TurnAround MomThe following is a conversation between several members of the Warrior Mom Book Club after reading “The TurnAround Mom”, the latest in our book club’s maternal mental health-related reads.  This book was authored by Carey Sipp, a parent-education advocate, an addiction and abuse survivor, and the mother of two children. You may visit the author at www.turnaroundmom.com.

APR: In the foreword, on page xviii, George H. Gallup, Jr. notes that the author ‘advocates pathways to change, among the most important are turning our lives and wills over to the care of something greater than ourselves, which for Carey is God. This means, in part, taking care of ourselves the way a wise father or mother would take care of a child: with love, discipline, understanding, compassion, natural consequences, and forgiveness.’ What role did self-care play in your treatment plan? What self care strategies did you try? What worked and what didn’t?

AK: Self-care…learning to do this at all was huge for me in my recovery. Because I was too ill to care for myself, let alone my child, it took me relearning to do little things, like taking a shower or clipping my nails. It’s not that I had an amnesia, but rather the intense anxiety and brain fog, as well as the deep depression and exhaustion from constant insomnia, prevented me from being able to muster up the motivation and energy to take on these everyday tasks. Once I was able to slowly do a few of these things, I proactively began getting massages (from my very understanding prenatal massage therapist) and taking time to see a chiropractor, have tea with a friend, and do anything that felt good. At first even these things created anxiety within me, but once I accepted that I needed to fill my own bucket back up in order to slowly take on caring for my family again, I was more open to do things for me and able to feel less guilty about taking so much time for myself or investing in my personal well-being. I think accepting that medication was a necessary component in my case because of the severity was a huge step. Overcoming my reticence to take prescription medication was key in taking care of myself so I could get well and take care of others.

APR: Since like you, AK, I was essentially unable to care for myself in many ways and was neglected, this increased my depression greatly. It was a vicious cycle—just knowing I wasn’t taking good care of myself was depressing. When I was well enough to begin caring for myself by exercising and sleeping, this really helped. But I needed medication to be able to get to this point.

APR: In the Introduction, on page 9, the author says we ‘create intensity to divert our attention from what really matters: the sometimes boring option of simply taking care of ourselves and our families.’ How does this statement resonate with you? The author goes on to say that ‘many of us go on automatic pilot, living our lives the way our parents did, not realizing that we do have choices.’ What did this statement mean to you? How did this relate to your experience with PPD?

AK: I do think many of us (particularly those who grew up in intense, neglectful, or abusive situations) seek out tension or intensity subconsciously because we don’t really have experience function in calm, “boring” situations. For me, the isolation and mundane tasks associated with newborn care (at home in the fall/winter) definitely exaggerated the PPD/PPA I already had. I was used to living a very active life—working, traveling, going out with friends. When I had a baby via surprise c-section, the recovery, sleep deprivation, and lack of contact with other adults certainly created more anxiety for me. The connection here for me is that had I been more used to slowing down, just being at home, etc., I don’t think motherhood would have been such a shock for me.

AC: AK, I COMPLETELY relate to what you wrote above. The same thing (c-section and all) happened to me and I do not think I was comfortable enough with myself to be basically “with myself” (and a non-verbal) baby for my maternity leave. I know I create drama and worry in my head on a “normal” basis, add the challenges of post-birth and raising a newborn, and goodbye! My anxiety went to the next 12 levels and thus the struggle of PPA/OCD began.

APR: This definitely happens to me. I too struggle with being home by myself with a baby/toddler and the dramatic lifestyle changes that happened when our daughter was born. We were a very active couple, always out and about doing outdoor sports. I think that both my husband and I use constant activity and ‘action’ sports to distract ourselves from whatever is going on. We went through major adjustments as a couple postpartum and even during pregnancy (especially me due to limiting activities) because of trying to do too much and too early. We went on our first camping trip when our daughter was 3.5 weeks old; to me this just seems ludicrous now. Eventually we agreed to do less because it was adding to our stress level.

I do find myself railing against doing common things like cooking dinner or cleaning because they are ‘boring,’ even though they are part of my ‘job’ as a SAHM. I guess that maybe when I’m feeling that way, it is a sign that I need to take care of myself, as best I can, in that moment.

APR: Chapter 3 focuses on how to create a sane and loving environment for your family. On page 89, Sipp says that if you are feeling irritable, it “..is a sign your needs are not being met. When you learn how to make direct requests for what you need and want, and start getting your needs met, you’ll be gentler with yourself and your children. One way to simplify making direct requests is to standardize the ongoing ‘house rules and requests.’” Extreme irritability is one of the most common symptoms of PPD, and for me, it was my biggest one. Learning to make calm requests for what exactly I needed from my husband, midwife, pediatrician, babysitter, etc., definitely helped me to feel less irritable. Did you experience irritability or some other sign that your needs were not being met? What helped to alleviate this?

