Infertility Support

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Researchers estimate that 12% of women (or, 1 in 8) at some point in their lives will be diagnosed with infertility. In my experience as a psychologist specializing in infertility and a researcher, this number sounds surprisingly high to the women who are diagnosed, as infertility can be an extremely lonely and isolating experience.

Research shows that the effects of infertility affect the mental health of both men and women, but women are more likely to internalize infertility as “their problem” or “their fault,” even when male-factor infertility is easier to test for and correct for in many cases. Sadly, the woman is often first to seek testing and treatment, even when the process is significantly more invasive, complicated, and painful. Even when the cause is found to be male-factor related, women tend to take the burden of infertility upon themselves and experience significant stress. This is likely due to how our society puts so much emphasis on the importance and joy of motherhood as an integral part of a woman’s identity. Without it, many women feel incomplete and broken. This is especially true (but not exclusive to) women in religious communities.

Infertility can be incredibly stressful, and it’s often a double-hitter: coming to terms with infertility can be both depressing and anxiety-provoking, and then on top of the diagnosis, infertility treatment has also been shown to further complicate existing mental health conditions or introduce them into the client’s life due to the stressful nature of testing, medications, injections, surgeries, and the unknown. It’s very common for the stress of infertility to overwhelm usually-confident and capable women whose life stresses up until that point have been handle-able and surmountable. But the stress of infertility from a myriad of feelings including loneliness, feeling broken, shame, anxiety about the future, feeling out of control, unfulfilled, and judged by family can tip the scales and cause usually-completely capable people be overwhelmed. Mother’s Day, other holidays when you have family gatherings, and baby showers can be especially rough.

Luckily, there’s hope. You are not alone. So many other women (you may already know them) have dealt with or are currently dealing with infertility. Consider joining a support group or opening up to friends you trust, who you know will listen to you without judgment or will dish out “quick fixes” that don’t help (for example: “why don’t you spend more time with your sister’s kids, so you don’t feel like you’re missing out!,” “Have you prayed about it?” “Try this diet, it’ll fix you right up!” “Maybe you should read your scriptures more,” or “it’s ok, even if you’re not a mom in this life, you can be in the next one!”

Regarding the last comment, I don’t mean to invalidate the sentiment for women who the thought of having children in the after-life is comforting to them. In my experience as a psychologist, I have heard a few women for whom, at some point in their life, it brought peace, and I validate their experience. For the vast majority of women I have counseled with and interviewed however, that sentiment brought little comfort in the present life, when feelings are raw and the thought of going through one’e entire life without the ability to conceive is heartbreaking. So to those who have loved ones who come out to you about their fertility journey, my best advice is to create a safe space, reflect their feelings, and avoid simple solutions, as it’s likely your loved one has already heard or considered them. Just let them know how you care about them, and how rough this is. If possible, try to avoid relating an experience in which you tried for 1-3 months to get pregnant before it finally worked, as your loved one may have been trying for years.

More good news for women: new research is discovering that relaxation and mind-body therapy adapted specifically for infertile women not only improved their quality-of-life (so, through stress reduction and addressing depression/anxiety), but also improved fertility rates. Relaxation improves endocrine functioning, and has even been shown to jump-start ovulation in women with irregular cycles or anovulatory. For this post, I’ll keep it brief and do-able, but here are some tips: 1) Take long relaxing walks where you focus your thoughts on what makes you happy, experiences from your past you cherish, or vacations you’d like to take. 2) Look up muscle relaxation exercises to do on yourself or listen to like this one here: mp3s with guided imagery exercises you can download and listen to when you feel stressed are wonderful, 3) join an infertility support group sponsored by your local community, hospital, or fertility treatment practice, 4) Talk to a professional about what is stressing you, especially if you are about to undergo treatment, in the midst of treatment, or don’t know what to do and feeling out of control. In short, take care of yourself, ask your partner, family, or friends for help so that you can focus on what will help you feeling better. This is a great sheet for friends or loved ones who have asked if they can do anything but are feeling at a loss.

If you have any questions, you are welcome to contact me for free support! Just ask the Fertility Shrink!

Control and Victimization

Let’s talk about control–who has it, and who does not. When individuals feel they have control over themselves and their lives that’s called an internal locus of control in the psychological literature. Those who see and feel that the world controls them have what is called an external locus of control.  Think about it like an  internal-external (I-E) continuum, rather than a this-or-that set of black and white choices. Internal control (IC) refers to the belief that events are contingent on individual actions and that people can shape their own fate. External control (EC) refers to the belief that events occur independently of an individual’s actions and that the future is determined more by chance and luck.

