Tell us a little about yourself – just who IS Susan Dowd Stone when she’s not advocating for women and families struggling with Postpartum Mood Disorders?
An empty nester, I enjoy teaching and clinical social work. I am ardently involved in the promotion of animal assisted therapy, i.e. exploring and demonstrating the curative powers of our animal companions in therapeutic settings. Through associations with Angels on a Leash and The Delta Society I have initiated and helped sustain AAT programs in hospitals. After the death of my canine partner,I began facilitating a pet bereavement program on a volunteer basis and writing a column on pet loss for the Animal Companion Magazine. Deeply mourning the loss of companion animals is sometimes viewed askance leading to another form of disenfranchised grief. Currently I evaluate teams of handlers and animals for hospital work and live with 3 spoiled dogs and a husband who completely enables this.
I see many human parallels in maternal animal behavior which has broadened my understanding of birth trauma. For example, I watched a show on HBO called “Weeping Camel” about a mother camel who had an excruciating breach birth. When her baby was born after two agonizing days, she rejected it. The movie focused on frantic efforts to effect that maternal infant bond, seemingly to no avail. Finally a shaman was called in to play soothing music while the baby was again brought to his mother. The moment of reunification was deeply moving. Yet, when human mothers suffer greatly during pregnancy, the birth process or its aftermath, we unrealistically maintain expectations of immediate maternal bonding and bliss.
How did you get involved in advocating for women and families struggling with PMD’s?
As a social worker in the Department of Psychiatry at Hackensack University Medical Center, I was charged with guiding the hospital’s implementation of the emerging, but not yet passed, NJ PPD legislative mandates. We initiated a free mother baby support group and invited every mother who gave birth at HUMC to attend. In addition, we developed a postpartum depression psychotherapy program for women identified or diagnosed with a perinatal mood disorder. As the programs facilitator I became more involved in the process and developed awareness of my own isolating experience with the illness, never acknowledged and never treated. I then became involved in a specialty peer group, was recruited by PSI to be their conference chair and then their president. The legislative work continues and I believe we will prevail.
Postpartum Mood Disorders are receiving more and more press coverage these days. Recognition and even treatment options have come a long way but in your opinion, what else needs to happen to improve the current atmosphere and attitude towards these disorders?
We need to spread the message that these are MEDICAL ILLNESSES with true biological underpinnings. It neither signifies weakness or strength if a woman does or does not develop a pregnancy related mood disorder. These disorders have no association to a woman’s character. Such stigma is crippling to progress understanding and obscures our ability to appropriately respond. The only time we can surely associate character with PPD is through acknowledgement of the tremendous bravery and courage it takes each woman to reach out and accept needed help.
We often encourage mothers to remember to take time for themselves. What is it that YOU do to recharge your batteries?
Top of the list is spending time with my “baby” girl Julia now 29. Like any proud mom, being in her presence brings incomparable joy which keeps me buzzed long after our lunches or conversations have ended.She’s a an intelligent hard working entertainment news executive who retains her grace and tender heart. My husband and I hike, read and sometimes just watch the sky. We are easily entertained by simple pleasures.
I find great solace and restoration in nature and try to practice Mindfulness when stressed. I am captivated by hummingbirds. Their population peaks in August when the babies start coming to the feeders; they do not know fear and will perch a foot away and watch you intently, a truly magical exchange. It reminds me that fear is a learned response. Their long migration every fall to Mexico and return to their same home each spring is profoundly wondrous natural mystery.
I am always interested in new and different therapies used in treating PMD’s. Would you share a little bit with us about EMDR as a type of therapy? What is the basic idea behind this therapy and who would typically benefit from it the most?
EMDR can be a powerful adjunct to psycho dynamic or CBT oriented therapy. It is an empirically validated treatment with solid research to support its application in trauma, but its mechanisms are not entirely understood. Theory postulates that stimulation of eye movement “loosens” traumatic memories held either by the body without conscious awareness, or stored in our brains’s trauma sector (the amygdala) where their reactivation can be stimulated by sights sound and smells associated with the original trauma. This may cause the victim to feel as if they are re experiencing the event and its accompanying feelings of terror and helplessness.
