Category Archives: women

Graham Crackers & Peanut Butter served with a side of crazy: Part I

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I had planned to post my full story here today. But as I typed, it got long. Really long. I’m at five full typed pages with a few more to go.

(You’ll have to wait until I’m hospitalized for the title to make sense. Just go with it for now!)

In Part I, we’ll work our way from waking up the morning of my hospitalization to later that afternoon when I finally called the doctor’s office.

Tomorrow will offer some background on what led up to the day of hospitalization.

This series is the most brutally honest I’ve ever been with anyone about my experience. Including myself. It feels good. It feels oh so good to get it all out in the open.

As I walked with my family this morning, I thought about this post. And for some reason the movie The Goonies popped into my head. You know the scene when they realize they’re in the wishing well?

Mouth gets pissy and says, “This wish was mine! And it didn’t come true. So I’m taking it back. I’m taking them all back.” Then he disappears under the water as he hunts for his other wishes.

Every mother wishes for a good postpartum experience. Many of us get that wish. Some of us don’t.

This is me. Taking back the power that Postpartum Depression had over me. Taking it ALL back. But I’m keeping my head above the water.

Four years ago this weekend, I visited a mental hospital. Involuntarily. This is how I landed there:

As I stumbled out of our bedroom, I remember looking out the living room window. Blue sky, sunshine, green forest stared back at me. Birds chirped, the dogs glanced at me, I heard our two-year old awake and prayed our almost three-month old was still asleep.

One question repeated over and over in my head.

“What would happen if I let go?” Just let go, they whispered. “You deserve to let go. Let go. Reality is a joke. Just.LET.GO. Let go. Let go. Let.go. let go….let go…..” the soft whispers echoed in my head all day long.

I fed our two-year old breakfast as I pumped. Set up our infant daughter’s tube feeding. Took our two-year old to her room to play. Laid down on her couch. Closed my eyes. Slept through her lifting my arms, dropping them down, begging me to wake up and play.

I did not want to play. I could not play. If I was unconscious, I couldn’t hurt her. If I was unconscious, the voices would shut up. If I was unconscious, visions of smothering them both with pillows would go away. If I was unconscious – no wait, if I was not here……maybe…. maybe…..but how… just.. if I wasn’t here, I couldn’t hurt them.

I dozed as she played. I heard her as she begged me to play with her. Yet there I lay, paralyzed, my mind miles and miles away, locked in a deep dark closet somewhere, refusing to come out just like obstinate toddler.

Our infant daughter’s Kangaroo pump alarm sounded. After a few minutes, I finally stumbled into her room to turn it off and disconnect her. Back to the kitchen to make lunch for our two-year old. I think it was a PB&J.

Let go. Jump. Take a deep breath and fall. The hardest part is just letting go. Let go, they whispered. Over and over and over and over and over……

I clearly saw myself with a pillow, hands tightly gripping either side. If I just made them go away, the voices would go away. The pillow would solve everything. I could just make them go away. Then I’d let go and everything would be okay. Everything would be okay. Everything. Would. Be. Okay. It’d be okay.

I put our two year old down for a nap and started another tube feeding for our infant daughter. I hadn’t pumped since 10:45 a.m. It was pushing 1:00 p.m. I didn’t want to pump. Why should I?

She’s asleep now, they both are. It’d be so easy. So easy.

My thin strand of reality shredding, I turned to the voices. They started to push me toward the brink of the canyon. I didn’t have much fight left inside. Home alone, it would be so easy. The monsters were gaining ground. Their battering ram tediously close to knocking down the last door I had shored up against them, I went to our bedroom and closed the door, disgusted with myself.

Our bed saved my children.

I lay down, curled up in the middle with the phone. I clutched it as a stranded sailor clutches a life ring. Tightly, refusing to give it up even as I rocked back and forth, staring past the squirrels scrambling up and down 200-year-old oak tree swaying softly outside our bedroom window.

As the tears began to slide down my face, my breath shallow and my chest felt tight, I dialed my husband at work.

“You have to come home.” I choked the words out.

“Why?”

