Postpartum OCD is also a Thing
Reframing a journey in overcoming a frightening perinatal disorder.
“Congratulations to my amazing executive assistant @kjnyc and her gorgeous newborn baby Sydney, born August 29th at 11:57am and weighing 6 lbs 10 oz. Katie always keeps me on schedule, so of course Sydney has defied all expectations and arrived early!”
In the social media age, we were honored to have such a “likable” birth announcement, but it also modestly highlighted the anal retentiveness required of an executive assistant charged with the administrative management of one of Forbes’ 100 Most Powerful Women. My neurotic organizational prowess in both the workplace and at home is a quality that I have always valued in myself. It is also something that I was able to monetize as a glorified secretary to some of New York City’s most influential people throughout my 10-year career preceding motherhood.
After bringing Sydney home from the hospital, many of our visitors marveled that our tidy, uncluttered apartment did not look like a newborn had just moved in. And nearly everyone who stopped by during the first three months would ask how we managed to keep baby stuff from taking over our 1000-square foot, two-bedroom unit in Midtown Manhattan. Having two bathrooms and a future mother-in-law on meal- and laundry-duty definitely helps, but mostly, it could be attributed to the fact that I am obsessive about organization.
I used to fondly reference my undiagnosed Obsessive Compulsive Disorder (OCD) in seemingly appropriate and relevant moments throughout both my professional and personal life. I joked as if it were a curse that I secretly found endearing, blaming such things as a tupperware organizer in my kitchen cabinet on “my OCD”. When so little thought is given to true OCD sufferers, who battle crippling phobias or are unable to suppress repetitive rituals, it was easy for me to glorify OCD as if it were a mark of enviable perfectionism and not a debilitating illness.
But then I had a baby, and I learned the horrors of what living with OCD can really be like.
Postpartum depression has gained some much-deserved traction in the media, books, online chat forums and blogs. My fiancé, Carlyle, and I sought as much information as we could about what to expect in perinatal life, and I reassured him in advance that I have not characteristically been susceptible to deep depression. Ever a thrill seeker and pursuer of bliss (Arianna used to ask me on Fridays if I was jumping out of anymore planes or off any other cliffs over the weekend), I truly did not believe that I was in any significant hormonal danger. While I was aware that certain levels of stress could cause my own disruptive thoughts to ruminate, my emotional track record reflected that I am not wired to remain angry or sad about most things for long. I relish joy, and I believe that I thrive most from an introspective place of perspective and gratitude. I cycled across North America in 2010 on what could have been described as a 50-day personal mindfulness journey before the self-improvement gurus began offering luxury consciousness retreats to the masses. Suddenly, it seemed, everybody was in search of enlightenment in the Hollywood vein of Eat Pray Love, and even those-who-teach-since-they-can’t-do were asking how they could jump on the bandwagon to monetize the movement.
All of that is to say that I was not concerned about my mental health going into my first pregnancy. My incessant need to find the good or the funny in most scenarios, ranges from G-rated corniness to X-rated sarcasm (I have always believed that a dirty mind is a terrible thing to waste). And I typically viewed my OCD tendencies as potential annoyances at most — particularly for anyone who has ever shared an apartment with me. However, while some suffering from legitimate OCD find themselves trapped in routines of obsessively washing their hands or locking and relocking doors according to a distinct soothing pattern, I did not realize that my obsession with order and organization also fluttered on the outskirts of a very dark place.
For the first several weeks after Sydney was born, I couldn’t tell anyone about what was happening in my mind. I was afraid that I would no longer be trusted to be alone with our new baby or that I would be involuntarily committed for psychiatric evaluation, but Carlyle, who I later realized had been observing my deterioration very carefully, finally pressed me to open up to him. Through tears pooling in the pillowcase under my cheek, I whispered into the darkness of our bedroom, “I am having bad thoughts … and I can’t stop them.”
I will spare the horrible details of the disturbing thoughts that I entrusted to Carlyle as I do not want to plant any seeds in the minds of other new or future mothers who might be susceptible to postpartum OCD, but that’s what it’s called. Postpartum OCD. Like postpartum depression, it’s also a thing. And Carlyle, armed with the details I shared with him, went to the Google the very next day and began researching the signs and symptoms that led to our understanding of this thing.
When the movie Saw first hit theaters (I did not see it, but I’ve heard about some of the scenes), I remember thinking, “How fucked up do the writers have to be to dream up some shit like that?” (Sorry, mom and dad.) Yet years later, everywhere I turned, it seemed as if nearly everything was a potential hazard and posed a violent, graphic and unlikely yet realistic danger to my newborn. The realism is what caused me the most anguish. I was logically aware that the visions I was having were unlikely, but the mental reels of graphic imagery playing on repeat in my mind had an excruciatingly realistic quality. If I didn’t figure out how to control them, I feared that I could face chance with an unlikely reality.
It is difficult for me to articulate the tenses in which the visions occurred. They were mostly third person, but with the undertone of experiencing them in the first person. Something like an urge. A “what if” urge. Meaning, I had no desire to commit any of the violent acts myself, but a tragic loss of self control was often a part of the visions, accompanied by a mental caption: “what if I … [insert unspeakable imagery here]”. Yet if the actions I was imagining were absolutely against my will, I could not reconcile why I was having the thoughts to begin with. That terrified me.
The least creative image that I am willing to share occurred when I was walking along the third floor of the atrium in the Time Warner Center in New York City’s Columbus Circle. I suddenly pictured myself rocking my baby in my arms before losing control and launching her over the glass balcony. But the horrifying mental imagery did not stop there. It played itself out.
The three-story descent.
Carlyle’s reaction upon hearing what I had done.
