Category Archives: public awareness

How the @BostonGlobe got Postpartum Depression Wrong

With more news stories mentioning Postpartum Depression these days, it is becoming painfully obvious that reporters are scrambling to get their facts straight. Bless them for trying but sometimes, even with the best of intentions, they fall short. Like Karen Weintraub’s article “When the ‘baby blues’ are something more” at the Boston Globe on October 21, 2013.

Karen defends herself in the comments (all two of them at time of writing) about the term “baby blues” by saying that in her researching for this piece, she discovered there is such a thing as baby blues:

Boston Globe Comments

Kudos to Ms. Weintraub for doing enough research to realize that baby blues ARE distinct from depression.

BUT.

There are a multitude of omissions and errors within the article as it stands right now. Let’s go through them:

Ms. Weintraub breaks the Perinatal Mood & Anxiety Disorder experience into only three groups:

  • Baby Blues
  • Postpartum Depression
  • Postpartum Psychosis

Immediately, sirens sound. Particularly because the case study, a Nicole Caligiuri, a first time mother, states she felt “angry and anxious” all the time. While anger/irritability is a sign of depression, anxiety combined with anger is typically (in my non-professional opinion) more closely related to an anxiety disorder. Ms. Caligiuri, however, was diagnosed with Postpartum Depression.

By ignoring the additional facets of the PMAD spectrum, Ms. Weintraub does a severe disservice to those mothers who may be suffering from Postpartum Anxiety, Postpartum Post-traumatic Stress Disorder, or Postpartum OCD.

Weintraub states that 50-85% of new mothers experience baby blues, 14% experience postpartum depression, and a “fraction of 1 percent of new moms” experience Postpartum Psychosis. If you go by those numbers (at the higher levels), nearly 100% of all new mothers experience one of these three phenomena and none experience Postpartum Anxiety, Postpartum Post-traumatic Stress Disorder, or Postpartum OCD.

According to Postpartum Support International’s Get the Facts page:

  • Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. Sometimes they experience anxiety alone, and sometimes they experience it in addition to depression. 
  • Postpartum Obsessive-Compulsive Disorder (OCD) is the most misunderstood and misdiagnosed of the perinatal disorders. It is estimated that as many as 3-5% of new mothers will experience these symptoms.
  • Approximately 1-6% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth.

But in Weintraub’s scenario, there isn’t room for the nearly 20-27% of women who develop these particular Perinatal Mood & Anxiety Disorders. As a survivor of Postpartum OCD, I find this troubling. Particularly because OCD can scare a new mother into thinking she is experiencing a form of Psychosis due to the horrific intrusive thoughts.

As I have mentioned multiple times, it is beyond important to differentiate the varying aspects of a Perinatal Mood & Anxiety Disorder. Why? Because when you lump Postpartum Psychosis sensationalism in with Postpartum Depression, things get murky. You scare new mothers who may be a bit depressed into thinking if they go get help, they will be thought of as potential criminals and have their babes ripped from their arms the instant they admit to feeling anything less than happy.

An additional issue with this article is the strong focus on early motherhood. The logic of this focus is evidenced by the study on which it is centered but a quick mention that PMAD can persist beyond early motherhood would have been a quick fix for this bias.

Why is it important to emphasize that PMAD onset can extend beyond early motherhood?

Often, many mothers do not realize they have issues until they are well into the 6th month or more. I have had mothers contact me at almost a year postpartum to share that they think something has been deeply wrong since the birth of their child but they did not recognize it until now. Many Perinatal Mood & Anxiety Disorders crop up within the first 2-3 months, often immediately after the period of baby blues, but some mothers do not recognize them or even get hit with them until much later. PMAD’s can crop up  within the first 12 months after birth and even then, may not be recognized until much later. But this information is not mentioned anywhere in the article nor are we ever told at what point Ms. Caligiuri sought help.

