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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

Abelsohn, K., Epstein, R., & Ross, L. (2013). Celebrating the “other” parent: Mental health and wellness of expecting lesbian, bisexual, and queer non-birth parents. Journal of Gay & Lesbian Mental Health, 17(4), 387-405.

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 , , , , , , , , ,

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

March 10th, 2015 by avatar

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

transformed cover

Walker Karraa, PhD, a former contributor to Science & Sensibility, has authored a new book, Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, that speaks to what lies on the other side for the 20 women she interviewed about their experiences with postpartum depression. Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM, who specializes in supporting people with postpartum mood and anxiety disorders and birth trauma presents a three-part series related to Dr. Karraa’s book. Today on the blog, Cynthia outlines the books content and its implications for practice. On Thursday, Cynthia shares her commentary on some of Dr. Karraa’s research and conclusions. Next week we are offered a glimpse into the person behind the book, when an interview with Dr. Karraa is shared with blog readers. Follow all three parts of this series on “Transformed by Postpartum Depression.” – Sharon Muza, Science & Sensibility Community Manager.

 In the last several decades, our awareness and understanding of postpartum depression have steadily increased. A wealth of research now exists regarding its prevalence, risk factors, prevention, symptoms, consequences, and treatment. Organizations, like Postpartum Support International and Postpartum Progress, champion the needs of families touched by postpartum depression and other perinatal mental health challenges, counter stigma, and contribute critical support and information to the safety net that all new families need and deserve. Many states in the United States have enacted legislation or developed projects related to public education, screening, and/or treatment for perinatal mental health challenges. And, at the national level in the US, the 2020 Mom Project seeks to remove institutional barriers that prevent depressed new mothers from being identified and accessing treatment.

In spite of this progress, we do not see the prevalence of postpartum depression dropping. Globally, it is as high as 82.1% when measured using self-reported questionnaires and as high as 26.3% when measured using structured clinical interviews (Norhayati, Nik Hazlina, Asrenee, & Wan Emilin, 2014). In fact, we see that depression during pregnancy and after birth routinely goes undetected and untreated (Miller et al., 2012). How is that possible? And, beyond the statistics that we have now amassed, what is it really like to experience postpartum depression, come out the other side, and make meaning from the experience?

Posttraumatic Growth after Postpartum Depression

In her new book, Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, Walker Karraa, PhD (2014) invites readers to join her in a touching and thought provoking exploration of the potentially transformative nature of postpartum depression. Her book, which is based on the findings of her dissertation research (Karraa, 2013), brings to light both the suffering and development that women can experience on this journey. In fact, her book is one of the fruits of her own transformation through her experience of severe postpartum depression. Parents, lay supporters, and perinatal care providers who appreciate the blend of research and women’s voices found in books like Depression in New Mothers: Causes, Consequences, and Treatment Alternatives (Kendall-Tackett, 2010) and Traumatic Childbirth (Beck, Driscoll, & Watson, 2013) will also appreciate Karraa’s book. It should certainly be considered “required reading” for perinatal care providers and lay supporters.

walker karraa head shot 2015Karraa begins with a brief review of the literature, including what postpartum depression is, who develops it, and its global prevalence, risk factors, and consequences. These facts and figures help orient the reader to the general nature and scope of a veritable global mental health pandemic. They also serve to illustrate the foundation of the dominant discourse regarding postpartum depression: an allopathic worldview that frames mental illness as pathology. The following five chapters, however, contribute to an expansion of that view by illustrating how postpartum depression can be experienced as a long and painful journey culminating in positive change.

In the course of conducting her qualitative research, Karraa used grounded theory to analyze the answers of 20 women to four questions (Karraa, 2013) about their experience of postpartum depression:

  • How would you describe your process of transformation through postpartum depression?
  • In what ways did you experience the process of transformation through postpartum depression?
  • What were the ways you saw yourself transforming?
  • How do you experience this transformation currently?

She uncovered five stages of transformation through postpartum depression: before, during, ending, after, and beyond. That the women described 1) feeling shocked by the nature and magnitude of their symptoms, 2) enduring physical and psychological disintegration to which care providers seemed oblivious, and 3) slowly finding a path toward recovery will strike a familiar chord for lay supporters, perinatal care providers, and individuals who have worked and/or lived with postpartum depression. What might not be familiar to all readers are the last two stages that Karraa identified: 4) an increase in self-care, self-confidence, authenticity, and compassion; improved relationships; and alteration of perception of self and purpose in the world; and 5) coming to view postpartum depression as resulting—paradoxically—in a profoundly positive transformation.

In her 7th chapter, Karraa gives the reader a thoughtful tour of her consideration of several theories that might explain her research participants’ experiences of transformation through postpartum depression. Ultimately, she recognized that the prolonged endurance of threat to their physical and psychological survival was so great that the women experienced postpartum depression as a traumatic life event and that the transformative nature of their experience of postpartum depression is, thus, an example of posttraumatic growth: “positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (Tedeschi & Calhoun, 2004).

