Hello, again! I took some time off from this blog during my pregnancy and the first months of my child’s life. I’ve been thinking for awhile about what to write for my first post back here. Then, all in one week, three extreme examples of the damage done by the stigma of mental illness appeared in the form of questions from readers of my personal blog. I love hearing from readers. It keeps me writing. But I cannot begin to express how sad it makes me that these three women, a thirteen-year-old girl, a middle-aged woman facing an unplanned pregnancy, and a woman afraid to have a baby with her husband, all come to me, each asking "Where do I even begin?" While I am a readily accessible voice happy to help, I believe that they are asking me because the stigma of mental illness, the reason so many of us end up feeling ashamed of our struggles, has made it difficult to find help in the "real" world.
I have some ideas specific to each question asked of me, but I want to take a minute to say this: if our culture did not stigmatize mental illness, maybe our daughters, sisters, wives and mothers would feel more comfortable talking to professionals. Asking for help in real life can trigger so many fears: what will friends and family think? What will it cost, financially? How do I find someone qualified to help me? If we were talking about something else, here, diabetes, for example, there would be no end to the resources available to help manage the issue. No one would call us weak for depending on insulin. No one would tell us to "tough it out" or "get over it." But we say these things to people who admit to struggling with mental illness, so three women who each need a different kind of professional to guide them through very difficult decisions have come to me, a blogger with personal experience but no medical credentials.
I repeat: I love hearing from readers. I am happy to help when I can. Overjoyed, really, just to have readers. But it should not be so hard.
Now. Three stories:
Em is thirteen-years-old and at a loss. She has asked me what to do, because the panic attacks and other anxiety symptoms are overwhelming. She feels depressed. She wonders if maybe it would be easier if she were dead.
At 13, I felt every single thing Em described to me. I don't know if she has "active" suicidal thoughts, but wondering if things would be easier for everybody if you died is called a "passive" suicidal thought. It's a big step from feeling so tired that you want to give up to actively making plans to end your life. But it's not a good way to live. It sucks.
In a strange way, being thirteen and anxious/depressed is a bit like being pregnant and anxious/depressed: no one knows what to do with you. It's hard to find someone to give you a realistic picture of your options, because we are terrified of what the side effects medication might have on a fetus or on a child. There is a bigger risk, there. I truly believe that meds are just one of many tools, but being in a place where no one wants to touch that issue with a ten-foot pole? That sucks. If your doctor isn't willing to discuss the risks, you may not be able to try something that has the potential to offer relief.
When anyone feels the way you feel, Em, we want relief. We want it NOW, especially when the work we are doing, like your work in counseling, doesn't seem to help us at all. I am so truly sorry that you have to go through this. It gets better. I promise you that life is better on this side of thirteen-years-old. Please, do whatever it takes to get through this time. It is amazing, the amount of pain a human can feel and still keep going. One foot in front of the other. One day at a time. Just believe that it cannot last forever.
CC is forty-two-years-old and facing an unplanned pregnancy shortly after the death of her mother; she is not thrilled to be finding out this way that, despite feeling sure that she could not become pregnant, surprise! she can. And is. And there's more. She writes,
"I was taking a boatload of everything and pretty much had some of my issues ironed out until this happened. Now I am told that, oops, that 3 mgs a day clopanpin a day you take could be the worst thing in the world for you. ... do you know anyone who took that much clonapin in the early stages and had a healthy baby?"
I wrote back, immediately, of course, that those doctors are OH SO VERY WRONG! And here is where I get angrier than the Hulk. In this country, a woman has the legal right to terminate a pregnancy. But we are talking about a woman who wants to have a baby! CC sat at her computer at 4 am wondering who on earth to talk to, without a cell phone or money for a phone card, because she left a doctor's office believing that she had to choose between her mental health and the physical safety of her fetus.
Just take a minute to let that soak in. An adult woman left the office of a licensed care provider with the idea that the medicine she considers a lifeline, her only path to sanity, would destroy the health of the fetus she is carrying.
