Chapter 16

Helping the One You Love: A Chapter for Family, Friends, and Partners

In This Chapter

Handling the diagnosis positively

Understanding that it’s not your fault

Taking care of yourself too

Staying kind no matter what happens

Showing your love through hands-on help

Saying the right things at the right times

Maybe you think your loved one hasn’t been acting like herself for a while now and you’ve been encouraging her to seek professional help. Or maybe you’re annoyed or angry with her for not responding to motherhood the way you or someone you know did or the way you think she ought to. Maybe you didn’t even believe that depression was an illness at all until now. And, finally, maybe you’re curious: You’re really happy with the new baby, so why isn’t she? After all, she’s the new mother — she should be the happiest of all. You may be asking yourself, “What’s wrong with her? Doesn’t she realize what a great blessing has come into her life?”

Lucky as she may be to have her new bundle of joy, a mom with a new baby may, in fact, realize the nature of that great blessing but may be completely and helplessly void of joy due to depression. But with the help of another blessing in her life — that is, you, her loved one — she can be set on the road to recovery much faster. The fact that you’ve picked up this book is a good sign for the new mom because even if this is the only chapter that you look at, you’ll get a good idea about what she’s likely feeling and thinking. And as you gain clarity about what she’s experiencing, you’re bound to be better motivated and equipped to help her get the support she needs.

In this chapter, I show you the best ways to support a woman who’s suffering from postpartum depression (PPD). I show you everything from knowing how to react to the diagnosis and how to handle the ups and downs, to staying kind throughout the ordeal (even if you are close to ripping your hair out).

In American culture and in other cultures as well, when a woman is quickly active again after delivery — maybe going to the gym, making meals, fitting into her pre-pregnancy clothes, and so on — she’s often complimented for her ability to adjust to motherhood. Sometimes she really is just adjusting well. But, sometimes it’s more than that. For instance, if at one or two weeks postpartum her house is immaculate, you may want to ask the new mom who’s cleaning her house. If she says she is, the new mom may not be sleeping (she may have insomnia so she’s cleaning instead) and may need some help. In other words, never assume from how it looks on the outside that she’s doing well on the inside.

Reacting in a Healthy, Helpful Way

If you’re reading this book, odds are that the time will come when you and your loved one have a one-on-one discussion (or maybe you already have) in which she clues you in on what she’s facing. Remember and heed this fact as you communicate with her: Everything you say and do will have an impact on her, whether she’s present or not. So, do your best to let good thoughts, encouraging actions, and respect and love be your guide. Before you even consider handling the details of working through this illness with her, think ahead so that you can determine how to best react to her and her PPD diagnosis. If you’re totally in the dark and you’re not quite sure how to react, don’t worry, the following sections give you some tips.

Showing your understanding and unconditional support

It’s critical for you to realize that your outward reaction to your loved one’s PPD diagnosis is important because it can affect both how she feels about herself and her ability to move firmly onto the path of recovery. Remember that she may be feeling ashamed and therefore worried about and vulnerable to possible judgment from those people she’s closest to.

You may feel the urge to offer your opinion, to go into judgment, or to criticize her, yourself, or the doctor who gave her the diagnosis. Hold all that in and wait until you understand more. Any sort of negative judgment on your part will only aggravate and exacerbate the bad feelings she already has about herself. Instead, simply say something like, “Interesting. It’s good to know this condition has a name. Thank you for telling me. As you learn more, I’d love to hear about it.” And give her lots of reassurance that she’ll get through this time just fine — support and reassurance is what she craves and needs.

Stay calm and be open to her sharing. Encourage her to talk, but don’t push her to do so. The more you listen in this way, the safer she’ll feel with you — and the safer she feels, the more open she’ll be. But, if she chooses not to share much, don’t take it personally. Her unwillingness to open up to you doesn’t mean you’re doing something wrong. She simply may be a private person in general, or just not ready to open up to anyone yet.

Acknowledging your difficult feelings

Your acknowledgment of any possible difficult feelings about depression in general or PPD in particular is hands down the most helpful thing you can do for your loved one. I don’t mean you necessarily need to talk about those feelings directly to the new mom — in fact, I don’t think that’s a good idea at all (unless it makes for an interesting discussion after you’ve worked those feelings through). You need to acknowledge them to yourself and be completely honest. If you’re struggling with accepting depression as an illness, for instance, you must accept it before you can be of real emotional support to the mom who’s suffering. Reading a few more sections of this book would be helpful to you. Also, consult a therapist for yourself if, for instance, you have some depression issues that are being inflamed due to the new mom’s PPD.

Keeping your lips sealed

You have to watch what you say about your loved one around other friends and family members. I can almost guarantee that anything negative you say — any knee-jerk reactions or judgments — will inevitably get back to her and make things even worse (this goes for all forms of communication, including e-mails). If you want her to get well as soon as possible, do whatever you have to do to keep your criticism to yourself (and your foot out of your mouth).

Information about your loved one’s PPD is private information and should be treated discreetly until she’s ready for others to know. Even if you’re sharing the information with others as a way to be caring and supportive, get her permission first (if possible) and be careful who you share with — you don’t want to undermine her trust in you. Sometimes she’ll want you to spread the word for her, but that, of course, is a different story. (Chapter 14 shows my tips for those moms who want loved ones to relay their messages.)

