Falling Into The Postpartum Mood Disorder Abyss: A Personal Story

By Deb Wachenheim
Guest Contributor

Over the past two days, The New York Times published a series of articles about postpartum depression and other related mood disorders. The first article looked at the science and policy on this topic and highlights a few women’s stories.

Today’s article is about my sister, Cindy Wachenheim, who took her own life in March of 2013 after struggling for six months with postpartum mood disorders. I say mood disorders because it was not just depression (and the fact that there are other postpartum mood disorders in addition to postpartum depression was something about which I was previously completely unaware). She had extreme anxiety about, and obsession with, her baby’s health and she was depressed because she believed she caused him to have serious health problems. Also, according to what I have been told by experts, she may have been psychotic: she was so convinced that something was seriously wrong with her baby — despite doctors telling her otherwise — that she strapped him to her chest when she jumped out of her apartment window, believing, I can only assume, that this was what was best for him. Thank goodness, he survived and is thriving.

Beyond what is written in the article, I think it is important to give more detail and information on some resources and policy activities in Massachusetts, in the hope that this could possibly help others who are facing similar struggles. As is mentioned in the article, I reached out to Cindy’s son’s pediatrician after Cindy had gone to see her multiple times about her concerns.

Pediatricians are key to screening for postpartum mood disorders and making referrals for needed treatment. Most women see their OB a few weeks after giving birth and if everything seems okay at that point then they are sent on their way until the following year’s annual exam.

However, woman bring their infants to see the pediatrician many times over that first year. It is pediatricians who could notice if something seems to not be right with the mother. Continue reading

Study: Primary Care May Be Path To More Effective Suicide Prevention

The unanswerable question, “What If?” often dominates the talk when it comes to illness. What if the tumor had been caught earlier; what if the child’s ache taken more seriously? When it comes to suicide, the agonizing “What Ifs?” can run rampant.

Recently, following three suicide deaths by high school students in Newton, Mass. there has been much talk about what, if anything, might have been done to prevent these acts.

A new national study offers no easy answers — indeed, many people who die by suicide do so without any prior mental health diagnosis, researchers report. But this new research does suggest there may be opportunities — through primary care doctors, and other specialists, for instance — to more accurately identify people at risk for suicide, and perhaps intervene before it’s too late.

The new federally-funded study — based on a longitudinal review of more than 5,800 people who died by suicide from 2000 to 2010 — found that nearly all of these individuals (83 percent) saw a doctor or received some kind of health care in the year prior to their death, but half of those individuals did not have a mental health diagnosis. Moreover, researchers report: “Only 24% had a mental health diagnosis in the 4-week period prior to death.”

Also, strikingly, one in every five people who died by suicide “made a health care visit in the week before their death,” says the paper’s lead author Brian K. Ahmedani, Ph.D., assistant scientist in the Center for Health Policy and Health Services Research at Henry Ford Health System in Detroit, who speaks about the work in an accompanying video.

The study, published online in the Journal of General Internal Medicine, concludes that: “Greater efforts should be made to assess mental health and suicide risk. Most visits occur in primary care or medical specialty settings, and suicide prevention in these clinics would likely reach the largest number of individuals.”

Of course, that’s easier said than done. Anyone familiar with a typical primary care visit knows it can be, well, a bit rushed — not quite the perfect venue for dwelling on complicated emotional issues that may be difficult to articulate. Unless specific psychiatric symptoms are raised, they are often not part of routine care, says Massachusetts General Hospital psychiatrist Steven C. Schlozman, Continue reading

Newton Suicides: Is High-Achiever School Culture Breaking Our Kids?

Nearly 400 parents attended a community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Nearly 400 parents attended a community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Dr. Gonzalo Bacigalupe is the president of the American Family Therapy Academy and a professor in the Department of Counseling and School Psychology at the University of Massachusetts Boston. He’s also a Newton dad, and writes here about the need to address the toxic effects of high-stress school culture and its possible role in recent teen suicides.

