Doctor's Review: Medicine on the Move

December 11, 2017
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Post-partum Depression

Did postpartum depression transform a 14th-century peasant into a madwoman or a mystic?

Postpartum depression has received a lot of press lately — from Tom Cruise and Brooke Shields' War of the Words, to a host of recent court cases involving women who killed their children.

Most new mothers get the so-called "baby blues," many even require treatment for their symptoms, but a few will unfortunately go on to experience a break with reality. It is these women that have caused a debate among physicians, lawyers, the media and the public — are they ill or evil?

While some estimates put the incidence of postpartum depression (PPD) at about 15 percent of new mothers, postpartum psychosis — the most serious form of the illness, characterized by severe depression, delusions and sometimes even violence — is extremely rare, perhaps affecting point-one percent.

Andrea Yates, the infamous Texas mother found guilty of murder in 2001 for the drowning deaths of her five children, was one of those unfortunate few. This month, her conviction was overturned for a second time, paving the way for a new trial and a second chance at an insanity defense.

Yates, a modern-day Medea, may be the most famous postpartum psychosis sufferer these days, but she certainly wasn't the first. Of those who've shared her devastating condition, Margery Kempe holds the dubious distinction of being the first-known case study in the history of medicine, not to mention the original Desperate Housewife.

Six centuries ago, questions surrounding mothers gone mad were somewhat different. The debate didn't centre on brain chemistry, legal issues or moral responsibility; it was religious in nature. When Margery Kempe's story emerged, people were divided — was God responsible for her bizarre behaviour, or the devil?

Medieval Madwoman
Social historians and students of literature have long studied The Book of Margery Kempe as one of the first known autobiographies in the English language. But in truth, it's just as valuable a tool in the history of mental illness as it is a peek into the world of late 14th- and early-15th century Britain.

Margery Brunham was born into a comfortable middle-class life in 1373. Her dad was the mayor of King's Lynn, a thriving shipping port in Norfolk, England. Not much is known about her youth, particularly, if she'd ever had trouble with mental illness. When she was 20, she met and married John Kempe, a successful local businessman. Everything was peachy until shortly after, when she became pregnant with her first child.

She describes her pregnancy as a difficult one, followed by a long labour and traumatic delivery. Afterwards, she acquired puerperal fever and feared she would die. She didn't, but her physical recovery was accompanied by a descent into madness so terrifying that she wanted to take her own life.

The delivery seems to have brought up extreme guilt related to a "sin" she committed as a teenager for which she had never confessed (and the details of which she never mentions). For weeks, she endured horrifying "visions" of devils and demons telling her that God would never forgive her and warning her not to confess — which was customary to do after childbirth.

Instead, she tried to do penance, fasting and praying incessantly. Eventually, she relented. Wanting to confess, she called for a priest. He was apparently unclear on the concept of absolution, however, and chastised poor Margery cruelly, fueling her fears of damnation. From then on, her nightmarish visions got worse.

For the next six months, Margery was in the grip of madness. She had near-constant hallucinations of demons torturing her and cursing Christianity, and she dreamed of being swallowed by burning hellfire, fuelling gruesome episodes of self-mutilation whose scars she carried for the rest of her life. Margery's imaginary tormentors threatened her, she claimed, inducing her to leave her faith, her friends, her family and the vanities of the world.

Hoping she would get some relief, Margery did exactly that. She raved loudly and publicly against God, church and family. People weren't exactly receptive to her blasphemous ramblings and condemned her as a witch and satan-worshiper. Margery was reviled by all those who knew her until, at last, she had a "vision" which would change her life and bring her back into the fold. As she records in her autobiography, Jesus Christ himself visited her bedside and asked, "Daughter, why hast thou forsaken me and I forsook never thee?" The clouds of her madness parted and Margery claims she was instantly cured.

From that point on, she vowed to spend her life trying to do good. For the first little while, things worked out well. With her husband's support, she attempted a few businesses (a brewery and a grain mill), but those eventually failed.

