Organizations like Postpartum Support International (PSI) do valuable work. They spread awareness of perinatal mood and anxiety disorders, offer resources and information, and connect women to the help they need (perhaps a trained provider, support group, peer mentor, or warmline). They also facilitate valuable training, some of which I have personally taken and found beneficial in a number of areas. Because of this, I often refer people to PSI and reference their work.
However, I almost always do so with caution: PSI’s work does not stem from a biblical worldview. And I don’t just mean their pro-abortion stance or their support of LGBTQ+ ideology.[1]Most believers already know that these things go against Scripture.
As a Christian, my bigger concern with PSI’s response to PMADs—or with any secular response—is that the foundations are faulty because they are not built on Scripture. Let me be clear: I am not saying not to use PSI’s many valuable resources! But I want to draw attention to areas that Christians will disagree with PSI, particularly regarding personhood, the Fall, sin, and gospel hope. A Christian understanding of PMADs can address the inner and outer person, understand that the world is fallen and broken, account for both sin and the Fall, and look to Jesus for ultimate hope.
Note: this post is a flyover treatment of these topics, with a lot of the Scriptural work in the background and applied systematic theology in the foreground. Really, each section could be its own long-form article and what follows is not in-depth. Please do not hesitate to reach out for more citations or Scriptural support.
A Christian Response to PMADs Addresses the Inner and the Outer Person
What the Bible says:
Scripture describes humans as being made up of two integrated parts: body and soul. So then, what happens in our physical being affects our minds and hearts, and vice versa. While our bodies will eventually waste away and return to dust, this doesn’t mean that they’re not part of our true selves or can be ignored—they will be restored forever in the New Creation!
What a secular response misses:
A secular response to PMADs gets part of this right: a woman’s body needs to be supported! Medical care is important in recovering from PMADs and should not be neglected. However, while we can’t downplay the physical side and focus only on the spiritual or emotional side, it’s easy for non-Christians to make the opposite mistake and reduce soul-care to self-care. Rest is an important part of caring for both body and soul, but truly supporting both inner and outer person is more than that. While others can help on the horizontal level with common grace wisdom, only Christians can offer the Godward, vertical aspect of soul-care and truly reach the heart. For Christians seeking help for PMADs, this is an extreme deficiency that must be kept in mind when receiving care from secular providers.
Thus, a biblically-founded Christian response to PMADs will have both a robust understanding of biblical spirituality and emotional health, as well as theological foundations for both counseling/discipleship and potential medical care.
A Christian Response to PMADs Understands that the World is Fallen
What the Bible says:
According to Scripture, Adam and Eve’s sin (the Fall, Genesis 3) brought this brokenness on the world. Infertility, miscarriage, birth emergencies, and PMADs all stem from the increased toil in childbearing (Genesis 3:16) and a world where “thorns and thistles” interfere with the good work God has given us (Genesis 3:17-19). Even without personal sin, death and the micro-deaths of decay, dysfunction, and pain are part of our daily lives. While some steps can be taken to prevent PMADs or to help prepare the body for birth, much that happens physically and emotionally in the perinatal period is out of the mother’s control. Suffering can and should be alleviated when possible, but isn’t always escapable. This side of Eden, there is no perfection or life without tears. As with all of life, pregnancy and postpartum don’t always go the way they “should,” in emotions and in physiology.
What a secular response misses:
Even non-Christians usually understand that something is broken in how a mother with PMADs processes her circumstances. They may propose secondary reasons for this with varying degrees of accuracy: sleep deprivation, relational stress, serotonin levels, and more. These may be real reasons, but they are not the true root.
Why does the true root matter? Connecting the dots between my PMADs and the Fall relieved a huge amount of guilt and uncertainty. While I could point to very real circumstances and physical causes—as well as personal sin—that made my life more difficult, it took weight off of my shoulders that there was also a reason for my suffering much bigger than my little life.
The truth about a fallen world has two implications.
First, because of the Fall, some degree of difficulty in motherhood is always going to be normal. While PMADs are not a normal response to the perinatal period, we’re also not looking for a pregnancy or postpartum that has no bumps at all, but one in which a mother can respond to difficulties appropriately.
Second, if we blame what is dysfunction in the body or the world on sin, we load guilt onto a mother where she has done no wrong. A biblical response to PMADs leaves room for difficulty that is not anyone’s fault. This frees moms from what-if’s and chasing perfection, removing guilt and shame for what is out of their control.
A Christian Response to PMADs Accounts for Both Sin and the Fall
Now we come to two areas that an unbiblical worldview cannot account for at all: sin and Christian hope. I hope the two sections above have made it clear that I do not think PMADs are always, even often, caused by sin. The Bible points to numerous other reasons for suffering: there is spiritual warfare (Job 2:1-10), the Fall (Genesis 3:15-19), persecution (1 Peter 4:12-19), and God’s glory (John 9:1-3). All of these can be at play with PMADs! And because PMADs occur in seasons of intense change and stress, they are much less likely than other mental health difficulties to be caused by sin. Yet, even in the most saintly mother, suffering often brings sin to the surface, and sometimes sin is even part of the cause. But Christianity meets this sin with a redemptive answer.
What the Bible says:
As a basic definition, sin is “disobedience to God’s law”—falling short of the glory of God, the standard of his holiness, failure to love God with all our heart, soul, mind, and strength and love our neighbor as ourselves. From this definition, we can see that feeling down or panicky may or may not be from sin. Yet because we are sinners, there is always the possibility that sin is mixed up in PMADs, if not in root, almost certainly in response. That is, a mother’s depression may be caused by spiritual or physiological factors that are outside of her and therefore not sin. However, the way she chooses to react to those outside factors (her response) can still contain sin.
