t’s an unfortunate coincidence for a book about anxiety to debut while most of the world is under lockdown. Many people, myself included, have been consumed by the news, encouraged by experts to set limits on information intake while struggling to concentrate on anything written before the world changed.
Consumed by heightened emotions in isolation, it’s easy to pinball between grief, panic, guilt, and rage, to grow hyper-vigilant against a murky threat that’s destroyed the future we’d imagined. Very few people on the planet have lived through a global pandemic, yet for some women, aspects of this collectively traumatic experience may feel eerily familiar.
Despite having chosen to become a mother five years ago, I was unprepared for the messy reality that followed. First, the physical experience of childbirth recovery (still taboo enough to get banned from primetime television), hinted by friends who suggested I steal hospital provisions before returning home.
Later came the obsessive worries that led to frantic Googling; the rumination upon details of a birth that hadn’t gone as planned; the intrusive thoughts that visualized every worst-case scenario; the waves of grief over the loss of my youth; the guilt over not kicking ass at motherhood like the other moms in my social-media feeds. I didn’t understand how I could love my son so deeply while feeling so ambivalent about the role I’d assumed, though telling that story seemed as unthinkable as appearing on TV in mesh hospital underwear.
I knew something wasn’t right. I thought I was the problem.
During this time, I discovered Sarah Menkedick by way of her editing. While breastfeeding late at night, iPhone in hand, I stumbled upon Hannah Stephenson’s essay “Portrait of a New Mom with Smartphone,” published in Vela, the site Menkedick founded in 2011 to address the gender gap in longform nonfiction bylines. Along with other work on the site edited or written by Menkedick herself, this essay was among those I devoured in my first few months postpartum — hungry for honest, literary accounts of motherhood, a human experience I’d completely overlooked in half a lifetime of reading. The essays in Vela put my complex feelings into words on a site that wasn’t trying to sell me something other than the power of women’s stories. They made me feel less alone, less worried and fearful, during a time when I was not okay.
Vela has been dormant for a few years now, coinciding with the 2017 publication of Menkedick’s debut collection of personal essays, Homing Instincts. Her latest nonfiction book, Ordinary Insanity: Fear and the Silent Crisis of Motherhood in America (Pantheon), further expands her platform, moving beyond memoir to more broadly examine modern motherhood, specifically the persistent fear that characterizes it, through a variety of lenses: biological, historical, psychological, sociological, and cultural.
This material is interwoven with detailed personal narratives from interviews with several mothers, as well as Menkedick’s own account of postpartum obsessive-compulsive disorder:
“For me, it began with mouse poop. We lived in a nineteenth-century cabin, so mouse poop should not have been an anomaly. I’d brushed it aside before, but then one day anxiety lit it up. Like a virtuoso author of magical realism, anxiety infuses objects with great power. Suddenly the mouse poop glowed with threat and I couldn’t unsee it. I turned to the contemporary wizard of Google to learn my fate: was it innocuous, or could it kill my baby? It could kill my baby.”
Menkedick aims for diversity in her interview subjects, who’ve experienced anxiety in varying degrees. Though none had postpartum psychosis, which lies beyond this book’s scope, two women were involuntarily hospitalized for severe postpartum depression (PPD), a label neither woman claimed. The trauma of their experiences, which both included a sudden separation from their infants that prevented them from breastfeeding, highlight considerable gaps in mental health services for postpartum women not met by conventional psychiatric facilities.
Instead of skirting race as a potential anxiety trigger, Menkedick explores the toxic effects of systemic racism on black mothers through the narratives of two women. Though she’s loaded these chapters with historical research that’s often digressive, her deep dives into the history of black midwifery and the abhorrent practice of involuntary sterilization provide context for grim statistics around black maternal mortality and morbidity rates in this country, living not only in a culture of fear but “under the perpetual stress of racism” as well.
Undoubtedly, my whiteness was a privilege as I navigated the health care system while pregnant, during labor, and after birth. When I complained of pain in the hospital, nurses listened. After returning home, what I felt was more difficult to put into words.
rdinary Insanity would have provided me great solace during my lonely months home alone with an infant, wondering what was wrong with me. Menkedick builds a compelling case around the reasons I may have felt that way, starting with physical changes to the mother’s body that begin during pregnancy. I now understand how my brain and hormones conspired to heighten my response to the slightest sign of distress. For most women, this hyper-alertness fades over time. But for some — three in 20, according to Menkedick’s research — it persists, morphing into a full-blown mood disorder, yet it’s hard to recognize it as such.
“In motherhood, many women discover for the first time an extreme alienation. Not only in hours of solitude with a needy and helpless new human child, not only via a biological experience that cannot be shared with anyone, but through having to confront a way of being that has no bearing or space in American culture: a disintegration of the self with all of its clear definitions, goals, parameters, and achievements…”
Because of a lack of awareness about postpartum anxiety — as Menkedick points out, it’s not a valid diagnosis in the DSM-5 — I sailed through the mental-health questionnaire during my six-week ob/gyn checkup that primarily screened for PPD. My therapist, one I’d seen since before I was pregnant for help setting better workplace boundaries, also skirted that label. She told me, “I think you’re just a little sad.”
