depression – UAB Institute for Human Rights Blog

Postpartum Depression Needs Serious Attention

by Marie Miguel

Maternity leave is necessary because it helps with postpartum depression

In the United States, maternity leave is almost non-existent. New parents in the U.S. get an average of three months of maternity leave, and some only get the twelve unpaid weeks of leave that employers are now required to offer under the Family Medical Leave Act. https://www.dol.gov/general/topic/benefits-leave/fmla Depending on where you work and how long you’ve worked for a company, you may not receive any paid maternity leave at all, which can cause a high level of stress for low-income parents and families. According to a study at the University of Maryland, longer maternity leave decreases the risk of postpartum depression. It’s suggested that this is because women can spend more time with their infants, and this is not surprising; if you don’t have the bonding time with your child that you need, it’s going to be depressing for you. You feel like you have to leave your child preemptively, and that’s not fair. Healthcare providers and policymakers need to think about how we can foster a more positive experience with maternity leave and help women get the care that they need. It’s essential that we think about maternity leave as being a preventative measure for postpartum depression.

Postpartum depression is serious

Postpartum depression is a severe mental health condition. Many women go undiagnosed with this mental illness because they unknowingly downplay their emotions to their mental health providers or general practitioners. Postpartum depression is a severe condition, and it needs immediate attention from a medical provider. It’s normal to be emotional after having a baby. But, there’s a difference between feeling down and having PPD. When you have a baby, it’s a huge life transition. You’re now responsible for taking care of a new life. Many moms have a difficult time with this change, and if you’re feeling overwhelmed, sad, or a variety of emotions after giving birth, that’s understandable. It’s when your feelings feel out of control that you need to worry whether or not you have Postpartum Depression. We’ll go over the symptoms of the condition, and you’ll see if you relate to them.

Postpartum Depression is not the baby blues

Postpartum depression is not just “the baby blues,” which affects up to 80% of new mothers. Postpartum depression affects childbearing individuals more severely. When you have PPD, it makes it nearly impossible to function. You feel severely depressed, hopeless, and scared. When a baby is born, you can have extremely intense emotions as a mother, which are frequently caused by changes in your hormone levels. Hormones make your experiences feel more powerful than they would ordinarily. You may be prone to crying or insomnia that occurs even after your baby is asleep, for example. Symptoms that can be considered part of the “baby blues” include mood swings, irritability, anxiety, and trouble sleeping. Postpartum depression, on the other hand, is a diagnosable disorder that exists as a potential side effect of giving birth. Unlike the baby blues, which is categorized by minor dips in mood, postpartum depression can be severely debilitating. Postpartum depression requires treatment, so if you have this condition or think that you might have it, don’t ignore it.

Symptoms of postpartum depression

The symptoms of Postpartum depression leave a mother feeling like she can’t cope with everyday life. You may be wondering what they are. The signs and symptoms of postpartum depression include severe mood swings, depression or depressed mood, feeling overwhelmed, not being able to sleep, feeling hopeless, fearing that you aren’t a good mother, restlessness, severe anxiety, inability to focus or think clearly, feeling worthless, thoughts of death or suicide, and intrusive, disturbing thoughts of harming yourself or your baby.

Postpartum psychosis is another condition to look out for and seek treatment if you think you have it. With postpartum psychosis, you may experience excessive thoughts about the baby, hallucinations or delusions, excessive energy or agitation, paranoia, and self-harm. If you believe that yourself or a loved one is experiencing postpartum psychosis, it’s vital that you seek treatment immediately.

What can we do as a society?

We need to take a stand as a society to help new mothers, and if we can prevent Postpartum depression, One of the things that we can do to help new mothers is to advocate for longer maternity leaves. Allowing new mothers to spend more time with their babies can prevent postpartum depression. In a society that’s so focused on productivity and getting back to work, one of the most important things that we can do to prevent postpartum depression is to push for employees to offer additional time for maternity leave. We want to spend time with our children; that’s only natural. If we’re not able to do that, of course, we’re more likely to experience postpartum depression, but it’s important to note that no new parent is immune to developing it. It’s nothing to be ashamed of, and it’s not your fault. Certain risk factors, such as family history or personal history of mood disorders, financial problems, unwanted pregnancy, and more, can increase a person’s likelihood of developing postpartum depression.

Getting help for postpartum depression

If you feel that you may have postpartum depression or if you’ve been experiencing symptoms of postpartum depression for over two weeks, it’s essential to schedule an appointment to talk to your doctor. Treatment for postpartum depression most often includes medication, if you need it, and most importantly, therapy. You can choose to see a traditional therapist or work with online therapy. New mothers can have the added challenge of trying to get out of the house, making it hard to get mental health treatment. Online therapy provides a forum to get therapy in the privacy of your home. A new mother may not have the energy to get out of the house to go to therapy. Online therapy can be an excellent resource for new mothers to get mental health treatment, prevent PPD or treat it. You can see a counselor with your partner or has individual therapy. Whatever your preference, it’s essential to seek treatment for PPD.

