thinky bits on medicine, mental health, and the like

It's becoming obvious that the Zoloft is finally kicking in. I have a hard time sitting still if I'm not actively doing something (typing, knitting, etc). Zoloft seems to be a bit more subtle, mentally speaking, than Lexapro was - it sneaks up on you, like sunrise, rather than being like turning on a flood light in your brain.

One of the benefits of it finally kicking in is that there's room in my head to sort out what's actually going on in there these days. A couple weeks ago, it was hormones and stress and just plain not knowing what was happening, with me and with Alex. Now though...it's mostly grief for the things that didn't go the way I had hoped and planned.

One of the things that I've realized in the process here is that American society is just plain fucked up. And in some respects, so is our take on mental health, and the medical profession's dealings with things like mental health and pregnancy.

First: Grief and depression are two different things that sometimes have the same outer symptoms - a lack of ability to cope with overwhelming circumstances, tears, sleep disturbances, etc.

While society doesn't handle depression as well as it could, it's somewhat acceptable, because they can give you a pill for it and it goes away. Grief, on the other hand, is messy and inconvenient and you can't just turn it off, and so it's completely unacceptable.

While grief can devolve into depression...there's no need to treat it as depression right off the bat. Grief is a process, and it is ok to grieve - important even - regardless of what society says.

Second: American medicine is often based in fear today - the fear of being sued if it's not perfect. As such, it causes doctors to do some things simply because something might happen, not because it actually will. It also causes them to treat normal conditions, like pregnancy and grief, as illnesses rather than natural processes.

Maybe one of the biggest examples of this phenomenon is post partum depression.

Please note: I have no problems with the idea of screening every woman for post partum depression. I do have some issues with how it's done.

At least here, you're screened based on past personal history and stress during your pregnancy, in the 24 hours you spend on the mother-baby ward before they send you home. If you screen as high risk, they interview you before you leave, and call you when you get home, and make your doctor fill out a follow up at 6 weeks post partum. They don't follow up at all if you don't screen as high risk.

This is all done in the name of not missing the next Andrea Yates - because the potential lawsuits are bigger than they want to even think about.

*****

A few years ago, I realized that, for me, part of the healing process was to be able to talk about these things - being able to admit that I'd been suicidal was a way of owning the situation, and being honest with my family is important to me. Further, it's a safety check - while I've promised myself never to let things get that bad again, it also means that those close to me are aware of where I've been, and check on me when I'm not doing so well.

Early in my hospital stay, the high risk OB asked point blank about depression, meds, and whether I'd ever been suicidal, and I very calmly answered him with the truth. He told me that if I thought I needed help on that front to ask.

A couple days after Alex was born, the same questions came from the OB on duty that day (Dr G, who I really like), along with questions about how things were going. After some discussion, we agreed that zoloft might be a good idea.

Of course, things got worse after that point, long before the meds could have an effect. By the time I made it to the mother-baby ward, things were falling apart in my head - though again, it was grief more than anything, and stress.

And between the screening test, the discussions with the doctors in labor & delivery, and the pre-checkout interview with the post-partum social worker, it appears that the report that came back to Herr Dr M was that I was already deeply depressed and I should be watched closely lest I harm myself or my child.

The post-partum social worker called the NICU social worker, and asked her to keep tabs on me. She asked all the same questions again, and was very pushy about counseling or attending support groups. And by this time, it was starting to feel like the inquisition - like I was being punished for being honest. Like if I'd just lied about my history, they would have left me alone.

The social workers keep saying, "oh, we know it's stressful having a baby in the NICU." And maybe I'm just weird, but it's really not stressful that Alex is there. Obviously he's already been forcibly evicted from my body, where he should still be, so he needs to be somewhere that can take care of him. If things go badly, if any issues come up, I am very comfortable that the NICU staff will do everything humanly possible to fix him.

There are stressful incidents (like holding him and watching him turn blue as his oxygen saturation tanks), and occasionally stressful periods of waiting for an answer or not knowing what the next step is, but the experience as a whole is much less stressful than before he was born, when the best they could offer is that his heart was still beating and he was probably still growing since my belly was growing, or that the ultrasound said he was still moving, so he's probably ok. This way I can walk in every day - call 100 times a day if I want - and find out exactly how he is. I can put my eyes and hands on him and check for myself any time.

Would it be better if he was healthy and at home? Absolutely. But he's not, and he needs more help than we can give him, so home is not the right place for him to be right now.

Even my mother has been asking about my mental state - and she's a therapist. She suggests that I should seek counseling instead of a support group, because it's fewer people and she'd rather see me address the larger issues at hand. Because, you know, she's a therapist, and these things are helpful.

The thing is...part of the reason it was so stressful to be questioned over and over again was that even then, before the drugs kicked in, I knew that the problem at hand wasn't depression per se - there was more to it than that, and blaming it all on depression was making me more stressed. Depression is an illness, but I can't allow it to be an excuse for things in life being fucked up, because when it becomes an excuse, that's usually a sign that I'm not taking care of me the way I need to. The assumption that I can't take care of myself, particularly coming from people who don't know any more about me than a survey about the stresses in my life, is one that bothers me a lot.

They weren't even giving me time to attempt to process the situation on my own before pushing the idea that I needed help to process it. And really, at this point, it just makes me mad. If I'm not broken, just somewhat off balance as I keep being told, why the insistence that I need help to be fixed?

Can grief become depression? Sure. Has mine? I don't think so - if so, drugs would fix more than they have. Was depression a factor? Yes - it's a factor for me every day, and it means when I get overly stressed, it's difficult to sort things out as quickly as I need to. Do I need counseling? Probably. But if so, I needed it long ago, so it's really only that this is adding to it, not that I need counseling specifically because of Alex.

So, I guess that leaves me still thinking, and deciding what the course of action to take is, in the midst of a fucked up system and a fucked up situation.