Alexandra Sacks
1,755,938 views • 6:16

Do you remember a time when you felt hormonal and moody? Your skin was breaking out, your body was growing in strange places and very fast, and at the same time, people were expecting you to be grown-up in this new way. Teenagers, right?

Well, these same changes happen to a woman when she's having a baby. And we know that it's normal for teenagers to feel all over the place, so why don't we talk about pregnancy in the same way? There are entire textbooks written about the developmental arc of adolescence, and we don't even have a word to describe the transition to motherhood. We need one.

I'm a psychiatrist who works with pregnant and postpartum women, a reproductive psychiatrist, and in the decade that I've been working in this field, I've noticed a pattern. It goes something like this: a woman calls me up, she's just had a baby, and she's concerned. She says, "I'm not good at this. I'm not enjoying this. Do I have postpartum depression?"

So I go through the symptoms of that diagnosis, and it's clear to me that she's not clinically depressed, and I tell her that. But she isn't reassured. "It isn't supposed to feel like this," she insists. So I say, "OK. What did you expect it to feel like?" She says, "I thought motherhood would make feel whole and happy. I thought my instincts would naturally tell me what to do. I thought I'd always want to put the baby first."

This — this is an unrealistic expectation of what the transition to motherhood feels like. And it wasn't just her. I was getting calls with questions like this from hundreds of women, all concerned that something was wrong, because they couldn't measure up. And I didn't know how to help them, because telling them that they weren't sick wasn't making them feel better. I wanted to find a way to normalize this transition, to explain that discomfort is not always the same thing as disease.

So I set out to learn more about the psychology of motherhood. But there actually wasn't much in the medical textbooks, because doctors mostly write about disease. So I turned to anthropology. And it took me two years, but in an out-of-print essay written in 1973 by Dana Raphael, I finally found a helpful way to frame this conversation: matrescence. It's not a coincidence that "matrescence" sounds like "adolescence." Both are times when body morphing and hormone shifting lead to an upheaval in how a person feels emotionally and how they fit into the world. And like adolescence, matrescence is not a disease, but since it's not in the medical vocabulary, since doctors aren't educating people about it, it's being confused with a more serious condition called postpartum depression.

I've been building on the anthropology literature and have been talking about matrescence with my patients using a concept called the "push and pull."

Here's the pull part. As humans, our babies are uniquely dependent. Unlike other animals, our babies can't walk, they can't feed themselves, they're very hard to take care of. So evolution has helped us out with this hormone called oxytocin. It's released around childbirth and also during skin-to-skin touch, so it rises even if you didn't give birth to the baby. Oxytocin helps a human mother's brain zoom in, pulling her attention in, so that the baby is now at the center of her world.

But at the same time, her mind is pushing away, because she remembers there are all these other parts to her identity — other relationships, her work, hobbies, a spiritual and intellectual life, not to mention physical needs: to sleep, to eat, to exercise, to have sex, to go to the bathroom, alone —

(Laughter)

if possible.

This is the emotional tug-of-war of matrescence. This is the tension the women calling me were feeling. It's why they thought they were sick. If women understood the natural progression of matrescence, if they knew that most people found it hard to live inside this push and pull, if they knew that under these circumstances, ambivalence was normal and nothing to be ashamed of, they would feel less alone, they would feel less stigmatized, and I think it would even reduce rates of postpartum depression. I'd love to study that one day.

I'm a believer in talk therapy, so if we're going to change the way our culture understands this transition to motherhood, women need to be talking to each other, not just me. So mothers, talk about your matrescence with other mothers, with your friends, and, if you have one, with your partner, so that they can understand their own transition and better support you.

But it's not just about protecting your relationship. When you preserve a separate part of your identity, you're also leaving room for your child to develop their own.

When a baby is born, so is a mother, each unsteady in their own way. Matrescence is profound, but it's also hard, and that's what makes it human.

Thank you.

(Applause)