There is only one post-partum depression treatment. You can't afford it.

Most of the time, I feel like a good mother. I read all the books I’m supposed to read. I stay vigilant against things like Screen Time and Under-Stimulation. I know what I’m supposed to do for my daughter: Feed her fresh fruit and vegetables, read to her every time she brings me a book, take her outside every day if it’s warm enough. I do all that. 

That said, there are times when I hit a wall. This is one of them. My daughter has suddenly decided to stop napping; or, more precisely, to stop napping when she’s at home, and catch up on all her sleep at day care. I’ve been adjusting her sleep schedule for weeks without making a difference. I’ve been skipping coffee. I’ve taken her out to play in the mornings, kept her so active she’s practically asleep by the time we get home. 

It doesn’t really matter what I do. She screams bloody murder for around 15 minutes every time you put her in her crib, falls asleep for half an hour, then wakes up mad and yells my name until I get her back up. I know why, and I know that adjusting her routine isn’t going to make a difference. She’s old enough to have a sense of cause and effect, and she’s not sleeping because this is the only time she gets to see me. Her days at home are her chance to play with me and (on the weekend) with her father, to have all her people together in one room, and being asleep takes precious hours of that time away. She can sleep at day care because her family isn’t at day care. Here, she knows who’s in the other room. 

It’s not that she can’t sleep, it’s that she doesn’t want to. And I can’t make her want to, because her reasons are good — sweet, lovely baby reasons, reasons that are almost totally about loving me, which I could never take offense to. The thing is, I’ve come to rely on those two hours in the middle of the day. It’s when I eat, answer e-mail, meditate for 15 minutes or so, have a cup of coffee. When I don’t get that breathing room, I’m in a terrible mood, and so is she. And the option of good motherhood suddenly isn’t available. 

My options, in a napless universe, are limited to (1) being the cruel, emotionally scarring woman who keeps her baby trapped in a crib — the very same punishment we use for time outs!!!! — in the hopes that her bodily exhaustion will overcome her desire to be held and comforted by her mother, or (2) letting that baby get by on 20 minutes of fitful, angry sleep, in which case she feels terrible for the rest of the day, and I don’t have the energy to do all that good-mom stuff, and it seems totally reasonable to just eat peanut-butter pretzels and watch an episode or seven of Queer Eye on the couch until her father comes home to do some actual parenting. 

I mean, I imagine there is an option (3), in which I suck it up and do my job — some babies just sleep less than others! every parenting guide warns you, terrifyingly — but it doesn’t feel all that achievable in the moment. At one point, I cried and said, Mama feels very sad when you don’t want to sleep, trying to conflict-resolution-I-statement my way out of the situation. She looked at me the way you’d look at an adult putting her emotional needs on a toddler; concerned, but also deeply weirded out. She gave me a kiss and started pulling clothes out of her drawer to play dress-up. 

She’s not sleeping. She’s not going to sleep. She’s willing to console me, if I’m taking it personally, but things are as they are. 

I imagine the above has bored at least some of you senseless, and made others angry. We do not live in a culture that affords mothers a lot of time to ruminate about their feelings on parenting, particularly not if those feelings are negative, or interfere with their obligations. It is a central tenet of motherhood, within patriarchy, that the work we do is “natural” — we are fitted to it by our gender, or by pregnancy hormones, or by God, but always by something, which is why Real Women can be naturally and totally “fulfilled” taking care of children, even if that means doing all the domestic work men won’t touch. 

The supposed “naturalness” of motherhood is why, for example, a teenager seeking an abortion in Florida must be ruled “mature” enough to end a pregnancy, but there’s no requirement to prove she’s “mature” enough to have a child. To give birth is natural, so a 13-year-old girl is presumed to be a fit parent because nature made her that way. It’s also why, in the Year of Our Lord 2019, there is only one drug for post-partum depression on the market, it won’t be widely available until June, and it will cost $34,000 dollars. 

Of course, medical science has a long history of neglecting “female” (or AFAB) bodies. It’s why many doctors can’t recognize heart attack symptoms in female patients; why Viagra was approved for use as a boner pill, while its effectiveness in treating severe menstrual cramps was ignored. In her book Like a Mother, Angela Garbes gives a whole infuriating history of how medical sexism has made childbirth unsafe; white, male doctors drove midwives (who were mostly women of color) out of business, due to concerns that their model was unscientific. Yet “science” was so incurious about pregnant bodies, and so un-empathetic when it came to women’s pain, that without the midwives, rates of maternal mortality actually went up. Even today, very basic, common complications — pelvic floor injuries, say — aren’t widely diagnosed or treated.

I got a C-section from a man who had a reputation as a dazzlingly gifted obstetric surgeon; “one of the best,” the hospital staff told me. After cutting me nearly in half, taking my organs out, and rearranging them, that medical genius gave me one postpartum visit to check that the incision hadn’t ripped open (it hadn’t; in this I am lucky) and sent me on my merry way. Nearly two years later, that incision still hurts; irregular little cramps, like a period coming on, or days when it’s too tender to rest my belly against anything. This is the best in the business; the very best medicine can do for my sort of body. This is all that we’ve got. 

