postpartum depression book, PPD bookI’m so excited for the first official review of a postpartum depression book by the newly established Warrior Mom Book Club. So without further ado, here’s Amber Koter-Puline, sharing the review of Hillbilly Gothic by Adrienne Martini. There’s a lot of great discussion here about stigma and how it feels to have postpartum depression. Hint: Be sure to read all the way through, because you might win something at the end!

This Summer, we began The Warrior Mom Book Club, a partnership between Beyond Postpartum and Postpartum Progress.  Katherine Stone and I are both super excited about this project.  The 32 women who participated in reading the book and being a part of this Warrior Mom book club debut review of Hillbilly Gothicare such a diverse and bright collection of women.This review (and perhaps those that follow) will be unique in that our goal is to share with you all our thoughts, feelings, and reactions to the style, content, and story Adrienne Martini shares in her book.  While we will provide general insights into how much we enjoyed the book or whether we recommend it, we don’t intend for this to be a critical literary review.

AKP: I chose this book for our first read in the book club because of what I thought was a great combination of wit, gritty honesty and interesting reading that seems almost conversational.  What were your initial thoughts about this choice?  What did you think of the book title before you dove into the reading?BR: The title was familiar to me, though I am not sure where I had previously heard about or seen the book, and I was not aware of its subject matter. I was drawn to the title – it sounds timeless and classic. I had read several “self-help” style books following my postpartum depression & anxiety diagnosis and I was excited to read a memoir.  I hoped to find a “friend” in Martini, who could understand what I had been through and was going through. I dove into it with enthusiasm.AKP: Martini begins her book with two quotes:

“Left my home in the valley put the mountains to my back there’s nothing wrong with where I come from Sometimes it’s meant to be just that.” — Scott Miller, Cross the Line

“As for me, I’ve chosen to follow a simple course: Come clean. And wherever possible, live your life in a way that won’t leave you tempted to lie. Failing that, I’d rather be disliked for who I truly am than loved for who I am not. So, I tell my story. I write it down. I even publish it. Sometimes this is a humbling experience. Sometimes it’s embarrassing. But I haul around no terrible secrets.” — Joyce Maynard, For Writers: Writing for Health

Why do you think Martini chose these quotes?

CF: I like these quotes better after having read some of the book. They didn’t mean as much before having started the reading.

BR: Both of these quotes were very meaningful to me as I was at a point of transition when I was reading the book. I was preparing to return to work full time, which for me marked a huge milestone in my recovery. I believe the Miller quote speaks to a moving on and a more deliberate leaving of the past behind. For me this is going back to work as someone who is well on her way to recovery and not still suffering. The Maynard quote is especially meaningful to me, as I am returning to work fully open and honest about what I went through. I let my team know before I returned and discussed it in my team meeting (I am a social worker, so I work in an environment that is more open to personal struggles than some other work places). I have approached this mission of openness and honesty with little care to how it may change the impression others have of me. I think my interpretation of the quotes has more to do with where I am in my life and my postpartum depression and anxiety than my reading of the text. I think they just match up well to my current situation.

CCP: I feel those quotes are in reference to her family history of mental illness. Regarding the one by Scott Miller, “…There is nothing wrong with where I come from…” There is nothing wrong with coming from a family who has problems with mental illness. Then the next quote by Joyce Maynard she is using to show that she is not willing to keep depression a secret anymore, as they had in the past in her family. I like when a writer begins with a quote. I feel it gives you a closer look into what she is trying to say through her book, and the inspiration behind writing it. I really like the quote by Joyce Maynard. In everything I have been through the past nine months, revealing my “secrets” were a huge step for me. It gave me the ability to express the scary stuff I held inside for so long; it was like a huge weight lifted off my back.

AKP: Speaking of scary stuff, this book had a lot of very vivid and detailed accounts of some scenarios that could be potential triggers for a reader.  While everyone needs to judge their own tolerance and ability to be triggered, what are your personal thoughts about who should or should not read this book?  Or maybe rather the question would be better worded, would you caution women who are still in the early or yet-to-be treated stages of a perinatal mood or anxiety disorder like postpartum depression to wait to read this book?

BR: Yes, I would caution women who are early in their diagnosis and treatment to take some time before reading this book. I began to read it when I was beginning to gain my footing, and settling into an effective treatment plan. There were statements in the book — thoughts that Martini shares — that I easily could have written myself. When I read the book I was at a point where I could read the statements and still felt a rawness, but was solid enough in my path towards recovery that they did not trigger and totally undo me.

