Discover the inspiring story of Dr. Katherine Wisner. Explore how Dr. Wisner convened a group of perinatal specialists at the historic Perinatal Mental Health Conference in Chicago, IL, leading to the creation of the Marcé of North America, also known as MONA. You will also hear about Dr. Wisner’s critical work addressing the needs of perinatal women with mood and anxiety disorders.
Send comments to MONApodcast@marcenortham.com.
Katherine L. Wisner, M.D., is a distinguished pioneer in perinatal psychiatry, currently serving as a member of the National Academies of Sciences, Engineering, and Medicine’s Standing Committee on Reproductive Health, Equity, and Society. In this role, Dr. Wisner joins a team of esteemed experts to assess the health, social, and economic impact of reproductive healthcare access both within the United States and globally. Their valuable evaluations inform the development of relevant programs and activities at the National Academies of Sciences, Engineering, and Medicine. With an extensive academic background, including an M.S. in Nutrition and an M.D. from Case Western Reserve University, as well as board certifications in general and child and adolescent psychiatry, Dr. Wisner has gained international recognition for her research on mood disorders during pregnancy and the postpartum period. Her contributions have earned her substantial funding and prestigious awards from renowned medical associations and societies. Dr. Wisner's commitment to advancing reproductive health equity aligns seamlessly with her passion for perinatal psychiatry and her dedicated service to the field. Beyond her professional accomplishments, she enjoys family picnics, perennial gardening, dressage riding, and she remains an avid Pittsburgh Penguins fan.
Discover the inspiring story of Dr. Katherine Wisner. Explore how Dr. Wisner convened a group of perinatal specialists at the historic Perinatal Mental Health Conference in Chicago, IL, leading to the creation of the Marcé of North America, also known as MONA. You will also hear about Dr. Wisner’s critical work addressing the needs of perinatal women with mood and anxiety disorders.
Send comments to MONApodcast@marcenortham.com.
Katherine L. Wisner, M.D., is a distinguished pioneer in perinatal psychiatry, currently serving as a member of the National Academies of Sciences, Engineering, and Medicine’s Standing Committee on Reproductive Health, Equity, and Society. In this role, Dr. Wisner joins a team of esteemed experts to assess the health, social, and economic impact of reproductive healthcare access both within the United States and globally. Their valuable evaluations inform the development of relevant programs and activities at the National Academies of Sciences, Engineering, and Medicine. With an extensive academic background, including an M.S. in Nutrition and an M.D. from Case Western Reserve University, as well as board certifications in general and child and adolescent psychiatry, Dr. Wisner has gained international recognition for her research on mood disorders during pregnancy and the postpartum period. Her contributions have earned her substantial funding and prestigious awards from renowned medical associations and societies. Dr. Wisner's commitment to advancing reproductive health equity aligns seamlessly with her passion for perinatal psychiatry and her dedicated service to the field. Beyond her professional accomplishments, she enjoys family picnics, perennial gardening, dressage riding, and she remains an avid Pittsburgh Penguins fan.
Studying Perinatal Well-being with Dr. Katherine Wisner
Podcast Transcript
Host (Lara-Cinisomo) [00:00:04] Welcome to Studying Perinatal Well-Being, the podcast of the March State of North America. This bilingual monthly podcast will allow new and experienced researchers, practitioners, students, and community members to hear about the latest research and community actions on perinatal well-being. I'm Dr. Sandraluz Lara-Cinisomo, your host. Today, I'm delighted to welcome Dr. Katherine Wisner. Dr. Wisner obtained her master's in science and nutrition and an M.D. from Case Western Reserve University. She is a board-certified psychiatrist. Dr. Wisner is a pioneer in perinatal psychiatry. Her research has advanced understanding of the natural history of mood disorders across childbearing benefit, harm, decision making for pharmacotherapy during pregnancy and lactation and the pharmacokinetics of medications across pregnancy and lactation. She is internationally recognized as an expert in the treatment of mood disorders during pregnancy and the postpartum period. Dr. Wisner has received over 21 million in NIH funding across her career and has more than 250 peer reviewed articles in addition to 21 book chapters. And I am proud to say that she and I also co-edited a book on perinatal depression in Latinas and Spanish-speaking women. Welcome, Dr. Wisner.
Dr. Wisner [00:01:28] It's a pleasure to be with you, Sandraluz.
