A Review of Ordinary Insanity: Fear and the Silent Crisis of Motherhood in America

The summer I gave birth to my daughter, I was so afraid to leave my house with her that we didn’t even go on neighborhood walks alone. I remember letting her sleep in the bassinet while I took my dog outside, paralyzed by fear and foreboding: What if she chokes on her spit up and dies while I’m gone? What if she suffocates in her sleeper? What if she cries so hard the blood vessels along her nose split and flood over her milk-white cheeks? 

I thought: If she dies, I die.

Sarah Menkedick’s Ordinary Insanity: Fear and the Silent Crisis of Motherhood in America is the book I needed to read three years ago during that anxious postpartum period. She combines years of research, interviews, reflections and anecdotes of her own personal struggles with perinatal mental health. What results is a comprehensive tome about fear, anxiety, and the remaking of American motherhood. “Fear has become the way American mothers police, educate, and define themselves,” Menkedick writes in her introduction. “It is the ritual with which they commemorate their transition to motherhood.”

While the crux of Menkedick’s book interrogates the thin line between nervousness and neurosis, she also explores an array of other topics to support this study: biochemistry and mood disorders, reproductive rights and the history of Black midwifery, and the way ideals of motherhood and femininity have changed throughout history, to name a few. Each section of Ordinary Insanity provides context and weight to the varied experiences of modern motherhood.

In her chapter entitled “The Risk Society,” Menkedick shows the reader how our fears are rooted in the excess of knowledge at our fingertips—it’s not how little we know as parents, but how much. Because of the biological rewiring of the mother’s brain during the peripartum period, everything can start to look dangerous: too-tight crewneck shirts (Choking!), plastic (Poison!), painted windowsills (Lead! Chemicals!). “Mothers enter into a zone in which the risk is the sole framework of their lives, every risk is peak, and each one is equally, imminently possible,” she writes. “Choking. Drowning. Falling. SIDS. Strangulation. Dog attack. Allergic reaction. Food poisoning. Infection. These are feelings as much as they are risks, and the feeling is a terror of harm to one’s child. What matters is the mere possibility, not the probability.” It is perceptive of Menkedick to humanize these thoughts, as well as explain the science behind them. Understanding the rational connection between risk and anxiety during moments of panic has been useful, at least for me. 

In “The White Advantage,” Menkedick leads with statistics about infant mortality rates, chance of death from pregnancy-related causes, birth outcomes, and other evidence to show how pregnancy and birth remain more dangerous for Black women. It’s as if she’s asking the reader, “Now do you believe me?” As someone outside the Black experience, I appreciated how Menkedick centered Black voices in both her research and storytelling and made a commitment to intersectionality when presenting her subject matter. This chapter introduced me to the idea of the weathering hypothesis—that Black women in particular experience toxic levels of stress due to systemic racism and that this stress has led to postpartum depression, low birth weights, and more, no matter their socioeconomic status. She writes: “These stress levels wear down [Black] bodies over time, making them more susceptible to illness, which is compounded by unequal access to health care and a medical system that is often skeptical of their pain.” Menkedick then contrasts this section later in her chapter when she discusses the rich history of Black midwifery. “Black women trusted midwives because they did not perform like doctors when they were with them…. By virtue of Black women’s exclusion from the mainstream realm of medicine and power, they developed strong connections to a realm of ritual, belief, and community.” Through setting up the comparison, she shows how the distrust of traditional medicine for many people of color stems from a long history of racialized care.

Interspersed throughout Menkedick’s vast reportage are stories of several women and their varied experiences with postpartum depression, anxiety, and obsessive-compulsive disorder (OCD). Her descriptions of their unique experiences are vivid and searing, offering me a glimpse into the lives of other women who had episodes of postpartum depression and anxiety. In one tableau, we meet Samantha, who was manipulated by her obstetrician into voluntarily admitting herself for psychiatric evaluation. In another, Marna shares how she personally experienced the effects of institutional racism in our healthcare system. Then there’s April, the sleep-deprived young mom whose anxiety was so high, she flew out of bed one afternoon when she heard noises coming from the kitchen because she worried that someone was putting her baby in the microwave. These women became my shepherds, steering me through the more researched passages, giving facts and statistics an added personal depth.

Interestingly, Menkedick’s tone varies when telling portions of her own story throughout the book. These were some of my favorite chapter sections; she’s contemplative, honest, and lyrical in her writing. She chooses to italicize these passages, which serves a dual purpose: it differentiates her voice from the others in her book and signals a more reflective state. One of my favorite sections occurs in the chapter “Empowerment,” when Menkedick remembers what it felt like to have an anxiety attack.

Menkedick’s personal anecdote presents such a realistic description of what it felt like for me to have an anxiety attack: the dull pain behind my ribcage, the heavy breathing, the dizziness and disappearance of the world around me. And that’s part of the beauty of Menkedick’s writing—she pays attention to the small details, the nuances of research studies, the things that no one else thinks to mention, and that makes her writing especially accessible.

In the weeks after giving birth, I remember feeling weak from blood loss and lack of sleep but also so empowered to protect this vulnerable little life of mine. Looking back, I can’t believe my daughter is already three. She’s become a tiny human in her own right, one with an iron-strong will and the sweetness of New Jersey taffy. I still worry about her running into the street and choking on grapes and getting her little heart broken. And yet: I know she’s strong because I’m strong. Reading Menkedick’s new book reminded me that it’s okay to feel fragile and powerful at the same time—and if there’s anything I want other mothers to know right now, it’s this.