Treating Postpartum Depression (and depression in general)

Hello!  Did you think I'd forgotten about this blog?  I haven't!  Now that my experience with PPD/PPA is mostly in hindsight, I've had a few more thoughts I've wanted to share, but it's been difficult to find the time because I've been extremely busy with work lately.  (I'm still a SAHM, but I work from home for my employer on an hourly basis, which means a lot of nights and weekends lately.)

In my experience, I struggled with two different types of depression.  These are not clinical categories, but just what I experienced.

1. The type of depression that hits you for no apparent cause.  You wake up, and before any thought has entered your mind, or before you are even fully conscious, you have a sinking feeling in your stomach.  You physically can't get out of bed.  You don't want to face the day, but there's no (obvious) reason behind it.
2. The type of depression or anxiety that is thought-based.  You think things like, I'm a terrible mom, or I'm a bad person, or No one likes me, or My life is pointless.

Sometimes, of course, I'd feel a mixture of the two.  I'd have panic attacks for "no reason," but I knew that my anxiety about my in-laws moving nearby was the overarching cause, even if I was not actively thinking about it at the moment.

So here's the thing, depression can have both physical (chemical or hormonal imbalance) and thought-based causes.  Medication can help with the first type, and therapy can help with the second.  A lot of times, the most effective treatment is a combination of the two because most people, like myself, don't just experience one or the other.

On medication - talk to your doctor about it.   You don't have to go to a psychiatrist; any family practice doctor can prescribe antidepressants.  However, I'm guessing a psychiatrist might be more helpful if you are struggling with something more than depression, like postpartum OCD or intrusive thoughts.  If you're hesitant to try medication, you could try St. Johns Wort or other natural remedies first.

On thoughts - One thing I've read over and over in the depression literature is that depression is not caused by emotions but by thoughts.  Eg: Sad -> Depressed doesn't tell the whole story.  It takes courage, but if you force yourself to figure out why you feel sad, you will usually find a thought lurking in there that caused the sadness.  Eg: I'm a bad mom -> Sad/frustrated -> Depressed.  Studies have shown that brain chemistry can cause depression, leading to negative thoughts, but that the opposite is also true: changing your thought patterns can actually change your brain chemistry.  (Don't ask me to cite any references...this is a personal blog, not a Wiki article!...just Google it.)  

So what to do about those thoughts?  Cognitive-behavioral therapy (CBT) is a systematic and widely accepted form of therapy to address these negative thoughts and has been proven in clinical studies to be just as effective as medication in some cases.  If you are thinking of going to a counselor, please look for one who uses a systematic approach, such as CBT, rather than just someone who uses "talk therapy."  You can also do CBT on yourself by following the exercises in the book Feeling Good by Dr. David Burns.  (Don't say it won't work until you've actually tried it.  Really - take a pen and paper and do the exercises, even if they seem too simplistic or that they won't work on you.)  It's supposed to work for not only depression and anxiety but also OCD.  You can also try a free, online program that walks you through the steps at https://moodgym.anu.edu.au.  Again, you really need to be committed to providing honest and detailed answers to some of their questions to expect it to work.  If you're too embarrassed to be completely honest with the online format, then stick with the book and pen and paper at home.

Sadly, one of the biggest barriers to treatment of depression is oftentimes the person herself.  If your trigger thought is, "I'm a bad mom," then of course you won't want to do any silly exercises to make yourself feel like a good mom because you don't think it's true.  It's a vicious cycle that the lie that makes you feel bad in the first place (eg: I'm a bad mom) is what keeps you from getting the treatment you need.  Unfortunately, you are the only one who can decide that you're ready to feel better.  But when you're ready, you'll know it!

Well, I hope this post has been helpful.  I'm not sure if I'll have time to blog in the new year, so I tried to pack as much helpful info in this post as possible.  If you're in need of other resources, please check out postpartumprogress.org.  It has a ton of resources and articles, as well as links to other personal blogs on PPD/PPA.

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Searching for Theodicy

When I was in college, I took a brief interest in Christian apologetics - defending the faith through objective and rational arguments.  I thought at the time that it was important for winning people over to Christ.  I then realized that no one (no one!) is ever converted through rational debate.  You could debate an atheist until you are blue in the face, and s/he wouldn't budge an inch.  Faith is not something that can be won through an argument but is the work of God.

