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“Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth”, Part Three, Interview with Walker Karraa

March 17th, 2015 by avatar

By Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM

© Walker Karraa

© Walker Karraa

Last week, Cynthia Good Mojab provided Science & Sensibility readers with the first two parts of her three-part series on the book “Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth” by Dr. Walker Karraa. Today on the blog, Cynthia shares her recent interview with Karraa. Dr. Karraa provides additional insights on her research and discusses her thoughts on how the book has been received and can be beneficial to professionals and families alike. I recommend that you go back and read Part One and Part Two as well as today’s interview. – Sharon Muza, Community Manager, Science & Sensibility.

Cynthia Good Mojab: First, Walker, let me start with congratulations! I found your book to be a page-turner. I think what you’ve uncovered is very important. I’m so grateful that your book is now a resource for perinatal care providers, lay supporters, and new parents. Have you gotten reader feedback yet? 

Walker Karraa: I have gotten feedback. The feedback I’ve gotten has been very much like what you’ve just shared. People have said that it reads very quickly. I like that feedback because it says that it reads for clinicians and for lay people. It reads from the stories. I didn’t want to take out the literature review—I believe that it’s important for individuals and families that experience perinatal mood and anxiety disorders to have access to that information. I struggled with how to put context in and not have it be heavy. So, I’m glad to hear this. I did have one reader tell me that it was hard to read emotionally because the stories hit home. I think that it is a hard read. It certainly was hard to research. I didn’t see that coming. It was hard to hear the stories and be touched in my own experience of postpartum depression. I was so surprised by the stark, universal level of suicidal ideation. That was one of the most surprising things.

CGM: I think that the structure of the book, the writing style, and how statistics have been combined with real life experiences are very effective. That it’s a painful read is actually helpful because we need many more people to grasp postpartum depression at a deeper level so we can change whether we screen, how we screen, and what kind of services, support, and treatment we’re providing.

WK: I think that is what is different about my work—both in the approach I took to the research question and how I went in asking. I got answers that are that deep and that reveal a picture of postpartum depression experienced as trauma. And, that’s why it’s a hard read. I will always be thankful on a deep, profound, personal level to the twenty women who sat with me in those initial interviews and the women, another ten after, who shared the most difficult parts of their lives. So, I’m so thankful that they had that courage because it revealed that there’s more to the paradigm of postpartum depression than, how we think of it right now anyway, a form of depression with a pervasive sadness.

And, you know we all have social constructs of depression as lack of energy, sadness, incredible fatigue, sleeping too much, these kinds of general symptoms. There’s no diagnosis for postpartum depression [in the DSM-5]. It’s an onset specifier for major depression. So, we all look at these symptoms as depression. And, what the women in the study showed us is that their symptoms go beyond the symptoms of major depression. And that there’s something that happens within the context of having a major depressive episode and a new baby that is shattering to all that women have known prior to that to be things that they could count on in the world—all of those preconceived assumptions about what was predictable in the world were completely decimated. So, that collision and deconstruction of the self that they all shared is a trauma to witness, and they see it themselves; they watched themselves almost from a dissociative place. So, I do think and I hope that it offers the opportunity for everybody to have a larger conversation about how the effect of a mood disorder after the birth of a child can be traumatic.

CGM: Another thing that really struck me in your book, Walker, was how unprepared the women were when they experienced the onset of symptoms of postpartum depression. Tell me more about that.

WK: Even the women who had a history of mental health challenges were completely unprepared for the physical and psychological symptoms of postpartum depression. Their providers had not prepared them and their social world had not prepared them. So, when those symptoms hit, they had no context for being able to articulate to anyone what was happening. As a result, the “During” aspect of experiencing postpartum depression was unbelievable invisibility as the symptoms got worse and worse and worse because they had been so unprepared. Because perinatal care providers were not offering the feedback—I see you and you are feeling this way—the situation reached critical mass for all of them. And, what was so interesting to me is that every single participant was responsible for her own recovery. She alone found her way to help. They had all been asking for help….They weren’t shy—which was different than what we see in the literature. What we see in the literature is that stigma keeps women from talking. But, these women were saying “Hi, I want to die and you don’t see me.” Often a provider would say something like, “You’re telling me you want to die. Why don’t you try putting your iPod on when your baby cries.” And, what was it that made them decide to stay? I would say it was the love of their baby. And, that, no one has looked at in the research. All these women had a plan when they were nearest death. They all had suicidal ideation. They all had thoughts of harming themselves or others. They all were at that quintessential existential end of the rope when they then reached out to someone that they hadn’t yet reached out to, all on their own. And, they didn’t want to die. They wanted the symptoms to end. That is very important. And for some, treatment meant going to hospital. For some it meant getting medication. For some it meant both.

CGM: My clients also tell me that very few providers are screening them for perinatal mental health challenges or even asking a casual “How are you doing with this?” Or they tell me how they start trying to tell care providers how they feel and they will get the same kind of discounting response like what you’re describing. We have other research that shows how undetected perinatal mental health challenges are. It’s just so clear that we are collectively failing.