AK: Irritability, in it’s most extreme form, was definitely the most severe and obvious symptom of my PMAD. And, six years later, it is the biggest remnant of my PPD experience. I still struggle with anxiety and irritability, which are easily triggered when I am overwhelmed. One of my coping strategies for adjusting to motherhood was to keep my calendar super full…because being “bored” (see Question 2) would set me off. The downside of that is that my kids and I haven’t really ever gotten into an easy routine of being able to just chill out at home. I try to make “I statements” when I need something, but sometimes I just react and snap at my family or shut down. I try so hard to hold it together with work and my other interactions that my family gets what is left—usually a short fuse. I am trying to work on this by asking myself if something is urgent or important and by leaving time in my calendar to just be. I also struggle with following through on things like yoga class which really do help tremendously, but I tend to put off because of other urgent things that aren’t as important.

SBC: Even before I had PPA and PPOCD, I noticed that I was really short with my husband. And I still struggle with this. I work as a middle school teacher and additional leadership responsibilities as teacher leader at the school. I am patient all the time with students (and adults). I try to be kind, but firm, supportive but not enabling. I work hard all day to maintain this level-headed exterior and then I come home to a toddler and I exhibit all those qualities again (even when my son is banging on doors and screaming at me and the dogs are howling!). Then my husband comes home and I have heard myself be so cruel to him. It’s not what I say but the tone I use. It is biting and cruel and I have felt like I can’t stop at times. I have realized that I take out way too much on my husband (who is not perfect but does not need that type of treatment from his wife). Three things have helped me: 1) My mother spoke awfully to my father and I hated seeing it and I don’t want to repeat that scenario, so I remember that 2) If I’m going to yell at or talk not nicely to my husband, I step back, go away, distract myself and wait to discuss my concerns when I’m not so angry 3) I make sure I am expressing my needs in all other areas of my life so I don’t feel so overwhelmed.

APR: AK, I can relate to keeping my calendar super full. We did that for a while, too, until it caused me to have a ‘breakdown’ and threatened our marriage. As I explain above, my husband and I decided to take on less and it really helped. So did upping my dose of antidepressant.

Like I wrote in the question, irritability was my most prominent symptom of PPD. Learning to make calm requests for what exactly I needed from my husband, midwife, pediatrician, babysitter, etc., definitely helped me to feel less irritable. Even now, I think Sipp’s advice rings true. When I am irritable, it really is a sign that I need to reach out for help, whether that is calling a relief babysitter, getting help from my partner, taking a deep breath, whatever. I need to work on this more than anything.

As for the second part of this advice ‘standardizing house rules and requests’ – this has been HUGE for me. I finally put up a white board that has a running list for the most common stores that we use. This has helped bigtime because everyone adds to it. I started planning meals just recently. We are just starting out but it is great because I don’t have to answer the question of what is for dinner ever again if I keep up with it. I used to get overwhelmed but I found an approach here that finally worked for me, and broke down the process step by step. I hope to eventually have a seasonal/rotating menu that we just reuse. It has also simplified and de-stressed the grocery shopping experience as well. As for immediately postpartum, with my daughter, I had so little energy that the more I had written out that I could tell my husband or mom to do, the less I had to say. I was so exhausted I couldn’t even ask for help. So, now that we are expecting another, I’m hoping to standardize as much of our ‘procedures’ as possible.

APR: In Chapter 4, Sipp focuses on creating healthy boundaries. Creating healthy boundaries can be very important when caring for an infant since energy is at such a premium. One tip she provides is to “postpone all emotional or highly charged discussions until the next day. At night, keep conversations short and stick to sports, news and weather.” In your experience, what boundaries were helpful for you to create?

AC: Honestly, I think I am just learning to create these healthy boundaries at 12 months postpartum. It is hard to think of yourself during those first few months, I guess even the first year, but I need to. Those boundaries are doing just that.

AK: Knowing who is a trigger for me, just by being in their presence or talking about them is huge. I never knew I had a right to protect myself from people who caused me to be anxious or did not respect my boundaries until I got PPD and I had to be careful about the company I kept for my own health. I have continued to keep my contact with trigger people (including immediate family members) very limited 6 years later. I can’t imagine life without those boundaries now.

APR: I really love her advice above. I have started to follow it in my own home as well. Becoming a new mom definitely showed me the hard way that I need more boundaries, especially in the first days/weeks after delivery. I gave birth in a birth center and so was home with the baby 3 hours after my daughter was born at 4 am. By the same night, over 10 people (family members) were at my house, passing the baby around, when she had barely been out of my body for 12 hours. That will not be happening this next time around. I think we’ll be spending about 3 days with no to very few visitors. Some of these visitors told distressing horror stories during this time; they will not be visiting us at all this time.

