Jerusha Clark

For Jeramy Clark

There is no one in the world I'd rather dedicate this book to than you. You vowed to love me in sickness and in health, and you have. Thank you. With everything I am, I love you.

Acknowledgments 9

Introduction 11

CHAPTER ONE: My Story 13

CHAPTER TWO: Postpartum Depression and the Body 31

CHAPTER THREE: Postpartum Depression and the Mind 61

CHAPTER FOUR: Hope for Hurting Husbands 87

CHAPTER FIVE: The Pain of a Parent 115

CHAPTER SIX: Familial Fallout 135

CHAPTER SEVEN: A Faithful Friend 149

CHAPTER EIGHT: Spiritual Implications of Postpartum Depression 161

CHAPTER NINE: Balancing the Body 179

CHAPTER TEN: Transforming the Mind 213

CHAPTER ELEVEN: Understanding Postpartum Psychosis and Suicide 235

CHAPTER TWELVE: Moving Beyond 253

APPENDIX A: Helpful Verses 273

APPENDIX B: More Helps for the journey 277

Notes 287

About the Author 299

Many thanks to ...

JAC and LeAnn Redford, Jessica, Jonathan, Ian, Spence and Rona, Nan and Art. When I was in great need, you were there. You did what you could, and often so much more than I could have asked for. I am deeply grateful to be part of our family.

Louie and Louise Moesta, Cameron Germann, Heather Caliri, Kathy Hansen, Kathy Moratto, Kristina Sklar, Katie Dorband, Kathy Walton, Todd and Gina Hoyt-for ministering to me practically, prayerfully, and powerfully.

Penny and Tom Anderson, who show love in countless ways, even when things appear to be at their worst.

Dr. Arlys McDonald. Jesus used your kindness and counsel to transform me.

Donya Duggleby, a woman after God's own heart. Thank you for understanding and challenging me - first as a professional, then as a friend.

Dr. Earl Henslin and Dr. Daniel Amen, whose wisdom and experience have shaped my life and work.

Dr. Steven Rudolph and Dr. Richard Putnam, for helping me learn to care for my body well.

Amy Rewa, Patty Branstetler, Karen Day, Heidi Faulkner, Victoria Fritch, Becky Dean, Angela Vincenti, Joey Rewa, and Dennis Keating, without whom this book would not be.

Dr. Phil Yphantides, for reading the manuscript with a keen eye for detail. Jeramy and I treasure you and Betsy.

Rebekah Guzman and Kris Wallen, for going to bat for me and for this book. You are more than colleagues; you are friends.

Those who brought meals, prayed for our family, and supported us during some very dark days. I cannot name you all, but I am thankful to and for you.

The Lord of my life, my Creator, Sustainer, and Healer. Thank You for loving me as I am. Use this book for Your glory and the benefit of Your people.

Hello. My name is Jerusha Clark. I'm married to a wonderful man- a pastor of spiritual growth. I am the author or coauthor of nine books, including three best sellers. I graduated from college summa cum laude in three years, with two majors. I was valedictorian of my high school and voted most likely to succeed.

I have also been severely depressed. I've been hospitalized in a psychiatric ward not once but twice. I understand what it feels like to want the pain to end so badly that death looks like the only option. This crushing darkness initially descended on me during what everyone seemed to think would be the happiest time of my life-the months just after my first child was born. Instead of reveling in the excitement of being a new mom, I battled a deep and suffocating despair that I pray no one else will have to endure. And yet, through it all, I've been rescued and healed and redeemed by the God who created me and loves me passionately. I know He is currently writing a similar story of anguish and restoration in the lives of many others. Maybe He's doing so in your own circumstances.

This book begins with the story of my journey. I want to share the sometimes-difficult details of my depression with you, hoping you'll see that no matter what you're facing, you are not alone. The depths to which I have sunk, the scars I bear are testimony-not to the agony of depression but to the awesome power of the One who is close to the brokenhearted, the God who promises to deliver you, the God who set me free.

My experience, however, is only a small part of what I hope to communicate. God has lifted many others from the pit of postpartum depression, and I want to tell of His victory in their lives, too. Together we will also explore facts and fiction about the physiological, psychological, and spiritual aspects of postnatal disorders.

Because the valley of suffering is a challenging one to navigate, I desire to be a guide for you-whether you are struggling with postpartum depression or walking alongside someone who is. If you are a loved one who doesn't know what to do, where to turn, or how to make things better, this book is for you. These words are for all who seek hope and help in the heartache of depression.

Within the pages that follow, you will find medical information and spiritual encouragement. God fashioned every human with a mind, body, and spirit wholly and inseparably integrated. The deepest of wounds-depression included-impinge simultaneously on the psyche and soul. Caring for those in pain fails if we doctor the body but ignore the mind. Healing falls short if we minister to the soul without treating the body. That's why this book will address the emotional, physical, and spiritual dimensions of understanding and treating postpartum depression.

With humble gratitude, I offer this work to you and, moreover, to my Savior. Blessed be His name!

I'll never forget the trouble, the utter lostness, the taste of ashes, the poison I've swallowed. I remember it all - oh, how well I remember - the feeling of hitting the bottom. But there's one other thing I remember, and remembering, I keep a grip on hope.... Because of the LORD'S great love we are not consumed, for his compassions never fail ... great is [his] faithfulness.

- LAMENTATIONS 3:19-21 (MSG); 22-23 (NIV)

I sat in the emergency room of Memorial Hospital, staring blankly at the stark white walls. My husband, Jeramy, sat beside me, making calls from his cell phone.

Snippets of his conversations floated through my mind, but I couldn't concentrate long enough to figure out what he was actually communicating. "Yeah, her mom is with Jocelyn." "No, I don't know what's going to happen next." "Dr. Harvey told me to get her to the ER right away."

I didn't know or care whom Jeramy was talking to. I just wanted everything to go away. I desperately wished I could disappear and never come back. I don't think I really wanted to die, but at that moment, death seemed like the only way to end my pain.

Just four months earlier, my life had been flooded with light. As I neared the end of my first pregnancy, euphoria swept over me. By seventeen weeks, Jeramy and I knew we were having a little girl, and I prayed for Jocelyn by name from that moment on. I had already lifted her up hundreds of times since my doctor confirmed that a missed cycle meant this precious little one was on her way.

Lest you think I escaped the pain of pregnancy entirely, let me assure you I experienced my share of nauseated exhaustion. However, those five rough months at the beginning had faded to a distant memory by the time I hit the latter half of my second trimester. Golden days of joy followed, marked by the thrill of her quickening, the excited planning and anticipatory nesting, even (or so I was told) the much-talked-about glowing. In all my life, I had never felt better.

Somewhat ironically (since I had struggled with poor body image in my teens and early twenties), I loved my blossoming body. Feeling Jocelyn dance around inside me-there really is no other way to describe how she moved within my womb-was hands down the most amazing experience I'd had up to that point. By the thirty-sixth week, Jeramy and I could watch our little girl barrel roll across my belly. Everything seemed miraculous and beautiful.

Delivering Jocelyn was a little less than ideal. Relatively early on in my labor, the fetal monitor keeping track of her heart rate indicated that our daughter was "in distress." My doctor whisked into the room and informed me that she wanted to start a Pitocin drip. This would help Jocelyn arrive faster, she explained. No problem, I thought. To me, that only meant Jeramy and I would-sooner rather than later-get to meet the girl we'd been waiting forty weeks to welcome into our family.

Dr. Schmagel never had the chance to induce a speedier labor. Before the nurse could get the IV connected, the whole room exploded with beeping, and, like a scene from some hospital television drama, nurses and doctors started rushing around, shouting things and telling my husband to "put some scrubs on ... now."

Within thirty minutes, a team of physicians brought Jocelyn into the world via emergency C-section. This was not what I had hoped for (I was one of those arguably crazy women who wanted to try childbirth without medication), but I was more excited about meeting Jocelyn than I was about going au naturel. To be honest, the biggest reason I didn't want to have a cesarean birth was that I had read C-section moms had a harder time both recovering and losing their pregnancy weight.

Such thoughts, however, flew entirely out of my mind when the hospital staff placed Jocelyn in my arms. I cradled her tenderly, if a bit uncertainly, and began to nurse her for the first time. The reality that I'd helped give life to this tiny, beautiful baby nearly overwhelmed me. Even more so than in pregnancy, the very air I breathed seemed saturated with wonder and awe.

Jocelyn was born in mid-November, and with Christmas so close, my entire family-parents, two brothers, sister and her husband-decided to come spend the holiday with us in Colorado. We joyously celebrated the birth of two babies that year: the Christ child and the wonderful daughter He had given us.

After everyone left, there was a bit of a lull, and Jeramy and I struggled, as all new dads and moms do, trying to figure out the whole parenting gig. We really didn't have time to get into a routine though, because my parents called to tell us tickets were on sale from Denver to Kahului, Maui, for a fraction of the normal cost. They promised to pay for the cost of lodging if we could cover our flight to Hawaii. Obviously, this was an opportunity we did not want to miss, so we packed up more infant paraphernalia than we could've possibly imagined necessary and flew across the Pacific with our eight-week-old in tow.

While there, Jocelyn slept incredibly well, and I ran every morning. Day after day, I watched the sun spill over misty mountains, awakening the steely blue of Kapalua Bay with breathtaking beauty. How could I not feel thrilled with how things were going? How could I be more blessed? I remember thinking as I crested Pineapple Hill and saw the glistening sea spread out before me.

Looking back, I can see red flags that might have alerted me to the fact that all was not as fantastic as it seemed. When I pumped milk so my parents could feed Jocelyn while Jeramy and I went on a date, it looked a bit blue, kind of like skim milk does in bright light. But since Jocelyn nursed well and was growing, I didn't worry about it too much.

Our troubles started on the way home from the Denver airport, when we stopped for lunch with friends who came to retrieve us. Because I wasn't practiced enough to nurse successfully in public, I tried to pump in the Red Robin bathroom so I could give Jocelyn a bottle. It was a complete fiasco. Less than an ounce was expressed after several frustrating minutes. I chalked it up to being exhausted after a red-eye flight; still, we all had to leave the restaurant without eating. This was hardly normal.

When we returned home and I was rested, I thought once again that things could hardly be going better. Jocelyn was practically sleeping through the night. I prayed or read Scripture while I nursed her. I felt like one of the "lucky ones." Friends also complimented me on how great I looked after delivering my first child. I felt encouraged by their attentions and worked hard to lose all my pregnancy weight. I remember running on my treadmill while Jocelyn napped, again feeling fantastic about how everything was going.

In the beginning of February, I started having more frequent problems with breast-feeding. Jocelyn would either want to nurse for an hour or reject my milk altogether. I called the La Leche League and tried to get some advice, but the suggestions they gave me didn't resolve anything.

During this time, Jeramy remembers coming home from work finding me in the recliner, rocking Jocelyn back and forth and weeping because she would not eat. My own memory of those days is rather fuzzy, but I do recall an increasing anxiety and sadness slowly overtaking me. I worried that maybe I couldn't handle being a mom, especially if I couldn't feed my own child. I don't know exactly why I equated breast-feeding with good motherhood, but that thought was emblazoned on my mind. How-in such a short span-could things have gone so terribly wrong, I wondered.

Near mid-February, I visited Jocelyn's pediatrician and told him what was happening. He asked me to come in and weigh Jocelyn, then nurse her, then weigh her again. This, the doctor told me, would reveal if she was getting enough nourishment. After that, he wanted me to pump some breast milk and bring it in for evaluation. I remember crying at home, trying to pump and failing miserably. Jeramy and I went to Babies R Us and bought a different breast pump, thinking maybe the first one was defective. It wasn't. My milk was simply drying up. Even when I was able to pump a few ounces, it looked almost clear. The nurse practitioner I showed it to called mine "nonfat breast milk." Needless to say, this is not an encouraging thing for any first-time mom to hear. It's especially distressing when the doctor continues by informing you there is not enough fat on your own body to sustain healthy breast milk.

At the time, I didn't know that people suffering from postpartum depression often lose weight with abnormal speed. Unaware of this, I simply assumed everything was my fault. I immediately regretted exercising so much and beat myself up internally for "causing this whole situation." I honestly had no idea that a mother actually needs more calories while breast-feeding than during her pregnancy. If only I had read more about nursing, I wailed inside. If only I had been more aware of the signs that flared up early on. If only, if only, if only ... A suffocating sense of failure and disappointment haunted me by the end of February. Though I didn't realize it at the time, my feelings of inadequacy and anxiety extended far beyond breast-feeding.

There was a small glimmer of hope when the doctors told me I could boost my breast milk by eating a high-calorie, high-fat diet. I did my best, though my appetite was next to nothing. I gagged down huge meals. I drank loads of Mother's Milk tea and tried to do everything the books and nursing experts told me to do. Still, I lost more and more weight, dipping below my prepregnancy numbers. Again and again, Jocelyn and I struggled to nurse. Desperate to "make things right" and terrified I wouldn't be able to, I started to obsess over the thought that if my milk was insufficient for Jocelyn, I was insufficient for her.

March dawned and found me journaling prayers like "Lord, I need You. I cannot do this on my own. I need Your help. Just a ray of light and truth in my mind. Please, Lord Jesus." I kept begging God to help things turn around. I became convinced that He was punishing me for my vanity (wanting to return to my prepregnancy body) and pride (thinking how great everything was going), as well as the sins of my past (most particularly, my struggle with an eating disorder).

I battled constant guilt about my thoughts. Awhile back, while rereading my prayer diary from those awful days, I found this plea: "Lord, please forgive me. I have had evil thoughts about my daughter [not wanting her, wishing she had never been born], calling her terrible names in my mind.... Forgive me for not loving her as I should." I had no clue why these things were in my mind, and I was too terrified by them to confide in someone who might have been able to identify my downward spiral as postpartum depression.

Though I begged God to convict and heal and help me, though I promised Him I would repent of everything and anything, I sensed only silence. I wanted His blessing back, but utter despair descended on me instead, bringing with it more dark thoughts and restless nights. Even though Jocelyn slept peacefully for eight or more hours a night, I tossed and turned, battling waking dreams filled with anxiety and confusion.

The second week of March I can only describe as horrific. Crazy images and ideas plagued me. My mom, concerned about what I was telling her in our phone conversations, flew to Colorado to help. She arrived, and I unraveled even further.

After a week of sleeping less than two hours a night, I kneeled beside Jeramy's side of our bed and pleaded with him to send me somewhere I could "get better." I didn't know where that would be, but I told him maybe I needed to enter a treatment facility for eating disorders. Thinking that losing weight so fast had triggered these crazy thoughts and feelings was the only thing I could come up with. I knew nothing of postpartum depression, or clinical depression of any kind for that matter.

Jeramy didn't understand what was happening any more than I did. When I handed him the insurance booklet I had pulled out so we could talk over costs and coverage, he became angry and threw the stapled pages back at me. "How could you do this to us?" he asked. Looking back, I know he was confused and frustrated, believing as I did that I had chosen all of this.

Over the next couple days, I entered an almost comatose state, unable to answer Jeramy's questions and staring off into space a good deal of the time. My mom and husband had to physically put me in the shower one morning. It didn't matter to me if I was dirty, let alone if anything got done around the house. I was still nursing, but I had stopped caring even about that. An oppressive numbness dragged me down, down, down.

Finally, it occurred to me that there was a way to end this pain. I could escape. I could free everyone from the burden of having to deal with me. Jeramy could remarry and find a better mother for Jocelyn. I started telling my mom that everything would be better if I just died.

Not knowing what to do, my mom and Jeramy decided to get some professional advice. They called a counseling hotline and the psychologist who had helped me recover from my eating disorder. Both told my husband the same thing: "Your wife is suffering from postpartum depression. You need to get her to the hospital immediately."

That's how I came to be at Memorial Hospital's ER, waiting for a doctor to evaluate me. Instead, a social worker came to take an inventory of my symptoms. She asked me quite a few routine questions, and I tried my best to sound "not crazy." Then she asked me two questions I will never forget: "Do you have a plan for hurting yourself?" and "Have you ever thought of hurting your baby?"

I wanted so badly to say no, but I couldn't. I had planned to take pills to end my life, and I had imagined-though I hated the thoughts and tried desperately to rid myself of them-hurting Jocelyn. Ashamed and broken yet still agonizingly numb, I waited while the woman spoke privately with Jeramy.

He later told me the social worker informed him, "In my twenty years of doing this, I've seen a lot of cases. Your wife has the most severe postpartum depression a woman can have." She gave Jeramy the option of driving me to the mental-health facility or having me transferred there by ambulance. There was no option to not be placed on a seventy-two-hour psychiatric evaluation.

One might think that a once-competent (almost fiercely so) woman would resist being taken to a psych hospital, but I put up no fight. I think-though it's difficult for me to remember exactly-that the predominant feeling I had was relief. I was willingly admitted on March 13, my daughter's four-month birthday.

The memory of my time in the hospital is mostly an incomprehensible blur, but I do recall meeting with a psychiatrist. He diagnosed me with major depression, compounded with borderline obsessivecompulsive disorder. I also remember being placed on medications, which they told me would alleviate my symptoms and help me sleep.

After three days, I was released into the care of my husband and mom. I didn't feel much better, but I was no longer seriously contemplating ending my life. In retrospect, I should have seen this as a positive sign, but at the time, no light penetrated the tunnel of my gloomy vision.

In order for me to be released from the hospital, the state mandated that I make follow-up appointments with a psychiatrist and a counselor of my choosing. I was in no position to look for a therapist, so Jeramy collected some names and numbers. We went to see one woman together, but it was a miserable experience. After that, I had less hope for the future.

Over the next two weeks, my physical condition started to improve. I was sleeping soundly at night, felt hunger again, and could concentrate on a conversation or task. Apparently, these mysterious medications were doing something. My emotional state, however, was still rather precarious (random things could tip me into deep despair), and my spirit felt weak and terribly confused.

Then I went to see Donya Duggleby, a marriage and family therapist who came very highly recommended. Waiting for my first appointment with Donya, I filled out a questionnaire she had given me. There were fill-in-the-blank questions like "Right now, I think God is with me" and "I feel about myself." I couldn't fit all the nasty words that described what I believed about myself and what God thought about me.

After three months of therapy, Donya told me that our first session was very sad for her. I was a shell, she remembered, a shadow of someone who once knew light and love. I praise God that He did not leave me in that place.

Though there were many things that came up in counseling, issues that required dramatic shifts in my thinking and a lot of difficult emotional and spiritual work, I loved meeting with Donya. Between the consistent therapy I received from her and the medication I took, I improved rapidly. In fact, eight weeks after my hospital stay, I felt like myself again. I was also incredibly hungry for God. I couldn't get enough worship through music, prayer, or the Word. My heart was so sensitive that I would weep, this time with joy and gratitude, at the slightest prompting from the Spirit. I loved our daughter with everything in me. Truly, it was one of the most beautiful times of my life.

When Jocelyn was seven months old, and I had recovered almost entirely, I had my first menstrual cycle after pregnancy. And then, in her eighth month, I didn't have one. Not thinking much of it since I had always had irregular menstrual cycles, I went along my merry way. Just to be certain, though, I took a pregnancy test. You can imagine my surprise when I discovered I was pregnant again.

Perhaps you think-and understandably so-that I might have been nervous or concerned about getting pregnant again. On the contrary, I felt euphoric. Surely God wouldn't have me go through the same valley again, I thought. I had learned my lessons; this was my chance to "do things right." I went off the depression medication and prepared to take the best possible care of my body during and after pregnancy.

In the midst of finding out I was pregnant and caring for a ninemonth-old, my husband was offered a job in California, only ninety miles from my parents and a one-hour plane ride from his. We were thrilled and packed our life in a North American moving truck headed west.

Relocating was tough in many ways, and I felt pretty overwhelmed while working from home part time, chasing after Jocelyn (who, to this day, slows down only to sleep), and trying to settle in a new home and community.

I didn't have much time to think about it, though, because just a short while later I delivered Jasmine Alyssa, our second daughter. We didn't know this time around I was pregnant with a girl, so meeting Jasmine for the first time was a different, though equally wonder-filled experience.

Convinced that if I protected my breast milk things would go better, and naively assuming that God wouldn't ask me to endure postpartum depression again, I did everything I could to make sure things went differently this time around. For six months, my efforts seemed to pay off.

Then, three things happened in quick succession: I got a terrible case of strep throat; my computer-on which Jeramy and I were supposed to be writing our fourth book-contracted forty-one different viruses; and our home sprung a slab leak in its foundation, which would require us to demolish and rebuild the majority of our kitchen.

I don't know if it was stress or the strep throat that started causing my milk to dry up, but it did-and very quickly. I made the difficult but necessary decision to stop nursing. Only a couple days after starting to wean jasmine, I felt like I had fallen off a physical and emotional cliff. I spent one night completely awake and determined the next day to strike preemptively and get back on medication. I made an appointment with my doctor and asked her to prescribe an antidepressant for me. I did not want to mess around and descend into the kind of despair I faced before.

Unfortunately, things got worse before they got better. Jeramy went away with some of his staff members for a retreat and got a call from my mom, asking him to come home early. I was experiencing full-blown postpartum depression once again. Spiritually, I was crushed. I didn't understand. Why would God want me to walk through the valley of the shadow of death again? Hadn't I learned from the first time around? Hadn't I tried to do everything right? How could this be?

A few days later, Jeramy received a phone call from Dr. Earl Henslin, a psychologist who knew my family and had been apprised of my situation. He told Jeramy about a procedure called single-photon emission computed tomography (SPECT) scanning, which would allow medical doctors to look at what was going on in my brain. Rather than guessing which parts of my brain were triggering this postpartum depression, SPECT scanning would be able to target the areas of my brain that were overactive, underactive, and functioning correctly.

After my SPECT scan at the Amen Clinic, I met with a psychiatrist who relayed the results to me. Dr. Reed basically told me my brain was on fire, overworking in key areas related to emotional stability and a physical sense of well-being. She made several recommendations, encouraging me to continue taking the antidepressant, add another medication-a mood stabilizer, she called it-watch my diet, exercise, and take a fish-oil supplement. I honestly didn't understand most of what she told me, as I was hardly functioning on full mental capacity. I am also chagrined to admit that I didn't thoroughly read the seventeen-page report the Amen Clinic sent home with me. Looking back at that version of myself, I feel sorry for her, confused and trying but not quite able to grasp what exactly was happening. None of it made sense to my nonmedical mind.

I did make an appointment to see a psychiatrist in my area, however, and trusted that he would be able to make sense of the wealth of information my scan and the accompanying report provided. When I met with this doctor, I gave him a photocopy of my entire Amen Clinic file. He looked at it and then at me and said, "I guess you really have to know what you're looking at."

Dr. Smith, we'll call him, asked how I was feeling, and quite genuinely I told him I was feeling better. He informed me that the antidepressant was working and told me he didn't think I should add another med "until we see how things go." Even though Dr. Reed at the Amen Clinic had told me that, in my case, a mood stabilizer was necessary, I followed Dr. Smith's advice. I didn't really want to take another medication anyway. After all, I was improving. Changing my diet, exercising, and taking the fish oil were pretty easy steps to follow, but paying for and using a drug I didn't really need seemed foolish.

Over the next couple months, I felt great physically, emotionally, and spiritually. So, roughly a year after I delivered jasmine, I decided that I probably didn't need an antidepressant anymore. I never consulted with a doctor; I just started taking less, not caring if I missed a dose, and so forth. Little did I know what serious consequences would follow these seemingly small decisions.

Slowly, almost imperceptibly, I started to decline. I couldn't deal with stress as well; I didn't look forward to the day ahead, even if I had plans with friends or something to do that I would normally consider enjoyable. Sometimes I didn't want to get out of bed in the morning (though I forced myself to), and I felt exhausted no matter how much or how little sleep I got. I was sinking into depression once again, but I couldn't see it. Maybe I just didn't want to.

Even after experiencing two bouts of postpartum depression, I had never educated myself about it. In 2003, relatively little information was available for the general public, but what was out there, I never bothered to seek. Because of that decision, I didn't know selfmedicating (whether taking more or less of your prescribed drug) can be deadly. I didn't know that those who have had one or more episodes of major depression are at exponentially greater risk if they discontinue their medication without medical consult, or without staying the course of time required for an antidepressant to take full effect.

I now see that I didn't want to educate myself. Postpartum depression was the last thing I would've chosen to think or read or talk about. I wanted all of that behind me, a part of my past that would stay there forever.

In my case, ignorance was not bliss. Instead, it was life-threatening.

By May, I was having thoughts I can now identify as distorted and dangerous but, at the time, I believed were "from God." As I had felt after delivering Jocelyn, I thought everyone would be better off without me. This time around, however, a new idea struck me: God wants me to take my life. I became convinced that He would be pleased if I relieved everyone of the unbearable weight of my life.

These were the darkest days of my life ... darker than even that horrid time after Jocelyn was born, darker by far than the days after Jasmine came into the world. I was ashamed because I didn't think the despair I felt could be connected to a postpartum condition. I was racked with guilt because I was depressed "even though I didn't have a reason to be." I didn't think I could-and didn't even desire to-tell Jeramy or anyone else what I was feeling. They don't need this from me ... again. I'm going to have to deal with my problems alone.

And so I planned to end my life.

One night, while everyone slept and the house was quiet, I crept from my bed and slipped into Jocelyn and jasmine's room. I said goodbye to them and kissed them lightly, so as not to awaken them. I didn't say farewell to Jeramy, fearing that I would disturb him and be unable to complete my mission.

I stood at the kitchen counter in the pitch-black stillness, slowly counting pills from a bottle of pain relievers. I wanted to make sure I consumed enough to get the job done. I tell you this simply, and somewhat clinically, because even now, many years later, it's the only way I can deal with the terrible reality of those moments.

Then a light flashed on. Jeramy stood by the switch, a confused look on his face. He asked me what I was doing, and, at first, I tried to make up a lame excuse for standing in the dark with a pile of pills in front of me. When he pressed the matter, knowing full well what I intended to do, I begged him to help me and make it look like suicide.

He immediately called Penny Anderson, one of our closest friends, and asked her to come and stay with the kids. Jeramy tells me I continued to say crazy things, most of which I cannot recall. Today, I am glad to have blocked them from memory. When Jeramy left me alone for a moment, I desperately tried to find another bottle of pills. My husband called 9-1-1, and the police showed up at our house within moments.

I was taken first to the ER of our local hospital, then to a psychiatric hospital called Aurora. The days I spent there were a mixture of pain, shame, and confusion. Even after being released, I planned to attempt suicide "for real" this time. When my sister arrived to pick up the kids and care for them over the weekend, I once again said goodbye in my heart.

That night, Jeramy asked me if there was anyone he could call for help. I don't know why, since I barely knew him, but I told him he could call his boss and our senior pastor, Dennis Keating. The Holy Spirit must have given Dennis special insight that night because he asked me point-blank if I still had plans to hurt myself. Against my will, my mouth said yes.

Jeramy looked shocked and frightened, and, with Dennis's help, he spent the next few minutes collecting all of the drugs in our house. My heart breaks to think of the pain Jeramy must have been feeling, the anger and confusion. I hate that he had to endure this with me, but the reality is depression doesn't affect only the woman who suffers. All those who love her agonize with her.

In the midst of this horrible trauma, God revealed His presence and provision for us in a powerful way. Jeramy received a call from the foundation that six months prior had enabled me to get the SPECT scan done. The woman asked how I was doing, and Jeramy told her how terribly twisted things had gotten. She immediately began to work on connecting me with a psychiatrist who understood SPECT reports. She also got me the name of a psychologist who was familiar with SPECT scanning and could work with the new medical doctor I'd be seeing.

This time around, my psychiatrist immediately prescribed the mood stabilizer I should have been taking since the time my brain scan had indicated it. How could I have known that the combination of antiseizure medication and an antidepressant would calm my brain down enough not only to let me feel myself again but to stay in that healthy place?

Within weeks, I was back in the psychiatrist's office, telling him that if I ever doubted whether I needed medication to heal from depression, the quick and complete efficacy of the drugs provided exhaustive proof. Dr. Rudolph told me that I had likely never fully pulled out of my first postpartum depression, having gotten pregnant so soon after and changing the chemical balance of my brain so dramatically and frequently in two and a half years.

I also sat in Dr. Arlys McDonald's office week after week, working through the soul issues that this latest bout of depression brought up. Anyone who has gone through counseling can attest to how difficult it can be to wade through the muck of your past, present, and concerns for the future. At the same time, I found it incredibly healing to evaluate and work on the things God brought up in my sessions with Arlys. What a gift her tenderly spoken words of challenge and wisdom were for me. I remember so clearly getting in my car after one particularly weighty appointment and shouting, "FREEDOM" (a la William Wallace in Mel Gibson's film Braveheart).

I truly understood Scriptures I had read many times before:

You will know the truth, and the truth will set you free. (john 8:32)

He will not crush those who are weak or quench the smallest hope. (Isaiah 42:3, NLT)

Jesus Christ was literally my Savior, my Redeemer. Those words were no longer metaphors for me. They were my very life. They told the truth of my story. Through suffering, God taught me that He is everything He claims to be in the Bible-Healer, Hope, Refuge, Strength, Truth, Peace, Grace, and Love. Oh, such love ... unfathomable, immeasurable, freely given for me.

Today, for you and moreover for His glory, I proclaim what He has done in my life. I also share openly because I want to encourage you who are currently walking through the valley or have endured the pain of postpartum depression, either in your own life or in the life of someone you love.

Over the course of my journey, I have made big mistakes and have done some things right. I have been as low as I can imagine someone going-despairing of my life and actively trying to end it. But God stepped in. He healed me ... body, mind, and spirit. He has restored to me the joy of my salvation and the hope of a future both on earth and with Him in heaven. By His grace, I now offer to walk with you through some important information and potentially challenging ideas about postpartum depression.

No matter where you or your loved ones are at this very moment, I pray you would accept the fellowship of suffering I extend through these words. I ask the Holy Spirit to fill both of us with wisdom and discernment, that this book would touch your heart and mind in just the ways He intends.

In the next two chapters, you will find a description of what postpartum depression (PPD) and other postnatal disorders are, how it feels to experience PPD, and what factors play a role in PPD. The chapters that come after will offer specific counsel and encouragement for different individuals who might be walking with a woman suffering from PPD-the husband, parents and in-laws, siblings, other extended family members, and friends. Even if you do not fall into the audience for which a particular chapter is written, I urge you to read each one of them. The information contained within, both the spiritual encouragement and practical tips, will help you. Perhaps you can also come alongside someone else with ideas and suggestions that can further equip him or her. In each chapter, you'll read stories from people who have been there, stories of hope and healing. Some of my own loved ones will speak through these pages, and you will be invited to "listen in" on conversations I've had with them about PPD.

Chapters 8 and 12 will focus on the spiritual implications of postpartum depression and life beyond PPD, while chapters 9 and 10 present facts about many of the treatment options available today. In chapter 11 we will explore the difficult topics of postpartum psychosis (the most extreme and least common of the postnatal disorders) and suicide.

Even though some of the topics in this book may be difficult for you to read about or understand, I trust that God will reveal Himself and His truth to you. I have prayed often for that very thing to happen.

Praise the LORD, 0 my soul; all my inmost being, praise his holy name. Praise the LORD, 0 my soul, and forget not all his benefits.

- PSALM 103:1-2

Most eagerly expectant parents assume that the birth of their child will bring immense joy and wonder. First-time mothers especially yearn-with an almost aching desire-to hold the baby who has been growing inside them. Many anticipate they'll feel a deeper level of fulfillment and delight than they've ever experienced.

Books that prepare families for childbirth often support such notions. Images of serene moms, peacefully rocking or playing with their babies (who are, by the way, never crying), likewise adorn the covers of glossy magazines. Adorable snapshots of newborns and silhouetted pictures of contented nursing mothers, bathed in soft hues of pink or blue, are prominently displayed on the walls of maternity wards and pediatrician offices. Toward the end of my pregnancy, everything around me seemed to declare, "Motherhood is going to be beautiful, natural, and wonderful."

Having (and then taking care of) a baby, your baby, is an amazing experience. It is also incredibly demanding-physically, emotionally, and relationally. An infant dramatically alters every aspect of a mother's life, and while a new mom (and by "new mom" I mean any woman with a newborn, not just a first-time mother) may feel exhilarated and blessed, she usually feels overwhelmed and exhausted as well.

Nearly all parents of new babies feel drained and pressured. The needs of an infant seem never-ending, sleep deprivation is common, and the mother's body is still trying to heal from the massive physical upheaval of delivery. Raw emotions often lie just below the surface, and an unbidden flood of tears is certainly not uncommon for the mother of a newborn. She may have anxious thoughts as well, concerns about the safety of her child: Is he breathing okay at night? Is she eating enough? What does that cry mean?

New moms often doubt their ability to handle the challenges of motherhood as well. Questions like, Willl be a good" mom? Will this baby ever sleep longer than two hours? and How can taking care of a tiny infant be so difficult and time-consuming? often float through a woman's mind.

Even women who have several other children at home sometimes find themselves "back at square one" when a newborn comes home from the hospital and joins the family. The fatigue, the fears, the frustrations typically associated with first-time motherhood can rush back with unexpected and unwelcome force.

Gratefully, weariness, uncertainty, and worry-all of which are natural responses to the birth of a child-usually subside as the baby grows and the family finds a rhythm that works. For some moms, however, a deeper distress begins to set in. Days drag on. Worry grows into persistent anxiety. The tears don't seem to stop. A heavy and defeating exhaustion descends, making getting up to feed or change the baby-again!-seem too much to bear. Hundreds of thousands of women each year discover that depression, not delight, describes their experience with motherhood.

Postpartum depression can be loosely defined as a state of relentless sadness and/or anxiety, which lasts more than two weeks after delivering a child. I use the phrase "loosely defined" because postpartum depression is significantly more complex than these words might indicate. For instance, the fact that PPD's onset can occur any time up to a year or more after birth complicates people's understanding of the condition, as well as the ability of clinicians to diagnose it.

DID YOU KNOW?

• Sometimes when a mother opts to breast-feed her baby longer than twelve months, PPD - which often coincides with weaning a child - can set in whenever she stops nursing.

• Because of its close association with hormonal imbalance, some experts believe that PPD can afflict women after a miscarriage, stillbirth, or abortion.1

• Postpartum depression often follows the experience of antepartum depression (depression during pregnancy).

• Due to consistent exposure to artificial hormones and psychological stressors, women who struggle with infertility are at a high risk for developing depression. Approximately 25 to 30 percent of women undergoing treatment for fertility are clinically depressed before becoming pregnant, and PPD affects a great number of these women after delivery.2

Before we delve any further into the specific nuances of postpartum depression, I think it's important that we explore how the word depression will be used in this book. According to medical practitioners, depression refers to a broad range of problems with a diverse spectrum of symptoms. It is far more than simply having a bad day, feeling down, or being worried about something specific. Clinical depression is a physiological condition that affects every dimension of a person's life-mental, emotional, physical, and spiritual.

Although the word depressed is widely used to describe any unhappy mood or emotion, depression is actually a very serious, potentially lifethreatening illness. Depression comes with a pervasive and even paralyzing sense of sadness that will not lift, often for weeks or months, sometimes for years. Persistent anxiety and profound apathy can characterize depressed individuals. Depression changes how a person thinks, acts, and relates to others. It alters the cycles of sleep, appetite, and libido in the body. When a woman suffers from depression, she may try to cheer herself up or snap herself out of it, but if the depression is clinical, such efforts are usually met with agonizing failure.

Sometimes, instead of squarely facing depression, a new mom will try to blame her feelings on circumstances-"If only the baby would sleep longer than three hours, I'd feel better." "If only my husband helped out more often, I'd bounce back from this." Loved ones may be tempted by similar thoughts: "If only she ate better or exercised more, she'd get back to her normal self." "If only she'd look on the bright side-she's got a healthy, beautiful baby, for goodness' sake-then she'd get over this."

While it may be accurate that certain changes in her environment or situation may help a woman's spirits to lift, if she's truly depressed, the results of such alterations will only be fleeting. Believing that "if something were different, I/she wouldn't be depressed" is almost always a damaging misconception.

Sadly, many other myths and misperceptions about depression are common as well. Despite increasing public awareness and exposure to physiological and psychological information, some people continue to see depression as a problem of the self-consumed or as an excuse used by people for their laziness, bad moods, and erratic behavior.

Others believe that because postpartum depression has received increased media attention in the last ten years, women are more likely to believe they are suffering from it. Some claim the poor nutritional value of our mostly processed-food diets or other toxic environmental agents have caused a spike in cases of clinical depression.

The truth is, we cannot conclusively determine whether postnatal disorders are "on the rise" or occurring at the same rate as in earlier days. Asking, "Did mothers in biblical times face this?" "What about women a hundred years ago?"-while interesting questions-does not help families currently struggling. We do know that serious research in this field has only recently expanded, and that makes it difficult to determine exactly why we're seeing more reported incidences of PPD.

The word reported is key in this equation. In the past, women were discouraged from talking about their difficulties, especially if they seemed "emotional" in nature. Only the most extreme cases of postnatal disorders, usually those ending in tragedy, received attention. We can be relatively confident that increased awareness of postpartum depression has given women more freedom to admit they're suffering. I believe we can also acknowledge that the way many live in today's day and age-with high stress levels and, yes, with less wholesome eating and exercise habits-does play a role in the number of people who battle depression. That said, it's still a dangerous myth that twentyfirst-century women are "quicker to believe" they have PPD. It's also a damaging misperception to tell new moms that if they just ate organic foods and took the right supplements, they wouldn't be or become depressed. We need to be very careful to evaluate what we think about postnatal disorders, as our beliefs determine what kind of care and compassion we will extend.

In the past, Christians have been especially hard on depressed people, telling them their feelings are a result of past, or an indication of present, sin. Believers often feel they "shouldn't" or "aren't allowed to" be depressed. Some wonder if being depressed means their faith isn't real; others question whether spiritual forces are oppressing them. Depressed moms have been instructed to pray and read their Bibles more, with the promise that if they would, their depression would lift.

Many doctors, counselors, pastors, and sufferers of depression have worked tirelessly to correct these misconceptions. Still, a survey conducted by the National Mental Health Association revealed that Americans are more likely to view depression as a sign of personal weakness than as a medical condition.3 Tragically, people with mental-health issues are sometimes rejected, scorned, and treated as second-class citizens. Someone who believes people should be able to "get over" their depression rarely has compassion or mercy for a depressed individual.

Postpartum depression shares many of the same symptoms as forms of depression experienced by the general population, but, because the onset of PPD occurs in conjunction with many other physical and emotional challenges associated with new parenthood, postpartum depression manifests itself in unique ways. PPD also differs from person to person; no two women experience PPD in exactly the same way.

Unfortunately, for both the new mom and her doctor(s), this makes diagnosing and treating postpartum depression more difficult. One medical study, which followed women through their postpartum period, documented the challenges of identifying PPD. Despite the fact that women in this study saw their physicians multiple times during the first months after delivery, fewer than 10 percent of women with postpartum depression were correctly diagnosed. As the postpartum period continued, doctors apparently became better able to recognize PPD. Still, nearly half of the cases were never identified.'

Furthermore, because healthcare professionals are trained to expect that all mothers experience a certain level of emotional overload in the days after childbirth, a tendency to dismiss or minimize a struggling woman's condition has developed. Many doctors are simply ill-equipped to recognize PPD and care for the individuals suffering from it. Just because a physician has told you, or a woman you love, that feelings of sadness and being overwhelmed are normal for all new moms, this does not mean that the internal battle you are, or she is, facing will die out on its own.

It's already difficult for most mothers to admit they're not doing well. Shame and guilt often haunt women with postpartum depression. I should be happy, they reason. Everyone else seems able to take care of themselves and their babies. Whats wrong with me?

If a new mom finally confides in a loved one or doctor, being brushed off or sent away may cause her to become even more hesitant and ashamed to ask for help. This is precisely what happened to author and PPD survivor Sue McRoberts. In her book The Lifter ofMy Head, McRoberts wrote,

I was ignorant of PPD, and my obstetrician treated me as if I was an idiot. He gave me a very low dose of antidepressant and said literally, "Get over it, its just a baby ... quit crying already. You'll feel better if you go home and have sex."I'm not kidding you, thats what he said! I had no reason not to trust him, so I believed I could just `get over" my depression.5

What's most tragic about interactions like this is that, if properly diagnosed, postpartum depression is very treatable. With the right combination of treatment methods, the vast majority of women who receive help for PPD recover and feel like themselves again. McRoberts went home and tried to follow her physician's advice, but instead of "snapping out" of her sadness, she sunk further and further into the quicksand of despair. Sadly, McRoberts's is not an isolated experience.

Without treatment appropriate to her situation, a woman with PPD may endure months of painful confusion or hopelessness. Women cannot simply "get over" postpartum depression (or any clinical depression, for that matter). They cannot think, pray, or even medicate their way out of it.

PPD must be treated as a disease that affects every aspect of a woman's life. That's why, in this book, we will explore the physical, emotional, and spiritual implications of postpartum depression. In the chapters to come, we will focus more concertedly on the psychological and spiritual components. For now, we'll start with the physiological dimension.

PPD and a Woman's Body

The National Institute of Mental Health reports that women are twice as likely to experience depression as men are.' Observation and experience further reveal that women are especially susceptible to chemical imbalance during their childbearing years. In fact, some studies suggest that, in the months following childbirth, women are actually twenty to thirty times more likely to suffer from depression than at any other point in their lives.'

Determining precisely how many women in the United States suffer from postpartum depression has been somewhat difficult. In April 2008, the Centers for Disease Control (CDC) released its most current statistics on postpartum disorders. According to this report, titled "Prevalence of Self-Reported Postpartum Depressive Episodes," approximately 10 to 15 percent of women suffer from a postnatal, which simply means "occurring after childbirth," disorder.8

I see two problems with this statistic. First, these numbers only reflect the self-reported cases. What about all the women who don't know or are too ashamed to admit what's happening to them? Also, numbers like "10 to 15 percent" mean very little to the average person. Please allow me to put this statistic into perspective.

According to the National Center for Health Statistics, there were more than 4.2 million live births in the United States during 2006 (approximately 4,266,000).9 If you lean toward the conservative side of the CDC's recent statistics on postpartum disorders (let's say 12 percent), that means roughly 512,000 women not only suffer through a serious postpartum illness each and every year but also recognize that they need help and report their condition (remember, the CDC statistics were for self-reported cases.)

How does this compare with the number of Americans diagnosed with other illnesses?

• Each year, approximately 50,000 people are diagnosed with Parkinson's disease.10

• Nearly 250,000 people are diagnosed every year with Alzheimer's disease."

• Roughly 10,400 people a year are diagnosed with multiple sclerosis.'2

• According to the American Cancer Society, 559,650 people died of cancer in 2007.13

That means there are almost as many women (and remember, this star is only for those who admit to it) battling postpartum disorders each year as there are people dying of cancer.

Here's another startling observation that often goes unnoticed: The statistics from each of these other medical conditions represent the general population of both men and women, whereas every one of the more than half a million postpartum sufferers is a woman. PPD is a far bigger issue than most people realize.

In Postpartum Depression Demystified, PPD survivor Susan McCloskey and Joyce Venis, president of Depression After Delivery, Inc. and a registered nurse with three decades of postpartum experience, noted that if self-reported cases and a conservative estimate of undetected ones were combined, we'd acknowledge that nearly 700, 000 new moms would develop postpartum depression every year. This amounts to approximately 20 percent of the female population.14 Karen Kleiman, author and founder of the Postpartum Stress Center, has also worked with families for close to thirty years. In her book The Postpartum Husband, Kleiman estimated that PPD affects up to 30 percent of childbearing women."

The vast majority of women who face PPD are entirely unprepared for it. They may have read all the usual pregnancy books and taken the suggested prenatal classes (most of which only cursorily treat the subject of postpartum depression). Few, however, really consider that they might battle PPD. I remember skipping the brief sections on postpartum depression in my "preparing for motherhood" volumes. I was confident that I would be a happy, well-adjusted mom. As you already know, I was instead one of the many new mothers who battled PPD.

No matter what the precise number of sufferers is, I want these statistics to encourage you in one practical way: You are not alone. Every year, hundreds of thousands of women-along with the people who love them-battle and heal from postpartum depression. What you or your loved one is facing is in no way insurmountable. It may feel like the dark cloud hovering over you will never lift, but with treatment, recovery is not only possible, it's likely.

Because you're reading this book, you've probably identified that you or someone you care about is struggling with postpartum depression. If you're not sure whether the depression is clinical in nature, take a look at the following physical symptoms of postpartum depression. Keep in mind that a depressed woman's symptoms typically begin as relatively mild and worsen over time.

• Chronic fatigue or lack of energy

• Restlessness or physical tension

• Difficulty falling asleep, waking frequently or too early (insomnia)

• Sleeping more than normal (hypersomnia)

• Significant change in appetite (either eating too much or too little)

• Rapid and/or substantial weight gain or loss

• Loss of sexual desire

• Difficulty concentrating (easily distracted)

• Common complaints of headache, back pain, upset stomach, muscle soreness or tension

• Noticeable change in how a woman walks and/or talks (she may seem spacey, restless, slow moving, or frenetic)

This is strictly a list of physical symptoms (we'll get to the psychological symptoms in the next chapter). If you or someone you love suffers from three or more of these for longer than two weeks, immediate medical evaluation is highly recommended.

Before a woman is diagnosed with postpartum depression, however, it's essential that some basic bloodwork be taken. The symptoms of conditions such as hypothyroidism (low functioning in the thyroid gland) and severe anemia (low red-blood-cell count) can mimic those of depression-severe fatigue, lethargy, decreased libido, mood swings, sleep problems, weight gain, irritability, and stress. Consider these facts:

• One in fifty women experience hypothyroidism during pregnancy.

• The level of hormones produced by the thyroid after delivery sometimes drops below prepregnancy levels.

• Poor thyroid production can be exacerbated by the body's increased production of the hormone prolactin (necessary for breast-feeding)."

Clearly, ruling out thyroid and/or other medical problems is important.

Unfortunately, there is no blood test that enables medical practitioners to diagnose postpartum depression definitively. There are, however, other testing methods that can help.

Seeing What You're Up Against

As I mentioned previously, I was fortunate enough to have a SPECT scan. During this procedure, a gamma-ray camera took close to 14,000 snapshots of my brain and formed a 3-D composite picture of my brain's exterior and interior.

Viewing the surface and blood flow of any brain gives physicians a more accurate understanding of the chemical imbalances that can lead to depression. SPECT scanning is a nonstandard form of testing and one with which your doctor may not be familiar.'? In using scans and describing what they reveal, my purpose is not to insist or recommend everyone pursue SPECT scanning. I would, however, like to share with you what a healthy brain looks like, as well as the results of my test, as it gives an effective-and important-visual picture of how PPD changes the brain. For our purposes, we will look only at interior views.

First, let's look at a healthy brain. The white areas indicate where and how much blood is flowing.

Used by permission, courtesy of the Amen Clinic

Now, take a look at my brain. These images were produced shortly after the delivery of my younger child and the onset of my second postpartum depression.

Used by permission, courtesy of the Amen Clinic

As you can see when comparing these two sets of pictures, there are several areas in my depressed brain that have significantly higher blood flow than in a healthy brain. Nor am I alone. In comparing my SPECT scan with the thousands and thousands of other scans performed over the years," clear patterns emerge.

Whenever an area of the brain "gets hot" or "overworks" (as indicated by the markedly intensified "white" activity on the scan), a person experiences disturbances in physical and mental health. Studying the chemical imbalances associated with depression has been an important part of my recovery. I have found Dr. Daniel Amen's and Dr. Earl Henslin's work of particular help, and you may as well.'9 Though this book will not delve into the intricacies of each part of the brain affected by and then contributory to depression, let me give you a brief-put as simply as possible-rundown on what you're seeing.

Imagine the underside view of the brain as a face. Do you see what look like eyes? These are the basal ganglia, a portion of the brain that, among other things, controls the level of anxiety throughout the body. This area of the brain also acts (with another part of the brain called-and labeled on my scan-the cingulate) as a "gear shifter." In the words of Dr. Daniel Amen, best-selling author and pioneer in the use of SPECT scanning, a healthy cingulate and basal ganglia allow someone to be "flexible, adaptable and open to change as needed." Overactivity in either of these sections of the brain can lead to anxiety (including panic attacks), rigid and contentious thinking and conduct, even addictive behavior.20 The brain of a woman with postpartum depression is often "inflamed" in these areas, which is why people with postnatal disorders may act on or experience paralyzing fear and irrational thoughts.

Barely visible on the scan of a healthy brain is the deep limbic system (DLS), the area of our brains that controls appetite, libido, and sleep cycles, along with mood stability and memory processing. In the brain of a depressed individual, the DLS can appear "enlarged" or "hot," as mine did, because it is overworking. (Notice the DLS in the center of the underside view; mine is shaped somewhat like a kidney bean.)

Overactivity in the DLS is largely responsible for the fatigue, insomnia or hypersomnia, weight gain or loss, decreased sexual interest or motivation, and low mood characteristic of depressed people. A healthy limbic system keeps the body's emotional tone balanced, modulates motivation, and aids in processing and storing emotionally charged memories, while a depressed limbic system leads to overemotionality, apathy, an inability to "get over" difficult memories, and resistance to (or fear of) relational bonding. I realize this information can get a bit complicated, but knowing what you or your loved one is up against is important. Also, recognizing that there are physiological explanations for why a woman is sleeping too much or not at all, why she can't find the energy to do anything or is frantically rushing from this thing to that, can help you battle the real enemy rather than getting frustrated or overwhelmed with the symptoms.

Seeing my brain scan helped me to acknowledge that I really was dealing with a physical condition. In the days before the procedure, I must have asked my husband a hundred times: "What if they don't find anything?" He was convinced (rightly so) that the doctors would not only find something but be able to help me once the areas of my brain that were overactive could be identified. How grateful I was that a physician took the time to explain to me what was going on in my brain.

Some people refuse to believe that depression is a physiological illness, but procedures like SPECT scanning prove otherwise. SPECT is also used to diagnose Alzheimer's, a condition people acknowledge as both a physical and mental disease. Clinical depression should be viewed in the same manner.

If you or someone you love is battling postpartum depression, I hope that these images encourage you as they did me. PPD is real, physical, and dramatically affects the body. If someone close to you does not understand that depression is a physiological disease, perhaps showing that person these pictures or taking him or her to the images of scans available for view in the "SPECT Galley" on Dr. Amen's website (www.amenclinics.com) will help. In chapter 10 you will also be able to compare the scans of a person struggling with depression before and after treatment. The dramatic results of effective treatment are sure to give great hope to many.