© CC Smoochi: http://flickr.com/photos/smadars/4758708634

© CC Smoochi: flickr.com/photos/smadars/4758708634

WK: I have a tremendous amount of respect for providers. I don’t think it’s their fault. I think that there is such stigma around mental illness—and in particular around mental illness in new mothers—that we’re blind. We are not receiving training to look at our own biases—to see that the elephant in the room is the belief that new mothers with mental illness are going to harm their babies. And we have Greek mythology and modern media to help support that belief. So, yes, it’s the primary responsibility of a care provider and that’s why women go to care providers because that’s who you go to when you say that you’re sick and you need help. But, the care providers themselves, including OBs, general doctors, ER doctors, psychiatrists, the whole realm of childbirth professionals…they haven’t been given the opportunity or the mandate to look at their own internalized and institutionalized stigma.

CGM: Like you said earlier, the stigma taps into our own fears. We’re afraid. It tugs on our own internal memories and experiences of when we’ve been vulnerable or someone significant in our life has been vulnerable.

WK: Yes. We are afraid. But women have been doing this for millennia. Most women get through it. And, this is what we need to help women know. The women in my book are just a tiny little window into the millions of women throughout the ages who have the fortitude, the skill, the strength, to be dragged through hell and survive. And not only survive, but be transformed. It’s beyond recovery. This is the trauma literature. This is the incredible literature from Tedeschi and Calhoun regarding posttraumatic growth that needs to be brought into the birth world. And, Viktor Frankl—the famous Viktor Frankl, Auschwitz survivor…. He endured that process. Every human being does that and women will do that. So we’re talking about what obstacles and paradigms are set against women. What I learned in the book is that women are more resourceful because of their attachment to their children—because of their unbelievable strength of love for their infant—than we know. I would even go so far as to say that, if I had a huge funding source, I would do a study on my hypothesis that women who have perinatal mood and anxiety disorders are more attached. We’re not less attached. We may have periods where we are less attached, but staying present while experiencing that makes us more connected.

CGM: Look at the love that it takes to feel so bad inside and still go and do these attachment building behaviors over and over and over again. The attachment is still being built even if parents can’t see it. And, the other thing I really appreciate about your work is that it’s such a refreshing focus on growth. Attending to growth is very effective and links well with cognitive behavioral therapy and solution-focused brief therapy. And, it makes me wonder, instead of what are all the risk factors, can we do some research on resiliency factors and on growth factors? What is it that helps parents grow through this and how can we nurture that?

WK: I hope more clinicians will read the book and think about these things. You know Tedeschi and Calhoun have a wonderful model for clinical intervention that’s growth based. And it’s only been used in situations that have already been identified as traumatic. But they have a really strong model for how to work with people who experience trauma, clinically, to develop more growth. And, I’m not a clinician. If I were, I would be interested in doing that kind of work. They were kind enough to let me use their scale. I found off the chart suicidal ideation. So, I asked them if I could use their posttraumatic growth inventory with the original sample and they obliged. And my wonderful original 20 women all took it. And they scored off the charts for growth. So then I interviewed somebody who is an expert in posttraumatic growth. And I also sent my result to Richard Tedeschi. I wanted some feedback: is this growth? And, they both said, well, it’s a small sample—it’s only 20—but yes. And, furthermore, they said that the level that I was getting off those scales is much higher than in other populations that they had looked at, such as people who had been through terrorist attacks or rape or surviving cancer. So, again, if I had money for research, applying that posttraumatic growth inventory to women who had been through a perinatal mood disorder would be really valuable on a larger scale.

CGM: I know it’s a small qualitative study, but what is your sense of how generalizable your findings might be?

WK: You know, generalizability in qualitative research is not necessarily a concern. Grounded theory would say that the generalizability of the findings has to do with if you’ve sampled well. And, theoretical sampling is about getting a condensed understanding. It’s like essential oil—you want the essence of it. I tell my doctoral students, who are just learning about the difference between qualitative and quantitative research, that quantitative research is like a fisherman casting a really wide net—huge—and you gather as much data in that net as far as you can go. And, that gives you information about the nature of the farthest reach of the ocean. Qualitative research goes straight down, plumbs straight down into the ocean—you know, a core area where the essence of that part of the ocean is. And, then you can take that and ask the same questions in other parts of the ocean. And, that would be the next part of the research.

CGM: Exactly. I know the whole purpose of your study was not to answer the question how generalizable transformation is but to explore the phenomenon of transformation. Your study design allowed you to do that. The question I have is: who do you think the women in your study are? Do you think they had characteristics that make them different than the big broad ocean? What did you notice about their membership in different social groups even though that was not the focus of your study?

