The Hopelessness of Postpartum Rage

The range of emotions that a woman can feel postpartum is so wide and vast.  We expect women to be exhausted, tearful, a bit more emotionally fragile, and more edgy than typical.  However, one of the symptom that is often overlooked is anger.  Even irritability is often overlooked as a symptom that is link to depression.  In my practice, I see many women who are relieved to find out that increased irritability is a symptom associated to postpartum depression and is something we can work on targeting in our treatment.  However, for some women irritability just scratches the surface.  Anger doesn’t even do it just to describe what they are feeling.  RAGE.  So many women find themselves where they feel so out of control with their anger, it becomes rage.  The rage scares them.  This rage is not just getting mad, it often elicits reactions that are so out of character.  Yelling, swearing, throwing things.  These women find themselves feeling completely overwhelmed and scared that they do not have complete control of the intensity of the anger they feel. 

Postpartum rage many times brings along feelings of shame. Many women feel so out of control and they look back at their responses with feelings of disappointment, disgust, and even embarrassment. Shame has a way of keeping people silent and isolated to themselves. When shame is present women started to identify their worth and value in relation to their behavior that they are struggling with. Instead of just saying I don’t like my behavior they start to say I don’t like who I am. This shame can become very destructive and cause women to feel hopeless in that they begin to feel they themselves have changed, afraid that they will never be the person they were before the rage took over.

One of the best ways to look at postpartum rage is to allow the rage or anger to be an informant.  The presence of postpartum rage is a warning sign that there are needs that are not being met.    When a woman who experiences rage she can start to learn that the presence of the rage is letting her know that she needs to figure out what need she has that is being missed.  This is also good for spouses to be aware of.  It does not mean that she is just over reacting and that she is just hormonal, although a chemical imbalance and hormonal changes can play a part in symptoms of postpartum mood and anxiety disorders but rage often comes in addition to the typical symptoms.  When we start to see it as an indicator that is alerting us of a need, it gives us a better understanding of what we can do in response.  One thing that can become very helpful is to track your mood and track what the situation was surrounding your rage.  The purpose of tracking is to allow us to get a peek into whether there is a pattern or something in particular keeps triggering episodes of rage.  The presence of rage my indicate that more sleep may be need, that they are too exhausted, it may indicate that they are overwhelmed with the responsibilities and expectations that are placed on them.  It may be expectations that they place on themselves or expectations that are placed on them by someone else. It may reveal feelings of a perceived failure on their part, a lack of support system, a feeling of loss of how they use to identify themselves as, it may indicate a big change in their social supports and relationships.  There are so many things that the rage can indicate.  Once we can pinpoint what the need is that is not being met we can begin to address the specific needs instead of just focusing on anger management alone.  Anger management may be helpful but if we do not get to the root than we still have women who are suffering experiencing intense emotional pain.  Getting to to the needs coupled with anger management skills allows for much better chances at quicker improvement in symptoms and help her heal.  

The Lies of Postpartum Depression and Anxiety

              The Lies Postpartum Depression and Anxiety Tell You

“I never should have had a child.”

“I will never feel like myself again.” “I’m going crazy.”

“If I tell others what is going on they will take my child away, but I deserve to have my child taken away”.

“I am the worst mother ever.”

“This must just be how motherhood is- misery mixed with a little bit of joy”.

            I could go on and on with the lies of mental illness.  Mom’s who suffer from postpartum mood and anxiety disorders (PMADs) can present with a wide array of symptoms.  As a therapist I ask my clients to describe what depression, or what anxiety looks like for them individually.  Therapists are trained to do this because it does not look the same for everyone.  For one Mama it can present with sadness, hopelessness, and frequent bouts of crying and for the next Mama it can be increased irritability, rage, and poor concentration, along with other symptoms.  Mental illness is tricky; especially after having a baby.  As a new mom, even a seasoned mother, all the changes that come with the territory of pregnancy and motherhood can make your head spin.  “Is this supposed to be happening? Am I supposed to feel this way? Is the baby ok? I don’t remember this from my last pregnancy?” And again this is another list that can go on and on. One symptom that you will see no matter what the diagnosis is or no matter what the main pervasive symptoms are is the lies.  The thoughts that occur with postpartum women are many and often times they are sad, depressing, worrisome and scary, but they are also untrue. 

            When you are struggling with anxiety and depression, on top of being over tired, physically healing, learning how to care for and soothe a brand new healing baby, the thoughts that can occur can be a trap.  These thoughts trap women into thinking that they will never be ok again in their life.  They tell women that they are damaged or that they are out of control.  The thoughts tell women things that are simply lies.  They will enslave moms to feelings of being terrified, isolated, alone, and full of guilt and shame.  The lies make these moms believe that if they open up and share the truth of what they are going through things will only get worse.  They will be judged, or misunderstood or even worse be labeled as a danger to their child and lose their child.  These lies that come with the territory of mental illness are brutal and often times relentless. They don’t let up and once you start to believe one of them it’s like they bring their friends along to join in on the fun, seeing if you will allow the whole gang of them to rent out space in your mind. 