Host (Lara-Cinisomo) [00:01:31] Thank you so much for making time to meet with us. So today, our listeners are going to learn a little bit about you, but also about the world of research and perinatal well-being. So, can you tell us when did you first get interested in perinatal mental health?
Dr. Wisner [00:01:46] Yeah, what a question. It's some time ago now, but it was when I was in my residency training program, and I was treating primarily women because at that time women were interested in seeing women. And that's continued to be true. But there were very few women psychiatrists back then, at least in training. And so I was seeing a lot of women patients, and I was seeing one who was pregnant, clearly depressed with all the criteria for depression, suicidal ideation. And when I presented her to my supervisor, who was an older male analyst, he said to me, Kathy, you know, you have to be wrong about the diagnosis because women are not depressed in pregnancy. They're fulfilled. And it just struck me as such a strange, you know, non-observing, sort of unfeeling comment that I began to look at, well, where is the literature about? Where is the literature about depression in pregnancy and bipolar illness and pregnancy and pharmacotherapy? And at that time, there was not even a real awareness of what was pretty much postpartum depression. People were saying, well, you know, it's the same thing as any other time. No big deal. And, you know, I got very angry about that, that there was such a lack of research and there were so many women who were coming to see me. I just felt like they deserved more data and more compassion to guide their decision-making.
Host (Lara-Cinisomo) [00:03:29] So it took a lot of courage to go against the grain and to say this area is needed. Where did you find that courage?
Dr. Wisner [00:03:37] Anger? You know, I don't know if it was so much courage as just being really angry at something, somebody saying something that I think of a correct word that I could put on a that was, you know, outrageous and completely off base that was so gender biased. And you women are fulfilled. I mean, give me a break. And, you know, the whole, women who were had postpartum depression who were, you know, being told what, you know, why are you sad? You have a beautiful baby. That kind of stuff just really bothered me that there wasn't, again, more attention to specific emotional mental health problems in women. And that's why I began reading more the British and Australian literature, where there was more information. And so, it was not so much courage. It was really just being very angry at that. And I was not about to tell my woman patient that she wasn't depressed because she was fulfilled. I mean, so anyway, again, not so much courage, but anger. And, you know, the other thing was, as I talked about these issues, other women, mental health professionals and many men thought it was just as unfeeling and inaccurate and needed to be investigated as well. So it was that time when there was an early effort at NIH even to point out that what was the phrase even the lab rats at NIH are white males. And there was that real sense of women need to be included. That was starting around then in the late eighties. So, I kind of was with that group and found companionship there and then ended up going to England to look at the mother baby units and talk to people who really understood what I was saying.
Host (Lara-Cinisomo) [00:05:42] Yes. Yes. So, you've now, many years later, many publications later, have you found a difference in terms of how this issue is being addressed from a clinical perspective?
Dr. Wisner [00:05:54] A huge difference. So, when I first began to do this work, I met Mike O'Hara, and Mike sort of introduced me to a few people who were interested, and Mike had begun to do some research, but you could count on one hand who was doing anything. And again, the general thing was no big deal. Women are fulfilled. So, there were very few colleagues back then. And certainly, the phrases we're using now, postpartum depression, perinatal depression, forget it. It wasn't even part of the jargon in the very first grant, small grant. I got to look at what I don't call childbearing-related disorders because I was looking at pregnancy terminations, abortion, miscarriages and postpartum. And I did a study based on presentations to Western psych emergency room and found some very interesting relationships with childbearing-related disorders, particularly around hypomania and mania. Some of the early findings that a lot of postpartum episodes were really cyclical mood disorders, bipolar disorder that clinicians were missing. That's another thing. Back then, it was manic depression. And you either in full blown mania and depression and that was it. The spectrum that we now understand in bipolar disorder none of that was out at all. So, it was really rudimentary perinatal mental health research and in fact, mental health research in general, which I mean, we're a couple a DSMs back, so it went from really nothing having to go to England to talk to people who understood what I was seeing, to a few core people who began to publish papers. Back then, it was Lori Altshuler who sadly passed away too young in life. Lee Cowan was doing some work. Deb Fishel from Harvard, too, although she kind of dropped out of the picture. So very few people really interested. And but as publications begin to come out and people learned what I was doing in particular, I started getting a whole group of people who were really interested and wanted to work on this. So, I had a whole group of mentees colleagues then began to do more like Kim Youngers and Jack Stowe. So, there were more people joining because it was such an interesting topic. And that's what I felt all along, that what you say you're doing. Women's mental health. The mentees are plentiful. People who want to learn are plentiful. It was like opening up a niche that everybody said, Yeah, this is really missing. So, I saw really a quite rapid acceleration initially focused around Marce International as the organization and to some extent NASPOG in America, but just really a lot of momentum and I think it's accelerating now across time. And for me now to see ads on the APA website for we want a perinatal psychologist or a perinatal psychiatrist, perinatal nurse clinician. But just to see that be valued as a profession and to have three women's health or perinatal psychiatrist become chairs of departments that it's, you know, validated as a real area worthy of, you know, assigning somebody as a department chair. I mean, it's like light years to me, I feel like a God is some sort of spaceship that was catapulted to this 2023. It's been amazing.