Highly aware that I was in public, it took all of the strength I could muster to keep from falling to my knees and wailing in despair at just the thought as I rushed toward the elevator. Instead I focused on not losing control of my arms even though I wasn’t even holding my baby. My sleeping infant was strapped securely into the stroller that I pushed in front of me, and I was nearly hugging the wall, trying to wheel her as far from the balcony as possible. My knuckles were white as I leaned into my grip, trying to stop the shaking. But the scenario that I had just conjured up did not stop when I exited the building. It followed me on repeat until the next disturbing image came along, and then the next. And with each image, I had a flash forward of the agonizing regret that can follow in the excruciating permanence of death. I was regretting things that had not even happened … but could … but were unlikely. I was spiraling into and on top of myself. The weight was crushing. It seemed so bizarre because I was not depressed. I still had a desire to interact with family and friends. I still wanted to cuddle my baby. I could still laugh, and I could hide a lot behind humor, but I wasn’t sure how long I could continue smiling outwardly about new motherhood with the darkness always lurking.
From his office across town, Carlyle began texting me links to various articles and blog posts about mothers who (have) experience(d) crippling intrusive thoughts. I bawled as I scrolled through them on my iPhone, rocking softly in the chair in our nursery, our precious newborn sleeping soundly in my lap even as my chest heaved from the emotional release. This time, however, they weren’t tears of fear and shame; they were tears of relief. I was not crazy.
But I still needed help.
According to Postpartum Support International, “Postpartum [OCD] is the most misunderstood and misdiagnosed of the perinatal disorders. You do not have to be diagnosed with OCD to experience these common symptoms of perinatal anxiety. It is estimated that as many as 3–5% of new mothers and some new fathers will experience these symptoms. The repetitive, intrusive images and thoughts are very frightening and can feel like they come ‘out of the blue.’ Research has shown that these images are anxious in nature, not delusional, and have very low risk of being acted upon. It is far more likely that the parent with this symptom takes steps to avoid triggers and avoid what they fear is potential harm to the baby.”
I talked to a therapist about the debilitating thoughts I was having. Since I couldn’t avoid the triggers, which ranged from sidewalk subway grates to everyday household appliances to the floor-to-ceiling windows in our highrise apartment, I needed a coping mechanism. There was a therapeutic quality in saying the thoughts out loud. The more I talked about them with her, the more absurd they began to sound and feel. One of the first things she wanted me to do was prioritize sleep. The less sleep I’ve had, she said, the harder it would be to quiet my mind. After supporting Arianna throughout last year’s book tour for The Sleep Revolution, having to have that connection drawn for me was a bit of a face-palm moment. I can’t tell you how many times I heard the directive “prioritize sleep” in 2016, but up until now, the major repercussion of failing to do so had been little more than a coffee-sputtering stumble into the office with a hangover.
With sleep less often on the postpartum chopping block (thanks to some recalibrating between my fiancé and future mother-in-law), I found that it was also helpful to just go outside (of both our home and myself) and be reminded that I am a member of a bustling society — and a much broader world — with its own independent and collective tragedies, issues, dreams, concerns, hopes and desires. It can be sobering to simply remember that the world never revolves around you.
Finally, my therapist also offered me an exercise to use outside of our sessions: when the intrusive thoughts imposed themselves on my day (or night), stop and honor them. Honor them? Yes, honor them. Honor them as thoughts. Honor that I am not my thoughts. Honor that these thoughts are unlikely to actually occur. Honor that the thoughts can pass.
When I stopped trying to control the thoughts, that is just what they did. They passed.
Using this tool, I began to view these thoughts as an intense mommy radar that my subconscious had created to fiercely protect my baby. I was having outrageous thoughts because I was on hormonal hyper alert to any danger — regardless of whether that danger had even the remotest possibility of being me. With Sydney’s birth, a tremendous burden had fallen on my shoulders. Yes, burden. The burden of having a tiny life placed entirely in my hands. It was an enormous responsibility unlike anything I had ever experienced before. For the first time, I felt the tremendous power I instantly possessed. This tiny, precious creature was utterly helpless. Not only did her survival depend nearly entirely on me (and our unwavering commitment to breastfeeding; an ordeal that I’ll have to save for a future post), but I often shuddered at the fact that I could conceivably crush and extinguish her life in mere seconds. The choice of whether she lived moment to moment was within my control. And when I wasn’t fearing a sudden loss of that control, I was haunted by the risk of any scenario in which my failure to be hyper alert could potentially lead to negligence resulting in a tragic accident. It was exhausting.
I have always valued my ability to choose my response, but I now felt the enormity of this new control so acutely that even the most inanimate of objects or most mundane of scenarios had the potential to pose a deadly threat. A graphic, violent, maddening threat.
I worked very hard to honor that intense mommy radar. And slowly, that madness evolved into respect. Respect for the miracle of life. Respect for the magnitude of the love that fuels our deepest, darkest fears. Respect for the fragility that helps us comprehend and value how precious life and love are. Respect is an empowering thing. It enables you to relinquish the need for control. It’s my first lesson in how to be a vigilant parent while simultaneously letting go.
Sydney will soon be six months old. The thoughts still come. They are fewer and farther between, but sometimes the vivid mental reel still hits me like a ton of bricks. My stress level and amount (or lack) of sleep typically determine how well I am able to cope at any given moment, but my biggest asset is the realization that postpartum OCD is a thing. It’s existence does not make me crazy. It is not a reflection of my level of desire to be a good mother. It is not an indication that I am doomed to failure.
It’s a hormonal imbalance that I attribute to the fact that I am one kick-ass assistant and a hell of a mother. The self-help gurus will tell you that it’s all about “reframing”.
Originally published at www.huffingtonpost.com on February 27, 2017.