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Dr. John Grohol Has Far More Patience (Patients?) Than I Do

Jul 16 2009 | Comments 28

There’s a prickly debate going on over at Psych Central on the subject of the MOTHERS Act, which, rather unexcitingly, suggests pregnant moms get screened for postpartum depression — something that’s rather standard in the UK and Australia. There is opposition to the Act, as embodied in a post by J. Douglas Bremner, psychiatrist and author, who believes the act stigmatizes motherhood. He quotes Amy Philo, who had a terrible experience after being misdiagnosed with PPD (and who was featured in a recent article in Time about the Act).

John Grohol wrote a response to Bremner’s assertions about the Act and about PPD in general. His response has caused a bit of a furor over there. In broad strokes, I agree with Grohol and endorse his position — which will have the Scientologists among you lashing out against me. But there does have to be a check embedded in the legislation so that medication is the last treatment prescribed rather than the first. And OB/GYNs should not be prescribing psych meds on their own but only in consultation with a psychiatrist. There are already too many scrips flying out of the hands of the wrong people.

It’s interesting that the issue of screening is rather uncontroversial in other countries. I wonder what that says about us. And about Scientology.

Grohol has been responding thoughtfully to all his commenters, which is why he has more patience than I do. I always get overwhelmed at the thought of doing that, so I retreat into a box of cereal or something. Tally-ho, John!


liz | 10:19 AM | depression

Gabriel... Says:

Scientology is today as Scientology always has been. What’s changed is the methodology they use for communicating their message… what their communications strategy regarding their opposition to the Mother’s Act is showing is how the Internet has killed the need for history and contemplation. Scientology doesn’t have to be Scientology anymore, they can be anything and any organization they want to be, it just takes a new URL and a little more separation between the Co$ and their spokesperson.

Jul 16 11:51 AM

Carter Says:

What you said, Liz. I’m in no position to comment on the specifics of motherhood or ppd, but any (relatively) simple screeing that can cut down on that obviously miserable condition should only help. Your point about medication also rings true, esp. given the uniqueness of childbirth in the human experience. You’d hate to see any mother robbed of that experience by inappropriate scrips.

Jul 16 12:54 PM

herb Says:

Yup, it’s getting a little testy there even amongst some of them their professionals.

It seems issues pertaining to mental health have a way of bringing out the best and/or hottest in the jalapeños.

Both sides having interesting positions then it reverts and degrades to the usual tactics noted in a comment by one of the participants, skillsnotpills, which I personal found of worthwhile interest to repeat and share here:

“Let’s look at the defenses of scoundrels, shall we?

Raise an issue or promote a cause that really is more gray, or is really less legitimate than claimed, and have ‘facts’ and questionable empirical evidence that is, in the end, refutable when closely examined. Then, do not give those with legitimate concerns a fair chance to review the data or have equal time to rebut. Then it begins:

1. Attack your opponent as being irrelevant and not supporting an issue that has merit, or claim the opponent is denying those who allegedly could benefit because the scoundrel says so and raised the matter first.

2. Once the opponents do in fact have positions of merit, then project, as the scoundrel is in fact guilty of doing, onto the opponent and blur the issues to obscure who is really guilty of inappropriate behaviors or unreasonable basis.

3. Once the opponent has shown he/she/group is not guilty of such false accusations, then the scoundrel will muddy the waters with spurious details that could give some merit to what the opponent has in fact raised, but in the end still claims the original intent has more pros than cons.

4. If the original pursuit still has too much to lose for the scoundrel, then try to bring on others who mistakenly buy into the scoundrel’s porous claims to try to legitimize the agenda.

4a. If the pursuit is a lost cause by now, the scoundrel will try to minimize the original claim and redirect the agenda, or try to slip out as best undetected, usually sloughing the baggage onto someone who had innocently come on board early on in the process.

5. Once the facts and goals are clearly understood and realized by the masses, the opponent is somewhat vindicated, but usually muddied and bruised.