Host (Lara-Cinisomo) [00:09:59] Well, you've been a key contributor to that trajectory, and you were president of the International Marce Society of Perinatal Mental Health, which is the Parent Society for the Marsce of North America. And in fact, you spearheaded the development and launch of the Marce of North America. What is your thinking behind that? What excited you are motivated you to really launch MONA?
Dr. Wisner [00:10:24] Well, one of the things I wanted to do was have something for our American clinicians, investigators who were interested in perinatal mental health to have a forum to meet, you know, to share data information. So, after that initial 2010 international meeting in Pittsburgh, I then had several meetings that I arranged in Chicago for perinatal mental health because, you know, it was really clear to me that if we were going to be in a field, we needed a place to communicate, present data, have our mentees be able to present posters, give awards. And I love it when I review CV’s and I see somebody that came for a MONA poster saying the presentation at MONA is really neat to see. And then after those were successful then I pulled together, people said, you know, we really need a meeting here in America. That's a standard meeting, an organization that meets on the off years. And, you know, we need to take responsibility for advancing the careers of all people in our field. And that's that's really what's happened. Again, I think it's because it's filled a need and there's such a draw. I mean, I'm still kind of blown away at, you know, the residents who come here, some other resident who come to our program say, well, I'm I want to come here because there's a there's a women's mental health program that's seen as an important part of their training. It's not all women either. It's men, too. So, I just feel like we need to continue to move towards ACGME fellowships, although, well, there's a pluses and minuses to that. But, you know, the fact that now so many programs are offering fellowships is, I think, really important. And clearly the field thinks perinatal mental health is a real thing because you're being advertised for those kinds of practitioners. So it was, you know, my my reason for doing that was always wanting to bring people together to advance the field.
Host (Lara-Cinisomo) [00:12:45] Yeah. And one of the advantages of MONA is that it includes Canada and Mexico. So, it really is bringing the Americas together to address this really critical issue.
Dr. Wisner [00:12:56] Absolutely. Yeah.
Host (Lara-Cinisomo) [00:12:58] Yes. And so, your research includes qualitative work, observational studies, clinical trials, and a vast range of collaborators and researchers, mentees and trainees. What advice do you have for people who are interested in entering this world? You say that you are excited to see mentees. How does one become a mentee? I'm thinking about those residents, those doctoral students, master's students or community activists who are really trying to make a difference in the lives of perinatal populations?