Image: Stuart Miles

So for awhile, I thought apologetics was just for people who wanted to argue and that it really wasn't worth my time.  I'm now realizing that apologetics is not just for defending the faith but also for encouraging believers.  Apologetics is, in essence, theology in different clothing, and good theology is vital to our faith.

I don't label myself as having postpartum depression/anxiety/intrusive thoughts anymore, but I still bear the scars.  I recently became lax about staying away from the news, and I read some news articles that shook me to the core.  I was awake almost the rest of the night doubting God's goodness, wrestling with my faith, wondering if I could even call myself a Christian anymore.

That night, I came across the term "theodicy" for the first time, which is basically an attempt to answer the problem of evil.  I think I know deep down that a true theodicy doesn't exist -- as in, there may be logical arguments for the existence of evil, but those arguments will never resolve the pain caused by evil or make it obvious that God had no choice but to allow this world to become as broken as it is.  I'm okay with that - I don't presume to think that I as a human being could ever have the same perspective as God does.  But I also think it's important to strengthen my faith with good theology.  My friend recommended Ravi Zacharias, so I'm looking to get one of his books soon.

And how did I end up getting to sleep that night?  I prayed.  Even when I doubt Him, God is my comforter.

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Guest post at Postpartum Progress

I don't usually blog twice in one week, but I'm incredibly privileged to share my story on Postpartum Progress today.  Postpartum Progress is an incredibly informational PPD website and blog that provides tons of educational material as well as support for postpartum mood disorders.  The website is where I first learned about intrusive thoughts.  I'm not usually a huge advocate for Asian-American issues, but my personal experience with PPD/PPA made me realize how little awareness and acceptance there is among Asians.  Please check out my story:  A Culture of Emotional Restraint: Asian-American Mom Shares Her Perspective on PPD.

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The mask I wear

It starts as soon as they begin to speak.  The first time my daughter said, "No Grandma!" I immediately shushed her.  We must be polite to others!  And she learned to be polite, but she also learned to put on her first, little mask.

Image: Adell Rucke

Later, we learn that the mask not only protects others but also protects us - from the rejection that might happen if others knew our deepest fears, our inner sufferings, our greatest dreams.  So we put the mask on a little more frequently.  And it starts to feel more comfortable, so that this mask, which was meant to hide who I really am, becomes a part of me.  I don't even have to put it on anymore because it's always there.

Sometimes when I talk to other people, I wonder, what's behind that mask?  Does she ever feel unsure of herself?  Does she wonder what the purpose of her life is?  Does she sometimes just want to run away?  Sometimes, there's a small, very small crack - just a faint look in the eye or a falter in the smile.  But most of the time, the mask is seamless, airtight.

When I started this blog, I wanted to take off my mask so that other women would have the courage to take their's off, too.  Because I have all this sadness, guilt, frustration, and anger that just wants to get out of me, but there's also love, sacrifice, joy, and beauty inside of me, too.  The mask keeps it all in and only lets out a sterile version of me.

But when I sit down to write what I really want to say, I start censoring myself immediately.  I don't want to make so-and-so feel bad.  I don't want my kids to read this someday and misinterpret what I mean.  I don't want to discourage my brothers and sisters in Christ.  I don't want to dishonor God.  Raw is good but raw can also be hurtful.  And by the time I'm done writing, I've written something with a lot of inspiration but very little of my heart left.

Don't get me wrong, I love inspiration.  But how do we also be real with each other?  How do we take our masks off without killing each other?  Maybe as long as we live in this broken world with our broken hearts, we can't.  So for now, I'll keep this mask on.  Because it holds together my brokenness.  And it keeps me from trampling on you and breaking you more than you already are.

So...all this is a very long and dramatic way of saying that I might be changing the content and format of my blog soon.  I'm just so tired of struggling.  What about you?  Are you comfortable with your mask?  Or do you wish you could take it off every once in awhile, let your heart breathe a little?

