This month our readers checked out A Mother’s Climb Out of Darkness by Jennifer Hentz Moyer. Published in 2014, the author described her descent into postpartum psychosis—and back out. It’s described as a must read for those dealing with or helping others with postpartum mood and anxiety disorders.
The following is a Part One of the transcript during their book chat. Part Two can be read here.
Warrior Mom Book Club: A Mother’s Climb Out of Darkness Discussion Part 1
A recurring theme in the beginning of the book seems to be a lack of being fully informed. This may be due to the doctor’s believing that due to her psychosis, Jennifer wouldn’t be able to comprehend the information. Do you believe that the doctor’s should have attempted to keep Jennifer more informed? Can you relate to a lack of information regarding any medical treatment (mental or otherwise) that you have received in the past? Do you think that if the doctors were better trained in treating and understanding PMADs that it may have helped?
CB: Yes! I know that doctors make a lot of decisions for you, during birth, so it didn’t surprise me. But I was horrified at how she described some of the staff as treating her like a child. Even if she couldn’t have been able to approve or disapprove of her treatment; at least she could have been told what she was diagnosed with and why she was getting that treatment.
SK: Yes, me too. i couldn’t believe how no one would even speak to her in the opening section of the book. I felt like my doctors did a good job of explaining things but I still had/have to do a lot of advocacy for myself. For example, trying to determine the difference between a psychologist and a psychiatrist and which one I needed.
CX: I do think that patients should be informed. I can totally relate to not getting the information in the beginning, however when I entered treatment in a hospital for specifically for PPD, that was the first time I was treated as part of the “team”. I was informed on everything, asked my opinion, and even my family was invited in to ask questions etc. Doctors in general are given little to no information on PMAD’s and this is such a reoccurring theme in stories from Mom’s I meet. My OBGYN prescribed me an addictive medication, with refills and no follow up.
CX: Jennifer Moyer – do you have any insight to why MD’s did not share much in regards to your treatment?
CB: Yes, I was just handed a script and told to follow up with a family doctor; didn’t see my family doctor until the meds stopped working a year later…got a new script…
CX: C.B – no therapy, no follow up appointments?
CB: Nope; I got therapy on my own when i got suicidal. Then I got a psychiatric referral when my family doctor quit….18mo later; I was put on the right medicine and diagnosed with PMDD at 21 months postpartum.
LN: I also think – based on my experience and what she says in the book – that perhaps many people who suffer from PMADs are those who like control and a) having a baby and b) having a PMAD both take that control we crave away. More information would help patients at least feel like they have some modicum of control perhaps, which to me is always calming.
SK: Not only do doctors need to do a better job of informing their patients, but they need more information. Like Jennifer explains later in around chapter 7, if she had been more informed and a part of her treatment then maybe she could have improved quicker and had better results.
TD: I felt like the people I was directed to were not sure what to do with me. I didn’t fit in the “traditional” track.
Jennifer Moyer: I think the initial assessment revealed that both the first responders and medical community did not have any understanding or knowledge of PMAD particularly postpartum psychosis.
SK: L.N that is an interesting way of thinking about it, I never thought about how much having control can be a comfort for most of us.
TD: As a nurse I try to give information as best I can, but I know that much of it is not received by patients. I feel it is always helpful to have a trusted (KEY!) & healthcare knowledgeable friend or family near to help with re-explanation as needed.
CX: That’s a great point T.D. – I wish I had had someone in my circle with me for those appointments.
SK: TD that makes sense too. When you are in the moment you may not be able to make informed decisions, however, as you digest it later you may have more questions and need someone to lean on.
TD: the other disparity I felt was that Jennifer Moyer IS knowledgeable and she was still conveyed that she was treated in this manner.
LN: I’ve only realized recently SK that my anxiety manifests itself as always being prepared/in control and flares when that is not the case…
TD: First responders, EMS, police, EDs, etc need much more psych information being given to them in general but certainly with PMADs
Jennifer Moyer: Type A personalities are at risk but PMADs affect every race, culture, age and income level. As moms, we are wired to oversee the needs of others.
In Chapter 6, Jennifer described how her family and her husband had turned on each other, casting blame on each other. I know with my situation, my family and daughters father experienced blaming each other as well. Did anyone experience this between family members, caregivers, etc. Were you able to address this? If so, how did you handle or address this?