Dr. Wisner [00:13:31] Yeah, I can give you some examples. So one of the perinatal fellows that we will join us this year was in a state with no perinatal programs at all, and she sort of took it upon herself to explore what was available in terms of education when on the NCRP website found that did all the modules and is now a resource in her stage is very small town and when she applied we were really impressed with how she on her own tried to get information, tried to be a resource. And I think it's that kind of I'm going to do this, I'm going to see what's out there and that kind of passion that really appeals to people. So, she'll be here. I wasn't clear. I don't know that she wants particularly a research career in the way that my career is going, but I think perhaps her interest is in how do you provide capable perinatal mental health care in a community more in the way of community engaged research and using teams to expand the care that can be given to a community. So, one is that passion that people feel that tends to propel individuals into research. The other example I would give is one of my residents who is a first-year resident, but she called and she said, I'm a first year resident. I really am interested in perinatal mental health and I'd like to get involved in research. And she you know; it was a very. What kind of papers do you need help with? Like, oh, geez, they have so much data around. So, she started out with more of a kind of an opinion paper. And then I got an invitation to do a paper on the role of estrogen in perinatal mental illness. And so, she wanted to do that, which is great because I think it's more not being afraid to contact people that you might like to work with and then being specific about what you want to do. So, she's actually quite a good writer and she knew that. So, she said, well, you know, I have experience writing and, you know, do you need some help writing? I’d love to do this. And like, Oh yeah. So, kind of doing some background on the person that you're asking to be involved with and kind of figuring out what they need on their plate. And again, not being afraid to ask, not being afraid to let your passion show that we have a medical student same thing. There's a scholarly project that's required of medical students here. And this medical student basically did the same things that I’d like to do. My project I’m really interested in culture bias, racial issues. And Krystal Clarke and I had a publication that she has now developed out into a really nice publication. So it's searching for a way to win. What do I get out of it? But how do I make sure that my mentorship team or mentors get something out of it as well? But that exchange is fairly equal, meaning the worry that I have is there are so many times that mentees are, I would consider abused by mentors in that, you know, they do all the work, they do a lot. And then, you know, but the mentor basically says, well, this is supposed to do my bidding, and they don't get there. They get their names like last on papers. And I've unfortunately seen a fair amount of that across my career, particularly for women mentees. So, I would just advise people to be clear upfront on what the arrangement is, what the mentees doing, what are the products and what are the products they expect from the mentor. You know, do they expect line by line editing or a more comprehensive, thoughtful review or what? What do they really expect and do they expect to be first author of a publication or have those kinds of things mentees tend to leave out. But I think it says a lot about the mentee. If they negotiate those kinds of issues upfront, it tells the mentor they're really thinking about those issues. And if the mentor is not willing to engage in that kind of discussion, I would go elsewhere.
Host (Lara-Cinisomo) [00:18:17] Yes. So, you identified a number of things that the mentee can do identify people who they're interested in working with, look at what skills and talents they bring to the collaboration. State those explicitly. I'm an excellent writer, for example, or I love data analysis and have a concrete conversation with the mentor about deliverables, expectations, and also the arrangement of the mentor mentee relationship.
Dr. Wisner [00:18:46] Very well said, Sandraluz.
Host (Lara-Cinisomo) [00:18:49] Thank you. Well, you have been a mentor of mine. In fact, I can attest to your collaborative approach. In fact, you were acknowledged as an outstanding mentor in 2022, where you received the Mentor of the Year award from the Medical Faculty Council of the Feinberg School of Medicine there at Northwestern. So, what do you think, in addition to having those concrete conversation, what do you think makes an excellent mentor?
Dr. Wisner [00:19:16] I think an excellent mentor is one who recognizes that the mentor mentee kind of dichotomy doesn't exist, that in fact we are all mentors and mentees at the same time. So, for example, one of the things that I think people who are identified as mentees don't get is how much they bring to the relationship, right? How much youthful energy, excitement about that field, excitement about seeing their first paper or, you know, all this sort of youthful joy, passion that kind of keeps me going because seeing a paper published is just not very exciting for me anymore. It really is the the seeing a seeing somebody that I've helped really be pleased with what they've been able to produce. And I learn so much from my mentees as well. Right. I mean when mentees ask really curious questions, you know. Well, how did this get to be practice and you should dare to go. And that's a good quite it's sort of the way we do it, but at least twice to three times a week. Somebody asked me a question. I always what an interesting question. So, this sort of questioning, why are things the way they are and that. Joy, passion, stuff. So, it really keeps me going. So, I think people underestimate what they bring to relationships. And, you know, it's again, a false dichotomy. I mean, you know, you're a mentor mentee all your life. Just depends on what context you're in.
Host (Lara-Cinisomo) [00:21:09] That is absolutely true. I like that you pointed out the fact that the mentors can gain inspiration from the mentee.
Dr. Wisner [00:21:16] Oh, huge.
Host (Lara-Cinisomo) [00:21:17] Yes, they can feel a sense of revival in their work if they're feeling it.
