The following is a conversation between several members of the Warrior Moms Book Club after reading “Behind the Smile,” the latest in our book club’s maternal mental health-related reads.  This book was authored by Marie Osmond. You may visit the author at http://marieosmond.com.

AKP: On pages 41 and 42 Marie discusses “not having been a stranger to depression in connection with her children” as she later realized by talking with a panel of experts on Oprah that what she had experienced was actually post-adoption depression.

Had you had any depression or anxiety with prior adoption or births that you didn’t realize was a form of PPD before you had the PPD experience that changed things or that was actually diagnosed or treated?

If so, did having that experience help you to more quickly realize it in the future or did it make it more difficult to detect?
If not, did having PPD after already having adopted or birthed at least one child and not having suffered PPD that time make it more difficult to detect? (We know that some moms do not suffer perinatal mood and anxiety disorders with first births but go on to suffer with later children.)

APR:  I experienced postpartum depression and anxiety with my first child, so I have not had this experience. I am hoping to birth a child and not suffer with this with my second (due any day now).

AKP: Speaking of giving birth, on p. 86 Osmond laments that “our current system of discharging a mother so soon after giving birth is a hazard. It may save money overall, but I have to question what the cost is to a woman’s well-being and the welfare of her infant. They are sending home an exhausted, hormonally confused, physically stressed woman with a tiny, fragile infant that needs 24 hour care. I think that alone is enough to cause depression in anyone.”
What are your thoughts about her statement and how do you think that we could best care for women in the immediate postpartum period in order to better prepare them for a healthy long-term postpartum experience mentally and physically?

SBC: I agree with Osmond’s statement. I think new mothers need community after having a child. We need friends, family members, co-workers, church members if we belong to a church, to help. So many people want to come and “hold the baby” right after birth, but it could be so helpful if these visitors also ran the dishwasher, made a meal or something. I needed this type of help and I asked for it. It was hard to ask for help, but I later realized my friends and family were so happy to help. Also, my health insurance company had something called Better Beginnings. Because I enrolled in this program, I had a free home visit with a lactation specialist, they sent me a good book and someone from the program called me just to see how I was (and they didn’t know I was having PPD). I felt pretty fortunate for this extra help.

SRK: I feel differently; I felt like the faster I could get out of the hospital the better. Maybe that was because I felt neither my husband nor I could rest comfortably in the hospital. My symptoms didn’t really start until our son was around 3 to 4 months old, so I don’t believe that being in the hospital any longer would have benefited me more. I definitely am a homebody through and through and enjoy having all the comforts of home available.

AJK: I agree.  The only benefit in my opinion to staying in the hospital longer would be IF it truly allowed the mother to rest. It wasn’t restful to me, or many others, to be there though. When/where the help and support is needed is afterwards, at home.

AKP: I wonder if there could be a middle ground on this. The hospital was awful for me, too, and my severe anxiety began there, both times — the lights, constant interruptions, lack of fresh air and access to the outside world. I watched a special on a particularly expensive Asian childbirth and postpartum care center for the wealthy about a year ago. Moms can stay up to two months postpartum and be cared for in the comfort of a medically equipped luxury hotel with round the clock care for themselves and their babies. But instead of the sterile hospital environment and being poked and prodded and fed awful food, they are pampered and nursed back to a place of recovery from birth while they are helped or taught how to care for their baby, which also boosts their confidence. If only this type of experience could be more standard, I do believe women would go into the postpartum period better equipped for a healthy experience. Nothing will fully prevent PPD, but having a full tool-box and being primed certainly would make it much less challenging to navigate and recover from.

LL: I also had a bad experience in the hospital. I was there for five days due to a failed induction and C-section and I never slept more than 45 minutes at a time. It was a teaching hospital so people were constantly in and out. Babies “roomed in” and when I asked them to take my baby for a few hours so I could sleep, they brought him back to me within thirty minutes. In addition, the nurses all gave conflicting advice to me about breastfeeding — every shift change someone would come in to “re-educate” me because apparently the nurse who had been there before had taught it to me incorrectly. While it was nerve-wracking to go home and not know how I was going to keep this child alive, I think the hospital (at least the one I was in) was not a helpful place to be. I am not going back to that hospital for my next birth, so maybe I will find a place that is more nurturing and would be beneficial like Marie states.

