Motherfectionism

Motherfectionism:  the cultural and intrapsychic insistence that mothers be perfect vessels of love and nurturance; responsible for, and in control of, all aspects of her child’s behavior and outcome.  

OK, so I made up my own word.  But it’s probably about time because it describes a process mothers often experience, and that I am witness to in my private practice and personal life. There are more examples of motherfectionism than I can count because women still bear the lion’s share of the emotional, logistic, and physical labor of parenting. And any form of perfectionism is first and foremost a coping strategy. 

Why am I framing the challenges of motherhood through this lens? Because I believe that our role as women’s mental health psychologists is to consciously not reinforce perfectionistic, unrealistic standards for mothers.  Indeed, there is a whole parenting advice industry that serves to replicate these standards, replete with two minute TikToks of confident, easy wins with our kids. I can’t tell you how many therapy sessions I have shared with mothers who feel confusion and shame in their parenting in the reflective glare of TikTok advice.

I believe our role as women’s mental health psychologists is to acknowledge the complexity of parenting,  and to shore up resilience within our female clientele for the emotional and pragmatic complexities - and labor - of motherhood. While we can offer parenting advice if needed, our job is to support you with all the flexibility and creativity that parenting requires.  Just like we do with every other important area in your life.

Shining a Light on Perinatal Mood and Anxiety Disorders

As a clinician whose practice focuses on all aspects of maternal mental health, I was motivated to write June’s blog after reading a tragically resounding story that recently made national news. Among other reactions I had, this story reminded me that the information I hold as a specialist in this area is not common knowledge for the majority of women in this country. As such, through this month’s blog I hope to educate, normalize, and destigmatize a disorder that affects so many American mothers and their loved ones. 

Arianna Sutton had a history of postpartum depression after the birth of her first child. But after her second pregnancy, her symptoms returned more quickly and stronger. Nine days after giving birth to twins, Arianna died by suicide. Tragically, Ariana’s story is not uncommon. Moreso, it underscores the importance for awareness of and knowledge about the most common pregnancy related complication: perinatal mood and anxiety disorders (PMADs). 

What are PMADs? 

PMADs include a variety of disorders and symptoms that a woman may experience during both her pregnancy and the year following birth. Postpartum depression is the most commonly known among them, but it is just one experience that fits under the PMAD umbrella. Specifically, additional disorders include anxiety, panic disorder, postpartum bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, and postpartum psychosis. 

According to Postpartum Support International, approximately 15 to 20% of women (or approximately one in seven) will experience symptoms consistent with PMADs. Additionally, women with a history of clinical depression or anxiety are at a significantly greater risk for developing PMADs, and those who have experienced PMADs during pregnancy are more likely to experience recurring symptoms in subsequent pregnancies. But important to also note is that a woman can be diagnosed with PMADs even if she did not experience symptoms during previous pregnancies. 

Although it captures most of the PMAD-related headlines, postpartum psychosis is a rare experience that occurs in 0.1% of women with onset two to four weeks postpartum (Postpartum Support International). Symptoms include, elated high mood, overactivity, racing thoughts, confusion, mania, suicidal or homicidal thoughts/actions, hallucinations and delusions. Though postpartum psychosis is a medical emergency that often requires hospitalization and medication, with early intervention, symptoms can typically resolve within weeks (Postpartum Support International).

In contrast, the so-called “baby blues” is a very common postpartum experience that occurs within two weeks of birth and whose symptoms include weepiness, fatigue, anxiety, and difficulty sleeping. Though the baby blues are typically resolved with simple self-care practices, if symptoms persist beyond three weeks postpartum, a diagnosis of PMADs may be considered.

Additional PMADs symptoms to be aware of include

• Feeling sad or depressed

• Irritability or increased anger

• Difficulty bonding with your baby 

• Feeling high or elated above and beyond what is typical 

• Reduced need/desire for sleep 

• Anxiety of feeling panicky

• Upsetting thoughts that you can’t get out of your mind

• Feeling as if you are “out of control” or  “going crazy”

• Feeling like you should never have become a parent

• Worries that you might hurt your baby or yourself

Treating PMADs

As many women feel shame, struggle to ask for help, minimize their symptoms, are fearful that they will lose their babies, or have limited support and awareness of PMADs, they often suffer their symptoms in silence. Fortunately for those affected, with proper intervention, PMADs are in fact highly treatable and have a favorable prognosis, often with a combination of medication management and psychotherapy.

Cognitive-behavioral therapy (CBT) is a highly effective form of psychotherapy treatment for PMADs, as it empowers sufferers to work in the “here and now” - as opposed to focusing on family of origin dynamics that are likely not helpful to the crisis at hand - to experience symptom relief.   CBT works with the interplay of a patient’s mood, thoughts, and actions, to provide a patient with alternative perspectives and experiences of her situation, healthy practices that can support her mood, as well as providing immediate coping strategies to the patient.  

