Chapter 4

Looking Within: Is PPD Your Big Bad Wolf?

In This Chapter

Understanding your emotions

Considering your self-talk and dark thoughts

Knowing the physical signs of PPD

Assessing yourself with a self-screening test

Discovering your professional help options

Obviously, if you’re feeling depressed, you want to feel like yourself again as quickly as possible. The first step is to be clear about what you’re dealing with. The quicker you’re able to identify how you’re feeling both emotionally and physically, the easier it will be to outline a plan of recovery.

Postpartum depression (PPD) fogs your thinking and makes it difficult to find clarity in anything, especially these new emotions you’re feeling. So, I’ve written this chapter to help you pinpoint what you’re experiencing. When you understand what you’re experiencing, you’re then able to clue in your support people as to what help you need. Because you’ll be able to put words to and describe your thoughts and feelings, the professionals on your treatment team will also have more of the necessary information to best help you psychologically and physically.

Facing the Beast Head-On: Tuning In to Your Emotions

Some women are crystal (and painfully) clear about what they’re thinking when they have PPD. If you’re one of these women, great. If you’re already aware and honest about what’s filling your mind, then you’re one step closer to being able to change those disempowering thoughts to empowering ones. If, on the other hand, your thoughts and feelings are all jumbled together in what feels like one big mess, you’ve joined the majority of women with PPD. A good therapist can help you disentangle the mass of put-downs, guilt, and other negativity so that you can finally tune in to the thoughts behind the emotions and change them (see Chapter 6 for more on finding a good therapist).

To help yourself tap into your emotions, say what you’re thinking or feeling out loud. If you’re more than mildly depressed, though, wait until you’re with a therapist. Don’t worry about sounding coherent, just start talking and trying to express your emotions. Pretty soon you’ll start hearing your own voice articulating some difficult and complicated feelings, which may surprise you. The reactions of my clients when they start voicing their pain range greatly. Some women cry from relief that, finally, even though the act was uncomfortable, they not only acknowledged their feelings to themselves but also expressed them to someone else (me). Other women cry with despair because they’re not sure they’ll ever get out of the deep hole they feel they’re in. And still others find themselves giggling at the absurdity of their depressed or anxious thoughts.

As you begin to tap into your emotions, assess whether you’re having any of the following feelings (if you do, consider them signs of a possible bout with PPD):

You feel guilty a lot, have low self-esteem, and are self-critical. New moms in general tend to doubt themselves, but if you’re feeling bad about yourself, are quick to feel guilty, and tend to put yourself down, you’ve crossed the line.

You feel sad a lot of the time. If you’re generally not feeling like yourself and you’re sad more often than not, this behavior is a signal that you need to make an appointment with a professional. However, if you’re just mildly sad off and on, but it doesn’t get in the way of your day and the sadness is gone by the third week postpartum, this behavior is normal.

You have scary thoughts. Scary thoughts can entail anything that’s disturbing to you, and they therefore vary quite a bit. Many women with PPD report that their scary thoughts focus on the subject of not getting well and needing to be hospitalized forever. However, the most obvious thoughts that need attention are thoughts of harming yourself or your children. Having scary thoughts about harm coming to you or your children doesn’t necessarily mean anyone is in danger. For example, the thoughts that often accompany postpartum OCD are frightening but not dangerous (see Chapter 3 for the details on that disorder), but you definitely need a thorough evaluation. The important differences between the kind of thoughts that are emergencies and the kind that aren’t are also discussed in Chapter 3.

You lose your temper frequently and easily and feel anger or rage. Sometimes PPD shows up more as anger than classic sadness. If you’re snapping a lot at little or big people, or if you fill with rage for any reason, consider this a warning sign.

You feel easily overwhelmed. If even the smallest tasks, such as washing dishes, paying bills, or making phone calls, are too much for you to bear, your blues are probably more serious than the average downer days. When the brain chemical serotonin is low, which is most often the case with PPD, overwhelm occurs. Overwhelm can feel puzzling and frustrating when the same tasks that used to be no big deal suddenly feel too complicated and difficult to handle.