BR: I remember shortly after returning home from the hospital, wishing I was back there. I had a mixed experience during my hospital stay (which was just shy of 48 hours). It was scary, as my daughter had to go through some tests that we weren’t expecting. But I felt secure being surrounded by the medical staff, who coached us through learning those early tasks of caring for a newborn and I knew if anything went wrong they would be there to provide immediate care. I think being in the hospital also validated that something significant had just happened, and that it was okay for me to get extra care. When we got home I felt like it shifted to being all about caring for my daughter, which was exacerbated by my extreme anxiety about my ability to care for a newborn and intrusive thoughts about SIDS that kicked off my PPD. Every mother will have her own distinct needs following giving birth, but in my experience I think I could have benefited from a longer hospital stay to feel stronger and more competent about my new role as a mother.

APR: I gave birth to my first child in a free standing birth center, partially because I didn’t feel like I wanted to be in a hospital postpartum. I felt like I’d be comfortable at home. But, I should have arranged more help for myself postpartum and made it more clear to visitors and well-wishers how they could help. It was overwhelming to go home three hours after the birth and to have so many people coming over to the house the same day because everything seemed fine. With this next birth I am putting so much more emphasis on postpartum support, hiring a postpartum doula, using babysitters for my older daughter, taking a friend up on her offer to arrange a meal train, and putting limits on the amount of visitors. I think Marie is on to something that postpartum support for women is sorely lacking in our culture, since extended families are separated and work often doesn’t even allow spouses to help moms much. The hospital is better than nothing I suppose, for women who have no support at all and who will go right back to their family or work obligations directly after coming home from the hospital, but it’s definitely not ideal.

AKP: Related to support, Marie talks about one of her mother’s moments of wisdom when she said, “You have to be as gracious in the receiving as you are in the giving. If you’re not, you deny the other person the blessing of giving.” How were you at accepting help/giving before PPD? Did having a maternal mental illness change that?

SBC: That statement is so true. When I was really struggling, I called my midwives’ office and a nice nurse said that exact thing to me. She said “Give your family the gift of allowing them to help you.” It was hard because before the PPD I had thought of myself as completely self-reliant, a leader and the type of person who helped others. But I had to let go of this self perception. It helped me to think about it the other way around. If I had a friend or family member in need as I was, I would want to help them.

SRK: No one really ever mentioned to me that I needed to accept help from my family and friends. Before PPD I tried not to need much help and was a lot less willing to ask for help. After PPD I am much more aware of when I need help and willing to ask for help. I have accepted that it is okay to need help, whereas before I would try everything I could to do it all on my own. I feel that I am a better mother and wife for accepting help when necessary and using my support structure when available has kept me from digressing back into my depression.

AKP: My faith has helped me to accept this. I do believe that God’s grace is the perfect example. He doesn’t require our prayers, thanks, and worship, but he accepts it and offers his grace freely. I try to think of this example in that he was us to offer grace and generosity to others and to accept it ourselves, whether we “deserve” or need it ourselves. I realize not everyone sees through this particular lens, but regardless of religion, like SC and SK, I also took this important lesson away from my PPD experience…surprisingly one of the many positives.

LL: I personally have never been good at accepting help from others but always felt that I should be able to handle things on my own. Having PPD was the first time where I had to admit that I was helpless and needed support from others. People from church brought me meals for weeks, my friend came and cleaned my filthy kitchen, and while at first all of this embarrassed me I later realized that people weren’t helping because they felt obligated — after all, I could hardly bring myself to ask. They were helping because they wanted to. Since things have become easier for me with PPD (I wouldn’t say I’ve totally recovered, but I’ve gone into remission so to speak) I have tried to make it my mission to help other new moms, and it is such a help to me now that I know it must have blessed the lives of the women helping me when I was struggling myself. I think it is all a cycle.

BR: I think I have always felt confident about asking for help when I need it. However, one feature of my PPD/anxiety was thinking I should be capable of doing it all, and the fact that I needed help not only caring for my daughter but caring for myself as well as well influenced a strong sense of failure. It took support from my family to encourage me to really communicate what I needed so that I could get the treatment I needed and be the healthy Mom I so wanted to be.

AJK: It was very difficult for me to accept help. Or rather, I think it was for me, to GIVE UP even more CONTROL and have others do things I “should be” doing and do things FOR ME. It was ultimately a GOOD THING but very difficult really for me.

APR: I was not good at asking for help and my husband is practically allergic to it. After our experience with postpartum depression and anxiety and now a difficult pregnancy, we know we’ve got to ask for help when we need it or things get so much worse. We’ve also become much less reserved in paying for help, because it pays off big time in the long run.

AKP: Shifting gears a bit, at the bottom of page 157, Marie says, “My reflection in the mirror would stop me in my tracks. I was unrecognizable to myself. It was like looking across a room full of people and seeing someone you think you know but being unsure of who it is.” Does this statement resonate with you? If so, how do you recall your postpartum experience, or if you are currently in the midst of PPD, how does this describe your current state?

