"On Healing" October 2007

Posted on Mon, October 29, 2007
Much more than 'baby blues'
By Dan Gottlieb

These were not the "baby blues." Three months after giving birth to her first child, Sally cried most of the time, hardly left the house, and felt she couldn't adequately care for her baby. She might have been right about that.

Up to 80 percent of new mothers feel vulnerable or have crying spells, and often they get irritable or restless - "blues" that usually pass on their own. But Sally was in a postpartum depression. All forms of depression can be debilitating, and 10 percent of Americans have it in any given year - twice that for the first year of motherhood.

Sally was too ill to call me. It was her mother, frightened and pleading, who spilled out her worries. Whenever she offered to help with the newborn, Sally would refuse, saying mothers are supposed to take care of their own babies. This type of response is not unusual for someone in the throes of postpartum depression; nor is extreme agitation or panic attacks. Many are afraid both for the baby and of the baby. A small percentage develop a psychosis that can include delusions and paranoia.

When I saw Sally several days later, however, her most noticeable symptom was to constantly berate herself for being a bad mother and a worthless person. Depression's typical shame and guilt get compounded when felt as a mother's inadequacy - so much so that the vast majority never seek treatment.

In my office, Sally did nothing but cry for the first 10 minutes. When she caught her breath, this 28-year-old woman said that although she had been anxious during pregnancy, she was looking forward to being a mom. But when the baby came, her anxiety turned into fear so overwhelming that she felt incompetent to even protect the child from harm. She stayed up all night worrying that she would lose the baby - and wondering if that was her real intent. It all fed on itself, she withdrew from the world and got worse.

We don't know the exact causes of postpartum depression, but Sally had several risk factors. She had a history of insecurity, and was treated for depression in high school. Her parents divorced when she was 7. And she was a single mother. None of these is a cause, but they increase the risk.

After a few sessions, Sally understood that her nightmare was about hormones, genetics and exhaustion (and plain bad luck), nothing more. And that she had a treatable, surprisingly common illness. This helped her feel less ashamed, which in turn enabled her to share some of the baby's care with her mother and a few close friends while she rested and recovered.

The big question in postpartum depression is always medication: What happens if it gets into breast milk? Research has shown that antidepressants do get into breast milk, although some release only minimal amounts. And there are risks to the baby from not taking medication - a mother's depression and agitation can create bonding difficulties that may have lasting effects.

After consultations with her obstetrician and a psychiatrist, Sally opted for a newer antidepressant. Although she didn't feel the full benefits for about a month, her anxiety began to diminish, as did her need to isolate. A sense of relief came quickly. Joining a support group would have been helpful; pressed for time, she found one online.

Sally did well, and so did the baby. Toward the end of the three months that we worked together, I suggested some ways that she could lower her risk of future episodes. All mothers must take extra care of their bodies, but this is especially true for women with a history of depression. Exercising, healthy eating and sleep should be high on the priority list. Meditation, yoga and massage also contribute to balance and well-being.

Key to Sally's success was learning that depression is a disease of the brain, not of one's character. She had an illness, she suffered, she needed care. Sometimes it's that simple.

Posted on Mon, October 15, 2007
Stress disorder infects the family
By Dan Gottlieb

All emotions are contagious, but post-traumatic-stress disorder has been compared to an infectious disease that affects everyone nearby. Anybody who has grown up in the shadow of trauma already knows that.

Linda was born in 1945, just 10 months after her father returned from the war. Her aunts said Morris was a lighthearted man, a bright and talented violinist before the war. But his children - Linda and her younger brother, Mark - never got to know that man.

Morris was severely injured in the Battle of Normandy. He suffered multiple shrapnel wounds and lost a finger, which prevented him from ever playing the violin again. He spent months in a hospital in Europe before returning home to start a family. He was no longer lighthearted.

Here's how Linda described the father she knew: "He was extremely moody, and when he got depressed, he would withdraw into his room. And he couldn't sleep because of the nightmares. We all knew about the nightmares."

People deal with trauma in different ways. Several years ago, I treated Pearl, whose mother lived through the Holocaust and refused to talk about her experiences. The violence she witnessed stayed buried inside along with her grief and survivor's guilt. Her silent suffering became the elephant in the living room; everyone was afraid to talk about it for fear of inflicting more pain on their suffering mother. Sometimes, Pearl told me, she could feel her mother's pain right through the pores of her body. Ten years after her mother's death, Pearl still feels guilty about not being able to help her.

