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Care(less) encounters: early maternal distress and the haunted clinic

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Abstract

In this paper we consider early maternal distress and clinical care, drawing on narratives of women interviewed to populate an Australian health information website. We consider the notion of ‘care barriers’, which has become popular in the biomedical literature as a means of explaining why ‘not enough’ women seek out clinical care. As an alternative to barriers we propose ‘care entanglements’, offering a way of conceptualizing socioculturally situated and biographically embedded formalized care. In part we argue that clinical encounters are ‘haunted’ by women’s biographies, circulating discourses, and the relational clinical moment, which accounts for why some women reject formalized care. However we also contend that many women have in fact already ‘slipped through’ to the clinic, whether this be in their adoption of medical language to describe their distress, or in their enactments in designated clinical spaces. Finally we reflect more broadly on the maternal, care and distress.

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Notes

  1. Clearly PND is not an acronym for peripartum depression, but rather postnatal depression. The ‘peripartum specifier’ was introduced in the latest version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (2013) in an effort to account for continuities between the antepartum and the postpartum. Although we wholeheartedly support the removal of disputed before/after divisions we use the acronym PND as this is the one more frequently used by our study participants. Our main aim is to consider how maternal distress is spoken about and relationally enacted rather than demonstrating the in/validity of contested constructs.

  2. For example the successful British singer Adele, whose coming out statement in Vanity Fair (Robinson 2016) in September 2016 included reference to ‘common symptoms’ of PND and an observation that PND “can come in many different forms” (which is also a key message of public health campaigns).

  3. ‘a “holding together” of the disparate itself, … without wounding the dis-jointure, the dispersion, or the difference, without effacing the heterogeneity of the other’ (Derrida 1994 in Barad 2010, p. 265).

  4. For further background information on these studies, see Stone and Kokanović (2016).

  5. This is a reference to Lacan’s Symbolic Order, also known as the Name-of-the-Father, or as we have been using in this paper, the big Other—a realm of language, sociocultural dictates, discourse. A similar concept is advanced by Julie Kristeva, who juxtaposes the paternal symbolic with the ‘feminine’ or ‘maternal’ semiotic—a domain of affect, body, prosody, non-textual relations. For a nuanced elaboration of how embodied mothers exist across so-called maternal and paternal domains see contemporary work in the field of maternal studies (e.g. Stone 2012; Baraitser 2009; Hollway 2015) (and indeed Kristeva herself, 1977).

  6. This is slightly misleading. There are several writers who offer ‘an alternative to the Clinic’, thinking in feminist ways about how both distress and being in relation are ‘inherited’ from the embodied mother. These include French speaking feminist psychoanalysts such as Irigaray (see Hirsch 1981) and Kristeva (1977), maternal studies scholars such as Baraitser (2009), Ettinger (2010) and Stone (2012), queer activists such as Bechdel (2012), and academics using novel research methods to integrate personal mother-inflected biographies with the literature on embodiment, trauma and subjectivity (see Blackman 2015; Cho 2008). Our point here is that this rich body of work has yet to filter through in discussions of early maternal distress and care.

References

  • American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association Publishing.

    Book  Google Scholar 

  • Armstrong, D. 1995. The rise of surveillance medicine. Sociology of Health & Illness 17 (3): 393–404.

    Article  Google Scholar 

  • Avrahami, E. 2003. Impacts of truth(s): The confessional mode in Harold Brodkey’s illness autobiography. Literature and Medicine 22 (2): 164–187.

    Article  Google Scholar 

  • Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning. Durham, NC: Duke University Press.

    Book  Google Scholar 

  • Barad, K. 2010. Quantum entanglements and hauntological relations of inheritance: Dis/continuities, SpaceTime enfoldings, and justice-to-come. Derrida Today 3 (2): 240–268.

    Article  Google Scholar 

  • Baraitser, L. 2009. Maternal encounters: The ethics of interruption. New York: Routledge.

    Google Scholar 

  • Beardsworth, S. 2004. Julia Kristeva: Psychoanalysis and modernity. Albany: SUNY Press.

    Google Scholar 

  • Bechdel, A. 2012. Are you my mother?: A comic drama. New York: Houghton Mifflin Harcourt.

    Google Scholar 

  • Berlant, L. 2008. The female complaint: The unfinished business of sentimentality in American culture. Durham: Duke University Press.

    Book  Google Scholar 

  • Beyondblue. 2016. Just speak up. https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/just-speak-up. Accessed 27 Mar 2017.

  • Bilszta, J., J. Ericksen, A. Buist, and J. Milgrom. 2010. Women’s experience of postnatal depression: Beliefs and attitudes as barriers to care. Australian Journal of Advanced Nursing 27 (3): 44–54.