You feel hopeless. Hopelessness comes when a person is very depressed. If you’re having thoughts that you’ll never recover, that life’s not worth it, or anything that comes close to those, get help immediately.

You worry excessively. New mothers are an anxious bunch, but typically the worry doesn’t take over the day. If you’re having trouble turning off your mind, if the littlest things bother you more than you think they should, or if you start obsessing over anything and everything, please seek help. (I’m not listing typical worries, such as health problems of the baby, because you might add them to your “worry list” if they’re not already there.)

You have difficulty making decisions. If the normal myriad of daily no-big-deal decisions seems to have become more complicated, pay attention what’s going on with you. What to wear, whether to drive or walk, which item to buy — all of these can be debilitating with PPD.

If I was able to get to the grocery store at all during the worst of my PPD, it would take me at least four hours to mobilize — organizing my thoughts and putting them into actions seemed close to impossible. I remember one time catching myself standing in front of the produce section staring at the fruit. I was just standing there staring. I literally couldn’t make up my mind on what to buy. It was a surreal experience. I was standing outside myself watching this woman, me, who I used to know, and was thinking, “What’s my problem? I have a master’s degree and two teaching credentials and I can’t decide whether to buy apples or pears?!” This situation for me was simultaneously ridiculous and tragic. At that time, I was unable to find any humor in the situation. You can access humor only when you’re clear that the condition is just temporary. At that time, I knew no such thing. I thought that this was the new me and that I had lost myself forever. Now, looking back, I can see the funny parts because I have the perspective. I know now that I would be able to live through it.

Because PPD clouds your judgment while you’re trying to make even the tiniest of decisions, now isn’t the time to try and make major life decisions if you can avoid it, such as moving, divorcing, or changing jobs.

If you notice that you’re being more forgetful and that you’re having a difficult time processing information, don’t fret. This PPD symptom is definitely annoying, but I promise you’ll get your get your brain back as you recover from the illness. Although frustrating, you won’t experience the severe kind of memory loss like you’d find with Alzheimer’s (but many a mom has voiced her concern to me before being reassured). You won’t forget where you live or what your name is. However, if you walk back into your house repeatedly, just to forget the same item time and time again, rest assured that this forgetfulness is typical. At this stage, you may be concerned that you’ll forget the baby and leave without her, but you won’t. You may feel like you’re in the middle of a silly sitcom and want to change the channel. Try your best to keep your sense of humor — this nuisance, like all the other symptoms I list in the previous bulleted list, is temporary.

I remember wondering whether I also delivered 50 IQ points from my brain when I birthed my baby. Suddenly I couldn’t remember easy vocabulary, and I would immediately forget what my husband had said to me a minute before. I couldn’t read, since by the end of the sentence I had forgotten what the beginning said. If you have a similar problem, don’t worry — it’s only temporary. I suggest that you not try to read right now — it will only frustrate you. If your normal self (before the PPD) liked to read, your reading and understanding the printed page again will probably be an indication of your old self coming back.

Minding Your Mentality: A Look at Self-Talk and Dark Thoughts

It may be obvious to you when your mood is low, but you may not be able to tell how low it really is. For example, often all you know is that you feel awful, but you may not be able to gauge your mood with any precision or be able to tell if what you’re feeling is normal or over-the-line depressed. It’s even a bit trickier becoming aware of what you’re actually thinking. But, when you are, that awareness can provide you (and your support people) essential information to help figure out how serious your condition is and where you fall on the continuum. This section gives you some guidance on paying close attention to your thoughts and assessing them.

Hearing what you say to yourself

Self-talk is extremely important, so I mention it in different ways throughout this book. Your energy is probably scarce, so why waste it by using self-talk that serves only to beat yourself up? Battling PPD takes a lot out of you, so pummeling yourself with put-downs is like standing in the middle of a boxing ring and kicking yourself when you’re down.

The vicious cycle goes like this: The more depressed you are, the more you tend to beat yourself up, which, in turn, makes you more depressed. If it’s unusual for you to put yourself down and if your self-esteem and confidence are usually high, it’ll be more obvious if your self-talk is suddenly negative — and this is a warning sign that you may have PPD. If, on the other hand, you’ve had a longstanding habit of self-deprecation but it’s worse now, this change is also a warning sign.

