Mothers have faced so many intense challenges during the COVID pandemic, including bearing the brunt of childcare and schooling responsibilities and the difficult decisions weighing the risk of exposure against all other priorities. Here’s a link to a recent article I published on Monarch about these challenges:
https://meetmonarch.com/health-resources/articles/motherhood-during-covid
Pain tends to overshadow everything else in our lives. Pain creates fear, and the two can become the focus, such that everything else in our lives fades to the background.
As we retreat from pleasurable activities, it is not surprising that depression and anxiety can follow. In fact, most chronic pain sufferers also suffer from depression or an anxiety disorder as well.
However, it can often be hard to know whether the psychological or physiological issues came first. Many chronic pain sufferers have a history of perfectionistic or people-pleasing tendencies that are also risk factors for depression and anxiety. And many pain sufferers experience multiple conditions that are commonly related to stress: digestive issues (IBS, Crohn’s, ulcers), migraine or tension headaches, fibromyalgia, bladder or pelvic pain issues, back or neck pain, hip, knee, shoulder or wrist pain, as well as anxiety or depression.
There is quite a lot of evidence that even pain that appears to have a physical cause can in fact be attributed to emotional factors. This was my experience. Years ago, I had chronic tendinitis in my wrists that was attributed to excessive keyboarding. I experienced inflammation and very real pain associated with using my hands to keyboard, garden, or even cook. I was treated by chiropractors, physical therapists, massage therapists and acupuncturists. I studied Alexander Technique and took Feldenkrais classes.
But the pain kept returning, and I had to severely restrict my activities to avoid it. I got voice-recognition software, an ergonomic workstation, regularly wore splints on both wrists, curtailed activities such as knitting and gardening, never ever bore weight on my hands, and still had debilitating pain on a regular basis for over two years.
Then I came across an interesting book written by a doctor of rehabilitative medicine, John Sarno. In his work with people who had undergone back surgery, he discovered that there was very little relationship between the severity of the objective problem (a bulging disc, arthritic vertebra, scoliosis, etc.) and the level of pain experienced. And he noted that other people who had the same conditions, as shown on their x-rays and MRIs, experienced no pain.
Dr. Sarno’s book, Healing Back Pain, addresses the psychological factors that produce pain in the body. He shows how stress and suppressed anger manifest in physical conditions that cause pain, and he has helped thousands of people overcome pain without any medical intervention. I read his book, and using his techniques I basically eliminated my wrist pain. I now type as much as I want and don’t restrict my activities, and I experience only occasional, fleeting pain. Pain does not affect my life in any significant way anymore. I highly recommend Dr. Sarno’s books. His second book, The Mindbody Prescription, addresses other sources of pain and illness.
It can be very difficult to explain this concept to people who are in pain, because no one wants to hear “it’s all in your head.” It sounds too much like “you’re making it up” or “it’s your fault.” And doctors treating pain conditions have reinforced the belief that the body is flawed and the fear of causing additional damage by attributing pain to structural variations that are normal age-related changes, such as bulging discs and arthritis. But studies have shown that many issues that are blamed for chronic pain are just as common in asymptomatic people (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/). A study of 3110 asymptomatic individuals at a range of ages found:
“Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”
All pain is perceived through the brain and is very real. However, the perception of pain is greatly influenced by our level of fear and our perception of the situation. People who believe that a treatment will cure their pain are much more likely to experience relief from it. The fact is that much of the pain we experience is due to learned neural pathways rather than tissue damage or structural abnormalities. And for those who believe that their pain has a psychological basis, it is just as likely that psychological treatment will reduce or eliminate pain.
I recently completed a training by the Pain Psychology Center in working with clients experiencing chronic pain. A new pain treatment, called Pain Reprocessing Therapy (PRT) was validated in a recent study at the University of Colorado. Many participants with longstanding chronic back pain experienced a complete recovery from their pain in four weeks of PRT treatment. You can read the peer-reviewed medical journal article here, or a Washington Post article summarizing the findings here.
PRT includes cognitive and behavioral strategies to overcome pain, not just learn to live with it. PRT can help clients overcome the fear of the pain and enable them to resume ordinary activities and greatly diminish or even permanently eliminate their pain. PRT includes mindfulness techniques can help calm the nervous system to reduce pain perception and increase a sense of safety in the body.