SBC: I don’t remember feeling like my physical reflection was unrecognizable, but I felt like I had lost myself internally. And I liked the old me and hated the new me and wanted her back.

SRK: I actually did not have this type of experience. I did feel like I was empty and then there was a point in my recovery where I realized that I actually felt like myself again, internally. It was hard to accept that I wasn’t “myself” for so long, but I have tried to realize that I could not control that time period, and move on and look towards how I can be a better me in the future.

AJK: It doesn’t really resonate with me, but I feel it describes things literally for her. She was probably so used to seeing herself smiling, happy, “perfect” and made up that she really probably couldn’t recognize that self she saw during that time. For me, it’s still so hard to even think about the experience because I was so, so lost in my own head – like there was a hurricane raging in my mind – that I have a hard time remembering what it was like for me to be in it. I just felt lost. Lost.

AKP: I would look in the mirror then, and at photos of myself, then and now, and see a complete stranger when I was ill. This statement totally resonates with me. I didn’t recognize the person outside or inside. My eyes were empty, I was unable to find joy in anything and I was wracked with obsessive guilt and a complete lack of confidence and decisiveness.

BR: I was in utter disbelief and so resentful of what my life felt and looked like as I struggled with PPD and postpartum anxiety. It was nothing like the picture I had in my mind of what it was going to be like before I gave birth. It is still painful to think back about what those weeks and months looked like, especially when I talk to other moms who did not have an illness. The pictures we have of that time tell the story of a happy, engaged new mom, but I can see behind all that to the intense pain of what I was experiencing.

APR: I look fine in pictures, like nothing was wrong. It was consistent with what was going on because I felt like hell but no one noticed until I put my foot down and said ‘this is not okay.’ My family, husband, midwives and friends seemed not to notice (or didn’t say so if they did).

AKP: Speaking of sharing “publicly”, Marie defends her decision to go on the Oprah Winfrey Show to her mother by reminding her mother how much it helped when she herself had admitted to Marie her own struggles. She says, “…one brief time when you couldn’t handle it either. You gave me strength to get through it. You did, so I knew I could. Maybe talking about it, I could do that for another woman.” What is your reaction to this thought process? Not to Marie’s decision to go on Oprah specifically, but rather to share her story publicly, particularly as she describes her family as one that has “never been ones to air their dirty laundry”?

LL: I completely, completely agree with Marie’s decision to share her story to help other women. When I had PPD, I had never met another woman who had admitted to having it. I felt like I was completely defunct as a woman. Of course I had heard the statistics that at least 1 in 10 women dealt with it, but no one I knew had ever spoken of it. I believe that the thing that saved my life was reading another book (Down Came the Rain by Brooke Shields) that showed me that others had experienced what I had without being horrible people. Even though I felt uncomfortable sharing what I felt with others, there have been multiple times when I have felt that I should share my experience with PPD so that other people know they are not alone. I think it was especially courageous of Marie to do that on public television.

BR: I imagine Marie’s family experienced a lot of shame for what they perceived to be their “dirty laundry.” How would people judge or respond to them if they found out that reality didn’t match the TV star image they were known for? I imagine that was a very scary thought that fueled the continued silence. Marie’s mother’s choice to share her struggles with Marie, and then Marie’s choice to share her story publicly on Oprah were choices that challenged that shame and fear, paving the way for a new way of viewing and understanding the struggles we are all faced with.

AJK: I read Down Came the Rain while hospitalized for ten days with my PPD , anxiety/OCD, intrusive thoughts, suicidal feelings, etc. because I was DYING to know if anyone else had ever had these horrible horrible thoughts and this terrible experience and if they were really “okay” after. I begged for books like that about real people who made it through. So I think books like these, and Marie going on TV, are so, so important. I’m not publicly “out” about what happened to me but I hope to be one day and to try to help others somehow.

APR: I’m not really public about what I went through either, but I may be someday. I have shared with other pregnant moms what to look out for because so few people know the various symptoms that occur.  I think it was pretty brave of Marie to do this and I respect her a lot for it.

SRK: I feel that was a very brave choice that Marie made. I personally chose to share my story as a Warrior Mom and in a postpartum luncheon hosted by a local hospital. I feel that sharing my story benefits other women by giving them hope, and also is healing for me to say that this happened and it sucked but I am okay and so is my son.

AKP: Later in the chapter, Marie shares about all the responses she got from her appearance on Oprah. She describes them as unique, but with one thread of commonality: SHAME. While Marie’s experience and appearance on Oprah was many years ago, it seems that guilt and shame remain as the remnants and common “symptom” of having had a perinatal mood or anxiety disorder. Why was this true then, and more importantly why is it STILL the case?