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How it all (sort of) ends

When I was in the midst of my postpartum anxiety, I feared that the daily panic attacks would affect my physical health.  The anxiety and stress were so intense and frequent that I could not imagine overcoming them.  I felt that my only hope would be a divine intervention - a miraculous healing or perhaps a certain Bible verse that would provide instant peace.

Image: Sura Nualpradid

And...nothing of the sort happened.  I got better over time, but there was no trigger or moment that I can point to as the start of the healing.  I no longer have daily panic attacks or intrusive thoughts, but I'm still susceptible to both.  Depression does not characterize my state of being, but it is still a familiar friend.

We give praise when God blesses with discrete changes in circumstance or emotional state (I was sick, and He healed me.  I was laid off, and He provided a job for me.  Bonus to anyone who gets engaged in the process.).  And rightly we should give praise to God for those blessings.  But sometimes our struggles in life do not have an identifiable turning point and resolution.

I read the poem Footprints in the Sand for the first time when I was in elementary school.  In my 8-year-old mind, it was the most inspired and beautiful piece of poetry that had ever been written.  I aspired to have a copy hanging in my house some day.  HGTV has since taught me that my house should be filled with gallery photos and pop art rather than cheesy Christian poetry, but I was reminded of the truth of that poem during my "dark night of the soul."   To be sure, in my darkest times, I felt alone, but even deeper than that feeling of aloneness was the security that no matter how much fear or anxiety filled my heart, no matter how much I doubted God's love and goodness, no matter how much I ignored Him, He would not abandon me.  Sometimes He doesn't "show up" the way we want Him to, but He's still there.

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How Depression Affected My Prayer Life

Soon after I had my second child, there was a famine in Africa.  There's been a famine in Africa for as long as I can remember, but this one was bad enough to make it to the news.  While struggling with intrusive thoughts, I lost the desensitivity that allowed me to read about suffering and then move on to celebrity gossip without blinking an eye.  I heard that some starving babies didn't even have the strength to cry, and it made me depressed for bringing my babies into such a sad and painful world.  I purposefully avoided the news so that I wouldn't read about it or see any pictures about it. 

I had the same one-sided conversation with God every day, "How could you give life to so many people and then just leave them to suffer, starve, and die?"  I felt foolish for trivial prayers over my kids' sleeping or eating habits.  I stopped praying for myself or for my kids and prayed only for Africa.  If God wasn't going to do something about a cross-continent famine, why would He care about making my domestic life easier?  I thought I would go ahead and do Him the favor of removing those prayers from His Queue so that He wouldn't have to toss them out Himself.

Honestly, I kinda thought that my life would be the same whether or not I prayed, but my prayer strike taught me that prayer is about more than giving God my wish list.  I found myself with a weightier load on my shoulders.  I was less sensitive to sin creeping into my life.  I became more self-centered.  I still don't have a satisfactory answer to the problem of unanswered prayer, but I learned that prayer is about more than just getting what I ask for.  I still pray for Africa, but I also pray for my kids, myself, and other people now, too.  I try to focus less on asking for things and more on giving my burdens over to God.

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Medicating with Will Ferrell

During the time when we were sleep training my daughter, she often took short naps lasting only 15-20 minutes.  She was a ticking time bomb that kept me on edge even when she was asleep.  During this period, my sister sent me two DVDs to help pass my time, and I watched them in short spurts over several naps.  What I didn't expect was the deep feeling of dread and disappointment I had when each movie ended.  I could almost feel my heart physically dropping in my chest when the credits rolled.  Both movies are great but not cinematic masterpieces (Baby Mama and Stranger Than Fiction), but I became incredibly engrossed in them because they provided an escape from reality.

His girlfriend left him for an actuary.

With the end of each movie, I was forced to face the depression, the stress, and the anxiety again.  I felt kind of pathetic for being depressed at the end of a movie, but if there's no shame in taking antidepressants, then I suppose there should be no shame for anesthetizing with Will Ferrell.  So many activities in life are just distractions from reality: TV, blogs, Facebook.  I've found that self-reflection is often the biggest enemy of someone struggling with depression, and sometimes these superficial distractions are what keep us going.

