As usual, it takes a celebrity to bring everyday, real-life problems to the forefront. Recently, "Nashville" actress Hayden Panettiere announced she is being treated for postpartum depression. Some accuse stars who go public with their personal struggles of trying to grab attention or get points for good deeds. Well, when it comes to raising awareness on issues like these, I don't really think it matters.
The truth is, most celebrities make it appear that childbirth is a magical carpet ride. From photos of those first sightings of baby bumps right through delivery, these women appear to glide into motherhood landing with baby in hand, looking fit and energized, ready to return to life as it had been.
Not so for Hayden, apparently, and not so for many women I see in my practice. Amy, a 39-year-old patient, came for therapy after having her third child. Pregnancy and delivery were normal and her doctor had given her the go-ahead to return to pre-pregnancy activities - teaching, tennis and sex with her husband -- but six months later she was disinterested in any of them. She wasn't suffering a full-blown postpartum depression -- 0.2 % of all new moms do -- but like many with newborns, Amy felt apprehensive about all the changes. "It's not just that I'm tired and overwhelmed," she told me in her first session, "but it feels like everything has changed and will never be the same."
The theme that arose in therapy was Amy's belief that the route to feeling better meant getting her old life back. Like the celebs she saw in the media, she wanted to regain control, look and feel as she once had, and return to life as she knew it. She told me that this pregnancy had wreaked havoc with her body in a way her previous two hadn't. She couldn't lose the baby-weight, her breasts hurt, her bladder leaked and her mood plummeted each time she glanced in the mirror. She said "I don't recognize myself, yet I don't have the wherewithal to do anything about it." Managing three children and household tasks, along with working, felt overwhelming. Fun seemed like a distant memory. She was just too uncomfortable inside and out, leaving her little interest in engaging with her friends or husband.
To start, I told Amy that getting "her life back" didn't necessarily mean returning to how things were before. Setting that goal would be frustrating and was meant for media stars whose professions depended upon it (with 24-7 support-staff to help along the way). Even celebs, I told her, have begun to resist that pressure, admitting that their real life experiences were often photo-shopped to enhance reality. I asked her to think instead about shifting her expectations -- not necessarily lowering them -- but aiming to create a better balance between her added responsibilities and a new kind of fun. The solution, I told her, would come from embracing what I call "controlled spontaneity," a more realistic goal for enjoying life after children.
What is controlled spontaneity and how can it be achieved? The idea is based on understanding that fun and responsibility can feel paradoxical. The very nature of pleasure is that it is associated with the experience of letting go -- think of play, laughter or sex for example. But as we mature, we learn that it's tough to have fun midst chaos, and that it's more likely to occur when our environment feels safe and in control. Just ask any mom how interested she is in having sex when the beds haven't been made, the dishes aren't done or her kids are crying for attention.
Amy needed a plan to begin gaining a modicum of control over her life. I asked her to choose just three small goals that she could focus on that might lead to a greater overall sense of control. Cognitive Behavior Therapy (CBT) suggests that we break down desired goals into smaller steps in order to achieve results. Amy chose three things that were important to her; getting more sleep, dealing with bladder leakage and having sex again.
I thought these were reasonable and went hand in hand. I knew if Amy was less tired and could feel less out of control of her body, intimacy and sex might follow. So I made the following suggestions; 1) She was to ask her husband to take over one bottle-feeding at night a couple of times a week so that she could get at least six hours of solid sleep. Even if a baby is being nursed, one bottle of pumped breast milk daily is a good idea. 2) She was going to try a new product for bladder leakage called Poise Impressa, an insert-like tampon, which actually helps prevents leaks, so that her body felt more under her control. Women tend to lose self confidence even with mild incontinence and there are simple ways to avoid that. 3) She was to plan a date night with her husband. Rather than wait for spontaneous moments to be intimate -- times that are hard to come by when there are children around -- they would hire a baby sitter so they could go out, or just lock their bedroom door for a night by themselves.
Controlled spontaneity means creating situations that allow for fun. Amy was waiting for her newborn to sleep through the night, rather than making a reasonable request for her husband's help. But, getting a couple of nights of sleep back allowed for more spontaneous fun during the day. She was also hoping her bladder would regain its normal resilience When she took advantage of new solutions for leakage, she began to gain some control, and with that her self-esteem rose. Our bodies change and so do our responses to them. Amy hoped her desire for intimacy would also reappear naturally, but rather than risk the isolation and tension that could arise in the duration, she became proactive. She and her husband decided to take time for themselves and manage their environment better. This enabled Amy and her husband to speed that process up. They began to remember what life was like - or what life could be -- enjoyable in a new way.
While severe postpartum depression, like Ms. Panettiere has described publicly, can require family intervention and hospitalization, Amy's struggles after childbirth did not. It took time, effort, and understanding, but she gradually moved on to the next stage of her life with confidence, control and spontaneity.
Vivian Diller, Ph.D. is a psychologist in private practice in New York City. She serves as a media expert on various psychological topics and as a consultant to companies promoting health, beauty and cosmetic products. Her book, "Face It: What Women Really Feel As Their Looks Change" (2010), edited by Michele Willens, is a psychological guide to help women deal with the emotions brought on by their changing appearances.
For more information, please visit my website at www.VivianDiller.com; and continue the conversation on Twitter @ DrVDiller.
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