Even if your loved ones aren't convinced, you can be assured of the physical nature of postpartum depression. It is essential we all remember, however, that depression-like Alzheimer's-is not strictly biological. According to Dr. Amen, genetic, chemical, psychological, and environmental factors all combine to influence the development of depression. Though we cannot determine precisely how these factors converge, we do know that clinical depression is directly associated with biochemical imbalance in the brain. We also know that chemical disturbances in the brain can lead to serious mental and emotional breakdown.

So What Causes Chemical Imbalance?

The exact causes of depression remain a mystery. Does this surprise you? It did me. Over the past fifty years, doctors and scientists have conducted extensive research investigating the physical triggers of depression, but our understanding still remains incomplete. Different theories, however, have arisen.

For some time, the most popular of these hypotheses centered on neurotransmitters, the chemicals that carry signals between brain cells. Scientists have proven that depressed individuals produce lower levels of certain neurotransmitters.21 Conventional antidepressants are used to increase and balance the levels of these chemicals.

Recent research, however, indicates that the neurotransmitters may only be playing a role in a much larger puzzle. Scientists have begun to focus their attention on how the body of a depressed person responds to stress as well. One area of the brain that mediates the effects of stress and, among other things, governs the survival responses we call "fight or flight" is the HPA (hypothalamic-pituitary-adrenal) axis.

In healthy individuals, the HPA responds only when under duress. In depressed people, it works in hyperdrive. Even relatively mild stressors can send a depressed person into a frenzy of damaging biochemical activity, causing the body to produce abnormally high levels of stress hormones such as cortisol.

Medical practitioners also postulate that the sex hormones - estrogen, testosterone, and progesterone, which scientists already know have significant effects on the brain-may contribute to the onset and persistence of postpartum depression as well. According to Dr. Ruta Nonacs, author of A Deeper Shade of Blue, "Receptors for estrogen, testosterone and progesterone are particularly dense (rich) in the limbic system."" It bears repeating that the limbic system helps regulate many of our physical cycles (eating, sleep, and sex), moods, and memories. As we noted in the last section, the DLS plays a major role in clinical depression.

Nonacs continued,

During pregnancy, estrogens are produced by the placenta and their levels rise about a thousandfold. Progesterone rises to about four hundred times its normal level. In the first few days after delivery, these levels drop dramatically. Within three to five days, estrogen and progesterone return to their pre pregnancy levels and remain relatively low until menstruation resumes.13

This extremely rapid and powerful decrease in hormones, Nonacs concluded, almost certainly contributes to the development of postpartum depression.

Again, don't let the complicated nature of this information deter you from understanding what's essential: You or someone you love is up against a very real condition that is complex and affects the entire body.

Joyce Venis and Susan McCloskey's book Postpartum Depression Demystified reveals more about the role of hormones in the body of a postchildbirth woman.

Prolactin, which is necessary for milk production, is low after birth but increases dramatically in the first week postpartum to accommodate breast-feeding. The placenta stimulates the production of endorphins, which [produce] a feeling of well-being while you're pregnant. After you give birth, your endorphin levels drop abruptly. While scientists have not proven it conclusively, these hormonal shifts are believed to play a role in the development of postpartum depression.24

In other words, it's not just pregnancy hormones bottoming out that can throw a woman's body into a frantic tailspin; biochemicals necessary for breast-feeding can as well. A new mom truly may be plagued by wildly imbalanced hormones on both sides of her childbirth experience.

Such was the case for popular actress Brooke Shields. In her memoir, Down Came the Rain, Shields recounted a doctor explaining that when the placenta left her body, so did many of the hormones that helped contribute to her happiness and stability during pregnancy.21 Once the hormones returned to normal levels, he posited, she would feel better. Unfortunately, for Shields and many new moms, things didn't turn out quite so nicely.

Taking the medical data and anecdotal information together, it's clear that PPD is a physical condition that affects the entire person. As I mentioned before, the precise causes of depression remain mysterious to even the most brilliant scientists. We may never know exactly how factors converge in the body to instigate depression. Great with Child author Debra Rienstra keenly observed that we can merely lift our heads to God and "humbly attest to the complexity of interaction between our minds and bodies .112' Truly, as David wrote, we are "fearfully and wonderfully made" (Psalm 139:14, NASB).

What Forms Does Postpartum Depression Take?

As I noted earlier, no two women experience PPD in the same manner. In this book, I will use the phrase "postpartum depression" as an umbrella term descriptive of a variety of postnatal disorders.

A brief synopsis of the different and specific ways a woman's body may become imbalanced after delivering a child is important, however, as a new mom may refrain from seeking treatment because her symptoms do not perfectly match those most typically associated with postpartum depression.

Angela, a mother of three beautiful girls, told me, "I thought that in order to have postpartum depression, I had to have thoughts of hurting my baby or myself; I wasn't suicidal and never felt like harming my daughter, so I assumed I couldn't have PPD." Angela's primary physical symptom was a sense of pressure on and in her head. Even when she had gotten a decent night's sleep, this heaviness made Angela feel as if she hadn't slept in days. The weight in her head also made it virtually impossible for her to hold a conversation or organize her day. In addition, "the pressure in my brain," as she described it, escalated to a fever pitch whenever Angela nursed, making it an extraordinarily painful experience to feed her daughter.

With her first child, Angela also assumed that she was simply experiencing the "baby blues." This is a common misconception, not only for those suffering from postpartum depression but also from many medical practitioners treating new mothers. "Baby blues" are not a form of postpartum depression, but rather a distinct, very common, and usually quickly resolved condition women encounter after childbirth.

When people speak of the "baby blues," they refer to the highs and lows that most mothers-in fact, as many as 85 percent27-expe- rience after delivering a baby. Alternating feelings of elation, weepiness, concern, and exhaustion are part of the postpartum landscape for almost all women. As their bodies adjust to postpregnancy levels of hormones and sleep (or, more appropriately, lack of sleep), the majority of women are far more emotional and sensitive than usual. This is what we describe with the phrase "baby blues."

As I mentioned before, having the "baby blues" is not the same as experiencing postpartum depression. Reviewing the chart below, which compares and contrasts "baby blues" and PPD, may help you evaluate which condition you or someone you love is facing.

Clearly, distinct differences exist between postpartum depression and the "baby blues." That said, the blues and depression often initially share the same symptoms, and a woman (like Angela) may misconstrue her experience with PPD as a case of the blues. Complicating matters further is the fact that PPD sometimes begins with the "baby blues," and many new mothers-as well as the doctors who care for them-erroneously believe the "baby blues" can last for several months after delivery. Any depressive symptoms persisting longer than two weeks are indications that medical evaluation is necessary.

Now that we know postpartum depression is not synonymous with the "baby blues," we can look at ways PPD does manifest itself in a woman's postchildbirth experience. Apart from classic postpartum depression-characterized by the physical symptoms listed on page 40-the following manifestations of postnatal disorder have been observed and documented.

It's important to note that the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) does not classify the conditions described below as distinct "diseases." In fact, according to the DSM-IV, postpartum depression is medically defined by the same criteria as clinical depression experienced by the general population and differs from it only in its unique timing. Still, many clinicians recognize that acknowledging the discrete symptomatic patterns we will now explore (and the titles often associated with them) can help to appropriately identify and treat the following forms of postpartum imbalance.

Postpartum Anxiety and/or Panic Disorder (PPPD)

According to author and veteran PPD counselor Karen Kleiman, postpartum anxiety "can take many forms, appearing as worry, nervousness, preoccupation with thoughts (obsession), excessive concern about physical health (usually her own or the baby's), sleeplessness ... or a sense of impending doom .1121

Characterized by extreme and usually irrational fears, PPPD usually manifests itself in the form of panic attacks -periods of extremely high anxiety in which a woman may feel that she is going crazy, spinning out of control, close to death, or about to "jump out of her own skin."

Panic attacks also come with other physical and emotional symptoms, all of which are far more powerful than those we routinely associate with worry or stress. Women describe sweating or shaking uncontrollably, feeling they cannot breathe or are choking, and being convinced they are having a heart attack (a pounding or racing heartbeat and/or tightness in the chest often accompanies this fear). Nausea, dizziness, muscle cramping, out-of-body sensations, tingling, numbness, hot flashes, chills, or "surreal feelings" are also commonly reported by those who suffer from panic attacks.

These surges of overwhelming anxiety often arrive without warning and seemingly without provocation. Sometimes, simply worrying about having a panic attack can trigger one. Panic attacks can last anywhere from a couple minutes to more than two hours. And they may occur frequently or only sporadically.

Women plagued by postpartum anxiety and/or panic are often consumed with "what ifs," specifically focused on their baby's wellbeing: What if I'm not feeding her enough? What if he stops breathing in the middle of the night and I don t wake up? What if I'm not providing my baby with the kind of stimulation that will help her develop well?

Fortunately, feeling anxious about motherhood-even having an isolated panic attack-doesn't necessarily mean you or someone you love suffers from PPPD. What separates normal concerns about parenting (you may have noted that almost every mom has worried about one or all of those questions) from postpartum panic disorder is the ability to quiet the mind and refocus on other, more positive aspects of life. If no relief from racing, anxious thoughts can be found, or if panic attacks become a regular part of a new mom's daily experience, it's possible she is suffering from postpartum anxiety and/or panic disorder.

It's crucial that I offer a word of caution about diagnosing PPPD here. Postpartum depression frequently manifests itself in "agitated or mixed depression," which means high anxiety is one of the primary presenting symptoms. Sadly, this sometimes leads healthcare professionals to misdiagnose postpartum depression as strictly a panic or anxiety disorder.

Because most antianxiety medications are not formulated to address underlying depression, focusing solely on a woman's symptoms of anxiety may fail to facilitate her complete recovery. Many conventional antidepressants, on the other hand, treat both depression and the panic that can accompany it. A knowledgeable physician should help you determine the nature of your physical condition and the treatment to combat it.

If a new mother is experiencing severe anxiety (particularly recurrent panic attacks), her doctor may prescribe an antianxiety medication, which can be taken on an "as needed" basis. This may prove especially helpful for a woman whose antidepressant has not yet taken effect (most psychotropic medications require two to six weeks to show efficacy). Again, the key is for a skilled practitioner to identify how anxiety and/or depression are presenting themselves in your, or your loved one's, particular circumstances.

Postpartum ObsessiveCompulsive Disorder (PPOCD)

Any person suffering from obsessive-compulsive disorder (OCD) becomes preoccupied with or fixated on specific thoughts, rituals, impulses (compulsions), or images. A compulsion may be defined as a behavior or routine repeated again and again in order to mitigate the anxiety engendered by a particular obsession (i.e., washing hands repetitively to help calm the fear of germs). PPOCD, however, most commonly causes a woman to fixate on something (or everything) involving her newborn child.

Repetitive behaviors or ritualized routines, many of which are quite time-consuming and/or superstitious, are common symptoms of postpartum OCD. A woman may, for instance, feel obligated to change her baby's diaper or sterilize her bottles in exactly the same manner every time, fearing that disrupting the pattern will cause infection.

A new mom may be convinced that if she doesn't do her errands at exactly the same time and in the same order as she "always does," or if she doesn't say a particular phrase or do a specific thing (repetitively check the locks and stove, perhaps) before she leaves the house, something catastrophic will occur. Logical healthy mothers understand that sticking to a particular routine or repeating certain words does not guarantee a baby's health or safety, but women with PPOCD often cannot distinguish reasonable thoughts from obsessive ones.

In order to deal with her intrusive and recurrent thoughts, an obsessed woman may establish coping rituals and repetitive behaviors, which, rather than helping, actually interfere with daily life and personal relationships (e.g., refusing to be separated from her newborn or checking on her sleeping baby compulsively). A woman affected by PPOCD may also become consumed with thoughts about her baby being harmed (whether by some outsider or by herself). She may fear that she will lose control and act on bizarre ideas that cross her mind.

Women who suffer from PPOCD may also see images obsessively replayed in their minds. Fixated on certain ideas, fears, or doubts, a woman with postpartum OCD cannot break free of her harmful and repetitive patterns of thought. Such was the experience of author Sue McRoberts, who described her experience with PPOCD in The Lifter of My Head-

I saw [my] baby hurt over and over again in my dreams. Eventually these became nightmares during the day, but I was wide awake and seeing the same images as I did in my sleep. Sometimes I couldn't differentiate between my nightmares and my daytime thoughts. I felt just as asleep mentally during the day as I did during the night. I often imagined myself hurting the baby. Yet, I was so worried even about dropping him.... It was especially distressing for me to walk down the stairs.... A few times I pictured myself throwing the baby down. I never ever wanted to hurt the baby. I never had any negative feelings toward him.... These horrible images just overwhelmed and overtook me. I was scared that I was losing my mind."

Sadly, such feelings and experiences are common to those suffering from PPOCD. As with all forms of postnatal disorder, however, the prognosis for those with postpartum OCD is very good: This is a highly treatable condition that responds well to therapy and medication, usually used in tandem.

Postpartum Mania

Women with postpartum mania feel "sped up" and find it virtually impossible to slow down or relax. They also tend to battle racing thoughts. While it's typical for a healthy mother to think of many things at once, intrusive thoughts differ radically from the relatively common experience of a preoccupied mind. Instead, racing thoughts form an incredibly rapid and disruptive mental flow that bounces erratically and often inexplicably from one topic to another. Since this frenetic activity consumes her mind, a woman may begin to speak in the same way, making it difficult for others to follow her conversation.

Like an unstoppable ball of energy, a manic woman may tackle huge projects (for example, insisting on making the newborn's baby book . . . in one night) or create long lists of things that must be accomplished. However, because she is highly excitable and irritable, a woman with postpartum mania may be too wound up, scattered, and disorganized to actually complete any of the tasks she's laid out for herself.

Some women with postpartum mania engage in impulsive behaviors as well, behaviors they would normally avoid and that may, in fact, be dangerous to themselves or their families-spontaneous and excessive gambling, for instance.

Furthermore, postpartum mania may alternate with periods of deep depression, in patterns similar to what clinicians observe in bipolar disorder. A skilled professional will be able to help you or your loved one determine whether pure mania or "mixed depression" is indicated by your circumstances.

Postpartum Posttraumatic Stress Disorder (PPPTSD)

Following a particularly distressing event or series of events (for example, a severe physical injury or fighting in a war), a person may develop posttraumatic stress disorder (PTSD), a condition often characterized by repetitive flashbacks and/or nightmares associated with the trauma. Emotional numbness or hyperalertness may follow. Panic attacks are common.

In some instances, the delivery of a child is so traumatic that it triggers PTSD in the new mother. An overwhelmingly excruciating or difficult vaginal birth, an emergency cesarean section, or having anesthesia ineffectively delivered during a C-section (causing the woman severe pain during the procedure) often lead to postpartum PTSD. Losing a child at birth may also cause PPPTSD.

Postpartum Psychosis (PPP)

Postpartum psychosis is the most rare and dangerous of the postnatal disorders. It occurs in only 1 out of every 1,000 live births. ° Despite the potential severity of PPP, however, the majority of women who suffer from it recover and go on to lead very normal lives.

As with other forms of postpartum imbalance, postpartum psychosis is associated with profoundly negative and alarming thoughts. Unlike the ideas or images a woman with other forms of PPD may face, the thoughts entertained by a mother with PPP are not grounded in reality. She may, for instance, believe that her daughter is the Virgin Mary or that her son is not the baby she brought home (insinuating that her child was switched at birth).

Psychosis is marked by a pronounced detachment from daily life and behaviors that are incomprehensible, bizarre, and sometimes highly dangerous. Still, women suffering from PPP are often convinced nothing is wrong with them. Because of this, outside observers who notice markedly strange actions or the regular expression of disturbing and surreal thoughts should seek medical help for the new mom immediately. Postpartum psychosis constitutes a medical emergency, as women with PPP are at significantly higher risk for suicide or infanticide than those suffering from any other form of postpartum imbalance (more on this in chapter 11).

Unfortunately, many people mistakenly equate postpartum depression with postpartum psychosis. They are not the same thing. During and after the tragic and highly publicized trial of Andrea Yates, who drowned her five children in June of 2001, some used the term "postpartum depression" to describe Yates's condition. In fact, Yates suffered from postpartum psychosis, as evidenced by her conspicuous detachment from reality (she believed she was "saving" her children from being tormented by Satan).

Other Myths About Postpartum Depression

People may not only mistake postpartum depression for the "baby blues"-or, in exceptional cases, postpartum psychosis-they may also harbor other misconceptions about postnatal disorders as well.

Here are some of the most prevalent myths about postpartum depression:

• It's normal for a new mom to feel depressed.

• This will go away on its own.

• Depressed mothers can't function.

• Depressed women can't go to work or manage their households.

• Moms who suffer from PPD shouldn't be left in charge of their baby's care.

• Depression is "all in a woman's head" (as we exposed in a previous section).

• Mothers who battle PPD always worry about hurting or wanting to hurt their babies.

• If she were stronger, a new mom would be able to deal with things without professional help (pharmaceutical or therapeutic).

• If she takes medication for depression, a mother must be severely ill.

• Women who are clinically depressed always need to be hospitalized.

Each of these misperceptions can keep the woman struggling and the loved ones around her from a true understanding of postpartum depression. And without a genuine comprehension of what she's up against, a woman's recovery and healing from PPD can be significantly delayed. Let's take these myths apart one by one.

The truth is, depression is never normal. If a woman feels sad, hopeless, isolated, extremely fatigued, or overly anxious or if she is unable to eat or constantly wants to consume everything in sight for weeks at a time, these are signs that something abnormal is going on in her body and mind.

Further, a new mom repeatedly told, "Don't worry; this will pass," may mask her true feelings from others, believing that her symptoms will eventually go away on their own. Unfortunately, for moms with clinical PPD, this will not be the case. The majority of women who receive no treatment for their postpartum depression battle it for months or years on end. Those who seek help, on the other hand, often begin to recover within a few weeks.

Depressed mothers sometimes attempt to disguise or deny their condition by throwing themselves into parenting, homemaking, or work. Postpartum depression, despite what many believe, does not debilitate every woman. Some moms who are depressed function quite well in their homes or work environments, all the while dying on the inside.

PPD does not make someone a "bad" or "unfit" mother either. Depressed women usually care for their children with the same love and concern healthy moms do. Doing so may simply be more difficult for, or require significantly more effort from, a woman with postpartum depression.

Like Angela, not all women with PPD have thoughts of harming their child or themselves, and many women with postpartum depression can be left in charge of their newborn child without worry. Again, daily life may be considerably more challenging for a mother with PPD, but thinking a depressed mother cannot tend to her baby is a fallacy. Only with severe cases of postnatal disorder-always with postpartum psychosis or with any woman who has confessed suicidal ideation-should family members and friends refuse to leave a mother alone with her child(ren).

Experiencing PPD is in no way a sign of weakness, and seeking professional help to overcome postpartum depression is actually a sign of strength and responsible self-care. Many women with PPD require medication to stabilize their condition. Taking an antidepressant does not necessarily indicate severe illness. Just as people on cholesterol medication may differ radically from one another in the severity of their condition, so people with PPD will have varying degrees of physical symptoms and struggles.

Finally, hospitalization for postpartum depression is actually quite rare, usually necessitated only by the most severe cases. Because I have "been there," I can testify that being hospitalized is not nearly as terrifying as it sounds. In fact, being regularly attended to by doctors and forced to slow down-they usually don't allow you to text or e-mail from the hospital, for instance-may actually lead to a quicker recovery.

Apart from these misperceptions about the physical nature of PPD, there are spiritual myths about postpartum depression, too (e.g., "It's always a sin or the result of sin," and "With prayer and Bible reading, it will go away"). We will reserve further comment on these specific religious misconceptions for chapter 8.

You may have believed any of these myths, or some others not listed here. However, as you begin to understand more about depression, and postpartum depression specifically, I pray you'll be able to believe in and act on truth rather than misperceptions.

As we have seen in this chapter, depression is a physical condition that disrupts the whole person by infecting the brain. While the biochemical dimension does not tell the whole story of postpartum depression-psychological, environmental, and spiritual forces all play a role as well-physiology is an essential piece in the puzzle presented by PPD.

In the next chapter, we will turn our attention to the psychological and environmental factors that can trigger and/or exacerbate a postnatal disorder. We'll explore questions such as these: What does it feel like to experience postpartum depression? How do the mind and emotions interact with the physiological components of depression? Do psychological factors influence the depth or duration of biochemical symptoms?

These are essential matters to investigate and ones we are ready to tackle now that we have discussed some physical facts and details about postpartum depression. In order to understand PPD fully, we must explore not only the physiological symptoms but also how depression affects the mind and heart of a depressed woman.

How long must I wrestle with my thoughts and every day have sorrow in my heart?

- PSALM 13:2

Shelby is one of the brightest, most delightful women you could befriend. Her smile radiates, and she listens to people with sensitivity and loving attention, an increasingly rare and precious quality these days.

I personally believe that anyone with four or more children under the age of five should automatically be nominated for sainthood, and Shelby is in that category. After delivering her firstborn, a son, there was a short window of time before she became pregnant with twins, adorable towheaded girls. Just a year and a half later, Shelby discovered she was pregnant again, this time with a little girl whom Shelby and her husband named Jane.

For the first two weeks after Jane's birth, Shelby told me she was "so happy." Then she began to have difficulty sleeping, even though her newborn and three older children rested peacefully. Lying awake in the dark night after night, Shelby was consumed with anxiety. During the day, her appetite virtually disappeared. At first, Shelby confessed, "It was nice because I thought I'd be able to lose my `baby weight' faster, but then I realized something was wrong ... I really couldn t eat. I had no desire to eat. And the sleeplessness was getting worse."

Shelby recalls a distinct moment when she realized things had gone from bad to worse. Her sister, Maddi, wanted to take Shelby's oldest child to the movies. As Shelby stood at the door to say goodbye, she told her sister that she would love to come. Maddi responded, "Why not? Just bring Jane and feed her there."

Shelby completely froze. She felt literally unable to step outside. Tears sprang to her eyes and wouldn't stop flowing. In a recent e-mail to me, Shelby described that day: "I was scared, anxious, indecisive, and feeling like a `psycho lady.' To my sister, going or not going to the movies was a simple decision; to me, it was huge. There was no way I could do it. I remember crying and crying. I was frustrated and angry with myself. Whats my problem? I remember thinking."

Shelby tried to believe things would get better. After all, having four kids under five is tough no matter which way you slice it. Things did not get better though. In fact, Shelby spiraled downward so quickly that no one knew what to do.

Shelby informed me, "I began to think that having a fourth child was the stupidest thing I could've done. My mind seemed to spin out of control, and repetitive, anxious thoughts ran over one another in an endless, frenzied cycle. Everywhere I turned-everything I saw, heard, or thought-stressed me out beyond belief. Fear and worry often escalated until I could hardly breathe. One day I went with my mom and sister to the grocery store. All of a sudden, the thought of going into Vons was just too overwhelming. I clung to the cart and tried to breathe, but just deciding if we needed lettuce seemed too big of a decision. I was a complete wreck. I really thought I was going crazy. And, even if it sounds strange to say, I missed myself."

Thoughts of worthlessness plagued Shelby during this time. The phrases "good-for-nothing" and "babbling idiot" consistently popped into her mind. She remembers feeling like a horrible wife and mother.

Instead of dissipating or evening out, the concerns continued to build over time. Shelby recollected: "Every little thing I saw would trigger a ton of anxiety. For example, I would see the kids brushing their teeth and be paralyzed by the question, How am I ever going to get everyone to the dentist, let alone pay for braces? Then I would start to wonder if I'd have to take them out of school for their appointments, which would make them fall behind and then, Oh my gosh! How in the world am I going to be able to help everyone with all of their schoolwork andprojects?! I know things like this cross other moms' minds, but I literally couldn't move past them, even if someone I loved tried to reason with me. I was totally consumed with worry and despair."

During these difficult weeks, Shelby describes feeling as if she were being tossed underwater, swept away by the undercurrent of a raging river, tumbling around with mud and rocks, unable to reach the surface for a breath of air. "It was dark and scary," she told me, and "very lonely."

Torturous thoughts wormed their way deeper into Shelby's mind. They took on a bleaker and more threatening quality as the days went on. "I literally felt like [the dark thoughts] were snakes slithering into my brain. Just to get through, I would have to imagine myself hitting the snakes over the head with a bat to kill them, to get them out of my head.

"At one point, I remember standing out on the deck that my husband was in the process of building. There was no railing, just a dropoff down to the concrete. I thought to myself, I could just throw myself offandprobably die. This idea-and the desire that came with it-terrified me because it felt so very real; I could actually imagine myself doing it. It was April 24, and my son was having a Mother's Day Tea at his preschool on May 9. I honestly had no clue how I was going to make it to May 9. I just cried and cried, imagining my little boy being the only kid at the Mother's Day Tea without a mommy."

Shelby also remembers feeling deathly afraid that, if she did live, she was going to be depressed for the rest of her life. Maybe I'll have to be in and out of hospitals, she feared. I'll never be the mom and wife that I dreamed of being.

For some time, Shelby couldn't admit she faced a distinct physical and psychological issue. "I had heard about postpartum depression and believed it was real," Shelby told me. "What I didn't know is how truly horrific it can be. It's a much deeper condition than what people typically use the word depressed to describe. I didn't realize that something could be so overpowering that you can't just `buck up' and get through it. I was completely incapable of `snapping out of it.'

"Before my experience with PPD, I remember hearing about depressed people who would just stay in bed all day or literally have to be dragged out from under their covers. There was no way I could have understood this until it happened to me. I could not get up. I felt like I had a ton of bricks on top of me. I would stare at the clock and negotiate with myself: Okay, in ten minutes, you for sure have to get out of bed. And then, two hours later, I would still be in my bed, gripped with anxiety and completely exhausted. Once I finally did drag myself out of bed, I would get to the family room and have to lie down on the floor. It was as if an unbearable force was pulling me down, down, down. This went on every morning, which then made my days so interminably long. I remember feeling as if every day was literally an eternity."

Finally, with the help of loved ones, Shelby sought treatment and started to recover. Though she had always had a wonderful support system of family members, friends, and the church, even these wonderful blessings weren't enough. The people who cared could do, and did, a lot to help, but to win the battle against postpartum depression, Shelby recognized she needed professional help. "As much as I didn't want to have to deal with all of it," she confessed, "I knew I had to or I wasn't going to make it." Seeing a Christian therapist and taking antidepressant medication set Shelby on the path to wholeness, to becoming "herself" again. As she sought physical, psychological, and spiritual help, Shelby saw the darkness break and Light shine through.

I thank God that Shelby did make it. Having been healed by God, she now shares her newfound understanding and empathy with others. You'll read more of Shelby's story throughout the book, but let's take what she has said thus far and explore what it feels like to have postpartum depression.

The Psychological Weight of PPD

Shelby described postpartum depression as an overpowering current that dragged her underwater. Angela, whom we met in chapter 2, likened her PPD to a dense fog, which enveloped her and caused a palpable pressure on her head. For me, depression felt like a black void; I was numb, catatonic, and perpetually exhausted, yet unable to quiet the furious storm in my mind.

In the previous chapter we looked at the physiological symptoms and manifestations of postnatal disorders. Now let's learn about the mental and emotional dimensions of PPD.

• Deep and persistent sadness

• Weepiness

• Lack of interest in activities that used to bring pleasure

• Apathy or decreased motivation

• Uncharacteristic anger or rage

• Pessimism

• Hopelessness

• A sense of helplessness

• Lack of self-confidence

• Feelings of incompetence

• Difficulty making decisions, starting or completing tasks

• Irritability, tension, or edginess

• Numbness (an inability to feel or express emotions)

• Decreased intimacy with close friends and family

• A strong sense of guilt or shame

• Heightened sensitivity to rejection or criticism

• Feelings of unworthiness

• Thoughts of death, dying, or suicide

As Shelby related, it's extremely difficult for anyone who has not experienced depression to understand how a person just can't "get out of bed" or "snap out of it." The visceral pressure of psychological symptoms associated with PPD is both devastating and grueling.

Christian women who suffer from postpartum depression often attempt to pray or Bible-read their way out of darkness. As they seek the Lord and beg for healing and hope, many feel like David did when he wrote Psalm 142:

You probably picked up this book because you've experienced (or are currently experiencing) the trauma of PPD, whether in your own life or through the battle of a loved one. I cannot communicate strongly enough that postpartum depression is an agonizing, heartbreaking, wearisome condition with physical, psychological, and spiritual dimensions. Not only does PPD ravage the body with the uncontrollable hormonal and chemical changes we explored in the last chapter, it also deeply wounds the psyche and spirit.

PPD can test the faith of even the most committed believer. Flooded with guilt, shame, feelings of worthlessness and/or incompetence, a Christian woman with postpartum depression may earnestly desire to trust that God will listen to her cries, even to the groanings of her spirit, which she cannot form into words. Trust and confidence in the goodness of God's plan is very difficult, however, when the weight of physical and psychological symptoms presses down with ferocious intensity.

This is not to say that a woman is incapable of trusting God through PPD. Insinuating that would be akin to diminishing or dismissing the power of the Holy Spirit, who indwells every believing woman, and that I would never do. I am only trying to help you understand the serious challenges that destructive thoughts and feelings present for depressed individuals.

For a moment, turn back to the list of psychological symptoms on page 65. Now, imagine that you feel all of these things, not just on a "bad day" but every day. What if-multiple times a day-a sense of incompetence, shame, helplessness, and hopelessness overpowered you? What if you had called to the Lord in every way you knew how, and still the thoughts in your head were dark and defeating, ugly and incomprehensible?

Genuinely understanding what it's like to have postpartum depression involves "getting in the pit," so to speak. Not that you have to stay there (praise God for that!), but the empathy and compassion that arise from sharing in someone else's sufferings are priceless gifts. In bearing the burdens of one another, as Galatians 6:2 commands us to do, we also obey Christ. I pray that the Lord would tenderize your heart and enable you to feel, if only for a moment, what it's like to live with PPD.

Fortunately, postpartum depression does not affect everyone as brutally as it did Angela, Shelby, or me. My friend Janette had a less severe, though still profoundly difficult, postpartum experience. I'd like to share a bit of her story with you so that you might see another unique way PPD manifests itself, and also how it can be combated on a psychological level.

I Can't Stop Screaming ... (as told by Janette Lewis) After delivering my second child, I knew something was "off." Initially, I chalked it up to the "baby blues"; I figured I was just tired, hormonal, and overwhelmed with taking care of a newborn and a two-year-old. It was only when I realized I was, on a daily basis, yelling at my older daughter and becoming so infuriated and out of control that I knew something had to change.

Rage, insane rage, would overtake me. I would often (three to four times per week) need to call my husband, Dan, and tell him to come home before I did something stupid. I never wanted to hurt my children, but I knew I was capable of it. Fortunately, I also recognized I had to listen to my instincts and call my husband. I felt so restless and out of control. It seemed like no one could understand me or what I was going through. More than anything I wanted Dan to get it; he simply couldn't. I was surrounded by people who loved me, but all I did was scream at them and tell them to leave me alone.

I was so fragile. It took so little to set me off. I resented my toddler for being needy. I just wanted her gone so that I could focus on the baby, but at the same time I wanted the baby gone so that I could focus on my toddler. On the days when both children would be sleeping at the same time, I had to fight - with every ounce of my soul - not to just walk out of the house and start driving. I envisioned the entire plan, even how I would clean out the bank account so there wouldn't be a paper trail. I knew exactly where I would go and thought how freeing it would be to take care of no one but myself. Then I would picture my children growing up without a mother, the resentment they would carry, and how I would forever alter their lives with my selfish behavior. By the time I got there in my mind, one of them would wake up and I would think, Trapped for one more day.

During this time, I was part of a Wednesday-morning ladies' Bible study. Though I didn't go into great detail, I did share some of my struggle with the other women. I remember so clearly the leader of our group taking me aside and explaining how this could be a time of "rewounding" by the Holy Spirit, a season in which God could help me face past experiences that I had buried and left for dead.

This godly woman's words now seem prophetic to me. Indeed, the Lord was gentle but firm with me over the next few months, compelling me to look at the pain of my childhood, as well the expectations I placed on Dan and myself. Ironically, I needed to be wounded again to start healing. I had mistakenly believed that the injuries of my past had been taken care of long ago. Instead, God showed me that He wanted to change me on a deeper level, breaking some entrenched and destructive cycles in my family. Through acknowledging the depth of my rage and the capacity within me to sin because of it, I began to experience God's restorative power and grace. He used my postpartum experience to refine me in ways I couldn't have imagined.

One of the primary ways He healed and transformed me was through counseling. I had been to therapy before I was married and had worked through many aspects of my difficult past. And truthfully, the fact that I needed to go back made me feel like a failure at first. But as my counselor urged and helped me to press further into my pain, I felt the layers of woundedness and wickedness inside me peeling away. She enabled me to recognize what led to my toxic thoughts and actions. She also covered me in prayer.

Engaging in the soul work of therapy was challenging enough as a single woman, but now that I was a wife and mother, I needed to face and confront my issues from an entirely different angle. I realized that I was trying with all my might to make sure that my children didn't have the same upbringing I had. I never wanted divorce to be a part of their legacy, nor did I want either of them to feel like second-class citizens in their own home. I emphasized the word my in that last sentence because I wasn't trusting God to help me overcome the deficits of my past. Only through counseling and a tremendous amount of prayer did I acknowledge that I didn't have to - and indeed could not- white-knuckle my way to a godly and happy home.

Looking back, I wish that I would've taken action earlier, squarely facing my condition and seeking counseling immediately. Because I didn't have an extreme case of PPD, I kept telling myself I could get through it on my own. I now realize that if I had waited any longer, greater harm would have come to my family.

An Emotional Roller Coaster

Just comparing Shelby's and Janette's experiences helps us understand that the psychological dimensions of postpartum depression differ vastly from woman to woman.

For nearly all new mothers, the first few days after birth are a time of powerful emotions and physical sensations. British pediatrician and author Penelope Leach painted a striking picture of the postpartum landscape: "Everything is felt too much: stitches and pleasure, responsibility and pride, selfishness and selflessness. You are still desperately tired. Your hormone balance is disturbed, your milk is not fully in, your cervix not yet closed, your body is striving for equilibrium." As for the baby, observed Leach, "All is bewilderment."'

For women with PPD, everything is "felt too much" not merely for a few days, but for weeks or months on end. Brooke Shields gives us a glimpse into the emotional depth of her postpartum anguish in Down Came the Rain:

At first I thought what I was feeling was just exhaustion, but with it came an overriding sense of panic that I had never felt before. Rowan kept crying, and I began to dread the moment when Chris would bring her back to me. I started to experience a sick sensation in my stomach; it was as if a vise were tightening around my chest. Instead of the nervous anxiety that often accompanies panic, a feeling of devastation overcame me. I hardly moved. Sitting on my bed, I let out a deep, slow, guttural wail. I wasn't simply emotional or weepy, like I had been told I might be. This was something quite different.... sadness of a shockingly different magnitude. It felt as if it would never go away....

I didn't have any desire to power through and care for this baby. I got hit with a wave of self-defeat and self-loathing and had an urge to smash my head against the wall repeatedly.2

Shields described how scared and heartbroken she felt when forced to recognize her postpartum depression. She recalled one of her prenatal doctors asking if she thought she might be a candidate for PPD. Offended, she remembers answering, "Of course not." Shields noted that, at the time, what she heard her physician really asking was, "Do you get depressed often, and will you be unable to handle becoming a mother?"3

As it did for Shelby, Janette, Brooke, and myself, shame and guilt seem to go hand in hand with postpartum depression. Often, they form the biggest barriers to a woman's recovery, as both make people leery of seeking help, no matter how badly they need it. Shame binds and paralyzes, leading many to falsely believe there is something intrinsically wrong with them.

The dynamics of PPD aside, almost every mother seems prone to guilt, perhaps because parenting presents no shortage of circumstances that inspire it. Departing from the supposed "right" way to raise your children, carefully laid out by the latest "revolutionary" plan for Christian parenthood, can induce significant guilt. Don't get me wrong; childrearing books can be great tools that help moms and dads. When parents take them to be a perfect formula for godly living, however, guilt almost always follows.

Having or choosing to return to work in the first few months after delivering a baby often brings intense guilt as well. Moms who stay home full time may feel guilty for wanting a break from diapers, feedings, and the laundry piling up in hampers around the house. Even putting the baby in a swing or bouncy seat to cook dinner or do the dishes can make some moms feel "less than." Being unable or not desiring to breast-feed can propel motherly guilt even further (we'll discuss this more in other sections). And every one of these sensations of guilt is felt with an exponentially greater intensity when a woman suffers from PPD.

Postpartum depression often brings other provocative emotions to the surface. Deep fears of incompetence may worm their way into a woman's mind after childbirth. Wondering whether you "have what it takes" to be a mom or if you are "doing the best" that you can for your child sometimes become an obsession for a woman with PPD. In Postpartum Depression Demystified, Joyce Venis recalled working with a mother who "was very upset when her baby didn't finish his bottle, because she was worried he wasn't getting enough to eat. Her pediatrician had told her that her baby should be drinking a certain number of ounces of milk each day, so if he didn't hit that mark, even by an ounce or two, she became distraught " Sadly, an experience like this is not an isolated incident, but rather an extremely familiar one.

Having a baby may also bring back painful memories from childhood. This seems especially prevalent with a woman's firstborn, though circumstances often combine to issue in periods of "rewounding" after the birth of other children (as was the case with my friend Janette). Dealing with the heartaches of a difficult past is virtually impossible when the weight of PPD presses down on a woman's heart and mind. Psychological counseling is a must in such instances.

Beyond guilt, shame, and inadequacy, the isolation of mothering an infant often breeds deep feelings of loneliness, too. Many new mothers spend the vast majority of their time at home, alone with their child(ren). Even for healthy moms, focusing attention on a newborn makes it difficult to maintain relationships or activities. For a woman with postpartum depression, solitude can progress into harmful alienation.

Most women go through some kind of grieving process after delivering a child. The life they once had is gone; the new life before them may seem mysterious and unnerving. Author Debra Rienstra captured this well. Reflecting on the days after her first child was born, Rienstra wrote,

Whoever I had been before motherhood was gone; whoever I was becoming had not yet taken shape. I could see that it would involve a great deal more se 7essness than I was used to ... I quietly sobbed out an unpleasant new feeling: the irreversible, inescapable realization that I was the grown-up now. This babys needs came first, would always come first. She didn't care how I felt.... I was at once grown up enough to love her fiercely and not nearly grown up enough to bear that fierce love.'

A woman battling PPD may grieve in this way and beyond. All too often, postpartum depression deceives a new mom into thinking that "things would be better had I never gotten pregnant." Though Shelby loved Jane with all her heart, though Jane is, in Shelby's words, "so beyond precious ... such a gift, such a joy," Shelby recalls thinking in her darkest days that it would be okay if Jane just didn't wake up. "I knew it would be devastating to lose a child," she told me, "but I also believed that at least our family would be back to the way it was before I had Jane. There were also a couple times that I thought I should give her up for adoption, that I should surrender her to someone who would be a better mom. That way, I mistakenly `reasoned,' I could focus on my other three children. Now, looking back, I can't believe those things even crossed my mind!"

As mentioned several times already, dark and confusing thoughts are common for women with PPD. High anxiety usually accompanies these intrusive ideas. Feeling like "I'm going crazy," worrying that vocalizing one's thoughts will make them "more real," and concern that seeking help will mean "I'll be locked up" or "my baby will be taken away" often come with postpartum depression.

Healthcare practitioners refer to this pattern of thinking with phrases like "intrusive thoughts," "racing thoughts," or "obsessive thoughts." Monopolizing or engrossing the mind beyond reason, these thoughts often induce tremendous fear and anxiety.

I want to be careful to emphasize that such "racing thoughts" should not be equated with simply "thinking fast" (a tendency common to many women). Intrusive thoughts are ones that, in spite of a woman's most concerted effort, will not go away on their own. They may hide in the background for a few moments, but the anxiety is ever ready to overtake a woman with PPD's consciousness.

Such obsessive thoughts take on a power of their own. Again, despite a woman's best efforts to quiet or contain them, racing thoughts persist and often heighten when resisted. A woman may recognize that her mind-set is irrational or destructive, but to a mother with postpartum depression, intrusive thoughts seem so real and so consuming. Even thinking about what she's thinking about can create a great deal of anxiety.

PREVALENT OBSESSIVE THOUGHTS INCLUDE:

• I'm going crazy.

• I'm a failure.

• Someone is going to take my baby away.

• I'll never get better.

• Something terrible is going to happen (that is beyond my control).

• A horrible accident is imminent (e.g., I may slip while walking down the stairs and drop my baby).

• I may hurt myself.

• I'm going to hurt my baby.

As you may well imagine, when racing thoughts persist, the anxiety already present in some women with PPD escalates at a rapid rate. It's terrifying for any of us to realize what we're capable of doing (even if we know we'll never actually do what has crossed our minds). Fortunately, women with postpartum depression almost never act on racing thoughts. Please note this is not always the case with postpartum psychosis. The racing thoughts characteristic of postpartum depression should not be confused with the psychotic ruminations of PPP, which are delusional and bizarre in nature (e.g., "This is not my baby," or "My baby is the son of God"). See chapter 11 for more detail.

The intrusive thoughts associated with PPD can leave a woman doubting herself on the deepest levels. She will likely feel terribly ashamed for thinking the things she has considered. Even in therapeutic treatment, some women initially refuse to express their thoughts out loud; they're afraid-sometimes rightly so-that they will be misunderstood or labeled an unfit mother.

The repetitive, negative, even frightening nature of obsessive thoughts makes them not only terrible to live with but also extremely difficult for women with PPD to battle. In fact, because intrusive thoughts attack a woman at the core of who she is, some clinicians believe that they are the most difficult symptom of postpartum depression to treat. Many struggle to "forgive themselves" for what has passed through their minds. Fortunately, if a woman receives treatment for her depression (usually in the form of counseling and often with psychotropic medication), her racing, anxious thoughts will quiet. She can then work on any destructive thought processes that predated her postpartum depression.

Through it all, we can hold on to the hope that even the hardestto-deal-with symptoms are merely part of a temporary condition. With proper treatment of the mind, body, and spirit, they will dissipate.

Did I Cause This?

One intrusive and repetitive thought women with postpartum depression often battle deserves special attention. The question "Did I do something to make this happen?" plagues most mothers with PPD at some time. Interestingly enough, the people surrounding these women often ask, "Did she do anything to cause this?" and for them, too, this can become an obsessive thought. Did not eating healthy enough lead to my/her PPD? Should I/she have exercised more or gained less weight? Could I/she have prevented this by doing X, Y, or Z?

Because these questions can never be answered, they plow through the mind and heart like an unstoppable, uncaring steamroller. We discussed in chapter 2 the fact that postpartum depression is never the result of only "one thing." It is always the combination of two or more factors-for example, genetics, environment, upbringing, physiology, ideology, and spirituality. Isolating one of these forces and blaming it for the PPD is never helpful. To best facilitate healing, a woman and her loved ones should look at how specific physical, psychological, and spiritual influences converged to trigger her postnatal disorder.

The following are some of the most common risk factors for postpartum depression:

• A family history of anxiety or depression (genetic predisposition)

• An unexpected pregnancy

• Complications during childbirth

• One or more miscarriages or other pregnancy loss (including abortion)

• A major loss in the past two years (death of a loved one or an undesirable move, for example)

• The death of a child

• Lack of familial or community support

• Recent change in marital status (separation or divorce)

• Childhood abuse (physical, sexual, or emotional)

• Rape or another form of violent assault (by a stranger or someone you know)

• A history of severe PMS

• Past drug or alcohol abuse

• Perfectionism

• Inability to ask for help

• Low appraisal of self-worth

• Past experience with depression, anxiety, or suicidal ideation

• A previous case of postpartum depression 6

Having one (or many) of these risk factors does not necessarily mean a woman will experience postpartum depression. And having no observable risk factors does not prevent a mother from developing PPD either. Being aware of these risk factors simply helps women who are pregnant or hope to become pregnant in the future to assess whether they might be likely candidates for postnatal disorders. It also enables those currently battling PPD to identify some of the possible causes of their condition, and gives them an idea of what to focus on in physical and psychological treatment.

For those who have experienced or are currently going through postpartum depression, or those who are walking with someone who is, acknowledging these risk factors may bring some comfort. Knowing that certain circumstances predispose a woman to PPD may begin to settle the agonizingly difficult question, "Did I cause this?"

Postpartum depression often strikes completely without warning or provocation, however. We may never know why postpartum depression descends on some women and not others, why mothers with multiple risk factors thrive during their postpartum days while others with no risk factors suffer debilitating depression. Again, we can only humbly and hopefully attest to the "wonderfully complex" way in which God made us (Psalm 139:14, NLT), the tragically awful ways in which sin infects our Creator's magnificent design, and the awesome power of Christ to redeem everything broken.

Beyond the risk factors we just explored, there are psychological and environmental factors that can play a role in the experience of PPD.

• Sleep deprivation (usually makes small issues seem enormous or insurmountable)

• A difficult time coping with things that previously seemed "easily manageable" (leads to frustration and anxiety)

• Loss of identity after delivery ("I am not who I was before, but I am not sure who I am to become")

• A disrupted or extremely difficult birth experience

• Excessive weight gain (leading to feelings of undesirability)

• Disappointment in the baby's gender

• Unrealistic expectations about motherhood ("If I don't have a perfect baby/a well-behaved baby, something's wrong with me")

• Pressure to breast-feed or difficulty nursing

• Financial strain

• A colicky or ill baby

• Age of mother (very young or advanced in age)

• Single parenthood

• Displacement (being in a community in which you are not known or grounded)

• Relational stress (including unhelpful comments from others-e.g., "How hard can taking care of a baby be?")

It's highly unlikely that any single one of these environmental or psychological symptoms could trigger postpartum depression, but all of them can contribute to and exacerbate a case of PPD. With that in mind, loved ones can help mitigate the effects of any factor that is within control. While no one can, for instance, change the age of a mother or the baby's gender, others can help with a colicky or sick baby, relationship challenges, or sleep deprivation.

Sleep deprivation is, in fact, one of the most prevalent aggravators of postpartum depression. Some clinicians wonder if severe sleep deficits can actually make a woman more susceptible to PPD or trigger a latent depression.

According to a study published by Dr. Ken Armstrong and his colleagues at the Royal Children's Hospital in Queensland, Australia, among mothers whose infants had significant sleep problems (thus making it impossible for mom to get a good night's sleep), 40 percent had symptoms that indicated postpartum depression?

Long-term sleep deprivation (medically defined as getting fewer than six hours of sleep per night) almost certainly escalates a current episode of PPD. Being sleep deprived makes everything more arduous-concentrating is a challenge, common tasks appear unmanageable, and making simple choices seems downright impossible. Everyone is tenser, edgier, more easily irritated, and a good deal more emotional than normal when sleep deprived. Women with PPD who have been deprived of sleep long term are extreme examples of this.

In the Old Testament, the afflicted yet godly job described well what sleep deprivation feels like:

Perhaps you recall the words of PPD sufferer Sue McRoberts, who chronicled the waking nightmares she experienced during her postpartum days. As time progressed and she slept less and less, McRoberts revealed she couldn't be sure when she was dreaming or awake. In a self-described delusional condition, McRoberts felt as if she had no control over her own thoughts. The world became surreal to her. Nausea and light-headedness were her constant (and unwanted) companions. "I was convinced that if I slept for a week I'd wake up okay," McRoberts wrote. "The only way in which I can account for what happened was that my brain short-circuited. It's as if something fried in my brain for a short while."'

Being sleep deprived can have a profound impact on the psychology of postpartum depression (and the "short-circuiting" that happens on a biochemical level). At the close of the last chapter, I posed the question, "How do the mind and emotions interact with the physiological components of depression?" Sleep deprivation, a physical problem associated with PPD, clearly has a dramatic influence on the depth and severity of postpartum depression's mental/emotional dynamics.

In the same section, I also asked, "Do psychological factors influence the depth or duration of biochemical symptoms?" The answer to this question is a definitive yes. If a woman fails to attend to the emotional and mental factors that have accompanied, escalated, or even triggered her depression, the physical symptoms will almost certainly last longer and can potentially worsen.

This reality has led some healthcare practitioners and therapists to develop theories indicating that negative thought patterns might cause depression. This idea, however, does not seem to fit with the physical evidence at hand. Remember, one singular factor cannot bring on a full-scale depression. While it is definitively true that toxic thinking can heighten and prolong depressive symptoms (in the same way doctors have observed that negative thoughts seemingly prevent cancer patients or victims of abuse from whole-body healing), we must be careful not to assume that, when it comes to her postpartum depression, a woman's negative thought processes are "to blame." This idea will only pile more guilt and shame on a mother who fears she has "done this" to herself.

Combining the question "Did I cause this?" with spiritual guilt is particularly harmful. We'll explore this in greater detail in chapter 8, but I want to emphasize right now that failing to pray or read your Bible "enough" never causes postpartum depression. Spiritual apathy or alienation from God can, like other factors, intensify and contribute to the experience of PPD. But, once again, no one factor causes postnatal disorders. There is always some chemical component in a full-blown case of postpartum depression.

That said, I will never claim that God cannot heal someone through Bible study and prayer alone. He is able. He is God and nothing is too difficult for Him (see Jeremiah 32:17). He does not, however, only or always choose to heal people in that way. I am exhibit A in this regard. My healing was absolutely governed by the Almighty and Sovereign God, who happened to use-in my case-medication, spiritual counseling, and various other forms of treatment (i.e., eye movement desensitization and reprocessing [EMDR] and brain scanning; look for more treatment possibilities in chapters 9 and 10).

Asking, "Did I cause this?" is usually extraordinarily painful and complicated for a woman with PPD and the people who love her. I hope that after reading this section, you have a clearer view of how to confront and answer this question. I also pray that you've gotten a taste of what it feels like to live through PPD, how psychological symptoms can manifest themselves in distinct ways (evidenced through Shelby and Janette's stories), and how the emotions that attend postpartum depression-namely guilt, shame, grief, and anxiety-can intensify a woman's experience with PPD.

The Pressure of "Breast Is Best ..."

Another specific thought associated with PPD that we must address is, "What should I do about breast-feeding?" This question, as with "Did I cause this?" is so prevalent and can become so consuming that I would like to devote concerted effort to exposing the myths about nursing as well as how breast-feeding or weaning can alter a woman's psychological state.

In recent years, the pressure for mothers to nurse their children has increased exponentially. Just a generation ago, leading experts almost universally recommended bottle-feeding, asserting that the nutritional engineering of mankind surpassed the milk produced by a woman's body. Evidence to the contrary is now touted in prenatal and childcare publications, and doctors often use the phrase "breast is best."