In Newton there have been three suicides in less than four months among our high school kids. To us, it feels like an epidemic. In general, the response of the school system has been to provide grief counselors plus meetings to air the sadness and share what the school is doing or plans to do in the future. Experts talk about suicide and psychological problems; they tell us, parents, what we already know: support your kids and be mindful of their mood and behaviors. The message: this is either a mental health problem or a parental issue.

But the school system is not taking responsibility for the stress the kids feel day after day because of the tremendous pressure the Newton high school culture exerts to achieve academically, participate in multiple extracurricular activities, and/or play competitive sports — never just for fun, always to score the best.

Of course, some students put pressure on themselves, and some feel pressure from their parents and peers. But the school system must hold itself accountable for the pressure it puts on its students.

The official message accepts this situation as an individual or family problem, rather than part of a collective narrowness and craze about achievement.

“Who could ever imagine that we’d be back here again under similar circumstances?” asked Newton Public Schools Superintendent David Fleishman Tuesday night as he welcomed nearly 400 parents to another community forum on teen suicide.

In the fall of 2013, some of us did tell him that this could happen again if systemic measures were not taken. I personally wrote him a long letter and forwarded the message to the principal of Newton South High School. In response, I received a thank-you note in which promises were made about the school doing more to support our children.

So just what is the culture of Newton’s public high schools? Despite the communal expressions of grief, this past Monday, the day of the funeral of Roee Grutman, many of his classmates, friends and acquaintances (this is a small high school) did not participate in this important event because most of the school kept all academic activities unchanged, including, for example, mid-year exams.

Despite the message to teachers about allowing students to miss classes, some teachers conducted business as usual. Many students may not have felt free to stand their ground and attend the funeral. They were deprived of participating in a collective healing that cannot be replaced by a session with a school counselor or a mental health practitioner. I know this; I am a psychologist, a family therapist, a public health researcher and a specialist in trauma response. Continue reading

As Newton Grapples With Teen Suicides, A Quick Primer On Resilience

As Newton grapples with its third suicide by a teenager this school year, some of the discussion revolves around resilience. WBUR’s Martha Bebinger this week quoted Dr. Susan Swick, chief of child psychiatry at Newton Wellesley Hospital. She has been advising Newton schools and spoke to parents about how to build up their children’s resilience:

Nearly 400 parents attended Tuesday night's community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Nearly 400 parents attended Tuesday night’s community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

“This involves maintaining good social connections,” Swick said. “It’s about coping skills, it’s about self-care, it about getting good sleep, adequate exercise and nutrition. It’s about cultivating an ability to be flexible, to use humor, some creativity. There’s no one recipe for the things that you do, but it’s cultivating good behaviors that build resilience.”

And make sure, Swick added, that children have a network of adults who know them, talk to them and keep an eye on them.

For more on resilience and how to cultivate it, we turned to Drs. Gene Beresin and Steve Schlozman, child psychiatrists at Massachusetts General Hospital and its Clay Center for Young Healthy Minds.

By Dr. Gene Beresin and Dr. Steve Schlozman
Guest contributors

A 10 year-old deeply invested in hockey develops juvenile diabetes.

Three kids, 4, 7 and 15, are told by their parents that they are getting a divorce.

The parents of a 16-year-old find to their horror that their son has taken a fatal overdose.

An 85-year-old woman who is a survivor of Auschwitz finds that her grandson is being deployed to Afghanistan.

A 35 year-old single mom who left an abusive relationship with her husband finds out that her 15-year-old has been sexually assaulted at school.

A 16-year-old boy is suddenly dumped by his girlfriend of two years.

Sometimes life deals a bad hand. While some might object to the relative merits of these particular vignettes as lacking equally weighted misfortunes, our goal here is not to rank the relative intensity of lousy events. Our goal, instead, is to accentuate that life itself is fickle, that life ebbs and flows, and that the fortunes and misfortunes that come with being human are in fact part of the human condition.

They key question is not “why” this stuff happens, but how in the world do we manage ourselves when these things occur?

That’s why we have pop music as well as Dostoyevsky.

The fact is that we all have horrible things happen to us. Understandably, these horrible things can potentially overshadow the good. It’s not like the vignettes above are uncommon. They are also, maddeningly, mostly not anyone’s fault.