Getting Information if Depression Is Foreign to You

It’s easy to deny that depression exists if you’ve never been depressed yourself. Perhaps you’re from a family that doesn’t “believe in” depression. Or maybe you’ve always been told to “snap out of it” when you’re feeling blue.

The truth is that depressed people can’t just “snap out of it” any more than you can snap out of the flu. If this is your first encounter with depression, you’re likely to be frustrated, confused, perhaps scared, and somewhere between mostly and completely unprepared. So, here I give you some of the basics on what a mom is going through when she’s suffering from PPD.

For example, given the nature of PPD, try to regularly remind yourself that the new mom will probably be constantly experiencing a mixture of many confusing thoughts and feelings:

She may be relieved that she has a diagnosis, but she may also be embarrassed about that diagnosis.

She may be feeling weak or inadequate because she can’t cope with her daily life, yet grateful that she has you and others helping her.

She may be glad deep down that she has a baby, but she may also be afraid of taking care of it.

All of these conflicting emotions will often bombard her at the very same moment. PPD is known for tossing moods hither and thither, so your loved one probably doesn’t know how she’ll feel at any given time. Just remember, you don’t need to figure out every mood she’s having. You’re helping her just by showing patience with her ever-changing moods.

In order to be the best support you can be, you really need a good understanding of what your loved one is going through, and you should always try to put yourself in her shoes — not literally, of course, but enough so that her needs and the reasoning behind them are clear to you at any given moment. Give the new mom a break and familiarize yourself with the nature of PPD. You can refer other chapters or to the resources section at the back of this book for more information.

Sometimes making an appointment with a knowledgeable professional can be helpful for gathering information. Often the professional can give just the information that’s needed by a loved one trying to help. I believe that the more support and information the woman’s loved ones get (including psychological counseling or help from a support group for themselves), the better off the new mom is. In fact, I love it when family and friends call me to receive their own support, education about the disorder, or information about what will be helpful to the mom. When this happens, I immediately know that the woman whose loved ones are calling has people around her who care and who are doing whatever it takes to help her recover. I provide them with specific do’s and don’ts about helping her, and I explain what her reactions and comments probably mean so that they aren’t in the dark and guessing.

As PPD becomes less foreign to you, you’ll be able to remain more grounded and centered in the face of what the new mom is going through, and you’ll be more able to serve her as a valuable resource and ally.

Seeing but not comprehending: A sister’s outlook

From my sister, Karen Gelender:

“What I remember most clearly about my sister Shoshana’s early motherhood are actual conversations we had during her first pregnancy. During one interaction, she explained that because she was on the best diet and was doing all the best exercises, her labor was definitely going to be natural and easy. She was also convinced that she was going to just go on with her regular life after the baby’s birth, insisting that not much would need to change. (She mentioned a friend who had effortlessly taken her infant camping.) I remember warning her that things with babies don’t always turn out exactly as planned. But not wanting to undermine her confidence and optimism, I didn’t press the point.

I was present in the delivery room for Shoshana’s difficult labor and for the miraculous birth of my gorgeous niece. I also observed that my sister’s reactions to her newborn were very different than my own had been. However, I misinterpreted her early detachment as a kind of shocked reaction to things not going as perfectly as she thought they would. I thought that she’d soon adjust.

As weeks turned into months, however, I was puzzled to observe that my sister didn’t seem to be ‘in love’ with her baby daughter as I was with mine. She didn’t appear to be excited as Elana reached milestones. Sometimes, I found myself enthusiastically pointing out to my sister how beautiful, smart, strong, and sweet her baby was. Her responses usually ranged from mild agreement to slight surprise.

I had never heard of postpartum depression. I wish I had. I felt sad because my sister was missing out on some marvelous moments, but I tried not to be judgmental. Were we just different kinds of mothers?

When our mother and sister came to visit, they stayed in Shoshana’s home. They told me that things were ‘really bad’ with Elana and her mother and they claimed to have witnessed a coldness toward Elana that I had never seen. Even after their reports, I continued to see my sister’s parenting style as simply different from mine. In retrospect, I feel very guilty that I hadn’t recognized that something awful was eating away at my sister.

I wish I had persevered more. I wish I had gotten more involved. I wish I had seen what was really going on. I tried to be a support for little Elana, but I regret that I wasn’t a source of support for my sister during this incredibly painful time. I just didn’t know about postpartum depression. I had no idea what I was seeing, and I had no idea what to do about it. I must mention, though, that seeing the relationship between my sister and her daughter now, after years of effort, is a magnificent thing to behold.

Thickening Your Skin: Not Taking Things Personally

Unless you happen to be a saint, odds are that you’ll be defensive from time to time when you’re around your depressed loved one. The closer you are to her, the more likely it is that you may react negatively to her behavior. Because it’s your friend or loved one who’s suffering from PPD, it’s far too easy to assume that what she says, doesn’t say, does, or doesn’t do, somehow has something to do with you. However, take the negativity with a grain of salt, and by all means, don’t take it personally. And, read on because the following sections give you tips on how to best deal with your depressed loved one.

The negative actions or reactions aren’t about you!

