Postpartum Depression and Social Responsibility

Introduction

When a woman becomes ill, it is not enough to seek a diagnosis: we must ask what support network surrounded her before the crisis and what network she will find after treatment. When a mother harms her child, an immediate, almost inevitable question arises: how could she have done it? It is a legitimate question, but it is not the only one. We must also ask what happened beforehand. Whether there were warning signs. Whether anyone had seen them. Whether anyone had understood that it was no longer simply a matter of exhaustion. Whether that woman had been able to say, “I can’t go on.” Whether there was someone willing to listen to her. Whether services were accessible. Whether the family knew what to look for. Whether there was a network capable of intervening before suffering became a crisis.

And there is an even more difficult question, one that comes afterward: what happens to a mother once the crisis has passed? Perinatal mental health cannot be regarded solely as a matter of diagnosis and treatment. It concerns the individual, the child, the family, services, and the community. Peripartum depression is relatively common. Postpartum psychosis is rare, but it can constitute a true psychiatric emergency, involving loss of contact with reality and, in the most severe cases, risk to both mother and child. Confusing these conditions would be a clinical error. Reducing them to a matter of individual responsibility would be a social error.

1. Not Everything That Happens After Childbirth Is Depression

In the days following childbirth, what is commonly known as the baby blues is frequent: tearfulness, emotional instability, irritability, and a sense of being overwhelmed. In most cases, this is a temporary condition. Postpartum depression is different. It may manifest as persistent sadness, loss of interest and pleasure, feelings of guilt, isolation, irritability, severe fatigue, difficulties in the relationship with the child, and the perception of being unable to fulfill one’s role.

Postpartum psychosis is different still. It can develop rapidly and may involve delusions, hallucinations, severe agitation, disorganization, mood disturbances, and loss of contact with reality. It is not simply a “very severe” form of depression: it is a condition that requires immediate psychiatric evaluation and, frequently, hospitalization.

This distinction is also essential in order to avoid a dangerous stigma. A mother who is experiencing depression is not, for that reason, a dangerous mother. Even intrusive thoughts concerning the possibility of harming the child do not necessarily amount to a desire or intention to do so. The situation changes when intent, delusions, hallucinations, loss of contact with reality, or suicidal or homicidal thoughts are present. Understanding this distinction means protecting, at the same time, the mother, the child, and the quality of the intervention.

2. A Diagnosis Does Not Tell the Whole Story

A diagnosis is indispensable. It makes it possible to give a name to suffering and to initiate treatment. But a diagnosis is not yet a protective network. A woman does not experience pregnancy and the postpartum period within the confines of a doctor’s office. She experiences them within a home, a relationship, a family, an economic system, a workplace, a neighborhood, and a culture.

She may be alone. She may have a partner who is largely absent. She may be experiencing family or relationship conflict. She may be in a financially precarious situation, have housing difficulties, sleep very little, or be overwhelmed by caregiving responsibilities. She may live far from her family, fear the judgment of others, or encounter difficulties in accessing services.

None of these factors, on its own, “causes” depression. But all of them can contribute to making a person more vulnerable and, above all, can make it more difficult for her to ask for help. This is where social responsibility comes into play. Not as a substitute for medicine, but because medicine can function only within a context that supports a person without leaving her alone.

3. Motherhood Cannot Be a Private Responsibility: A Social Support Network Is Needed

For far too long, perinatal mental health has been approached as though the problem were simply this: a mother is unwell, therefore she must be diagnosed and treated. This is necessary, but it is not sufficient. The question should also be: what kind of environment are we providing for that mother? Who takes care of the child when she needs to sleep? Who notices that she has not left the house for days? Who recognizes that her behavior has changed? Who can listen when she says, “I can’t go on,” without turning it into a judgment? Is her partner truly involved? Do the pediatrician, family physician, midwife, care center, and mental health services communicate with one another?

These are not questions unrelated to medicine. They are questions that affect the concrete possibility of treatment being provided in time. Prevention does not consist solely in recognizing an illness. It consists in ensuring that, when suffering emerges, someone notices and knows what to do. It means activating a network that must already exist before the crisis occurs.

Effective prevention should operate on several levels. First and foremost, at the social level: reducing isolation and excessive burdens, making services accessible, supporting families, promoting a more equitable distribution of caregiving responsibilities, and paying attention to economic and housing conditions.

Pregnancy and the first year after childbirth constitute a period during which monitoring physical health alone is not enough. It is also necessary to ask how the person is doing. Screenings and questionnaires can be useful, but only if they are connected to genuine care and follow-up.

A mother cannot be left alone to care for a newborn without knowing how to do so, because no one teaches her and no one cares for her while she learns how to care for her child. Prevention also means teaching, following the longstanding practice according to which the best way to learn is to learn from other mothers.

