If you're a mother, you probably have heard all about Marianne Williamson's ignorant opinion about PPD.
Who IS she, anyway? I had to Google--apparently she is a spiritual self-help guru. If it does help people, then that's great. Some people like non-denominational spiritual help.
But if that comes at the cost of minimizing mental illness, then that is not kosher. Here's what she said:
CODE ALERT: U.S. Preventive Services Task Force says women should be "screened for depression" during and after pregnancy. Their answer, of course, is to "find the right medication." And how many on the "Task Force are on big pharma's payroll? Follow the money on this one. Hormonal changes during and after pregnancy are NORMAL. Mood changes are NORMAL. Meditation helps. Prayer helps. Nutritional support helps. Love helps.
In writing class we were always taught to identify the good things first before launching into the critical part.
Here are the good things.
Hormonal changes during and after pregnancy are NORMAL. This is true. Huge changes happen, and it can be frightening if it's your first time or tenth time.
Mood changes are NORMAL. Also true. It comes with the hormonal changes, plus your whole life is changing. It's nice to know you're not the only one.
Meditation helps. Prayer helps. This can be true for some people. But if you are not the spiritual kind, this boils down to "take time for self-care," whatever is the best self-care for you.
Nutritional support helps. Love helps. The latter two are the most true. It's good to keep nourishing your body through these changes (and I should talk--my anxiety was through the roof and I barely ate for two weeks after my daughter was born.) It's also so, so important to have supportive people around you, people who don't say, "You're just being a martyr" or "Get over it."
Now, here the problem with Marianne's post. By talking about changes that are NORMAL, she is minimizing the times when it is abnormal. Maybe someone is having a trauma reaction. Maybe their existing depression is getting worse. Maybe the changes are setting off postpartum psychosis, but if you told her about that, she'd say, "But mood changes are NORMAL!"
The trick is that there is a range when it comes to mood changes. There's the normal levels of mood changes, and there's the abnormal levels. How can you tell when the baby blues are becoming abnormal? Through the screening.
In the comments below, Marianne tells someone,
"I have never said that psychotherapeutic drugs are never positive, or that serious mental illness does not exist"
BUT by vilifying the screening process and talking meditation and prayer, she is minimizing mental illnesses until it almost no longer exists.
And she's also qualifying it by saying "serious mental illness." How does she define "serious"? Is it serious enough when your child cries, and you don't feel anything? When you are unable to eat or sleep for weeks? Or is it only serious when you get to the point of suicide?
Let's back up a little bit--Marianne asks a decent question cloaked in anti-medication sentiment: "How many are on big pharma's payroll?" Let's check.
Using this database, I was able to determine that Dr. Francisco Garcia was taken to lunch 6 times, Dr. Alex Krist once, by pharmaceutical representatives. That is two out of sixteen, and neither of them are chairpersons. I wouldn't necessarily describe them as being on pharmaceutical payrolls, and only Dr. Garcia was taken to lunch by Abilify, which Marianne vilifies.
What money is there to follow? Meals do not necessarily make doctors more biased toward prescribing certain drugs. And one doctor talking with psychotherapeutic pharmaceutical companies wouldn't bias the entire study, thanks to the balancing force of the 15 other doctors on the team. That's the beauty of having an independent review team--it helps to ensure that such recommendations are done without undue influence from any one source--including Big Pharma.
Now, this brings us to the final issue I have with Marianne's post--the issue of "finding the right medication." What does the recommendation actually say? When Marianne put that into quotes, it made me (and likely others) assume it was a quote from the recommendation. It is not. It only mentions medication twice--once about having adequate support to ensure people who need medication get it, and once pointing out that it can get expensive.
Interestingly, the team stated that "only 1 small, short-term trial of screen-detected depression in postpartum women included antidepressants as an intervention." All other interventions focused on CBT, cognitive behavior therapy, "which had adequate evidence that treatment with cognitive behavioral therapy (CBT) improves clinical outcomes in pregnant and postpartum women with depression." They also found that second generation SSRIs are associated with some harms, listing the side effects. These harms were only "small to moderate."
It really does not sound like the team is promoting the "mercenary intentions" of Abilify, as Marianne eloquently put it in another comment.
So, where's the harm in screening women? What does the recommendation say?
Only 1 trial, which focused on the effects of screening alone in postpartum women, specifically reported on adverse effects of screening and found none.15 None of the other screening trials showed any signals of concern. The literature search did not identify additional trials addressing harms of screening.
Therefore, it is important that a range of treatment options are available for pregnant and postpartum women with depression who are identified through screening and that treatment choices are made through shared decision making.
Doctors and women should make the decision together about what's right for them and the child, essentially.
So, where is the problem, Marianne? I recommend some meditation and prayer to allow yourself to look into the real reasons why you are so frightened of Big Pharma to the point that you are reading ill intentions into a reasonable recommendation. I suspect the answer is in you somewhere.
Also prayerfully consider the negative impact statements such as yours have on pregnant and postpartum women. Women may hesitate to seek help even when they are really suffering for fear that people will think the same way you do.
We're not canaries in a coal mine. A good number of us just fucking need medication.
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