Sides of a coin: postpartum depression and ritual confinement anxieties.
Childbirth has produced intense states of mind from the dawn of humankind. Fear of the unknown, anxiety caused by the mysterious process of conception was expressed in numerous cults, rites and superstitions around the world, many of them still active today. Even modern technology has been analyzed as a clue on archaic human needs, a perspective that reminds us of William Robertson Smith and his method of searching common cultural elements between the remote past and present day (1889). Cristina Gavriluta believes that ultrasounds are nothing more that a contemporary form of the ancient attempt to foretell future (2014). Modern people lost magic thinking patterns, but psychological reactions to life remained the same throughout millenniums. The human need to know what lies ahead and the illusory feeling of control evolved from compelling deities by sorcery to inventing more and more technological means of investigation.
Care for distressed women after childbirth produced a plethora of researches on the postpartum depression topic. Long before this psychiatric approach, traditional societies acknowledged the specific condition of confined women and isolated them from the public space by enforcing taboos and interdictions. Both the scientific attitude toward childbirth and the magic perception induce a socio-cultural expectancy that the first weeks after birth will be critical. Hence, pathological/superstitious sensations are more likely to be experienced by the new mother undergoing pressure from the community, as a placebo type of effect.
The mental tension caused by radical life changes (confined women face physiological transformations, emotional challenge and social reactions) may be regarded in antonymic terms. Antidepressants seem a rational response to the uneasiness of mind, something that puts the contemporary human being "apparently in a more favourable position with regard to archaic man" (Jung, 1992, 143). The latter, on the other hand, believes that women after childbirth are vulnerable to almost everything: guests, neighbours, witches, maleficent entities. Moreover, any careless gesture she does may offend the personified environment and repercussions will not be deferred, according to magic reasoning. Actually, postpartum depression or confinement folk beliefs reveal a psychological reaction to a life event still covered in enigmas. How pregnancy appears in some women while others cannot reproduce, why babies cry endlessly and fall ill unexpectedly and what are the causes of the "baby blues" are questions that await impossible firm answers.
The article uses empirical ethnographic data from the Folklore Archive of Moldova and Bukovina and international references to add to the debate on the postpartum period. First, medical facts are used to define the critical condition. The effects of such information are then compared to behavioural patterns from traditional communities in order to extract similar implications on a socio-cultural level. The second section of the article discusses anxieties induced to women as part of the folk knowledge from around the world and Romania. The last part considers ritual prescriptions as traditional management of the childbirth crisis, in an attempt to complete the comparison between the medicalization of PPD and the folk treatment of this life event.
The concern with the importance and high frequency of postpartum depression (PPD) is revealed by the vast body of literature on the topic and by existent specialized institutions such as Postpartum Support International (http://www.postpartum.net). Childbirth comes along with a wide range of emotions that were classified in various ways: maternal distress, baby blues, anxiety, obsessive symptoms, stress disorder, panic disorder, mood disorder, bipolar mood disorders, depression or postpartum psychosis.
"Faulty biochemistry" has been blamed for the negative states of mind. Whether it is the low docosahexaenoic acid (DHA) level, the hormonal disorders (of the thyroid, testosterone or estrogens) or a lack of vitamins B or magnesium, they all have been proven correlated with PPD.
The popular series that explains complex themes in a manner which is clear even for dummies contains a book on PPD that opens with a discussion on the pressure of popular culture on new mothers (commercials and, generally speaking, social stereotypes suggest that all mothers are in best shape and have perfectly happy families). The author advocates the changing of mothers' mindset. Women should stop feeling that all things have to be done by them. Thus, the author believes that most of the experienced anger and frustration will cease. The "big adjustment" (Bennett, 2007: 9) in women's lives is therefore a self-referential case.
The Diagnostic and Statistical Manual of Mental Disorders included "depression with postpartum onset" in the forth version from 1994 (Godderis, 2010: 456). The Illustrated Medical Dictionary considers motherhood "not only a biological process, but also a psychological crisis that reactivates and brings again to personal attention issues connected to affective and sexual development" (Rosati, 2015: 317).
