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A Functional Medicine Approach to Perinatal Mental Health – Part Two

February 20th, 2014 by avatar

In a two part post this week, regular contributor Kathy Morelli shares information about and an interview with Kelly Brogan, MD on her nontraditional approach to working with women who are dealing with perinatal mental health issues.  Today in part two, Dr. Brogan shares information on incorporating a whole body Functional Medicine approach alongside traditional Western medicine to help and support women dealing with postpartum mood and anxiety disorders. Part one of this short blog series ran on Tuesday. – Sharon Muza, Community Manager, Science & Sensibility.

Kathy Morelli (KM): In the news, there’s been a lot of information about the negative impact of a dairy-gluten-and- sugar based diet on the body. Can you tell us a bit about the impact of gluten and sugar on thyroid function after childbirth? Can you reference research on this?

Kelly Brogan, MD (KB): Yes, there’s an explosion of research implicating the immune-modulating and inflammatory effects of gluten and sugar (often co-occuring). Many individuals perceive that they are totally “fine” until that day when they’re not. In reality, there has been a long period of “incubation” of their symptoms.

Istock/GoldenKB

Istock/GoldenKB

When it comes to autoimmunity, we know that the postpartum population is very vulnerable to new onset autoimmune disorders, and we know that autoimmunity requires three ingredients: genetic susceptibility, environmental trigger, and intestinal permeability. This has been well-established by Dr. Alessio Fasano of The Center for Celiac Research.

We know that gluten causes an inflammatory response in all people, locally, in the intestine, and that in a subset of about 80% of people, it provokes intestinal wall changes that allow for compounds, food particles, and bacterial molecules called LPS or lipopolysaccharide into the blood stream. In animal models, LPS is used to induce “depression”. There is a large literature, since 1991, establishing the role of inflammation in depression, including in the postpartum depression population.

We also know of a process called molecular mimicry, whereby, immune responses to a food particle or pathogen can lead to attacks on our own body because of common amino acid structures.

We know how to modify inflammation through diet, and we know how to support appropriate immune response through nutrients such as Vitamin A, D, Alpha Lipoic Acid, probiotics and others. I have written about the research supporting these claims on my website if you are interested in the references, but suffice it to say that elimination of gluten, dairy, corn, soy, and sugar is my first step with patients and a primary reason that I no longer need to use medication. It’s quite powerful.

 KM: And can you elaborate on the impact of dairy products on brain health? Can you share a research article on this?

KB: I don’t think that dairy is an issue for every person with mental health symptoms, but I believe it is a compelling variable to control for.

But sure, I can talk about dairy and its impact on health. In schizophrenia and bipolar, in particular, there are papers discussing the role of casein antibodies in clinical presentations. Some of these papers are listed in the references at the end of this article. Some speculation about the reasons that casein, a protein, particularly from Holstein cows which we use in America, is stimulating to the immune system, relates to its being heavily processed – homogenized and pasteurized – so that the fats and nutrients are no longer in their natural state and are provocative to the immune system.

In a paper by Severance et al (2010), they found that new onset and long-term schizophrenics were 8 times more likely to have circulating antibodies to casein than controls and up to 16.5 times more likely in a subgroup of those with psychotic depression.

kelly brogan head shot

© Kelly Brogan MD

In a separate study, this team found similar results in the setting of Bipolar I diagnosis and found that medication treatment did not mitigate this immune response. In a study this year, Li et al (2012) found that new onset schizophrenia was associated with immune activation and a 34% increased risk of developing schizophrenia if their levels of antibody were 2 standard deviations elevated. Casein and gliadin (a component of gluten) interact with opiate receptors in the brain in an unpredictable way.

KM: Based on your research and clinical practice, looking at it as a public health issue, do you believe that the overall public incidence of postpartum depression and anxiety can be reduced by educating women about modifying their diets and lifestyles?

KB: Absolutely and unconditionally, yes. Conventional psychiatry has made no progress with regard to identifying markers for vulnerable populations. We are overly focused on serotonin and examination. Research by Oberland et al (2008) into serotonin transporter polymorphisms has been confusing and inconsistent.

We must look at the cumulative burden that pregnancy places on some women and how it exposes the dysfunction of their interrelated neuroendocrine systems resulting in depression, anxiety, and psychosis as non-specific indications that there is lifestyle imbalance and inflammation.

I have a detailed research article about the Neuro-inflammatory Models of Postpartum Depression published here for your further reference.

KM: Based on your research and clinical practice, do you believe that the personal incidence of postpartum depression and anxiety can be reduced for a woman modifying her diet and lifestyle?

KB: Yes. In my clinical practice, with the preventive cases that I work with, I have yet to have an incidence of a woman with postpartum onset symptoms, including those women with previous history.

KM: I’ve heard you lecture about the nutrient deficiencies and dietary factors that could feed into an occurrence of postpartum psychosis. Based on your research and clinical practice, do you believe that the incidence of postpartum psychosis can be reduced by a woman being aware of the risk factors and modifying her diet and lifestyle?

KB: I am very interested in research like that of Bergink et al (2012) that suggests a significant overlap between thyroid autoantibodies and postpartum psychosis.

We know that these antibodies portend endocrine dysfunction and we know that thyroid stimulation can result in psychosis. We also have precedent, in the literature of bipolar and schizophrenia being induced by nutrient deficiencies, even as simple as niacin.

It is myopic to abandon simple and potentially effective interventions in the interest of medicating these patients, particularly because of the established incidence of mania and violence toward self and others with SSRI treatment. I believe these medications, in the postpartum population account for incidences of violence that might have otherwise been avoided. Ssristories.com explores these cases.

KM: In the hierarchy of risk factors for perinatal mental illness, such as an individual’s previous history and family history, where do you think the role of lifestyle management and diet modifications fall?

KB: I think that it trumps all other risk factors, and this is because of what we have learned about the 98% of “junk DNA” that we found after the completion of the Human Genome Project.

This is called “epigenetics” and refers to the role of lifestyle or the “exposome” to modify gene expression within one lifetime.

We outsource much of our bodily function to out bodily microbes, as well, which outnumber our human cells 10:1. This is exciting and empowering because it means that we are not condemned by our family histories or genes. We can change them with each bite off a fork, with each step, and with our home environments.

KM: In your work, you do a thorough assessment and then work carefully to support a woman to taper off their psychotropic medications, if possible. Do you advocate that a woman go off of her medications without supervision?

KB: I do not recommend that women go off their medications without supervision.

My initial consultation is 2 hours and I work intimately with patients during tapers. As I deal with some complicated cases, I require patients to optimize their health and wellness prior to initiating a taper to confer resilience and assure adrenal hormone reserves which are often highly perturbed during a taper (the impact of SSRIs on glucocorticoid functioning is well understood).

Then, we initiate a taper that can take 1-2 years.

This is the most responsible way to do it, and keep in mind it cannot always be done.

This is why I believe that true informed consent prior to beginning a medication must include disclosure of dependency. It is not the original symptoms returning, as I was taught to parrot in my training, it is drug-induced withdrawal and associated “relapse” that often looks like agitation and profound anxiety, often novel symptoms to the patient who has never experienced such autonomic nervous system disruption.

KM: Generally, how do you help a woman who is depressed preserve the breastfeeding relationship, if she states that she wished to do so?

KB: Great question. I believe that lactation support is non-optional and must be daily for the first week and perhaps even the first several weeks. Women need to be supported to nurture this skill and to protect it at all costs. They can’t do it alone (in my observation). Here is a link to more information I’ve published about how to help meet breastfeeding goals.

Once lactation is in place, and supply is established, breastfeeding becomes protective of depression. I will be publishing an article about studies supporting this in the coming weeks. I also encourage pumping early (beginning at 2 weeks) so that there is flexibility around night feedings with partner support.

Basically, we have a crisis of failed lactation that I believe relates to environmental toxins called endocrine disruption, undiagnosed thyroid conditions, and insulin resistance from high sugar diet. >Of course, in the end, it’s a woman’s decision to care for and feed her infant as she sees fit. Here’s a link to some very detailed information about finding safe organic formula products.

KM: What do you recommend as readily available methods a woman can do herself to help her heal postpartum depression and anxiety holistically?