In the U.S., research finds that high internality correlates with attributes highly valued by U. S. society, such as mastering one’s environment, superior coping strategies, higher achievement motivation, etc.  Other research on generalized expectancies of locus of control suggests that non-white folks, socio-economically disadvantaged people, and women score significantly higher on the external end of the locus of control continuum. Using the I-E dimension as a criterion of mental health would mean that people of color, females, and poor people would be viewed as possessing less desirable attributes.

The problem with an unqualified application of the I-E dimension is that it fails to take into consideration the different cultural and social experiences of the individual. While the framework from which the I-E dimension is derived may be very legitimate, it seems plausible that people of color, women, and the poor have learned that control operates differently in their lives relative to how it operates for more privileged sectors of society. Powerlessness may be defined as the expectancy that a person’s behavior cannot determine the outcomes or reinforcements they seek. A strong possibility exists that externality may be a function of a person’s opinions about prevailing social institutions.

And telling minorities, women, the mentally ill, and the poor to just “pull yourself up by your bootstraps!” doesn’t help much, though it seems to have helped Seth, and more power to him.  In point of fact, power is something he already has quite a lot of as a college-educated, white Mormon male that is upper middle class (just guessing, given he has enough resources to go on a LITERAL odyssey).   If the pull-yourself-up-by-your-bootstraps rhetoric really worked for everyone, we’d have racism and sexism SOLVED.   Instead, systemic, structural responses to aid those who have not had access to the kind of power Seth does have often proven more helpful.  For example, the home state of Seth’s faith, Utah, just did an amazing thing to reduce homelessness.  Did they just give folks two spoonfuls of “You CAN CHANGE!” motivational speeches? Nope.   The state reduced homelessness by 74% in 8 years by simply giving homeless people an apartment and a case worker, and asking questions later.    Now that’s empowerment.

Let’s all be a little gentler with ourselves and each other:  agency is contextual, it depends on your environment, beliefs that abusers, racism, sexism, etc have molded onto you, and, of course, poverty.   Unpacking all those restraints on agency isn’t as easy as “snap out of it, you’re in control!”  It takes time and resources.  And at the same time, I’m all for folks unpacking their privilege as well.  I highly recommend this oldie-but-goodie on how to do that, here.   This is tough stuff, folks.  But it is also necessary if we want a more empathic, compassionate society and communities.

Let Your Husband Love You: And Be Yourself

Express yourself, or quietly suppress and let your man love you:  a Victorian false dichotomy.  It’s human to feel like crap, because parenthood is tough, tough stuff.   In my clinical opinion, the last thing a woman needs who is battling feelings of self-worth and exhaustion, authentically displaying it to her husband is to “suck up your pride, your anger, your frustration, and your crazy.”  

I recommend authenticity and processing.  And depending on the situation, therapy.   Irritability and feelings of worthlessness, along with not enjoying the things you used to enjoy (like, sex or spending time with your partner) are hallmark symptoms of depression and/or anxiety.  A counselor can help appropriately diagnose and get you the help you need to feel better end enjoy your relationships more.    Perhaps, if the original post brought up a ton of guilt or shame, considering scheduling an appointment with a counselor.  At the very least, I recommend processing your feelings about the post with an empathic friend or your partner.   You’re not alone. It’s normal to want to be real in your own home and the thought of sucking it up and pretending everything’s coming up roses feels either:  a) exhausting, b) anxiety provoking, c) guilt-inducing.

A counselor can also help process how current relational dynamics are working/not working for you.

To be specific, this post seems to highlight how very black and white division of labor between home and career just doesn’t work for so many.  It will work for some, I acknowledge that, but far too often after a few years of this set-up something’s gotta give:  and all too often its the wife who “sucks it up.”  Usually men work toward their careers, women work at home.  This is not the kind of post to argue which is better for men and women:  only the individual can decide that (P.S.  End Mommy Wars!).   I’m only here to gently suggest that reassessment at some point between the couple on how to help each other (whether it’s doing more housework or meal preparation together, husbands taking the *entire* evening/night shift–rather than a 1-2 hour “break” for mom, supporting mom if she really wants to go back to school or work outside the home) is beneficial.