CB: I avoided telling family and had my husband be my primary caregiver; because I was afraid of judgement. But in recovery, I learned that blogging about my experience helped. My mom hated that. She even bought me a journal. But my husband supported me and attempted to explain why that was therapeutic for me. That was all I needed to hear!
SK: I think my husband shouldered most of the blame, and it was hard for him to figure out what was wrong so he then fell into depression. It wasn’t until I was able to slightly pull out of my depression that we were able to address it and go to counseling to get it all out and resolve the issues.
CX: I explained a little above that was a really tough situation for me. My parents felt my daughter’s father wasn’t pulling his share and he felt they were overbearing. Luckily, the hospital allowed us to have family meetings and 1:1’s which helped us work through those issues. i was way too overwhelmed to even listen to these issues nevermind fix them.
SK: CB were you able to resolve the issue with your mom? Has she come around to your blogging or is that still a point of contention?
CB: Still contention. However, through speaking with my aunt (my mother’s sister), I was able to discover a lot more about our family history of mental illness…
TD: We worked very very hard, much like Jennifer Moyer and her spouse. He carries a great deal of blame and I didn’t realize until his brother had a baby and asked how long he should take off & he said, “as long as you can!”
LN: Not guilt really but my parents are definitely anti-med and I was the first person in our family to ever see a therapist so likely anti that too….I quickly fell in love with both 🙂 but it’s definitely weight on my recovery. Like I want to be done with meds and therapy but likely won’t ever be. And now I tell everyone in the world I’ve been on them!
SK: CX that’s awesome that you had that hospital available and they sort of forced you to work through those issues
CB: Me too LN!
CX: SK – absolutely! I am so fortunate to live in a state that has a PMAD treatment facility you can bring your baby to.
SK: LN my family isn’t anti med, but my mom basically refuses to go to therapy. Although she is supportive of me going, which I have found odd, but obviously I am not going to question the support.
TD: What will you tell your daughters? I am nervous to share my story with my daughter. Although I know in 20 years when this is an issue she will be as familiar with it as I am! I hope!
CX: My family as well – I’m 1st generation to this country so my family has never been in therapy or taken meds – they aren’t outright against it but they don’t understand.
SK: TD I plan on telling my son that I had a rough time after having him and that I had to do a lot of work to get better. But in the end it made me a stronger, more emotionally stable (ironically enough) mother.
CB: I’m excited to tell my daughter! I haven’t gotten support so I am happy to be there for her and let her have a different journey, hopefully, if she has a PMAD.
LN: I tell Rebecca that sometimes mommies have babies and are so happy but sometimes they aren’t so happy. So we do our Climb and mommy does work to help all the mommies be happy. I figure if we start with small truths now it’ll be easier to understand later….
Jennifer Moyer: Be honest and open. Good Therapy over the years has been critical for my son and family.
TD: SK &CB good points! I rarely incorporate how it made me better in the long run – just that I survived.
On pg 84 Jennifer quotes one of her former colleagues saying, “I can’t believe you did this to yourself.” This impacted me deeply because, personally, I think it shows how much farther we still need to go in educating the medical community and general public, about mental health issues. Did this quote affect you also? Were there any specific phrases or quotes that stood out to you?
CB: I was totally horrified at that comment. i couldn’t imagine what it must have felt like.
LN: Horrified as well. I had two other highlighted quotes:
“Recovery does not happen because you swallow enough pills – even if they are the right kind of pills. It is a long-term process, with a series of ups and downs, and some very unexpected twists. It requires you to learn, all over again, how to care for your mind, body, and spirit. A major illness changes you; you are not the same person you were before your illness and your needs will be different than they once were; but then, so will your strengths. Usually, the process of recovery uncovers a kind of courage you never knew you had. Discovering that is one of the gifts of recovery, but it often comes at a very high price.”
“I simply did not have the memory or concentration I once had, and I struggled against my new limitations”
SK: This made me so sad, but at the same time made me reflect on my opinions on mental illness in the past. Prior to experiencing depression myself I had no understanding of how or why anyone would be suicidal. After experiencing it and realizing how little control I had, I understood. However, I do feel that those in the medical community should be held to a higher standard and should have a better understanding of mental illness than your average person.
