Stories needing to be told

Louis Theroux spoke recently on Desert Island Discs about how his film-making style has changed, from looking to expose ridiculousness in the early days of working with Michael Moore, to a more nuanced, sympathetic way of relating to interviewees and subject matter. I watched Mothers on the Edge a little on the edge myself – when the stakes are so high, and these women and their babies are so very vulnerable, I was concerned that we might not see enough of the latter Louis.  

It’s a fine line between helping an audience understand a complex issue and causing distress, when you’re asking people to relive almost intolerable feelings and experiences… particularly here, in an inpatient setting where mothers and their babies are living together. By and large, Louis managed it pretty well, helped perhaps by a seemingly natural engagement with both the mothers and the babies, to the point of changing nappies, and an ability to intuit when he should back off.

The word taboo is overused, but when it comes to maternal mental illness, particularly at the severe end of the spectrum as shown here, there clearly is still a taboo. Mothers spoke of guilt, pain and failure to live up to society’s expectations: feelings of not being good enough, being overwhelmed, and (spoiler alert – no discussion of mental health in 2019 is complete without it) having to project a perfect image through social media (with one woman Instagramming photo after photo of her smiling happy baby, whilst feeling incapable of bonding with him or relating to him).  

Postnatal mental illness comes in many shapes and forms, and like most mental illness, is on a spectrum. Many women will experience 'baby blues' a few days after birth, as the aftermath of the medical processes, lack of sleep, raging hormones, and anxiety about responsibility for a new life all create a perfect storm, bringing a period of weepiness, even distress. For most women this passes, but postnatal depression is different – it is longer lasting and more difficult to recover from, but still much more ubiquitous than generally appreciated, affecting an estimated 10–15 per cent of new mothers. At the other end of the scale is severe postnatal mental illness, when mothers are so ill that they require inpatient hospital treatment. This was the focus of Mothers on the Edge, and the documentary was at pains to explain that depression is just one facet of this. We also heard the stories of women with diagnoses of psychosis, post-traumatic stress disorder, and emotionally unstable personality disorder.

The humanity of those involved in their care was striking, as is often the case in acute mental health settings. Dr Trudi Seneviratne at the Bethlem Hospital leads a team which shone through as doing the best possible work in the most challenging of circumstances, having to balance risk (one mother was on 'one to one' 24 hour watch as being at risk of suicide), with recovery (the same patient later in her treatment was given leave to go for a walk in the grounds, and absconded and made an attempt on her life). 

Society does not want to believe that a woman can feel indifference for their child, or ambivalence, even hatred. The reality is that many women do, to various extents, for various periods. Motherhood can be horribly overwhelming, and when it is, many women try to cover up their emotions, or soldier on, and feelings of guilt and failure can serve to make things worse. Theroux talks about how the everyday aspects of new parenthood can tip into the most severe form of mental illness.  There has been a huge amount of awareness raising in mental health in recent years, but in a field of programmes on mental health, the stories of these women and their children stand out as needing to be told.  

- Reviewed by Sally Marlow, King's College London and Associate Editor for Culture. 

Watch the programme now.