Dr. Wisner [00:21:23] Well, I feel a sort of with the K Awards, I start calling my k-kids and I leave to call my kids. And in fact, you know, there is this strong sense of people that a mentor, when they, like one of my mentees, was accepted to medical school this week. And she just is so excited and called and she said, you know, I would have never gone down this path if it wasn't for. This is a young Latin X woman who was a research assistant who’s really bright. And I said, you know, she said I’d really like to go to med school. I said, Well, then go work towards it. And she was accepted two years in Colorado. So, you know, and I feel like a proud mama. I really do. And you feel like you've been able to help someone see their own strengths. And it's giving back because I had some wonderful mentors in my own life who literally kicked me in the butt couple of times and got me going after some disappointments. And so, I feel like I owe it to people.
Host (Lara-Cinisomo) [00:22:32] Yeah. So, I think you're pointing out another thing that the mentee can bring is what are some of their goals? What are some of their aspirations? And perhaps discussing how the mentor can help them achieve those. And on the flip side, the mentor being open to ways that they can contribute to the professional development of these aspiring researchers or practitioners.
Dr. Wisner [00:22:54] Yes. Yeah, absolutely.
Host (Lara-Cinisomo) [00:22:57] So the next question I have is about doing research. The research has changed over time. We're now moving more toward talking more about diversity and inclusion, but also focusing on increased attention on anxiety. For example, depression got much of the attention early on, and now I see more interest growing in anxiety. Why do you think that is?
Dr. Wisner [00:23:24] I have sort of a different take on that. So, you know, early in my career, I looked at not only major mood disorders, but panic disorder across pregnancy, OCD across pregnancy. You have some of the early publications on those disorders. And so, I draw a distinction between mood disorders and anxiety disorders. And there has been research in how those disorders evolve across pregnancy and postpartum. Where I think it gets confusing is people use depression, anxiety to describe symptoms. And, you know, in my experience, some of the moms that come in, I'll say, well, you know, is this depression or anxiety? And I say yes, because to me, there's almost no postpartum depressive episode that doesn't include a lot of anxiety symptoms and sometimes panic and sometimes OCD symptoms. I think they're really fluid. And then in that big study screening study we did, we showed that two thirds of those women with major depression also had a comorbid anxiety disorder. And then the other thing is, in postpartum onset or even OCD in pregnancy, postpartum, in my experience, is it's really rare to see somebody who doesn't have co-morbid major depression. So, I know people say, well, now people are more interested in anxiety. That hasn't been my sense. I've been basically convinced that they were highly comorbid disorders throughout my career and published on that. And I think where I would like to see more distinction in this, I review papers as well is people who are throw out words like anxiety, depression, and it's not clear whether talking about anxiety symptoms and depressive symptoms are talking about disorders. And I think we need to be a bit more clear about that. That's said, I think all of the anxiety spectrum symptoms and depressive symptoms and bipolar, I think they're all incredibly co-morbid. So right now, I'm working with a patient with pretty unstable bipolar illness. We just got that fairly stabilized. And now the co-morbid OCD is what's presenting her a lot of difficulty. So, she's making lists everywhere, all over her house and piles of lists that she never does. So, tackling which disorder do you get first, or do you even think about disorders? I don't anymore. I tend to think more about symptoms. So, I don't see this as a big change. I am aware, though, that, you know, with now calling things perinatal mood, and anxiety disorders, there's a label that. Implies more inclusiveness, but I never really thought anxiety disorders were excluded, so I don't quite see it the way that others might.
Host (Lara-Cinisomo) [00:26:36] Yeah, well, that's very insightful. So, what direction would you suggest we take Perinatal mood disorders? And what advice do you have in terms of studies that we still have yet to do or consider? So many. So many. But any that you think we should start talking about.