Marie Miguel has been a writing and research expert for nearly a decade, covering a variety of health-related topics. Currently, she is contributing to the expansion and growth of a free online mental health resource with BetterHelp.com. With an interest and dedication to addressing stigmas associated with mental health, she continues to specifically target subjects related to anxiety and depression.

No More No Less: Basic Human Rights are Transgender Rights

I am a person who is transgender.

Transgender is an umbrella term that includes those that identify on the gender spectrum. It is the term used to describe an individual whose gender identity and expression are different from expected societal norms. Gender identity is the personal sense of one’s own gender, and for the majority, it correlates to the sex assigned at birth. Gender expression is a person’s behavior, mannerisms, interests, and appearance that are associated with gender in a particular cultural context. The social normative gender spectrum in most western cultures has been for centuries, binary: male and female. The basis of this binary was the presence of sexual organs at birth. When I was born, the doctor, based upon the presence of a penis, assigned me male at birth, in accordance with the binary gender spectrum. However, internally I was female.

I identify as female. As a transwoman, I continually fight a battle against erasure of my life and existence. Since transitioning I have suffered erasure by losing a career of 23 years, health insurance that will not cover medically necessary treatments, been refused treatment by medical professionals, and the state will not acknowledge my identity.

To live my life, I had to do this without acceptance from others including family and friends. I did not live on the streets because I remained hidden. I understood from growing up with my deeply religious grandparents that if I were different—my true self, I would be disowned. I made many poor choices, started drinking at age 11 and dealt with anger issues up until I got ordered to anger management counseling by the United States Marine Corps (USMC). It must have been bad for the USMC to think I was too angry to deploy. I grew up before access to the internet (no old jokes), and I had no names for what I knew about myself, so like many I suffered in silence until I figured it out much later in life. I want to make it better for the young transgender and non-binary individuals that are coming out today.

Social-Ecological Factors

Every level of the social-ecological model, from individual or intrapersonal level, all the way up to the societal or structural level in the transgender community fights against identity erasure. Many, including myself, suffer from internal transphobia. Tran individuals encounter internal transphobia as a byproduct of absorbing negative messages about not following the societal norms. Internal transphobia can occur with something as simple as not using the preferred name or pronouns, and/or through the attempt by family members to “correct” the behavior through abusive methods. For example, if society continued to identity Caitlyn Jenner as Bruce Jenner, then society contributes to the manifestation of internal transphobia she might seek to overcome. Additionally, by not employing gender pronouns like he/him: female transitioning to male (FTM), or she/her: male transitioning to female (MTF), and encouraging abusive practices like conversion therapy or berating about dating/sleeping with members of the opposite sex, society infringes upon the rights of Trans individuals to dignity and personhood.

The feelings associated with internal transphobia are the result of many years of discrimination, rejection, and ignorance about the rejection of gender norms. Depression can result in dangerous behavior. At the interpersonal level, family and friends reject many trans folk when they come out as transgender or gender non-conforming, mainly due to the preconceived notion of a binary gender system. The rejection becomes isolating and often leads to homelessness. In addition, some receive abuse from programs designed to rid individuals of these kinds of thoughts. The non-conformance to traditional gender norms of male and female can lead many to demonize transgender people who are out and trying to live their life. As a marginalized community, members of the transgender population are subjected to violence, harassment, discrimination, and vilification by society as a whole. The National Center for Transgender Equality (2011) survey found that those individuals that are gender non-conforming in grades K-12 were 78% more likely to be harassed, while 35% report surviving assaults. The current situation in the U.S. in regards to which bathroom transgender individuals should use leads to increase harassment. Transgender people are viewed as perverts, and being attacked for wanting to pee in peace. These types of attacks create high levels of anxiety, depression, and isolation.

The constant threat of discovery lead many to remain in hiding, leading to increased suicidal ideology. For example, the Transgender population suffers from an abnormally high suicide rate of 41% compared to 1.6% of the general population in the US. The murder rate of transgender continues to climb each year here in the US. Since 2013, an average of 25 trans women have been murdered, and there have been 18 killed this year. According to Bauer et al., a high social support network showed a 48% decrease in suicide ideation and of those with ideation, 82% decrease in attempts of suicide. The population suffers from many forms of social exclusion, and one of the main determinates is that this population is rarely counted; thereby, resulting in the marginalization of the transgender population.

At the societal level, this population is highly marginalized, even within the LGB community and the “T” not well represented. Due to fear, many of those who identify as transgender, are unable or unwilling to make their voice heard. This discriminatory practice reinforces an individual’s ability to care for one’s self. Few policies provide protection for, and individuals gender identity or expression. The lack of protections at the local, and state level allows discriminatory practices to continue, contributing to the overall marginalization of the transgender community. The use of conversion therapy to cure this non-compliance with gender norms is only illegal a few states and the District of Columbia.

