Blog Book Tour: Ghost in the House

MUBAR is the first stop on the blog tour for Tracy Thompson's much anticipated book, The Ghost in the House: Motherhood, Raising Children, and Struggling with Depression. (Canadian readers can link to Amazon.ca.)

As many of you who have been reading me know, I suffered from post-partum depression with both of my children. I now feel "normal" (whatever that means) most of the time thanks to a great perinatal psychiatrist (shout out to Dr. Young at Mount Sinai) and a maintenance dosage of Zoloft. But even though I feel OK and my childbearing years are now past me (yes, we are standing firm at two), I do not see myself as out of the woods.

The story one typically hears about mothers and depression is that of a mother who has been skipping merrily through life when, out of nowhere, she is felled by a hormonally-charged episode of depression shortly after giving birth. It is a storm to be weathered with the knowledge that "this too shall pass". Less often do you hear the stories of women like me, who have managed their depression all of their lives, but find that the constant mental and physical drain that accompanies child-rearing unhinges them. Mothering through ongoing depression is rarely discussed.

Enter Tracy Thompson's The Ghost in the House: Motherhood, Raising Children, and Struggling with Depression. In this book, award-winning former Washington Post journalist Tracy Thompson (author of The Beast: A Journey Through Depression) explores the topic of maternal depression. In her book she intertwines her research findings, quotes from her interviews and surveys with hundreds of mothers, and her own story of both mothering through depression and being mothered by a women suffering from the illness to create a text that is part medical journal, part self-help guide for depression sufferers and part biography. While Thompson's is not the first book on the subject (Anne Sheffield's Sorrow's Web is a very solid text about maternal depression), Thompson's up to date research and gorgeous writing style make her book one well worth reading.

Thompson first sets out to define maternal depression. One of her best definitions is one of her simplest: "Maternal depression is a Bad Day that comes for a visit and refuses to leave." Thompson sets out to show how maternal depression is not always diagnosed as it does not manifest itself in the way people think depression looks. Some people have surprised to discover that I have suffered from depression for the better part of my life as one would be hard pressed to find me shuffling around a dirty house in my bathrobe and unwashed hair. Instead my depression manifests itself in a need to withdraw from the noise and chaos which define parenting. Playdates can be a chore and I often weigh the benefits of a social encounter with the exhaustion I know I'll feel after (I can't not put away the toys). When mothers are depressed, there can be a tremendous desire to escape, which often takes the form of burying oneself in paid work or volunteer assignments, organizing the closets, or doing housework (on the heel of my reviews of the current Housewife Chic books, the very suggestion that an exaggerated interest in housework may be signs of mental illness made me smile just a little). Thompson's description of a mother who "needs order in her environment in order to compensate, just a little, for the periodic chaos in her head" could easily be me. Just this past week a producer from a television show called me to ask if I'd be interested in having a professional organizer reorganize my closet for a last-minute field segment. Sadly, my very first thought was, "But my closet is perfect! What if they mess it up?" I also saw myself vividly portrayed in the section entitled Our Lady of Perpetual Irritability. Children are expert at trying one's patience and in mothers, irritability and anger, are as common ly symptoms of depression as sadness. In fact, in maternal depression it seems that, save for the occasional guilt-driven crying jag, out and out sadness is rarely mentioned. Perhaps, mothers just don't have the time for tears.

Maternal depression is defined in the book as "what happens when a mother's depression reaches out to ensnare her child. It's depression created or exacerbated by stresses common to motherhood, and -- most important -- it can be transmitted from mother to child via learned behavior, environment, genetics, or any combination of the three." As a mother, as someone who is susceptible to depression, and as a feminist who is constantly on the look out for examples of mother judgement, I found this definition a tough pill to swallow. Why does the mother's mental health play such as strong role in the mental health of her children? What is the father's role in all this? What role does society play? Although it is unsettling, however, the definition is not wrong; motherhood and depression seem to play off one another in a particularly vicious fashion. Thompson spends the next section of the book exploring why this seems to be the case.

One of the reasons why depression so often manifests itself when women become mothers is simply because the condition becomes harder to hide. As Thompson describes, many depression sufferers become masters at masking the disease due to the stigma associated with all mental illness. Often they self-medicate with drugs or alcohol, or they throw themselves into work. Depression sufferers can understand all too well how one "can be dying and still work a fifty-hour week." Motherhood simply unmasks the disease: "My new job [as mother] was not something I could use to distract myself during times of depression. Now my depression had a direct and daily impact on my children -- may have begun affecting them before they were born -- and this had potentially profound consequences. " As Thompson writes, depression when you are a mother "comes as a sickening realization: your plane is going down, there are two of you, there is one parachute." The knowledge that her depression can affect her children will often make a mother seek help, stigma be damned.