AKP: Early in the book, Martini remarks that, “Once you stop wanting it to make sense, the way always becomes clear”. (p. 18) What do you think she means by this?BR: While this passage is in reference to the confusing streets of Pittsburgh, I believe what she is really getting at is an idea of letting go of preconceived notions and expectations. Through the book, the reader is led through Martini’s account of her investigation of her life as she makes sense of her history, the impact of her geographical location, her identity as a mother and her postpartum depression.   This letting go happens when we stop thinking of people, places, events and ourselves in a logical way and instead open up to the odd, roundabout, frustrating and dumbfounding ways things often are. Martini’s book goes through this process as she explains and makes sense of her experience. I believe in the strength and truth of this, because it is what I have had to do to make sense of my own experience. When I was first addressing my postpartum depression, I was so angry and frustrated, because it just didn’t make sense to me. It was not how things were supposed to happen after my baby was born! During that period I would cry and rail against the “unfairness” of it all, and what I thought was being taken from me. My healing has come from viewing my own experience in an open and accepting way, and in a way that does not focus on expectations that I feel haven’t been met. AKP: What do you think Martini means, both literally and a figuratively, when she says, “I will be doing this for the rest of my life, this pushing”? (p. 53)AM: When Martini writes that she will be pushing for the rest of her life, she is literally talking about the labour of childbirth. She pushed for what seemed like forever. But pushing is an act of strength in which you are trying with all of your might to bring about progress. It takes effort, determination, and it is exhausting. In many ways battling postpartum depression or anxiety is pushing. You are fighting, working, trying to do something that is not coming easy. You push and push your way through. It feels like you will push forever. That it will never be natural and easy, always such a strenuous effort.BR: In the literal sense, I agree that Martini is getting at the overwhelming nature of labor and the act of pushing which for many women is the final obstacle course they must traverse to meet their babies. This obstacle course is again unpredictable and can fulfill no expectations (some women such as myself push for 20 minutes, while others must push for hours). Figuratively I believe she is referencing the many obstacle courses of life, perhaps those of rearing a child and surviving mental illness more specifically. As she describes her pushing as an exhausting, unpredictable, painful event, but one that eventually produces the outcome of a child. That is also the nature of the many elements of our lives as we persevere as parents and survivors of mental illness.AKP: Martini expresses a strong sense of needing to belong as evidenced by how often she attempts to “prove” that she does indeed belong and that people like her. “Even crazy, I still got it.” (p. 47) Why is that? What does that say about Martini? What does it mean both for the story and her personally? Is this related to the postpartum period, to having children, or simply to Martini’s personality?

BR: I think the need to belong comes from fear of being different and of not meeting the expectations others have of us when they look at us. I think that this is an underlying fear that can play into postpartum depression. If we feel as mothers that we aren’t living up to expectations that puts further pressure on our already weakened selves. Not belonging is also scary because it means we are ungrounded, not connected to something that can bring comfort, strength and the framework for understanding our experiences. I believe that Martini’s focus on discussing where she came from (both genetically and geographically) is perhaps her way of attempting to put that framework in place for herself. I think this theme has much to do with being a mother, experiencing postpartum depression and with Martini’s personality. I think she might fit into a “type A”, high achieving, but also having high expectations of herself. I believe those of us with such a personality are very shaken when we feel we don’t belong.

Editor’s note: Perfectionism is a risk factor for postpartum depression.AKP: Speaking of a “type A personality,” when I was ill, and even now, I feel a strong need to know that I was/still am not alone in being an educated, high-achieving woman who still experienced this incredibly humbling and revealing disorder.  While I didn’t attend a support group or have social media support like #PPDChat available to me at the time I was suffering five years ago, I have been facilitating a support groupsince I recovered.  The reassurance I get each time one or ten women walk into the room once a month to meet and support one another is huge in my continued healing and reconciling what I went through.  How does sharing your story or participating in some sort of support group impact your sense of belonging?BR: I live in an area of the country that does not have an active support group for women with postpartum depression. I am fortunate enough to have a wonderful pediatrician who connected me with the mother of another one of her patients who was only three months ahead of me in her journey through PPD. When I met this other mom for the first time at a local coffee shop we both shared our stories with each other, for the first time talking about our experiences to someone with the intimate understanding of someone who can fully relate to an experience. I found this to be so incredibly validating and reassuring. I suddenly felt less alone in my struggles. My support network broadened when I found #PPDChat and this book club. In spite of the hell of my postpartum depression, I have developed a new aspect of my personal identity that I am very proud of: the membership of a collective of an unknown number mothers around the world who have struggled and survived and now work to tell our stories to others to help them survive as we are.JPG: Sharing my story has made me feel like I am doing something positive with this horrible experience. I blog at http://tranquilamama.wordpress.com/and I have found catharsis and healing in sharing my story. It helps me to realize that other moms have found my blog and realize that they are not alone. I received so much support from reading your blog, Amber, as well as Postpartum Progress and the #ppdchat community that I felt like my blog was a way to pay it forward.AKP: Martini feels there is a stigma around depression and psychiatric medication. Do you agree?  What does that stigma look like in your family or culture?TM: There’s certainly a stigma around depression. Everyone’s heard the “If you would just…” advice usually followed by, “…and you’d be better.”  Taking medication implies weakness. Moreso for black women who have some ethnic ideal of “strength” that the general public and even medical professionals seem to enforce without knowing it.  Perhaps it’s also a southern cultural thing, as in the olden days one wouldn’t say “so and so is crazy” if so and so was rich they’d be “eccentric” if so and so was poor, they’d “have problems.”  End of story.  Martini’s feelings hurt her because she beats herself up a lot for needing help mentally when it isn’t her fault. She even knows it’s not her fault but still feels guilty and horrible.  In that way it hurts her but it also helps her because it drove her to write this book.  Her feelings say that she is an intense and persistent person.