They just happen.

They key question, then, is not why this stuff happens, but how in the world do we manage ourselves when these things occur?

Do we crumble? Do we become depressed or hopeless? Or do we rally?

Perhaps most important – how do we rally?

These questions of course make us once again visit the concept of resilience. How do we understand this? Are we born resilient, or do we build our resilience as we might train for a marathon?

Although we have some answers to these questions, the jury is still out. We’ve only recently as a culture become nationally invested in understanding the phenomena of resilience. Continue reading

Third Teen Suicide In Newton: What Can You Say?

Newton South (Wikimedia Commons)

Newton South (Wikimedia Commons)

Tonight at the Newton South High School auditorium, school officials and mental health experts will try to offer some guidance on how to talk to children about suicide and how best to support kids and families reeling from the news of a third teen suicide in this community since the start of the school year.

Tonight’s gathering comes after reports that 17-year-old Roee Grutman, a popular Newton South junior, committed suicide earlier this month. (According to the state Executive Office of Public Safety & Security, Grutman’s death was a result of “asphyxia by hanging.”)

Grutman’s death follows two other suicides: Katherine Stack, a Newton South sophomore, took her own life in October, shortly after Karen Douglass, a Newton North senior, also committed suicide.

At a memorial service for Grutman last night, hundreds of classmates and family members gathered to remember the “bright, articulate, compassionate” young man, The Boston Globe reports:

“One after another, the speakers at Monday’s service told of a young man who lit up a room when he walked in, and despite his schedule busy with honors classes and sports, always had time for a friend.”

According to parents in the Newton South community, many children are still in shock (as are their parents and teachers) and struggling to comprehend the string of suicides in general, and in particular, the death of a boy who appeared to be so well-adjusted, socially connected and stable.

“I think the kids are beside themselves,” said Elizabeth Knoll, whose 17-year-old daughter, Anya Graubard, is also a Newton South junior and was friends with Roee. “My daughter was gray and pale and tightlipped for the last two days.” (Knoll says Anya gave her permission to be named here.)

Knoll said in Newton — where many kids have been classmates since the age of 4 — Grutman’s out-of-the-blue suicide is particularly excruciating. “No one among his family or friends…could see anything like this coming,” Knoll said. “It’s impossible to make any sense of it.” Continue reading

Memo: Death Of Second Newton Teen This Month

Update: 10/25/13:  Katherine Stack’s death was due to “asphyxia by hanging” according to Terrel Harris, a spokesman with the Executive Office of Public Safety & Security Commonwealth of Massachusetts. The state won’t comment further beyond the manner and means of her death, Harris said.

Update, 10/22/13: “The cause of death for Katherine Stack was determined to be suicide,” according to an email from Terrel Harris, a spokesman with the Executive Office of Public Safety & Security Commonwealth of Massachusetts.

It’s another horrible tragedy in Newton.

Newton South (Wikimedia Commons)

Newton South (Wikimedia Commons)

Authorities say the death of teenager Katherine Stack, a sophomore at Newton South High School, “is not suspicious and there is no foul play.” And while no one has uttered the word “suicide,” it’s no doubt on the minds of many students, parents and administrators today, following the death earlier this month of Newton North High School senior Karen Douglas. (Her death was described by her sister as a “suicide” on Reddit.)

Here’s a letter from Newton Superintendent of Schools David Fleishman to the community:

October 17, 2013

Dear Newton Community,

It is with great sadness that I am writing to inform you that Katherine Stack, a Newton South sophomore, died unexpectedly last night. Authorities have stated that the death is not suspicious and there is no foul play.

Our thoughts are with Katie’s family during this very difficult time. It is hard to imagine what they are going through right now.

The death of any young person is a terrible tragedy. This loss is compounded by the recent death of a Newton North student, Karen Douglas. Please know that we will have counselors available at our secondary schools, as we know that many of our students will have heard about this news through friends and social media. If you have any concerns about your child/children, please make contact with their guidance counselor and they will make sure to follow up. Processing two sudden deaths within a short time frame is very difficult to comprehend so we have provided some information below that you may find helpful.