There are also tremendous physical demands placed on mothers which feed the illness. The sleep deprivation that goes hand in hand with newborns is very hard on sufferers who need that sleep to recharge. Attachment parenting may be wonderful for the children but can be very hard on the mother who bears most of the physical burden. Ditto for breastfeeding. Thompson writes, [depression] is "an evil unwittingly perpetrated by the movement to get more mothers to breast-feed. Breast-feeding is without a doubt the best possible thing to do for anyone who can manage it, but to be entirely successful, it requires the mother's twenty-four-hour-a-day availability for months -- a demanding commitment for women in the best of health." Even the American Academy of Pediatrics lists only a few reasons not to breastfeed, such as chemotherapy and testing positive for HIV. Depression is not on the list because, as Thompson puts it, "Preserving a new mother's mental health is not, apparently, a good enough reason to give a baby formula." Thompson will undoubtedly make a few enemies based on her honest words but she makes a very important point.

There are tremendous emotional demands on mothers, too. Thompson takes a quote from Adrienne Rich's  Of Woman Born : "The worker can unionize, go out on strike; mothers are divided from each other in homes, tied to their children by compassionate bounds; our wildcat strikes have most often taken the form of physical or mental breakdown." The already stressful experience of mothering is then coupled with today's so-called "intensive mothering", whereby all of the bad things in the world -- crime, disease, stupidity -- are seen as being preventable if only the mother is vigilant enough. We need to set up playdates and expose our child to sports and culture, but not overschedule them. We need to establish a close maternal bond, but not smother them. We need to teach them to take risks, and yet ensure that no harm comes to them. It is almost impossible to live up to the definition of "good mother" and yet falling short simply is not acceptable. And since depressive episodes are often triggered by stress, this intense policing and guilt-tripping of mothers is anything but helpful.

Motherhood and depression are not good bedmates. Depression makes one crave isolation, but "Motherhood is simply incompatible with solitude. You may crave it, but what you get is another "Mommeee!" scraping the surface of your brain like a rusty razor." Whereas a depressed person without children has the option of staying in bed for a few days, children do not allow you that luxury. And, while it is certainly not a bad thing, having children also closes certain doors to the depressed mother. As Thompson says, "Having children also sentences you to life." In the film The Anniversary Party, Phoebe Cates's character Sophia Gold was even more direct as she tells her friend about one of the downsides of having children: "You can't do yourself in. Kids just rob you of that option." Children can make you feel like you are trapped with your disease.

Feeling depressed as a mother can be isolating. It is hard to talk about maternal depression because moms are supposed to be happily whipping up cupcakes and picking daisies with their little ones. As Thompson dryly reports, "These days, it's probably easier for a man to talk about problems with his penis than it is for a new mother to admit that (in her own eyes, anyway,) she is a failure at the one task for which women are supposed to have an instinctual gift." Mothers are supposed to be happy: "The trap that awaits mothers who speak frankly about the difficulties presented by motherhood is that anything they say may be -- often is -- interpreted  by listeners as sniveling. Haven't they just had a baby? How can there be anything bad about that?" It's no wonder that so few women talk about it. "For mothers, admitting to suffering from depression is admitting that having children has not brought them the kind of serene fulfillment Hollywood moms talk about." It is refreshing to hear the voices of so many of the women Thompson interviewed talking about a subject one rarely hears discussed at the local splashpad.

As a mother with depression who constantly worries about the effect of my moods on my children, this book was, at times, an uncomfortable read. The book makes clear that a mother's depression leaves a permanent etching on her children starting at conception: "research into the effects of untreated depression during pregnancy indicates the high levels of stress hormones secreted during depressive episodes, mainly cortisol, can harm the fetus's developing HPA axis [a major part of the neuroendocrine system which plays a primary role in the body's reaction to stress]." Babies whose mothers were depressed during pregnancy move around more in utero, they cry more, they have higher levels of stress hormones, and they tend to have disorganized sleep patterns. They continue to show higher than normal levels of the stress hormone cortisol beyond their first birthday. Hardly words of comfort.

In spite of this, however, it "is by no means a foregone conclusion that children of depressed mothers will suffer from depression themselves; most, in fact, never will." Research seems to indicate that while the genes for depression can be passed to one's children, whether or not the genes are "turned on" is influenced by the child's environment. Nurture can either exacerbate or mitigate nature. A mother who is able to teach her child good coping skills can break the chain of transmission. It ought to be a hopeful message: depression is not a genetically foregone conclusion. Frankly, it scared the hell out of me. I have taken comfort in the belief that children are pretty resilient and that, save for extreme examples of abuse and neglect, they will turn out the way they turn out. To read that it is up to me, as primary caregiver, to model good coping skills in order to offset my flawed genes, is terrifying.