As a concrete example, consider irritability, which is a common symptom of PMADs. We may look at a mother who is angry and assume that it’s because she’s unsanctified or she’s made sleep an idol and so she is angry when she doesn’t get it. That may be the case, and those possibilities can be probed.
But let’s consider another option: what if her mind and body are constantly stressed and overwhelmed, so that a child chewing with their mouth open or the baby waking early from a nap are straws that breaks the camel’s back and send her spinning out of control? To respond in anger in this case is still sin. But we should approach the “treatment” from a different angle and target circumstances alongside or even before the heart. Anger and irritability may point to an idol that needs confrontation and counseling; they may also point to sleep deprivation and the need to alleviate daily stressors (which may require community support more than counseling!).
What a secular response misses:
Christians may sometimes make the mistake of blaming PMADs on sin. But a secular response falls off the horse on the other side. Often, mom receives encouragement that she’s a great mom, she’s enough, she’s just who her baby needs. Christians do need to recognize and affirm Christ’s work in mom: her perseverance, her desire to love her children well, etc. But if we disconnect such affirmations from the gospel and a woman’s actual circumstances, they are empty and sometimes even false. The reality is that mom isn’t always doing a good job (when she is, let her know that you see and what you see, and when she isn’t, help!). Sometimes she doesn’t know what to do next. Sometimes she isn’t enough and needs others to support or disciple her. Occasionally, she may even need a gentle, probing question: “Have you confessed that sin to the Lord and remembered his forgiveness and grace toward you?”
In a biblical response to PMADs, we must make sure what we call sin actually is sin, but we also don’t need to be afraid to call sin sin, even in the life of a suffering mother, because we also have good news for all sinners.
A Christian Response to PMADs Looks to Jesus for Ultimate Hope
What the Bible says:
This brings us, finally, to the Christian hope, which is the gospel, the good news of forgiveness for sinners through the death and resurrection of Jesus Christ. The gospel tells us that we aren’t enough to save ourselves—but that’s okay, because we are given the righteousness of Christ and the help of the Holy Spirit and the church to live a life honoring to God. On a good day or a bad day, moms have a solid place to put their hope. Guilt, shame, and identity struggles—all common for mothers with PMADs—find their answers in the gospel. Sin is forgiven because Christ bore it. Shame is overcome because we don’t earn God’s favor. Identity is secure because we are not ultimately this, that, or the other thing but in Christ.
Perhaps the gospel seems like hope for later, when what she needs is hope now. But in truth, the gospel does speak to now: not only does it address guilt, shame, and identity (see above), but the future hope it gives tells us about who God is now—a God who is working to end the effects of the Fall, rescue us from sin, and restore life to what it was meant to be. He is a God who hears and sees us, and in the incarnation, entered our suffering to pull us out of it. He gives his people the Holy Spirit as a guide and comforter, and gives them the church to bear one another’s burdens. Other treatments and supportive measures can help heal PMADs. Our glorious hope and God’s ever-present help don’t mean we shouldn’t pursue them (go back to the “human person” heading!). But God and the gospel are where our hope lies.
What a secular response misses:
Because unbelievers deny God’s existence and the deity of Jesus Christ, they can’t offer mothers this hope at all. They can still give them encouragement and support, but only in a temporary way. At a time when everything may seem to be falling apart around and inside a mother, she needs something unshakable to hold onto. Self-esteem boosts, self-help, and even community support will all leave her empty at times. She needs something outside of her and her circumstances to rest in and rely on, and that comes only through trust in an unchanging, good God.
Conclusion
There are numerous other aspects of a Christian response to PMADs; I only touched on four in this article. These four are the areas where gaps in secular resources for PMADs are the biggest and also where Christians are most likely to misunderstand or misapply their own theology (the role of worship and the direction of our desires is another big one). When this happens on either side, mothers suffer for longer and sometimes more deeply.
Does God still use resources that fall short of a biblical worldview to bring moms through PMADs? Yes! Absolutely, he does! I and many other mothers have been the recipients of such help. This is why I continue to be grateful for the work of Postpartum Support International, other organizations, and medical professionals who don’t have a biblical worldview. Sometimes, this is all a mother can find or she needs a therapist or psychiatrist who has training specific to her suffering. These groups and people are part of numerous “common grace” supports available to mothers with PMADs and an often necessary part of well-rounded, whole-person care: Christian mothers should not feel shame in the wise use of medication or other helps that are not specifically Christian. But these tools will be most effective when connected to her ultimate hope and help: Christ. Likewise, the goal for those of us who follow Christ is that everything we think, say, read, and do is filtered through the lens of God’s Word, and so we must be aware of how a non-Christian response to PMADs falls short in these four areas.
If you want to see how more theology addresses PMADs, check out my theology for PMADs series.
If you want more practical guidance for responding to PMADs, click here.
[1] One note I need to make here: in disagreeing with abortion and gender ideology, we cannot overlook the women in these circumstances who are suffering from PMADs, often at a higher rate than other mothers. Treating PMADs from a biblical worldview does not mean sidelining or ignoring women who have had abortions, are lesbian, or have gender dysphoria. Nor does it mean that supporting a mother who has one of these lifestyles will focus only on that sin. Jesus’ compassion on the crowds who were “like sheep without a shepherd” is an example for us. However, PSI turns a blind eye to issues which are likely contributing to the suffering of these women and misses what would truly help them.
The Sorrows of Eve 