Continue reading

Sadness And Beyond: Psychiatrists Respond To Death Of Newton Teen

More than 1,000 origami cranes at a suicide prevention event titled 'Walk Out of Darkness." (US Navy on Wikimedia Commons)

More than 1,000 origami cranes at a 2012 suicide prevention event titled ‘Walk Out of Darkness.” (US Navy on Wikimedia Commons)

The news darkened Sunday for everyone it reached. Karen Douglas, the 18-year-old Newton North High School student who’d been reported missing on Thursday, had been found dead Saturday night in Natick. Official sources said only that the death was not “suspicious,” and did not appear to have been caused by foul play. But a heartbroken post on Reddit by Sonya Maria Douglas, who identified herself as Karen’s sister, was headlined without euphemism: “Karen Douglas found in suicide. Thank you Reddit for your prayers and actions.”

We asked Dr. Steve Schlozman and Dr. Gene Beresin to respond, and in particular, to offer guidance on how best to discuss and absorb such painful news. They are child and adolescent psychiatrists at Massachusetts General Hospital and are directors of the Clay Center for Young Healthy Minds.

By Dr. Steve Schlozman and Dr. Gene Beresin
Guest contributors

We’ve tried over and over to begin this post. We want to, need to and indeed feel we have an obligation to write about adolescent suicide following the possible suicide of a teen in Newton last week. Gene and I have read over and over the well-publicized, incredibly moving, and palpably sad Reddit post that the girl’s sister penned.

We’re just so very sad.

And that’s an okay place to start…really the only place to start. We could discuss the statistics, the risk factors, the phenomenon of copycat suicides. We could talk about early detection and prevention, and we could talk about community support.

Still, we too often leap to these numbers – solid things, measurable things – because we can’t imagine falling into the abyss of pain that these stories create. People suffer with illnesses; that’s the definition of illness. But a young life ending is heartwrenching, whether by suicide or any other means.

And suicide just feels different. We know that people who take their own lives are in immense pain. We know that the dark cloud of stigma hovers over those who suffer mental illness. We know that feeling suicidal can be intensely private. Those who take their own lives feel profoundly alone. We know as well that we are, paradoxically, herd animals…that we don’t do well when we’re alone. A condition that makes us feel as if we deserve to be lonely makes us suffer all the more. We are least compelled to reach out exactly at the time when we can be most powerfully helped by each other. And the suffering is often greater when we realize the pain it may deliver to those who love us. Even then, we can’t reach out.

Combine all that – the stigma, the pain, the swirling desperation and the sense of utter and desolate loneliness – and we retreat instead to our statistics and our epidemiology.

There will be time for those facts in just a few lines. But for now, let’s note, together, that we are sad and that we are saddened. It is impossible to move forward in the absence of that acknowledgement.

Remember that suicide is a symptom. Continue reading

The Checkup: Meltdown U. And Mental Health Tips For Parents Of College Kids

For all those freshman just settling into dorm life this fall, college can be exhilarating, mind-blowing, the best years of their lives. But many parents don’t realize that their children are also facing a potential double whammy. Not only must new students navigate an entirely unfamiliar social, emotional and intellectual landscape, but they’re also entering a time in their lives — the ages between 18 and 21 — when many mental illnesses, from anxiety to depression to eating disorders, peak.

This week, The Checkup, our podcast on Slate, explores the mental health of college students. Here’s one sobering statistic: up to 50% of college-age kids have had or will have some kind of psychiatric disorder. That’s why we’re calling this episode “Meltdown U.” (To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

The Checkup

Consider some more scary numbers:

–80% of college students who need mental health services won’t seek them

–50% of all college students say they have felt so depressed that they found it difficult to function during the last school year

–Suicide is the second leading cause of death among college-age youth – over 1000 deaths per year.

–The rate of student psychiatric hospitalizations has tripled in the past 20 years.

