This evening I happened upon a guest post over at KevinMD by Dr. Srini Pillay, MD, an author and an Assistant Clinical Professor at Harvard Medical School. KevinMD has been a site I read more and more these days. I enjoy the insight offered by his knowledgeable guests. Today’s post, however, has me shaking in anger.

Dr. Sirini Pillay’s post is entitled “What a psychiatrist learned in therapy sessions with mothers.” It’s also posted at Pillay’s other blog, Debunking Myths of the Mind under the title “I love my children but hate my life: Solutions to Dilemmas Mothers Face” with the subtitle of “A balm for all guilty mothers.”

(Please note: All text below in italics and bold is directly from Dr. Pillay’s article)

Dr. Pillay pontificates a few reasons for the psychological issues/stress mothers experience during their lives. With every one of them, his explanation (in my opinion) places even more guilt upon the already exhausted and stressed out mother rather than offer true solutions for her success as a mother. Perhaps most glaring  in his examination of the trials and tribulations of motherhood is the omission of any mention of a Postpartum Mood Disorder as the source for the points upon which he offers his expert insight. I find it impossible to believe, given the statistics of Postpartum Mood Disorders (1 in 8 new mothers), Dr. Pillay has never seen a mother with a Postpartum Mood Disorder or is unaware of the additional issues a Postpartum Mood Disorder brings to the dynamic of Motherhood, especially if said Postpartum Mood Disorder goes untreated. It is both appalling and irresponsible to me for a Psychiatrist to fail to mention such a glaring issue in the face of addressing issues faced by Mothers.

First up, Dr. Pillay mentions Perfectionism. “New mothers often expect to be perfect rather than the best that they can be,” Why does the mother expect to be perfect, Dr. Pillay? Is it because SHE has placed those ideals in her head? No. It is because society has placed these ideals in her head. We are absolutely expected to be pristinely Stepford in our execution in the assigned task of Motherhood while Fathers are expected (also unfairly) to be aloof idiots. What Dr. Pillay fails to mention is that those of us who are obsessive perfectionists are at a higher risk for developing a Postpartum Mood & Anxiety Disorder. What he fails to mention is that, in order to overcome this “Peril of Perfection” society must also change their view of Motherhood. Instead, Dr. Pillay perpetuates the stigma and tells Mothers “you can always strive to be better by making small changes. Holding yourself to a standard of perfection can lead to burnout in all areas of life, because you are constantly striving for something that does not exist.” I agree, Dr. Pillay. But the same society fails us when they perpetually hold us to a standard of perfection, for which when not reached, we are then automatically judged and crucified.

Next up, burnout. Burnout is a direct result of perfectionism. It’s also the direct relation of attempting to care for an infant while struggling with the depths of a Mood Disorder. Study after study has proven the adverse effect of Postpartum Mood Disorders on sleep. Have a Postpartum Mood Disorder? You won’t sleep as well when you do sleep. Sleeping less and lower quality of sleep are both symptoms of a Postpartum Mood Disorder. Yes, everyone knows new mothers don’t sleep much. But moms with a Postpartum Mood Disorder sleep even less and achieve a lower quality of sleep when we DO sleep. Another kicker? Our children sleep less and at a lower quality as well. So now you have an exhausted dyad attempting to live up to an impossibly high societal standard which is now even further out of our grasp. Need more ammunition here? We’re also told to snap out of it if we seek help. Stigmatized. Made to feel guilty. Not allowed to have the “time” to be depressed because by God we have an infant to raise which is what we were bred to do. Failure is not an option. So we stay silent, we suffer, we weep, we wail, we dry our eyes in the face of the public realm because we’re not allowed to have emotions other than those seen in Johnson & Johnson or Pamper’s commercials. Everything is to be picture perfect. If it’s not, we’ve failed. Dr. Pillay’s suggestion here? “So rather than force themselves to think and feel differently, addressing the burnout can help many problems all at once.” I would have loved to have addressed the issue of burnout. I attempted to address the issue of burnout with each one of my children. I asked for help. I begged for a night nurse from the pediatrician once our second daughter came home after nearly a month in the NICU after being born with a cleft palate. His response? “Why do you need a night nurse?” I had a toddler. Two dogs. A husband who worked 70+ hours a week. I was exclusively pumping every three hours and running a Kangaroo pump on the same schedule. I had to clean my daughter’s PEG site and jaw distraction sites a total of 4-6 times a day on TOP of everything else. Sleeping would have been a gift from the Gods. Yet I was denied and landed in a Psych Ward less than two months after my daughter’s birth through no fault of my own. No amount of forcing myself to think and feel differently would have helped. But I tried to address the burnout. That too, failed.

