Happy Maternal Mental Health month! Early records by Hippocrates from around 500 BC mention birthing women suffering from “agitation” and “delirium” in the perinatal period. Later medical documentation from the 14th century called it “madness” which evolved into “melancholy” and “hysteria” in the 16th century. Hundreds of years later, the field of perinatal mental health was born, finally adopting a feminist, person-centered, evidenced-based clinical lens to address what is now called perinatal mood and anxiety disorders (PMADs). Art therapy is an integrative mental health profession around since the 1940’s, (though humans have of course been using art as therapy since our cave painting days.) It incorporates trauma-informed, sensorimotor-based practices that can be extremely effective in supporting birthing people in coping with challenges along their family building journeys. The powerful intersection of these fields is only recently being written about, with this groundbreaking text "Art Therapy and Childbearing Issues" edited by Nora Swan-Foster at the top of the list. Grateful for the fellow unicorns, movers, and shakers who are paving the way in developing innovative, compassionate, and creative maternal mental health care. It’s about time! #perinatalarttherapy #pioneerwomen #maternalmentalhealthmatters Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C
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Today is World Maternal Mental Health Day, first established in 2014 to draw awareness to the many socio-emotional challenges perinatal families face. 1 in 5 birthing people and 1 in 10 partners worldwide experience a perinatal mood or anxiety disorder (PMAD) during pregnancy or postpartum, and yet only 25% of those struggling receive treatment. There are a kaleidoscope of reasons why new parents don’t seek out help and end up suffering in silence, including stigma around mental health issues and lack of education, awareness, and routine screenings to assess maternal mental health risk factors. There are also more nuanced reasons perinatal people often don’t disclose the extent of their suffering to loved ones or professionals. Author, therapist, and perinatal mental health pioneer Karen Kleiman MSW, LCSW highlights the “ambiguity” factor during this massive life stage transition: “because moods and other internal experiences are expected to fluctuate following childbirth, women sometimes decide it is best to brave any discomfort and hope it goes away by itself.” Often birthing people end up “white knuckling” it through this period on their own as a result, despite the fact that “research literature consistently demonstrates that communities with strong social support provide shelter and yield lower rates of postpartum depression.” Shame around being judged as an “unfit, ungrateful, or bad” caregiver also heavily influences how much is shared, if any. And yet, especially with anxious, obsessive, or depressive thinking, the critical inner voice only gets louder when extreme distress is avoided, denied, or repressed. Kleiman reminds us, “Depressive thinking can inhibit attempts to deal appropriately with scary thoughts by distorting or exaggerating the possible outcomes of disclosing.” Fears that they are alone in their experience, will be labeled as “crazy,” or become institutionalized or separated from their baby against their are powerful shame-based rationales for avoiding treatment. Above all, deeply embedded societal messages around motherhood being “the happiest time in a woman’s life” create an environment of toxic positivity where any presence of negative thoughts or feelings becomes taboo or forbidden. Only when the full spectrum of experience around this vulnerable life stage is accepted and shared freely will those struggling feel safe enough to seek help when they need it most. Let’s start today. #maternalMHmatters Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Excerpts adapted from from Kleiman (2010) Dropping the Baby and Other Scary Thoughts. Original Photograph by Kelly Sikkema via Unsplash The World Health Organization just released a new report that coincides with National Infertility Awareness Week. Almost 18% of the global adult population–which averages to 1 in 6 individuals worldwide–are impacted by infertility in their lifetime, regardless of biological sex, socioeconomic status, or location. Generally speaking, infertility is defined as being unable to conceive after one year (or longer) of unprotected sex. Some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex, since fertility in females is known to decline steadily with age. While infertility affects males and females at nearly equal rates, it is often associated with a women’s health issue, which can be both isolating and frustrating. Dr Tedros Adhanom Ghebreyesus, Director-General at WHO reflects, “The report reveals an important truth: infertility does not discriminate. The sheer proportion of people affected show the need to widen access to fertility care and ensure this issue is no longer sidelined in health research and policy, so that safe, effective, and affordable ways to attain parenthood are available for those who seek it.”