The period of PPD is conventionally considered to last for 30 to 40 days from childbirth (Rosati, 2015: 318). "Typically, the postpartum period is of four weeks duration; however, women remain at risk for occurrence of depression for several months following delivery. According to the International Classification of Disease, an episode of depression is considered to have postpartum onset if it begins within the first 6 weeks after delivery" (Sharma, Corpse, 2008: 77). A more general time limit states that the first twelve months after childbirth (Wisner et al., 2006) are defined by the transition from pregnancy to full mothering acknowledgement.
On the other hand, specialized discourse on PPD came into focus, since it may "influence how women are treated by the health care system and the possibilities afforded to subjects to develop their own identities" (Godderis, 2010: 453). An article like Postpartum Mood Disorders (Seyfried and Marcus, 2003) may induce a certain level of expectation since it suggests that "30-75 percent of women experience postpartum blues, 10-15 percent of women experience PPD, and 1-2 percent experience psychosis. When the maximum percentages are combined, up to 92 percent of women who have given birth could be labelled as having one of the three conditions" (Godderis, 2010: 457).
Feminist researchers could not agree to such a bleak perspective and they noticed a psycho-cultural phenomenon that also takes place in traditional communities. While discussing Jane Ussher's book, titled Managing the Monstrous Feminine (2006), Rebecca Godderis states, "mental health discourses in psychology and psychiatry work to control and contain the power of the female body by medicalizing women's experiences, particularly in relation to the reproductive cycle. The continued search for hormonal causes for conditions such as pre-menstrual syndrome and PPD supports the positioning of women as inherently more 'mad' than man because of their biology" (2010: 453).
The author turns her attention to the "gendered discourses" under the influence of Foucault's thinking and she believes that medical statements have a great impact on women's treatments and self-definitions. The pressure is similar, though built on different parameters, to the effect of folk knowledge on women. They obey pre-exis ting cultural patterns that induce anxiety. Both medical literature and traditional beliefs tell the pregnant woman and the confined new mother that they are in danger. Psychiatrists consider them to be 'asymptomatic' or 'pre-symptomatic' (Rose, 2007: 19) patients, while the rural group isolates them and imposes numerous taboos in an attempt to protect them and their infants, as well as the public space. Despite the clash between the two types of society, childbirth causes social reactions that may bear comparison. "The high-risk mother [for PPD] is not an individual woman; rather it is a concept that is constructed by establishing a set of life circumstances" (Godderis, 2010: 458), and so is the ritually confined woman all around the world.
Medical education uses statistics and clinical studies to generate expectancy and therefore to manage any probable circumstances. Traditional knowledge also influences cognition, by using specific examples of taboo infringements to persuade community members. Moreover, any unwanted event has a unique code of interpretation, namely implacable punishment for disobeying ritual prescriptions.
E. G.'s statement illustrates the adaptive power of the rural socio-cultural system: "especially you shouldn't make the fire, because if you handle fire the child may get burned or hurt by the fire ... Now what can I tell you. I tend to believe this one. When I had my second son, I lived in a house in Pacurari and my baby was not baptized. Of course I had to ... my husband was working; I had to cook, to do something. After a while, at some point when my boy grew up, I had a niece over and she ironed something on the table, he climbed the table and the iron fell on the back of his palm.
He has a sign here, a burn mark. Here [on the back of the palm], his entire hand is burned. At that point, I realized and I said: 'I was in charge of the fire. [immediately after childbirth]'". Although her existence took place in a large city (Iasi) and she did not use a traditional hearth, E. G. needed magic patterns to cope with her life changes. Such "imminent repercussions" of ritual transgressions (Hulubas, 2015: 57) are based on widely spread beliefs. Scientific and magic reasoning are the two sides of the same coin trading childbirth perception. Firstly, mothers-to-be are told they are "pre-patients" (Rose, 2007: 85) to psychiatrists; secondly, the folk set of rules induces a deeply shaded horizon of expectations.