There are a lot of things with which I don't cope particularly well. I don't deal well with uncertainty. I have a low tolerance for stress. My glass is pretty consistently half empty. Life, I believe is hard and, like Thompson, I too have suspected that "Optimists . . . were people who were too stupid (or ideologically blinded) to grasp the nature of the problem." I was not thrilled with these traits, but I had come to terms with them. Knowing that the "quality of mothering a child receives matters" forces me to view things in a different light. I have just started to see my two and half year old daughter pick up on some of my bad habits. She is a bit of a tidy-up freak. She hates a break in her routine. When angry, she swears. I know that at this point she is a normal two year old who is dealing with monster-sized emotions and that, while she is mimicking me, she has not yet internalized all of my neuroses. If left unchecked, however, she'll turn into her mother and it will to a certain extent be my fault -- not just because of my flawed genes, but because of my less-than-perfect parenting. The message is not an easy one to digest. It seemed bitterly ironic to me that a disease fueled by intense mothering can in part only be prevented by intense mothering. Thompson is careful to point out that this is not the same Freudian "blame the mom" psychology that was so popular in the 1980s; the information is meant to be hopeful and helpful. But at the same time, Thompson addresses the difficulty of the message: "It probably seems unfair, maybe even overwhelming. If you are a mother who struggles with depression, how can you possibly be a decent coping skills coach for your children? How do you teach children skill you may not even have? You can't. On the other hand, doing nothing is not an option."

Based on her discussion with experts in the field, Thompson outlines a raft of very useful coping techniques -- improving nutrition, getting enough sleep, getting time away to recharge, keeping a journal, meditating, exercising. And she is careful to distinguish how one can do things things in a way that facilitates renewal rather than in a way that perpetuates depressive withdrawal. She is also a strong supporter of cognitive behavioral therapy in helping to heal one's brain. Thompson has done extensive research with experts in the field and is very clear about the role she believes anti-depressants can play: "Drugs are not cure-alls; they are tools. But they are extremely valuable tools, and can jump-start the brain's natural healing response. This is especially valuable for women with maternal responsibilities. Dump any preconceptions you have about anti-depressants. If you need them, take them." Tom Cruise will not like this book. As a mother who made the very difficult decision to continue to take my meds while pregnant with my now one year old (and perfectly healthy) son, I found this section to be a tremendous source of comfort.
 

After being a bit of a tough read at times, her concluding chapter, The Struggle Can Make You a Better Mother, is a salve. There are hard won blessings that can emerge out of depression. Thompson writes: "I am a better mother for having had to deal with this illness. It's taught me that I can make fundamental changes in my life when I have to. It's taught me self-respect. . . . it has taught me the type of empathy that I don't think I would have developed any other way." As another mother stated, "I have seen myself as completely broken, and then accepted and loved even in that broken state. This is a powerful peace and a sense of grace that I can now teach my own children." I don't yet see any benefits to this disorder, but the book makes me hopeful that in time I might

While the book includes a detailed overview of the most up-to-date medical research on depression, this is by no means a dry text. Thompson writes rich and descriptive prose as in this passage about the therapeutic nature of physical contact with one's children: "It is a scene I like to imagine: mother, baby, and two little boys, one big heap of arms and legs, the smell of talcum powder and small dirty feet, the unexpected calming effect of  beloved skin against your own. Such moments make up for a lot of regret." She is also able to write about her own experience skillfully. She is not trying to place blame or make excuses; the book is devoid of the bitterness or resentment that often pepper autobiographies of this nature.

The book concludes with a bittersweet tone. Thompson recognizes while there have been tremendous strides made in the study of depression, neither she nor her daughters are entirely safe: "So this is where we have arrived -- squarely at the crossroads of nurture and nature, enlisting all the tools science currently offers in the cause of beating back a fire in the brain that has smoldered in my family now for at least four generations. I can trace it back as far as that sad, taciturn woman who cut up her only winter coat so that her children would not be cold, who passed it along to the young mother who would sit in the red vinyl chair, silently weeping; who passed it along to me; and I in turn handed it down to that lovely child who, at the age of two, could say only, "I sad too." It's a long road we've been on, and it's foolish to think it ends here. But there are times I let myself hope that, at least for my daughter, the road ahead won't be as hard."

I hope that too.