Breast milk is indeed a gift from God. Since the dawn of creation, mothers have been naturally equipped to nourish their babies through their own bodies. Truly, this is a marvel, a miracle we should never dismiss. I believe with all my heart that breast milk has been designed by God to protect (through the passing on of certain immunities, particularly in the first six weeks after birth) and provide for newborns.

That said, we must remember that for centuries there have been women who physically could not nurse their own children. The presence and/or combination of a variety of factors (including the shape of a woman's nipples, the inability of certain infants to latch or suckle, etc.) make it extraordinarily difficult, if not impossible, for some mothers to breast-feed. In the past, without wet nurses or the opportunity to feed a child tolerable animal milk, many newborns died because they could not nurse.

I realize that some die-hard breast-feeding advocates will disagree with my next statement, but I stand by this as truth: Not every mother should or can nurse. Members of certain breast-feeding organizations assert that any obstacle to nursing can be overcome, but this is simply not the case for women with PPD. In some instances, the chemical reactions associated with breast-feeding and the hormonal changes brought on by high levels of prolactin-the organic compound necessary for a woman to produce breast milk-can be destructive rather than life-giving for a woman and her newborn child.

If you are not a mother, you may not be able to comprehend the extreme pressure that now accompanies breast-feeding. Women who find it severely painful or seemingly impossible to nurse often feel like second-class citizens. The disapproving glances or comments from others when bottle-feeding a newborn can leave deep wounds for any mom. For those already suffering with PPD, such experiences can be more than devastating. Women who deliberately choose not to breast-feed are held in even greater contempt by the "breast is best" contingency.

As is recommended by so many doctors these days, I wanted to nurse until my children were a year old. My milk dried at four months with Jocelyn and six months with jasmine. I did everything within my power to keep my breast milk flowing. As nursing became more and more difficult for me, I drank organic teas, pumped, and fed often. Once I found out nursing mothers need even more calories than pregnant women do, I ate everything in sight. Nothing helped. My days of nursing Jocelyn and jasmine came to an end before I desired, and there was little I could do to prepare for how it would unravel me. I constantly felt the need to explain to people that I didn't choose to stop breast-feeding. Perhaps I was more self-conscious than I needed to be, but my already precarious emotional state became worse because I was forced to stop the one thing that made me feel like a "real mom."

The issues and decisions surrounding breast-feeding and PPD are extremely complex, both physically and psychologically. I mentioned in the last chapter that the onset of postpartum depression often corresponds with weaning. Though I already had symptoms of PPD, I did not experience the worst of my postpartum depression until my body underwent the hormonal changes of weaning. Whether a mother chooses to stop breast-feeding or finds herself forced to, the chemical reactions that occur during and after weaning send some women into a hormonal tailspin that rivals or exceeds that which follows childbirth. Indeed, some women with stillborn infants or with children who die within the first few months after delivery experience PPD precisely because they can no longer nurse their child.

Reading this may cause you to assume that if you have already begun nursing, you should definitely continue. It's essential that you know: Breast-feeding can perpetuate PPD, too. It's not as simple as saying if you wean, you may get depressed or get worse. In fact, many women find that when they stop breast-feeding, whether because the hormonal changes that occur after weaning actually help to balance their disrupted stasis, because the emotional and physical pressure associated with nursing is alleviated, or, in some cases, due to a combination of both, an already present case of postpartum depression actually improves, and significantly so.

There is no surefire way to predict how weaning will affect a specific mother. I wish there were, and if you are wondering what you or someone you care about should do about breast feeding, you probably do, too. Any previous experience with breast-feeding may help you determine which route to take, but even the past cannot define the future perfectly. Just remember that if you suspect nursing is deteriorating your emotional and physical state, there is nothing-and I repeat nothing-wrong with stopping. If you are concerned that someone you love may be holding on to breast-feeding despite the fact that it seems to cause extreme psychological or physiological pain, you can find ways to graciously encourage a woman to reconsider whether nursing is actually best for her.

There is simply no way to communicate adequately what breastfeeding means to some mothers. I remember what Brooke Shields communicated about nursing in Down Came the Rain resonating so deeply with me. She confessed that, even though others told her to stop breast-feeding and said in no uncertain terms that they believed it would help her to recover more speedily, there was no way she was going to wean. For Shields, it felt like breast-feeding was the only thing she was good at as a mom, the only thing she could do for her baby girl. I understand this on such a deep and agonizing level. Perhaps you do, too. Maybe you recognize the internal battle going on in the heart and mind of someone who is contemplating weaning-whether of her own volition or because she's being told to do so by those around her.

Imagine you've been told by every leading expert and you've read countless online articles and have seen poster after poster recommending that you do something that you just can't do. What if everything around you seemed to be screaming, "You're not good enough unless ..." If you can put yourself in this position, perhaps you can begin to comprehend what it's like for some mothers.

Just recently, I counseled a young mom battling PPD. Because of past experience with clinical depression, her physicians told her she needed to start a course of medication, but this gal was undone by the idea that the drugs she needed were considered unsafe for breastfeeding. She was so afraid that she would damage her baby forever if she weaned him. The psychological strain of it heaped guilt upon her already heavy-laden shoulders. Her son was colicky, and she's a single mother. She was trying to do what was best for the two of them. Deciding between breast-feeding and weaning brought so many conflicting emotions to the surface.

I tried to encourage this woman that what was most important was being healthy enough to care for her son. The thoughts and physiological symptoms of her condition were making it increasingly difficult for her to be there for her son emotionally and physically. She needed to get healthy enough to care for him. My heart broke that the pressure to nurse and the assumption that weaning would be harmful for her baby had so consumed her. How grateful I was when she opted to courageously stop nursing and take the medicine her body needed to balance chemically. She also started to see a Christian counselor who helped her wade through the feelings of shame and failure that came not only with her PPD but also with her decision to wean.

Breast-feeding does not automatically make someone a better mom. Weaning does not destine a child to a life of failure and unrealized potential. Nursing can be a wonderful experience for some women and a horrific one for others. If someone you love is battling guilt surrounding this issue, try to be as lovingly supportive as you can. If you are enduring this pain, you can embrace the weightlessness of God's grace, the power of mercy that overcomes false shame and guilt. Ask Him for it.

Whether you or someone you love chooses to continue nursing or to wean, it's crucial to stay in close touch with a medical team that can monitor any changes that come with weaning. Under the care of competent physicians, a woman will be able to weather the storm of chemical reactions that come after a decision to discontinue breastfeeding or after being compelled by uncontrollable circumstances (for example, lack of breast milk, malformation, or death) to do so.

So often what we do physically-as well as things that happen to our bodies that are outside our control-affects our minds, emotions, and spirits. Through the previous two chapters, I trust you've seen how true this is.

Now that you're armed with important and detailed information about the physiological and psychological dimensions of postpartum depression, we're ready to venture into the ways people who walk beside a woman with PPD can understand and help her in unique ways.

If the LORD had not been on our side ... the flood would have engulfed us ... the raging waters would have swept us away.... Our help is in the name of the LORD, the Maker of heaven and earth.

- PSALM 124:1,4-5,8

Of those who walk with a woman through the valley of postpartum depression, no one typically suffers more than a faithful husband. You might think I'd have discovered this watching my sweetheart, Jeramy, endure the agony of my illness twice over, but it actually wasn't until I began writing about our journey that I fully recognized the depth of his own anguish.

One of the most difficult things I did for this book was interview my husband. Hearing the pain in his voice as he described feeling confused, angry, helpless, and frightened was nearly unbearable. He is so even, such a rock for me. I knew on one level that he, too, had suffered profoundly during the extreme ups and downs of my childbearing years. And it's not as if, before I began to research for this book, we had never discussed that agonizing time in our married life. It's just that our conversations had previously and primarily focused on the gratitude we felt to be "on the other side." We praised God together; we looked back and breathed a collective sigh of relief-the Lord had healed me and rescued both of us. Asking Jeramy to relive that time and answer specific questions, however, uncovered a slew of emotions and experiences I knew little about.

If you or someone you care about is the husband of a new mother ailing from postpartum depression, let me encourage you: Others have been where you are. Others have faced what you're facing. Of course, you are dealing with a unique manifestation of this disease ... your circumstances, your background, your chemical makeup, and that of the woman you love all make your situation distinct.

Still, while no one can know exactly what you, your wife, or someone you love is going through, there are others who have been in the pit. I hope that sharing not only Jeramy's story with you, but also the experiences of another loving husband, Karl, will encourage you. As you read what Jer and Karl learned by living through extraordinarily difficult times, perhaps you will find comfort and counsel. And after learning how these husbands would advise others who want to help a man battling PPD with his wife, I pray you will feel directed and equipped.

I Just Didn't Get It

When I first began to struggle with postpartum depression, there was relatively little public discussion of the condition. That which was covered by the media was nothing short of terrifying. My husband recalls hearing about mothers who killed their own children and being frightened when the doctors told him I had what he thought of as "the same thing." Of course, as more research is done, it becomes clear that women who take such drastic and tragic measures almost invariably do not have postpartum depression, but rather postpartum psychosis, a rare disorder that sometimes (though, thanks be to God, not always) leads to infanticide.

Jeramy didn't, however, know anything about PPD, let alone postpartum psychosis. Nobody differentiated those terms for him. Until he sat with me in the emergency room at Memorial Hospital, he basically thought I was making decisions to indulge in despair. He admitted, "I didn't understand why you were choosing death over life, why you couldn't choose me and our baby over this darkness inside you."

As Jeramy began to understand the tremendous difficulty-the impossibility, really-for a woman with severe postpartum depression to simply "choose life," his compassion grew and deepened. At first, however, he was just plain mad.

"I felt like you were being a coward," he told me, "because you couldn't cope. To me, everything in our life seemed so easy-we had a stable income, supportive family and friends, a nice home, and a healthy baby ... things were going well for us. I didn't understand why you would want to give up. I also believed your attitude was disrespectful to God; here He'd given you so much and there were no major issues in our life, but you were choosing to obsess about something as trivial as losing weight [Jeramy saw this as the problem that led to my deep desolation]. I didn't understand why you would choose that over being a mommy to our daughter. In my mind, it was as if you walked right up to a cliff and threw yourself off. I had no framework to understand what you were going through. It wasn't until I (unwillingly) walked down this road with you that I finally understood."

Karl, whose wife struggled with postpartum depression, described his initial thoughts and feelings in this way: "I was so confused. I kept thinking, Whats happening? What can I do to fix this? What am I not doing right? Then the frustration set in, and the anger: I couldn't understand why my wife would behave like this or say these things. Sometimes I thought, This is definitely spiritual warfare: Why else would such negative thoughts be entering her sweet head and heart? As the days stretched into a string of painful weeks, I wondered why no one was coming to help. I later realized I just needed to communicate better with others, but at first I desperately wanted someone to know intuitively, to understand, to offer us some help and give some encouragement. I feared that if I didn't do something soon, I would lose my wife. I thought time was running out. I would have nightmares and wake up in the middle of her funeral or something. It was all really scary and horrible."

In the beginning, neither my husband nor Karl wanted to accept that PPD was now part of their entire familys life, not just their wife's. As I mentioned previously, Jeramy had his own ideas about what was going on (namely that I was returning to previous unhealthy behaviors), and Karl recalls being unwilling to call or identify his wife's condition as postpartum depression. "Though the signs were screaming at me," Karl confessed, "I wouldn't face up to it." He counsels other men: "Accept it. The sooner you can start to deal with your wife's sickness, the faster your family can get on the road to healing." Admitting that your wife is ill might not be easy (it certainly wasn't for Karl and Jeramy), but you may find that acknowledging your wife's PPD actually brings a sense of relief. Knowing what you're facing also enables you to confront the problem head-on. This aids in the healing you and your loved one need.

Even helping a new mom start the process of recovery, however, can present challenges for a loving husband. Both Karl and Jeramy expressed they often felt powerless. They wanted their family's trouble to "end . . . and quickly." Like many husbands in the battle against PPD, Karl and Jeramy tried to fix things. "This is a problem," Karl remembers thinking, "so I should be able to find a solution. There must be one, right? But then each of my attempts was like hitting a wall. My suggestions fell on deaf ears or met major resistance. At first, I couldn't find anyone who was of any use as far as understanding or overcoming PPD was concerned."

After I was admitted to the hospital close to our first child's fourmonth birthday, Jeramy felt helpless because both of our families were a thousand or more miles away. He recalls driving home from the hospital wondering how I was ever going to be able to take care of our little girl. Jeramy also felt conflicted, unable to trust what I was saying. "You had denied anything was wrong for so long," he remembered. "Your struggle was so quiet until the dam burst and you plunged into that incredibly dark place. How could I believe you when you said things were better?"

A couple years later, after the birth of our second daughter, and when depression overcame me once more, I shook Jeramy's trust again: "You didn't even talk to me about going off your medication. You made decisions that impacted our whole family, and I was powerless to change that. I was so angry that you couldn't see your choices were destructive." When the doctor told Jeramy and me that I never really pulled out of my first PPD (my body didn't have time to recover fully since I became pregnant so quickly after I started to get better), we both understood more clearly why things happened the way they did. On one level, I made hasty and unreasonable decisions-particularly regarding my medication-because I wasn't thinking rationally. My brain functioning was still impaired by the chemical imbalance of depression. Yet I recognize and grieve that I wasn't more honest with Jeramy about what I was feeling.

During seasons of depression, a couple's communication and trust will be tried. Jeramy believes that by expecting this and looking for ways to develop new methods of relating, husbands and wives will be equipped to weather the storm of postpartum depression more effectively.

Though Karl and his wife had always related very well, communication often became difficult during her battle with PPD: "Gretchen is so great at expressing her thoughts and emotions, and I've always been able to pick up on her hints. During her postpartum depression, though, there were so many times she couldn't, or didn't know how to, say what she was feeling. In those times I wasn't sure what I needed to do, how I should relate to her. I felt at a complete loss when thinking about what to do next. I just wished I could find the source of her troubles. There were days when I thought I had finally figured it out, what the right things to say and do were. Then I would suggest Gretchen do one thing with the kids or for her health and all hell would break lose. Back to square one. Relating to my wife during PPD was all about rise and fall ... kind of like the tide, but less predictable. There wasn't much of a pattern to her behavior. I was on one crazy ride, my wife was driving (well, sort of... the depression sometimes forcefully took the wheel), and we were all over the road. I had to just wear my seat belt, hang on, and be flexible. I also had to learn not to take all of her comments at face value. Discerning when it was the depression talking, as opposed to my wife, required a lot of patience. At first, I would get so offended and would take everything personally. Slowly, though, I began to separate my feelings from the reality of the situation."

One surprise blessing that God gave both Karl and Jermay was a deepening closeness with their children. Because they were forced-at least for a time-to fill the role of both father and mother, Jeramy and Karl drew their kids near, investing time and love in them, learning to nurture tenderly. Please be aware this isn't always the case, however. Some fathers feel more incapable or ineffective when trying to help their wives and care for their child(ren). If you or someone you love is in this situation, reaching out for help-or offering help, depending on which side of the coin you are on-is key.

Karl and Jeramy emphasize it's essential a husband walking with his wife through PPD learn to ask for and accept help-not only with the kid(s) but with virtually everything. One man cannot care for his spouse, nurture his children, work full time, and run a household. It is, quite simply, impossible. I recognize this is often difficult for husbands to accept; it can be humbling and frustrating to need others. For many (if not most) men, it's extremely frustrating to admit limitations of any kind. Yet God never calls us to face life, and its manifold trials, on our own. We need one another to bear the burden of postpartum depression (see Galatians 6:2).

It can also be challenging for a man to acknowledge the indispensable part he plays in his family's health. Karl told me that he came to understand "how important the dad is in the family, especially during a crisis like postpartum depression presents. He can make or break the whole deal. Depending on how I would respond, the day could be great or horrible."

Of course, this isn't to say that the husband can "fix" his wife (we've already alluded to that). A husband can't "cause" a depression either (even though this was intimated to Angela, whose counselor led her to believe if only her husband were more helpful at home, she would get better).

Both research and experience reveal that women with loving spouses do recover more quickly and completely than those without. In general, women with a broad support network fight PPD more effectively, but, without a doubt, the husband plays an essential and unique role in the community surrounding a woman enduring postnatal trauma.

Because of this, one of the most important things a husband can do is reach out to others. Karl recalls growing closer not only to his own family during this time but also to his wife's: "I really had to rely on our families to help with the kids and chores around the house. They were great with taking our little ones overnight. We all drew near to each other, in a huddle at the feet of Jesus. I felt more spiritually and emotionally close to them than ever before. We were traversing a deep and dark valley together. They called daily, sometimes twice or more. My father-in-law would bring Starbucks by. Thankfully, my wife is really tight with her family and they were ever ready and willing to help out. Through this, we all learned so much about PPD and about each other."

Jeramy, too, expressed his deep gratitude for my family and his, their willingness to jump on a plane or offer financial help (with counseling especially). Jer admits that if he had let pride get the better of him, if he had kept our struggle private and hadn't reached out for support, we might not have made it.

And it wasn't just family members who came alongside Karl and Jeramy during this time. Both asked friends to help as well. Jeramy called my girlfriends to come and sit with me (even though, during my darkest days, I was virtually catatonic and not much of a friend to anyone). Katie and Heather, two of my closest friends, played cards with me for hours (this was one of the few things I could do to keep my mind occupied). Kristina helped me do laundry. Penny and Tom cared for our kids more times than I can count. Kathy H., Louie and Louise, Cameron, and Kathy W. prayed for me, sent me notes of encouragement, did whatever they could to help. So many meals were brought that I couldn't name everyone who came to our aid in this way. Often, in fact, I didn't know whom to thank for our dinner or the groceries that were brought to feed my family. For Jeramy and me, the list of those to whom we owe so much goes on and on.

Again, I know that it's often difficult for men to admit they need help, let alone ask for it. If you find yourself in this position, please believe me: There are many for whom it is a blessing to walk with you through the valley. To those who genuinely love you and your family, your need is not a burden but an opportunity to share God's love. Are you embarrassed to ask others to help your wife clean or cook? If, perhaps, you could come to see this as a beautiful and essential way that Christ is teaching you humility (as opposed to humiliation), would it become somewhat easier for you? It did for both Karl and Jeramy.

Even more than reaching out to friends and family members, both my husband and Karl realized that they needed to cry out to God. Karl advises other spouses, "Pray, pray, pray without ceasing." Jeramy told me he used the psalms of lament to express himself to God, to plead with Him for help. When his own words seemed to fail, Scripture provided hope and peace sufficient for that moment, that day.

Reading the Bible may not solve everything, and there is certainly no "magic prayer" that will deliver a woman from PPD, yet both prayer and God's Word are integral pieces in the recovery puzzle. Jeramy recalls how I would ask him to pray for me or to read Scripture out loud. He admits now that he regrets not doing it more. "Back then, it sometimes felt futile," he remembers. "I knew intellectually that God would use these things, but I also observed that they usually didn't make things instantly better. That was difficult to deal with."

Another challenge accompanying a battle with PPD is dealing with people who just can't understand. Chances are good that those around you know very little, if anything, about postpartum depression. Jeramy told me that everyone seemed to have "the solution for him-and for me." Almost every time the words "If you ..." or "If Jerusha..." came out of someone's mouth, Jer recalls fighting the urge to say, "You have no idea what you're talking about."

Stigmas attached to any form of depression, including PPD, are still very real. There's nothing wrong with deciding that with some people you can share freely, while others need to know only the bare minimum. Some, perhaps, don't need to be in on your struggle at all. When confronted with a misinformed or insensitive person, you may find a phrase such as "I'm sorry that you don't understand" works well to end a difficult conversation. In other instances, offering no response at all may be best, particularly if continuing the dialogue would only lead to further aggression or defensiveness.

Some days, Jeramy told me, he just wanted to punch the next person who offered his or her advice (that's honesty for you, isn't it?). Though most of these people had good intentions, and even though a good deal of what they said was motivated by love, what our family needed most was loving support, not advice. If you do have counsel to give, consider asking first if it's a good time to talk about something you've read or discovered. It's not that a husband never needs counsel or direction, but rather that there are certain times when, and ways in which, such guidance can best be received.

Jeramy and Karl both learned they not only needed to educate themselves about postpartum depression, they also had to help others close to them understand it. Karl encourages, "Either give them information or point them to it." Your healthcare team-physicians, counselors, etc.-should be able to direct you to some helpful resources. In this day and age, we also have a wonderful research tool in the Internet. Of course, you should be discerning about which sites you visit and whose counsel you listen to. I've listed some particularly good websites in appendix B at the back of this book.

Equipping yourself and/or the people you love with information is an important step in the process of recovery. Getting professional help is as well. Jeramy didn't understand PPD well until he spoke with several wise Christian therapists. Donya Duggleby, Dr. Vickie Harvey, Dr. Earl Henslin, and Dr. Arlys McDonald each provided important pieces of the puzzle Jeramy was trying to put together. Several medical doctors also helped by evaluating my condition and prescribing medications. Understanding how and when these drugs will begin to work is likewise an important thing to discuss with your wife and healthcare team.

Karl urges other men to seek professional assistance right away: "Whatever the cost, get your wife to counseling. Discuss medication options early and without fear. And remember that if drugs are needed, they may not take effect right away." Maybe you recall reading in chapter 2 that Angela actually became worse for a short time after starting her meds. But as the needed dosage got into her system, she started recovering rapidly. Still, it can be extremely difficult and frustrating for a husband and wife waiting for medication to kick in. Unfortunately, in some cases a variety of drugs may be tried before the right one is selected. Often, this can be avoided by pursuing a diagnostic test (such as SPECT scanning), but if a woman's body is particularly sensitive to meds and their side effects, physicians may have to introduce medication(s) slowly.

Because of the many challenges associated with walking alongside a woman battling PPD, it may be helpful for a spouse to seek counseling himself. Husbands often feel they are carrying an unbearable weight, trying to be strong for the whole family. This brings up emotions and thoughts a man may be ill-equipped to process on his own. As it is with asking for help, admitting he needs to talk with a counselor can be awkward and humbling. It is ultimately, however, far more difficult for a man to "go it on his own."

The best thing you or a husband you know can do is to stay as balanced as possible. Karl advises, "If you need to exercise to blow off steam, if there's something else that keeps you sane [something positive and constructive, not damaging like drinking or overworking], find time to make that happen. It's okay to ask people to help so that you can stay healthy. Your wife is counting on it. Get as much sleep as possible. Eat well. There were days I didn't feel like eating, but I knew I needed to so that I could be there for my family."

Clearly, a husband's role is both important and intense. Let's look at some other ways in which postpartum depression affects husbands.

Making Sense of This

Many people, including husbands of women suffering with PPD, struggle to understand that postpartum depression is actually an illness. A woman with PPD is not concocting her symptoms or "making this up." Her condition did not develop because she is an incompetent mother, because she doesn't love her baby enough, or because she is weak and not trying hard enough to snap out of her depressive state. Furthermore, a new mom doesn't contract postpartum depression simply by thinking negative thoughts (which means she cannot think herself out of it).

Believing any of these misconceptions, while understandable, is ultimately destructive. When confronted with PPD, which no one desires and few genuinely understand, trying to place blame on someone or something is reasonable but also extremely counterproductive. Spending your time trying to figure out how and why this happened will only keep you from pursuing what is most important: healing.

That's not to say husbands can't ask God, "Why?" Christ Himself cried out from the cross, "My God, my God, why have you forsaken me?" (Matthew 27:46, emphasis added). I appreciate so much what Ruth Graham said on this subject: "Asking God why he ... allow[s us] to suffer adversity ... [is] a natural question and one that presuppose[s] God's goodness. When we ask why, we are asserting our desire to dialogue with the God in whom we have put a measure of trust."' Though some people see asking God, "Why?" as an indication that a person doesn't have enough confidence in the Lord, I agree with Mrs. Graham: We actually demonstrate that we believe in God's ability to answer and His power to change things when we ask Him our most agonizing questions. Of course, this doesn't mean I encourage you to ask, "Why?" while furiously shaking your fist at heaven. If you do, I'm still not concerned ... God can handle your confusion and anger. He knows it already. Asking, "Why?" may prove healing for you.

While awaiting His response, it's important to remember that the Lord determines when to act, and His timing may differ from what you consider ideal. Even if the Father answers you right away, you may not receive the kind of specific reply you were hoping for. Very likely, He will encourage you with words from Scripture or the example of Jesus and other Christians, many of whom have suffered without knowing the exact reason. While you may want an explicit answer-and you may, on occasion, get one-God always offers you a Person, His very Son, to walk with you through these agonizing times. He is our perfect provision in an imperfect world. We experience pain, in part, because we live in a broken, sin-stained world. We sometimes suffer due to the choices of people in our lives, choices we cannot control or change. And we often endure grief because of our own misguided (or flat-out wrong) decisions.

No matter what the source of our suffering, or the pain experienced by someone we love, we can take comfort in the words of 1 Peter 5:7: "Give all your worries and cares to God, for he cares about what happens to you" (NLT). Did you notice the word all in that verse? God does not limit which concerns we can lay at His feet. Whatever the reason for your wife's PPD or that of someone you love, you are invited to cast it all upon the God who cares.

Husbands often fear that their wife will never get better, that they'll lose the woman they love. Even if your wife doesn't die, you may be worried the woman you married will disappear in the fog of depression. Men sometimes express they feel postnatal diseases "steal" their wife and leave only a painful trail of resentment, anger, and frustration.

Please believe me: With the proper treatment, a mom battling PPD will heal. You can have your wife back, and you are invited by God to play an integral role in her recovery. Your heavenly Father can use this situation-powerfully-to change your life and bond you even more intimately to your spouse. It may feel as if this will last forever, but it will pass. In the meantime, cling to words of hope such as those found in 2 Corinthians 4:16-18:

We do not lose heart. ?hough outwardly we [or the people we love] are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.

Granted, battling postpartum depression usually feels anything but "light and momentary." When facing PPD, it's hard to imagine that what we see right now and the troubles all around us could be outweighed by anything. But "what is unseen"-the great glory that God has in store for us-can and does prevail against the hellish pain of postpartum depression. In order to press on, you need this hope and the eternal perspective it brings.

Without an eternal mind-set, men search futilely to find the solution that will resolve their wife's struggle with PPD. Many believe they know what to do, but their wife won't or can't do it. This kind of thinking helps no one. No matter how much you wish the depression would go away (and trust me, your wife wants this as much as or more than you do), healing will probably take a different form and longer time frame than you'd like.

A "fix-it" mentality may tempt you to offer suggestions based on what you would do in her situation, but consider carefully that what works for you may be neither best nor effective for your wife. For instance, you may imagine that ...

• You'd want to be alone, yet she wants someone with her at all times.

• You'd keep your thoughts to yourself, but she needs to talk about everything.

• You'd get out of the house and push your way through this, while she stays inside and has no "get up and go."

• You'd throw yourself into work, but she can't seem to accomplish anything.

• You'd take a "mind over matter" approach, yet she doesn't seem able to think straight at all.

• You'd turn sadness into anger, while she feels inadequate and worthless.2

These may or may not be ways you think you'd tackle what your wife is going through, but the point is, what would be helpful for you isn't necessarily what will encourage healing for the woman you love. It always works best to stop expecting your wife to behave in the ways you would. Instead, you can enter her world by asking her what she thinks would be most helpful. Depending on the severity of your spouse's condition, she may or may not be able to articulate her thoughts on this matter, but beginning the dialogue and then deliberately continuing it will help tremendously. Though it may sound silly to note, remember that you cannot read your wife's mind. Ask, and keep asking throughout her battle, what she thinks, feels, and needs.

Communicating your care and support in other ways will benefit your family as well. Some husbands try to encourage their wife with phrases such as "Our baby is so wonderful ... you should be so happy" or "Don't worry; everything will be fine." Though you may have the best of intentions in saying something like this, doing so might inadvertently compound your wife's guilt. She already wonders why she can't rejoice over her newborn child. She already feels ashamed that she's so consumed with worry and despair (especially if spiritual guilt is playing a role in her battle against PPD).

You'll never be able to choose your words perfectly, but this should actually be encouraging to you. Knowing that you will say some things that you'd rather reel back into your mouth may allow you to give yourself some grace. Don't try to be perfect; just aim to be compassionate. Let yourself off the hook when you screw up- everyone does, and a couple misplaced comments by someone who genuinely loves her are not going to send a new mom over the edge. That said, you can learn some phrases that have helped other husbands. For example,

• I know you're afraid, but we are doing and will keep doing everything we can to get you better.

• Even the best mommies get sick. You can be sick and still be a good mommy.

• I know you didn't ask for or cause this. I'm sorry you have to go through this, and I'll do whatever I can to help you heal.

• I know it seems you'll be like this forever, but the doctor believes you'll be yourself again soon, and I do, too.

• No one can tell us exactly why this happened. But with help, we can maximize the recovery process. I'm in this for the long haul.

• I'm proud of you for fighting this. It would be so easy to throw in the towel, but I see that you did to engage with life (noticing any small step in her recovery can really boost your wife's spirits).

• I love you (never underestimate the power of these three little words!).

You may find you can help your wife by writing encouraging words-1 love you," "I'm here for you," "You will get better" - or verses (for example, Psalm 34:18; Isaiah 54:10; 43:2 and 5; Lamentations 3:21-23) on sticky notes or index cards. She may be able to look at these throughout her day and focus on your love and, moreover, on God's promises.

As you try to be careful with your communication, be aware that your wife will likely make statements that anger or confuse you. She may express that she wishes she "never had this baby." I know it's difficult, but try to remember that PPD distorts a woman's thinking. It's wise not to give such negative thoughts more power by overreacting to or dwelling on them. As much as possible, remain emotionally neutral and choose not to reciprocate.

It will be easy for you to get frustrated if your wife is constantly irritable or pessimistic. It's no simple task to live with someone who's depressed. You can avoid some angst by taking breaks for yourself- going to the gym, grabbing coffee with an understanding friend, or staying up after everyone is in bed to have a few moments alone. You can also think of ways that you, your wife, and any older children can engage in positive ways-playing a favorite family game (especially one that doesn't involve too much strategizing) or doing a puzzle (puzzles were very therapeutic for me, as they helped to distract my mind from the spinning negativity that accompanied my PPD). Perhaps you could watch a funny movie or order dinner from your favorite restaurant and have a family-room picnic. It's important to remember that your wife may not "enjoy" these activities right away. I recall wanting so much to laugh when my husband came home from Wal-Mart with two comedies from the 1980s that I really loved- Ghost Busters and 17hreeAmigos!Though I couldn't engage as I wanted to, watching these movies did provide a temporary respite for my mind.

You can also care for your wife by taking some initiative around the house. Place the phone off the hook or screen your calls. Pick up a takeout dinner on your way home from work. Throw in a load of laundry. Taking on some simple household chores for a period can relieve tremendous weight from your wife's shoulders. This is an added benefit for "fix-it" types ... it may help you feel you are doing something in the battle against PPD.

If you're able, you may want to take some time off work. Use your vacation or sick days as necessary. Even if it means canceling a family trip planned for later in the year, using your time off now is very important. Just being in the house with your spouse can make her feel less isolated and better able to "do life."

Your employer may not provide benefits like paid sick or vacation days. If so, under the Family and Medical Leave Act (FMLA) many companies are required by federal law to allow their employees (both men and women) twelve weeks of unpaid family leave after the birth of a child. At the end of such a leave, the employer must allow its workers to return to the job they vacated or a similar job with the same salary, benefits, working conditions, and seniority. Of course, it would be difficult for many families to survive twelve weeks without a steady source of income, but this is an option that can be considered, especially in cases where a woman is unable to care for her children and no family or friends are available to provide support.

If you are unable to take time off work, call to check in on your wife. You can help her get as much rest as possible by giving her a break from the kid(s) after dinner. Simply looking your wife in the eye or sitting with her on the couch when she talks to you can be a blessing to a hurting mommy. And exercising as much patience as possible will certainly help. God can provide more patience than you think you're capable of, so ask Him for help.

I titled this section "Making Sense of This" because one of the biggest challenges husbands face is understanding what their wife is going through. Another difficulty that confronts spouses is learning to deal with the specific thoughts or actions associated with their wife's condition. I'd like to turn our attention now to some of the particular obstacles PPD presents for men.

What About ...?

Karl told me that seeing his wife so distraught was the hardest thing he faced in battling PPD with her. "She has always been tough and a gogetter. Once she sets her mind on something, she can accomplish it. She is motivated, caring, loving, and the best friend anyone could ever long to have. She is an amazing mother and wife. To see her discount all those qualities in herself, to not believe any of that, to hear she felt worthless and thought she was no use to our family killed me. I know it killed her to feel that way, too. She cried a lot. There were times when her brain would just take her off on tangents ... a downward spiral. So once our conversation got going on what she couldn't do or how useless she was, I knew where it was heading. I had to change topics quickly."

For Jeramy, the most challenging part of our struggle was "not letting PPD ruin our relationship. I felt like you were giving up on us, so I was tempted to want to give up, too. It was hard for me not to resent you."

These things may resonate with you, or you may find another aspect of postpartum depression more trying. It's very likely, however, that you are facing difficulties like these ...

My wife cries all the time. Jeramy vividly recalls coming home day after day and finding me weeping in the rocking chair. He felt helpless, clueless about what to do or how to make things better. The seemingly endless flood of tears that some women with PPD experience can be extremely hard for a man to understand or watch. Your wife may feel the need to just cry and cry. If so, the best thing you can do is let her. When she's not crying, you may want to ask your wife if there's something you can do to help her when she's in that place. She may or may not be able to tell you. Crying is often simply part of the body's natural way of dealing with crisis. Let her tears flow.

She s afraid she'll never get better. It's highly likely that your wife fears she will never be herself again. While this is not true, it can feel that way (to both of you!). The fog of depression is very difficult to see through. Remind her (and yourself) that there is a way out, and you're determined to walk through this valley with her. Though it may take longer than either of you would hope, the two of you will get through this and she will rediscover her life.

She takes everything out on me. Women with PPD often become frustrated, irritable, and aggressive. They sometimes make their husbands feel that they can do or say nothing right. This is part of the disease, and remembering that may help you. It is extremely difficult, however, to live with a woman who is constantly lashing out, especially if she's unable to express gratitude for all that her husband has been doing. She may not even be able to see your efforts. You could be taking care of the house, the kids, and trying to make your wife happy, but still she feels terrible. This is very hard on everyone. Husbands often bear the brunt of what their wives go through; they carry an incredibly heavy load. Men may be used to shouldering extra weight at work, but doing so at home may be foreign and uncomfortable for them. Try to remember that as she recovers, your wife will be able not only to appreciate what you're doing/have done, but she'll also be better able to control her angry and annoyed outbursts as well as manage her responsibilities. In the meantime, you'll be learning to reject acting as her whipping post (definitely not a healthy role for you to take on) and begin forgiving her for what she's doing.

She feels so guilty about everything. Most mothers with PPD battle a tremendous weight of guilt. They feel as if they're letting everyone down. A woman with postpartum depression may look at other moms who seem to be doing fine and think everyone else is better able to handle motherhood. Guilt over ideas like these may feel to your wife as if they are 100 percent accurate, but such thoughts are actually part of her distorted perception. Counseling and working on replacing toxic lies with biblical truths will help your wife tremendously.

She thinks she's a bad wife/mother/friend/Christian. Thoughts like these are full of shame. While guilt makes us feel bad for what we've done, shame makes us feel bad for who we are. PPD often reveals deep-seated insecurities in new mothers. Through His mercy, God allows women to process feelings of both guilt and shame while recovering from postpartum depression. Over the course of my treatment, the Holy Spirit peeled back many layers of shame, healing some incredibly dark corners of my mind (strongholds of false belief I didn't even know existed!). If your wife is facing a similar road, you can help by pointing out the things she is doing, no matter how small, even though she feels awful. If someone else needs to care for your baby for a stretch, you can tell her how grateful you are that people love her enough to help when she's sick.

She doesn't want to do anything or go anywhere. If you make a suggestion, your wife's gut reaction may be "I can't," "I'm not up to it," or "I don't want to." Lethargy, decreased motivation, and discomfort in social situations often accompany PPD. It's hard for me to convey how profoundly difficult it is to do anything when fighting a severe depression. If you can acknowledge that you know it's hard for her (even if you don't understand it completely), you may be able to help your wife see options other than staying in bed, avoiding her friends, and cooping herself up inside. If there is an event or activity you think your wife may enjoy, you might try encouraging her: "I know it's hard for you right now, but would you be willing to do or go with me to for a little while? If it's too difficult for you, we can stop or leave together." Giving your wife the option and letting her know you're trying to be sensitive to the predicament she's in may enable her to pluck up the energy to go somewhere or do something. And again, try to remember that as she recovers, your wife will get back into life.

She doesn't believe anything I say. You might try to lift your wife's spirits with phrases such as "You're beautiful," "I think you're a great mother," "Our baby will be fine; just focus on getting better," or "You will get better." Your spouse, however, may repeatedly discount these expressions of love, despite the fact that you mean it and tell her every day. Try to hang on until her thinking gets straightened out. When she tells you she's afraid you'll leave her or stop loving her, you can remind her that even if she can't believe it right now, you aren't going anywhere and will never stop loving her. When she worries obsessively about your child(ren), offer to pray with her for God's peace. If she feels guilty when you tell her you're coming home from work early, going to do some household chores, or asking people for help, do these things without her knowledge. She may doubt your words or your intentions now, but as she gets better, she'll begin to see what you have been/are doing is motivated out of love.

She's started treatment, but she s not getting better. Beginning treatment does not mean everything will go back to normal. Once your wife has been diagnosed with postpartum depression and has begun therapy and/or medication, you may think she'll get better quickly. This happens for some women, but for others healing takes a longer course. As Ruth Graham wrote in her book In Every Pew Sits a Broken Heart, God "can and does work in immediate ways. So many of us, however, must go through a process; and this process can be long and arduous. Healing is not subject to a predetermined time frame, nor is it a reflection of our spiritual maturity. Some people bounce back right away while others progress little by little. The pace is God's business; our part is to cooperate."3

Apart from trying to process what your wife is thinking and feeling, you may be dealing with internal struggles such as these ...

I just can't help her. Remember how hopeless and helpless Jeramy and Karl felt? You're not alone in feeling this way. The harder you are on yourself, the less energy and emotional reserve you'll have for each day. You can help; it just may take you a while to figure out what you can do. Remember that you don't have to have all the answers. You don't even have to have any of the answers to be a good listener or to hold your wife while she cries. And God will direct you if you ask Him to. As James 1:5 reminds us, "If you need wisdom-if you want to know what God wants you to do-ask him, and he will gladly tell you. He will not resent your asking" (NLT). Indeed, God "is generous and enjoys giving to all people, so he will give you wisdom" (James 1:5, Ncv, emphasis added).

I don't know if I can endure this. This isn't an easy road you are walking. You're probably exhausted. You may bounce back and forth in your mind between thoughts like She's indulged this long enough; My patience is wearing thin; and I love her so much; I just wish I could make things better. Depression is an incredibly selfabsorbing illness, and it will be challenging for you to deal with some of the selfish thoughts and feelings your wife has. Marriage may feel like too much work right now. In fact, if you had an especially strong marriage before your wife's PPD, you may feel the change in your relationship more acutely. Things are so different that you may wonder if you can keep pressing on day after day. There may be times you think about escaping, even if you know you would never abandon your wife and child(ren). Caring for someone who is depressed can be exhausting, but loving someone who needs your help can also be tremendously rewarding. Remember that God can and will give you all you need for the present. The past is His and so is the future. He will complete the good work He's started in you and your wife (see Philippians 1:6).

This feels so out of my control. It may be frustrating for you to hear, but this is beyond your control. None of this is what you hoped or planned for before you had the baby-whether it's your first or fifth. It's almost as if you packed your bags and boarded a plane for Tahiti but landed in Siberia instead. It's okay to be angry about things, as long as your frustrations can be channeled in healthy ways (i.e., at the PPD and not at your loved ones). Anger at the disease can actually become a positive source of energy because it can spur you to fight the battle with everything you've got. Being out of control may make you feel resentful as well as infuriated.... Why didn't anyone warn you this could happen? Do the doctors and authors of childbirth books have their heads in the sand? You probably feel blindsided by this illness, and you may develop feelings of bitterness. Unlike anger, resentment usually can't be directed in positive ways. Looking for someone or something to blame will only leave you feeling more out of control. Better to surrender control to God, whom the Scriptures call the "blessed and only Sovereign" (1 Timothy 6:15, NASB). He alone can control this situation and He alone can do it well. (He is not only sovereign, but blessed-in other words, right, good, perfect-in that role.) You cannot get around PPD. You can only get through it-with God's help. As the psalmist did, cling to this promise: "Even when I walk through the dark valley of death, I will not be afraid, for you are close beside me" (Psalm 23:4, NLT). He is near, and He is able to work all things, even this, together for good (see Romans 8:28).

I don t know how we're going to pay for treatment. Good care is often expensive. Insurance may not cover the medications or counselors that have been recommended or prescribed. Even if it eats away at your savings or necessitates you taking out loans, getting help has to be a priority. If your baby was diagnosed with a serious but treatable disease, would you hesitate-even for a moment-getting him the care he needs? If you were bleeding profusely, would you refuse to go to the hospital because you couldn't pay for treatment? God will not abandon you in your need. Ask Him, whose name is Jehovah Jireh (translated, "the Lord will provide"), to meet your financial need.4

I don't know what to do with her scary thoughts or persistent questions. Your wife may obsess about certain ideas or questions. She may ask you the same thing over and over again: "What if ...?" "Do you ...?" "Will I ...?" This can push you to the point of exhaustion. It may make you want to withdraw. Your wife will likely confess negative and frightening thoughts to you as well. Even if the things she tells you scare you as much as her, try to remind her (and yourself) that this kind of thinking almost always comes with PPD. As she pursues healing, thoughts like these will be replaced with healthy ones. And remember that your fear can exacerbate your wife's, so when you're afraid, I encourage you to talk it over with a trusted friend or counselor rather than your spouse. Please note: I'm certainly not advising that you ignore any potentially dangerous ideas your wife expresses. Talk about harming herself or others should always be taken seriously. You can still encourage her with the words above, however, and take appropriate action without intensifying the situation. Ask God for clear discernment when determining how to respond to her distressing thoughts.

I can't meet all of her needs. Your wife may expect things of your time and schedule that you simply cannot give. If you can help her make a plan for each day (the night before is a good time to do this), she may be better able to manage things on her own. Let her know you'll check on her a couple times throughout the day. Help her identify the people with whom she would feel comfortable spending time. Being alone can create high anxiety for women with PPD, especially those in the initial stages of treatment. This does get better with time. In the most acute stages, such stresses can often be avoided by asking friends to be with your wife (as Jeramy and Karl did), whether or not she claims she wants to be alone. If financially feasible, you may also consider hiring someone to clean or cook for a short period of time.

I don't know what to do for our older child(ren). Kids' fantasies are always worse than what's actually happening. Help your children by talking to them. Depending on their ages, kids don't need detailed specifics, but they do need to hear you recognize that their mom is ill. So often (this is particularly true with young children) kids fear they did something to make Mommy sick or that she doesn't love them anymore (especially if your wife is too ill to take care of them as she used to). Reassure them there is nothing they did to make Mom feel the way she does, and she's going to the doctor so she can get better (this also works if your wife must be hospitalized). You can tell your children, "You may see Mommy cry and she may be sad a lot, but it's never your fault. You couldn't have prevented this. She loves you just as much as ever and is doing everything she can to get better." Explain to your kid(s) that being sick sometimes makes people do things they normally wouldn't. Tell them that if Mommy says something hurtful to them, they can talk to you about it.

As much time as you can spend with your older child(ren), do so lovingly. Even sitting on the couch and watching a movie with them can make everyone feel better about what is going on. This is a "normal" thing to do and helps them feel that some things in life are still as they were. Also, giving your children a little extra attention and affection, which they may be missing from your wife, can go a long way. Depending on your wife's state of mind and ability to be alone, you may want to take the kids out for some fun activities. This can have the added benefit of giving your wife time to relax in the bath, read a good book, or take a nap. Remember that even very young children can sense that something is wrong with their mommy. They will notice that she's either more quiet or quicker to yell; she doesn't play as much as she used to or take them to the park after school anymore. Being clear and honest about Mommy's sickness is important for the child(ren) and for you.

We haven't had sex in a long time. Depression decreases libido. Unfortunately, this is a side effect of many antidepressants as well. Even healthy women struggle with sex after giving birth. Their bodies need time to recover. Many moms are contending with the physical demands of breast feeding, and all are faced with exhaustion and hormonal changes. Women often feel self-conscious, unattractive, and overweight after delivering a child, and they may fear getting pregnant again. All of these factors can be severely exacerbated by PPD. You may have thought that you and your wife would pick up your sex life right where you left it before the baby was born. Your disappointment and sexual tension may be extraordinarily high. You might feel tempted to do things that normally would not even register on your mental radar. All of this can be enormously frustrating. Though it may be difficult to do even in the best times, talking with your wife about sex is a necessity.

Please remember that PPD is a temporary condition when treated appropriately. If you previously had a satisfying physical relationship with your spouse, keep in mind that the current condition of your sex life was not caused by problems in your relationship. Your wife doesn't love or desire you less; her depression just makes intimacy much more difficult. As best as you are able, try not to take things personally. Ask your partner what kind of intimacy she can handle right now. If cuddling and touching is all she's up to, find ways to do that and satisfy both of your needs. Failing to verbalize what you're thinking or feeling will put both of you in an even worse predicament when it comes to sex. Of course, accusing your wife of being frigid or making her feel guilty for not being interested in sex won't help anyone. But just expressing to your wife that you want her love and touch may give her the bit of confidence she needs to be intimate with you. If it doesn't, hold on. This won't last forever.

Your Place in the Fallout

Author Anne Sheffield described the painful, complex thoughts and feelings that arise when living with someone who is depressed as "depression fallout."5 You are in the midst of a fallout not unlike that of an atomic bomb. A cloud of toxic debris rains down on you (sometimes every day), and your resources to deal with the trauma are likely stretched to the breaking point.

In this difficult season of marriage, the most critical thing a husband can do is simply be there for his wife. That may sound overly simplistic, but your very presence in her life and your commitment to be with her speak volumes about her worth, your devotion, and even God's goodness.

Yours are the hands Christ has chosen to touch your wife with. Yours is the human love He has given for her to experience most intimately. The Lord is literally loving your wife through you. On the days you cannot conjure up one more positive thing to say, in the moments when you think there is just no way you're going to get through this, He is faithful.

Second Corinthians 12:9-10 reveals this hopeful (yet seemingly paradoxical) truth: "[His] grace is sufficient for you, for power is perfected in weakness.... When [you are] weak, then [you are] strong" (NASB). Even if it's difficult for you to understand, when you feel powerless while confronting PPD or while walking through it with your wife, you're in the best position possible. In your weakness God can meet you. When you try to be strong, when you struggle to hold it all together, He cannot move. Only in surrendering will you be able to experience His all-sufficient grace.

No one likes to be weak. No one signs up for it. But every single one of us on this crazy, spinning globe will, at some time or another, be swept under by the tide of things we cannot control. At some point, we all become weak. The question is, how will we respond to that weakness? Will we grasp hold of any measure of control with white knuckles and raging bitterness, or will we release ourselves into the hands of a loving God whose power is perfected in our weakness?

As you ponder those questions, I'd like to close with a prayer for you, taken directly from Ephesians 3:16-21:

I pray that from his glorious [and] unlimited resources he will give you mighty inner strength through his Holy Spirit. And I pray that Christ will be more and more at home in your hearts as you trust in him. May your roots go down deep into the soil of Gods marvelous love. And may you have the power to understand... how wide, how long, how high, and how deep his love really is. May you experience the love of Christ, though it is so great you will never fully understand it. Then you will be filled with the fullness of life and power that comes from God...

By his mighty power at work within [you], he is able to accomplish infinitely more than we would ever dare to ask or hope. May he be given glory ... forever and ever through endless ages. Amen. (NLT)

Almighty God, to whom the needs of our daughter and son are known before we even ask, help me to ask only what accords with your will; and those good things which I dare not, or in my blindness cannot ask, grant for the sake of your Son Jesus Christ our Lord. Amen.1

If intimately involved in their daughter or son's life, the parents and in-laws of a woman battling postpartum depression suffer deeply. Oftentimes, they can't understand what's happening, let alone see why. A new mom's parents grieve for their little girl, for whom they can no longer provide kisses that "make everything better." Her husband's parents may feel heartbroken and confused, unsure of how they can or should help. Most parents and in-laws fear stepping over some unspoken boundary or saying the wrong thing. Still, they want so much to do something ... anything.

Though it's often hard for the parents of a woman with PPD to admit, the relationship with their daughter can become strained during a season marked by depression. My mom and dad remember that it was difficult to grasp how PPD had changed, and was continuing to change, me. My mother recalls, "I experienced such euphoria after each of my own children were born, a joyousness like none other. Seeing you cry silent tears as you nursed or stare zombie-like into space as you held those precious little ones was incomprehensible for me. Great waves of helplessness crashed over my love for you, my love for Jocelyn, even my love for God. I remember lying awake praying, begging God to heal you ... now, realizing how pathetic my own patience, long-suffering, trust, and faith must be to hate this trial, to want out of it now for everyone's sake, including-selfishly-my own."

My father remembers trying to comprehend what was happening to me: "It was clear we [he and my mom] had no real grasp of or control over your situation. We could only watch, hope, and pray. Yes, we prayed for wisdom in our response, but most often we simply prayed for you, `Kyrie eleison ... Lord, have mercy.' Over and over again we cried out for mercy."

Spencer and Rona Clark, my in-laws, also recall praying their hearts out. Because they lived hundreds of miles away when I delivered Jocelyn, they couldn't "be there" to meet the everyday needs of our struggling family. They prayed fervently and often. There were times, Rona confessed, "when all we felt like we could do was pray. I was physically sick with grief. My stomach ached a good deal of the time you were hurting." Spencer added, "We didn't really know what to do." Both my mother- and father-in-law felt "at a loss" and "pretty helpless."

Darlene, whose daughter suffered from postpartum depression after delivering her fourth child, related, "Becky scared me because I had never seen her like this ... she had such dark thoughts. She was in the depths of despair, and I didn't know how to help. I supported her in every way possible, but I also felt paralyzed. I was so afraid that what I said or did would be the wrong thing. Because I didn't fully understand what my daughter was experiencing, I was frightened I might somehow make things worse."

When I interviewed Darlene via e-mail, she emphasized the importance of gathering information about PPD. One of her sons-inlaw (not Becky's husband) headed up the research unit for their family, searching for help on the Internet and sharing it with everyone else.