“You have to come home.”

“I can’t just leave work for no reason. Why?”

“I’m not doing well. You have to come home. I need you to call the doctor for me.”

“I can’t leave work. Why can’t you call the doctor?”

I gasped for air. The one person I felt safe in reaching out to was shooting me down. I needed help. I needed… I needed…

“Because I just can’t. I can’t… I…. “ burst into tears.

“Call them and let me know what they say, okay?” his voice was slightly softer.

“But I… “ argh. I hung up on him. I had tried to call the doctor’s office for the past four days, dammit. Yet somehow today had to be the day I made it happen. The day I had no strength left in any corner of my mind. Yeh.

I dialed the doctor’s office. And hung up.

I dialed again. Hung up.

I dialed again. Hung up.

Dialed. Ring. Ring…..ring… automation. Press 0.

Hang up. Dammit.

And now my husband was calling me back as I tried again. Ring…ring. Automation.

PRESS 0, dammit, said the only sane part of me. Press it! Say something when they answer. SAY something.

“Hello, this is Dr. X’s office. How can we help you?”

“I… I… I need help. My name is Lauren Hale and I’m not okay. I need help.”

It felt good and so horribly wrong all at the same time.

(Click here to read Part II.)

Just Talkin’ Tuesday 05.18.10: How did you first share your Postpartum Mood Disorder story?

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Today is a mash-up of posts.

It’s the APA’s Mental Health Blog Party day and my weekly installment of Just Talkin’ Tuesday. (If you’re interested in reading other entries for today’s Blog Party, the APA is rounding them up here.)

Today, the APA is asking all mental health (and not) bloggers to raise our voices in order to shatter the stigma which surrounds mental illness and disorders. In that spirit, I had to give quite a bit of thought to the topic for today’s Just Talkin’ Tuesday post. It had to be a topic we had not covered recently as well as one that fit the blog party spirit. And wouldn’t ya know it, inspiration strikes right as I am seriously craving some time with my bed. This topic has been meandering about upstairs for a few days but decided to wait until the last second to make a mad dash for the door, er, keyboard. So here I sit, at 1215am EST, words pouring onto my blog. I make no promises as to the length of this ramble. Proceed at your own caution and time restraints.

It started with a simple phrase uttered to me while at psych ward on a suicidal/harm to others hold during my second postpartum experience.

“You don’t have to tell anyone where you were this weekend.”

Why?

Why would I want to keep this experience a secret? What reason would I have for not wanting to share my struggle?

My mother raised me to keep the communication lines open no matter how deep the trauma. And my father taught me to always, ALWAYS think before I spoke. So you see, I strive to keep a balance between the two. Sometimes this means holding my tongue or my thoughts for a bit longer than I should and missing out on opportunities to speak up. But then I figure maybe it is for the best I didn’t say anything in the first place.

"Raffles Resort Beach"by fpugirl @flick

More than anything though, I believe strongly in both values. And these values are what caused me to question why on earth the nurse told me I didn’t have to tell anyone about my visit to the psychiatric wing. And what pray tell, would I have told them? That I had won a trip to the Carribean? Been waited on hand and foot? Slept the weekend away on pillows flatter than ironed Martha Stewart Linens? C’mon, people!

From the very beginning of my downfall, I was vocal about my experience. I asked questions. I sought answers. I wanted to talk to other mothers. I needed, desperately, to know that I was not alone in this new pitch black rough and tumble sea.

There was something I clung to as a lifesaver in the midst of my temporary insanity. And I don’t think I have ever properly thanked him for saying it to me right when I needed to hear these words the most.

“You are reacting no differently than anyone else in your shoes would be. Don’t let them tell you any different!”

My father spoke those words to me during a phone call from the hospital. I clung to that phone like a lifeline. My father’s words echo through my mind every so often but back then, when I needed to hear them most, they were a shiny buoy of hope in my dark dark sea. I never let go. Thank you Dad, thank you for knowing just what to say right when I needed to hear it. I am sorry if I have not thanked you before now but THANK YOU. From the very depth of my very healed heart.

