Viewing entries by
Erika Mitchell

Oh (M)other: Welcoming the Other in Mother with Dr. Marguerite Maguire MD

January 29, 2023

Below is a conversation between Erika Mitchell, LMFT and Dr. Marguerite Maguire, MD , our former and beloved in-house psychiatrist at Michelle Harwell Therapy. Dr. Maguire has a specialty and personal interest in treating issues related to maternal mental health.

E: I've heard the term 'maternal mental health' refer to the moment a person conceives through the first year of that child's life, so considering that time-frame, I'm curious what are some cognitive/hormonal shifts or changes in the brain that could impact mental health, and that you might assess for when seeing a new patient coming in for concerns related to being the birthing person?

M: There is a drastic identity shift when you become pregnant and even greater when you become a mother. You may still the same inside but suddenly society sees you completely differently, you can feel the sudden shift in expectations. I think that shift, trying to match up how you feel with outsiders' vision of you, is a dramatic one that is a bit intangible and so often goes unrecognized. Society sort of puts you away as a viable, sexual, vital being and ushers you into a lane of service, selflessness, endless giving. Birth often changes your body permanently. 1 in 3 people who have been pregnant have some degree of incontinence and 1/2 have some degree of pelvic organ prolapse. It's really wild that we don't hear more about this. Women just quietly soldier on. I think I've gone a little off topic here, let me reign myself back in. As you progress through pregnancy, your estrogen is climbing and climbing. Those last weeks of pregnancy I find are usually quite anxiety inducing and depressing for patients. They are about to take a leap off a cliff from which there is no return, even if they've done all they can to prepare, they have no idea what to expect, and they're likely not sleeping well due to size and comfort. Then you give birth and you lose 99% of your body's estrogen in the 24 hours after birth. The real sleeplessness sets in, and on day 3 or so, your milk comes in so the hormonal changes leave you whiplashed with how quickly they change. I find the first 4 weeks to be the toughest on most birthing people's mental health.

E: How does the intersection of birthing-person mental health disorders with other identities such as race, ethnicity, sexual orientation, and gender impact the experience of mental health disorders?

M: Oh man, wish I had more expertise on this subject but I think it's important that it be widely known that black women are three to four times more likely to die in pregnancy and five times more likely to die from pregnancy-related cardiomyopathy and blood pressure disorders than white women. Also the majority of black women live in the 22 States that have banned abortion. Black women also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to white women and these figures have not changed with improvements with overall healthcare quality and access. Also limited abortion access in the south disproportionately affects black women so we can expect all the above facts to worsen as abortion access becomes more and more restricted.

“Society sort of puts you away as a viable, sexual, vital being and ushers you into a lane of service, selflessness, endless giving.”

— -Dr. Maguire

E: In what ways do societal expectations and norms surrounding motherhood contribute to birthing person mental health disorders, and how can we work to challenge and change these expectations?

M: Society's expectations of pregnant people are extremely strict. When you're visibly pregnant people automatically know something intimate about you that you didn't maybe mean to tell them or consent to them knowing. People often touch your belly without asking and offer unsolicited advice. There are signs at bars and coffee shops warning pregnant people about birth defects which I find a bit condescending. It's strange that one day, when a fetus implants, all of a sudden Starbucks is educating me on how I ought to be living my life. We expect people to make mistakes and choices that are less than ideal for their health, like smoking for example, but the second that person becomes pregnant, society gasps if you haven't figured out a way to give up all your vices and become a perfect person overnight.

E: What are some common myths or misunderstandings related to mental health disorders of the birthing person?

M: The most important myth is that PREGNANCY IS A HAPPY TIME. There's immense pressure to be overjoyed at being pregnant. 1/2 of pregnancies in the US are unplanned so we ought to be careful when we congratulate people upon learning they are pregnant. It might not be happy news and it definitely might be ambivalent news. Especially if a person had a hard time getting pregnant, went through cycles of infertility treatments, they are under enormous pressure to be grateful every second of pregnancy and parenthood. But because of hormones, and role changes, and body changes and a whole host of intricate psychological underpinnings, pregnancy is not happy for everyone all the time. Any mental health condition you've experienced prior to pregnancy, is more likely to return during pregnancy. So if you've been depressed before, there is a good chance you'll have depression in pregnancy or in the postpartum period. Wouldn't it be nice if that were an okay thing to speak about.

