Documentary follow up...

 ...from Kristin Morgan, PMAD Support Group Leader

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Last week, I had the privilege of serving as a panelist for a post-screening discussion of the film When the Bough Breaks. Looking back on this experience, I have a few thoughts and feelings that I hoped to share with you, dear reader.  

 

First, I’m immensely proud to be part of an organization that cares deeply about the women in our community; so much so that TMC was willing to take a risk, show a documentary about a painful, overlooked issue, and then host a raw discussion about this topic. That is brave. And difficult.  

 

In an attempt to muster similar bravery, I’d like to share something that may come as a surprise: I actually didn’t care for the film.  

 

Not because it was painful to watch, or because it brought back feelings that I’d rather not revisit. Surely, it did those things, but as a clinician who is passionate about working with women who have postpartum depression, I thought the film really missed the mark. And unfortunately, I believe it communicated a message that could potentially cause unintended damage due to lack of clarity.  

 

Specifically, I wish the film had more clearly identified the spectrum of postpartum mood disorders. Instead, the primary focus was on extreme cases of depression. The (close) secondary focus was on postpartum psychosis. This confused me because postpartum psychosis occurs at a rate of .1% of the population (Gaynes et al., 2005 as cited in Kleiman, 2009). If postpartum psychosis occurs at such a low rate in the general population, why were the tragic stories of no less than 5 women who suffered from postpartum psychosis detailed in a film about postpartum depression?  

 

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To be clear, postpartum depression is a term used to describe a range of mood disorders that present from mild to severe. Typically, postpartum depression presents predominantly as anxiety. Therefore, when a woman says that she has postpartum anxiety, technically, she has postpartum depression.  

 

“Anxiety is a hallmark sign of postpartum depression. Postpartum depression is an agitated depression marked by excessive and predominant anxiety” (Kleiman, 2009).  

 

This came as a surprise to me, because after the birth of my son, I had crushing anxiety, but never really felt sad, persay. This was also a bit embarrassing because I assign diagnoses as pivotal aspect of my job. How had I missed this?  

 

Well, unfortunately in the entire 947 page Diagnostic and Statistical Manual (DSM 5), which is published by the American Psychiatric Association, there are a whopping FOUR PARAGRAPHS dedicated to this issue. We didn’t talk about this in grad school, it never came up in our diagnosis courses, and it can be very difficult to find a counselor who specializes in treating postpartum depression and mood disorders. In fact, it’s very name “postpartum depression,” or “perinatal mood and anxiety disorder,” isn’t even the term the DSM uses (it’s Major Depressive Disorder with peripartum onset). Therefore, its likely that many cases of postpartum depression are being misdiagnosed, say as an anxiety disorder for example. Unfortunately, as long as that’s the case, postpartum depression will not get the attention and credit it deserves. 

 

So, I’d like to start more conversations about the spectrum of postpartum mood disorders, and how they can include post-traumatic stress disorder, adjustment disorder, mild anxiety, grief responses, or a range of classic clinical depression, from mild to severe.  

 

I think this is what When the Bough Breaks was trying to do, and I appreciate that. But it got a little dicey at times, specifically surrounding the issue of postpartum psychosis. To be clear, postpartum psychosis is it’s own entity. It is not postpartum depression, and to call it such would be a misnomer. By nature, postpartum psychosis is more severe than postpartum depression because the mother cannot differentiate between reality and psychotic thought. Sadly, this is what often leads these women to face the tragic outcomes that we see plastered across news headlines.  

 

In the film, one of the producers said something along the lines of, “…women with postpartum psychosis have these intrusive thoughts and…” 

 

And then my skin crawled a little bit. The hallmark sign of postpartum psychosis is not intrusive thoughts, but rather hallucinations and delusions. To give an example, a hallucination may be auditory (hearing a voice speaking to you), visual (seeing shadows or figures), tactile (feeling something that isn’t there), or olfactory (smelling something that isn’t there). A delusion is typically believing something that would be perceived as wildly untrue to someone else (e.g. believing your child is the messiah).   

 

Conversely, I’ve never met anyone, whether riddled with anxiety or not, who hasn’t had an intrusive thought of sorts. In some ways, intrusive thoughts are normal ways that our brains protect us from engaging in risky behavior. For example, I wear my seatbelt because I don’t want to get into a car accident, but thinking about that car accident may be an intrusive thought, especially depending on the amount of anxiety I have surrounding car accidents. Of course, these occur differently for every person, but having these thoughts and being afraid of them is normal, especially for someone with anxiety and/or postpartum depression.   

 

Now, this is a complex issue and presentations of postpartum mood disorders are always a bit different because we all have different brains, life experiences, and personalities. I’m not faulting the creators of When the Bough Breaks for not reading to us straight from the DSM for 2 hours, because that would have been suuuuper boring. I also appreciate that there were several interviews with highly knowledgeable professionals in this field who accurately spoke to the issues at hand. And ultimately, I’d like to think that the creators of this film and I agree on this very important point:  

 

Regardless of the specific way in which any emotional or mental turmoil occurred for you during or after pregnancy,  

 

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You are not crazy.  

 

Your story matters. You matter.  

 

And there is help.  

 

-Kristin Morgan, PMAD Support Group Leader, Resident in Mental Health Counseling 

 

Support Group times and locations can be found here.