WORLD WIDE WORRIES
Almost a century ago, Carl Gustav Jung diagnosed the mental state of the modern man as a spiritual yearning "for an answer that will allay the turmoil of doubt and uncertainty" (1992: 243). The renowned psychoanalyst remarked the absence of a metaphysical system that can coherently support contemporary existence and blamed it on science, since it "has destroyed even the refuge of the inner life" (Jung, 1992: 236). Pragmatic behaviour induced by an exclusive cause and effect reasoning may suffice on a daily basis, but its effectiveness ends where scientific knowledge does, whereas traditional education manages to maintain a vigorous cultural system, always able to offer an answer to ontological questions.
Jung's mentor, Sigmund Freud, was the first to blame societal development for the uprising of mental afflictions, in 1898: "we may justly hold our civilization responsible for the spread of neurasthenia" (1962: 6). However, the disciple detaches himself from the idea that basic instincts are repressed in order to be integrated within modern society and argues that the loss of a spiritual involvement, as a result of rational demeanour, represents the cause of the "turmoil". Nevertheless, both psychoanalysts identified the feeling of unhappiness (the initial title of Freud's Civilization and Its Discontents was Unhappiness in Civilization), of failure and inner discomfort in "the man of the immediate present" (Jung, 1992: 227), who turned his face away from unverifiable beliefs, nonetheless still active in rural societies.
Since an energizing feeling "is itself the expression of a strong need" (Freud, 1962: 19), the absence of a "metaphysical system" (Jung, 1992: 234) that supports mental processes annihilates essential inner demands, therefore positive states of mind become impossible. Women confront themselves with a hollow cultural space after childbirth, unlike traditional wives who are informed about the magic dangers of the confinement period and about specific "antidotes". Not knowing what makes them feel vulnerable and why, and not even how to fight with these unseen "foes" adds a lot to the strains of motherhood.
Aboriginal communities helped last century scholars discover that childbirth blood is considered a universal destructive threat. In 1902, Ernest Crawley wrote that "women in child-bed and for some time after, are called 'unclean', frequently tabu" (10). Most of the ritual negative prescriptions are the same during the first weeks after childbirth and menstruation, since blood is considered extremely harmful for the social environment. Firstly, it "contaminates" the public space and consequently causes social misfortune. M. D. (a 67 year-old woman) is convinced that drought and extremely hot weather are produced by women that gave birth and then walked in the public space without being subjected to a specific religious ceremony (molifta) intended to purify them from the sin of birth. Such hyperbolic punishments work as community instruments. "The laws of nature are dragged in to sanction the moral code" (Douglas, 2001: 3), to predetermine behavioural patterns.
Secondly, lochia transform the new mother into a contagious source of impurity. Women in childbed "are supposed to be in a dangerous condition which would infect any person or thing they might touch; hence they are put into quarantine until, with the recovery of their health and strength, the imagery danger has passed away" (Frazer, 2009: 208). Such folk knowledge is being transmitted very early to young girls, and when the moment comes for them to become mothers, the entire psycho-spiritual itinerary is clear in their minds. Not only do they know that a sense of uncleanness will cause them inner tension, but also they will master all the measures to ward off dangers, and this traditional "battle plan" may keep them safe from despair, a feeling that is common among women with PPD.
Mary Douglas established that impurity signifies disorder and that all attempts to isolate sources, hence to eliminate contagion represent "a positive effort to organise the environment" (2001: 2). On the other hand, both the new mother and the child are receptive bodies, and community itself becomes a threat. "The confinement period allows people to thwart possible actions of witches that may aim to harm the mother and her infant, in a time when both are most vulnerable" (Bartoli, 2007: 207).