Pain, as awful as it is, can be serving many purposes in our lives. It gives us permission to take a break, rest, and take care of ourselves, or get support and care from others. It distracts us from thoughts and emotions that we find unacceptable or inconvenient to address. It fills our lives with doctors appointments and treatments that allow us to avoid figuring out what we truly need in order to be happy and fulfilled. Truly believing that our bodies are strong and resilient and refusing to let pain rob us of activities we enjoy can allow clients to take back control of their lives and not be a victim to pain any longer.
Take a test to see if your chronic pain is likely treatable using a mind-body approach
References:
Published online 2014 Nov 27. doi: 10.3174/ajnr.A4173
You know the feeling when it starts: an unpleasant burning in your chest or abdomen, a feeling of cold on the back of your neck, tingling in your arms, or tightness in the back of your throat. Anxiety is a physical phenomenon. Many of us are unaware of the specific physical sensations associated with our anxiety, but it sends a signal to our brain that we are in danger. On its own, anxiety tends to pass quickly and without much ado. It is the way we attribute meaning to the sensations in our body that causes anxiety to feel unbearable and to stick around. We interpret our anxiety as being “out of control.” We look to our environment for signals that we really are in danger, either physically or emotionally. And we beat ourselves up for feeling anxious, telling ourselves “What is wrong with me?” “Why can’t I feel calm?” And even worse, “I can’t tolerate feeling this way.”
But in reality, we can tolerate anxiety. By tolerating it and observing its physical manifestations, we rob it of its power over us. And over time, anxiety will diminish if we refuse to escalate it by letting it take over our thoughts.
Mindfulness is one of the most powerful tools for coping with and transforming anxiety. While it may feel like WE ARE anxious, bringing awareness to our body and choosing to focus on the specific physical sensations we are experiencing allows us to see that we are the observer of anxiety, not its victim. We can choose to halt self-defeating thoughts by returning awareness to our body and reminding ourselves “Anxiety cannot hurt me. It is only a feeling, and it is temporary. I am in control of myself. I can choose to be aware of the anxiety without letting it take over my thoughts.”
Practice doing mindfulness exercises such as this one when you are not feeling particularly anxious, as a way of being ready for anxiety when it comes. Learning to focus your full attention on your body rather than your thoughts takes some practice, but only five minutes a day can make a huge difference in reducing anxiety and helping you cope with it when it comes.
Anxiety is often associated with depression, even if the depression is not severe. Taking steps to address negative patterns of thinking, grieving losses, and learning to take better care of ourselves physically and emotionally is another important step in dealing with anxiety. If you need help to learn to identify and challenge negative thoughts, work through with past trauma or loss, or learn to improve your self-care and relationships, finding a therapist you trust is a great place to start.
One of the common themes I come across when working with mothers experiencing depression and anxiety is perfectionism and people-pleasing. Moms get worn out when they are trying to make everyone happy all the time.
There are often good reasons for a tendency to be over-responsible for the feelings of others. Many of us come from families where there was an unspoken expectation that a child must be “good,” because one or both parents were unable to tolerate the challenge of even normal childhood misbehavior. Or sometimes, children develop an unconscious habit of caretaking for others as a way to get their own needs met.
Take a test to see if you have Prenatal or Postpartum Depression
What are the risk factors for Postpartum Depression and anxiety? Can your personality contribute to your risk? Check out this article of mine, published on www.GoodTherapy.org.
Take a test to see if you have Prenatal or Postpartum Depression
Whenever I talk about the symptoms of perinatal mood and anxiety disorders, I always include “unusual physical symptoms.” What does that mean? It means that any new physical symptoms that begin during pregnancy and postpartum can be related to mental health.
My own experience with postpartum depression and anxiety was quite atypical, and that was partly why I suffered for months before receiving the proper diagnosis and treatment.
I had lots of risk factors for postpartum depression: a previous bout of depression, the sudden loss of my mother only a few years before, a previous birth trauma, an unsupportive marriage, and breastfeeding difficulties. But even though I had suffered from depression before, after the death of my mother, my postpartum symptoms were not recognizable to me.