EMDR seems to enhance the conscious processing of such memories allowing analysis and sometimes rapid resolution of troubling symptoms when managed in a secure safe environment. EMDR is especially helpful in supporting recovery from PTSD including war and other disasters. Offered prior to infant delivery it can help increase levels of tolerance and acceptance in women who have suffered physical or sexual abuse in the past, or who are fearful about delivery. In addition, it can be helpful in the postpartum for women who have had traumatic birth experiences and are “stuck” in an endless loop of traumatic recollection.
I also use EMDR to “install” positive associations between achievement of new skills and feelings of mastery. As interpersonal challenges often accompany new motherhood, many women are motivated to choose different behavioral options to better parent their child. This offers mothers and clinicians alike a unique therapeutic opportunity to remediate long standing issues.
EMDR is not appropriate for women who are experiencing suicidal ideation, who evidence psychosis, or who are extremely anxious. It should always be offered within a supportive psychotherapy framework AFTER the mood has stabilized and works best in this context as an adjunct treatment to supportive therapy.
What is your philosophy regarding your approach to Postpartum Depression? How did you develop this philosophy?
First, that it is a medical illness with optimal recovery dependent on attention to biological, psychological AND social support issues.
Secondly, NO TWO ILLNESSES or RECOVERY PLANS are alike. I am outraged when I hear someone discouraging a woman from doing what she, her doctor and her family feels will best help her recovery. The incredible guilt associated with these disorders is often unbearable, increasing and prolonging associated symptoms. Well meaning loved ones can make it worse by presenting comparisons and opinions which invalidate sufferers experience.
This philosophy was developed witnessing the agony of women who felt like failures if they were unable to live up to recovery or treatment expectations set forth by others – including practitioners!!! If one recovery plan is not working, we need a new plan… As one of my therapy icons Marsha Linehan of DBT fame says, clients don’t fail, but treatment can!!
What advice would you give to medical professionals who may come in contact with a mother who is depressed? What are some of the best things they could do for this mom? What should they not do?
If depression is identified at a medical visit, an immediate referral should be given for further assessment, along with respectful reassurance that the mother is “not alone, not to blame and with help she will be well!” (PSI’s motto). This simple early validation goes a long way to mediate a mother’s sense of fear, shame, failure and isolation.
Many medical practitioners do not want to be in the business of mental health as their training and practice may not have prepared them for this additional challenge. But developing a referral list of professionals with a specialty in maternal mental health is both doable and essential for obstetrical and pediatric practitioners. This could lead to greater likelihood of more rapid engagement in the recovery process.
No one should EVER say…”Don’t worry, You’ll get over it, this is normal, go home and enjoy your new baby!! Even if a physician has known their patient for 30 years, all bets are off when rapid emotional and hormonal shifts introduce new and powerful vulnerabilities. The moment for connection is then lost and the silent suffering resumes. Many solid homes that lasted through decades of natural wear and tear on the Texas coast couldn’t survive Hurricane Ike! But we don’t blame the builder!
I feel family support is essential to postpartum recovery. What can we do to foster family involvement in the recovery period?
While we are doing a better job of implementing social support for moms, how about support groups for partners? They often feel ignored in the process and may develop their own feelings of depression as dreams of parental bliss are challenged by a mystery illness claiming their partner while increasing their responsibilities. How about friends and family members who want to know WHAT TO DO. Women often ask me “Can you tell that to my husband, father, mother, sister??” So I bring in the immediate circle who are often grateful for clear information about what is happening to their loved one and how to best support them.
Family and partners MUST be part of the recovery plan. The social work perspective tells us that without environmental (as well as psychological and biological) adjustments, stressors may continue which prolong the primary episode. My assessment always includes inquiry about what has always been important in this new mother’s life, what she has found comforting in the past. If she rates her spirituality at 10, we explore how to incorporate such options. It’s not just about focus on psychological dynamics, mothering skills and past and present relationships, but on reintroducing the uniquely individual environmental and emotional supports that make each woman’s life worth living.
What is it that you are most grateful for today?
The capacity to love and exchange ideas with others. Solid belief in God and country. Optimism.
And last but not least, if you had a chance to give an expectant mother (new or experienced) one piece of advice, what would you tell her?
Successfully parenting your child requires diligent attention to your own needs. Self care and self love are no longer optional and illusive concepts, but requirements of motherhood.