Despite her best intentions, during those first few years, Margery remained tempted by the pleasures of the world. As before her bout with madness, she sought social status, fine clothes and the other middle-class vanities that she, her husband and friends coveted. Eventually, however, her dissatisfaction grew and she began to develop a more spiritual outlook.

Born-Again Virgin
Number one on Margery's spiritual to-do list? Proving her devotion to God. And the best way to do that, of course, was to remain chaste. Much to her husband's chagrin, Margery spent years stubbornly negotiating the pleas of her return to chastity. At one point she even told the long-suffering John Kempe that she would rather see him dead than in her bed.

Though Margery was a good negotiator, she was an even better ovulator. She had another 13 children before she and her husband settled on terms: John would leave her alone to do the fasting and piety thing six days a week, but on Fridays, she would agree to eat and drink with him and pay off his debts when she returned from her pilgrimage. John, it seems, genuinely enjoyed her company despite her strange reputation and apparent physical revulsion towards him; he missed his wife, sex or no sex. She was fond of him too, later caring for him lovingly for over a year until his death.

Local religious leaders began to take notice of Margery, and they weren't liking her one bit. Her piety was dramatic, excessive. She was obsessed with Christ's suffering, would faint whenever she saw a crucifix, and wept constantly and hysterically in Church. She would even howl randomly throughout the day whenever she sensed the presence of God. Still tortured by guilt surrounding her teenage "sin," she would confess three, even four times a day.

Eventually, Margery's ever-growing faith led her to make pilgrimages throughout Europe and around the world, travelling to Italy, Spain and Jerusalem. On her voyages, she occasionally encountered women who, like her, had greatly suffered with madness after their children were born. She even mentions one case in which a woman had to be tied to her bed following the birth of her child in order to prevent her from killing herself and her baby.

However, once Margery began to gather a following, archbishops and other religious leaders accused her of heresy. Among her infractions were wearing white clothes, despite the fact that she was no longer a virgin, as well as teaching scripture to laypeople, a big no-no since at the time it was forbidden to translate the Bible into English. Margery was tried more than once, though she always managed to avoid conviction. She was also accused of being a Lollard, a follower of rebel theologian John Wycliffe (1320-1384), who emphasized the authority of the scriptures over the authority of the Church.

Feminist Or Fertile Myrtle?
Some medical historians claim Margery didn't actually suffer from PPD, suggesting her alternating episodes of mania and depression sound more like bipolar disorder instead. There are also some feminist scholars who believe Margery didn't have PPD either, and that it was shrewdness, not depression, which drove her. They point to her as an extremely intelligent, high-functioning woman struggling to take back her life.

Given that Margery was deeply traumatized by her labours and deliveries, that she admitted that having sex with her husband disgusted her and that her children are barely mentioned in her autobiography, is it possible Margery's mad outbursts, claims of mystical visions and obsession with chastity were a complicated form of birth control?

Eventually, she did convince her husband to agree to a sexless marriage — an impressive accomplishment in a time when a wife's role within the family wasn't exactly open to discussion.

Margery Kempe died in 1438, living to the ripe old age of 65 — a miraculous feat for a medieval mom who'd had so many kids — if childbirth didn't kill her, it's a wonder the laundry didn't. The Book of Margery Kempe, which she wrote shortly before her death, actually remained lost until 1934. It was rediscovered in a private library in Lancashire, fuelling a great deal of interest in her life which continues to this day.

Most of her book is a travelogue, an account of her many pilgrimages. But she spoke of her madness frankly and candidly as the catalyst which led to her ultimate redemption. If Margery Kempe were alive today, one wonders what her fate would be. A mental institution? A jail cell, like Andrea Yates? The talk-show circuit?

If nothing else, the honesty with which she discussed her battle with postpartum depression — though it wasn't called that at the time — allows us access to the very modern mind of a very medieval sufferer.

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