Dropping the Baby and Other Scary Thoughts

Breaking the Cycle of Unwanted Thoughts in Motherhood

Karen Kleiman, Amy Wenzel

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781136857690
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

What if I drop my baby when I go down the steps? What if I burn the baby in the bathtub?

Thoughts like these can be frightening to new mothers, but are a common symptom pregnant and postpartum women can experience. Dropping the Baby and Other Scary Thoughts addresses the nature of these intrusive, negative and unwanted thoughts. Kleiman and Wenzel offer answers to the women who seek information, clarification, and validation in this useful resource for healthcare professionals working with these mothers. Written by two clinicians who have established themselves as leading experts and authors in this specialized field, this book maintains a compassionate tone that will be a voice familiar to many women in the postpartum community. Whether you must confront these negative notions personally or in your practice, this book will explain what these thoughts are, why they are there, and what can be done about them.

Section III
Breaking the Cycle of Scary Thoughts

7

Things You Can Do to Feel Better

I swear I was possessed. It was like one part of my brain was off on its own with stabbing thoughts that didn’t make sense to the other side of my brain. I felt like a stranger in my own body, almost like I was there and not there at the same time. It was weird. I told no one how I was feeling. Absolutely no one. I believed if I told anyone how I was feeling they would surely think I had lost my mind. Everything looked good on the outside so I just pretended everything was fine. I mean, no one could tell there was so much chaos in my head. But the thoughts would pierce through my brain when I least expected it, usually when I was bathing the baby. Bath time took only as long as I could hold my breath and get it over with. I didn’t know what else to do.

Jen, 5 months postpartum

Dealing with scary thoughts is not just a matter of willpower, as some claim. Although willpower may indeed be part of the solution, we’ve seen throughout this book that it is more complicated than simply wishing thoughts away. We’ve all heard the truism that if we think positively, we’ll feel better. Sounds good, doesn’t it? Research has shown that one of the most significant attributions for recovery from anxiety or depression seems to be the individual’s belief in her ability to take control and be successful (Kinnier, Hofsess, Pongratz, & Lambert, 2009). In other words, if someone believes she will be successful, she is more likely to succeed.

For our purposes here, even though some of the suggestions may feel counterintuitive at first, it will be helpful for you to believe that some of what you read in this chapter will help you feel better. Though we realize it is much easier said than done, great personal power can come from shifting the focus of your energy from fear (negative) to acceptance (positive). For mild to moderate degrees of distress, women report that they feel more in control of their lives when they take responsibility for how they are feeling and identify the specific actions they can take to feel better.

In Chapter 5, we discussed the barriers to disclosure, or those things that get in the way of women speaking up about how they are feeling— the critical voice, the sentencing factor, the depression factor, the ambiguity factor, the propaganda factor, the community factor, and the what-if factor. All of these impediments combine to create a setting that discourages women from admitting they are having scary thoughts. Due to the high degree of distress you may be experiencing with your scary thoughts, our attention now turns to some specific self-help strategies you can rely on to ease the impact of your anxiety, depression, and scary thoughts. As you read, keep these six principles in mind:

• Denying the feelings and thoughts will not make them go away.
• Panicking will make them worse.
• Resistance creates persistence.
• Distraction will help for a while.
• Enhancing awareness might feel counterintuitive, but it is meaningful.
• Acceptance is hard but essential.

WHAT WON’T HELP: COUNTERPRODUCTIVE REACTIONS

Most women respond to the distress of scary thoughts with mechanisms that are called upon to protect them from emotional pain. Some might refuse to believe the thoughts are there (denial). Others might try desperately to make the thoughts go away (thought suppression). Another common response is to react with sudden, intense fear that interferes with the ability to function (panic). Although these three responses are quite common and understandable, they will not help you feel better, and they can even make you feel worse.

Denial

One of the first responses reported by postpartum women with scary thoughts is denial. Maybe if I just pretend it isn’t happening, it will go away. Denial serves to protect people emotionally. In some instances, it can be temporarily adaptive, such as when someone is forced to deal with the reality of unbearable news. Likewise, this common psychological defense seems to soften the blow of scary thoughts. However, when someone refuses to or simply cannot accept the certainty of a situation over time, denial is viewed as maladaptive. Because scary thoughts are so often accompanied by feelings of shame and the belief that one is damaged in some way, they often are wished away with fierce determination. Many women who are having scary thoughts believe it would feel better to pretend they weren’t there. Sometimes this is evident from the initial phone call to the clinician:

“Are you having any thoughts that are scaring you?”