In chapter 8, Karraa shares the confirming feedback of four experts in the field of postpartum depression, including the illustrious Cheryl Tatano Beck, Jane Shakespeare-Finch, Karen Kleinman, and Jane Honikman. Then she closes with a chapter acknowledging that her work has revealed a connection that has been right under our noses waiting for us to formally notice and describe: postpartum depression is one of the adversities of life that can precipitate growth. Karraa researched, recognized, and named that connection. Naming an experience honors it. It also provides a language for new parents, lay supporters, perinatal care providers, and researchers to use as they seek to express, understand, provide support for, treat, recover from, and/or grow from the life-altering experience of postpartum depression. And, perhaps most importantly, it offers hope to those who are fighting their way back from the devastation of postpartum depression. Not only can recovery be found at the end of the darkest tunnel; transformation may await.

Care Provider Failure: A Call to Action

The power of Karraa’s book continues in its appendices, where she describes an informal survey that serves as an(other) urgent call to action for all of us: in spite of the high prevalence of postpartum depression and its negative consequences when untreated, we are collectively failing to help those who are experiencing it. Because so many women in her qualitative study reported that their care providers had failed to help them, Karraa conducted the Changing Depression Survey (n=486). When asked who was most responsible for their getting help for postpartum depression, 65.4% of her participants selected “Self,” 23.0% selected “Partner,” 16.9% selected “Family Member,” 11.7% selected “Medical Care Provider” (which includes OB/GYN, Midwife, General or Family Physician), 8.8% selected “Other (Friend),” and 6.6% selected “Therapist.” When asked who was least helpful in getting them help for postpartum depression, 43.2% of her participants selected “Medical Care Provider,” 21% reported “Family Members,” 20.6% reported “Partner,” 19.3% reported “Self,” and 6.8% reported “Therapist.”

While this is, admittedly, an informal survey, the patterns seen here match clinical experience as well as research findings that only a fraction of new mothers with postpartum depression are identified and treated (Milgrom & Gemmill, 2014). My own clients, who are new parents, frequently report finding me after seeing a series of care providers who did not formally screen or refer them for perinatal mental health challenges, did not informally ask them about how they are coping with new parenthood, and/or did not respond with sensitivity, validation, or assistance when they tried to share their struggles. A delay in diagnosis, support, and treatment can both worsen and prolong suffering for new parents struggling through postpartum depression. Karraa’s research suggests that, in some cases, it may also delay the experience of posttraumatic growth.

This call to action must be heard and effectively responded to by individuals as well as by institutions. Yes, perinatal care providers and lay supporters will benefit from reading Karraa’s book. But, reading the book is not the same as developing the skills to apply the book’s insights in practice. Her research is an invitation for organizations and credentialing institutions in the diverse fields that provide services to new families (e.g., childbirth education, doula care, midwifery, obstetrics, pediatrics, family practice medicine, lactation education, lactation consulting, counseling, social work, psychiatry, naturopathic medicine) to develop, offer, and require training related to perinatal mental health, including:

  • how to reduce stigma and increase awareness by educating expectant and new parents about perinatal mental health issues
  • why, when, and how to screen and refer
  • how to effectively provide care to new parents struggling with perinatal mental health challenges—including using approaches that incorporate an understanding of postpartum depression as potential transformation to be nurtured, not just as pathological symptoms to be eliminated.

Conclusion

Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth consistently engages the reader with the poignant and inspiring stories of 20 women, as well as with the intriguing insights of the author and four experts in the field. The moving narratives and cogent analysis effectively describe the women’s experience of postpartum depression as traumatic and the transformation of their suffering into growth. The book also invites us to transcend the dominant view of postpartum depression as pure pathology and to learn how to take effective action to keep new parents struggling with perinatal mental health challenges from falling through the cracks. I congratulate Dr. Karraa on authoring a book that makes such a meaningful contribution to our understanding of postpartum depression and, refreshingly, offers a significant focus on recovery and development. Join me here on this blog on Thursday to read my commentary regarding frameworks that might explain her findings as well as my hopes for future research.

References

Beck, C., Driscoll, J., & Watson, S. (2013). Traumatic Childbirth. New York: Routledge.

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. (2010). Depression in New Mothers: Causes, Consequences, and Treatment Alternatives. New York: Routledge.

Milgrom, J. & Gemmill, A. (2014). Screening for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 13-23.

Miller, L., McGlynn, A., Suberlak, K., Rubin, L., Miller, M., & Pirec, V. (2012). Now What? Effects of On-Site Assessment on Treatment Entry After Perinatal Depression Screening. Journal of Women’s Health, 21(10), 1046-1052.

Norhayati, M., Nik Hazlina, N., Asrenee, A., & Wan Emilin, W. (2014). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175C, 34-52.

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

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.

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

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 , , , , , , , , ,

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 , , , , , , , ,