The Harm of the “Just Do It” Culture in Medicine: a Story of Postpartum Depression

Reposted with permission from the KevinMD.com Blog.

Author: Jennifer Lycette, MD

“There’s no such thing as postpartum depression.”

These were the unsolicited words from my obstetrician in the third trimester of my first pregnancy.

“It’s only sleep deprivation,” she explained.

As an MD, I’d been taught there was indeed such a thing as postpartum depression. But as the patient in that interaction, a pregnant woman, I didn’t feel in any position to challenge her words. They would, however, stick in my brain forever. Even now, twenty years later, I can hear her voice.

I heard it during all three maternity leaves when I wondered if something was wrong with me. When everyone around me would normalize the “baby blues.”

But I didn’t feel safe to bring it up with the physician who’d told me she didn’t believe in it. Her words had instead instilled shame.

At least she’d acknowledged sleep deprivation as real. My husband didn’t get paternity leave, so I took the parenting night shifts. My infant daughter wouldn’t sleep until 6:00 a.m.; if I was lucky, the baby and I would then sleep until 10:00 a.m. (We’d moved to a new city for my fellowship when I was five months pregnant, so we had no family to help us.)

Nearing the end of my maternity leave, I asked my obstetrician in a small voice, how was I to return to work? It was so much harder than even a MICU call schedule—there was never a night off.

She gave me a cold look and said, “You just do it.”

And I meekly nodded. Because I understood she was speaking to me not as her patient but as a fellow woman physician. And I knew about “just doing it.” Soldiering on through inhuman conditions to, ironically, provide care for other human beings. Suppressing the need for sleep, food, and even using the bathroom. This would be one more thing I would “man up” and do so that, as a woman, I wouldn’t be accused of being too weak, nor allow myself any negative performance that could reflect poorly on my female peers.

All of that was encompassed in her four short words. The weaponization of shame. Something the culture of medicine does all too well.

So, somehow, I did it. I “womaned up.”

And then, after three subsequent miscarriages and the grief and physical suffering that entailed, I made it through two more pregnancies. My husband and I were blessed with the family we’d hoped for.

But in my third postpartum period, I found myself overcome with moments of unexplainable severe anxiety. If I had the kids in the car with me, I’d have to pull over so I could turn around and physically look at them, afraid somehow their images in the rearview mirror weren’t “real.” A part of me knew this was irrational—and probably not normal. But it couldn’t be postpartum depression, right? It was just the sleep deprivation. So I told no one. I was too ashamed.

At work, I mentioned one day on rounds how, after grocery shopping and buckling the baby into the car seat, terror would overcome me that in the thirty seconds it took to put the bags in the trunk, someone would steal my child, even while I never took my eyes off her. For some reason, I tried to make this story sound funny, and the attending responded by laughing and saying, “That’s cute.”

“There’s no such thing as postpartum depression.”

“That’s cute.”

All the messaging continued to signal that my experiences, feelings, and fears were either not real or trivial.

The day this finally shifted would turn out to be something ordinary. After being back to work for several weeks, exhausted, my husband and I decided to go out to dinner. It was our first time venturing into a restaurant as a family of five.

My older two kids were acting like … kids. As children do. The baby, of course, was crying nonstop. I felt under a spotlight—as if everyone in the restaurant was staring, judging me. I was a terrible mom. I was a failure. I didn’t deserve my kids. All this and more, a litany of horrible self-flagellating thoughts, and then I started to cry. And couldn’t stop.

But doctors don’t cry in public.

I grabbed the wailing baby and fled to the car, leaving my husband to wrangle the other two kids and pay the bill.

After we got home, I sat immovable on the couch for four hours, clutching the baby. My husband put the two older kids to bed and tiptoed around me. I imagined him thinking, “What’s wrong with her?”

When, in reality, he wanted to help. But instead of an obstetrician who’d prepared my spouse for the possibility of postpartum depression, we’d had one who told us it wasn’t real.

Finally, the next day at work, as I saw my own patients, the rational part of my mind woke up.

If I were my patient, what would I tell myself to do?

At lunchtime, I called my PCP.

“I think I have postpartum depression,” I said. “I think I need medication.”

And she said the one word I desperately needed her to say. “OK.”

Even now, I’m apprehensive about writing this. Afraid of the stigma. Fearful of appearing “weak.”

But when, in the same month, there’s a headline about a young oncologist taking her life and her child’s in the postpartum period and a headline about the “first medication for postpartum depression” being approved by the FDA—in 2023—it has to be time.

It’s well-established that physicians have higher rates of infertility, miscarriages, and suicide. These aren’t things to “tough out.” They deserve massive study and mobilization of resources to solve.

We need to foster a culture of support and empowerment, not continue to perpetuate one of silence and shame.

I regret it’s taken me twenty years to find the strength to write this.

If I can help even one other woman by sharing my story, it will be worth it.

Postpartum depression is real. And there is help.

Please don’t suffer alone. Please reach out.

To me, if no one else. My contact info is in my bio.

About the Author: Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.