If I could be on the phone, by golly, I was on the phone. Talking. Sharing. Being HONEST about where I was and how I had gotten there. And every last person on the other end accepted me, loved me, did not judge me. I know how fortunate I am to have that kind of support. Believe me, I am above and beyond grateful for the support which exists in my world. There are others who exist and fight with no support, no place to turn, alone in their dark sea upon which they are now sailing. Sailing with no compass, no supplies, lost.

There are mothers out there who struggle in the darkness for a very long time. So long, in fact, that Dr. Arlene Huysman coined a term, Progressive Postpartum Depression, an undiagnosed Postpartum Depression which gets darker and darker as time marches forward, dragging the darkness along for the ride. So long that there’s an entire Scientific American article dedicated to the topic and a ton of research on the impact of untreated Maternal Depression if you should care to go looking for it via Google or med journals. Why do they stay quiet? Why do they not seek help? It does not make sense. If your throat is sore, you see the doctor. Heart attack, ER. So why not this? Is it not the same? It should be treated as such.

But it is not.

Many believe you should be able to snap out of a depression. That Happiness is a choice. That somehow, we are choosing to be sad, insane, or conjure up these intrusive thoughts to get out of being a mother. That it’s all a conspiracy. But it’s not. Oh, it is SO not a conspiracy. There’s no dark back room to which we all retreat in the middle of the night and agree on what symptoms to exhibit the next day to escape the humdrum of domesticity. We don’t choose straws to see who gets to be the happy housewife and who gets to curl up in a ball muttering to herself. There are no auditions for this. IT.JUST.HAPPENS. And guess what? We don’t like going through it anymore than you enjoy watching us go through it.

A Postpartum Mood Disorder is sheer hell. First, there’s the myriad of symptoms from anxiety, to depression, to not eating to not sleeping to obsessing, to thinking horrific thoughts about what might happen to baby, what we might do to baby, etc, so on and so forth. And then there’s the guilt. OH the guilt. The guilt of not wanting to have anything to do with our baby. The guilt over not gushing over baby or not snapping back as quickly as celebrities or not coping like the suave women in the Johnson & Johnson commercials. The suave women who invade our homes every day as we sit in front of the TV with a screaming infant as our hair becomes ratty and our bathrobes and slippers wear thin because we haven’t changed our clothes in over a week. And then, there’s the judgment. We are supposed to be happy. Anything less than happiness is unacceptable in most families. Suck it up. Get over it. Yeah, motherhood is hard but I just did it. I didn’t get sad. I didn’t curl up in a ball. I don’t remember.

We are all different.

We are ALL beautiful.

And there is a quiet power in each and every one of our stories. An important power. One we must protect and share so that others will listen, learn, and understand.

"Stormy Sea" by Xeubix @flickr

When I was in the thick of my Postpartum sea with waves crashing all around me, I dreaded sharing my story. I hated having to explain to yet another person what had brought me to my knees. I hated answering questions.  At some point, that changed. At some point, it became liberating to tell others how I had managed to escape and heal. The mode of transportation whether it be natural, pharmaceutical, physical, spiritual – does not matter. All that matters is that you find what works for you, for your personal philosophy and situation. And damn anyone who dares to judge your choices. YOU are in charge of you – don’t ever forget that. It is your path to wellness and not that of anyone else. Take command of your decisions and let no man judge you for them.

When I first shared my postpartum story with power behind my words, it was with Wendy Davis of Postpartum Support International as I applied to be a Coordinator here in the state of Georgia. At the time, there was only one other Coordinator. There are now four of us, a statewide support network, and two support groups in operation according to the PSI Georgia webpage. That’s a lot of growth in just three years. Since then, I’ve operated my own support group (which has stopped meeting due to lack of local interest and support), began blogging to reframe a third pregnancy, and also become the Community Leader for two iVillage message boards dedicated to helping both Postpartum and Pregnant women who are depressed or struggling with mental illness. I’ve also recently started a #PPDChat at Twitter. Turnout there is still small but it has been powerful. I believe in quality vs. quantity when it comes to peer support. Every time I share a piece of my story, I empower another woman, another family. I continue to empower myself through my sharing. I am always healing, a work in progress.