I deeply appreciate Ms. Weintraub’s effort to reach out to Dr. Katherine Wisner and Dr. Michael O’Hara, respected experts in the research field of Perinatal Mood & Anxiety Disorders, however, I wish she (or her editor) had taken the time to allow this article to be a bit more clear regarding the wide scope of Perinatal Mood & Anxiety Disorders. I also wish a side bar had been included to resources for women and families who are struggling with these issues, particularly given that Ms. Weintraub included this quote from Dr. O’Hara:

Social support is probably the most important thing to provide a new mother, who is at a particularly fragile point in life, said Michael O’Hara, a professor of psychology at the University of Iowa, who has been researching and treating postpartum depression for three decades.

 

Postpartum Support International will connect new mothers with social support. Also, specifically in Hadley, Massachusetts, there is Mother Woman, a fabulous organization who is making fantastic strides toward improving access to support and care for struggling women & families. Advocates in the trenches, such as the volunteers with PSI and Mother Woman, recognize how important it is to have peers support each other so they do not feel all alone in the dark. It is an oversight that neither of these organizations are mentioned anywhere in Ms. Weintraub’s piece.

Overall, Ms. Weintraub, despite making a few blunders, seems to handle the issue at hand with a respectable grace. The study at the heart of the article focuses on the development of depression in children born to mothers who struggled with depression but Ms. Weintraub is fabulous in her handling of this issue, particularly with this paragraph:

But parents shouldn’t feel like they’ve ruined their child’s life if they go through a period of depression, Pearson said. The increased risk of depression in their children is small. Overall, 7 percent of teens are depressed, compared with 11 percent of teens whose mothers were depressed early in their children’s lives.

She side-steps the potential onslaught of guilt and gracefully allows parents to breathe a sigh of relief by including this information from the study’s co-author.

As I stated in the opening, coverage of Perinatal Mood & Anxiety Disorders is greatly improving. But we still have a long way to go to get to fully informed reporting. For the most part, Ms. Weintraub’s article is generally free of sensationalism, includes quotes from respected experts, and manages to allay any potential guilt a new mother with a PMAD may feel in reading it. However, it is still just a few small adjustments away from being truly spectacular and informative.

Dear Sting, Postpartum Depression is No Joking Matter

Sting played a small venue in Chicago last night to promote ‘Last Ship’, according to this article written by Scott C. Morgan.

The article discusses the process Sting went through to bring ‘Last Ship’, a Broadway musical, to life.

Then at the end, is the kicker.

Though Sting is writing the score for “The Last Ship,” he won’t be appearing in the show. So Seller asked the singer how it will be for him to see other people performing his songs onstage.

 

“I imagine I’m going to have postpartum depression,” Sting joked.

 

Oh, Sting.

I have been a fan since I was a pre-teen and had to sneak off at my grandmother’s house to watch videos on MTV. Yanno, back when MTV actually showed videos.

You’ve been a source of solace for me in my dark times. I used one of your songs in a playlist of mine as I healed from my own bout of severe Postpartum OCD. The rhythm was just right and I liked the emotion it evoked within me.

But now?

I can’t do that.

Because you’ve said this.

In eight words, you have managed to completely undermine the seriousness of what I experienced. What millions of women experience every year. In eight words.

Do you see how easy it is to marginalize someone else’s experience? How easy it is to compare the hell that is a Perinatal Mood Disorder by saying you’ll go through the same thing as you watch other people perform your songs? While it may not be easy to see other people perform your art, I guarantee you that it is a hell of a lot easier than the depths of hell I and millions of other women witness as survivors and warriors in the trenches against PMADs.

We fight, Sting, for our fields of gold, fragile as we are. We fight because maybe, just maybe, tomorrow we’ll see a brand new day filled with hope. We don’t want to be the shadows in the rain, never coming home.

Please, think about what you are saying before you say it. Because when you do not think before you speak, you end up hurting people, minimizing their experiences, and comparing their hell to something which is not even close to their experience.

For now, I am gonna have to do the opposite of Rick Astley and give you up because you let me down.

