A Secret Sadness: Interview with Dr. Valerie Whiffen

For information about my book, A Secret Sadness, listen to my podcast interview with psychologists, Dr. Brian Macdonald and Dr. Guiseppe Spezzano.  The interview is published in two parts.  In the first part, we talk about patterns in parent-child relationships that may promote the development of depression later in life.  In the second part, I describe how women’s romantic relationships can lead them to become depressed.  For reviews and other information about my book, please visit www.secretsadness.com.

Those of you who are interested in family relationships and parenting will find lots of valuable information and interviews with other writers and researchers at the website hosted by Drs. Macdonald and Spezzano.

 

The Six Myths of Postpartum Depression

Myth # 1: Having a Baby Causes Postpartum Depression

The name says it all: “postpartum” depression is brought on by having a baby.  It’s true that women are more likely to be depressed during and following pregnancy than at other times in their lives.  Surveys of women who recently had babies show that about 13% are depressed which is higher than the normal rate for women in their childbearing years.  However, this finding doesn’t mean that they became depressed after giving birth.  Studies that follow women from pregnancy through the postpartum period show that up to 40% of the women who are depressed after childbirth also were depressed while they were pregnant.  At this time, we don’t know how many of these women were depressed before becoming pregnant or what role the pregnancy played in their depression.  At least some of these women will be depressed for reasons unrelated to their pregnancy, such as the death of a family member.

Myth #2: Postpartum Depression is caused by Hormones

Myth #2 follows from Myth #1.  If having a baby causes postpartum depression then postpartum depression must be caused by hormones.  You read it in magazines; you hear it from your doctor.  This is the most persistent – and the least substantiated – of the six myths.  For 50 years researchers have tried to find a link between hormones and postpartum depression.  They’ve looked at the levels of estrogen and progesterone, both in isolation and together.  They’ve looked at the rate at which these hormones return to normal.  They’ve found nothing.  There is not a single piece of evidence to support the myth that hormones cause postpartum depression.

However, the persistence of this myth is impressive.  I’ve had the experience of sitting in my office with a postpartum depressed woman and telling her what I’ve just written only to have her say, “Well, yeah, but I’m feeling really hormonal.”

Myth # 3: Postpartum Depression isn’t the same as Regular Depression

This myth follows from Myth #2.  We know that reproductive hormones don’t cause depression if a woman hasn’t recently been pregnant.  So if postpartum depression is caused by hormones, it must be a different kind of depression.  Some people argue that the symptoms are different; others believe that postpartum depressed women want to hurt their babies.  The media are particularly keen to link postpartum depression and killing one’s baby.

What does the evidence say?  When postpartum depressed women are compared to depressed women who haven’t just had a baby, there are very few differences.  One is that the postpartum women tend to be less severely depressed.  However, the types of symptoms they report and how long their depression lasts are the same.

Another issue is the predictors of postpartum depression.  If this is a different kind of depression then it should be predicted by different factors.  However, the predictors of postpartum depression are identical to the predictors of regular depression: life stress, a lack of social support and a difficult marriage.

In all the ways researchers have thought to look, postpartum depression looks the same as regular depression.

Myth #4: Postpartum Depression doesn’t need to be treated

This myth also follows from Myth #2.  If postpartum depression is due to hormones then the woman just has to wait for her hormones to come back to normal.  Physicians will often assure postpartum depressed women that their depression will get better as time goes on.

This myth is dangerous.  It may be one of the reasons that postpartum depressed women typically don’t receive any form of treatment.  But they should.  Women who are depressed during or after pregnancy are at risk for more depressive episodes, both after the birth of later children and at other times in their lives.  For many women, the postpartum episode is just the first of many.  This finding makes it an important episode to treat because the research shows that every time a woman gets depressed she increases her risk for another depression.

Depression at this point in a woman’s life also can have enduring consequences for her baby and her marriage.  When a new mom is depressed, her baby develops more slowly, cries more often and is less likely to form a secure attachment to her, which can create problems for the child later in life.  Women who experience postpartum depression also are less happily married 5 years later than women who didn’t become depressed.

Myth #5:  Postpartum depression occurs out of the blue to emotionally healthy women

This myth certainly reflects what many women tell me.  However, the impression that they were okay before the baby simply isn’t borne out by the research.  The majority of women who develop postpartum depression have sought help for emotional problems in the past.  The strongest predictors of an episode of postpartum depression are: 1. A previous history of depression and 2. Feeling depressed during pregnancy.

Myth #6: Only women experience Postpartum Depression

Again, this myth follows from Myth #2.  If postpartum depression is due to hormones then there’s no reason to think new fathers will become depressed.  In fact, having a baby is even more disruptive for fathers than it is for mothers, and on average more distressing.  Up to 10% of new dads experience significant levels of anxiety and/or depression.  This rate is 1 in 4 if their wives are depressed.

So what is Postpartum Depression?

