Friday Q&A: Ask A Psychiatrist

0:00Confidence. It's listening to your gut. It's moving forward even when the path ahead is unclear. For nearly 160 years, Pacific Life has helped people keep their promises, building confidence for generations. Whether you're confident in your financial future or just beginning to envision it, we're here to help. Ask a financial professional how. Pacific Life. The power of a promise. Pacific Life Insurance Company, Omaha, Nebraska and in New York Pacific Life and Annuity, Phoenix, Arizona 1965, London The world's largest uncut diamond has been stolen from the Natural History Museum Shortly after, a young London window cleaner is arrested They said you're nicked, you're in a lot of trouble But was he set up?

0:52Wanted app led to fall of two cops His family say he is guilty, but of a totally different crime. You don't want to end up going to prison, do you, kidly? I'm Josie Long, and this is Rough Diamond. Listen now, wherever you get your podcasts.

1:10Hello and welcome to Made by Mamas, the podcast. I'm Zoe Hardman. And I'm Georgia Dayton. And this is your parenting safe space, where no conversation is off limits. With five kids between G and I, we have seen a lot. We really have. Each week, we'll be joined by some famous faces and experts, and we'll chat about the brands and products that have saved us along the way. In short, we're the parenting podcast for you. Before we get started, hit subscribe or follow so you're the first to know when each episode lands. And they're on Tuesdays and Fridays. And it really helps if you leave a rating and a review.

1:43You can also find us on Instagram. We're on at Made by Mamas. But for now, George, should we get into it? Hello, and welcome to Friday's episode of the podcast. um no zo today she is voiceovering i don't even know if that's the thing um but we wanted to have this chat and we wanted to get it in this week because tomorrow is actually world mental health day and following our conversation with the amazing jade on tuesday we thought it would be really important to continue the conversation around mental health particularly maternal mental health with an expert, which is exactly what we're going to do today.

2:21So joining us today is the incredible Debbie Raphael, who is a child and adult psychiatrist. So welcome to the podcast, Debbie. Thank you so much for joining us. Hi, well, I'm so, so happy to be here. Thank you for having me. Yes, I'm a child and adult psychiatrist. I've been in practice for about 20 years or so. I have two kids of my own. I've seen a lot of things over the years and I'm very, very happy to support. I have a book coming out in a couple of months called Carry My Strength that is for parents on the journey of parenthood. And it includes a lot of information about mental health and protecting mental health along the way.

3:07and it involves relational health and how best to relate to our child for the best outcomes possible for everyone in the whole family. So I really like to share these messages. So thank you for having me on. No, thank you. Just before we get into, we've had a lot of questions from our listeners as to be expected, but just before we get into it, do you want to just tell us a little bit about, you know, what you see day to day, the sort of things that you hear, what's, you know, why is there such a big issue with mental health, particularly, you know, post having children or while having children?

3:43What's going on? Yeah, such a good question. Yeah, so oftentimes, you know, when people become parents, it's just kind of viewed as like a rite of passage, right? Like we do certain things in our lives at certain times that we're looking forward to and expecting. and sometimes when people become parents, the reality of what they're kind of faced with at the time doesn't always match what they expected and that can feel very jarring and for some people really like a shock to their system and it can feel confusing, especially if up until that point they'd been kind of goal-oriented in what they were doing and then now they have a baby, they're at home for a little while with their baby and everything is different.

4:33Like when we talk about transitions being difficult, this is kind of an ultimate transition for people. And so with everything being so different, it can be a little bit of a shock to the identity and how you view yourself. And then also just in the day-to-day routine and how you operate. And then also sleep, of course, which is one of the most important things that we need as human beings to function, and it protects our mood, and it protects our thought process, and all of that. And sleep is really at risk after people have babies, of course. And part of the reason it's just so, so important to address also is because these transitions and associated risks really are, are not really talked about or validated enough, you know, in the way that they should be.

5:35And, you know, often there's this like six week postpartum check for people, which, you know, in and of itself is not of course enough to have this one visit and then they're like cleared, whatever that means to move forward. But in terms of how they're doing emotionally, sometimes there really isn't the time to fully get into that. It is recommended by the American College of Obstetrics and Gynecology, which is ACOG, that this screening test be done at the six-week check at least to screen for postpartum depression, postpartum anxiety, and some of these other things. But it turns out that 40%, if you can believe it, at least in the US, of women don't even make it to that six-week postpartum check, which is kind of like the bare minimum, right of what we'd like 40%.