***

Some Follow-Up Questions with Author Tracy Thompson

While the book discusses the role society plays in fueling maternal depression, it does not focus as much on the role society can play in helping women overcome the disease. While the book is intended to be a resource for sufferers rather than a political call to action, I wanted to find out from author Tracy Thompson what role she thought society could play.
 

Jen Lawrence: Do you see this primarily as a personal health issue or is it also a political issue since the intensive mothering culture in which we live seems to feed the disease?

Tracy Thompson: I see is as roughly half and half. Yeah, it's a political issue. Nobody will take maternal depression seriously unless they take motherhood seriously. Mothers won't take it seriously unless that happens--we've all been too conditioned to accept so much stress and martyrdom as part of the package. It wasn't that long ago, in fact, that women were being explicitly told that martyrdom was what it was all about (I was just reading some old mother advice magazine articles from the late 1900s the other day). I imagine that somewhere along the line I will hear somebody say, "Geez, I wish these women would quit whining--nobody held a gun to their heads and made them become mothers" -- and that is a way of dismissing the work of motherhood. Because, really, when it comes down to it, motherhood isn't a choice. The timing of motherhood is a choice (usually . . . sometimes), but unless we're gonna vote for mass extinction, somebody is going to have to procreate -- and unless our culture changes radically next week, women are going to be doing most of the heavy lifting in that field. So in a political sense, we have to remind ourselves that this is hard work that we do (no matter what structure we do it in) -- and, like all jobs, motherhood has occupational hazards. The main occupational hazard these days is stress. And while it's not a direct x-causes-y thing, stress -- internal or external -- plays a huge role in the development of depression.

And, of course, it's obviously a personal issue, too. Depression affects you to your core -- your self-image, your confidence, your sense of being a valuable person -- and that's aside from the other physical and cognitive symptoms. Plus, you can't take care of anybody else for long if you're not taking care of yourself, and untreated depression in the mother definitely affects kids. The good news is that depression that is competently treated almost always can turn things around, even after children in the family have developed psychiatric symptoms of their own. This is according to some research hot off the press by Myrna Weissman of Columbia University (http://www.psychiatrictimes.com/showArticle.jhtml?articleID=191100245 which I was just reading at Starbucks this morning.

Jen Lawrence: What are some key changes we could make as a society that might also be helpful to mothers suffering from or at risk for maternal depression (you touched on improving physician education, for example)?

Tracy Thompson: It has to start by just talking about it. Problems find their own solutions once they get brought out into the open. Just look at the huge -- really huge -- difference there's been in the past decade or so on the subject of depression generally. It used to be nobody would mention it in polite company. When I wrote my first book, The Beast, in 1995, I had co-workers at the [Washington] Post dragging me into stairwells to whisper to me they were suffering from depression, too. Now you can hardly open a magazine or turn on the TV without some antidepressant ad staring you in the face. People are much, much more open about it, and consequently I think a lot more people are being treated appropriately. Once mothers start admitting that, yeah, this is a real phenomenon and that some of us are more at risk for it than others, that the stress of motherhood is harder to manage for some of us than others, then we'll be halfway there. We'll have to overcome the inevitable response from a lot of guys who won't get it (which is to be expected -- there's a lot about motherhood guys don't get, and how could they?) -- but we'll also have to overcome the sanctimonious moms out there who will say, "Well I enjoy my children, and I can't imagine being depressed by being around them." Well, most people who have never been truly depressed can't imagine depression, period. This is not evidence that depression doesn't exist; it's evidence that people have limited imaginations. I would say to those women: Be glad you can't imagine it, honey; thank your lucky stars you can't.

The medical profession is already coming around, slowly. I think there are a lot more doctors out there than there used to be who are savvy about psychiatric illness, and a lot more OB-GYNs in particular. But you have to shop around. There are still a lot of glaring gaps in medical education. I have had to learn how to "fire" my doctor. I fired three OB-GYNs before I found one who knew her stuff and who I trusted. It only took me --what? -- about 10 or 15 years to figure all that out. (Since then I've gotten much better at it and have fired other doctors too.) There are enough really good doctors out there that nobody should have to put up with someone whose medical education stopped about 1980.

Finally, I think we need to educate young women -- not to scare them away from motherhood at all, but just to say: look, if you have a history of this illness, motherhood is likely to pose special challenges for you. Get your support system in place. It might just be harder than you imagine -- and if it is, it is no reflection on you or your maternal aptitude. It's a reflection of the fact that you are susceptible to this illness. Get women before they fall down the hole -- it will be so much easier.