CCP: In my family, medication to treat mental illnesses is acceptable to most; but there are some who feel it is used as a band-aid to cover up the real problem. Those people, of course, have never been medicated for depression or any other related mental illness. I believe the medication can be necessary to make you stable enough to fight your battles, but the medication alone is not a “cure.”

JPG: I agree with CCP that the medication alone is not a cure. My sister seemed to think that I would get better simply by taking my antidepressant faithfully. That just was not the case. In the circles of my family and friends, the medication is acceptable. Some people do not see the benefit of therapy or support groups. It is still considered a taboo subject.

CCP: Yes, Jennifer, I have had some people say that the support group might be hurting me more than helping me, but they have no idea how much it has helped since they are not in my shoes. It also gives me the opportunity to support others going through PPD and gives me a real confidence boost!  I feel that the MMC PPD support group has been the most helpful in my journey through PPD. The amount of support I get daily is amazing. I also find that being able to support my new friends through their own journey with PPD has been very healing for me. Postpartum depression has revealed so much about me to myself and those close to me.

BR: I do believe there still remains a stigma around the medications and treatments described for depression, especially in regions or environments that do not have a strong understanding of mental illness. I would say that Martini comes from a region and a culture that treats mental illness as a defect in the individual, and not as a disease needing treatment just like cancer. This background just sets up another hurdle for her to negotiate and make sense of as she survives her own experience.AKP: Related to stigma, throughout the book, Martini talks about feeling like a failure — from breastfeeding, to not loving Maddy enough, to suffering from depression. (See pages 185, 188, and 190.) How do you think our generation’s culture and its competitive nature of parenting impacts this stigma ?BR: This is a sentiment that I can relate to from my own experience with postpartum depression and anxiety. I believe we see images everywhere that create expectations of motherhood that are not true to the actual experience. I remember staring at the picture of a joyful mother and happy baby on a box of diapers, and just wanting to laugh at the irony. There has never been a diaper changing experience in my time as a mother that resulted in such enjoyment for me or my daughter! Breastfeeding is projected as something natural, when really it is a real struggle for many moms and babies. We see unrealistic images in movies, on TV, and in the polished stories told by other parents. These form a heavy pressure on the new mom to live up to expectations that she most likely had for herself throughout her pregnancy because of these images. I know that was the case for me. My struggles hit me like a ton of bricks, because they didn’t match up with my expectations, and left me feeling like a failure.JPG: I felt like I could never measure up to my own expectations and society’s expectations of me. As a perfectionist, I wanted everything to be just right. In reality, I was setting myself up for a big fall. Each child is unique. Each relationship is unique. I felt like I was not being with my girls because I work full time. I felt like I was not a perfect mom because my girls were in daycare. Society told me that I should be able to “have it all”, but there’s no guide on how to do that.CCP:  The words “I’m a failure” have been a constant in my mind since the beginning of my pregnancy. Society tells women to read to thier bellies, sing to it, breast is best, etc… There is enough pressure put on women being employed full time+, caring for a home, and being the family nurturer (most of the time). All of these expectations combined are a recipe for failure, at least the feeling of failure. I don’t know anyone who could be all of those things, postpartum depression or not, and be 100% perfect at each one. And in regards to not loving her child enough, there is this idea that when that baby comes out of you you will be so in love and you will cry. We see this so many times on “A Baby Story” and in movies. Very rarely do they show a women who doesn’t have that instant bond and explosion of love on TV. Women are totally influenced by all of these things. Between societies expectations and our own visions and ideas the feeling of failure almost seems inevitable.AKP: Were you surprised at the end of the book to find out that Martini is again expecting? What do you think of her decision to become pregnant again?  How does that align with your decision to have more children or not?