The current data suggests there are about 1.4 million adults within the US that identify as transgender. This estimate is double the widely used previous estimate, and many organizations believe this number remains far too low. The lack of research and information on transgender issues is a direct result of this form of social exclusion and leads to incorrect assumptions about the population. Individuals suffer from social exclusion by losing family and friends when they “come out,” or being bullied at school, work, or on social media sites because they are different and challenge the gender norms. Most Trans folk keep their identity private due to discrimination and harassment. Ninety percent of Trans adults report experiencing attacks or discrimination because of their identity. In the workplace, 47% of Trans folk are fired, denied a promotion, or not hired. I lost my career of 23 years when I transitioned.

I lost my job as a fire department captain/paramedic. When I began my transition I believe that my history of good performance and exceptional results over the years of service would provide a buffer for any negative concerns that were raised. However, this was not the case and upon my coming out to the fire chief and deputy fire chief it was clear they did not wish to continue my service to the community. Things were rocky, but the mayor and personnel director had taking my side in the arguments that developed. But, to my dismay the chief had work with the city council and gathered enough votes to begin my termination. I had 23 years in public safety and two more years till retirement. Due to the lack of protects for transgender workers, there were not many options available at the time. However, I had returned to school to build my education, fearing that this might happen I wanted to be prepared.

Despite the setbacks, I have accomplished what many transgender individuals are unable to do. I returned to school, completed my undergraduate and graduate coursework, and graduated with a Master’s in Public Health. Now, I work at UAB which has been accepting and minus a few speed bumps been inclusive of my gender expression/gender identity. I hope to make a difference in the local transgender community here in Alabama by starting the conversation and showing that Tran men and women positively contribute to society and only want to live their lives just like everyone else. So please come join the conversation with UAB’s Institute for Human Rights and Department of English as they present “A Human Rights Approach to Transgender Issues.”

I am just a woman trying to leave a better place than what I found and live my life authentically.

Refugees: Peace of Mind

The Storm Refugees – Tribute To The Victims Of The Harvey Storm. Source: Daniel Arrhakis. Creative Commons.

“Armed conflict kills and maims more children than soldiers,”

-Garca Machel, UNICEF

Global unrest and armed conflict are becoming more common, intense, and destructive. Today, wars are fought from apartment windows, in the streets of villages and suburbs, and where differences between soldiers and civilians immediately vanish. Present day warfare is frequently less a matter of war between opposing armies and soldiers than bloodshed between military and civilians in the same country.

In 2014, there were 42 armed conflict, resulting in 180,000 deaths worldwide. Civilian death tolls in wartime increased from 5 per cent at the turn of the century to more than 90 per cent in the wars of the 1990s. War and armed conflict is one of the most traumatic experiences any human can endure, and the brunt of this trauma is felt by civilians- most especially children. In 2015 alone, some 75 million children were born into zones of active conflict. As of May 2016, one in every nine children is raised in an active zone of conflict. Two hundred and fifty million young people live in war zones, with the number refugees at its most prominent since World War II. Currently, there are 21.3 million refugees worldwide, and half of them children.

For refugees, the events leading up to relocation (notably war and persecution), the long and unsafe process of relocation, settlements in refugee camps, and overall disregard for human rights, takes a major emotional and mental toll. PTSD, depression, anxiety, and sleeping disorders are just few of many problems refugee children experience. Respecting human rights is essential to society’s overall mental health. Equally, a society’s mental health is essential for the enjoyment of basic human rights. Addressing the psychological needs of victims of armed conflict is essential for the prosperity of war-battered children’s future.

The Relationship between Mental Health and Human Rights
Armed conflict affects all aspects of childhood development – physical, mental, and emotional. Armed conflict destroys homes, fragments communities, and breaks down trust among people, thereby undermining the very foundations of most children’s lives. The psychological effects of loss, grief, violence, and fear a child experiences due to violence and human right violations must also be considered.

Throughout the process of becoming a refugees, the three main stages in which people experience traumatic and violent experiences include: 1) the country of origin, 2) the journey to safety, and 3) settlement in a host country. The interrelationship between human rights and mental health are recognized in various universal human right conventions and resolutions. Numerous legislative measures exists for mental health, but two main conventions that address the situations refugees experience include: 1) Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and 2) The Convention on the Rights of a Child. These two conventions specially address mental health pertaining to violence.

Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment: 1987
This Convention is significant towards the promotion of mental health as a human right because “torture,” any act that creates severe pain or suffering, can be both physical and mental. This convention is particularly relevant to refugees because they are more vulnerable and susceptible to mental and physical torture. The short video documentary released by the UNHCR provided refugees and migrants to tell their own stories of kidnap and torture during their journeys to Europe. The stories told by survivors are emotionally distressing but highlights the realities refugees continuously experience.