WK: I have a couple of responses to that. First, it would be definitely an indication of the need for future research. In the demographics that I got, I would say that it was pretty diverse regarding race. And, socioeconomic status was all over the place. It was very diverse in terms of educational status. I had women with professional degrees and women with a high school education. But they were all English speakers. And when I say racially diverse, I will say that they identified as “American.” So, I didn’t have folks who were immigrants and that’s definitely something that should be looked at. Regarding whether there is some different quality in women who transform through postpartum depression, again I look at the research done by Tedeschi and Calhoun. They’re looking at that very issue. Are there personality characteristics that lend themselves more toward being able to grow through a traumatic event? What they have found is that people who are more optimistic are slightly more likely to experience growth through trauma than those who are not. But, it’s not set in stone. In other words, the numbers aren’t so high that we can go out and say that if you’re an optimistic person you’re going to have this amazing growth. There are so many variables involved with the quality of the growth, the characteristics of the person, access to time, and the circumstances. I think that there are probably shades of growth—that anybody who has ever been through a clinical mood disorder following the birth of a child probably experiences some amount of growth. And, this is just me shooting from the hip. I think there’s something inherent in being a parent. All of the research about having a child in the NICU, losing a baby, losing a baby in pregnancy…these are all traumas. Anything that’s a life or death experience is a trauma. And every human being grows. That’s just my personal belief. It’s just the human experience that we have the ability to grow—because we need to make meaning about these horrible things that happen. And, that meaning usually comes from making choices to believe in our ability as a parent. 

CGM: What is your number one take away? How do you think your findings can be applied by childbirth educators, doulas, midwives, and other perinatal care providers?

WK: I think that the take away is that it’s a call to action. At the very least 1 in 7 of your clients or your students is going to have this experience. What are you going to do about it? What kinds of information do you need to be able to help them? And then ask your organizations to give you that.

CGM: In my work as a clinician and an educator, I need tools and resources that I can point people to that I think are useful. So, I’m really excited about your book. I think it’s going to have a lot of ripple effect in terms of new research but also in supporting a shift in broadening our worldview of postpartum depression to include growth. So, I think your work is great. I’m so delighted that you did the research and you published it.

WK: Thank you so much for spending this time. It’s been a pleasure and a gift. I so appreciate it.

About Cynthia Good Mojab

cynthia good mojab headshot 2015Cynthia Good Mojab, MS Clinical Psychology, is a Clinical Counselor, International Board Certified Lactation Consultant, author, award-winning researcher, and internationally recognized speaker. She is the Director of LifeCircle Counseling and Consulting, LLC where she specializes in providing perinatal mental health care. Cynthia is Certified in Acute Traumatic Stress Management and is a member of the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management. Her areas of focus include perinatal loss, grief, depression, anxiety, and trauma; lactational psychology; cultural competence; and social justice. She has authored, contributed to, and provided editorial review of numerous publications. Cynthia can be reached through her website

Book Reviews, Childbirth Education, Depression, Guest Posts, Infant Attachment, Maternal Mental Health, New Research, Perinatal Mood Disorders, Postpartum Depression , , , , , , , ,

Book Review – Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth – Part Two

March 12th, 2015 by avatar

By Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM

Dr. Walker Karraa has written an insightful book examining depression as a transformative event in the lives of women who have experienced it after the birth of a child. Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM, reviews Dr. Karraa’s book and interviews her in a three-part series on “Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth.”  Today, Cynthia examines two theories that relate to Dr. Karraa’s research and book and shares her commentary on the book’s findings.  Next week, Cynthia will share her interview with Walker Karraa, regarding her research and book. Find Part One of this series here. – Sharon Muza, Community Manager, Science & Sensibility.

walker book header

One of the many things I appreciate about Dr. Walker Karraa’s (2014) book, Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, is its multidisciplinary mindset. Not only does she contribute to broadening our understanding of postpartum depression beyond a worldview focused on pathology, Karraa seeks to understand the bigger theoretical picture in which postpartum depression as transformation can be placed. This isn’t just analysis for the sake of analysis. When we understand how and why something happens, we become more able to seek out and identify factors that help it happen and that get in the way of it happening. Having a good framework for understanding transformation through postpartum depression will help guide future research and application of that research with a goal of improving identification of, support for, and treatment of new parents with postpartum depression. In this commentary, I share my thoughts about two theoretical frameworks that can aid in our understanding of growth after postpartum depression: posttraumatic growth and positive disintegration.

Posttraumatic Growth or Positive Disintegration?

In chapter 7, “Trauma and Transformation,” Karraa (2014) reviews several theoretical frameworks that might explain how postpartum depression can be experienced as traumatic and precipitate transformation. She ultimately settles, quite insightfully, on posttraumatic growth (Tedeschi & Calhoun, 2004; Tedeschi & Calhoun, 2004). She also acknowledges the historical understanding that people often grow through experiencing life’s challenges. How many of us have heard some version of Nietzche’s maxim, “What does not destroy me, makes me stronger”?

When I read Karraa’s book, the explanatory theory that came to mind was Dabrowski’s theory of positive disintegration (Mendaglio, 2008a), which predates the coining of the term “posttraumatic growth” (Tedeschi & Calhoun, 2004a, 2004b; Nelson 1989). Positive disintegration is a theory of personality development that has been extensively researched and applied in the fields of giftedness and gifted education though it encompasses the development of all people. I have found Dabrowski’s theory both personally and professionally helpful in understanding how people are and are not changed by difficult life experiences, including the experience of postpartum depression. The theories of posttraumatic growth and positive disintegration have notable parallels and connections (Tillier, 2014; Mendaglio & Tillier, in press). Furthermore, the growth that can be experienced after a traumatic event fits well within the broader scope of the theory of positive disintegration.

