Prerna Tolani and Sathyaraj Venkatesan explore guilt and postpartum depression through the lens of Teresa Wong’s 2019 graphic memoir, Dear Scarlet: The Story of My Postpartum Depression.
Postpartum depression (PPD) is a psychiatric condition that affects new mothers. Characterised by persistent and intense low mood, typically accompanied by sadness, worthlessness, and/or hopelessness, postpartum depression is described as the “effect of temporary and curable hormonal imbalance experienced by women in transition periods” (Gawron, 2020, p. 87). Despite the fact that postpartum depression affects approximately 1 in 7 women worldwide, (Mughal et.al, 2022), it is not given enough attention in social and medical discourse. A key aspect of the limited clinical research that there is, demonstrates that the intensity, prevalence and healing process of postpartum depression is highly individualised and dependent on the socio-cultural factors surrounding the mother (Beck, 2002, pp. 453-472).
Written and illustrated by the Chinese-Canadian writer, Teresa Wong, Dear Scarlet: The Story of My Postpartum Depression (2019) is a graphic memoir, addressed as a letter to the author’s first born child, Scarlet. Reflecting on her personal struggles and eventual coping, Wong uses the text to narrate her postpartum depression in a visually stunning form. In this essay, we engage in a close reading of Wong’s Dear Scarlet, in order to investigate the lived experience of postpartum depression in conjunction with guilt.
Postpartum Depression and the Social Production of Guilt
The patriarchal constructs of womanhood objectify women and reduce them to prescribed gendered roles, stripping them of their agency (Butler, 2015). When it comes to mothers, societal expectations further perpetuate toxic cultural scripts, demanding that women prioritise their child’s needs above their own and conform to prescribed norms of motherhood. (Hays, 1996; Lee, 2008). Despite its prevalence, postpartum depression remains overlooked in medical research, with no mention of it in comprehensive histories of depression, psychiatry, or obstetrics (Callahan & Berrios, 2006; Shorter, 1997; Cassidy, 2007). The absence of this widely experienced condition reflects how deeply embedded the societal constructs of motherhood are and the need for a critical examination of cultural norms surrounding the topic.
The twentieth-century saw the rise of feminist autobiographical writing, allowing for a critical examination of motherhood and previously taboo topics, including postpartum depression (Gawron, 2020, p. 88). Seminal narratives, such as Simon de Beauvoir’s The Second Sex (1949) and Adrienne Rich’s Of Woman Born: Motherhood as Experience and Institution (1976), brought attention to how motherhood has been shaped by social and cultural institutions. More recently, texts such as Brooke Shields’ Down Came the Rain: My Journey Through Postpartum Depression (2006) and Amanda Munday’s Day Nine: A Postpartum Depression Memoir (2019), provide intimate accounts of individual struggles surrounding the expectations of being mothers.
These narratives all share the common theme: that women are burdened with unrealistic societal expectations regarding what it means to be a mother. The texts identify how these social expectations produce a sense of guilt and shame amongst those who feel that they are failing to live up to required standards, and how this can cause, contribute to, and exacerbate forms of mental distress.
Such an observation is reflected in the research of Cheryl Tatano Beck, an American obstetric nurse and a distinguished professor at the University of Connecticut, who has dedicated her efforts to studying postpartum mood and anxiety disorders. According to her extensive body of research, mothers who experience postpartum depression often struggle with overwhelming feelings of guilt. These feelings may stem from various factors, including a sense of inadequacy, perceived failure to meet unrealistic expectations of motherhood, and difficulty forming an emotional connection with their newborns. In severe cases, some mothers may even experience intrusive thoughts of harming their infants, further compounding their horror and self-blame (2002, p. 465).
Pregnancy and motherhood can take a significant toll on a woman’s physical and mental health, as evidenced by heavy bleeding during childbirth, painful breastfeeding, and chronic sleep deprivation. These challenges can intensify the exhaustion and isolation experienced by new mothers and contribute to identity crises as they adjust to their new role as caregivers (Gawron, 2020, p. 94).
