Perinatal bereavement is not postpartum depression, but it can become one. What is important to know.

by Claudia Ravaldi

“Depression is a worldwide epidemic. In 2020, according to WHO estimates, depression will be the most widespread disease on the planet. I personally believe that most depressions have their roots in loneliness, but the medical community prefers to talk about depression rather than loneliness. It’s easier to get rid of the problem by giving a diagnosis and a box of medications. ”Patch Adams

Patch Adams uttered these words in 2006, during a conference that generated numerous controversies and protests from patient associations and medical specialists. If I think of Patch Adams and his glittering story, first as an individual and then as a doctor, these words seem strange or improper in the mouth of him, known to most as the revolutionary doctor in his approach to childhood pathologies and known for his attention to the sick person, to their overall well-being, and to their good humor. His words, still current today, are the mirror of the great cultural contradictions in which we live and of the relative ignorance with which public opinion and a good slice of health professionals approach issues related to the psyche, its functioning, its disorders, to the prevention and treatment of the most frequent mental disorders.

Furthermore, although provocative, this discourse highlights another serious and widespread trend of our days, represented by the inappropriate use of psychiatric drugs, created to combat psychiatric diseases with inauspicious outcomes, even when not strictly necessary.

I find bereavement, including perinatal bereavement, a prime example of a problem that is generally “ignored” in its complexity: in many cases, no bereavement support itself is offered, expects it to pass, or prompts you to “get over it.” “quickly, in some cases it is” overtreated “with drugs, to” cheer itself up “, more often it is” mistaken “for depression (major or post partum), due to some dynamics and characteristics of bereavement that are reminiscent of mood disorders: it should be remembered that major depression and postpartum depression have specific characteristics and are important and serious diseases that must be recognized quickly and just as quickly treated. Bereavement and depression can coexist in some cases, but it is not the norm of physiological presentation of bereavement.

It is therefore very important to understand what we are talking about when we talk about depression, bereavement, physiology or illness.

It is very important to understand who we are talking to when our interlocutor presents with one or more signs or symptoms, which could be relevant to bereavement or depression or both.

Observing the problem thoroughly and having a good theoretical background in our support is essential, to avoid under-treating or over-treating the problem, with the consequences that we all know.

About generalization:

Would you ever tell a person with a cold that they definitely have early-stage pneumonia just because they can’t breathe well through their nose?

or to an elderly lady with an ingrown toenail due to a pair of too uncomfortable shoes that will have to amputate her finger for severe gangrene, which is not yet seen, but which will surely come?


You would not say this, for the simple fact that, by evaluating all the signs and symptoms present with the means at your disposal, you would know with sufficient certainty that there is an abyss between colds and pneumonia, as well as between ingrown toenails and massive gangrene.

So, only a few of you (very few, I hope), would think of an ongoing emergency in the face of a cold or ingrown toenail, suggesting intravenous antibiotics, lungs of steel, or preventive foot amputation.

Many of you (the whole, I hope) would rather do what common sense (medical, and more generally human and social) suggests in cases like this: they would take care of that congested nose, or that aching nail, with small daily gestures, with patience and willingness to follow the course and evaluate any changes, for better or for worse, in a careful and timely manner, up to a total or partial resolution of the symptom.

Faced with a health problem (whether physical or mental, we are always talking about health, assuming that even today this unfair and humiliating distinction must be made between body and mind, between liver and brain) it is very important to carefully evaluate any causes, understand if and how they can be removed, and hypothesize a therapy, appropriate to the case and to the extent of the symptoms.

To do this, it is important to have time, to evaluate their problem together with the person affected, establish a hypothesis of cure, and observe the course. Especially if we are talking about bereavement, which is not a disease, as menopause or pregnancy are not, but can become a disease, acting as a predisposing factor, observation of the course and in-depth knowledge of the problem are essential.

The observation of a phenomenon, whatever it may be, therefore provides for our active and personalized presence.

It provides for careful monitoring, provides for a good starting preparation (it is important for the observer to know what he is observing and what he can possibly expect and therefore that he knows in depth the problem in question), provides for the humility of the comparison (I am humble if I evaluate the problem in its complexity, if I frame that particular patient in its specific context, I am not humble if in front of the patient and his problem I only partially investigate what is convenient for me to quickly arrive at a diagnosis and a prescription).

If it is a question of observing a person with an ongoing problem and his experiential baggage, made up of experiences that are sometimes dramatic, such as mourning events or disabling mental or physical illnesses, observation also includes the commitment to “take actively taking charge of the part of the problem that may fall within our competence as operators and offer support in a comprehensive way to the person, offering him a remedy, when possible, or an indication to improve the situation.

The social stigma of mental illness and the Western taboo of death contribute to the confusion surrounding certain types of suffering. We know little about depression as an illness, we know little about emotions and the handling of negative emotions, we know little about grief and the physiological processing of grief.

Often, we use important words in an arbitrary way, we generalize concepts that should instead be evaluated in their uniqueness, and we “confuse” with each other very different life experiences. In the meantime, due to these psychosocial and cultural misunderstandings, people suffer more, and precisely in the moment of greatest need, they do not find an attentive observer who will provide them with the keys to understanding the problem and the information necessary to understand how to deal with it.

One can be sad without being depressed.

One can be grieving without being depressed.

You can be alone without being depressed.

You can be depressed, without being sad, mourning, or lonely.

One can be grieving and be alone. And this combination is a particularly risky combination for developing depression.

A recent article that will appear at the end of the month in extenso in the American journal of pediatric and perinatal epidemiology underlines the presence of an association between stillbirth and depressive symptoms between six months and three years after the loss. This association, already observed in other studies also in women who in the meantime had had successive pregnancies with success, deserves to be investigated. The tool with which the presence of postnatal depression is investigated, which in my opinion does not suit the subgroup of women affected by loss, deserves to be investigated. The difference between “Mourning” and depression deserves to be contextualized. Once again, it is crucial to understand what we are talking about, what we are looking for, and to ask ourselves if, properly caring for a bereavement immediately after bereavement could allow us to avoid the epidemic of maternal depression that studies point to us with growing concern.

“every mourning is a wound, and wounds are known to heal, as long as they have been opened” P. Racamier.

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