Dabrowski’s theory of positive disintegration posits that personality has the potential to be dynamic—a possible journey toward authenticity and altruism—and that negative emotions are essential, though insufficient, for its development (Mendaglio, 2008a). (The quality of the social environment, for example, can support or hinder development.) Therefore, depression and anxiety, which we experience as negative symptoms we wish to eliminate, can also be understood positively as precursors of growth. A full description of the theory—and related research, analysis, and applications—is well beyond the scope of this commentary (see Mendaglio, 2008a). And, it understandably takes time to become accustomed to the terminology used to describe the theory. But, in brief, Dabrowski theorized that personality is shaped over the lifetime through two developmental processes, disintegration and reintegration, that involve five levels of development (Mendaglio, 2008b, pp. 34-39). We begin life with a less developed mental organization that seeks to meet basic biological instincts, needs, and drives and conforms to unquestioned social norms. (This is called level 1, “primary integration.”) As we struggle with internal conflicts caused by developmental milestones and life crises, we experience intense emotions, like anxiety and despair, as well as uncertainty and confusion about our identity. When we find that what we know and believe does not help us cope with and make sense of a crisis, our mental organization becomes less fixed and our distress increases. (This is called level 2, “unilevel disintegration.”) At that point, we have three basic options in our developmental path: 1) we can stay in a state of unilevel disintegration (which holds risks like suicidality, psychosis, and traumatic stress reactions), 2) we can return to (reintegrate at) our prior level of mental organization, or 3) we can move toward the transcendence of our original level of mental organization (we can grow).

Another way of describing the disintegration seen with depression and the possibility of personality development is the experience of existential depression. In existential depression, we struggle with our lack of control in our lives as well as with the very meaning of life and ourselves within it:

“While not universal, the experience of existential depression can challenge an individual’s very survival and represents both a great challenge and at the same time an opportunity—an opportunity to seize control over one’s life and turn the experience into a positive life lesson—an experience leading to personality growth.” (Webb, 2008, pp. 1-2).

This is exactly what Karraa (2013, 2014) describes in her research: postpartum depression threatening a woman’s physical and psychological survival (thus qualifying as a traumatic life experience) and resulting in transformation to an entirely new way of thinking, feeling, acting, and being in the world (e.g., more authentic and altruistic). Karraa is describing posttraumatic growth as well as the even bigger picture of personality development through positive disintegration.

walker head shot 2In Dabrowski’s theory, moving toward greater personality development after experiencing unilevel disintegration involves three more levels (Mendaglio, 2008b, pp. 37-39). In the first of these, we spontaneously start to examine, challenge, and reject beliefs and understandings that no longer work for us. We begin to see the clash between the actual (how things are) and the ideal (how things should be). We develop more autonomy and authenticity toward ourselves and others. And, we experience great distress while engaging in this work. (This level is called “spontaneous multilevel disintegration.”) In the next level of moving toward greater personality development, we cultivate a stronger sense of social justice, empathy, and responsibility for others. We become active agents in our learning, growing, and healing. And, our daily behavior is more consistently guided by higher values that are increasingly aligned with our transforming ideals. (This is called “organized multilevel disintegration.”) The last level is the full development of our personality. Our behavior is in alignment with the hierarchy of values that we consciously constructed during our developmental struggles—rather than with unexamined values that are common in our society or with our basic needs and drives. Because of this alignment, we are able to live in harmony with ourselves. (This is called “secondary integration.”) This very brief description of Dabrowski’s theory of positive disintegration leaves out a great deal of nuance and detail. But, I hope that it conveys that positive disintegration offers a useful framework for explaining transformation after postpartum depression.

Clinical Experience with Positive Disintegration through Postpartum Depression

In my experience as a perinatal mental health care provider, parents coping with perinatal depression, anxiety, and trauma are often helped by Dabrowski’s positive reframing of their symptoms as potential harbingers of growth; they become less afraid of what they are going through as well as more hopeful about the future. The analogy I use is that sometimes we have to take something that isn’t working apart so that we can re-assemble it in a better way. Like a child knocking over a tower of blocks, we can build anew. And, this is what I often see in postpartum depression, particularly in the context of moderate to severe postpartum depression: something isn’t working at a very fundamental level. Our conscious and unconscious expectations may have been shattered by our experiences in pregnancy, birth, parenting, and/or life. We may grieve the loss of roles that were intertwined with our very identities. Our relationship to ourselves and to others may be jolted profoundly out of balance by the arrival of a completely dependent baby whose unrelenting needs chronically supersede our own in a widespread context of insufficient social support. Our very paradigm of who we are and how the world works may be challenged to the core right when sleep deprivation diminishes our capacity to even try to make sense of it all. Our lifeways may not support our experience of severe stress, creating an inflammatory response (Kendall-Tackett, 2007) and a diminished capacity to physiologically sustain our mental well being. And, the dominant culture in the US impossibly expects us to return quickly to our before-baby lives and selves as though nothing out of the ordinary has happened and without feeling anything negative because “having a baby is a happy event.”

