In Ordinary Insanity (Pantheon, Apr.), Sarah Menkedick calls postpartum anxiety “the last major taboo of American motherhood.” The book, which incorporates personal narrative, journalistic reportage, and medical research, aims to shine light on an issue that Menkedick writes is “having a devastating, corrosive effect on maternal well-being in the United States today.”

Is there anything in the book that might surprise readers?

What we tend to think about postpartum mood disorders is flawed. The most prevalent symptom is anxiety, but we have these rubrics that are designed to diagnose depression because we’re concerned about depression, and suicidal ideation in particular. We don’t have any rubrics for describing anxiety as problematic. The magnitude of the disconnect there was shocking.

You’re best known as an essayist. How does this craft inform your new book?

The initial incarnation of the book was a lot more of me reckoning with my own fear, and all these existential philosophical questions related to that. I kept saying to my editor, “I don’t want the book to be just information. I want there to be feeling.” I want to inform the reader about all of these aspects that they may not have known about related to motherhood—everything from the changes in the brain to the history of motherhood—and bring a depth of feeling and larger quest for meaning that the essay does so naturally.

Your reportage and interviews with young mothers paint a very grim narrative. What was the experience of writing the book?

I found it incredibly cathartic. There were a number of times where I got off the phone with someone and I sobbed at my table. There is healing power in these stories. There’s something powerful about struggling silently by yourself, not knowing where it begins and ends, and realizing that it’s not you necessarily, it’s this beast that everyone is dealing with.

Why does the taboo of discussing postpartum anxiety persist?

Mothers are chastised for being too anxious and also for not being vigilant enough. This has happened throughout history, but our contemporary incarnation is particularly vicious. We’re inundated with more and more “expert” information about parenting, and mothers are expected to have an insane degree of knowledge and control over every aspect of their children’s lives—yet also not be overly anxious, to just go with the flow. There’s no real reward for standing up to that and saying, “No. I’m just going to speak out because I need to do this for my sanity.”

What systemic changes need to happen in order to counter what you call the “silent epidemic” of postpartum anxiety?

We need to start paying a lot more attention to mothers. There needs to be more care given to mothers in the first year. We also need to frame pregnancy as a period of vulnerability—to make it much more explicit that if you have any history of grappling with sexual assault or an abortion or with anxiety or depression, pregnancy can set off changes in your brain. We need to do it in a way that doesn’t infantilize women, but says, “Let’s be aware of this.”

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