Winter wrote that while potentially one in seven women suffers from perinatal and postpartum mood and anxiety disorders (or P.M.A.D.s, a category that includes postpartum psychosis), these disorders’ “neurochemical byways are not well mapped.”
Dr. Veerle Bergink, the director of the Women’s Mental Health Program at Mount Sinai, told Winter this about postpartum psychosis:
There is no money for it, not for research, not for treatment. There are no guidelines. This is one of the most severe conditions in psychiatry, one that has huge impacts on the mother and potentially on the child, and there’s nothing.
This shouldn’t surprise and anger me as much as it does, because I already knew that diseases that tend to afflict women don’t receive as much funding as diseases that tend to afflict men. According to a 2021 paper published in The Journal of Women’s Health:
In nearly three-quarters of the cases where a disease afflicts primarily one gender, the funding pattern favors males, in that either the disease affects more women and is underfunded (with respect to burden), or the disease affects more men and is overfunded. Moreover, the disparity between actual funding and that which is commensurate with burden is nearly twice as large for diseases that favor males versus those that favor females.
I emailed Maya Dusenbery, the author of the 2018 book “Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed and Sick,” to get her take on why women’s reproductive health — which includes hyperemesis and postpartum psychosis — is in particular so poorly studied.
Dusenbery said that there are knowledge gaps across areas of women’s health because we’re still “playing catch-up in understanding that women’s experiences can sometimes differ from men’s when it comes to the risk factors and presentation of the same disease or the effectiveness and side effects of the same treatment,” and that some of the knowledge gap can be traced to “the tendency to psychologize women’s illness. In attributing women’s unexplained symptoms to ‘hysteria,’ medicine didn’t have much motivation to study their biological underpinnings.”
When it comes to women’s reproductive health, she said, “there’s been a more complicated dynamic” because there’s been a history of looking at women’s biological functioning “as sort of inherently pathological.” Menstruation, childbirth and menopause were seen as a kind of permanent sickness or weakness, which (conveniently, for some) prevented women from fully participating in public life. But there’s also been a history of psychologizing “women’s unexplained symptoms,” Dusenbery said, meaning women have also been told that their painful cramps or extreme morning sickness were just signs of mental illness.
During her second pregnancy, Fejzo was so sick that she couldn’t swallow a teaspoon of water, lost 15 pounds and ultimately miscarried. Her doctor, Callahan wrote, told Fejzo that “women make themselves sick during pregnancy to gain the sympathy of their husbands, and later, that her illness was a ploy for attention from her parents, who were helping with her medical care.”