If this doesn’t qualify as a developmental milestone—as well as a life crisis—with the potential to trigger what Dabrowski calls “unilevel disintegration,” I don’t know what does! No wonder so many new parents experience postpartum depression. When our depression is on the more severe end of the spectrum, we disintegrate. We fall apart. We are shocked by the onset, magnitude, and nature of the symptoms of our devastation (Karraa’s “I Was Shattered;” Dabrowski’s “disintegration”). We experience this disintegration as a threat to our survival—meeting the definition of a traumatic event. If we stay in a prolonged state of disintegration, we may become suicidal, experience psychosis, or live with the debilitating symptoms of traumatic stress. Or, our recovery can return us to our prior level of functioning (Karraa’s “Getting Better;” Dabrowski’s reintegrating at the level of “primary integration”). Or we may instead take control of our development and healing, intentionally choose higher values to guide our behavior, increase our empathy and authenticity, and experience transformation and reintegration at a higher level of personality development (Karraa’s “I Was a Different Person” and “Metamorphosis;” Dabrowski’s “organized multilevel disintegration” and “secondary integration”).

Perinatal researchers and clinicians whose worldview is solely a medical model of postpartum depression may not recognize its developmental potential (Karraa’s “posttraumatic growth;” Dabrowski’s “positive disintegration”), viewing the goal of treatment only as the elimination of “negative” symptoms rather than as the facilitation of transformation. But individual experience, clinical experience, and now Karraa’s research show that both recovery and transformation are possible.

Whose Voices Were Heard?

The goal of Karraa’s research was to deeply explore the nature of transformation through postpartum depression—something that had not yet been studied. Her qualitative approach matches this goal perfectly. In a small qualitative study, it’s not surprising that she did not collect much demographic data related to the social group membership of the 20 women who participated in her study. She does report ascertaining their occupations (e.g., mental health care provision, marketing, finance, higher education, computer science, volunteer), which suggest that many participants had at least a middle class socioeconomic status (SES). Speaking English and having access to internet, email, and phone communication were inclusion criteria for the study. So, overall, the reported demographic data hint that many participants had access to resources, opportunities, and power that are disproportionately available to members of dominant social groups (e.g., white, at least middle class SES, cisgender, heterosexual, able-bodied).

I am left wondering: whose voices were included and whose were excluded in this initial research? If they were not included in this small study, what would we learn from the voices of depressed new mothers who cannot afford to attend college or to volunteer; who live in the chronic stress of poverty (Isaacs, 2004); and/or who do not have equitable access to culturally competent mental health care, support, and information? If they were not included in this small study, what would we learn if we had heard the voices of depressed new parents of a variety of gender identities/expressions and sexual orientations (Abelsohn, Epstein, & Ross, 2013) who live with intergenerational trauma (Graff, 2014) and the trauma of inescapable, ongoing racism (Bryant-Davis & Ocampo, 2005), cisgenderism (Mizock & Lewis, 2008), classism (Collins et al., 2010), ableism (Browridge, 2006), and/or other systems of oppression?

Dabrowski’s theory of positive disintegration recognizes the role of a variety of factors on personality development, including the effect of the social milieu (Mendaglio, 2008a). Do those who live as members of social groups targeted by systems of oppression have equitable access to experiencing postpartum depression as both suffering and recovery, much less as growth? Are there circumstances in which the human spirit is so persistently crushed that transformation after postpartum depression cannot occur even when the potential for growth exists? Or would the resiliency that can manifest even amidst chronic stress and trauma (Mullings & Wali, 2001) allow growth to still be possible? Further research and analysis is needed to uncover 1) how growth is and is not experienced by depressed new parents who hold membership in a wide variety of social groups, 2) what social factors support or undermine transformation after postpartum depression, 3) what kind of information, support, and treatment best supports growth after postpartum depression in a variety of social contexts, and 4) how perinatal organizations, care providers, and lay supporters can contribute to the dismantling of institutional oppression that creates inequitable access to resources and services that support recovery and growth from postpartum depression. And, then we need to take action to provide effective support and treatment that is equitably accessible to all new parents.

Conclusion

That people have the capacity for growing through life’s challenges has long been recognized. Karraa’s (2014) book, Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, offers a moving account of such transformation in the context of postpartum depression. The fact that the women in her study experienced physical and psychological symptoms that threatened their survival led Karraa to insightfully frame their transformation as an example of posttraumatic growth. Transformation through postpartum depression can also be understood through the lens of the theory of positive disintegration—a theory which subsumes and is broader than the experience of growth after trauma. Positive disintegration explains the possible outcomes of 1) transformation through a traumatic experience of postpartum depression, 2) recovery without transformation, and 3) remaining in a prolonged state of disintegration (e.g., suicidality, psychosis, traumatic stress reactions). Both theories offer hope to new parents experiencing the devastation of moderate to severe postpartum depression. Postpartum depression is more than pathology; it can lead to deeply meaningful transformation. Regardless of which theoretical framework is used to explain growth after postpartum depression, Dr. Karra’s findings are a compelling invitation for further exploration and application. I hope that her work will inspire more multidisciplinary research and analysis of the development that can come from postpartum depression so that more new parents will have access to the information, support, and treatment that they need to recover—and possibly even to be transformed.