The Convention on the Rights of a Child: 1990
The Convention on the Rights of a Child is the first legally binding international instrument to integrate the full array of human rights. This convention is also an important document for mental health. The CRC explicitly highlights the significance of both the physical and psychological wellbeing of a child. This convention is particularly important because it addresses the relationship of affect armed conflict on mental health. First, Article 38 of the Convention highlights state parties’ obligation under international humanitarian law to protect the civilian population in armed conflicts, and shall “take all feasible measures to ensure protection and care of children who are affected by an armed conflict.” International humanitarian law is a set of rules which aim, for humanitarian purposes, to minimize and protect persons from the effects of armed conflict. Second, Article 39 of the Convention states “States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect,… torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts.” For children refugees, the Convention on the Rights of a Child is an imperative document for the security of their right to mental health, and mental health services.

Barriers to Accessing Health Care Services
The process of becoming a refugee takes a tremendous emotional and mental toll on all refugees. PTSD, depression, anxiety, and sleeping disorders are just few psychological diagnoses given to refugee children. The fundamental right to mental health care is addressed in various international standards, such as the Convention of the Rights of the Child, however, there continues to be numerous barriers preventing access to these services. There has been an unparalleled surge in the number of refugees worldwide, the majority of which are placed in low‐income countries with restricted assets in mental health care. Currently, responsibility for mental health support to refugees is divided between a network of agencies, including the United Nations High Commissioner for Refugees (UNHCR), the World Health Organization (WHO), government, and nonprofit organizations. Yet, the reality is that most refugees with mental health problems will never receive appropriate services. Cultural barriers, such as language, persistently affect a refugee’s capability to utilize mental health series. A study examining health care barriers of post-settlement refugees reveals language is the most impeding cultural barrier to accessing healthcare. Refugees and mental health service providers often do not speak the same language, making successful communication during healthcare visits less effective. Language barriers affect every level of the healthcare system, from making an appointment to filling a prescription. A lack of multilingual interpreters for refugees and health care providers weakens the healthcare system, making miscommunication about diagnoses and treatments possibilities common. Lastly, stigma surrounding mental health is another barrier to health services. Refugees often feel the words “mental health issues” should be reserved for individuals with extreme learning disabilities, and do not understand mental health problems can be conditions like depression and anxiety.

Psychopathologies due to trauma are very powerful, however, recovery is possible. In Judith Herman’s book Trauma and Recovery, she discusses her theory of recovery. She states recovery happens in three stages: 1) establishment of safety, 2) remembrance and mourning, 3) re-connection with ordinary life.

Stage 1: Safety
Trauma diminishes the victims’ sense of control, power, and overall feeling of safety. The first stage of treatment focuses establishing a survivor’s sense of safety in their own bodies, with their relations with other people, in their environment, and even their emotions. Self-care is also an important focus point during this stage. The purpose of this stage is to get victims to believe they can take protect and take care of themselves, and they deserve to recover.

Stage 2: Remembrance and Mourning
The second stage of Herman’s recovery theory highlights the choice to confront trauma of the past rests within the trauma survivor. It’s important for victims to talk about their goals and dreams before the trauma happened so they can reestablish a sense of connection with the past. That second stage begins by reconstructing the trauma beginning with a review of the victim’s life before the horrors and situations leading up to the trauma. This second step is to reconstruct the traumatic event as a recitation of fact. The goal of this step is to put the traumatic event into words, and come to terms with it. Testimonies are ways for survivors to get justice, feel acknowledged, and find their voice.

Stage 3: Reconnecting
In the final stage, the victim focuses on reconnecting with oneself and the recreation of an ideal self that visits old hopes and dreams. The third stage also focuses on emotionally and mentally reconnecting with other people and social reintergration. By this stage the victim should have the capacity to feel trust in others. A small but influential minority of individuals revolutionize the meaning of their trauma and tragedy, and make it the foundation for social change.

Peace. Source: John Flannery. Creative Commons.

A Peaceful Future
Even though human rights activists are not psychological clinicians, we can still contribute to the success of these stages. At present, more than half of the refugee children population are children. Despite the violence these children have experienced, refugee children are the foundation and hope for a peaceful future. However, for that to happen, refugee children need to find peace in themselves. Respecting human rights is essential to society’s overall mental health. As activists we need to advocate for refuges and children who don’t have a voice. Activists for human and mental health rights should start focusing their goals on ensuring their communities and hospitals contain mental health care provisions. As activists, we can lobby for more accessible mental health services throughout our health care system, join and volunteer at non-profit organizations, and advocate for the rights of refugees. As Herman Melville states, “we cannot live only for ourselves. A thousand fibers connect us with our fellow men.”