Jennifer Moyer: It is even more horrifying that it was a doctor that I had worked with and knew personally. He was a primary care doctor overseeing the inpatient unit patients.
SB: Yes LN!
CX: I was also horrified at this comment. There were so many things that stood out to me that have been said. i think about them rarely now, thankfully. But I do remember ruminating over them, day in and day out. One thing that definitely stood out and still does is when I was told, “this will pass”…like it was that easy.
That is horrifying Jennifer Moyer – just shows how much work there is to be done on educating.
LN: CX a friend told me not to have help and “just start taking care of your daughter. Like ripping off a band aid.”
SK: LN yes, the idea that it is more than taking a pill. Taking the meds will relieve you of some of the symptoms, however, you have to do the work to fully heal.
CX: LN oh my gosh!
SK: Also to go back to TD’s question, Jennifer Moyer you wrote about one specific former co-worker and the pity and condescending tone that they gave you in the hall….have you since seen that co-worker? and how was that interaction?
CX: Actually another one was I was told my PPD was because I allowed my parents to help so much and this caused me not to learn how to properly be a Mom.
TD: Actual gasp out loud! Jennifer Moyer have you spoken with this co worker? I would like to think they did not intend to have it come across this way….I’d like to think the best of people….
SK: CX that is horrible! I can’t imagine having someone say that to me, and especially if you are deep in the PPD that can be so damaging.
LN: I don’t think people realize that PPD or another PMAD has lasting impact. Most think you should be better and back to yourself with treatment. But myself is different now – stronger, happier, more anxious and emotional, forgetful and smarter.
CX: LN I love your above comment! Question 4
This book, thus far, has really led me to think about the women who have no history of mental illness, and are completely surprised and ill prepared for a perinatal emotional complication. How can we improve their awareness of what can happen and what a perinatal emotional can look/feel like?
CB: I am pushing for the education in pregnancy. i became depressed in my pregnancy and just said, this feels different, i.e. I don’t feel like the child inside me is mine. And it got worse after delivery….no history of mental health issues.
SK: I was one of those women, I had no idea what was coming or what it could be like to have PPD. I think the only way we improve people’s awareness is through better education of the medical community and that education being spread down to their patients during pregnancy.
CB: Great minds SK!
CX: I truly believe like CB said above – at pregnancy, in pregnancy groups, obgyn appointments, etc.
LN: This was me. This came out of nowhere and knocked me – a strong, outgoing, always happy person – on my ASS. Nothing could have prepared me as I had virtually none of the risk factors – but maybe being given a list of the various potential symptoms to look out for and some stories of different women’s experiences could have helped?!
CX: Same here LN – no risk factors, no past history of mental illness etc. I also think family members, partners etc should be given the info.
TD: I thought I was prepared, but not for the disconnection that I experienced. I thought I had outsmarted my predisposition (family history) but I did EVERYTHING the right way and it still hit like a ton of bricks. I think more education in pregnancy about the fact that it can happen to any one of us regardless of history or genes.
DC: I think it needs to be a mandatory part of childbirth prep classes. Parents need to be aware of possible physical and emotional complications.
LN: I also think people need to know that reading information on it during pregnancy will help not hurt them. I think people are scared to hear about potential complications like it will jinx them or something, and that’s just wrong. Information can only help you if eventually you need it and hopefully you never will.
SK: LN that’s a good point, it is scary to read the things that can go wrong, and you would rather hear about the “normal” things that occur.
SK: Jennifer Moyer do you have some ideas on how to better prepare moms? Is there something in particular we can be doing in our communities to raise awareness?
Jennifer Moyer: Everyone involved in care of mom and baby needs to talk openly about PMADs. Education is key. Increasing awareness and decreasing stigma must be tackled in every community.
DD: I agree with DC and everyone else who said education is the key. My doctors and everyone around me acted as if they never saw such a thing before so I searched for years trying to understand how this could have happened and why. At least I feel I can stop searching for some unknown illness.
LL: I know in some countries midwives make home visits or nurses come by the first several weeks. I think this would have helped me SO much. I didn’t see my doctor until six weeks in and wasn’t even MY doctor, it was another because my son was in the hospital so I went somewhere closer to where he was staying. With this pregnancy my doctor wants me to come in at two weeks and six weeks postpartum, which I think is a step in the right direction. But wouldn’t it be awesome if someone could come check in at home?