Green Shoes, The NFL, and Mental Health Stigma

The NFL is making a “Crucial Catch” this month but it has nothing to do with Mental Health. Instead, they have been partnered with various breast cancer organizations to raise awareness and funds for battling breast cancer.

Participation started back in 2008 with a myriad of events as evidenced in this article, “NFL Supports Breast Cancer Awareness Month”. This year, the awareness campaign continues. Not only do players wear pink gear, but it is also auctioned off to raise funds for research. Which, in theory, is a great idea, and as someone who has lost a family member to breast cancer, I understand the desire to increase awareness and provide funds for research.

As a football fan, however, I hate the month of October. I cannot stand pink. I have hated the colour ever since I brilliantly decided at age 7 that Pepto Bismol Pink was a terrific colour for my walls and I lived in that Pepto “Abismol” Pink room for nearly 5 years before escaping it into a soothing forest green room with merlot trim.

My point here is not about the colour. It’s about the NFL ignoring an awareness week which occurs during the month of October.

In case you do not follow mental health news OR the NFL, there has been a lot of discussion regarding Brandon Marshall’s desire to wear green cleats during tonight’s Bears v. Giants (don’t get me started on the Giants’ 0-5 giddyup to the season because that’s a whole ‘nother post) game. The NFL flat out told Marshall he couldn’t do it. Then they said he could but that he would be fined. Marshall plans to pay the fine and match it with a charity donation. A donation most articles make clear will go to a cancer-care organization with the mention that he is also trying to work out details of donating to an organization making a difference in the Mental Health World.

Here’s the thing, though, from my perspective – with the big brouhaha the NFL has made regarding Marshall’s desire to wear green cleats, it seems to the casual observer as if they do not want to raise any awareness regarding Mental Health issues. On the other hand, however, their very refusal and the back and forth with Marshall does have people talking about his condition and desire to raise awareness. The NFL’s aversion to Marshall’s desire to raise awareness on the field also makes it seem, to me, that the NFL cares more about the state of a woman’s breasts vs. the state of her mind.

Marshall struggles with Borderline Personality Disorder, something an article in SI from May 2012 describes as evidence of the strides the NFL has made in making the mental health of players matter:

The hope is to create a stigma-free environment in which players feel more comfortable working through their mental health issues. Bears receiver Brandon Marshall reached a breakthrough of sorts last July, when he announced that he had been diagnosed with borderline personality disorder; the moment hints at the strides engagement programs are making behind the scenes.

 

The NFL also runs a Life Line specifically for players, former players, and their families, accessible on the web and via phone. The Life Line was launched in 2012. I wasn’t aware of it until today as I was Googling for this piece.

“There is no higher priority for the National Football League than the health and wellness of our players,” NFL Commissioner Roger Goodell wrote in a letter to personnel and fans at the time. (quoted from CNN) 

In addition, the NFL has been adding more and more psychologists to behind the scenes team rosters, something the previously mentioned SI article details.

With this internal attention to the mental health of their players and families, isn’t it time the NFL brought some of their powerful presence in the psyche of the American male to the table and made mental health awareness an issue? With the loss of Junior Seau, last year’s incident with Kansas City’s Jovan Belcher, Paul Oliver’s recent suicide and the loss of several other players in the same manner, the NFL needs to do more than just support mental health behind the scenes because without public action, it is all too easy to assume that nothing is being done. It is also extremely easy to assume there is no support when you have the NFL threatening a player wanting to do something as simple as wear a different colour cleat to raise awareness for Mental Health issues, something said player struggles with himself.

I get that October is taken for Breast Cancer Awareness.

All I’m asking for is one weekend where the players wear Green, as Brandon Marshall wants to do tonight, to raise awareness for Mental Health Issues. If they can do it for Breast Cancer and raise millions of dollars for research and awareness campaigns, imagine what they could do if they dedicated the same amount of energy to Mental Health research and awareness, particularly in a sport with a hard-core dedicated male audience taught by society NOT to talk about their emotions.