“Subfertility” generally describes any form of reduced fertility with prolonged time of unwanted non-conception, in other words–taking longer to conceive than hoped or planned for–which is an incredibly common, yet still taboo, scenario for those on their family building journeys. Struggling with infertility is also a risk factor toward developing a perinatal mood and anxiety disorder (PMAD) later on, due to emotional distress and social stigma that it can carry, along with the financial burden of high out of pocket costs of assisted reproductive technology like in-vitro fertilization (IVF). Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO states, "Millions of people face catastrophic healthcare costs after seeking treatment for infertility, making this a major equity issue and all too often, a medical poverty trap for those affected.“Better policies and public financing can significantly improve access to treatment and protect poorer households from falling into poverty as a result.” Clearly, there is an urgent need to increase both awareness and access to affordable, high-quality fertility care for those who seek it. Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Original photo by Everton Vila via Unsplash Today I had the incredible opportunity of facilitating an arts-based wellness workshop for the Education department at the Whitney Museum of American Art. As we creatively explored the behavioral, physical, and professional hazards of chronic stress, themes of playfulness, nature, and connection to others emerged during the writing and art-making components. Pablo Picasso said it best: “Art washes from the soul the dust of everyday life.” The use of art as therapy has countless benefits for one's overall well-being. Creating “art for art’s sake” is an exercise of self-care that can cultivate self-compassion and aid in healing. Art making in a safe space can provide a non-threatening way to access feelings that may otherwise be too overwhelming to name through language alone. The organizing, containing, and stress-reducing effects of art making can alleviate free-floating anxiety and build self-esteem through helping one to develop a sense of mastery over the successful completion of an art project that is within one’s control. Feelings of self-worth are also cultivated through challenging oneself to learn new and take healthy creative risks. Feelings of hopelessness and depression are countered with opportunities to “produce” something of personal value. Creative problem solving is encouraged through artmaking and the use of unfamiliar art media, as well as reframing perspective when observing the art product, which helps foster a more positive outlook; this is a key component of creative resilience. In a group context, the relational component of having another person witness a creative process or product can reduce feelings of isolation, foster connection, and help one feel seen and validated. From a humanistic perspective, a new social identity as “Artist” can be fostered as opposed to more fixed roles which alleviates the effect of role fatigue that is so common when experiencing burnout syndrome. #artastherapy #wellnessworkshop #burnoutprevention #stress #artheals #creativeresilience Post and artwork by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C It’s not easy to practice what we preach. As a working mama of 2 supporting other caregivers for a living, it’s hard to find the time/energy/motivation/space/art supplies/etc etc etc to engage in any kind of regular art-making practice like I used to. Today I was inspired to create a response piece after a perinatal art therapy session to help me process the complexities of the case. I grabbed a piece of cardboard left over from a package, cheap paint pens I had previously forgotten about, popped on my headphones and let myself go for 15 minutes. That’s all I needed. This is what emerged. My clinical training as an art therapist frequently involved creative processing to integrate and explore complex case material, and I’m grateful that this technique remains so intuitive and accessible whenever I need it. Just like my breath, my art practice is always there for me whenever I need fresh energy, a release, or grounding. #processoverproduct #arttherapylife #momtrepreneur #selfcare #mindfulart #nurturingthenurturer Post and artwork by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C In honor of Creative Arts Therapy week, I want to highlight a recent “Art and Object” article about the fascinating intersectional field of “neuroaesthetics,” which is the use of evolving brain imaging technology to measure exactly how engaging in visual art, music, and dance impacts the human body and corresponding behavior, with evidence that only 20 minutes of art exposure daily can positively impacts both. Susan Magsamen, founder, and director of the International Arts + Mind Lab Center for Applied Neuroaesthetics at Johns Hopkins University School of Medicine shares, “Curiosity, surprise, wonder — all attributes found in art for the maker or the beholder — these are really important for human development. Researchers are finding that we as humans are hard-wired for aesthetic experiences. The arts are not just fundamental aspects of our humanity, but also essential to our well-being…the way we grow and learn is through neuroplasticity. The more enriched environments, the more sensorial — not chaotic, but in