Uggh!! What Postpartum Depression is Not...Only

From my voice mail---"Hello, my name is ....I just came from my OB office and we are pretty sure--No, totally sure I don't have Postpartum Depression because I don't want to kill myself or my kids....I just need to talk to someone. Can you call me?"

In a panicked rush I write down the caller's name, phone number and then return her call. No answer, I leave a pleasant, non-panicky message, acknowledging her call and request for services and leave a directive to please call back. No call back.  Next day, another pleasant engaging message left. Two days have passed without a returned call.

As a therapist who works with women challenged by the symptoms of Postpartum Mood Disorders I have several concerns about this call, but here are my top two. 1.) The caller gives me the impression that her OB cleared her of PPMD because she isn't a danger to herself or infant. The caller also seems to believe that this fact is the true litmus test for PPMD.  2.) The caller is probably a common representation of what the general public incorrectly thinks or believes about PPMD--which is Postpartum Depression is when you want to kill yourself and or your kids. I blame the media for this because the stories and the faces of PPMD that make headlines have unfortunately all been on the violent end of the spectrum of this awful disorder.

Here's what could be going on; the caller could be having racing thoughts, not sleeping or sleeping all the time, highly irritable, experiencing paralyzing intrusive and disturbing thoughts, she might not be eating, not showering, she is crying all the time, she feels alone even though she has a tremendous support system, she is not bonding with her baby, but she is not having thoughts of wanting to harm herself or her children. But guess what? That is postpartum depression or anxiety or OCD or a budding psychosis.  Her need for services and intervention are significant. Who knows whether or not her OB even asked her about these other symptoms.

It makes me wonder how many women are denying themselves relief of the symptoms I outlined simply because they believe that what they are feeling is "normal" when you have a newborn to care for (normal for PPMD but not normal for a new mom) or other well meaning people in her life are "clearing" her of PPMD simply because she doesn't want to harm herself or her child.  Worse yet, maybe someone is telling her that she is simply experiencing cringe The Baby Blues. Yes, suicidal and homicidal ideation, intent and plan are symptoms of PPMD but the absence of these thoughts does not absolve a woman from suffering from debilitating symptoms of PPMD. 

So, I debate calling this woman again. Not too strongly as I most likely will place another pleasant call to her. I hope I am wrong, I hope her initial reason for calling was that she is debating whether or not to stay home with her kids or return to work and just wants an objective ear to process this decision. I bet not, but I hope.

To further quell my worry I will end this post with links to iron clad resources any woman or concerned family/friend can use to get help and read the straight dope on PPMD and hope this post goes viral on Twitter or Facebook. Share it if you read it.

www.postpartum.net
www.postpartumprogress.com

Mary Jackson Lee, LCSW is a psychotherapist with a private practice in Wheaton, IL
www.maryjacksonleelcsw.com

Perception is Everything

"Perception is everything" it is a phrase I have been saying and hearing often. When discussing politics, religion, interpersonal relationships, disagreements, all of it can be wrapped up in the reply, "perception is everything". In other words, five people can be witness to an accident and you will have five different explanations of what happened. "Just the facts mam" falls to the wayside when an individual shares what they view as their facts or their impression of any seemingly benign to emotionally charged situation.

We tend to assume that our perception is fact. Makes good common sense, right? It's our worldview, we experience a situation, a person or thing and we have feelings and thoughts about it. We are only relaying what we are experiencing and interpreting it as fact for us, but more importantly and incorrectly we assume it for others as well. When we come across a person with thoughts or feelings counter to our perception on the same stimuli we can make broad stroke assumptions that the person is wrong, misinformed or just plain ignorant. We rarely are as objective as we believe we are.

Life experience is a hard thing to flesh out and few people have the  ability to understand another persons polar opposite opinion/perception. Politics and religion are excellent examples of this phenomenon. We believe that the opposing parties or religions are just misinformed. Perhaps we take an aggressive or patronizing stance, shaking our heads at those who just are not in line with our "facts" our "perception".