            Here’s the thing, these thoughts are lies, and these lies are sneaky. Think back to a time where you discovered that someone lied to you.  A time where you believed them without a doubt and then remember the betrayal you felt when you found out the truth.  The truth probably changed things in your life.  Once you found out the truth you likely had different behaviors and actions, you likely had new thoughts about the situation or the person that you didn’t have before.  You likely felt differently too.  The lies of depression and anxiety are a betrayal as well.  They will have you behaving in ways that are not typical for you, they will perpetuate negative and irrational thinking, and they can leave you feeling a sense of desperation that life can never be good again. 

So, how do we fight these lies when they feel so true? The first step is to listen to yourself.  If you think something is wrong, it likely is.  Once you are able to identify that something just isn’t right don’t feel you have to solve it on your own.  Speak to a professional, a maternal mental health therapist, your OB/GYN, a postpartum doula or your midwife and tell them what is going on.  Allow them to educate you on what you are experiencing and to point you in the direction to get help and get better.  Remember that all of the PMADs are treatable.  You can and will get better with the right help.  You can enjoy motherhood and not have to suffer your way through it.  One of the most effective interventions for mothers is being educated on what the symptoms are, what the condition is, and that recovery is possible and what recovery can look like. This information helps women to be able to dispute the lies of irrational thoughts and feelings with truth.  Once informed with actual facts about their condition they become empowered to fight for themselves and begin their healing process. 

Truth will be one of the most powerful tools you can have on your side when you are dealing with a PMAD.  Make sure that you are seeking out the truth from trusted professionals and get information that can start your journey to healing.   

More Than JUST Postpartum Depression

In recent years postpartum depression has gotten an increased amount of attention in the public eye. With celebrities like Gwyneth Paltrow, Kendra Wilkinson, Hayden Panettiere, Chrissy Teigen, Bryce Dallas Howard, Carnie Wilson, and Courtney Cox who have come out to speak about their own experiences with postpartum depression. They have help to shed light on the fact that too many women have been suffering in silence. The more information and awareness that can be brought to the issue of postpartum depression is always going to be beneficial. However, we still have a very long way to go. There is so much information that is lacking, misconceptions, and downright misinformation that still leads to stigma and feelings of shame that make many woman fearful to speak out about what they are going through.  Often times our own healthcare professionals are left with little resources and lacking a full understanding of the scope and magnitude that comes with mental illness during pregnancy and the postpartum period.

MORE THAN JUST DEPRESSION
I can remember the first time I heard about postpartum depression. I can remember Brooke Shields speaking out about her struggle after her first child was born. I remember the battle with Tom Cruise and his opinions on medication to treat postpartum depression. What I remember learning about postpartum depression was that the mom was sad, had no energy, no motivation no bonding with the baby, didn’t want anything to do with baby, didn’t feel any connection or love towards their infant. That was the limited education and knowledge that I had on postpartum depression, the picture that I obtained from media. My guess is I am probably not the only one that the extent of knowledge and understanding of postpartum depression looks fairly similar to that. For some that suffer from postpartum depression the above description is the exact picture of their personal experience. This, however, is not the exact or even similar to what other women experience who struggle with mental illness during pregnancy or the postpartum period. 

There is more than just postpartum depression. There are postpartum anxiety disorders that moms can cause constant, overwhelming worries. There’s postpartum Obsessive Compulsive Disorder (OCD) that can bring about scary intrusive thoughts, Post Traumatic Stress Disorder (PTSD) which can bring nightmares, flash backs and make a new mom easily startled and there is postpartum psychosis, which is the most rare of all the disorders, but extremely important for our mothers to be able to recognize the symptoms or have family members who can recognize the symptoms and understand the severity of it and the importance of ensuring treatment. All while understanding that with help mom can go on to live a healthy, happy, and thriving life as a wonderful mother. We still have far to go to get to a place where women don’t feel that they have to suffer in silence, to sit in shame, out of fear of judgment, out of fear that their child will be taken from them, out of fear that healthcare providers will misunderstand what they’re saying and will react in ways that end up being traumatic and more harmful to our moms.

