Perinatal RAGE, Its a real thing! Sara Pogue LICSW talks about her experience and treatment.

Listen to Sara talk about rage she experienced postpartum, how it effected her relationships and parenting and the interesting realization she was not alone.  Sara also describes her treatment journey of healing with the three pillars she now uses with her clients; Identifying triggers, Attending to our body and Understanding our internal Parts.


"Postpartum rage is a symptom of PMADS that is often missed and can hold a lot of stigma".

Sara is a LICSW at WildTree Psychotherapy and has been practicing social work for 7 years. Sara is trained in DBT and EMDR and is in the process of receiving her certification in Perinatal Mental Health. Sara’s areas of special interest in trauma, ecotherapy, somatic work and the perinatal community. Sara lives on a farm with her family and their various farm animals.

Transcript

Speaker 1: 0:10

Welcome listeners. This is baby brain PPPs M's podcast. I'm Samantha hug, your host. And with me today is Sarah Pope. She is an MSW L I C S w, and therapist with wild tree psychotherapy. So welcome and thanks for joining us, Sarah. Thank you for having me. Could you begin by telling us a little bit about what's your connection to PMA perinatal mood and anxiety disorders is sure. Um, a couple of years ago I started working for wild tree psychotherapy. They're very connected with the community. Prior to that, I had only had my own personal experience with peds. When I started with wild tree, it became more of a professional experience. Prior to that, it was just my own experience. I had my first child when I was 26 and I was in 2016 and then I've had, I have a three year old and then I just had a baby a year ago. Tell us about your connection with pregnancy and postpartum support, Minnesota and it's parent PSI. I have been in the process since I started with wild tree psychotherapy. I've been in the process of, uh, getting certified as a perinatal mental health professional. And so I've been doing some trainings with them. So my connection is, has been, uh, professional over the last few years. Uh, and I just keep having babies. So it's taken me a minute to get my, uh, credentials in place here. You mentioned a personal connection to PM ads. Do you wanna tell a little bit about your story with my first son who I had in, uh, 2016, I experienced what I would call like pretty typical postpartum anxiety type symptoms. And even though I was in the world of, you know, mental health, I'd been practicing as primarily doing D B T at the time when it was happening to me, my own insight, it wasn't quite there. So I was having the experience of, you know, you, you, your baby falls asleep and then you can't fall asleep. And the preoccupation with like, is he breathing all this kind of stuff and just kind of the general high level jitters anxiety throughout the day throughout the night. So a lot of this started when I was actually pregnant with my, my first son. I was having some panic attacks, things like that never made the connection that this might be something that is a perinatal mood, anxiety type disorder. And then postpartum that's when I was having a lot of the difficulty sleeping, all of that with my second son who was born in 2019, when I was pregnant with him, I ended up starting to have what I would call perinatal rage. And for me, this was, it was really unexpected because I, again like I've got all of these great coping tools I've been in this world. I've had my own therapy, I've done a lot of my own work. Somehow. I was still having this experience where I didn't feel like myself. I ended up receiving some medication management during that time, which I found super beneficial throughout that pregnancy and postpartum, I would say had some, some moments where the, the rage and anxiety and things like that would still come into play, but they weren't, they were manageable. You know, they were just pretty what I would say, kind of typical for somebody that kind of runs a little anxious anyway with, um, kind of in between the birth of my second son and then my pregnancy with my daughter. I was noticing a lot more stress in my life. We had the pandemic, there was a lot of isolation, so there was a lot more factors going on just in my own personal life. And I was really noticing just when I started, I think it was just when I got pregnant with my, with my daughter, I was experiencing all sorts of when I was pregnant with my sons and after they were born, I was mostly experiencing postpartum anxiety. I've got a label for that. I know what that is, but the, and you know, these, these few little things that happened when I was pregnant and postpartum with my second son, these little outbursts, those were, I don't know what those were. I didn't really have a, a label for that at that at the time, probably yeah, a year and a half, two years ago, uh, where I started really exploring what is postpartum rage? What is perinatal rage? How is it different from, uh, some