Mental health articles

Mental illness or adjustment difficulties?
The transition to parenthood, which occurs at a biological, psychological and
social level, and the range of factors that influence the ability of an individual or couple to adjust to the many changes associated with parenthood, have been discussed (see Chapter 5). Many, but not all, of those who have difficulties at this
transitional stage were already vulnerable or mentally ill, or had long-standing,
interpersonal difficulties (personality disorders) before they became parents.
Parenthood brings with it a range of contradictory social expectations and
attitudes. Men, as well as women, make many adjustments and may experience
losses in the transition to parenthood, but do not have the enormous bodily and hormonal changes experienced by women at this time. Societal attitudes to women who choose to either work or parent full-time remain ambivalent and the
many women who attempt to combine both often struggle to get the right
balance for themselves and their families.
There is an argument that mental health and adjustment difficulties are best
understood as a normal part of adjustment to parenthood. Arguments are made against ‘medicalising’ emotional distress at this time on the grounds that this
further stigmatises the woman having difficulties at a time widely regarded and represented as one of joy and celebration. The argument is made that this disregards the effect of unrealistic and contradictory social expectations of, and
attitudes to, mothers and mothering and the evidence, for example, that a lack of
social support increases the risk of depression post-natally.
The counter argument is that if the reality of perinatal mental illness is not
recognised, many women and their infants suffer without adequate intervention
and treatment. Severe mental illness at this time has implications for the
immediate safety of the parent and the infant as well as a potential longer term effect on infant development. In summary then, the argument against
medicalising perinatal distress and disorders highlights the importance of the
social and interpersonal factors that contribute to vulnerability. It must also be acknowledged that a range of disorders occur at this time, some of which are
best understood and managed as ‘adjustment disorders’, while some women will
fulfil criteria for significant psychiatric illness and lasting disability. Appropriate
management will include what can be considered ‘medical’ approaches in
combination with a range of psychological and social strategies.

Tags: Illness, mental illness