4. When Illness Intersects with Criminal Responsibility

The issue becomes particularly grave when a mother kills her own child. Two opposing oversimplifications must be avoided: “She is ill, therefore she is not responsible”; “She killed, therefore the illness is irrelevant.” Neither formulation is sufficient.

Criminal responsibility concerns the specific condition of the individual at the time the act was committed and must be assessed in accordance with the rules of the applicable legal system. A severe psychiatric illness may, under certain circumstances, impair or eliminate a person’s capacity to understand and to exercise volition. However, a psychiatric diagnosis does not automatically establish an absence of criminal responsibility. The legal question differs from the clinical one: to what extent was that person capable of understanding reality, comprehending the significance of her actions, and exercising self-determination at the time the act was committed?

Recognizing this distinction means neither turning a diagnosis into an automatic justification nor disregarding the illness when it has genuinely impaired the person’s capacities. Cases can differ greatly from one another and must not be turned into stereotypes.

The case of Lindsay Clancy in the United States brought this debate back to the forefront of public attention. Clancy is accused of killing her three children in 2023 and subsequently attempting suicide. The defense maintained that she was suffering from severe postpartum psychosis; the prosecution, by contrast, maintained that there had been planning and awareness. In September 2026, the trial concluded with the jury unable to reach a unanimous verdict, resulting in a mistrial.

Before that, there was the case of Andrea Yates, who killed her five children in 2001 and who, upon retrial, was found not guilty by reason of insanity and committed to a state psychiatric institution. These are extreme cases. Precisely for that reason, they must not become the lens through which all mothers suffering from a mental disorder are viewed.

Extreme cases should instead compel us to examine what occurred before the tragedy: what warning signs were present, what opportunities for intervention existed, and what obstacles prevented the support network from functioning. And after the tragedy, they should also lead us to ask another question: what does it mean to treat, rehabilitate, and accompany a person when her life has been profoundly marked by illness?

5. Protecting the Child, Caring for the Mother: A Social Responsibility

When there is a concrete risk, the priority is to protect the child. This principle is non-negotiable. But protecting the child and caring for the mother are not necessarily opposing objectives. A situation involving severe psychosis may require hospitalization, pharmacological treatment, continuous supervision, and the involvement of the family and social services. The response must be proportionate to the risk and continuously reassessed. The question should not be only: how do we remove the danger?

It should also be: how do we create the conditions that allow the mother to receive treatment and, whenever possible, to recover? A psychiatric crisis does not erase the person. And a person is not forever defined by the most severe moment of her illness. There is a social responsibility that begins with prevention, but does not end with prevention.

Here, perhaps, lies the most overlooked aspect of the debate. To speak of social responsibility does not mean arguing that, when a mother commits a crime, “society is to blame.” It means recognizing that society has a responsibility before, during, and after the crisis. Before, by creating conditions that reduce isolation and vulnerability. During, by ensuring access to treatment and the protection of the child. Afterward, by making recovery possible. Because recovery does not always coincide with the end of symptoms.

A woman may be clinically stable and still feel incapable. She may be discharged from the hospital and return home to the same loneliness she experienced before. She may adhere properly to her treatment and continue to live with feelings of guilt, shame, and fear of being judged. She may no longer be in an emergency and yet still be suffering.

It is here that rehabilitation becomes a social responsibility. Rehabilitation does not simply mean continuing to treat symptoms. It means restoring possibilities: the possibility of regaining autonomy; of rebuilding relationships; of progressively reclaiming her role as a mother; of returning to relationships with people and places; of resuming, whenever possible, personal and professional activities; and of regaining confidence in her own abilities. Above all, it means ensuring that the woman is not defined by her diagnosis.

A mother who has experienced severe depression or postpartum psychosis should not be regarded solely as “a psychiatric patient.” She is a person who has gone through a crisis and who may need a process that enables her to return to living her life. Treatment means intervening in the illness. Rehabilitation means helping the person regain control of her own life. These are different processes, but they are inseparable.

6. The Mother–Child Relationship Also Needs to Be Rehabilitated

Illness can interfere with the relationship between mother and child. But precisely for this reason, that relationship must be able to become part of the recovery process. This should not occur through constant evaluation of the mother’s “ability,” but through concrete and respectful support. A mother may deeply love her child and still need help caring for him. She may want to be with him and, at the same time, feel afraid. She may need someone by her side as she regains confidence.

Helping a mother does not mean replacing her. It means restoring to her, whenever possible, the opportunity to once again become the protagonist of her own motherhood. Naturally, the child must also be protected. But protection and the relationship itself need not necessarily be regarded as alternatives. When clinical and safety conditions permit, supporting the relationship can itself form part of the rehabilitation process.