E: Much of the literature related to 'maternal' mental health seems to emphasize social support as a huge protective factor against mental health disorders. Any advice for introverts or those who are choosing to have a child on their own?

M: Birthing a child on their own-- enlist the help of friends and family! It need not be a romantic partner. Introverts-- warn anyone you'll be spending time with ahead of time how you like to be cared for. Perhaps rather than sitting around and socializing with you, or watching you intently as you breastfeed, a loved one could show their support by popping into your house, doing your dishes, putting away your laundry, then leaving without a word.

E: What's up with breastfeeding (or chest feeding as is the new, more proper terminology)?

M: There has been a big push toward "breast is best" and the American Academy of Pediatrics now recommends exclusive breastfeeding for the first 6 months and ongoing breastfeeding for 2+ years. This is A LOT, especially for a person who has any predisposition to mental health issues. Some people find breastfeeding to be a bonding experience, a special time between them and their baby, and they feel good giving the baby all those antibodies especially during a pandemic but I want to give a blanket ITS OKAY TO STOP to anyone who has a hard time with breastfeeding. Most of my friends and patients continue to do it out of obligation and guilt, feeling selfish if they don't want to do it. If you exclusively breastfeed you have to do ALL the night time feedings whereas formula can be given by any one in the household. It wreaks havoc on your sleep. The data for how much more beneficial breastmilk is compared to formula is not strong. Much more important to have a happy, well rested, emotionally attuned parent. "FED IS BEST." I say. I think the guilt of breastfeeding is just another way in which mom guilt lurks around every corner. You know it's Mom Guilt when either way you do things, you'll feel bad. In those cases you have to just kick that thought to the curb. If you go back to work you're abandoning your baby but if you're JUST a stay at home mom you're not setting an example for your kid that women can have multifaceted identities and successful careers etc etc, there's no winning, its mom guilt, chop it up and toss it to the wind!

E: Thank you so much Dr. Maguire for all of your words of wisdom, I always appreciate your down to earth approach to mental health. As an expecting parent I feel a sense of relief after talking with you about some of these things, and I hope others feel the same :)

Erika Mitchell, MA, LMFT is a Licensed Marriage and Family Therapist.. Erika specializes in helping her clients bring mindful, attuned awareness to their sensations and emotions.

Radical Humility

August 15, 2020

“Humility can play a role both in intimate alliances as well as serving as fortitude for those who participate in activism more publicly.”

As the call for racial justice takes hold of our nation, I feel the gravity of what is needed of me and I’m noticing that I continuously need to ground myself in a stance of humility to stay engaged in meaningful ways. I think humility can be a valuable friend to white people and others who are trying to ‘do the work’ right now. Humility when taking risks to call someone into a deeper understanding and commitment, humility with oneself when feeling inadequate or insufficient, and humility when entering unfamiliar spaces and conversations with those who live and breathe the unrelenting work of racial justice. Humility can play a role both in intimate alliances as well as serving as fortitude for those who participate in activism more publicly. A stance of humility helps to maintain curiosity and radical non-defensiveness such that we can listen deeply to what is needed with enough left in the tank to move to action as well.

This is a stance familiar to many therapists, though challenging indeed. As much as therapy offers ways of understanding self and other, it can just as easily harm the other without the active examination of implicit biases and racist indoctrinations on the part of the therapist. Conversations about race can evoke anxiety to the point where people can easily become defensive, shutdown, or avoid the topic all together. I have heard some therapists rather cheekily suggest a slight dissociation can be useful when in an anxiety provoking conversation to make space for justifiable anger, rage, sadness, or other feelings that may be unbearable or unimaginable. I might also suggest that leaning heavily into humility and letting go of the need to be knowledgeable, good, helpful, seen as expert or right can also be a protective factor against the internal emotional blows, often known as guilt and shame, that can ultimately be roadblocks to listening deeply.