KB: I certainly recommend consulting with a holistic provider such as a naturopath, acupuncturist, homeopath, or certified physician. That said, dietary modification, mild exercise, and 20 minutes daily or relaxation response is a great place to start.

KM: What are some of your other projects going on now?

KB: My cup runneth over! I am writing a book that I hope will be a resource to the women I cannot personally see in my busy practice. I maintain an active blog at www.kellybroganmd.com and am also on Huffington Post. I am directing a conference and participating in several in the coming year, and will be providing a course with Aviva Romm, MD to help educate women about holistic health. Fearless Parent will be very active throughout the year with events, blogs, and weekly radio shows to help parents navigate all of the information that comes at them in the realm of thoughtful parenting. Join us!

KM: Thank you for your valuable time & input!

KB: My absolute pleasure. Your interest and support mean a lot to me, as does the mission and educational dedication that Lamaze upholds. I’m an enormous fan!

How do you feel about the information that Dr. Brogan shared?  Have you or your clients had any experience with Functional Medicine?  Would you provide this information to women along with more traditional recommendations, for them to explore when they are being treated for perinatal mood disorders? – SM.

References

Bergink V. et al. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis. British Journal of Psychiatry, 2011;198:264-8. Epub February 22, 2011.

Black, M.M. (2008). Effects of B12 and folate deficiency on brain development in children. Food and Nutrition Bulletin, June (29), 126-131.

Brogan K. (2013). Putting theory into preliminary practice: Neuroinflammatory models of postpartum depression. OA Alternative Medicine, May 01;1(2):12.

Dickerson F, Stallings C, Origoni A, Vaughan C, Khushalani S, Alaedini A, Yolken R. Markers of gluten sensitivity and celiac disease in bipolar disorder. Bipolar Disorder. 2011 Feb;13(1):52-8. doi: 10.1111/j.1399-5618.2011.00894.x.

Fasano, A. and colleagues at the Celiac Center, numerous medical research articles.

Jackson, J., Eaton, W., Cascella, N., Fasano, A., Kelly, D. (2012). Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity.Psychiatric Quarterly, 83(1), 91-102, http://dx.doi.org/10.1007/s11126-011-9186-y

Li J, Harris RA, Cheung SW, Coarfa C, Jeong M, et al. (2012) Genomic Hypomethylation in the Human Germline Associates with Selective Structural Mutability in the Human Genome. PLoS Genet 8(5): e1002692. doi:10.1371/journal.pgen.1002692

Niebuhr DW, Li Y, Cowan DN, Weber NS, Fisher JA, Ford GM, Yolken R. Association between casein bovine antibody and new onset schizophrenia among US military personnel. Schizophrenia Research, 2011 May;128(1-3):51-5. doi: 10.1016/j.schres.2011.02.005. Epub 2011 Mar 4.

Oberland, TF, Weinberg, J, Papsdorf, M, Grunau, R, Misri, S, & Devlin, AM (2008). Prenatal exposure to maternal depression, neonatal methylation of human glucocorticoid receptor gene (NR3C1) and infant cortisol stress responses. Epigenetics, Mar-Apr,3(2), 97-106.

Severance EG, Dupont D, Dickerson FB, Stallings CR, Origoni AE, Krivogorsky B, Yang S, Haasnoot W, Yolken RH. Immune activation by casein dietary antigens in bipolar disorder. Bipolar Disorder. 2010 Dec;12(8):834-42. doi: 10.1111/j.1399-5618.2010.00879.x.

Perlmutter, D. (2011). Grain brain: The surprising truth about wheat, carbs, and sugar – Your brain’s silent killers. New York: Little, Brown & Company

Depression, Guest Posts, Infant Attachment, Maternal Mental Health, Perinatal Mood Disorders , , , , , , ,

A Functional Medicine Approach to Perinatal Mental Health – Part One

February 18th, 2014 by avatar

 In a two part post this week, regular contributor Kathy Morelli shares information about and an interview with Kelly Brogan, MD on her nontraditional approach to working with women who are dealing with perinatal mental health issues.  Dr. Brogan shares information on incorporating a whole body Functional Medicine approach alongside traditional Western medicine to help and support women dealing with postpartum mood and anxiety disorders. Part two of this short blog series runs on Thursday. – Sharon Muza, Community Manager, Science & Sensibility.

Creative Commons Image: Pamela Machado

Creative Commons Image: Pamela Machado

I’ve been interested in Integrative medicine for many years. I’ve gotten a lot of feedback from Science & Sensibility readers and my psychotherapy clients that they are very interested in holistic approaches to their health.

On a personal level, I struggled with depression at different times in my life. Nineteen years ago, I suffered a long postpartum depression. I didn’t want to take any psychotropic drugs as I was breastfeeding; there wasn’t much research available then about medication and breastfeeding. I looked for other ways to heal. In the short term, homeopathy is what healed my severe depression. On a longer term basis, I studied many forms of mindbody healing: diet, exercise, bodywork and professional counseling techniques have been my holistic program for mental and physical health. I’ve been fortunate that I haven’t had depression in 17 years.

On a professional level, in my clinical practice, I’ve seen the whole gamut of results in my clients’ levels of anxiety and depression when using psycho-trophic drugs: successful, lackluster and very poor results. So, I’m always searching for complementary and gentle therapies to add to my own toolbox and referral list to improve my clients’ mental health.

Disclosure: I want to clarify that I’m not a doctor and I’m not licensed to prescribe medication, but in my role as a licensed counselor, I often share clients with psychiatrists, who do prescribe medications.

Medication Taper: I want to clarify that this article does not suggest that women should discontinue their medication.

In some ways, what is old is new again! Conceptually, functional medicine (FM) mirrors the approach of Traditional Chinese Medicine (TCM), which approaches the patient from a holistic level. However, functional medicine is an evolutionary development in the practice of modern conventional medicine. FM is a systems biology approach. FM uses all the tools now available to the modern medical doctor: current assessment and diagnostic technology, cutting edge research into the interaction of the endocrine, gastrointestinal, and immune systems with our environment and treatment with a range of integrative and pharmaceutical medical therapies.

A doctor trained in this sophisticated approach performs a personal and careful assessment of an individual in order to find and then correct the underlying imbalances in the body, rather than treat separate symptoms. This is a departure from the conventional “organ based” practice of medicine, whereby the focus of diagnosis and treatment of a person is set up in silo-like medical specialties.

Dr. Kelly Brogan practices Holistic Women’s Psychiatry in this manner. She has impressive academic credentials, having studied cognitive neuroscience at the Massachusetts Institute of Technology and medicine at Cornell University Medical College. She is Board Certified in both Reproductive Psychiatry and Integrative Medicine and certified in Endocrinology. She is a leader in Functional Medicine. For her clinical work in Holistic Women’s Health Psychiatry, she analyzes and combines the research from the intersection of these three fields. She has appeared at many conferences, including the recent 2013 Postpartum Support International conference, the 2013 Lamaze International conference, is the Medical Director at Fearless Parent, blogs for Green Medical Information and has blogged for Postpartum Progress.

At her private practice in New York City, she offers a supervised lifestyle and food-based approach for women to manage perinatal mood disorders without psychotropic drugs.

This article is meant as an introduction to a different medical approach to women’s mental health. The functional medicine approach integrates the emergent research of the past three decades that suggests that a modern diet high in processed food, carbohydrates and sugar not only impacts the body with such chronic diseases as diabetes and heart disease, but also impacts brain health and contribute to the rising rates of mental illnesses such as depression and postpartum depression, postpartum psychosis and more severe mental illnesses such as schizophrenia.

Kathy Morelli (KM): Dr. Brogan, I was excited to discover your work via the Fearless Parent website, where you’re the Medical Director. You’re also active on the Green Medical Information website, where you regularly blog and present webinars. I admit, I was at first skeptical. However, after attending your webinar, and finding the information to be so very detailed and well-researched, I’m very intrigued. How did you become interested in your particular niche, Reproductive Psychiatry and Maternal Mental Health?