After you take a good, hard look at all the things you say to yourself, you’re likely to be in for a big surprise. Take one of my clients, for example: After listening to what she was telling herself throughout the day, she was astounded. “Dr. Bennett,” she said, “I’m so mean!” My client considered herself a compassionate person, so what amazed her most about this assignment was that she wouldn’t have dreamed of saying those nasty things to anyone else she cared about — so why should she say them to herself?

The rule for self-talk is this: If you wouldn’t say it to anyone else you love, don’t say it to yourself. This rule isn’t just a recovering-from-PPD thing either — it’s a rest-of-your-life thing. Don’t be kinder to yourself because you’re suffering. Be good to yourself always because it’s the right thing to do.

Whenever I tell my clients that I knew as soon as they contacted me that they were good mothers, they usually respond quizzically, yet intrigued. These women are desperate for any evidence that proves their own negative thoughts about themselves wrong. I hardly ever know these women when they first call, but I know they’re good moms because bad mothers don’t try to get help. Bad mothers don’t care how their behavior is affecting their child or children. Only good moms try to improve the quality of their family’s life by getting some help for themselves.

Some of the most common statements that I hear from women who are struggling with PPD and who in turn become paralyzed by the thoughts are

“I’m weak and incompetent.” The shame underlying this statement may keep a woman from calling a support group where she’ll see that she’s not alone and that others will accept her and work with her toward healing.

“What kind of mother will others think I am if I’m out and about all the time?” If a mother’s feeling guilty and shameful about wanting to leave the house a lot, she may not be willing to come forward and tell anyone because she assumes that other people will judge her the same way she’s judging herself.

“I admit that . . .” Whenever I hear the word “admit,” I know the mom is feeling shame about her PPD. If she says, “I admit that I’m not enjoying my baby” or “I admit that I can’t do everything myself,” what she’s really saying is that she thinks poorly of herself and thinks that she must be a weak person or bad mother.

If you’re identifying with these types of statements, try eliminating the word “admit.” For example, instead of saying, “I admit that I can’t wait to go back to work outside the home,” say, “I can’t wait to go back to work outside the home.” “Admit” implies shame, but just being honest acknowledges your feeling without judgment and is simply matter-of-fact. You have nothing to be ashamed about, so make your speech reflect that truth.

“I’ll always . . .” or “I’ll never . . .” Loss of perspective is another common symptom of PPD. So, if you find yourself frequently using absolute terms, such as in “I’ll always feel like this” or “I’ll never get my old self back,” I urge you to revise your wording. Say instead, “I’m worried that I’ll always feel like this, but I know that’s just the PPD talking — it’s not the truth.”

Remember that by revising your wording, you reinforce the positive truth and serve your mental health well. Affirmations work, so if you’re going to use them, please say truths, not lies.

Recognizing the difference between fantasies and reality: A word about suicide

You need to know that with PPD, as with depression in general, comes a risk of suicide. PPD tragically takes lives every year, and this suffering of families is totally needless. As you see throughout this book, severe PPD can make you feel worthless, perhaps even like a burden to your family. However, there’s an enormous difference between feeling the huge weight and working to remove it, as opposed to actually acting on it in a way that harms you and leaves your family forever agonizing.

So, moms with PPD (and moms without PPD who are burned out) often have what I call escapist fantasies, which are fantasies of getting away and leaving the pain behind. When I was going through PPD, I daydreamed about getting on a bus and riding as far away as I could. Even though these daydreams weren’t pleasurable, they did provide a sense of temporary relief.

These thoughts occur most frequently with PPD because overwhelm is always present with the illness (technically speaking, overwhelm develops when serotonin, a brain chemical, is low). When you have PPD, the escapist fantasies can be frequent, occurring several times each day. A woman with PPD tends to feel guilty when she thinks about what these fantasies may imply about her as a mother. A normal but stressed-out mom may also face similar thoughts periodically, but she typically doesn’t obsess about what a terrible mom she must be. She doesn’t take herself on guilt trips as a depressed mother does. As a matter of fact, when I drop in to new moms’ groups to speak with them, most of the moms seem to have a healthy perspective and even laugh about these thoughts. Remember, though: These fantasies aren’t suicidal thoughts — they don’t show any intent to harm and show no actual plan to end anyone’s life.

