Abstract
In this paper we consider early maternal distress and clinical care, drawing on narratives of women interviewed to populate an Australian health information website. We consider the notion of ‘care barriers’, which has become popular in the biomedical literature as a means of explaining why ‘not enough’ women seek out clinical care. As an alternative to barriers we propose ‘care entanglements’, offering a way of conceptualizing socioculturally situated and biographically embedded formalized care. In part we argue that clinical encounters are ‘haunted’ by women’s biographies, circulating discourses, and the relational clinical moment, which accounts for why some women reject formalized care. However we also contend that many women have in fact already ‘slipped through’ to the clinic, whether this be in their adoption of medical language to describe their distress, or in their enactments in designated clinical spaces. Finally we reflect more broadly on the maternal, care and distress.
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Notes
Clearly PND is not an acronym for peripartum depression, but rather postnatal depression. The ‘peripartum specifier’ was introduced in the latest version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (2013) in an effort to account for continuities between the antepartum and the postpartum. Although we wholeheartedly support the removal of disputed before/after divisions we use the acronym PND as this is the one more frequently used by our study participants. Our main aim is to consider how maternal distress is spoken about and relationally enacted rather than demonstrating the in/validity of contested constructs.
For example the successful British singer Adele, whose coming out statement in Vanity Fair (Robinson 2016) in September 2016 included reference to ‘common symptoms’ of PND and an observation that PND “can come in many different forms” (which is also a key message of public health campaigns).
For further background information on these studies, see Stone and Kokanović (2016).
This is a reference to Lacan’s Symbolic Order, also known as the Name-of-the-Father, or as we have been using in this paper, the big Other—a realm of language, sociocultural dictates, discourse. A similar concept is advanced by Julie Kristeva, who juxtaposes the paternal symbolic with the ‘feminine’ or ‘maternal’ semiotic—a domain of affect, body, prosody, non-textual relations. For a nuanced elaboration of how embodied mothers exist across so-called maternal and paternal domains see contemporary work in the field of maternal studies (e.g. Stone 2012; Baraitser 2009; Hollway 2015) (and indeed Kristeva herself, 1977).
This is slightly misleading. There are several writers who offer ‘an alternative to the Clinic’, thinking in feminist ways about how both distress and being in relation are ‘inherited’ from the embodied mother. These include French speaking feminist psychoanalysts such as Irigaray (see Hirsch 1981) and Kristeva (1977), maternal studies scholars such as Baraitser (2009), Ettinger (2010) and Stone (2012), queer activists such as Bechdel (2012), and academics using novel research methods to integrate personal mother-inflected biographies with the literature on embodiment, trauma and subjectivity (see Blackman 2015; Cho 2008). Our point here is that this rich body of work has yet to filter through in discussions of early maternal distress and care.
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Acknowledgements
First and foremost, we express our gratitude to all research participants who shared with us their personal stories of emotional distress. The paper is based on data collected within two research projects, funded by the Australian Research Council Linkage Project (LP0990229) and Healthdirect Australia, a national, government owned, not-for-profit organisation. Thank you to Dr Kate Johnston-Ataata, who collected many interviews for the research that informed this paper, and to Maureen Robinson for her support. Renata Kokanović thanks RMIT University, which, through the RMIT University Vice-Chancellor’s Senior Research Fellowship, supported her completion of this paper. Finally, we are thankful to anonymous reviewers for their insightful comments that assisted us in refining the final version of this paper.
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Stone, M., Kokanović, R. & Broom, A. Care(less) encounters: early maternal distress and the haunted clinic. Subjectivity 11, 108–127 (2018). https://doi.org/10.1057/s41286-018-0047-0
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DOI: https://doi.org/10.1057/s41286-018-0047-0