On the other hand, I'm not sure God wants us to medicate with media.  I suspect the only things keeping Him from yanking these superficialities out of our lives are His gentle mercy and patience.  I hope one day I will be able to come face to face with my depression and offer it up to God in exchange for a deeper understanding of His grace and abundance.  For now, I'm acutely aware of the depression lurking in the corner of the room, but I only have the courage to look at it askance, trying on most days to just pretend it's not there.

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Single women, mothers, and the nuclear family

I recently read an interesting Atlantic article on the current singleness epidemic among women, and while the topic was singleness, the article also made some broader statements about how women participate in society.  One idea in particular struck me:

“We are not designed, as a species, to raise children in nuclear families,” Christopher Ryan, one of the Sex at Dawn co-authors, told me over the telephone late last summer. Women who try to be “supermoms,” whether single or married, holding down a career and running a household simultaneously, are “swimming upstream.” Could we have a modernization of the Mosuo, Ryan mused, with several women and their children living together—perhaps in one of the nation’s many foreclosed and abandoned McMansions—bonding, sharing expenses, having a higher quality of life? “In every society where women have power—whether humans or primates—the key is female bonding,” he added.

Image: graur codrin

My mom lived with us the first month after I gave birth, and I still went into my room to cry without her knowledge almost every night, so having other people around won't prevent PPD.  But my mom's presence did help with a lot of new-mom anxieties.  She didn't know how to use the new, high-tech diapers we have these days (she used cloth back in the day), but she reassured me of some obvious truths:  newborns can't be controlled by a schedule, kids are resilient and won't be easily messed up, and most importantly, it will get better.  Not to mention her cooking and what a relief it was for me to have someone else do baby-rocking duty when I couldn't stand it any longer.   I believe in the traditional, nuclear family, but it's quite possible that the way our nuclear families are organized (each one separated by walls, fences, and a lot of space) may not be the way God intended. 

I don't see our society ever moving back toward communal living, but the concept goes a long way in perhaps explaining why motherhood is so hard for so many of us.  Stay-at-home-moms have a martyr complex about their brains turning to mush for the sake of the kids, and working moms have a constant guilt complex about not being home with the kids.  Maybe if we lived more communally, SAHMs would have more of the community and intellectual stimulation they seek and working moms would have a greater ability to work from home to be around their kids more.

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What misconceptions do you have about counseling?

For anyone seeking counseling, finding the right counselor might seem overwhelming.  There are so many different counseling designations, approaches to therapy, and on top of that, you need to have chemistry with whoever you see.  My friend who is a counselor recently addressed many of my misconceptions about counseling.  Below is a condensed version of an email she wrote in response to my asking what differentiates the types of therapists (counselor vs. psychologist vs. psychiatrist) and in response to my frustration that I never got a clear diagnosis of PPD.  I wish I had known the information below before seeking counseling so that I would have had a better idea of what to expect (it’s very possible that my counselor was using the goal-oriented method, but I just didn’t see it because I was focused on getting a diagnosis).

Image: Ambro / FreeDigitalPhotos.net

The term "therapist" or "counselor" is just a loose word for any professional who has a license to engage in therapy. This is usually an LPC (Licensed Professional Counselor), an LCSW (Licensed Clinical Social Worker), or a Psychologist.  LPCs, LCSWs, and Psychologists can all do the same thing, but they just have different designations from going to different graduate schools.  It is really someone's training and expertise (not the letters behind their name) that qualifies them to address clinical disorders. A psychiatrist is a medical doctor who gives meds--but they usually do not provide any therapy.

Unfortunately, there are a lot of therapists out there who just do “talk therapy”--they listen, support, and "explore" with you.   It sounds like you were frustrated with this approach and would have benefited more from therapy that was goal-oriented and had specific therapy approaches designed to decrease symptoms, get to the root of irrational thoughts/lies/myths, and develop healthier coping skills.

Also, the therapists that I am on a team with don't really spend a lot of time focusing on the diagnosis.  Even if your therapist told you that you had PPD, a skilled therapist would be focused on:

1. Identifying the specific symptoms that are interfering with your quality of life,
2. Coaching you in coping skills to decrease and eventually eliminate the symptoms,
3. Explore what made you vulnerable to the symptoms and then addressing this vulnerability area (ie: the root issue causing the symptoms), and
4. Walking with you through the cognitive and behavioral changes so that you can see progress and feel better.

