Jeanne Watson Driscoll, PhD, PMHCNS-BC is a Clinical Nurse Specialist providing psychotherapy and pharmacotherapy for women who experience mood and/or anxiety disorders through the childbearing years and beyond. Dr. Driscoll also serves on the President’s Advisory Council of Postpartum Support, International.
She is co-author with Deborah Sichel, MD of Women’s’ Moods. What Every Woman Must Know about Hormones, the Brain, and Emotional Health. (1999) and, with Cheryl Tatano Beck, DNSc, CNM, FAAN, co-authored Postpartum Mood and Anxiety Disorders : A clinicians’ guide (2006). Dr. Driscoll is also know for her videos “Postpartum: A Bittersweet Experience”; “Breastfeeding: Better Beginnings”; “Fragile Beginnings: Understanding postpartum mood and anxiety disorders”; “Taking Care of Mom”; and “Staying Sane”.
Dr. Driscoll, along with Dr. Sichel, developed the Earthquake model to understand how hormonal events, such as the onset of menses, pregnancy, postpartum, oral contraceptive use, androgen decline, etc. impact mood and wellbeing and also the NURSE model for meeting the needs of the postpartum woman but further for any woman exploring ways to navigate life’s changes. I spoke with her about her work in honor of Perinatal Mood Disorder Awareness Month.
The purpose of The Thriving Place is to offer women insights into wellness throughout life stages. Do you work with women in other aspects of life transition?
I ended up taking care of these women from pregnancy to menopause. I have women in my practice from starting at age 20- 60 or 70. I’m an advanced practice clinical nurse specialist so have prescription writing privileges. I provide holistic care as far as the psychotherapy as well as the psychopharmacology.
Explain the Earthquake Model.
In Women’s Moods, Deborah Sichel and I published an assessment model that looks at various biochemical physiologic areas that we can track throughout a woman’s life. It looks at stress events or allostatic loading, reproductive or hormonal events and the underlying ‘fault line’ of genetics or predisposition. Earthquakes occur (mood changes or emotional upheaval) when the internal pressures on a destabilized subterranean fault line become overwhelmed or pressured. Often women describe “tremors” that have occurred before the emotional earthquake. The tremor was bothersome but did not require medication. Often pregnancy and postpartum can be the events that trigger the earthquake.
Do you find that there women who experience mood disorders in the childbearing years that experience the same vulnerability or risk for mood disorders when they go into other hormonal events, such as peri-menopause or menopause?
Clinically I would say yes. Once you’ve had the earthquake you are forever vulnerable. Nothing goes back to normal ever. That’s life! The body has an accumulation of its own stressors, vulnerabilities, its aging process and its resiliency. I tell women that another time that they may be vulnerable is during peri-menopause and menopause. The hormones are going to have a sputtering conversation and it’s typically a 7-10 year process. Some women do well with hormonal replacement and for others it’s disastrous.
How do you know which approach to implement?
When women have a bipolar disorder or variation you take notice (when considering treatment for androgen decline). You have to listen to women’s stories. If they tell you that they had an intolerance to synthetic birth control pills it’s a high risk flag that you want to pay attention to. They tend to do well with natural estrogen patches and I see a mixed response to progesterone. It’s important to have an individualized care plan. What works for one woman is not going to work for others and it would be malpractice to say otherwise.
You’ve illustrated that so well in your books. It’s important to have a very personalized approach based on deeply listening to women’s stories, and respecting their observations.
Some women may have changes in mood that can be significant to understand their history. Such as those who have an elevated mood during pregnancy. They may have a biopolar diathesis- they do well with estrogen that is high. And they lose the estrogen after delivery– and then they crump. And it’s very abrupt. That’s the part that is so frustrating at times. With all we know why are women falling through the cracks? We say we’ve come so far and we have but we still have women who are jumping off buildings and killing themselves. They had a history. How did we not notice? How is it that we are failing to put these puzzle pieces together. That’s my plea for the future.