The cost of pursuing the truth. No good deed goes unpunished. This is my epitaph.

Note I am not saying this directed to Dr Grohol, but I do feel this issue has qualities of this process as started by others, maybe with some true, responsible intent, but now very muddied.

Transparency, folks, and deeds speak louder than words. What defines healthy and appropriate intent. Or, as the business model also says, Buyer Beware! I now leave having said my peace and piece on this issue, as I agree with a blogger who earlier this PM advised me this issue is too emotional to maintain levelheadedness, as I have been guilty of today. But, legislating this issue is wrong, and as someone on the front line of post partum depression, I do know what I am talking about.

Hopefully, and ironically, sanity will prevail.”

Warmly,
Herb
VNSdepression.com

Jul 16 3:39 PM

Brenda Mayer Says:

As someone who went through PPD after both my pregnancies I’m inclined to be in favor of screening but it would depend on how it is carried out. I think it would be more worthwhile if screening led to a referral to a psychiatrist or mental health therapist for further evaluation rather than a PCP or OB/GYN making the determination and immediately writing a prescription.

Although I understand and appreciate the concerns regarding overtreatment of baby blues or normal emotional fluctuations, I believe automatic screening will increase awareness and reduce stigma. Unfortunately, the idea of PPD that many have comes from media attention to extreme examples. Add that stigma to what I perceive as a common desire to be seen as a good mother (ie not depressed) and it’s quite possible to have undertreatment to the detriment of mothers and their children.

I wanted to post here as it looked a bit heated over at Psych Central.

Jul 16 10:09 PM

TMack Says:

I’d been in the company with someone with PPD. It was brought to the Doctor’s attention. We talked about options including talk therapy, meds if necessary. We monitored it closely. Thankfully it went without incident by us talking and our support with each other.

I don’t have an issue with pre-screening in general for anything. You are made aware of the possibility and you have the choice on how to act. How can that be a bad thing?

Made aware of any illness so you can be prepared and educate yourself about it. Hell ya!!!

This is just my opinion. Hopefully I read this right.

Jul 17 9:20 AM

TMack Says:

Oh, and I’m sorry about this. My apologies to anyone that I may offend.

But as far as Scientology is concerned… we may only hear from until when in 2012 their mothership returns to take them home.

Jul 17 9:23 AM

Charlotte A. Weybright Says:

In response to those who think this would be a good idea – remember if we are talking about informed consent for just an individual, it is different than laying a guilt trip on a mother if she is diagnosed with some level of depression, emotional ups and downs, etc. during pregnancy.

She will more than likely be offered drugs, and, if she doesn’t take them, perhaps she will be sent on a guilt trip – either self-imposed or by others. Informed consent then loses its luster and becomes forced consent.

Jul 17 2:02 PM

Naomi Says:

One should not attach stigma to drugs. One should attach stigma to misuse of drugs. And it is silly to pretend that drugs so rarely benefit women with PPD, that any stigma outweigh the benefits of merely *screening* for depression. It is no different than screening for cancer. Which is another disease that people used to whisper about, rather than face head on.

Jul 18 1:25 AM

Ken Don Says:

I’d like to voice my disgust at Spikol’s blanket assertion that any opposition to psychiatric ideology is sectarian. There is significant secular opposition to psychiatry, and spikol just uses the scientology label as a semantic blackjack to stifle debate. Of course, I’d like to voice my disgust at Spikol being pro force, on forcing the psychiatric ideology down the throats of all new mothers. If a consenting adult mother wishes to persue fanatastical ‘brain disease’ explanation for their despair, let them, but to mandate it? You’ve got to be kidding me.

Jul 18 7:12 AM

Lisa Van Syckel Says:

Im in opposition of this legislation,.. and Im not a Scientologist. This is one of the reasons that those who are in favor of this bill are looked upon as behaving immaturely. Only second graders believe others have the cooties.