The most common period of time that conjures the new mother and her child to stay indoors is 40 days for numerous civilizations (Bartoli, 2007: 207-213), Romanians included. This limit is provided by the magic significance of the number 40, which allows enough time to complete a spiritual and physiological sequence. Christian feast lasts for 40 days at Christmas; the ritual mourning period ends after the same amount of time. Moreover, the Bible abounds in references to this period of: King David, King Solomon, Noah, Moses and Jesus Christ were connected to the symbolism of the number 40. It signifies "a completed cycle" that leads to radical changes (Allendy, 1948: 385), and it is the number of "waiting, preparing", a number that suggests a trial and a punishment (Chevalier and Gheerbrant, 2009: 683). All these implications are found during ritual childbirth confinement.
Magic concerns that define the first forty days after childbirth are twofold. On one hand, the profane world can be damaged by the new mother's impurity; on the other hand, the sacred dimension (both pagan and Christian deities, the sun, the woods) may be offended by her. Nevertheless, both the social world and the spiritual environment are capable of harming, in their turn, the woman and her infant. The individual and his surroundings are communicating vessels, and this is exactly why the "dirty" woman has to be isolated and removed temporarily from this symbolic relationship. Frazer stated that menstruous girls, just like women after childbirth are "suspended, so to say between heaven and earth" (2009: 606).
Perils that lurk in the profane world start with the magic powers of the "evil eye". This universal danger is believed to be caused by people's evil eyes. The Italian name for this mysterious disease bears the name of its agent: malocchio [bad eye], as it happens in Romanian language, too. Deochi means "caused by the eye". Neighbours, friends, and relatives should not come in contact with the confined woman, and usually the traditional birth attendant denied them access to her room, as we were told in Draxeni village, county of Vaslui. She would take them out of the house if they already entered (Motoceni--Bacau) or she would simply lock the door to the new mother (BerzunCi--Bacau). Both the mother and her child may be affected by "evil eye", and dangers consist in loss of lactation, sleeplessness, illness and even death. People's envious eyes can also harm the woman while being outdoors, reason for which she may not visit anyone, according to beliefs observed in Romania, South -Eastern Asia (Bartoli, 2007: 217) or in the Slavic world (Kabakova, 2000: 105). Seclusion can easily cause depression among women facing the new challenges of motherhood.
Furthermore, the sacred world becomes a threat to them. Uneasiness of mind may be the effect of folk beliefs implying the fact that lochia may even "outrage the gods". This expression was used by Lise Bartoli as a subtitle for providing empirical data from Catholic countries, Guatemala, South-Eastern Asia, and China (2007: 211-212). There and in Orthodox countries, too, women are considered unclean and cannot enter sacred establishments. Pre-Christian beliefs from Romania also forbid her to touch the ground, to come near the hearth (Hulubac, 2012: 237-239), to look at the sun (Ciaucanu, 1914: 380) and to throw a glance at the woods (Hulubac, 2014: 86). Otherwise, she would offend Mater Genetrix (the Earth) and crops can be destroyed, or Vesta, the domestic fire, or Sol--the god of sun, and woodland deities similar to the Roman Diana.
Although the cult for these gods disappeared under the pressure of Christian doctrine, folk beliefs are active in the sociocultural dynamics in Romania. D. L., a villager from Neamt County, declared in 2011: "while confined, the woman should not look at the forest, for the forest will impair her, the Mother of the Woods (Mama Padurii) will impair her. She should only look down, at her feet; the light should not be on all her face! They say that if you take a glance at the forest, while being outside it, of course, the forest will impair you and will give you headaches..." Confinement headaches represent a frequent anxiety in rural settlements, but they are also acknowledged by numerous medical facts. According to a study from 2005, 39 percent of parturients experience postpartum cephalalgia in the first week after delivery (Goldszmidt et al.).
Restrictions thus appear as relics of complex worshiping from the remote past. Frequent taboos of coming close to the fire before and after childbirth are related to the adoration of hearth gods. "The hearth is considered sacred by most modern populations. Nothing impure should be found either on it or behind it, and even more so in the hearth fire, because it is a sin according to folk beliefs. It is hence obvious that we are presented with reminiscences of a religious cult which only preserved this respect for the place that was once an altar and a dwelling for deities completely forgotten by tradition today" (Caraman, 1988: 120-121).