How is it that we miss the fact that perception is at play versus a case of "who is smarter?" "who just doesn't get it?" "who is just in denial?" The process of being open to other people's perception has a huge learning curve. We tend to change our opinion about people and their perceptions when we learn their history and realize that their polar opposite opinions are the result of the people, places and things that they have been exposed to and nothing more. Often we ignore this and assume it is our responsibility to inform, school or confront others with our more educated and insightful world view. The question "would you rather be right or happy?" comes to mind in these situations as most folks who militantly force their opinions on to others usually are perceived as pretty miserable people. It is not uncommon for those with the most polar opposite opinions to be the most cantankerous of people, vigilant to attack those who are not on "their side". Doesn't sound too happy to me and at a far distance seems kind of silly as you are only forming another strongly charged experience when trying to stuff your opinion down someones throat.

History has shown us that sometimes a small population of organized people who will not tolerate or accept polar opposite opinions  have played out well for the general good of all, take civil rights leaders or sufferegettes. Some times the risk of going up against the grain of general "perception" is good, but like noted it often involves a learning curve.

This reminder that "perception is everything" can dismantle so many unnecessary interpersonal conflicts. If when we are feeling ready to attack a person or judge a person with opinions that disgust or frustrate us and instead we remember that that person can possibly be "right" based solely on who and what they have been exposed to we might tone down our superiority and instead enter a state of acceptance.

The thing about Happiness

I just read an small excerpt from a study done several years ago that basically said winning a large lottery doesn't make many people happy. I struggled with the results. Personally, I thought of all of the day to day tasks (grocery shopping, housecleaning, meal prep and planning, shoveling, weed pulling, etc) that a little bit of coin could eliminate from my personal to-do-list. When looking a little deeper though what the study suggests is that yes, money, and a large amount of it, can make many things easier for you, but ultimately after that initial high of newly obtained fortune you will return to your original level of happiness prior to winning that big jackpot.

It is not uncommon for us as humans to believe that when we dump the lousy spouse, move into a custom home or land the right job that our life will be perfect and we will feel happy. Think about the excitement of a new relationship, new spacious home or new promising job. We feel on top of the world and set. But in time, unless we are mindful of the shift in our perception, the luster wanes in the relationship, the house needs updating and the ideal job feels oppressive. In other words, like the lotto winners, you return to your baseline level of happiness you had prior to obtaining the person, house or job.

I often remind clients that ultimately we need to work on what we own in a soured relationship because it will absolutely without fail show up in the next committed relationship, especially if we branded the cause of our last failed relationship on the other partner. The same goes for that bigger and better home. Nothing beats a new home meeting all of your specifications and amenities but it won't resolve day to day happiness internally, it only gives you a new setting to be miserable.

I offer these suggestions to consider if you are in a place right now where you feel your surroundings, the people in your life or your situation is what is causing you to be unhappy.

1. Find what is good in the situation that is causing you distress. If it is a relationship that is your identified source of misery and it feels all bad all the time, perhaps it means accepting that that isn't exactly true. There was a time when you really enjoyed this person and perhaps the decline in your happiness with the other person involved a collective abandonment of that relationship. Just owning that there is a history, that was good at one time takes away that feeling of having been victimized by that other person in this relationship and allows for healing or separation to occur in a better light.
2.  Take daily ownership and inventories of your moods and thoughts. There is often a pattern of negative thinking and feelings that can minimize the good and maximize the bad. Again, a person who is in a daily state of mind looking to be offended or disappointed will never be let down. What kind of internal business is coloring your view on your world around you?
3. Be grateful for what is in your life. If you are in a state of gratitude you can appreciate things like a bigger home but your happiness isn't contingent on obtaining it. You are able to take pride in your current living arrangement and be grateful that you have a safe place to live. Perhaps your home won't be a home featured in House Beautiful any time soon, but you have heat, running water, a full pantry and frig. Be grateful for what is.
4. Go back to that dream of winning the lottery. Are you at your absolute happiest in the here in now with what you already have? If not continue to play that game of luck but work on your happiness now. Be happy before that lotto lands in your lap and you will truly enjoy it in the long run!