Dr. Kelly Brogan (KB): My post-residency fellowship training was in medical psychiatry, which is looking at how bodily problems like infection or liver disease can cause psychiatric symptoms. I specifically focused on reproductive psychiatry and the treatment of mood and anxiety disorders related to menses, pregnancy, and postpartum.

Despite my extensive training in helping women to navigate the risks and benefits of medication treatment during this vulnerable time period, I found that many women chose to discontinue medication.

Because of this and also because I wanted to help the women in my care optimize their health for anticipated or current pregnancy, I decided to investigate some common body-based drivers of psychiatric symptoms. I focused on these areas of the body: thyroid and adrenal dysfunction, food intolerances and gut infections, and sugar imbalances, rather than solely looking at the neurochemistry of the brain.

I also began to research what evidence there was to support mood-enhancing treatments that were also beneficial to the baby (given maternal deficiency) such as vitamin D, fatty acids, magnesium, and b vitamins.

Now I focus on inflammatory models of depression and anxiety and look at environmental exposures first and supporting the immune system and minimizing inflammation second. I haven’t started a patient on an antidepressant in some time.

KM: Dr. Brogan, as I understand it, you approach your work by focusing on the underlying human physiology of depression and anxiety, which is impacted by such factors as a sedentary lifestyle and a nutrient-poor diet which, in turn, causes inflammation. The inflammation in the body negatively impacts hormonal and neurotransmitter production and balance, which causes mindbody ailments, such as thyroid dysfunction and depression and anxiety. How would a woman coming to your office experience her visit with you differently than she would in a conventional psychiatric visit?

KB: The backbone of my clinical interventions is a sophisticated diagnostic assessment which includes a large battery of blood work, stool samples, salivary hormonal assessments, and urinary organic acids. In this way, I can personalize interventions rather than just empirically suppress symptoms. All of my patients require expert nutritional guidance, which I support them through, as well as personally tailored exercise and relaxation response interventions.

I’ve developed deep concern for the excessive, and what I believe to be irresponsible, use of medications to manage chronic disease. We have lost touch with our body’s native ability to heal itself and to correct, through elaborate checks and balances, any disturbances.

We’ve lost touch with this because we look to doctors when we should first be looking to our homes, our plates, and our minds to see how we can better facilitate that healing process, as you have done, Kathy. I believe that psychiatric medications, but also common medications prescribed for pain, acid reflux, and high cholesterol are wreaking havoc on the body’s ability to function optimally.

Here is an example of how I work with a simpler case: A lovely woman comes in to see me. She says she has debilitating melancholic depression, no energy and brain fog. I even note some instability when she walks. When I take her history, she tells me she was put on an acid blocking medication 2 years ago for her heartburn. I ask about her diet, which is high in sugar and fried foods, which is most likely causing her stomach discomfort. It’s well known clinically and in the research literature that long-term suppression of stomach acid blocks the absorption of the essential B12 vitamin.

Did you know B12 is one of the building blocks of life? A B12 deficiency is a silent condition that disrupts the myelination process, which leads to depression, confusion and eventually, to brain shrinkage. B12 protects your brain and nervous system, regulates rest and mood cycles and also keeps the immune system functioning properly. In fact, in persons over 65, B12 deficiency is linked to memory decline, brain shrinkage and a greater risk of age-related dementia, as the production of hydrochloric acid slows down with age.

In addition, because my patient is of childbearing age, it is very important to help her maintain her proper B12 levels, in order to help maintain her baby’s health. An infant born to a woman deficient in B12 is at serious risk for negative neurological symptoms, such as lethargy, developmental delays and delayed cognitive and motor development.

So, back to my patient. I’ll run a simple blood test to determine B12 levels to see if this lovely woman has either a suboptimal B12 level and/or a secondary marker of B12 deficiency. If so, I treat her with non-invasive B12, which can resolve all of her symptoms.

I do this because there are cases in the research literature describing patients receiving electroshock and antipsychotic medications before someone bothered to check their B12 levels and then successfully treat them to remission with this vitamin!

I work overtime to uncover what might be driving symptoms and driving inflammation. I don’t believe that the answer lies in a psychiatric medication, and I do believe that these medications can cause significant short and long-term side effects. Some have posited that, in addition to often containing synthetic preservatives, titanium, and gluten, medications such as Prozac contain fluoridated molecules which may impact the body as fluoride – a neuroendocrine toxin – does.

If they were seeing someone else, they might be started on an antidepressant after a 45 minute clinical contact. They can expect to take that antidepressant for the rest of their lives because few prescribers are experienced in medication discontinuation.

On Thursday, Kathy continues her interview with Dr. Brogan, sharing more information about the role of diet on the childbearing woman’s mental health and how the functional medicine approach can help to improve perinatal mental health and provide help to those who need it. – SM

References

Bergink V. et al. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis. British Journal of Psychiatry, 2011;198:264-8. Epub February 22, 2011.

Black, M.M. (2008). Effects of B12 and folate deficiency on brain development in children. Food and Nutrition Bulletin, June (29), 126-131.

Brogan K. (2013). Putting theory into preliminary practice: Neuroinflammatory models of postpartum depression. OA Alternative Medicine, May 01;1(2):12.

Dickerson F, Stallings C, Origoni A, Vaughan C, Khushalani S, Alaedini A, Yolken R. Markers of gluten sensitivity and celiac disease in bipolar disorder. Bipolar Disorder. 2011 Feb;13(1):52-8. doi: 10.1111/j.1399-5618.2011.00894.x.

Fasano, A. and colleagues at the Celiac Center, numerous medical research articles.

Jackson, J., Eaton, W., Cascella, N., Fasano, A., Kelly, D. (2012). Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity.Psychiatric Quarterly, 83(1), 91-102, http://dx.doi.org/10.1007/s11126-011-9186-y

Li J, Harris RA, Cheung SW, Coarfa C, Jeong M, et al. (2012) Genomic Hypomethylation in the Human Germline Associates with Selective Structural Mutability in the Human Genome. PLoS Genet 8(5): e1002692. doi:10.1371/journal.pgen.1002692

Niebuhr DW, Li Y, Cowan DN, Weber NS, Fisher JA, Ford GM, Yolken R. Association between casein bovine antibody and new onset schizophrenia among US military personnel. Schizophrenia Research, 2011 May;128(1-3):51-5. doi: 10.1016/j.schres.2011.02.005. Epub 2011 Mar 4.

Oberland, TF, Weinberg, J, Papsdorf, M, Grunau, R, Misri, S, & Devlin, AM (2008). Prenatal exposure to maternal depression, neonatal methylation of human glucocorticoid receptor gene (NR3C1) and infant cortisol stress responses. Epigenetics, Mar-Apr,3(2), 97-106.

Severance EG, Dupont D, Dickerson FB, Stallings CR, Origoni AE, Krivogorsky B, Yang S, Haasnoot W, Yolken RH. Immune activation by casein dietary antigens in bipolar disorder. Bipolar Disorder. 2010 Dec;12(8):834-42. doi: 10.1111/j.1399-5618.2010.00879.x.

Perlmutter, D. (2011). Grain brain: The surprising truth about wheat, carbs, and sugar – Your brain’s silent killers. New York: Little, Brown & Company.

Depression, Guest Posts, Infant Attachment, Maternal Mental Health, New Research, Perinatal Mood Disorders, Postpartum Depression , , , , , , , ,

What is Pregnancy Negation? What is the Childbirth Professional’s Role?

November 14th, 2013 by avatar

Today on the blog, regular contributor Kathy Morelli shares information on an uncommon but very serious mental health disorder called pregnancy negation (pregnancy denial and pregnancy concealment) that can occur in women.  This unusual phenomena may never have crossed your radar or you may have met women who have experienced this situation.    Learn more here about this illness and what you can do as a childbirth professional, should you meet a woman or family dealing with this situation. –  Sharon Muza, Community Manager for Science & Sensibility.

Original Painting © Johann Heinrich Füssli

The research studies about negation of pregnancy generally consist of small sample sizes, so there isn’t a lot of data available about negation of pregnancy. More study is needed in order to understand this topic more thoroughly. I do see this phenomena in my psychotherapy practice, so I believe it’s a topic that birth professionals might see it in their community as well.