Dr. Wisner [00:26:55] So my biggest concern is that we have wonderful screening programs, but individuals who get positive screens, if they're seen in non-mental health professional offices, that is where most people are screened, which is primary care offices or OB-GYN offices. If they get a positive screen, say, of 14 or 15 on the EPDS, they're likely to get a prescription for an antidepressant because that's what's available in the primary care office. Unfortunately, there aren’t enough therapists, I mean, in Chicago were begging for therapy time. It was just such pressure. So, my worry then is that these patients get the antidepressant prescription. There may or may not have a follow up appointment. And if they do, sometimes they're not given an appointment for six weeks or it's call me if it doesn't work out. And we know from MONA and many other unfortunate circumstances that if that woman has bipolar illness and that's not recognized, the anti-depressant could make her worse. And I don't think we are giving people the tools that they need to rule out bipolar illness. That's why we did the study of can the MDQ be useful in that regard. And it can. We were able to identify about 70% of the screen positive for depression women who actually have bipolar illness, but that's 30% that a screen doesn't identify. I really worry that we're still not identifying these women at risk for postpartum psychosis and screening is great, But I think that that's a potential issue. It's also very difficult to diagnose bipolar illness. So now we've done some publications looking at other symptom differences between unipolar bipolar illnesses that we picked up in a big screening study. And we are always looking for clues, clinical clues. We've published that as well. What are some clinical clues that women may have bipolar illness? But I think our attention to that problem has been lacking. And in fact, I think our not only in perinatal psychiatry, but in psychiatry in general, we do a really lousy job identifying and treating individuals with bipolar disorder. And there's now a national initiative to pull together a learning collaborative to see what we can do to do better. But that, I think, is just a real vexing problem, difficulty diagnosing bipolar illness. And also, the second thing that really worries me is incredible lack of mental health professionals. I mean, the waiting lists are especially for children. I mean, if you have a yearlong wait for an appointment, its almost like what's the point? You know, so that those are the things that really worry me. And I'm pleased with the programs like the program for Moms, like our collaborative care program, where we're really trying to extend the expertise to more patients. But those are my two, two big concerns.
Host (Lara-Cinisomo) [00:30:22] But are there key symptoms that an individual or family member or friend can keep an eye out for to help them distinguish between depression and psychosis or bipolar disorder?
Dr. Wisner [00:30:37] Yes. And even that's a little bit tricky. So, the thing that I see most commonly is cognitive changes so that the person isn't speaking, acting as they normally would, responding as they normally would, and that's variable. So, they can be not answering long delays in their responses or talking so quickly. So, there's a lot of not only mood but energy fluctuation and saying strange things that aren't like them. So, so they're sort of cognitive. The person is just not quite right. Then typically there are delusions or hallucinations, more likely delusions and worrying about the baby. Saying strange things about the baby you know is the baby, okay? My baby could die. So, these these things that are just out of character and I'm talking now about some of the more subtle forms because if she's acutely psychotic in or out, that's a little bit more obvious. And a lot of women are. But there is this more subtle kind of form where people know something's not quite right and then watching for unusual behaviors. So, the one case that I will always remember is what I described in that article on postpartum psychosis, where a very well-dressed. Polished nails. Beautiful hair made up. Lovely clothes. Woman comes into my office. And if for an evaluation and says, Doctor Wisner, I'm here because I'm depressed. But nobody believes me. Isn't that interesting? So, she went on to say to describe her depressive symptoms. And her baby was about a month old and she had a toddler was about three. And so, I asked my usual questions about anything that other people might think are unusual happening to her, so that she proceeded to tell me with in a very articulate way about this black shadow that exists within her that comes out sometimes. And I said, you know, what would I see if I saw the black Shadow? And she said, well, it would look just like me, but it's a little bit outside of me. And you can see through it. And the shadow makes me do things. So yesterday, the shadow made me put my hands around my baby's neck, and I think I might have strangled him if my toddler hadn't pulled on my pant leg. I said, oh, well, I'll try to get more information. Turns out what she was doing to try to stop the black Shadow from coming out because she recognized she might hurt the baby while she was walking back and forth on her front porch with the kid, the baby and the toddler in January in a Midwest city. And I'm sitting there, you know how you respond and you're calm and you're like. But but this was a case of postpartum psychosis that had she gone to a primary care, and she had she was trying to say, nobody believes I'm depressed because she was so well put together. But that was one of the most unusual presentations I've seen. So really, as clinicians, I think we have to be very careful about not assuming because somebody is well put together and articulate, you still have to ask them those questions about psychosis. And that's what I think happened. So many people say, well, gee, we didn't know she was so sick. She was so. But you really have to ask those questions. So again, what struck me about that is did anybody in her community see her walking on the porch with the kids? Know her husband was an attorney? So maybe people I don't know. I'm just surmising. I mean, if I saw somebody walking on the porch of my neighborhood with her two kids, I would ask, you know, how's it going by the common side? How about a cop? You know, it just seemed to me to be very odd. And I think, sadly, there's a reluctance to get involved when you see something like that.