Mary Jackson Lee, LCSW is a psychotherapist with a private practice in Wheaton, IL.


Suggested/related reading

"The holidays are hard for people"

I heard the comment, "the holidays are hard for people" several times this weekend when being asked about how my busy private practice was going. I think partially it is true that the holidays can bring up a lot of sadness, unresolved problems with family, reminders of what we haven't accomplished as the year closes and for some a feeling that they just didn't have the holiday that they had hoped for or projected in their mind.

I also believe that the holidays at the end of the year are hard to avoid. Any other holiday whether it be Fourth of July, Easter, Memorial Day, can be avoided. Much of life continues on for these holidays grocery stores are open, people can be busy doing other things if they chose to not be with family or friends or don't have family and friends to fill the day with a BBQ or get together. But Christmas is deafeningly quiet if you are not out with family and friends.

Additionally, some people find that the requirement to be with family is upsetting. Dread fills the minds of many who still have unresolved issues with family members or in-laws as they remember they need to spend the day with them. Marriages might feel more strained, financial issues may feel more exacerbated, alcohol can loosen inhibitions, things are said and done and the attempt to have the perfect Christmas comes crashing down.

As a cognitive behavioral therapist I always steer clients to look at what they are thinking in any situation that brings them distress. Christmas can be loaded with distorted thinking patterns.

One such distortion is that we should be able to sideline our internal distress or conflicts for the holidays. On the contrary, for many people they feel more heightened. Yes, ideally we could shelve our differences and be civil with each other, kind even would be an accomplishment. Instead many become more isolating, more judgmental, more excluding of those they hold most in contempt. While it might seem justified what we miss is that it takes mental energy to do this. Ultimately it makes us more bitter, more depressed, angry and leaves the already scarred relationship even more splintered.

So what do we do? How do we go forward into the next year? For many the suggestion that you turn inward and work on your own stuff when someone else is appearing to be your source of upset is not easily swallowed, but it is an effective goal.

Now is a perfect time to start keeping a journal if you don't already. Maybe you begin with a summary of your holidays. What went right? What went wrong? What do you wish you could get a "do over" on? Who really annoyed you? How were you involved in any of the conflicts? In other words, someone can be a pill, but do you sling mud right back over the fence in a justified stance? How do you end up feeling after that mudslinging?

Some relationships do need to end, some need to come to a truce of a basic common sense of respect for the other person or persons. Often we give others the power to make us feel a certain way and again, it is hard to see that no one can make us feel anything. We are in charge of our feelings and our thoughts. We can also choose not to be offended. There is a saying that if you go looking to be offended you will rarely be disappointed.

January traditionally is a month that many adults enter therapy. Overtly it may be linked to the holidays but I generally see folks who had issues worthy of work with a therapist with an onset long before the holidays. The holidays only acted as a spotlight on an already festering wound.

Not everyone has to address their stress with therapy. Once you know better, you do better. Once you accept it isn't your nemesis that makes you miserable you are half way there. You actually have some say in your experience. That is an empowering concept to grip and act on.


Suggested/related reading:

Thinking About Your Thinking

It is not uncommon for me to ask a client, "So, have you been thinking about your thinking?". They generally laugh and reply, "Yes, I have!" Initially it is quite hard to think about thinking. We do it on automatic pilot all day everyday. A recent study out of Harvard University indicates that the more detached we are in thought to what we are actually doing the more unhappy we are. So if you are playing a board game with your young child, yet worrying internally about the balance in the checking account you will have a greater chance of being unhappy and further attaching your discontent to a benign and potentially enjoyable activity such as playing with your child. So, it makes sense that we would want to learn to become more accountable for what we are thinking.

One starter exercise I offer to my clients is to make a personal inventory every night before going to sleep. A personal inventory is lifted from the 12 Step Tradition, Step Ten to be exact. I ask clients to review their day, just that day and list the bad and good. I urge them not to work another person's inventory, just theirs. So if there is something someone did that ticked you off, you note your reaction solely. So your co-worker did X, how did you reply? What did you do? How did you feel? We can only make changes in how we think and feel when we become accountable for our thinking patterns. Thinking leads to more thinking, which often leads to emotions and sometimes to behavior.

