Last month my neighbor dropped off a library book, which always gives me anxiety, because most library books and Blockbuster videos get lost in my abode, or torn to pieces by the little animals inside. But this one, “The Ghost in the House: Motherhood, Raising Children, and Struggling with Depression,” was worth the risk. The title itself suggested the author knew a lot about my life, and I’m not referring to the Holy Ghost.
I was absolutely blown away by all the studies, knowledge, life experiences, and insights Tracy Thompson compiled neatly into this book. How can you not love a woman who describes herself this way on her website, www.tracythompson.com:

I’m a writer and journalist who used to have grand ambitions about saving the world. These days, my biggest ambition is to take a pee without some donkey kid trying to pick the lock on the bathroom door. The best way to describe the transition between my crusading journalist days and the way my life is now is to say it was kind of like a spectacle I remember from my Georgia childhood, when my dad tried to feed kudzu through the hay baler. Neither the kudzu nor the hay baler were ever the same.

I couldn’t make myself shorten Tracy’s biography, because it’s all good stuff, so here it is:

In 1989, Thompson went to work for the Washington Post. In October 1992, she wrote a first-person article for the Post’s Health section chronicling her own decades-long battle with depression and a 1990 suicide attempt and psychiatric hospitalization. The article became a book, “The Beast,” published by G.P. Putnam’s Sons in August 1995. In February 1998, she was honored by the National Alliance for the Mentally Ill for her “lasting contributions to mental health issues.” In April 1999, she won a national reporting award from the National Mental Health Association. Her book has been published in Germany, China and Japan, and has been included in two anthologies, “The Healing Circle,” published in 1998 by Plume Books, and again in “Out of Her Mind: Women Writing on Madness,” published by Random House in January 2000.
Thompson left the Post in October 1996 to go on maternity leave, and has been a freelance journalist ever since, as well as an occasional trainer with the Washington-based Committee of Concerned Journalists. Her work has appeared in O, the Oprah Magazine, Redbook, Good Housekeeping and Working Mother.
Her most recent book, “The Ghost in the House: Motherhood, Raising Children and Struggling with Depression,” was published by HarperCollins in August 2006. It is based on a survey of nearly 400 mothers who have suffered from major depression, and incorporates both in-depth interviews with some of those women with her own experience. The survey on which the book is based was created in collaboration with Dr. Sherryl Goodman, professor of psychology at Emory University in Atlanta.

She also writes a great blog, Maternally Challenged, that you can get to by clicking here.
She lives in the Washington, D.C. suburbs with her husband and two daughters.

1) The first two sentences of your book are brilliant:

Motherhood and depression are two countries with a long common border. The terrain is chilly and inhospitable, and when mothers speak of it at all, it is usually in guarded terms, or in euphemisms.

You’re obviously on my team–of those moms fighting against the stigma of mental illness. But even I shy away at times–like when someone will joke about another mom being “so schizophrenic”–of telling people how strongly I feel against discrimination. If I’m in a good and confident place, I’ll blab about my psychiatric history. And then I retreat, thinking “oh no, now David won’t have anyone to play with,” and then I blab again, and so it goes. What about you? Do you openly talk about your depression to the moms you interact with on a daily basis?