My father, on the other hand, said he "didn't read much about it, because I didn't really understand what `it' was ... Of course, I'd heard the term `postpartum depression' and had actually read quite a bit about depression in general. Even that, however, was split in my mind into two compartments: one for a temporary, relatively minor condition and the other for cases like that of a friend, who went mad with it, thinking she was a prophet and trying to turn the water in toilets into wine. Surely, this tragedy had no application to you!"

My mother and father-in-law had only heard about PPD through the news. "But of course," Spencer admitted, "the media doesn't report the everyday battle against postpartum depression. We only knew of the extreme cases, and it was pretty frightening for us to think that you had the same disease." My mother-in-law added, "It was hard for me not to wonder, Is it okay for her to be alone with the kids? Will she hurt them, or herself.?"

Having previously been through some private counseling, my mom and dad both encouraged me to pursue it. However, it was challenging for them to see that therapy alone did not alleviate my physical symptoms. "Because I had studied, experienced, and believed in the value of cognitive therapy," my dad confessed, "it was difficult for me to come to grips with a clinical depression that seemed so resistant to psychological input or volitional change."

Some parents just can't understand why their daughter or daughter-in-law won't "snap out of it," "tell herself to get over it," or "make the choice to get better." Even if they don't harbor such misconceptions themselves, loving parents might discover that others' lack of understanding wounds them. My in-laws told me that when they shared I was going through another postpartum depression, a friend of theirs replied, "She's struggling with that again? Didn't she learn the first time around?"

When I asked my father-in-law a bit more about how people around them reacted to the news, Spencer talked about how many of his male friends misunderstand depression. "Men often look at psychological problems as something cooked up in a crazy woman's imagination. Being around guys who said stuff like, `My wife is nuts; she's actually going to see a shrink!' made me so glad that Jeramy never took that stance. So many men are insensitive about depression and almost make a joke of it. Jeramy always treated your situation as something serious, something that needed to be addressed holistically. I encourage all the dads out there to view your daughter or daughter-in-law's PPD as realistically and empathetically as possible."

Whether parents believe misperceptions or hear them from others, flawed thinking can create barriers of error and confusion. And though it's crucial that in-laws and parents don't push a woman to "just get on with life," it's equally important no one entertains the misconception that there's nothing a woman with PPD can do to move forward in healing. Depressed moms can make some decisions to pursue health and healing (even if the choice is something as seemingly small as agreeing to see a doctor). Saying that a woman with postpartum depression can't just "decide to feel better" is absolutely true. As she recovers, however, a suffering mother will be better able to make the kinds of choices that lead to deeper peace and joy. Postnatal disorders, as well as the fallacies associated with them, are extremely complex. That's why it's so important for family members to get equipped with the right information.

Trying to navigate the sea (though still a relatively small one) of facts about PPD now available through the Internet, books, and articles can be frustrating. Secular sources usually relate good details about the physiological and psychological facets of postpartum depression; however, they often neglect the intricate and inseparable spiritual battle. Many religious sources, sadly, gloss over PPD with a glib, "pray a lot and eventually you'll/she'll get better" attitude. My mom told me, "I never found what I hoped for: an authentic integration of all the dimensions you, Jeramy, me, both of our extended families, and friends were experiencing." Knowing which sources you can turn to for information and assistance is essential. Other families who've experienced postpartum depression can be a wealth of helpful counsel. Every parent or in-law who has "been there" with a daughter or son would encourage you: Don't be afraid to ask for help. Most people who've battled PPD are eager to share with other strugglers.

Parents I spoke with also stressed the importance of involving as many friends and family as possible in the recovery process. At first, my mom felt pressured to be "just what I needed" to start healing. She said, "Everyone told me that you'd get better once I arrived. After all, weren't we close? Yes. Didn't I know you well? I thought I did. Didn't I have that special love that only mothers have? Of course. Still, I alone could not be everything for you."

Darlene's entire family, and the community of believers around them, got involved in her daughter's fight against PPD. "Praise God for those who reached out to help," she wrote. "Our family was a little numb, in shock, at first. God definitely ministered to us through others. Meals were coming in; friends would stop by and pick up bags of laundry to do; they would also spend hours doing chores at my daughter's house." If you are a parent or in-law of someone struggling with postpartum depression, God may be asking you to lean on your entire family- both blood relatives and those connected to you in relationship with Christ.

My mom also urges other parents to "listen, listen, listen. Approach each day humbly, trusting that whether or not you can see improvement, the Lord is at work in all the lives affected. You may be shocked by the dramatic difference in your daughter. You are probably deeply distressed and may be virtually clueless. There were certainly times I was."

If your daughter or son is open to the idea, Darlene suggests having a family meeting with those ready and willing to help. "Chart everything that needs to be done in a day," she encourages. "Make a schedule for people to come and help out with the meals, chores, laundry, shopping, getting kids to school. Be sure to cover the time that your daughter has doctor appointments. Someone may need to drive her. Freeing my daughter's husband of the household chores so that he could have energy to love his wife and enjoy his children was absolutely essential."

A family meeting may be a good time to discuss other facets of the battle against PPD as well. Darlene counsels, "Everyone needs to be prepared for and talk about the long adjustment period of getting better. Finding the right therapist or the proper dosage of medication can be a slow and delicate process." My mom also urges parents and sons/sons-in-law to talk about reasonable expectations. You may find forgiveness for perceived or actual failure is necessary.

If you live far away, as my in-laws did during my fights against postpartum depression, you probably can't take part in driving your daughter/daughter-in-law to doctor appointments. When possible, you might consider taking some time to come and help your family. My mother-in-law, Rona, came for a week during the depression I experienced after delivering Jasmine. She urges other parents or inlaws who can take time to be with the hurting family: "Do whatever you can . . . fold laundry, make meals, take care of the kids, meet basic physical needs. Let your loved ones rest. They need to rest their bodies, minds, and spirits." Rona also counsels others "not to expect your daughter or daughter-in-law to share what she's thinking or feeling. Try not to ask pointed questions. If she wants to talk, let her direct the conversation."

Even if their daughter or daughter-in-law does want to open up, some parents find discussing postpartum depression extraordinarily difficult. It may seem easier to ignore the consuming and overwhelming pain your family is enduring. You may not want to air your concerns because, by doing so, you fear you'll "make them real." But what else can you say if you can't talk about the elephant in the room? Though it may be hard for you, communicating with others, especially those who've waged or are waging war against PPD on behalf of a loved one, is so crucial.

For every parent watching a family member suffer from postpartum depression, there are challenges and worries. My mom admitted she was terrified that she had failed me so completely and would lose me forever. She also confessed a concern that she would, in the weariness of the trial, come to hate God.

For my father, "trying to fall asleep at night with an imploding black hole of fear in my gut was extremely difficult." As I mentioned, my mother-in-law felt physically ill with worry. My dad also reported, "The length of time it required for healing to take hold and the lack of measurable markers to hang our hopes on led to enormous frustration. It was especially difficult to hear how flat and colorless your voice sounded, how weak and small. It was such a blow to hear that voice coming from you, normally such a vibrant, passionate person. I didn't know how to talk to you. Everything I said seemed to be wrong. I was often discouraged."

You, too, may feel disheartened. If so, let me and others who have walked through the valley of postpartum depression encourage you with a few practical observations and suggestions.

Consider with Me ...

According to the Centers for Disease Control and Prevention (CDC), the average length of hospital stay (LOS) for new mothers declined by 50 percent from 1970 to 1992. In 1992, women were hospitalized for an average of 2.6 days (2.1 days for vaginal deliveries and 4.0 days for cesarean deliveries). By 1996, following the institution of costcontainment measures by health-insurance companies, stays of twelve to twenty-four hours after an uncomplicated birth became common.' As the average LOS plummeted, forty-three states enacted legislation-based upon the recommendations of the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG)-to protect mothers and newborns from untimely discharge.'

A CDC article explains why shorter hospital stays are not usually a positive thing.

Consumer groups, legislators, and health-care providers are concerned that early hospital discharge may adversely affect (1) the mothers feeling ofpreparedness to care for the infant and herself, (2) the ability of hospital staff to effectively teach a mother to care for the infant and herself [as well as] assess her ability to do so, (3) initiation and continuation of breastfeeding, [and] (4) early diagnosis and treatment of infant and maternal morbidity [aka the presence of illness or disease, including postpartum depression]. 4

Post-childbirth practices in the United States differ sharply from much of the greater world. Latin Americans often place new mothers on la cuarentena (literally, "the quarantine"), which gives her forty days to rest while other female relatives take over the household duties. The Chinese have long practiced a similar custom, zuo yue zi, which can be translated "doing the month." A new mother in China is cared for by her extended family during this time. In Japan, the comparable tradition of satogaeri bunben dictates that one to two months prior to delivery, the mother returns to her family of origin so that her extended family can tend to her. After the birth, families practicing satogaeri bunben wait until the baby is two months old before returning the new mother to the child's father. Considering the fact that women with strong support systems are less likely to experience postnatal disorders, it's not surprising that (at least among immigrants to the United States), those who practice customs like these have lower rates of postpartum depression than women who do not.'

I certainly am not recommending that every family adopt one of these approaches to caring for a new mother. I only hope that by drawing a distinction between these and the current U.S. practices (which, for many, amount to "call your doctor or the La Leche League if you have trouble"), you might see that familial support and care directly after childbirth make a significant difference in the postpartum time. As hospital stays shorten, the role of the family becomes more critical than ever. I know that many of you either did (or plan to) help care for the new mom and baby after delivery. I applaud you. For those who do not consider this important, however, I'd only ask you to consider the facts.

You've already read Darlene's, my own parents', as well as my inlaws' encouragement to give practical help with babysitting, chores, and the like. My dad adds, "Sacrifice your own comforts if necessary." Throwing a load of laundry in, enabling a new mom (and dad!) to get as much rest as possible, fielding phone calls at her home, or calling to check on them when you're not/can't be there are simple acts of kindness that go a long way. If you're not close enough to help, you could offer to make phone calls to family and/or friends in the area, people who your son/son-in-law knows will be understanding and helpful. He may not have the time or energy to make these calls himself. A woman with moderate to severe PPD almost never has the emotional or physical reserves necessary to reach out for everyday assistance.

If it's financially feasible, you might consider offering to hire some help for the hurting family. Should you plan to make this available, it's a good idea to research a couple options and present them to your loved ones (you can find telephone directories and even recommendations for housekeeping or nannying services in your daughter/ son's area online). Again, an exhausted mom or dad may not have the wherewithal to do this legwork. If you cannot provide monetary assistance, perhaps there is someone in the family who can, or a group who could pitch in to help.

Another way you and your family can ease the monetary burden of battling PPD is helping to underwrite the recovery process. Depending on her insurance coverage and plan, a new mom may not be able to pay for or even receive the care she needs. My parents generously offered to take care of the bills for some of my counseling sessions. This was a blessing of enormous magnitude. When Rona came to stay with our family, she purchased groceries and take-out meals, which allowed us to divert some household funds to my recovery. Every little bit helps, so don't feel that a few dollars here and there are a worthless drop in the bucket. They're not.

I recognize that for many families financial assistance is simply out of the question. If that is the case for you, there are many other ways to help. Advocating for your son and daughter with insurance companies and social services is one very practical step you can take. Some government organizations will pay for all, or a portion of, mental-health services. If you're interested, you can research whether any (and then which) options are available in your family's community. Again, the Internet can be a great tool for you in this.

Apart from these practical helps, there are still other ways you can minister to those in need. Loving communication is one of these.

Knowing What to Say (and How to Say It)

As mentioned earlier, many parents struggle to know what they should say to someone battling PPD. They fear saying the "wrong thing" will worsen the situation. And the reality is, some parents and in-laws, especially those with preconceived and misguided notions about postpartum depression, do convey (even if inadvertently) disapproval and frustration that heighten a new mom's despair or anxiety.

In an effort to help you navigate the difficult waters of communicating with a woman suffering from PPD, I'd like to suggest both some techniques and cautions that may help.

If you would like to expedite the healing process, try to help your daughter/daughter-in-law feel understood and valued. Even ifyou don't "get" this disease, you can reassure a hurting mom that you're there for her ... for the long haul. You don't even need words to express this. When they stayed with me, both Rona and my mom hugged me over and over again. Their loving physical touch spoke volumes: I'm here for you ... I love you ... I accept you as you are. My moms' affection incarnated Jesus' caring concern for me.

Though it sounds simple, another important thing you can do is look your daughter/daughter-in-law in the eye when she talks to you. This basic sign of love and respect can wordlessly express your support. Listening quietly, without offering advice, might be a challenge for you, particularly if you have strong opinions about how things should be done, but this may be an opportunity for you to develop patient ears and an unhurried mouth.

I appreciate how the Amplified Bible renders James 1:19: "Let every man be quick to hear [a ready listener], slow to speak, slow to take offense and to get angry." If we could put this one biblical injunction into practice while walking with our loved ones through the valley of postpartum depression (or any struggle, for that matter), we would help tremendously. You may have noticed that this verse from James also commands us to be "slow to take offense." This, too, is an important part of communicating with family members battling PPD.

My dad encourages other parents to "be open for your son-in-law to speak honestly about his experience. Listen deeply. Be ready to hear things about your daughter that you might not want to hear. You can be his ally, working and praying together for your daughter's healing. But you must trust him."

A great deal of trust is built through open channels of healthy communication. Rona suggests, "Even if your son or daughter-in-law can't give you detailed explanations, listen to what they do tell you and be there when they do want to talk."

Because PPD changes a woman's personality, your daughter/ daughter-in-law may very well offend you during this time. If her depression is an agitated one, she may be extremely irritable or angry. You may be on the receiving end of a rage you don't deserve. As far as you are able, be patient with a suffering woman. Forgive her. In John 20:23, Jesus asked us to consider a crucially important question: "If you forgive someone's sins, they're gone for good. If you don't forgive sins, what are you going to do with them?" (MsG).

Should depression manifest itself in deep feelings of guilt, shame, and hopelessness for your daughter/daughter-in-law, you can provide encouragement, backing up what her husband is (hopefully) saying:

• Though this will take time, you will get better.

• You did not cause this to happen.

• This does not mean you don't love your family (especially your baby).

Even if she can't believe you when you say these things, emphasizing them again and again is a ministry to a new mom who's hurting. You may find that your daughter wants you to answer the same questions over and over: "Aren't you tired of me?" "What if the baby is irreversibly damaged by this?" "What if I never get better?"

Repeatedly going over the same ground can be frustrating for anyone. Facing persistent uncertainty in your own mind can exacerbate the distress already weighing on you. Rona and Spencer remember wondering if I would ever feel like myself again. They actually considered relocating to our area if depression was going to be an ongoing battle for me. Not knowing and having to retread the same ground can be exhausting. I only encourage you to exercise patience and faith as best you can.

Your daughter likely fears that you will tire of, and then abandon, her. She probably struggles to believe she'll ever be a good mother, or that she'll ever be herself again. If you can lovingly help her battle these toxic and recurring thoughts, you'll help train her brain to replace lies with Truth. Arm yourself with Scriptures that counter the false beliefs assaulting her (e.g., 2 Corinthians 4:8-10, which says, "We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed. We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body."

Hoping to alleviate their daughter or daughter-in-law's pain, some parents try to characterize postpartum depression as a "bad spell" or "rough patch." While it is certainly true in light of eternity that this is a blip on a new mom's life map, depression is a serious illness (but, praise God, very treatable). Minimizing her experience will only leave your daughter/daughter-in-law feeling more hopeless. If a suffering woman thinks you've dismissed her PPD, she may not want to confide in you any longer.

Well-meaning but misguided parents sometimes try to pull their loved one out of a depression by telling her what to feel. The following phrases, and others like them, are not helpful in the fight against postpartum depression:

• Your baby is so wonderful; you should be happy.

• Don't worry; everything will be fine (this sometimes compounds a new mother's guilt that she can't just "get over this").

• God's blessed you with so much; you shouldn't be down.

• This should be the happiest time of your life.

• You would feel better if only ... (you would pray or read the Bible more, work or quit working, stop breast-feeding, change your diet, take these supplements, exercise more consistently, lose some weight, make some parenting and/or schedule changes, etc.).

• This is just a phase.

• All new moms feel this way. (Not only is this untrue, it seriously minimizes the experience of a woman with PPD.)

• You wanted this baby, so this is what you have to go through.

Of course, it goes without saying that phrases such as "I liked you better the way you were before" or "I'm tired of your negativity" are not helpful. You may think these things, but please don't express them out loud. As I've mentioned before, you may want your daughter to "get over this," "snap out of it," or "choose to be happy." I ask you to remember that these are not decisions a woman with PPD-or anyone struggling with a chemical imbalance-can make. True, she can participate in her healing and will be able to make more and more healthy choices as she recovers, but no one can pull him or herself out of a genuine depression.

In her battle against PPD, your daughter or daughter-in-law will likely say things that confuse you. Darlene told me, "I remember standing in the bathroom with my daughter when she told me that she didn't really know how to take care of her newborn baby. I immediately thought, How can that be? This is your fourth child! What do you mean, you don't know how to take care of the babyN At first I wondered if she was kidding, but as I watched and listened closely, I soon realized she was revealing a deep internal struggle. That was the beginning (from my perspective) of my daughter's downward and despairing spiral. I literally watched her plunge deeper and deeper as the days went by."

As Darlene discovered, listening closely will help you determine what the perplexing things that your daughter might be saying actually mean. Often, because the depression colors her view of the entire world, what a woman with PPD expresses doesn't line up with reality. Learning to discern which of her thoughts are valid and which are largely a result of the depression is very important.

Another essential facet of communication involves embracing your new role as parent or in-law. You may have been a grandparent for a long time. You've been a parent even longer. But loving an adult child with postpartum depression-whether she is your own or yours by marriage-presents unique challenges. It also provides unique opportunities to build up your relationship. Let's look at some dynamics of your shifting roles.

A New Perspective

When their children are hurting, loving parents want to make things better. I know if I could, I would take all of my daughters' pain away. This is impossible, of course, but I want it nonetheless (as you probably do for your own children and grandkids). Desiring to alleviate suffering is a natural and beautiful expression of parental love. Such precious dimensions of a mother and father's love, however, can become imbalanced during the fight against postpartum depression. When yearning to provide loving care turns into a controlling or manipulative approach to assistance-even if done with "the best of intentions" -a dangerous dynamic comes into play.

It may sound a bit strange to observe, but it's essential for parents and in-laws to remember that the woman who battles PPD is the mother of her child(ren). Even if she is unable to care for her little one(s) during the most difficult days of her struggle, she is still the mother. Undermining her decisions, correcting her, or disregarding her wishes will only make a new mom unsure of (or more insecure in) her abilities to parent.

You may witness a loved one caring for your grandbaby in ways you disagree with. Without meaning to hurt her/him, you may "encourage" your daughter or son to do things the way you think is best. Criticizing in this manner is beneficial to no one.

It's difficult for any new mother or father (especially first-time moms and dads) to figure out what they want to do the same-or differently-from what they experienced and observed. I guarantee there will be things you did that your son and/or daughter don't want to repeat (this is unavoidable since every single one of us is flawed). Please consider this carefully: Your loved ones need to define their relationship with their newborn baby, as well as their approach to parenting in general, apart from you.

Postpartum depression often complicates this process of differentiation because suffering parents are usually quite needy. You may think you are "helping" by pointing out how your daughter or son is parenting the new baby (especially if you disagree with what you see), but this is not the time to bring up negative observations. If you are seriously concerned that some choices made by a new mother are harming the baby, talk to her husband, and then let him evaluate the situation and take any necessary steps. You can support him in this without manipulating matters. If your daughter is a single parent, you might want to ask if you can meet with her and her pastor or therapist in order to present your concerns respectfully.

Because things are so tumultuous during seasons of depression, you may think making decisions for a hurting loved one is the best course of action. Isn't it a good thing to take little choices off already overflowing plates? Sometimes, but not always.

In her book Why I jumped, PPD sufferer Tina Zahn related that during her dark days certain family members selected everything from the nursery decor to what clothes the baby would wear. This became a hidden source of grief for Tina, who felt unable to assert her own opinions or wishes. Whenever possible, include the new mom in any decisions you plan to make. If she can't communicate well, try to defer as many choices as possible until she begins to recover. Any decisions you must make, do with your daughter/daughter-in-law's preferences in mind, not your own.

Understanding that your role is no longer to make medical judgment calls for your daughter may present additional challenges. If you have firm beliefs about depression, mental-health medications, or psychotherapy, now is not the time to air opinions that differ from the approach a hurting family is taking. If you have information about the dangers of a specific treatment or drug, you can provide the resources and give your daughter or son the option to review them. Please remember, however, the choices are ultimately up to them. When your kids were little, you could decide everything-what doctors they would see, which medications they would take, the best way for them to get better. Your role now is primarily to support, possibly to inform, but never to control.

Comparing your daughter and son to other parents, or seeing how your grandchild "measures up" to other babies, is likewise not your role. The evaluation game, even if you're sure that your family is the "better one," leaves everyone losers. Be careful not to draw comparisons in front of a woman battling PPD, as she is very likely struggling with this already.

When your daughter begins to recover, your new role does allow you to help her see the ways she's growing and making progress. My mom wishes that she'd recorded the specific challenges and prayers, as well as the ways in which they were overcome and answered. Writing down times when you felt God's presence in specific ways or saw answers to prayer can be a great encouragement to your loved ones. Indeed, the Lord tells us in Psalm 102:18-20,

Your role also includes praying for your daughter or son in new ways. You have probably prayed that he or she would be protected from harm and blessed with health, but, nonetheless, this horrible disease has descended upon your family. Perhaps your prayers will be transformed during this time, that you might pray for God's will to be done no matter how long it takes, no matter how painful the process. These are not easy things to pray. Such words are often offered to God with weeping, wailing, and suffocating grief. But "thy will be done" is the only prayer that never fails. 6

The Lord commands us to "pray without ceasing" (1 Thessalonians 5:17, NASB) and "pray in the Spirit on all occasions with all kinds of prayers and requests. With this in mind, be alert and always keep on praying for all the saints," your son and daughter included (Ephesians 6:18). Likely, learning to pray in new ways is a blessing God has hidden beneath the toxic fallout of PPD.

God also hides the joy of rediscovering your absolute dependence on Him. You cannot fight this on your own. You cannot make everything better. This is out of your control. And though it may hurt to acknowledge these truths, I hope doing so ultimately uplifts you and deepens your relationship with Jehovah Rapha, our healing Savior.

Cling with me to the hope found in 1 Peter 5:10: "In his kindness God called you to his eternal glory by means of Jesus Christ. After you have suffered a little while, he will restore, support, and strengthen you, and he will place you on a firm foundation" (NLT). If your son and daughter is a believer, this promise is for him/her as much as it is for you. You can pray that Yahweh would begin to restore, support, and strengthen you and your loved ones. If they have not yet come to know the Lord, your prayers will, of course, include beseeching God to woo them into an intimate and dynamic relationship with Him. People often turn to the Lord during seasons of suffering.

When we pray with full dependence on God, convinced of His power to strengthen and sustain, we are praying in faith. Again, this isn't easy to do. As author Ruth Graham so succinctly and powerfully noted, "The prayer of faith is a costly prayer." 7 We can ask God to help us be there for our loved ones, but He calls us to trust that He is the Sovereign Healer. You may find yourself trying to rescue your son or daughter. This is a natural inclination. But you can ask God to help you let go of that burden. Rescuer is not part of your role. He alone is the Restorer of body and soul. It's one thing to pray these truths in abstract ways; it's an entirely different matter to see them fleshed out in your life and in the lives of those you love.

I pray that during this painful time in your life and your beloved one's life you would come away absolutely certain that God can and will bring good out of any circumstance. It may take awhile to see what He is doing, how He is weaving blessing in the midst of suffering, but you and I can pray for eyes to see, ears to hear, and a mind to comprehend His work.

Remember, my friend, the promises of these well-known words from Philippians 4:5-7: "The Lord is near. Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus." I pray His peace for you. He is near to you and your beloved ones. Right now, and in every agonizing aspect of this fight against PPD, you can be sure of His presence.

With this truth in mind, I'd like to close with one last story from my mom's experience. After hearing about my attempted suicide and second hospitalization, she went to church bereft and heartbroken. A reflection for that morning's worship came from Acts 16.

Verses 22-24 describe Paul and Silas being brutally flogged, then imprisoned by the Romans. The apostles were not only placed under armed guard, their feet were forced into stocks as well. Still, as verse 25 records, "Paul and Silas were praying and singing hymns to God, and the other prisoners were listening to them." Suddenly, a violent earthquake hit. The prison doors flew open. Everyone's chains broke loose. The jailer awakened with a start and, after realizing what had happened, drew a sword to end his life. Naturally, he believed the prisoners had escaped. In that day and age, any soldier in this position would have been sentenced to immediate death. As the story climaxes, and before the warden can commit suicide, Paul shouted, "Don't harm yourself! We are all here!" (verse 28).

In the biblical account, the jailer and his whole family were saved, converted to the Way of Christ, and set free from their sin. In my mom's life, on the day after I attempted to end my life here on earth, the words "Don't harm yourself! We are all here!" became incarnated in an extremely powerful way. She told me that night, through tears, "Rusha, don't hurt yourself. We're all here for you ... everyone who loves you. We're not going away." In that moment, I couldn't take it all in, but I did hear that she loved me. The assurance of her acceptance and the reality of her concern penetrated some of my despair. Today, it brings grateful tears to my eyes.

As a parent, in His strength, you can offer your son and daughter this same blessed confidence. An earthquake may not break your beloved's chains, but our Healing Savior will, in His perfect time and ways, redeem this pain. Like Paul and Silas, you can pray to and praise Him who is Immanuel, God with you, God near you, God who cares for you ... and your loved ones.

Carry each other's burdens ... in this way you will fulfill the law of Christ.

- GALATIANS 6:2

When Laurie Wilson returned from a five-day Spring Break trip to Mexico and called her sister, something was definitely wrong. Because Laurie and Kathy had always shared a special sisterly bond, it was immediately obvious to Laurie that Kathy wasn't herself. Just five days before, her sister had been extremely happy, rejoicing in the birth of her little girl. But now, two weeks after Kathy's baby was born, things had started to spiral.

Initially, I felt concerned about taking a trip so soon after Kathy's delivery. My parents, who joined my husband and me in Cabo, had the same misgivings. We all thought Kathy might need some extra help, seeing as this was her fourth child in less than six years. In the beginning, everything seemed to be going so well for my sister that we decided to keep our travel plans. Coming home to a completely altered Kathy, a Kathy who doubted her abilities as a parent, shocked us. It seemed so strange; it happened so fast.

She struggled with basic things like when to feed her baby girl. She asked questions that first-time moms might ask. At first I assumed that the exhausting reality of caring for four little ones was simply taking its toll. She probably just feels overwhelmed, I reasoned. Wouldn't anyone in her situation feel stressed? This is just an adjustment period. Things will even out.

Over the next few days, however, things got worse, not better. Kathy seemed to lose more confidence. She was so down on herself and frustrated that she couldn't make simple decisions. At times she seemed mentally paralyzed.

The days dragged on, and Kathy's discouragement continued to pull her under. My mom and I started swapping stories about what she had said or done. As we compared notes, so to speak, Mom and I became more and more concerned. Kathy constantly obsessed over the idea that she couldn't "do it" (take care of the kids). She would say things like, "They'd be better off without me." Then Kathy started having a hard time getting out of bed. It was so painful to watch my bright and spunky sister sink into a black hole.

Honestly, remembering those agonizing weeks feels like trying to recall the details of a bad dream. You know how with dreams your mind goes a bit fuzzy? How the exact details may not be clear, but awakening from a nightmare still leaves you with a sick feeling in the pit of your stomach and the depths of your heart? Looking back on my sister's dark days is kind of like that for me.

I kept telling her to call the doctor. A friend of Kathy's who had struggled with postpartum depression encouraged her to as well. Kathy promised she would call - she wanted to call - but she just couldn't. "I just feel so exhausted," she told me, "I don't know where the day went. Maybe I'll feel well enough to make an appointment tomorrow." As tomorrow melted into the next day, and then the day after that, it quickly became apparent that, as far as getting help went, Kathy wasn't able to do anything on her own.

Her husband took charge and called the doctor. Kathy's friend who had experienced PPD lined up an appointment for my sister with a Christian psychologist. She also made calls to the church, asking for help with the cost of counseling. These were huge blessings because no one in our family knew of a good therapist, let alone how Kathy and her husband could pay for all the sessions. As a family, our mission became getting Kathy to her appointments. Sometimes it felt like we were forcing her to go. But slowly and surely, Kathy started on the path to recovery.

Things didn't instantly get better, and that was hard on everyone (most of all on Kathy). She needed us to show confidence in her, and in the steps she was taking to beat this disease, so I cheered her on whenever I could. I went into a "you can beat this, you're going to get better" mode.

Because a close friend of mine in college had struggled with depression (though not PPD), I knew that what Kathy faced was an illness. It was completely obvious to me that Kathy had very little, if any, control over her physical state. My sister was sick, and her thoughts and emotions were being radically and destructively affected. I never wondered why she couldn't just "get a hold of herself." Thank God I was able to understand that this was no fault of her own; this wasn't something she could simply choose to end. It's hard for me to imagine how difficult it must be for people who blame themselves for their struggle. Or, even worse, for those who have to face judgmental family and friends on top of their depression.

Knowing my sister wasn't to blame for what was happening to her and that she couldn't just "snap out of it" gave me some comfort, but I remember feeling really afraid for the same reason. Because Kathy wasn't in control of herself, I worried about her being alone with the kids. For a while, someone stayed with my sister every minute of the day. I was with her whenever I could be and continued to be her "you're going to make it" cheerleader.

When I went home though, or when I lay in bed at night, my mind would race with dangerous scenarios. What if something awful happened to my nieces and nephews? What if Kathy got so bad that she left them unattended? Did Brent, Kathy's oldest son, know how to call 9-1-1? We had better teach him just in case, I determined.

Sometimes, my thoughts spun with even more horrifying possibilities. Though I tried to deny that I felt it, I genuinely feared I would lose my sister, that she would never be the same again. She'd always been my best friend, such a big part of who I am. I started thinking about what it would be like if she was gone, and that terrified me - not only for her kids and her husband but also for myself. What would I do without her? I never shared my doubts with Kathy, but during her battle with PPD, these thoughts haunted my days and nights.

Seeing my sister's spark, the exuberance that made her so special, totally snuffed bored a hole in my heart. I almost didn't recognize her anymore. Intellectually, I knew it was the illness changing Kathy, but my heart still ached. I missed who she was. My sister had always been the happy, cheerful, friendly, energetic, fun girl who was full of life. The "real Kathy" was missing for quite some time.

I remember one day I was at home listening to music while trying to get some grading done. Celine Dion's song "I'm Alive" came on, and I started bawling. I think that may have been the first time I really cried about everything that had been going on. I had spent so much time being the strong one, the cheerleader, the one ever ready to convince Kathy she'd get better. That day, though, I just broke down and sobbed. "I'm Alive" had always been a song that Kathy and I loved. We had danced to it, been inspired by it when life was going well. And I remember despairing that the fire of Kathy's life burned so dim. She didn't feel "alive" at all. I was so scared that her flame would never blaze again.

Instead of giving in to these discouraging worries, I became a problem solver. In Kathy's presence, I continued to exude complete confidence that she would get better. Looking back, I was probably also trying to convince myself she would be herself again. I made up my mind we would accept no outcome other than complete recovery. I started making Kathy do things that fell outside her comfort zone because I knew they would help her.

For instance, I told Kathy one night on the phone that, whether she liked it or not, I was going to start coming over to take her walking. Kathy had always been very active, and I knew that exercise would hasten her recovery. So far she had been unable to do it, so I jumped in to help her start.

As the weeks passed, Kathy began to resemble herself more and more. I am amazed at how she battled PPD and cared for her family despite her illness. Kathy may have been beating herself up with negative thoughts, but I saw what a good mom she was still being. I don't even think the kids were really aware of what was going on, let alone feeling neglected in any way.

My sister made it to the other side, and for all the people reading my story, I want to encourage you: With the right help, your family member can, too. You don't have to be an expert on postpartum depression to understand what you need to do. If you can see that your loved one is not simply being "overly emotional" but has a chemical imbalance that's bringing out all of the negativity, fears, and heartache that may have been hidden deep within her, you'll be able to love her - your sister, your cousin, your granddaughter, your niece - through this.

Try not to be judgmental or make her feel bad about what's going on. She already does! If you can support or even assist her in pursuing professional help - whether counseling, medication, or both - embrace that role. Don't wait until things get "so bad" that you have to see a doctor. Recognizing the signs of postpartum depression and getting help as soon as possible are crucial.

Of course, if you're close enough, you can be there for your loved one by helping around the house, watching the kid(s), taking her to appointments or the grocery store. And just being present is a ministry. Even if miles and miles separate you and her, you might be able to make calls to her doctors or insurance company, a counselor, or other people who could help. If you'd like to advocate for a loved one with any medical practitioner or carrier, remember that because of the HIPAA Law, you must first obtain written consent from the patient.

Most of all, cling to hope. Your loved one, and you with her, can move beyond this and experience renewed hope and joy.

The Law of Love

Laurie's story speaks volumes about how extended family members can help women battling postpartum depression. Active and loving involvement, as modeled by Laurie and the rest of her family, often makes the difference between a woman who recovers from PPD relatively quickly and one who fights it for months, even years. Remember that while the onset of postpartum depression usually occurs within twelve months after delivery, unattended cases of PPD can stretch far beyond that time frame.

As a concerned family member or friend (and I feel completely safe in categorizing you as such; you wouldn't be reading this book if you weren't!), you can play a unique role in your loved one's recovery. Like Laurie, you may have a special bond with the woman who struggles. Perhaps you are the one God is calling to be encourager, grace giver, even personal trainer (we'll explore this more later, but Laurie rightly observed that exercise is often a key component in a woman's healing).

You may feel, however, that you'll cross some invisible boundary by trying to help "too much." From experience, I can tell you it's far better to offer what you can and be told no, than restrain yourself and miss out on the opportunity to bear part of your loved one's burden.

Galatians 6:2 commands us to "share each other's troubles and problems, and in this way obey the law of Christ" (NLT). The law of love, the law of mercy, the law fulfilled by Jesus on the cross compels us to walk with others in their valleys. As most of us have experienced, it is often a greater blessing to give the help, bearing the weight of a loved one's pain, than it is to receive it. God charges us to share the heartache of those around us in love. And this is no burdensome obligation. "This is love for God," wrote the apostle John, "to obey his commands. And his commands are not burdensome" (1 John 5:3).

In part, Christ calls and enables us to bear one another's burdens because He knows it blesses and refines all those involved. In accepting some of a loved one's pain, you say yes to Jesus, and He promises to bear the weight with you. Both you and the suffering person then share in the joy of realizing that your burden is actually lighter. And both of you may be challenged by the reality of sharing a burden-needing help is humbling and extending it selflessly is a sacrifice. In choosing to regard others more highly than themselves, in looking out not only for their own interests but also for the needs of others (see Philippians 2:3-4), burden bearers learn humility as well.

Consider with me the observations of Matthew Henry, the great biblical commentator, about Paul's words to the Galatians:

It becomes us to bear one anothers burdens, as fellow-travellers.... This obliges to mutual forbearance and compassion towards each other, agreeably to [Christ V example.... It is very common for a man to look upon himself as wiser and better than other men, and as fit to dictate to them. Such a one deceives himself,• by pretending to what he has not.... The better we know our own hearts and ways, the less shall we despise others, and the more be disposed to help them under infirmities and afflictions.I

It seems easy enough to understand why Henry would observe that compassion and long-suffering are the benefits of bearing one another's burdens. But why would Henry link this with mankind's proclivity to think more highly of himself than he ought?

Paul himself united the two in Galatians 6. After the admonition to share in each other's pain, the apostle warned, "If you think you are too important to help someone in need, you are only fooling yourself" (verse 3, NLT). The NIV renders this verse, "If anyone thinks he is something when he is nothing, he deceives himself."

There is great danger in believing that you are "above" the person you are helping. Instead of approaching a loved one with pitying condescension, we can approach the situation with humble hearts, recognizing that our own bodies and minds are weak. All of us are as dust and ashes before the living God (see Genesis 18:27). It could very well be you in the throes of a debilitating depression.

If you have never faced an illness that affects your brain, it may be difficult for you to imagine struggling with depression yourself You may not go as far as to believe that the person you love should just "snap out of it," but perhaps you still think that if you were in her shoes, you would do things differently (maybe better). These thoughts are natural and exactly why, in essence, Paul exhorted us to place ourselves in the boat with the person, not on the shore giving directions.

Over the course of the past six chapters, you have heard the voices of various strugglers and their family members encouraging you to avoid judging women battling PPD. There is a reason for this refrain: Placing ourselves above someone who is struggling-anyone, not simply someone with depression-is easy. You may have no intention of doing this. You may only want to help. And, by the Lord's grace, you may truly be free of judgment or condescension. I cannot and will not attempt to evaluate your heart. I mean only to urge you to examine yourself as you offer assistance. Can pity be transformed into empathy? Can condescension be transformed into respectful service? In the hands of a merciful Lord, absolutely!

To all family members, no matter how close or distant in relation, the words of Paul echo into your loved one's present struggle. Bear her burdens, obeying the law of Christ. And do so with a humble heart, eager to serve, without judgment and ever aware of God's care for your own body and mind.

From a Masculine Point of View

Stereotypes become stereotypes because particular patterns repeat themselves over and over again. And while it is certainly stereotypical-generally observable, though not invariably true-to say that women have an easier time showing love and compassion, this is often the case.

Perhaps you are a male relative or friend reading this book. Have you found yourself struggling to imagine how you can help? Hormones, childbirth, and postpartum life may be a complete mystery to you, a mystery you may not be particularly keen to figure out. Even though you hurt for your loved one, talking or learning about "female issues" may be the last thing you'd choose to do. Some of the suggestions others have made-cooking, cleaning, or babysitting for a woman with PPD, for instance-might not only be out of your comfort zone but akin to recommending you scale Mount Everest in a Windbreaker and flip-flops.

Maybe you're not comfortable with dropping by unannounced and offering to throw a load of laundry in. Perhaps even the thought of expressing your love and concern in a verbal way causes you to freeze up. Be encouraged. You are not alone. And guess what? It's definitely not just men who feel this way. Many women also find helping a loved one through her PPD quite difficult.

My brother, Jonathan, with whom I have always had a close relationship, told me it was somewhat difficult for him to figure out how he could help. "I've always wanted to be someone who writes notes and shows that they care more, but I have a hard time expressing myself in those ways. This became even more clear when you were hurting."

Though we often talked on the phone before I started to struggle, Jonathan and I were separated by thousands of miles during my first postpartum depression and hundreds during my second. We weren't spending a lot of time together to begin with, and he couldn't simply stop by our house.

He heard about my depressions primarily through our mom and dad. "The conversations were mainly requests for prayer and updates on your health," he remembers. "But I knew so few specifics about what you were going through that it was hard for me to process.

"At first I thought your struggle was an extension of things you had experienced before [i.e., the eating disorder]. Until I researched it online, I was just guessing. After becoming slightly more informed, I still remember being extremely confused, because it seemed so out of character for you. Plus, I've always been a `mind over matter' person, and I was confused why you couldn't just `overcome' your thoughts. Research and discussions with the family helped me learn more of PPD's intricacies.

"Mainly I was afraid and sad for you. You seemed so fragile, but I had always known you as a strong and confident woman. I felt awkward about asking you directly what you were going through. I was curious and wanted details, but I didn't want to exacerbate the situation, so I just ignored my feelings. Unfortunately, that led to less communication between us and, thus, less understanding of your situation.

"If I could encourage others, especially other male friends and relatives, with one piece of advice, it would be to keep the communication lines open. It's an extremely sensitive subject, I know, but the more you share together, the better able you'll be to help and relate. I personally wish I would have communicated more and been more supportive. If you can't talk with the person who's suffering (and this may often be the case), try talking with her husband or other family members close enough to the situation to help you understand it."

As Jonathan noted, communication is often difficult or, at the very least, interrupted by the fact that women sometimes find it difficult to discuss their postpartum depression. Some feel embarrassed at the thought of admitting weakness. PPD makes them feel vulnerable and exposed. If you can assure your loved one of your support and presence, however, she may be blessedly surprised at how compassionate her family can be, even the members with whom she has a more distant relationship.

If you don't believe your relationship with the woman going through postpartum depression is close enough to ask her questions directly, or if you feel like my brother did-worried that you will exacerbate the situation by wanting details-you can, as Jonathan did, research and talk with other family members. These lines of communication are vital as well.

More important, even than good communication, are your prayers. As Paul admonished, "Pray in the Spirit at all times with all kinds of prayers, asking for everything you need. To do this you must always be ready and never give up" (Ephesians 6:18, NCV). Persevering in prayer for your loved one is by far the most precious gift you can offer. Perhaps this will be a time during which your personal prayer life will take on new life and fresh vibrancy. Interceding for another often leads to such results.

Your First Resource

Many faithfully prayed for me, but few perhaps more so than my Nan, my closest grandparent. "I knew that I needed to pray mightily!" she recently wrote me. "I stayed in close touch with your mom and dad to monitor your progress. But as a woman of faith, my first resource was always to go to the Lord. I felt assured by the Spirit that ultimately you would be all right, but it was still hard to see someone I loved so much going through all that you went through.

"It was also difficult for me not to worry (I come from a long line of first-class worriers!). Of course I was concerned for you, distressed by your obvious unhappiness and confusion. And, to be honest, I was anxious for those beautiful little girls. I never really believed that you would do anything to harm them (I had heard of women who, in their misery, actually did), but I grieved to see you indifferent to your babies at times when I wanted so much for you to enjoy them."

Like many loved ones, my Nan found it difficult to relate to me because she feared saying the wrong thing. "I didn't want you to feel that I was judging you in any way, intruding, or putting pressure on you. I just tried to keep expressing my love and support. Looking back, I guess I was flying blind. Nothing like this had ever happened to someone so close to me. All I knew to do was just love you, love you, love you, and entrust everything to the Lord.

"When we came to visit you in Colorado, I remember sitting with you on the couch one night. Jocelyn was either with your mom or asleep, and I just held you in my arms. I am a very tactile person, and close physical contact is such a comfort for me. I hoped that, at that moment, you were being comforted as well.

"It was so difficult watching you struggle not just once, but over again. Considering my natural impatience to have everything get better yesterday, the fact that your illness reappeared especially troubled me. Still, I have learned over the years that while the Lord always hears our prayers, His answers sometimes don't come when or in just the way we would like them to. In retrospect, I can see there were things you had to learn-for instance, you needed the doctors to figure out the chemical imbalance in your brain that worsened your condition so they could treat it appropriately. Had you not been properly diagnosed, you probably would not be in the good place that you are now.

"Though it's certainly difficult, I would urge other grandparents (or any loved one, for that matter) not to panic but to be patient in offering love and any physical support they can. I wanted to be closer, but it was hard for me because so many miles separated us and you rarely felt like talking on the phone. So, again and again, I turned to prayer, constant prayer. As with others of my loved ones who have gone through hard times, every time I thought of you, I offered a silent prayer."

Now recovered, hoping to help others on the road to restoration, I'm thoroughly convinced that those prayers were a significant part of my healing.

Blood Is Thicker Than Depression

The ties of family and blood that connect you to a loved one with PPD are powerful, as is the solidarity forged by family members bonding together to fight this disease. Working side by side with other loved ones may alleviate some of the helplessness and confusion that often come from watching a woman go from happy to depressed in a relatively short period of time.

Partnering with other family members (and friends) may also help you to transcend stereotypes about people with chemical imbalances of the brain. While not all are, some of the most misguided stereotypes seem to arise between generations.

The world is a much different place than it was when the grandmothers of today bore their children. Medical evidence indicates that most likely our bodies, and most certainly our knowledge, have changed over time. Mankind appears to be either more susceptible to certain illnesses than ever before or simply better able to diagnose what ails the struggling. It's essential that, as loved ones who want to help rather than hurt those who suffer, we embrace the realities of today's world rather than fight them.

Of course, many of the ways your parents chose to raise children will remain the same. No matter in what day and age they started their families, Christ following parents want their little ones to grow into men and women of character, men and women passionate about God and in dynamic relationship with Him.

However, other aspects of parenting have morphed dramatically. Parents today face different and, in the eyes of some, more challenging dilemmas than parents of the past. Our ancestors may have worked hard to provide food, clothing, and shelter for their children. But mothers and fathers in today's world, in addition to dealing with their own rapidly increasing physical health concerns, worry about the drug pushers now prowling elementary schoolyards, the epidemic of sexually transmitted diseases (even among Christians), the moral disintegration of a society they hoped would be a place where their children and grandchildren could thrive.

While this is not the book to delve deeply into a discussion of why some people of different generations have a more difficult time accepting the fact that depression is not a choice but an illness, and that PPD is not simply the result of bad decisions or new-fangled parenting methods, it is important for the purpose of this work to recognize that many people hold on to such misconceptions.

Some think that if things were done how they "used to be done," or if everyone parented the way they parent(ed) children, things would be much better. I'm sorry to say this is not the case. I genuinely wish there were a formula every new mom could follow to avoid postpartum depression. If there were a perfect book or CD, sermon series, or Bible verse that could heal your loved one, I'd be thrilled to share it with you.

God has not provided such formulas, but He has given us something far better-His presence. As you and your loved one draw nearer to Him, the path of healing and ways you can help will become more clear.

God has given you certain gifts and abilities that can bless the hurting. With His help, you can discover what you've been uniquely prepared to do. In asking the Holy Spirit what specifically you might do, you'll avoid the traps of "I just don't understand this," "Things were better `back when. . ." "I can do nothing," and "I can't ... (watch the kids, help with housework, say the right thing)." A willing heart, compassionate spirit, and open hands are what God asks of each of us. And no matter what age or stage of life you're in, these you can offer Him.

The prayers abound We connect through the pain The circle of friends tightens around

It's difficult to watch a beloved friend suffer with any affliction, and postpartum depression is certainly no exception. Faith, the woman who wrote the words that open this chapter, walked through the valley of PPD with one of her dearest friends. Faith not only witnessed Rachel's pain, she entered into it. And in doing so, God enabled her to see both battle and victory. She wrote the following poem for a party where family and friends celebrated the first birthday of Rachel's precious little girl, as well as the triumphant grace that brought her mommy out of a very dark place.

Remembering Your Pain

by Faith Thompson

Clearly, the broader story Faith tells between the lines of her poem focuses not on the depth of her friend's depression but on the conquering power of the God who healed her. Rachel's pain was, however, very real. "The depression seemed to have a life of its own," Faith remembers.

It was almost palpable. I felt extremely sad for Rachel and helpless as a friend. I remember thinking it was like she was falling into a deep black hole and I was standing there watching her sink, yet there was nothing I could do to prevent it from happening. Knowing how Rachel normally is, it was devastating to see her so depressed. My heart ached when I was with her.

During nursing school, I learned some about postpartum depression, so it wasn't a complete mystery to me. I had also known a couple friends who suffered from PPD, although I was not nearly as close to them as I was to Rachel during her struggle. Even with my basic understanding of her situation, it was still somewhat difficult for me to relate to Rachel. I had never experienced postpartum depression myself. I felt inadequate to understand. I definitely empathized and "felt" her pain but couldn't fully grasp what she was going through.

It was also difficult for me to relate because I was honestly quite frightened by her PPD and afraid of where it could lead. I was aware a great deal of that anxiety came from my own past (namely my mother's prolonged battle with severe mental illness). I know what it's like to be the child of someone struggling with chemical imbalance, but it was new territory for me to be the close friend of someone in the depths of despair. Looking in Rachel's hollow eyes, I saw such pain. Knowing I couldn't change how she was feeling tore me apart.

I talked to some of our other friends, hoping to gain insight on how to be there for Rachel during this time. I also remember praying that God would prevent anything I said or did around her from causing her more grief than she was already experiencing. I felt I needed to be very careful, not just quoting verses to her or promising that if she prayed more, everything would be fine. Sometimes people (myself included) use Scripture with the best intentions - they want to comfort someone in need, helping them to feel Christ's love and discover His will - but I've found that there are many times I need to wait until a friend is ready to hear and receive the Word. Loving Rachel often meant just being there for her, listening if she wanted to talk (not rushing to talk or offer advice), crying if she needed to cry.

One Sunday, while Rachel was in the midst of her battle, she came to church. I was thrilled to see her but could tell after a quick glance that she was not feeling well. I immediately went over and gave her a hug. Looking in her eyes, I could see the despair. The pain made her voice break. I asked how she was feeling, and she said, "Awful. It's awful. This is just horrible. It's the worst thing I've ever been through. I just want it all to be over."

I noticed that while she told me this, Rachel was looking around, as if she was concerned that someone else might hear her. I felt sad that, from her perspective, dark feelings didn't belong at church. I don't know if she was afraid of what others would think if they knew how badly she was feeling or if she wanted to spare them the sorrow of helping to bear her burdens, but seeing the furtive glances of a friend who was already in so much pain truly grieved my heart.

Another time, Rachel confided that sometimes she'd look over at her sleeping daughter and wonder what it would be like if she didn't wake up. Rachel hated that she felt this and assured me she didn't want her baby to be gone, just the horrible feelings that seemed to have come with her. It seemed very important on both of these occasions that I let Rachel be completely honest. I think she needed to tell me what she really felt. Maybe it released some of the agony swirling inside her.

When Rachel began the process of healing, I watched as she not only became "herself" again but took on a deeper beauty and greater strength than she ever had. God literally transformed the pain etched on her face into a brilliant sparkle, not unlike the one that formerly illuminated her clear blue eyes, but again richer, truer, tougher. She was Rachel "plus." Seeing God work in and through her so clearly was absolutely amazing.

Looking back, I do wish that I had simply called more, even just to leave a message and say, "I'm thinking of and praying for you." I was worried I'd bother Rachel or her husband, but now I realize that those little reminders of love are very important for a struggling family. I also wish our group of friends would have organized a consistent prayer time. We all prayed individually and together when we could, but I think a regular time of intercession would have been a special gift, not only for Rachel's family but also for those of us who walked with them.

Rachel's husband took on so much during that time. He carried such a load, caring for the home, their older kids, and his wife. Our group of friends pitched in with chores, babysitting, shopping, etc., so that he could feel free to focus on the needs of his family.

I'd encourage other friends out there to help with as many of the daily duties as possible. Also, if you can connect the family with another woman who's gone through postpartum depression, that provides a lot of support. And even though Rachel's husband didn't attend a group, I know that, for some, a support group or some private counseling sessions can alleviate a lot of stress and equip someone with tools for wading through the emotions and weightiness of watching a loved one suffer from PPD.

I am so grateful to have my friend "back." But I know my joy is relatively small when compared with the delight her heavenly Father has in her healing. He truly is worthy of our praise!