Jul 18 11:03 AM

Gail Says:

If the hormonal depletion that comes along with menopause can trigger full blown depression that can disrupt some lives, certainly the hormonal changes accompanying childbirth can do the same in individuals susceptible. False positives may be a result of screenings but false negatives may be a result of NOT screening. In which direction should the scales be tipped? In which direction would less harm be done?

Jul 18 11:13 AM

kimbriel Says:

Gail- that’s hard to say, but having spoken with hundreds of people who’ve shared stories of psychiatry gone wrong, both directions have risks involved. Remember that Melanie Blocker-Stokes was undergoing “treatment” herself when she leapt to her death. Until psychiatry can post better long term outcomes on a widespread basis (I have also looked at the data, and it’s not good)- I refuse to support this bill which would only result in the intrusion of psychiatry into people’s lives. And no, I am not a Scientologist.

Jul 18 3:10 PM

Gail Says:

kimbriel-It is most unfortunate that Melanie Blocker-Stokes PPD treatment was ineffective in saving her. I wonder if she had been screened before the depression was in full throttle whether the outcome might have been different. I understand that psychiatry isn’t an exact science and that different combinations of medications and therapies have to be tried before one works for that individual and also that it takes time to overcome depression. Ten years ago I was diagnosed with cancer. The treatment depleted my hormones and sent me into an early menopause in one day. NO ONE SCREENED ME FOR DEPRESSION and I went into a deep depression, not sleeping or eating, much like Stokes. I recovered from the cancer with medical treatment, and the depression as well. Hormone replacement therapy was necessary, along with antidepressents, and talk therapy all temporarily, BUT IT SAVED MY LIFE. Sometimes vigilance can do that. Not all doctors and hospitals are equal and some of us learn the hard way. No, I don’t think screening for depression could be a bad thing.

Jul 18 8:01 PM

kimbriel Says:

Thank you for sharing your story– glad to hear that you had a positive experience. Here’s my story: I had the EXACT SAME condition as Stokes (postpartum psychosis) and I don’t know about her, but I had no symptoms of depression or anxiety during the pregnancy at all- they caught it as quickly as they could. After I was “treated” psychiatrically, I have no idea why I didn’t kill myself. I sure felt like it.

Four years later, I had another “manic” episode (there is much research saying that Postpartum Psychosis IS Bipolar disorder, it’s a manic episode that coincides with the postpartum timeframe). I tried medication for over a year. I swear to you, it was the craziest, most dysfunctional year of my life– NO ONE in my life thought I was doing “better on medication” except for the psychiatrist I met with once every 6 weeks for half an hour. Bipolars are known for their “impulsive decisions” but honestly, the only decision I made while manic that I regret is ever getting involved with psychiatry. I believe that the decision to disclose a woman’s emotional life should be left up to the woman and based on a trusting, genuine relationship between her and her practitioner– not a screening test.

Jul 18 9:54 PM

Gail Says:

Your story is quite different than mine. Thank you for sharing it. I am trying to learn as much as I can so that I can make sound decisions for myself, as well as advise my daughter, who has been diagnosed with bipolar disorder. It is a difficult road to travel with many pitfalls. There are choices that have to be made and risks that have to be weighed. I wish you the best.

Jul 18 11:30 PM

Joe Says:

I wish there was a study of the outcomes for individuals who have been screened for mental illnesses. Can we reasonably expect that persons screened positive will be able to access the care they need and achieve successful outcomes? Is there that elasticity in the mental health system sans additional funding or the personal resources of the individual screened to allow those suffering from PPD to access the services they deserve?

Depression Patients Lost to Follow-Up After Leaving Emergency Department [2009].

“Only 1 in 10 callers posing as patients just released from hospital emergency departments and diagnosed with acute depression could get appointments for community-based follow-up care, regardless of insurance status.”

The Relationship Between Quality and Outcomes in Routine Depression Care [2001].

“Only 29 percent of the patients received guideline-concordant treatment.”

