How the @BostonGlobe got Postpartum Depression Wrong

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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.

"Chest" by Flood G. at Flickr.com (http://www.flickr.com/photos/_flood_/7750480094/)

Wishing Upon a Magic Wand

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Once upon a time, there was a little girl who lived in a modern house at the edge of suburbia.

"Chest" by Flood G. at Flickr.com (http://www.flickr.com/photos/_flood_/7750480094/)

“Chest” by Flood G. at Flickr.com (http://www.flickr.com/photos/_flood_/7750480094/)

One of her favorite things was a trunk filled with dolls and stuffed animals from far away lands. She would open the trunk slowly, and carefully select a few toys with which to have tea.

Her favorite was a stuffed panda bear from China. There was nothing shiny or sparkly about it but the panda bear fit just so in the crook of her arm. When she wrapped it in a blanket, the bear transformed into a baby. She would rock it for hours after tea, whispering sweet nothings into its ear and smoothing the fur in between its ears.

Then, at night, just before bed, she would tuck the bear back inside the chest, telling it good night and wishing it happy dreams.

The little girl would clamber into bed for a night full of happy dreams about things she could do the following day with all her perfect toys tucked ever so neatly into the fancy trunk at the end of her bed.

As she grew older, she had different dreams. Dreams of a real baby of her own. The trunk grew dusty and the panda bear stayed inside, asleep for years and years.

Eventually, the little girl had a child of her very own. She wanted very much to hold it, rock it, and whisper sweet nothings into its ears. Kiss the sweet innocent cheeks and tuck it away for the night as she slept too.

But it did not work that way, the now-grown girl discovered. The sweet nothings were trapped deep in her heart, quelled from bubbling to the surface. The now grown-girl was sad, depressed, and anxious instead of being happy and carefree. What was this? How could she make this go away?

Then she remembered a story her father told her – about an enchantress in a forest far, far away. This enchantress turned sadness into happiness with the mere flick of a wand, something her father showed her every time she cried, imitating the enchantress’s wand with his finger as he carefully wiped her tears from her cheeks. So the now-grown girl decided to make the journey. She set about making preparations. Food, check, baby strapped to her chest, check. Unicorn to ride, check.

As she rode away from the castle, an uneasiness settled over her heart as she wondered if she would be able to make the journey all alone, with no help to care for her child. But she pressed on because she did not know where else to turn.

She rode for days until she saw the edge of the forest in the distance. As she settled in for the night, she snuggled her child close to her and stroked its hair. In the morning, she whispered, things will be better. You’ll see.

As the sun rose, so did she. She gathered up the things spread out from camp the night before and once again, strapped her wee one to her chest before flinging herself upon her unicorn. They galloped toward the forest. After a short while, she heard more hooves on the road behind her. Glancing back, she saw hundreds of other mothers, all with infants strapped to their chests, riding on unicorns. They too, were headed to see the great magical enchantress for the were exhausted with fighting against wave after wave of emotion.

Surely, one wave of a magic wand and they would be whole again.

They grew closer to the forest by the end of the day but could not quite seem to reach it as the sun sank in the sky behind the towering trees. So all the women dismounted and set up a great big camp not too far from the edge of the woods.

Together, they prepared dinner, they sang, they laughed, they shared caring for the babies they held. Then, at long last, they slept peacefully for the first time in months as volunteers took turns tending to the babes at the mothers’ sides. In the morning, breakfast was prepared and shared amongst the camp.

As the sun rose higher, the women, having been lost in their camaraderie, finally realized the forest had again shifted even farther away. But no one made a move to pack up and ride onward. Instead, they went about their business, laughing, crying, sharing, and helping where they could in the camp.

For you see, you do not need a magic enchantress with a magic wand when you have the support and compassion of those around you.

While peer support has been proven to heal women faster as well as prevent severe cases of Perinatal Mood & Anxiety Disorders, it is not often the only tool one needs to fight back. You may also need to see a health care professional to discuss more serious and intensive care methods such as therapy or a variety of medicine approaches – whether it be pharmaceutical or homeopathic. If you or a loved one are struggling with a Perinatal Mood & Anxiety Disorder, know that you are not alone. Reach out to Postpartum Support International to help locate resources near you.