 Many women equate postpartum depression with a lack of bonding with their child, crying all the time or immense sadness so they immediately assume they are not suffering if those aren’t the exact symptoms they are experiencing. Instead, they’re worried all the time, or they have the scary thoughts that keep coming in their mind that they can’t control, or they can’t sleep or their uncharacteristically irritable, and so many other different symptoms and scenarios playing out constantly. But the lack of common knowledge and understanding of all the possible complications that the postpartum woman and a pregnant woman can go through, keep these women held captive in a secret suffering. They don’t identify with the little bit of common knowledge that they have postpartum depression, so they don’t know what to call it or how to identify it. They are scared that they are the only ones and feel isolated and alone. They’re afraid that what they’re going through means something bad.  That it makes them bad or defective as a mother. And it is bad. It is bad because the last thing we should be allowing as a society is our women who are bringing new life into this world to be left alone, suffering on the battlefield called postpartum, all while having to put every once of any life that is left in them into someone else. It’s like asking someone who is already drowning to play life guard and to save the lives of the other poor swimmers out in the ocean, while they themselves are barely able to bob their head out of water long enough to catch a full breath.  It doesn’t make sense.

COMMON MISCONCEPTIONS

Many women do not realize that they are susceptible to a postpartum mood or anxiety disorder during anytime within that first 12 months after giving birth. This Is not only being missed by moms, but it has also been missed by healthcare providers. We are not screening our moms enough throughout the first 12 months after giving birth and we are often times not asking the right questions.  Obstetricians see moms 6 to 8 weeks after giving birth and they are done. Pediatricians aren’t screening enough, if they are even screening, shortly after the mom is giving birth and they are done. Focus is completely shifted to baby and the new mother is left to be, assuming that all is well, and everything is fine. Women don’t have a common knowledge of knowing that this can occur six months postpartum, eight months postpartum, eleven months postpartum.  They don’t know to be aware when they wean their babies from nursing or that when their menstrual cycle resumes again that this things can also trigger postpartum illness.

It is also important for women and family members to understand that struggling does not always start in the postpartum period but that many women start to experience symptoms of depression, anxiety, or mood instability during their pregnancy. This can be an indicator that they will indeed experience a mood or anxiety disorder post-delivery, but it is also just as important to realize that it may be severe during their pregnancy and they may need to seek out professional treatment and need additional support from their partners and support systems.

We also need to lay a better foundation for good understanding of what the baby blues are. Baby blues typically include mood swings, weepiness, difficulty sleeping, and anxiety. The baby blues can start a few days postpartum and last up to two weeks.  If symptoms are lasting past two weeks, it is not “just the blues”.  If it is lasting longer than two weeks than it is more sever than the blues and mom can benefit from getting help, to aid in recovering faster and not having symptoms worsen. Yes, there are adjustments after giving birth and having a newborn. The newborn stage is a blessed time and cruel time all at once. However, we must be really careful that we are not just dismissing what women are saying they are experiencing as “normal” postpartum difficulties, challenges or adjustments. We need to implement additional follow up and more services to better ensure that new moms get the help they need.  We need to be careful that we are not saying “it’s OK what you’re going through is normal for new moms”. I am afraid we are confusing the word normal, when we really mean to say common. Anything that meets criteria for any perinatal mood or anxiety disorder is not “normal”, unfortunately it is however, common. All too common. And all too often missed.

WHAT DO WE DO

I don’t write all these things to strike fear and make it seem that there is so much more doom out in the postpartum and pregnancy world than we are telling women.  On the contrary, my desire for women is to live lives of freedom and power and struggling with a mental illness without the understanding of it and without knowing that you can fully recover from it leaves women enslaved to pain and suffering.   For many moms I think the lack of knowledge and understanding of what really can occur leaves them stuck, scared to go forward, left to their own thoughts and surmises of what is happening to them. They don’t realize it is common, that it can be treated, and that they are not the only one. 
So, what do we do? How do we change things for our women? How do we make safe spaces for them to speak out and get the help that they need without creating more stigma? How do we educate women and family members and healthcare providers so that there is an air of security and assuredness that when they do speak out they will be taken seriously, they will not be handled in a haphazard way where people are panicking and looking at them as if they are monsters, shocked by the things they are disclosing? How do we ensure that they will be handled compassionately and that they will be given the appropriate care with a chance to get better? What women need to hear is that they can get better. They need to hear there is a name for what they are going through, that it is real and that there are professionals who know how to help them get through it and beyond it.  They need to know that they do not to have to feel ashamed and they need to feel from society, our culture, our professionals, our healthcare system, and our mental health professionals that we are not ashamed of them, that they are not less than.

To any mama out there struggling during your pregnancy or postpartum I need you to hear me.  You are not defined by this.  You do not have to take blame for this. You are not the only woman to have experienced this.  There are women that you admire, women that you think are amazing mamas, women that you look up to, that have had their own battle and they have overcome and you can and will get better too. And I believe that our system of how we handle the mental and emotional wellbeing of our pregnant and postpartum women will and can get better as well, we just have to keep the dialogue going.