Welcome to our updated website and new blog!!

We are so glad you are here!!

After months of planning and discussions (and endless cups of coffee!) we are delighted to announce the launch of our new blog, IMA’S BLOG.

As postpartum advocates, we understand like so few can- the pain, guilt, and shame you may be experiencing through your journey and recovery.

But we also know that with the right support and encouragement there is HOPE.
Continue reading ‘Welcome to our updated website and new blog!!’

Dear Yad Rachel…

I was recently perusing through one of the local newspapers and spotted an ad from Yad Rachel. You weren’t asking for donations, your weren’t hosting a dinner, and you weren’t advertising a Chinese Auction. Your ad was inviting all women who are experiencing pre or postpartum distress/depression to reach out to you for help.

The advertisement brought back a rush of memories- all the way back when I was in 8th grade. My mother had given birth to our youngest, and everyone knew there was something wrong. My mother was completely not herself, constantly crying, and was hardly talking. I didn’t understand at the time what it was that she was going through, and I thought that I could do something to help the situation. I took to cleaning the house from top to bottom, bathing and caring for my younger siblings, and acting as the mommy at bedtime. All the while waiting for that expression of thanks from my mother. None was forthcoming. This continued for weeks, and I felt like I would crack. That’s when Yad Rachel, then a fairly new organization stepped in. Someone started coming to make suppers, someone got the extended family to get involved to come and take the children on outings, and most importantly, Someone was helping MY MOTHER GET BETTER.

The whole episode took about 2-3 months at most, but while we were going through it, it felt like forever. Only many years later did it dawn on me what my family actually went through. It was a truly frightening experience. Now, as a young mother myself, b”h, I realize the tremendous chessed that Yad Rachel does and how it gives everyone involved a new lease on life.

Thank you from the bottom of my heart!

My Anxiety Disorder

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We are not transparent. Our fears and struggles are hidden under the façade of confidence and nonchalance. An acquaintance once told me, “You’re the calmest, most relaxed person I’ve ever met!”

If she only knew! I thought to myself! I am the one who suffers from irritable bowel syndrome, insomnia and fatigue, racing thoughts and heart palpitations. I am the one who clutches the little bottle of pills hidden deep inside my pocket while I struggle to breathe deeply and take it easy.

To Continue article click here.

When a Loved One Has Depression

8 tips to help you cope.

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The suicide of beloved comic actor Robin Williams has again brought the topic of depression to the forefront. I cannot imagine what it feels like to have the weight of such unendurable despair that is so intense you cannot bear even staying in this world. But I know all too well what it is like to live with family members who have depression. One of my parents, a sibling, my husband, and one of my children have also suffered from this black cloud, in varying degrees, and for varying lengths of time. I have spent much of my life living with people I love with all my heart who often have trouble feeling happy or optimistic. This is in itself is very, very painful.

Depression runs in families, and seems to be especially common among Ashkenazi Jews. Maybe our difficult history somehow let it seep into our psychological DNA. Depressive episodes don’t necessarily have causes. While traumatic events can trigger depression, in many cases it is part of a person’s psychological make-up, and I was at first baffled when years ago, my daughter, who had everything going for her, including friends and success in school, suddenly descended into a black cloud, seemingly “for no reason.”

Too often I have seen “that look” on a loved one’s face: the grimly set mouth, eyes slightly hooded, shoulders slumped, the entire demeanor broadcasting the message to stay away, that she cannot cope now. I had to learn that my daughter’s or sister’s or father’s or husband’s depression was not my fault, that I didn’t do anything wrong as a child, sibling, spouse or parent to “cause” it. I have also had to learn coping skills to deal with it. Here are some of the most important lessons I have learned about living with someone who has depression.

1. Offer your love and support emphatically and consistently, especially when your loved ones are in their least lovable states. A depressed person has trouble believing in herself, no matter how much she has going for her. Hearing someone say, “I love you” and “I believe in you,” and knowing that they mean it emphatically, is hugely important. Your expressions of love will register, even if they cannot be returned at that time.

2. Get help to deal with your own stress. You need to still try to live your life to its fullest, and you have to balance all your other obligations in addition to being a caretaker of sorts for a depressed person. Confide in wise and close friends. Support groups or short-term therapy could be a good idea.

3. You cannot “convince” someone not to be depressed. Nor can you “cheerlead” her out of an episode. Accept the reality that these episodes will repeat from time to time, but that they will pass. Offer that same reassurance to your beloved family member that you know it will pass, like a wave.

4. It is not okay for someone with serious depression to refuse treatment or stay in denial. If that is the case, she has no right to expect ongoing unconditional support. The behavior and moods of a person with depression affect everyone around them, and it is their responsibility to acknowledge the problem and agree to a plan of action. It is helpful to reassure the person that there is nothing to feel guilty about if they need to take medications to stabilize moods. Just like a diabetic needs insulin, someone with significant depression will need medication on a short-term or perhaps long-term basis, as well as therapy. I have been fortunate that most of the relatives I have dealt with have recognized the need to be proactive and been willing to get help.

5. Take care of yourself and do not let the wave of depression engulf you. Just like when you are in an airplane and advised that if traveling with children, you need to put on your own oxygen mask first before putting it on your child, you need to do things that lift you up, provide you with satisfaction and joy. In fact, it is extremely important for your loved one to see that you are making self-care a priority, especially in cases where a relative, consciously or not, uses their depression as a tool to exert power over you.

6. People predisposed to depression are predisposed to it in their own individual ways. When life’s accumulated stressors or traumas line up in a certain way, the result can be anxiety, depression or even schizophrenia. Our genetic make-up is God-given, and because our make-up is so unique, it is not easy to find the right therapeutic modality right off the bat. For some people, a combination of medication and cognitive-behavioral therapy works well; for others, dialectical-based therapy (DBT), psychodynamic therapy, or mindfulness based stress reduction work better. This is only a short list of treatments that can help. Start with a good therapist who will be willing to offer referrals to other practitioners if he or she cannot help get results.