The only reason therapists will "diagnose" is to help clients make sense of things and to help them normalize what they are going through, but the real focus of the therapy should be on addressing the symptoms, getting to the root of how to cope, and being sure you understand what made you vulnerable in the first place so that you have LONG term healing.  A good therapist will help you connect the dots by understanding the deeper issues underneath the symptoms and how to change that, not just put a band-aid fix over your symptoms.

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For better or for worse

Men can be pretty clueless most of the time.  I asked my husband to pick up some winter squash for one of our meals this week, and he came home with decorative gourds.  I know a guy whose wife had the baby blues after having each of their kids, and he said, "I don't know why she was depressed.  I mean, she just had a baby, so shouldn't she be happy?"

Image: nuchylee / FreeDigitalPhotos.net

On the other hand, men can be exceedingly patient and compassionate, despite not knowing what's going on.  When I asked my husband whether or not he thought I had postpartum depression, he said, "No."  He later claimed that he was afraid saying yes would cause me to feel sorry for myself and get even more depressed.  Whether he really knew I had postpartum depression or not, what matters is how he treated me.  We had the same conversation almost every day.  "What should I do?  Will I ever feel normal again?  What if I'm like this for the rest of my life?  Do you wish I would stop being this way?"  And every day he engaged in this conversation with me with patience and a listening ear.  It wasn't just my depression and anxiety he had to put up with either.  I was irritable and angry, and my husband bore the brunt of it.  He later told me that he literally had to recite Bible verses to himself on the way home from work to be able to face whatever he was coming home to.

One time near the end of one of my counseling sessions, I was talking about my husband and how he had an unwavering faith in God.  He read the Bible, prayed, and did memory verses every day.  He reminded me that God was good.  He told me that God loved me.  He trusted God to heal me.

And then I cried.

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Mental health and faith

People with mental health struggles (depression, panic attacks, OCD, etc.) are often encouraged to pray for God's healing in their struggles.  Pray for joy instead of depression.  Pray for peace instead of anxiety.  Pray for trust instead of fear.  I completely agree that we should pray to God for healing and grace in these areas.

Image: graur razvan ionut / FreeDigitalPhotos.net

However, our focus is often on how our faith can positively impact our mental health struggles, and we don't often discuss how our mental health struggles impact our faith.  PPD and intrusive thoughts, specifically, were destructive to my faith.

The scary thoughts I was having on a daily basis forced me to confront "the problem of evil" in a very personal way.  As soon as I gave birth to my first child, I knew that I would do anything to protect her from fear or harm.  So why did God not protect us from all the fear and harm in this world?  Instead of helping me to understand God's unconditional love, having a child actually made me question it.

Happiest robot on the block.

The problem of evil has been one of God's PR problems for a long time, and I know what the correct Christian responses are to these questions.  But sometimes knowing the correct answers don't keep your heart from asking the questions.  Hint:  The correct answers have something to do with "free will" and "It's not about me, it's about God's glory."  Call me crazy, but I'd rather be a happy, little robot than to live in a world full of broken people with free will.  (Unfortunately, have yet to find proof that this world is actually all about me.)

My faith struggles resulted in something that I hope no other Christian has to experience.  I started to fear that God would punish me for my thoughts.  I would lie there at night having waking nightmares about terrible things happening to me or my baby, and I would think, "God is going to punish me for having these fears by making these things come true."  I wanted to fly away, to hide my thoughts from God, but I knew I could not.  Writing these words, I am filled with a deep sense of sadness for how a relationship that was supposed to bring light to my life actually filled me with a dark and dreadful fear.

Although the intrusive thoughts have lessened, they awakened in me an awareness of evil and resulting fear that I have not been able to shake.  The apostle John wrote, "There is no fear in love.  But perfect love drives out fear, because fear has to do with punishment.  The one who fears is not made perfect in love."  Oh how I long for the day of my perfection!


