A critical need for the concept of matrescence in perinatal psychiatry

Aurélie Athan•View original
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Psychiatry has long examined mothers through a lens of dysfunction rather than development. Aurelie Athan traces this tension back to the late 19th century when mothers were studied mainly as agents shaping children's outcomes — and when distressed, as sources of harm. Perinatal psychiatry, the field focused on mental health during pregnancy and the period after birth, shifted attention toward mothers themselves. But a biomedical bias persisted. Maternal experience kept getting medicalized rather than understood as a normative developmental process. The numbers tell you how widespread that experience is: Athan cites estimates that 15 to 21 percent of the general population experience depression, and up to 80 percent of mothers report some distress. Yet only 20 percent are screened. Maternal mental illness accounts for one in four pregnancy-related deaths in the United States. Something is clearly missing from the framework. What's missing has a name. The word matrescence was coined by anthropologist Dana Raphael in the 1970s — Raphael also gave us the word "doula" — and introduced in her 1975 book Becoming a Mother. Raphael wrote: "Giving birth does not automatically make a mother out of a woman. The amount of time it takes to become a mother needs study." Athan revives and expands that idea. The deliberate echo of adolescence is the point. Adolescence names a period of growth that includes mood shifts, identity reworking, and social upheaval — and we don't pathologize a teenager for going through it. We recognize it as development. Athan's updated definition frames matrescence as a lifespan developmental transformation that is biological, neurological, psychological, social, cultural, economic, political, moral, ecological, existential, and spiritual. It recurs with each child. It may last a lifetime. Naming it matters: the terminology reduces confusion, avoids over-medicalizing common perinatal distress, and reshapes how health systems support mothers. Athan argues that a workable framework needs a unified nosology — a shared classification system that lets psychiatry, anthropology, sociology, and developmental psychology speak to one another. Without agreed definitions, research is fragmented and screening tools produce false positives. She proposes building standardized measures that probe both vulnerabilities and strengths, not just symptoms. This would let clinicians distinguish developmentally normal disorientation from genuine psychiatric disorder, so care is neither dismissive nor overpathologizing. The argument also pushes outward. A mother's mental health is inseparable from her community, her culture, her economic circumstances, and her era. Athan names concrete forces: the maternal wage penalty, the leaky pipeline in professional life, the quality of a mother's holding environment, and historical shocks like COVID. These are not background noise. They are part of the transformation itself. The proposal is direct: adopt matrescence terminology in clinical and research settings, train clinicians to see mothers as people undergoing self-development, and design healthcare services that are continuous and comprehensive. This strengths-based reframing does not deny that mothers suffer. It insists suffering is not the whole story — and that getting the story right is what maternal mental health care has been missing.

Psychiatry has long examined mothers through a lens of dysfunction rather than development. Aurelie Athan traces this tension back to the late 19th century when mothers were studied mainly as agents shaping children's outcomes — and when distressed, as sources of harm. Perinatal psychiatry, the field focused on mental health during pregnancy and the period after birth, shifted attention toward mothers themselves.

But a biomedical bias persisted. Maternal experience kept getting medicalized rather than understood as a normative developmental process. The numbers tell you how widespread that experience is: Athan cites estimates that 15 to 21 percent of the general population experience depression, and up to 80 percent of mothers report some distress.

Yet only 20 percent are screened. Maternal mental illness accounts for one in four pregnancy-related deaths in the United States. Something is clearly missing from the framework.

What's missing has a name. The word matrescence was coined by anthropologist Dana Raphael in the 1970s — Raphael also gave us the word "doula" — and introduced in her 1975 book Becoming a Mother. Raphael wrote: "Giving birth does not automatically make a mother out of a woman.

The amount of time it takes to become a mother needs study." Athan revives and expands that idea. The deliberate echo of adolescence is the point. Adolescence names a period of growth that includes mood shifts, identity reworking, and social upheaval — and we don't pathologize a teenager for going through it.

We recognize it as development. Athan's updated definition frames matrescence as a lifespan developmental transformation that is biological, neurological, psychological, social, cultural, economic, political, moral, ecological, existential, and spiritual. It recurs with each child.

It may last a lifetime. Naming it matters: the terminology reduces confusion, avoids over-medicalizing common perinatal distress, and reshapes how health systems support mothers.

Athan argues that a workable framework needs a unified nosology — a shared classification system that lets psychiatry, anthropology, sociology, and developmental psychology speak to one another. Without agreed definitions, research is fragmented and screening tools produce false positives. She proposes building standardized measures that probe both vulnerabilities and strengths, not just symptoms.

This would let clinicians distinguish developmentally normal disorientation from genuine psychiatric disorder, so care is neither dismissive nor overpathologizing.

The argument also pushes outward. A mother's mental health is inseparable from her community, her culture, her economic circumstances, and her era. Athan names concrete forces: the maternal wage penalty, the leaky pipeline in professional life, the quality of a mother's holding environment, and historical shocks like COVID. These are not background noise. They are part of the transformation itself.

The proposal is direct: adopt matrescence terminology in clinical and research settings, train clinicians to see mothers as people undergoing self-development, and design healthcare services that are continuous and comprehensive. This strengths-based reframing does not deny that mothers suffer. It insists suffering is not the whole story — and that getting the story right is what maternal mental health care has been missing.