Some of the time, women with PPD have darker escapist fantasies or thoughts that follow this train: “If I were to walk out into the street and a bus were to come and run me over, that would be okay.” Or these women may think, “If I just didn’t wake up tomorrow morning that would be fine.” These moms don’t really want to die — they just want the pain to stop. They also don’t want to take the responsibility of making that terrible decision to kill themselves.

Occasionally, escapist fantasies escalate into the circumstance where a woman purposely puts herself in dangerous situations so that some disaster might befall her. When a mom feels worthless, it’s easy for her to think she won’t be missed and people around her will get over her death easily. (This couldn’t be further from the truth! Your family needs you!) If her fantasies take this course, they now need to be treated more as a death wish and as a potential precursor to suicide — not simply as an escapist fantasy. And in case you’re skeptical about how much of an issue suicide really is with PPD, consider this fact: It’s estimated that at least 400 mothers in the U.S. alone commit suicide due to PPD each year.

If you’re intending to hurt yourself, and have an actual plan by which to do so, I urge you to get help immediately. This is an emergency. Let at least one support person know so he or she can stay with you at all times. Call your therapist if you have one, or your doctor, and tell him or her what you’re thinking. If you need to drive yourself to a hospital or call 911 (or an alternate emergency number if you don’t have 911) so that a healthcare professional can pick you up and drive you to the hospital, do it. Suicide isn’t an option! Do whatever it takes to keep yourself safe. No need to worry about being in a hospital — recovery is often quick and you’ll be home, feeling much better, soon. You should have a follow-up healthcare plan with a therapist (and probably an MD) when you’re released. People devote their lives to helping others in your situation, and you will get well. Take it from me — I’ve been there.

Here are two suicide hotline numbers in case you’re not sure whom to call:

1-800-273-TALK

1-800-SUICIDE

I have worked with many young and grown-up children whose mothers have ended their own lives. Believe me, if you could see the pain and devastation I’ve seen in these children, you would never in a million years consider putting yours through this.

Watching for Warning Signs of the Physical Kind

Physical signs of depression and anxiety in new mothers are easy to overlook. For instance, many new moms aren’t sleeping a lot at night. But the key question is why aren’t they sleeping? Are they able to sleep but they’re awakened every hour by their babies, or are they waking up even when their babies are sleeping? The same goes for eating. Is the new mom not eating because she’s not setting aside the time to feed herself, or is she not eating because her anxiety level is shooting through the top of her head, which is causing a knot in her stomach? The same question should be asked for any kind of self care — showering, getting dressed, calling your friends back, and so on. PPD can make any of these daily activities challenging, due to low self worth, low energy, and an overwhelming desire to avoid social contact (mostly to avoid the “How’s motherhood” question).

Your closest support people know you the best, and so they can provide a good reality check for you. These people are the ones who can tell you if you’re not acting like your normal self. They can help you identify possible PPD if they notice some of the common signs.

Later in this chapter, I give you a more in-depth self-screening test. For now though, keep an eye out for the following red flags. Make note if you

Have trouble sleeping: Often the inability to sleep is the initial sign of PPD. If you have a difficult time falling asleep at night when your baby is sleeping, or if you fall asleep easily only to wake up a couple of hours later for no apparent reason, you may be experiencing PPD.

Cry frequently and easily: Crying for no apparent reason — for example, every time you see the cat food commercial — is very normal during the first two weeks following delivery (this is called the baby blues). After a couple of weeks, if you’re still often bursting into tears (even if you’re not sad), get checked out.

Lose your appetite: What you need to notice in the appetite category is whether or not you actually feel hungry. If you feel hungry but aren’t setting aside time to eat, that’s a different issue entirely — in that case you just need to take a closer look at your schedule and re-prioritize.

