. 1999. “A Review of Postpartum Depression.” Primary Care Companion to The Journal of Clinical Psychiatry 1 (1): 914. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/.
Asher, Marshall and Mary. The Christian’s Guide to Psychological Terms, 2nd ed. 2004.
Bernard-Bonnin, Dr. Anne-Claude. “Maternal Depression and Child Development.” US National Library of Medicine. October 2004. Accessed April 13, 2019. https://www.ncbi. nlm.nih.gov/pmc/articles/PMC2724169/.
Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000.
“Interview with Charles Hodges & Jim Newheiser {Transcript}.” 2017. IBCD. March 24, 2017. https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.
O’Hara, Michael W. 2009. “Postpartum Depression: What We Know.” Journal of Clinical Psychology 65 (12): 1258–69. https://doi.org/10.1002/jclp.20644.
STUART, SCOTT, and MICHAEL W. O’HARA. 1995. “Interpersonal Psychotherapy for Postpartum Depression.” The Journal of Psychotherapy Practice and Research 4 (1): 18 29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330386/.
[1] Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American
Psychiatric Association, 2000.
[2] Asher, Marshall and Mary, The Christian’s Guide to Psychological Terms, 2nd ed., 2004, 149.
[3] Anderson, Gary R. 2017, Postpartum Depression: Prevalence, Risk Factors and Outcomes, Health Psychology Research Focus, Hauppauge, New York: NovaBiomedical, http://search.ebscohost.com/login.aspxdirect=true&AuthType=shib&db=nebk&AN=1453453&site=ehost-live&scope=site&custid=s8898283.
[4] O’Hara, Michael W. 2009, “Postpartum Depression: What We Know,” Journal of Clinical Psychology 65 (12): 1258–69, https://doi.org/10.1002/jclp.20644.
[5] “Interview with Charles Hodges & Jim Newheiser {Transcript},” 2017, IBCD, March 24, 2017, https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.
[6] Asher, Marshall and Mary, The Christian’s Guide to Psychological Terms,
[7] Andrews-Fike, Christa, 1999, “A Review of Postpartum Depression,” Primary Care Companion to The Journal of Clinical Psychiatry 1 (1):914, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/
[8] O’Hara, Michael W. 2009, “Postpartum Depression: What We Know,” Journal of Clinical Psychology 65 (12): 1258–69, https://doi.org/10.1002/jclp.20644.
[9] Bernard-Bonnin, Dr. Anne-Claude, “Maternal Depression and Child Development,” US National Library of Medicine, October 2004, Accessed April 13, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724169/.
[10] STUART, SCOTT, and MICHAEL W. O’HARA, 1995, “Interpersonal Psychotherapy for Postpartum Depression,” The Journal of Psychotherapy Practice and Research 4 (1): 18 29, https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3330386/, 20.
[11] “Interview with Charles Hodges & Jim Newheiser {Transcript},” 2017, IBCD, March 24, 2017, https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.
The Encyclopedia of Biblical Counseling 