I never went back: on psychiatric ignorance of breastfeeding

I wrote this piece (cross-posted) for Melodie at Breastfeeding Moms Unite! She’s running a series on mental health and breastfeeding, and asked several bloggers for stories on their experiences with the mental health field while nursing. While I haven’t had any contact with mental health practitioners in the 2.5 years the Boychick has been breastfed, I immediately recalled an incident with a psychiatrist from years before, when I was on medication and was first contemplating the idea of someday procreating. Although this incident was almost a decade ago, I still recall it strongly. And although I am a strong advocate for alternative therapies in mental health, I am also a strong advocate for rationality and options in pharmaceutical treatment of lactating women. This is part of why.

I Never Went Back

I don’t know how to tell this story. On the surface, it doesn’t seem so bad — just another case of an ignorant douchebag doctor being an ignorant douchebag; no especial reason for me to have wound up sitting on the floor of my mother’s office, sobbing into her skirts. No real reason I should still be carrying around this pain, which clenches around my heart when I think about it. Certainly to an outsider, it must seem like “not a big deal”. And yes, my reaction was extreme, a symptom of my instability at the time. And yet, that’s the point, isn’t it? If it isn’t safe to be crazy around a psychiatrist, then who can we be vulnerable around? Psych workers should be held to higher standards, and they need to understand how seemingly “small” remarks can have a large, lasting impact on those they work with. This is why my story — my small, seemingly insignificant story — is worth sharing.

I had been seeing this psychiatrist friend of my mom for a couple years, since I first sought help for my bipolar disorder. As a fellow physician, he offered her the “professional courtesy” of seeing me without out of pocket costs, even when I had no insurance. He’d even given me several months’ worth of “samples” of my medication, which would have cost hundreds if not thousands of dollars full-price at a pharmacy. I liked him well enough, and trusted him well enough — even if he didn’t get the full truth, because some things I could only say out loud very recently. I had no more defenses against him than I did against myself (which is to say, some, but none I would admit to at that point). I had no reason to expect anything but professionalism. I had excepted to be respected. I had expected to be safe.

Which is why, when I talked to him about my oh-so-tentative plans for pregnancy and breastfeeding and attempted to discuss options for medication management through that time, I wasn’t expecting to be told “Oh, I wouldn’t have you breastfeeding on anything. Formula is fine, and we don’t know what these drugs do to developing brains.” I wasn’t expecting the fight-or-flight adrenaline spike sitting there in that quiet room; I wasn’t expecting the panic attack as I realized I was in a room with an enemy, not an ally. I wasn’t expecting to know more than the supposedly-educated man sitting across from me; I wasn’t expecting to have my knowledge so blithely, casually dismissed. I was expecting a rational discussion of what my options might be, of how best to balance my medication needs and the potential risks to my maybe-baby; I wasn’t expecting that.

I still don’t remember how I got out of there. I don’t remember what I said; I’m fairly sure I did not say what was going through my head, because I didn’t start yelling and raving until later. I must have gone into fully walled-off protection mode, and probably smiled, and nodded, and mouthed whatever I thought he wanted to hear. Somehow, I walked out, trust and sanity in tatters, dignity and pride tied around me, holding me together. Somehow, I walked out; I never returned. I rode the elevator down the single flight to my mother’s group office; I found her talking with her colleagues; I went back to her office and waited for her. There, just ten feet below where I had been ambushed, attacked so unknowingly, the ropes unraveled and I fell apart. I cried — great gulping sobs, fluid falling everywhere, halting, hiccup-interrupted explanations bawled into my concerned mother’s lap.

I was so angry. Hurt, yes; shocked, shaky, unstable, yes; but angry. I was angry at his ignorance — in fact, we know formula causes harm to developing brains, and immune systems, and so much else, and we don’t know if most mood-stabilizers do anything but give babies saner mothers. I was angry that I was so easily dismissed, that he didn’t question his own assumptions, that he was so arrogant he couldn’t consider I might have a point, that I might know things he didn’t. I was angry that instead of being treated with respect as an equal, a person, I was just being treated, like a patient — like a thing.

I never went back. For the next many months, I went without med management of any kind. My dosage wasn’t great, but it was — almost — good enough. I might have done better on another dose, or another drug altogether, but I didn’t know, and had no one to tell me. I might have gone into liver failure, because I wasn’t getting my levels checked, and had no one to order the lab tests for me.