Host (Lara-Cinisomo) [00:35:11] Yeah. So that brings me to training and thinking about how to train a community in addition to physicians and mental health professionals, but encouraging the community to be available, to be aware, to look at these things, to talk to their partners. I almost think that in addition to the baby information at delivery or even in pregnancy, that there be a handout to family members about the signs that family members should look out for depression, anxiety, psychosis, even if they're afraid that there is a phone number that they can call to just verify and get some questions answered.
Dr. Wisner [00:35:49] I think that's absolutely right. Sandraluz. I mean, one of the things that I think is sad is how we have lost communities. I mean, there was much more community interaction, moms supporting other moms, dads supporting other moms. There was the now there seems so little, but it's sort of like some of the work that Sheehan Fisher's doing here with, you know, recognizing that we have limited time with our patients and family members, have way more time and can reinforce act in ways that promote the maternal wellness as opposed to, you know, what little we can do in the time that we have. And I think reconstructing that community and educating, I think, is critically important. And one of the things that I've done in my career that's along these lines is unless somebody is acutely suicidal or overtly psychotic. I am reluctant to put a woman with postpartum psychosis on an inpatient unit. I would far prefer to work very closely with the family and get those meds into her quickly and have her in her home setting with rather I you know, she so many people decompensated in the inpatient unit because they're just so anyway and that really depends upon intact caregiving families and I think that's really a better way to care for these women than pulling them away from everything and putting them on a unit with patients who are going to act very, very bizarrely, more bizarrely than these patients with no baby. And then what happens is that she's discharged in the entire family, scared to let her hold the baby, because they're worried if there's just so much we do wrong. But engaging the families, I completely agree with you and debunking some of these myths. So, some of the fathers that I see will say, well, is it my fault she got this illness? Or, you know, they worry about this and they want to get in there and help. There's some really ill patients that I saw in pregnancy, you know, really depressed woman that I got from an ILP and they didn't know what to do with her. And so, we treated her with frequent visits. It was during the pandemic with her husband in Zoom. I mean, we did the treatment was for the two of them together, and she eventually recovered. And you know what happened? She had a healthy baby. She did well and minimal postpartum disruption when she was well. Well, he got depressed. It's like that thing, you see, where the guy would be starting to get to be strong and their wives get well and then they crash completely. So, I think we saw a lot of that. So, I completely agree with you. And I love these different cultures where I is it in Mexico, where the woman has 40 days and she's nurtured and recognized for the gift she's given to the world. Here, get out of the hospital. Go back to work. You know, it's so primitive.
Host (Lara-Cinisomo) [00:39:14] Yes. And absolutely. The conversation needs to move toward the resources we provide all parents, whether it's a single parent, a dual partner parent, perhaps it's a young parent, an older parent, a third child parent. Vastly different languages and cultures. And we need to remember that there is still something someone can do to help. Yes. And I think that you are making a big difference in ensuring that we can make a difference in the lives of perinatal individuals in pregnancy and postpartum, and by training people to really think about the different factors to consider when we're working with this population. This has been tremendous. Are there any closing thoughts that you'd like to share for young, aspiring researchers, community members, family members or those who have more experience that maybe there are things we can still learn?
Dr. Wisner [00:40:10] Yeah, I think. My advice would be use your passion to keep going because there will be disappointments along the way. And so many of the mentees colleagues have thought, oh, well, you know, maybe this isn't the area for me. You know, I'm disappointed paper didn't get published. Grant and give, but keep going. Let your passion propel you because the need is incredible. And if you're passionate about this field, there's plenty of room for you.
Host (Lara-Cinisomo) [00:40:41] Yes. And you've highlighted where we can fill some important gaps. And I think that there are many opportunities out there. Thank you so much for being with us today.
Dr. Wisner [00:40:50] Oh, Sandraluz, thank you for doing this. I really have enjoyed it.
Host (Lara-Cinisomo) [00:40:54] Thank you so much.
Dr. Wisner [00:40:56] Okay, Bye bye now.
Host (Lara-Cinisomo) [00:40:59] Thank you for joining in studying perinatal well-being. Please see our show notes on the MONA Podcast website for more information about today's guest. We always look for great perinatal well-being students, community members, researchers, and practitioners to interview. So please email your suggestions to monapodcast@marcenortham.com. That's monapodcast@marcenortham.com. Until next time, practice compassion for yourself and others.