There are power in your words. Share them but share them wisely and carefully.

How did you finally share your Postpartum Story? What made you decide to share your story? Was it with a loved one? With a colleague? A complete stranger? In person? Online? Or have you held it in for years, filled with shame because there was no one to tell who wouldn’t judge you?

Let’s finally get to just talking – and beat the crap out of PMD stigma while we’re at it, ladies and gents!

Postpartum Depression formal screening not worth the cost, BMJ study says

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According to a recently published study in the British Medical Journal (BMJ), Postpartum Depression Screening is not…. brace yourselves. Worth the cost.

That’s right.

NOT.WORTH.THE.COST.

In their cost effective analysis, the researchers used “A hypothetical population of women assessed for postnatal depression either via routine care only or supplemented by use of formal identification methods six weeks postnatally, as recommended in recent guidelines.”

The conclusion was that overall not using a formal screening method was much more cost effective as it eliminated false positives.

So the mental health of a woman which will then affect her child, her family, her community, the world at large, are just not worth it to the National Health System of the UK. The EPDS scored out at about $67,000 per quality adjusted life years while no screening method scored at a price tag of just $20 – $30,000. No value for the money was found to exist when using the formal identification methods.

Did these researchers not read Murray & Cooper’s Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression which explores the effects of postpartum depression treatments on children?

There is SO much more at stake here than the dollar value to the National Health System.

There’s the potential for broken families. The potential for children growing into their own mental health issues, the potential for continued need for mental health treatment due to an undiagnosed episode of postpartum depression, potential for increased incarcerations due to untreated mental illness, continued sadness, the continued stigma, continued and perpetuated lack of education on the part of physicians in regards to Postpartum Mood Disorders.

The most interesting aspect of this study is that it focused on screening for Postpartum Depression in the Primary Care setting. Primary care physicians are not always comfortable or knowledgeable in screening for mental health issues. If a patient were to screen positive, that physician is then morally responsible for referring them to a specialist. Often times, at least here in the states, a Primary Care physician is unaware of where to refer a patient for help with a Postpartum Depression Disorder. Therefore, they become afraid of screening because they fear what will happen if a positive were to occur. What would they do with the patient? Where would they send them? How would they respond? Are they familiar enough with Postpartum Mood Disorders to recognize a false positive?

I think the key to the results of this study is not so much in blaming the high percentage of false positives but in urging that Primary Care physicians receive more training to enable them to recognize a false positive through more in depth questions after a positive is scored via the Edinburgh Postnatal Depression Scale.

original photo/graphic "Hand holding necklace" by K.Sawyer @flickr

A stronger safety net involving a stronger communication between midwives, Obstetricians, Pediatricians, and General Practitioners is so desperately needed to keep women from falling through the very big cracks which currently exist in the system.

Let’s think about this for a moment, shall we?

A woman gets pregnant. She sees a medical physician to get the pregnancy confirmed. Most mothers seek OB or midwife care for their entire pregnancy. Unless they’re depressed – depressed and mentally ill mothers are less likely to take good care of themselves during a pregnancy, making specialized care even more important even when baby is still in utero. Once mothers give birth, they are then shuttled off to the pediatrician’s office for the bulk of their medical contact. One six week or eight week visit to the midwife or OB to ensure mom is healing properly then an annual PAP visit unless something arises in between. Many Pediatricians focus on babies and not mother. But the tide is changing as more and more Pediatricians are taking into account the family lifestyle and well-being. My own Pediatrician does this and I absolutely adore her for it.

But overall, there is typically no continuity of care, no communication between physicians throughout the birth process. There should be. There needs to be. A woman deserves a team of support. She deserves to thrive. So do her children.

No matter what the cost.

Because once you fail woman and her children, you fail society.

Fail society and we fail to exist.

If we fail to exist….

Enriching postpartum therapy through at-home activities

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In addition to the different types of therapy we discussed yesterday, there are some at home activities you can do (provided your therapist has approved them) to enrich your professional care and journey toward wellness.