“No.”

“Is there anything else you would like me to know before we set up the appointment?”

“Not really.”

“Then let me take a look and find a time for you to come in as soon as possible so that you can start to feel better.”

“Okay … um … uh … I … I’m not having thoughts of hurting my baby or anything. My doctor asked me that and I’m not having thoughts like that.”

“Okay. Are you having any other thoughts that might be worrying you? It might feel better if you tell me now before we meet. Perhaps I can reassure you, so you don’t have to worry so much in the meantime.”

“No. Everything’s fine. I’m just crying all the time. I’ll be okay until our appointment.”

Women would rather not admit that they are having scary thoughts, at least not at first. The denial we are talking about here is slightly different from the unconscious, ego-protective defense mechanism taught in Psychology 101. Here, the denial is more of a conscious or deliberate attempt to shield one from the reality that feels so unacceptable. The distorted belief is that if I don’t put words to it, it isn’t really happening.

The benefit that comes from denial is a short-term reprieve. Essentially, what it does is grant some time to adjust. After all, having a scary thought, however fleeting or purposeless, can be unsettling. The refusal to acknowledge it becomes a stumbling block in the long run because it prevents one from taking action that could help alleviate one’s stress. In this way, denial is self-sabotaging by directly interfering with the management of scary thoughts, as well as postponing relief from them.

Thought Suppression

We’ve seen that denial can surface as an immediate reaction to uncomfortable states of anxiety; it also requires a substantial investment of energy. Because of this, other defenses may be called upon. Thought suppression is the deliberate act of trying to force the unwanted information out of your awareness.

Remember the old brain teaser: “For the next 2 minutes, think about anything you want, but you cannot think about pink elephants. Think about whatever you want, but you must not think about pink elephants!” Of course, everyone reports seeing one or more big pink elephants in the mind’s eye immediately after being told to suppress that image.

Over 20 years ago, a study was carried out to test the prediction that a person’s attempt to suppress thoughts can result in preoccupation with that thought—a phenomenon the researchers referred to as a rebound effect (Wegner, Schneider, Carter, & White, 1987). In this experiment, participants were asked to speak spontaneously for 5 minutes straight, talking about anything and everything. Next, they were again asked to verbalize everything that came to mind, but this time they were told not to think about a white bear. They were instructed to ring a bell each time they said or thought “white bear.” Interestingly, when compared to a group that was told to think about white bears, the group that was asked to suppress white bear thoughts had significantly more thoughts on this topic.

The researchers concluded that attempts at thought suppression had a paradoxical effect, suggesting that suppression might produce the very thought it is intended to stifle. Subsequent research has supported this notion and confirms repeated failure by people to suppress unwanted thoughts (Wenzlaff & Wegner, 2000). In other words, thought suppression just does not work.

This work has strong implications with regard to thought control as a self-help strategy for postpartum women with scary thoughts. Most postpartum women will admit that their initial instinct is to suppress the thought; quite simply, they want to make the bad thought go away by trying not to think about it. The notion that it is unhealthy and even dangerous to stifle emotions and bottle them up inside is not a new one. But the message here is an important one: The instinctive response to control a scary thought by holding it in or concealing it typically backfires and makes things feel worse. Persistence creates resistance; the more you try to push thoughts out, the bigger they get.

This paradox was described in Therapy and the Postpartum Woman (Kleiman, 2008) using the metaphor of a filled water balloon. Imagine trying to control a wobbly water balloon resting precariously in the palm of one’s hand. Your instinct is to grab it as it rolls from side to side. But in doing so, you find that the overstuffed balloon either pops out of your gripping fingers and onto the floor, or it bursts right within your grasp into a sopping mess. Either way, control has been lost. The only way to gain control over an unsteady water balloon is to release your fingers, slowly open your hand, and let go of the tight grip. This exercise demonstrates the paradox of control. Letting go when you are overwhelmed and frightened is difficult and can feel counterproductive, but it works. We say more about letting go at the end of this chapter.

