Historically, postnatal mental illness has received far more attention than mental illness occurring during pregnancy. However, it is now estimated that more than 1 in 10 pregnant women experience antenatal depression.1 As part of an intercalated BSc in neuroscience and mental health at Imperial College London, I learned how this illness can directly affect both the health of the mother and the neurophysiological development of the child. Despite increasing awareness, there is still a huge amount of stigma stemming from a lack of understanding of this topic. This creates a barrier to diagnosis, treatment, and support. I chose to research antenatal depression in more detail as part of a medical humanities course, aiming to improve comprehension of the subjective experience of the illness and allow better empathy with patients.
During this project I analyzed representations of depression and pregnancy in visual art and literature, and explored patient narratives. A central component to how antenatal depression is often described and understood is the use of metaphors, alluding to more tangible experiences to help others comprehend the intensity of emotion felt. I found visual and literary metaphors could be attributed to four major themes which are combined in my painting: (1) ideas of descending, (2) feeling trapped or isolated, (3) referring to darkness or loss of color, and (4) changes in identity. Trapped depicts a woman suffering from antenatal depression, confined behind an invisible glass barrier and engulfed by water and darkness. It provokes a greater curiosity in the subject, and its dramatic presence confronts viewers in stark contrast to the way mental illness is often hidden.
During both pregnancy and depression patients can encounter a transformation in perceived identity. Women often experience a significant change when they take on the role of a mother. However, sufferers of antenatal depression feel the value of this new identity is undermined by their lack of enjoyment of pregnancy, which many associate with a sense of shame. In addition, a prominent part of depression is a feeling of loss or disintegration of self. To emphasize this I depicted the subject in Trapped as unidentifiable and out of focus, achieved by blending oil paints on the canvas.
My research revealed that imagery of sinking in deep water and submersion are common ways to portray the experience of antenatal depression. This effectively alludes to the all-encompassing nature and seemingly endless depth of depression. The dark, deep water I have painted also reflects the literal darkness of the thoughts and feelings of hopelessness during this illness. The chosen palette of blues and grays attempts to convey this mood and was inspired by colors sufferers associated with their episode of depression.
In their testimonies, patients with perinatal depression expressed painful feelings of being trapped and alone, using metaphors that described being encaged or separated from the world behind glass. I allude to this with the splayed hand in the painting, highlighting an invisible barrier between the viewer and the woman. The hand also reaches out to the audience, communicating a plea for help.
Undertaking this exploration in the medical humanities has allowed me to bring a much greater depth of empathy to clinical consultations with patients suffering from antenatal depression. I hope that by improving understanding of this illness some of the surrounding stigma will be alleviated, helping these women to be better supported during their pregnancy, not only by the medical community but also by friends and family.
Gabriella S. Bernstein
G.S. Bernstein is a fifth-year medical student, Imperial College School of Medicine, Imperial College London, London, United Kingdom; e-mail: [email protected]
1. Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323:257260.