In “Screaming on the Inside: The Unsustainability of American Motherhood,” Jessica Grose combines a journalist’s perspective with ferocious personal candor to lay bare the subject of motherhood in America. Grose,  a New York Times opinion writer who focuses on parenting, interviewed over a hundred mothers during the pandemic — all while slogging through lockdown with her own two young daughters — so if this book feels like it’s sounding the alarm on the state of American motherhood, well, that’s because it is.

Part of the reason American mothers are struggling is obvious — the cultural and economic forces that flooded the workplace with professional women in the ’70s, ’80s and ’90s were not accompanied by a basic safety net that prioritized child care or paid leave. But the even greater challenge may be our cultural notions about motherhood, which Grose skewers while also acknowledging their devastating impact.

The contradiction embedded in the DNA of American motherhood, Grose argues, is that women internalize the message that raising children should be perpetually joyful, representing one’s highest purpose, and that this state of nirvana should be achieved without help, meaning that if something goes wrong, it’s your fault.

Raising children is joyful. It’s also incredibly hard. And while mothers in the U.S. are not a monolith, a persistent sense of maternal guilt is the consistent element in Grose’s interviews. On a personal level, Grose describes how during her first pregnancy, she “failed at ideal motherhood before I even had a child,” because she suffered from crippling prenatal depression and had to quit her dream job. It’s bracing to see her write so honestly about her decision to go back on antidepressants during pregnancy, and to stop nursing after two weeks because she realized her mental health as a mother was more important to her baby’s well-being than following rigid parenting norms. She’s also candid about the anguish that accompanies these decisions, and how hard it is to push back on the often-absurd expectations we have for mothers.

The notion of mothers needing to be the “perfect vessel” for their children has been around since the dawn of our republic and was supercharged in the early to mid-1900s, when the scientific community believed that “hysteria” during pregnancy caused children’s health problems. While we’ve moved away, in theory, from this Freudian framework, it’s amazing how much it still resonates, bringing home the point that while a lot has changed for mothers, a lot hasn’t.

One of the book’s most fascinating passages relates the experience of Eliza, a mother in the 1800s, who writes to her mother about her postpartum agony — she’s up all night trying to nurse the baby with what is most likely the breast tissue infection mastitis, and then her older children wake her at dawn, all while her husband wants her to focus more on him. Update the language, and it could be any mother during the pandemic screaming into the dark on a message board.

The picture the book paints of American motherhood stands in stark contrast to the gauzy, Instagram world of parenting bliss, which Grose argues is also making us miserable. While the original online parenting forums were raw and confessional, the moment advertisers realized there was money to be made in the “momternet,” the product they wanted to sell was breezy mom perfection. But outside of a small number of momfluencers, women are not benefitting from this economic boom. They’re just feeling bad about themselves because they’re not prancing around in a peasant blouse and perfect hair while their kids frolic alongside them.

The fact that this perfectionist ideal of motherhood makes money while the actual labor of raising children and caregiving is invisible in the U.S. — it’s not even counted in our gross domestic product, Grose dryly notes — is perhaps the best example of how we value and devalue mothers in America. But COVID has at least sparked a reckoning about the importance of caregiving, with more support for policies like paid leave and child care.

We need structural change to support families, and on this point, the book pivots to familiar territory, calling on mothers to advocate for change. But it’s always mothers who are asked to do the work — the very same people who may be most strapped for time, financially strained and exhausted. This notion feels almost reactionary amid the bolder ideas this book champions. Then again, mothers are the ones who truly understand the stakes.

Screaming on the Inside: The Unsustainability of American Motherhood
By Jessica Grose
(Mariner Books; 240 pages; $28.99)