References

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Browridge, D. (2006). Partner violence against women with disabilities: Prevalence, risk, and explanations. Violence Against Women, 12(9), 805-822.

Bryant-Davis, T. & Ocampo, C. (2005). The trauma of racism: Implications for counseling, research, and education. Counseling Psychologist, 33(4), 574-578.

Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward, A., Kiser, L., Strieder, F., & Thompson, E. (2010). Understanding the Impact of Trauma and Urban Poverty on Family Systems: Risks, Resilience, and Interventions. Baltimore, MD: Family Informed Trauma Treatment Center.

Graff, G. (2014). The intergenerational trauma of slavery and its aftermath. Journal of Psychohistory, 41(3), 181-97.

Isaacs M. (2004). Community Care Networks for Depression in Low-Income Communities and Communities of Color: A Review of the Literature. Washington, DC: Howard University School of Social Work and the National Alliance of Multiethnic Behavioral Health Associations.

Karraa, W. (2013). Changing Depression: A Grounded Theory of the Transformational Dimension of Postpartum Depression. (Doctoral dissertation). Retrieved from ProQuest/UMI. (3607747.)

Karraa, W. (2014). Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth. Amarillo, TX: Praeclarus Press.

Kendall-Tackett, K. (2007). A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal, 2(6), 1-14.

Mendaglio, S. (Ed.) (2008a). Dabrowski’s Theory of Positive Disintegration. Scottsdale, AZ: Great Potential Press.

Mendaglio, S. (2008b). Dabrowski’s theory of positive disintegration: A personality theory for the 21st century. In S. Mendaglio (Ed.), Dabrowski’s Theory of Positive Disintegration. Scottsdale, AZ: Great Potential Press.

Mendaglio, S. & Tillier, W. (2006). Dabrowski’s theory of positive disintegration and giftedness: Overexcitability research findings. Journal for the Education of the Gifted, 30(1), 68-87.

Mendaglio, S. & Tillier, W. (in press). Discussing Dabrowski: Has the time come to emulate Jung? A response to Piechowski’s most recent rethinking of the theory of positive disintegration: I. The case against primary integration. Roeper Review.

Mizock, L. & Lewis, T. (2008). Trauma in transgender populations: Risk, resilience, and clinical care. Journal of Emotional Abuse, 8(3), 335-354.

Mullings, L. & Wali, A. (2001). Stress and Resilience: The Social Context of Reproduction in Central Harlem. New York: Kluwer.

Nelson, K. (2004). Dabrowski’s theory of positive disintegration. Advanced Development Journal. 1989; 1:1-14.

Tedeschi, R. & Calhoun, L. (2004a). Posttraumatic growth: A new perspective on psychotraumatology. Psychiatric Times, 21(4), 1-4.

Tedeschi, R. & Calhoun, L. (2004b). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18.

Tillier, W. (2014). Dąbrowski 201: An Introduction to Kazimierz Dąbrowski’s Theory of Positive Disintegration [PDF document]. Retrieved from http://www.positivedisintegration.com/Dabrowski201.pdf

Webb, J. (2008). Dabrowski’s theory and existential depression in gifted children and adults. The Eighth International Congress of the Institute for Positive Disintegration in Human Development. Calgary, Alberta, Canada.

About Cynthia Good Mojab

cynthia good mojab headshot 2015Cynthia Good Mojab, MS Clinical Psychology, is a Clinical Counselor, International Board Certified Lactation Consultant, author, award-winning researcher, and internationally recognized speaker. She is the Director of LifeCircle Counseling and Consulting, LLC where she specializes in providing perinatal mental health care. Cynthia is Certified in Acute Traumatic Stress Management and is a member of the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management. Her areas of focus include perinatal loss, grief, depression, anxiety, and trauma; lactational psychology; cultural competence; and social justice. She has authored, contributed to, and provided editorial review of numerous publications. Cynthia can be reached through her website.

 

 

Birth Trauma, Childbirth Education, Depression, Guest Posts, Maternal Mental Health, New Research, Parenting an Infant, Perinatal Mood Disorders, Postpartum Depression, Trauma work, Uncategorized , , , , , , , , ,

Every Day Should Be Maternal Mental Health Awareness Day! What Educators Need To Know!

May 27th, 2014 by avatar

Friday_may_campaignMay is Maternal Mental Health Awareness month, when agencies on the local, state and federal level along with private and public organizations promote campaigns designed to increase awareness of perinatal mood disorders.   While it is good to increase awareness of the symptoms, sources of help, treatment options and impact of perinatal mood disorders on parents, families and communities during the month of May, the focus really needs to be 365 days a year!  Over 4 million babies are born every year in the USA.  Pregnancy and birth happen every single day to women and families.  Perinatal mood disorders affect women and their families every single day!

Recently, the tragic death of three young children in Torrence, CA was in the news and the children’s mother was arrested on suspicion of murdering her three daughters.  While many details have yet to be made public, this was a new mother  whose youngest child was just two months old.  This woman may have been experiencing a crisis as a result of a postpartum mood or anxiety disorder (PPMAD).