Negation of pregnancy, a term that encompasses both pregnancy denial and pregnancy concealment, are rare, but not uncommon, disorders of pregnancy. One in 475 pregnancies result in negation of pregnancy. A very minute portion of this statistic results in neonaticide- the act of killing a baby in the first 24 hours of life (Beier et al, 2006).

As with other psychological conditions, the underlying etiology of negation of pregnancy exists on a spectrum. The person can suffer from a lifelong, persistent “splitting” of the self due to trauma, she can suffer from a persistent biological mental illness, such as schizophrenia, or she can be experiencing a type of severe adjustment disorder.

Current research indicates that not all women who experience negation of pregnancy have previous diagnoses of serious and persistent mental illness. Some women who experience negation of pregnancy have pre-existing diagnoses of biploar with psychotic features and schizophrenia, and psychosis is part of their life experiences. But others do not have a previous diagnosis and after integrating the episode of negation of pregnancy, they adjust to their life situation and cope realistically.

Definition 

Pregnancy denial is defined as a woman’s unawareness, in varying degrees, of her pregnancy. Pregnancy concealment is defined as actively deciding and hiding the pregnancy from others. Pregnancy denial and pregnancy concealment often co-occur and occur intermittently. There is usually a great deal of shame, fear, guilt and dissociation, a strong psychological and emotional defense, accompanying this disorder. Due to the level of emotional conflict around the pregnancy, there are gradations of denial and complexity and subtlety of emotional response from both the pregnant woman and those around her.

The term negation of pregnancy is also used to encompass and describe these co-occuring disorders, whereas the internal process is called denial and the external process is called concealment. Therefore, it is considered the same process, but the woman’s defense mechanisms vary in intensity.

Neonaticide, the killing of an infant on the day of birth, is a form of infanticide that is often preceded by pregnancy denial. Neonaticide can be one of the complications of pregnancy denial.

Pregnancy denial is a real phenomena that has a long history of documentation, by doctors, mothers, their families and artists.

One famous literary exploration of pregnancy denial and neonaticide is illustrated in George Eliot’s novel, Adam Beade, published in 1859. It is the novel of a woman’s experience, examining the intersection between women’s unique emotions around reproduction and their disempowered social standing. Taking place in 1799, the story is about a love triangle involving Hetty, a 17 year old girl. She becomes pregnant out of wedlock. Hetty knows she is pregnant, but never openly acknowledges this. She knows she will face extreme shame and ostracization by the town, should anyone find out. She successfully hides her pregnancy and gives birth to her baby in a field. She commits neonaticide, abandoning her baby boy where she birthed him.

Characteristics of Women Who Negate Pregnancy

Early research indicated that pregnancy denial and neonaticide is more likely to occur  in women who are young and unmarried, where the relationship with the father is dissolving or non-existent and the woman lives at home with relatives.

However, more recent research shows that pregnancy denial and neonaticide occurs in women of all age groups, cultures and marital status in response to a conflicted pregnancy. Many women already have several other children, so it is not always the first time mother who negates her pregnancy.

Research by Shelton and colleagues (2011) indicates that pregnancy at an early age, multiple young children, a history of childhood abuse and trauma, current fear of abandonment (even if in a stable relationship), and a deprived social situation are all risk factors and common characteristics for women who negate their pregnancy.

The pathway to pregnancy denial and concealment often begins with an unplanned pregnancy. The woman has accompanying feelings of extreme fear and shame. She begins with pregnancy concealment. She hides her pregnancy with baggy clothes and isolates herself in her room. To help facilitate concealment, she sees less and less of people. Thus, she becomes more and more emotionally isolated.

Eventually, she finds she has no one to confide in. This results in a vicious cycle, and her emotional defenses develop a sense of pregnancy denial. The pregnancy denial is described by researchers as intermittent, her lack of self-awareness comes and goes and she is able to compartmentalize her pregnancy. She successfully dissociates from her body sensations.

The denial and dissociation is so potent that women often describe beginning birth pains as flu symptoms, gas pain and menstrual cramps. Women often go to the bathroom and deliver the baby silently, with others nearby. Women often describe the feeling of giving birth like having to defecate and are shocked when a baby appears.

Women in this type of delivery report dissociative symptoms at the birth and afterward when coping with the newborn. Women also often report a fantasy that the infant was preterm or stillborn. Often, sadly, the outcome for infants born to women who are experiencing negation of pregnancy are death a short time after birth, either from drowning in a toilet bowl, or hitting their head on the floor in a precipitous, unassisted birth.

Another fascinating aspect of pregnancy concealment and denial is that the family and even doctors are drawn into “community denial” by the emotional intensity of the denial. Interestingly, in one study, only 5 out of 28 women studied who negated their pregnancy had any family members inquire about their pregnancy at all (Amon et al, 2012)! Another study indicates that even long term family doctors who know the woman well will sometimes fail to diagnose the pregnancy (Amon et al, 2012).

Treatment

Treatment for negation of pregnancy is as nuanced and varied as each individual case. Whenever there is dissociation of parts of reality and parts of the self, the treatment path can include techniques used to treat post-traumatic stress. Such techniques would include EMDR, guided imagery, object relations techniques embedded in an overall therapeutic structure that balances leaving a woman’s psychological defenses intact, while at the same time helping her through her issues of denial (Anonymous, 2003).

Depending on the cause and severity of the negation of pregnancy, the processing of dissociated emotional material, the buried shame, the confusing physical symptoms, and the integration of the parts of her self could take place over an extended period of time in a safe, therapeutic atmosphere.

In general, directly asking or accusing a woman who is negating her pregnancy about her situation isn’t an effective treatment method. In order to survive, the person has most likely developed a method of dissociative “splitting” or “compartmentalizing” differing parts of the self. It is a normal psychological response to dissociate from trauma in order to survive. Dissociative coping exists along a continuum, from intermittent denial to having developed separate parts of the self to contain the trauma (Amon, 2012; Anonymous, 2003).

For example, in order to survive complex emotional trauma, such as childhood abuse, incest, rape, pregnancy from rape/incest, a woman would survive by dissociating. She may have unconsciously developed a way to “split” or “compartmentalize” parts of her self. Her unconscious coping mechanism assigns one part of the self to be covertly sexually active while another part of the self overtly maintains the social and familial facade that she is not sexually active. The psychological defenses can be so strong that she has intermittent dissociative awareness about her pregnancy and even amnesia around childbirth.

On the other hand, a woman may be experiencing a less mild form of dissociation and negation of pregnancy. She may need time to integrate her pregnancy into her life and shift towards healthy adjustment, coping and planning.

What birth professionals can do

If you suspect you have encountered a woman with this condition, be aware of your own reactions to her situation. Convey an accepting attitude about her situation. It’s best not to ask her overt questions about her circumstances. Ask open-ended questions, wait for her responses. 

Importantly, convey an accepting attitude about sexuality, pregnancy and motherhood, without being overt.

Have a good set of referrals to health professionals, including mental health professionals,  in your area. You may not be able to help her in the moment, but there may be another time you’ll see her and she might be open to accepting help. Your accepting attitude could be part of her healing and reaching out.

Conclusion

To sum up, negation of pregnancy has been documented in the popular literature and in medical literature for many years. It was once thought that negation of pregnancy only occurs in young and unmarried women, but current research shows that older women with multiple children experience this as well. It is a condition of many emotional and psychological nuances. In a very rare number of cases, can lead to neonaticide.

As a birth professional in your community, you can help by developing an awareness and understanding of negation of pregnancy as a real condition, with many emotional and psychological nuances. By being accepting and by having a solid set of referrals for her and her family if she reaches out to you. More study is needed in order to understand this topic more thoroughly. 

References

Amon, S., Putkonon, H., Weizmann-Henelius, G., Almiron, M.P., Gormann, A.K., Voracke, M., Eronen, M., Yourstone, J., Friedrich, M. & Klier, C.M. (2012). Potential predictors in neonaticide: the impact of the circumstances of pregnancy. Archive of Women’s Mental Health, 15, 167-174.

Anonymous (2003). How Could Anyone Do That? A therapists struggle with countertransference. In M.G. Spinelli (Ed.), Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill (pp. 201 – 208). American Psychiatric Publishing, Washington, D.C.

