By Cassie Shortsleeve | May 20, 2022

"Ask any new birthing person about the realities of postpartum life or anyone post-menopausal about menopause and they'll usually say something along the lines of, "No one told me it was going to be like this."

There's a lot no one tells you about the way reproductive transitions impact mental health, say reproductive psychiatrists—doctors who specialize in the historically siloed field of mental health throughout the reproductive cycle, from adolescence through menopause.

People have long experienced reproductive transitions and the symptoms and conditions that come with those shifts—like postpartum depression (PPD), for example—but the medical community has not known much about them until recently. While the American Psychiatric Association (APA) has dozens of textbooks on all kinds of psychiatric topics, there has been no comprehensive textbook in reproductive psychiatry—until now.

In December, thanks to a volunteer effort by 80 authors from more than 30 different institutions around the country, the APA put forth a textbook: Textbook of Women's Reproductive Mental Health.

In the authors' words, it's "the first comprehensive text for understanding, diagnosing, and supporting the unique mental health needs of women and others who undergo female reproductive transitions during their entire reproductive life cycle."
Lucy Hutner, M.D., a reproductive psychiatrist in New York and one of the book's co-editors adds: "It's a flag-on-the-moon moment for women's mental health."

After all, when she was training to be a doctor, she was told that the field that she specializes in today didn't exist. As recently as the 1980s, doctors and research studies alike suggested falsehoods such as the idea that mood is protected in pregnancy or that "without exception" psychological changes after having a baby were positive.

It's ironic, Dr. Hutner says, considering that postpartum depression is the most common complication of childbirth. But when you have patients with symptoms of diseases that exist and a field that doesn't, it's more than just ironic; it's detrimental to the overall health and wellbeing of that population. A lack of legitimacy perpetuates shame, misinformation, silence, and stigma.

"This medical textbook is almost symbolically more important than anything else," says Dr. Hutner. "It sort of says, 'Hey, this is as important as any other aspect of medicine.' It validates people's voices. It says, 'We don't need to have this stigma anymore. We're done.'"

The Messy World of Reproductive Mental Health
There's nothing non-existent or niche about reproductive psychiatry. But today, if you find yourself with something like PPD or postpartum anxiety (PPA), one of your first touchpoints with the medical system is likely your six- or eight-week follow-up appointment with your OB-GYN or a few trips to the pediatrician.
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If you're lucky, you might land in the office of someone like Dr. Hutner for specialized treatment. But too often new moms wind up in an OB-GYNs offices crying and reporting their symptoms with little to no guidance.
Just as this setup fails patients, it fails providers trying to care for those patients, too. The American College of Obstetrics and Gynecologists (ACOG), for example, recommends mental health screening at least once in the perinatal period. But as Dr. Hutner puts it, OBs may not always know what to do with positive screens, or may not know how to treat crying patients.
"The training, education, and dialogue around reproductive mental health have been ad hoc. There hasn't really been a standardized way of approaching it," says Dr. Hutner.

In short: Some physicians have training; some don't. Some are great at providing resources or spotting symptoms; some aren't. There are also big issues including systemic racism in medicine, as well as lack of awareness of queer health issues. This leads to a lot of patients who inadvertently wind up feeling invalidated and alone, without treatment.

Looking Ahead at Reproductive Mental Health
Most people recognize the importance of reproductive mental health, and doctors in training are eager to learn more about it. Lauren M. Osborne, M.D., one of the co-editors of the textbook and the director of the Johns Hopkins Center for Women's Reproductive Mental Health, has piloted a new curriculum designed to educate medical trainees in the field. She asked budding psychiatrists to rank six subspecialties of psychiatry—including reproductive psychiatry along with five officially recognized fields. Doctors ranked reproductive psychiatry in the top half, consistently outranking other specialties that are deemed essential knowledge for independent practice and board certification.  
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Yet because reproductive psychiatry isn't yet an official subspecialty of psychiatry, it currently lacks government funding for more post-graduate fellowship programs. And learning about widespread problems such as postpartum depression is elective, not a requirement. This contributes to a lack of faculty to teach reproductive mental health and a lack of providers to treat it."