6:36Yeah. And so many things contribute to that can get in the way, like having to take care of other kids, even like just being overwhelmed, feeling overwhelmed, not being able to make it in for whatever reason. But also sometimes people have fears of stigma and all kinds of like issues, you know, coming up in the office and they just, you know, don't feel like they should go. And so lots of barriers exist for people even making it into the screening. And so the point is, these issues are there. Mothers are struggling sometimes, and it's not necessarily acknowledged or managed or caught in the way that it needs to be.

7:27And really, one in five women have postpartum challenges, postpartum depression, postpartum anxiety, and more. So one in five is a high number. And this has such implications for ongoing mental health of the whole family, right? Because if the mother is having significant difficulties and is struggling, she's likely not going to be able to interact with her baby in the way that maybe she would like and in the way that is recommended for the baby to then also thrive. So there's an exchange that goes on in the very early life, and we call it relational health being formed. And that is that back and forth exchange between the parent and baby, where we're able to be responsive and reflect back to the baby what their experience is and meet their basic needs and also these relational needs.

8:35And that helps form their sense of self, their sense of trust, and also the connection and how they'll do in like relationships. And so if that isn't, you know, uh, set up in this way because the mother is struggling, which we've said happens so much of the time, like one in five, right. Um, then that can also, um, you know, cause some challenges sometimes for, for the developing child and then their mental health. Right. And, uh, and so there's all kinds of relationships between this and it's not to like put pressure on people, but really what it is, is to kind of pressure the system to support parents better, to validate the caregiving role, validate the parent role.

9:26Because when people feel validated and seen and acknowledged in their experience, that is in the service of mental health in and of itself. And so it's when you fight it and it's like, oh wait, there's a mismatch between reality and what my experience is and what the narrative is and how it's treated when there's a mismatch there, then it actually is kind of a setup sometimes for things getting worse. So that's why things like your podcast are so important, you know, to work on changing the narrative. Absolutely. Because it's interesting because it's a time that there's a lot of pressure to enjoy, I think.

10:08You know, we hear so much, it goes so quickly, you really want to enjoy it. And then I also think, you know, you can look to friends, to family, to parents, you know, and talk about what you're going through. But I think you do quickly forget the challenges and struggles as a new mom. For instance, I look back now when I actually found the beginning okay. My mom came to stay with me. And I think that probably changed the whole trajectory for me that she was around. To be honest, it was amazing. But I remember that there was this particular mother and baby group. And I think it was say it was like on a Wednesday at 10 a.m.

10:50Now, in my working life, I had been up at 5.30 a.m. every day. I used to get an hour of walking or an hour of exercise in before work every day. I'd be at my desk really early. But as soon as I had a baby, I could not get myself together to get to this 10 a.m. like baby group. And I look back now and I think, how could I, how could I not get there? Like, what was I doing? Like, how, how did it never align that I couldn't be ready or the baby wasn't ready or the baby was sleeping and so I think it's really easy to forget all of the stumbling blocks that it that do happen at the beginning and to you know as as women and as mothers to support other mothers in those times we'll be right back after this short break Thank you.

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12:59Welcome back to this episode of Made by Mamas. Now, where were we? We've had loads of questions. So I am going to kick us off because I think lots will come from the questions that have been sent in. Someone here has actually said, how can I protect my mental energy while I'm pregnant with a toddler and working? It's a good question. You know, I do recommend, because there are, like you said, these two sides at play in parenting, right? There really is the wonder and the joy. And then there is the energy suck. And the demands, right? So there are these two sides and they coexist and that is okay.

13:45And so protecting your energy. I recommend, and this is a strategy that I've kind of come upon and talk about in my book. I recommend when you're feeling overwhelmed and emotionally drained, to try to set up an intentional emotional barrier or boundary, a boundary where you view the parent role as a job. And when you can view, and that's an interacting with the toddler. So if you can view it that way and have that boundary, then you'll be less inclined to have that blurring between like your personhood and what you're doing as a parent. Because if that blurring occurs, which of course it's so prone to doing, then we can take what the toddler is doing and demanding personally.