of these other things that I'm familiar with? For me, I would say the foundation of my postpartum perinatal rage was anxiety. Like I said, I, I just like hover, anxious. I've got a nice genetic cocktail of anxiety already. So I just run anxious to begin with. And then you throw some external factors, some hormonal things. It's just, it's just a lovely little cocktail that I have going on here. But so these experience how I experienced my perinatal, um, postpartum rage was it's, it seemed like it would just come out of the blue. I would be completely in my mind, completely normal, absolutely fine. Nothing's going on. And then something would set me off and I would just, it, it felt explosive. I would start yelling. I remember once I hit a wall, like just things that this is not really in my nature. So again, when I was pre, when I was had my second son, I sort of was like, oh, these are just little flukes. These just, I was really tired that day. Um, but then it started happening more and more often. And I started kind of taking it on almost as this. Some sort of, it just felt like such a burden. I never felt like I knew when it was gonna happen. I never had the connection or the mindfulness to, to be able to anticipate what was gonna happen. And it didn't fit with my values. It didn't fit with who I know myself to be. It didn't fit with my parenting philosophy. I was like, I, I know how I know what the impact of, you know, yelling at your children is. So all of these things that I knew kind of professionally, and then this experience that I was having, having in my, you know, my own mental health in my body was a very physical experience. It all kind of became, um, I would say like intolerable for me. And then I, uh, started exploring like, what could this possibly be? And I started talking to some of my friends about it and almost all of my friends are also mental health professionals. And it turns out almost all of my friends were also experiencing these symptoms that I was. And so once we all we kind of were whispering about it, we're like, oh, do you, do you kind of lose your mind sometimes, oh, you do this too. And we all started talking about it. It turns out it was a pretty common experience. And again, these are, we're all mental health, professional folks. Like we are, we've got the skills, we know all the things we practice, the mindfulness best. We can just in our own, you know, perinatal experiences. This was something that was coming up for a lot of us. And it's made me passionate and curious about like, who else is experiencing this? If, if it's not just the mental health professionals, I don't, I don't think so. Uh, yeah, something I've become a little bit passionate about a little interested in since then. Can you help us define postpartum rage? Like in your mind, if you could write a Websters for it, what's the definition. Yeah. I'd love to, like I said, I think of it as like a symptom, so it's not its own category. I don't know. Maybe someday it will be, but the foundation is often like a postpartum anxiety experience, a postpartum depression experience, maybe even a postpartum O C D type experience. And I like to think of it differently. I hear the word, um, irritability thrown on thrown in a lot. You know, you hear that when you're doing assessments or when you've ex when you've you get the, you know, the GAD from your doctor or something like that, you, you hear I, the word irritability. And whenever I was thinking about that, I was thinking, you know, that's different. I think about irritability is like, oh, I just, I'm a little, I'm a little upset. So I think of it differently than that. It, it often comes out of nowhere. So there's kind of that explosive hard to anticipate type factor. And I think it can happen in situations that are related to parenthood, but it doesn't have to be. So it, it can be, you know, my, my kid, you know, knocked down the, the glass of milk for the third time today. And it was the last straw. I just lost it, but it could also be I'm sitting in traffic and I'm 10 minutes late and I just lose it. There is also often a physical component for a lot of folks. So a lot of people describe feeling, you know, heat, a lot of tension. I notice like my jog, it's really tight. Sometimes when I have experiences like that, I I'm, like I find myself clenching my fists, rapid breathing, all this stuff. And then there's kind of the behavioral element. So this can look like yelling, hitting things, throwing things, saying things, swearing, just things that are often, um, like I had mentioned before, just not typical. And it can just feel very unpredictable, so explosive, um, yeah, hard to anticipate what's the impact of postpartum or perinatal rage. So I think for a lot of, um, clients that I see or my own experience is similar, it can be really isolating, uh, because I think of like isolation and shame kind of go hand in hand. And there's often this experience of shame for folks that are having these types of symptoms and these types of