SBC: This question and the responses remind me of how I dealt with my sister-in-law. I had always felt that she judged me and told me what to do, but I never did anything about it. I usually just let it happen and then took pleasure in talking about her afterwards (to my husband–—so her brother—and that wasn’t cool to put him in the middle). But when I was recovering, I just knew to keep distance from her. I knew I would end up getting upset. I became very good at having brief conversations. I had struggled with these boundaries with her for years, but in crisis, I knew what I had to do to stay well. I hold on to that knowledge still today when I find myself in similar situations.

APR: I loved Chapter 5, it was hard to pick out a specific part to highlight. Some of my favorite tips from Sipp for “sane ways to make better choices” (pages 126-130) were:

-“Make decisions when you’re feeling calm and peaceful

-Rarely say yes in the moment

-When you’re tired and overwhelmed, take the path of least resistance

-Constantly seek ways to conserve your energy

-Make a list of three little things that annoy you, and change one of them this month.

-When it comes to making any decision, be honest and clear on your real needs..Getting your needs met is a challenge if you’ve been in a depressed state for a long time. Practice meeting your needs by asking for little things first..then work your way up to the bigger needs and wants…”

What tip above is most meaningful in your experience with PPD and why?

AK: I wouldn’t necessarily say that this tip is specific to PPD, but I will say that it is huge for me in my wellness after PPD: “Rarely say yes in the moment.” I find it almost impossible to say no. Sometimes I am capable of saying yes with conditions, but rarely can I just flat out say no. I have begun to learn how to take things off my plate (way too many yeses over the years), but identifying which of these I should give up has become my new challenge. I guess all those years of always saying yes has left me with little experience comparing what needs to be done or will fill my bucket vs. tasks that do not need to be done by me or will not benefit me/loved ones. Perhaps taking the time to reflect before answering would help me to do this. I intend to employ this practice as much as possible moving forward.

AC: I like the tip – “when you’re tired and overwhelmed, take the path of least resistance”. When I was leaving the hospital, I remember the nurse specifically handing me the stomach support belt to wear to help recover from my c-section. I literally touched it once and then just left it lying there. I really believed that would be able to do it all, despite being tired and overwhelmed. I couldn’t have been more wrong. I would definitely go back and redo that moment if I could.

APR: I like “Make a list of three little things that annoy you, and change one of them this month” the most lately. As a stay-at-home-mom, I get overwhelmed with all the tasks on my plate as I didn’t expect or want to stay home, it just sort of happened. I am not a domestic goddess and don’t want to be one, I don’t consider it the best use of my talents; it’s the best choice for the moment. Those things that really annoy me like my car being really messy or my robe being dirty just feel like a special treat for me personally when I deal with them. And one thing a month helps it be less overwhelming.

AC: In Chapter 6, Sipp describes “toxic intensity” in terms of “buy-highs” and doing “whatever takes the pain away for the moment. (pg. 131)”. The last sentence of chapter 6 reads, “Saving money is actually another form of self-care” (pg. 146). The author realizes this after years of doing the exact opposite as a way to deaden the pain. The idea of “toxic intensity” (and the need to save money as a form of self-care as I recover from PPA) resonated with me, strongly, and this chapter brought some clarity to my own “toxic” moments. Has anyone experienced their own type of “buy-high”, or “toxic intensity” patterns to deaden the pain of PP illnesses? What is/are they and how did you acknowledge this and work towards ending the pattern?

AK: I definitely went on buying sprees when I was in the depths of PPD/PPA. Packages were arriving from Amazon everyday because I thought the latest baby gadget or book would solve my baby’s “sleep problems” which would cure me. In reality, I was the one with the problems, and buying things didn’t do anything but create clutter and guilt for my wastefulness. With my second child, I intentionally scaled down and bought almost nothing. It was fabulous to feel so free. Investing in the long term solutions like therapy or an exercise regimen seem too much for me, even today. I find myself using other coping techniques that are less healthy because they are easier and work faster. I think breaking this cycle would really complete my PPD journey.

SBC: Even before the author explained “toxic intensity” I knew what she meant. I have always thought my intense attention to detail, high expectations and stuff like that were my greatest strengths, but over the years I have seen how these strengths have a toxic side when I go overboard. I wouldn’t say I was spending too much money. (Though I relate to AK’s point about hoping the right baby gadget would solve all the problems.) I have noticed that when I’m not fully taking care of myself, I become financially irresponsible. I’ll forget to pay bills. I throw my hands up and think “I have to do that too?” It can lead to bad things. So I force myself to sit and look at bills weekly with my husband so I don’t end up feeling so overwhelmed that I run away from them.