The Elephant in the #PPDChat Community

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Inferior without your consent

This past week, Katherine Stone over at Postpartum Progress announced the the Warrior Mom Leadership Team, an editorial team comprised of a diverse group of writers and advocates, who will help run her blog throughout the year. I am a member of this team along with several other fellow dedicated and amazing survivors who have battled through so much. Along our journeys, we all have been incredibly honest, dedicated, vocal, and driven to share our stories. Some of us started with the most basic of intentions but somewhere along the way, we became recognized advocates through hard work and repeatedly putting ourselves out there sometimes meeting with Fall Get Uprejection along the way. We brushed ourselves off and put ourselves back out there all over again.

Often, we did not even mean to put ourselves out there but had our stories noticed for whatever reason, forced into a higher level of publicity with our very personal battles than perhaps we were ready to deal with. So we rolled with it because we had to not because we wanted to.

One of my primary goals with my growth as an advocate was to develop an online network women and families could access 24/7. My goal with #PPDChat was not to develop a network to lift bloggers and advocates to higher popularity or to create popularity cliques within the community. My goal was to increase peer support for women and families to access whenever they need it, wherever they were. The worst aspect, for me, about a PMAD, is the overwhelming feeling of being all alone. That isolation, the fear that YOU are the only one stuck in this dark hell, is absolutely terrifying and what needs to be remedied first.

#PPDChat exists to create a sisterhood and community, yes, but it is not meant to cause divisiveness or jealousy of any friendships which may seem to net more opportunities or be more intimate than others. I realize these things will happen because this is the nature of humans in a group setting. We gravitate toward others like us. It’s hard-wired deep within us to do so.

The primary goal with #PPDChat was to create a safety-net. To move those who are hurting and isolated toward a place of healing, warmth, and eventually, a return of joy. One of the side-effects of this community has been the development of advocates as they have felt supported and buoyed by the community at large. Certain members have grown stronger in their advocacy voices as they have discovered they truly are not alone and witnessed the power of conjoined voices will do for a woman still fighting. Other members have continued along their own personal path of healing, not joining in the advocacy movement for their own personal reasons. But we have come this far together, as a community.

One of the definitions of community is: “a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals.” #PPDChat is definitely all of those and what keeps it fascinating is that even though PMAD has brought us together, our interests are broad and undefined – allowing for individual friendships to organically develop. Not once have I ever seen it as something which has intentionally excluded certain members. If anything, there have been multiple opportunities to include yourself with other members through guest posts, guest hosting within #PPDChat, and various other outreach situations. We all operate within our “circle of comfort” because of our various issues, something which may limit our exposure to the Social Media world at large, something which often moves faster than the speed of light. It can be exhausting to keep up and we are all moving at a different pace.

Regarding reaching out to involve everyone on an equal footing, Katherine has multiple opportunities for being involved at Postpartum Progress:

I, too, have offered to post guest stories and often highlight Postpartum Voices of the Week. I realize I have been slack over the past year but now that I am actively blogging, I plan to resuscitate this part of My Postpartum Voice. It is important to remember, however, that neither Katherine nor I nor every advocate can possibly read every single thing on the internet about PMAD’s. So we all highlight what we can when we can, which leads to some people feeling left out while others get a few minutes in the spotlight which may lead to other “opportunities”.

That said, those who have become more public and vocal are not any better than those who have not.

Repeat that.

Those who have become more public and vocal are not any better than those who have not.

This is where we return to the quote with which I started:

“No one can make you feel inferior without your consent” ~Eleanor Roosevelt~

When you allow a decision which seems exclusive to hurt you so deeply you lash out toward those who have been included, you are giving that decision power over you and thereby creating your own storm of emotions.

For those of us who ARE more public and vocal, opportunities are not viewed as something we covet or even necessarily seek out. For many of us, the “opportunities” may even be anxiety-inducing but we see them as an opportunity to educate, inform, and raise awareness so we charge forward. We do not see the opportunities as making us better than those who are not “chosen” for these opportunities – they are not a platform on which we place ourselves so others may look up at us and feel left out. Our words, our fight, our journey, for whatever reason, has included these turns and curves. As I emphasize ALL THE TIME:

EVERY JOURNEY IS DIFFERENT AND MUST BE RESPECTED AS SUCH.