Take this quick ten question quiz and test your knowledge of perinatal mood disorders.  Then read on to find out more and what you can do to help the families that you work with.

While PPMAD can affect a mother during pregnancy or the first year postpartum, there are some risk factors that may increase the likelihood of a woman experiencing this complication:

The above list is from the resource: Postpartum Progress

There is a wonderful three minute video from the 2020 Mom Project that explains more about why so many women are not receiving the help they need. This video was released by the National Coalition for Maternal Mental Health. We do not have the infrastructure in place that screens every woman or enough skilled providers who can recognize the symptoms and provide or refer to suitable treatment options.

Some typical (but not all inclusive) symptoms of Postpartum Mood and Anxiety Disorders

  • Are you feeling sad or depressed?
  • Do you feel more irritable or angry with those around you?
  • Are you having difficulty bonding with your baby?
  • Do you feel anxious or panicky?
  • Are you having problems with eating or sleeping?
  • Are you having upsetting thoughts that you can’t get out
  • of your mind?
  • Do you feel as if you are “out of control” or “going crazy”?
  • Do you feel like you never should have become a mother?
  • Are you worried that you might hurt your baby or yourself?

Childbirth educators and others who work with women during the childbearing year have a responsibility to discuss, share, educate and provide resources to all the families they work with.  Ignorance is not bliss, and the more we discuss the symptoms, risk factors and resources that are available to help families in need with those we have contact with, the fewer women will suffer in silence and go without the help they need.

Resources for Women and PartnersPostpartum Progress

 Postpartum Psychosis Symptoms (in Plain Mama English)

Postpartum Support International 1-800-944-4PPD

 National Suicide Prevention Lifeline 1-800-273-TALK

Mother to Baby (formerly OTIS)

Medications & More During Pregnancy & Breastfeeding.

(866) 626-6847

Text-4-Baby Health Info Links

How do you talk about perinatal mood and anxiety disorders in your classes?  What activities do you do to convey this information effectively?  Do you bring up this topic again at the childbirth class reunions you attend?  Can you share what works well for you so that we can all learn?  What have your experiences been in helping women and their partners to be knowledgeable and informed? What do you do to be sure that every day is Maternal Mental Health Awareness Day?

 

Babies, Birth Trauma, Breastfeeding, Childbirth Education, Depression, Infant Attachment, Maternal Mental Health, Paternal Postnatal Depression, Perinatal Mood Disorders, Postpartum Depression , , , , , , , , , ,

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 , , , , , , ,

Don’t Ever Give Up! An Interview with Katherine L Wisner, M.D., M.S. American Women In Science Award Recipient

April 30th, 2013 by avatar

“Childbirth educators are crucial front-line professionals in providing information to women about their risks for medical complications related to pregnancy and birth, and postpartum depression is a common problem.” – Dr. Katherine L Wisner

Katherine L. Wisner, M.D., M.S., has been involved in clinical work and research since the mid-1980’s. Prior to her medical training, she achieved a Master’s Degree in Nutrition. Dr. Wisner did a pediatrics internship, is board-certified in both adult and child psychiatry, and completed a 3-year postdoctoral training program (NIAAA-funded) in epidemiology. Her major interest area is women’s health across the life cycle with a particular focus on childbearing. In January 2011, Dr. Wisner was chosen as the recipient of AMWA’s Women in Science Award for the year 2011. Dr. Wisner is a Norman and Helen Asher Professor of Psychiatry and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine.

Most recently, Dr. Wisner and colleagues (2013) published the largest American study to date (N = 10,000) investigating the value of screening for depression in postpartum period (4 to 6 weeks) using the Edinburgh Postnatal Depression Scale (EPDS)1

I know I speak for all in welcoming Dr. Wisner to Science and Sensibility.

_____________

Walker Karraa: Congratulations to you and your colleagues on this most recent JAMA Psychiatry study. The findings have significant implications regarding the value of screening for postpartum mood and anxiety disorders. What role do you think childbirth education has in the area of perinatal mental health?

Dr. Wisner: Childbirth educators are crucial front-line professionals in providing information to women about their risks for medical complications related to pregnancy and birth, and postpartum depression is a common problem.  

WK: Should childbirth educators and doulas be trained to screen for PMADs? 

Dr. Wisner: My answer would be yes, but the controversy in the field is about routine screening – that women with depression can be identified, but getting them to mental health treatment if it exists outside the obstetrical care setting is difficult.  So the counterpoint is– why screen if we don’t have on-site, accessible, acceptable services for mental health?  My opinion is that we ought to work toward this model of integrated care rather than decide not to screen!   I certainly think childbirth educators and doulas can increase education and awareness and are often the first professionals that women call for help, so that group of women who want to and can access care can get the help they need.

WK: How could childbirth education organizations use this study to inform their practices and curriculum?

Dr. Wisner:The study provides evidence that the prevalence of depression is high both during and after pregnancy and evidence that screening is effective in identifying women with major mood disorders.  Women with psychiatric episodes certainly can be assured that they are not alone, which is a common belief of pregnant women and new mothers.  