14:39And that adds so much of the energetic response. Like mom, mom, mom, like not leaving you alone, which toddlers will do. It just can take everything out of you. But if you have a boundary and you realize, oh, in my role of parent, I recognize they're two or however old they are. And this is just what they do. I don't need to respond every second. And I can just calmly say, you know what, I'm just, I'm getting these things ready. We'll be ready in a minute or whatever the response is and treat it that way. But if we take it personally, like they're really demanding all of this of us, how dare they?

15:24It's just all consuming. Then we're not having that boundary and it's going to take so much more energy and our experience of it is going to be harder. So that is what I would recommend to kind of protect your energy during this time is to step back and try to view it as a job. Like, okay, this is my parent role. This is just what I'm doing as a parent right now. And it can be protective. I kind of learned that because as a psychiatrist and I was, you know, parenting as a psychiatrist, I had practiced doing that in the office and in conversations with my patients, right? And we had boundaries.

16:07That's part of the job, right? And it is part of our job to reflect back the person's experience to them. And that is how they can heal and come to understand themselves and to feel validated is to have their experience understood, organized, and reflected back. And that is really sort of the key for what parents can do in their role to validate their child and to help manage their child is to try to organize the child's experience. Oh, they're really frustrated. I see. I'm going to say that back to them. Oh, wow. You're really frustrated right now. Yeah, you're right. Well, we'll get to that in a minute.

16:48But but I understand it's it's hard and you feel upset. And then sometimes if you just reflect back their experience to them, it brings their struggle down a notch. It brings their intensity down a notch and then everyone is better off for it. So that's what we do, like in a therapist's office. but um but if a parent can do that as part of their job in the parent role um just reminding themselves in the moment to do it so they can respond the way they like instead of having a big reaction which is more visceral and you know interesting yeah it can really do wonders for how everyone is doing so that's what i would recommend for like preserving the energy and i love that this listener is thinking about that, about preserving the energy because her wellbeing is so important, not only for her kids and for the developing baby, which of course is important, but also for herself, you know, and for her wellbeing.

17:51So I'm really glad that she's thinking about that. And I would also recommend doing things for herself that she can enjoy, um you know uh because that can go a long way too to like carving out a little bit of time each day to do something that brings her joy um also to try to do things with her toddler that bring her bring them joy together because that's really good for the relationship too yeah no i was gonna say you don't have to do too much i mean i when i had this when i was pregnant with gigi anyone listening um she she would there's this almost three year age gap between them so like when I was pregnant I had a two-year-old and I would do things like you know lay on the sofa with Axel and watch a movie because that would make me feel good like I was being a good parent because we were bonding and but actually I was laying down and putting my feet up and relaxing and having a minute but I just yeah I mean I think it's really important and it's important to like understand that you can't do everything that when you're pregnant that you were doing maybe before you were pregnant you know you might not be climbing up the slide or you know all that kind of thing but there's always other things that you can do this is an issue someone sent in for her daughter so she says daughter five has bad anxiety and pulls her hair out all the time she does it out of habit and I've tried everything.

19:20Yes, this is not so uncommon and, you know, a really good question. This is one example of these habits that kids can form. Kids can have all kinds of habits, grownups too, but we see it in the kids and hair pulling is one. Some kids get like different kinds of tics, which are types of habits like motor tics, where they have like eye blinking or a habit of moving their head a certain way. And this is just something that can happen in childhood that oftentimes people do outgrow. Sometimes they don't necessarily outgrow it. And there's all kinds of ways for managing it. I think noticing it in a really, really non-judgmental way is a good approach.

20:12So, you know, can mention it to their child, see if their child has noticed it, because oftentimes it's not uncommon for children to have some of these behaviors and not even be aware. It can be something that just sort of happens. So just gently talking to the child about it, see if they notice it. And then the second thing would be to see if it bothers them, see if it bothers the child. It may not, but it's good to know if it's bothersome to them or not. And then, you know, kind of see what comes from those really gentle, non-judgmental discussions. And then you can always, of course, seek out a professional to kind of talk about it more one-on-one also, if it continues.