At CTWPS, the specialized training our practitioners have into the specific challenges of women with PMADs makes us uniquely qualified to work with affected individuals. We strive to not only provide our patients with effective symptom reduction strategies, but also to normalize, educate, decrease shame, and improve their quality of life. If you, or someone you know, may be experiencing a PMAD, we at CTWPS are here to help and provide support. Reach out today!

References

https://www.today.com/parents/family/mom-dies-suicide-twins-rcna88579

https://www.postpartum.net/learn-more/

Our Boys

My son, a freshman at a large university in the midwest, called me early this week to share the tragic news that a friend of his had died by suicide while on campus.  I write this post still struggling with grief for my son’s friend, his family, my son, their community, and for the many young men struggling with their mental health in seeming isolation. My son was profoundly shocked by his friend’s suicide, and saw no warning signs, no signs of distress, no drug or alcohol use, or any form of self-harm by his friend. He is unable to wrap his mind fully around this, nor am I, even as a psychologist and therapist.  What I often believe about suicide is that the suicidal person is in a profoundly altered state.  But of course, I can’t really know that to be true.

While we all have heard the statistics on the mental health crisis facing young people, it is important to acknowledge that young men sadly are more apt to commit suicide than young women, perhaps partially because they typically  use more aggressive means to do so. Per the CDC, men die by suicide nearly 4 times more than women. While the mental health of young men and women is deeply concerning, young women may be better at expressing their high risk ideation and seeking help as compared to young men. 

I mourn the seeming mental isolation of my son’s friend, but also the many young men in the world who may not be able to find a way to share their suffering with others.  I write this not to provide a psychoeducation on suicidality, but to encourage us all to reach out and connect more to the people that matter in our lives.  To talk more, to open up all sorts of conversations - especially with our boys and young men.  The conversations don’t have to be serious, psychological, or profound, I think it’s ok to start with the silly, the mundane, the playful.  

But however it is that we connect, are we willing to connect some more?

The CTWPS Commitment to Women*: Talking about hormones, periods and the full female experience

The CTWPS practice has always been dedicated to addressing the specific mental health needs of women. Our clinicians are passionate about the need for increased understanding of, and compassion for the particular biological, psychological and socio-cultural experiences of women. In our psychotherapy work, we often support women in developing greater insight around the ways in which their womanhood impacts their thoughts, feelings and behavior on a daily basis; and ultimately, how aspects of their womanhood influences their mental health. 

Given my exposure to many women at many different stages of life (e.g. perinatally, postpartum, premenopausal, menopausal) ,over the years, I have developed a wealth of clinical experience that continuously reinforces my belief that there can be close ties between a woman’s reproductive cycle and her mental state. This is not to say that every woman experiences the same fluctuations in mood and mental state at similar points in the reproductive cycle; but simply, each woman responds to the rise and fall of estrogen and progesterone in her body at different points throughout her cycle, to differing degrees, in different ways. Furthermore, the multitude of changes I have observed and tracked with my patients over time are not limited only to the days leading up one’s menstrual period, as popular culture’s interpretation of “PMS” might suggest. A woman’s body, mind and mood is truly influenced by fluctuating hormones throughout the full reproductive cycle - all month long, month after month. Notably and thankfully, these hormonal fluctuations do not always have a negative impact on life! In fact, some women report feeling energized, experiencing greater clarity of thought, and having increased libido at certain points of their cycle. 

Just as I have become more convinced of how tightly woven reproductive hormones are in women’s daily lives, I have also become increasingly aware of how infrequently this topic is brought into the therapy room. As normal as it is, menstruation is, and always has been, stigmatized around the world. Historically, menarche and menstruation has symbolized religious impurity and contamination, been linked to witchcraft and evil, and been blamed as the cause of hysteria, disease and disorder. Unfortunately, to this day, playful words, disparaging metaphors and misogynistic themes persist when describing menstruation, (if it is mentioned at all). These tendencies undoubtedly perpetuate the embarrassment, shame and discomfort many women continue to feel about their body and its functions.

Thus, I and my colleagues at CTWPS make it our business to (gently!) inquire about the menstrual cycle with each of our female clients. We encourage exploration of how each woman experiences her cycle, and actively support the destigmatization of these topics. We help women track and assess changes in their mental state, mood and functioning alongside their monthly cycle, in order to better understand when interventions might be most beneficial to alleviate the negative impact of reproductive hormones. We assist women in developing (and following through with) plans for making lifestyle changes and/or medication changes to address difficulties they experience at different points in their cycle. And of course, we continuously educate our clients (male and female alike!), about the role of reproductive hormones in women’s lives, to encourage increased awareness, understanding and compassion for the full range of female experience.