I did OK after my first child was born, although it was a difficult time for me. But after my second child, my stress level was off the charts. My older son was kicked out of two day care programs because he wouldn’t use the potty (he regressed after his brother was born). I never made enough milk for the new baby because of my stress level and because he was so big (born almost 10lbs) , and he refused to nurse completely as soon as he started solid foods. I felt guilty about “failing” at breastfeeding, and I was also afraid that I would not be able to go back to work after maternity leave because I couldn’t find daycare that would take my challenging and potty-resistant older son.
In the meantime, I had difficulties in my marriage. My husband worked long hours, and when he was there he criticized my parenting style, my cooking, and my housekeeping. Even our challenging preschooler was my fault! I was trying my best to make everyone happy, but I was clearly failing.
During this time, I started to have odd physical symptoms. I started feeling that the room was tilting and that I was off-balance. I had to lie down and felt the room was spinning around me. My doctor thought it was either an inner-ear infection or possibly Multiple Sclerosis, and I was sent for neurological testing. The tests came back normal, although MS couldn’t be ruled out (a bonus for my anxiety, of course!).
My symptoms came and went, and then began to include nausea and vomiting along with the dizziness, a complete lack of appetite, and an inability to sleep. I had a low-grade fever on and off for a couple of months and my white blood-cell count was high. I lost 16 pounds beyond the baby weight, slept about three to four hours a night, and threw up regularly — out the door of the car, in the sink at the pediatrician’s office, etc. I felt that my body was swaying even when I was perfectly still, and my bed felt like it was shaking as I lay in it trying to sleep. My skin felt prickly, my chest burned and my hands tingled. The dizziness made watching TV or reading impossible, and walking or driving became difficult. I felt sure that I was dying.
My doctor considered an inner ear problem, hormones, diabetes, thyroid issues, and even encephalitis, but every test came back normal. I was living on Ensure and Gatorade, because I couldn’t keep any solid food down. The stress of caring for my children became unbearable, so we hired a babysitter and I spent most of every day lying in bed, praying to fall asleep for a couple of hours to get some rest. I was prescribed Ativan, but it just knocked me out for an hour or two and I would wake up feeling even worse than before.
After about four months, I fell apart completely and told my doctor that he had to hospitalize me because I was dying, and at that point I wanted to die if they couldn’t stop the misery I was living in. I was admitted to a psychiatric inpatient unit, but my doctor was still sending me around to specialists, trying to figure out what was physically wrong with me.
I stopped vomiting as soon as I was admitted to the hospital. That was when I realized that whatever was going on with me had to do with stress. I spent 12 days in the hospital, during which time I started taking antidepressants and was prescribed an anti-anxiety medication that allowed me to sleep. For a few days, all I did was sleep. When I was awake I was no longer nauseous, but I was filled with unbearable emotional pain. I was terrified that I would never be able to care for my children without getting sick. I felt like the worst mother in the world.
After I was released from the hospital I did a full-day partial hospitalization program for a month, which gave me time for the antidepressant to start working and allowed me to take care of myself for a change. I learned in group therapy about the ways in which I had prioritized my responsibility for others way above self-care, in unhealthy and unhelpful ways, and I began to heal. With the help of medication, therapy, and later couples counseling, I recovered. I still had anxiety at times, but I also had joy and passion for life. I became a lactation educator, started a small business helping other new moms, and led new parent support groups for several years. Eight years later I went back to school to become a Marriage and Family Therapist.
I still have to be vigilant about managing stress and maintaining good self-care. I tell myself that this is the “gift” of being prone to depression and anxiety: I don’t have the luxury of tolerating a great deal of stress like some people seem to do, or living life in a way that generally makes me unhappy. I am obligated to do work that I love, to have a healthy relationship with my husband, and to prioritize joy, peace and comfort as well as caring for my family. I know that I always have to be mindful to avoid a recurrence of depression, but I also know that I am strong and resilient and will do whatever I have to do to be healthy and take good care of myself and my children.
My mental health issues began when my second child was seven months old, and yet no one ever considered a postpartum condition. My symptoms were fully consistent with panic disorder and depression, and yet my doctor and my therapist (yes, a trained therapist!) never considered these diagnoses. My hope is that in the future, mothers and their caregivers become better educated to recognize perinatal mood and anxiety disorders so that they can be treated early and mothers can return to enjoying their lives again.
Call PSI Warmline (English & Spanish) 1-800-944-4PPD (4773)
Email support@postpartum.net
Take a test to see if you have Prenatal or Postpartum Depression