The entire family cannot be left alone. The partner may not know what to do. Grandparents may feel powerless. Other children may be indirectly affected. All of them may experience fear, anger, shame, or feelings of guilt. It is not enough to tell a family, “Stay close to her.”

The family needs information, guidance, and support. It can become a fundamental resource, but it cannot be turned into a substitute for professional services. Family solidarity is a resource. It cannot be the only mental health policy.

For this reason, the support network must include professionals and the community: midwives, gynecologists, pediatricians, primary care physicians, psychologists, psychiatrists, care centers, social services, associations, family members and, when necessary, emergency services. They must all learn to communicate with one another so that the network can function; at times, someone must show them how to do so, coordinate the different interventions, and facilitate dialogue among them.

The real question we should ask ourselves when faced with the risk of postpartum depression is: what will that woman find when she returns home?

It is a question we should ask more often. Not only: Has a diagnosis been made? Has treatment been prescribed? But rather: What will that woman find when she returns home? Will she find someone who will help her? A service that follows up with her? A professional who knows her history? An accessible care center? Support for her relationship with her child? Concrete assistance if her economic or family situation is precarious? A community in which she can encounter other people without feeling marked by her illness? Or will she find only the expectation that she quickly return to normal?

If the latter occurs, responsibility for recovery is once again placed entirely upon the woman. But a person cannot be expected to recover in an environment that continues to produce the conditions of her isolation. An effective and integrated social support network is needed.

7. A Support Network That Does Not Disappear When the Emergency Ends

Social responsibility can therefore be understood as a responsibility that extends throughout the entire process. Before the crisis, it means prevention. When the first signs appear, it means detecting them. During the crisis, it means protecting and treating. After the crisis, it means rehabilitating and reintegrating.

This is a fundamental distinction. If the support network is activated only when the danger becomes evident and dissolves once that danger diminishes, then we have built an emergency system, not a system of care.

Rehabilitation, by contrast, requires continuity between the hospital and community-based services, between mental health services and maternal and child health services, and between healthcare professionals and social services. It requires time. And it requires a different understanding of recovery. Recovery does not simply mean no longer being in an emergency. It means being able to have a future again.

We must move away from the concept of the “ill” mother and toward the image of a woman living within a support network. Perhaps this is the most important cultural shift. A mother should not be viewed solely as a patient to be diagnosed. Nor should she be idealized as someone naturally capable of coping with everything.

She is a person undergoing an enormous biological, psychological, and social transformation. She may be vulnerable while, at the same time, possessing resources that illness can temporarily render invisible.

For this reason, we should learn to ask different questions. Not only: “Does she have postpartum depression?” but also: “How is she?” “Is she sleeping?” “Is she alone?” “Who supports her?” “Can she ask for help?” “How is her relationship with her partner?” “Will someone follow up with her?”

And when severe symptoms emerge: “What is the risk?” “Who is protecting the child?” “Who is taking responsibility for the mother’s care?” “What is the course of action over the next few hours and the next few days?”

And when the acute phase has ended: “What does she need in order to begin living again?”

This final question is as much a part of treatment as all the others.

8. Prevention Begins Before Diagnosis. Responsibility Continues After Treatment

Postpartum depression and postpartum psychosis remind us of a broader truth: mental health is not solely an individual matter. Medicine must recognize and treat illness. The family and the community can provide presence and support. Services must ensure accessibility and continuity. Institutions must create conditions that do not turn vulnerability into isolation. In extreme cases, the justice system must distinguish between the act committed and the psychological condition of the person who committed it.

But there is something that extends across all these levels: the responsibility not to leave a person alone, either before or after a crisis.

Prevention cannot be reduced to screening. Treatment cannot be reduced to a prescription. Rehabilitation cannot be reduced to hospital discharge. And motherhood cannot be regarded as a private responsibility to be undertaken in isolation. A diagnosis can give a name to suffering. A social support network can transform that name into an opportunity for treatment.

And a network that remains present after treatment can transform surviving a crisis into the possibility of living again.

This should be the true objective of social responsibility: not to replace individual responsibility, not to eliminate criminal responsibility where it exists, and not to attribute the blame for every tragedy to society. Rather, it means assuming a more demanding responsibility: creating the conditions in which a woman can be welcomed and supported before she reaches a breaking point, treated by her physician but also cared for by those around her when she is unwell, and accompanied when she must begin again.

Because the most important question is not only whether we have been able to prevent a tragedy. It is also this: after treating a mother, are we capable of giving her back a life?

If the answer is no, our support network is still incomplete. And if prevention means not arriving too late, rehabilitation means not leaving too soon.

To prevent is to arrive before the crisis; to rehabilitate is to remain after the crisis.

This allows us to give “social responsibility” a much broader meaning without turning it into an attribution of blame to society.