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“Unfortunately, there wasn’t the same conversation about mental health back then that there is now,” Spears writes in her new memoir, The Woman in Me. “I hope any new mothers reading this who are having a hard time will get help early. Because I now know that I was displaying just about every symptom of perinatal depression: sadness, anxiety, fatigue.”
Approximately 1 in 7 women will experience a perinatal mood or anxiety disorder—like postpartum depression or anxiety—in their lifetime. And while these mood disorders have become less stigmatized as a result of more mothers publicly sharing their experiences, unfortunately not much has changed since the aughts, when Spears was forced to navigate her own perinatal mental health issues under the near-constant scrutiny of hounding paparazzi. It is estimated that nearly 50% of new moms with postpartum depression will go undiagnosed, despite exhibiting the prevalent signs and symptoms.
As a psychologist who specializes in reproductive and maternal mental health, I’ve often wondered what the state of postpartum mental health would be if society at large and clinicians in particular paid just as much attention to the wellbeing of pregnant people as they do the infants they birth. Yes, Spears’s status as a global pop star created certain exceptional circumstances, but her experiences while pregnant are almost universal among women without adequate access to maternal mental health services.
Spears did indeed show signs of perinatal mood disorders, and long before she actually gave birth—a common experience for pregnant women that often goes overlooked. In the book she writes: “Two things about being pregnant: I loved sex and I loved food…. Other than that, I can’t say there was much that brought me any pleasure. I was just so mean.”
Intense irritability and anger are common symptoms of postpartum depression—and contrary to popular belief, you do not have to be “postpartum” in order to exhibit signs or symptoms of this not uncommon mood disorder. It is believed that 50% of women who develop postpartum depression start showing signs and symptoms during pregnancy. Yet rarely, if at all, are women screened for mood disorders while pregnant.
Instead, popular depictions of pregnancy as nothing but a welcomed, joyous moment in a woman’s life reign supreme, causing both external and internal stigma, shame, and guilt, while making it that much harder for women like Spears to recognize that they’re in need (and worthy) of help and support. Like so many women, Spears did not realize she was experiencing postpartum depression and anxiety long before her babies were born. She fell prey to a perinatal mood disorder myth that still exists to this day—that you can’t be depressed and anxious when you’re pregnant.
Spears went on to write that “you did not want to hear from me those whole two years” that she was pregnant with her two sons, adding that she did “not want to be around almost anyone at all.”
“I was hateful,” she writes. “I didn’t want anyone, not even my mom, to come near me.”
Like so many of the women I treat within the confines of my therapy office, Spears was withdrawing from friends and family during her pregnancies, another common sign of depression and anxiety. Yet Spears chalks her behavior up to being a “real mama bear.” In the book she recalls: “When I was pregnant, I wanted everyone to stay away: Stand back! There’s a baby here!” Feeling innately protective of a pregnancy is understandable, but it is not uncommon for those feelings to become so intense that a pregnant person self-isolates—and to the detriment of their overall mental health.
And like so many, without any support during pregnancy, Spears’s mental health continued to deteriorate after the birth of her sons. In the book, she says she “began to suspect that I was a bit overprotective when I wouldn’t let my mom hold Jayden for the first two months,” adding that she “shouldn’t have been that controlling.” Spears describes moments caught by the paparazzi that made her feel like an inadequate mother—moving her vehicle with her son on her lap, for instance, or tripping with her son in her arms, resulting in paparazzi photos that made it look as if she was going to drop him.
These moments—feelings of inadequacy as a new mother; of severe anxiety to the point that no one else could hold her child—are all common signs of postpartum depression that, again, so often go overlooked. For Spears, this time preceded the highly publicized events of 2007, when her children were taken from her and the world saw what is now known as the infamous “head-shaving incident.”
“With my head shaved, everyone was scared of me, even my mom,” Spears writes. “Flailing those weeks without my children, I lost it, over and over again. I didn’t even really know how to take care of myself.”
Like many mothers, Spears endured the devastating effects of perinatal depression and anxiety that goes untreated, including loss of custody and suicidal ideation. Data shows that suicide is one of the leading causes of maternal death, accounting for an estimated 20% of all postpartum deaths.
Britney Spears deserved better. So do my patients, the women still suffering in silence, and every mother in the United States. And it should start long before they give birth.
Jessica Zucker, Ph.D., is a Los Angeles–based psychologist specializing in reproductive health and the author of I Had a Miscarriage: A Memoir, a Movement. Her next book, Normalize It: Upending the Silence, Stigma, and Shame That Pervades Women’s Lives, is due out in fall 2024.