behaviors, the guilt and shame. Like I said, a lot of us, it doesn't fit with our parenting philosophy or how we like to be in the world. I don't like to identify myself as a angry type person or anything like that. So each time for me, at least each time I'd have one of these experiences where I'd be yelling or things like that, then instantly it was just guilt and shame. I think that's a pretty common experience for folks. I also think, you know, especially those of us that identify as women's, there's kind of an oil and water experience with expressing anger. You know, there's some of these traditional ideas that even in our most progressive society, I think we, we still kind of come, come to the table with women, should be, this women should be that. And anger still has a lot of shame associated with it. So I think that adds like an extra layer of stigma. Somebody that identifies as a man is showing anger. It might look a certain way or the experience of people around them might look a different way, but then an unpredictable mother who's experiencing anger. That's a whole nother game for a lot of people. I think a lot of folks also experience distance from a partner. Maybe, you know, if you're not used to seeing your partner in this type of way, and then you see your partner yelling and screaming and doing all sort, you know, things, clenching things that you don't normally see them do that can create some distance. Those of us that are experiencing this, I think it's easy to feel distance from your children. Maybe some people feel worried, I'm feeling so unpredictable. Can I, can I be trusted around my kids? What if I do something I regret those types of thoughts and that can create a lot of distance, the identity of a parent, which is already, you know, and we have kids we're already kind of creating our parent identity and things like that to feel disconnected from yourself as a parent and not feel like you can trust yourself as a parent. I think those are huge impact of that postpartum rage experience. And then I also think that relationship with yourself can be really challenging too. Like I said, that unpredictability can be really scary and to feel like you can't trust yourself or feel like you can't connect with yourself in the way that you want to. I think that can have another impact, another layer of impact for folks. What are some treatment strategies and what do you think healing from postpartum rage looks like for well, yourself and other people that might be experiencing it? I'll, uh, share my experience, my own treatment. And what's worked for me. And this is a lot of stuff that I've ended up, uh, using with clients as well. When I was experiencing a lot of these symptoms, I first went and, uh, decided to reach out to a med provider and, uh, get some medication specifically for the postpartum rage. And I even sharing with my med provider, she knew I was a mental health professional. She knew I was in this world. I remember just that experience being like, so I'm getting really angry and she asked just the right questions and she knew exactly what I was talking about, but even the, the internal shame that I had sharing with my med provider when I was experiencing that played a huge role. The other next thing that I did was like identifying my triggers, feels like such an unpredictable experience to have about, of postpartum or perinatal rage once I started digging in. And really, I actually remember like charting some things out and say, thinking about, okay, so these are the days that I was having. I, I yelled this day. I had that kind of experience what was going on. And as I started to pick things apart, like I said, I like to think I'm so mindful, but this really made me really mindful. I started noticing, uh, the days that I would have these types of experiences, I often hadn't been taking care of myself very well, three kids, or, you know, at the time two kids and I was pregnant. Um, it's so easy to just like, you know, you just get in your zone, I'm gonna get the kids ready. I'm gonna, I work from home a bit. I'm gonna try to work. I'm, you know, I, I was going through all these different types of things. Often it would be, you know, 10:00 AM noon. I'd forgotten to eat breakfast. Maybe I hadn't actually taken my medication that day, even water. I was noticing if I had, if I was properly hydrated, this didn't happen or didn't happen to the extreme that it did on other days. The other thing that I was noticing for me, it's a huge factor. I am so vulnerable to having these bouts of perinatal rage when I haven't had the type of sleep that I need. And even that I had to pick that apart and see, okay, it's not just number of hours because you know, these days I'm up with kids at, at night. I'm, you know, I was nursing a baby, things like that. So having, you know, eight hours of uninterrupted sleep, that was just not gonna happen in my house for me. I ended up noticing that if I could, even if my nighttime sleep was really interrupted, if I could get a