Despite the apparent clash between cultural anthropology (which subsumes ethno logy, ethnography and folklore) and medical sciences, as a consequence of the different research instruments, afflictions may fall on the fine line between the two sciences. As echoes of psychological reactions to the world, disorders require the entire context in order to be treated effectively, and the collective unconscious that stores cultural information could play a significant role in the pressure exerted on PPD women. As noticed, a female ethnographer was the first to speak about a distinctive "postpartum psychology" in Romania at the end of the 19th century (Marian-Balaca, 2013: 38) . The loss of the rural sociocultural coherency has not been compensated by the pragmatic outlook on life. Traditional knowledge provided specific causes, clear explanations and efficient remedies for a radical life change, whereas modern mothers are only left with possibilities and uncertainties. However, the social pressure is comparable in both societal types. Folklore influences women and predetermines what they feel, just as much as medical discourses do. The latter solve the psychosomatic crisis with drugs. Taboos and amulets are their correspondent in magic reasoning.
Seclusion and restricted access to domestic elements represent specific magic reactions to childbirth. No unexpected distress is apparently possible for the new mother, since traditional culture warns her about perils constantly. As a teenager, she heard about them from her female relatives, while as a pregnant woman she was watched by the entire community. On a psychological level, the confined woman knows what lies ahead, how to ward off evil and what omens are used for her own well-being and for her newborn. Traditional birth attendants took great care of women's mental state when allowed to assist labour, decades ago. For example, in Moldavia, she sweet talked women in parturition, caressed and emboldened them and even sang songs and told fairy-tale stories (Hulubas, 2012: 188) to take their minds off the pains.
Empirical midwives in most traditional communities around the world closely guarded the first eight to 40 days after childbirth. Access denial to harmful spaces represents the main countermeasure to unwanted situations. Archaic prescriptions forbade confined women to touch pots in Uganda (Frazer, 2009: 539) and even food in Tahiti (Frazer, 2009: 208). In Romania, women are still forbidden to cook and even touch the food of the rest of the family (Hulubas, 2014: 90). This prescription marks a symbolic hearth taboo that we discussed above and self-consciousness helps women feel secure. Once they obeyed the old, socially proven precautions, they were protected from all dangers.
The access is also denied to sources of water, since the impurity of lochia will spoil it (in Moldavian villages, small red worms are believed to appear in fountains after confined women take water from them). Fields, orchards and public roads are also affected, according to Romanian folk beliefs, by an unseen fire which burns underneath the new mother's feet (Marian, 1995: 84). On the other hand, visits can affect her, as a consequence of the "evil eye" or of the attention she draws upon her from evil spirits. Remedies consist in specific amulets. Metal is believed to have apotropaic powers since time immemorial. Because it is extracted from the earth's womb and then purified, metal is compared with "the spirit that detaches itself from substance" (Chevalier and Gheerbrant, 2009: 582). As an expression of spiritual power, metal--just like spit--is used against maleficent sightings, to prevent "evil eye" and to mitigate intense fear, according to Romanian beliefs.
Women after childbirth wear needles on the inside of their coats when going in public spaces (Curtesti--Botosani). The prickly metal is also a magic component of other stave off settings. A red thread in a needle is pinned behind the door to the newborn's cradle and it is also placed in a pot containing naphtha or excrement (Hulubas, 2012: 231). Both practices are intended to chase away dark forces. The needle scratches and manages to "catch" evil intentions, on a symbolical level, whereas the red thread distracts the unwanted attention. The vessel with bad odours indicates a folk belief that maleficent entities loathe exactly what humans do. Therefore, they will leave the confined woman alone if such a pot (also containing a weapon--the needle) lies underneath her bed.