7. Take it one day at a time. Don’t allow worrying thoughts to pile on, imagining “what if” scenarios that have bad endings. A friend of mine gave me a little laminated card with this bit of wisdom: “Worrying does not empty tomorrow of its troubles; it empties today of its strengths.” Stay strong by pushing long-term worries away.

8. Pray. This is an opportunity to grow closer to God and to ask Him to help you. I have told God very directly, “I cannot do this without You. I need Your help.” And I have found comfort and solutions in this. One year ago, right before Rosh Hashanah, I began to pray like I never prayed before for my daughter to heal from persistent depression. And for the first time, I replied to an advertisement from an organization in Jerusalem to have someone pray for my child at the Kotel for 40 days. While I believe in prayer, I had considered these annual pray-for-something-or-someone at the Kotel pitches to mostly be about fundraising. But last year, when things looked very dark, I figured I had nothing to lose and possibly much to gain. I wrote to the organization about my very wonderful child and all her talents and potential. I sent a picture of her. I also had everyone else in our immediate family also say the special prayer that was being said for her during those 40 days. At first things got worse, but after two weeks we had a wonderful breakthrough, finding a new and different treatment that has worked better than anything else has over the course of many years. I believe that heartfelt prayer does work, and that the Almighty is the ultimate Healer.

Depression is an illness that can be pernicious and debilitating, and it takes a toll on those near and dear. But there is always hope for a better tomorrow, and with effort, teamwork, faith and patience, you and your loved one will survive those occasional black clouds and see the sun shining through again.

 

by Pearl Goldman.

http://www.aish.com/

 

Dealing with Depression

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There is a world of difference between clinical depression and having a bad day.

When I was a young rabbi and I first encountered someone with depression, I vividly remember thinking to myself, why can’t he just snap out of it? What does he mean when he says he sleeps most of the day and can’t concentrate on anything? We are all tired and dealing with stress. Just resolve to get out of bed and get going. I remember not being able to understand why he was so depressed. After all, by all measures, his life was pretty good. If he were to just focus on the blessings and simply choose to be positive, he wouldn’t be depressed at all.

Looking back, I am incredibly grateful that I didn’t articulate any of these sentiments to him, but nevertheless, I feel ashamed and even guilty for having being so ignorant and insensitive to what depression is all about.

We perpetrate a terrible disservice by using the exact same word to describe how we feel when our favorite team gets knocked out of the playoffs or when our cell phone breaks, and a chemical, clinical illness that can be debilitating and incapacitating. Clinical depression is not about feeling blue, or down in the dumps or terribly sad. It is a serious illness that can be the result of a combination of genetic, biological, environmental, and psychological factors.

Depression is no more the fault of the person suffering with it than cancer or Alzheimer’s are the fault of someone suffering with one of those conditions. Just as the patient with cancer cannot simply will his or her cancer away and the individual with Alzheimer’s cannot simply determine to stop forgetting, the person with depression cannot just decide to not feel anxious, worthless, or exhausted. It is terribly unfortunate and unacceptable that depression remains stigmatized even today. Having a physical illness can be awkward, but should not be a source of embarrassment or guilt. Similarly, having depression, equally out of one’s control, should not be a source of shame or inadequacy.

If you are experiencing the symptoms of depression like decreased appetite, inability to sleep or excessive sleeping, restlessness, fatigue, difficulty concentrating, or thoughts of death, I urge you to seek support. If you recently had a baby and despite the newfound blessing you just can’t get yourself out of your rut, you may be suffering from postpartum depression. You are not the first person to experience this, and you have nothing to be embarrassed or ashamed about. Please don’t hesitate to reach out to a local Rabbi or Rebbetzin who will guide you to the resources and people that can help you without judgment.

Like any illness, depression requires diagnosis, intervention, and treatment. Like all illnesses it also requires the love, patience, understanding, and support of family and friends. However, for the most part, while people extend themselves remarkably to cook meals, shop for groceries, babysit children, or even just send a thoughtful text to check in on someone recovering from cancer or another physical condition, the person with depression or another mental health diseases often feels isolated, alone, neglected, and ignored.

May is Mental Health Awareness Month, a perfect time to educate ourselves. As we resolve to be more sensitive, please consider the following:

  • Don’t use the term “depressed” unless it is clinically appropriate. Find another way to say you are sad, bummed out, disappointed or feeling blue. Saying you are depressed over a relatively minor issue minimizes the suffering of someone struggling with true depression.
  • When someone you know is acting differently or unusual, don’t judge them or jump to assumptions about them. Ethics of the Fathers (2:4) quotes Hillel who said: “Do not judge another until you have stood in his place.” Since it is impossible to stand in another person’s place, to be them, to have their baggage or to live their struggles, we can never judge another. Instead, we should be kind, sensitive, supportive and understanding of everyone around us.
  • Never assume you know everything going on in someone’s life or what motivates his or her behavior. Ian Maclaren, the 19th-century Scottish author once said, “Be kind, for everyone you meet is fighting a battle you know nothing about.”  Cut others slack; give people the benefit of the doubt.
  • When you know a friend or family member has depression or other mental illness such as bi-polar, anxiety disorder, etc., be as supportive as you would be with someone suffering with a physical illness or disability. Offer help and assistance, check in, and let them know you are just thinking of them. Unlike acute illnesses, most of the time, depression is chronic. Once diagnosed, it can be controlled, lessened, or perhaps, even go into “remission.” But it is never cured. Support will be needed in some form always.
  • When reaching out to someone with depression, never judge, criticize or make comparisons. Don’t offer advice or minimize the person’s suffering. Simply listen, be present, and be a friend.
  • When someone has depression it places a tremendous burden on other members of the family who often need to take over chores, responsibilities and even produce greater income. Go out of your way to be inclusive of them, to check in on them and seek to unburden them.

 

This article originally appeared on aish.com by Rabbi Efrem Goldberg

 

NETHERLANDS: Mommy Shoes

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It has been nearly two years since I asked for help.

Motherhood and life felt like too much of a burden for me. After years of thinking that the problem was me, it finally dawned on me that there might be something wrong.

I started therapy and found out that I had suffered from postpartum depression. Not once but three times. I also found out that the feelings I struggled with in my early teens were not just regular teen struggles. I found out that it was also depression that I had struggled with.