CCP: I was not surprised that Martini was pregnant again at the end of the book. I am struggling with that decision constantly. Seeing that after all she went through she was willing to give it another try gives me hope that maybe one day I will get there too. For now I just want want to recover from PPD and then, just then, maybe I will consider doing it again.

MCM: I wasn’t surprised at all, either. I suffered from postpartum depression for about 9-10 months. It took me five months to get help. Now I am prego again & due Aug 27th. My first is only 21 months. It’s all worth it.BR: I was not surprised to find that Martini decided to have a second child. Her decision brought hope to me, as my plan and hope was always to have two children. Approaching such a decision with openness and awareness regarding the struggles of surviving PPD is something I will share with Martini when I begin to try for my second child.JPG: I had already decided that two was enough for our family. If I had known then what I know now, I would still have had my youngest even with the PPD and PPA. She and her sister are the lights of my life.AKP: Like Martini, I too went on to have a second baby after experiencing horrific PPA/PPD.  Thankfully, my experience was glorious, comparatively speaking.  I am really glad that I made the choice I did.  It was such an integral piece of my final healing to have a significantly positive opportunity to bond with my newborn, being active and enjoying his infancy in a way that did not occur the first time.  It has allowed me to offer others hope that with planning and treatment, subsequent children don’t necessarily mean subsequent PPD.  However, I have several friends that have chosen not to have more children who are confident and happy with that choice, and of course I support them and any healthy decision that women make.  Each experience and person is unique and needs to do what is best for her and their family.AKP: Lastly, would you recommend this book?  Why or why not?CCP: I would recommend this this book because of Martini’s raw honesty. I would be cautious though because some people may find it difficult if they are in the thick of PPD. There were some parts that hit really close to home for me, but I pushed through and I am glad I did.

RMM: I’ve just finished the book, and thought it was terrific and very brave for her to write.

SJ: I’m still reading but loving it!

MJ: I finished the book a few weeks ago. It was much harder to read than I expected, partly because it brought back memories, partly because it just felt like something was missing, even though she’s a talented writer and, I agree with Rebecca, very brave.

KP: I found the book to be incredibly insightful, although same with several of you, it definitely brought back memories and made me rethink my own experience and all the trials and tribulations. Given that I’ve already read several books on postpartum complications in my healing journey thus far, it was a wonderful breath of fresh air to read a book that was full of witty retort. It was at times painful, captivating, yet inspiring to me to one day document my journey.

LH: I enjoyed the book; it shed a “softer light” on postpartum depression.

MJ: It’s probably the best PPD book I’ve read, way better than Down Came the Rain, which didn’t have the level of writing talent and honesty. Was it just me that wished she’d found more joy by the end?

JPG: I would recommend this book. I am glad that I read it after having recovered, though. It was so raw and honest that it could trigger people who are still really struggling.

BR: Yes, I would definitely recommend this work to others. Actually, my mother is reading it now on my recommendation. She did not have PPD when my sister and I were born, but she has battled with anxiety and depression for much of her life (as have many women in the past generations of her family). I believe that readers who are currently journeying through or have survived postpartum depression will find reassurance, validation and a friend in this work. I believe those who have not gone through PPD will gain a greater understanding of the experience of those who have. I also feel like this work will appeal to many other audiences, including those who enjoy memoirs and those with a connection to Appalachia or their own geographical history. In general I found this to be a very smartly written and engaging book that I know I will read again.

AKP: Thanks, everyone who participated in the Warrior Mom Book Club, and to those of you who are reading this review.  Great news!! The author, Adrienne Martini, has offered a signed copy of Hillbilly Gothic to one lucky reader!  All you have to do is comment on this book review at Beyond Postpartum or here below at Postpartum Progress by August 25th to be entered in the random drawing.  Please include your email so we can let you know that you’ve won!

Thanks, especially, to the following active participants in this review:
Becky Ruess
CCP
CF
Maxine Jaffa
Amanda Michetti
MCM
TM
Rebecca Mabanglo-Mayor
Susanne Jones
Katie Premo
Lindsay Hays
Jennifer Pody Gaskell
Yuz Rozenblum


~Amber Koter-Puline