So I talked a little about processing above (with your partner and perhaps a counselor).  Let me just end a little on a note of authenticity.  First, my own:  I completely resonated with her exhaustion with my 2 babies 18 months apart.  Some won’t though, and that deserves mention.  Men and women who have carved out work and home in different ways won’t relate much at all, and that should be acknowledged.   Given that caveat,  I personally can very much relate to how smelling like vomit, being climbed all over all day can be soul-crushing.  Of course I haven’t believed my husband when he compliments me.  And yes, I could say “thank you” more often.  But there’s nothing wrong with speaking your mind, with processing how you’re REALLY feeling. Lots of women have been trained since they were children to keep words and actions in pretty-mode.  I imagine the author of this article did, too, as highlighted in her comments:  “Dude, I so get it. It was such an eye opener for ME when I stepped outside of myself and saw what my man comes home to sometimes. Not pretty.”   I totally did it when I was younger.  In college, I remember dating some guy who even said after a few months, “you know, I wish you’d express more how you were really feeling–I want you to vent, express, be REAL with me.”  And I did, and I married him, dear reader.  Best decision I’ve ever made.

I emphatically and unequivocally support being yourself, expressing yourself.   Let your partner love you AND be real.  It’s not an either/or, folks.   Personally, I don’t want to be adored/pedestaled.   I prefer to be loved, as myself–exactly the way I am, feelings and all.

Postpartum Care

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New research suggests the length of time a woman takes off after giving birth influences her risk of depression— a finding at odds with the typical amount of maternity leave in the U.S.

University of Maryland School of Public Health researchers found the more leave time from work that a woman takes after giving birth — up to six months — the better protected she will be.

“In the United States, most working women are back to work soon after giving birth, with the majority not taking more than three months of leave,” said Rada K. Dagher, Ph.D.

“But our study showed that women who return to work sooner than six months after childbirth have an increased risk of postpartum depressive symptoms.”

The study is published in the Journal of Health Politics, Policy, and Law.

The first year after childbirth presents a high risk of depression for women, with about 13 percent of all mothers experiencing postpartum depression, with debilitating symptoms similar to clinical depression.  Here are some suggestions about navigating through a difficult pospartum period:

Consider talking to your boss about more maternity leave, if you can afford it.  I know this is unrealistic for so many, as laws in the U.S. do not protect new mothers like they do in most of the world. To me, that is criminal.  Still, if you feel your job will not be at risk for asking, here is a handy worksheet to broaching the topic and negotiating with your boss (as well as more family-friendly work hours in general):   http://www.familyfriendlywork.org/new-free-guide-and-template-for-requesting-flexibility.html

Anyone reading this who doesn’t know what to give new mom?  Clean her house.  If you live far away, hire a service and pay for it, maybe put it in a nice envelope at the baby shower or as a congratulatory gift after the birth.   Do as often as you can afford, I’d suggest at least once a week for 4 weeks, or once every other week for 8 weeks.  Perhaps pull together as a group gift?

Also, arrange meals for the new mom.  Freezer meals are great, very convenient, and here are some recipes:  http://www.sixsistersstuff.com/2013/08/50-easy-freezer-meals.html  Bring them to her home and put them in her freezer.  Moms, don’t feel guilty about take-out.  Already prepared food is a beautiful thing, and if you have other kids, they’re gonna be ok.

I’d also recommend a little sign on a doorknob that says “Quiet, baby sleeping.”  Would make a cheap and thoughtful shower or baby gift.  Something like this, so you won’t  get unannounced neighbors and friends who want to see the baby, or when you really need to sleep:

baby sleeping

Let me say something here about the oft-neglected “4th Trimester.”  If you are feeling anxious about the prospect of family descending on you (you may not even feel it until after giving birth), try to help your family understand your need to not have houseguests or play hostess while recuperating in terms of a 4th trimester. You need time to bond with your baby, your body needs time to heal, and your family (you, partner/spouse, kids) need time to bond together and get used to each other.  Usually I’ve found it can be about 3 months, but only you know when the time is right.  

Finally, consider a post-partum doula (or hiring your doula on to help take care of you and baby).  Or loved ones of new mommas, hire a post-partum doula for her!   If you feel you may have postpartum depression, talk to your OBGYN for a referral to a psychologist or psychiatrist.   And above all, take care of yourself.

Porn is NOT Adultery

Pornography can be very problematic. The porn industry exploits women who work within it, gives its viewers unrealistic expectations of what a healthy relationship looks like (and what real women look like for that matter). It can degrade women. Child porn is horrible, tragic, and needs to be wiped off the face of the earth. And it’s SO understandable and valid for wives and girlfriends to feel like their loved one is cheating on them by looking at porn. Especially given the rhetoric that is very prevalent by well-meaning folks who say that it is. Many of these people have their flock’s best interest at heart, and are just not well-versed in  sexuality and mental health. And that’s OK, many are from a different generation besides not being psychologists, and who can blame them for trying to help? This post isn’t here to bash anyone who thinks differently than I do. My purpose is to provide some helpful tools to help reframe and contextualize the issue of pornography in psychologically healthy ways:

I was a psychologist-resident for a detention center for young sex offenders, so I know a thing or two about sex. We Ph.D. residents received extensive training on sex addictions, the neurobiological mechanisms behind porn use, and how to promote sexually healthy behavior (and stop re-offending behavior). First off, to use another Princess Bride reference: Sex Addiction. People keep using that phrase. I do not think that means what you think it means.  Occasional porn use is *not* an addiction. While it is possible to be addicted to it (I saw it with a few of the inmates), in our culture the word “addiction” gets overused and stigmatized, referring to anyone who has viewed porn and masturbated once in a while. I won’t argue the morality of masturbation, since everyone needs to follow their own moral compass. What I will say is that it’s not a sex addiction, it’s not in the DSM (what doctors, psychologists, and psychiatrists use to diagnose people), and when we call it an addiction it can lead to even more shame and continuing the behavior. And if someone wants sincerely to cut back for religious reasons, shame does not help them get there: it makes it worse.

The porn industry exploits women. Those who produce it objectify those they film (usually women, but men too), take advantage of them, and use them and often spit them out and leave them in the dust. Can we please talk more about why porn is wrong for those reasons and direct our anger at the producers, instead it out on our brothers, sisters, husbands, wives, neighbors, coworkers, friends…and ourselves? Also, women are objectified in other places, like advertising, TV, and movies. Can we have an open and honest discussion about how and why that happens culturally, and focus on reducing the harmful messages all objectification sends to/about women, rather than focusing our wrath and indignation on those who view pornography (which only contributes to more shame, and makes them more likely to do it more)?

Also troubling to me as a psychologist is how women (wives, mothers, sisters, girlfriends) are sometimes triangulated into the shaming about pornography (i.e. it destroys families! It’s disgusting! It’s adultery!), worsening the negative impact it will have on that person’s life because they are acutely aware how much their behavior hurts their wife/girlfriend/mom (if they’re young), as we women are told to be hurt about it. We are being recruited–albeit out of good intentions–for further hurt to our loved ones and ourselves. Think of it like an eating disorder: telling our daughters to “stop it!” when they refuse to eat at the dinner table isn’t going to accomplish anything. It’s a complex psychological process that involves digging much deeper psychologically, unpacking her relationship with food, and not shaming or attacking the behavior, as it will only get worse. It’s little wonder our relationship to sex and eating aren’t that far apart.

Just like the bingeing/purging cycle with those who have bulimia, people who feel horrible about themselves can go through a similar cycle with porn. The goal is to treat your loved one gently, as you’d want to be treated if you were struggling with disordered eating.  Recognize that sex (like food) serves a very natural purpose and you want to help them:  not by policing them or holding them accountable.  You may say you want to help them by letting them know you understand nobody’s perfect, their sex drive is normal, and that you’ll always be there for them.  It might also be helpful for both partners to keep in check any repulsion (perhaps process it with a counselor), because it will hurt you both.  Like I said, it’s totally understandable that you’d feel that way–you may have been raised to feel that way!  The goal is just to work through it over time. It won’t happen in a day, don’t beat yourself up, either way.  But don’t *ever* blame yourself for how you feel.  And in fact, you may have a completely healthy view of sexuality or not say a word to your loved one about their porn use, and your loved one might still down-spiral in shame and shut you out.  Not. Your. Fault.  Sometimes people retreat into their own world because the guilt/shame from inner and cultural sources that you never contributed to in the relationship, along with any deeper psychological baggage are too much for them to deal with.  All you can do is suggest they talk to someone and keep telling them you love them.  It can feel very lonely when a partner gets to that.  Very isolating–for both partners.   If you, as a partner, ever hear that it’s your duty to help someone overcome a porn addiction, run away. Far away.  It’s wrong, it’s damaging, and it makes me so sad to hear women report that she was told she just wasn’t satisfying her husband’s needs enough and maybe if she did he would stop.  Wrong!

Let’s all work together to discuss ways media (ads, tv, movies) can exploit/objectify women and treat each other a little gentler for being human.

Suicide, Loss, and Hope

 I wrote my dissertation on suicide prevention in the Western U.S. (where suicide rate are highest).   I also counseled imprisoned young men and women during my doctoral residency year in Texas, and I saw firsthand how hope saves lives. In life’s difficult moments we may lose sight of hope, and that’s understandable. In fact, sometimes we may feel locked away in a prison, not of steel bars, but of hopelessness and isolation.