couple hours in the morning from six to eight or something like that, where my husband would get up and he would do all the kid stuff in the morning and I could just sleep in a little bit. It just gave me that extra fuel that I needed to be able to start my day. Right. Some of these little things that I was able to do really changed how I experienced my symptoms. I did a little bit of parts work on myself with a, I did some with a professional, and then I did some just on my own. And as I was digging into sort of my internal system, as we like to call it sort of the ifs type of model I started noticing, I, I had mentioned before the idea of like, we feel so disconnected from ourself sometimes just in the perinatal period to begin with. Uh, and then for me, it ended up being, as I, as I sort of was identifying parts and trying to figure out what's going on inside here. I noticed I had a really strong, protective part, which when you think about it makes so much sense because I had mentioned earlier, some of those body experiences that we get with postpartum, perinatal, rage, you know, the, the heat that you feel and the clenching, and some people get a lot of feeling of maybe like fidgety or things like that in their feet and hands. So it sounds like a fight or flight type response. And when I was able to look at it from that perspective, then this protective part that was coming out, it had a purpose. And you think about having children, that's almost like a primal part of having children for a lot of us is we need to protect our children. And so a lot of these experiences that I experiences that I was having when I was able to be mindful of what was going on, some of those, besides the physical triggers that I was having and the vulnerabilities, I was also noticing the kind of precipitating event often did something to activate that protective response in me. And once Simon was able to make that connection, I was able to have some compassion and some empathy for myself, I guess I would say when I was experiencing these types of things, then I was able to go, oh my gosh, she's just trying to protect her kids here. That's a wonderful thing. And it took, it took a little bit to get there because the shame and the guilt and all of that, that was still pretty strong. But once I was able to use kind of a compassionate lens versus a judgmental lens with myself and kind of my inner inner world inner workings, that changed a lot for me. So I identified this protective part and then I did, and still am really working on giving a lot of time and attention to expressing like my nurturing side on myself. So that would look like when I feel that protective feeling come up and I have all that experience, then I've done a little bit of work on my inner dialogue. So that, that nurturing part or that kind of voice that we all have in our head that we, we sort of talk to ourselves, then I'm able to use that empathy towards that part and going, this is a really great thing. I don't have to do this all by myself. I've got, and then I was able to, uh, lay out my internal resources and my external resources. A lot of the times when I have this experience, I feel cornered again, that fight or flight response, I feel cornered. And I feel like, oh my gosh, I'm, there's just so much to do. And then I get these thoughts in my head that are like, okay, I'm all alone here. You know, you've had these thoughts before maybe. And so that's where if I can have a little bit of a switch in my internal dialogue that can change the whole experience, sort of a threefold, identifying the triggers, taking care of the body and doing a little bit of work on my parts, identifying maybe a protective part, figuring out what other parts, what can my inner dialogue look like so that I can take care of myself. And I have to say, when I've AB, when I've been able to do some of that, the rage goes from like an 11 goes down to like a three manageable, manageable. So that's been my experience. And often that's kind of the framework that I use with clients too, identifying those triggers, those vulnerabilities, uh, taking care of the body, figuring out what we can do about that. And then what's going on in the, in the internal world. Sarah, this has been a great conversation about identifying postpartum rage or perinatal rage, which some people may carry a lot of shame about even acknowledging exists. So any words for people who might know somebody that's struggling or having an issue themselves, I think the theme of self compassion, and if you've got somebody in your life, that's experiencing this compassion for them. And just remembering that a lot of folks experience this, we often don't like to talk about it. It's so common and there's ways to experience treatment and healing. Thank you so much for sharing your story and your insights and the treatment approaches with us tonight for postpartum rage. For more information about Sarah and her practice. See the description of the podcast below. Thank you so much for having me.