First, start a gratitude journal. But I don’t journal. I hate writing! Don’t worry – this isn’t having to write an entire page every day. It’s a simple two entries a day. In the morning, when you first wake up, grab your pen and journal. Write down three things for which you are grateful, no matter how small that thing may be. As your day progresses, focus on what has made you laugh or smile. Once you have retired to bed each night (even if it’s for two hours), write down at least three things which made you smile or laugh during the day. At the beginning, even just barely cracking a smile counts. This activity is two-fold. First, it forces your brain to refocus on the positive things in your life. Second, it provides physical evidence of the positive influences in your life you can look through on the particularly tough days.

Second, write down all five senses on a sheet of paper. Taste, touch, smell, sounds, and sight. Write down five of your favorite things for each sense. Chocolate, silk, a favorite perfume, a cd or song that makes you smile, favorite color or flower or art. Post the list on the fridge. Treat yourself to at least one thing from EACH SENSE every week. Rotate them out. Putting the list on the fridge helps family members and friends to know what to help keep around the house as well. (Sneaky, I know)

Third, take time for yourself. Schedule it if you have to. One thing I love to do is to dress up my lunch. It’s my quiet time of day and I have been known to make a frozen pizza and a coke look like it belongs on a table prepped by Gordon Ramsey. Lean Cuisine never looked so haute. I’ll also treat myself to the routine of making tea. The key is finding one thing you love and making sure you do it at least once a day. Without interruption.

Some other moms will put positive post-its throughout the house and even in the car to help give them a boost when they need it most.

A successful recovery relies heavily on your active participation. If you’re not participating, you’re not getting better. YOU are the most important quotient in the equation when it comes to journeying toward mental health wellness!

How did you actively participate in your recovery? Have any tips for currently struggling moms? We’d love to hear them!


Be sure to stop back tomorrow for the triumphant return of the Friday Soother, my weekly gift to you!

Therapy Choices for the Postpartum Woman

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Once diagnosed with a Postpartum Mood Disorder, you are then faced with a literal bevy of choices regarding your path to wellness.

Some doctors may toss pills at you. If that happens, run. Run very fast and very far away from any physician who shoves anti-depressants your way before you’ve even finished describing what’s wrong. A good prescribing doctor will sit down with you and hear you out before grabbing for his pen and pad (or these days, keyboard and internet connection). A good physician should also run a couple of simple blood tests first to rule out thyroid disorders or anemia which need completely different types of medication to show improvement.

Some doctors may suggest psychotherapy. And that is where things start to get a little sticky. What kind of talk therapy? Will there be a couch? Will it be comfy? Will I have to talk about how my Great Aunt Edna used to kiss me on the cheeks and leave funny lipstick stains? Will I have to talk about things not related at all to my current state of mind? Will I be hypnotized? Or any other strange mumbo jumbo I’ve seen happen on TV or in the movies or from my best friend who found this website and…

Hold the phone there.

Cognitive Behavioral Therapy proved to be the best option out there for me. There was a couch but I didn’t lay down on it. I sat cross-legged on it as I drank coffee and chatted with my therapist. She sat in a really cool rocking chair with a foot stool. I got along fabulously with my therapist. That’s not to say we were bestest of buds but she knew what she was doing, just let me talk and work a lot of my issues out. I did occasionally talk about things in my past but it wasn’t at all like “So, you were born… let’s start there.” She met me where I was and let things fall where they fell. Or at least she seemed to. She did ask questions to get me to think about issues and how I was reacting to them. I had not planned on staying in therapy for long but once I became pregnant again, I made the decision to stay in through my pregnancy. Therapy gradually stopped at about 6 months postpartum of that pregnancy as we scaled our sessions back.

While I will not be covering every single last type of therapy out there, my goal is to provide some basic information for the most common therapies  used with Postpartum women.