On the other hand, if food is no longer interesting to you, this factor is warning sign. A loss of appetite is quite common with PPD. At the beginning of your recovery, it may feel like you basically need to force-feed yourself to get some good nutrition in your body (hop over to Chapter 12 for some simple ideas).

Want to eat everything in sight: Contrary to the previous point, some women have the opposite reaction to their brain chemicals shifting. If you’re always hungry (and often crave sweets and carbs) and rarely, if ever, feel satisfied — as if the mechanism that typically alerts the brain that the stomach is full is out of commission — consider this factor a heads up.

Had my OB been trained to identify PPD, he may have noticed that, even though I left the hospital down to my pre-pregnancy weight, two months later I was 40 pounds overweight. I felt like a human vacuum cleaner, consuming everything in the refrigerator on a daily basis. The voluminous amounts of food I was consuming was shocking to both me and my husband, but the hunger was always present.

Evaluating Your Postpartum Slump

You may be wondering how you can tell for sure if what you’re experiencing is regular new-mom behavior or PPD. Some of your friends who recently became mothers may also feel worried and guilty sometimes. So, should you dismiss yours as normal and try to forget it or should you pursue it further? The rule of thumb is, if you feel that something is “off” and you aren’t yourself, chances are good that you have PPD.

It never hurts to find out more information. Educating yourself is never the problem — it’s the lack of education that can be harmful. By finding out more about what you have (or don’t have, as the case may be), you’ll be able to normalize what is expected for all new moms, or you’ll see what needs more attention.

So, any way you look at it, you have nothing to lose (and everything to gain, really) by digging deep and assessing your inner self and getting a professional evaluation, if your own assessment leads you to concern. You may be wondering why I recommend having two separate assessments. The main reason is that informal, do-it-yourself tests can be valuable for giving you information and helping you think about your condition, whereas formal tests, which you’ll find in doctor’s offices and clinics, have been researched and evaluated as tools to measure PPD. I discuss getting a formal professional evaluation in Chapter 5. But, for now, in this section I provide a self-test that I recommend for anyone who thinks she may be struggling with PPD. This test can help you begin to identify what’s going on inside and where to go from there.

In the following self-test, check any of the boxes next to the statements that apply to you. If you or a support person has noticed something about you that isn’t indicated on this self-test, I suggest you add it on the side, so you can refer to it later, if you make an appointment with a doctor or therapist. Here are the statements to consider:

□ I have missed appointments lately.

□ I don’t enjoy the things I used to.

□ I worry a lot about my health.

□ I worry a lot about my baby’s health.

□ I don’t want to be with the baby.

□ I’m not interested in sex.

□ The thought of being alone makes me feel panicky.

□ Parts of my body hurt but the doctor can’t find a reason.

□ I don’t feel hungry.

□ I’m angry a lot.

□ I’m not making enough milk for my baby.

□ I cry a lot.

□ I feel like my life is over.

□ I’m not bonding with my baby.

□ I’m tired all the time, even when I rest a lot.

□ I don’t feel comfortable around my baby.

□ I crave sweets and carbs and eat all the time.

□ I don’t want anyone else to hold my baby.

□ My family would be better off without me.

□ I can’t sleep at night, even when my baby is sleeping.

□ I feel sad a better part of the day.

□ My baby doesn’t like me.

□ I have a difficult time focusing.

□ I’m not a good mother.

□ I don’t have support, and I feel like I’m all alone.

If at least five items on this list describe you, you may have PPD. I suggest that you make an appointment with a therapist who has specialized training in PPD (see Chapter 6) so you can receive a full assessment. And if you’re feeling hopeless, feeling like your life is over, or feeling like your family would be better off without you, please get help immediately.

It’s easy to downplay your PPD and therefore delay in getting help. You may be thinking, “I’m not that bad. It’s not like I want to kill myself or hurt my baby or anything. I can tough it out.” Don’t wait. Lots of women think that in order to justify getting help they need to be severely depressed. Actually, though, the faster you catch the PPD (if it’s mild to begin with), the easier your life can be as you recover because you can spare yourself the typical spiral downward.