If it’s not what the myths say it is, what is it?  The causes of postpartum depression are just as varied as the causes of regular depression.  A woman can become depressed because one of her parents dies, because she loses her job in a bad economy, because she’s all alone in a foreign country.  There are just as many causes of depression as there are individual’s life stories.

That being said, the research does suggest certain patterns.  The typical woman who experiences postpartum depression is unhappy in her romantic relationship and may fear that her partner does not love her.  She feels unsupported by him.  Perhaps her partner does not help out around the house or with taking care of other children.  Outsiders may see her partner as indifferent to her.  These factors induce depression at any point in a woman’s life.  When women are unable to have close and harmonious relationships with the people who are most important to them, they feel bad.  I believe this is especially true when a woman is pregnant or has just had a child because the baby is a tangible sign of her commitment to her partner, and she is sensitive to any indication that this commitment is not shared.

There is a reason that women who’ve just had babies are more likely than other women to experience depression – it just has nothing to do with hormones.

The Dance of Marital Distress

Like many people, most of what I know about the private lives of celebrities comes from the covers of the magazines at the supermarket checkout.  Most of this information makes a fleeting impression (Whatever happened to those twins Jen was carrying?)  But occasionally a story catches my eye because it feels heartbreakingly familiar. 

A few years ago I read that Demi Moore’s name on twitter was “mrskutcher.”  I was taken by surprise because in films she gravitates toward parts where she is strong, independent, even witchy.  I was struck that a woman who projects such a strong image would invest her identity in her relationship with her husband.  Of course, women do this all the time.  Even when we’re highly successful, we often think of ourselves as wives and mothers first. As a therapist, though, another possibility presented itself: sometimes women who project a strong image are longing for a romantic relationship in which they can feel safe. 

Last fall, as the Kutchers’ marriage unravelled, Demi Moore gave an interview to Harper’s Bazaar in which she confessed to feeling “unlovable.”  “Unlovable” is a big word to a therapist.  We can all feel unloved at times, by a specific person or in a particular context, but the word unlovable suggests that not being loved is part of who she is, not an aspect of her marriage.  Why would a successful woman, a rich and beautiful woman, think she wasn’t worthy of love?  It’s in the past, Demi explained.  Although she didn’t say what had happened, her past has left her feeling “unsafe” whenever she isn’t in control.  When people feel unlovable and unsafe in relationships, they’ve often grown up in families where they felt rejected or were abandoned. They enter new relationships afraid there’s something fundamentally wrong with them and terrified they’ll experience rejection again. And, as it did to Demi, the outcome that is most feared is the one that often happens: Ashton had an affair.

A couple of months later, an alcohol and drug-fueled meltdown landed Demi in a mental health facility for treatment of her “addictions and eating disorder.”  When relationships end, it’s often the person who felt most insecure who is devastated.  She can feel that she’s failed and become depressed; she can use drugs and/or alcohol to numb the pain; she can hold tenaciously to the belief that if she was just more beautiful, or 10 pounds thinner, the relationship wouldn’t have ended.

Meanwhile, Ashton was photographed partying in Brazil with a clutch of lovely young women.  He returned to LAX the day after his wife’s hospitalization, stony-faced and silent.  Implicitly, the media accused him of indifference.  In his defense, unnamed sources claimed Demi was no longer the woman he’d married, that she’d become “needy” and insecure. 

This pattern – an insecure, needy and emotionally distressed woman and her apparently indifferent husband — is so common when couples are unhappy that it has a name: the academic-sounding “demand-withdraw interaction pattern.”  80% of the couples I work with show this pattern.  One partner demands, pleads and cries, or is angry, controlling and critical, while the other retreats, is defensive and withdrawn, and passively refuses to do what the demander wants. Around the world, and regardless of sexual orientation, couples that show a demand-withdraw pattern are unhappy.

Like the Kutchers, the majority of demanders are women, while the majority of withdrawers are men.  In my practice, three-quarters of the demand-withdraw couples are woman-demand and man-withdraw.  The combination of a demanding wife and a withdrawn husband is particularly toxic, and these marriages frequently end in divorce.

Over time the partners become increasingly polarized: the demander gets more distraught, needy and controlling, while the withdrawer becomes even more distant and shut down emotionally.  The problem gets worse because demand-withdraw is a dance in which each partner’s behaviour escalates the problem.  The demander says she wants communication, but she often shows so much anger toward the withdrawer that he can only respond with silence.  His silence communicates that the demander’s concerns aren’t valid or important. 

It’s easier for partners to see what the other person is doing to create problems than to see their own contribution.  One demander that I worked with micro-managed her husband to the point that she advised him about the correct way to walk their dog.  But when her husband told her she was “controlling,” she was astonished.  She was the one who was controlled by him, she said, because he made all the major decisions in their life.  Similarly, he was so afraid of his wife’s emotions that when she cried and told him how uncared for she felt, he told her she was “over-reacting.”  When she replied that he had just “shut her down,” he also expressed surprise. Really?  She was the one who was always telling him what to think. Both partners feel misunderstood.  Both are highly emotional, and, as a result, neither is capable of co-operative discussions that might lead to solving their problems.  Once the dance starts, it’s extremely difficult for either partner to leave the floor, and so they go round and round, arguing about the same topics, over and over again, without resolution.