21:02Yeah, I would say if it continues. But also just in general, stepping back and, you know, thinking about the basic kind of things we would recommend to be kind of the background in the home. So, you know, recent research has really identified the impact of what we call positive childhood experiences, PCEs. And the reason it's called that is because historically, there's a lot of research on ACEs, ACEs, which is Adverse Childhood Experiences, and how sometimes if there's adversity in childhood, you know, that can have a link to increased risk of health problems later on. And so PCEs, it's so nice that they've been identified, the positive childhood experiences.

21:54So we take a strength-based approach. Now we know kind of the basics of what's protective in childhood. And so the main one is a feeling of safety and security in the home. So just feeling safe and secure and then also having maybe some rituals at home that can feel comforting and familiar to a child at home and even in the community, like if they're part of a larger community that has certain rituals, that's protective. And then like a feeling of belonging in school, that's another one that is a positive experience. And these experiences are actually shown to counteract the effects of adverse childhood experiences, which is so good to know.

22:39And so my point in kind of talking about this here is just for all families, everyone to kind of keep an eye on this background at home, right? Is there a feeling, a general feeling of safety and security? Do we maybe have some of these familiar rituals and things like that? Because all of these are soothing. And so if there's any kind of stress in this child with the hair pulling, just stepping back and saying, okay, how can I make an environment that's like kind of as lower stress as possible that's a good thing to just keep an eye on also I mean all of us should keep an eye on that but just in particular if we feel like stress could be playing in just kind of thinking about that larger environment and how can we kind of reduce stress too it's always recommended.

23:33When you say rituals you know rituals in the home rituals in the community what exactly do you mean oh that's such a great question thank you um yeah I would say the simplest thing and I put this in my book also um the simplest thing is um but it can go such a long way is the act of um having dinner together that's an example of a ritual right when the family like comes together at dinner time to talk and connect and share a meal. This is an example of a ritual that can over time feel comforting and grounding to everyone in the family. So it helps with connection between the family members. It helps everyone feel like they matter and they're kind of part of something larger.

24:28So that's an example of a ritual. It's kind of like one of the simplest things is having dinner together as a family. Another could be like, if a family has like, a game night once a month, you know, that's another example, spending time together things they enjoy together. Yeah. And then on the outside, like if they're part of a larger community, if there's a ritual, that's like something in their religious community, or something in their neighborhood, like if there's a neighborhood potluck that happens like once a quarter or something like that just to have these kind of rituals yeah yeah I was gonna say in my house like I mean 98 % of the time my husband and I split each night my husband goes into my daughter's room has a 10 minute chat with her I go into my son's room have a 10 minute chat with him and then we swap every single night pretty much unless one of us isn't there we do that before bed every night to talk to them find out what's going on like just even just lay with them chat about just anything and they have that time when we're not both there it's it's one-to-one and like they haven't got their sister or brother there either um but yeah that's that's just an example of what we do in our house anyway beautiful ritual exactly that bedtime ritual so meaningful especially over time that consistency yeah we'll be right back after this short break

26:06Hi, everyone. It's Katie Couric. And on my podcast, Next Question, we love stories about how women are taking control of their lives. They are increasingly leading financial decisions in their households. Yet many say they don't feel fully prepared for the long-term financial choices ahead. Real confidence comes from knowing your financial future is protected whatever happens. Pacific Life has helped generations protect what matters today and prepare for tomorrow with life insurance and lifetime income solutions. It's a promise Pacific Life has kept for nearly 160 years so its customers can keep theirs.

26:48Ask a financial professional about how Pacific Life can help you create a more confident financial future. Pacific Life Insurance Company, Omaha, Nebraska, and in New York, Pacific Life and Annuity, Phoenix, Arizona. 1965, London. The world's largest uncut diamond has been stolen from the Natural History Museum. Shortly after, a young London window cleaner is arrested. They said you're nicked, you're in a lot of trouble. But was he set up? Wanted out led to fall of two cops. His family say he is guilty, but of a totally different crime. You don't want to end up going to prison, do you, kidly? I'm Josie Long, and this is Rough Diamond.

27:34Listen now, wherever you get your podcasts.