I recently posted about a conversation I had with my 9 year old daughter about perinatal mood disorders. It felt very hopeful – that I can help her understand her wellbeing holistically and I related to her ways that she can care for herself during puberty changes and the rest of life’s transitions.
What’s your advice on how we can help our daughters be well?
I had postpartum obsessive thought disorder that no one diagnosed for years. I came into having children as a critical care nurse and never heard anything about postpartum mood disorders as I was getting my advanced degree. In those days you lived in silence. What happened changed my whole career. I was furious that mental illness was so stigmatized but also furious that no one had heard of what I was complaining of, which was a severe anxiety disorder with obsessive thoughts. I was very fortunate that I could take this horrific time in my life and make it something positive.
In that struggle I realized that my mother had depression and never got treatment. I find that there are lots of women of my generation (women in their 60s) who had mothers with low grade depression. Because it was World War II, it was the Depression. There was a lot of stress, anxiety, deprivation. And years ago we didn’t understand how stress affected the body. We know now about the cumulative effect of all the stress in womens’ lives. We know that women already carry an increased stress load. I’m talking about a first world country but even more so in 3rd, 4th world. We have lots of 3rd world problems in our country too it’s just hidden.
What was striking was the absolute dichotomy between physical health and mental wellness. And yet, it’s all part of one body. I had a lot of grounding in the psychosocial. My whole foundational way of thinking led me to assess anxiety and to see how anxiety impacts health and I was studying Hildegard Peplau and Harry Stack Sullivan.
My daughter is 37 and she just had her second baby 7 months ago. When my daughter was first pregnant we were all on alert. She told her midwife about our family history. I live close by and was able to help whenever she needed me. She faced challenges with breastfeeding, a cesarean delivery and we worked to get her resources that she needed.
She never had any depression. Some down days but she was ok. She was allowed to feel whatever she needed to feel. To cry, to be present to whatever came up. You just love the hell out of them and you pay attention. If she slipped we would be there to catch her.
We have to support women to build their own resiliency – to trust that what works for them doesn’t need to work for another. To find their own way and trust themselves.
The childbearing year is a transitional time in the lives of women. You’ve written in the past and in your forthcoming book on how the events of labor, birth and postpartum have an impact on women’s lives.
My foundation is in women’s psychological development as observed by practitioners that came out of the Stone Center. (Wellesley). Women’s Growth in Connection is a collection of writings by Judith Jordan, Alexandra Kaplan, Jeanne Baker Miller, et.al. It was inspiring to look at the differences between men’s experience and women’s experience. Women are in the world differently than men. Carol Gilligan talked about this in In a Different Voice.. Girls up to the age of 12 or 13 say “I know, I know, I know!” Then move into “I don’t know.” Then they end up with, “you know, you know.” They give their power to the other.
I see this happen in pregnancy and postpartum. Women start off professionally directed, assertive, authentic, powerful. They go into pregnancy and their vulnerability increases, they can’t advocate as well for themselves anymore. They give power away to the health care providers. They somehow go into a regressed state. I say this not in a negative way but in psychological terms. As educators, advocates, we can help them stay in that place of power, to help them maintain their authentic strength. We can help them question these assumptions, help them go back to their doctors and to ask questions. We do this gently and mindfully.
Pregnancy is a time when a woman has an opportunity to absolutely rewrite her own life script.
I think that if you get good mental health care during pregnancy and postpartum you can experience self-awareness, you can rewrite your narrative, which then rewires your brain and changes the developmental script for your child. That’s why I think that pregnancy and postpartum mood disorders can be the biggest gift that a woman ever has. I feel it was the biggest gift for me. If I hadn’t had that terrible time I would not have sought help. I would have functioned but maybe at about 80%. But not 100%. It opened up doors to escape the reactionary repeating of the past. I could be more clear about what triggered me and I could work on that. It was such a positive gift. When I say this to women who are a mess, I know that they can’t understand in that moment, but I know it’s there for them.
Dr. Driscoll’s newest book, Traumatic Childbirth,also co-authored with Cheryl Tatano Beck, is due out this summer.