I don't even know where to begin, there is so much wrong with CC's experience at her doctor's office. I reread her letter so many times, wondering if it was possible that she had misinterpreted a responsible doctor's explanation that there is a risk in taking meds to mean "meds will definitely hurt this fetus." But she did not leave that office thinking that medication in general is terrible during pregnancy, a myth that many people believe. She left thinking that only one of several medications she takes is basically poison. It takes a special kind of incompetence to so severely misinform a patient.
I don't know the end of CC's story. I hope that, whatever she has decided, she is doing ok. Obviously, I told her that she deserves a care provider who can show her enough respect to at least do an internet search on her meds before telling her which to stay on and which stop taking. I also told her that I took four mg of Klonopin every day of my pregnancy and had a healthy baby, but that this did not mean that everyone taking the drug would enjoy the same outcome. But the specifics just don't matter, here. At the root of this woman's encounter with a medical professional is the idea that she can just go without the medicine and that she should, because she is pregnant. Did you know that asthma inhalers pose risks to a growing fetus? Did you know that some women end up hospitalized because they try to go without their inhalers? Do you know what doctors tell them? They say, "Use your inhaler! You are breathing for both you and the baby, and neither of you can do without oxygen!" CC told me that she is afraid that she will become suicidal again without her medication. She is also afraid that she will become suicidal if she terminates this pregnancy. If she were not pregnant, every doctor would see the risk of relapse after stopping a medication like Klonopin. But as soon as there's a fetus involved, most stop seeing that risk to the woman and only see potential birth defects. The worst part is that most of them don't even know the actual probability of that happening.
And this brings me to the last letter, written by a woman very much like me. Laura put off thinking about the potential conflict between her desire to have children and the use of medication to manage her anxiety and depression. Now that she and her husband of three years want to have a baby, she has no idea where to begin trying to understand her options. She wants to stay healthy, mentally and physically. She wants to have a healthy baby. She went looking for "resources" on this topic and found nothing.
I started this blog in summer, 2010, because I couldn't find any sort of guide to help me understand my choices. In the eighteen-plus months since I went looking, not much has changed. There are articles about individual studies that have come out since then. There is more information in the world about pregnancy and mental health. But it's not any easier to find.
I'm simply not qualified to create that resource guide, nor do I have the time and energy to do it. Maybe it should be done. Or maybe our doctors should look up the medical research that exists on databases that are readily available to physicians and, at the very least, translate what they have read for their patients from medical jargon into English. Maybe medical schools should look into training obstetricians to prepare for the fact that this is going to come up, given that, as the Mayo Clinic website reports, "About 1 in 5 women develop depression at some point in life." You know how I learned that? I did a Google search for "percent of women with depression."
Somebody. Please. Tell me why it is too much to ask that doctors who exclusively treat women prepare themselves for the possibility that some of us will have such a common illness? Why do we just accept it when a doctor is uneducated or, worse, misinformed, about something that happens all the time.
The only answer I can come up with is the thread that connects these three letters, for me: as a society, we send the message that depression and anxiety are not "real" problems. In a thousand ways, we imply that medical treatment for depression and anxiety is optional. Those of us who struggle with mental illness learn quickly that others become uncomfortable when the topic arises. We learn to hide it. We learn shame. Even if we manage not to feel shame, we hide it for the sake of convenience. We learn to justify taking medicine, going to therapy, seeing a psychiatrist, because our culture still promotes the absurd idea that, unlike a heart condition or diabetes, mental illness can be willed away. It is not a "real" illness; it is more like a weakness.
Just get out of bed.
Just stop crying.
Just go for a walk.
Just talk to someone.
Just go off the meds for the pregnancy.
It's been weeks/months/years, aren't you past this, yet?
Are you going to have to take that stuff forever?
It's all socially acceptable, even for doctors. It's all wrong. I love that my little corner of the internet is a place where we refuse to accept that kind of nonsense. I have carefully crafted this blog so that it will show up in search engine results for the very specific problems I encountered ("klonopin and pregnancy" is quite common). But my heart aches, because for this one safe space, there are a hundred hostile environments. Em, CC, Laura and all the rest of us deserve better.