For now, though, I guess we will suffer through the month o’pink and hope everyone has healthy boobs instead of healthy minds.

WAY TO GO, NFL.

Saturday Sundries: When Suicide becomes reality

Saturday Sundries Banner

Morning y’all.

I hope you have imbibed at least one cup of coffee because today I am going to get serious. Life and death serious.

Over the course of my time as a peer advocate/support person for women and families struggling with Postpartum Mood Disorders, I have faced suicidal mothers more than once. Each time it is draining. The first time I faced this issue I’ll be honest – I didn’t know what to do. The first time I faced it on Twitter, I recruited people to support me via DM, reached out to emergency contacts, and the mom connected with someone via phone. It wasn’t me but that did not matter. What mattered was that she reached out and held on to hope. She got help and is still here.

Over time I have grown more comfortable at dealing with someone in a suicidal crisis. Each time it still drains me though. But it’s part of what I do. I am very careful to ensure care for myself during and after an intense time of support. I watch a lot of comedy, exercise, and talk with others honestly and openly. I love that my support asks how I am doing if I’ve clearly gone through supporting someone.

I have had to learn how to help others. I have also learned how to help others deal with very real tragedies resulting from the often invisible illness that is a Perinatal Mood & Anxiety Disorder. Right now, our community, those who suffer from, have survived, and fight for those who are struggling, is coming to grips with the events which led to the death of Miriam Carey. There’s a wonderful article over at USA Today dealing with the situation. The article covers PMAD’s respectfully and take the time to differentiate the various types of disorders. If you read any article about what happened, make it this one.

Do you know facts and statistics about suicide? Would you know what to do if someone you loved or knew admitted to active suicidal feelings? Would you be able to recognize the signs of potential suicide? It’s important to be able to do so… think of it as basic first aid for the mind. Just as our bodies can hurt, our minds hurt too. And sometimes? Sometimes we’re not capable of recognizing the extent of the injury until it’s too late.

You are not at all helpless when it comes to suicide. You CAN do something. Start with this list over at the National Suicide Prevention Lifeline. Know how to report suicidal behaviour on Facebook. Program the National Suicide Prevention Lifeline number -1-800-273-8255- in your phone.

Start a discussion about suicide with friends. If someone jokes about it, correct them by saying that it is a serious matter and deserves serious attention, following that statement up with facts and statistics. It is absolutely not something one should ever joke about. Ever.

Despite all this, sometimes we lose people. Even if we know all the signs and know exactly what to do. We can’t put our plans into motion if we do not know the plans and thoughts of those around us. It hurts like hell to lose someone to suicide. It is a pain I know well. It is a pain others I know also know well. We can do everything right and still have suicide implode our lives. How do we cope then?

When we have lost someone to suicide, we are then termed as “survivors of suicide.” People who have survived someone who completed suicide. You are not alone in this, not at all. There are others out there who are going through the anger, the frustration, the sadness, the regret, the what if’s… the entire gamut of emotions one goes through after losing a loved one to suicide. There are a few online resources. The first one is at Suicidology on their Suicide Survivors page. Then there is Alliance of Hope for Suicide Survivors.

There are also friends and family. Some of them may not understand your grief. They may not understand the length of it or the manner in which you choose to grieve. But grief is different for all of us, just as life is different for all of us. Grieve in the manner which feels best to you and don’t worry about what anyone else thinks. Let it out, let it flow through you, and process your emotions in the best possible way for YOU.

Bottom line – suicide is not something we need to remain silent about. It’s not something we should continue shoving in a corner and pretending it doesn’t happen. It happens, to everyone in all walks of life. We ALL are affected by suicide.

Let’s get together and talk about it – open up, let people know they are loved, they matter, and we do care. Today, take the time to smile at a stranger. Say hello and ask how they are and mean it – stick around for the answer, don’t drift off into the crowd. Offer to help someone with something. Do a good deed. You may just be the one thing they’ve been needing to brighten their ever so darkened life.

