A Culture of Emotional Restraint: Asian-American Mom Shares Her Perspective on PPD

postpartum depression asian momsToday we’re so happy to welcome Cat, a Chinese-American Warrior Mom, who blogs at Postpartum Thoughts.  The story she has shared with us is fantastic and I’m so excited for you to read it …

When I was pregnant with my first child, I received all the standard prenatal care: frequent OB visits, lab tests, and ultrasounds.  I also received a large packet of materials on postpartum depression.  However, I wasn’t worried about the immediate postpartum period because my mother would be living with us for five weeks after I gave birth.  How bad could it be if I had help from someone who already raised two kids herself?

In the Chinese culture, it is common for the new mother’s mother-in-law or own mother to live with her for a month after giving birth to help with the baby and to cook for her.  According to traditional Chinese medicine, our bodies have a “hot” and “cold” nature, which must be balanced for good health.  Giving birth makes the body “cold,” so in the first postpartum month, new mothers are not supposed to drink cold water, go outside, or shower, all of which can make your body “cold.”  (That’s right – no shower for a month!)  Additionally, they are supposed to eat “hot” foods such as ginger.  My mom gave me a hot water thermos before I gave birth and adamantly told me not to drink any cold water during or after delivery.  When my husband and I came home from the hospital with our daughter, my mom and several pounds of ginger greeted us.

I experienced the normal mixture of gratefulness and stress to have my mom around.  I was grateful that I didn’t have to be alone with the baby, that I didn’t have to cook for myself, that she was always willing to rock the baby to sleep when I was too tired to do so anymore.  At the same time, I was stressed because my mom seemed to be watching my every move, not giving me space to learn to be a mother on my own.  I thought I was disappointing her when I caved in after two days and took a shower, and I felt anxious asking for her “permission” to leave my own house when I couldn’t stand being trapped indoors anymore.  However, the friction we experienced was not unusual for any typical mother-daughter relationship.  I was managing as well as any new mother would.

Then one day, my baby woke me from a nap with her crying, and a sinking feeling immediately washed over me.  I couldn’t open my eyes, let alone get up.  I felt as if I had lead weights on my arms and legs.  This feeling of dread upon waking became a regular occurrence.  I willed myself to get up each time, mostly because I knew my mother would come knocking if I kept my daughter crying.  By the time my mom left, panic attacks had replaced my depression.

To call them “attacks” isn’t accurate because I was in a state of panic throughout the entire day, every day.  From the minute I woke up until the minute I went to sleep, I couldn’t take a single deep breath.  My heart was constantly racing.  I felt scared and paranoid about someone kidnapping me or my daughter.  I also felt a great deal of anxiety about my in-laws moving to our neighborhood.

At the time, I thought my anxiety was due to character flaws.  I had never heard the term “intrusive thoughts” before, so I thought I just needed to “get over it.”  I pushed through and “got better” on my own over the course of about half a year, even though I still had semi-frequent panic attacks and nightmarish thoughts about someone harming me or my baby even two years after I gave birth.  It was not until I came across Postpartum Progress that I was able to “diagnose” myself with postpartum depression because I learned about intrusive thoughts and postpartum anxiety.

So how is postpartum depression or anxiety different or the same in an Asian context?  At least in the Chinese culture, there is such a large emphasis on physical recovery that a new mother may not feel comfortable admitting to mental or emotional struggles.  Some of the restrictions for the first month, such as not leaving the house, might aggravate postpartum depression.  On the other hand, having live-in help definitely alleviated some of my anxiety because I had someone to talk to.  My panic attacks flared up after my mom left and I was left alone with my baby for the first time.

Before I had my second child, my mom also told me “not to cry as much” because it was bad for my eyes (due to the tears affecting my hot/cold balance).  This may sound insensitive, but Asian cultures value emotional restraint rather than emotional expression, counter to Western cultural values, which may lead an Asian woman to believe she should just hide her depression or anxiety.  There is also definitely a stigma in the Asian culture against mental illness, often rooted in superstition (eg: a person suffering from mental illness has “bad luck”).  Finally, Asian cultures operate on the concept of “saving face,” which requires doing whatever you can to preserve your dignity and honor.  The emphasis on emotional restraint, the stigma against mental illness, and the desire to “save face” might prevent some Asian women from admitting they need help or from seeking help.