You may be the suffering woman’s nearest and dearest, but you absolutely must keep this point in mind at all times: Her PPD is about her, not you. For instance, if she acts antisocial — which is very likely — remember that she isn’t trying to attack you, make you unhappy, or push you away. It’s the PPD — not the way she feels about you — that’s making her withdraw socially.

So, don’t be offended if she doesn’t answer your phone calls or e-mails, gets irritated at the littlest things, or forgets your birthday. Instead of taking her strange behaviors as insults, remind yourself that you’re important to her, and that she’s probably just so overwhelmed that even the tiniest of tasks are now difficult for her.

It’s important that you not react negatively to her lack of communication. If you write ten e-mails or make five phone calls criticizing her for not returning your communication, you’ll only worsen her depression, because she’s no doubt already worried and feeling guilty that your feelings (and the feelings of others) are being hurt. So, reassure her that you aren’t judging her and that you stand behind her 100 percent. You can say something like, “I know you’re having a really tough time right now. I love you, and I want you to know I’m here for you. When you’re up to it, give me a buzz. I’ll be here when you’re ready.”

You aren’t the trigger (or the fixer) of your loved one’s PPD

Friends and family members (especially partners) often tell me that they feel responsible for the new mom’s PPD, that somehow they should’ve been able to protect her from it — or at least fix it after it happens. For her sake, not just your own, you need to know that you didn’t cause her PPD and you can’t take it away. This situation isn’t like a broken hinge on a door. In a half hour you can’t just find the tools, fix the door, and that’s that.

It doesn’t help that some women often outwardly blame their friends and family for their PPD. Just remember, in general, people are rational beings, so they try to make sense of the irrational way their minds are behaving with PPD. It’s easy to blame the ones closest to them, which makes it difficult for you not to take on the blame. But, it’s imperative — for her and for you — that you not take it on.

However, if you’ve been unsupportive in the past for whatever reason, you may have contributed to her depression — but you still didn’t cause it. And even if this were the case, by reading this book and following the suggestions I’ve outlined, you’re demonstrating an active and positive change in your attitude and behavior.

Always keep these two important truths in mind:

No one is responsible for causing PPD. Many friends and family members tend to believe that if they had done something differently — been a better friend or partner or insisted that she eat differently or exercise more or less during her pregnancy — the PPD wouldn’t have happened.

A husband recently told me, “I must not be doing something right. Maybe I caused her depression. She’s not happy with me.” If you feel this way, keep in mind that, even though sometimes you may need to change some things about your behavior toward her, you didn’t cause this. Much of what she’s undergoing is biochemical, and your job is simply to support her as she recovers. Recriminations about what went on in the past aren’t going to make a bit of difference in helping her recover. In fact, they can actually get in the way.

You can’t make her depression go away. Her recovery is an ongoing process (see Part III for treatment options), and your ongoing support during this process is critical. So, if you feel the “fix it” response arising, simply channel that desire and energy into your willingness and ability to provide whatever kind of support she needs — watching the baby, cooking, being around to listen, and so on.

Caring for Yourself . . .

To be the best supporters they can be, many of those people closest to a new mom suffering from PPD need some support of their own. Especially if you’re the main — or one of the main — support people, make sure to get whatever help you need for yourself. Calling the mom’s therapist and asking for a referral is my top suggestion. Or sometimes just being able to speak openly to a close friend is enough. If you don’t, however, you won’t be able to support the new mom as fully as possible. Remember, even if she always has been before, the new mom obviously can’t be your support person right now. Instead, all her energy needs to be directed toward healing herself.

. . . to benefit her

Ultimately, the new mom needs to know that you, a major pillar of support, are getting support for yourself and aren’t being debilitated by your constant caring for her. Unless she knows you’re well and being taken care of, she’ll be concerned that she’s burning you out, that you’re getting sick of her and the situation, and that you’re thinking of leaving for good. You know that you wouldn’t ever get sick of her and leave, and you may assume that she would never think that you would, but in her current state of feeling weak, dependent, and unworthy, she needs your reassurance. So, follow these guidelines:

Communicate the truth to her. Tell her what you’re doing for yourself to make sure that you don’t burn out or fall apart.

Be honest and tell her if you do need a break from helping her. By being honest, she’ll then know for sure that she can trust you and she won’t have to guess if you’re okay.

If your main job, for instance, is to be on duty every afternoon for two hours, and you need a couple of days off, line someone else up for those days so that you can get your break (just make sure that she’s comfortable with the person you choose).

Reassure her that you’ll see her through this illness, just like she would see you through one that you were having.

When you’re visiting her in person, make sure that she doesn’t end up taking care of you — especially if in the past she typically had the role of care taker. For example, if she tries to serve you, insist that she sit down and let you do the work.

. . . to benefit you

It’s a commonly recognized phenomenon that when partners don’t get the appropriate help for themselves while holding down the fort, they often get depressed too — either during the PPD or as the moms get better. For example, my colleagues and I have noticed that when partners take on the stress of their jobs, take care of their partners and children when they get home, and finish much or all of the household chores without allowing some relaxing and recharging time for themselves, they can fall apart during or later.