Medical incuriosity about postpartum depression — which affects around 15 percent of mothers and other childbearing parents — is not, in this context, surprising. PPD is just another weird thing childbearing bodies do, another odd defect; granted, PPD kills many mothers, and even some of their children. Suicide is the second leading cause of death in postpartum people. But that doesn’t mean it’s worth prioritizing over, say, making a pill so that cis men can get boners on command. 

Yet the reason that PPD is so evidently under-researched — and why its only medication is priced as some kind of luxury, rather than the common psychiatric treatment it ought to be — also has to do with our contempt for mothers’ interiority, for the very idea that they might have emotional needs other than “more babies.” PPD is massively under-reported precisely because the feelings it causes are embarrassing; the condition causes unkind, unmotherly thoughts, makes women feel overwhelmed by their parental responsibilities, makes them think they can’t stand to be around their babies or as if their babies would be better off without them. 

Those thoughts fly in the face of the idea that motherhood is a 24-hour love parade, that it will make you a better person or fulfill you or teach you the meaning of happiness, that your “maternal instinct” will immediately kick in and make you think and behave in the ways our society has deemed “motherly.” Women avoid reporting those feelings because they’re afraid to be called bad people, or bad mothers; afraid to be unnatural. It’s just that, if you don’t report those feelings, and get treatment, there’s a not-insignificant risk that they’ll kill you. 

PPD is like an unruly thought experiment that broke into reality and started taking casualties: Would we rather see mothers dead than hear them express their pain or ask for help? So far, at least according to company that set that drug price, the answer is yes.  

I’m still not sure if I had PPD or not. You’d expect it from someone with my profile — I’ve had severe depression before — and I think there was one dark spell, when my daughter was two or three months old, that may have qualified. Or it was just a dark spell, or (given the relatively late onset) it was depression but not postpartum, or something: Like most women, I was too busy taking care of the baby to schedule an appointment for myself, so I didn’t get it checked out. 

What set off the dark spell, then as now, was that my daughter stopped sleeping. I thought, in the early days, that things would be better if she and I stuck to a schedule, so that I never forgot what she needed and when. But I tried to slip into the E.A.S.Y. (Eat, Activity, Sleep, You) thing too early, or else the E.A.S.Y. thing just doesn’t work (this is a matter of some contention on parenting boards). At any rate, I somehow messed up her internal clock to the point that she was unable to fall asleep during the day. She’d wake up at 6 AM, cry all day — worse and worse, as the day went on — and then pass out at 7 PM. At dawn, it would begin again. 

I knew it was something I had done wrong. And I couldn’t fix it, no matter how often I tried to sleep next to her or rock her or shush her; I couldn’t make it right. The sense of failure was overwhelming. I had wanted to do good, I had wanted to raise her exactly right, the whole point of the schedule was to raise her exactly right, and I had broken her. It had taken me only two months to ruin my baby’s life. Online, people who hated me speculated about what a bad mother I’d be — one of them posted a video I’d taken, a few days after her birth, in which I am glowing with happiness, captioning it “oh, no;” someone found a Tweet about the baby’s first laugh and said that I’d “already screwed up the baby” — and I started reading those a lot, going back to find older ones and re-reading them when there wasn’t enough fresh content to satiate my digital self-harm needs. I called my mom every day in a panic, until my mom broke her ankle and I felt like too much of an asshole talking about myself. I posted a lot of panicked Facebook updates, or wrote them and then deleted them when I realized the people who made jokes about me abusing the baby might screen-cap and share them around. 

Then the baby started sleeping again. I did the cry-it-out thing, after trying every other option listed in two or three baby sleep books, and she fussed for 20 minutes and went to sleep. Things got better. Or they slipped into a sort of oscillating pattern of challenge and solution, the baby developing new needs and me figuring out how to meet them, which I’m told is all good parents ever do. But I remember two things from that bad patch. I remember that I thought my daughter would be better off without me, that I would be doing her a favor if I disappeared. And I remember feeling that I must never tell anyone about this, that that the whole world was already waiting to call me a bad mother, and that it was up to me to prove them wrong, to keep looking happy no matter what. If I let on how much pain I was in, I would be a failure. 

Some of this is unique to me — not everyone has a choir of weirdos trawling their Instagram and Twitter feeds for new things to insult — but I don’t think most of it is, really. I think most mothers know that the world is already waiting to call them shitty parents; that the flip side of our dogma of “natural” motherhood is the idea that any woman who’s struggling is “unnatural” or defective. Now, I write a lot about the darkness within motherhood, the ugly feelings that can come with it. It’s not that the darkness is the only important thing about motherhood; it’s not even most of motherhood. It’s just that I remember what it was like to be drowning in darkness and afraid to let anyone know. 

My daughter will learn to sleep again, or she won’t. I will suck it up, and get through the day without binging self-help TV, or I won’t. It’s not the end of the world, either way. We were all raised by women who watched Queer Eye during the day when they were bored, or whatever their era’s version of Queer Eye was, and yes, we are all twitchy, attention-span deprived phone addicts now, but we’re alive, aren’t we? We’re alive, and if we’re lucky, so are our mothers.