These past two years have been the most intense years of my life. I have experienced tremendous growth. I have opened new doors and have closed old doors behind me.

People talk about therapy lightly. They think therapy is nothing more than paying someone to listen and to give you advice. Therapy is no such thing. Therapy is facing yourself. Therapy is opening doors and looking into the dark corners of your soul. It is work. Hard work that sometimes  leaves you exhausted. Being as courageous, as walking into a lion’s den unarmed. Vulnerable. It is raw naked honesty and perseverance. Going down a steep, rocky and sometimes dark road without knowing when you will reach the end of it. It’s knowing that you can decide to leave that road at any moment, yet not giving in to that thought. Because you want to get well.

For the past two years I have been going down this road. To say it has been a roller coaster ride, is to take a devastating hurricane and to call it a warm summer’s breeze. The hardest part? Being a mother at the same time.

There is no time off. No time to lick my wounds or to take a break. When I come out of therapy I need to step quickly into my mommy shoes. Some days I come out of therapy feeling empowered. I stand tall and firm and switch roles like a pro. Other days I feel delivered, freed from a burden that has been carried for way too long. Those are the days that my mommy shoes feel like dancing shoes. Then there are days that I am exhausted from the hard work and I feel empty with little left to give. On those days my Mommy shoes are put on reluctantly.

Some days the carefully constructed bandages around my heart are ripped from their place and old wounds are exposed. My heart breaks and scatters into a thousand pieces. An hour passes as I work through the pain.  When the clock strikes reality, I hastily gather the pieces and put them back into place as best I can. I wear my mommy shoes, and though it is I that longs to be nurtured, it is I that gives the loving smile; it is I that spreads my arms in welcome;  I that carries and I that offers warmth and shelter.

On such days my feet struggle to find solid ground underneath my shoes. When my child reaches for me, my grasp is firm. And as I hold her little warm hand softly in mine, the ground underneath my feet gradually feels stable again.

This is an original post to World Moms Blog by our author in the Netherlands, Mirjam.  http://www.worldmomsblog.com.

Even though…

Even though you feel like a bad mother,
Doesn’t mean you aren’t a good enough one.

(There is NO such a thing as a perfect mother. It doesn’t exist. The desire to be one is what makes you great! Your willingness makes u great!)

 
Even though you feel like you are doing nothing,
Doesn’t mean you are worthless.

(You are valuable and precious to so many with a heart of gold that’s just broken right now.)

 
Even though you are angry at your kids and sometimes yell,
Doesn’t mean you don’t love them.

(Kids are resilient and more forgiving than any adult. They understand mommy’s not feeling well.)

 
Even though you feel weak and tired and can’t do as much as you once did,
Doesn’t mean you aren’t the strongest bravest person who is battling a huge battle with courage and dignity.

(Admitting you are broken and need help takes superhuman strength.)

 
Even though everyone around you seems to be managing and functioning,
Doesn’t mean they are judging you even if it feels that way.

(Compare and despair – not everyone’s outsides match their insides!)

 
Even though this PPD feels endless and hopeless,
Doesn’t mean there isn’t a light at the end of this tunnel.

(You will get better. You will feel stronger. You will become as a result a more empathetic, caring , loving person.)

 
Even though you have Postpartum depression,
Doesn’t mean it is your fault.

This too shall pass.

Thank You Thank You Thank You!!!

We are so thrilled to share with all our readers that our Walkathon 2015 was a tremendous success!!!!

For those of you unaware, our annual fundraiser is our Yad Rachel Walkathon, an event geared to girls ages 8-12! It takes place each year in the May-June time, on a Sunday morning in a beautiful Lakewood park.

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Our sweet Lakewood girls grades 3 thru 8 register a month in advance and spend the next four weeks raising money and collecting for our cause. They find innovative and creative ways to fundraise; bake sales, carnivals, barbeques, babysitting, or just plain old knocking on doors and asking!

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Upon arrival to the event, they are each rewarded with a prize depending on the amount they bring in – then the fun begins! Walking around the track, stopping at booths to collect drinks, nosh and freebies,  passing by an ice cream truck we parked there which gave out free cones.  Then grand finale- a breathtaking trampoline act by award winning acrobats!

 

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The atmosphere is exciting, the girls are enthusiastic and happy to participate.

 

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Due to the unbelievable large turnout, We had close to 100 volunteers, moms and post high school young adults, to supervise and cheer on the girls. We are so grateful to our yummy little supporters and all their commitment and effort.

 

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Most of all, Thank you, Lakewood community, for helping out these young entrepreneurs by giving them those precious dollars and coins, by doing so you are donating to our cause and supporting the important work we do!!! This is are one and only fundraiser, we depend on these donations!!

For those of you who missed out on the opportunity to donate, it’s never too late!!

http://yadrachelnj.org/donate.html

 

 

 

S.E.L.F Care

HERE ARE SOME IMPORTANT TIPS AND TOOLS TO HELP NEW MOMS TRANSITION INTO THEIR NEW ROLE AFTER BIRTH. FOLLOWING THESE STEPS WILL HELP KEEP YOU HEALTHY AND STRONG.

 

Sleep-  A lack of sleep increases anxiety and depression. Mothers need a minimum of a 5 hour stretch with naps during the day to function.

Exercise- A little exercise moves your body, even when you don’t want to a little exercise is better than none. It promotes sleep and helps our mind by releasing endorphins (the feel good hormone).

Laugh- It feels good to laugh. It helps our immune system  and reduces stress. Look for fun in life, its there. tip: look in the mirror- stretch your lips to a smile. Your facial expressions are hard wired to our brains. Then look in your eyes and say something silly.. you will laugh ;)

Food- Always eat healthy. Low carbs, limit sugars and eliminate caffeine.  Keep hydrated- 6 glasses of water a day. Increase vegetables and protein for energy. ex: start your day with oatmeal covered in nuts and cranberries.