It’s easy to avoid this trap — just take time for yourself and get the proper support, including professional support, if you’re under severe stress. Men, especially, aren’t used to being given permission to talk about feelings or to get help, and some men think it’s wimpy and weak to accept help. So, if you’re one these men, get over it. Do your family a huge favor and get the help you need now.

As a key source of support for your loved one, now’s the time to cash in some chips with old friends to ensure that you’re being lifted up as well. Let them know what’s going on and that you need their support to help you through this so you can give the new mom everything she needs. A simple discussion will help, especially if you’re new to depression in general. As you talk to people you trust and unload your feelings, you’ll find that taking care of everything becomes easier and that you have more energy to help the new mom through her challenges.

Only share information about the new mom that others need to know in order to help you. For instance, to understand your frustration, your support people may need to know generally how unpredictable her moods are, but they probably won’t need detailed information about what medication she’s taking and at what dose. Be respectful and present what’s going on with her in an enlightened, nonjudgmental, and noncritical way.

Keeping Kindness in Your Countenance

If you know someone who’s struggling with PPD, it’s important that you acknowledge the effects of this illness, both emotional and physical. You’re likely to see your loved one endure a substantial drop in energy, frequent aches and pains, and the inability to cope with simple physical tasks, such as getting a bowl of cereal (let alone addressing the needs of a newborn). How, then, do you act around that person without crushing the eggshells you’re walking on? The following sections show you how.

Continually caring even when you’re frustrated

According to general principles of law, if you see someone in an emergency — you aren’t obligated to save them. But after you do get involved, you’re obligated to see the rescue through all the way to the end. The same applies to seeing your loved one through her PPD: If you’re her partner or a close family member, you’ve committed (even if not verbally) to being her ultimate support; if you’re her friend and you decide to get involved, be prepared to see her through to recovery, regardless of how long it may take or how frustrating it may become.

Even though you love this suffering woman and always want to be there to support her, the effort of trying to figure out what she needs can make you go crazy, because much of the time she doesn’t know what she needs either — she just knows she feels awful.

If you’re her partner, you face that helpless feeling day in and day out. So, it may help your frustration, sadness, or worry if you accompany her to one of her therapy or doctor’s appointments so you have a chance to ask questions, vent concerns, and stay informed as to what she needs.

If you’re a friend of a woman with PPD, you’re in a unique position — you can help her in ways that are beyond even what her partner can do. For one, if she needs to vent or wants suggestions about how to handle her home life, you may be able to lend an objective ear. You also may know more of her friends than her partner does, so organizing a meal “help wagon” or a team of babysitters for a couple of weeks could be extremely constructive.

Suppose you get tired or frustrated as the days, weeks, or sometimes months of supporting her go on (you should assume that at some point you’ll feel as if you’ve reached your limit). In addition to calling on your own support systems (see the “Caring for Yourself . . .” section earlier in this chapter), remember that her “best” will keep getting better as time goes on.

When she dips, instead of expressing your frustration or otherwise negatively coming down on her, reassure her that you understand that she’s coping the best she can right now (see Chapter 11 for more info on dips). Every time you don’t react negatively, but instead turn it around and express your unconditional support, you make her full recovery that much easier. Make a point to do something nice for her at the very moment when you feel like giving up. It will change your mindset back to the positive, and will help her at the same time.

Holding closely the virtue of patience

The flip side of not becoming frustrated is knowing how to cultivate patience. Living with PPD is a difficult situation, and you’re not going to be perfect in your deliverance of support, just like the new mom won’t always be perfect in the way she receives your support. So, having patience can help you both make it through to recovery.

If you tend to react quickly to things when they don’t turn out the way you expect them to, try to focus on the positive in whatever situation you find yourself. And if you tend to speak too quickly when you’re angry and later regret what you’ve said, practice counting to ten before you speak. Deep breathing can work wonders as well. Taking ten deep breaths when you’re stressed can have a surprisingly positive effect on your mental outlook under almost any circumstances (it sounds simplistic, but it really works). In addition to those two suggestions, here are a few more:

Let her know (nicely) that you need a break and go outside or into another room.

Take the baby for a walk.

Direct your energy toward a task you’ve been wanting to tackle.

Repeat to yourself, “We’ll get through this. The PPD is temporary and she’s recovering. I’m doing a great job supporting her.”

It’s especially important that you have patience with respect to the mom’s willingness to share what’s going on with her. She’s probably embarrassed and confused, among the many other emotions she’s feeling, and she may not feel like talking much with anyone. Respect this and have patience, but don’t take it personally. Simply accepting your support may be a big step for her already.

Radiating optimism and hope

A mom with PPD may be lacking or incapable of generating something that you, as supporting loved one, can endlessly provide: A positive attitude that radiates optimism and hope. Like yawning, a positive attitude is usually catchy. Clinical depression and anxiety, however, tend to filter out the contagious aspect for anything positive, so don’t be too disappointed if she doesn’t immediately “catch” your mood.

There’s a fine balance between being positive and being over-the-top happy, and it can get confusing for both of you. If you’re too exuberant and cheerful, you may actually annoy the depressed mom. So, just be positive and upbeat, and understand that for the most part, even if you can’t see the positive rub off, she appreciates being around your uplifting mood. If she reacts negatively, on the other hand, you’ve probably crossed the line. You don’t need to change your behavior — don’t squelch your enthusiasm for life — just understand that she may need to distance herself for the moment. The truth is that she’s probably envious and wants so much to enjoy life again like you do.