LL: I think for most women the “maternal instinct” is a part of our identity, and when our experience doesn’t line up with our expectations of ourselves we feel deficient.

BR: I think there was and still is a significant cultural stigma connected to those who experience any kind of mental illness. Society sends some strong messages that suggest that mental illness is the result of some inherent flaw in the person who experiences it. Therefore, those with mental illnesses have been conditioned to hide their experience, and often that results in a lot of shame. This is changing, as we better understand all mental illnesses, understand that a significant number of our population experiences some form of mental illness, and as advocacy groups and individual survivors come forward to show what the true face of mental illness looks like.

SRK: When I shared my story I heard from so many moms that had had similar experiences but weren’t willing to be forthright about it. I feel that as more and more people share their experience with maternal mental illness we can erase the stigma and get the help we deserve.

AKP: Speaking of learning from the experience, on page 210 Marie says, “A wise person once told me this about difficulty: ‘Live through it. Learn from it. Move on.'” She says, “It’s really the only positive choice we have.” What are your thoughts about this quote?

BR: This is a sentiment I continue to contemplate. When I was in the midst of the most acute moments of my illness I just wanted to stop moving. I couldn’t see that I would get through it. But when I began to feel hope and set my sights on a brighter and healthier horizon I started to live by these words. When challenges come up in my life now I remind myself that it really isn’t a choice I want to make to just stop, and that if I keep my eyes on the future things will change, usually for the better. I have also gained such a great sense of strength in knowing that I am capable of moving through and learning from the struggles in my life, rather than just avoiding them or getting through them as fast as I can.

AJK:  It’s true. There is nothing to be gained by beating ourselves up over this happening to us. Or in feeling guilty about what was.

SRK:I feel similarly about my experience. I try not to dwell on the past and to move on. Nothing I can do will change what happened to new and there is no point in dwelling on it.

AKP: Question for all of you…how did Marie’s experience compare to yours? Was it similar or different? In what ways? What are your thoughts about the book in regard to how she tells her personal story?

BR: There were definitely a lot of differences in my experience, but the most familiar aspect of Marie’s experience was the urge to just run away. I didn’t actually run away but I definitely fantasized about getting in the car and just driving away from it all. I really appreciated her honesty in telling her story, and especially the connection she made with her mom. My mom was my biggest supporter through my experience, and part of that was because of reflections my mom shared about her own experience with her mental health, and what she knew about the experiences of women in our family from past generations. Knowing I came from a line of Warrior Moms gave me a sense of strength and belonging before I connected with the greater Postpartum Progress Warrior Moms community.

AJK: I guess mine was similar. And I relate to BR.  I wanted to run away and sort of did in little short bursts where I would drive or walk off and want to stay away (with people caring for my baby of course) and there were times I wanted to disappear, i.e., not exist, but I never became actually suicidal. I believed everyone, especially my daughter, would be better off without me! But I had an incredible support team in my husband, sister and mom (plus getting professional help).

I’m really glad Marie shared her story and I always appreciate it when people in the spotlight do so to try to help remove the stigma. I wish her husband had been a little less clueless-seeming. I mean, I get it, she was doing a lot of work to try to be sure NO ONE knew what was happening to her, but him just taking her word for it that she was okay so much of the time seems really ignorant to me and bothered me. I was angry for her. He left her alone so often for so long with all those kids and stressful situations too many times I felt! I don’t want to place blame but that bothered me and it saddened me for her that she couldn’t communicate her situation and needs better.

SRK: Yeah, one similarity that I thought was very interesting was her experience with her spouse. My husband and our relationship suffered because of my PPD. One large difference was her reliance on religion. I am not a religious person so it was hard for me to relate to her on this level.

AKP: While my experience was much different than Marie’s, I found this book to be helpful both times I read it.  I can’t exactly relate to her symptoms, her efforts to cover up her illness initially, or her running away, but I totally related to other pieces like her faith, her desire to disappear, and the confused support of her husband.  Regardless, I think that most books that are honest accounts of PPD, whether by celebrities or “everyday” moms are helpful and can be a component in the recovery process or healing later on for many survivors.  I am grateful to all of you for taking the time to read and talk about this book.  And I am excited for our next read, as well!

Next up in the Warrior Moms Book Club is Inconsolable by Marrit Ingham.  Please join the group, and begin reading if you would like to participate. You can reach out to me at atlantamom930 @ gmail . com.

~   Amber Koter-Puline, Warrior Moms Book Club