What I notice for Jennifer, is just how many doctors it takes to get well. You need one that prescribe the correct meds AND be willing to change/adjust them, another for talk therapy (sometimes it takes a few tries to find a good therapist) and then the money to support it all. Have you had difficulties navigated the maze of doctors? What do you think could help new moms with this maze in the future?
CB: I think a psychiatrist should be the first evaluation, along with a therapist. Luckily I found a good therapist, but it took a lot of warming up. My psych knew more about my situation than my OB and family doctor….but that’s just me.
SK: CB I still don’t have a psychiatrist because my midwife and general practitioner have been able to prescribe what I need and I have received guidance from my therapist….not sure if this is the correct approach, but it’s what I have been doing. I think it may have helped to have a psychiatrist so I didn’t have to make 50 phone calls to change my medication, but now that it is all in place i don’t really want to make more appointments and make more calls to change it.
LN: I just have one doctor who prescribes and does my talk therapy. She is my savior and secretly my second daughter is named after her.
DC: I’m not sure navigating the maze to get proper medical treatment is just in the mental health community…..
SK: I think having a guide, or a suggested plan of action for moms who are suffering could be a good idea for new moms. it is so hard to know who to call to get help.
CX: I think it is so overwhelming for new moms, especially when you’re given a list of therapists to call, trying to figure out who will take your insurance, how long wait lists are etc.
CB: Great idea SK!
TD: PSI, Postpartum Support International, has a list of warm lines organized by state that can point you in some direction.
TD: CX even longer for doctors!! http://www.postpartum.net/
SK: Jennifer Moyer is there a place women can go to find information about what doctors they need to contact?
Jennifer Moyer: There is no formal one stop guide or place to go but Postpartum Support International and Postpartum Progress are two major US based organizations that are helping and can direct to resources.
TD: And there are other online communities but please be careful!!! make sure they are monitored by a professional so that you are not triggered – this was very important to me when I was looking for a support group!
So much of Jennifer’s and most people in general, mental health is tied to their sleep patterns. do you notice your sleep changing during difficult times? Is this an indicator for you that you may need some more self care? Jennifer Hentz Moyer, what do you do today for self care?
CB: Insomnia is definitely a trigger for me. I try to combat it through working out and putting myself to bed at the same time and getting up at the same time; so I stay on a schedule. Plus, it’s my self-care because no one bothers me during this time 🙂 and I have a lot of accountability partners to make sure I’m getting self-care in!
SK: I find that I am lucky in that I have ways of getting myself to sleep no matter what. I also did not have bouts of insomnia with my PPD. I tend to have irritability and a short temper, and then bad self talk as my indications that I am snowballing. My self care though consists of one hour of time to myself, watching tv that requires no thought every night. This is my time to decompress and my husband knows not to bother me. If I don’t get quiet time for a few nights in a row, then I can start to get bad.
LN: Lack of sleep or even the possibility of it (a sick child, trave, etc.) triggers my anxiety. Insomnia comes shortly thereafter even if the original problem doesn’t factor in.
CX: Insomnia and anxiety for me as well. It was a like a vicious cycle of not sleeping because of anxiety and anxiety becasue of not sleeping. I literally had to have my daughter stay with my mom at night downstairs, while I got my sleep cycle back on track with medication and therapy. Now I take time for myself, especially when things get tough, whether it is a pedicure, a hike or just some netflix and wine. My parents are a huge help in allowing me to do this.
TD: This would be a good thing to remind new moms and educated caregivers in. Maybe it would make the intro to PMADs less scary. Start with self care.
SK TD yes, and I feel like so many moms feel guilty about self care, but it is really necessary to the be best mom you can be.
CX: I will admit I still have a hard time telling friends, especially other moms about my self care – I’m working on it.
SK: LN do you have any self care tricks that help you when those things begin to occur?
LN: Slef care is a struggle for me – my PPD came with apathy toward my daughter so leaving for time to myself made me feel bad then (“what’s wrong with you that you feel better away from your baby than with her?”) and still does now. I do it because I know I come back better by my guilt is on a different level than just, “ I shouldn’t take time for me….”