For a while, that’s what I thought, too. I was sad — grieving not for a loved one, but for everything I felt I had lost. Menkedick suggests that it’s “taboo to mourn in the postpartum context,” and that “postpartum depression might be the only ritual American mothers have to express their grief.”
She explains that, instead of seeing postpartum mental health on a spectrum, we classify new moms as either pathological or normal. In the absence of conventional PPD symptoms, it was easy to assume I was in the latter category. Like many of Menkedick’s interview subjects, I knew about PPD and was aware of celebrities such as Brooke Shields who’d spoken about their experiences, yet my feelings didn’t match what they described. I wasn’t weepy, I didn’t feel hopeless, and I was strongly bonded to my baby. I was a nervous wreck who was terrified of illness and couldn’t stop Googling ex-boyfriends.
“This is a refrain I hear from all of the women I’ve talked to: postpartum depression is the sensationalist news story, the rare absurdity that afflicts a woman unlike me, a woman unhinged and reckless and unstable. It is distant and pitiable, on the far fringes of society.”
Fortunately, at some point, I also searched for postpartum anxiety, which, like April, one of the women Menkedick interviewed, led me to Postpartum Progress, a comprehensive online resource for maternal mental illness. It prompted me to find a new therapist with a better understanding of postpartum mood disorders and helped me to forge a path to recovery.
hile Ordinary Insanity dedicates more attention to postpartum anxiety than I’ve seen elsewhere in print, the book also addresses structural forces in the U.S. that create an environment toxic to all mothers, even those who don’t struggle with mental illness. Starting with pregnancy, mothers are encouraged to make decisions not by intuition, but to mitigate risk. If you do everything right, the thinking goes, you’ll be rewarded with the perfect baby. The burden is on the mother alone to harness the excess of knowledge available at her fingertips, yet there are so many do’s and don’ts that it’s impossible to get everything right.
When I was pregnant, for example, I diligently avoided alcohol, caffeine, deli meat, sushi, tuna, and rare steak. Yet one night, over dinner at an Italian restaurant, I indulged in generous helpings of burrata smeared on wood-oven-toasted ciabatta before it occurred to me that the cheese might have been unpasteurized. Our server said, “Oh yeah, it’s definitely unpasteurized,” as though that was what I wanted to hear.
My stomach dropped through the floor as my mind spun out: I screwed up, and it’s going to hurt my baby. I spent our entire car ride home scrolling through strangers’ testimonials in online parenting forums to reassure myself that I hadn’t done irreparable harm. My fetus was fine. But I didn’t eat another bite of unpasteurized cheese for the rest of my pregnancy.
Similar impossible standards apply after the baby is born, especially around SIDS, which Menkedick describes as the perfect outcome to fear, as an infant’s sudden death is terrifying, yet no one knows what causes it. Even though its incidence is rare, American parents are instructed to never put their babies down on their stomachs, even if that position helps them sleep, and to avoid bed sharing, even if that’s the only way anyone in the family can get some rest. Now, COVID-19 has given pregnant women and new parents an additional set of concerns about a novel virus — fresh flight-or-fight fodder for the amygdala. During a pandemic, no risk seems safe.
“…the consequences of defying risk are loud and clear: exile from the realm of the good mother.”
Yet in our culture, mothers are told that this period of heightened vigilance should be joyful, the happiest of their lives. Even other moms, usually older women with significant distance from their own postpartum experience, will tell you to cherish every moment. Mothers are given an impossible task, Menkedick says, told “they must not only do everything right but must also love doing it,” while expressing any ambivalence remains taboo.
“Anxiety is thus necessary and normalized. But too much anxiety reveals weakness, and mothers who demonstrate this weakness are shamed.”
American mothers are also bringing new life into the world amid a regressive social system, stuck in an outmoded 20th-century model of a single-income nuclear family, that does not offer universal paid leave, childcare, or healthcare. Menkedick argues that as women’s responsibilities have expanded in the workplace, expectations have grown higher than ever for mothers to play an intensive role in their children’s lives — a hybrid of risk manager, creative director, and therapist — without a social safety net to support these efforts.
Under these circumstances, I’d chosen to leave my job after my son was born, a choice that now seems less freely made than I’d first believed, having long perceived having such a choice to be a privilege. I’d known parents who’d been forced to stay in jobs they hated, or to leave jobs they loved, because nothing else would make the childcare math work. Perhaps true privilege would have been to give birth in a culture that supports all parents with adequate prenatal and postpartum resources, instead of forcing myself to feel lucky for having opted out of a toxic system.
At times, the exhaustive research that scaffolds the stories in Ordinary Insanity can feel like an insurmountable bummer. It’s especially triggering in the scenes of women recounting their involuntary hospitalizations. But Menkedick seeks to lead the reader to a place of hope rather than despair. She envisions an alternative to the current culture of fear that produces such anxiety for new mothers, one in which women feel empowered to make choices about their lives that are driven by intuition and common sense. She speaks of her acceptance of her own diagnosis, and the empathy that comes from climbing out from the depths of personal darkness to help others.
“I believe, I hope, that on the other side of this loss is a love that I have found in connecting with other women.”
Though anxiety is an affliction of excess care, Menkedick says it can be redirected toward society at large, channeling that care into becoming more mindful of the concerns of others, an outwardly focused mindset that would make us all better citizens, especially when it seems like the world is falling apart. It starts by removing the stigma around mental health — one story at a time.