For me specifically, I never felt like I could openly talk to my mom about my depression and anxiety due to cultural stigma and restraints, even though she was my primary companion during the day. Thankfully, my husband, who is also Asian-American, was very supportive and always offered me patience and a listening ear. However, despite some cultural barriers in getting support from my mother, my primary hurdle in getting help had little to do with my cultural background but more with poor education.  I had access to educational material, but the material was not effective in helping me to identify postpartum anxiety.  I read all the pamphlets from the doctor about postpartum depression, and although they mentioned anxiety and “thoughts of hurting your baby,” they were not presented in a manner that made me realize the breadth of how postpartum mood disorders affect women.  My mind focused on the word “depression,” and therefore, when I experienced severe anxiety and intrusive thoughts, I didn’t recognize them as anything but personal struggles.

I hope that my story will enable other women, particularly Asian women who may feel a cultural stigma against mental illness, to recognize that their struggles are not just personal flaws that they should bury, and to find the courage to seek help.

Did cultural stigma against mental illness prevent you from seeking help for PPD?  For Asian women, did you participate in the one-month sitting period, and if so, how did that affect your postpartum recovery (both positively and negatively)?

-Cathy Q., Postpartum Thoughts

About Katherine Stone

is the creator of this blog, and the founder and executive director of Postpartum Progress. She has been named a WebMD Health Hero, one of the fiercest women in America by More magazine, and one of the 15 most influential patient advocates to follow. She is a survivor of postpartum OCD.

Tell Us What You Think

Comments

  1. Cat, I'm happy to see another Chinese-American woman speaking up and not being afraid to share her PPD story!

  2. Thank you for sharing your story Cat!

    I love that women of all backgrounds are being represented here.

    • Mirjam – I agree there needs to be more representation among all backgrounds for mental health issues, particularly PPD. Hopefully women of all backgrounds will realize it's not just a Western thing, or just a white thing, or just a ____ thing.

  3. I think her story speaks also to just simply the culture you grew up in too. My mom wasn't perfect, but in my head she was. She took care of her house beautifully and cooked dinner every night. When I had a baby, I couldn't do any of those things. Which only made those intrusive thoughts worse. "I can't take care of my house or my family, therefore I'm a bad mom". Which only propelled the depression. Which then led to major anger. I was somehow comparing myself to my mom, to this perfect scenario I had in my head. When in reality, I was just surviving the beginning months of having a baby.

    I also really like Cat's description of the educational material not being effective. I have to whole heartedly agree. Had I known that PPD symptoms included anger, among other things, then I might have been able to catch it sooner. All information given was about hurting myself or my baby.

    Thanks for a great article!

    • Brandi – I agree that culture or background can be defined so much broader than just race or what country you come from. We all have a culture within our own families that we try to live up to and often fail. It's definitely hard to step into your own mom's shoes once you become a mother yourself!

      And yes, it's quite unfortunate that most women think of PPD as depression only (just as I did). Even if other symptoms are listed in the pamphlets, they usually only emphasize the depression part. Hopefully we can change that by sharing our stories with others.

  4. My Mom never told me she went through post partum depression. When I told her I was really struggling, she said she already knew I had PP. It's kind of her way to be a bit guarded and constantly second-guess herself if she's somehow intruding.

    PP should be taught with real depth in baby basic and childbirth class. The only thing they told me was "If you're depressed for more than 2 weeks, tell someone." the day I left the hospital. Still. I'm glad they said anything at all.

    I moved out of state in the middle of my pregnancy and my old OBGYN never mentioned that big of a life change could throw me for a loop. Nor did my new practice. In hindsight, I was depressed during the last part of my pregnancy but didn't really acknowledge it.

    • Susan – I can't even imagine moving out of state and then having a baby. I hope you've gotten the help you need and are thriving now. Too bad your mom didn't feel comfortable sharing her PPD struggles with you so that you could be better prepared. Some things are hard to talk about, even with your own kids or own mom.

  5. Thanks for sharing your story Cat. I found it quite helpful – I am an Anglo-Australian, but my husband is Asian-Australian (Chinese-Singaporean ethnicity). Although our different cultures have rarely been much of an issue between us, it has been very interesting seeing the cultural differences, particularly with his parents, when we had children. My mother-in-law stayed with me for the 'confinement' period just after I had my first, when I struggled with some PPD. Even though this was not my cultural norm, there were things about confinement that were definitely helpful, especially having someone else look after all the meals and cleaning!! I did struggle however with having someone else giving me very specific particular 'rules' for how to look after my baby at that time (no bright sunlight, no letting them cry even if its just while changing their nappy, no going outside for the first month, how to dress them, etc). I think this added to some anxiety already there (though this was not my MILs fault!).