Even if you don’t feel particularly happy or optimistic on any given day or you feel bummed out that your friend or family member has PPD, it’s still your job to act as positively as possible. Think of it as part of your long-term caring commitment to your friend, family member, or partner.

For instance, personal growth seminars, books, and CDs often teach people to pretend or to “fake it until you make it.” The same applies in your experience with PPD: Regardless of how you feel on a particular day before spending time with the new mom, make up your mind ahead of time that you’re going to be positive. As your attitude has a positive effect on the new mom, you’ll likely begin to feel better as well.

You’re allowed to have a bad day. Simply make sure you check your anxiety at the front door. Do tell her about your day — she knows you well enough to know when you’re having a difficult time — but do it without spilling the worry onto her. It’s a delicate balance between sharing information and spewing anxiety and negativity. On the other hand, don’t try to protect her, thinking that her depression will worsen if you tell her what’s happening. Her imagination about what’s going on is usually worse than the reality anyhow. Just make sure that if you have an anxiety-producing situation that you get outside support (and tell the suffering mom that you’re getting it for yourself). Most importantly, don’t expect the guidance from her, or she’ll take on the worry.

Putting Your Love into Action

You care deeply about the mom with PPD, and now you’re thinking positively about her recovery and feeling good about your role. But that’s not enough. There are a few more specific points that, when put into action, can make the remaining recovery time and your ongoing relationship even stronger.

No matter what your relation is to a PPD sufferer, you need to keep two important principles in mind as you walk with her to recovery:

Support her choices. What she craves hearing from you is that you’ll support whatever actions she feels she needs to take (within reason) in order to recover.

If you’re attacked unfairly, stand up for yourself. PPD often shows itself with short tempers and anger. If you’re being pounced on irrationally or unfairly, you’ll be doing yourself, your relationship, and the new mom a favor by calmly but firmly standing up for yourself.

Don’t yell back at her or be critical. Just say something like, “I don’t think I deserved that. When you can talk to me with respect, I’ll be glad to listen.” Or, “I’m sorry you’re having a difficult time. The PPD is not your fault or mine. If you know what you need right now, tell me and I’ll help you.” Walk out of the room, if necessary, letting her know that when she calms down, you’ll be glad to talk.

Listening without trying to fix her (or her problems)

If you haven’t already, give up the “fix-it quick” mentality — she’s not broken and she can’t be “fixed” with the flip of a switch. As a support person, you have to develop your ability to listen to her without offering advice, or otherwise trying to fix her. If she asks for advice, feel free to give it to her (if you can). But, remember, often a great deal of healing happens in the simple act of her talking and you listening. Allow yourself to believe (because it’s true) that you’re accomplishing a great deal just by sitting there and listening. On the deepest level, she just wants to know that you’re tuned in to her, that you’re there to support her without any judgment on your part, and that you love her.

When you do get together, invite her to talk, if she’s open to it. Let her choose the topic, and don’t offer your opinions or suggestions unless she asks for them. Sometimes she may want you to do the talking, however, so ask her if she prefers to talk about her PPD experience or would rather be distracted from it.

Moms with PPD get sick and tired of what’s going on in their heads, and they sometimes feel they can’t escape from their thoughts. So, offer her a distraction if she wants one, and talk about normal adult stuff that has nothing to do with PPD, her situation, babies, or mommyhood.

Providing the partner support she needs

If you’re the depressed new mom’s partner, you obviously play a special role that no one else can. In particular, the following types of support are those that only you can provide:

Back her up in her decision making. If she needs to see various practitioners, take medication, join a PPD support group, stop breastfeeding, or whatever else, she needs to know you’re behind her 100 percent. You can certainly participate in the decision-making process, but the decisions themselves should ultimately be hers.

It can be helpful for you to accompany her to a therapy or doctor’s appointment so you can ask any questions you may have regarding her treatment. As a therapist, I find the partner’s attendance useful and I encourage it at least once. My client is always relieved to know that her partner is getting support and now understands more about her situation and the illness.

Show her you’re a willing caretaker of your house and child. She may think that all the housework and childcare is her job. New mothers, especially stay-at-home moms, often think this way. With PPD, she takes on an extra layer of guilt if she can’t do it all.

Start out by setting her straight and telling her that it’s your home and child too, and that she can rely on you to do your part. By sharing the duties, you’ll end up bonding much more with your child, and your marriage will be strengthened as well. Everyone wins (and you get a cleaner house, too).

Don’t mention how much her care costs. She’s already feeling guilty about what she’s costing the family, both emotionally and financially.

You’re talking about your partner’s mental health — without it, nothing else matters. During PPD recovery couples use up savings and take out loans — consider it an investment in launching your new family in a healthy way. Be open to doing (and spending) whatever it takes to get her the right, specialized help, not just whoever is covered by the insurance plan.

Take over for half the night. Like everyone else, a new mom needs at least five to six straight hours of sleep per night (it’s not enough, but this many hours at least allows for a sleep cycle).