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IF YOU ARE CONCERNED ABOUT YOUR EMOTIONAL HEALTH AND SUSPECT YOU MAY NEED ADDITIONAL HELP, HERE ARE A FEW MORE IMPORTANT SUGGESTIONS:

Journal- Write about your baby’s day, rate your anxiety level with a number and then look back for good days and pinpoint why they were good.

Support Groups- Talking with others eases the burden. New moms share experiences, you bring the baby and can make new friends.

Therapy & Medication- If symptoms are increasing, ask your OBGYN for a referral to a mental health professional. Be open to hear a diagnosis and follow their direction.

Distraction- This interrupts the loop of negative thinking temporarily, because our brains can only perform a limited amount of functions at one time and emotions begin to calm down.

Relaxation techniques- Deep breathing (Relax, close your eyes, breathe in through your nose. Count 1, 2, 3. Exhale through your mouth 1,2,3. Repeat 5-10 times.) Massage therapy can also help you relax.

Mindfulness- Close your eyes, focus on the moment, quiet the words in your head by being still. Do not judge the moment as good or bad just stay still. Take note of your body sensations. Notice your breath  but don’t think about it. Stay with this for 5 minutes, but start off with 1 minute, then 2 and work up to 5 and then work to 10. Practice, Practice.

Get out of the house- walk with your baby in your neighborhood, do some shopping or a small errand a day.

Acceptance and acknowledge what is happening- There is power in acknowledging one’s powerlesness. Don’t fight the reality, try to surrender and validate yourself. Its the first step in recovery. ex. “I am feeling very anxious. I don’t really understand why this is happening, but I do know it is common and happens to other mothers.” Write this on a note to carry with you to read. ” I don’t like the way it feels, But I am doing everything I need to do to feel better.”  This will not last forever, I will get through this.

 

THESE STRATEGIES ARE MOST EFFECTIVE WHEN FAMILY, FRIENDS AND HEALTH CARE PROFESSIONALS ARE COMPASSIONATE AND SUPPORTIVE DURING THIS DIFFICULT TIME.

 

Delivery from Darkness

This article originally appeared in Mishpacha/Family First (Issue 425, January 14, 2015).

@Mishpacha Magazine 2015

www.mishpacha.com

 

WHAT HAPPENS IF YOUR NEW BABY BRINGS YOU ANXIETY AND DEPRESSION, INSTEAD OF JOY AND DELIGHT? HOW TO RECOGNIZE – AND RECOVER FROM- POSTPARTUM REACTIONS

 

“MOMMY, I WANT TO MAKE YOU A BIRTHDAY PARTY,”

Shloimy said, eyes bright.

“Hmm,” Leba mumbled, her head ensconced in a novel.

“You know why, Mommy? Maybe if I make you a party, then you’ll smile.”

An English teacher by profession, Leba Katz was as normal as they come. She was geshikt too: Despite giving birth to her sixth child just months earlier, her family always had fresh suppers, clean laundry, and sparkling floors. Which is why, despite repeated red flags, it never dawned on her that something was wrong.

“My son’s remark should have been a bulletin from Shamayim,” Leba reflects. “But depression was for weirdos. I was Leba Katz, the oldest of a well-known heimishe family from Boro Park.”

It took another alarming incident for Leba and her husband to realize they needed help.

At 11:30 p.m. one night, Leba began walking out the door, wearing only a robe and socks. “Where are you going?” her husband asked incredulously.

“I’m leaving,” she declared. “I’m just going… somewhere.”

“This is crazy,” he said. “We’re going to a doctor.”

A CLINICAL DEFINITION

Leba was suffering from postpartum depression (PPD), a form of maternal mental illness affecting at least one in eight — and as many as one in five — women across the world.

In the past, researchers referred to any post-birth mood disorder as “depression,” but today the medical world talks about postpartum reactions, acknowledging the range of conditions that can result from wildly fluctuating hormones: anxiety, bipolar disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or a combination.

Not to be confused with baby blues, a short-lived bout of irritability affecting 90 percent of mothers for the first two weeks after birth, postpartum reactions generally do not go away without medical or therapeutic intervention — or an integration of both.

What’s more, a fast-growing body of research indicates that maternal mental illness does not always wait for delivery:

33 percent of women diagnosed with PPD developed the condition in their third trimester. Symptoms can also develop anytime in the baby’s first year of life — not just the first few months.

“With each child, the depression hit later and later,” Sari, a Baltimore mother of four relates. “With my youngest, I was fine until he was five months old. Then it hit.”

What causes maternal mental illness? A complex interplay of genes, stress, and hormones. “Hormones go up more than a hundredfold” during pregnancy, says Dr. Margaret Spinelli, director of the Maternal Mental Health Program in Columbia University, as quoted in the New York Times. After birth, hormones plummet, causing a crash that can “disrupt brain chemistry.”

Some primary risk factors are biological: Women whose moms had postpartum (PP) reactions are highly susceptible, and women who once experienced pregnancy-related depression have a 50 to 62 percent risk of recurrence.

Environmental factors also play a big role: the more stressors in a woman’s life — from financial strain to shalom bayis issues — the more likely she is to get a PP reaction. Experiencing a scare during pregnancy — even if it never materialized — can also trigger PPD.

Internal stressors impact a woman’s risk as well. A woman from a family of high achievers, for example, is at high risk. “She had a baby, she’s more limited, she can’t cope as well — but she’s expecting the same output of herself,” says Dr. Shula Wittenstein, a seasoned psychologist who works at Nitza, the Jerusalem Postpartum Support Network.

Perfectionists are more likely to fall into depression when their birth or after-birth experience does not go as planned, because they aim for “perfect” even in areas they can’t control. “Many women are brainwashed not to take an epidural, or told that a C-section will negatively affect the baby for life,” Dr. Wittenstein notes. “They’re also told nursing is a must. And they feel the powerful societal pressure to have many children in close succession, regardless of circumstance that warrant rabbinic instructions to the contrary.”

The result, asserts the psychologist, is that women aim for these goals even when they don’t have the capacity for them. And when they don’t succeed, they feel like failures.

Chaviva, who suffered from classic PPD, says, “I made myself insane trying to nurse, but it simply didn’t work. It took having three kids and consulting seven lactation consultants for me to accept that this is the way Hashem made me.”

