Preserving life in a pandemic
Jessica Greenhalgh, clinical director at Honey Lake Clinic in Greenville, Florida, told CP that she could not speak specifically about how Paige Hilken died at the mental health facility in Arizona where she went for care. But she knows that when people take their loved ones for in-patient mental health treatment, the main focus is to preserve life.
The Honey Lake Clinic was started by a group of pastors, clinicians and businessmen who saw a need for Christian mental health treatment in the U.S.
“When it comes to someone going inpatient, the purpose of that is to make sure someone is safe enough in order to continue to be here with us," Greenhalgh said. "And so a lot of the facilities are created specifically to make sure that someone stabilizes from a crisis so they can return to their families or return to less intensive placement. I think it’s unfortunate [that she died in the facility]. If someone is having suicidal ideation, as a clinician, I have to make sure they are safe.”
Greenhalgh also agreed with researchers that there is a need for better understanding about the mental health challenges that come with motherhood, even among healthcare providers.
“I think that there are a lot of expectations that are often put on mothers that we don’t always recognize. A lot of times those expectations may be unrealistic especially if no one knows what that person is going through. But there are not necessarily many places that specify for postpartum,” she said.
“I worked in a former place where they [some staff] attempted to create a partial hospitalization program specifically for postpartum depression and the engagement was lacking. And I think part of it is a lack of understanding of what it means to have postpartum."
Greenhalgh said that when there is a "lack of recognition" or understanding, it can "lead to a feeling of being alone or being different, which also can increase the risk of worsening mental illness."
Kay Warren, the co-founder of Saddleback Church in California, has evolved into an outspoken mental health advocate since her youngest son, Matthew, fatally shot himself at the age of 27 in 2013 after a long and private struggle with mental illness. She told CP that the decision on whether to institutionalize a loved one facing a mental health crisis or giving them support in the home can be challenging.
“Obviously, I’ve dealt with that a lot with my own son and ministry to thousands of parents and family members. It’s a both-and,” she said when asked if it was better to help loved ones in mental distress with institutionalized care or support at home.
“I think we make the mistake of hospitalizing people when we don’t need to and I think we make the mistake of not hospitalizing people when we should have. So you can err on either side," Warren said.
"There’s a place for institutionalized care and there’s a place for being at home with intense intervention of family and friends. It’s really not an either or. There will always be a need for places where we can keep people safe from themselves. And then, there will be other times in which to do so will actually make the situation worse.
“I speak as a mom. I wasn’t sure I knew how to keep my son safe. And there are things I’ve learned in the years since he’s passed away, there are some ways that families can pull in very close and help someone pass through maybe a season of intense desire to kill themselves, but it will pass. But there are other times, for instance, when their psychosis [is too great] and you can’t reason,” she continued. “It takes great wisdom, and great insight and discernment to know which is required at what point in time. And the fact is, unfortunately, people make mistakes on either end of that.”
And that delicate discernment is even further complicated amid the coronavirus pandemic, Greenhalgh says.
“During this pandemic, there is a lot of isolation and that is something that we see as a major increase. The suicidality [comes] when we don’t feel connected. We are built for fellowship and I think for a lot of people, this pandemic has first created strife in our ability to connect with other people,” she said.
In an op-ed for The New York Times updated in July, psychiatrist Pooja Lakshmin also pointed to the increased vulnerability of pregnant and postpartum women amid the pandemic.
“As a psychiatrist who specializes in taking care of pregnant and postpartum women, I’ve seen an increase in intrusive worry, obsessions, compulsions, feelings of hopelessness and insomnia in my patients during the coronavirus pandemic. And I’m not alone in my observations: Worldwide, mental health professionals are concerned,” she wrote.
Lakshmin cited an editorial in a Scandinavian gynecological journal calling attention to the psychological distress that pregnant women and new mothers will experience in a prolonged global pandemic and a report from Zhejiang University in China about a woman who contracted COVID-19 late in her pregnancy and developed depressive symptoms.
The struggle to talk about maternal mental health
The Rev. Adriene Thorne, who serves as senior minister at First Presbyterian Church Brooklyn and was previously executive minister of a 1,000-member church in the East Village of New York City, says she isn’t shocked by recent findings on maternal suicides and suicidal ideation.
“Is it something that I find shocking? No, I do not,” Thorne began.
“I ran a mothers group at my former church, and it was actually started by a member of the congregation who herself had two young children and wanted to be in conversation with other moms for mutual support. I, myself, at the time had a child. And I remember personally going through a really difficult time right after my child was born,” she revealed.