Droid Image: Ben Jacobson

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The postpartum trifecta: depression, anxiety, and intrusive thoughts/OCD

As I mentioned previously, postpartum depression often involves symptoms other than depression, including anxiety and intrusive thoughts (my husband would like to add a fourth category called postpartum aggression).  I actually only recently learned the term "intrusive thoughts," prior to which I referred to them as "scary thoughts."  Postpartum intrusive thoughts might include thoughts of your child getting sick, of you doing something to hurt your child, or of someone else doing something to hurt your child

Back when I was struggling with it more, intrusive thoughts would just pop into my mind.  It's not like I was sitting around thinking, "Hmmm, what are all the possible ways my child could be hurt?"  No, I'd be cuddling with my daughter, and all of the sudden the thought of something really terrible happening to her, sometimes at my own hands, would pop into my mind.  It was very disturbing.

I'm not going to go into detail about what my thoughts centered around in case there are any postpartum moms reading this.  Thinking or reading about scary things can actually make intrusive thoughts worse.  I believe my intrusive thoughts were aggravated by me looking at some pictures of POWs from a war documentary book.  Don't ask me what I was doing looking through a war documentary several weeks postpartum.  I'm a very intellectual and well-read sort of person.

In addition to having scary thoughts about things happening to my daughter, I also had scary thoughts of things happening to me.  I would lie awake at night imagining various scenarios of things that put me in a sweat and made my heart pound.

Emma Pillsbury wiping a grape.

My intrusive thoughts were bad enough to affect my behavior.  On the bad days, I wouldn't leave the house because I was afraid something would happen to me or my daughter.  Severe intrusive thoughts can lead to OCD.  The intrusive thoughts are the Obsession, and the Compulsive behaviors are rituals that help you cope with the thoughts.  The classic depiction is of someone constantly washing their hands or cleaning things.  Think Emma Pillsbury from Glee.  But let me tell you that in real life, coping with intrusive thoughts is not cute and fun like an episode of Glee.

I mentioned the intrusive thoughts to my counselor, and she only told me that "thoughts of mortality" are common for postpartum moms but didn't say much more about it.  My husband knew I was having scary thoughts but didn't understand the extent of how much fear they created in me until two years later.  This whole time, I thought my intrusive thoughts were some macabre part of my psyche that had suddenly come out and that it was primarily a spiritual issue.  I didn't trust God enough.  I didn't know His love and was therefore afraid.  I was relieved when I only very recently learned that there is a biological basis to these thoughts.  I'll be sharing more in future posts about my experience with intrusive thoughts, how they affected me spiritually, and other thoughts I have from the experience.

Have you ever battled any of the postpartum trifecta: depression, anxiety, or intrusive thoughts?  What helped you to cope?  I would love to hear from you, so please leave a comment.  If you have questions, please also feel free to leave in the comments.  I will address any questions/comments in the comments or in future posts.

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Postpartum depression and trusting God

The thought that my postpartum anxiety might never go away was a devastating thought to me.  Imagine being anxious about a whole host of things related to your newborn child, and then on top of that, being anxious about the anxiety itself.  Now, you might ask at this point where my good Christian faith was.  And I will be honest.  I did not want to have faith that God would to heal me.

Image: dan / FreeDigitalPhotos.net

Notice I did not lack faith that God could heal me.  I never questioned his ability to do so.*  He is all-powerful.  He can do anything.  And that is what scared me.  He could heal me.  Or He could not.  And if I trusted Him for healing but it was somehow part of His comic plan for me to suffer like this for the rest of my life, I don't think I could have handled that disappointment.  So I protected myself and did not let myself hope that things would get better.

I haven't always been such a spiritual cynic.  In the past, I would pray with great faith for others.  You had a falling out with your friend?  I'll pray for love and healing.  You just survived a natural disaster?  I'll pray for emotional healing and the rebuilding of your home.  But in the end, I was still in my nice, cozy bed in my nice, air-conditioned house living my nice, first-world life.  I also prayed through major life decisions.  God, please provide a job for me.  But if I don't get a job, I'll just move back home.  There was always an out in the past.  When it really came time to trust God with my life, I was too scared to.

*I'm not advocating that anyone pray themselves out of postpartum depression.  I believe that God can heal us of anything but that He may use medicine, counseling, or other resources to aid in that healing.