a way that feels safe and often novel — is how our brains grow dramatically.” Similarly, in“Atomic Habits,” author James Clear emphasizes, “the human body has about 11 million sensory receptors. Approximately 10 million of those are dedicated to sight.. Given that we are more dependent on vision than any other sense, it should come as no surprise that visual clues are the greatest catalyst of our behavior.” With the help of contributions from neuroaesthetics research, the invaluable and ongoing work of Creative Arts Therapists across both clinical and non-clinical settings, and spikes in mental and physical illness since the pandemic began, other fields are finally recognizing the life-enhancing power of art. Magsamen continues, “...because of noninvasive technology allowing us to get inside heads, we’re understanding more neurobiology at a detailed level. And the only reason that matters is so we can create better solutions using the arts for personalized prescriptions, fine-tuning what to dose and dosages, and understanding how to apply art forms for healing." Indeed, doctors nation-wide are now “prescribing” art museum visits for some patients and even burnt out hospital employees. For example, the NYC Health and Hospitals Arts in Medicine program via The Whitney Museum of American Art uses professional art therapists and museum educators to facilitate staff and patient wellness programming inspired by art collections featured in their facilities. Magsamen concludes, “We have relegated art to only entertainment or enrichment – not lifeblood or birthright. We want to put art at the center of our lives, not as something that would be nice to have.” Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMHC Original photo by Marcus Spiske via Unsplash It was such a pleasure to be featured on the “Fit as a Fiddle” podcast with my colleague Dr. Sneha Gazi discussing how art therapy can be helpful in navigating more “messy” life stages throughout the reproductive spectrum, building creative resilience to manage stress, and learning to make meaning from overwhelming or traumatic experiences. Listen to the podcast or watch the video here!
As Black History Month draws to a close and we enter Women’s History Month, it feels fitting to highlight a major issue that intersects with both communities: Perinatal Mood and Anxiety Disorders. PMADs are one of the most common medical complications related to child-bearing, affecting roughly 1 in 5 birthing people, including partners. In the past six months, ten children tragically lost their lives to the unspeakable actions of mothers who were all suffering from severe and untreated symptoms of PMADs, including Erin Merdy in Brooklyn, Dimone Fleming in the Bronx, Paulesha Green-Pulliam in San Francisco and Lindsay Clancy in a Massachusetts town. And yet, the only one of the most recent tragedies to make national headlines was that of Lindsay Clancy’s, a white labor and delivery nurse in a Boston suburb. In response, perinatal mental health Hajara Kutty writes, “...it is disturbing and hurtful that these same conversations failed to materialize when Black children were at the center of similar tragedies. In the absence of a relevant angle, many media stories involving the racialized mothers morphed into narratives about how they lived in shelters, were on the brink of eviction or facing custody battles. The implication is that these mothers took their children’s lives because of hardship. As those in the field of postpartum mental health, we know this is not the case. All of these women were postpartum and many were exhibiting bizarre behavior before the tragedies (a key symptom of postpartum psychosis).” The media frequently mislabels symptoms of postpartum psychosis as postpartum depression, further muddying and stigmatizing the public’s already distorted awareness of maternal mental health risks. Postpartum psychosis usually occurs around 1-2 weeks postpartum and impacts roughly 1 of 1,000 postpartum birthing people. It is often associated with previously undiagnosed bipolar disorder and the most common symptoms are severe agitation, delusional or bizarre thinking, hallucinations, insomnia, confusion, & dissociative feelings. Although a fairly rare condition, it is both preventable and treatable with timely and appropriate medical attention. Kutty concludes, “We need to add our voices to steer the conversations to the topic of postpartum mental health whenever the tragedy involves any mom within a year of giving birth. If postpartum mental illnesses don’t discriminate, then neither should we.” Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Original Image by Max Larochelle via Unsplash Just three weeks after George Floyd’s murder, 26 year-old Sha-Asia Semple died shortly after the birth of her first child due to fatal errors in properly administering her epidural and a subsequent failed intubation in a Brooklyn public hospital. In September of 2021 in Queens, NY 29 year-old mother of two Denise Williams died 48 hours after being admitted to the hospital for complaints of postpartum depression. Although at first the cause of her death was unknown, later reports confirmed it was a pulmonary embolism that had gone undetected. According to her family, Ms. Williams had been under enormous physical and emotional stress during her two month postpartum period, but hadn’t been able to address her own health needs until it was too late.