Another internal stressor is the guilt felt when seeking a husband’s help. “The mother is drowning, but she doesn’t want to take away from her husband’s Torah,” describes Dr. Wittenstein. “She valiantly tries managing alone, pushing herself deeper into depression.”

Sari, an almost ten-year-veteran kollel wife, remembers feeling like a horrible Jew. “How could I ask him to stay home? I must have no chashivus haTorah, I’d think. Then I’d get angry at him for not offering to stay, thereby relieving me of the inner turmoil.”

A GLIMPSE INTO DARKNESS

Depression, the most common postpartum reaction, varies significantly in severity. Many affected women report a constant state of sadness and irritability.

Naturally upbeat and optimistic, Chaviva couldn’t find it in herself to smile. “Everything was wrong,” she remembers. “I couldn’t shake the anger.” Chaviva was unable to react to normal life challenges in a balanced way. When minor things went wrong, she would stew in a negative headspace — for days. “If my husband didn’t take out the garbage, he didn’t love me, my marriage was falling apart,” she says.

Other mothers paint a picture of perpetual “overwhelmedness.”

“Taking care of my kids just didn’t end. I felt I was being buried,” says Mindy. “My toddler whining, my baby crying — anything would set me off.” Mindy’s black feelings were exacerbated by a massive cloud of guilt: She had struggled with infertility for years. “G-d gave me these two amazing gifts after all these years — how could I not be happy?”

Rivka, who felt similarly submerged by routine responsibilities, says that in hindsight, she realizes her depression began in pregnancy. When she and her husband would read about their unborn baby’s weekly development, the soon-to-be-Tatty would get excited and emotional. Rivka, in contrast, would be completely detached.

“I kept telling myself: You can’t see the baby, that’s why you’re not feeling anything.” Months later, Rivka had no difficulty loving her sweet infant — she just couldn’t handle even life’s tiniest curveballs. “If I was in a rush and the baby had a dirty diaper, I’d lose it,” she recalls. “I couldn’t make decisions or problem-solve. I felt like I was about to crash — all day long.”

Most difficult to diagnose are cases of milder depression. Here, the woman functions outwardly — cooking and laundering, caring for the baby — but her inner world is in tatters.

“I put on a Broadway show. No one in the neighborhood could have known,” Leba says. “At home, though, I was in a fog. I wasn’t relating to my husband, my kids.”

For Shira, who held a high-powered finance job through several babies — and years of untreated depression — the farcical charade was the scariest part of it all. “I was having awful, awful thoughts: What’s the point? Why am I living? I knew I could do something really bad to myself, and no one would even know to prevent it.”

Years later, in a discussion about that bleak period, Shira’s husband remarked: “If you had stayed in bed for three days straight, I would have done something, gone for help. But you were totally functioning — I assumed you were just in a really bad mood.”

BEYOND DEPRESSION

Other widespread postpartum reactions include anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

“People don’t associate anxiety with birth, but it’s very, very common,” notes Dassy Gordon, coordinator at Nitza. She’s worked with mothers who were suddenly scared to leave the house, enter an elevator, or stay home alone. It’s a vicious cycle: If the anxiety deteriorates into a full-blown panic attack, the woman starts feeling anxiety about having another attack.

Anxiety often centers on the baby: Is she healthy? Happy? Developing right? In severe cases, a form of OCD may develop, where the mother constantly checks her baby’s breathing. Sometimes it manifests only in thought: The mother has to keep telling herself — again and again — “Everything will be okay.”

“Women suffering from OCD know it’s illogical,” Dassy says. “But they feel out of control. Their brains are being manipulated.”

Mindy, whose mother passed away suddenly when Mindy was in her eighth month of pregnancy, suffered from a mix of anxiety and PTSD. Coursing through every diaper change, bath, and bedtime was an underlying worry that she’d die too — leaving her children orphans.

“I was terrified. I was sure I would die, and who would take care of them?”

Birth is a particular trigger for PTSD: Studies suggest that the delivery process revives old stresses. What’s more, many women experience birth itself as a trauma, especially if there are complications.

“Birth can be very frightening,” Dassy observes. “It’s understandable that many mothers have to process this trauma.”

Using hormonal contraceptives after birth may exacerbate — or impersonate — maternal mental illness. While some gynecologists gloss over the side effects, many women experience radical mood swings and mistakenly assume they’re having a postpartum reaction. For others, hormonal treatment aggravates a preexisting condition, introducing new levels of despair.

“I had low-grade PPD for years,” shares Shira. “But it was only under the influence of hormonal treatment that I started having suicidal thoughts.” Shira found viable alternatives quickly.

PPD  AT HOME

Maternal mental illness of any kind has a profound effect on the family. “Akeret habayit is not just a cute catchphrase,” says Dassy Gordon. “It’s reality.”

In extreme cases, the household stops functioning: Kids wear dirty clothing to school, hygiene falls by the wayside, the supper table remains empty.

In milder cases, the cogs keep turning, but the inner damage is acute. A mother with a postpartum reaction cannot attend to her children’s emotional needs. Her marriage is severely compromised. And her relationship with her baby can be frighteningly flawed.

“It was the worst at night,” Chaviva remembers. “She’d wake up, again, and I thought I would hurt her.”

Sari remembers thinking, I don’t want to look at this baby.

While most women experiencing such intrusive thoughts never hurt their children, writes Pam Belluck in an extensive New York Times piece on the subject, some take extreme measures to protect their babies. One woman  slid down the stairs in a sitting position for months because she’d imagined throwing her baby downstairs, reported Wendy N. Davis, the executive director of Postpartum Support International.

Maternal stress may cripple a woman’s ability to bond with or care for her child, studies indicate. As a result, the child’s emotional and cognitive health may suffer.

Dassy Gordon says passivity is a common fallout. Baby is developing a relationship with this world. When he smiles or cries and doesn’t get reactions, he subconsciously thinks, “Why should I smile or cry? What effect do I have on my surroundings?”

“These babies can become apathetic, lying in the crib for hours each day,” Dassy says. “They may grow into children who recoil from emotional attachment, who can’t build healthy relationships.”