27:42Welcome back to this episode of Made by Mamas. Now, where were we? Someone here has put, I suffered with awful postpartum anxiety first time round. if I have a second child will it be the same oh that's such a good question oh it depends you know I would say there is an increased risk of it doesn't mean it will happen right but it would be very important to be mindful and be on the lookout and also have all of these like protective factors in place so that, you know, kind of even if it's not for sure that it would happen, but your risk is increased, having as much support as you can have in place around the time of the birth.

28:35If there's a possibility of something like a doula, that would be like really recommended, any kind of support you can have around you. You know, we talk about the concept of a village, right? And this is in my book as well, of having a village for new parents. It's so important. Support systems on like different levels, whatever you can have, family, chosen family, friends, neighbors, professionals like doulas, you know, any support you can have in your village. And then sleep, like we said before, especially with a history of postpartum anxiety, sleep is going to be so important. And that means protecting your sleep, having like a partner, you know, hopefully if there is a partner, you know, to, to cover a lot of the nighttime needs, or again, hiring like a doula or a night nurse, if that's possible.

29:29Um, but protecting sleep for someone with a history of postpartum depression or anxiety is like paramount. Um, so right into the basic needs, sleep, nutrition, having a village support system, also time to yourself, just being cared for the way that really we're meant to be cared for, you know, when we have a baby, but kind of like magnified if you do have this history. And that can be very, very protective. So, and knowledge is power, right? So sometimes just really being aware of what's going on can be very empowering. So, I mean, I guess that's the one benefit. Yeah, I love that. You know? Yeah, exactly.

30:13So, yeah. Yeah, no, that's such great advice. Someone else here has put, I never used to be an angry person, but since having kids, I snap over the smallest things and then I spend the evening feeling guilty. Is mum rage a real thing and what's going on in our brains when it happens? That's such an excellent question and a question that I think so many people can relate to. Right. So so again, the blurring between our our personhood and our parent role. Right. It's it's just there, you know, so it's. The thing is, when we think about family and what family is right, family is supposed to be a support system, people who are there for you.

31:06But then when we become parents, all of a sudden our role in the family is so different. And we are the caregiver. We're the one taking care of everyone else. And we used to be kind of nurtured ideally in a family, right? So all of a sudden it's different and there's so many expectations on us. And there's a lot of stresses associated with parenthood that are so real. And we can go into that too, because the U.S. Surgeon General Murthy in 2024 put out a big advisory called Parents Under Pressure, and he really kind of delineated all the different stresses that people who are parents are under that are too often brushed under the rug.

31:50And so we know that parents have an inordinate amount of stress on them. And sometimes if we carry things from our childhood and the way that we were maybe parented or just any trauma or any kind of adversity that we may have experienced in our own childhood, depending on the extent of it, we can have an elevated stress response already that we carry with us because of maybe things that we've gone through and combining that elevated stress response that we might have. And what that means is like quicker to react, you know, or going into fight or flight a little bit more easily, being prone to that, if we already have that and then we combine it with all the very real stresses of parenthood and then being triggered by things from our kids that feel personal too because of that blurring, all those three things put together, you know, yes, we can react and then we can really regret it afterwards, right?

32:50And then we feel guilty. And it can become this cycle that really we start to internalize. And then it can start to really feel bad and weigh on us because we're not wanting to react that way with that mom rage, as the listener says. So what we can do is we can think about the difference between reacting and responding the way we would like. And then how can we kind of take a pause and step back so that we're able to let our prefrontal cortex part of our brain, which is the part of our brain that is able to kind of think about what we'd like to do next. So if we can, if we can take a pause to allow that part of our brain to kick in, and then we can come up with and choose how we respond, then that can really go a long way.

33:42So it's like, how do we get ourselves to take that pause so that the emotion part of our brain isn't just reacting automatically, but we allow the thinking part of our brain to also weigh in to how we respond. So again, kind of stepping back and reminding ourselves of the role. Okay, wait, I'm the parent here. What is my role? What is my job in terms of how I would like to respond in this role right now. So if we can remind ourselves of those boundaries, it can be really, really helpful. And then that's not always going to work perfectly, you know, and we are not and should not be perfect. You know, I mean, authenticity is important too.