Shelton, J.L, Corey, T., Donaldson, W.H. & Dennison, E.H. (2011). Neonaticide: A comprehensive review of investigative and pathologic aspects of 55 cases. Journal of Family Violence, 26, 263-276.

Miller, L. J. (2003). Denial of Pregnancy. In M.G. Spinelli (Ed.), Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill (pp. 81- 103). American Psychiatric Publishing, Washington, D.C.

Spinelli, M. G., (2003). Neonaticide: A systematic investigation of 17 cases. In M.G. Spinelli (Ed.), Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill (pp. 105 – 118). American Psychiatric Publishing, Washington, D.C.

About Kathy Morelli

Kathy Morelli is a Licensed Professional Counselor in Wayne, NJ and the Director of BirthTouch®, LLC. She provides Marriage and Family counseling in Wayne, New Jersey with a special interest in perinatal mood disorders, sexual abuse and its impact on parenting. EMDR is one of the mindbody therapies she uses to address trauma.   She blogs about the emotions of pregnancy, birth, postpartum and couples. Kathy is the author of BirthTouch® for Parents-To-Be and BirthTouch® Healing for Parents in the NICU. Kathy has lectured on BirthTouch® at the University of Medicine and Dentistry of New Jersey’s Semmelweis Conference for Midwifery and at birth conferences. She presents trainings to allied health/birth organizations about maternal mental health, family systems and good-enough parenting and is found on web media, such as PBS’ This Emotional Life, writing and speaking about this subject. She volunteers on Postpartum Support International’s warmline. Kathy co-moderates #MHON , a psycho-educational and supportive Twitter chat led by credentialed Mental Health professionals around mental health issues, working to reduce the stigma around mental illness.

 

 

 

 

 

Babies, Birth Trauma, Childbirth Education, Depression, Guest Posts, Infant Attachment, Maternity Care, News about Pregnancy, Parenting an Infant, Prenatal Illness, Trauma work , , , , , , ,

The I-Baby: A Baby’s Brain On Technology

April 11th, 2013 by avatar

Regular contributor Kathy Morelli takes a look at babies and media and technology exposure.  If you are working with expectant families or with families parenting young children, you have an opportunity to share the impact of media on developing brains.  Take a moment to read today’s post and share how you bring up this topic with the families you work with. – Sharon Muza, Community Manager, Science & Sensibility. 

http://flic.kr/p/DVbyu

Today’s babies are definitely digital natives! They grow up in a world saturated by media. The research about the effects of media on child development is in its infancy (no pun intended). 

On one hand, some research suggests when the developing brain is over-exposed to multi-tasking, attentional and learning difficulties can result. On the other hand, other research contradicts this finding. Additionally, there are lots of claims from DVD and TV producers that using their media enhances learning and social growth. 

What’s a parent to believe?

First Off: Parent with Awareness and Moderation

Put some perspective on this issue by reframing parenting around media issues as similar to parenting around other issues. 

Parenting with awareness and moderation through the infant years, around any topic, depends on three important tips.     

Tip One: Parent, Heal Thyself 

Encourage parents to be aware of their own emotional reactions to their baby. Have them own their emotions as their own, not their baby’s.

If the parents themselves have felt abandoned as a child, they may need to do their own hard emotional work, centering on their reactions to their baby’s dependency needs. Feelings around their own issues persist no matter what media is in use in the house. Parents should recognize them as their own feelings and work to own them. 

Tip Two: The Baby is an Individual  

All the statistics and information in the world doesn’t change the fact that each baby is an individual, with individual needs.

All babies need one-on-one attention from their caregivers, but some need more than others. Some babies cry more than others, some have colic, some are calmer and quieter than others. And learning occurs differently in each individual.

Have the parents look for clues. If their baby needs more attention than they think he needs, remember he is an individual and cannot be compared to other babies in their life. If their baby has a negative reaction to some type of media, have the parents either reduce its use or don’t use it at all. It might be a signal that he needs more interactive attention from the parent.  If the baby seems confused, frightened or agitated by some imagery or sounds from media, don’t force him to watch it. Cut it out of the home’s media diet. 

Tip Three: Baby, It’s YOU

There is no substitute for the parents. Have parents plan to spend meaningful time with their baby. A baby’s healthy development depends on attentive, personal, touchable, multisensorial, fully embodied experiences.

Newborn Baby’s Brain – Not So High Tech

First, an infant’s growth is intertwined on all levels; physical, mental and emotional growth are all related. In other words, brain development, movement, emotional development, and language are all inter-related and unfold together, at a biologically prescribed pace.   

Second, in the first three years of life, there are multiple critical periods (windows of opportunity) when a baby must be exposed to particular life experiences in order to learn particular skills. If these windows are missed, it’s extremely hard (or impossible) to learn the skill at a later time in life. The windows of opportunity are biologically based on brain development (Zero to Three, 2012). 

For example, vision and language are two skills dependent on critical windows of time. Acquisition of binocular vision and depth perception depends on a normal early experience with vision in the first few weeks of life.  Language skills must be acquired before five years of age, or there is little chance of developing language later in life (Zero to Three, 2012).  

Third, babies are born with immature brains. Experts estimate in order for the human brain to be fully developed at birth, the gestational period should be 18 months.  But human babies come out in nine months in order to compensate for the size of the human female pelvis (Christakis, 2009).  

Many baby experts refer to the first three months of life as the “fourth trimester” (Karp, 2003).  In the fourth trimester, a baby is still very fetus-like.  At at the beginning of life, a baby’s brain is only a quarter of its adult size and will grow about 20% in just the first three months of life. Her brain structures are in place, but are waiting to grow, based on her experiences. (Stamm, 2007). 

Think of the huge differences between a four day old baby and a four month old baby. That four month old child is cooing and smiling right at their parents, enticing them to connect! That newborn is depending on the parents to connect with her to help her grow (Marvin & Britner, 2008).      

The time between birth and two years old is naturally and biologically a period of extraordinary growth. An infant’s brain naturally grows based on genetics and interactive experience (Zero to Three, 2012; AAP, 2011; Stamm, 2007) 

The Infant Brain – How Babies Learn  

Babies Learn by Social Interaction:  Popular hype says any type of stimulation helps the infant brain grow and learn. But the consensus of child development specialists everywhere is  normal infant development depends on normal social stimulation  involving all the senses (touch, sound, sight, smell) (Vygotsky, 1978; as cited in Fenstermacher et al, 2010).   

What is normal social stimulation with all the senses?

It is responsive care by the parents (caregivers) using all the senses, including skin to skin contact, movement (swaying, walking, gentle dancing), holding, feeding, cuddling, talking,  loving direct eye contact, smiles, gentle play, comforting, and mature acceptance and modulation of your baby’s changing feeling states (angry, happy, sad) (Cozolino, 2006; Wallin, 2007). 

Emotional Attachment Style is Learned: A baby’s emotional template is encoded neurologically based on her earliest experiences with her parents and other caregivers. The biological attachment sequence enacts no matter what type of care a baby receives.

A good quality, secure attachment is created by good quality and consistent interactions between baby and parents. The human brain is plastic, so the attachment template is continuously updated and developed throughout life, but it is much easier on a person to begin life with healthy connectivity patterns, than to correct them as they go along (Wallin, 2007).        

Neglect & Abuse Affect Brain Growth: Research shows children growing up in neglectful and abusive homes, who are rarely spoken to, who do not have the opportunity to explore, may fail to develop the neuronal pathways necessary to learning (Zero to Three, 2012).

No Media vs Hey, It’s Educational!   

Parents of the under two set are understandably concerned by the conflicting messages out there about screen time.

American Academy of Pediatrics (AAP, 2011) strongly discourages any media consumption by children younger than two.

The AAP’s policy statement is based on research findings that media time tends to elbow out time spent in unstructured, creative play time and interactive activities with a parent or caregiver.  High quality, multi-sensorial interactions with a consistent caregiver are essential for healthy child development.

Yet, media is an integral part of our culture. On the average, 100% of children under two watch 1 – 2 hours of media every day and 14% watch over 2 hours a day (AAP, 2011).  40% of all children younger than two years live in households where the TV is on all day long as background noise (Courage & Setcliff, 2009). 