I eventually got stable — mostly through my own hard work — and found someone to oversee my weaning off the medications. In the end, I was able to go through pregnancy and breastfeeding without any of the drugs the doctor who had betrayed me said he would deny me. But if I had needed pharmaceutical assistance — or, to be more honest, if I had admitted I needed more help than I had — I had no one to turn to. I would have had to start anew, and overcome the aversion I learned on that day years before, try to learn to trust again while struggling with postpartum neurology and new life with a neonate. And all because of an off-hand assertion by a psychiatrist ignorant of normal physiology and human development, of the risks of formula and the damage of denying a woman’s right to breastfeed.

I’ve been med-free for almost five years, and breastfeeding for just over half that. I have been lucky that I have been able to avoid the psychomedical complex almost entirely since that day, but I am still angry that one physician’s ignorance and arrogance has alienated me for so long — and I’m angry at myself, no matter how nonsensical it is, for not standing up to him that day. I always wonder: how many other women and babies has he harmed with his ignorance on lactation and medication? How many other women didn’t know as much as I, and didn’t walk out, and didn’t breastfeed their babies? How many other women did walk out, and were alienated, left alone, but weren’t as lucky as I? How many needed medication they were unable to acquire for risk of being bullied into weaning?

How many of us need to speak out before there is change?

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17 Responses to I never went back: on psychiatric ignorance of breastfeeding

  1. Oh, man, so much WORD. I’ve had the straight-up “won’t consider changing your meds unless you stop breastfeeding, come back in two weeks when you have”, the “it’s too hard for someone like you to manage breastfeeding”, the “insisting on breastfeeding is part of your illness”, the “normal people breastfeed for six months”…

    I’ve also had some fabulous, supportive medical types – like my awesome former health visitor – but they’ve never been psych professionals.

    • “insisting on breastfeeding is part of your illness”

      This is the one that slays me. It’s an entirely too effective way of policing behavior. “Do what we say, or you’re proving you’re exactly as sick as we say you are.” *incoherent scream of rage*

      I also encounter it when questioning traditional pharmaceutical treatment of bipolar: “Questioning the need for medication means you really need meds!” I don’t disagree that treatment aversion (including, conceivably, using breastfeeding as an “excuse”) can be a symptom of instability, but to deny that ANY of us might EVER have a legitimate reason for the position? That’s when I start getting all sweary and whatnot.

  2. I’m still waiting for a psychiatrist who will actually listen to me, and not read the ‘Borderline Personality Disorder’ on my notes and immediately read that as ‘attention seeker, do not take seriously’. :/

    • I count it as pure luck and blessing I avoided that diagnosis ever (given the overlap and confusion between bipolar and “borderline” diagnoses — I have a theory, worth what you paid for it of course, that “borderline” is generally a bipolar manifestation of PTSD, usually primal). I get enough stigma with the bipolar diagnosis: having seen what friends go through with “personality disorder” stamped on them makes me want to strike it from the language altogether.

      • It’s not as bad here as it is in the USA, I know that much. Thing is, I’m pretty sure I’m bipolar in addition, but the psychiatrist I’m currently seeing is really reticent to give me the damn diagnosis, and I have a feeling he believes that my BPD is making me want to be bipolar or something. :o/

      • And that :o/ was meant to be :/ ;)

  3. I went on lofepramine when Andrea was just under a year. My GP was happy to find an antidepressant that didn’t have breastfeeding warnings all over it, but whenever I suggested it wasn’t having much effect, her attitude was that there were no other suitable medications, so I could take that or do without.

    Then I started to have the same conversation again and again.
    Me: I’m finding such-and-such really hard.
    Social worker: You need to be on antidepressants.
    Me: I am on antidepressants.
    SW: Well, you need to be on a different antidepressant.
    Me: My GP says this is the only one that’s safe for breastfeeding.
    SW: Well, she’s one now, you’ve given it a good go, you can wean her now.
    Me: *Crying inside*

    • Oh gods, how horrible. :( There’s SO MUCH we can try, especially as our children get older. (Right now, when the Boychick is nursing just a little twice a day or so, I’d laugh in the face of anyone who said I couldn’t take so-and-so because it gets into breastmilk. The amount he’s getting is SO much less now, and his liver, while still immature, is far more developed. We can’t just take legitimate concerns for neonates and apply them to ALL nursing dyads!)

  4. This is the link I sent my sister in law when her Doc told here to formula feed her baby. http://www.drjacknewman.com/help/Breastfeeding%20and%20Medications.asp
    After reading this she went round and round with her doc but they did find a drug that worked for her. 8 months and still nursing!