Some researchers believe that the person who wants change in the relationship is the demander, while the one who wants to keep things the way they are is the withdrawer.  This is what researchers find when they watch couples discuss their problems.  In our culture, wives usually want more change than their husbands do, which would lead to more female demanders. 

Other researchers argue that gender is less important than power. The person who feels less powerful in the relationship is the demander.  Anyone who wants her partner to change is in a low power position from the get go because she has to rely on him to give her what she wants.  On average, husbands have more power than their wives.  They usually make more money and have more influence over big decisions, like how money is spent or where the couple lives. 

On the face of it, the power explanation seems to fit the Kutchers.  She feels unlovable.  She’s more than a decade older than him and on the brink of physical changes that no amount of exercise or diet will stave off.  Her career is well past its peak.  She’s reduced to bit parts, while he recently joined a popular TV show as the hot new guy on the block.  Ashton appears to have more power than Demi.

In my clinical experience, however, it’s difficult to judge who has the power in a couple, even when you know them well.  When I work with couples, often both partners feel powerless.  The demander may feel helpless to have an impact on her partner.  She may feel he doesn’t hear or value her concerns.  But the withdrawer often feels inadequate.  No matter how hard he tries to please his wife, he can never get it right, which leaves him feeling helpless. 

In therapy the couples who are most stuck are those for whom the demand-withdraw pattern touches old and deep wounds.  A woman feels scared of rejection and unsafe unless she can control every aspect of her husband’s life.  She can’t talk about these shameful feelings, so he doesn’t know that vulnerability lies behind her criticism and control.  He starts to shut down emotionally, which makes it easy for him to have an affair and tell himself it means nothing.  His affair tells his wife that, at least for a time, someone else was more desirable than her, which, with the logic of the heart, makes the other woman more lovable.  And in that moment he has confirmed her worst fear about herself.

That’s the dance of distress. 

© 2012 Valerie Whiffen

Dealing with Infidelity

Dealing with Infidelity? Therapy Can Help You Move On

Guest blogger: Dr. Janny Thompson

At Thompson and Whiffen, Psychologists, we use an approach that research has shown to be helpful and that was developed by therapists who have worked with hundreds of couples who were coping with infidelity.

What counts as an affair?

  • Affairs come in many varieties—physical, emotional, long term relationships, one night stands, in-person emotional or physical involvements, long distance emotional involvements
  • Affairs involve violating the expectations and standards of a committed relationship by becoming emotionally or physically involved with someone outside that relationship
  • About 45% of men and 25% of women engage in some form of infidelity (emotional or physical) at some point in their lives

How Can Therapy Help You?

First, therapy can help you cope with the aftermath of discovering an affair. The discovery of an affair usually leads to emotional turmoil—strong feelings of hurt, betrayal, anger, sadness, disbelief, and insecurity—and a sense that your world has been turned upside down. The first stage of therapy helps you:

  • Restore a sense of equilibrium
  • Develop strategies for coping with your feelings
  • Develop strategies for getting on with your daily life
  • Develop ground rules for talking about the affair
  • Develop ground rules for dealing with the outside party and others
  • Take care of yourself emotionally and physically

Second, therapy helps you understand what made your relationship vulnerable to infidelity so that you can go on to make well-informed decisions about your future. Once you have regained a sense of equilibrium, you may feel like moving straight to making decisions about what to do next—stay together, get help, separate. But you want to make good decisions—and good decisions are well-informed decisions. This stage of therapy helps you to collect the information that you need to make good decisions after infidelity. Our focus is on helping you understand what made your relationship vulnerable to an affair by taking a close and systematic look at some important questions:

  • What your relationship was like before the affair?
  • How did you deal with conflict?
  • How emotionally connected were you?
  • Why did the participating partner have an affair?
  • How may the injured partner have contributed to the context in which the affair took place?
  • What outside pressures and circumstances may have made your relationship vulnerable to infidelity?

Finally, therapy helps you make and implement well-informed decisions about how to move on. It is only with the benefits of the equilibrium you regain in the first stage of therapy and the understanding you achieve in the second stage that you can make well-informed decisions about how to move on. The third stage of therapy focuses on moving on and making decisions about the future.

Therapy helps you address issues such as how to get past hurt and anger, whether to move on together or separately, how to strengthen your relationship or yourself, and how to minimize future risks.

Who can therapy help?

  • The individual whose partner has had an affair
  • The individual who had the affair
  • The couple together

When can therapy help?

  • At any point after an affair has been discovered—whether it has just been revealed or whether you’ve been trying to get past it for a long time.

Want to know more?

The approach we use is described in detail in the book, Getting Past the Affair by Douglas Snyder, Donald Baucom, and Kristina Coop Gordon.