For a book addressed primarily to medical practicioners, there are several wonderful gems in this book for the lay and professional reader alike. I found it to be empowering, especially in dispelling myths. For example, we learn that PPD is NOT caused by hormonal changes or imbalances, does not go away with time, and can be as efficaciously treated with exercise and other alternative treatments as it can with drugs.
The most powerful part of the book, in my opinion, is the section describing the rituals surrounding birth and the transition to motherhood in cultures where researchers have found a surprising absence of PPD. I found these descriptions beautiful, moving, and illuminating, especially in the context of the voluminous research summaries that make up the bulk of the book.
Kendall-Tackett describes the social structures that protect new mothers including a distinct postpartum period, social seclusion and mandated rest, household and childcare assistance, and social recognition of her new role and status:
In almost all the societies studied [which displayed low instances of PPD], the postpartum period was recognized as a time that is distinct from normal life. Postpartum is a time when mothers are supposed to recuperate, their activities are limited, and they are taken care of by female relatives. This was also common practice in colonial America, and was referred to as the "lying in" period (Wertz and Wertz, 1989). [. . .]
In cultures where there is a low incidence of the blues or depression, there is a great deal of personal attention given to the mother. This has been described as "mothering the mother." In these various cultures, the new status of the mother is recognized through social rituals and gifts. For example, in Punjabi culture, there is the ritual stepping-out ceremony, ritual bathing and hair washing performed by the midwife, and a ceremonial meal prepared by a Brahmin. When she returns to her husband's family, she returns with many gifts she has been given for herself and the baby. Ritual bathing, washing of hair, massage, binding of the abdomen, and other types of personal care are also prominent in the postpartum rituals of rural Gautemala, for Mayan women in the Yucatan, and for Latina women both in the U.S. and Mexico. Here is a description of one of these recognition rituals performed by the Chagga people of Uganda
"Three months after the birth of her child, the Chagga woman's head is shaved and crowned with a bead tiara, she is robed in an ancient skin garment worked with beads, a staff such as the elders carry is put in her hand, and she emerges from her hut for her first public appearance with her baby. Proceeding slowly toward the market, they are greeted with songs such as are sung to warriors returning from battle. She and her baby have survived the weeks of danger. The child is no longer vulnerable, but a baby who has learned what love means, has smiled its first smiles, and is now ready to learn about the bright, loud world outside." (Dunham, 1992: 148)
There is something very wrong about a culture where we expect and are expected to pop out a baby and get right back on the horse acting as if we are the same person we were before we birthed a new life into the world. We are not and will never be the same.