After that good deed? Start a conversation somewhere about how important it is to discuss suicide and the issues that can cause it but also what to do when the mere thought of it is looming on the horizon. You may just save a life doing both. And that, my friends, is why we all matter.

Sticks and Stones Will Break My Bones But Words….

I started this post the other day after a comment was left on a post I promoted on Facebook. Then I had to walk away because I started down a path I did not want to go down. This was a difficult post for me to write as it forces me to revisit a meeting which left me both enraged and shaken. I’ve calmed down quite a bit and the following is a much more polite response than the one I started the other day.

The post is a wonderful interview of Dr. Katherine Wisner by Walker Karraa. The interview, found here, focuses on Postpartum Mood Disorders, of course, but also addresses the challenge and controversy of screening mothers for the presence of Postpartum Mood Disorders.

Screening is a hot topic and has been for quite awhile. There are a lot of unknowns regarding when to screen, how to screen, what happens after a positive screen, liability for care of the patient, when to refer, etc. Bottom line, I feel, is that we need to screen in order to start the dialogue about Postpartum Mood Disorders with care providers in every field that comes in contact with both expecting and new mamas. We also need to work more diligently to create supportive nets of care for women in our communities – coalitions of OB’s, Midwives, Pediatricians, IBCLC’s, Psychiatrists, Psychologists, therapists, doulas, and other various caregivers for pregnant women and young children. It needs to be comprehensive.

Those of us who advocate for the care and support of families battling Postpartum Mood Disorders must be well-versed in all things relating to pregnancy and postpartum. Our scope of knowledge must include a basic grasp on the rights of the expectant woman and as a new mothers. This is in addition to the psychiatric knowledge we also hold and are constantly researching in order to better arm new and expectant mothers.

It is exhausting sometimes, to read all of this information. I myself have suffered from information overload. But, empowering new and expectant mothers to make healthy and better decisions for their care and therefore for their families, is what I have been called to do so read I must.

In the past couple of years I haven’t been reading as much, I’ll admit, but prior to that, I read voraciously. I dove into all things birth related. So when there was a chance to go see Henci Goer at a local get together on August 26, 2010, I went.

Henci, a well-known author and advocate for Lamaze birth and healthier women-empowered births, was someone I admired.

Until the night I met her and discussed my experiences which led to my own advocacy with her.

Henci, after discussing at length, her new project, completely shot down my experience with a very dismissive sentence, the gist of which was left in a comment at Karraa’s interview with Dr. Katherine Wisner I referenced above.

Here was a woman, who seemingly was all about empowering women and improving their birth experiences, failing to even acknowledge the difficulties I experienced after my own. I didn’t experience Postpartum Depression, according to Goer, my experiences were directly related to my birthing experience and therefore weren’t my fault but that of the system’s.

While I agree there are far too many interventions in the modern birthing realm for many mothers and it’s sad that organizations like Solace for Mothers even have to exist, to shoot down the experience of another and how she has worked through it in one dismissive sentence is almost as bad as what my first OB did to me.

PTSD QuoteTrauma is about perception. It’s not about what happened to you, it’s about how you perceive what happened to you. This perception is shaded by our own personal experiences and baggage. These experiences and this baggage also directly affects how we process our experience after our brush with trauma.

No one has the right to question a woman’s perception of her birth experience.

No one has the right to re-frame her experience FOR her. It is hers and hers alone to process. It is hers to share as she feels necessary, with whatever details she deems necessary.

The comment Henci left on Karraa’s interview with Dr. Wisner reads as follows:

I am extremely concerned that the focus on screening for postpartum depression using an instrument solely designed for this purpose will miss diagnosis of childbirth-related post-traumatic stress symptoms and full-blown PTSD altogether or will mislabel women experiencing post-traumatic distress as depressed. PTSD symptoms are fairly common–as New Mothers Speak Out found, 18% of women were experiencing symptoms and 9% met the diagnostic criteria for PTSD–and while some symptoms overlap with depression, the treatment differs.