We asked Dr. Eugene Beresin, M.D., a child psychiatrist at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, to offer some guidance on what parents should know about helping their college-age kids cope with the high stress of undergraduate life. Here’s his advice: Continue reading

Swartz On Depression: ‘Unable To Feel The Joy’

I can’t stop thinking about what, exactly, drove 26-year-old Aaron Swartz, the technology whiz kid and free-information crusader facing federal charges for wire and computer fraud, to hang himself last Friday. What was the final straw that broke this brilliant, so-very-promising young man?

His family clearly believed it was government persecution. In a statement they said his suicide “is the product of a criminal justice system rife with intimidation and prosecutorial overreach. Decisions made by officials in the Massachusetts U.S. Attorney’s office and at MIT contributed to his death. The U.S. Attorney’s office pursued an exceptionally harsh array of charges, carrying potentially over 30 years in prison, to punish an alleged crime that had no victims. Meanwhile, unlike JSTOR, MIT refused to stand up for Aaron and its own community’s most cherished principles.”

But Swartz’ own writings suggest that he suffered from depression, which could have been a factor as well.  In 2007 he offered this portrait of his distraught state of mind; the deadened outlook and sense of being trapped in a downward spiral:

Depressed mood: Surely there have been times when you’ve been sad. Perhaps a loved one has abandoned you or a plan has gone horribly awry. Your face falls. Perhaps you cry. You feel worthless. You wonder whether it’s worth going on. Everything you think about seems bleak — the things you’ve done, the things you hope to do, the people around you. You want to lie in bed and keep the lights off. Depressed mood is like that, only it doesn’t come for any reason and it doesn’t go for any either. Go outside and get some fresh air or cuddle with a loved one and you don’t feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness. Continue reading

When You Lose Your Sport, What Happens To Your Self?

I saw this flyer recently on my gym’s bulletin board. The loneliness and loss of identity it describes are surely shared by a great many people who have to leave sports, famous or not, but what comes to mind is the suicide of Junior Seau, the 43-year-old former NFL player who shot himself in the chest last week.

Much of the coverage has focused on the possibility that Seau, like many other football players, suffered concussions that wrought permanent damage to his brain. But what struck me most were the descriptions of him as a player — upbeat, intense, loving the game — and then his life after retiring: He drove his car off a cliff in 2010. His girlfriend told police he assaulted her.

Junior Seau smiles during 2007 football training camp in Foxborough, Mass. (AP)

“I’m sorry to say, Superman is dead,” said San Diego Chargers chaplain Shawn Mitchell after Seau’s suicide, according to The Associated Press. “All of us can appear to be super, but all of us need to reach out and find support when we’re hurting.”

Finding support is the idea behind the therapy group that Dr. Matthew Krouner, the Brookline post-doctoral fellow in clinical psychology who posted that notice above, is aiming to put together.

It would not be only for elite athletes, he said. “This group could be for anybody who has at one time identified themselves as an athlete. It could be high school, it could be they like to run marathons, it could be they play pick-up basketball once a week. But once you’re not able to do that anymore, even if it’s not a professional identity, there’s a real sense of loss and a grieving that can take place. For elite athletes, the transition out of sport is conceptualized as a loss or grief experience.”

‘For elite athletes, the transition out of sport is conceptualized as a loss or grief experience.’

Dr. Krouner never had a stellar sports career himself, he says, but always played, and had long been fascinated by stories of pro athletes whose lives deteriorated after they retired from sports at young ages, when many people are just starting their careers. They had to face the monumental challenge of losing an “all-encompassing identity — it’s how you relate to other people, it’s how you use your body, it’s your mental stimulation.”

Athletes have become more open in recent years about mental health issues, reducing the stigma. So “it seems like a good time for more supports to be out there,” Dr. Krouner said. “There tends to be a sort of expected toughness factor among athletes and that may make them less likely to seek out mental health resources, but hopefully by putting more and more out there, it can appeal to the need that is present.”

That need is very real, said Justine Siegal, director of sports partnerships at Northeastern University’s Sport in Society program and a doctoral candidate in sports psychology there.

Plan the exit well in advance

It is estimated that about 20 percent of athletes need “considerable psychological adjustment” after they leave the sport, she said. Continue reading