Thorne explained that her initial approach after returning to the church from a three-month maternity break was to talk about how “God was faithful” and the joys she experienced. But, she also chose during a prayer with her group for mothers to share about “this really deep bottom to it that I was completely unprepared for.”
“I didn’t dwell on it for a great deal of time but was really using it as a way to say God is faithful," she said. "After I led that prayer, all these moms came up to me. And the one that stuck out to me the most was herself a mom of two who said, 'yes.' And the reason no one talks about this great depth of sorrow is because of what she called the ‘cult of motherhood.’ And I just was like, 'Tell me more.' And she said, 'Well, everyone talks about how great it is to have children and it is. And everyone talks about maternal instincts and how they’re just born to do this thing.'
“I think this is what she was calling the cult — this notion that you as a mom should just know what to do and not only know what to do but do it well and be ecstatically happy about it. And the reality is much more I would say, complicated,” Thorne said.
The New York City pastor talked about coming to grips with sleep deprivation and “surging hormones.” She also recalled discussing the challenges of motherhood with her doctor. Even with significant resources and support at her disposal, Thorne was unable to protect herself from having thoughts of harming her own child.
“I had sisters who came, my mom came [to help]. She [my doctor] said think about the women who have none of that who are single moms, who have other children. And when she said it, the next thing she said was 'and now you understand why women leave their children under a bush or at the firehouse.'"
"She said, ‘you don’t get it until you have gone through it.’ When you read about it in the [newspaper], you go, ‘Oh my God, how could a mother who’s so happy and at the peak of her joy leave her child in a dumpster?’"
Thorne said that once she had a child and experienced sleep deprivation and surging hormones, she began to understand.
“I remember being on the balcony of my apartment, holding my child. And I stepped out on the balcony, and I thought to myself, ‘Wow, I could just let her go.’ I was so freaked out that that went through my head that I just backed up into the apartment, and I sat on the couch and I called my sister who is a mom of two," she recalled. "And I was just sobbing. And I said, ‘this is what happened, this is what happened. What’s wrong with me?’ Because again, the culture says, this should be the happiest moment of your life."
"I wasn’t upset. I wasn’t particularly tired. I just thought something’s wrong with me that I thought that," Thorne continued. "And my sister said, and this was very helpful, ‘It’s normal, Adriene. We all go through this. You didn’t let her go. So it’s OK.’”
Unlike Thorne, however, many new mothers have let their children go in the throes of mental distress.
In June, Dejhanay Jarrell, a 24-year-old mother who lived alone with her 1-month-old and a 2-year-old child at a building on Rockaway Parkway in the Brownsville section of Brooklyn, threw them out of a second-story window before jumping out of the window herself, ABC 7 reported.
All three survived, but Jarrell was charged with attempted murder. Several other stories highlight mothers jumping to their death with young children in New York City or other instances of maternal murder-suicides around the country.
“I think what works against women is a culture that says this is the best thing that will ever happen to you without also saying, there is a bottom to this. There is a dark side," Thorne reiterated. "There is an underbelly. There are hormones, fatigue. There’s moms not getting the help they need, lack of childcare."
“The fact that we live far apart from our support networks — my parents are in D.C. I’m in New York — so my mom had to make an effort to come help me. My sisters had to travel. We don’t live in family networks that would provide us with [what] the African proverb [calls] the ‘village’ to raise a child. We don’t have that. And if we don’t have financial resources, particularly in a city like New York, where I live, you’re very much on your own,” Thorne explained.
She believes a cultural shift including more open dialogue on maternal mental health and a stronger safety net for mothers could be helpful in mitigating the crisis.
“I would hope for some cultural shift and communal network. A safety net for moms. For us to be an industrial nation that provides no childcare. I think the U.S. is one of the few if not the only industrialized nation at its level of production that does not support mothers and children. It’s very difficult for women to balance work-life and raising their children. And I think that’s another myth, the myth of the supermom who should be able to do it all. You can’t do it all,” Thorne said.
“I think it’s a lot of shame for women once it’s not all happiness and joy, and so we don’t talk about it. I even said to my own sisters, ‘Why didn’t you tell me that there was this dark side?’ And they just kinda shrugged their shoulders. And so I kinda had made it my mission to check on moms and say to moms this is going to happen to you.”
Warren agrees that when it comes to suicide, the more awareness is raised about the issue, particularly when it comes to mothers, the more people can get help.