TD: Guilty as charged! Self care is SO important!
LN: Ummm Candy crush SK? My therapist also gave me a list of meditation apps. Sometimes I listen to that. I’ve gotten better about calming my mind myself but can’t always.
Jennifer Moyer: Sleep deprivation is a huge trigger and indicator so I normally do not watch TV close to bedtime, I keep my room dark (no blue light/turn off cell phone), keep the temperature cool and if possible I journal as getting my thoughts down helps clear my mind. I take Melatonin on nights I may have difficulty sleeping and continue to have regular therapy. The biggest thing for me is to keep a heart of forgiveness and kindness towards myself and others. Eating healthy, exercise and regular activity during day is important as well.
SK: Jennifer Moyer, thank you for sharing. I think that is huge having a heart of forgiveness and kindness towards ourselves. I often find I am much more forgiving of other people than myself.
SR: Sleep deprivation is a trigger for me as well. My husband is a huge support and gets up with the kids on the weekends so I can get some extra sleep.
LL: Sleep is definitely a trigger for me. i have been having some antenatal depression and anxiety with this second pregnancy ( I am almost 32 weeks) and I realized after a particularly rough, anxious day that I was only sleeping six hours a night because I was trying to be super woman. After getting more sleep I felt much better. I also think exercise is essential for me and I have a hard time being happy if I don’t read at least a little bit. When I first had my son I didn’t read at all for like a month, and then my mom convinced me to do it for myself and I only managed about a page a day for the first few weeks but I still love that book because it took me out of my stress and depression and helped me enjoy life for just a few minutes each day when things were at their worst.
Extra Question 1
In the beginning of Chapter 7, Jennifer talks about the blame and guilt we put on ourselves after experiencing a PMAD. What are some of the ways you cope with that guilt? Is it possible to alleviate some of that guilt for future mothers? How?
ST: I try using my years of CBT, but there are some days I just can’t overcome the negative self talk.
SK: ST Negative self talk is something I am still trying to combat. I am trying to look at things more as regrets than guilt, like we learned at the Warrior Mom Conference. It is a difficult change but a good one.
ST: I still struggle with it. So many years with depression. I’ll be in therapy forever.
CB: I blame myself a lot; but I try to be present in the moment, to be gentle with myself, and remind myself that other warrior moms are out there fighting like me. Once you get in that thought process – it is so hard to get out of it.
LL: I feel like meeting a discussing others’ has been so good for me. i read Brooke Sheilds’ book in the midst of my depression and just knowing there was someone else like me saved my life. At that time it was the only thing I’d ever heard about postpartum depression. now groups like these and reading other books have continued to help me. In turn I try to be as open as possible to help other’s guilt be alleviated – I think being vulnerable helps others more than it hurts me if that makes sense.
Extra Question 2
Jennifer describes the point at which she “graduated” from the hospital at that point she had to make a decision fo going home to her husband and son or staying with her father. She stated that the advantages of being with her father were the support, working part time to pay medical expenses, and a doctor nearby. This is such a difficult and heavy decision. What were some difficult decisions you have had to make in your treatment process?
ST: Entering the short term psych unit at the hospital only one month after S. was born. It was the hardest decision I made but the biggest turning point in my recovery.
SK: The hardest decision for me was to take medication and continue breast feeding. that was a very scary and very difficult decision but one that I am so happy that I made.
CB: Getting help when in denial.
Extra Question 3
It is so difficult to know what to ask, or what is “normal” with a mental illness. Especially when you are so far in it that you cannot advocate for yourself. What symptoms did you experience that you knew were not your “normal”? Did you or someone in your circle notice things that you said or behaviors you had that were not your typical?
ST: Vomiting…Constantly. Thoughts of running away.
SK: I thought that what I was experiencing, wanting to run away, crash into a tree, was normal due to being a mom and it being hard. What I learned is those things are not normal. By talking about them and sharing my experience with others I hope they are able to realize the difference between what is normal and what is not normal faster than I could.
CB: I didn’t feel like the child I was pregnant with was mine, then I had trouble balanching it all and I got worse as my self esteem diminished. I wanted to run away too ST!
Join us for Part 2 of our discussion.