I will not apologize for being a member of Katherine Stones’ Warrior Mom Leadership Team. No one should have to apologize for being a member of this team nor should Katherine be made to second guess the folks she has placed on the WMLT. Katherine is entrusting her blog, a blog she has worked tirelessly to develop a strong, ethical, and respected reputation for, to the members of this team. I get that she needed to choose people SHE felt she could trust to continue the tradition of the brand she has developed. I know I would be unable to trust my blog to just anyone. I respect her decision as just that – HER decision.

I feel I would be remiss if I did not also point out that this is not an award, this was not a contest, and we are not being paid to be on the WMLT. It is volunteer – and something we agreed to do because it promotes the community and it is going to help further reduce the stigma and misconception of PMAD’s.

Would I be saying all of this even if I were not on the WMLT?

Hell yes.

Because I GET that it’s her choice because it’s Katherine’s blog.

We cannot (and should not) internalize everything. We cannot expect every single door to open for us – the doors which open for us are the doors MEANT to open for us. Some may take more work, more drive, and some may seem as if they open easier for other people.

While it’s perfectly normal and acceptable to feel left out, the manner in which this has been expressed over the past 48 hours in reaction to Katherine’s announcement has greatly saddened me. The sub-tweets, the sub-textual expressions, and the chit-chat behind the backs of those chosen (and yes, I saw a good deal of this on Twitter) has broken my heart because for me, this defeats the very idea of a unified community.

We are all advocates. We are all responsible for dismissing stigma and fighting back against myths with our voices and our journeys. When we fail to support those who, for whatever reason, end up surging forward in the public realm, we fail the community as a whole.

Am I saying it is wrong to be upset?

Absolutely not.

What I AM saying is there needs to be honesty and respect in how we express these emotions. There needs to be the realization that your words WILL be read by those who have managed to not be “looked over” or become “it” girls. Words DO hurt. I get that you are disappointed and you are hurt, I do. I have felt that myself when yet again, my blog fails to gain any recognition or when #ppdchat fails to gain any recognition in an awards process. It’s frustrating as hell. But do I publicly denounce those who have won recognition? Hell no. I congratulate them with grace and deal with my disappointment privately.

BECAUSE THAT’S WHAT YOU DO. You support the community, you empower it, and you rejoice that the subject matter is receiving attention. It does not matter WHO is doing it, but WHAT is receiving the recognition. It is about furthering the cause, not about garnering individual attention. (Again, however, human nature celebrates when individual attention is received and deflates when it is not – hard-wired, not a faulty reaction at all).

The moment you make it about “ME” is the moment you are not advocating for “US” and that, in my opinion, is failing to kick stigma’s ass.

In that scenario, no one is a winner.

We all have different reasons for writing and when we summarily dismiss the achievements of those around us based on a personal negative reaction, we damage any progress we may make as a whole.

I write because I love to write and I will be damned if I let someone journey along this road alone. I do not write for glory or to be an “it” person, whatever the hell that is. I have never, ever considered myself to be an “it” person, in fact, I have always thought of myself as the complete opposite.

It’s okay for people to be sad and I’m not trying to fix it but at the same time, in expressing their feelings, they are dragging those who HAVE been chosen down and not expressing their disappointment in a healthy manner, which leads to divisiveness and guilt. “United we stand, divided we fall” and all that.

For me, accepting a place on the WMLT means Katherine can focus on doing more with Postpartum Progress, the non-profit which means she can make even MORE strides against PMAD’s. She’s been kicking ass for years with her blog and is already making waves with her non-profit. So if she asks for help, I will say yes as long as it doesn’t interfere with what I already have going on (because it is healthy to make sure you don’t overload your plate).

I’m speaking up because I do not want this recent decision to divide the community. I want us to remain supportive of each other. I want us to be able to express disappointment without attacking other members and without making other members feel guilt and/or shame for achieving something for which others feel they have been “overlooked.” When we drag one person down for achieving something, we impede EVERYONE’S progress toward a better tomorrow. Is that what we want?

We, all of us, are better than this.

We, all of us, know battling alone sucks.

We, all of us, want to win the fight.

We, all of us, are winning this fight, in our own little ways.

Let’s just make sure we do it together – as a team.