    It's very interesting for me to read your thoughts on Asian culture and mental illnesses. In my experience, I've found that while very accepting of what some would call 'alternative medication' (certain foods to eat, yin-yang beliefs), there is a hesitation and almost scepticism of modern medication (such as anti-depressants/anti-anxiety medication) and a feeling that it is 'weak' to need talk therapy (whereas, I think it is strong to recognise you need help and to reach out for it). Though there's also elements of that in my culture, too!

    • Aimee – It's interesting for me, as well, to hear about your perspective as an Anglo-Australian dealing with an Asian MIL. That could definitely add stress and contribute to postpartum anxiety! The things your MIL said about taking care of the baby make me chuckle because my mom is exactly the same way! šŸ™‚

      Also, I completely know what you mean about the Asian culture being open to "alternative medicines" but skeptical about modern medicine. For a traditional Asian person, what we think of as "alternative" is actually traditional and has been a part of their culture for centuries. My mom would be much more open to me taking an herbal brew with who-knows-what in it than to take a pill for depression.

  6. Thank you so much for sharing your experience and a look at PPD from your cultural perspective, I learned a wealth of information and gained an understanding I didn't have before.

    I understand the emotional restraint aspect-African Americans practice something similar, we do a lot of "bootstrap" pulling, not taking time to focus on how we feel, deciding instead to just "get over it."

    I also didn't understand or know that the thoughts I was having had a name…

    I think cultural stigma and lack of real education on PPD and other perinatal mood disorders keeps women from even understanding or acknowledging that they need help.

    Thank you again for sharing and choosing to speak up.

    • Adriane – Thanks so much for your words of encouragement. It's funny how cultures that are so different from each other (Asian versus African American) can also have some distinct similarities. Thanks for sharing your perspective!

  7. Great post! And, thank you for your Warrior Moms of Color. Increasing awareness of PMAD with cultural competence is a terrific service!

  8. Great post! And, thank you for your Warrior Moms of Color series. Increasing awareness of PMAD with cultural competence is a terrific service!

  9. Reading your article it was like going through it all over again. Although from a slightly different angle. I had a “mix” confinement, in that my mother moved out the day the baby came home (my parents previously lived with me 5yr prior). I was always told what happened in confinement, so during my pregnancy I was sure that I would be fine as mum would be there. But she was not. This was very difficult for me, as I expected something to happen, but it didn’t. My saving grace was my husband, who saved all his leave to be with me for the first month. But when he went back to work, the panic hit. Mum dropped off the food every few days, told me what I couldn’t do, gave the baby a cuddle and left. My only guide was Google. In the hours by myself I would plan elaborate ways in which I could run away and never be found again. I would make plans about who the best person would be to leave the baby with until my husband came home, how I would send child support without being located….this all seemed okay because, as you said, I didn’t want to harm my baby, so I didn’t have PPD. I would cry all day and all night. But to the outside world I was fine because I couldn’t let the emotions our, or show people that I was struggling. Thankfully I am in touch with myself enough to realize that this wasn’t normal, and marched myself off to a doctor, saving face be dammed! I still wonder if the emotional restraint that I have been raised to show is an issue. I wonder if I should be cuddling my child more…?

Trackbacks

  1. […] Looking back, I wish my doctors and infant care teachers had spent time talking to me and my husband about the serious nature of PPD, how to look for signs and get help. I wish they had told me that PPD is now also called Postpartum Depression Spectrum because it manifests in so many ways, including intense prolonged anxiety, and rage. I also wished people had shown me articles written by survivors, especially women of color like this African American mother, and this Asian American mother […]

  2. […] Looking back, I wish my doctors and infant care teachers had spent time talking to me and my husband about the serious nature of PPD, how to look for signs and get help. I wish they had told me that PPD is now also called Postpartum Depression Spectrum because it manifests in so many ways, including intense prolonged anxiety, and rage. I also wished people had shown me articles written by survivors, especially women of color like this African American mother, and this Asian American mother. […]