Horseshoes are hidden underneath the waist belts in Gradistea--Valcea, to prevent nighttime dangers (Ghinoiu, 2001: 34). The Encyclopaedia of American Folklife mentions silver as an amulet fit for babies, thanks to its capacity to distract evil eyes (Bronner, 2015: 780), and this is a clear example of a cultural relic. The unfriendly eyes that can physically hurt the newborn are perceived as "ugly" in Timoc, Bulgaria (Jircomnicu, 2010: 54) and the risk of encountering them is higher if the baby is taken outside the house. The interdiction to take the infant outdoors in the first 40 days after birth has also been attested in the Slavic world (Kabakova, 2000: 105).
When seclusion ends, the first road taken by the new mother always leads to church. A three-stage religious service has to be performed for her, according to Romanian folk beliefs. First, she needs to confess all her sins and to receive the sacrament of Holy Communion, before she gives birth. Eight days following childbirth, the confined woman calls the priest to her home (it was the traditional birth attendant who used to bring him over), and she is subjected to a special religious service (molifta). Thirdly, her first outdoor walk after delivery takes place after 40 days and it consists in going to church, where she is again the subject of a specific prayer and religious service. Only afterwards, can the new mother return in the community as a full member. This Christian rite of exit mixes heathen beliefs into its doctrine, since the timing and explanations used to argue the woman's impurity are older and they can be found at various civilizations around the globe.
Nevertheless, it is more important here to observe that the social monitoring of women who give birth is very active in traditional communities. It starts during adolescence and it continues on two levels. Firstly, folk knowledge creates "typologies" of menaces and then it provides "battle plans". Secondly, the Orthodox Church offers mystical remedies and shields all possible attacks with religious services. Postpartum depression dims in this thick network spread over heaven and earth. Traditional mothers know what to expect and how to fight back, unlike modern new mothers who experience a comparable pressure based on scientific facts, but who can only benefit from prescription drugs instead of community support.
Discourses on postpartum depression are not as different as one might expect when comparing traditional perception to the scientific one. Childbirth brings along a plethora of complicated implications on various levels: material issues, physiological afflictions, psychological effects and spiritual needs have to be taken into consideration. Medical investigations are limited to rational instruments, whereas magic reasoning succeeds in reassuring women that anything that will affect them and their babies can be handled. Rites, folk beliefs and superstitions act as confidence enhancers, as long as prescriptions are observed. On the other side of the postpartum depression, "coin" is the effigy of self-induced serenity, the antidote of any anxiety. Biology is blamed for female-specific disorders in medical discourses and women blame themselves eventually. Therefore, the feeling that "something must be wrong with me" is the effect of such an education. Traditional knowledge shifts the focus from the "impure" woman to the universal interest she becomes. Bad intentions are blamed and not physiology. Something wrong may be happening to confined women at any time, however folk knowledge is prompt in delivering efficient means of defence.
ACKNOWLEDGEMENT AND DISCLOSURE
The authors have no potential conflict of interests to disclose.
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Adina HULUBAS--Senior Researcher, Ph. D., Romanian Academy--Iasi Subsidiary, Romania
No. 2 str. Th. Codrescu, zip code 700505, Iasi, Romania
Submission: December, 5th, 2015
Acceptance: January, 29th, 2015
 Any nervous excitation can shake up her entire body. Some even die other go crazy or remain in fear for their entire life. The postpartum woman is like a balance: the smallest weight set on one side startles her equilibrium; in some cases, she strengthens up, in some other she's lost. The fresh mother must be guarded during her burden, when nothing came to shake her soul, to bitter up her life with dark and painful thoughts and, if left alone all sort of strange things can glitter in her mind. A small thing, set in shade, takes before her the most exaggerated and ferocious proportions; an unclear voice that comes to her ear seems to her frightening and threatening. Her sensitivity and susceptibility are to such a tension that one step only can push her into insanity. Who in his life has never seen a dead passing or a big fire? Well, the postpartum woman should not see it, otherwise she fell sick or mad, this is why the postpartum woman must be guarded. (Sevastos, 1892: 196, apud Marian-Balasa, 2013: 39-40)
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|Title Annotation:||Multidisciplinary contributions|
|Publication:||Bulletin of Integrative Psychiatry|
|Date:||Mar 1, 2016|
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