APR: I can definitely relate to the baby gadget thing too. My baby had colic and I was willing to buy anything to stop the screaming. But part of me wonders if some of the screaming came from within, and my baby was just reflecting my inner state.

Just like one of my parents, I get into fits of anger (toxic intensity) and take it out on my husband. It has gotten a bit better over time as I’ve adjusted to my new role in life and become gentler with myself as I come through the healing process. A lot of my anger/irritation stemmed from very rigid beliefs that my life wasn’t measuring up to. Once I lowered standards and expectations, that really helped.

APR: Triggers are always going to be present in our lives as we continually recover from and survive our pp illnesses. I have begun to recognize mine, and on page 152, Sipp describes a moment that is clearly a trigger for her anxiety, “Months later I am on that same highway…an anxiety attack wells up in my chest…”. Our memories and experiences affect us, the news affects us, but we need to be able cope as these will never go away. Have you discovered any “triggers” that seem to be setbacks for you, and any ways to cope with them when they arise?

AK: Like I mentioned in the earlier responses, I am very aware of my triggers, even now. In terms of coping, besides avoidance…I usually try to breathe, not react to the person, remind myself they are a trigger and that my contact with them is generally limited. Reminding ourselves that we won’t be triggered 24-7 (even if it feels like it) is important, because in the moment of panic it feels like it will never end.

APR: This is a tough one. I am not great at recognizing my triggers yet until I am in the midst of anxiety. I think that the basic ones that Sipp points out with the HALT test (stop what you are doing and take care of yourself if you are Hungry, Angry, Lonesome, or Tired), have definitely helped me. As a pregnant mom of a two year old, I cannot always drop what I am doing and take care of myself but I know if I run that mental checklist and come up with the fact that I am one of those things at the moment, I can be especially careful and try to take precautions so that I don’t hurt anyone else or myself because I am depleted. So, even if I can’t take care of myself, I can be gentler with myself, if that makes sense.

SBC: I noticed my anxiety is driven by a need to do great things, take on all the problems and save the world. But then I criticize myself for failing or not meeting ridiculous expectations. In order to stay healthy, I routinely try to remind myself that I am okay, loved and accepted just as I am. I don’t need to join one more committee at work to prove my competence. I don’t need to have everything perfect and figured out. I suppose in a way, I am my own trigger. But a few months ago, I slipped into a two-week-long depression/high anxiety mode. I am still trying to figure out what triggered that. I think it was caffeine withdrawal, plans to try for a second baby, returning to work, deadlines I placed on myself and a toddler who stopped napping. I am doing better now, but very sad b/c we decided to wait on baby # 2. It was the practical decision for now, but it’s been hard for me to accept that that is what is best for me.

AC: On page 179, Sipp discusses ways to avoid “toxic intensity” and offers a great idea to replace obsessive thoughts – creating a quiet mantra to repeat over and over again in your mind. Do you have a mantra, where did it come from, and how often do you find yourself using it?

AK: My motto is “This is not forever.” I feel awful that I can never remember whom in the #PPDChat community I “stole” it from, but it was someone who made a wonderful difference in my life. Regardless of whether it is PPD or a particularly bad job, relationship, etc. it is not forever. So important for those of us who are easily anxious or overwhelmed.

APR: I have a mantra that I use to ‘reset’ when I am experiencing especially anxious thought cycles, especially at night, when they interfere with sleeping. Mine is an actual chant from Kundalini Yoga, which I practiced during prenatal yoga, and many of the practices stay with me now since they were so healing and useful. I usually get in the shower and chant/sing it for a while. It is called the Kirtin Kriya or Sa Ta Na Ma Meditation. You chant each of the four sounds Sa, Ta and so on as you touch your thumb to the pointer finger, middle finge, and so on. I find yoga and especially chanting especially helpful in ‘rewiring’ my brain. According to my therapist, this has actually been proven in brain research and I know it to be true for myself.

AC: A mantra I have hanging over my computer at work is “Faith is the bird that sings when the dawn is still dark”. – Rabindranath Tagore. This mantra helps to keep believing, even when I “think” believing is pointless. The sun always comes back up…always…and I need to believe that when I am feeling down.

Thanks to all who took the time to read this book and share so honestly your reflections and personal experiences.  The “TurnAround Mom” is a great resource for moms or women considering motherhood who have a history of difficult or traumatic relationships, particularly with their parents.

Next up in The Warrior Mom Book Club is Marie Osmond’s fantastic book, “Behind the Smile”.  Please join the group, and begin reading if you would like to participate. You can reach out to me at atlantamom930 @ gmail . com.