So what’s a parent to believe?

Does media consumption hurt babies?

Many parents say they are comfortable with allowing their under 12 month babies to watch educational media. There are a lot of educational firms pushing DVDs for the under 12 month old set, claiming learning enhancement and improvement for school readiness.

Are their claims substantiated by research?

The Research

What follows are some key points from the research about media consumption, learning and attentional effects on the developing brain.

Media, the Developing Brain and Attentional Difficulties

In 2004, Dimitri Christakis, MD, MPH of the University of Washington, reviewed data from an existing study. He found an association between children under three who watch on average more than two hours a day of television and attentional difficulties. In 2007, further studies by Christakis and his colleague, Fred Zimmerman, found the attentional difficulties were more precisely linked to program content. That is, cartoons and fast paced media seem to be linked to attentional difficulties, but not educational and appropriately paced programs. Christakis theorizes that over-stimulation of the developing brain with flashing and changing sights and sounds might be harmful to the developing brain (Christakis and Zimmerman, 2007; Christakis, 2009; Zimmerman et al, 2009).

On the other hand, there are researchers such as Tara Stevens and Miriam Muslow (2006) who feel the evidence linking media usage and attentional difficulties is highly correlational and Christakis and Zimmerman did not properly account for other factors in their information. Clearly, there is a need for the National Institute of Health to fund a large scale study to see if and how the digital native brain is affected by media saturation.   

How Babies Learn from the Screen 

Video Deficit Effect: Research about screen learning versus live learning indicates infants learn less from video than from live interactions; this is called the “video deficit effect.” The video deficit effect persists to about three years of age (Barr, Muentener, & Garcia, 2007; Zack et al, 2009).

The video deficit effect is mitigated by repetitive viewings, media content design and the context in which the media is used (Barr, 2010).

Repetition: So, babies under 12 months will retain behavior after seeing it performed once by a live model. But it takes repeated viewings for a baby to learn the same behavior from a screen.   

Content design: Retention of information is also enhanced in the under 12 month set by story content. If the story lines are simple, in sequence, and uninterrupted by multiple story lines or commercials, retention is enhanced. (think Teletubbies).

Context: In addition, if the media is in the context of a family situation, that is, if there is an appropriate adult moderator present, to discuss, distract and limit screen use, retention is enhanced and deleterious effects are reduced (Christakis, 2009).

Individual learning differences: In addition, there are differences in how and how fast individual babies learn. In general, at about the age of 12 months, a child becomes capable of seeing something on a screen and then performing it himself. But there are individual variations, and these variations persist into toddlerhood (Barr, 2007).     

But, as discussed above, child development specialists agree infants primarily learn via social-interactional-sensorial methods.

Educational Claims

Let’s take a look at the claims made by current educational DVDs targeted at infants.

In 2010, Susan Fenstermacher and her colleagues conducted an overview of 58 popular DVDs (culled from a total of 218 made between Fall 2007 and Spring 2008) marketed as educational to parents for their infants. A total of 17% of 686 claims made by the producers were that the DVDs provide socio-emotional educational content. However, the researchers found that only 4% of all the scenes were socio-interactional in content and these scenes were not of high quality.

In general, producers of DVDs do not use research-based child development learning principles, despite their claims. Of course this may be changing as these producers begin to use child development experts as content consultants.  

Language Development and Media

Language: Research shows babies learn language from being directly spoken to by their caregivers. Babies don’t learn language from the television or from observing conversations between adults, they need direct attention.

Matthew LaPierre and his colleagues (2012) found that children from eight months to eight years are exposed to over 4 hours of TV a day. This can be reduced by not having a TV in the child’s room.

Studies have shown that having the television on at home all day as background noise causes language delays and reduced interaction between parents and children (Kirkorian et al, 2012; LaPierre, Piotrowski & Linebarger, 2012).

Profoundly, a study of 1000 infants found that babies who watched over 2 hours of DVDs a day had poorer language assessments than babies who did not watch DVDs. Specifically, for each hour of watching a DVD, a baby knew 6 – 8 words less than babies who did not watch DVDs (Christakis & Zimmerman, 2007).

On the other hand, in 2010, Allen and Scofield found that 2 year olds can learn simple words from very simplified content, from a video.  They found the Blues Clues format was good for this.

Again, the research is not yet complete, but still points to the benefits of parental awareness and judicious use of media.   

Reality vs Fantasy in the Young Mind

Remember babies brain structures are not yet developed. The lower brain centers, the emotional centers, with structures such as the amygdala, are fully formed at birth. The amygdala is in charge of emotional designation. But the neo-cortex, the logic center is not fully formed until the early twenties (Cozolino,2006). Thus, the capacity to differentiate between fantasy and reality is limited in babies, toddlers and children. Babies are wired to empathize with the emotions of the people around them and have the capacity to do so. And remember that babies do retain information from repeated viewings.

For an example of how differently children view reality than adults, studies show children believe that many planes hit the World Trade Center, not just two, as the event was shown over and over again on TV.

So keep in mind babies/toddlers and adults have a different understanding about fantasy and reality as applied to what is viewed on the screen and they also can “catch” emotions from the people around them and from the screen. 

Five Tips for Parents: Media & Infants 

So, when it comes to media consumption, think about parenting a young baby with awareness and moderation. Some age appropriate media is ok, and its ok to for parents to take breaks with a TV show, but don’t let it edge out stroller walks, hikes in a baby back pack in the woods, and bonding time. 

Tip One: There is no substitute for the parent.

Studies indicate using media over 2 hours a day steals precious interactional learning time from the baby.  Encourage parents to help their baby grow by being present with her.

Tip Two: Like any parenting decision that needs to be made, make the decision from a place of awareness and in moderation.

Tip Three:   Be aware of how much your TV is on.

Again, research has found that children in the US are exposed to over 4 hours of TV a day. Reduce this time limiting the number of TV’s in the home, and not putting a TV or computer in the child’s bedroom.

Tip Four: Those educational DVDs? Well, research shows they make a lot of claims and the content is not based on research.   

Since some studies have implicated attentional and language deficits in babies who view more than two hours of media per day, limit the amount of media with your infant. A baby’s primitive brain learns socially and with many senses involved: touch, smell, sight, sound. A baby’s early interactions and experiences are encoded in the brain and have lasting effects. Choose media that has child development consultants working on the production.  

Tip Five: Think twice about exposing your young baby/toddler to violent imagery on the screen. Remember repetitive showings increase retention, babies are naturally wired to empathize with emotions and studies show that children have a different perception of reality and fantasy than adults.

Five positive ways for parents to interact with their babies: 

  • Consistently interact with a baby using prolonged eye contact, gentle skin to skin touching and smiling
  • Actively watching appropriate media with a baby is a way for parents to get a needed sitting rest and also enhances learning and mitigates negative effects
  • Baby massage is a wonderful tool for parents. Studies show it reduces anxiety and depression in both parents and babies (Field, Hernandez-Reif, M. and Diego,  2006)
  • Teach her to regulate her emotional states by appropriately soothing her when necessary. She is learning how to accept and tolerate her own emotional states from parents, so remain calm and consistent.
  • Remind parents that they don’t need to be perfect, they just need to be good enough!

 References 

American Academy of Pediatrics, Council on Communication and Media (2012). Policy Statement: Media Use by Children Younger Than 2 Years. May 15, 2012 from  http://pediatrics.aappublications.org/content/128/5/1040.full.html

Barr, R, Muentener, P, and Garcia, A. (2007). Age related changes in deferred imitation from television by 6-18-month-olds.  Developmental Science,10(6), 910-922.  

Christakis, D (2009). The effects of infant media usage: what do we know and what should we learn? Acta Pædiatrica, 98, 8–16.

Christakis, D. and Zimmerman, F. (2007). Associations between content types of early media exposure and subsequent attentional problems. Pediatrics, 120(5), 986 -992. doi: 10.1542/peds.2006-3322

Courage, M. and Setliff, (2009). Debating the impact of television and video material on very young children: Attention, learning, and the developing brain. Society for Research in Child Development, 3(1), 72-78.

