Experiencing a dilemma--accounts of working with PND.

Various ways of thinking about postnatal depression (PND) are evident from the literature. From the clinical-medical perspective, it is an illness of the individual mother. The social approach locates its cause in the environment Feminists/social constructionists have critiqued such models as problematising women--they see them as pressured by oppressive forces such as society's stereotype of 'the joy of motherhood'. From the psychoanalytic perspective it arises from unrecognised conflict and ambivalence, related to the re-emergence of conflict between the mother and her own parents. Health visitors working with PND--the frontline of health professionals in this aspect of maternal mental health--stand between the professional/academic accounts on the one hand, and the lay accounts of their clients on the other. The aim of this study was to examine how health visitors understand and make sense of PND. We adopted qualitative research methodology to analyse transcripts from interviews with eight health visitors about their work with PND. The findings demonstrate the diverse roles they have to adopt, and the complexity and lack of clarity of the very concept of PND itself. There were clearly ambiguities and dilemmas of thinking involved--not apparent from the literature, tensions with which the participants struggled. A subsequent paper will present training to address these issues.