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Prior to the 19th Century
Western medical science's understanding and construction of postpartum depression has evolved significantly over the centuries. Ideas surrounding women’s moods and states have been around for a very long time, typically recorded by men. In 460 B.C., Hippocrates wrote about puerperal fever, agitation, delirium, and mania experienced by women after child birth. Hippocrates' ideas still linger in how postpartum depression is seen today.

A woman who lived in the 14th century, Margery Kempe, was a Christian mystic. She was a pilgrim known as "Madwoman" after having a tough labor and delivery. There was a long physical recovery period during which she started descending into "madness" and became suicidal. Based on her descriptions of visions of demons and conversations she wrote about that she had with religious figures like God and the Virgin Mary, historians have identified what Margery Kempe was suffering from as "postnatal psychosis" and not postpartum depression. This distinction became important to emphasis the difference between postpartum depression and postpartum psychosis. A16th century physician, Castello Branco, documented a case of postpartum depression without the formal title as a relatively healthy woman who suffered from melancholy after childbirth, remained insane for a month, and recovered with treatment. Although this treatment was not described, experimental treatments began to be implemented for postpartum depression for the centuries that followed. Connections between female reproductive function and mental illness would continue to center around reproductive organs from this time all the way through to modern age, with a slowly evolving discussion around "female madness".

19th Century and Beyond
With the 19th century came a new attitude about the relationship between female mental illness and pregnancy, childbirth, or menstruation. The famous short story, The Yellow Wallpaper, was published by Charlotte Perkins Gilman in this period. In the story, an unnamed woman journals her life when she is treated by her physician husband, John, for hysterical and depressive tendencies after the birth of their baby. Gilman wrote the story to protest societal oppression of women as the result of her own experience as a patient. Her tale is likely to have resonated with many women because female hysteria was a common medical diagnosis at the time, having arisen many centuries earlier as the first mental disorder attributed to specifically women. Hysterical neurosis was not removed from the DSM until 1980, whereas postpartum depression continues to be excluded as a unique "distinct disorder" and was only added into the fourth edition as a "course modified" in 1994. Thus, in the 19th century, the idea of female hysteria was often conflated and confused with symptoms of postpartum depression, all in connection with the prevailing mindset that women were weak and vulnerable to mental illness.

Also during the 19th century, Gynecologists embraced the idea that female reproductive organs, and the natural processes they were involved in, were at fault for "female insanity." Approximately 10% of asylum admissions during this time period are connected to “puerperal insanity,” the named intersection between pregnancy or childbirth and female mental illness. It wasn't until the onset of the twentieth century that the attitude of the scientific community shifted once again: the consensus amongst gynecologists and other medical experts was to turn away from the idea of diseased reproductive organs and instead towards more "scientific theories" that encompassed a broadening medical perspective on mental illness.

Media Attention and Public Dialogue
Certain cases of postpartum mental health concerns received attention in the media and brought about dialogue on ways to address and understand more on postpartum mental health. Andrea Yates, a former nurse, became pregnant for the first time in 1976. After giving birth to five children in the coming years, she suffered severe depression and had many depressive episodes. This led to her believing that her children needed to be saved, and that by killing them, she could rescue their eternal souls. She drowned her children one by one over the course of an hour, by holding their heads under water in their family bathtub. When called into trial, she felt that she had saved her children rather than harming them and that this action would contribute to defeating Satan.

This was one of the first public and notable cases of postpartum psychosis, which helped create dialogue on women's mental health after childbirth. The court found that Yates’ was experiencing mental illness concerns, and the trial started the conversation of mental illness in cases of murder and whether or not it would lessen the sentence or not. It also started a dialogue on women going against “maternal instinct” after childbirth and what maternal instinct was truly defined by.

Yates' case brought wide media attention to the problem of filicide, or the murder of children by their parents. Throughout history, both men and women have perpetrated this act, but study of maternal filicide is more extensive.