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Postpartum depression: my biggest fear

I consider a counseling session successful if I cry.  It means that we didn't just sit around making small talk about surface issues but that we hit on a topic that is painful to me - the reason I am seeking counseling in the first place.  I distinctly remember two times that I cried during counseling for my postpartum depression and anxiety.

The first time I cried was during my first counseling session.  My counselor asked me what my biggest fear was.  I answered immediately.  It was that my panic and anxiety attacks would never go away.  My answer and the tears that came with it surprised me.

I suspect that for many women, the worst part about postpartum depression/anxiety is not knowing when and if it will go away.  When you are in the midst of it, the pain is so severe and so constant that you can't imagine the possibility of being normal again.  More terrifying than hearing your baby cry, more terrifying than the thought of hurting your own child, and more terrifying than the thought of someone else hurting your child is the thought that there may not be an end to the anxiety that is eating you up.

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Counseling: some frustrations

Even if I never changed out of my pajamas all the other days of the week, I would always do my makeup and wear something cute for my counseling sessions.  I didn't want her to think I was a total loser, even though I was already revealing to her what a dysfunctional mother, basket-case wife, and terrible daughter-in-law I was.  One time we showed up to a session wearing the same shirt from Ann Taylor Loft (different color).  That was a little weird.

Image: nixxphotography / FreeDigitalPhotos.net

Getting the most out of counseling is difficult for me.  I'm constantly worried about what the counselor will think of me, which makes it hard to be completely honest.  When I would talk about the anxiety I had regarding my in-laws and how I was pretty much blockading them from seeing their one and only grandchild, I couldn't help but think, "She's probably hoping she never gets a daughter-in-law like me."  I tempered myself and never revealed to her the true depths of how anxious I was, how I was afraid to lose my daughter's love to my in-laws, how I wanted to be the only one in her life.  Instead, it became more a conversation about getting comfortable with other people taking care of my kids.  It was helpful but didn't really address the core issue I was dealing with.

Counseling is also very frustrating and sometimes awkward.  I never really know if I'm supposed to just start talking about myself, or if I should let her lead with the questions.  Sometimes I felt like she would ask a lot of questions about a particular issue that was irrelevant to my issues.  Other times I would bait her with something that I thought was perhaps part of my dysfunction (my need for control, for example), but she would gloss over it.  The most frustrating part is that she never really gave me any advice or a diagnosis of any sort and instead would always just ask me how I felt about things.

Me: My husband said that I should be open to the idea of medication if that's what I need.
Counselor:  And how does that make you feel?

Me: Someone suggested that maybe I should just face my fears and start dropping off my daughter with my in-laws on a regular basis.  Then I would see that it wasn't so bad.  (Please tell me that's a bad idea!)
Counselor:  How do you feel about that?

Stop asking me how I feel!  Just tell me what to do!  Yes, I was annoyed that my counselor was trying to get me to explore my feelings.  You definitely don't ever want me as a counseling client.

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Getting help for postpartum depression requires telling someone

I tried to get help from my OB, but it just didn't work out.  Before you have a baby, the nurse gives you all these pamphlets and brochures about postpartum depression, and they even make you sign a form that says you have been educated about it.  I used to work on the financial side of the healthcare industry, and I'm a big believer in preventive health.  So I compliantly went to my six week follow-up visit fully intending to get help for what I was sure was postpartum depression.

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However, when the triage nurse asked me if I was experiencing any signs of postpartum depression, instead of saying, "Yes, I wake up crying every day.  I don't want to get out of bed when my baby cries.  I have panic attacks that start when I wake up and don't end until I go to bed.  I can't breathe."  I said, "Um, I think I might have a little bit of anxiety."  I watched her write "anxiety" on my chart.

My OB then walked in looking at my chart, and cheerily asked me how I was doing.  I beamed at her and said, "Great!  I'm doing just fine!"  She never asked about the "anxiety" written on my chart.  I don't blame my doctor.  She asked how I was doing, and I didn't answer honestly.  She was trained to take care of me physically, and she is extremely competent at what she does.  It's just not easy to come out and say, "I think I have postpartum depression" the way it's easy to say, "I have really bad nausea," or "I think I have hemorrhoids."  I was insecure about a lot of things, and I guess I would feel like a drama queen saying I had PPD.  I was a little afraid that she would say it was nothing, and then I would be really embarrassed.