I'll Come Running

I love the James Taylor song "You've Got a Friend." If you've never heard it, you should put down this book immediately and connect to iTunes or Amazon Music. The words paint a wonderful portrait of a good friend, someone who "all you got to do is call." I needed-and Rachel needed-friends like this during the battle against PPD.

One of the most beautiful and humbling things God used to bless me during each of my seasons of depression was the presence and ministry of my friends. Even if you have only a pretty good relationship with your relatives, everyone sort of expects family to rally around during troubled times. They are, after all, irrevocably tied to you, both by blood and by experience. When family doesn't come through during crisis, deep bitterness and resentment often take root. Why? Because families are supposed to be there for one another.

Some might argue that the same applies to good friends. A really good friend is supposed to be there. But I think such expectations trivialize the beauty of faithful friendship. Friends choose to ally themselves with the one in need. They do it, not because of some blood-bound obligation but because the wounds of one they love become their own wounds, too.

I know I was fortunate. I did not have to call on my friends. They came running, as if they heard the deep and anguishing, yet stifled and silent cries of my heart. Even now, years later, the tears are brimming in my eyes as I think of the women who surrounded me with love and mercy, served alongside steaming casserole dishes liberally seasoned with words of encouragement. My friends lived out the command found in Romans 12:15, "Rejoice with those who rejoice; mourn with those who mourn." They shed tears and mourned with me. They rejoiced at the smallest sign of hope and healing. Many walk with me still.

I remember reading the way another PPD sufferer described the blessing her friends became during the painful battle against postpartum depression. She observed that although she often wished that God would just "zap" her sickness away, she realized in retrospect that had He done that, she would have missed out on a lot of deepened relationships with extraordinary friends.

To that I add a most hearty, "Amen!"

This heartbreaking time in your friend's life presents a unique opportunity for you. The strongest relationships are forged, not in the careless days of summer but in the darkest winter nights, when physical and spiritual enemies crouch at the door, ravenous lions ready to devour.

In the previous chapter we explored the oft-quoted verse from Galatians 6, "Bear one another's burdens, and so fulfill the law of Christ" (verse 2, ESV). I like how Sue McRoberts applied this verse to the days after a child is delivered: "Aren't dinners, piles of dirty clothes, exhaustion, dirty bathrooms, unkempt kitchens, and groceries a burden when you have a newborn? Let your friends bear your burdens and be obedient to Christ!"'

As women who've been taught we can "do anything we set our minds to" (accompanied by the implication that then we must do everything set before us), we sometimes subconsciously limit the "burdens" we're enjoined to share with others to emotional or spiritual things. Does someone else really need to bear the burden of my daughter's smelly socks? (Seriously, my seven- and eight year-olds' feet flat-out reek after a day on the school playground.) Does the toilet I haven't been able to clean for (should I admit this?) weeks and weeks count as a burden that someone else might be called to bear? Yes!

For a new mom with postpartum depression, however, these are impossible questions to answer. Most women with PPD already feel like failures as wives and mothers. They question their ability to run a home and provide care for their children. Brooke Shields so aptly articulated what many of us feel during the fight against PPD:

Suddenly, not only could I not do the thing I planned on doing (raising a child), but I couldn't handle any aspect of it. The frightening part was that I didn't even want to try. Somehow I felt responsible for the predicament I was in, but I also felt it was futile to attempt to improve my situation. I was too unhappy to believe it could ever get better.... Everyone said it would pass and that it would all turn out okay. I kept hearing how normal these feelings were and how I wouldget over them. I knew, however, that I was the only person who would never get over them.'

It's often up to friends to step in and fulfill the law of Christ by shouldering the weights a suffering woman cannot currently identify or accept as burdens (e.g., housework, child care, errands). Not only can you help a hurting loved one see that she can get better, you can also carry some of the daily heaviness that descends on a woman with postpartum depression.

Your contributions do not have to be of epic proportions. You don't even have to be close enough to stop by with a bag of groceries. A deficiency of adult interaction, no matter what kind-phone, e-mail, or face-to-face-can exacerbate a new mom's depression. Don't underestimate the power of a phone call. For someone in pain, hearing the voice of a friend is like breathing fresh air, diving into the Pacific Ocean on a scorching day, dropping your oversize luggage after dragging it through security. It can be, all at once, a physical, emotional, and spiritual release.

I am a writer and not much of a phone talker (my parents may be shocked to read that since I was one of those teenagers who spent ludicrous amounts of time on the telephone). Written words, however, form a major part of my love language. Cards and e-mails blessed me immeasurably. I still cherish many of the notes I received and keep a file of them in my desk.

Of course, as it does for others, physical presence fills my tank as well. I realize many of those reading this book (because of life stage or distance) will not be able to "be there" for their friends in this way. But those who can, I urge you to be present with the people you care about. As Faith noted, the most comforting things she could do for Rachel seemed to be listening, crying, sometimes just sitting with her quietly yet lovingly. For many in the darkest places of their lives, words don't do much good. Even for a girl like me, a word girl if there ever was one, on the most painful of days I didn't long for a spoken word as much as I did the promise of presence. If that means sitting silently on the phone or on the couch while your friend weeps, invite her tears to flow.

One of my best girlfriends in the entire world, Kathy, told me: "I cried many tears away from you because I thought I needed to be strong for you. I believed I needed to put on the smiley face. One time, while your mother-in-law was watching the kids, I wanted to get you out of the house. I didn't know what to do, so we went to a movie; it was a horrible film. We walked around downtown for a bit. It was a quiet walk. We talked some about the movie, but that was about it. Then I took you home. I kept thinking, I know jerusha is in there. I didn't know how to pull you out, but I wanted you to know that I was here. Throughout the summer I prayed for you a lot. I felt helpless-that's the main thing I felt during the whole ordeal. I didn't know what to do other than to be there for whatever, taking care of the girls, bringing little things by, praying again and again. It's hard to help when you don't know what to do."

There is much that you cannot do for a friend in need. You cannot make her medication work faster. You cannot pry open the storehouses of her heart for healing through counseling. You cannot protect her from this storm.

You can, however, validate her experience. Kathy did this for me simply by being with me through one of the worst periods in my life. During one of his programs, psychologist and talk-show host Dr. Phil McGraw pointed out that we cannot truly heal from the scars of our lives unless someone sees and understands what we've been through. As a friend, you can see. You can understand, even if imperfectly. Yahweh is also known as El Roi, "the God who sees" (see Genesis 16:13). You can reflect His character to a loved one in need.

Kathy, like Faith, often felt ill-equipped to help someone deal with PPD. "I didn't know much about depression," she confessed. "I've never been given to long-term despair, so I didn't understand how a person could be sad for more than two days. I'd also never had thoughts about ending my life. Sure, we all think about death, but I hadn't ever done that for more than a few seconds. Even in the days of my deepest sorrow, I don't remember thinking that ending my life would be the best solution.

"I was also frustrated because I didn't know how best to help you. I didn't feel qualified, but I so wanted to help. Your struggle reconfirmed the truth that I don't have all the answers, nor can I ever have them all. I'll never totally understand the hopelessness you felt, but God does. During your fight, I turned to the psalms, which are filled with examples of David's deep despair. If someone doesn't understand the depression their loved one is facing, they can do the same, listening for the psalms to echo eternal truths into our present lives. His Word gave me strength to walk with you, strength I know you needed."

Though she may not have known it at the time, Kathy gave me something else I needed. She validated my experience simply by accepting where I was. You, too, can acknowledge that what your loved one went through or is currently enduring was/is real, that it has changed and will forever change her. And in the hands of a loving Redeemer, this change can be beautiful.

To me, Redeemer is one of the most glorious names of God (see Job 19:25 and Psalm 19:14). In the Bible, a human redeemer repurchases a field sold during a time of need, frees a slave who sold himself due to poverty, or avenges the blood of a slain relative.

In the realm of the Spirit, Haggo'el-our Redeemer God-buys back the time and energy taken from us during illness. After the Israelites had been devastated by a plague of locusts bringing "a day of darkness and gloom, a day of clouds and blackness," Haggo'el promised, "I will repay you for the years the locusts have eaten ... you will praise the name of the LORD your God, who has worked wonders for you" (Joel 2:2,25-26). Our Redeemer transforms the blackness of past plagues into the praise of our future. Physically and emotionally, He frees us from bondage to our weak bodies and minds. On every level, He avenges and vindicates. He delivers. Even when your friend cannot believe this, you can hold up her arms.

Exodus 17 recounts a truly amazing story involving Moses, his brother Aaron, Hur (a biblical character we know virtually nothing about), and some Amalekite enemies. When the warriors of Amalek attacked the Hebrews, Moses commanded the Israelite's military general, Joshua:

"Call the Israelites to arms, and fight the army of Amalek. Tomorrow, I will stand at the top of the hill with the staff of God in my hand."

So Joshua did what Moses had commanded. He led his men out to fight the army ofAmalek. Meanwhile Moses, Aaron, and Hur went to the top of a nearby hill. As long as Moses held up the staff with his hands, the Israelites had the advantage. But whenever he lowered his hands, the Amalekites gained the upper hand. Moses' arms finally became too tired to hold up the staff any longer. So Aaron and Hur found a stone for him to sit on. Then they stood on each side, holding up his hands until sunset. As a result, Joshua and his troops were able to crush the army of Amalek. (verses 9-13, NLT)

Your friend is obviously not Moses. But there are parallels within this story that we, as loved ones, cannot miss. A battle rages in and around our friends. The enemies of physical illness and spiritual discouragement, mental torment and emotional confusion have attacked with ferocity. Only the hand of God (represented by the staff in this biblical account) can deliver.

Whenever your friend relies on God and turns to Him for hope and healing, the advantage is hers. When her arms droop from exhaustion or doubt, however, the Enemy gains ground. There are times your loved one's arms may become so tired she can no longer hold them up.

This is the moment a friend (or more than one friend) enters, providing a rock for the beleaguered one to rest on and a fresh set of arms to hold up her sagging ones. Are you willing to lift up your friend's hands, the hands that ache to uphold the staff of God (trusting in His power to save and deliver) but, because of overwhelming physical and spiritual exhaustion, cannot? Are you in this for the long haul (remember, Aaron and Hur stayed "until sunset")? You can be part of God's victory in your friend's life. This is an awesome privilege, and I pray you will embrace it. And this privilege is not simply for the moments you walk with someone battling PPD. This is what friendship is about every day of your life.

If you choose to accept this wonderful opportunity, the Enemy may try to shame you into thinking you should've or could've done something to prevent your friend from getting to this place. Kathy admitted to me, "I was devastated that I didn't even know things had gotten so bad. I felt like such a failure as a friend because I didn't see the signs. I remember you telling me you had just gotten out of the hospital because you had tried to overdose on pills.

"I needed to sit, so I got in my car and put my head on the steering wheel. I cried silent tears as I listened to how you had planned out how many pills you would need, how you thought it would be easier on Jeramy and the girls if you were gone. I didn't know what to say- I was screaming inside, No! It wouldn't be easier! I was devastated at the thought of losing one of my closest friends, and I didn't know you were at that point. In that terrible moment, I didn't know what to do, so I prayed. I prayed with you because that's all I could do, and sadly, it didn't feel like enough."

There are times when all you can do is pray, and that is enough. There will be occasions when God calls you to do something specific. We've talked about meals, laundry, dishes, errands, and child care, for instance. I've also encouraged you to listen, to be present, to communicate love through word and deed.

Whatever you offer to Him in your friend's service is enough for that day, that hour. When your friend doesn't even know what she needs, ask God for discernment. You cannot do everything. You can, however, incline your ear to His voice and obey His leading. And that is what makes a faithful friend.

I love the LORD, for he heard my voice; he heard my cry for mercy. Because he turned his ear to me, I will call on him as long as I live. The cords of death entangled me, the anguish of the grave came upon me; I was overcome by trouble and sorrow. Then I called on the name of the LORD: "0 Lord, save me!" The LORD is gracious and righteous; our God is full of compassion ... when I was in great need, he saved me.

- PSALM 116:1-6

When I shared my story with you in chapter 1, I mentioned that I came home from the hospital still desperately empty and numb, ready to take my own life. Jeramy asked me whom he could call for help. I heard myself say, "Dennis Keating," but (at least in human terms) I honestly can't explain why I did.

God obviously knew our senior pastor, who also happened to be Jeramy's boss, was the one both Jeramy and I needed to see. But it would have made more sense (again, humanly speaking) for me to ask for someone not in charge of my husband's career, someone who wouldn't be concerned about how my mental state could affect our church's image or Jeramy's productivity at work. Fortunately for me, God does not think in the ways of man. And because he is a man of God, neither does Dennis Keating.

I recently sat down with Dennis to talk about that night. During our conversation, I also asked him what Christians think about depression. With close to three decades of experience under his belt and a ministry that stretches across the world, Dennis has encountered nearly every imaginable attitude toward illnesses of the mind. And because he struggled with anxiety after assuming the role of senior pastor at a church of more than five thousand, Dennis also understands on a very personal level what it's like to feel "off," "distressed," sometimes even "out of your mind."

Allow me to step aside for now and let Dennis explore each of these facets of dealing with depression with you.

In the Land of the Living (as told by Pastor Dennis Keating)

When Jeramy called me, he told me you were in serious trouble. You needed help. Our staff already knew you had been in the hospital, and Jeramy had tried to explain to me and the other pastors what postpartum depression does to the brain. I knew plenty about depression in general and understood that you were chemically imbalanced. I also knew the issues at hand were significant. After Jeramy's phone call, it didn't take me long to get over to your house.

I arrived and saw you were a wreck. [Author's note: It's always a little humbling to hear your senior pastor call you a "wreck"!] My first thought was, This woman is in a deep pit. Your state didn't unnerve me; I had dealt with similar situations, though perhaps not specifically in the postpartum period. It was immediately obvious that you were very ill.

Perhaps it would be helpful, so that your readers might connect with me, to relate some of my own experiences. In 1995, just over a year after I took on the senior pastorate at Emmanuel Faith, the counseling and executive pastors suffered from a cerebral hemorrhage and heart attack, respectively. Not only was I getting used to preaching four times a weekend and leading a multilayered staff, I was also suffering from what I now see as a "father to the world" sickness. I wanted to be everything to everyone. It wasn't that I stopped relying on God; I just assumed He wanted me to do everything good and ministerial that people asked me to do. Of course, I only recognize this in hindsight. At the time, it was my reality.

Exercise has always been a great way for me to destress, but I had injured my knee and was unable to play basketball or work out in the other ways I most enjoyed. On top of it all, a close family member and her three children left a very destructive situation and had no place to go. My wife and I took them in without question, and I do not regret that choice. What I do wish I would have realized is that I slowly began to question whether I had "done enough" to help prevent the horrible things in their lives.

Under the weight of these manifold pressures, I experienced an anxiety attack. I quit eating, was unable to sleep, and found myself crying often (not something I normally do). I originally believed that my struggle was mostly instigated by stressful circumstances, but, after seeing a doctor, I also understood that lack of sleep and proper nutrition, the toxic chemicals released as my body tried to respond to stress, and an inability to self-soothe in customary ways (i.e., exercise) had created a physical imbalance in my brain.

Not only did I need to deal with the emotional and spiritual heaviness pressing upon me, I also needed to help get my body back in balance. I did this through healthier and more regular eating, lots of "makeup" sleep - sometimes more than twelve hours at a time - and, for a time, antianxiety medication.

God taught me a great deal during this time of struggle, but the lesson I continue to see played out in my own life and the lives of those around me is this: Everyone is dented. I'm dented. You know, like a Coke can that's taken too many hits. It was almost as if God told me, "Now you understand how every member of your church feels . . . broken, needy, wounded in some way."

All this was in my mind when I saw you ... and I knew what you were enduring. I asked you to tell me what was going on in your heart, and you said a few pretty basic things. Jeramy shared his fears and wondered aloud if you needed to be hospitalized again. We talked about you seeing a counselor who specialized in severe depression, and I asked if you would be open to that, if you realized that you were in a hole that you couldn't climb out of on your own. I tried to emphasize that we- me and, in fact, the whole church -were here to help. "We'll take you as a wreck," I tried to communicate.

As we continued to talk, it seemed like you were able to accept that you needed more help than you were currently getting and, even more importantly, that we weren't going to throw you out. Since I typically do this with anyone who has contemplated or is contemplating suicide, I asked if you had any plans to hurt yourself. Without hesitation, you looked at me and said yes. You walked into the kitchen and retrieved a huge bottle of Advil you had hidden. Do you know I still have that bottle at my house? It's one of my trophies, both to God's awesome power and to the truth that every single one of us hurts. But, back to that night ...

Right about then, Jeramy flipped out. He was terrified, worried that there might be something else hidden and that he was going to wake up in the middle of the night to find you dead. I had a very strong sense that you were being honest with me when you claimed the Advil was your only plan. I also believed that you really wanted to live. You displayed more clarity in those moments than at any other point that night. Jeramy and I made an action plan (which included me removing some potentially dangerous items from your house), I left, and you started on the path of healing.

Watching you recover, and seeing what God has done through you since that time, has truly been a gift to me. Your battle and subsequent healing illuminated and confirmed truths for me.

Years ago, when my journey in ministry first began, depression was viewed as a "nonillness." Those who struggled were often looked down upon or ostracized. I am glad to say that, over time, I've seen great strides taken among Christians to understand depression and to love those fighting it. As science revealed that chemical imbalance and circumstantial pressures both contribute to and perpetuate depression (PPD as well as other forms), churches and their congregants have slowly shifted their attitudes and assumptions in favor of truth.

Unfortunately, there are still those who believe depression can be eradicated simply by reading the Bible or praying more. While God certainly can heal in this manner if He so chooses, the Great Healer also asks us to trust that whatever means He wants to use, perhaps medication, counseling, or both, should be accepted and embraced by all believers.

I've seen medication used with great results, and I've also seen it tragically misused. I've observed people placing their hope in meds rather than in the Maker of medication, and that grieves my heart. I've watched people explode in spiritual growth under the direction of a godly therapist or psychologist, and I've also ached to see people desperately attempt to hide their weakness, their shame, their "dentedness" behind the psychological jargon of victimization or blame. Christians are never called to present an "I've got it together" image. It hurts me when other pastors intimate that people of the faith don't struggle with "that kind of stuff."

It's just as distressing, however, to see people excuse all kinds of unloving behavior because of their chemical imbalances. Depression often - nearly invariably - makes the sufferer self-centered. I believe that's one reason why some respond to mental illness with glib, unrealistic statements like "Just get over it" or "Just trust God more." Does reading the Bible help set the mind on things other than your pain? Yes. In this way, it is important to turn a depressed person's thoughts to God's Word and His presence through prayer. These things do play a major role in healing those who are downcast. But God may not use prayer and Bible reading alone; He may, and indeed often does, combine these with other forms of treatment.

When we approach depression holistically, understanding that addressing the spiritual, mental/emotional, and physiological dimensions are equally essential, we give people the best chance for lasting healing. This is a strongly biblical approach, as we are enjoined by Jesus to love the Lord our God with all our heart, mind, soul, and strength [body] (see Deuteronomy 6:5 and Mark 12:30). The Scriptures enable us and command us to confront every aspect of our lives - physical, psychological, and spiritual - with truth. We can neither deny the reality of the body's pain nor sidestep the work of sanctification that the Lord desires to do in each person's mind and soul.

This Means War!

In the spiritual realm, we are constantly embattled. There is no movement toward God's love and grace unopposed by the Enemy. It's important to note that this does not mean every sickness is sent directly "from the Devil." God's Word tells us to be prepared for and anticipate spiritual warfare of all kinds (see Ephesians 6 and 2 Corinthians 10, especially verse 4). We cannot, however, focus solely on the spiritual fight when dealing with something like depression. What I mean to say is that you should not expect that praying the blood of Jesus or binding Satan over a suffering person will automatically heal him or her. We know that the Evil One is actively pursuing the destruction of God's people and His kingdom. We must not neglect the spiritual warfare that we know is there. But again, we must approach the battle with balance, both praying for spiritual freedom and addressing the transformation of mind and body that the Scriptures also command (see Romans 12:1-2).

One of the ways the Enemy infiltrates a depressed individual is through his or her belief system. The Evil One's MO is deception. He is the "father of lies" (John 8:44). If he can get someone to believe she's worthless, for instance, or that she'd be better off dead, he'll do so. If he can convince people what they're dealing with isn't their fault and they can do nothing to change it, he'll jump on that opportunity. Of course, he also uses afflictions of the body in order to destroy God's work (as he did with job), but he just as often, if not more frequently, attacks through the mind with deceptions.

Here's one trouble people face, however: Our minds need to be transformed, but step one in the healing process cannot be reordering the belief system. That's usually the final frontier, one approached when a person is physically able to do the difficult work of therapy and when the emotional state is balanced enough to separate lies from truth. Like Elijah, we often need to eat and sleep-in other words, be physically restored-before we're able to hear God's voice.

In 1 Kings 19, after the epic battle on Mount Carmel between the prophet of God and the false prophets of Baal, Elijah fell into a deep pit of despair. In 1 Kings 19:4 he prayed, "I have had enough, LORD ... take my life." I find it fascinating that God didn't immediately answer Elijah. Instead, Elijah fell asleep. When he awoke, the Lord sent an angel to command him, "Get up and eat" (verse 5). According to the Word, Elijah "ate and drank and then lay down again" (verse 6). Once more the prophet was awakened, and

the angel of the LORD came back a second time and touched him and said, "Get up and eat, for the journey is too much for you." So [Elijah] got up and ate and drank. Strengthened by that food, he traveled forty days and forty nights until he reached Horeb, the mountain of God. (verses 7-8)

On Mount Horeb, God sent wind, fire, and an earthquake before He spoke to Elijah through the still small voice of His Spirit.

As it was for Elijah, the journey is sometimes too much for us. And we can praise God that He understands our physical needs as well as our spiritual ones. He is a high priest acquainted with all of our weaknesses (see Hebrews 4:15). Though there are many misconceptions about depression among humans, there are no misunderstandings with God. He is fully aware and fully with us in whatever pit we find ourselves. Depressed, dented people desperately need both rescue and empathy. Our God is mighty to save and tenderly compassionate.

Before Pastor Dennis left me that night, he shared a passage of Scripture that has meant a great deal to me. Psalm 27:13-14 proclaims, "I would have despaired unless I had believed that I would see the goodness of the LORD in the land of the living. Wait for the LORD; be strong and let your heart take courage; yes, wait for the LORD" (NASB, emphasis added).

Depressed people sometimes think it would be better to escape to the world of the dead, but God's goodness is on display in the land of the living.

Falsehoods and Facts

Dennis aptly spoke to some myths about depression within the church. Throughout this book we have addressed lies such as "If you read your Bible more, you'd be healed" or "You should just get over it." In this section, I'd like to explore further some of the most common spiritual misconceptions, not just about PPD but about mental illness in general. I hope that the "lie and truth" formatting helps you to separate falsehoods from facts clearly.'

LIE: "You've got nothing to be sad about."

TRUTH: Depression may or may not have anything to do with what's happening in the life of the sufferer. A woman may experience deep postpartum depression despite her wonderful life. Furthermore, a depressed person may not feel sad as much as empty or confused or anxious (often without clear reason). We cannot assume that someone is depressed because of his/her current circumstances.

LIE: "Scripture tells us that everything that happens is for our good."

TRUTH: Romans 8:28 actually declares, "We know that God causes all things to work together for good to those who love [Him]" (NASB). This in no way implies that everything that happens to us is good or is intended for good. Many things that happen to us, or that are caused by the misguided-sometimes evil-actions of others (including the Enemy) are incredibly not good (see Genesis 50:20, for example). In His days here on earth, Jesus also revealed, "In this world you will have trouble" (John 16:33). Depression is not, in and of itself, something "for our good." It is, indeed, one of the deep troubles of this broken world Jesus spoke of. It may take years before you can see the good that God plans to bring out of your or your loved one's depression. In the interim, we can take comfort in the truth unveiled in the second half of John 16:33, "In this world you will have trouble. But take heart! I have overcome the world." Can God use depression for good in the life of one who loves Him? Absolutely. But is depression inherently for someone's good? As the apostle Paul might say, "By no means!"

LIE: "Good Christians don't get depressed."

TRUTH: The Scriptures are full of stories of devoted followers of the Lord who struggled with what we would call "depression" in today's world. We already mentioned Elijah's experience in 1 Kings 19 and that of job (on tragic display throughout the entire book of the Bible by the same name), but there are others as well: in the book of Psalms, David recorded his agonizing discouragement with both honesty and beauty. Hannah "in bitterness of soul ... wept much" and would not eat (1 Samuel 1:10). She kept "praying ... out of [her] great anguish and grief" (verse 16). And Jeremiah wailed, "I am the man who has seen affliction ... [I] walk in darkness rather than light" (Lamentations 3:1-2).

In the words of one astute blogger, "I'd say it takes more faith to hold on to the fact that God exists when your situation is screaming out that even if there [is] a God, he hates you [or is punishing you] than it does when all is going your way."' Depression is no respecter of persons nor does it take into account the depth of an individual's relationship with the Lord. In fact, those who are walking intimately with Him may be more obvious targets for spiritual attack on the mind and body.

LIE: "You must be in sin" (aka "There must be something wrong with your spiritual life if you are depressed," "There must be hidden sin in your life," or simply "This is your own fault").

TRUTH: Job's so-called friends tried this tactic, and God revealed the faultiness of their statements. Sadly, there are many today who think along the same lines as job's buddies. The truth, however, is that depression is not always the result of sin. In one sense, because no sickness would exist in a world unmarred by sin, depression-and diabetes and cancer and heart disease-are technically "results of sin." But experiencing depression is no more a result of personal sin or of a distanced spiritual life than having a broken leg or battling MS is. Can we do things that make us more prone to illnesses like heart disease, diabetes, even depression? Yes. But there are factors beyond our control as well-genetics and unforeseen circumstances, for instance. It's essential to note that depression can be a result of sin, but it is not invariably so (as evidenced by the lives of Hannah and Jeremiah especially). It is a nefarious lie that depression is always the result of sin in a person's life.

That said, we must remember that in Psalm 38, David cried,

If you ask me, David sounds depressed. And he did not keep the reason for his depression a secret: "Because of my sinful folly.... I groan in anguish of heart." David's sin brought on a depression that became physical. If depression is a result of sin in your life and you are listening for His voice, God will convict you, just as He used Nathan to convict David. The Lord does not play "guess what I am thinking" games with your mind. If He wants you or someone you love to repent of some specific sin that is causing depression, He will make that clear. And if depression is not the result of personal sin, He will give peace and assurance of that as well. We must all learn to differentiate the conviction of the Spirit from the accusations of the Enemy.

LIE: "Taking antidepressants shortcuts God's ability to heal" (aka "You are `playing God' if you take medication for a mental illness").

TRUTH: God often uses methods that confound the human mind (think of Jesus healing the blind man in John 9 with mud He mixed from dust and His own saliva ... not quite the means I would have imagined). God also does not usually "zap" people into restored health. Most often in our day and age, He uses methods He's already created and put into place-modern medicine, proper nutrition, and counseling, for instance. Is He not Lord over these things, too?

LIE: "Depression is a self-discipline problem" (aka "Depressed people are selfish or lazy").

TRUTH: Mental illness of any kind is often viewed as a character flaw (in both the secular and Christian worlds this is believed to be true). Because most people do not understand depression, it's easier to give uninformed advice and judge the situation and people involved, dismissing the condition as "their problem." Depression does not always indicate a flaw in one's character, however. Perhaps you'll allow me to act as exhibit A for a moment: I am an extremely disciplined and hardworking person. Lazy is probably the last word someone would use to describe me. My depression certainly wasn't the result of lack of self-control or laziness. In fact, my almost neurotic discipline is more likely to have contributed to and perpetuated my battle with PPD.

Furthermore, what appears to an outside observer as laziness may not be so. A common feature of depression is disrupted sleep. A sufferer may sleep far too much, and finding a spouse or friend asleep at two in the afternoon may cause you or someone else to think, Boy, that sure is lazy of her. What you may not know is that this person was awakened at one forty five in the morning and could not-despite her best efforts-get back to sleep. We know that the deep limbic system, which helps regulate sleeping pat terns, is almost invariably compromised in depressed individuals, so have mercy on depressed people who are suffering from insomnia or hypersomnia.

Keep in mind as well that some depression or anxiety medications contribute to disrupted sleep. Tina Zahn recounted in Why I jumped,

I was . . . on numerous medications that made me groggy in the morning. I had a hard time simply crawling out of bed. I'd have to ask God to help me with the most mundane things: "Lord, give me the strength to sit up. Now would you help me to stand and get dressed?"I know that people in depression must look lazy and selfish to others who are not, but take my word for it, sometimes it takes more courage for clinically depressed people to simply get up in the morning and put one foot in front of the other than it does for those whose brains are balanced to climb a mountain.3

I would never claim that I am unselfish (I know myself far too well to lie in that way), but I also know the depression that descended on me after delivering my daughters was not strictly a result of self-focused living. While depression can be the result of sin but is not always so, it is also true that selfishness or laziness or lack of self-discipline may play a role in depression. In a genuine clinical depression, however, this is never the end of the story. No amount of self-discipline or hard work or service in God's name will cure either a torn ACL or postpartum depression. A medical problem like PPD must be addressed on a physical level as well as on any level that might indicate a problem with self-consumption, laziness, or lack of self-control.

LIE: "The Devil is just trying to steal your joy" (which sometimes comes with the injunction, "You need to rebuke that spirit of depression!").

TRUTH: Depression, as Pastor Dennis noted, is not always caused by demonic forces. Can it be? Yes, but this is not always the case. The Enemy does want to steal our joy by afflicting our bodies and distorting our thinking, but this is not the only reason you or someone you love is battling depression. In fact, it may be that God is helping you and your loved one see that joy is not dependent on, nor the result of, positive circumstances. This is no easy lesson to learn. Indeed, it is one of the most difficult. But God can help you understand true joy through the darkest of situations. As Jeremiah proclaimed,

The thought of my suffering ... is bitter beyond words. I will never forget this awful time ... Yet I still dare to hope when I remember this:

The unfailing love of the LORD never ends! By his mercies we have been kept from complete destruction. Great is his faithfulness. (Lamentations 3:19-23, NLT)

Blaming a "spirit of depression" is tempting for some. But if we could cast out the cause of our sickness (whether depression or leukemia), we would be spared the long-term process of recovery. It would also place healing in our court, implying that if we were spiritual enough, we could pray our way to complete restoration. This is a tragically misguided approach to any illness, including PPD.

LIE: "If you were praying more, you'd be over this by now."

TRUTH: There are two important dimensions to the truth that combats this lie. For one, we cannot schedule recovery from depression any more than we can from a shattered femur (thigh bone). The leg will heal in its own time. Of course, we can do some things to help the process-we can wear a cast, see the doctor regularly, and avoid things that might cause further damage-but we cannot decide how quickly our bone will repair.

Secondly, statements like these (as we noted when exposing the lie "You need to rebuke that spirit of depression") assume that sufferers have the power to pray away-in others words, compel-their own healing. Some people mistakenly believe that a single "righteous prayer" (though they would probably not call it a "magic prayer") solves everything. The next time they see a person who has been "prayed over," they expect all will be well. This is rarely the case. Of course, God is able to heal someone instantaneously, but most often He calls us to continual intercession and a healing process.

Unfortunately, we don't always want to "keep on bearing one another's burdens" as the progressive verb tense used in Galatians 6:2 indicates we should. Carrying another's burden requires something of us -our time and energy, perhaps sacrifice of other kinds as well-and many of us are sadly ill-equipped to offer "long haul" prayers. I often find that I pray for a couple days and then, though usually not consciously, move on to other people's pressing needs. Sometimes I simply forget that a friend or family member is suffering. Perhaps you do too? If so, we can ask God to help us embrace and/or walk with someone through what might be a very long and painful process of recovery.

It is no more true to say that once a person has prayed "enough," his or her depression will disappear than it is to claim that simply reading the Bible and praying will eradicate depression.

As you can see, the lies about depression and the Spirit are manifold. And this section has probably left some of your questions or experiences unaddressed. I wish that I could perfectly answer all of your concerns or combat with God's Truth the specific lies you've battled. If I could, however, you would have no need to turn to the LORD and ask for His guidance. I pray that, in your weakness or in the pain of one you love, you will incline your ear to the Spirit within you, the Holy Spirit who can lead you in all truth.

When I Am Weak, Then I Am Strong

One of the greatest truths of Scripture, and one of the most difficult to comprehend, is found in 2 Corinthians 12. Paul, speaking of a "thorn in his flesh," which continually tormented him, revealed that he prayed three times for his affliction to be removed. The New Living Translation uses the words "three different times I begged the Lord to take it away" (verse 8, emphasis added) to express Paul's anguished desire to be free of this pain.

People who have been, or are, depressed can often relate. They've pleaded with God to heal them. They've done so over and over again (I certainly prayed many more times than three ... I guess that shows I didn't learn my lesson as quickly as Paul did!).

"Each time," Paul told us, the Lord said, "My gracious favor is all you need. My power works best in your weakness" (2 Corinthians 12:9, NLT). Paul responded with a beautiful decision: "Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with weaknesses ... hardships ... and calamities. For when I am weak, then I am strong" (verses 9-10, ESV).

When I am weak, then I am strong.... Why? Because when I am weak, God is my strength. Because when I am weak, I no longer rely on my own abilities nor mistakenly assume that I'm succeeding because of my own physical well-being. When I am weak, His power is on display. When I am weak, His grace is sufficient for me. This is true for you as well.

The woman who battles PPD is weakened. The people who walk alongside her are as well. Both you and the people who care about you need the all-sufficient grace of the God whose power is best revealed in brokenness ... dentedness ... woundedness. Weakness makes room for God to fill us with His strength.

Most of us cannot appreciate or embrace weakness when it descends upon us unbidden and undesired. Sometimes, if we think very hard about the past, we can see the blessing of weakness when we're back to "full strength." We may see how God prepared us to offer deeper compassion to those who hurt or developed in us a more authentic faith in the Savior we serve. But when we're in the midst of weakness, we often neither feel nor see God's power. Sometimes, it seems, we literally cannot. In seasons of brokenness, I usually feel like Great with Child author Debra Rienstra, who observed, "When I am weak, then I am bewildered."4

Like Rienstra, when I am weak, I am forced to let go of the things I would like to control or manage, the things I am used to "doing well." There's not much-in human terms-to enjoy about weakness. Only with His divine perspective for our right now, for the present pain that plagues us, can we cling to His strength, strength that may be masked or unrecognizable.

The first question of the Heidelberg Catechism is "What is your only comfort in life and death?" The answer, which I pray would shape my every thought and action, is "That I am not my own, but belong with body and soul, both in life and in death, to my faithful Saviour Jesus Christ."5

Do you believe-I mean really believe-that you and those you love belong body and soul, in life and death, in sickness and health, to a faithful (in other words, true and good and loving) Savior? It's not enough to acknowledge this intellectually. Unless they change our daily lives, these are merely words.

A portion of my journal from the time of my postpartum depression explored similar thoughts. I wrote, "This is, without a doubt, my deepest crisis of faith. It is time for me to decide if I really do believe what I've so often professed, that only in the love of Christ is there any hope for me."

Is His grace sufficient for me?

Is His power enough?

When I am weak, am I strong?

I have discovered the answer to each of these questions is a resounding yes! I cannot answer these questions for you, however. Your own journey with the Lord will bring you to the place where you are confronted with these questions. It may be that time for you right now; it may be that time for someone you love.

How we reply to queries like these changes us on the deepest levels. The ways in which we choose to respond draw us closer to Jesus or drive us further away. My prayer is that, as you ask and answer difficult questions such as these, you will encounter God in a way you might never have if you had not suffered so. Perhaps you will be able to say, with Isaiah, "You restored me to health and let me live. Surely it was for my benefit that I suffered such anguish" (38:16-17). Today I can pray these words ... and mean them.

We are pressed on every side by troubles, but we are not crushed and broken. We are perplexed ... but God never abandons us. We get knocked down, but we get up again and keep going. Through suffering, these bodies of ours constantly share in the death of Jesus so that the life of Jesus may also be seen in our bodies.

- 2 CORINTHIANS 4:8-10 (NLT)

God has blessed me with the opportunity to give many seminars on depression and related biochemical conditions. He's enabled me to counsel men and women across the country about the realities of brain functioning and emotional breakdown. Praying with and for hurting people is one of the most deeply rewarding experiences of my current ministry.

But I'd never encountered a group of such desperately confused and despairing women as I did while speaking at a ladies' retreat in 2009. I hadn't been contracted to teach a breakout seminar, only the large-group gatherings, but I sensed strongly that the Lord wanted me to present the facts, fiction, and faith that inform any Christian's struggle with depression. The session I offered was considered "optional," scheduled during free time. I honestly wasn't sure if anyone would come.

Fifteen women attended, every one created uniquely by God, every one with a story to tell and a heart in need of healing. Because the group was relatively small, I asked them to move their chairs into a circle, hoping this would facilitate greater intimacy, personal connection, and learning. As time went on, I realized each woman in that room, myself included, was there for a reason.

I spoke about different forms of chemical imbalance, showed brain scans, and explained why every depression cannot be treated identically. Eyes widened and ears perked up. As I discussed the need to address depression physically, cognitively, and spiritually because God created us with body, mind, and spirit in an integrated whole, understanding dawned on several faces. And while exploring the spiritual and physiological myths about depression, tears started to flow.

Though the more formal part of the seminar was wrapping up after about an hour, it was easy to see the women wanted to stay around and ask questions, so I opened the conversation up to accommodate that. The stories that poured out of these ladies were nothing short of heartbreaking.

One told the group how she had been bounced from this medication to that yet never seemed to get better. In tears, another woman could barely put her experience into words. She had struggled so long and felt so weary ... why was nothing helping when she was doing everything that was "supposed" to make a difference?

Teri related how taking Zoloft had helped her depression, but she was about to run out and had no medical insurance to cover the rising cost of prescription drugs. Later that night, this same woman informed me she had noticed over the past few months she'd been more edgy and angry with her children. When I asked if this change coincided with any alteration in her treatment for depression, she paused to think. "Yes," Teri responded, somewhat startled. "That's exactly when I switched from another medication to Zoloft." She had never heard that some antidepressants can exacerbate feelings of aggression or anxiety. Of course, this may not have been the case for Teri, but it was certainly a possibility that should have been investigated.

Blanche recounted a woeful tale of taking supplements and pursuing alternative medicine without staying under the care of a knowledgeable medical doctor. "Natural doesn't always mean safe" was a lesson she learned the hard way.

The pain-laced stories continued to spill out: One woman told the group about her husband's best friend, who was diagnosed with adult ADHD. He was placed on Ritalin and another psychotropic (simply meaning "acting on the central nervous system") drug. A week later he was dead, having taken his own life. The son-in-law of another woman had also committed suicide, despite the efforts of family members who called the police, asking them to intervene and have him hospitalized. He was so persuasive that he "talked the cops out of it," Candace remembered sadly.

Though only a couple of the women in that group of fifteen had gone through postpartum depression, all their experiences have parallels for women suffering from PPD. Without the right kind of treatment, healing is stalled, if not inhibited completely. On the wrong medication, or with homeopathic/natural remedies that fail to complement or even work against a particular woman's body, she can suffer more intensely, all the while thinking, This has got to work. Maybe it just takes awhile. As time drags on and nothing seems to alleviate the pain, thoughts like these dissolve into despairing ones: I'll probably never get better.

During that seminar, I encountered precious women with gaping wounds in their bodies and souls. I could tell you the stories of hundreds of other sufferers, male and female, whom I've met over the years as well. Their heartache may or may not resemble your own. I've only shared a bit of what I heard from these particular women, but perhaps you know all too well the kinds of experiences I referred to. Perhaps someone you love has been "in recovery" for a long time but actually doesn't seem to be recovering at all.

This chapter and the next will focus on different forms of treatment for PPD and associated postnatal conditions. The remainder of this chapter will explore techniques and tools that help balance the body- the physiological side of recovery will be our central theme. In the next chapter, we'll dive into cognitive and spiritual methods of treatment. Both physical and psychological care are equally important and indispensable.

The National Institute of Mental Health estimated that only onethird of those who suffer from depression pursue and receive treatment.' That means two out of every three depressed people get no help for their condition. Lydia Lewis, executive director of the Depression and Mood Disorders Association (DMDA), also reported, "78% of people with depression have not experienced complete control of their illness in the past two months. 78%.... There's a real problem here."' Can you or someone you love be part of the 33 percent who do pursue treatment, or, better yet, the 22 percent who do find lasting healing for depression? Yes, yes, yes!

Depression is a very treatable illness that responds incredibly well to effective and personalized methods. There is every reason to believe that you or someone you care about will be "herself" again. Sometimes it may feel as if things will never get better, but evidence shows that the vast majority of women with postpartum disorders who receive proper care show improvement within several weeks. Though the road to recovery often extends for some time, with persistence and patience, full healing is possible. And we can certainly thank God for that!

Embracing the Inescapable Reality of Our Flesh

"For good or for evil," wrote theologian Dallas Willard in Renovation of the Heart, "the body lies right at the center of the spiritual life."3 Maybe this seems a curious idea to you at first glance, but think with me for a moment. Does how you feel physically ever affect the way you relate to the Lord?

I, for one, am not particularly prone to intercede for others when I have the stomach flu. Instead, between trips to the bathroom in a nauseated stupor, I'm usually wallowing in a "Why me?" sort of way. Feeble prayers rise from my lips, but they're mostly regarding my own pitiful condition. Though I hate to admit it, my menstrual cycle can similarly affect my walk with Jesus. When hormones are raging, cracking open my Bible sometimes seems like too much effort, let alone actually striving to encounter God through His Word.

How healthy-or unhealthy- I am affects how I treat others, too. Are you the "best you" when you're sick? Are you the "most patient you" when operating on three hours of sleep? If you're anything like me, a sheepish "Um, not really" might be your response to these questions.

Before we can pursue or help someone pursue healing from depression, it's absolutely critical that we acknowledge we are not only made up of mind and soul but flesh and blood, bone and chemicals, too. And here's what fascinates me: God doesn't plan on doing away with our bodies when we cross over from death to Life. Instead, He promises a glorious, perfected, redeemed body will be ours (see Philippians 3:21).

I've endured enough physical pain to understand why the ancient heresy of Gnosticism appeals to people. Gnostics believe that the material world and the physical body are problems to be overcome, not realities to be embraced. It definitely annoys me-indeed, sometimes infuriates me-that I consistently have to confront bodily ills and that they affect my relationships and spiritual growth. Wouldn't it be easier if we had to deal only with the soul? Well, maybe not easier, but at least a little less complicated? Do we really have to face that our souls, minds, and bodies are broken and needy?

Yes, we do.

It's tempting for Christians to think that if we focus on the spiritual side of things, the physiological and cognitive will fall into place. This, however, is just not the way God designed our world to work. We cannot pray away a bruised rib. If your tooth is rotting from the inside out, no amount of Bible reading is going to cure it. The Lord does miraculously heal some from disease-cancer, heart disease, and, yes, depression-but most people have to walk a road of physical, emotional, and spiritual healing that involves pain every single one of us would rather avoid.

Ignoring a body ravaged by depression benefits no one. If you want to recover, or help someone else heal from depression, you must treat the body ... and well. More often than not, a person cannot even attempt the difficult work of soul and mind recovery, done in counseling and through intimate relationship with the Lord, until the body is in a healthier place.

People sometimes assume treating a depressed body means taking medicine. This may or may not be the case for you or your loved one's circumstances. That's why we'll explore many physiological treatment methods in the pages to come. Let's start with a discussion of psychotropic medications and forms of depression.

Those for whom prescription drugs have been ordered, or recommended, often ask me what taking medicine for depression is like: Did it solve your problems right away? Will I have to take it forever if I start? Aren't there horrible side effects? Though this is a simplistic way of approaching rather deep questions, I can answer each of these queries with a no.

Medication is not a magic cure-all. In fact, medicine solved only one aspect of my depression, and, though it was a big thing, it was still only one thing. The prescription drugs I took lifted my body from the quicksand it was sinking into. It got my head above the water just enough that I didn't suffocate on my own pain. But during and after taking medication, I still had to look long and hard at my own life-among other things, the ways I attempted to cope with stress and the flaws in my character (most notably neurotic perfectionism and rabid control-freakishness) that kept me from the freedom Christ died to give me.

When I first started therapy after being discharged from the hospital, I could barely string together a coherent sentence, let alone deal with the sin and shame that my postpartum depression exposed. As far as I could see, there was no light in my mind. And the illuminating Truth that eventually healed me did not dawn until after my body began to rebalance.

I want to tell you very clearly that my own experience does not make me believe that everyone needs medication. In fact, I think it likely that many people on antidepressants probably shouldn't be taking them. Whether someone needs a different type of drug or no medication at all, it's crucial that we start looking more closely at the "just take an antidepressant" approach. I cannot understate the importance of understanding this: Psychotropic drugs literally change the chemistry of a person's brain. Like the man I mentioned who took his own life after starting medication for ADHD, some people are placed on drugs that hurt rather than help. Their suffering is tremendous.

When a depressed individual visits his or her family doctor, the usual outcome is a sample of some antidepressant and a prescription for more. The hurting person may be informed that the medicine will take four to six weeks to show any efficacy and counseled to call the office if side effects become intolerable. In today's HMO age, few patients are actually referred to see a psychiatrist. In fact, the American Psychiatric Association reported that 74 percent of Americans who seek help for depression or symptoms of depression will go to a primary-care physician rather than a mental-health professional.4 Only the most desperate cases prompt hospitalization. As with the statistics I shared earlier, this reveals a real problem.

Why? Because depression is extremely complicated. It usually takes longer than a fifteen-minute office visit to appropriately diagnose an individual, especially if the appointment is with an MD who receives relatively cursory training in the complex dynamics of mental-health issues (as opposed to the years of specialized training a psychiatrist undergoes). This is, by no means, intended as a derogatory comment on family-practice doctors. It is simply impossible for one practitioner to know every detail about each physical condition. We see specialists because they specialize in certain areas of medicine.

Furthermore, as we previously heard from renowned neuropsychiatrist Daniel Amen, depression is never just "one thing." The SPECT research conducted by Dr. Amen and his colleagues indicates several different types of depression, which can be divided into multiple categories (see sidebar). While we cannot delve into the intricacies of each of these manifestations of depression here, we will refer to some of the different forms throughout this chapter. I have tried to phrase things as simply as possible. For more information, you can find thorough descriptions and common treatments used to balance these conditions in Dr. Amen's books, especially Healing Anxiety and Depression.

FORMS OF DEPRESSION

• Pure depression: The form of depression most widely recognized, evidenced by things such as - but not limited to - persistent sadness; loss of enjoyment in previously pleasurable activities; feelings of guilt and worthlessness; changes in sleep, appetite, or libido; decreased energy; and potentially suicidal ideation. (Note: It's essential to note that each of the other manifestations of depression also includes at least four of the symptoms of pure depression. Perhaps it's helpful to think of pure depression as the "baseline" condition, which may take different forms (see below) depending on an individual's unique chemistry and circumstances.)

• Mixed anxiety and depression (also known as agitated depression): With mixed anxiety and depression, a person may feel both sad and wound up at the same time. Panic attacks and suicidal thoughts may exist simultaneously. Mania may or may not be present.

• Unfocused depression is characterized by restlessness, impulsivity, and often seen in conjunction with ADD/ADHD.

• Overfocused depression sometimes includes symptoms of, or is a result of, OCD and/or PTSD such as panic, neurotic compulsions, flashbacks of trauma, and extreme fear. Remember, at least four symptoms of pure depression will also be concurrent.

• Cyclic depression is episodic, unpredictable, and characterized by major mood swings. This category includes conditions such as bipolar disorder, cyclothymia, and premenstrual dysphoric disorder, also known as PMDD. Cyclic depression is often mischaracterized or identified as mixed or agitated depression.

• Temporal lobe anxiety/depression: The symptoms include mood instability, temper outbursts, even dark or evil thoughts. Once again, it's important to note that at least four symptoms of pure depression will be simultaneously present as well.5

After reading the brief descriptions of these unique forms of depression, I hope you can see how crucial it is that we not treat every depression in the same way. You wouldn't take a blood-pressure medication for strep throat, and you shouldn't take a drug for agitated depression if what you really have falls under the unfocused umbrella. The results could be disastrous.

We'll explore more on this shortly, but before we dive into distinct approaches to balancing the body, I want to be certain that you understand this essential truth: We cannot escape the fact that our bodies need help, and specific help at that. Don't assume that walking out of the doctor's office with a prescription will solve everything (or anything, for that matter). Your body, or the body of whomever you see suffering, must be treated uniquely and effectively. In order to do that, we need to start at the proverbial "beginning."

MEDICAL ASSISTANCE

Note: Once again, I would like to emphasize that no information in this chapter should be considered a substitute for care overseen by a knowledgeable physician (or team of practitioners). Because each woman's situation and chemical makeup is different, it's vitally important that you not self-diagnose or self-medicate (even with "natural" supplements or methods). Discuss everything with a well-trained professional who has experience with depression, and, whenever possible, specifically with postpartum conditions. Remember, the research regarding PPD is ongoing and part of a rapidly expanding field, so between the time / write this and its final publication, additional information will likely become available. Seek that, too. You and your medical team will benefit greatly from staying abreast of the most recent developments in understanding and treating postnatal mood disorders.

As I mentioned in chapter 2, the best place to start is with a full physical and blood panel. We explored previously how thyroid conditions and anemia can mimic depression, and it's essential that you and your loved one rule out possibilities such as these. If your doctor or insurance carrier is resistant to performing basic tests, you have the right to insist or seek help from another doctor. Some women suffering from depression have few emotional resources and are in no position to be adamant with a physician or insurance company. If you are a friend or family member, perhaps you can help in this regard. I cannot emphasize this enough: Do not simply accept a "you're depressed, here's an antidepressant" approach that leaves out a basic workup of physical examinations and labs.

Some offices use questionnaires that have been developed to help clinicians diagnose postpartum depression. Before you even go to your doctor, you or someone you love may want to get ahold of a PPD checklist. (Many are available free online, others require a minimal cost. See appendix B for some suggestions.) Just remember that while questionnaires and checklists are useful tools, no one should use them in place of thorough medical evaluation.

One positive outcome of taking stock of symptoms before a visit to your doctor is that doing this may help a woman with PPD identify and remember her unique symptoms so that she can clearly present them to a physician. Women with postnatal disorders sometimes battle memory problems, and forgetting certain feelings or experiences could affect the efficacy of a diagnosis. If a woman is struggling with coherent thinking, a friend or family member can help her distinguish and communicate her circumstances. Sadly, many women minimize or underreport their struggles. It's also quite common that a husband or close friend will observe things a woman with PPD does not have the objectivity to recognize. This perspective can be invaluable to a healthcare practitioner. Especially at the first appointment, having someone come along who knows the true extent of a woman's depression is always a good idea.

