Cardi B at Balmain RTW Spring 2025 as part of Paris Ready-to-Wear Fashion Week held at Palais de Chaillot on September 25, 2024 in Paris. Credit – River Callaway—WWD via Getty Images

Iin 2019, rapper Cardi B opened up about the postpartum depression she experienced after giving birth to her first child. “I thought I was going to avoid it,” Cardi explained, noting that her doctor had warned about the possibility. “But out of nowhere,” she said, “the world was heavy on my shoulders.” She recovered with the support of her mother and taking a break from touring.

When she recently had her third child, Cardi’s postpartum health made headlines again. This time she drew criticism for exercising eight days after giving birth, and later for partying with her friends. She slammed the critics, explaining that he was doing everything he could to avoid depression.

Cardi is far from the first celebrity mom to discuss her postpartum mental illness. Only in recent years, Chrissy Teigen, Serena Williams, Alanis Morissetteand others shared personal stories about dealing with the disease.

Their opening reflected how, for about 25 years, celebrity mothers in the US have shared such stories. These testimonies have educated Americans, increasing awareness and decreasing stigma around postpartum mental illness. Importantly, however, they often included a conservative message about good motherhood, framing their victory over postpartum illness as enabling them to be the best mothers possible. This is a logical way of thinking about an illness that too often invites judgment about how someone is a “bad mother” rather than compassion for a person suffering from the illness.

However, by framing their stories in this way, these celebrities have created a cultural expectation about acceptable ways to deal with postpartum illness that causes backlash against women like Cardi who refuse to have selfless motherhood.

Before the 1990s, American celebrities rarely discussed their mental health struggles publicly, including struggles with postpartum mental illness. Several British public figures have acknowledged their postpartum distress, including Princess Diana in 1995.

However, American celebrities have kept their postpartum illnesses private, often for good reason. An article from 1997 in People perfectly explained that “(p)ostpartum depression is not an option for celebrity moms like Whitney Houston, Madonna and supermodel Niki Taylor.” Women were just too busy. That’s not how postpartum depression worked, of course.

Read more: There is now an oral treatment for postpartum depression

But celebrity moms have faced a culture dominated by “the mothers’ wars,” which led the media to praise those women who seemed to balance demanding careers with the high expectations of being a good mother. There was no understanding for female celebrities who struggled with these expectations, forcing them to remain silent.

This changed in 1999, when singer and television star Marie Osmond discussed postpartum depression that hit after the birth of the seventh child. She did interviews with TV Guide magazine and Oprah Winfrey, where she described how the pressure to return to work just weeks after giving birth left her reeling. Osmond handed her baby over to a babysitter and drove 250 miles down the Pacific Coast Highway, looking to escape.

She reported it thousands of women emailed him after these interviews, thanking him for putting a name to their suffering. Men also called, seeking help for their wives and daughters.

Osmond’s decision to speak out was groundbreaking. But the Mormon star’s discussions of postpartum depression also framed her illness and recovery in a conservative light. She discussed her suffering primarily in terms of its impact on her as a mother, not as a person. When Osmond described was driving in a fog of depression, she explained that “part of the reason I got in the car was because I love my kids so much. I love my children…” It took feeling like she wasn’t a good mother for Osmond to admit she had a problem.

Osmond explained to Americans that the solution to her illness was to take time away from work to focus on her family and her faith. She prioritized family dinners and scripture reading, as well as immersing herself in preparing her oldest son for a mission trip. Osmond emphasized how much work she turns down to stay home with her children, including several Broadway shows.

Her message resonated because she argued that one could survive postpartum illness and still be an excellent mother. For many women, hearing this was critical because it gave them hope not only for recovery from depression, but also for reestablishing their status as “good mothers.”

However, there was a negative implication in the way Osmond framed her story: it reinforced a narrow definition of good motherhood, built on a limited imagination of what a mother’s wants and needs might be. He communicated that the central objective of recovery was not the woman’s own well-being, but the restoration of her capacity as a mother.

In 2005, when actress Brooke Shields released her own memoir of postpartum depression had a very different politics and a different experience of motherhood. However, she reinforced the idea that addressing the disease is more about making a woman a better and happier mother and less about her own needs.

Shields desperately wanted a child and struggled with miscarriage and fertility treatments. But having that child was not what she expected. “Why was I crying more than my baby?” she asked. She emphasized in the memoir what a positive person she normally was and how surprising motherhood was. “Where,” she asked, “was the happiness?”

Shields recounted her struggle to accept psychiatric help and psychiatric medication, though she eventually agreed to both. She matched them with a nurse who traveled with Shields and accommodations that allowed the actress to keep her child with her when she returned to work.

Shields criticized the media’s romanticization of motherhood, but often used the language and ideas that fueled it. Promotional material for her book included images of Shields lovingly holding her baby. She dedicated her book to the baby, who she said made “life worth living”. She described her regret for not appreciating early motherhood during the Depression. Early postpartum love, she explained wistfully, was “so consuming and beautiful that it’s a shame not to feel it more.”

A year later, Shields proved her restoration when she had another child. This time, a magazine profile pointed out, the star was neither depressed nor in need of medication.

Shields’ confession about postpartum depression reached a huge audience, mainly because of the actor Tom Cruise criticized publicly her use of antidepressants. The public backlash against Cruise was swift and shone a light on postpartum depression and its treatments.

It was comforting, Shields said, when her doctor told her that her depression had a chemical basis. This helped explain her non-maternal feelings. Without Paxil, she said, “I would not have become the loving parent I am today.”

Read more: The overwhelming feeling of going back to work after giving birth

Shields’ public story and her subsequent advocacy work helped countless Americans learn about postpartum depression and helped destigmatize the use of psychiatric drugs. Her approach to the subject challenged the popular belief that women suffering from postpartum depression were bad mothers, some of whom were so bad as to justify taking their children away.

However, Shields’ recovery story framed her journey not around her own well-being, but in terms of becoming a “loving parent.” This reinforced the idea that postpartum depression was fundamentally an illness that threatened a woman’s ability to mother, as it centered loving motherhood as the key victory of recovery. Like Osmond, then, Shields helped create a hierarchy in which a mother’s wants and needs would always be secondary.

More recent celebrity narratives about postpartum depression are more subtle than those of the early 2000s, but often reproduce aspects of this scenario. In April, actress Halle Bailey gave an emotional account of her postpartum illness, but quickly added that her new son “… is perfect. It’s beautiful… When I look at it, I cry because of how special it is.”

Countless famous women have authentically described their experiences, helping to educate and raise awareness about postpartum depression in a way that little else can. However, these discussions prioritized women’s motherhood over their personhood and emphasized the mother’s self-sacrifice. This framework has created a culture where judgment awaits the celebrity mom who behaves differently – like Cardi B.

This helps explain both the backlash she experienced and the damage the public’s limited understanding of postpartum depression can have. Cultural expectations of selfless motherhood for women struggling with mental health ultimately discourage women from determining and pursuing their own needs on their own terms. It is essential to recognize that recovery from postpartum depression is different for every woman, and there must be cultural space for different types of healing and rebuilding.

Rachel Louise Moran is the author Blue: A History of Postpartum Depression in America (Chicago, 2024). He is an associate professor of history at the University of North Texas.

Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. The opinions expressed do not necessarily reflect the views of TIME’s editors.

Write to Made by History at [email protected].