Sometimes our thinking is distorted. For example we might reflect on what that co-worker did today and hold a dialogue with that person solely in our head without any checks and balances and most likely with some significant distortion. So the next time we see that co-worker not only are we angry about the actual event but we have also built up more resentment because of that dialogue or argument we had with that co-worker in our head.

Additionally when we are thinking in distorted patterns we often make up truths. Again with the co-worker, we may start using the distortion of "Mind Reading" implying that we know the motives and thinking of another person without checking it out as fact. This only layers on to our pattern of distorted thinking and makes us feel worse.

It is important to remind my clients that our brains don't know the difference between what we tell it and what is 100% fact. So, a person cuts you off on the highway in an attempt to not miss an exit. You might think, "That person is a jerk that doesn't take anyone but themselves into account when they are driving!" Your brain hears that as truth, 100% truth and begins to experience feelings, anger, upset, and fury. Now, bring it to the judge, do you know for certain, that is what is happening with that person? No! Who knows, that person's wife could be in the passenger seat ready to give birth and he is anxious, almost missed his exit. That person could be a mother with a small child in the back seat who is sick, that person may be very anxious about driving on the highway and not familiar with the area and just made a human mistake. All are possible. How do you feel or think in one of those scenarios? Less angry? More empathetic? More accommodating?

Again, I remind my clients to "bring it to the judge" when they are getting into a funk due to their patterns of thinking. Can you say that your thinking is all fact base? Is it an assumption? Did you check it out with the person you are holding in mental contempt? If the answer is no, then you cannot have that thought. Perhaps you can re-frame the thought. Most likely when you do you will feel less distress over the given situation.

So, think about your thinking and remember your brain doesn't know the difference between what you tell it and the truth!


Mary Jackson Lee, LCSW is in private practice in Wheaton, IL. Visit her website to learn more about her practice and services.

Bandit Therapist

As we open the month of October in Chicago, many long distance runners are eagerly anticipating the Chicago Marathon. I have run the race twice. Well, to indicate that I ran it as a “race” might imply that I had hopes of “winning”, so perhaps I am more accurate in calling the marathon a really long run of 26.2 miles, that I completed in, without question, one of the most awe inspiring cities, with the most energetic spectators. The marathon is, by some statistics I have come across, a distance that only 1% of the general population will ever attempt. That statistic to me might lead people who have never run a marathon to believe that it is a unique person who would or could run a marathon. I beg to differ with that assumption. Now, I am not minimizing the distance or the commitment it takes to train for and complete a full marathon. I will always have respect for the distance. It is daunting, it is a long time to be running, even for the faster paced runners and it does result in a lot of wear and tear on your body.

My bigger point is that we all have the mental and physical capacity to endure pain of body and mind and eventually cross the finish line, changed forever. In another way, we all can and do run “marathons”of life. They are often categorized differently though and don’t result in a obtaining a finisher’s medal or PR. But boy, I wish we did honor these challenges of life as much as we do running 26.2 miles.

I have the very privileged honor to facilitate and witness marathons and finish lines on a daily basis in my work. I see objectively adults who have sailed through life without much problem only to hit “the wall”. The wall is the point in the marathon when your tank is empty, your body hurts, and you want to cry, die or just lie down. I am not running the marathon this year but I will “bandit” and jump in around mile 18 to bring a group of women that I run with on a regular basis in to the finish line. I must clarify; these women are fully capable of completing that distance without my help. They are all well trained and conditioned for this race. My purpose will be to give encouragement, or stay silent, speed them up, or meet them at their pace, suggest a gel or tell them a joke. I cannot help but to see the parallels in my job as a therapist. Many times a client doesn’t need me to say anything, they want a witnessed, private cry, or a cursing session, or just to sit for a moment in silence, but not feel alone. Make no mistake, all of my clients are capable of “getting through” to their own finish lines, but gosh, as a runner and as someone who has also benefited from the services a therapist, I know for sure it is a whole lot easier to do it with the help of another.