Because managed care is so common these days, it's likely that you or someone you love will need to see a primary-care doctor before a specialist. In extreme cases, where hospitalization is required before a doctor is consulted (I fell into this category), immediate psychiatry will be available. In most cases, however, a referral is necessary. If you feel that circumstances warrant it, it is appropriate to respectfully push for the chance to see a psychiatrist. Even if the result/diagnosis is the same as it was in the doctor's office, that confirmation itself will be valuable to you. Something different may come up with the specialist, however (and often does), so be your own advocate or actively involved in advocating for a loved one.

QUICK FACTS ABOUT PSYCHIATRISTS

• Psychiatrists have medical degrees and receive the same basic training in medicine as all types of doctors. In addition, they are required to complete a three-year residency in the mental-health field.

• Psychiatrists specialize in the diagnosis and treatment of mood disorders and psychiatric illnesses, which is why most moderately to severely depressed individuals should see them (mild depression may be treatable by a primary-care physician).

• There is nothing wrong with seeing a psychiatrist (no one with chronic upper-respiratory ailments would hesitate to see an ear, nose, and throat specialists), and I'm grateful that stigmas associated with psychiatry are diminishing.

• Because a psychiatrist is a medical doctor, he or she can prescribe and monitor psychotropic drugs such as antidepressants, antipsychotics, and mood stabilizers. It's important to note that, in most states, neither a psychologist (a PhD, but not a medical doctor) nor a psychotherapist can prescribe medication.

• Some psychiatrists are referred to as psychopharmacologists. They choose to specialize in treatment with prescription drugs.

• Psychiatrists rarely provide psychotherapy, though they do ask about emotional situations and then commonly recommend psychotherapists with whom they work. More on this in chapter 10.

The type of treatment that will best alleviate the particular symptoms you are, or someone you care about is, facing will depend on the severity and unique manifestation of PPD in a woman's body. Nearly all sufferers from postpartum depression benefit from therapy, and those with moderate to severe depression should most likely combine counseling with medication. In severe cases of PPD, and for those with postpartum psychosis, prescription drugs can be considered a medical necessity. Thankfully, if appropriate steps are taken, the majority of women experience some kind of relief from the most acute symptoms within two to six weeks.

Medicine is particularly important for any new mother whose symptoms impair her ability to function in daily life, dramatically alter how she is eating or sleeping, cause abrupt and disturbing mood swings or agitation (including panic), affect the level of her concentration, or lead to suicidal thoughts.

Because it takes nearly all psychotropic drugs a certain amount of time to build up in a person's system (usually between four to six weeks, sometimes less, sometimes more), other forms of physical-and certainly psychotherapeutic-treatment may help the sufferer until the medication takes effect (often a difficult period of waiting). Things such as dietary changes, massage and sleep therapy, exercise, even aromatherapy can successfully uplift or calm an anxious or depressed person. We will explore these later in this chapter.

Whether or not to use medication for depression is a decision that may be very complicated for you. You may be afraid because you've heard that medication changes a person's personality (making her numb or emotionless). You may think that medication and breastfeeding are mutually exclusive. Both of the previous statements are misperceptions. Perhaps you think that God never intended for people to take antidepressants. This claim opens a more complex discussion.

I firmly believe that God helped scientists develop medication that enables the body of a woman with postpartum depression-or, for that matter, chemical imbalance of any kind-to come back into balance. I realize that not everyone ascribes to this perspective, and I respect those who hold other views.

If someone were to ask me why I feel the way I do, I would respond with words very similar to those the restored man in John 9 used when others questioned whether his healing was authentic:

"One thing I do know. I was blind but now I see!" Then they asked him, "What did [Jesus] do to you? How did he open your eyes?" ... He put mud on my eyes," the man replied, "and I washed, and now I see." (verses 25-26,15)

In awe of the mysterious and glorious sovereignty of our mighty God, I simply say, "One thing I do know. I was depressed, but now I'm free." Jesus did it. "How?" you may ask. The great Creator helped scientists put specific and complex chemicals together in the form of a pill and then inspired a physician to prescribe it to me. He caused what was lacking in my body to be balanced by the medication; I pursued counseling; I drew near to Him; and I was healed.

I love the story found in John 9 because Christ used such a physical, unconventional (and, if we're honest, a somewhat distasteful) method to heal the man born blind. Jesus spit in dirt and put it on a pair of sightless eyes. Really?! And that healed someone? Yes, beloved, yes. Oh, what a glorious and surprising God we serve!

I also love this narrative because the blind man had to take some responsibility for his own healing. He could have scoffed at Jesus' strange manner of treatment. He could have wiped the mud from his eyes and gone about his business as usual. But this faith-filled man trusted that when Christ said, "Go ... wash in the Pool of Siloam [this word means Sent]" (verse 7). He was sent for a reason, for his physical restoration. A bottle of pills alone did not cure my depression nor did the spit-and-dirt mixture instantly give sight. I had to actively pursue healing just as the man who washed in the Pool of Siloam.

Please hear me: Taking medication for depression is not a cop-out. It may, in fact, be obedience. It was for me. I didn't even want to admit that I needed a psychiatric medicine, let alone take the stuff. But as I began to heal, I saw that the medicine was a demonstration of God's love for me. Christian psychologist Dr. Earl Henslin described this well in his book This Is Your Brain on joy:

In almost all cases of a severe depression, we need to use the best, targeted medicines available to get the person out of danger to themselves. There's a point where medicine is simply Gods mercy to mankind. Once stabilized, we can look at other alternative therapies that support or perhaps someday will replace medication.?

Medicine is simply God's mercy to mankind. On this side of my battle with depression, I understand that. I didn't always, though.

Wherever you stand on the issue of taking psychotropic drugs, judging the decisions of others will not help. If you believe medicine is a gift from God, arguing defensively with someone who comes from a different perspective usually ends rather poorly. The same is true in reverse.

There are many misconceptions about medication in both camps, and I hope that giving you information will help clear some up. Medicine in the right dose will neither alter a new mom's personality nor make her zombie-like or "spaced out." On the contrary, appropriately administered medication should improve her ability to think, to engage with life in meaningful ways, and to continue her journey of healing.

Which One? What About Side Effects?

So, how do you know which medicine is right for you? Well, you can't. Only a well-trained physician can tell you.

Unfortunately, many people now walk into their doctor's office and say something along the lines of "Doctor, I saw that depression commercial, and I think I need Cymbalta" or "I was reading online and know Paxil would be best for me." Of course it helps to educate yourself so that if a drug is recommended, you have a basic understanding of its uses, benefits, and potential side effects. I want you to be discerning when it comes to medication, and that involves arming yourself with information, but please leave diagnosis and prescription to trained and knowledgeable medical professionals.

Psychotropic drugs are classified in families based upon their action and formulation. The most commonly prescribed antidepressants are from the selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inihibtor (SNRI) families. SSRIs like Prozac and Zoloft, as well as SNRIs or atypical antidepressants such as and Effexor and Wellbutrin, are often recommended for women with postnatal disorders. Often, significant improvement can be seen within a matter of weeks.

Troubles can arise, however, if a new mom takes medicine not targeted to her particular condition. Remember, postpartum depression is not "the same thing" for every woman. Still, many practitioners routinely prescribe one of the most popular psychotropic drugs for every depressed patient. In some cases, this leads to serious repercussions that either worsen a new mom's condition or delay her healing interminably.

It's also important to keep in mind that depression can be divided very broadly into two categories: unipolar and bipolar. Bipolar depression is differentiated from unipolar depression, among other things, by the evidence of sustained and intense mood swings (whether or not the mood shifts dramatically or over the course of a longer period of time, even some months). For those with any form of bipolar depression-and there are many-a drug formulated for unipolar depression may actually exacerbate their struggle.

Instead, mood stabilizers such as Lamictal and lithium can be prescribed and taken with great result. Because I suffered from a cyclical mood disorder (an atypical bipolar condition), taking Lamictal made all the difference in my recovery. I could have tried every antidepressant on the market, all to no avail but with a significant amount of frustration and confusion. Fortunately, I didn't have to; I saw doctors who understood what I needed and prescribed accordingly.

Though mood stabilizers have primarily been used to treat various manifestations of bipolar depression, this family of drugs has recently shown marked effectiveness in the treatment of certain unipolar depressions by augmenting the action of more conventional antidepressants.

And though their name may suggest these medications are used only in conjunction with postpartum psychosis, antipsychotics such as Seroquel and Abilify can be used for a wide variety of psychiatric conditions. I wish there were a nicer name for this family of drugs, as I believe some people (okay, let's be honest ... most people) are immediately frightened by the term psychotic. I know I was. But at one stage in my journey, Seroquel was incredibly effective for me, and I know others who have been helped similarly.

Because these medications work on different parts of the brain than SSRIs, SNRIs, and mood stabilizers, those who do not respond to treatment with the more common antidepressants may find relief from their symptoms when an antipsychotic is added to the mix. Like mood stabilizers, antipsychotics can augment the action of other psychotropic drugs, working to relieve symptoms much more quickly. And, as the name suggests, this family of medication treats postpartum psychosis quite effectively.

Benzodiazepines, which act to balance the body's natural deepwake cycle, are commonly prescribed along with antidepressant medication to restore healthy sleep patterns, as some forms of PPD (as well as some antidepressants) can cause insomnia. Physicians may also recommend benzodiazepines to "take the edge off" or help severely agitated women "make it" until their other psychotropic drug(s) kicks in.

When prescribed and taken at the right dosage, antianxiety medications (the family of medication to which benzodiazepines like Xanax belong) relieve symptoms quickly. This is a family of extremely fast acting drugs that take effect within a matter of minutes. It's important to note, however, that these medications relieve anxiety and panic but will not treat depression as a whole.

Taking an antianxiety drug "until I get stable" may or may not be an effective strategy in your particular case. You should be aware that a temporary-relief solution like this might actually be dangerous for some women with PPD, depending on which portions of their brains are currently under- or overactive. Also, there is some risk of a patient developing dependency, so these medicines alone are usually not considered a long-term treatment plan. Instead, antianxiety drugs are primarily used for acute symptoms and on an as-needed basis. Remember, psychotropic drugs change the chemical activity of your brain. It's crucial that you and your medical team consider how each medication may affect and/or is affecting the body.

It's also essential that no one assume "the medication just isn't working for me" if the person has tried only one family, and certainly if he or she has tried only one specific drug. The cluster of symptoms you or someone you love is battling may require a different approach to pharmaceutical treatment, and God has given a variety of medications that can and do work on specific portions of the brain.

Another family of medicines on the rise is pharmaceutical-grade supplements. Examples are Lovaza, an FDA-approved fish-oil preparation, and Deplin, an L-methylfolate formulation. Both claim to either augment the action of psychotropic drugs or reduce the need for them altogether. Some insurance companies won't cover these prescriptions yet, but don't give up until you discuss these options with your healthcare providers.

I think it's wonderful that as medical science advances, God equips us to give our bodies what they need, not only to be balanced but to thrive. I also recognize this is a lot of information to take in. You won't be able to remember all of it. I hope you can return to this chapter if medication is recommended or prescribed for you. Should the action of a particular drug remain unclear to you, talk with your medical team or do some research on reputable medical websites. With a little digging, you'll be able to find lucid descriptions decipherable by nonmedical folks like you and me.

Before we move on to other forms of physical treatment, I'd like to address the issue of side effects briefly. Because each medication has its own list of potential side effects, I cannot detail them all. Even within a family of medications-SSRIs or mood stabilizers, for instance-the range of side effects can be extremely wide.

There are, however, a few important and general things to remember when it comes to side effects.

• Side effects can vary, and dramatically so, from woman to woman.

• Many women never experience a troublesome side effect.

• It's crucial to emphasize again that many women believe that, because of the prevalence of negative reactions to psychotropic drugs, they cannot breast-feed if they take antidepressant medication. This is a myth. There are some medications that have been approved for use while nursing, and a woman does not need to be afraid to take one of these medications if she wants to continue breast-feeding (more information below and in appendix B).

• There is no "perfect" medication.

• Most women who experience side effects will do so during the initial stage of pharmaceutical treatment, after which negative effects almost always subside.

• There are things you can to do deal with troublesome side effects. I found the list on pages 245-248 of Dr. Ruta Nonacs's book A Deeper Shade of Blue quite helpful.

• Sometimes simply altering the amount or frequency of the dose, the hour when the medication is taken, or how the body processes it (i.e., using time-released or extendedreleased preparation) can help relieve side effects.

• Because there are so many psychotropic drugs now available, if the side effects of one medication are simply intolerable (most often distressing for women are loss of sexual pleasure and weight gain), switching to another medication is always an option. Don't be afraid to discuss this with your prescribing physician(s).

• Alcohol has a direct effect on almost all psychotropic drugs and on psychiatric conditions. It can either potentiate (unhealthily increase the efficacy of the drug) or inhibit them. This is not to say someone with depression can never have an alcoholic beverage again; it's simply wise to be circumspect and limit your alcohol. Some medications cannot be combined with any alcohol at all, so if your prescription drug includes the warning "Do not drink alcohol while using this medication," please follow those instructions carefully.

• Taking over-the-counter medications (cold remedies, allergy drugs, etc.), herbal treatments, or dietary supplements (even some vitamins) can disrupt the efficacy of medicine used to treat depression. Consult with your doctor and bring a list of anything you currently take or plan on taking.

• And please remember, "all-natural" does not mean "causes no adverse effects." Homeopathic remedies and herbal supplements can also lead to serious side effects, so please do not use them without consulting a knowledgeable physician (more on this later). Such methods can be very efficacious, and are preferred by many, but they should always be pursued with the same discernment as prescription drugs.

• If you experience any heightening of your symptoms, new symptoms (such as thoughts of suicide), extreme agitation and anxiety, or energy and euphoria, you should contact your doctor immediately. Using the wrong antidepressant can actually make some cases worse, or indicate an underlying condition such as bipolar disorder, so do not "wait and see" with side effects like these.

As I have mentioned at several other points throughout this book, not everyone who suffers from postpartum depression needs medication. There are a great number, however, who do require medication to rebalance the chemical disturbance in their bodies.

It's also essential to remember that feeling better does not mean a woman should go off the medication prescribed for her. Instead, it likely means that the drugs are working well. When depression sufferers ask Dr. Lisa Bode, a Christian analyst who saw me once upon a time, whether they should stop their medicine because they've started to feel better, she often replies, "Why? Because it's working?"

You or someone you love would probably rather not take medication. But if this is the path God has for you, walk it with courage and in His grace, trusting His timing and the counsel He gives through your healthcare team.

In most cases, women with PPD who need medicine will stay on the drug that has been effective and tailored to therapeutic doses for at least six to nine months. Depending on the severity of depression, or if any history of chemical imbalance is involved, a new mother may need to stay on medication for a longer term. I took two meds for three years after my second daughter was born and then went off both. I, like many people, would have preferred to go off them much sooner. But my life and the stability of my mind were far too important to risk returning to the level of imbalance my brain had previously experienced.

Women often ask how they will know if a drug is working, or whether medicine will really help at all. If I ever wondered at the efficacy of psychotropic drugs, the beginnings of my dramatic turnaround after only a few weeks on medication silenced any concern. A general rule of thumb is this: If you begin improving significantly after taking medication for four to eight weeks, it's helping. Don't stop. If you haven't experienced any alleviation of your symptoms after four weeks, it's time for reevaluation. It's possible that you are on the wrong medication or that the dosage is insufficient. It's also possible that your condition will respond to nonpharmaceutical treatments.

Non pharmaceutical Approaches

For mild to moderate cases of postnatal disorder, dietary and other lifestyle changes (taking certain supplements, for instance) may prove effective in alleviating symptoms of depression, anxiety, etc.

Thirty minutes of vigorous exercise releases endogenous opiates (which simply means "naturally occurring feel-good chemicals," including endorphins, norepinephrine, and dopamine), which elevate mood and can have the added benefit of helping a new mom feel better about a body that's been dramatically changed by pregnancy and delivery. If you are a friend or family member of someone suffering from PPD, help the person you love get out for a walk or take a swim. She may not feel up to visiting the local gym, but if she does, offer to go with her. Exercise is good for you, too, and doing it with someone else is always more fun.

Adding more whole grains to your diet; increasing the amount and variety of fruits and vegetables in your diet ("eating from the rainbow," as some call it); trying tofu or soy products; eating organic meats, dairy products, and produce; as well as other such changes can be extremely beneficial for everyone.

Organic may mean "more expensive" to you, and eating organically simply may be unfeasible for your family, but trying to do what you can to eat the best foods available is extremely important. Other dietary suggestions include eating smaller meals and snacks more often and limiting simple carbohydrate and/or sugar intake. Women with PPD, in an attempt to self-medicate, sometimes indulge in "comfort foods," which can heighten their symptoms rather than relieve them. Being aware of this and working against it can help significantly.

Now, regarding dietary supplements ...

Along with many others, I recommend an omega-3 fatty acid supplement for anyone interested in brain health and happiness (not to mention vascular and bone health!). Fish oil is now available in various preparations almost everywhere, but if it is at all viable for you financially, it's best to purchase the highest grade possible. These are not only almost mercury- and contaminant-free (although most toxins are in the flesh of the fish, not in the oil, so fish oil in general is very safe) but are also absorbed by the body in higher concentrations.'

For those hoping to avoid a "fishy" aftertaste from omega-3 fatty acids, Christian psychologist and brain-health enthusiast Dr. Earl Henslin suggested enteric-coated capsules in his book This Is Your Brain on joy. They are a bit more expensive but worth it for those turned off by some fish-oil preparations.

Dr. Henslin further noted that "amino acids like 5-HTP or L-tyrosine have also proven to be as effective as prescription drugs for many mild to moderate brain imbalances . . . help[ing to] lift several types of false moods resulting from a shortage of feel-good neurotransmitters." 9

Henslin indicated that along with L-tyrosine, L-phenylalanine, SAMe (S-adenosyl-L-methionine), and grape-seed extract may prove helpful for those with depression marked by lethargy. Agitated depression may respond to 5-HTP, tryptophan, St. John's Wort, SAMe, g-amino-butyric acid (GABA), or a combination of GABA with the aminos taurine and glycosine or inositol.

For further information, Dr. Henslin also pointed people to Dr. Daniel Amen's website (www.amenclinics.com), his books, and Julia Ross's The Mood Cure.10 And as I mentioned previously, between the time I write this and the final publication, there will likely be even more information available about dietary supplements, so research as much as you can in order to ask your medical team the best questions.

A definite benefit of trying supplements for mild to moderate symptoms is that, if they work, a new mother may need to take them for only a few months while her body rebalances. If you have the time and patience to give amino acid or herbal supplementation a "go" (always under the guidance of a physician), this may be a great route for you. If, however, significant emotional and physical distress marks your current circumstances or develops while taking supplements, please do not "wait and see." Consult with the physician who has been overseeing your herbal treatments immediately.

Finally, as with pharmaceutical solutions, a combination of symptoms may mean that you need a blend of appropriate supplements to address different issues. For instance, you may need an energy boost during the day and a calming agent at night. Something along these lines is often the case, so, again, be willing to try different options under the direction of a skilled medical team.

Because herbal preparations are considered dietary supplements in the United States, they are not required to meet the same FDA standards as pharmaceutical drugs. They are usually not regulated or even evaluated by the FDA. This means, for instance, that concentration levels may vary from pill to pill. Consuming unregulated substances-yes, even herbs and supplements-can result in debilitating physical trauma. (I myself experienced this while taking an "adrenal support" product, which a doctor eventually informed me was formulated from crushed bovine adrenal glands. I thought I was taking something "safe" and "good for me" because it was "natural," not a drug. I was wrong.)

The unregulated nature of herbal preparations and dietary supplements should be of particular concern for women of childbearing age. Some "all natural" remedies actually contain high levels of lead, mercury, and other heavy metals. Since both lead and mercury are toxins closely associated with neurological disturbance, including anxiety, sleep disturbance, seizure, and dementia, you should be very careful about which brands and preparations you try.

Sadly, the general populace is unaware that serious side effects can be associated with herbal supplements. You may think herbal remedies are safer or more benign, but they do have side effects and may also interact with prescribed medications (whether those medications are for depression or any other physiological condition). For instance, St. John's Wort (the herb many take to combat symptoms of depression) is not recommended for breast-feeding mothers because adverse reactions in infants-e.g., colic or unnatural drowsiness-have been observed. Side effects for the mother herself can range from confusion and dry mouth to sexual dysfunction, headaches, restlessness, dizziness, and gastrointestinal symptoms. At higher doses, severe skin rashes or deeper psychiatric disturbance may result.

Of course, this does not mean St. John's Wort is ineffective and should not be considered. On the contrary, it has proven quite effective for many. I bring up these concerns simply to point out that every approach to treatment requires discernment and attention to the particulars of a depressed woman's body.

Additionally, while hormonal treatments using progesterone and phytoestrogens (herbal remedies with estrogenic activities) have been used in countries outside the United States, they ultimately have not been proven efficacious for the treatment of postpartum depression. I would be very leery of attempting any treatment involving these hormones. Until we know more, do not consume excessive amounts of phytoestrogens (such as preparations of isolated, often high-dose isoflavone and lignan, which are phytoestrogens currently sold over the counter). Naturally occurring phytoestrogens, such as those found in soy products or flaxseed, do not appear to carry this risk but, at the time of my writing and study, do not seem particularly helpful for those with PPD anyway.

Bottom line: All-natural does not mean better, nor does it mean safer or more effective. I will reemphasize: Each woman's body is unique and should be treated accordingly. Herbal or homeopathic methods may prove efficacious for you and dangerous for someone else. All this to say (and I have said it before in a variety of ways), be careful, be aware, and be in constant consultation with a knowledgeable healthcare team.

More Alternative Options

The following "alternative" (by this I simply mean nonpharmaceutical) options may help to alleviate symptoms, but it's crucial to remember they do not treat the underlying causes of postpartum depression. Still, a woman may find pleasurable relief in ...

• Aromatherapy

• Clary sage essential oil can be used for those with insomnia and/or anxiety.

• Basil essential oil is helpful with fatigue and/or anxiety.

• Rose essential oil is great for the entire nervous system.

• Sandalwood essential oil contains sedative properties effective for the relief of depression and tension.

• Lavender essential oil helps to alleviate pain associated with headaches, hypertension, insomnia, migraines, nervous tension, and stress. (An added potential benefit: Lavender can function as an aphrodisiac!)

• Jasmine essential oil often increases the beta waves in the prefrontal cortex, which helps people be more alert and responsive."

• Massage. A great stress reliever, massage helps many relax and also serves to relieve the tension and muscle pain of those with PPD. It will not "cure" postpartum depression, but it may make a new mother feel much better.

• Acupuncture. Traditional Eastern medicine has relied on acupuncture for thousands of years to treat a wide array of medical conditions. While various theories exist as to how acupuncture works, why it proves efficacious for some remains unknown. During a session, a trained acupuncturist inserts fine needles into specific points throughout the body. For many, this actually relieves pain and lessens the symptoms of anxiety and depression. For others, it shows no benefit.

• Relaxation breathing. Learning how to self-calm through relaxation breathing can help many women. Suggestions for how to do this are available on many websites, including http://altmedicine.about.com/od/optimumhealthessentials/ ss/Belly_Breathing.htm. Of course, while instructing others in relaxation breathing, some may suggest techniques that do not complement the Christian faith, so simply be aware that you can learn the physical means of relaxation without taking on any tantric spiritual principles. This also applies to yoga, pilates, and tai chi (see below).

• Yoga, pilates, and tai chi. These "quieting" forms of exercise may help a woman with PPD both relax and release endorphins at the same time. (What a great combination!) As with relaxation breathing, I recommend you be aware that, while practicing the physical methods of yoga, pilates, or tai chi does not inherently lead to spiritual disruption, certain approaches do stand in opposition to the Christian faith. I took my first "Christian yoga" class recently, and it was a fantastic blend of working out (boy, was I stretched and sore) and calming the mind. The instructor, Pamela Reno, played beautiful worship music and led us in poses that promoted great physical health and strength. She also read verses that inspired the heart and soul. It was a fantastic experience for me.

Additional Medical Treatment Options

We've discussed psychotropic medications and nonmedical approaches to healing. Along with, or instead of these (again, this should be decided by your healthcare team), you may also wish to utilize nonpharmaceutical medical treatments such as biofeedback, EMDR, or ECT.

Biofeedback

Years of research have identified biofeedback as an effective way to reduce the intensity of psychiatric conditions, including postpartum depression. Biofeedback attempts to change neurological patterns by essentially training the brain to do what drugs do chemically.

According to a profile for the Association for Applied Psychophysiology and Biofeedback,

Biofeedback is a treatment technique in which people are trained to improve their health by using signals from their own bodies.... Psychologists use it to help tense and anxious clients learn to relax. Specialists in many different fields use biofeedback to help their patients cope with pain. rs

Though you probably did not recognize it as such, the last time you took your temperature, you used biofeedback to determine the seriousness of your condition. The thermometer you used "feeds back" information about your body. If you are running a fever, you may decide (and wisely so) to rest, drink plenty of fluids, or see a physician. Biofeedback clinicians, in much the same way, rely on machines, though theirs are significantly more complicated than thermometers.

According to Bette Runck of the National Institute of Mental Health,

[Biofeedback] machines can detect a person's internal bodily functions with far greater sensitivity and precision than a person can alone.... Both patients and therapists use [this information] to gauge and direct the progress of treatment.

For patients, the biofeedback machine acts as a kind of sixth sense which allows them to "see" or "hear" activity inside their bodies. One commonly used type of machine, for example, picks up electrical signals in the muscles. It translates these signals into a form that patients can detect: It triggers a flashing light bulb, perhaps, or activates a beeper every time muscles grow more tense. If patients want to relax tense muscles, they try to slow down the flashing or beeping.13

Becoming aware of and able to control the body's responses can prove invaluable for those with PPD, particularly those who feel alienated and disconnected from their own bodies.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR helps individuals access their memories, process and metabolize experiences or feelings that have been "stuck" in the nervous system, reframe memories and emotions, and ultimately inhibit the revisiting of their trauma-inducing triggers.14 After my second postpartum depression, I benefited from EMDR techniques administered by the Christian psychologist I was seeing.

During an EMDR session,

The therapist works with the client to identify a specific problem as the focus of the treatment session. The client calls to mind the disturbing issue or event, what was seen, felt, heard, thought, etc., and what thoughts and beliefs are currently held about that event. The therapist facilitates the directional movement of the eyes or other dual attention stimulation of the brain, while the client focuses on the disturbing material, and the client just notices whatever comes to mind without making any effort to control direction or content.... Sets of eye movements are continued until the memory becomes less disturbing and is associated with positive thoughts and beliefs about one's self.'s

An EMDR therapist might facilitate directional movement of the eyes, for instance, by asking patients to concentrate on an event or incident while moving their eyes horizontally, following the light on an electric screen. Additionally, clients may wear earphones, which enable them to hear a soft beep corresponding to the direction in which their eyes are moving. If this sounds strange, let me assure you: EMDR is not hypnosis, and it produces no side effects such as dizziness or headaches.

The EMDR International Association (EMDRIA) website describes in practical terms what happens after a day's therapy:

Following a successful EMDR session, a person no longer relives the images, sounds, and feelings when the event is brought to mind. You still remember what happened, but it is less upsetting. Many types of therapy have similar goals. However, EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Therefore, EMDR can be thought of as a physiologically based therapy that helps a person see disturbing material in a new and less distressing way.'

According to the EMDRIA, "To date, EMDR has helped an estimated two million people of all ages relieve many types of psychological stress."" EMDR can be particularly helpful in identifying and debasing psychological triggers that stem from trauma such as childhood abuse, abandonment, loss, or exposure to disaster. If you would like more information, visit the EMDRIA website at www.emdria.org.

Electroconvulsive Therapy (ECT)

Unfortunately, the images ofECT available to the general public-particularly Jack Nicholson's character being treated with it in One Flew over the Cuckoo's Nest-would terrify nearly everyone. This is not an accurate representation of how ECT is used today, however, and should not even be considered when and if electroconvulsive therapy is recommended in conjunction with treatment for PPD.

Electroconvulsive therapy is usually reserved for those women with extremely severe postnatal conditions, and for whom psychotherapy and medication have thus far proven ineffective. Also, ECT is used for those who are at imminent risk of suicide. ECT is, in the words of neuropsychiatrist Dr. Daniel Amen, "sometimes lifesaving." That said, Dr. Amen told me, it is "not the first thing to think about it."

During electroconvulsive therapy, an electric stimulus is applied for a short period of time, which produces a generalized seizure lasting approximately one minute. No one is certain exactly how or why ECT helps treat psychiatric conditions, but for some, it is quite effective.

Because muscle relaxants and anesthesia are given to the patient, no pain is felt. The common course of treatment requires ECT to be given three times a week, with a full course typically consisting of six to twelve treatments.

Especially for those at imminent risk of suicide, ECT often results in quicker relief than antidepressant remedies. Possible side effects, however, include headaches, nausea, temporary confusion, and muscle stiffness. Many patients also report loss of memory, particularly for events that occurred in the days, weeks, or months surrounding the ECT. While most of these memories come back, others may not. In a few cases, patients may notice disruption of their entire short-term memory functioning. This can persist for some months after treatment by electroconvulsive therapy.

PPD survivor Tina Zahn wrote about her experience with ECT in her book Why IJumped.

The first time I had the treatment, I felt like a whole new person-for about forty-five minutes-before slowly sinking back down into hopelessness again. The effects of the second treatment lasted about two hours. The third had me feeling better for almost the whole day. Little by little, I was pulled out of my dark despair.18

While electroconvulsive therapy is not a "front line" treatment for PPD, in severe cases it may help prevent suicide and relieve acute symptoms.

Special Concerns About Breast-feeding and Medication

Before we close this chapter and move on to exploring approaches for cognitive and spiritual healing, I'd like to address special considerations related to physical treatments and breast-feeding.

I understand completely if you are reluctant to use medication while breast-feeding. One of the primary reasons I did not want to take psychotropic drugs was I assumed I'd have to discontinue nursing. At the time of my first postpartum depression, little information was available to the public about the effects of medication on breastfeeding mothers or infants, but I am happy to say that much more is now at hand. Studies are under way that should help us understand even more in the years to come.

Before we discuss some of the pros and cons of taking specific medicines while nursing, let me emphasize: If you or someone you love is experiencing a severe postpartum depression, please do not withhold or withdraw treatment because of breast-feeding concerns. This may result in a disastrous increase of symptoms. I resisted care for my first episode of PPD because I wanted to nurse, and I believe doing so exacerbated my condition significantly. I do not want the same to happen to you or someone you care about.

Now, let's turn to some of the evidence ...

Several studies show that medications commonly prescribed to treat postpartum depression are reasonably safe to take while breastfeeding your child. Of course, as with all drugs and all medical conditions, there is a certain amount of risk in consuming any pharmaceutical or herbal preparation. I can't tell you that there are absolutely no risks in nursing while taking psychotropic drugs.

Dr. Thomas Hale, an experienced clinical pharmacologist with many years of lecturing in all areas of pharmacology and therapeutics, however, has studied these risks for years. Hale is considered a leading expert in the use of medications for breast-feeding women. His website provides a wide array of information for the general public on breastfeeding and medications and is constantly being updated. If you are a medical practitioner, you can participate in forums via this site (this is not an option currently available to everyone). Should you become concerned about taking a medicine recommended by your healthcare team, visit http://neonatal.ttuhsc.edu/lact/index.html for more information about specific drugs and interactions.

At the time of my writing, researchers have studied the possible impact of Zoloft (sertraline) and Paxil (paroxetine) on breast-fed infants and found no adverse effects. However, no results of long-term studies of infants exposed to antidepressants have been made available, so I cannot tell you what long-term effects might be.

Several reports have indicated that fluoxetine (Prozac) may be found in breast milk at higher levels, so this SSRI might not be the best choice for a nursing mother. Dr. Hale reported on his site that Lexapro may induce drowsiness in breast-fed babies, particularly newborns, so he advised mothers and healthcare practitioners to watch for sedation. Lexapro can still be used while nursing, however, and with little to no negative effect."

According to Dr. Ruta Nonacs, author of A Deeper Shade of Blue, although medication can be detected in the breast milk, scientists have observed that the levels of the aforementioned psychotropic medications in an infant's blood actually tend to be either very low or completely undetectable.

For the new mom concerned about medicine and breast feeding, this translates into two important pieces of information: (1) studies indicate that babies absorb a very small amount of psychotropic medication through the breast milk; (2) the drugs do not accumulate in the baby's bloodstream, meaning they do not reach toxic levels. Premature infants may have a harder time processing the psychotropic medications currently considered safe for breast feeding, but for full-term babies, there are only minor concerns. Looking at the data as a whole, noted Dr. Nonacs, it appears that nursing while taking some antidepressants poses no significant risk to a newborn .21

Helpful research developments from Dr. Zachary Stowe and his colleagues at Emory University also point to evidence suggesting that drug levels in the breast milk typically peak six to eight hours after the mother takes an antidepressant drug.

Since Stowe's research continues to show this as a predictable pat tern, some experts advocate a "pump and dump" technique, which further reduces exposure to the drug in nursing infants. Following this tactic, a mother pumps between six to eight hours after taking her medication and simply discards the breast milk. According to Dr. Stowe, this approach decreases exposure by about 25 percent. Theoretically, this technique seems ideal, but some newborns nurse around the clock. Other mothers have a very difficult time pumping, or feel discouraged (something a woman with PPD needs no more of) when "dumping" precious breast milk. Moms with older babies who nurse less frequently or on a more predictable schedule may find this easier.

Stowe's research is, as I said, helpful, but it may or may not work for you. You don't have to force it, but if you can manage the "pump and dump" approach, it may help you feel better about taking medication while breast-feeding."

In Summary

It's so important that women with postpartum depression seek and keep getting physiological treatment. I realize that PPD sufferers will not need every one of the medical or nonpharmaceutical treatments discussed at length in this chapter, but presenting as many of the options as possible is crucial. The following chapter will give information on psychotherapeutic and spiritual approaches to healing postnatal disorders. Again, the best approach is always to treat the body, mind, and soul in tandem.

If you do not, or the person you love does not, seek treatment, the severity of postpartum depression can increase. Please remember that of those with a history of depression "50 to 85 percent will have at least one more episode when they discontinue medication. This incidence increases incrementally with each number of previous episodes .1122

Earlier in this chapter I shared that 78 percent of those who suffer from depression never receive treatment. Experts in this field rightly observe that this is a significant problem. Not only do I want to encourage you to be part of the 22 percent who seek, or help someone else seek, treatment, I also want to challenge you to be a partner in providing a real solution for this problem, helping others in your sphere of influence understand and treat depression well.

Since I've "been there," I've become somewhat of a crusader for this cause. I pray that as you find, or someone you love finds, hope and healing from PPD, you too will be able to share with others what you have discovered about treating the body, mind, and spirit.

Before we close this chapter, I'd like to share two more brain scans with you. The first, as its caption indicates, is the scan of someone struggling with depression. This image was captured before treatment. The second is a picture of the same person's brain, scanned after treatment.

Used by permission, courtesy of the Amen Clinic

Isn't the transformation remarkable?!

You may have noticed the second scan was performed after treatment with nonpharmaceutical options. Psychotropic medicines are, as we noted previously, often God's mercy to mankind. They are not, however, the only game in town.

No matter what form of treatment works for you or someone you love, I pray the kind of radical healing evidenced by these scans is yours as well.

We use our powerful God-tools for smashing warped philosophies, tearing down barriers erected against the truth of God, fitting every loose thought and emotion and impulse into the structure of life shaped by Christ.. building lives of obedience into maturity.

- 2 CORINTHIANS 10:5-6 (MSG)

I remember sitting in our house somewhere, though I couldn't tell you where. I'm wearing an old green sweatshirt from better times-the days of water-ski trips and all-nighters with youth groups Jeramy had pastored. A pair of truly hideous black sweatpants is attempting to keep my spindly legs warm. Why in the world, when I've forgotten so much about that period of my life, does what I wore one day stick in my memory? Perhaps because I spent who-knows-how-many hours staring at the frayed drawstring of that hood. Perhaps because it's the same thing I wore when Jeramy dropped me off at the hospital. Years later, Jer told me he cried all the way home.

I've seen my husband cry only once, maybe twice, in the elevenplus years we've been married. Knowing that he shed tears, which do not come easily for him, because he loves me (and probably because he was afraid and angry and confused and exhausted at the same time) rips at my heart to this day.

That green-hoodie-wearing morning at home, my four-month-old daughter, my husband, and my mother were with me, but I was so lost in the fog of my head that I honestly don't know if I would have noticed (or cared) if one or all of them had left. From a mental distance, I heard Jer tell me that I needed to get in the shower. I didn't respond; I couldn't. Maybe he asked me if I'd heard him, maybe not. In any case, the next thing I knew, I was sitting on the floor of our master-bedroom shower.

Apparently, Jeramy and my mom had taken off my clothes, turned on the hot water, and forced me into the steam behind our red gingham curtain. I must have had no strength to stand, because I distinctly recall sitting, almost directly on top of the drain.

I don't usually sit in the shower, so I had never seen our drain from that particular perspective. It struck me how disgusting it was, long hairs protruding from the grate. Though I observed it, I didn't really care that it was nasty and probably hadn't been cleaned the entire time I'd been ill. For some unknown reason, I started to pull one hair, then another from between the metal slats. Soon I had a clump of matted, slimy hair on the floor next to me. I kept tugging, yanking. And it wasn't pretty, my friend. It was heinously gross, in fact. But I didn't stop. Revolting as it was, it felt strangely good, oddly cleansing. Who knew this enforced shower would be a step toward healing for me?

The doctors had told Jeramy when he picked me up from the hospital that recovery would take time. I wouldn't get better right away. The medication prescribed for me-fluoxetine hydrochloride (Prozac, though no one called it that for some reason) -needed to build up in my system. This can't happen instantly, they explained. I vaguely recall the strain in Jeramy's voice as he asked, "How long, do you think?"

Four to six weeks, the discharge papers indicated. And "we might need to play with the dosage a bit," someone informed us. Even then, as disconnected as I was from life, the idea of doctors "playing with" brain drugs didn't sit well with me. Still, I was too weak and apathetic to resist.

The hospital also insisted Jeramy and I sign a legal document requiring that we make an appointment with some kind of therapist. The paper didn't specify that it had to be a particular psychologist or counselor, which was at least one ray of light in those extremely dark days. The fact that we could choose meant that we could find a Christian therapist, someone who would address the spiritual ache inside of me at the same time as the physical.

A few days after my release, Jeramy took me to a psychologist who worked out of one of the larger churches in Colorado Springs. I remember only two things from that visit: (1) I did not like the woman at all (which is quite rare for me . . . I can usually find something to like about anyone); and (2) she told me that I needed to purposefully do something imperfectly each day. "Break a dish," she urged me, "overcook the meal. Free yourself from this bondage of perfectionism." I thought she was crazier than I was.

Looking back, I recognize that this therapist identified, in less than fifty minutes, one of the defining struggles of my life. Perhaps the greatest evidence of God's work in my life to date is that my drive-no, scratch that, my neurotic, suffocating drive-for perfection has now been healed (well, almost entirely ... I won't say "completely" since no work of God is finished this side of heaven). Only the Perfect One, the Wonderful Counselor, could have accomplished what needed to happen in my heart and mind-transformation, renewal, the unleashing of freedom.

Jeramy, I discovered only recently, was burning with anger when I told him that I didn't want to see "that woman" again. "I thought you should try harder to get better," he admitted. "I didn't think you wanted to like her, or work with her, or realize that what she said about your obsession with doing things `right' was spot-on."

Someone in our church told us about a counselor who came very highly recommended. Donya Duggleby, the hastily scribbled note said. A phone number was scrawled underneath. To my surprise, I actually had the strength and desire to call her myself. I left a message of some kind-probably along the lines of "the doctors tell me I have postpartum depression and I have to see someone about it."

The day of my first appointment, I remember getting dressed in some of the few professional clothes I owned. As sick as I was, I wanted to present myself well. I was an author and pastor's wife after all. I carefully lined the hollow lids above my eyes; I outlined my pale lips with too-dark-for-the- occasion lipstick. Even the pearls hanging from my neck, the ones Jeramy had given me as a wedding present, seemed to droop morosely.

I walked into Donya's office and found a clipboard with quite a few pages to fill out. There were the standard "whatever you say or do will be kept confidential" forms you find at every healthcare office, and then, toward the back, there were some fill-in-the-blank questions for me to answer. I wish today that I had those to look back at.

I remember clearly that one simply had the word "God" with a long blank line after it. I wrote, "is punishing me." God is punishing me, I reread. Yes, thats right, my thoughts confirmed. Another line started: "I'm afraid ." I filled in, "that I'll never get better." There were other questions; I gave other answers, but they all led back to the same root: I was frightened, hurting, desperately mixed up in mind and spirit.

Months after my therapy ended (coinciding with our family's move to California), Donya and I built a friendship. I cherish the relationship God's given me with this amazing and beautiful woman. She is a one-in-a-million lover of Jesus and world changer for Him.

Donya told me recently that I came into her office a shell of a person. Despite my attempt to hide the pain inside me under makeup and nice clothing, Donya could see the resignation in my haunted eyes. The strained gauntness of my face couldn't be masked. Imagining myself from her description presents a pitiable picture.

Weeks went by, and the curves of my face started to fill in with flesh once again. The hollowness in my eyes dissipated, and, most importantly, God used Donya to shine light upon the shadowy corners of my mind and heart.

We talked about everything-the pressures of my past, the heartrending disappointment I felt at having to stop breast feeding, the fears that I would be a terrible mother and that I had irreparably damaged my marriage and the daughter borne of our love. Maybe it was simply because I was now ready to face it, but I also talked again and again (during every session I can recall) about the perfectionism that stalked me, like a starved lion, anxious to devour.

One day I remember Donya telling me she liked to use art therapy. I shuddered at the prospect. Stick figures are a stretch for me. Relieved when she simply drew a ragged circle and asked me to fill it in with words, I thought, Okay; this I can do. The written word is right in my comfort zone. To my dismay, I found out she wanted me to fill it in with terms that described what I was feeling, what I feared, what ached inside me. Words failed me, so Donya wrote while I described the emotions haunting my mind and soul. I kept that sheet of paper, and all these years later it stays tucked in my Bible case.

After marking the page with the words pain, hurt, deep grief, unmet longing, disappointment, and out of control, Donya drew two arrows coming off the circle. These "chutes," she called them, were ways I tried to avoid everything within the circle. Just off the point of each arrow Donya wrote, "Anger at self" and "I'm foolish/a failure." Anger at self, she explained, is your path of self-punishment. Calling yourself foolish or a failure is your way of trying to exert control over uncontrollable circumstances. "If you truly failed, it was because you could've made things turn out differently. Is that true?" Donya asked.

Wow. I didn't know quite how to reply.

She opened her Bible and asked me to read Matthew 5:4. "Blessed are those who mourn," I read, "for they will be comforted."

"What does it say?" Donya prompted.

I gave the standard Sunday school answer: "God will comfort me when I'm hurting." I sounded unconvinced because, at that moment, I still was. I didn't feel His comfort. The pain was still deep, a seemingly endless well.

"Look at it again, Jerusha."

I glanced back at the verse (slightly annoyed, to be honest with you). "That is what it says," my heart responded wearily.

Then, as if a light (or rather the Light) exploded in my mind, I realized, "I have to go through the mourning, don't I? To get the comfort, I mean." How clearly I saw it. I couldn't escape the center of the circle, that jagged stronghold of all my anguish and grief, the disappointment of unmet longings and dashed hopes, the agonizing weight of shame.

"Jerusha, you have to lean into this pain. Listen to what God wants to tell you in and through the pain. Don't hide from it anymore."

Dear reader, it's never easy to lean into your pain, no matter what kind of heartache you're facing. In fact, it often feels as if your soul is being cauterized, burned in order to heal. But I vow to you, by the God who saves, that Jesus, your Friend and Refuge and Deliverer, is there. He is in the circle with you. He is a God who gets in the pit in order to lift you out. True, you might have to walk through the valley of the shadow of death, but, beloved one, I plead with you: refuse the ways of false escape.

As I mentioned, I fled the circle of disappointment and grief with self-blame, but I very well could have blamed others, too. Indeed, resentment might inform your own pain, or that of someone you care about. If you do not run away, but run toward God in your heartache, the Good Shepherd will guide you to safety. As you lean into your hurt, where He will be found, your cup will begin to overflow again (see Psalm 23).

During another session, Donya asked me to draw a picture of my family of origin. Remember I told you that stick figures are difficult for me? Well, my family "portrait" contains six of the most pitiful stick figures you'll ever see.

I drew myself with no mouth.

You must understand a bit about my family to know how utterly bizarre this is. My parents, siblings, and I have lovingly referred to ourselves as the "loud" family. Not one of the six of us lacked for words. In fact, steely silence was, at least for me, the surest way to communicate displeasure or anger. In our home, whoever yelled the loudest usually "won," and I almost invariably told everyone everything. When I didn't use verbal words, my facial expression conveyed it all.

Why, then, would I draw myself with no mouth?

Because that's how I felt.

Ultimately, despite all the words spilling from between my lips, the endless stream of language never communicated what I longed for most-unconditional acceptance. To me, words were cheap. In the end, they did little to free me from the pain of perfectionism, from the fear of failure and criticism. In some ways, I think the words I spoke actually propelled me down the chutes of self-blame and self-condemnation more than kept me in the circle where healing could be found.

Slowly, through many sessions with Donya, the once-dark recesses of my mind and spirit became infused with light. The psycho-spiritual gunk of many misguided years of living was drawn to the surface, cleansed, and tossed as far as east is from west.

One afternoon, I confessed to Donya that I knew what the showerdrain experience signified. God was doing through therapy what I had done to my shower drain. And in freeing me from the tangled, slimy mess of my mind, God transformed my entire existence.

Romans 12:2 has become a life-defining verse for me. "Do not conform any longer to the pattern of this world," God wrote through Paul, "but be transformed by the renewing of your mind. Then you will be able to test and approve what God's will is-his good, pleasing and perfect will" (emphasis added).

The goal of counseling is nothing short of the renewing of the mind, the transforming of thought life, the replacing of toxic lies with the Truth that sets us free (see John 8:32). This, dear friend, is what I hope for you and for those you love. This is the kind of treatment that lasts.

Some Better, Some Worse, but All Shaped by the Gift of Pain

Instant healing of the mind and heart does not exist, which often troubles and discourages people. I know it did me. The fact that there will be good days and awful ones in between is a hard reality to face. Please let me assure you that the ups and downs of recovery are normal. Understanding this may help you separate the moments of terror- "Does this mean I'm going to go back to where I was before?"-from truth-the slow transformation of our minds is actually a blessing.

We, as finite humans, cannot absorb more than a few glimpses of truth at a time. We need time to process and to ponder. It's actually a gift of God-not a curse-that soul-healing is a journey. Of course, we may be tempted to (or convinced that we should) return this potentially painful present unopened. Pain is the gift no one wants to accept, observed author and physician Dr. Paul Brand, who worked with leprosy patients for years. That lepers cannot feel pain is one of the most terrible of their symptoms. They have no way of knowing, for instance, when their flesh is burning, when their skin has been pierced.'

Dear one, if you can tell your heart hurts, and you can identify what you are enduring as hard and grievous, that is a gift. If you could not feel it, you might never know the healing power of the God who saves. Instead, as a leper does, you would simply lose parts of yourself to an agony you did not recognize, a pain you could not fight. "The path to health, for an individual or a society, must begin by taking pain into account," noted Dr. Brand. "Instead, we silence pain when we should be straining our ears to hear it."2

Who wants to strain their ears to hear the voice of pain? No one! And yet, recovery is a process of unearthing your sorrows and discovering the healing that is - rather ironically, if you ask me - within the heartache. It's in the circle of mourning where we receive comfort. The prophet Isaiah described Jesus as a "man of sorrows, and familiar with suffering" (Isaiah 53:3). Those who admit their pain find themselves in very good company.

I firmly believe that counseling should be part of the recovery process for every woman who suffers from PPD. Yes, every woman. Pills are not enough. Sometimes, perhaps I ought to say often, God ordains that prayers for healing and Bible reading are not the only things that bring deliverance. Godly counsel is as much a gift from the Lord as pain is, as His Word is, as His availability and wisdom in prayer are.

I don't need therapy, some women may argue. I have a supportive family. My friends and my church are all pulling for me and encouraging me. Besides, I don't have the time or money to see a therapist. And to make matters worse, people may judge me. On top of it all, how can I admit to someone that I'm hopeless, when the God of hope dwells in me? Will everyone doubt my salvation?

Other women strongly dislike the idea of talking to a "stranger" about their personal issues. And some have family or friends who would genuinely disapprove of their seeing a psychologist or counselor. Fear of being judged or rejected after seeking therapy is sometimes not unfounded.

I cannot convince anyone of her need-moreover, of the incredible benefits- of good counsel. Perhaps holding myself as exhibit A for the power of Christ centered therapy will be strong enough testimony for some. For others, more specific detail may be needed.

In an Effort to Be Concrete ...

If you're confused about either what counseling will look like or how you and someone you care about could benefit from therapy, allow me to answer some questions for you.

First of all, what kind of counselors are out there?

• Psychologists hold a degree (MA, PhD, or PsyD) in clinical psychology, a field devoted to the study of human behavior. A psychologist must be trained for five to seven years on the graduate level. Developing an expertise in therapeutic methodology and diagnostic assessment during that time, a psychologist must also complete a clinical internship. In almost every state, psychologists provide therapy but cannot prescribe medication (this is the role of a physician, usually a psychiatrist).

• Pscyhotherapists, a generic term to identify anyone who practices psychotherapy, should hold a bachelor's degree (often in psychology or a related discipline). Unfortunately, in some states, anyone can call himself or herself a psychotherapist, so it's wise to ask about a practitioner's training and credentials. Evaluations and/or recommendations for therapists in your area may be available online.

• Marriage and family therapists (MFTs, for short) are psychotherapists who specialize in counseling related to family issues. Many have experience with postpartum depression.

• Licensed clinical social workers (LCSW) receive a master's degree with approximately two years of graduate work in mental health. Some social workers pursue specialized training in psychotherapy. If there is a good LCSW in your area, he or she can be an invaluable resource. Not only may LCSWs provide counseling services, but the community connections available to social workers can be an excellent help. LCSWs often assist people in locating medical and therapeutic practitioners based on their particular needs. You will read in chapter 11 about how an LCSW changed the course of one family's life.