34:29So it's everything's a balance, right? So we want to regulate our emotions if we can and really work on that by having some self care, tending to ourselves, making sure that we have care because our care needs do not stop just when we become a caregiver, right? Our cup needs to be filled to some degree as well. It's very important. So making sure that these needs are met, then we can implement this boundary, you know, if we can. All these things are very helpful. But if things do go awry and we react in a way that we wish we didn't, we can repair. And so for this listener to know, you know, with that guilt, that mom guilt, you know, or, you know, associated with it, we can come back and say we're sorry.

35:19And sometimes when a parent says they're sorry to their kid, it can be like the most powerful form of validation for the kid. Yes. Um, cause wow, my parent took the trouble to reflect afterwards and to admit to imperfection, which is really good modeling for the kid because nobody is perfect and that's the way it is. So it's good modeling and they care enough to say they're sorry. And they're validating the kid's experience. And like, really that was not warranted. I'm really sorry. You know? So for all these reasons, apologies can be so powerful. Um, and I love that. to know. Yeah, it's weird, isn't it?

35:58I don't know why we think we shouldn't apologize to our kids, but because when you do and when you allow yourself to apologize, it does feel so much better. And we're just we probably just got time for one more. So I'm going to go with this one, because I think so many people can relate to this. I lie awake every night running through lists, school forms, birthday presents, what's for dinner tomorrow, when does the mental load tip over into actual anxiety? Oh my goodness, it's such a good question. The mental load, yeah, there are so many things involved in planning, in executing tasks. There's just so much, and when does it actually become, reach the level of being anxiety, we usually say when it starts to really interfere with things.

37:01So if it interferes with getting the sleep that you need, you know, then it really is anxiety. Because sleep, as we said before, is so important for mood and for energy and for focusing cognition. It's so important to have the sleep that we need. And so if it is truly interfering with sleep, then that's something to address. And also if it's interfering with anything else, if it's interfering with being able to enjoy enjoy things day to day, then yes, it has maybe reached that point. Also, if it's interfering with being able to get things done that you normally would be able to get done. So really interfering to any degree compared with the person's baseline.

38:01So compared with their usual way of things. If now things are different, that's kind of a sign that it could be significant and just to get more support. And that means more support with the mental load too, right? So, so trying to, to figure that out because it just can be so much, like we said, all the very real stresses of parenting. So support and self-care. Yeah. And I think asking for help, I think, I mean, that's probably the last question that we have time for. But I think, you know, reflecting on everything you've said, so much of it is asking for help, ensuring that you actually, you know, take care of yourself and what you actually need as well.

38:48Because I think as parents, as mums, especially, so many of us just ignore our needs because we're caring for everybody else. but thank you so so so much for your time and do you just want do you want to tell everyone where they can find you and when your book is out and yeah anything else absolutely thank you so much yeah it's also so important yeah so I am on LinkedIn Dr. Debbie Raphael and my book Carry My Strength, A Parent's Guide to Growing and Thriving Alongside Your Child is coming out on January 12th with Wiley and it should be available everywhere books are sold and it's available for pre-order now on Amazon so you can go pre-order it and then you'll have it right on January 12th and hopefully it can be helpful for all of the listeners so yeah thank you so much for having me on.

39:48Thanks so much, Debbie. And anyone listening, if you've got any feedback on this episode or any guests you'd like to hear from, please do drop us a DM on Instagram. We're on at Made by Mamas. And we'll be back on Tuesday.

40:08Confidence. It's listening to your gut. It's moving forward even when the path ahead is unclear. year. For nearly 160 years, Pacific Life has helped people keep their promises, building confidence for generations. Whether you're confident in your financial future or just beginning to envision it, we're here to help. Ask a financial professional how. Pacific Life, the power of a promise. Pacific Life Insurance Company, Omaha, Nebraska, and in New York. Pacific Life and Annuity, Phoenix, Arizona. Our children's big feelings don't wait for a good time to show up. They turn up at bedtime, on the walk to school, or right in the middle of an ordinary afternoon.

40:52I'm Evie Pickerel, and my podcast, Evie Asks, is here to help. With gentle stories, mindful breathing, and positive affirmations, each episode helps children process their emotions and feel safe and supported. whether they need help calming down for bedtime, finding confidence for school, or handling those really big feelings. Listen to Evie Asks wherever you get your podcasts. Oh, and you can watch on YouTube too.