Rant Alert: How Doctors are Still Getting it Wrong …

I truly believe most doctors really do care about their patients. I sincerely hope this is, at least in part, the reason they made the decision to go into medical school.

I also believe, or hope to believe, that most doctors are  continuing to educate themselves about prenatal and postpartum depression.

Why is it, then, that so many doctors continue to misunderstand this illness?

I didn’t have postpartum depression after giving birth to my children, some twenty hundred years ago. But had I felt overwhelmed with anxiety or paralyzed by fear or stymied by guilt or hopelessly hopeless, I can’t imagine not telling my doctor.

So we tell women to tell their doctors. Disclose your feelings. Expose your vulnerability. Ask for help.

And many do.

Hopefully, most get the help they need.

Some, however, still get this:

“I told my doctor how bad I was feeling. I told him I couldn’t breathe, sometimes, and that I didn’t think I should be a mother; that I made a mistake and that my son deserved someone who loved being a mother. I told him that I didn’t think anything was wrong, really, because my son was healthy and my husband was amazing but still, I couldn’t shake this feeling that something was terribly wrong and that I would never feel like myself again. I told him I stayed up at night worrying that something terrible would happen and that I couldn’t stand how I was feeling. He sat writing some notes in my chart and barely looked at me. When I started crying, he looked up for a quick glance, of course I felt judged, but I don’t think he was really judging me. I think I was judging myself because I felt so fragile and so emotional, so unlike me.  But since he didn’t offer any kind words of support, I took a deep breath and tried to keep it together. I felt like I was going to jump out of my skin.  Then, he put down his pen and took off his glasses to look directly at me, the way that professors do when they have something serious to say. That was nice. I felt listened to. I felt cared for. I didn’t feel rushed. I think he really cared. But then, he said the wrong thing.”

“What did he say?” I asked.

“He said, ‘just be grateful.'”

Collective sigh.

“I AM GRATEFUL!!! UGH. That’s not the solution. That’s part of the problem! If I weren’t so grateful for my gorgeous son and my fabulous family, I would have killed myself by now. Just be grateful? Are you kidding me? Oh please. I am so in the wrong place.”

Yes, she was, in that moment, anyway.

To be sure, being grateful has enormous healing powers. Gratitude and a host of other positive emotions can sprinkle bits of magic into an aching soul. Make no mistake about it, being truly grateful from deep within your heart, can be a life-altering and amazing experience.

But it is not, in and of itself, an antidote to depression.

Women who are depressed cannot (yet) turn it around by inserting a corrective emotion.  Although this is clearly where we hope she can go, fairly soon, it is not likely that she can do that simply when instructed by her healthcare provider. It feels dismissive, though I will give him the benefit of the doubt and presume he meant it supportively.

It was too soon.

Rather than tell postpartum women who are depressed that they should be grateful when they are acutely symptomatic, they should be comforted with reassurance and expertise, then referred for treatment. That’s all. I know doctors are busy and incredibly overloaded. But please, if a postpartum woman has the courage to tell you how bad she is feeling, please do not tell her to be grateful.

Tell her you will help her feel better.


3 Responses to Rant Alert: How Doctors are Still Getting it Wrong …

  1. Dear Karen and community,
    Thank you for this honest, informed reminder. Provider failure is unfortunately still prevalent, and a serious obstacle to treatment. This has come to my attention specifically in my dissertation study with 20 women, where 80% reported provider failure to screen, and in many instances, serial failures in multiple systems. It is also important to make sure we widen the definition of provider to include lactation consultants, midwives, postpartum doulas, birth doulas, family and general practitioners, psychiatrists, social workers as well as OB/GYNs.

    Thank you for all that you do, Karen…you are my hero!

  2. Very frustrating!. Wish every doctor had to take a course in PPD and mental illness each year. Especially male doctors just to get and understanding of what happens to a mothers brain and body during postpartum. I hope the mother in the story received compassionate care in the end.

  3. I have a couple of comments on this. Unfortunately, I have heard stories about doctors in my community saying things like “The only time you need to worry is if you want to hurt yourself or your baby”-from a pediatrician; and “You can handle it, you just need to toughen up”- (seriously?) from an OB. These statements not only show a lack of even understanding what postpartum depression is, but a total invalidation of the mother’s feelings. As if it wasn’t difficult it was for these mothers to speak up in the first place, now they feel will feel more isolated and ashamed after hearing things like this. Or more guilty when hearing they should just be “grateful”-as if she doesn’t already feel guilty enough about the PPD.

    I am a Licensed Professional Counselor, who also had PPD after the birth of my first child. I was told by my OB’s office that they don’t handle PPD concerns and to go to my PCP. Also, during my current pregnancy I have been asked once at the initial visit if I have a history of pyschiatric issues (generally), and since then have not been asked a thing more (at 25 weeks currently). During the first birth, screening took place the second day in the hospital, and that’s it.

    I at least knew that I needed to advocate for myself. What about other moms who don’t know this? And when they do speak up they receive insensitive and uneducated responses.
    It is very frustrating that the medical community has so little knowledge (or soemtimes care?) about this area. There is still so much work to be done!

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