I mentioned how important it is that you ask about a psychotherapist's-or, for that matter, any clinician's-credentials, but there are other questions that may be appropriate to ask as well:

• Do you have experience with postpartum depression?

• Do you have an opinion about PPD that I should know about?

• For example, do you believe or disbelieve that PPD is a medical illness? Some biblical counselors deny that depression is both a psycho-spiritual and physiological condition.

• Do you have any experience with different types of depression?

By this, I mean the different manifestations of depression in the brain and circumstances of each individual (refer to chapters 2 and 9). Remember, depression is never just "one thing." You may need counseling based on the type of depression you have. For instance, if you suffer from an agitated depression, your therapy should follow a unique path designed to address your anxiety and depression.

• What are your fees? (Important note: Good therapy may be expensive, but expensive therapy is not always good.)

• How long do sessions last (thirty minutes versus one hour or more)?

• Do you work with insurance?

• Do you offer payment plans?

• Do you have a sliding scale for families in financial need?

Because some managed healthcare plans limit the number of covered visits to a psychotherapist, it's also a good idea to call your carrier if you plan on using your medical insurance to help with the cost of counseling.

These are questions you would be wise to ask practitioners, but there are questions about therapy you can ask yourself-or help a hurting mom with PPD ask-as well.

Are you ready to set aside time, energy, and resources for healing? Therapy will not benefit anyone who begrudges the cost of recovery (which, I will be completely honest with you, can be great, both emotionally and financially). My friend and gifted Christian psychologist Dr. Earl Henslin once observed that healing is in no way accidental. A deliberate examination of the past and present, as well as a concerted effort to replace destructive thought patterns with healthy and holy ones, is involved. Mothers are usually the last ones to set aside time or money for themselves. They are used to taking the leftovers, whatever energy or resources are remaining after the meals have been cooked, kids bathed, laundry and dishes at least started. To those who feel guilty about spending time or money on therapy, I want to say you will spend far more of your resources-emotionally, spiritually, physically, and even financially-trying to battle this yourself. In the long run, therapy wisely invests money and energy that could have been thrown into the pit of untreated depression.

Is therapy selfish?

Perhaps this strikes you as a strange question to ask. Isn't counseling, on many levels, about self-reflection? Perhaps, but it is also about enabling a depressed person (who is often quite selfabsorbed) to establish healthy boundaries for self-examination. Setting aside a particular and limited time frame for self-reflection actually helps divert energy away from selfishness during other times. This was a huge blessing to me, as when I left Donya's or Arlys's (the woman who counseled me after my second postpartum depression) office, I didn't feel as consumed with what was happening to me.

How will this help now? And in the future?

Those struggling with depression often have a skewed perspective of their past and present circumstances. Therapy helps people reframe a reality broken by PPD. The fragments of the past and the shards of a shattered "now" can be pieced back together during godly therapy. Counseling helps individuals to reorient their vision and establish healthier ways of looking at their experiences and current stressors. These are life lessons that will bless not only the participant but those around her as well.

What type of therapy is right for me?

Since there are many different forms of therapy, I'd like to devote an entire section to answering this question. Though I cannot tell you definitively which method will best meet your needs, I believe that the Holy Spirit will guide you-perhaps through open or closed doors, perhaps through the wisdom of others or an internal sense of His direction-to the right treatment approach for you or the person you care about.

Methods of Therapy

Individual therapy is the form of counseling with which most people are best acquainted. It may be called psychotherapy or referred to as "talk therapy" as well.

This involves seeking a practitioner (best-case scenario, one who has a solid reputation coupled with an understanding of the physical, mental, and spiritual aspects of depression). To describe the process as simply as possible, here's what happens: You make an appointment to discuss what's going on currently and, usually, what has happened in the past as well.

As indicated by the terminology, clients of individual therapy mostly see their therapist alone. On occasion, someone close to the situation-a family member, for instance-may join in on one or more sessions.

Within the broad category of individual therapy, there are several distinct approaches a counselor may take. This is by no means an exhaustive list of the forms of counseling, but it represents the most common.

• Behavioral therapy focuses on what prompts behavior and why a person feels compelled to act in a certain way. It then moves to help a participant change harmful ways of responding to life. Secondary aims are tracing behaviors to thoughts, then evaluating false beliefs. Behavioral therapy is often used in conjunction with other forms of treatment, including CBT.

• Cognitive-behavioral therapy (CBT) concentrates on a person's thought life, as well as how beliefs powerfully influence the way we live and feel. CBT identifies negative patterns that perpetuate depression and helps replace them with healthier perspectives. CBT usually requires that a participant record situations, mood, and automatic thoughts, along with the dates and times at which these occurred. For some, especially in the throes of a deep depression, this may seem overwhelming, but it can be incredibly illuminating and well worth the effort.

• David Burns' immensely popular book Feeling Good is often used in or, because it follows a similar path to CBT, instead of professional treatment. (This I do not recommend in any case of moderate to severe postpartum depression. Even in mild cases of PPD, trying to "self-treat" can be a dangerous prospect.) My sister gave me a copy of this after the onset of my second depression, and I did find it very helpful when used in conjunction with professional counseling. That said, I was disappointed by Burns' lack of attention to the role faith plays in the development of healthy thought patterns.

• Supportive therapy helps patients manage the day-in, day-out business of life (again, this is often part and parcel to other forms of treatment).

• Interpersonal therapy (IPT) focuses on how relationships with others-most especially the conflicts that arise within them-affect the self.

• Psychoanalysis and psychodynamic therapy help a person discover and understand emotional conflicts that may be contributing to his or her depression. While CBT and IPT tend to focus on the "now," psychoanalysis or psychodynamic therapy often centers on unresolved issues rooted in past experiences.

• As a small note of caution: It is sometimes difficult for a woman with PPD to venture immediately into the pain of her past. In fact, it may prove counterproductive in a time when managing current symptoms is top priority. Generally speaking, the fire that needs to be put out first is the present one-the postpartum depression. Then a new mom can sift through the ashes and see how her past contributed to the blaze. A discerning clinician practicing psychoanalysis or psychodynamic therapy will know how to balance this.3

• Faith-based counseling focuses on the spiritual dimensions of behavior and the motivations behind it. Biblical counseling is best practiced by a therapist who attends not only to the spirit, but also the body, mind, relationships, and behaviors. Some people insist there is only one "correct" way to counsel biblically, but I do not agree. For more information on this, as well descriptions of two specific forms of Christian counseling, theophostic prayer ministry and nouthetic counseling, please refer to the additional resources in appendix B.

No matter which method you lean toward, remember that the most effective counseling combines elements of all these approaches. I trust that by reading in earlier chapters about the role of experience and brain chemistry in depression, you've seen that the mind, body, and soul are intimately connected. Consequently, in order to facilitate genuine healing, therapy should address the internal dialogues and cognitive distortions (the toxic beliefs that precipitate unhealthy actions) of the mind. It should help with physical struggles and the daily realities of life. And it should always care for the wounded spirit. We are integrated beings-physiologically, psychologically, and spiritually. Recovery must occur in each of these dimensions.

Whatever form it takes, individual therapy can make it easier for a new mother to identify possible triggers for anxiety, obsession, and/ or depression in her life. It will likely equip her with techniques for managing stress as well as anger. It can assist a PPD sufferer in reorienting emotions that have previously been misdirected (for example, my escape routes of self-blame and self-punishment). Counseling often aids mothers in making role transitions as well.

Becoming a mother for the first time brings up all kinds of conflicting emotions and rather disturbing questions:

• Why do I both want to and not want to be a mom?

• How does this change my roles outside the home?

• How has my life been affected by having a baby?

• How has becoming a mother altered my image of myself and what others think of me?

• Why do I feel so lonely?

• Why do I long for my "old life" back?

• Why did no one tell me it would be like this?

• Why do I suddenly feel overwhelmed by memories of my childhood-its pains and joys?

• Why do I feel so incompetent and inadequate?

These questions are typical and, I would argue, healthy ones to ask. And they are not just for first-time moms. Oftentimes, particularly for those struggling with PPD, women already parenting one or more children need to revisit these questions after the birth of a new baby.

I could not have addressed these deep issues by myself. I won't venture to assert that no one can, but I would guess that a great majority of mothers have neither the time nor the mental energy to do such soul-searching on their own. In addition, most of us have never been equipped with the tools needed for this kind of self-evaluation.

In her online review of a book titled Life After Birth: What Even Your Friends Won't Tell You About Motherhood, MaryKate Newcomb shrewdly noted,

The conspiracy of silence surrounding those first few months left me feeling like I was the only one facing a minefield of identity crisis, confusion, out-of-control emotions, exhaustion, lasting physical pain, and sometimes mourning for my former life....

Things instantly change when a woman gives birth, and I was taught to expect that. But how things change took me completely by surprise: the intensity of emotions, unexpected strains in my marriage, a new connection with in-laws, the unintended disconnect from friends without children. All of these new circumstances require time and solitude to process, two luxuries new mothers rarely have.4

Individual therapy can enable a woman to seek God's answers for the questions that confront her. It can also equip women to tackle deep-seated conflicts with others that arise during, or are revealed through, this process of life-evaluation.

Apart from individual therapy, the following methods are popular in treating postnatal conditions:

Group therapy is a gathering of those who are going through or have been through similar struggles. A trained therapist or psychiatrist (sometimes a graduate student in his or her field) leads a group discussion and helps direct conversation in positive ways. Sometimes, groups require that a person has been in individual therapy for a certain amount of time and is beyond the "crisis" stage of recovery.

Group therapy can be helpful not only for a mother suffering from PPD but for those around her as well. It may encourage everyone to see he or she is not alone. Group therapy also helps foster realistic beliefs and supports socialization (which is often lacking for those who are depressed). It may likewise help people develop awareness of and gain insight into their behavioral patterns, with the aim of changing those that don't work or are destructive.

Mutual-help groups perform a similar function, but are usually not tied to a professional therapist. Instead, they are run by lay counselors, pastors, or those who have previously been through the program (think AA's "sponsors").

More than forty years ago, two brave men established Alcoholics Anonymous (AA). Most mutual-help groups, including Christian ones like Celebrate Recovery and Overcomers Outreach, use principles similar to the twelve steps first laid out in AA.

Because mutual-help groups are structured in such a way that no supervising clinician oversees meetings, they are not considered group therapy or a form of medical treatment. Instead, leaders and sponsors are individuals who have worked through the program, experienced some level of recovery, and made themselves available to help others.

Therapists and psychiatrists often encourage participation in a mutual-help group as an adjunct to counseling. These gatherings provide another form of consistent support, another place to develop healthy relational and communication skills, and a "safe" place to go.

Sadly, Christians sometimes avoid mutual-help groups. "Jesus is the only support I need," they may believe. "If I share my problems with Him, everything will work out." It's true: Jesus is enough for you. He is always there for you and will minister to you in the direst circumstances. But He has created us to experience His love and healing through relationship with others, too. No one heals in isolation. We feel His embrace in the hugs people give us. We experience His grace and compassion through phone calls, notes, and support during tough times. Recovery takes place in the everyday world of relationship.

No matter what kind of therapy you engage in, it will be imperfect. You are dealing with imperfect people in an imperfect world. That said, you can and should find someone with whom you feel comfortable and with whom you agree on an approach to healing. This will facilitate the best approach to whole-person treatment.

Generally Destructive Thoughts

I mentioned a book earlier in this chapter called Feeling Good, and before we close this chapter, I'd like to convey to you a couple helpful things I've gleaned not only from the research of that book's author, Dr. David Burns, but from neuropsychiatrist Dr. Daniel Amen as well.

This chapter has explored forms of treatment that encourage transformation of the mind, and Feeling Good identifies a variety of destructive thought patterns. It gives excellent examples of each, offering practical solutions for overcoming these thoughts. Even in a cursory read, I discovered many detrimental patterns ingrained in my own thinking.

Again, the problem I found with Burns' book was that it focused only on human solutions to the problem of toxic beliefs. Dr. Burns is clearly a humanist at heart-in other words, he buys into the lie that man can progress beyond his current state strictly through education and determination. I call this a lie because the Bible clearly teaches that devoid of the Holy Spirit's power, no one changes. This is not to say that God cannot and does not use the wisdom of those who reject Him, or that He does not work to change/heal those who refuse to acknowledge Him. Indeed, I believe He does, which is why I will never be opposed to people reading and learning from books like Feeling Good. Many of the books from which I've learned about depression were written by those who claimed no faith at all. The key is to apply any truths you discover in ways that are, all at once, practical and Christ-honoring. Allowing God to transform a mind damaged by destructive patterns in whatever way He chooses (even through socalled secular sources) is not only possible, it's wonderfully beneficial, too.

David Burns is certainly not the only person to discuss such negative thought patterns. Dr. Daniel Amen, for whom I have deep personal respect and from whose work I have discovered a great deal, has been a pioneer in the research and treatment of recurrent destructive thought patterns. He calls such automatic negative thoughts "ANTs" for short (easy to remember for those of us who live in areas where homes are periodically attacked by hordes of marching insects trying either to escape the rain or to find water in seasons of drought).

I detest both ants and ANTs. Acknowledging and getting rid of automatic negative thoughts is one way in which Dr. Amen helps people find healing from different forms of mental illness. You can find his descriptions of ANTs, as well as insightful examples, techniques, and-though I won't spoil the fun of discovery for you-how ANTeaters can change your life in Dr. Amen's book Healing Anxiety and Depression.

Both Dr. Amen and Dr. Burns categorize unhealthy thoughts in their own particular ways, but many similarities exist, and I'd like to give you a short list of some of the most common destructive thoughts/ ANTs. An example of each from my own struggle follows.

Don't be surprised if you find that your thoughts often fall into one or more of these patterns. Virtually everyone struggles with flawed thinking in one or more of these areas.

• All-or-nothing thinking. "I am a total failure" (as opposed to the healthy recognition, "I mess up sometimes").

• Overgeneralization. Jeramy points out that depression makes people selfish, and I assume that because he thinks I am perpetually selfish, he dislikes me.

• Mental filter. I may think, "That dinner was horrible. The green beans were soggy." Even if my family enjoyed the meal, my mental filter focuses all energy on the negative.

• Disqualifying the positive. "Any positive attributes and accomplishments I have could never outweigh my faults."

• Jumping to conclusions. "She hasn't called. She doesn't want to be my friend anymore."

• Magnification and minimization. "Our trip to the beach was completely ruined because I forgot the sand toys" (magnification). "I've done only a couple things today; what a waste" (minimization).

• Emotional reasoning. "I feel fat, so I am fat." (This gives emotions greater weight than objective reality.)

• "Should" statements. "I must serve at church," "I ought to send a card to my cousin who is sick," "I have to volunteer every week in my daughter's preschool class ... that's what good moms do, right?" (These thoughts center on obligation. A person ruled by such ideas feels driven to do something rather than drawn to it.)

• Labeling and mislabeling. "I am a depressed person" (rather than "I suffer from depression").

• Personalization. The Sunday school teachers page me because one of my kids is throwing up. I assume they are angry with me for bringing her, even if she seemed fine this morning before we left. (I've made my daughter's sickness and the fact that I had to be summoned from church about me and how bad I am.)

Perhaps reading this abbreviated list of negative thought patterns has given you pause. Am I reading this book for me or someone else? you might wonder. No matter what our circumstances (PPD or not), combating the toxic lies that bind us is part of the work any person of faith must do.

A dear friend and former mentor of mine, Marsha Williams, once described a great illustration to me: Just as the Colorado River cut the Grand Canyon through years of erosion, so the canyons in our mind are whittled by our thoughts. Whether they will be beautiful or hideous depends on what's running in the river of our mind.

What runs in yours? Are your thoughts healthy and holy, or does the tide of your thoughts ebb and flow through the destructive categories above?

Philippians 4 charges every Christian to evaluate his or her thoughts. "Finally, brothers," Paul wrote to the church at Philippi, "whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable-if anything is excellent or praiseworthy-think about such things" (verse 8).

I can give you no better counsel. Whether it's you or someone you care about who struggles with PPD, I urge you to identify the false beliefs, the toxic thoughts that keep you from dwelling on "such things" as Philippians 4:8 commands-lovely things, admirable things, that which is excellent and praiseworthy. I will not sugarcoat the truth, beloved. This is difficult work. But, as Jesus declared, when you know the Truth, "the truth will set you free" (John 8:32, emphasis added).

Freedom ... the transformation of a mind broken by pain. Isn't that what every hurting person longs for? And isn't this what Jesus promises? Yes!

Hebrews 4:15-16 reveals glorious truth and then counsels us to act on it:

We don't have a priest who is out of touch with our reality. He s been through weakness and testing, experienced it all-all but the sin. So lets walk right up to him and get what he is so ready to give. Take the mercy, accept the help. (MSG)

Take the mercy. Accept the help. It is there for you, for those you love, and He is so ready to give it.

Turn to me and have mercy on me, for I am alone and in deep distress. My problems go from bad to worse. Oh, save me from them all! Feel my pain and see my trouble.

- PSALM 25:16-18 (NLT)

Throughout this book, we've explored many of the myths and misconceptions about postpartum depression. Now I'd like to turn our attention to two of the most difficult topics associated with illness after childbirth-psychosis and suicide.

Even reading these words may awaken a great deal of grief or fear within you. I hope to encourage you, no matter what your past, present, or future circumstances may be. We can explore painful realities of life like psychosis and suicide because we have a God who knows every detail of our physiology, psychology, and spirituality. He's enabled us to make amazing medical advances, to understand our minds and souls in so many ways. Under the care of good doctors, armed with truth, and in His grace, we can confront even the most frightening possibilities. When we don't take the steps, both physical and psychological, necessary to move toward healing, when we lose sight of truth, that's when issues like psychosis and suicide feel insurmountable.

We observed previously that the popular media often plays a none-too-helpful role in disseminating information about postnatal disorders. Unfortunately, news reports and magazine articles mistakenly identify all cases-including the extraordinarily rare ones in which mothers take the lives of their own children-with the name postpartum depression. Doing so is not only terrible reporting, as it spreads patently false notions about the nature of PPD, it also cruelly stirs waves of anxiety. It's no wonder husbands, family members, and friends are terrified to hear that a woman they love has PPD. Is she going to turn out like that crazy lady I saw on TV? some wonder fretfully. New moms diagnosed with a postnatal disorder may fall into a pit of deeper despair imagining that they are only one step away from doing the unthinkable. How I wish I could undo the damage that's been done!

In truth, infanticide and suicide, so incredibly difficult for most of us to comprehend, are almost always associated with severe cases of the far less common and more serious disorder, postpartum psychosis. PPP and postpartum depression are very distinct conditions and should be understood as such.

While learning this may help those battling postpartum depression to breathe a sigh of relief, it probably still leaves some devastated. If you or someone you love is battling postpartum psychosis, you may be forced to answer horrible questions like "Isn't that the same thing that those crazy moms who kill their kids have?" Statements like this are not only awful, they also reflect a deep misunderstanding of most experiences with PPP.

I am happy to affirm for you that with proper treatment, the majority of women diagnosed with postpartum psychosis do recover and do not harm themselves or their children. However, it is also crucial to remember that PPP is considered more serious than other forms of postnatal disorder because the risks of suicide, infanticide, and other major medical emergencies are significantly greater for those with postpartum psychosis.

Again, if you or someone you care about has been diagnosed with PPP, that information need not scare or discourage you. Postpartum psychosis is both a condition that can be overcome with appropriate treatment and something that must be considered very seriously. Being diagnosed with PPP is not a death sentence for you, your family, or someone else you care about. Indeed, many women experience a renewal of joy and life when they recover from this condition. Before those fighting it can move forward in healing, however, they must recognize what psychosis can do to the mind, body, and spirit.

In order for us to better understand PPP, I'd like to share a story with you. I hope that a glimpse into some personal experience will illuminate a little of what postpartum psychosis is like, as well as how it can be overcome.

"I Thought Her Brain Had Snapped"'

Madeleine Bambridge only made it to seven and a half months in utero. Born premature, with many complications, Madeleine was lucky to be discharged from the hospital within six weeks, a relatively quick release for a preemie like her.

Alex and Elisabeth, Madeleine's parents, slowly started to get back into the swing of normal life after the extra stress of preterm labor, delivery, postnatal difficulties, and, of course, the exhaustion faced by all new parents. Then Elisabeth started to face health issues of her own.

At first, neither Alex nor Elisabeth noticed anything was particularly wrong. The initial indication came several weeks after Madeleine's birth, when the Bambridges were invited to a summer barbecue at a friend's house. Before Madeleine was born, both had looked forward to spending time with friends, but the day of the get-together, Elisabeth didn't want to go. Alex recalls his wife "didn't feel right. But she couldn't describe exactly what it was."

Later that afternoon, one of the couple's friends dropped by, and Elisabeth took Madeleine upstairs to nurse. Moments later, Alex heard a desperate cry from his wife. Rushing up the steps, Alex threw open the door and found Elisabeth "gasping for breath, digging her fingernails into the palms of her hands."

Frantic, Elisabeth confessed she was terrified for their baby, and for herself. To Alex, none of this made sense. His wife had seemed fine just a short while ago. From his perspective, they had already made it through one of the most harrowing experiences of their lives (the difficult pregnancy and birth of their daughter). There was nothing to get hysterical about now.

Elisabeth's frenzied emotion and agitated physical state frightened Alex. Calming her down as best he could and getting her in the car, Alex intended to drive directly to his mother-in-law's, where he could drop Madeleine before heading with his wife to the emergency room. Elisabeth wouldn't have any of it. She vacillated between "exhausted calm" and "manic anxiety" before she finally fell asleep at her mom's house.

Sadly, the extreme ups and downs of that day were only the start of a downward spiral that persisted over the following weeks. After being told Elisabeth had "new-mom jitters" by the Bambridges' doctor, Alex filled a prescription for Ativan, an antianxiety drug. It simply wasn't enough.

The panic attacks continued, then worsened. One night Alex awakened to what he describes as his wife's "horrific scream." In the living room, Alex found Elisabeth "riding his 73-year-old mother-in-law's back." When she noticed her husband, Elisabeth screamed, "Get away, get away, get away!" Trying to hold his wife and calm her down, Alex was repeatedly clawed and scratched by a frantic Elisabeth. Emergency EMTs arrived shortly after this terrifying incident, and Elisabeth confessed she felt afraid she would take her own life. Transported immediately to the local hospital, Elisabeth was heavily medicated.

Alex says he will never forget the out-of-place smile on his wife's face-euphoric and scary at the same time-nor will he forget the presence of a security guard outside her room. Elisabeth was transferred to the psychiatric ward of another hospital for the next twenty-four hours. The attending physician diagnosed her with extreme anxiety disorder. He added Zoloft to her medication regimen. Again, it simply wasn't enough. As Elisabeth's condition worsened, Alex became more desperate for help.

Finally, Elisabeth saw Vivianna Schilpp, LCSW, a licensed clinical social worker at their hospital. After that meeting, Elisabeth was hospitalized again. That night in the waiting room, Alex remembers sobbing uncontrollably. Ultimately, doctors diagnosed Elisabeth with postpartum psychosis.

The physicians attending Elisabeth's case prescribed Klonopin for her, which gratefully worked to relieve her anxiety within a very short time. The doctors also ordered her to attempt no housework and informed Alex he would need to delegate Madeleine's care to others for an indefinite period of time. Elisabeth could play with and enjoy Madeleine for a couple hours a day, but any caretaking responsibilities were not recommended. The Bambridges sought professional counseling in both individual and group settings, and this helped tremendously.

Still, the recovery period was difficult because Elisabeth was in no condition to deal with anything but her own health. Alex found he had to carry the weight of his wife's illness, his infant daughter's care, his job, and the daily duties of his house. Though it was weeks before he recognized the depth of his own pain, Alex admits that he "found himself bouncing between his own bouts of tears, anger and emotional numbness.... He was detached and unable to concentrate." Friends called and observed, "He'd respond as if giving a newscast."

"I would just cry while I was driving alone," Alex noted. "And I couldn't make simple decisions. I was constantly distracted. I was living on adrenaline." He also awakened from nightmares both exhausted and anxious. Exercising to relieve stress and writing his feelings in a journal were recommended by his counselor, and these things, too, aided in his own recovery.

Alex found a good deal of help from attending a support group specifically for fathers. The Bambridges were also encouraged by their extended family and local church. Alex knows they're one of the "lucky" couples who have loved ones surrounding them. Other families are not so blessed. He did confess, however, that needing to ask for help was an extremely difficult thing for him to do.

LCSW Schilpp told the Orange County Register, "Alex is a good example of someone who could see he was in the middle of it as well, and that it was not just about Elisabeth.... I would love to see more men do that-to participate, ask questions, be honest about how it affects them and admit that they don't know what to do."

Schilpp also commented that men most often attempt to "fix" the situation. Many become angry or depressed about what their family must face, and the exertion of caring for "everyone's" physical and emotional needs can quickly drain husbands who carry such heavy loads. Strain on the marriage relationship is another devastating consequence.

The dramatic onset of Elisabeth's PPP is typical of the disease. The symptoms of postpartum psychosis usually appear within a couple weeks of childbirth and descend with severity and speed. Anxiety, paranoia, and frenetic energy (all of which Elisabeth experienced) often accompany PPP, as do delusions and hallucinations.

Elisabeth Bambridge made a full recovery from postpartum psychosis and now enjoys mothering her beautiful red-headed daughter. The anxiety passed, and her family was restored. And that is a happy ending worth reporting.

Facts and Other Essential Information

Postpartum psychosis afflicts only 1 to 4 in every 1,000 women post- delivery.2 The most common symptoms are high anxiety (sometimes classified as mania), profound detachment from reality, and bizarre or inexplicable behavior (which may be dangerous). If you recall from Elisabeth Bambridge's story, she experienced all of these. Here is a list of other common symptoms:

• Insomnia or a decreased need for sleep

• Excessive energy, restlessness, or agitation

• Recurrent and/or intrusive (racing) thoughts

• Inappropriately elated or euphoric mood (e.g., how Alex described Elisabeth's "scary" smile during her hospitalization)

• Depression or despair

• Extreme mood changes

• Marked irritability

• Grandiosity (thinking one is uniquely empowered or called to a "higher purpose")

• Talking too quickly or too much

• Distractibility or confusion

• Paranoia

• Auditory or visual hallucinations

• Delusions (false beliefs, strongly held)

• Religious ideation

• Inability to care for self or baby

• Thoughts of harming self or baby

• Self-injurious behaviors (e.g., cutting, eating disorders, burning)

Risk factors for postpartum psychosis include any previous psychotic behavior, schizophrenia, and bipolar disorder. Sometimes PPP reveals an underlying mood disorder, which was previously managed by the individual without treatment. In fact, many of the symptoms associated with PPP resemble those of a condition formerly known as "manic depression," now classified as bipolar disorder (more specifically bipolar type II). Still, postpartum psychosis should be treated first as its own distinct condition. After the immediate crisis passes, a medical doctor should determine if an underlying chemical imbalance is indicated.

Postpartum psychosis usually begins within the first forty-eight to seventy-two hours postdelivery, but, as Elisabeth Bambridge experienced, in some instances the onset is not until several weeks later. In nearly all cases, the symptoms appear very quickly and dramatically. They may be preceded by a period of seemingly good health, and the rapid downward spiral is usually surprising and confusing to both the mother and those surrounding her.

Because women with PPP frequently experience bizarre thoughts, delusions, hallucinations, grandiose thinking, and religious ideation, coupled with mania and severe agitation, postpartum psychosis is considered a medical emergency. The risk of suicide and harm to a child or children in the home is heightened when PPP attacks a woman's body.

While women with postpartum depression, postpartum OCD, and postpartum anxiety disorder may have repetitive and extremely negative thoughts, even thoughts about harming themselves or their babies, women with these conditions are typically horrified by such ideas. In contrast, those with PPP often consider their thoughts rational and, consequently, are much more likely to act on them.

The rapid mood swings that accompany postpartum psychosis, ranging from despair to irritability to frenzied euphoria, dramatically disrupt the lives of everyone involved. Still, women with PPP do not immediately admit or recognize anything is wrong with their health. They may accuse a husband, friend, or family member of "being too sensitive" or "jumping to conclusions." In attempting to justify behaviors or statements, a woman with PPP may reveal a deep level of mental imbalance. Postpartum psychosis definitely affects a woman's ability to judge objectively.

Immediate attention should be given to new moms who exhibit a symptom pattern even remotely resembling PPP. Even if she is not diagnosed with postpartum psychosis after evaluation, it is extremely important that any woman experiencing symptoms such as those listed on page 241 be evaluated by a knowledgeable physician. I emphasize that word because, as in the case of Elisabeth Bambridge, PPP can be misdiagnosed as postpartum anxiety disorder, PPD, or another postnatal condition.

A woman with postpartum psychosis will be markedly different from her "normal self." She may seem fuzzy or confused to those who know her. Some women report feeling like "detached onlookers." Others recall feeling aimless. One woman confessed leaving home with her baby in the stroller, then "awakening" to find she had wandered for miles. She had no idea where she was or how to get back. Still other women admit trying to find things to do with the frantic energy they feel- cleaning obsessively, tackling projects of all different kinds. Any neurotic or compulsive behavior such as this can be a sign of PPP.

As was the case with Elisabeth Bambridge, postpartum psychosis often begins with anxiety. Quickly, however, the fear evolves into a more all-encompassing condition. Lashing out at people she loves, responding to life circumstances with unpredictable and often frightening intensity, and/or talking about suicide may occur. Women in this mental state are not simply seeking attention or crying out for help. They are experiencing a medical emergency.

Delusions about a newborn child are a particularly distressing symptom of PPP. Women may be convinced their infant has an incurable disease and will die imminently. They may believe the baby they brought home from the hospital is not their own, but someone else's.

While these delusions have a shred of plausibility to them, others are completely divorced from reality. Women have reported such things as believing their son is Jesus Christ and they are the Virgin Mary. According to Dr. Ruta Nonacs, a patient of hers held her baby aloft and announced at the end of a church service, "Here is the Son of God."3

Andrea Yates, who drowned her children in their family bathtub, testified that she thought her kids would be tormented by Satan unless she protected them. The only way to do this, she believed at the time, was to take their lives.

Other women have reportedly harmed their children because they believed them to possess evil powers or be afflicted by evil spirits. A mother who thinks her baby is a changeling may abandon the child in search of her "real baby." And tragically, women who believe their babies have incurable diseases sometimes attempt to put a baby "out of his/her misery."

In attempting to understand PPP, it's important we note how very real these delusions feel for a suffering woman. She may be absolutely convinced-and ferociously defend-that what she believes is true, even when confronted with physical evidence to the contrary. You should not attempt to-indeed, you cannot-combat delusion with "common sense" or "rational discussion." Medical intervention is necessary, as the chemical changes going on in the brain of a woman with postpartum psychosis will not heal without swift and effective treatment. The good news is that once on the road to recovery, a woman will find greater and greater freedom from unreasonable and dangerous thoughts. With good treatment, they should go away altogether.

Like the delusions (erroneous thoughts or beliefs) experienced by women with PPP, psychosis-induced hallucinations (sensory experiences) can feel very real as well. Auditory hallucinations may include a command, a voice telling a woman what to do. This should be taken extremely seriously, as a woman with postpartum psychosis may act on hazardous directives. Visual hallucinations of shadowy or hazy images, multicolored apparitions, or "spirits" should likewise never be ignored.

Preoccupied by what is happening to her or inside her, a new mother with PPP may neglect her child. She doesn't usually choose to do this; it is simply a function of her medical condition. Those surrounding her should do their best not to judge or criticize her parenting, as bad as it may appear. Instead, they should calmly but firmly participate in caring for the infant and any older children, whether that means setting up a rotating schedule of loved ones to be in the home with a suffering mom or, as was true of Elisabeth Bambridge, removing caretaking responsibilities for some time. Hospitalization is often necessary for those with PPP.

Again, any symptom pattern resembling those described here calls for immediate evaluation. Do not be dissuaded by a persuasive woman who claims "everything's fine." If necessary, bring in an emergency team to forcibly take her for treatment. Let me reemphasize: Trying to rationalize with a woman suffering from PPP will not work. Even if you reasonably draw a distinction between what is "real" and what she believes, a woman with postpartum psychosis may tenaciously cling to her perspective.

I recognize this is a lot to take in. All this information may feel overwhelmingly discouraging to you. That's why I'd like to point out again that the vast majority of women recover from postpartum psychosis and go on to lead normal lives. A woman with PPP is not crazy; she just needs treatment, and you can help her get that.

Recovering from Postpartum Psychosis

Because of the severity of PPP, women are usually prescribed antipsychotic medication as the first line of treatment. These drugs are specifically formulated to address symptoms such as high anxiety, mania, hallucinations, and delusions. Thankfully, studies show that the newest antipsychotic medicines are both highly effective and extremely welltolerated. Although this is rare, if a woman is unwilling to take the medication prescribed by her doctor(s), injection may be required.

Treatment should also include an extensive evaluation of a mother's medical history. While the exact causes of PPP are not known, it's important that a woman be screened for other health issues that may have sparked the psychosis. Bipolar disorder, as I mentioned previously, may exist as an underlying mood disorder, and because of this, any antidepressant should be prescribed carefully (some antidepressant medications can actually exacerbate bipolar disorder; your doctor should know and share this information with you). Blood tests, a CT scan, or brain scans may also be ordered by attending physicians to rule out the possibility of other medical conditions contributing to the psychosis (for example, a tumor on the brain). These tests and treatments often require hospitalization to assure the safety of individuals and families.

After a safe environment is established, treatment can continue. With regard to this, an overview of postpartum psychosis provided by the Mayo Clinic was very helpful to me. The report observes,

When ... safety is assured, a combination of medications-such as antidepressants, antipsychotic medications and mood stabilizers-may be used to control your signs and symptoms. Sometimes electroconvulsive therapy (ECT) is recommended as well. During ECT, a small amount of electrical current is applied to your brain to produce brain waves similar to those that occur during a seizure. The chemical changes triggered by the electrical currents can reduce the symptoms of depression, especially when other treatments have failed or when you need immediate results.'

If a woman is diagnosed with any accompanying or underlying mood disorders, it may be necessary for her to take more than one medication. Depending on her medical history and experience of symptoms, these may or may not need to be taken long term.

After the initial period of stabilization and thorough evaluation, the path to recovery will follow that of others who struggle with any other postnatal disorder. Pursuing the physical, psychological, and spiritual forms of treatment mentioned in chapters 9 and 10 will be just as important for a woman with PPP as they are for anyone with postpartum depression.

In summary, while postpartum psychosis may seem frightening at first, there is great hope for those who experience it. Proper treatment is necessary, of course, but with it, you or someone you love can recover. It grieves my heart to say that some women, however, do not receive the appropriate treatment. As I mentioned previously, they are at a greater risk for suicide, the final subject of this chapter.

A Pain So Great

When left untreated, any mood disorder (postpartum disorders are no exception) can end in the most tragic way: the loss of life. Those with postpartum psychosis may be at higher risk for suicide, but they are certainly not the only strugglers who battle suicidal thoughts. Nor are they the only ones who act on them.

Suicide is neither an easy topic to discuss nor think about. I know because I have been suicidal. I understand the deep agony, the lifecrushing force of suicidal ideation. I know how hard it was on those who love me to hear me say that I didn't want to live, that there was nothing that made life worth hanging on to. Though I may never be able to grasp you or your loved one's situation fully, please know that I feel with and for you.

Unless people have experienced the despair that leads to suicide, or have walked through that valley of death with someone else, most don't understand what suicidal individuals are thinking or feeling. Some, in fact, judge those who think about, attempt, or commit suicide with little sympathy; others judge extremely harshly.

To give you a glimpse into the mind of a suicidal person, let me share that I believed very strongly that taking my own life would make things easier for my husband and children. I now see the sad fallacy of such thinking, but, at the time, my suicidal ideation seemed logical and true. It was the only reality I could see.

I didn't even really want to die. I just thought it was the only way. It would not only end my own pain but spare my loved ones from having to deal with me. I had no hope that I would get better-ever-so my death appeared a logical conclusion. It would free everyone from the agony weighing on us. I didn't think I could confide any more in my poor husband, parents, or friends. I rationalized, No one will really understand anyway. And I knew that people would try to convince me that none of what I was considering was true or good. I just assumed they were lying.

While the Bible clearly teaches that life is in Gods hands, not our own, many characters within Scripture have despaired of life. In a previous chapter, I mentioned that the prophet Elijah wanted the Lord to take his life. David, too, penned words echoing a similar sorrow: "0 LORD, you are my rock of safety. Please help me; don't refuse to answer me. For if you are silent, I might as well give up and die" (Psalm 28:1, NLT). I understand David's words. I understand Elijah's longing. Sadly, I went further in my distorted thinking. I ultimately came to believe that God wanted me to take my own life.

This was a spiritual delusion of sorts, and though I did not suffer from postpartum psychosis, the fact that I had this thought enables me to understand some of what those who have PPP experience. Only in retrospect could I see the deception and devastation of my muddled thinking. At the time, my perception was reality.

Though only a small fraction of women with postnatal disorders commit suicide, any woman who expresses thoughts about taking her own life should be given prompt medical attention. If a plan is confessed, immediate medical intervention is necessary. Jeramy did the right thing in calling 9-1-1 the night I begged him to help me end my life. Though I was angry (well, a little angry-mostly I felt numb) that he took me to the hospital, he did what was necessary to assure my safety, and I will be forever grateful.

Even passive talk about death-perhaps something along the lines of "I just want the pain to end so badly that I wish I could die"-should not be ignored. Hospitalization may or may not be required, but no one should determine for himself or herself whether a loved one is at imminent risk for suicide. It's essential that we let qualified physicians make those calls. Erring on the side of caution never hurt anyone irreparably, but "waiting to see how she feels in the morning" has.

Despite what she may believe, a new mom who successfully takes her own life does not free people from pain. In fact, the anguish that floods family members and friends after a suicide is so deep that many never fully recover from the trauma. I interviewed a woman gracious enough to share the devastating effects of her cousin's suicide with me. I hope by relating her story to you, it will encourage you to be very aware of any risk of suicide for yourself or a woman in your life.

I Didn't Even Know Things Were That Bad ...

My cousin Taylor was a positive and fun-loving girl. She had a laugh you could hear and recognize from any room in the house. When in a group she was rarely the one "putting on the show" but was always the one enjoying it the most. She loved her family and loved Jesus Christ. That something as terrible as she experienced can take control of a strong, Christian, family-oriented woman and cause her to lay her baby in a crib and take her own life.... It's unfathomable to most of us. It's "drop everything, grab your loved one, sit her down, and have the hard conversation" serious. I wish I had known how grim things were for Taylor.

The first day any of us knew that Taylor was struggling was the day she committed suicide, about six months after she delivered her baby. It caught us completely off guard. Though I wasn't in close contact with her, I saw her at family events and heard about her through other family members. We were both busy raising our kids and trying to do that well. I can't imagine why Taylor believed that the only answer to whatever she was feeling was to take her own life.

I knew postpartum depression was a serious issue, but I had never known anyone who suffered from it. After Taylor's death I began to wonder if anyone else in my life had struggled but hadn't felt able to talk about it or confess it. I started reading about PPD and tried to find programs that prevented this kind of thing. It turns out there just aren't enough resources. I want to help others who might be feeling what Taylor felt. I want to help the families left behind to deal with the agony spread by one decision.

Thinking of my cousin's kids and husband has been the most difficult thing after Taylor's death. Those little ones can never get their mommy back. Her husband can never reach across the bed for his wife again. He's probably overwhelmed, and I imagine he's dealing with a lot of guilt. Right after her suicide, I felt powerless in the face of the whole situation. I was shocked. At times I was very angry. Taylor was only thirty-seven. She had another child, a toddler. She didn't even have the chance to get treatment for whatever she was facing.

A lot of people - this seems especially true of Christians - assume that all new mothers should be "head in the clouds in love and totally content with this new little baby finally here," but that simply isn't the case. Hormones are all over the place, mothers are sleep deprived, and it's okay . . . no, it's good and essential for them to feel like they can vocalize their frustrations, disappointments, and fears. Those kinds of conversations can give new moms an outlet. In every way you can, make it safe for the people you love to talk about what they're worried about. Try not to judge what they are saying or feeling. If your loved ones aren't communicative, make it your job to check in on their emotional wellbeing. It can spiral out of control so quickly!

My cousin's death left all of us - her family, her friends, fellow Christians - with a lot of questions. I honestly don't know what Taylor was thinking when she made that decision. There are times I wonder if she needed someone to talk to but didn't think she could. I wonder, if I had known, or if other people who loved her had known something was wrong, would things be different? I don't want other people's stories to end the way Taylor's did. I want to do whatever I can do to help others. I hope sharing my story will do that.

Hope for the Future

There's no greater risk, or tragedy, than the loss of life. New mothers shouldn't have to ask the question, "Would death be better than life?" No husband or child, no mother or father should be left with the devastating grief of suicide.

If you are in this situation, facing this pain right now, I want to affirm that you are not alone; the God who cares for each sparrow that falls (see Matthew 10:29) also knows your anguish. There may be no quick fixes for the heartache you are facing, but no matter what has happened or will occur, "There is hope for your future," says the Lord (see Jeremiah 29:11).

While I felt it was essential to talk about the risk of suicide and the pain that goes on both in the sufferer's mind and in the minds of those who love her, this book is not specifically designed to discuss prevention techniques or how people can grieve after a suicide. You can find excellent and uplifting exploration of this subject in Aftershock: Help, Hope and Healing in the Wake of Suicide, written by David Cox and Candy Arrington. Please refer to the resources section in appendix B for websites and other helps that may be of additional assistance to you.

Those of us who have agonized over suicidal thoughts, as well as those who have lost loved ones to suicide, are usually eager to help others. While we cannot bring back those who have already taken the final step to end their pain, we can participate in the crusade to prevent others from doing so. And I'm glad to report there is good work being done in both the personal and public spheres.

On September 27, 2007, after six years of determined work and leadership on Capitol Hill, U.S. Representative Bobby L. Rush received a unanimous, bipartisan vote to advance H.R. 20, the Melanie Blocker-Stokes Postpartum Depression Research and Care Act. This bill requires the National Institute of Health to expand its research efforts with regard to depression during and after pregnancy.

H.R. 20 was originally sponsored by Congressman Rush in light of the tragic death of Chicagoan Melanie Blocker-Stokes, who, despite a valiant effort to fight the disease crippling her, eventually took her own life after the birth of her newborn child. The bill also provided for increased funding to execute a national public-awareness campaign. Additional resources are designated for local community-health organizations, which will provide screening, counseling, and education to women and families.

Congressman Rush declared,

With this bill, my colleagues and I in this committee, and I believe ultimately in the full House, are saying to this nation that no woman need suffer in shame or silence if she's confronted with feelings ofdepression following the birth of a newborn. Iam very, very proud of the good faith efforts- demonstrated by both Democrats and Republicans-to find common ground so that no mother, like Melanie s mom, need bury her daughter under [such] conditions.... Our hope is to transform this nation into one that recognizes that postpartum depression is not a badge of shame but, rather, a hurdle that can be overcome by new mothers with support, counseling and the early intervention of their families and loved ones.5

A companion bill (S. 450) was introduced in the U.S. Senate by Sen. Richard Durbin (D-I11.), cosponsored by Sen. Peter Fitzgerald (R-I11.) and Sen. Hillary Clinton (D-N.Y.).

"I firmly believe that postpartum depression is a national problem," Clinton said in a public statement issued in February 2003 when S. 450 was introduced. "This bill seeks to fill a glaring void in the understanding of this illness and provide treatment and care options for new mothers."6

Blocker-Stokes's mother, Carol Blocker, testified at the congressional hearing before the bill's passing. Blocker, an outspoken activist for increased awareness, education, and treatment of postnatal disorders, was blunt about her experience at the hearing in front of the male-dominated House of Representatives.

"Nobody wants to believe that this sort of experience happens to women," Blocker stated. "To talk about hormonal differences in a woman's body, I don't think they are too interested." Fortunately, Congress was interested enough to move forward with the Melanie Blocker-Stokes-inspired bill.?

If you want to get involved with the good work to educate the public and pass legislation that will help women and their families, contact your local congressman, state senator, and/or any organization in your community working to provide treatment and education. Right now may not be the time, especially if you are in the midst of a battle for your or a loved one's life, but please consider this for the future. It's so important that we actively participate in the prevention of death by suicide.

Thankfully, public awareness about postpartum depression is increasing. Sadly, many misconceptions still exist, but I hope that my own work and the diligent labor of many others will help people understand what postnatal disorders are, how they can be treated, and the risks associated with each form. Will you join me in the fight?

We were crushed and completely overwhelmed, and we thought we would never live through it.... But as a result, we learned not to rely on ourselves, but on God ... He did deliver us ... and we are confident that he will continue to deliver us.

-2 CORINTHIANS 1:8-10 (NLT)

When I was twenty years old, I attended a women's conference in Southern California and heard author Jill Briscoe give a talk on suffering. The refrain of her message was "Don't waste the pain," and I have never forgotten that phrase. Briscoe spoke of the wounds of her own life, as well as the heartaches that have pierced the lives of those she loves. For reasons we do not always (I might say usually) understand, God allows pain in our lives. He also, and miraculously so, enables us to move beyond our grief, in addition to the sting of disappointments, failures, and the uncontrollable circumstances that often assault us.

Some years after I had endured the doubt, frustration, and agony of two postpartum depressions, I began to see that though none of us can erase the sorrow of our past, we can reverse the flow of its anguish by surrendering it to God. In His hands, no pain is wasted.

I found a beautiful articulation of this thought in the words of theologian Lewis Smedes, who wrote brilliantly about "redemptive remembering." According to Smedes,

there is a healing way to remember the [wounds] of our irreversible past, a way that can bring hope for the future along with our sorrow for the past. Redemptive remembering keeps a clear picture of the past, but it adds a new setting and shifts its focus... .

People are not [meant] to remember [only] their misery. What ha[s] to be remembered [is] the miracle of survival and renewal. What ha[s] to be remembered [is] not the days when God was on a leave of absence, but the day when God came back.'

Allow me to say it again: We cannot erase the sorrow of our past, but we can reverse the flow of its anguish. We can choose to remember the day God "came back."

As the intensity and immediacy of your experience with postpartum depression wanes, redemptive remembering is, will be, and will continue to be an integral part of healing and restoration, both for the sufferer and for all who love her.

In many ways-and some not comprehensible this side of heaven-the memory of our pain tells us who we are and who we are designed to become. Our future is born of yesterday's experiences; by remembering our past well, we can embrace the significance, grace, beauty, and freedom of today. Through memory, we can also begin to discern what God has planned for our tomorrow.

Depending on where you are in the journey, this chapter will influence you in a unique way. If you are currently in the throes of a battle with postpartum depression, either your own or that of someone you care about, the words that follow may give you a glimpse of the future. It may seem like a distant future right now, but I assure you: There will be a time for you and those you love to move beyond the anguish of PPD and into the joy of redemptive remembering. These words from Psalm 30 have always been especially meaningful to me, as they promise ...

The agony of mourning and weeping may be upon you right now. You may wonder if light will ever break over you again. Take heart; the dawn is approaching. I cannot tell you when (how I wish I could! How I wish I could have known when I was in the fight for my own life!), but I can tell you that God will clothe you with joy once again. He will not-verily cannot-break His word.

Were it not for God's help, I would very likely have perished. I do not say that to be dramatic. It is simply true. I chose to publish this book as a means of "putting up" a memorial to God's greatness. I wanted to obey the commands to "Write down for the coming generation what the Lord has done, so that people not yet born will praise him" (Psalm 102:18, GNT). As you are delivered, as you see others restored to life, I urge you to do the same.

You, too, can "publish his glorious deeds among the nations [and] tell everyone about the amazing things he does" (Psalm 96:3, NLT). You certainly do not have to write a book. Indeed, you can publish His glorious deeds in so many ways, but never so powerfully as when you live out what you have learned, allowing others to see His victory through you. In actually living what you have learned, you write your story on the hearts of all who come in contact with you.

This is what moving beyond postpartum depression is all about. And moving beyond involves many aspects of physical, emotional, and spiritual healing-acknowledging your pain, understanding it as best you can, continuing on the path of recovery, and then helping others who are experiencing their own grief.

PPD often causes us to be absorbed in what we are experiencing. As you heal, you will be able to refocus your attention. You will no longer need to dwell on the pain of the present but can both look back at God's redemption and look forward to what He is calling you to do. This is a wonderful by-product of healing, as postpartum depression usually steals hope for any future, let alone a good one, in which we can not only be blessed but also be a blessing to others.

The first step in moving beyond PPD-or any grief, for that matter-usually involves viewing the past with greater perspective. Let's look at some of the ways you might do this, or help someone else to do so.

What Did It Mean?

It's essential for any mom who has suffered with postpartum depression to realize that PPD did not, does not, and will not define the story of her life and relationship with her child. Remember that postpartum depression clouds understanding: Though it may appear PPD was the only reality of that time, this is not true (and here is yet another reason to praise God). As Christian philosopher Peter Kreeft so wisely wrote in Making Sense Out of Suffering, "Are the appearances the whole story? Hope says not. The appearances are only the facade, the epidermis, the surface. Below the surface lie the deeper tides."2

The deeper tide, the force behind and beneath pain, is mercy. God is merciful to those who battle PPD. Mother, child, and all those caught in the fallout of depression may be changed by postpartum depression, but they are not defined by it. As Philip Yancey observed, "No failure, no suffering, no discouragement is final for the God who stands with us in the shadows."3

As we've noted, it is extraordinarily discouraging for a new mom to face postpartum depression, particularly since being a mother is supposed to be so wonderful (and even glorious) for women. Clearly, PPD is a suffering, and many feel that it is a failure (though, as you now know, this is a false understanding of the experience). No matter how it once appeared, the battle against postpartum depression is not the final word: Your victorious God, standing with you in the shadows, always has the last word. Recognizing this, and looking back on the days of your grief with this in mind, is vital for your ongoing healing.

Seeing the past with renewed perspective allows you to see that God was and is near. The well-loved biblical commentator Arthur W. Pink once wrote that the promises of God never shine so brightly as in the furnace of affliction. In his exposition on the book of Hebrews, Pink revealed, "If you, my brother, my sister, had not been cast into the furnace of affliction, you would not have known the nearness and preciousness of His presence with you there. Yes, God intends us to prove the reality and sufficiency of His grace."4

You are and will be proof to a hurting world that God is near and precious to those in the throes of painful affliction. Your life does and will show others that God does not abandon the wounded, that He keeps His promises: "The LORD is near to the brokenhearted and saves those who are crushed in spirit" (Psalm 34:18, NASB).

