Multi-disciplinary perspectives on post-partum depression: an anthropological critique.

One negative outcome of the post-partum period is the occurrence of post-partum depression. While the incidence levels are high in the U.S. for the 'Blues' and the 'moderate level depression disorder', the nature of this phenomenon--as a disease and as an illness--remains unclear. It is suggested that an anthropological perspective incorporating symbolic behavior and biological processes may more effectively address the problem than isolated biological and psycho-social research. Theories of etiology based strictly in biological mechanisms have resulted in a treatment bias towards pharmacological intervention; this paper suggests that more attention should be given to the impact of the cultural patterning of the post-partum period, e.g. the structure, organization of the family group and role expectations. A review of the anthropological literature on childbirth provides little evidence for post-partum depression. Our own observations and an examination of the cross-cultural literature have identified common elements in the social structuring of the post-partum period. They include: (1) cultural patterning of a distinct post-partum period; (2) protective measures designed to reflect the vulnerability of the new mother; (3) social seclusion; (4) mandated rest; (5) assistance in tasks from relatives and/or midwife; (6) social recognition of new social status through rituals, gifts or other means. A hypothesis is proposed that a relationship exists between post-partum social organization/mobilization and post-partum depression. The experience of 'depression' in the U.S. may represent a culture bound syndrome resulting from the lack of social structuring of the post-partum events, social recognition of the role transition for the new mother and instrumental support and aid for the new mother.