Let her know that you recognize that she’s working hard too, and that you know she needs her sleep. (Take a look at Chapter 11, which shows you an in-depth discussion on how splitting the night can work, even if she’s nursing and you need to leave the house early for work.) Reassure her that you, too, should have bags under your eyes. You may both be tired, but at least you’ll be a matched set!

Practice the work/life balance. You’ve probably read your employee handbook at work about your company’s work/life balance program. Well, now’s the time to make it work for you. Tell your manager what’s going on at home, that you need to leave work every evening on time, and that you can’t take extended business trips for the foreseeable future.

You may see this practice as career suicide, but it isn’t. Many of my clients’ spouses and partners have taken parental leave, and have made the effort to be at home on time every night during this difficult period. Federal law provides husbands job-protected time off from work following the birth of a baby or to care for a seriously ill spouse. If you’re a domestic partner, it depends on the state in which you live whether or not you’ll be covered.

If necessary, go ahead and move off the corporate fast track to help your partner recover. Your physical presence to her is more important than the next promotion, and years from now, when you look back on your life, you’ll never regret having chosen family over work. I hear over and over from my clients that they don’t care about the big house (with the big mortgage). They just want their partners at home. So, if you’re thinking that it’s for her and your kids that you’re working long hours, traveling, and so forth, you may want to ask her what she thinks — you may be surprised.

Maintain intimacy. As you and your partner walk the road to recovery, it’s important to maintain intimacy, even if it’s (for now) void of any sexual activity. You may be rolling your eyes with the thought of “just cuddling.” After all, what’s the point of cuddling if it doesn’t lead to anything? But for her, just being close to you and being held by you is comforting and healing. She may also have some physical healing to do following the birth process. Just remember not to take her lack of interest in sex personally. This isn’t a rejection of you — it’s mainly about hormones, brain chemicals, and life changes.

If you’re the one returning from work at the end of the day, make sure you greet her first, before you greet any other member of the family (including furry, four-legged ones). The relationship with her is the most important one and without it, no other little person would be there (see Chapter 15 for these and other sex and intimacy issues).

Lending a helping hand

Ultimately, talk is cheap. In other words, it’s the physical actions you take to support the new mom that will get noticed — they’ll signal to her how much you care for her. Few things are appreciated more than a helping hand. Of course, you don’t want to overcommit yourself, but you do want to do whatever is reasonably within your limits and capacities to make her life easier right now.

The kinds of help that you can and should offer differ depending on your relationship with the new mom, but in any case your actions make a tremendous difference to her and her recovery. Here are just some of the many actions that you can take:

Be proactive. Don’t wait for a mom with PPD to ask for your help — you may find yourself waiting for a very long time. Remember that she’s probably feeling inadequate, embarrassed, or ashamed, and that asking for help in such a state can be difficult. Instead, call her and ask if you can do something for her. Ask her what she wants you to do. If she has a difficult time telling you or even knowing what she wants, ask her partner, if she has one, for suggestions.

Baby-sit. Take care of her baby for a couple of hours, or come over and be on duty with the baby while she naps, goes out, or talks with you. If she has an older child, invite that child over to your house, or offer to drive him or her to school. If you have children, consider having your kids play with hers at your house or at the park.

Organize her support network. As part of her social circle, you may know more of her friends and social acquaintances than her family members do. You’re therefore in a perfect spot to pull these friends and acquaintances together and create a support squad for her. You can organize who’s bringing dinner when, who’s driving her older children to school or daycare, who’s calling her on what day to check in with her, who’s coming over to keep her company. If you aren’t good at organizing this kind of schedule, you can figure out which one of her friends is good at it, and you can delegate.

Give her gifts (for herself, not the baby). Gifts for the mom (such as a massage) or for the couple (such as money for dinner out and babysitting) can be much more helpful than more gifts for the baby. It’s the mother who needs the extra nurturing right now — typically, the baby will already be getting tons of attention, clothes, and toys.

Here are some gift suggestions (some not requiring money) that you can give or pass on to others:

• Babysitting (or paying for a babysitter)

• Watching the older kids

• Cooking

• Bringing food

• Shopping

• Taking over at night

• Cleaning

• Doing other chores

• Hiring (and paying for) a housekeeper

If you’re bringing a gift in addition to your smiling face and heartfelt energy, make sure not to bring her anything that ultimately causes her more work. For example, don’t bring flowers or other plants that need watering (unless of course she has specifically requested these items). I remember giving away all of my plants — and even my pets — after I came home from the hospital. I could barely take care of myself and my baby, let alone the so-called calming bonsai tree. Just the thought of other living things being dependent on me for their lives — even if they sat in potting soil near my sink — made my anxiety shoot out through the top of my head. It was just way too much to handle.

Encouraging healthy habits

Someone who’s depressed and overwhelmed may very well fall prey to preexisting or new bad habits. At the same time, many of their good habits — such as eating well and exercising — may fall away partially or entirely. This cruel irony is important to consider because right now those good habits are necessary and the bad habits are harmful.

Take exercise as an example. If you know her “real” self loves taking walks, offer to be her exercise buddy. If she resists, ask her if it would help if you came over and helped her get ready (for example, depending on her level of functioning, she may need anything from you coming over to prod her a bit to you actually helping her physically get dressed). She just might say yes. If she says that she really isn’t up to walking yet, don’t bug her. Just remember that you reserve the right to ask her again in a few days or weeks.