“The stigma around suicide, it’s still one of the last taboos. It’s still very difficult and uncomfortable to talk about. It is a gut-wrenching thing that happens to people, that happens to families. We’re just not comfortable and the more we can talk about it the more that people who are at risk can get the help that they need,” she said.
Unlike many churches where a focus on maternal mental health is not even an issue that's addressed, Saddleback Church, which is one of America’s largest churches, has been actively addressing it since a murder-suicide involving a young congregant and her newborn several years ago.
“I think probably because Saddleback is such a large church we deal with thousands of people on a regular basis. We had a very tragic loss in our church a few years ago of a mom with postpartum depression and psychosis who took her life and that of her baby. That was just heart-wrenching news and out of that we started our first post-partum depression support group,” Waren said.
“The grandmother, for her own pain, she wanted to highlight the reality of postpartum depression and how it’s not only just difficult it can be lethal, and so she started that support group. Some other moms joined in both as leaders, they had experienced it themselves or were there to help other new moms,” she explained.
Warren also agrees that it’s often very difficult, particularly for new or young mothers, to reconcile a frequently romanticized view of motherhood they are sold in media or society in general compared to the realities they face.
“I think it can lead to some deep feelings of shame and guilt because we’ve really romanticized motherhood much the same ways we have romanticized marriage,” she said. “When your own personal experience doesn’t match up to the romanticized versions of what’s out there in media or in all the stories that we tell each other or all the advertisements that make it seem like marriage is the best thing that ever happened to you or motherhood is the best thing that ever happened to you, and when your own life experience is different from that, you can feel like what is wrong with me?
“As a young mom, the sense of why do I not like this baby? Or why am I thinking of harming the child or why can’t I sleep? Why isn’t it like the way it’s supposed to be in all the books and movies and magazines? So I think there is an element of shame that can keep moms from getting help,” Warren explained.
“And I think there’s also the idea that this will pass. This is just a short-lived thing and I’ll get over it, and I'll enter into that place where everybody else is where they’re just thrilled to have this baby, and sometimes it does, because it’s pretty normal.
"About 80% of women experience the baby blues as your body adjusts hormonally to not being pregnant … and then for some other women it doesn’t go away. In fact, it gets worse or it builds over the months,” Warren added. “There’s just a lot of pressure to be superwoman, supermom, more than human, very idyllic, and very romanticized. Life is usually a lot more gritty than that. It’s a lot harder.”
The vilification of troubled moms, an opportunity for people of faith
In the absence of a national response to the crisis, Warren believes that the faith community, which in many churches is made up of predominantly women, now have a unique opportunity to respond, particularly when it comes to supporting young mothers.
“I think that what we have in the faith community, we have an opportunity to come alongside young moms. We have a Bible study called ‘Treasured’ that is for young moms. And the whole point of it is not to glorify motherhood or not to romanticize it, but to be there on a weekly basis, very strong support of getting women with their spiritual roots deeply connected into God, deeply connected into each other so they can have community. So that they are not alone,” Warren said.
“They might live three states away from their mom and their aunts and their grandma but there is a group of women there who are going be there every week to support them and to hopefully help them recognize when reality hits that it’s not the romanticized version. It’s actually a lot harder than that," Warren explained. "They don’t feel ashamed to ask for help. They don’t feel embarrassed, they don’t feel hesitant. They know they’re going to be accepted and somebody is going to know what to do — how to connect them back to their doctor to make sure they’re getting the help that they need."
The megachurch co-founder also wants society to stop vilifying mothers who die by suicide or harm their children in the throes of mental distress.
“There has been almost complete vilification of mothers who take their lives with that of their children, and sometimes we find on further examination that those mothers were experiencing postpartum depression or postpartum psychosis. And when you can begin to understand that that is not somebody’s character ...,” Warren stressed.
“What they did, of course, was evil. It (sickness) killed their baby. That is evil. But the motivation was not from a person who is an evil person, but from a person whose body betrayed her, if you will. Whose body and brain were malfunctioning. That postpartum psychosis actually requires compassion rather than judgement and vilification," she continued.
"I think that when we can even shift to look at [it] almost as an entirely medical problem then it can reduce the shame, it can encourage us to say, 'We’re going to be more open, to talk about it. We’re going to do what we can for those moms. We're going to make sure that they get the help that they need.' And so at the end of the day, the church can play a powerful role in recognizing the medical nature of postpartum depression and that the women who are vulnerable to it, and the babies who are with vulnerable mothers, we can kind of move in as people who save lives rather than people who encourage silence and hiding and shame,” she said.