At the top of the list is Cognitive Behavioral Therapy which is actually a blanket term for several types of therapies with similar traits. Primarily Cognitive Behavior Therapy (CBT) promotes that WE have power over our moods through our thoughts. You can read more about it by clicking here. A great resource now available for women and clinicians alike when it comes to treating Postpartum Depression is Karen Kleiman’s Therapy and the Postpartum Woman. You can read more about it by clicking here. (In the interest of full disclosure now required by the FTC, I have not been compensated at all for including this link. I sincerely believe it’s a good resource.)

EMDR or Eye movement desensitization and reprocessing is gaining popularity as an option. EMDR is most effective with Post Traumatic Stress Syndrome. You can read more about this approach by clicking here.

Peer Support/Group therapy is also an option. The primary benefit of this option is the realization it provides to women of not being alone. They really aren’t the only ones having a panic attack when they get in a car or experiencing frightening thoughts prancing through their mind at the most inopportune moments. Many times this option is a cost-effective option as well because many groups do not charge. A group led by a therapist may only charge a small fee such as $10-15 for attending. While peer support should absolutely not replace professional medical care for Postpartum Mood Disorders, it is an important aspect to add to recovery. If your area does not have a local peer group, you can find help online. The Online PPD Support Page has a very active forum for postpartum women. You can also visit the iVillage Postpartum or the Pregnant & Depressed/Mental Illness Boards. (Shameless plug on the iVillage boards, I am the Community Leader for both.) Another bonus of peer support? It reduces the recovery time.

Pharmaceutical therapy is also an available option. Some women are against taking medication and that’s perfectly okay. No one should ever be forced to take medication. Typically, pharmaceutical therapy is paired with another type of therapy. In fact, combining pharmaceutical therapy with a type of Cognitive Behavioral Therapy has proven to be one of the most successful approaches for the Postpartum Woman. Sinead O’Connor really put it best during an appearance on Oprah in regards to the function of psychiatric medications. They are the scaffolding holding you up as you revamp yourself. There are risks involved with taking medications and you should absolutely educate yourself, talk with your doctor, and if you end up deciding to take medication, be sure to inform your child’s pediatrician if you are nursing so they can be involved in monitoring for any potential issues.You should also familiarize yourself with the symptoms of Serotonin Syndrome, a fast-acting reaction which occurs for some people when they do not metabolize medication quickly enough. The build up results in a severe toxic situation. You should also avoid stopping any pharmaceutical therapy without consulting with a physician. Stopping suddenly can cause very negative symptoms similar to Serotonin Syndrome. If you have any signs or symptoms of Serotonin Syndrome, get medical help immediately.

For more serious cases of Postpartum Depression that do not respond to medication, Electroconvulsive Therapy may be suggested. ECT has come a long way since the 50’s and is a viable choice for many women who do not respond to medication. Now, I am not saying that if you choose not to take medication, you’ll be given ECT. This is for women with severe depression who cannot metabolize or do not respond at all to medication. Choosing not to take medication does not buy you an ECT ticket at all.

For women who want to use a more natural approach, there are a lot of choices. Again though, I have to urge you to make sure you are seeing a professional during your recovery. Don’t take something because it worked well for Aunt Martha. Check with your doctor and make sure it’s applicable to your situation and okay for you to take in combination with any other medication you may already be taking. Be sure your naturalist or herbalist is licensed and trained. You’ll also want to make sure that any herbs/natural supplements you are taking are compatible with breastfeeding if you are doing so. You can visit the blog over at Rebuild from Depression for a food/diet based approach.

Note: I had a reader, Steve, from Noblu.org leave a comment regarding IPT or Interpersonal Therapy. You can click here to read his comment. Thanks, Steve, for stopping by and sharing your knowledge with us!

As you can see, there are a lot of options available if you are diagnosed with a Postpartum Mood Disorder. More and more practitioners are becoming familiar with these disorders. More help is available today than even 6 years ago when I was first diagnosed. Remember to ask questions when choosing a therapist, advocate for yourself and what best fits your personal lifestyle philosophy. Don’t settle just because you want to heal. You have the power to say no. It’s your body, your mind, your say.

Tomorrow we’ll be discussing some things you can do on your own to help your recovery along. Stay tuned!