Morris dealt with his trauma quite differently. Linda said her father would talk about what happened almost every day. "From the time I was 5 or 6," she said, "he would tell me stories about his friends losing limbs or what a body looked like after it was blown up. At first I didn't understand what he was saying, but when I was old enough to understand what it all meant, it was terrible. And it was daily."

And it went beyond talk. Whatever Morris carried inside was acted out on his children - especially Mark, who said it was predictable and terrifying. "I was told I had to be tough and strong," he said. "I was never allowed to be a child. And for many years, I thought I was being beaten because I was not good enough."

All children tend to feel responsible for their parents' problems; it's their way of trying to control their own environment. Parents' problems typically are temporary and manageable, so the child's development is not impaired. When they reach the level of significant trauma, however, the suffering becomes like a member of the family whose needs dominate everything.

Pearl spent her childhood afraid to do anything that could upset her mother. She grew into a quiet and withdrawn adult who rarely acknowledged her own needs. Mark has difficulty with intimate relationships: "The kind of anxiety I felt growing up stays deep inside. I don't think it will ever go away."

What might have made a difference for them? In today's world, of course, post-traumatic-stress disorder is far better known, and professionals have more effective treatments. But a very simple thing might have helped a great deal: Talk. Not the one-way kind that was so frightening to Mark and Linda, but open family discussions - everyone included - about what happened to mother or father then, and what they are experiencing now. Beginning the conversation can be very difficult. Often, these families have unspoken rules about not raising the subject. But remember: Open discussion like this rarely causes harm. Silence does.

Still, it won't change the parent's past; it might not even diminish the symptoms. But it will help the children. Morris' kids never realized their father had PTSD until shortly before he died. What if they had known earlier?

"I spent the early years of my life thinking that all this was happening because there was something wrong with me," Mark said. "Even if he couldn't have been helped, at least I would have known it wasn't my fault."

Posted on Mon, October 1, 2007
What's lost by 'saving face'
By Dan Gottlieb

I recently had lunch with a friend who said he was being treated for clinical depression and was having difficulty with even simple day-to-day tasks. He runs a successful small business that requires a great deal of energy and attention to details. He was concerned, he said, that his business might not survive his depression.

Since we always need a support system when we are vulnerable, I asked him if his employees knew he was depressed and would be willing to temporarily pick up some of the slack. He told me he could never tell his workers about his depression because he would lose their respect.

He said he had to "save face."

That got me thinking about the concept of "saving face," which originally comes from the fundamental Chinese belief of living up to society's perception of one's moral character. But how can we live up to society's perception if it doesn't match who we really are?

And when we say we are "saving face," are we really saving something we are proud of - or are we actually hiding vulnerabilities we are ashamed of?

As I see it, "saving face" is about protecting an image based on who we think we should be. I see it often in men who feel they have to be strong and confident even when they don't feel that way. Saving face helps us get through some tough times, but it could also compromise the quality of our lives.

I first met a man I'll call Albert last year, when he complained that he was constantly frustrated with people at home and at work, and felt pretty ineffective at both. He was especially concerned about his 14-year-old son, who he said was doing poorly at school because he was lazy. Albert said that he had tried many times to get his son to change his ways, with no success. To make matters worse, he and his wife argued almost daily because he felt she was not respecting his paternal authority. Albert was certain that if he could just figure out what he was doing wrong, he would know how to motivate his son and get respect from his wife.

After my client and I got to know each other, I asked what he really wanted out of his life. Albert seemed confused, almost disoriented. "No one asked me that question before," he said. "To be honest, I haven't even thought about it for many years, I've just been trying to become a better person."

Eventually, he said he secretly wished that one day he could own his own music store and make people happy. But that would not conform to expectations that he perform and produce at very high levels. So he still works at a high-pressure job that he does not enjoy.

Growing up, his father told him what was expected of him as a man. It's the same message that many men get: Being a man means working hard, raising high-achieving children, and earning the respect of your spouse, family and community.

That was the image he had to live up to - the "face" he had to "save." In fact, his greatest fear was that his wife and son would find out how insecure and unhappy he really was. If they knew the truth, he said, he would certainly lose their respect and they would leave. As he thought about it, he realized he had two choices: to live an unhappy life, or take a risk with his family.

He chose the latter. His family responded with care and compassion. In the ensuing discussions, he learned that his wife also wanted a smaller, quieter life. Her way of saving face was to stay quiet out of fear of upsetting her husband and disrupting the family image. And his son? Part of the reason his son wasn't performing well was that he did not want to live the life that his father had.

Sometimes, continuing unhappiness and irritability are symptoms that need to be treated. Other times, these frustrations are the voice of a malnourished spirit speaking from behind a "face" that is not one's own.

Our Partners and Sponsors