Dear Scarlet: A Brave and Therapeutic Act
Pathography is a literary genre that involves the autobiographical or biographical account of personal experiences of illness, treatment, and sometimes death (Hawkins, 1998, 1). Dear Scarlet is a poignant example of this genre, providing a raw and intimate portrayal of the author’s journey through postpartum depression and recovery. Sarah Gildden, an American cartoonist, notes that “in a society where women’s stories of childbirth and early motherhood are expected to be either fairy tales or else not told at all, Dear Scarlet is an act of bravery” (2019).
Despite her initial scepticism regarding her drawing skills (Koverdan 2019), Wong conveys her vulnerability in the book through the inclusion of simple drawings. Five full-page illustrations are spread throughout the memoir, caveated with the phrase “not for the faint of heart”; she cautions the readers about the visual depictions of her experiences of postpartum depression. In an interview, Wong discussed the creative journey of the memoir, sharing how this artistic endeavour was conceived as a means to find “the final piece of closure”, and describing the experience as “very cathartic and therapeutic” (Koverdan 2019).
Intensifying Guilt
Throughout the memoir, Wong vividly portrays the overwhelming sense of inadequacy and helplessness that she felt while caring for her new-born. She highlights how certain socio-cultural customs that appear to have positive intentions can have negative and guilt producing consequences. For example, in Chinese culture, it is common for a new-born child and their mother to be isolated at home for about a month after birth. While this tradition provides a peaceful and safe environment for the mother and baby, Wong points out that it can also trigger distress. The isolation can lead to helplessness, overthinking, and feeling trapped and disconnected from the outside world. Spending the entire day around the baby can be overwhelming and may exacerbate negative feelings (Wong, 2019, pp. 59-60). Equally, self and social guilt prevail when socio-cultural norms are seen as not being followed.
Breastfeeding is a significant source of maternal guilt for Wong. After experiencing heavy bleeding during the childbirth process, she faced difficulties in lactation and initially had to rely on a breast pump. Despite the extreme discomfort and pain, Wong breastfed the infant naturally, to avoid being labelled as a “bad mother” (2019, p. 32). This is an example of the pervasive influence and internalisation of mainstream cultural scripts of motherhood which often require women to prioritise the baby’s needs over their own physical and emotional wellbeing.
In the text, Wong draws “A DIAGRAM OF MOM GUILT” (Fig.1), which conveys the guilt resulting from her choice to not breastfeed her baby. The diagram uses contrasting handwritings to convey the difference between the clinical realities of her new-born infant (like constipation and low weight) and her emotionally tumultuous reality. While the clinical is represented in formal fonts, the runny and cursive handwriting conveys Wong’s subjective reflections on the seemingly selfish choice to prioritize herself over the baby’s needs, which gradually becomes an overwhelming sense of guilt. The diagram captures the complexity of maternal guilt, which can arise from a variety of factors and have a significant impact on a mother’s mental health (Wong, 2019, p. 42).
The socio-patriarchal expectations placed on mothers seep into clinical settings, adversely affecting the quality of care. Wong discusses her experience in different healthcare settings in Canada, recounting the varying professional responses to her postpartum depression. While some clinicians acknowledged her inability to continue with natural breastfeeding, others trivialised major parts of her experience (such as crying spells, anxiety, fatigue and recurrent thoughts of death).
Wong’s experience of helplessness, isolation, and guilt were exacerbated, for example, by her family doctor’s inadequate support when she shared concerns regarding her depressed mood. The doctor dismissed her symptoms, attributing them to “baby blues” and recommending exercise (Wong, 2019, p.45). Baby blues are milder form of postpartum depression that typically lasts for up to two weeks after giving birth, and are attributed to hormonal changes (Mayo Clinic, 2022). Wong sought clarification and expressed doubt, but her concerns were met with silence; the doctor suggested she return after two months (Wong, 2019, p.46).