Do I blab about my psychiatric history? No. Do I talk freely? Yes. By which I mean that when the context is appropriate, I’ll speak up. Recently a friend told me she hadn’t heard from her brother in months. She assumed he was sulking about something. I said, “Make sure he’s not depressed.” Or there will be a story in the news about some psychiatric patient that people will be talking about, and I’ll have a chance to say, “No, psychotropic drugs like that are not addictive.” And then people will say, “What makes you an expert?” and I’ll say, “I’m not an expert on everything but I do know about this from experience.” This is especially true when the subject is PPD, because new moms (especially first-time mothers) can be made to feel so incredibly guilty about having it, and an amazing number of medical personnel are still ignorant about it.
Just yesterday the Washington Post had a front-page story about a female soldier who suffered a breakdown in Iraq. She’d had episodes of depression before joining the Army; when she went to Iraq, the stress level (she ran a medical trauma response team) was just too much. The Army is actually prosecuting her for attempting suicide. Yeah, I know. It’s medieval.
I don’t go on and on about my own experiences unless somebody specifically asks–but, you know, that’s just basic courtesy. Very few people want to hear the gruesome details of my gallbladder operation, either. But when it’s appropriate, I try to be straightforward and utterly unvarnished. “Yeah, I’ve been in a psychiatric hospital, I’ve overdosed on pills, I’ve self-medicated with alcohol, I’ve even had to have ECT.
Fortunately, I’m much better right now”–or some version of that. I see it as a chance to demonstrate that maybe some of their preconceptions about “the mentally ill” may be wrong. IN a way, it’s like being a combat veteran. You have to walk a line between talking too much and bottling it up inside. “Cautious honesty” is probably the best description of what I strive for.
I get three kinds of reactions. Often, it’s relief. “Oh, thank God, somebody besides me has been struggling with this.” Sometimes it’s amazement. “Really? I would never have guessed” etc.–which is fine; I let that play out according to how interested they are. And there are the people who shut down, or give me this glazed-eyed smile, or suddenly don’t want their kids to play with mine…and that’s fine, it really is. It’s valuable information, just the same as if they had said, “I don’t like immigrants” or “Aren’t these black people ruining the neighborhood.” I don’t want my kids around intolerant people.
When it comes to depression and motherhood specifically, I guess I just have a contrarian streak that gets activated whenever I hear anybody saying something like, “Oh, I just so looooove being a mom,” like everything was a 24-hour-a-day love fest. Usually I’ll say something like, “Yeah, but aren’t there days when you just want to drop-kick the little hellions off a cliff?” If they don’t at least laugh at that, I know their either in serious denial, or they just terminally phony. Or maybe they really ARE like that, in which case I am not up to dealing with them, and that’s my problem, not theirs. I would be cowed by Martha Stewart, too. –Now, having days like that doesn’t make you a depressed mom, but admitting that there are days like that lays the foundation for honesty, and if you can’t be honest about the bad days you can’t be honest about depression.
Finally, when it comes to talking about depression–I guess I’ve reached the point where I realize that there is such a thing as too much talking. Depressed people ruminate too much as it is; we really don’t need too many endless explorations of our misery. What we need is concrete, practical things to do. Somebody to exercise with. Somebody to call us once a day and make sure we’re out of bed. Somebody to take the kids away once in a while for a few hours. The encouragement to keep on trying to find a drug combination that will work. The name of a good shrink. That’s the kind of thing that’s helpful.
2) You began collecting stories of depressed moms in 2003, when you placed a query in 170 newspapers across the country. In 2004, you placed a query in the May 2004 issue of “O: The Opera Magazine.” And at 500 responses you stopped counting. Wow. Then you narrowed down the responses from moms who had been diagnosed with major depression and submitted to them a 170-question survey produced by Dr. Sherryl Goodman, a psychology professor at Emory University. You conducted 32 in-depth, personal interviews. You spoke to researchers in the fields of genetics, epidemiology, psychiatry, endocrinology, obstetrics, and brain imaging. And you spent months reading the medical literature on the subject of women and depression. Tracy, I give you an A for effort and I believe whatever you say. Before I ask you some questions about the responses, let me ask you this: what was most surprising to you … after you put all of it together and let it gel awhile in your brain. Any “Aha!” moments or epiphanies?

I think what struck me the most, looking back, was how long I tried to white-knuckle it after the birth of my first child. I’d gone off my meds during my pregnancy and then stayed off after she was born. Why? I do not know. I just wanted to see if I could, I guess. Wish fulfillment, sort of like a two year old: “If I cover my eyes, maybe it’ll go away.”
Looking back, I put three people (me, my daughter and my husband) through a year of hell for no good reason. I did learn, though; when my second daughter was born, and I felt the onset of the same PPD symptoms (raging anxiety, mostly), I was back on my meds in a flash. My shrink later read the book and said to me, “Where was I when all this was happening?”–meaning the first nine months of my oldest child’s life. And I couldn’t answer him.
I guess I just wasn’t in contact with him, or I was lying to him, or both. In retrospect, I was really, really sick. I probably should have been in a hospital for at least some of that time. It was a combination of denial and stoicism, I guess, and at some level it fooled even my husband. I realize I have to be continually on guard about that.
I’ve heard that when people freeze to death, they just kind of go to sleep; at the very end, it’s actually a rather painless way to die. I think depression can be like that. If you don’t pay attention, if you just keep slogging on trying to pretend nothing is wrong, one day you may just kind of lie down in the snow and that will be that. You have to constantly ask yourself, “Am I cold? Do I have enough clothes on?” –or, as the case may be, “Am I distancing myself from my family? Am I taking these little anxiety pills too much? Have I been grumpy way too much lately?”
3) The three categories–the most common symptoms of maternal depression–evidenced in your responses, you say, were: withdrawing (emotionally, physically, or both) from the child; chronic hyperirritability; and the inability to impose limits on behavior. I actually started to cry when I read those because my sister, who recently visited, told me she thought that my depression of two years ago might have something to do with their extra pecking when they see me phase out (“Uh oh, are we losing her again?”). So in reading so many other mom’s experiences, I was somehow consoled. Is that really the purpose of your book and your blog: to name the illness, the symptoms, the treatments available, so we can start to feel less guilty about it and be more proactive against further damage in ourselves or others?
Yes, exactly. I think I kind of touched on that in the paragraph above. And the inability to impose limits on behavior–that comes from fatigue. Being consistent is really mentally taxing, especially when you know that saying, “No, you may not watch TV right now” is going to elicit howls of protest and dramatic expressions of impending catastrophe if someone misses the next episode of “Hannah Montana.” It’s SO much easier to say, “Oh, all right” and go back upstairs to the bedroom and shut the door. I mean, moms who have never been depressed a day in their lives fall into this trap, so it’s no surprise that mothers who struggle with depression have a hard time doing it.
And there’s nothing, on a day-to-day basis, that’s going to make that job any easier. The only thing you can do is to be proactive, and make dealing with your own health a number one priority–because that falls apart, chances are many other things in the household will fall apart too. It’s not being selfish to look after your own health; it’s a way of looking after your family. But being vigilant about their own health is usually at the bottom of most mothers’ priority lists; we are conditioned to take care of everybody except ourselves.
4) Thank you for writing this paragraph:

