Classifying Maternal Mental Illness: Race and Diagnostic Categories in the Early Twentieth Century

• In Event: Naming Stakes: Critical Histories of Classification and Categorization

English Abstract

This paper explores how, in the late 1920s, new eugenicist thinking led to a shift in how maternal mental illnesses were understood and classified. Beginning in the 1840s, American mental health professionals and obstetrician-gynecologists argued that psychiatric and psychological ailments that impacted women during pregnancy, childbirth, and early childrearing constituted a unique and distinct diagnostic category, which they called “puerperal insanity”. While such a framework would suggest that all childbearing people were candidates for the diagnosis of puerperal insanity, in reality, the disorder was constructed in relation to white (feminine) normativity and, disproportionately, excluded non-white racial groups. However, in the 1920s, Edward Adam Strecker, a leader in American, and his colleagues, advocated for the removal of the term “postpartum” from mental illness classifications. Instead, they argued that pregnancy, childbirth, or postpartum changes simply unveiled pre-existing vulnerabilities and underlying mental illness. Such advocacy, ultimately, resulted in the removal of the term “postpartum” from the Diagnostic Statistical Manual. While this framework facilitated the erasure of the unique nature of postpartum disorders, it also further perpetuated the racialization of postpartum disorders by failing to recognize how different racial groups were seen as more or less prone to particular mental illnesses. This, ultimately, resulted in highly divergent and racialized prognoses and therapeutic practices.

Author

• Udodiri Okwandu, Harvard University