WK: Due to the prevalence of self-harm ideation in postpartum period found in your study and other studies supporting this alarming rate, and the fact that suicide is the second leading cause of maternal death, how might childbirth education organizations and professionals address this critical problem?

Dr. Wisner:Screening with the EPDS, which has the item 10 self-harm assessment questions, and sensitive exploration of self-harm and suicidal ideation is the primary approach to suicide prevention.  It has to be identified before intervention can occur.  

WK: A remarkable finding in your study was the rate of bipolar disorder among women who had screened positive (10 or higher) on the EPDS. Additionally, among those with unipolar depression, there was high comorbidity for anxiety disorders. What are your thoughts as to how childbirth education might begin to help childbearing women unpack and understand the symptoms of anxiety in prenatal education?

Dr. Wisner: In our study we found that women with depression usually had an anxiety disorder that pre-dated the depressive episodes—this observation is true for women who are not childbearing as well.  Having anxiety or depression as a child or adolescent increases the risk for peripartum episodes.  There are excellent pamphlets and websites about perinatal depression (www.womensmentalhealth.org; www.postpartum.net) which can be used to frame a brief discussion and give to the patient for reference.  This also gives the message that talking about mental health before and during childbearing is an important topic, just like surgical births, anesthesia etc.    

WK: The data you have contributed to science are unsurpassed, yet early in your career many questioned whether postpartum depression was real, and doubted if you would be able to pursue a research career in postpartum mood disorders.

Dr. Wisner: Indeed!

WK: How did you persevere–and particularly in a male-dominated field?

Dr. Wisner: I got angry that so few data were available to drive care for pregnant and postpartum women and never let go of the importance of obtaining that information.  That motivation was coupled with a real joy in taking care of perinatal women and their beautiful babies!  

WK: Do you think there is still an underlying doubt as to whether postpartum depression (or perinatal mood/anxiety disorders) is real?

Dr. Wisner: Not in academic medicine, and I have not heard anyone say this in about a decade (thankfully!). 

WK: What is your favorite part of the research? Data collection, analysis, or interpretation?

Dr. Wisner: Publishing findings that make a difference in women’s lives, and holding the babies. 

WK: What new trends do you see in research as hopeful signs of progress?  

Dr. Wisner:  The incredible number of young clinicians and investigators who are interested in perinatal mental health.  Also,  our field has been so accepting of interdisciplinary enrichment of research questions.  

WK: What advice would you share with women in research today? 

Dr. Wisner: Network with  your colleagues inside and outside your organization frequently, attend perinatal mental health meetings and don’t ever give up!  

___________

What are your thoughts regarding Dr. Wisner’s expert opinion?   How do you currently address postpartum depression and anxiety in your childbirth classes?  After reading this interview and taking at look at Dr. Wisner’s just published research, might you reconsider how you teach about this important topic or change your approach?  Let us know in the comments section below- Sharon Muza, Community Manager

More about Dr. Wisner

Dr. Wisner’s research has been NIMH funded since she completed her post-doctoral training in 1988. She served on NIMH grant review sections continuously from 1994 to the present. Dr. Wisner completed was a founding member of the NIMH Data Safety and Monitoring Board, and is only the second American to be elected President of the Marce International Society for the study of Childbearing Related Disorders.

Her major interest area is women’s health across the life cycle with a particular focus on childbearing. She is a pioneer in the development of strategies to distinguish the effects (during pregnancy) of mental illness from medications used to treat it (Wisner et al,JAMA 282:1264-1269, 1999; MHR01-60335, Antidepressant Use During Pregnancy).

In recognition of her work, she was a participant in activities related to the FDA Committee to Revise Drug Labeling in Pregnancy and Lactation, a committee member for the National Children’s Study (Stress in Pregnancy), a consultant to the CDC Safe Motherhood Initiative and the Agency for Healthcare Research and Quality Report Perinatal Depression: Prevalence, Screening Accuracy and Screening Outcomes.

Dr. Wisner was elected to membership in the American College of Neuropsychopharmacology in 2005. She received the Dr. Robert L. Thompson Award for Community Service from Healthy Start, Inc., of Pittsburgh in 2006 and the Pennsylvania Perinatal Partnership Service Award in 2007 from the State of Pennsylvania. 

Dr. Wisner was the first American psychiatrist to collect serum from mothers and their breastfed infants for antidepressant quantitation as a technique to monitor possible infant toxicity. She published the only two placebo-controlled randomized drug trials for the prevention of recurrent postpartum depression and showed that a serotonin selective reuptake inhibitor was efficacious.

References 

1.Wisner, K.L., Sit, D., McShea, M. C., Rizzo, D.M., Zoretich, R.A., Hughes, C.L., Eng, H.F., Luther, J.F., Wisneiweski, S. R., Costantino, M.L., Confer, A.L., Moses-Kolko, E.L., Famy, C. S., & Hanusa, B.H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, Published online March 13, 2013. Doi: 10.1001/jamapsychiatry.2013.87

 

Childbirth Education, Depression, Evidence Based Medicine, Guest Posts, Maternal Mental Health, New Research, Perinatal Mood Disorders, Postpartum Depression, PTSD, Research , , , , , , , , ,

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