Furthermore, on-site mental health services would be of little use to women suffering from childbirth-related emotional trauma because one of the prime protective responses is avoidance of environments and personnel that re-trigger traumatic memories.

I have as well a philosophical issue with making depression the preeminent postpartum mood disorder. Depression centers the problem in the woman, and therefore the cure is centered in her as well. PTSD, however, is centered in the system, and therefore its cure depends on systemic reforms. The incidence of emotional trauma can be minimized by reducing the overuse of cesarean surgery and other painful and invasive treatments, by implementing shared decision-making, and by providing physically and emotionally supportive care. So long as postpartum mood disorders are primarily seen as an issue of depression, little or no attention will be paid to the all too common glaring deficiencies of medical model management in this respect.

I have several issues with Henci’s comment.

She seemingly assumes that the Postpartum Mood Disorder community is unaware of the difference between Postpartum Depression and Postpartum Post-traumatic Traumatic Stress Disorder. I can assure her that we are indeed not unaware. Most providers and advocates I know work diligently to go beyond the EPDS to dig deeper for possible birth trauma. The EPDS, while yes, not designed to pick up specifically on PTSD, is a starting point for a conversation about emotional issues during the perinatal period. Henci’s issue with this illustrates exactly why we work to educate providers about the many aspects of Postpartum Mood and Anxiety Disorders.

The discussion with a mother who had a traumatic birth experience is wildly different than with one who did not. Not all mothers who experience a Postpartum Mood Disorder necessarily experience PPTSD. Nor are their issues rooted in an issue with the so-called system. May I remind you, Henci, that PMD’s have existed since the time of Hippocrates. It is not some new fangled “too-many interventions” kind of disorder.

Not all of us are not “victims” at the hand of the system as you would have us believe, Ms. Goer. I’ve held discussions with mothers who had home births or natural births in a birthing center and still gone on to experience a Postpartum Mood Disorder. While it’s certainly not as common and there is a seeming correlation to interventions during the birth experience, there simply isn’t enough evidence to claim interventions (particularly cesarean sections) are the definitive root of all Postpartum Mood & Anxiety Disorders as Henci claims in her comment. (See article “Is there a link between C-sections and Postpartum Mood Disorders?)

We, the advocates for care and empowerment of women who do experience emotional trauma during and after birth, are working diligently to bring to light the additional issues on the Postpartum Spectrum such as Postpartum Post-Traumatic Stress Disorder, Postpartum Obsessive Compulsive Disorder, Postpartum Anxiety, and others. We no longer focus solely on depression. If we do, it is only because Postpartum Depression has been used as a catch-all phrase for so very long.

In the past six years I have been blogging, the term has graduated from Postpartum Depression to Postpartum Mood Disorders to Perinatal Mood Disorders to Postpartum Mood and Anxiety Disorders. In fact, I’m often at a loss as to which one to use. Postpartum Mood and Anxiety Disorders covers it most thoroughly, I believe.

There are researchers who focus on nothing but birth trauma and Post-Traumatic Stress Disorders – such as Cheryl Tatano Beck. I had the pleasure of meeting Cheryl at the 2010 PSI Conference in Pittsburgh. That meeting was so much different than my meeting with Henci. Cheryl was warm, accepting, and thanked me for my work in bringing my experience to light and fighting for others who had been through the same thing.

I do not hide that my first birth was a rough one. I know there are other mothers out there who had even more horrific experiences. But I talk about it because negative birth experiences do happen. I talk about it so that other women will read it, and know that it’s okay to talk about their experiences. If I simply dismissed the experiences of all the women who reached out to me, well, I’d be doing a huge disservice to the community around me. To women in general. In essence, I’d be traumatizing them even further.

With wisdom and knowledge comes power. With that power, comes great responsibility. I hold that responsibility as if it were a fragile ball of glass. My goal is to keep it from shattering. My goal is to create a safe and soft space for it as it grows stronger.

If only Henci Goer saw the birthing world the same way.