Older siblings can also sustain long-term effects. Struggling with typical new-child jealousy and insecurity, they need extra love and attention. Instead, they might receive copious amounts of screaming and yelling, or feel obliged to take on a protective role, propping up a fragile mother who cries endlessly.

But, Dr. Wittenstein stresses, children are very resilient. If a woman seeks help in a timely manner, her kids will likely make a full recovery.

Beyond the children, the marriage relationship is obviously undermined. Many men — especially first-time fathers — are unfamiliar with postpartum reactions, and their ignorance adds insult to an already difficult dynamic. “You have a young boy who married a beautiful, charming wife,” Dassy Gordon says. “Then she’s sick for nine months straight. When she gives birth, he’s thinking, ‘Finally, I’ll have my happy wife back!’ But the opposite happens.”

Some husbands brush it off as “normal moodiness.” Then the wife starts making demands, and he gets resentful. “He doesn’t understand that he needs to stretch beyond his normal schedule to help her get past this,” Dr. Wittenstein says.

Sari blamed her husband for everything. Unwilling to admit another factor was at play, she attributed her never-ending upset to him: “If only you helped more, I wouldn’t feel this way.” The anger predictably intensified during high-pressure times like Yamim Noraim or Pesach. One Succos, she remembers not speaking to him all Yom Tov.

Shira, whose depression went undetected for years, felt deeply betrayed: She was in a dark pit, and her husband wasn’t pulling her out of it. “Every woman wants her husband to take care of her,” she says. “But I didn’t realize what was happening myself, and my husband didn’t pick up the cues.”

A CULTURE OF COPERS

Whether they suffer from depression, anxiety, or PTSD, frum women experiencing postpartum reactions face unique challenges. In a community that prides itself on large families and masterful juggling skills, mommies who are not managing feel enormous shame. And because of the emphasis placed on the beauty of motherhood (“Eim habanim semeichah!”), the woman who finds herself resenting — even hating — the role feels completely inadequate.

“We are raised with expectations about how happy we’ll be as mothers,” says Rebbetzin Michal Cohen, LCSW, a kallah teacher, social worker, and rebbetzin of Congregation Adas Yeshurun in Chicago. “Then you have a woman who can’t get out of bed, or has thoughts of hurting her baby. What is she supposed to think?”

“I lost my bren for Yiddishkeit,” Chaviva recalls. “Life was about keeping my head above water instead of becoming close to Hashem. I felt like a terrible Jew. I’d been so passionate in seminary, I had so many dreams… what happened?”

Chaviva’s pain was magnified by the fact that no one — not even her husband — validated her pain. When she reached out to mentors, they pooh-poohed her feelings, telling her it was normal to be overwhelmed after birth.

“That was the hardest part: not feeling heard,” Chaviva says.

When she finally went to the psychiatrist, who told her, “You have textbook PPD,” the relief was profound.

Denial of postpartum reactions is unfortunately not the exception. This flawed approach to mental health illness — resulting from community stigma or plain lack of awareness — can cause years of needless suffering, sometimes irrevocable emotional damage.

For Leba, it took six children and ten years of strained shalom bayis to seek help. Her refusal to face reality was part stigma, part ignorance. “My husband had a wife every other year,” she says sadly, adding that he was nothing short of a tzaddik for putting up with her. “I used to tell people: ‘It takes eight full months to recover from birth, you’re supposed to feel yucky!’ Looking back, I realize how abnormal that sounds.”

When Leba’s husband would show concern, wondering why she snapped so frequently at the kids, she’d say, “This is not medical, it’s avodas hamiddos.” When Leba finally made the trip to the doctor — at her husband’s insistence — she put up a tough fight.

“The doctor — who I’d already decided was a quack — recommended a mild antidepressant, and I was like, ‘Are you out of your mind? Do you know who you’re talking to? I’m Leba Katz, I’m normal!’ ”

“If your eyes weren’t working well, would you not get glasses?” the doctor matter-of-factly stated. “You’re missing some serotonin. That’s the whole story.”

The shame associated with therapy and mental health meds causes many frum women to delay treatment until the situation becomes untenable. “We have to be crawling on the floor, gasping our last breaths, in order to seek help,” rues Rebbetzin Cohen. “Why do we do that to ourselves? I wish therapy were one of the Aseres Hadibros: Thou shalt seek help.”

Another factor possibly aggravating PPD incidence in our community is the fact that there isn’t much emphasis on mothers taking care of themselves. Rebbetzin Cohen shares a telling incident: At the first session of a newly launched parenting class, she asked each woman to introduce herself. The questions included name, age, and range of children, and what each woman does to relax or unwind.

“Most of the women could not respond to the last question,” Rebbetzin Cohen reports. “I was floored. If you don’t outfit yourself with the oxygen mask first, your entire family will be comatose!”

Part of being a mother, says Rebbetzin Cohen, is making sure you are mentally and emotionally capable of caring for your kids. A 45-minute exercise routine is just as important — if not more so — than making a fresh supper.

“After all these years, I finally started treating myself to facials,” says Shira. “It sounds silly, but the emotional impact is real. Someone is taking care of you.”

Precisely when families are large, it’s critical that women stay on top of their emotional wellbeing. The larger the family, the more children are affected each time Mommy lapses into a postpartum reaction.

GETTING HELP

Treatment for postpartum reactions involves a multipronged approach of physical support, emotional support, therapy, and medication.

The first stop for a woman who suspects PPD is her obstetrician, who might refer her to a psychiatrist to evaluate if medication — usually in the form of antidepressants — is necessary. Next, the woman might call a postpartum support network like Nitza, who would refer her to a qualified therapist, hook her up with a support group, or arrange for a “phone friend” — based on her preferences.

Fearful of side effects to their unborn or nursing babies, many women are wary of taking medication (though research indicates the risk is minimal). But the damage of not taking it might be far more serious.

Mindy, whose psychiatrist prescribed a low-dose antidepressant, says the impact was immediate. “Within a week, I saw a difference,” she says. “I was reluctant to take it, but eventually I realized: You take Motrin for a headache, antibiotics for an infection, and antidepressants for mental illness.”