  5. @Nick – That is exactly the type of social worker I do NOT want to be.

  6. Geez, I guess I’m really lucky to live in the U.S. and have a psychiatrist who is fine with me taking psych meds while breastfeeding. I’m on Anafranil, Ritalin, and now about to start Seroquel low dose for sleep improvement (for a non-psych medical condition that I have). Have a great pediatrician, too. The $32 I paid for Dr. Hale’s book to take to appointments was also well worth it, but these guys I guess are (rare) gems in the first place.

  7. Pingback: I Never Went Back: On Psychiatric Ignorance of Breastfeeding | Breastfeeding Moms Unite

  8. <3 stories like this remind me of why i've chosen not to tell my psychiatrist that i am a nursing mom.

  9. I am thoroughly convinced that 90% of people in the therapy field need to be out selling shoes. {and this is from someone who worked in the field} The other 10% get to deal with the fall-out from the incompetents. This man is the proof.

    A counsellor’s job of any stripe be that psychiatrist, therapist, social worker [unless you have chosen directive psychology such as Rational Emotive Behavioral Therapy or Cognitive Behavorial Therapy]is to *ask the necessary questions*–in other words help you explore all the alternatives before you make a final decision. Only poor counsellors give advice or tell you how to live your life.

    A friend of mine calls them “Lie-chiatrists” because people are forced to lie to them about taking medication or taking less medication or whatever so the person [Note: you are NOT a "patient" that is an object, you are a PERSON who happens to be getting some healthcare] can get their therapeutic or medical needs met.

    Ludicrous IMO.

    Of course you felt de-humanized. This man didn’t explore what options you had, in the case of wanting a child and breast feeding–he was giving orders like a drill Sargent and “thinging” you. {Meaning, you are not a real person with your own ideas, you’re just a Patient-thing}. It’s a failing many doctors share.

    His job was to point out the risks should want to stop medicating and if you chose to do so, in order to breast feed or become pregnant–helped you to taper down the medications that were unsafe during pregnancy. Then explain, to the best of his ability what the possible psychological results might be. And possibly to hook you up with others who could support such a decision and prepare you for the future.

    Of course, that would entail him actually doing his job and we can’t have that now, can we?


  10. And for the “Borderlines” out there.

    That label is often thrown around heedlessly. And in my experience, it’s usually chucked directly at feminist women, or women who will not submit in some way to the Holy Order of Male Doctor-Hood.

    Frankly it needs to be chucked out the door. One is either sociopathic or not, meaning someone has a conscience or not–or one *does* have a conscience and is, to meet some dire need or other, manipulating the doctor or refusing to play nicely in the sandbox with [usually] a male doctor or medical staff. I’ve noticed that women who stand up for their rights either in a psych ward or in a medical environment tend to get slapped with “borderline”. Bluntly, the amount of women I’ve seen wearing that label on their foreheads just does NOT compute.

    I worked with mentally ill, actively using drug users and sex trade workers for years. And I can honestly say out of the thousands I met over the years, there were maybe 3 so-called “real borderline women” [and I would have said they were sociopaths] and perhaps 5 true male psychopaths. If it’s that low a percentage in the people who suffer the most in this society–for those in a better strata, it must be even lower.

    The rest? Large percentage of PTSD, clinical depression, bipolar, a few with schizophrenia, many with physical illness resulting in unclear thinking and problem solving.

    It also occurred to me that every woman I ever met with the label “borderline” was intensely creative and intelligent. I can only recall one single woman with that label who had an IQ under 120.

  11. I stopped breastfeeding my daughter when she was 2 months old with very mixed feelings. I had been on Effexor before I got pregnant and stopped to have a baby. Pregnancy was fine, but when she was born I crashed completely. My anxiety became terrible, I was depressed and being exhausted all the time didn’t help. The idea that breastfeeding and medication didn’t mix was so firmly in my mind that I refused to go on any kind of medication and just suffered for those two months before finally going back on Effexor and stopping the breastfeeding.

    I had always wanted to be the Mom who breastfed in public, doing my share to make it more common for women coming after me. I saw myself rocking her and nursing her at night and I never expected to stop before 6 months; if anything, I wanted to go as long as possible. I can’t help but wonder now what might have happened if I had gone on medication right away when she was born. Could I have avoided the PPD? Could I have kept breastfeeding? It bothers me that I can never know the answers to those questions.

  12. Pingback: Say Something Good « Raising My Boychick

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