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Thomas D’Angelo, M.D.


Invasion is a structure not an event

M. Jacqui Alexander is referring to colonialism, which we will definitely get into, but the double meaning
is relevant to maternal mental health too. For most of human history(99%?)conception, pregnancy, birth and the
postpartum period were communal projects. Hopi communities think about a coming child in everyday activities:
tying a rope around a sheep with intention so as not to tighten the umbilical cord around the neck, or peeling
vegetables for soup and creating a smooth path for the delivery. The Saami know the orange butter from the
fast growing grass of new spring is the perfect food for having, growing, delivering and recovering from child
birth. Just like the NGATI-KAHU use shark liver and the Haida salmon roe. Traditions born from deep
relationship with the land and water and ancestors over vast periods of time create a structure for having children
that is a shared, participatory and creative act of repetition, imitation and retrospective reinvention. This is in
direct opposition to settler states like America where pregnancy and childbirth do not take place within a
community context but are instead a medicalized and private experience. My concern is that approaching
maternal mental health through the lens of the individual mother in isolation is inconsistent with the ecological
cultures of our world and ultimately maladaptive.

Colonialism is one profound and violent fragmentation

This is why I’m drawn to M. Jacqui Alexander when I think about the work of normalizing, validating,
empowering and stitching together of support systems that is done on the Perinatal Psychiatry Unit and in the
Women’s Mood Disorders Clinic. Colonialism starts with a sundering: nature is something that can be exploited
as opposed to something we are part of, and nature includes some people(who can be exploited)but not others,
as racism is colonialism’s perfect partner. Violence is absolutely structural to these processes of extraction,
commodification and production. I would go even further in saying that this colonial/imperial lens on reality was
directly created by thousands of years of violence in Europe. Capitalism as a way to organize/imagine/dream
reality is born more from trauma than from science or economics. The destruction of the planet clearly calls out
the fantasy structure on which capitalism depends: constant growth, expanding markets, infinite resources and
capital expanding infinitely. That’s without even getting into the simulacrum, the hemorrhaging of the real, the
cultivation of lack and diversion of desire into acquisition, or the endless failed comparison bombarding us with
what we are not and what we do not have. However, even if conception, pregnancy, birth and the postpartum
period are medicalized to be profited from, the opportunity to rebuild community out of the hospital/clinic remains.
One way to think about DEI is that it’s a way to rediscover, reclaim and recall what we’ve lost because of
colonialism, racism, repressive military force and reactionary conservatism. Like an act of translation that can
carry tradition “across profound gulfs of historical discontinuity created by violence.” Which for me gets to the
central question of maternal mental health in a settler state: can the work of supporting and caring for women
and their families be done without ourselves returning to the land, water and communal practices decimated by
colonialism? Because as M. Jacqui Alexander puts so perfectly:

Remembering is different from looking back