Leba’s results on medication were so positive that she’s continuing to take them, even though her baby is now pushing two. “I’ll get off of them one day. In the meantime, I have to be an effective mother.”

For Chaviva, landing on the right medication and dosage took time. “It’s not an instant happy pill,” she says. “But it did allow me to become grounded again. Life’s ups and downs kept coming, but the downs didn’t send me flying down a staircase anymore.”

Therapy is another critical treatment piece. It often comes in the form of cognitive-behavioral therapy (CBT), a structured, present-oriented psychotherapy focused on solving current problems and recasting negative patterns; or of psychodynamic therapy, a more analytical approach that examines the client’s past to reveal the unconscious intent of his actions or choices,

Therapeutic healing is also essential. This refers to a woman sharing her experience: letting go of the guilt, shedding feelings of inferiority, and internalizing that postpartum reactions could happen to anyone.

These feelings are facilitated when mothers speak openly with each other, normalizing the condition.

“Instead of pretending you have the perfect life,” Dr. Wittenstein urges, “share your story. For every person who courageously shares, so many others are affected.”

Alternative healing methods like reflexology or massage may be beneficial. But, warns Esther Gross, author of You Are Not Alone and moderator of a Williamsburg-based support group, these alone cannot be effective. “It’s like using an ACE bandage for a broken foot,” she says. “I meet women who spend $30,000 a year on alternative healing. I tell them: ‘Stop sabotaging yourself. Go to a doctor.’ ”

The importance of a solid support system in treating PPD cannot be overemphasized: Research indicates that proper social support (regular phone calls, home visits, offers of help, empathy) can reduce symptoms by 50 percent.

Husbands especially must be on board, offering extensive technical help and showing support for the interventions. Chaviva’s husband’s rosh yeshivah unilaterally directed her husband to make himself available both physically and emotionally.

“It’s funny — now that I know he’s available, I don’t need his help as much,” she says. “Knowing he’s there physically is so important to me emotionally.”

In contrast, Sari — who’s endured PPD four times — has developed some coping mechanisms, but she still hasn’t gone for professional help. “I wish my husband would put his foot down and tell me: I’m going to watch the baby and you have to go,” she says. “He’s just not that type.”

But whether or not Husband “gets it,” women like Sari must realize they deserve to take care of themselves. The short-term babysitting technicalities pale in comparison to the potential fallout of non-treatment.

A narrow slice of PPD cases resolve spontaneously within three years. Most untreated cases deteriorate or become chronic. And because depression often occurs with comorbidities like anxiety or PTSD, the depression may diminish while the comorbidity remains.

“A 45-year-old woman may still be suffering from postpartum depression,” says Dr. Wittenstein. “With each year, the impact becomes progressively more severe.” This means that at first, PPD struck an otherwise healthy family. Now, after years of abstaining from treatment, the mother must deal with PPD along with a host of marital and parenting issues that developed as a result.

What’s more, Dr. Wittenstein tells mothers, even if the condition fades away, “Two to three years is a long time to live like this. For you and your family.”

PREPARATION AND PREVENTION

Women who endured postpartum reactions are generally determined to use every means at their disposal to avoid a repeat experience.

“Next baby, I will not leave the hospital before going on medication,” Mindy says. “I will pursue therapy before birth, while I’m pregnant.”

“I will get more help,” Chaviva says resolutely. “No one else can mother my kids, but lots of people can wash dishes, fold laundry, and cook supper.”

“I’m open to bottle-feeding,” Rivka says, recalling the physical pain that plunged her further into depression. “I wanted to nurse so badly, but I’d do anything — anything — to avoid this again.”

On a communal level, reducing the rate and severity of postpartum reactions requires greater awareness and open discussion. Dr. Wittenstein feels strongly that childbirth education classes should include more emphasis on “not-dream births” and associated feelings of inadequacy and shock. Expectant mothers must learn more about PPD and its red flags, in a clear, non-alarming way.

“I assumed every woman with PPD was suicidal,” says Rivka, who suffered from milder depression. “If I’d only known to get help, I could have avoided two years of misery.”

Husbands must be especially prepared, since they are often the only ones in a position to help. Dr. Wittenstein’s dream is for every rosh kollel or rebbi to check in with new fathers every few weeks after birth, asking, “Is your wife getting enough sleep? Is she back to herself? Is there anything you’re concerned about?” Rabbanim should be supportive, lightening the pressure of husbands who may need to spend more time at home. Neighborly nurturing after birth is far-reaching. Besides meals and babysitting, women should try to tune in to the emotional needs of kimpeturin mothers. “Instead of only asking, ‘How are you managing?’ try asking, ‘How are you feeling? Are you happy with the baby?’ ” suggests Dassy Gordon.

Most of all, mothers must validate, validate, validate, scratching out the stigma with every conversation — so that women like Sari feel comfortable seeking help. “Even after experiencing depression many times, it’s so hard to face it,” says Sari. “I’m still convincing myself: If I ignore it, it will go away.”

Meanwhile, women like Leba — who have found relief through medication and support — are continually stunned at how joyful and manageable motherhood can be.

“I am beyond crazy about my baby,” Leba says. “He’s 24 months; I’m still nursing him; I’m hopelessly attached. I feel like he’s my first kid.”

 

DEPRESSION IN DADS

A little-known cousin of maternal mental illness, paternal postnatal depression (PPND) affects as many as 14 percent of fathers in the US. Experts dub it the “underscreened, underdiagnosed, and undertreated condition,” contending that real incidence is probably much higher, since men are less likely to report symptoms.

Depression in fathers presents differently than in their female counterparts: while men exhibit more traditional symptoms like fatigue, loss of appetite, or low motivation, they are less inclined to cry or show sadness.

Which men are vulnerable? Researchers have found a strong link between maternal depression and PPND, likely due to poor marital satisfaction. Some studies even propose that maternal depression causes PPND. But regardless of the mother’s condition, first-time fathers, unemployed fathers, and fathers of kids with special needs are associated with the highest rates of PPND.