***

Next stop on the tour is Mir at Woulda Coulda Shoulda (Aug 8) followed by Jenny at Three Kid Circus (Aug 9), Asha at Parent Hacks (Aug 10), Trace at Sweetney.com (Aug 11), and Dooce's Heather Armstrong over at Alpha Mom (Aug 15). (I know, I know. I feel like Lee Fiora in a world of Gates Medkowskis.)

Thank you so much to MotherTalk for making this review possible.

 

Comments

[Ann D]

Thanks for this very insightful post, Jen -- and to Tracy for tackling this very important topic. This is a topic very near and dear to my heart, for personal as well as professional reasons. Can't wait to read Tracy's book, in the hope that it will help me to deal with the backstory of my own life, my mother's life, my daughter's life -- etc.

[haley-o]

I chose to come here too late tonight to finish reading your post properly. I need time with it....Time that I rarely have because I am a mother and busy mothering and wifing....It does, indeed, get stressful, and, by extension, anxiety-provoking (which lead me to almost stop my blogging--a thing that I do for myself).

Your post couldn't have come at a better time. And, I look forward to sitting with it tomorrow, and, if I'm lucky, with a nice cup of tea....

[Rebecca]

I've read this post a couple of more times and I can't help but nod and uh-huh while digesting all it covers.

I'm a patient of Dr Young's as well, but have been treated for depression (on and off) since I was 18. I was on Effexor throughout my pregnancy and have recently had my dosage increased. Having grown up with a father who wrestled with his own black dogs, it's a bone of contention that my own parents didn't recognize my depression which started around age 10.

Motherhood and depression can be an ugly mix. It's fine and good to take to your bed when it's just you, but add a child or two to the mix and that is no longer an option. There's not a moment alone, rarely a moment to think, to spend the time with your usual techniques to get past a particularly ugly mood. It's draining - emotionally, physically, mentally. It's 24/7/365. Even returning to my full-time job when my daughter was 5 months, my mind buzzes with guilt (for not wanting to be a SAHM), exhaustion (for not having a moment that isn't being an employee or mom), confusion (for not knowing how I can do this). It's like having a pinball game going on in my head and I'm constantly pressing the flippers to keep things moving. Pause for a second and the ball ends up in the gutter.

There does need to be more attention on maternal depression - pre-natal and post-partum. I had wrongly assumed that I couldn't be pregnant and on meds. With the help of my own GP and Dr Young, I knew ahead of time what I needed to do post-delivery to try and avoid the worst of the worst. My midwife clinic (however) was useless when it came to recognizing my depression. Never came the question: "How are you feeling?". It was glossed over in my health history and I had to explain what my 150 mg/day dose of Effexor was for.

Here's hoping for education for the masses; courage and recognition for people like Jen and Tracey to speak up despite the stigma; for more programs like Sinai's Peri-Natal Mental Health Program; for more recognition on what motherhood really involves - not just joyful moments, but second-guessing and mommy judgement.

Thanks again, Jen, for sharing your experience. It takes alot of bravery to speak up and speak out.

[DaniGirl]

Wow, Jen. This post is so timely for me. Thanks.

I would say more, but I just don't know where to begin. Can I tell you, though, that this made me admire you all over again? Brava, to you and to Tracy Thompson. And thanks.

[bubandpie]

I have such mixed feelings about the idea that depression can be passed on to one's children. On the one hand, if that information helps create a culture that takes maternal depression seriously, then it's a good thing. But how twisted is it that the mother's mental health can be perceived as significant only when it begins adversely affecting her children?

Your remarks about breastfeeding are so right on. It angers me that the pro-breastfeeding movement seems to rely so heavily on pressuring mothers rather than supporting them.

[ella]

As someone who feels unable to take meds at the moment, but may well in the future, I am interested in the role society can play and the whole issue of raising awareness. My website was featured in a UK article dealing with depression and maternal depression and by the number of mothers contacting me I have begun to discover just how widespread it seems to be. I think we are at the beginning of a real shift in how maternal depression is perceived and both blogs and books like Tracy’s are an important part of this shift. You have combined both admirably, as always, here.

[Rebecca]

Thank you, Jen. Thank you. It's been a particularly hard week for me. I've been home with my daughter full-time while her sitter is on holidays. We haven't done this since she was 5 months old and I returned to work full-time.

It's frustrating to love my 9 month old kid, but not love being with her. Usually our quality time is limited to the weekend and by the time Sunday afternoon rolls around I'm itching to get back to work, to take a break from this adorable baby who is learning to say Mom but sleeps for only 20 minute powernaps twice a day.

I would comment more, but I'm being beckoned with a high-pitched shreik.