Now we move into “The best balance.” This paragraph’s opening sentence really captures judgment of mothers across the world: “When women feel overwhelmed, they essentially need to ask themselves why they expect something impossible from themselves.” Again, he’s absolutely right. Yet again, it’s society which has trained us to expect the impossible from ourselves. Dr. Pillay goes on to suggest “The reality is that if a woman has a need to work and have a baby, she needs to find a best balance that is right for her and her family.” Again, I agree. But if a woman has a Postpartum Mood & Anxiety disorder, she is already wracked with guilt. Attempting to find balance in her life is not achievable until she has begun to heal from her fragile mental state. A woman with a Postpartum Mood & Anxiety disorder can barely survive her day let alone find balance in her life until her mental health issues are addressed. Any health professional or anyone I knew mentioning to me all I needed to do to improve was to “find a best balance” in my life when I was in my darkest days would have heard an earful. We’re barely able to keep our own heads above the fray – how are we expected to balance too?

“There is no one-size-fits-all type of mother, and different types of mothering produce different positive and negative outcomes.” Amen. And yet, society expects Sally to parent like Suzie and Suzie to parent like Bethany and Bethany to parent like Rebecca and Rebecca to parent like Jody and Jody to parent like.. well.. you get my drift. It’s the whole Stepford thing. Again, society does not allow for this sort of flexibility. Mothers with Postpartum Mood Disorders parent far differently than any other mother on the planet. We realize the value of self-care because it’s necessary for our survival. For some of us, it’s necessary for our children’s survival. We are judged for how we parent. How we HAVE to parent. We are judged for expressing our frustrations, for choosing to formula feed, for choosing not to go the attachment parenting route, for letting our little ones watch TV because we’ve had a tough day. Yes, we heal from a Postpartum Mood Disorder but when you’re in the thick of it and family members or random people in public are judging us, we have a harder time letting it go and then BAM. Hello guilt. Hello Xanax. I love the idea, I love the theory of “no one -size-fits-all type of mother,” I do. But it doesn’t work in the real world and certainly doesn’t work when the public thinks of mothers with Postpartum Mood Disorders. A mother with a Postpartum Mood Disorder is a horrible mother to most – we’re stigmatized and in addition to overcoming the every day normal judgmental issues which accompany motherhood – we must also overcome the additional perception of our “bad mother” rep.

The final paragraph recognizes that “It’s not all you.” It’s not. It’s genes. It’s how our child is wired to react. But guess what? Kids of depressed parents are more at risk for issues like ADHD. They sleep less. Their quality of sleep is less. Dr. Pillay says, “Parents who take on all the responsibility of this often distort this, feeling as though they are fully responsible for how a child turns out.” Wait a second. Aren’t we? What about Parents who are arrested for the behavior of their children? Parents who are judged because their child isn’t yet sleeping through the night or wets the bed or isn’t getting good grades in school? Or Parents who have infants who are not yet eating solid foods even though they keep trying? Yet, Dr. Pillay’s solution is for PARENTS not to blame themselves when their child doesn’t “lean on their own sense of responsibility.” He also goes on to add this gem: “Also, mothers who are alarmed by their own mistakes set a challenging standard for their children who may grow up to learn that mistakes are “bad” rather than inevitable but not a reason to give up.” Let’s say a mother has a doctor for her Postpartum Mood Disorder who keeps telling her she’ll get better with every therapy they try. Instead, she continues to worsen. Eventually she’s convinced the fault lies within her. That SHE is the problem. Some of these mothers may even give up and just live out the rest of their lives without trying any more therapy because they are the issue, not the therapy. So of course she will raise a child to believe mistakes are bad as opposed to inevitable. Of course she will raise her child to believe once a mistake is made more than once that giving up is the proper course of action. Or even worse yet, let’s say mom doesn’t get treatment at all (which is the case with most mothers struggling with a Postpartum Mood Disorder, by the way), this issue will spill over into how she raises her child and no amount of pulling herself up by the boot straps will change her thinking. She’s leaned on her own distorted sense of responsibility and it didn’t work for her. Why should she then expect it to work for her child? Why would she not consider herself fully responsible for her child’s behavior when society does just that on a daily basis?

My absolute favorite part of Dr. Pillay’s piece is the closing paragraph:

“Thus, when mothers find their relationships thrown into disarray, they may want to re-examine their own standards and relax their judgments toward themselves as they allow themselves to be more human and the very best that they can be without needing to be perfect.”

Sighs.

If only society would let us, Dr. Pillay. If only society would let us.

I’d like to add though should a mother finds her relationships thrown into disarray, she should not immediately blame herself for the fault of the disarray. Yes, she may truly be at fault but the other party may be at fault. She may be struggling with a Perinatal Mood Disorder or another type of mental illness. There are many additional reasons for the fault of relationships to be at fault other than the internal (yet societal driven) standards imposed on Mothers today. Perfectionism is imposed, not perceived. Failure to achieve perfection is perceived yes, but the standards we fail to reach were, at some point, imposed upon us by society. If we truly want to help mothers overcome the perception of succeeding by not being perfect, we need to first change society’s view of mothers, not mother’s view of themselves. The standards we try to reach our not our own… they are the fences between which we are forced to live. Until these barriers are removed, we will never succeed.