Well, I take it back.
I went to see Tully after criticizing it so much, quoting blogs and articles from colleagues in my field. I was disturbed, however by the turn towards favorable comments I was reading as more people went to see it, and that's what prompted me to go. Having seen it, I really haven’t changed my mind. My initial review is here.
There will be spoilers in this review. Be warned.
And here is problem #1. Why is there a plot twist and spoiler?
This is a story of a postpartum woman’s psychosis. Why is it marketed as a comedy? While it isn't funny, it could easily be heartwarming to a good segment of today’s mothers. Perhaps my fore knowledge of the plot informed my grave sense of danger in the last quarter of the movie, but no viewer will doubt that something is disturbingly wrong when Tullly’s behavior becomes erratic. And the descent into madness is hardly an untouchable subject. Dramas like Ordinary People, The Fisher King, Girl Interrupted, One Flew Over the Cuckoo’s Nest have all portrayed mental illness in poignant, truthful, and powerful ways. Is a mother’s postpartum story not worthy of such a portrayal?
Which leads to problem #2: What, exactly, is being portrayed?
Marlo’s son is very clearly neuro-atypical. He’s acting out and has a history of behavior that is repeatedly called “quirky.” I don’t recall if his age is mentioned, but why was there no mention -- like what I hear often in my community of fellow mothers with elementary-age children -- of sensory processing, or neuropsych testing, or spectrum, or ADHD? Some term to ground the viewer? Maybe the viewer has seen mothers in public with out of control children, and those mothers have felt the judgemental gaze of people who pass by. In fact, the viewer might even be that mother.
Marlo’s brother provides the generous and loving gift of a night nanny, alluding to a difficult time she had after her son was born. I wish he had just said she was depressed. Or sad. Or pointed out something like: she didn’t have the energy to care for her baby, or she wept frequently, or she was quite irritable, or she was sleep deprived to the point of irrationality. Marlo’s doctor, towards the end of the movie, states that Marlo is extremely sleep deprived and severely dehydrated. Marlo was far more than that. And she was far more than depressed, if that's what she was after her son was born. Marlo was psychotic. She also could have possibly been manic.
All of this would have created a sympathetic character and an emotional drama (see problem #1 above), and perhaps would have thrown in some education, too. But maybe that wasn’t the point of the movie. Maybe the point of the movie was to grab an unsuspecting, ripe audience on Mom’s Night Out, and shock them. (Note: my first word choice was not shock but prey).
Then there's problem #3: to whom is this movie going to appeal? Tully is yet another portrayal of middle class white life that is meant to be seen as Everyman - or Everymom, in the case of this movie. I won’t deny that there are elements of this movie that I, a middle class, educated mother, can relate to. As a professional in the field of maternal emotional well-being, my client base would probably relate, as well. Resources and financial stability (even though Marlo’s family wasn’t especially wealthy) do not shield mothers from the judgement of strangers, nor the burden of being the chef, launderer, shopper, and all around manager for household and family responsibilities, duties which which largely fall on the shoulders of mothers, both SAHM and Working.
The New Yorker Magazine review addresses the interesting casting of Tully. The only actors of color in this movie are antagonists to Marlo. Critic Richard Brody states that he doubts Reitman’s casting of “Tully” was "intentionally skewed to suggest that bureaucrats and technocrats of color stifle white people’s emotional authenticity and vitality; I think that he simply didn’t see what he was doing—and that his own lack of perspective mirrors that of the script." Criticism around predominantly white Hollywood is well reported: #OscarsSoWhite was a real thing, and the excitement around movies like Hidden Figures, Black Panther, A Wrinkle in Time, Moonlight and their box office earnings reflect the long wait that diverse audiences have had in seeing themselves on a major motion picture screen. The casting of Tully is like a lateral step in the status quo, if not a step backwards.
Why does it matter? Personally, I’ll tell you that I certainly understood Marlo’s exhaustion and the relentless sense that she was failing. I was depressed, and I had intrusive thoughts that were terrifying. I altered my behavior in order to avoid those intrusive thoughts from becoming a reality. But here’s something that Marlo didn’t experience: racism. If implicit bias is an easier term to swallow, then fine; implicit bias.
How does race play into this? What is the thing that no one would ever say to Marlo? In real life -- not in my intrusive thoughts -- people commented in one way or another that my baby was white, and I was not. My Filipino family would describe her cuteness as puti, which means white. A woman at the park, white like most of my circles are, observed me with my daughter. She leaned over to me with a hopeful smile, and said, nodding to my daughter, “Do you work full time for her family? I would love a caregiver as attentive as you are to her.” Another time, I ran down the street on a spontaneous trip to Walgreens for diapers, baby on my hip. It was a summer day, and she was wearing one of those cute little dresses that have matching bloomers, but I forgot to put the bloomers on her. In order to grab my wallet and pay for the package of diapers, I took my baby off my hip and set her on the cash register counter. The man behind me in line scolded me: “Her disgusting diaper is on that counter. I doubt that baby’s mother would approve of you putting her on the counter, which is probably dirtier than that diaper.”
