“I know what I’m ‘supposed to do’ to feel better. Everyone keeps telling me the same thing. I should exercise. I should sleep more. I should eat well. I should take the medicine. I know, I know, I KNOW. But something inside my head keeps telling me to push through this. I can get better. I don’t want to take the medicine while I’m breastfeeding. I can’t possibly keep feeling this bad, so I’ll just wait. But then I start feeling desperate, like I’ll never feel better again....This isn’t working. Nothing I’m doing is helping. It doesn’t matter if I exercise or not, everything is dark and heavy around me. Inside and out. Nothing looks the same. I wish someone would just tell me what to do. Or do it for me. My head keeps spinning with all the reasons I shouldn’t take the medicine. I know I’m getting in my own way, like my therapist keeps telling me. I know that. But I can’t help it.”
Women with postpartum depression know only too well how the symptoms of depression interfere with help-seeking and solution-oriented behaviors. Therapists, doctors, partners, friends and family members can tell them over and over and over again, how they should be taking care of themselves, but many women find themselves swirling around the vortex of distorted thoughts and misperceptions. Anxiety driven ambivalence becomes a fierce enemy, what if…? Why can’t I just…? How do I…? Maybe I could just…
Postpartum depression and anxiety do not discriminate. Symptoms impede the functioning of devoted stay-at-home moms and Harvard-educated attorneys. Intrusive thoughts can puncture the most perfect plan. When this occurs, rational thought seems to evaporate. Any previous accomplishment or personal triumph takes a back seat to the all-consuming and interminable anxiety. Soon, that is all that is felt. Women describe this by proclaiming “this isn’t me” or “I just don’t feel like myself” or “I’m usually so easy-going, I don’t know who I am now.”
As thoughts and feelings alternate between despair and rapid-fire obsessiveness, women with PPD begin to lose focus, along with the ability to successfully advocate for themselves.
If your baby were sick right now, would you know what to do to get him help? The answer is usually yes.
If your husband needed to get to the emergency room right now, while you’re feeling this bad, would you know what to do? The answer is usually yes.
But women have difficulty fighting for themselves when they are entrenched in this battle of their lives. Their energy, motivation, inspiration and zest for life has been eclipsed by the cruel paralysis imposed upon them. They also have difficulty responding appropriately to the loving guidance from those around them. They simply cannot see through the shame, the guilt, the incredible disbelief that they feel so ineffective in their own life. And so they sit, rocking back and forth between their opposing thoughts.
If symptoms are bad enough, if hopelessness sets in, functioning is severely impaired, and clarity has vanished – others must make some decisions for her. When it reaches the point when her wellbeing is at stake, we become less concerned about hurting her feelings or saying things to protect her. At this point of personal crisis, we no longer defer to her sadness or her longing to do this “her way.” If doing it her way means postponing treatment or prolonging suffering, it is not okay. This is when it becomes necessary to intervene on her behalf, tell her exactly what she needs to do next and how we will help her do that.
This commanding posture is not always a comfortable one for therapists who are working hard to empower their clients. But remember: Our objective is to lead her to symptom relief, before any other work can be done. One of the ways we do this is by demonstrating a sense of expertise, confidence and composure. After all, it is our composure, our self-control, our trust in the process, that will convey our expectations of a positive outcome. And that, indeed, is empowering for her.
And so, we say:
1. You will not always feel this way.
2. You must take care of yourself and you need to follow through, whether you feel like it or not.
3. If medication is part of your treatment plan, you need to take the medication – whether you are breastfeeding or not. Discuss any concerns you have with your doctor and then decide whether you will continue breastfeeding or whether you will wean. Either way, take your medicine if it has been prescribed for you.
4. Do not let the noise in your head sway you from doing what you need to do. It may feel like you have no energy but you do. It may feel as if you have no power left, but you do. It may feel like no one knows how bad you feel, but some do.
5. Pick a person you trust and listen to them. Do not question the veracity of their words. Let yourself believe that this person can help guide you through the darkness and then, stop fighting against them.
6. You need to keep moving forward through this, even if you don't feel like it. Get up when you don’t feel like getting out of bed. Go outside even if the sunshine is too bright for your weary eyes. Eat even though you may not be hungry. Rest even when you are not tired. Try to turn off the chatter in your brain. Distract yourself. Count backwards from 300. Take a walk. Call a friend. Avoid caffeine. Avoid alcohol. Avoid people and things that make you feel bad. Come to therapy. Talk to your partner.
7. Your depression is not your friend. It is an illness that confuses you and distorts your thinking. Do not forget this. Challenge the illness, not those who are there to help you. Take your pills, no matter how you feel about having to take them. Remember that your fight is against the illness, not against yourself or those who support you.
8. Believe that you will feel better again.
copyright 2012 Karen Kleiman, MSW, LCSW postpartumstress.com