Jul 19 4:33 AM

farmily member Says:

It has already been proven that women with post partum depression are not able to interact and bond with their newborns in the same way as a woman who is not suffering from post partum depression. In Philadelphia they are starting the screening at the newborns pediatricians office appointments (that is they will screen the mother too). Since it is also proven that having a parent with untreated or not treated properly mental illness can and does affect the children, why wouldn’t you want it screened and treated. The children are innocent and do not need a mother that is not able to function at her best during a critical time of interaction with her infant. Kids who are not bonded with, with a healthy mother, do have problems later in life, including bipolar!

Jul 20 10:40 AM

Maria Says:

Please check your facts!! Why is it that mental health and especially women’s mental health is so mystified? OB/GYN’s as well as family practitioners and arguably ANY other licensed physician must be trained to diagnose and treat depression and prescribe treatment. It is not a subjective/magical call, the standard for diagnosis is the the DSM-IV and although a great deal of controversy already surrounds it’s adequacy, it remains the standard in the psychiatric community. It is not true that OB/GYN’s should not be prescribing medication for depression. Considering the prevalence of this condition in women of reproductive age it would be a disgrace if women’s doctors were not capable of treating them. In a society in which health care is a luxury, the least amount of professionals a busy new mom needs to visit to ensure her wellbeing and that of her baby, the better. The bottom line is that PCP’s, OB/GYN and family practitioners should not be encouraged to pass the buck on mental health issues and make it someone else’s problem. Depression is a medical condition and licensed physicians are under the obligation to treat them.
Thank you,

Jul 21 1:54 PM

Joe Says:

I wonder if things have changed since 1997,”Treatment of Depression by Obstetrician-Gynecologists: A Survey Study” includes, “Ninety-five percent of obstetrician-gynecologists reported that they referred severely depressed patients to a mental health professional. A majority of respondents neither received residency training (80%) nor completed a continuing medical education course (60%) on the treatment of clinical depression in women.”

journals.lww.com/greenjournal/Abstract/1997/08000/Treatment_of_Depression_by.28.aspx

Jul 21 3:18 PM

Jennifer Says:

Gabriel, you nailed it! Amen. End of story.

Jul 23 7:31 PM

Jennifer Says:

Herb, you haven’t read much else by skillsnotpills, have you? He does a good job of “passing” as reasonable when he’s in control of himself. When he’s not, look out….arrogant, ignorant, and paranoid as h***.

Jul 23 7:34 PM

herb Says:

Jennifer,

No, I haven’t.

Warmly,
Herb
VNSdepression.com

Jul 24 4:48 AM

Aaron B Says:

“I believe that the decision to disclose a woman’s emotional life should be left up to the woman and based on a trusting, genuine relationship between her and her practitioner– not a screening test.” –Kimbriel

That really is all there is to say, isn’t it? Supporters and activists for women’s rights are quick to say, “Keep your hands off my body.” but what of the mind, or if you want to accept the medical model, what of the brain?

Jul 28 9:07 AM

Katherine Stone Says:

Thank you for writing about this Liz, and encouraging your readers to discuss it.

Jul 29 9:39 AM

herb Says:

Dear Katherine,

While I thank you for your thoughts regarding the discussion of this matter what you omitted and which I personally found to be well presented is the link to your posting of Alison Palmer’s letter to Time Magazine.

A Nurse/Mother’s Letter to Time Magazine: Alison Palmer

http://postpartumprogress.typepad.com/weblog/2009/07/postpartum-depression-time-mothers-act-palmer.html

In my opinion Ms. Palmer’s thoughts are extremely well presented, professional as she is and mediated in temperament and understanding of the issues as opposed to the anti-pharmacy and anti-psychiatry zealot’s rhetoric and more directed to the issues and needs of the mother (patient).

Warmly,
Herb
VNSdepression.com

Jul 29 11:17 AM

Katherine Stone Says:

Herb,
Thank you. You should see the rest of the letters. Try this one: http://postpartumprogress.typepad.com/weblog/2009/07/open-letter-to-time-magazine-about-postpartum-depression.html

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