One of my recurrent intrusive thoughts was of my baby, naked in a pile up with other naked babies, and I couldn't tell her apart from the other babies. That vision left me so afraid that I would lose her that I rarely let her go. I joined a moms group, a baby music class, and I had friends with similarly aged babies. These gatherings would default into a circle, moms sitting so we could all see one another and chat, babies laid down in front of us on blankets. I was afraid to take my hand off my baby, to get up and be one of those breezy moms who says to the woman next to her: “Watch my baby for a sec?” while I ran to the bathroom or got a coffee. In the circle, I often opted to nurse or cradle her, or change her diaper -- so that I wouldn’t lose track of her. But maybe she wasn't mine to lose, anyway, since we didn't look like one another, and every one noticed it. And that, right there, is the descent into illness.
I have learned, professionally and personally, that the fear of not recognizing your own baby is not an uncommon one. But racism adds another layer, and it gave my intrusive thoughts its own signature. Marlo is not Everymom, no matter how much the experience of a white mom is sold to us as Everymom. Race and class have their role in postpartum mental illness; sometimes they weave together, and sometimes they don’t. Let’s look at the different experiences of many mothers. There is room for all of us on the big screen, if we really care about maternal mental health and postpartum quality of life.
Tully was not an unlikeable movie, and Marlo is certainly a sympathetic character. It’s just not a comedy. Dead stop. Instead, it’s a movie that joins the canon of movies that don’t recognize people of color and their stories as part of the fabric of a universal experience. And in trying to be a comedy with a plot twist, it bears the responsibility of a missed chance to engage women on a level that could really make a difference in maternal mental health.
Full disclosure: I haven’t seen this movie. But while it doesn't appeal to me for a few reasons, I’m highly interested in the criticism coming from within my field,* namely that this movie doesn’t draw a distinction between postpartum depression and postpartum psychosis — a dangerous omission.
Postpartum psychosis occurs in less than 1% of the postpartum population, yet it is one of the most common depictions of “postpartum depression” in broadcast news, movies, and TV shows. Postpartum depression occurs in at least 1 in 7 women, and some symptoms would make it 1 in 5, but many of those women won’t seek help because what they are experiencing doesn’t look like it does on a TV or movie screen.
In an interview, Theron links postpartum depression with childbirth; because she adopted her children, she says her only experience is with friends who have had it after giving birth. If Theron didn't experience PPD, it certainly isn't because she didn't give birth to her children. The rate of postpartum depression in adoptive families is equal to families who gave birth.
I am all in favor of real depictions of mother -- including the honest stories of struggle and illness and racial health disparities. But the information that gets dispensed must be accurate if we really want to reach women and have the impact we desire.
In Silicon Republic, Eva Short wrote about this fantastic
infographic from CashNetUSA, illustrating perfectionism and its potential dangers in a professional setting. Because "perfectionist" is frequently a word that new moms use to describe themselves (or their former, pre-motherhood selves), I wanted to adapt it to the postpartum period. Live Science reported about a small Canadian study in 2010 of 100 first-time mothers, and found that perfectionism was a common feature in the women surveyed. Findings are significant for 2 reasons: perfectionism may make it hard for people to tell that moms are struggling, as the mom may mask it well; and the results underscore the need to dispel the myth of the "perfect parent."
So, are you a perfectionist? Or do you feel pressure to be perfect, even though you are a new parent crash learning on the job? It could be that once perfectionism enabled you to excel. But could it now be stressing you out?
Here are 9 skills to practice if you feel like perfectionism is controlling your life. And remember, if these tips don't work for you, it doesn't mean you will feel this way forever. It just means you need a different type of support. Ask your OB, midwife, or primary care provider for a referral to a mental health provider with pregnancy and postpartum specialty. Or call Postpartum Support International for your local resources.
*disclosure: if I could free mothers from
the burden of thank you notes, I would!
Baby showers are a long-standing tradition of pregnancy: laughter, maybe some games, and of course, gifts -- impossibly tiny onesies, cute little pants, and ever-practical diapers.. Typically, there are multiple generations of women, from grandmothers to mothers to sisters to daughters. They are there to shower love on the honoree, give her sage advice, and celebrate motherhood, pregnancy, and babies.
In a post for Women’s Health Today, Dr. Kathleen Kendall Tacket, Health Psychologist, author, and IBCLC, looks at studies of countries and cultures outside of the US and their postpartum customs. She describes ritual baths, hair washing, massage, laying-in traditions, and ceremonial meals as some of the mother-centered rituals that celebrate not the birth of a baby, but a woman’s passage into motherhood. She cites examples from Nepal, Peru, Guatemala, and Punjabi and Mayan cultures.
While it wouldn’t be right to appropriate traditions from other cultures, Kendall Tacket argues that lacking our own traditions of postpartum ceremony and support can lead to stress and isolation for new mothers, which can then lead to postpartum emotional complications like depression or anxiety. We also don't have the same social infrastructures in place in the US as in these other cultures, yet there are ways for us to honor a woman who has become a mother.
