PMADs and the ER: How Does the Gospel Apply?

Part 3 of 4 in a series of posts by nurse and counselor Amber Thiessen. Part 1 covers when to go to the ER, part 2 talks about what to expect when you go to the ER, and part 3 is about what husbands and the church should know, as well as how the gospel applies to PMADs and the ER.

What do husbands or others close to a mom with PMADs need to know about what to watch for?

For the Husbands:

When depression hits hard, you’re going to notice a lack of motivation to get up in the morning, disinterest in doing things around the house and often withdrawing from people. It’s important to pay attention to your wife, to support her, encourage her and pray for her. What’s happening with her body isn’t what she wanted nor what she expected. What you understand about the guilt she feels is probably only the tip of the iceberg.

While these symptoms are common with depression, they’re not healthy. This would be the time to start talking with her about what you’re noticing and continue that conversation together with your family doctor, pastor, counselor, if you haven’t already, start learning ways to cope, discover resources and supports available, and treat the depression.

If left untreated, what become passive thoughts can start coming out in her expressions, in thoughts about death and dying, remarks that everyone would be better off without her. There may be an increase in irritability or volatile emotions, anger.

She may not want to be left alone. You may need to take some days off work. If this isn’t possible, it’s really important that you arrange for someone to come and stay with her. Sometimes it’s anxiety, the fears and worries about caring for the baby on her own, or just afraid of being left alone. Other times, it’s possible she’s thinking about suicide and is afraid of what she might do if left on her own and she can’t manage.

Please remember that it’s not just one thing causing these symptoms, but a combination of her hormones and physiology, thoughts, emotions, relationships, and faith all knotted up to form her experiences. There’s likely not one single solution, like simply getting your appendix removed for appendicitis, but a collective gathering of skills and supports needed to help you both along the way. 

For many moms, the thought of a hospital stay or ER visit brings up a lot of shame. From your experience as a nurse, your counseling training, and personal faith, can you speak to that shame? Where does the gospel intersect with a mental health emergency?

When we experience crisis, it can be shocking and terrifying. The trail of our thought life has spiraled to a low we’ve never been or our body isn’t cooperating by responding to every situation as danger, leaving us exhausted from anxiety and fatigued from low mood.

Remember, you are a good mom by seeking help! By recognizing when you need help, when you need rest, when you need the support of others, this is not only important for you, but it’s also what’s best for your baby.

As Christians, we believe God’s good, beautiful, created order, that we’re designed to bring children into the world in families for the glory of his name. We’ve been longing and waiting for this blessing.

Then, as we face difficult circumstances in our postpartum season, we wonder how God would allow something so wonderful and exciting to bring such pain and despair. The answer is revealed in the effects of sin on creation; we see these repercussions in our world daily. Our bodies don’t respond as they once did, we become sick and unwell, impacting our thoughts and emotions.

While many physiological factors contribute to postpartum mood disorders, we also need to be mindful of any ways we perpetuate what’s happening.

I delivered two healthy children while we lived overseas in Tanzania. The challenges of a cross-cultural delivery, being away from home and family were significant risks for PMADs, but in God’s providence he saw us through. We left Tanzania and came home when I was pregnant with our third child. We faced an unexpected overseas move and transition from a church planting team ministry to my husband entering pastoral ministry. When we returned I began seeing a counselor to work through some of the stressors and changes. After delivery I continued seeing her and I’ll never forget the day she told me she thought I was depressed.

I don’t know why I was surprised. But it really hit me.

A myriad of thoughts torpedoed through my mind. I felt depressed that she thought I was depressed. I felt guilty, as if I could’ve prevented all the situations in my life which were out of my control. I felt ashamed, thinking, “I’m a pastor’s wife, I can’t be depressed” or “I love the Lord, it can’t be this way.”

I share this because these thoughts prevented me from sharing my struggles with anyone, other than my husband. I didn’t tell my friends, although I think they knew. I didn’t tell my family doctor, but he always looked at me knowingly to ask how I was really doing.

It had become normal for me to solve my own problems, to prize independence and self-sufficiency. I could accept depending on my therapist because she was helping me get through it and my beloved husband because we’re blessedly bound in covenant to each other.

But otherwise I kept it to myself.

It’s hard to feel weak, to think you’ve failed, but God’s Word says, “My grace is sufficient for you, for my power is made perfect in weakness” (2 Cor. 12:9). Not my own strength, but his power. And not only is the grace of God enough for us, the apostle Paul writes that he would gladly have more weakness so he might see more of God’s power. Our weakness isn’t a bad thing, it reminds us of how confidently we rely on ourselves.

The gospel is enough. Our salvation came through the person and work of Christ, “for by grace you have been saved through faith. And this is not your own doing; it is the gift of God” (Eph. 2:8). From beginning to end, the grace of God abundantly sees us through.

So we cling to the truths of the gospel, we hold fast to the faith even in our suffering. We press into community because part of God’s created design is for our connectedness both with him and with others. The church stands as a light to the world because of the bond of love expressed in care. In difficult times, we need each other.

Our church communities emulate Christ and the hope we have in him today and in his coming when all things will be made new. Though things aren’t as we expect and difficulties abound, we have great hope in his return.

Article: Dear Anxious Heart

The Sorrows of Eve is a resource for the church, not just moms. What would you want the whole church to know about mental health crises that lead to the hospital? What about pastors? Any resources you would recommend?

For the Church:

Mental health crises that lead people to the hospital don’t develop in just a day. Typically deteriorating circumstances are a result of a decline in mental health in the days and weeks before, sometimes occurring after a significant life event. In order to “one another” as the Scriptures teach us, we will be challenged out of what’s comfortable for us and into a life of fellowship, accountability, partnership and vulnerability.

It takes intentionality to cultivate a mindset of seeing people. During a busy worship service, it can be hard to connect with others, but it’s also a great opportunity to touch base. To really see others, we want to pay attention to what’s going on in others and how they are. Consider Hagar as she ran from Sarah in Genesis 16. Pregnant with the child of her master, mistreated by her mistress, alone and feeling hopeless, she runs into the wilderness. God saw her there. He didn’t ignore her, but spoke words of encouragement to her and she “called the name of the Lord who spoke to her, “You are a God of seeing,” for she said, “Truly here I have seen him who looks after me” (Gen. 16:13, ESV). May we be a people who shift our lens away from ourselves and emulate our compassionate Father.

For the pastors:

Creating safe spaces means allowing people to share their struggles and being equipped in how to address their emotions and needs. This often requires extra training. The sacred responsibility of shepherding your flock means caring for and deepening their faith. Be comfortable talking about issues related to mental health, and teach a biblical worldview of suffering and perseverance. Firstly, because we all experience heightened (or dampened) emotions at one time or another through life and second because we all experience the distress of a fallen world. We all need to hear how the gospel impacts us daily in our weaknesses and God’s grace.

General Resources:

Mental Health and Your Church by Steve Midgely, Helen Thorpe

Broken Pieces and the God Who Mends Them by Simonetta Carr

Side by Side: Walking With Others in Wisdom and Love by Ed Welch