Concluding thoughts
Dear Scarlet uses the affect of guilt to investigate the social dimensions of postpartum depression and motherhood, shedding light on the often stigmatised and gendered experience of the disorder. The graphic memoir highlights how postpartum depression can result in self-blame, which permeates Wong’s experience as she strives to balance her needs with those of her new-born. Her black and white illustrations further deepen the reflective and visceral components of her story. Drawn together, Wong’s graphic memoir serves a dual purpose: it helps her as an individual to express her experience, which she finds therapeutic, and it also educates those who are struggling with postpartum depression. Wong’s Dear Scarlet is a significant medical narrative that brings attention to the critical issues of postpartum depression and guilt.
About the authors:
Prerna Tolani is a PhD graduate student in the Department of Humanities and Social Sciences at the National Institute of Technology, Tiruchirappalli (India). Her research concentrates on graphic medicine and literature and medicine. She can be found on Twitter @prerna_tolani.
Sathyaraj Venkatesan is a Professor of English in the Department of Humanities and Social Sciences at the National Institute of Technology, Tiruchirappalli (India). His research concentrates on graphic medicine, comic studies, and American literature. He is the author of nine books and over hundred research articles that span African American literature, health humanities, graphic medicine, film studies, and other literary and cultural studies disciplines. His recent co-edited book is Pandemics and Epidemics in Cultural Representation (Singapore: Springer, 2022). He can be found on Twitter @satnitt.
References
Beauvoir, S. D. (1956). The Second Sex. Jonathan Cape.
Beck, C. T. (2002). Postpartum depression: A metasynthesis. Qualitative Health Research, 12(4), 453–472.https://doi.org/10.1177/104973202129120016
Butler, J. (2015). Gender trouble: Feminism and the subversion of identity. Routledge.
Callahan, C. M., Berrios, G. E. (2005). Reinventing depression a history of the treatment of depression in primary care, 1940-2004. Oxford University Press.
Cassidy, T. (2007). Birth: A History . Chatto and Windus.
Gawron, A. (2020). Illness of the soul, body or culture? postpartum depression as a theme in contemporary literature. PraceLiteraturoznawcze, (8), 85–99. https://doi.org/10.31648/10.31648/pl.5660
Glidden , S. (2019). Dear Scarlet. Arsenal Pulp Press. Retrieved February 24, 2023, from https://arsenalpulp.com/Books/D/Dear-Scarlet
Hawkins, A. H. (1999). Introduction. In Reconstructing illness: Studies in pathography (pp. 1–30). essay, Purdue University Press.
Hays, S. (1998). The Cultural Contradictions of Motherhood. Yale University Press.
Koverdan, J. V. (2020, January 16). Teresa Wong chronicles her battle with postpartum depression in her debut graphic memoir | CBC books. CBCnews. Retrieved February 25, 2023, from https://www.cbc.ca/books/teresa-wong-chronicles-her-battle-with-postpartum-depression-in-her-debut-graphic-memoir-1.5093892
Lee, E. J. (2008). Living with risk in the age of ‘intensive motherhood’: Maternal identity and infant feeding. Health, Risk & Society, 10(5), 467–477. https://doi.org/10.1080/13698570802383432
Mayo Foundation for Medical Education and Research. (2022, November 24). Postpartum depression. Mayo Clinic. Retrieved April 7, 2023, from https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
Mughal, S., Azhar, Y. (2022, July 10). Postpartum Depression. (W. Siddiqui, Ed.). Retrieved February 25, 2023, fromhttps://www.statpearls.com/point-of-care/27543.
Munday , A. (2019). Day Nine: A Postpartum Depression Memoir. Dundurn Group.
Rich, A. (1996). Of Woman Born: Motherhood as Experience and Institution. W.W. Nortan & Company.
Shields, B. (2006). Down the Came Rain: My Journey Through Postpartum Depression (Reprint). Hyperion.
Shorter, E. (1997). A history of psychiatry: From the era of the asylum to the age of Prozac. John Wiley & Sons.
Wong, T. (2019). Dear scarlet: The story of my postpartum depression. Arsenal Pulp Press.