As a female-focused psychotherapy practice, CTWPS is committed to honoring all that it means to be a woman in today’s world. If you or anyone you know would benefit from our expertise treating menstrually-related mood disorders (e.g. PMS, PMDD, Perimenopausal Depression) or mood disorders that tend to be exacerbated by hormonal fluctuations (e.g. depression, anxiety, OCD, and insomnia for example), please reach out to schedule a consultation. 

* A note about inclusivity: The aforementioned writing uses terms such as “woman” and “female” to reference individuals whose biological sex assigned at birth is female, and who possess female reproductive organs. We acknowledge that some cisgender women don’t have periods due to menopause, stress, disease or a hysterectomy. They may have never started menstruating due to a variety of medical conditions or they may be transgender or intersex. We also acknowledge there are people who menstruate who aren’t cisgender women. They might be trans men, intersex, genderqueer or nonbinary.

Surviving Infertility with Your Mental Health Intact

Women struggling to conceive often express how frustrating it is to be unable to get pregnant once they’ve decided the timing is right - after years spent trying to to avoid untimed pregnancy. Many women lament the fact that friends and family members appear to become pregnant when their husband or partner “simply looks their direction;” while they may spend months peeing onto ovulation sticks, tracking basal body temperatures, and timing sexual intercourse. A friend’s pregnancy announcement on Facebook may trigger an acute sorrow for the woman who has been injecting hormones into her stomach, waking at 5:00 am for monitoring appointments, and experiencing repeated disappointments for months on end. There is no doubt, a feeling of utter unfairness accompanies one’s (unwelcome) membership to the community of women who struggle with infertility. To add salt to the wound, oftentimes “membership” is granted only after a year (or several years) of failure, after many invasive medical exams, and, in the case of repeated miscarriage, after enduring heartbreaking losses.

Managing the myriad of emotions that come with infertility can be incredibly taxing, on both male and female partners. Anger, sadness, jealousy, fear and disappointment are just a few of the emotions that may arise when struggling with infertility. Depending on an individual’s unique personality traits, history, vulnerabilities, and life stressors, sometimes these emotions become truly impairing and develop into clinical depression and/or anxiety. At CTWPS, we are attuned to these issues – we understand the emotional toll of infertility on you and your relationships, and we honor the psychological anguish that often comes with this journey. While we cannot wave a magic wand and make you pregnant, we can help you cope with the negative emotions you may be experiencing about your body, your partner, and the process of conception. We can help you develop tools for managing depression and anxiety in the face of disappointment and loss. And, through it all, we can support you by providing a safe, judgment-free space to express the full range of emotions you may experience.

When addressing infertility-related mood concerns, cognitive-behavioral therapy functions in the same way it does for many other mental health concerns. CBT aims to help the individual 1) see the relation between her thinking, mood and behavior; 2) develop skills to evaluate her thinking in order to view their life circumstances as accurately and helpfully as possible; 3) engage in healthy behaviors that promote optimum mental health; and 4) develop the ability to tolerate uncertainty, discomfort and adversity that we all invariably experience in life.

One of the primary goals of treatment at CTWPS is to increase hopefulness. To do so, we first need to acknowledge the intense fears that underlie catastrophic or fearful thoughts. These thoughts are real and significant, and yes, there is almost always a kernel of truth to our greatest fears. However, while the worst case is possible, it is almost always unlikely – and living in that place of “worst case scenarios” before it is a reality, is unproductive.

Oftentimes, our minds jump to worst case scenarios out of an innate desire for certainty: “If I know the worst is going to happen, then at least I don’t have to wonder, wait, and worry.” However, living in this dark place of hopeless negativity is counterproductive to our mental wellbeing, and may leave us feeling sad, depressed and helpless. Thus, the work of CBT is to increase our tolerance of uncertainty (and adversity), such that we can properly assess the opportunities we do have to improve or change the situation. Taking action – rather than catastrophizing – provides a sense of self-efficacy, hopefulness, and the opportunity for positive change.

Infertility can be extremely stressful and overwhelming, heartbreaking and painful. For couples who are ready to conceive, the disappointment of unrealized expectations can become emotionally disheartening or even debilitating.  At CTWPS, we recognize how lonely this struggle can be. Our goal is to support you during this difficult time by providing emotional support, by teaching you strategies for managing maladaptive thought processes, and by offering practical strategies for navigating your life and relationships in the face of infertility. Our goal is to help you live a full and balanced emotional life, whereby a set-back like infertility is a challenge, but is not life-defining.