Cozolino, L. (2006). The neuroscience of human relationships. New York: W.W. Norton & Company. 

Fenstermacher, S. K., Barr, R., Brey, E., Pempek, T. A., Ryan, M., Calvert, S. L. and Linebarger, D. (2010). Interactional quality depicted in infant and toddler videos: where are the interactions?. Infant & Child Development, 19(6), 594-612. doi:10.1002/icd.714

Field, T., Hernandez-Reif, M., & Diego, M. (2006). Newborns of depressed mothers who received moderate versus light pressure massage during pregnancy. Infant Behavior and Development, 29, 54-58.

Kirkorian, H. L., Pempek, T. A., Murphy, L. A., Schmidt, M. E., & Anderson, D. R. (2009). The Impact of Background Television on Parent–Child Interaction. Child Development, 80(5), 1350-1359. doi:10.1111/j.1467-8624.2009.01337.x. 

LaPierre, M., Piotrowski, J., and Linebarger, D. (2012).  American children exposed to high amounts of harmful TV. Unpublished paper presented at International Communication Association’s annual conference (Phoenix, AZ, May 24-28, 2012).

Marvin, R.S. & Britner, P.A. (2008). Normative Development: The ontogeny of attachment. In J. Cassidy & P.R. Shaw (Eds),  Handbook of Attachment, (pp. 269-294). New York: The Guilford Press.

Stamm, J. (2007). Bright from the start. New York: Penguin Books.

Stevens, T. and Mulsow, M. (2006). There is no meaningful relationship between television exposure and symptoms of attention-deficit/hyperactivity disorder. Pediatrics, 117(3), 665-672. Retrieved May 21, 2012 from http://pediatrics.aappublications.org/content/117/3/665.full.html

Wallin,D.J. (2007).  Attachment in psychotherapy. New York: The Guilford Press.

Zack, E., Barr, R., Gerhardstein, P., Dickerson, K., and Meltzoff, A.N. (2009). Infant imitation from television using novel touchscreen technology. British Journal of Developmental Psychology, 27, 13–26.

Zero to Three (2012). General brain development. Retrieved May 15, 2012 from  http://main.zerotothree.org/site/PageServer?pagename=ter_key_brainFAQ#bybirthZimmerman, F. J., Gilkerson, J., Richards, J. A., Christakis, D. A., Dongxin, X., Gray, S., & Yapanel, U. (2009). Teaching by Listening: The Importance of Adult-Child Conversations to Language Development. Pediatrics124(1), 342-349. doi:10.1542/peds.2008-2267 

American Academy of Pediatrics, Babies, Childbirth Education, Guest Posts, Infant Attachment, Newborns, Parenting an Infant , , , , , , ,

EMDR Part Three: Listening to Women; Personal Experiences of EMDR for Treating PTSD

February 28th, 2013 by avatar

In this series about EMDR (Eye Movement Desensitization and Reprocessing), Part One looked at qualitative research evaluating EMDR as treatment for post-traumatic stress disorder (childbirth onset). In Part Two, EMDR clinicians weighed in on their feelings about the safety of EMDR during pregnancy. When those EMDR posts were published, I received a lot of behind the scenes feedback from women who either loved or hated their experiences with EMDR; there didn’t seem to be a middle ground!

Women Thrive When They Learn Emotional Skills Istock/GoldenKB

I felt these women’s voices need to be heard (many thanks to Sharon Muza, S&S Community Manager, for her gracious agreement!) The results are here: four interviews conducted with four real women who suffered from trauma in the perinatal period and tried EMDR.

It’s unfortunate these lovely women suffered extreme emotional turmoil at such an important time in their life; when they were working and hoping to build their emergent family and when they were primarily responsible for the safety and care of their infants.

Through sharing their stories, all women indicated to me that they hope that their voices will contribute to the collective movement to incorporate mental health care into the overall care of women and their families in the childbearing year.

Characteristics of Their Trauma

All of the women interviewed experienced trauma in the early postpartum period. Three suffered specifically from birth trauma; all experienced a severe perinatal mood disorder. Three of the women additionally were coping with complex, long-term, multi-layered emotional trauma, stemming back to abuse in childhood.

All of the women interviewed were seeing licensed therapists who incorporated EMDR into their overall treatment plan for trauma. Some asked to have their identities masked, so identifying details and names are obscured, but the overall personal statements and feelings are preserved.

They are empowering to all of us in that ALL of them valued their mental health and were brave enough to seek professional help!

Personal Healing Processes

The women interviewed are all emotionally mature adults. They’re aware of their life situations and the impact of trauma on their well-being. They’ve worked hard to explore and develop life-long skills and methods of managing their emotions. Thus, these are all women who are proactive, sophisticated and intelligent about their emotional healing processes. Before they used EMDR, all of the women had already incorporated many forms of healing into their personal self-care plans.

Their self-care plans included: long-term psychotherapy, journaling, expressive therapies such as art, music and movement, yoga, exercising, gardening, cognitive behavioral therapy, goal setting and medication. One woman indicated she was in so much pain from long-term, severe, past abuse she had seriously discussed electroconsulsive therapy with her psychiatrist. So, when their trusted therapists suggested trying EMDR, specifically designed to treat trauma, all the women agreed.

Personal Perinatal Traumatic Events:

In their own words, the women share their individualized, personal perinatal trauma experiences below.

Birth Trauma:

Kim (not her real name) shares her traumatic birth story:

“My son was born after an easy pregnancy but a complicated birth. I’d very nearly had a vaginal birth; the nurses could see the top of his head, but it was turning to the side each time I pushed. After nearly 2 hours of this, I underwent a c-section because I had spiked a fever and things were not progressing. During my c-section, I was overcome by anxiety and completely paralyzed by fear.

I literally thought I was dying as my son was being born, yet due to the panic, I was unable to verbalize this fear to anyone.

I spent that time shaking and having what I thought were my last panicked thoughts and breaths. It was the the most afraid I’ve ever been in my entire life, and also the most alone I’d felt, despite being surrounded by others.

After the surgery, I wasn’t able to hold my son for 3 hours. I spent the time in recovery, scared that something were wrong and nobody was telling me. I am still not sure of the reason for the delay.

My maternity leave felt long, due to postpartum anxiety and depression and a baby who barely slept and I cried nonstop some days. I felt like a terrible mother who was unable to console her child or enjoy him. I felt tremendous guilt. In addition to the emotional aspects, my c-section scar was not healing properly, so I felt as if I were constantly making a 30-mile trek (newborn in tow) to my ob-gyn’s office for checkups. “

Birth Trauma Layered on Childhood Trauma:

Karen (not her real name) said:

“My very traumatic birth triggered already active memories of severe childhood abuse, parental suicidal attempts in front of me, active alcoholism & substance abuse in the family and severe childhood neglect.”

Helen (not her real name) said:

“I was working on birth trauma at the start of the EMDR, but later on, abuse, illnesses, and marital distress. I was mainly focused on the birth trauma I had experienced when I used EMDR.”

Postpartum Traumatic Event Layered on Childhood Trauma:

Jessica Banas explained her perinatal trauma as such:

“I was traumatized by my childhood with my father. He was very emotionally abusive. Seeing him overdose (on a drug called GHB) the first night my parents were to supposed to have been watching my infant son for me, so I could rest, felt like the ultimate betrayal. Once again, not only were they NOT there for ME, but I had to SAVE them (again) instead!!!”

Women’s Experiences Show Us Moms with PTSD Suffer Co-morbid Perinatal Depression & Anxiety

It is fascinating and sad that all three women with pre-existing trauma stated their prior trauma was re-triggered by a perinatal traumatic event (traumatic birth or other traumatic event postpartum). And all four suffered from severe postpartum depression and anxiety after their traumatic perinatal event. A woman’s mental health is an important aspect of the childbearing year.

As discussed in a previous blog post, one in four women suffers depression at some point in her life, and women are more likely to suffer depression during and shortly after pregnancy than at any other time (Nonacs, 2006). Ruta Nonacs, MD (2011), editor-in-chief of Massachusetts General Hospital’s Center of Women’s Mental Health’s website estimates annually in the US, there are about 4 million births, and about 950,000 to 1,000,000 mothers suffer from depression either during or after childbirth every year. 