Although seemingly unrelated incidents, both cases involved the untimely death of two black mothers in NYC related to huge disparities in our maternal healthcare system. In New York City, Black women are nine times more likely to die of pregnancy-related complications than white women. Research suggests that racial disparities in maternal deaths are also linked to the fact that Black women are often more likely to deliver at hospitals with a lower quality of obstetric care, ranging from lower-performing doctors to understaffing, which forces patients in distress to wait longer. This breeds negligence and incompetence, making tragic but preventable cases like Sha-Asia and Denise’s more common. In a post-Roe America, there are more barriers than ever preventing black birthing people from getting the critical perinatal care they deserve, including lack of paid parental leave as well as lack of insurance coverage for postpartum doula care or mental and behavioral health care for PMADs, (approximately 80% of which go undetected due to lack of awareness, routine screening, and stigma.) The words of Shawnee Benton Gibson, whose daughter Shamony Gibson also died from a preventable pulmonary embolism in 2019, echo louder than ever: “Black wombs matter. Black minds matter. Black bodies matter. Black communities matter.” Post by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C Original photo via Unsplash A recent "Discover" magazine article highlighted the benefits of visual art exposure on mental health. Viewing visual art activates the same brain reward systems as other pleasurable, highly sensory activities. Studies have shown that regardless of the context of where the art is observed–whether it's a gallery, museum, or even an online exhibit from home–other physiological benefits can include lowered stress levels, blood pressure, and anxiety when engaged in mindful art observation for at least two minutes. “Maybe it makes you think about your identity, evokes certain memories or elicits different sensations. This may allow you to learn new things about yourself and make the art-viewing experience something transformative,” reflects art therapist Sarah Vollmann. Imagine if this positive impact could be translated to stressful workplace environments as well. Particularly for those in “frontline” helping professions during the ongoing pandemic, caregiver burnout remains an underreported yet incredibly common mental health syndrome exacerbated by lack of systemic support and exposure to chronic stress. This can lead employees to feel “checked out,” undervalued, resentful, and/or reactive, which in turn, negatively impacts job performance and quality of patient care. In response, the Whitney Museum of American Art has recently partnered with NYC Health + Hospitals Arts in Medicine program to provide integrative arts-based wellness workshops to hospital employees inspired by art pieces on loan from their collection and featured throughout the medical facility. Yesterday I was privileged to begin a new role in co-facilitating the first of these integrative workshops at a Manhattan hospital, where we applied creative resilience skill-building, social-emotional learning, and art observation mindfulness techniques to creative responses pieces and personal reflection. Vollmann continues, “I believe that the importance of art cannot be overstated. We are living in difficult times, and struggles with mental health are on the rise. The exhibits of museums and galleries can provide a sanctuary of sorts from the chaos and stress of our daily lived experiences, and, conversely, they can help us to face and make meaning of the struggles that we face.” Now, through this program, we are working to bring these crucial creative safe spaces to the workplace as well. #burnoutprevention #caregiverburnout #mentalhealthawareness #artheals #creativeresilience #mindfulness #safespaces Post, artwork, and photograph by Sharon Itkoff Nacache ATR-BC LCAT LPAT PMH-C |