The way doctors educate and screen for postpartum depression should really be designed by psychologists instead of legislators or whoever came up with the current method.  Instead of making you sign something saying that you received PPD education before you have the baby, they should also give you a short, one-minute quiz a few weeks or months after you have the baby.  I don't know if some doctors already do this, but I'm assuming it's not required by law, since I didn't get any such quiz.  It would be much easier to circle a bunch of yes/no questions than to come out and say "I think I have PPD."

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Postpartum Anxiety

Postpartum depression is a bit of a misnomer. Although PPD is characterized by depression, many women also experience anxiety, intrusive thoughts, or OCD (among other things) when they are postpartum. My own postpartum depression soon turned into a raging anxiety.

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Depression is like being stuck in mud. It slows you down to the point where it’s easier to just lie there than to do anything. It’s like going into involuntary hibernation. Anxiety is the complete opposite. Anxiety fueled by postpartum hormones is like swallowing a sparkler and having those sparks fly around inside of you constantly. Every waking moment is one long panic attack. My heart was constantly racing, breathing always on the verge of hyperventilation. I’m not sure which one is better.

My anxiety was triggered by my in-laws moving to our neighborhood within a month of my giving birth. It was just too much change at once for me to handle. I worried that my in-laws would be over all the time, even though they have always been nothing but polite and genteel when it comes to manners. I worried that I would be responsible for my in-laws’ happiness. They had sold their dream retirement home in another suburb to be near us after we had their first grandchild. I worried that my daughter would love them more than she loved me, and that was the crux of my anxiety. A friend consoled me by telling me that mom would always be at the center of a young child’s life. Even when the circle expands to include more people who love her and for her to love back, mom would still be at the center. I knew it was true, but I was so scared of losing her love that I wanted to be the only one in the circle.

I know...very dysfunctional, co-dependent, and insecure. I was crazy. Crazy in thinking that way, and crazy in my anxiety. However, I’ve come to realize that we’re all a little crazy and dysfunctional, but we’re just too scared to admit it because we’re afraid of what people will think. My best friend and I will often start conversations with, “This is kind of embarrassing, and you’re going to think I’m crazy, but...” I think if we would all be a little more honest about our dysfunction, we’d realize that crazy is actually pretty normal. So maybe my fears about my in-laws were actually kind of normal crazy, but the level of anxiety I felt was truly crazy crazy. I was sure that my body couldn’t sustain the elevated heartrate and shallow breathing much longer. The physical effects of my anxiety were going to shorten my lifespan. So I went to see a counselor.

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Getting out of bed

I suffered from postpartum depression. I remember the baby’s cries waking me from my sleep. A feeling of dread immediately enveloped my whole body. I knew I needed to get up, but I felt like I had lead weights on my arms and legs. My body was immobile.

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It’s like being in the middle of a dream in the early morning, when you’re half-awake but still mostly in your dream state. A very small part of your consciousness wants to wake up, to move, but you can’t. You try to open your eyes, but they won’t because they’re already open in your dream. You put all of will into opening your eyes, moving an arm, moving something, anything. Finally, with one last shove of effort, you open your eyes, and you’re finally awake. That was the amount of effort it took for me to get up out of bed when my baby cried.

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Finding other moms like you

People often say that raising kids is “the hardest thing you’ll ever do.” I’ve found it to be true but also a gross understatement. When I had my first child, comments like, “It will get better” didn’t offer much encouragement to me. Instead, I took solace from a woman who candidly proclaimed to me (in church), “It was hell the first few months. I hated it.” I wasn’t alone.

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I didn't hate my baby or hate being a mother.  Quite the opposite.  I was in love with my daughter, possibly a little obsessed.  Ok, definitely obsessed (will get to that later).  I hated always feeling inadequate. I hated not being in control.  I hated that instead of becoming a more warm, patient, joyful person, motherhood  had made me anxious, jumpy, and cynical.

Most of my mom friends are the "I <heart> being a mom" type, but there are a handful who are the "I hated it" type.  I leaned on the "I hated it" type more in the beginning, but more recently, I have also found real encouragement and great tips from the "I <heart> being a mom" type.  It's good to have both.

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