Plan a gathering after the baby is born
In the first weeks postpartum, she may need her circle of women to come together for her again. Two or three of her closest friends, people whom she doesn't feel she needs to dress up for or clean her home for, can bring breakfast. Welcome her to motherhood.
Stern note: Remember that this is not people coming to see the baby. The new mom is not to entertain anyone. I feel like this should go without saying, but I continue to be stunned by my clients' stories of an endless parade of oblivious visitors who come to the hospital while the mom is juggling her new baby while tending to her own tender body, and the parade continues as the mother struggles to keep her home presentable for guests who need to eat and drink..
Start a tradition.
Is there something meaningful your mother told you when you became a mother? Share it with her. Did she give you a gift that comforted you or gave you strength when you were experiencing big changes? Give it back to her with the same intention. Read her a poem about strength and learning; frame it so she can put it on her dresser and look at it every day. Ask each of her friends to write an inspirational or affirming quote on a square of paper; read them to her, and place them folded in a bowl or a jar. She can read them when she wants to feel the presence of her friends. Do your friends knit, sew, or quilt? Perhaps together you can make a shawl for her. Drape it over her shoulders and tell her she can use it to keep her warm while she’s feeding her baby in the middle of the night. Maybe someone can do the same for the next woman in your circle when she becomes a mom. That's how traditions are born, and traditions make us feel timeless connection to something outside of our own individual experiences.
The cultural traditions Kendall Tacket describes not only focus on the mother and celebrate her; they are also a practical way for women to gather and help her rest. Since we can't scuttle her away for any period of time nor move in with her temporarily, how can we care for her physically?
Focus on her.
Call her regularly and check on how she’s recovering from childbirth or how she is feeling emotionally. Ask her if there’s anything she needs from the store or if she’s had a nap or a shower. Plenty of people will ask about the baby, but she may need something.
This post isn’t so much for the pregnant or new mom but more so for her friends and family, to be read ideally before the baby is born. If the mom has already given birth, though, it’s not too late to consider how to care for her.
Sage Therapeutics is studying a drug to treat postpartum depression, and has launched a media campaign to raise awareness. The lead images show women sucking on a pacifier, crying, and the text is simple” Silence sucks. Online, the lead image isn't a still shot. The woman rears back her head and spits the pacifier out, like toddlers do when showing defiance.**
STAT, a publication for medicine and scientific discovery, summarizes the opposing ways that Sage’s media campaign has been received, and closes their article with the statement: “There are many women who suffer in silence.”
YES, there are women who suffer in silence. Can we please not perpetuate the status quo by infantilizing and sexualizing them?
Additionally, the ads I've seen at bus stops in Boston are women of color, just tacked-on tokenism rather than visibility when portrayed in this light.
I want to emphasize that my criticism is entirely about the marketing campaign. I am all for more and better treatment options for women, particularly how attitudes towards women and our perceptions of them in our culture impact their mental health. Many professional conversations divert to the clinical trial of this drug, and that MUST BE a separate conversation, as that is not the issue here.
**UPDATED TO ADD: The lead image on the website is now a still image.
Just yesterday, someone asked me a huge question: How do we prevent postpartum depression?
Honestly, all I could do was repeat her question with a half-chuckle, half-sigh.
But there is nothing funny about it; I know that (and believe me, so does my husband). My clients know that, too.
When I speak with people about preventing postpartum depression, I don't speak in the language of guarantees or absolutes. I use the language of risk reduction rather than risk elimination often. Because the postpartum is a steep learning curve, because meaningful maternity leave is a privilege and not a right, and because culturally we value independence and strength through adversity (these are huge concepts I'm throwing around, which I have discussed repeatedly and surely will another time!), perinatal emotional complications occur at a rate of 1 in 5 women. Think about how many moms were in your prenatal yoga class. Or your childbirth ed class. Or how many rooms there are on the the labor and delivery floor at the hospital where you gave birth. One in five is high.
A timely article was published yesterday; it discusses one aspect of risk reduction: caring for the mother, at a time when she is depleting herself taking care of her baby. The author observes her close friend with her newborn, and states:
"In her three weeks since having a baby, she had been so bogged down with infant care, that caring for herself and her basic needs felt impossible...considering herself at all had somehow been pushed away because she had been made to feel like her only priority should be her baby. And no one had ever told her otherwise — that it was OK to hand him off to her husband and take a long hot shower or walk around her neighborhood, or to tell the people who were coming to see the baby to hold him while she took a nap...it was the same lack of support that most mothers of any age learn to simply accept during postpartum."
The article, from the website Ravishly, can be read in its entirety here.
Here's one suggestion I have for you, if you are a friend visiting a new mom. Ask her how she is doing. Make the purpose of your visit or call to check in with her first, and ask about the baby second. As cute as that baby is and as lovely as it is to snuggle a baby -- tend to the mother's needs first. When was the last time she ate a real meal? Showered? Napped? Took a moment away from the baby? Take care of her.
And if you are a new mom or are about to be one, who in your support network can you pinpoint to care for you first? Let that person know that that is the special role he or she can play in your postpartum. Ideally before the baby is born, of course, but NOW is as good a time as any.