By: Carla Shuman Ph.D | May 13, 2022

"May is Mental Health Awareness Month. As I thought about what to write to promote mental health and resilience, there was no shortage of topics to consider: We are living in turbulent times with a great deal of uncertainty about our personal futures and the future of the world around us. So I decided to write something that would encourage people to take care of themselves and to think about what mental health looks like for them. After all, we struggle with different challenges depending on our circumstances, our relationships, and our desires. We are all fighting different battles at different times in our lives.

However, there are ways we can take care of our mental health that we share in common. Doing these things will help you stay focused on staying mentally healthy, strong, and resilient.

1. Identify what is within your control and what you can change.
Many of us tend to focus on what is hard, what we cannot change, and what holds us back. This can quickly become discouraging. We can get stuck in the trenches of despair when we focus on what isn’t possible and why we can’t do certain things.

In contrast, identifying what we can control makes us feel empowered. We begin to believe in ourselves and realize that there are things we can do to make our lives better, have better relationships, and take care of our needs.

2. Keep cynical thoughts to a minimum.
While sarcasm can certainly have a place as a means of coping with life‘s disappointments, too much sarcastic humor can lead to a cynical attitude as our default. We can then get stuck believing that things will never change and that the world is out to get us. That does not lead to an optimistic viewpoint or to the resilience we need to stay grounded and focused on living our best life. Catch yourself in cynical mode and remind yourself that it isn’t useful as an everyday coping tool.

3. Identify the people in your life who don’t belong there.
There are some people who treat us badly, bring us down emotionally, and sometimes even convince us that we can’t achieve our goals or be our best. Focusing on what those people say and do and letting them get the best of us until it reaches a point that we are stuck can be toxic for our mental health. It’s our responsibility to identify bad relationships and then to break free and move forward, not to continue to dwell on what they have done.

At the end of the day, it’s up to us to make our own decisions and to create our own paths. Those who love and accept us for who we are will follow us and provide their support and encouragement.

4. Surround yourself with like-minded people who are making their best effort to live a good life.
Everyone is influenced by the people in their lives. Our friends, family members, coworkers, and significant others affect our worldview. Behavior patterns and moods can be contagious, whether they are positive or negative.

Prioritize time with people who make you feel good and encourage your dreams. Spending too much time with people who are critical or who constantly question your choices and your motives may decrease your self-confidence and make you question your decisions. Being around people who are optimistic, responsible, and who take action on their own goals is inspiring. Their behavior will encourage you to be proactive, and you can support each other in living a good life and taking care of yourselves.

5. Self-advocate.
As we walk through life, we will have varying degrees of social support and encouragement from others. There may be times when we do not have as much support, and that’s when we have to be our own best advocates. Recognize if you are being treated unkindly or unfairly, and be assertive in making your concerns or needs known.
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Sometimes, other people are not aware of how they are affecting us, and their negative influence is not intentional. So we don’t want to draw assumptions about others until we talk to them about what’s going on. Similarly, if we feel as though the way we are treated is creating difficulty for us or has affected our quality of life, we have to communicate so that we can be heard and understood. Sometimes, self-advocacy is as simple as making a request or a desire known to others."

By: Alison Ledgerwood | TEDxUCDavis

"​Alison Ledgerwood joined the Department of Psychology at UC Davis in 2008 after completing her PhD in social psychology at New York University. She is interested in understanding how people think, and how they can think better. Her research, which is funded by the National Science Foundation, investigates how certain ways of thinking about an issue tend to stick in people's heads. Her classes on social psychology focus on understanding the way people think and behave in social situations, and how to harness that knowledge to potentially improve the social world in which we all live."