And while the effects of PPND are milder than those of maternal depression, normal child development can still be hampered. Research indicates that children whose parents are not depressed have a 6 percent rate of emotional or behavioral problems. In homes where only the father was depressed, 11 percent of children will develop problems; where only the mother had symptoms, the rate among children was 19 percent.

Alarmingly, a child with two depressed parents has a 1 in 4 chance of having emotional or behavioral problems later in life. So both mothers and fathers should be on the lookout for the telltale signs of depression — and deal with them swiftly.

 

Therapy: A Sneak Peek Inside

BOUND TO HAVE BOUNDARIES

 

Listen to me.

You may find yourself in this scenario.

For months you have been miserable. Maybe years. You have spoken to friends, confided in mentors, consulted with rabbis, and vented to sisters. And you just couldn’t seem to feel better. So you let your husband, your friend, your Rav, even your own dear self, convince yourself to try therapy. And you do. And, it must be a coincidence, but within a few weeks of beginning therapy, you are actually feeling better. Like I said, a coincidence. Probably nothing at all to do with therapy; but okay, you will continue with therapy because just in case it’s therapy actually that’s making you feel better…..

But not only is therapy starting to bug you, the therapist is beginning to bug you, too.

You feel stupid paying her just to talk to her. I mean, can’t you just talk to your sister?

And you hate the way it’s exactly fifty minutes a session and as soon as that stupid clock ticks and tocks onto the fiftieth minute of the hour, your therapist tells you that time is up. Like, why can’t she just let it be an hour, or an hour and half?

And it annoys you that you can’t just call your therapist any old time you want to. I mean, you could; but it feels weird because you usually pay her so you feel strange if you call. And anyway, what exactly are you calling about? It’s not like you can schmooze with your therapist. She’s not your friend or anything.

You are not even sure what she is. Okay, she’s a therapist. But what does that mean? And what’s with all these boundaries?

If you are in therapy, these questions sound familiar. And if you are not in therapy, then you may have been wondering about the same things. Or if someone you know or love is in therapy, you may not understand these boundaries, and would like to understand so you can be more supportive.

Therapy is very different than any other relationship, even other helping relationships, because of its set of boundaries. These boundaries are about paying the therapist for each session. It’s about how long each session is, how to manage out-of session contact between therapist and client, and the consistency of appointments. Boundaries manage client’s request for physical touching/hugging, monitor therapist’s self-disclosure, and maintain confidentiality. There may be other boundaries, but these are the main ones I will explore in this column.

Therapy works to relieve a person’s symptoms that bring him into therapy to begin with, in ways that talking to a friend, sibling, or rav fail to help. It’s because of the boundaries of the therapy experience, so different than the boundaries in a friendship, within family, or as a constituent of a rav, that a person finally finds relief from the the burden of pain, anxiety, or depression they have carried for months, or sometimes years.

If a therapist would not charge money, would not abide by the constraints of the therapy hour, the need to identify boundaries of contact outside sessions, and to maintain confidentiality, then therapist would be the same as the other helpers that did not help.

The therapy hour is an experience whose effects spreads over the week. It is not isolated to the single fifty minutes in which the client and therapist meet. It creates a disequilibrium in the client so that positive change is forced to happen.

Everything that happens in the therapy room is significant.

And that is why the therapeutic boundaries are so crucial. They keep the client safe while therapy does its work.

A therapist that keeps a client overtime past the session, or cannot create/maintain appropriate boundaries of out-of-session contact may be sending messages like, “Your problems are so terrible, I must help you more,” or “Only I can help you, so I will give you more time,” or “Your problems are so huge, you can’t possibly manage them by yourself, so I need to give you more time.

Boundaries of space and time and payment and touch give a powerful  and positive message: “You are capable of doing the work you need to do to feel better, and I am only a temporary facilitator.”

It would be inappropriate in most cases for a therapist to meet a client in any other venue except for the therapy room, except where therapy is otherwise established (i.e. if a client is anorexic, therapy may take place in restaurants or other such places). A therapist would not invite a client to her home, attend her simchos, or spend an inordinate amount of hours together, even if there is payment for those hours. Touching or hugging a client is generally not appropriate, nor is a therapist’s self disclosure. When a therapist self-discloses, it must be very carefully assessed if the information being disclosed is therapeutically necessary, or sound. It can never be for the therapist’s aggrandizement or personal needs.

When a client pays a therapist, it forces the two to acknowledge that even though the therapist has chosen to go into this field from a desire to help; it is still a job, and is the responsibility of the therapist to do her job. If the job is not being done satisfactorily, there must be constant assessment of why, and how the client’s needs would be best met.  There are treatment goals and objectives; this is not simply two friends, or a mentor and disciple meeting once a week to talk. Payment makes that very clear. Foregoing payment blurs this understanding of the roles of client and therapist.

As a therapist, I know that a client struggles with her feelings of weirdness that she must pay to talk to someone, when she can talk to her friends for free. So when a client shows discomfort, or resistance, or anger at the reality of this and other therapeutic boundaries, I find it important to acknowledge them, even if the client is unable to process the reasons why they exist.

Of course, therapists are human (surprise! Surprise!), and sometimes we make mistakes with boundaries. And sometimes in our humanness, we also sometimes break boundaries. And yes, we will go over the fifty minutes, and we will take a reduced rate, and we will accept a call in between sessions, and we will accidentally self-disclose.

And if you want to know the truth, here it is: Sometimes we are really enjoying your company and wish we can spend another hour with you, and sometimes we wish we can hug you, and sometimes we wish we can see you for free, and sometimes we wish we can  self-disclose and let you know how we really understand your pain because we have been there, too.

But because we care, the greatest gift we can give you is to keep you safe within the therapeutic boundaries and experience so that in time, you will no longer need us.

Mindy Blumenfeld LCSW maintains a private practice in Brooklyn working with individuals, couples, and families. This column has been previously published in Binah Magazine where she writes a regular column about therapy. You can read more articles on her blog at https://frumtherapist.com or find out more about her on LinkedIn. For questions, comments, or even complaints, she can be reached at mindy.blumenfeld@gmail.com or 347.489.3380 via phone or text.