Having a personal history of a mental illness in her lifetime, such as depression, anxiety, PTS/PTSD, OCD or bipolar disorder (remember, this is whether it was diagnosed & treated or undiagnosed & untreated) increases a woman’s risk of postpartum depression. A previous history of previous postpartum depression increases a woman’s risk of a recurrence to 50 – 80 % risk of recurrent PPD, as compared to a 10- 20% risk factor without having had a prior episode.

It’s important to note that the women’s constellation of PTSD symptoms intensified and they developed severe postpartum depression and anxiety.

Jessica eloquently states how important women’s mental health is to the postpartum period:

” One important symptom of my PTSD that complicated and worsened my PPD was when my infant son would cry and interrupt my ruminations of my father Od-ing. I’d get angry….that would trigger thoughts of wanting to harm my son and cause me great anxiety and incredible guilt…..there were many times I was too afraid if I went to tend to him, I’d treat him harshly, or hurt him This created such a sense of worthlessness and shame, I thought of suicide one night. Instead, I told my husband and we reached out and got help.

It is a very important aspect of PTSD in that I am personally aware how detrimental it is on PPD. My PPD rapidly escalated after getting PTSD. And one seemed to feed on the other. Getting treated for BOTH issues was very important.”

Women’s Experiences Show Us the EMDR Outcomes

Two very positive experiences

Kim’s Experience with Traumatic Birth & Postpartum Anxiety & EMDR

Kim, who suffered from birth trauma and postpartum anxiety, had a positive experience with EMDR. Here is her story of healing.

Kim said that her therapist incorporated EMDR into her current psychotherapy sessions. She said she hadn’t realized that she’d been suffering with PTSD until almost a year after the incident. She says she discovered her anxiety was stemming from a traumatic birth experience at a therapy session:

Kim says:

“…of course I’d had PTSD from thinking I was dying while my son was being born! My anxiety, which had a lot to do with waiting for something terrible to happen to me or my son, started to make sense in light of this new revelation.”

Kim experienced the EMDR itself as calming. She held tappers in her hands while her therapist led her through visualizations. Her therapist warned her that EMDR could be emotionally triggering and if she needed to call her, she was welcome to do so. And it was triggering for Kim. After her first session, she suffered from an anxiety attack and had to call her therapist, and received the help she needed.

Ultimately, Kim’s overall experience with EMDR was emotionally freeing and healing.

She goes on to say:

“Up until the EMDR, I was unable to speak about my c-section at all. I couldn’t see anything related to the birth experience (with or without c-sections involved) on television, either. If I caught a glimpse of a birth on TV, I cried. I had a lot of anxiety on the few occasions I tried to watch A Baby Story on TLC, as a test to see how I felt watching another woman’s experience.

After EMDR a few times, I became more comfortable thinking about and processing my experience, and even eventually talking about it with others. I no longer viewed my scar as something horrible and ugly. Having EMDR gave me back my confidence because it helped me stop seeing myself as a failure (because I needed a c-section instead of birthing vaginally). “

Kim would recommend EMDR to another person trying to recover from trauma, but with some warnings about the emotional response.

Jessica’s Experience of Postpartum Traumatic Event, PPD, Suicidal Ideation & EMDR

Jessica, who experienced the trauma of her father’s overdose while her parents were supposed to be watching her baby, had a positive experience with EMDR. Here is her story of healing:

Jessica said that her therapist incorporated EMDR into her current psychotherapy sessions. Her therapist suggested she try something “new” that would remove the sting of the trauma from her mind. Jessica was skeptical but thought she’d give it a try.

Jessica says:

“The EMDR was pretty much wrapped around by talk therapy in that we’d start out by talking and end up by talking… EMDR took the emotional ties from the traumatic memories away. I no longer find myself reliving any of those memories that were treated with EMDR. I no longer feel any emotional pain from the OD event. I have no loss of sleep, anger, depression, or any anxiety over that event.”

Jessica says she did not find the EMDR emotionally triggering at all, but many childhood memories came flooding back. .

“Not at all…frankly, I thought it was lame at first (wiggling a finger in my face? REALLY?) and had no hope it would have ANY effect at all. Once we (quickly) healed the OD trauma, memories from my childhood did come flooding back! I found that to be very interesting! Fortunately, my childhood was not as terrible as many, so I could handle this phenomenon.”

Jessica recommends EMDR:

“…as long as the person is seeing a well trained, compassionate therapist! EMDR helped me and I have gone on to suggest it to other people who were in pain as I was….those people have been healed by EMDR as well….I find it a useful treatment and extremely non-invasive compared to other treatments!!”

Two very negative experiences

Karen’s Experience with Birth Trauma, Past Trauma, PPD, PPA & EMDR

“My experience was physical and emotional and in both cases negative. I felt physically ill, vertigo, nausea. Disorientation, short-term memory loss, headache. Emotionally, it was detrimental as it brought up my most difficult trauma and I felt completely triggered. I tried to hang in there with the process, but only did a few sessions. The EMDR sessions were not processed with in-between traditional talk therapy sessions. The EMDR made my symptoms worse, my anxiety worse, and the neurological side-effects were horrible. While my therapist did a wonderful job at regrouping,  after we decided to stop doing it, I actually went up on my medications and saw her 2x a week for a while. It was just too much. What I think had happened to me was more resurfacing of old memories that I had compartmentalized in years of talk therapy and medication. I actually think I needed a medication adjustment when I was so desperate for relief. “

Karen would not personally recommend EMDR to another.

Helen’s Experience with Birth Trauma, Past Trauma, Postpartum Mental Health Complications & EMDR

“My therapist suggested the EMDR may be helpful for both traumas (birth and childhood). I had 6 sessions that were each an hour long. Some of this process was also traditional talk therapy in between the EMDR. I found EMDR not helpful in treating my traumas.”

“It was extremely triggering and the therapist pushed me into a lot of it. She would try to help me regroup by taking deep breaths and little breaks in between. But I always felt drained after each session and even more triggered with PTSD.”

Helen would not recommend EMDR for another person:

“I do not think I would personally recommend EMDR to another person for a trauma. I believe the therapist shoved me into it too soon and left me for days swirling in the emotions of that. I have heard it can be wonderful and healing for others. For me, it triggered too much to soon and my experienced left me more traumatized. I can’t think of those (EMDR) coping skills and techniques without feeling overwhelmed with memories.” 

Conclusions

As we can see from real women’s experiences, EMDR was extremely triggering to two of the women, but resolved emotional distress well for the two other women. Again we are reminded that one size does not fit all when it comes to treating mental health.

The women’s experiences indicated that when working with EMDR for trauma, even experienced and trusted therapists encountered strong triggering responses in their clients. In these instances, these therapists needed to know how to appropriately re-group and therapeutically support their clients either in the session and/or be appropriately available outside of scheduled sessions.

It was not appropriate for a therapist to urge a client to try or keep using EMDR if the client did not really want to, or if the client was having an overall non-therapeutic effect.

As we can see from these real women’s experiences, the treatment of post-traumatic stress has the potential to be devastating to the client as far as awakening or re-triggering compartmentalized past emotional distress.

In this small article and small example, it is interesting to me that the four women who volunteered to share their stories in this small had extreme reactions to EMDR, none neutral. These results reinforce my usual conservative approach to managing emotional distress, that is, if one is suffering from debilitating mental and emotional distress, it is best to consult with a licensed professional.

What I find empowering about these interviews is that ALL of these women VALUED their mental health and were brave enough to seek help. Fight the stigma! Don’t be afraid to get help!

Author’s Note: None of these women were or are my clients. I sought out non-clients for the purpose of these interviews.

References

Nonacs, R. (2006). A deeper shade of blue. New York: Simon and Schuster.

Birth Trauma, Cesarean Birth, Childbirth Education, Depression, Do No Harm, EMDR, Evidence Based Medicine, Maternal Mental Health, Perinatal Mood Disorders, Postpartum Depression, Pregnancy Complications, PTSD, Research, Trauma work , , , , , , , ,