I never expected to work in a prison as a therapist, but my husband was accepted to a nearby university, and it was the closest doctoral residency. My first day, I felt almost overwhelming hopelessness as I read these youth’s records. Stories of their traumatic pasts struck me so deeply that I wept over their files. Common to many were histories of abuse, broken homes, and illicit substance abuse–heavy burdens for children so young. On the other hand, I felt disgusted, I felt angry, and I struggled to feel compassion as I read the stories, some in lurid detail, of why these adolescents were incarcerated. I struggled to find a balance between anger and compassion. These details settled into the background as I met and counseled with each individual. When they first arrived, the despair in their voices could not be hid as they talked about how much they had messed up and how lonely they felt. My heart hurt.  Several of my inmate patients confided in me to wanting to end their life.  One almost did.

While I was writing my dissertation on suicide prevention, I spoke with family and friends of one particular young man who did take his life while in prison. I listened reverently as they shared their stories. He didn’t fit the mold of a delinquent. He was a sensitive boy who loved toy trucks, helped out on his friend’s farm, and kept his baby blanket close even when it wore to shreds. I gleaned from their stories his fear of disappointing, how he heaped guilt onto himself, how he told his family he felt like he was a lost cause, and toward the end of his life, he separated himself from his friends and family.  He was clinically depressed. He seemed to have lost all hope. When I later presented these findings to my dissertation committee, I sobbed through most of it. Wise mentors pointed out how in the midst of such sadness, we can glean hope from his story because certain patterns came to light: expressing hopelessness, fear about disappointing others, feeling inappropriate guilt, and self-inflicted isolation. They noted that these warning signs are lessons learned from this tragedy. Noting these warning signs and intervening we can save lives. Most importantly, we can recognize the importance of hope.

If you feel you have no one to turn to, you actually do. Turn to friends and loved ones for support. It is a myth that talking to someone else about feeling hopeless and thinking about dying leads to suicide.  Being honest and asking friends, loved ones, or your spiritual leaders for help saves lives and helps you regain hope.

If a loved one, friend or student has expressed feeling hopeless, burdened with excessive guilt, and has expressed a loss of interest in life, follow-up and ask them directly if they are thinking about ending their life. If so, and if they have a plan and means of hurting themselves, they need to go to a hospital immediately. You may offer to accompany them, so that they do not feel alone.

It is important to acknowledge their suffering, listen, and ask them to talk about their feelings. Since hopelessness most often precipitates suicide it is critical that hope is encouraged and felt again. Ask, remind, and listen to their reasons to hope, including specific sources of love and support from others, and from God (if they are a spiritual person).

We can be that source of hope for each other, daily.  Even through social media, we can let others know how much we care.  From my dissertation research I learned that depressive disorders are the highest risk factor for suicide risk.  If you know know someone who is depressed or bipolar, let them know how much you love them and how much they mean to you.  Not that you could ever have controlled another’s actions, please don’t feel like there’s more you could have done in the face of tragedy (THERE ISN’T).  I’m only here to give education and tools based on my skill-set.  A word of caution:  most suicidal behavior occurs when someone is on the “up-swing” of a bipolar episode or just coming out of a very severe depression.  This happens because, when someone is deeply depressed, they often lack the energy and motivation to plan/do something drastic.  However, it is still a dangerous situation because when it resolves eventually (whether to a dysthymic, hypomanic, or even manic emotionality), motivation and energy return to follow through with suicidal thoughts.  Also, triggering events precede most suicidal deaths:  like a break-up, fight with a loved one, being fired from your job, getting arrested, or other emotionally charged events. So it’s important to be physically present and supportive if someone you know who is struggling experienced a triggering event.

If you have lost a loved one to suicide, you are not alone.  Suicide survivors can (the term used for those who have experienced this loss) experience anything from normal bereavement to profound psychological pain, which can happen immediately or take months to surface.  It can be especially painful and resurface during anniversaries and birthdays of your loved one.   I highly recommend seeking out a local (preferably) or online suicide survivor support group.  A national database of these can be found here:

http://www.allianceofhope.org/alliance-of-hope-for-suic/support-groups.html

To end on a personal note, two years after I published my dissertation I lost a childhood friend to suicide.  Even though I knew intellectually there’s nothing anyone could have done, I still blamed myself and became very depressed.  She had recently been married, seemed happy at her wedding, and I was blindsided by how hard her life continued to be.    I thought, I literally wrote a book on the subject and I didn’t save my friend. I wracked my brain for ways I could have helped her better.  My husband tried to tell me what any good counselor would do to comfort me, but I still felt terrible, left his company for the bedroom, and cried alone. I felt lonely, hopeless, and helpless. But I soon heard my husband’s footsteps, and on the other side of the door he began playing an old love song on the guitar he often sang to me when we were dating. He said he didn’t want me to be alone, and that he always loved me.  May we be that song of hope for each other.