Drugs are not cure-alls; they are tools. But they can be extremely valuable tools, and can jump-start the brain’s natural healing response. This is especially valuable for women with maternal responsibilities. Dump any preconceptions you have about antidepressants. If you need them, take them.

And also for this one:

Being able to see the brain better has been invaluable in any number of ways, from tracking the effects of various drug treatments to testing the efficacy of various kinds of therapy. By showing researchers, for example, that antidepressants cause the growth of new nerve cells in the hippocampus–a finding that could explain why it often takes weeks for them to have a therapeutic effect–or that prolonged stress and/or depressive episodes result in structural changes in highly specific parts of the brain, the new imaging techniques help researchers avoid blind alleys and point the way to the most promising areas of inquiry.

This is all fascinating stuff, and you skillfully translate the medical jargon into language that the normal reader (me) can understand. I was especially helped by your explanation of environmental issues versus biological vulnerabilities, a sophisticated nurture vs. nature argument, that SOME women with a propensity toward depression may very well be able to avoid it by lifestyle choices. Can you say a little more about that?

Yeah, I think women who know they have a tendency toward suffering from depression have to look at what stresses tend to trigger their depression. Is it too little sleep? Is it marital friction? Is it job-related? –And then, make some hard decisions about how to eliminate or greatly curtail that particular kind of stress in their lives.
For instance, I always knew that I probably could not be a foreign journalist, and I knew without question that I did not have the psychological stamina to, say, be posted to a war zone. I can’t be far away from my support system, and I can’t have an irregular schedule, and I find it unbearable to even read about what happens in war zones, much less witness it. Knowing this was a disappointment, and in some ways a career hindrance, but that’s just the way it was.
Looking back, I wish I had known before I became a mother just how taxing it was going to be; I would have tried to set up a better support system for that, too. I would strongly advise anybody out there who has a history of depression and who is contemplating having a child to a) have a good psychiatrist on call; b) find an ob-gyn who is knowledgeable about psychiatric issues and c) set up a support network somehow, some way. It’s hard to say this without it sounding like women who suffer from depression shouldn’t have kids, which I would never say, and it’s hard to say it without frightening mothers-to-be. But if a pregnant woman had diabetes or a heart condition, she’d be vigilant about it. Depression is no different.
5) I just read parts of “Microtrends: The Small Forces Behind Tomorrow’s Big Changes” by pollster Mark Penn and Kenney Zalesne. They claim that parenting is harder today in the Reign of the Child than it was for my parents, that all this nurturing of kids’ individuality and uniqueness come at the cost of a mother’s exhaustion. Do you agree? Does this contribute to the spike in maternal depression?

Yes, absolutely, I would say that parenting today is harder. The standards have changed. In the book I talk about what sociologist Sharon Hays has called the “culture of intensive motherhood,” and since then that culture has, if anything, only gotten more intense. You need to bond with your baby. You must spend “floor time” with your toddler.
If you really want to be a good mom, you should probably stay home until you kids are old enough to go to school–and then you should go back to your super-duper job while finding time to bake cookies for the PTA bake sale. And take your kids to the library on the weekends, when you’re not watching culturally enriching theatrical performances or going to their soccer games or attending church. And don’t forget being emotionally available for their every need, because if you aren’t, their self-esteem could suffer….It makes me tired just writing this.
Moms get the brunt of it, I think, but I see plenty of hollow-eyed dads these days, too. I know of couples who barely see each other because they split shifts, so that one parent can be there at the beginning of the day and the other can cover after school. You put this together with demanding employers and the expectation of 24-hour availability via Blackberry, and I am surprised we are all still vertical.
And chronic stress like this can definitely contribute to depression. It’s not a direct cause-effect thing, but it’s sort of like flu season: when the weather is cold and rainy and people are cooped up indoors, those little viruses have a field day. Conditions are ripe, in other words.
I try to do this stuff, don’t get me wrong. But I also think that it would benefit kids to know that they are NOT the center of the universe. I don’t think there is anything wrong with saying to your child, “Scram, kid” if you are trying to read the paper and he or she is jumping up and down for your attention.
We try for family dinner at our house a couple of nights a week, but there are also a couple of nights a week when my husband and I shoo the kids out of the kitchen and make them go elsewhere while we do this thing called “talking to each other.” On any given day I usually think I did something wrong–either I’ve given my kids too little, or I’ve let my kids suck me dry. I never seem to get it right. But I keep trying, which is all you can do.