As a child, I listened to my parents read C. S. Lewis's The Horse and His Boy. When I decided to reread it last summer, I realized that I remembered little of this beautiful story. I certainly did not recognize the significance of a scene late in the book, when the hero, Shasta, has been separated from his friends and must journey through the night in a strange and cold forest. At first, Shasta comforts himself with the thought, "After all ... this road is bound to get somewhere." But as time drags on, tired and freezing, Shasta begins to pity himself and despair of getting anywhere at all. "He felt so sorry for himself," Lewis wrote, "that the tears rolled down his cheeks."

The story continues,

What put a stop to all this was a sudden fright. Shasta discovered that . . . somebody was walking beside him. It was pitch dark and he could see nothing. And the Thing (or Person) was going so quietly that he could hardly hear any footfalls. What he could hear was breathing. His invisible companion seemed to breathe on a very large scale ... and he had come to notice this breathing so gradually that he had really no idea how long it had been there. It was a horrible shock.5

At last, Shasta can bear the fright no longer and asks, "Who are you?" An unknown voice responds, "One who has waited long for you to speak.... [Now] tell me your sorrows."6 And Shasta does. Through the night, he pours out all the pain of his life. The unseen friend listens. As dawn breaks, Shasta sees "pacing beside him ... a Lion." A golden light falls on the travelers, and Shasta believes it to be the sun. Yet

it was from the Lion that the light came. No one ever saw anything more terrible or beautiful... .

After one glance at the Lions face, [Shasta] slipped out of the saddle and fell at its feet... .

He lifted his face and their eyes met. Then instantly the pale brightness of the [dawn] and the fiery brightness of the Lion rolled themselves together into a swirling glory and gathered themselves up and disappeared.?

I have experienced what Shasta did. I felt alone and afraid, cold and forsaken in the forest of postpartum depression. The tears fell down my cheeks. I pitied myself. And then I began to sense His presence-the breath of Life. His nearness was almost frightening, for in the darkness I could not see Him, could not tell if it was the Lord accompanying me on this journey I neither wanted nor planned for.

How long did He wait for me to speak, to pray from my heart? Perhaps I will never know. Maybe it would break my heart if I did. But eventually, and through the dark night, I told Him my sorrows. The Lion of Judah paced beside me and Light came from Him. As healing and hope dawned, I lifted my eyes and saw His face. I told you in chapter 1 that I have never been hungrier for God's presence and fullness than after my postpartum depressions. His fiery brightness in the furnace of affliction was my one desire. But here on earth, that intimacy, the swirling glory, cannot be mine perpetually. Oh, that it could. How I hope that you experience this, as the heroic Shasta did, and I-far less heroic-did as well.

Even now, years later, I can barely hold back the tears, remembering how near He was, how true He was to His promises:

Beloved friend, these are only four of His promises. He keeps these and all that He vows to do and be for us. "Withness -that is the word of love. Does he descend into all our hells? Yes. In the unforgettable line of Corrie ten Boom from the depths of a Nazi death camp, `No matter how deep our darkness, he is deeper still.""

The answer to the deepest suffering of our lives can never be something-it must be Someone. Why? Because the problem of pain touches, on the most basic level, on our beliefs and questions about that Someone-God. Why does He . . . ? Why doesn't He . . . ? As a weeping child seeks reassurance from his father, we need His presence, His love, His "withness" more than explanations or answers. And this is what we get in the person of Jesus Christ-the presentwith-us encouragement of a Father who promises to deliver us and to be with us while He does. Just this morning I read these words from 2 Chronicles 20:17:

Take your positions; then stand still and watch the LORD'S victory. He is with you, 0 people of Judah and Jerusalem [and every nation]. Do not be afraid or discouraged ... for the LORD is with you! (NLT)

I know how fearful and discouraging the battle against PPD can be. It is, for lack of a better word, extraordinarily depressing to fight day after day against the tide of hopelessness and anxiety, whether your own or someone else's. But you are not alone. God is with you. The words "watch the LORD'S victory" call each of us to focus on His deliverance more than on the wounds of our past or present.

Can you see Him at work in the anguish of your struggle? Can you "write down for future generations" the story of His nearness and faithfulness in your life? If not now, can you glimpse a future in which you might do so? My friend, do not seek to forget your past. Remember it redemptively. Declare to others how God reversed the flow of your heartache. Do not waste the pain. Choose to see your past through the lens of mercy, deliverance, restoration.

Whether or not you can currently recognize it, you have not been alone in your struggle. If you can perceive how He has been with you and is close to you, perhaps it is time that you help another see the "withness" of His love.

I do not have an answer for why you or someone you love had to fight or is currently battling PPD. But I know the One who does, and I cling to the peace that comes only in trusting Him. We cannot always discern the whys of our pain. We cannot even understand His love half the time. Indeed, perhaps the reason we share in a suffering we do not comprehend is precisely because we are loved by and with a Love we do not understand.' Let me reiterate: We do not need explanations as much as we need withness.

At times, I believed that God was disappointed in me for struggling with postpartum depression. Perhaps you or someone you care about has faced this same misconception. I now see that God was saddened by my pain rather than quick to judge it. As Lamentations so beautifully unveils, "The Lord does not abandon anyone forever. Though he brings grief, he also shows compassion according to the greatness of his unfailing love. For he does not enjoy hurting people or causing them sorrow" (3:31-33, NLT). I am, you are, every human being is His beloved. He longs to shower us with tender compassion.

And herein lies something even more astonishing: He wants us to love Him in return. He yearns for it. "I don't want your sacrifices," Our God proclaims. "I want your love;, I don't want your offerings-I want you to know me" (Hosea 6:6, TLS, emphasis added). He wants your heart, not compulsive obedience.

The Message translation renders Matthew 5:3-4 so poignantly:

You're blessed when you're at the end of your rope. With less of you there is more of God and His rule.

You're blessed when you feel you've lost what is most dear to you. Only then can you be embraced by the One most dear to you.

Postpartum depression robs us of much that we hold dear-our love, our zest for life, our delight in the gift of children and our own precious newborn. But as we are embraced by the One most dear, we discover His blessing and the restoration of all things good and glorious. Remembering this will give you renewed perspective on the pain you and your loved one have faced.

Keep On Keeping On

Once upon a time my brother, Ian, was part of a musical production. I don't remember much about it, but I do recall the ensemble singing a chorus that repeated the phrase "you've got to keep on keeping on."

After seeing your past with renewed perspective, an important second step in moving beyond is staying with your healing and recovery (whether or not you are the one who went through/is going through PPD, you are still called by God to "keep on"). Once He sets you and someone you love on the path of healing, you are urged by Him to continue practicing the things you have learned. There are many ways to do this, and I'd like to discuss a few with you.

One is to express your gratitude. Perhaps you could keep a "thanks journal" or devote a portion of your devotional times to simply thanking God for what He has done and is doing. I like to write down the things I am grateful for, as it helps to cement the memory of them in my mind.

Keeping with the lessons for healthy living you may have learned in cognitive and spiritual therapy, or from your medical team, is also essential. If you made dietary changes, stay with them. If you began exercising, don't stop because you feel better. If you discovered that toxic beliefs about you, God, or the world around you had infiltrated your thinking, "Let God transform you ... by changing the way you think" (Romans 12:2, NLT).

You may have identified specific sources of stress in your life, and part of moving beyond is continuing to evaluate and avoid triggers for anxiety and despair. As you recognize which situations (or people) tempt you to discouragement and stress, and then learn to respond to them, don't forget that new and different stressors will arise. What you learned and are learning during this season can be an invaluable resource for dealing with future situations.

Appropriate self-care when confronted with stress is likewise essential. I sincerely hope that whether it's you or someone you care about who struggles/struggled with PPD, you've already begun a program of regular exercise and healthy eating. Again, don't stop this as recovery proceeds. Many do this, and suffer setbacks. Exercise and eating well benefit everyone, so keeping on with these life changes is crucial.

Another important technique for self-care is building breaks into your day (even if you can find only five minutes at a time). The people depending on you (including your family members, and especially your children) will survive-despite what you may think-if you sit down with a book, magazine, and/or your favorite beverage for a couple moments. It's very tempting to use whatever quiet time we do have to catch up on work, cleaning, phone calls, and e-mails. Beloved, there are many times all of that can wait. Our frenetically paced culture teaches us that productivity is next to godliness, that you should be able to "bring home the bacon and fry it up in a pan," but this is a deception of the gravest magnitude. You need not succumb to the pressures of the day.

People in the work world are mandated to take breaks. True, some people refuse to use their breaks well, but studies show that those who actually "break" from the stress of their day, relaxing a bit by conversing with others or simply getting outside to breathe some fresh air, actually perform better on the whole than those who work through lunch and breaks (and the rest of their lives).

In our accomplishment driven society, it goes against the grain to build margin into our days. You've probably heard again and again that God rested on the seventh day of creation and commands us to rest. But have you really taken this to heart? "In repentance and rest is your salvation," the Lord teaches. "In quietness and trust is your strength, but you [will] have none of it" (Isaiah 30:15). What would our lives look like if we experienced even a small measure of the quietness, trust, and rest that God describes in this verse?

Along with taking breaks, we can continually evaluate our expectations. What does the phrase "good enough" mean to you? Does it turn your stomach because it seems like a cop-out? Does it sound like a relief? Are you willing to strive for excellence while recognizing that "well done, good and faithful servant" not "good, you did that perfectly" is the goal?

You are living with a new kind of normal.10 What was normal before your postpartum depression, or the experience you had with someone who went through it, is no longer "normal." You may need to relearn what daily life looks like. A big part of your ongoing recovery is accepting the person you have become and the ways in which PPD has altered your perception of life.

For a mother who suffers from or has suffered through postpartum depression, it is often difficult to determine which feelings are normal. After I got "out of the woods," I still remember being afraid every time I felt sad that I was destined to get depressed again. I wondered if my thinking was still clouded, and often second-guessed my decisions. This is normal and, indeed, to be expected in most cases. If you're walking with someone you care about, keep this in mind as a way to encourage her. You can help her separate which emotions are simply part of the human condition (all of us feel discouraged and down sometimes) and which might be red flags that depression is reasserting itself (one thing that may help is remembering that with depression, feelings will usually be accompanied with one or more physical symptoms, such as sleep disturbance, anxiety, and decreased or markedly increased energy levels).

Another thing to keep an eye on is the tendency for women who experienced PPD to overcompensate for the disappointment they felt (and assume others felt about) the first days of their motherhood. Brooke Shields described how, as she began to pull out of her depression, she strove so hard to prove she was a good mom that she became completely exhausted. Guilt about the darkness of her depression weighed down on her and she desperately wanted to "make up for" what she saw as her failure."

Shields also candidly talked about how difficult it was for her to interact with people who were concerned she was still depressed or would get depressed again. I understand how she felt, as I, too, experienced the same. Helpers cannot grow through the therapy and physical healing in the same ways a recovering sufferer can, and they often assume that even if a previously depressed mother says she's doing well, she's only masking what she "really feels."

There were times when it seemed everyone was watching how I would react to Jocelyn or jasmine, to see how I would or could respond to daily stress. Jeramy, especially, didn't want me to fall into the pit again, and there were times he was almost visibly holding his breath. This was hard on both of us.

The only thing a person who has struggled can do is assure you that if she starts to feel low again, she will tell you. You may not initially trust the woman you care about, but there is no way for her to prove she is doing better.

That said, I want to note that some women fear sharing the improvement, as they worry doing better will mean everyone expects them to get back to "normal life." Keep in mind that expecting a recovering woman to do more than she feels able is neither healthy nor helpful. It may or may not trigger a setback, but it will cause stress and challenges that could be avoided with gracious understanding. It takes time for life to get reestablished. And, even then, your "normal life" will be altered.

If you are the woman overcoming depression and moving on, try to be sensitive to the people who walked with you through this valley. The weeks or months of your depression took a toll on those who cared about you. Gaining the trust of those who love you may take some time. Some people will continue to worry about you and treat you as if you have not improved at all. Patience is called for in such instances. Remember, people don't want you to hurt again. They are trying to help you avoid pain. As you keep on keeping on, you will help others see God's victory in your life. It simply may take more time than you would hope.

Time is such an important part of healing. We need time to process what we learned, to be physically and spiritually restored, to reorder our lives with a new kind of normal, to allow others to do their own healing and trust that we are healthy again.

Women who have battled PPD also need time to prepare their bodies for any future pregnancies. Some women who have struggled with postpartum depression immediately opt to prevent all further pregnancies with a tubal ligation or her husband's vasectomy (though even these surgeries cannot eliminate with 100 percent accuracy the chance of pregnancy). Such drastic measures are not necessary if you or someone you love would like to consider another pregnancy. There are, however, a couple things to keep in mind with regard to having more children.

There is no question that a woman should not attempt to get pregnant again before she is fully recovered from her PPD. As I know from personal experience, however, things sometimes do not go according to the best laid plan. I became pregnant when my first daughter was seven months old. This was not premeditated, and I had no idea it would increase my risk for another postpartum depression. Of course, I now would not wish for anything different-my second daughter is such a treasure, and I cannot imagine life without her-but I would not advise women to purposely try to get pregnant while they are still in recovery. Indeed, it is generally recommended by experts in the field that women wait at least a year before trying to get pregnant again."

Because studies show that women with previous episodes of postnatal disorder are at an increased risk-approximately 50 to 62 percent-of reoccurrence with subsequent pregnancies, it's also wise to think through what you can do if depression once again descends on you.13

Having a treatment plan in place before another pregnancy is a great idea. The main purpose of such a plan is to make as many decisions as possible about the care for and response to a possible depression in advance. Making choices after a baby's birth is stressful enough; it's even more difficult when depression saps your strength and mental clarity.

Keep your healthcare team, therapist, and any supportive loved ones (family, friends, pastors) informed about your plans. Alert your physicians to a new pregnancy as soon as possible. They can help you be on the lookout for symptoms. Don't assume that your doctor(s) will remember your previous struggle well enough to be prepared for any future difficulties. If you switch practices, be sure to give your new doctor(s) a detailed account of your experience.

Some practitioners believe that women who have suffered from PPD should wait until their child(ren) are old enough to do some things independently before having another baby. That way the mother can attend to the newborn's care more completely. Since older children can be dropped off for playdates or at preschool and are better able to occupy themselves at home, this seems logical. Many women, however, opt not to wait so long and experience no adverse effects. There is currently no physical evidence that proves waiting until your other children are older decreases your chance of getting postpartum depression again. Perhaps the main issue at stake is whether the stress of having two or more small children will negatively affect your emotional health.

Keeping on the path of recovery clearly involves staying attentive to many different aspects of physical, emotional, and spiritual health. And as we keep on keeping on, we begin to see that the pain of PPD can actually become a bridge to growth, both for ourselves and for others. You and the people whom you love have emerged and/or will emerge from the experience with a new depth of understanding, a new awareness of the pain of others, and a new strength of spirit. Though none of us would ever choose to go into the depths, it almost always seems that we must endure pain and struggle in order to reach new heights until we grow into the capacity to engage with others in new and beautiful ways. We do this by using the pain in our lives to bless others.

A Wounded Healer

In Thornton Wilder's play The Angel That Troubled the Waters, an injured physician seeks healing in a pool reputed to restore perfect health to all who enter it. His path, however, is blocked by an angel who declares, "Without your wound, where would your power be? ... The very angels themselves cannot persuade the ... children on earth as can one human being broken on the wheels of living. In Love's service, only wounded soldiers can serve.""

Whether the battle against PPD was/is your own or someone else's, you have been wounded. You are also a soldier of the God of the Angel Armies. Without your wound, I ask, where would your power be? Indeed, God seems to prefer using our wounds, not our strengths, to heal others. As the apostle Paul revealed in 2 Corinthians 12, weakness is where His power is best displayed:

I was given the gift of a handicap to keep me in constant touch with my limitations. Satan s angel did his best to get me down; what he in fact did was push me to my knees.... At first I didn't think of [my suffering] as a gift, and begged God to remove it. Three times I did that, and then he told me,

Once I heard that, I was glad to let it happen. I quit focusing on the handicap and began appreciating the gift. It was a case of Christ s strength moving in on my weakness. Now I take limitations in stride, and with good cheer, these limitations that cut me down to size ... I just let Christ take over! And so the weaker I get, the stronger I become. (verses 7-10, MSG)

Beloved, this is not a message that makes any worldly sense. Only with the eyes of eternity, with faith in the truth of God's economy, does it follow that the weaker we get, the stronger we become. Certainly, this does not mean we should go looking for ways to become weak. (I, for one, am extremely grateful that God does not command us to do so!) It does, however, mean that we can "quit focusing on" our suffering and appreciate the gift of Christ's strength moving in on our weakness.

This is a life lesson not limited to postpartum depression. No matter what your wounds, you can minister from your sorrow and brokenness. With regard to PPD, whether you suffered or walked with someone who did, you have been and are invited to become a wounded healer. Those who enter into another's struggle, and are pierced along with those in pain, can restore others with the Life and Love they have found.

One of my absolute favorite gospel accounts chronicles the story of a paralyzed man whose friends courageously and creatively bring Him to Jesus. Matthew 9, Mark 2, and Luke 5 record the dramatic happenings:

Several days later Jesus returned to Capernaum, and the news of his arrival spread quickly through the town. Soon the house where he was staying was so packed with visitors that there wasn't room for one more person, not even outside the door. And he preached the word to them. Four men arrived carrying a paralyzed man on a mat. They couldn't get to Jesus through the crowd, so they dug through the clay roof above his head. Then they lowered the sick man on his mat, right down in front of Jesus. (Mark 2:1-4 NLT)

The text in Luke 5:20 (MSG) also tells us Jesus was "impressed by their bold belief" (how wonderful would it be to have your legacy be defined by that, the Lord being impressed by your faith?!). Christ proceeded to heal the paralytic not only physically but spiritually as well-and this to the great consternation of the religious leaders of His day. But I love that God treated this man, His beloved child, as an integrated person. He addressed the needs of the man's body, mind, and spirit, so that he might be truly and completely free. I wonder how often this man told his story, how many people were moved by the tale of his healing and forgiveness? Jesus proclaimed that this paraplegic's healing proved "that the Son of Man has authority on earth to forgive sins" and heal the broken bodies of His treasured ones (Luke 5:24).

The Lord proved His power through healing this man. He continues to prove Himself through you and me and all who are restored. And then He uses us to work healing in others. What a marvel!

Disappointingly for me, none of the Gospels reveals for us the stories of this man's bold friends. Had any of them been touched by Jesus? Had they simply heard of His power and believed He was who He claimed to be-Messiah, Deliverer, Healer? What life experiences made these friends so brave as to take someone else's roof apart to get a stretcher in front of Jesus? What hurts had they suffered?

It struck me as I meditated on this passage that we're all on the mat at some point in our lives. Whether our life wounds are massive or minor, we all hurt. We all need Jesus' healing touch, His hope, His forgiveness. Sometimes we can't get to Him by ourselves. We need stretcher bearers.

Furthermore, we can't usually choose how and when we find ourselves on the mat, paralyzed by heartache or fear or depression. None of us wants to be on the stretcher, ever. Who among us wouldn't rather play the role of the courageous friend who does whatever it takes to get a beloved one to Jesus? Every one of us longs for freedom from suffering, most of us do all that we can to avoid it, but no one can escape the human condition. You will be on the mat now and then (some of us more often than others).

I don't know about you, but this is not my favorite biblical truth. Here's a thought that undid me even further as I analyzed this story: I can choose what to do when I am not on the mat. I can be a stretcher bearer or I can try to avoid the pain of others, perhaps because it reminds me too much of my own. I can proclaim God's healing touch or I can ignore my past. If I choose the former, I become a wounded healer. Deciding upon the latter does dishonor to both God and self. To this day, I'd still rather be carrying the mat than on it, but I also know that the wounds that put me on the stretcher yesterday are the source of my compassion today. I choose to be a wounded healer.

Charles Spurgeon chose to as well. Did you know this renowned pastor and writer struggled with a depression so deep that he was forced to step away from his pulpit, sometimes for two to three months at a time? In 1866 he admitted, "I am the subject of depressions of spirit so fearful that I hope none of you ever get to such extremes of wretchedness as I go [through]." He explained that during these depressions, "Every mental and spiritual labor ... had to be carried on under protest of spirit."15

The pain of Spurgeon's personal life became the catalyst for teaching that healed and challenged many. His work continues to do so. You may never preach sermons or write books, as Spurgeon did. But you, too, can be a wounded healer. You do this through comforting others with the comfort you have received.

"Praise be to the God and Father of our Lord Jesus Christ," Paul wrote to the Corinthians, "the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God" (2 Corinthians 1:3-4).

Whatever you have received from God, pass on to others. This is, for many, the final stage of their recovery. Comforting others helps you to move even further beyond the pain of your experience. In embracing your role as a wounded healer, the anguish of your past becomes the beauty of both present and future.

The prophet Jeremiah was also a wounded healer, and his words in Lamentations 3 speak to all of those whom God invites to join His work of restoration and hope. Jeremiah endured suffering that few of us can comprehend. He wrote,

The thought of my suffering and homelessness is bitter beyond words. I will never forget this awful time, as I grieve over my loss. Yet I still dare to hope when I remember this:

The unfailing love of the LORD never ends! By his mercies we have been kept from complete destruction. Great is his faithfulness; his mercies begin afresh each day. I say to myself, "7he LORD is my inheritance; therefore, I will hope in him!"

The LORD is wonderfully good to those who wait for him and seek him. So it is good to wait quietly for salvation from the LORD....

For the Lord does not abandon anyone forever. Though he brings grief, he also shows compassion according to the greatness of his unfailing love. For he does not enjoy hurting people or causing them sorrow. (verses 19-26,31-33, NLT)

I love these verses because they express such raw emotion. Jeremiah acknowledged the depth of his woundedness and revealed that he would never forget it. He grieved his loss, yet he dared to hope in the Lord. Yet he declared that the faithful love of the Lord never fails. Yet he proclaimed that God's mercies never cease. No one is abandoned by the Lord forever, the prophet urged us to believe. Our God may allow grief, but He also shows compassion. We observed before and proclaim again: He does not enjoy hurting people or causing them sorrow.

These are truths only wounded healers can speak, and you have the opportunity to live out these words, as Jeremiah did. Do you believe the mercies of the Lord never cease? Do you know that His faithfulness is great? Do you both grieve over your loss and suffering-the bitter pain that is beyond words-and yet dare to hope? If so, tell others. This is part of your journey. This is the call of God. This can be the source of your greatest joy- to comfort others with the comfort you have received.

Now may not be the time for this in your life. The time will come. And when it does, or if you are now in this position, I pray you embrace your role as a wounded healer with everything in you ... the very power of God.

Apart from the Scripture used throughout this book, you may find the following verses comforting or instructive:

Information

There are many websites devoted to understanding and treating postpartum depression. As with all web information, you should be careful who has built and is maintaining the site. Anyone can register a domain. Some even pretend to be medical practitioners when they have no training whatsoever.

The following is a list of sites with a good reputation and solid information. Additional contact information is included below the URLs.

Postpartum Support International: 1.800.944.4PPD

For those contemplating suicide: The National Hopeline Network: 1.800.SUICIDE

National Suicide Prevention Lifeline: 1.800.273.TALK

Questionnaires

Medical practitioners most often use the Edinburgh Postnatal Depression Scale (EDPS) or the Postpartum Depression Screening Scale (PDSS) to determine a new mom's risk or incidence of postpartum depression. Both are available online, though, unlike the EDPS, which is free and easily obtainable on the Internet, you must either purchase access to the PDSS or have a healthcare practitioner administer it. Because the PDSS questions concern sleep and eating disturbances, anxiety, insecurity, emotional instability, feelings of guilt or shame, and suicidal thoughts, it may be a more comprehensive help.

For the Edinburgh Postnatal Depression Scale (ten questions), see: http://www.nj.gov/health/fhs/postpartumdepression/screening_for_ ppd.shtml

For the Postpartum Depression Screening Scale (thirty-five questions), see: http://portal.wpspublish.com/portal/page?_pageid=53,70428&_ dad=portal&_schema=PORTAL

Anyone can take the Mills Depression and Anxiety Symptom Feeling Checklist, available, among other places, at http://www.pndsa.co.za/ symptom_checklist.html. The Mills helps you evaluate different feelings on a scale from 0 to 3. Zero means you never have the feeling, 1 means you have it from time to time, 2 means you have it quite often, and 3 means you have it most of the time. Please note this is not specific to postpartum depression but is used for all forms of depression and anxiety screening.

Additional information about psychological testing can be found at:

Specific Forms of Christian Therapy

Theophostic prayer ministry (TPM) is often considered another kind of therapy. Known as theophostic counseling, theophostic therapy, or, most appropriately, theophostic prayer ministry (this is not only what founder Ed Smith calls it, but it's also the most appropriately descriptive term for the practice), TPM is an increasingly popular approach to treatment.

In fact, according to the Christian Research journal, theophostic prayer ministry is spreading more quickly in evangelical circles than almost any other approach to inner healing! However, TPM is also highly controversial, provoking zealous pro or con pronouncements from supporters and critics.

TPM takes its name from two Greek words that, when combined, mean "the light of God." The Theophostic Prayer Ministry website, www.theophostic.com, explains its exclusively Christian approach:

[TPM is] Christ centered and God reliant for its direction and outcome.... It is encouraging a person to discover and expose what he believes that is a falsehood ... and allowing the Lord to reveal His truth to the wounded persons heart and mind. It is not about advice giving, diagnosing problems, or sharing opinions or insight. It is about allowing a person to have a personal encounter with the Lord Jesus in the midst of . . . emotional pain.2

So what happens in a typical theophostic prayer ministry session? Elliot Miller of Christian Research Journal explained,

After receiving the recipients permission to do so, the facilitator invites Jesus into the session and asks Him to reveal His truth about the memories that will be brought to mind. The recipient is then asked to try to identify the memory where she (or he) first felt the emotions that are troubling her in the present (e.g., feeling unloved).3

From there, the recipient is encouraged to describe both the circumstances surrounding this memory and how remembering the experience makes her feel ("I'm afraid of being left alone"). The facilitator asks Jesus to communicate what He wants the recipient to know about the memory and accompanying feelings. The recipient waits on Christ to impress something on her mind-a vision, words, or new insight. This may come in the form of biblical truth ("I will never leave you nor forsake you"), factual truth (the pain of being deserted as a child is real, but God has given me a loving husband and a supportive network of friends who care about me), and/or strong feelings ("I feel ready to forgive those who abandoned me and trust that God will always be there for me").

The conservative Christian Research Institute (CRI) "finds nothing in TPM's core theory and practice that is inconsistent with Scripture." Still, CRI cautions that there are "specific concerns that Christians could raise regarding TPM's core theory and practice that should not be ignored,"4 including founder Ed Smith's teachings on spiritual warfare.

If you are interested in TPM, the official website is extraordinarily informative. The "What Is Theophostic Prayer Ministry?" section is especially helpful. A Google search for "Theophostic Prayer Ministry" will yield links to both supporters and critics. I encourage you to research both if you are interested in learning more.

Nouthetic counseling, like TPM, is a specific type of Christian therapy. The National Association of Nouthetic Counseling, according to its website, "exists to help pastors and those who would be ministers of the Word of God by providing help and encouragement."'

This is an aim I am in complete agreement with. There are, however, other things about nouthetic counseling, or at least the practice of it, with which you might come into contact, that trouble me. I do not wish to offend any brother or sister in Christ with the following evaluation of how nouthetic counseling is sometimes practiced .6 I'M confident that there are many nouthetic counselors who are used by God to offer His healing to the hurting. I am not against nouthetic counseling altogether. I would simply like to offer a few words of caution so that those with PPD can be informed about why certain nouthetic counselors may not be the best choice for them.

One thing that concerns me is that nouthetic counselors often claim there is only one form of acceptable "biblical counseling." This usually means that the Bible and only the Bible should be used in counseling. In fact, some nouthetic counselors would shudder to read that I associate their work with "therapy" at all. To them, the very word therapy connotes a form of treatment that is wholly opposed to what they consider appropriate and God-honoring.

I simply do not believe that God uses only one method of healing people and transforming their minds. To be sure, I believe the Bible to be the most precious-and the only perfect-form of revelation God has given man. Its healing powers are unmatched, its relevance to every life situation undeniable, its beauty and truth piercing on the deepest levels. God's written Word is indispensable in every recovery process.

Does He, however, use other things in addition to heal people? I would say-with strong biblical conviction-yes! The God who healed a blind man with mud, a leper with the water of a river, and others in ways we might scoff at and certainly could never repeat ourselves is in the business of healing people through a variety of means.

Some forms of nouthetic counseling, however, seem to discount methods God may choose to use while facilitating a person's recovery. One practitioner wrote,

Nouthetic Counselors seem to take a lot of flak] from ... counselors with different mindsets . . . Probably ... because they actually point out sin in [people's] lives. But they don 't just point out sin, [they] help bear the burden and ... move a believer to [draw] near to God...

Probably the biggest misconception about Nouthetic counselors is that they refuse to accept that drugs can help.... Nouthetic counselors seek to help people become healed without drugs, no doubts [there], but will refer a patient to a doctor when drugs are needed. For the most part people can be healed without the use of drugs for the mind. (emphasis added)'

I believe that it's both false and foolish to claim that nouthetic counseling is the only form that points out and deals with people's sin. I certainly had to face my sinful disbelief in God's character and my lack of love for others (transgressions this practitioner identifies as the primary root of all problems), though I did not receive nouthetic counseling. The ideas that nouthetic counseling is the best method of getting to the ultimate root of people's struggles and that nouthetic counselors better bear other's burdens and draw them closer to God are, in my opinion, also misguided. I believe many forms of therapy can do this if the participant and practitioner are both believing Christians.

Regarding the claim that "for the most part people can be healed without the use of drugs for the mind," I do not know on what research nouthetic counselors who believe this may base their claim, but it is simplistic and, I believe, dangerous. For those who have brain-chemistry issues that cannot be balanced by their own bodies, contending that medication is unnecessary can lead to disastrous and lifelong difficulties.

This is not to say that God cannot choose to heal people using the Bible alone. I know He can. He is omniscient and all-powerful. Does He always do this, however? No.

Some nouthetic counselors discourage medication so adamantly that a person who does take or should take medicine feels guilty and ashamed. This may not be the goal of all nouthetic counseling, but, sadly, it is often the outcome. Jeramy was trained to believe that using medication was a sign of a weak and deficient faith, a cop-out in no uncertain terms. Many people have been similarly misinformed.

While I do not believe someone should reject nouthetic counseling out of hand, I do advise you to be very careful in asking questions about a practitioner's approach. This is particularly important if a new mother is experiencing a severe postpartum condition (characterized by catatonia, mania, psychosis, or other physical symptoms that are seriously life-hindering). God may choose to use nouthetic counseling in your life, or in the life of someone whom you love. If He does, that's wonderful! I simply wanted to present a few of the difficulties with the method as it is sometimes practiced.

Mental-Health Centers in Your Community

Long-term medical treatment, whether in the form of therapy or hospital care, can place significant strain on a family's or individual's resources. And though it may go against your desire and the way you were raised, applying for public assistance (including, but not limited to, welfare) gives you access to the mental-care system in a way your personal finances may not allow.

Many community health centers take clients in need. You can find free or low-cost mental-health care through some universities, research facilities, nonprofit hospitals, even some churches.

There may even be benefits to working with publicly funded programs. Since state or federally funded hospitals often affiliate themselves with major research and teaching institutions, patients can benefit from the latest information and treatment methods for minimal cost.

You can inquire with the government offices in your city, county, and state about sources of funding for mental-health care. You can also contact the National Coalition of Mental Health Professionals and Consumers in New York (contact information below).

There is no shame in maximizing every available resource for you or the one you are trying to help. Your life, the life of your loved one, and the health and stability of your entire family matter most.

Specific Forms of Medical Treatment

Note: On the Amen Clinics website, you can find locations and recommendations for practitioners around the country who use and understand brain imagery.

CHAPTER 2: POSTPARTUM DEPRESSION AND THE BODY

1. According to Dr. Richard Neugebauer and his colleagues at New York State Psychiatric Institute, approximately 10 percent of women develop depression in the six months after a miscarriage. See Neugebauer, J. R. Kline, P. O'Connor, P. Shrout, J. Johnson, A. Skodol, J. Wicks, M. Susser, "Depressive symptoms in women in the six months after miscarriage," American journal of Obstetrics and Gynecology 166, no. 1 (1992): 104-109, 166.

2. M. P. Lukse, N. A. Vacc, "Grief, depression, and coping in women undergoing fertility treatment," Obstetrics and Gynecology 93, no. 2 (February 1999): 245-251.

3. Ruta Nonacs, A Deeper Shade of Blue: A Woman s Guide to Recognizing and Treating Depression in Her Childbearing Years (New York: Simon & Schuster, 2006), 3.

4. Nonacs, 163.

5. Sue McRoberts, The Lifter ofMy Head (Mustang, OK: Tate Publishing, 2007), 127-128.

6. See the National Institute for Mental Health's report "Breaking Ground, Breaking Through: The Strategic Plan for Mood Disorders Research," 9, http://www.nimh.nih.gov/about /strategic-planning-reports/breaking-ground-breaking-through -the-strategic-plan-for-mood-disorders-research.pdf (accessed November 1, 2008).

7. Nonacs, 180.

8. See "Prevalence of Self-Reported Postpartum Depressive Episodes," Centers for Disease Control (April 11, 2008), http:// www.cdc.gov/mmWR/preview/mmwrhtml/mm5714al.htm (accessed May 6, 2009).

9. National Center for Health Statistics, "Births: Final Data for 2006," Center for National Vital Statistics Reports 57, no. 7 (January 7, 2009), http://www.cdc.gov/nchs/data/nvsr/nvsr57/ nvsr57 07.pdf (accessed May 6, 2009).

10. Per statistics from the National Institute of Neurological Disorders and Stroke, available at http://www.ninds.nih.gov/ disorders/parkinsons_disease/detail_parkinsons_disease.htm.

11. Per statistics from the National Institute on Aging's Alzheimer's Disease Education and Referral website, http://www.nia.nih .gov/Alzheimers.

12. According to the National MS Society, http://www .nationalmssociety.org/about-multiple-sclerosis/who-gets-ms/ index.aspx. (The statistic listed is new cases diagnosed per week-200. Extrapolating for per-year comparison, I determined 200 new cases per week x 52 weeks = 10,400 new cases per year.)

13. A downloadable chart- "Estimated New Cancer Cases and Deaths by Sex for All Sites, US, 2007"-is available at http:// www.cancer.org.

14. Joyce A. Venis, and Suzanne McCloskey, Postpartum Depression Demystified: An Essential Guide for Understanding and Overcoming the Most Common Complication After Childbirth (New York: Marlowe and Company, 2007), 1.

15. Karen Kleiman, MSW, The Postpartum Husband.- Practical Solutions for Living with Postpartum Depression (Bloomington, IN: Xlibris, 2000), 17.

16. See Nonacs, 155, 165-166; and Venis and McCloskey, 53-54.

17. Some physicians are skeptical of SPECT scanning even if they are aware of it. I have encountered this attitude myself, though I am firmly convinced of the efficacy of SPECT scanning based on medical research and anecdotal evidence.

18. If you are interested, you can view additional images at http:ll www.amenclinics.com or in any of Dr. Daniel Amen's excellent books.

19. Try Dr. Amen's Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness (New York: Three Rivers Press, 1999) and Healing Anxiety and Depression (New York: Putnam Adult, 2003). Also, Dr. Henslin's This Is Your Brain on joy (Nashville: Thomas Nelson, 2009).

20. Daniel G. Amen, Healing the Hardware of the Soul (New York: Free Press, 2000), 45, 54.

21. Particularly monoamine neurotransmitters, including norepinephrine, serotonin, and dopamine.

22. Nonacs, 26.

23. Nonacs, 110, emphasis added.

24. Venis and McCloskey, 11.

25. Brooke Shields, Down Came the Rain (New York: Hyperion, 2005), 81.

26. Debra Rienstra, Great with Child (New York: Jeremy P. Tarcher, 2002), 263.

27. Venis and McCloskey, 263.

28. Kleiman, 38.

29. McRoberts, 34-35.

30. Nonacs, 171.

CHAPTER 3: POSTPARTUM DEPRESSION AND THE MIND

1. Penelope Leach, Your Baby and Child, rev. ed. (New York: Knopf, 1997), 31-32. Note: The phrase "you are still desperately tired" is apparently included in the 1979 edition but not the paperback edition currently available.

2. Brooke Shields, Down Came the Rain (New York: Hyperion, 2005), 65, 67.

3. Shields, 140-141.

4. Joyce A. Venis, and Suzanne McCloskey, Postpartum Depression Demystified: An Essential Guide for Understanding and Overcoming the Most Common Complication After Childbirth (New York: Marlowe and Company, 2007), 47.

5. Debra Rienstra, Great with Child (New York: Jeremy P. Tarcher, 2002), 184.

6. You can view an excellent list of risk factors that expounds upon this one at www.postpartumstress.com.

7. K. L. Armstrong, A. R. Van Haeringen, M. R. Dadds, R. Cash, "Sleep deprivation or postnatal depression in later infancy: separating the chicken from the egg," Journal of Pediatrics and Child Health 34, no. 3 (1998): 260-262.

8. Sue McRoberts, The Lifter ofMy Head (Mustang, OK: Tate Publishing, 2007), 53, 55.

CHAPTER 4: HOPE FOR HURTING HUSBANDS

1. Ruth Graham, In Every Pew Sits a Broken Heart: Hope for the Hurting (Grand Rapids, MI: Zondervan, 2004), 39.

2. Portions adapted from Karen Kleiman, The Postpartum Husband.- Practical Solutions for Living with Postpartum Depression (Bloomington, IN: Xlibris, 2000), 51.

3. Graham, 32.

4. Keep in mind that just because a doctor or drug is expensive does not mean that person or that drug is the best choice. Evaluate your options carefully, but never refrain from seeking treatment because of cost.

5. From her website of the same name. See http://www .depressionfallout.com for more detail.

CHAPTER 5: THE PAIN OF A PARENT

1. Adapted from Phyllis Tickle, The Divine Hours: Prayers for Autumn and Wintertime (New York: Broadway, 2000), 340.

2. "Average Postpartum Length of Stay for Uncomplicated Deliveries-New Jersey, 1995," Morbidity and Mortality Weekly Report 45, no. 32 (August 16, 1996): 700-704, http://www .cdc.gov/mmwr/preview/mmwrhtml/00043388.htm (accessed December 17, 2008).

3. "2002 PRAMS Surveillance Report: Multistate Exhibits Infant Follow-Up and Well-Baby Care," Centers for Disease Control and Prevention (2002, updated 2006), http://www.cdc.gov/ PRAMS/2002PRAMSSurvReport/MultiStateExhibits/ Multistates17.htm (accessed November 2009).

4. "Average Postpartum Length of Stay for Uncomplicated Deliveries."

5. Ruta Nonacs, A Deeper Shade of Blue: A Woman s Guide to Recognizing and Treating Depression in Her Childbearing Years (New York: Simon & Schuster, 2006), 168.

6. As one of my favorite authors, Jan Karon, puts it.

7. Ruth Graham, In Every Pew Sits a Broken Heart: Hope for the Hurting (Grand Rapids, MI: Zondervan, 2004), 30.

CHAPTER 6: FAMILIAL FALLOUT

1. Matthew Henry, Concise Commentary on the Whole Bible. First full edition published 1706 in Chester, England; available in the public domain, http://www.biblegateway.com/resources/ commentaries/Matthew-Henry/Gal/Exhortations-Meekness -Humility (accessed January 7, 2009).

CHAPTER 7: A FAITHFUL FRIEND

1. Sue McRoberts, The Lifter ofMy Head (Mustang, OK: Tate Publishing, 2007), 120, emphasis added.

2. Brooke Shields, Down Came the Rain (New York: Hyperion, 2005), 216, 72.

CHAPTER 8: SPIRITUAL IMPLICATIONS OF POSTPARTUM DEPRESSION

1. The very helpful article by P. & A. Hawke and L. Ray, "Religious or spiritual things that get said," found on "Christian Depression Pages," informed some of the following. See http:// www.christian-depression.org/cdp/sayings-xtn.php (accessed February 4, 2009).

2. Hawke, Hawke, and Ray.

3. Tina Zahn with Wanda Dyson, Why I jumped.- My True Story of Postpartum Depression, Dramatic Rescue and Return to Hope (Grand Rapids, MI: Revell, 2006), 168-169.

4. Debra Rienstra, Great with Child (New York: Jeremy P. Tarcher, 2002), 47.

5. The Heidelberg Catechism was first approved and used by the Protestant church in 1563. This quote is from the modern English translation, authorized by the Canadian and American Reformed Churches, available in full at http://www.wts.edu/ resources/heidelberg.html (accessed July 23, 2009).

CHAPTER 9: BALANCING THE BODY

1. Lydia Lewis, "Depression: The Unwanted Cotraveler: An Advocates' Perspective," an address for the National Institute of Mental Health Public Day, March 2001, http://www .dbsalliance.org/site/PageServer?pagename=media-speeches -cotraveler (accessed March 5, 2009).

2. Lewis.

3. Dallas Willard, Renovation of the Heart: Putting On the Character of Christ (Colorado Springs, CO: NavPress, 2002), 159.

4. C. Brendan Montano, "Recognition and treatment of depression in a primary care setting," Journal of Clinical Psychiatry 55 (12, Suppl): 18-34. Additionally, statistics are listed and available at http://psychservices.psychiatryonline.org/cgi/content/ fu11/54/6/878 (JianLi Wang, Donald B. Langille, and Scott B. Patten, "Mental Health Services Received by Depressed Persons Who Visited General Practitioners and Family Doctors," Psychiatric Services, June 2003).

5. See Dr. Daniel Amen, Healing Anxiety and Depression (New York: Putnam Adult, 2003), 46-82.

6. An otolaryngologist, for you medical types.

7. Dr. Earl Henslin, This Is Your Brain on joy (Nashville: Thomas Nelson, 2009), 145.

8. If you have particularly good health insurance, you may consider asking if your doctor would recommend Lovaza, the first pharmaceutical-grade fish oil available. I investigated this route myself, but many HMOs consider this a "nonformulary" drug and charge exorbitant co-pays. For those with great prescription coverage, however, Lovaza may be available at a significantly lower price than the high-grade fish oils sold at health-food stores or online.

9. Henslin, 56.

10. Julia Ross, The Mood Cure (New York: Penguin, 2004).

11. Adapted from Henslin, 164-165.

12. Bette Runck, "What Is Biofeedback?" National Institute of Mental Health, Division of Scientific and Public Information, reprinted online by the Arizona Behavioral Health Associates, P.C., http://www.psychotherapy.com/bio.html.

13. Runck.

14. EMDR International Association, "EMDRIAs Definition of Eye Movement Desensitization and Reprocessing (EMDR)," http://www.emdria.org/displaycommon.cfm?an= 1&subarticlenbr=3.

15. EMDR International Association, "What Is the Actual EMDR Session Like?" http://www.emdria.org/displaycommon .cfm?an=1&subarticlenbr=5.

16. EMDR International Association, "How Does EMDR Work?" http://www.emdria.org/displaycommon .cfm?an=1&subarticlenbr=2.

17. EMDR International Association, "What is EMDR?" http:// www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=56.

18. Tina Zahn with Wanda Dyson, Why I jumped: My True Story of Postpartum Depression, Dramatic Rescue and Return to Hope (Grand Rapids, MI: Revell, 2006), 162.

19. See Texas Tech University Health Sciences Center School of Medicine at Amarillo, "Lexapro," http://neonatal.ttuhsc.edu/ lact/newdrugspage.html (accessed March 18, 2009).

20. Ruta Nonacs, A Deeper Shade of Blue: A Woman s Guide to Recognizing and Treating Depression in Her Childbearing Years (New York: Simon & Schuster, 2006), 292.

21. Susan Dowd Stone, Alexis E. Menken, eds., Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner (New York: Springer Publishing, 2008).

22. Dr. Michael O'Toole, quoted in Zahn, Why I jumped, 229-230.

CHAPTER 10: TRANSFORMING THE MIND

1. See Dr. Paul Brand and Philip Yancey, The Gift of Pain (Grand Rapids, MI: Zondervan, 1997).

2. Brand and Yancey, 149.

3. These thoughts were adapted from Joyce A. Venis, and Suzanne McCloskey, Postpartum Depression Demystified: An Essential Guide for Understanding and Overcoming the Most Common Complication After Childbirth (New York: Marlowe and Company, 2007), 112.

4. MaryKate Newcomb, review of Life After Birth, by Kate Figes, Mothers Movement Online, http://www.mothersmovement.org/ books/reviews/life after birth.htm.

CHAPTER 11: UNDERSTANDING POSTPARTUM PSYCHOSIS AND SUICIDE

1. Theresa Walker, "Daddy's Baby Blues," The Orange County Register (April 9, 2007): Life Etc. section, 1, 10. All of the direct quotes in this section come from this article.

2. Various sources, including Ruta Nonacs, A Deeper Shade of Blue: A Woman s Guide to Recognizing and Treating Depression in Her Childbearing Years (New York: Simon & Schuster, 2006), 171, and Office on Women's Health, http://www.womenshealth.gov. See FAQs accessed at http://www.womenshealth.gov/faq/ depress ion-pregnancy. cfm.

3. Nonacs, 177.

4. Mayo Clinic staff, "Postpartum depression: treatment and drugs," Mayo Clinic, http://www.mayoclinic.com/health/ postpartum-depression/DS00546/DSECTION= treatments %2Dand%2Ddrugs.

5. "Fantastic News!!!! Rush Bill Passes Committee with Unanimous Support-Success at Last!" Postpartum Depression Alliance of Illinois, http://www.ppdil.org/ melanieblockerstokesbill.htm. For more information, or to help in the endeavor, contact Toure Muhammad at toure. muhammad@mail.house.gov.

6. Catherine Spader, "Erasing Myths About Postpartum Disorders," Nurse.com, July 4, 2005, http://include.nurse.com/ apps/pbcs.dll/article?AID=2005507040355 (accessed February 11, 2009).

7. Spader.

CHAPTER 12: MOVING BEYOND

1. Lewis B. Smedes, Forgive and Forget: Healing the Hurts We Don't Deserve (San Francisco: Harper and Row, 1994), 136-137.

2. Peter Kreeft, Making Sense Out of Suffering (Ann Arbor, MI: Servant Books, 1986), 69.

3. Philip Yancey, Soul Survivor (New York: Random House, 2001), 30.

4. Arthur W. Pink, "An Exposition of Hebrews" (Granbury, TX: Providence Baptist Ministries), chapter 91, "Divine Chastisement," available in its entirety at http://www .pbministries.org/books/pink/Hebrews/hebrews_091.htm.

5. C. S. Lewis, The Horse and His Boy (New York: Harper Trophy, 1994), 161-162.

6. Lewis, 163.

7. Lewis, 165-166.

8. Kreeft, 134.

9. Several of the ideas in the previous three paragraphs were sparked by Kreeft, Making Sense Out of Suffering. Though I did not include direct quotes, I want to acknowledge the profound impact his writing made upon me.

10. This phrase comes from Carol Kent's excellent books When I Lay My Isaac Down (Colorado Springs, CO: NavPress, 2004) and A New Kind of Normal (Nashville: Thomas Nelson, 2007). I highly recommend both of these works, which address the reality of suffering and the hope of living not only with it but through it.

11. Brooke Shields, Down Came the Rain (New York: Hyperion, 2005), 201.

12. Suggestions to this effect were present in each of the books from which I have quoted.

13. Joyce A. Venis, and Suzanne McCloskey, Postpartum Depression Demystified: An Essential Guide for Understanding and Overcoming the Most Common Complication After Childbirth (New York: Marlowe and Company, 2007), 59.

14. Thornton Wilder, The Angel That Troubled the Waters, The Collected Short Plays of Thornton Wilder (New York: Theatre Communications Group, 1998), 74.

15. Charles Spurgeon, quoted in Earl Henslin, This Is Your Brain on joy (Nashville: Thomas Nelson, 2009), 204.

APPENDIX B: MORE HELPS FOR THE JOURNEY

1. Elliot Miller, "Theophostic Prayer Ministry (Part One): Christian Prayer, Occult Visualization, or Secular Psychotherapy?" Christian Research journal29, no. 2 (2006), http://www.equip.org/articles/theophostic-prayer-ministry -part-one-.

2. Ed Smith, "What is Theophostic Ministry?" International Association for Theophostic Ministry, http://www.theophostic .com/page12414933.aspx.

3. Miller.

4. Miller.

5. "What Is NANC," National Association of Nouthetic Counselors, http://www.nanc.org/About_Us/What_Is_NANC .aspx.

6. Some nouthetic counselors still adhere to the extreme and incendiary claims of Jay Adams, who was a founder of the nouthetic counseling movement.

7. "Convicted by the Spirit," post to Pastoral Ministries, BaptistBoard.com, February 16, 2006, http://www.baptistboard .com/showthread.php?t=6244.

JERUSHA CLARK is the author of Every Thought Captive, The Life You Crave, Inside a Cutter's Mind, When I Get Married, and the coauthor of four other books, including the best seller I Gave Dating a Chance. She's passionate about ministering to people and wrestling with the questions closest to their hearts. Jerusha resides in Escondido, California, with her husband, Jeramy, a pastor at Emmanuel Faith Community Church, and her daughters, Jocelyn and jasmine.

Table of Contents

Acknowledgments

Introduction

ONE: My Story

TWO: Postpartum Depression and the Body

THREE: Postpartum Depression and the Mind

FOUR: Hope for Hurting Husbands

FIVE: The Pain of a Parent

SIX: Familial Fallout

SEVEN: A Faithful Friend

EIGHT: Spiritual Implications of Postpartum Depression

NINE: Balancing the Body

TEN: Transforming the Mind

ELEVEN: Understanding Postpartum Psychosis and Suicide

TWELVE: Moving Beyond

APPENDIX A: Helpful Verses

APPENDIX B: More Helps for the journey

Notes

About the Author

Table of Contents

Acknowledgments

Introduction

ONE: My Story

TWO: Postpartum Depression and the Body

THREE: Postpartum Depression and the Mind

FOUR: Hope for Hurting Husbands

FIVE: The Pain of a Parent

SIX: Familial Fallout

SEVEN: A Faithful Friend

EIGHT: Spiritual Implications of Postpartum Depression

NINE: Balancing the Body

TEN: Transforming the Mind

ELEVEN: Understanding Postpartum Psychosis and Suicide

TWELVE: Moving Beyond

APPENDIX A: Helpful Verses

APPENDIX B: More Helps for the journey

Notes

About the Author