Panic

Negative self-talk can trigger or aggravate a state of acute anxiety. Karen refers to this as an “uh-oh” response: Oh no, I’m having that thought again. Uh-oh, here it comes again. Oh my God, now I won’t be able to do what I need to do. Oh what if I get sick again like the last time? I can’t do anything; oh no, I can’t breathe. I really cannot breathe. This snapshot of a paralyzing moment in time demonstrates the power of negative thinking and the manner in which it can escalate from one short exclamation into a blast of memories or associations. If one is experiencing panic, recognizing the thoughts that precipitate this barrage of emotion is an important step toward relief. In the next chapter, we will examine some specific strategies to help restructure negative thinking into more productive patterns.

Panic and negative thoughts have a reciprocal relationship; that is, one contributes to the other. Knowing this can promote both awareness and management of the scary thoughts. If a postpartum woman is in treatment for anxiety or depression, she will notice that as her anxiety is successfully managed, her scary thoughts will likewise decrease in degree and/or severity. This is because, as stated previously, it is not the content of the scary thought that is noteworthy; rather, it is the level of distress it causes. Thus, even though a woman may be preoccupied with the content (Why would I have a picture in my head of my baby lying in a coffin on the beach?), trained clinicians will focus their intervention away from the specific content and toward treatment of the anxiety.

Panic has the innate capacity to undo lots of hard work. Jen felt for sure that she was driving herself crazy. She knew she didn’t have any good reason to worry so much.

“Does anyone?” she would ask. “I mean, yes, I know some people have real reason to worry, God knows. So that makes me feel guilty, of course. But don’t most people who worry a lot worry for no good reason?”

“What do you mean, ‘no good reason’?” Karen asked.

“I mean my baby is healthy. My husband is awesome. I have everything I’ve ever wanted. I should feel great, but I don’t. I worry about everything. And nothing. And then, BAM!! Just when I think my brain is coasting along for a slow ride, I smack into some nasty insane thought about some God-awful thing happening to my baby or my husband. Slam! Right out of nowhere.”

“That’s a terrible feeling, especially when you’re not expecting it. What do you do when that happens?”

“Oh my God, I freak. I can’t breathe, and I start to sweat. My whole body shakes like I have a chill or something.”

“Do you know what you’re thinking when you are feeling that way?”

“Yeah. I’m thinking, ‘Shit, I can’t believe this is happening again!!’ ”

Jen was a 33-year-old mother of two, with the youngest only a few weeks old. Unlike her sister, who experienced significant anxiety growing up, Jen was unfamiliar with this agitated state and even seemed to dodge it after her first child was born. But with her second baby, she was overcome with anxiety from the start. Each day brought unfamiliar waves of uneasiness that made her wonder if something really awful was happening to her. During those times when she felt less anxiety, she would feel closer to her wish that all of her scary thoughts and feelings would magically disappear. Then, BAM (as she described it)—an unwanted thought would strike like an electrical jolt, setting aflame every worry she could possibly imagine. The worst, of course, was worry about harm coming to her baby.

Jen’s resistance to her anxious thoughts created the perfect setting for panic, which then found its way right to the heart of her vulnerability— harm coming to her baby. Here’s an oversimplification of what was happening: When a woman experiences a scary thought, she can go down one of two roads. She can say or think, Okay, I know what this is. I understand this is an irrational thought and has nothing to do with what is really going to happen or not happen. I can try to distract myself. Maybe I’ll call my friend. On the other hand, she can say and/or think, Oh my God, why is this happening again?! I thought I was okay. I thought this wasn’t going to happen again. Maybe I really am going crazy. What do I do?! Jen’s “uh-oh” response is an example of this second response. That road is more likely to increase feelings of helplessness, loss of control, and panic.

The core principle behind the first response is learning to refocus and label scary thoughts as unwanted and, more importantly, unthreatening. This takes practice and is typically not intuitive. The knee-jerk reaction for most postpartum women, particularly those with a predisposition to anxiety, will be to charge down the second road. It seems automatic, sometimes, to do what’s familiar, even if it accentuates the mental stress.

Choosing the first road requires a deliberate decision to respond differently by modifying the usual response with an unfamiliar, more practical one in order to achieve a better outcome. It’s easy to imagine in theory. All you have to do is respond differently, and you won’t panic as much! Sure. Easier said than done. Nevertheless, understanding that you do have power over how you feel is an enormous victory. Putting it into practice and believing in your capacity to follow through is the next step.

WHAT WILL HELP: SELF-HELP STRATEGIES AND NONPR...