    Google Scholar 

  • Blackman, L. 2010. Embodying affect: Voice-hearing, telepathy, suggestion and modelling the non-conscious. Body & Society 16 (1): 163–192.

    Article  Google Scholar 

  • Blackman, L. 2015. Affective politics, debility and hearing voices: Towards a feminist politics of ordinary suffering. Feminist Review 111 (1): 25–41.

    Article  Google Scholar 

  • Bollas, C. 1987. The shadow of the object: Psychoanalysis of the unthoughtknown. New York: Columbia University Press.

    Google Scholar 

  • Byatt, N., K. Biebel, R. Lundquist, T. Moore Simas, G. Debordes-Jackson, J. Allison, and D. Ziedonis. 2012. Patient, provider, and system-level barriers and facilitators to addressing perinatal depression. Journal of Reproductive and Infant Psychology 30 (5): 436–449.

    Article  Google Scholar 

  • Butler, J. 1997. The psychic life of power. Stanford: Stanford University Press.

    Google Scholar 

  • Butler, J. 2001. Giving an account of oneself. Stanford: Fordham University Press.

    Google Scholar 

  • Chattoo, S., and W. Ahmad. 2008. The moral economy of selfhood and caring: Negotiating boundaries of personal care as embodied moral practice. Sociology of Health & Illness 30 (4): 550–564.

    Article  Google Scholar 

  • Cho, G.M. 2008. Haunting the Korean diaspora: Shame, secrecy and the forgotten war. Minneapolis: University of Minnesota Press.

    Google Scholar 

  • Circle of Moms. 2017. Circle of Moms. http://www.circleofmoms.com/. Accessed 30 Mar 2017.

  • Clough, P. 2009. Reflections on sessions early in an analysis: Trauma, affect and “enactive witnessing”. Women and Performance: A Journal of Feminist Theory 19 (2): 149–159.

    Article  Google Scholar 

  • Conrad, P., and A. Rondini. 2010. The internet and medicalization: Reshaping the global body and illness. In Culture, bodies and the sociology of health, ed. E. Ettorre, 107–120. London: Routledge.

    Google Scholar 

  • Cvetkovich, A. 2012. Depression: A public feeling. Durham: Duke University Press.

    Book  Google Scholar 

  • Dennis, C., and L. Chung-Lee. 2006. Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth 33 (4): 323–331.

    Article  Google Scholar 

  • Department of Health. 2009. Framework for the national perinatal depression initiative 2008-09 to 2012-13. http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-f-perinat-toc~mental-pubs-f-perinat-fra#int. Accessed 27 Mar 2017.

  • Derrida, J. 1994. Specters of Marx: The state of the debt, the work of mourning and the new international. New York: Routledge.

    Google Scholar 

  • Devisch, I. 2013. Jean-Luc Nancy and the question of community. London: Bloomsbury.

    Google Scholar 

  • Ettinger, B.L. 2010. (M)other re-spect: Maternal subjectivity, the ready-made mother-monster and the ethics of respecting. Studies in the Maternal 2 (1): 1–24.

    Article  Google Scholar 

  • Fine, M., and C. Glendinning. 2005. Dependence, independence or inter-dependence? Revisiting the concepts of “care” and “dependency”. Ageing & Society 25 (4): 601–621.

    Article  Google Scholar 

  • Fisher, M. 2014. Ghosts of my life: Writings on depression, hauntology and lost futures. London: Zero Books.

    Google Scholar 

  • Flinders, D. 2001. Nel Noddings, 1929–. In Fifty modern thinkers on education: From Piaget to the present, ed. J. Palmer, 210–214. London: Routledge.

    Google Scholar 

  • Foucault, M. 1973. Madness and civilization: A history of insanity in the age of reason. New York: Vintage.

    Google Scholar 

  • Foucault, M. 2008. The birth of the clinic. London: Routledge.

    Google Scholar 

  • Frank, A. 1997. Illness as moral occasion: Restoring agency to ill people. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 1 (2): 131–148.

    Article  Google Scholar 

  • Frank, A. 1998. Stories of illness as care of the self: A Foucauldian dialogue. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 2 (3): 329–348.

    Article  Google Scholar 

  • Frosh, S. 2013. Hauntings: Psychoanalysis and ghostly transmissions. London: Palgrave Macmillan.

    Book  Google Scholar 

  • Frosh, S. 2016. Relationality in a time of surveillance: Narcissism, melancholia, paranoia. Subjectivity 9 (1): 1–16.

    Article  Google Scholar 

  • Goodman, J. 2009. Women’s attitudes, preferences and perceived barriers to treatment for perinatal depression. Birth 30 (1): 60–69.

    Article  Google Scholar 

  • Greenhalgh, S. 2001. Under the medical gaze: Facts and fictions of chronic pain. London: University of California Press.

