This is a tough subject to write on, but it’s probably in my top 5 most-emailed about questions/comments, so I know it’s one people are hungry to read about.
There is a frustrating level of stigma and shame which still surrounds mental illness: the way we talk about it on a cultural level, the image of ourselves we present to the world, the words we choose to use when discussing things like medication and therapy, and a whole host of other factors.
Last month a story surfaced about Pope Francis having seen a psychoanalyst for six months during his early priesthood, and the chatter online was pretty evenly split between “good for him for being so open and modeling good mental health” and “was it okay for him to have admitted that?” (with a dash of “aha, I knew he was nuts!” thrown in just because it wouldn’t be the internet without trolls.)
I’ve been really open online about my own struggle with depression and anxiety – especially the postpartum variety – because I think one of the most important things we can do for people with mental illness is invite them into polite society, so to speak, and jettison the antiquated notion that mental illness is somehow shameful, scandalous, and necessarily furtive.
Having now been on and off (but mostly on) antidepressants for more than half my life, I can honestly say I don’t care whether someone thinks less of me for needing them, or whether they believe that depression and anxiety are even real conditions.
You might have great success using an essential oil before bed to calm your anxious nerves, and that’s fantastic! I also like a drop of lavender on my wrist and pillowcase at night, but it doesn’t stop me from popping an SSRI before bed, and nope, I don’t believe that I could easily handle things “naturally” if I just took the time to read up on it. (Because I’ve tried all the things and dabbled in all the naturopathy. Not opposed! But also not sufficient, at least in my case.)
The truth is, mental illness, much like physical illness, is both unique to the individual and also excruciatingly uniform. How depression feels in my brain might be worlds apart from how it feels in someone else’s, but the outward effects are drearily similar: dark thoughts, exhaustion, flashes of inappropriate anger and bouts of crippling sadness and despair.
I frequently hear from women with questions about NFP, and about safely combining pregnancy + drugs. The answer to many of the NFP questions is heartbreakingly obvious: “Is avoiding pregnancy because of mental illness a grave reason?”
YES. Yes. I want to shout from the rooftops “YES! And I am so, so sorry if there is nobody in your life who understands that or is willing to validate that for you.”
Nobody blinks an eye if a woman staring down chemo decides to step off the baby train for 18-24 months. But a mom struggling with a crippling mood disorder gets a raised eyebrow for wondering, in the depths of her suffering and with symptoms raging out of control, if maybe she’s actually “done” having children.
It’s okay to not be okay.
It’s okay to be suffering and searching for answers and not totally sure when – or if – you’re going to come up for air.
Now, this is the part of this essay that gets (more) intensely personal, so bear with me. (My virtual living room, my prerogative.)
I am currently 6 months pregnant with baby number 5. I have had crippling postpartum depression and/or anxiety with all but one of my children, and have been on antidepressants for either all or part of each of those pregnancies, including the current internal resident.
I have fielded many, many questions over the years about the safety and wisdom of using medication while pregnant and breastfeeding, and will preface this with the same answer I give to everyone who has ever asked: it is an intensely personal decision, and one that only you can make for yourself, your baby, and your family.
(And before someone @’s me with the “aha, your body your choice!” zinger of a gotcha, let’s be clear that making a decision to treat un underlying medical condition is worlds apart from killing your baby for any reason. For further nuance pls google “intention and moral objective.”)
Now, if your husband, parents, spiritual director, etc, think you should be treating your mental illness with medication and/or professional counseling, take that advice seriously as you make a decision. And when you decide, consider that the common good of your family is the criteria–if you don’t like being on anti-depressants or hate the thought of being vulnerable with a stranger, but your kids need a mom who is able to make dinner, the just thing to do might be to suck it up for their sake.
Mental illness is at once intensely personal and painfully corporate. And for whatever reason, it can often present a bigger target for speculation and strong opinions than most physical illnesses do. This is helpful to keep in mind when someone is confiding in you about their condition, because it can be more tempting with mental illness to offer advice and recommendations perhaps not rooted in good science and best medical practices, but in internet-derived research and personal anecdotes.
For example “I cut out gluten and now I don’t need Prozac anymore so you probably don’t either” or “Using essential oils completely cleared up my anxiety and you really should try something natural before you put toxic drugs into your body!”