The same thing goes for all activities. If you think it may be something that she’d enjoy, encourage her to do it. Sometimes it just takes a little nudge for her to decide to muster the energy it takes for her to do the activity. Just make sure you stay on the inviting and encouraging side of the line and don’t cross over into anything that’s annoying and nagging. If she says it’s too much for her right now, respect that.

Regarding her nutrition, which is a vital part of balancing brain chemistry (see Chapter 12), be consistent and inviting, not judgmental or pushy. Follow these guidelines to help her with healthy eating habits:

If you bring food over, make sure it’s as healthful as possible. For example, bring turkey, chicken, nuts, or cut up veggies or fruit. Bringing sugary foods will not help her — they’ll only make her blood sugar levels spike and crash, which won’t help her PPD.

While you’re with her, make sure that you model for her what it’s like to drink plenty of water.

If you’re having a meal out together, order wisely and go light on (or avoid) things like white bread, fried food, caffeine, sugar, and alcohol. If she’s taking an antidepressant or antianxiety medication, she should avoid alcohol. Caffeine should also be avoided, especially if she has any anxiety or insomnia. You aren’t her police officer, but it would be easier for her to resist these things if you’re ordering more healthfully for yourself.

Even when you aren’t with her, consider stepping up the healthfulness of your own lifestyle as a way of strengthening yourself so you can provide her (and yourself) with more energy and support. The mom with PPD can use this difficult time as an opportunity for growth — and so can you.

Referring her to helpful resources

Another way of lending a hand is for you to do the research and other legwork necessary for the new mom to access the spectrum of resources that are available to help her. There are written resources, such as this book, and electronic sources, such as the Internet, which can be a vast gold mine of resources, especially concerning alternative and complementary health options (see Chapter 9). The Internet, by the way, is only for your use — not hers. Anxiety can easily be worsened by the Internet, so you can filter the information and share only what’s positive and helpful. Be willing to check out these resources and make the calls for her (even book the appointments for her, if she wants you to).

In addition, you can help the new mom by finding appropriate support groups and professional assistance for her. The woman herself may be so depressed or overwhelmed that she isn’t capable of seeking out and making a determination with respect to groups, therapists, or doctors. You can make the initial inquiries for her, and then help her make decisions as to which support options to go with. As a therapist, I have received hundreds of calls just like this from wonderful friends and family members of women with PPD. I smile to myself when I get these calls, because I know the woman will recover much better with this kind of a support system paving the way. To help out even further, you can drive the new mom to her appointment or you can watch her children while she’s at the appointment.

When PPD Escalates: Recognizing the Warning Signs of Suicide

If your loved one starts exhibiting any of the behaviors listed below, stay with her or make sure someone is watching her at every second — including in the bathroom — until she’s seen by a doctor (which should happen immediately) and becomes more stable (which may take days or weeks). Most of these signs are warning behaviors of suicide, and the last two bullets may also indicate psychosis (see Chapter 3):

Saying things like, “I’m a burden to my family and they’d be better off without me.”

Putting herself in dangerous situations.

Talking about or showing interest in death quite often.

Avoiding all social contact.

Feeling hopeless most of the time.

Talking about strange things that don’t make rational sense.

Talking about hurting herself or the baby.

If you feel she or the baby is in imminent danger, call 911 or another emergency number even if she doesn’t want you to. Having her mad at you (but your family safe) is much better than the alternative.

Practicing Sensitivity: Knowing What’s Okay and Not Okay to Say

Given the nature of PPD, what you say and don’t say to your friend, family member, or partner, can make a huge difference in your interactions with her. If you’re really there to help, you need to vigilantly practice sensitivity and cultivate a strong internal sense of what is and isn’t okay to say out loud.

As a starting point, try putting yourself in her shoes — imagine that you feel depressed, overwhelmed, and anxious and that you have a new baby to care for — and then decide whether what you’re about to say will likely help the situation or make it worse. Practicing self-censorship is highly advisable when talking to a woman suffering from PPD.

Most importantly, don’t approach her directly until you can do it with no judgment. She’ll probably be sensitive to your comments, so even an implied criticism could damage your long-term relationship and otherwise set her recovery back.

Leaving constructive criticism by the wayside

Most new moms, depressed or not, tend to be sensitive to criticism. So, when you add in PPD, new moms are often even more sensitive, which means you need to be particularly careful that you say only positive things to her. Praise her as often as you can, and keep criticism to yourself, even if you feel it’s justified. Consider the following sets of statements as an example of staying positive with the new mom:

DO say: “I love the way you hold your baby — just like a pro.”

DO NOT say: “The way I always held my baby was like this.”

As a general rule, unless a new mom (with or without PPD) asks for suggestions, don’t offer any. And even if she does ask for suggestions, you can offer them without putting her method down. Remember that with PPD, she will often doubt her worthiness as a mother and even as a person. She has enough dragging her down, so you should try to build her up whenever possible.

Lauding her efforts

PPD isn’t a disorder that you somehow contract by wandering around the house with nothing to do. Being extra busy can sometimes distract the mom from feeling her depression, but it certainly won’t help her avoid the reality of her condition for very long. Acknowledge her for what she has been able to do, however little it may seem to you, and soon enough she’ll be able to do more. Check out the following set of statements that show you how to best acknowledge a mother’s efforts:

DO say: “This is a lot to deal with, and you’re doing such a good job.”

