The Great Divide: Researchers, Clinicians, Medical Professionals, Peer Support Advocates, Struggling Patients


All across the globe, there are Researchers dedicating their lives to exploring all aspects of Postpartum Mood Disorders. Many of these researchers work in clinics, some are purely academic, and others review the research of others and present a compilation to conclude results.

Clinicians (for our purposes here) are trained in a variety of professions from therapists to psychiatrists to psychologists. These are the professionals on the front line. Some may be trained specifically in Postpartum Mood & Anxiety Disorders while others may be largely unware of the nuances of these conditions.

Medical Professionals often see Postpartum Women prior to a Clinician is involved. These are General Pracitioners, Family Practice doctors, Pediatricians, Obstetricians, Midwives in some areas, ER doctors, nurses, etc. These professionals again, may or may not have additional specific training in Postpartum Mood & Anxiety Disorders yet it is highly unlikely they are familiar at all with the nuances involved.

Peer Support Advocates are in the trenches. These may be made up of survivors, passionate and informed Clinicians, nurses, pediatricians, IBCLC’s, doulas, and a number of other people various walks of life. They become Peer Support Advocates for various reasons but largely due to personal experience from either a lived experience or the experience of a loved one.

Struggling Patients are in the thick of a Postpartum Mood & Anxiety Disorder, often navigating the system for the very first time. Many of them have never had a mental illness before giving birth or pregnancy. They are not familiar with their rights, the issue of medication, diagnosis, follow-through, or where to turn for help. They are filled with guilt, shame, and fear. These families and patients are often afraid to speak up and reach out for help. But their voices are increasing. Yet they are still echoing into an empty cavern as they scream out for the help they so desperately need.

Peer Support Advocates often are the first to hear the cry of the struggling patients. We work with them to find knowledgeable support in their locale. While the possibility of connecting these patients with knowledgeable or compassionate care is increasing, often times, we find ourselves up against a brick wall riddled with barriers to treatment. The biggest barrier is lack of knowledgeable local referrals. Primary referral in many areas is often to an uninformed or untrained Medical Professional.

An uninformed Medical Professional may do more harm than good with a Postpartum patient. He or she may erroneously take the DSM guidelines to heart, refusing to acknowledge a Postpartum Mood Disorder if the patient had her baby more than four weeks prior to presenting with symptoms. Nevermind that the APA itself admonishes the usage of the DSM in such a manner. If the non-mental health trained Medical Professional is informed, then the patient may find herself ushered higher up the ladder into the office of a professional Clinician trained to deal with psychiatric illness and disorders.

Clinicians are not always trained in Postpartum Mood & Anxiety Disorders. Therefore, it’s important for the patient to know what questions to ask when making an appointment with a specialist in the psychiatric field when seeking help for a PMAD. Questions like “Have you been trained in Perinatal Mood Disorders?” or “By whom have you been trained?” or “How long has it been since you were trained?” or “What is your approach to treating PMADs?” are all excellent questions someone who has been trained in Perinatal Mood Disorders would be comfortable in answering. A good clinician will answer honestly that he/she has not been trained but is willing to learn. He/She should offer her viewpoint on treatment and not force you into accepting their way or the highway. A good (and informed) clinician will also keep up with the latest research regarding PMADs.

Researchers are often not in the field with patients. On rare occasion they are clinicians themselves. Many are academic researchers. These researchers study everything from epidmeology to treatment to type of Perintal Mood Disorder, to risk factors, to contributing factors, birth trauma, etc. The issue with Researchers comes in when their research is manipulated, funded by Pharmaceutical companies, involves retro-data, a small data group, or a limited field in which some factors are not viable simply because the size of the group or source of the group is inherently flawed or for some other various reason. This is not to say that all research should be thrown out the window. It shouldn’t be at all. BUT it is important to be able to distill the research with a keen eye and apply some common sense to the outcome.

This is where Clinicians, Medical Professionals, and Peer Suppport Advocates come into play. Anyone trained or in contact with experts in the field of Perinatal Mood Disorders will be able to help you recover. Even those not well-trained but well-meaning and open-minded will be able to help you. If your Clinician, Medical Professional and Peer Support Advocate is willing to help formulate (or find) help which fits your personal lifestyle and belief system, your chances of recovery increase. But if you have a Clinician, Medical Professional or Peer Support Advocate who is closed off to certain avenues of treatment due to a certain aspect of your own life such as breastfeeding, other children, pregnancy, etc, then you may want to continue looking for help elsewhere.

In light of the new guidelines in the DSM-5 which will keep the Postpartun Depression Identifier at 4 weeks, we need to work to get those involved in care for Postpartum Women struggling with disorders talking with each other instead of at each other or indirectly with each other via research, peer support survivors, and trainers, etc. But how do we do this?

How do we get the researcher to share with the Clinician their goals, interests, and conclusions? How do we then get the Clincian to spark interest in the Medical non-specialist Practioner to learn about Perinatal Mood & Anxiety Disorders? Then how do we plug in the Peer Advocate and the patient? How do we open the discussion between Professional, Peer Advocate, and patient? How do we keep the communication going once it’s started? What will it take? How many more tragedies must we endure before everyone involved is ready to talk and on the same page?

Enough is enough. We need to stop talking at each other, around each other, to each other and instead talk WITH each other. Until we do, innocent women, children, and families will continue to struggle, suffer, and possibly even die. I am not willing to let that happen. Are you?

Speak up. Say something. EVERY Word makes a difference. Every.Word.

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Therapy and the Postpartum Woman by Karen Kleiman


Karen Kleiman, a wonderfully dedicated therapist to the PPD world,  has authored yet another wonderful book, Therapy & the Postpartum Woman. Available for pre-order now,  this book will release in September and is written for the benefit of both clinicians and women with PPD to maximize the therapy experience on both sides. Click here to pre-order: Therapy & the Postpartum Woman

Here’s an excerpt of what Shari Lusskin, MD says in the foreword of the Therapy & the Postpartum Woman:

Ms. Kleiman presents a theoretical framework in which the therapist “mothers the mother” by acting as the “good” mother, who “must achieve that equilibrium between absolute support and appropriate boundaries.” Using compelling patient narratives, she demonstrates just how to achieve that balance in order to teach the patient how to develop confidence in her own skills as a mother. There is a treasure trove of “clinical pearls” in this eminently readable book, which even the most experienced clinician will be able to use right away. For those new to the field, and for patients and their loved ones, the book offers a wealth of information on the nature of postpartum depression as a medical illness and the psychosocial issues that arise when a woman is faced with caring for a baby. Ms. Kleiman describes how the medical community tends to minimize the complexity of these issues and use a “one size fits all” approach to treating depression. Readers will learn to be more effective advocates for proper treatment of perinatal depression. Therapists will also learn how to draw from their own experiences to facilitate the human connection between therapist and patient at a time when women feel isolated by shame and insecurity. Together, the therapist and the patient can work towards discovering the innate resilience that has allowed women to raise children even in the most extreme circumstances. Ms. Kleiman has developed a humanistic approach to psychotherapy for postpartum mood disorders that gives recognition to psychodynamic theory, but then uses many cognitive–behavioral techniques to reach well-defined goals. Therapy and the Postpartum Woman is an elegantly written book that not only offers practical advice but also does so in a way that will touch the lives of both patients and therapists. It is destined to become a classic for those experiencing or treating perinatal mood disorders.