True though those two statements may be for the person making them, that does not grant them a blanket status of efficacy when applied to other people’s conditions.
One person might well be able to get their blood sugar under control through diet alone, and another may need an insulin pump for life.
Every body – and brain – is different, and I personally thank God that we have multiple choice options when it comes to mental health. My life would have been very, very different 100 years ago, and not a day goes by that I am not grateful for the privilege of living in a first world country with access to life-changing medication.
A large part of that gratitude stems from the fact that because these medications do exist, and because I have found different options that my body responds well to, I am able to continue to be open to life.
I would not have been able to continue having children without SSRIs. I say that without a hint of hyperbole or a smidgeon of exaggeration. The ability of my brain to apply this class of drug to my particular chemical makeup and smooth out the rough edges is nothing short of miraculous, and life on these meds versus life off of them is very, very different.
I’ve found at the tender age of 34 the perfect combination of diet, medication, therapy, prayer, and supplements that makes things pretty darn good. For now.
It’s a tricky thing when hormones are involved (and, increasingly, as science is demonstrating, inflammation) because they’re designed to fluctuate. So what works one month (or maybe even one part of the month) might not work as well 2 weeks later.
Pregnancy is generally a time of smoothed-outness for me, emotionally speaking. I can get by with a low dose of an SSRI (Zoloft is my doctor’s preferred pregnancy prescription and is working well for me this time) a low dose of LDN (low dose naltrexone, addresses inflammation and my autoimmune thyroid disease), a desiccated thyroid medication, progesterone supplementation, and a strictly (and I do mean strictly) gluten free diet.
I’ve also found – not that this is a biggie during pregnancy, but other times, womp womp – that I can no longer tolerate most kinds of alcohol. Single tear. Beer’s off the table for obvious reasons, but sadly, in my advancing middle age, so is wine of every color and variety. Cider is similarly catastrophic.
Over the years I’ve engaged in a fair amount of cognitive behavioral therapy, healing prayer and deliverance, naturopathic supplementation, regular exercise, and chiropractic care. All of these things have helped tremendously. But for me, at least while I’m in my childbearing years, they haven’t been sufficient.
And that’s okay.
I’m okay with being “not okay,” and with needing a little extra help to get through these demanding investment years of building a family.
Of course I worry about possible adverse side effects from the medicine, just like I worry about the 5 weeks I was too nauseous to choke down my prenatal vitamins, the hormones and chemicals in my tap water, the other drivers on the road with me, the bacteria in the swimming pool, and any potential unknown genetic time bombs lurking within my DNA.
But ultimately, this baby’s health and his or her safety – as is also the case for my other children – is beyond my control. When I send them off to school each morning, it’s a trust exercise in best decisions made weighed against possible adverse outcomes.
I could breastfeed each little angel for 2 full years, avoid every vaccine or vaccinate to a full schedule, feed them an exclusively organic diet, avoid all inflammatory food groups, restrict all devices emitting harmful electromagnetic pulses, and still end up with a 4-year-old with a brain tumor one day.
But the essence of parenting is making the best possible decisions possible for all parties involved, using the information at hand, a well-formed conscience, and a dash of common sense.
And the essence of motherhood is making a sincere gift of self without annihilating one’s self in the process. A shattered, broken down mother is not nearly so beneficial to her children as a sane, whole one. And to the extent that we can take care of ourselves in order to give the most to our families, we should.
I am a better mom when I’m on medication. And I feel no shame over that. What I do feel shame for are the months and months I’ve stubbornly tried to go it alone, gritting my teeth and yelling (so much yelling), refusing to do the thing that could help because it wasn’t natural, it wasn’t ideal, and it wasn’t what I wanted.
But sometimes it’s not about what I want. Most of the time, turns out, according to this motherhood gig.
I hope if you’re reading this and are struggling with mental illness yourself, you find a little respite here. I hope you’ll find that after reading this you feel more able to bring your fears to someone and ask for help shouldering the burden.
Because you are not alone in your illness, and you needn’t suffer alone. And a psychological cross needn’t also be a death sentence for one’s fertility.
Other women are out there making similarly brave and difficult choices: they’re called mothers. And I want to invite them into the conversation to share their stories.
(I invite you over to the blog’s Facebook page to join the discussion and share your own experience there.)