DO NOT say: “I never had time to be depressed.”

Keeping her stress under wraps

PPD may make a new mom feel like she’s all alone and having to face an impossible burden by herself. Using the word “we” can help alleviate that feeling and give her the strength to go on. For example, consider these do’s and don’ts:

DO say: “We’ll get through this together.”

DO NOT say: “I can’t take this much longer.”

Steering clear of mentioning her shortfalls

Reminding your loved one that PPD is temporary can be very healing. Hopelessness is caused by losing the faith that the suffering will eventually end. However, be careful when you talk about bringing a new mom’s “old self” back. For example, consider these two statements:

DO say: “I know you miss the old you. I miss her too, but I know you’ll get yourself back.”

DO NOT say: “Boy, I liked the old you a lot better. When is she coming back?”

The previous “do not say” statement refers to her “old self” in a critical way that puts the burden on her to somehow bring herself back — like somehow she’s in control of the PPD. Using this statement also increases her worry that you’ll get sick of her and leave because she’s a burden and is unlovable. Instead, by simply affirming that she’ll be back to her old self at some point soon, the new mom will feel relief and hope.

Remember also that she may be doubtful of her worth as a person, a woman, and a mother. The more you compliment her mothering, the more secure she’ll feel about herself. Even if she’s not physically able to do much of the childcare, you can always find ways to compliment her. For example, if she’s hospitalized, and she has expressed concern about who’s taking care of the children, her concern shows that she’s a good mom, so you can truthfully tell her that she is. Take a look at these statements:

DO say: “You’re such a good mom.”

DO NOT say: “Once the PPD is over, you’ll be a great mom.”

The person who said the previous “do not say” statement probably meant well, but he or she has inadvertently implied that the woman isn’t a good mother now.

PPD from a dad’s-eye view

The following excerpt of my first bout with PPD was written by Henry, my husband of 25 years. Keep in mind that our first baby, Elana, was born in 1983, long before PPD was recognized in this country. It was about a year after our son Aaron was born in 1987 that PPD started to be officially recognized in the United States. Henry writes:

“My wife was gone. I could see it in her eyes the instant our daughter was born. She was holding her and smiling for the camera, but the smile was fake. I could tell. Her smile, the real one, didn’t come back for over two years. During that time, the happiest in my life, my wife suffered from a disease with no name. We knew something was wrong, but we didn’t know what it was, what to do, or what to say.

Everything we did was wrong. Her obstetrician told her to take a cruise and buy a new dress. My mother, a mother of five and a postpartum nurse for over 30 years, said Shosh wasn’t ready to be a mother. I came from a ‘just snap out of it’ family, where you took control of your own sadness. That approach didn’t work here.

Every night I came home from work, I was greeted with a smiling baby and a wife in tears. She handed me the baby and left the house. The house was a disaster: No food, clutter everywhere, dirty laundry on the floor, and dishes piled up in the sink. It was chaos. On weekends, when I suggested family outings, she grudgingly went along, but I knew she didn’t enjoy them.

I thought that if we acted like a normal family, she’d just snap out of it. Boy was I wrong. Family gatherings were abysmal. My wife was a good actress, and smiled her way through, but I knew it was just for show. Driving home, I just got more tears, more ‘I hate this Mom stuff,’ and more despair about losing the life she once had and hating the life she had now. I knew telling her to shut up wasn’t the right thing to say, but that’s what came to mind.

I loved my new life as a dad — it was hard work, but the best work ever. I tried not to let my wife’s misery affect me, but I’m not as good an actor as my wife. I couldn’t keep it bottled up any longer. I finally had to tell someone what was really going on at home. I confided in a trusted colleague at work and an old friend. Neither had ever heard of such a thing, but I felt better talking it out and getting their sympathy and support. Unfortunately, it didn’t end the misery at home.

I focused my attention on my daughter, giving her the eye contact, hugs, and love she needed. I wasn’t going to let my wife’s behavior affect her. My wife would eventually come around — or so I hoped.

A miracle finally happened. My wife recovered and began enjoying life again, and she finally enjoyed being a mother. Only after the birth of our second child and another year of pain did we learn what she was suffering from. It was a real illness that had a name and a treatment.”

Making her sure of your loyalty

A mom with PPD may be feeling like “damaged goods,” wondering if you regret being her friend or marrying her. To reassure her, make sure you tell her often that you love her, just as she is. And avoid statements that try and force her to get better (which is impossible and only increases pressure and stress):

DO say: “I love you.”

DO NOT say: “I’ll probably feel a lot better about our relationship when you get better.”

By showing up physically to help, and then verbally reaffirming that you’re committed to helping the mom as much as you can, you’re telling her how important she is and how much you love her. Give her a reminder that even though you can’t fix the illness, you can give her hugs and reassurance, and you can share the physical responsibilities of caring for the home and the children. For example:

DO say: “I can’t take the PPD away, but I’m here, and I’ll do everything I can to help.”

DO NOT say: “No matter what I do, it’s always wrong. I give up.”