Running a marathon changes you. There is no doubt about it. There is a shift in your belief system and what you think is impossible changes. I often reflect back to my clients that the issues they struggle with and eventually conquer will also change them and hopefully if they choose to gaze upon it in the right light, it will mirror back to them their own “finisher’s medal” and shorten up their own personal list of what is impossible.

Mary Jackson Lee, LCSW is a psychotherapist with a private practice in Wheaton, IL.

Click here to see Mary's practice website.

What's your story?

Everyone has a story. People will eagerly share the story of how they met their spouse, the story of their latest vacation, the story of how they got a great deal on a new item of clothing, the list is endless. I suggest that every person walking around today has another story or more importantly many stories going on in their head that they will not share with you verbatim. These are the stories that are influencing their choices, their feelings, and their overall life situations. Each person has an internal narrative that helps them navigate their world.

Let me give you an example, take the person who is neck deep in unsecured debt yet cannot accept downsizing their home, or getting rid of their high monthly payment foreign luxury car because they feel it would impact on their image,or the image they are trying to sell to the outside world. Perhaps the story that they are influenced by is

"I am what I drive", "I am where I live", "I am things that are exclusive", "no one will respect me if I don't have this", "everyone will think I am a failure if I don't drive this".

Stay with me because behind that story line is another story line.

"I am worthless", "I am a failure", "I am scared", "I am anxious", " I have not accomplished much".

So ultimately, the things (the car, the possessions) will help keep the debate going.

"I cannot be a failure, look at my car!" "But you are in debt, how are you going to pay off that credit card?" feeling anxious... "Look, we bought a new TV!" "On credit!" feeling depressed...


To further add to this layer most people don't know that they are telling these stories day in and day out. They will be able to rationalize their behavior and choices, "you need to spend money to make money", true enough, but not if you are in debt.

When I meet with clients for the first time I obtain a full history on them, or in most cases, I get to know what they will let me know. I take into consideration that outside of the objective information like their name, age, date of birth, they have a "story" playing in their head too. This story is sometimes in conflict with what is happening in their life at that time and sometimes this is what prompts them to enter therapy. It is not uncommon for a person to report, "I just never thought I would be the kind of person who would need to see a therapist." Stop right there! The client is responding to a story. Maybe it is a family story passed on to them from their parents. Maybe the family agrees that their story will not include weakness, or overt displays of emotion, or need. Perhaps the story is gender based, perhaps this is a gentleman who has never felt weak, never felt he needed help with anything and he has accomplished quite a bit in his personal and professional life. His story " I will never need therapy" is backed up by his objective history.

This is where uncomfortable feelings like depression, anxiety and fear and the related stories they carry, "I am sad", "I feel worried", "I am scared", cause great internal discord.

For some people, once I suggest that they have stories they are telling themselves, they begin to become more aware of the automatic thoughts that are occurring in their mind every day. They are able to then look at what those thoughts are debating and more importantly what they make them feel,

"I sure feel sad and I don't know why" "Come on buck up man, you have a meeting today, people are depending on you!" "I don't know why people depend on me, look at me!"

..and thus this pattern continues and with it, symptoms of depression and anxiety. When the stories we live by are conflicting and debating we feel unrest. Often the stories are distorted. This is the real meat and potatoes of therapy because once a client realizes that he/she is operating under thoughts that are distorted or inaccurate they can be mindful of that pattern of thinking and work to challenge those thoughts with more realistic viewpoints. Clients begin to use their feelings to tell them how they are thinking. Chances are when their emotions are out of balance, their thought process involves stories being told that are either debating each other or are just plain inaccurate distortions.

Consider taking note of your own stories, especially when you find yourself attaching a story or motive behind the behavior of someone else that you find especially annoying or wrong. Chances are, their behavior is stirring up one of your stories.
Be well!

Mary Jackson Lee, LCSW is s psychotherapist with a private practice in Wheaton, IL. Click here to see her practice website