    Google Scholar 

  • Hirsch, M. 1981. Mothers and daughters. Signs 7 (1): 200–222.

    Article  Google Scholar 

  • Hollway, W. 2015. Knowing mothers: Researching maternal identity change. New York: Palgrave Macmillan.

    Book  Google Scholar 

  • Kokanović, R., and J. Flore. 2017. Subjectivity and illness narratives. Subjectivity 10 (4): 329–339.

    Article  Google Scholar 

  • Kokanović, R., and M. Stone. 2018. Listening to what cannot be said: Broken narratives and the lived body. Arts and Humanities in Higher Education 17 (1): 20–31.

    Article  Google Scholar 

  • Kristeva, J. 1977. Polylogue. Paris: Seuil.

    Google Scholar 

  • Lacan, J. 1973. The four fundamental concepts of psychoanalysis. Harmondsworth: Penguin.

    Google Scholar 

  • Laplanche, J. 1999. Between seduction and inspiration: Man. New York: Unconscious. (in Translation).

    Google Scholar 

  • Lupton, D. 2013. The digitally engaged patient: Self-monitoring and self-care in the digital health era. Social Theory and Health 11 (3): 256–270.

    Article  Google Scholar 

  • Massumi, B. 2003. Navigating movements: An interview with Brian Massumi. 21 C Magazine. http://www.21cmagazine.com/issue2/massumi.html. Accessed 30 Mar 2017.

  • Miller, P., and N. Rose. 2008. Governing the present: Administering economic, social and personal life. Cambridge: Polity.

    Google Scholar 

  • Mol, A. 2008. The logic of care: Health and the problem of patient choice. London: Routledge.

    Google Scholar 

  • Nicolson, P. 1998. Psychology, science and the transition to motherhood. London: Routledge.

    Google Scholar 

  • Noddings, N. 1984. Caring: A feminine approach to ethics and moral education. London: University of California Press.

    Google Scholar 

  • Oakley, A. 1980. Women confined: Towards a sociology of childbirth. Oxford: Martin Robinson.

    Google Scholar 

  • Ram, K., and M. Jolly. 1998. Maternities and modernities: Colonial and postcolonial experiences in Asia and the Pacific. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Raphael-Leff, J. 2000. Spilt milk: Perinatal loss and breakdown. London: Institute of Psychoanalysis.

    Google Scholar 

  • Robinson, L. 2016. Adele: Queen of hearts. Vanity Fair. http://www.vanityfair.com/culture/2016/10/adele-cover-story. Accessed 30 Mar 2017.

  • Rose, N. 1990. Governing the soul: The shaping of the private self. London: Free Association Books.

    Google Scholar 

  • Rowe, J. 2015. Is this my beautiful life?. Sydney: Allen & Unwin.

    Google Scholar 

  • Shields, B. 2006. Down came the rain: My journey through postpartum depression. New York: Christa Incorporated.

    Google Scholar 

  • Stone, A. 2012. Feminism, psychoanalysis and maternal subjectivity. New York: Routledge.

    Google Scholar 

  • Stone, M., and R. Kokanović. 2016. “Halfway towards recovery”: Rehabilitating the relational self in narratives of postnatal depression. Social Science and Medicine 163: 98–106.

    Article  Google Scholar 

  • Turner, B.S. 1992. Regulating bodies: Essays in medical sociology. London: Routledge.

    Book  Google Scholar 

  • Watson, N., L. McKie, B. Hughes, D. Hopkins, and S. Gregory. 2004. (Inter)dependence, needs and care: The potential for disability and feminist theorists to develop an emancipatory model. Sociology 38 (2): 331–350.

    Article  Google Scholar 

  • Wetherell, M. 2013. Affect and discourse—what’s the problem? From affect as excess to affective/discursive practice. Subjectivity 6 (4): 349–368.

    Article  Google Scholar 

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Acknowledgements

First and foremost, we express our gratitude to all research participants who shared with us their personal stories of emotional distress. The paper is based on data collected within two research projects, funded by the Australian Research Council Linkage Project (LP0990229) and Healthdirect Australia, a national, government owned, not-for-profit organisation. Thank you to Dr Kate Johnston-Ataata, ​who collected many interviews for the research that informed this paper, and to Maureen Robinson for her support. Renata Kokanović thanks RMIT University, which, through the RMIT University Vice-Chancellor’s Senior Research Fellowship, supported her completion of this paper. Finally, we are thankful to anonymous reviewers for their insightful comments that assisted us in refining the final version of this paper.

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Correspondence to Renata Kokanović.

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Stone, M., Kokanović, R. & Broom, A. Care(less) encounters: early maternal distress and the haunted clinic. Subjectivity 11, 108–127 (2018). https://doi.org/10.1057/s41286-018-0047-0

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