Recently, I participated in a listening exercise related to hearing some of the demands of the Black Lives Matter movement and I was struck by just how much my ability to listen can get clouded by my own self-judgement and anxiety about my capacity. Sometimes it is helpful to be aware of one’s own internal dialogue and feelings, and then sharing them can strengthen relationships depending on the level of intimacy already established. However, when attempting to be an effective steward of anti-racist activism, I find that being able to shelve those inner thoughts for examination later is key for listening more actively in the moment. This means humbly letting go of the importance of one’s own perspective and potential embarrassment at times to ask questions and understand what is being asked of you.

“The mental health field also has a long way to go toward detangling its roots in white supremacy and making the structural changes needed such that cultural competency truly percolates to the standard of care...”

There is so much to learn about where we have been as a country, as a people, and I know that given how deep the history is, it will take sustainable and enduring approaches to create real change over time. We may be humbled by our limitations, but we must be careful not to let humility be a resting place for passivity, rather a place to recharge and know that we can survive our own inadequacy, and keep moving into the discomfort and tragedy of the work that needs to be done.

I know that I have a long way to go in terms of reckoning with my own privilege and with the white supremacist systems that I benefit from and operate within. This will be a lifetime of dismantling and fighting, and I hope to maintain humility along the way. If you are also on this journey and wanting to know more about organizations who are leading the way in inclusive and socially just psychotherapy, please consult the list of resource links below. The mental health field also has a long way to go toward detangling its roots in white supremacy and making the structural changes needed such that cultural competency truly percolates to the standard of care, and I hope that our field can embrace a stance of humility necessary to advance further.

Therapy & Mental Health Organizations:

The Loveland Foundation: https://thelovelandfoundation.org/
Therapy for Black Girls: https://therapyforblackgirls.com/
Inclusive Therapists: https://www.inclusivetherapists.com/
BEAM (Black Emotional and Mental Health Community): https://www.beam.community/

Social Justice Organizations:

Advancement Project: https://www.advancementprojectca.org/
Embrace LA: https://www.embracela.org/

Erika Mitchell, MA, is a Registered Associate Marriage and Family Therapist #109385, working under the professional supervision of Michelle Harwell, PsyD, LMFT 50732. Erika specializes in helping her clients bring mindful, attuned awareness to their sensations and emotions.

Home: Of the Earth

November 12, 2019

This November, MHT is participating in the Miry’s List Friendsgiving Fundraising Drive. The money goes to programs that support refugee families that have been resettled in the United States. In tandem with these efforts, our clinicians are writing posts reflecting on what home means to them.

Meditating on what “home” means to me stirs up a lot of feelings - sadness, pain, grief, fear, disappointment - just to name a few. Having moved homes frequently throughout my childhood and into adulthood, I always felt a strange knot in my stomach when someone would ask about my home or where I'm from; like there was so just too much too explain. As I’ve come into more stable footing and appreciation for the lessons I have learned through all of my moving around, I realize that to me home has always been a place within me. It’s a place that I often find through my connection to the Earth. When I am feeling at home within myself, my body literally feels connected to the ground beneath my feet, and I will imagine all the layers and elemental compounds of the Earth all the way to it’s core, while also tuning in to the shimmering rays of light or the movement of the air, all the way up to feeling the life that I am given by the sun. I come to feel at ease and grateful in the comfort I can take in my own breath and my own aliveness. I feel safe within myself and more eager to connect with the other earthlings living on this beautiful planet.

I trust in nature’s wisdom even through its death and destruction. As storms pass and seasons change, maybe even climates change, I am reminded of how complicated and tumultuous a place called home can be. Amidst the chaos and uncertainty I take solace in knowing that I am a person of the Earth and that I belong here. I hope we can all stay attuned enough to the moods of the only home we really have in this universe to do our part to conserve what we can for future generations of earthlings.

“When I am feeling at home within myself, my body literally feels connected to the ground beneath my feet, and I will imagine all the layers and elemental compounds of the Earth all the way to it’s core, while also tuning in to the shimmering rays of light or the movement of the air, all the way up to feeling the life that I am given by the sun.”

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Give! Visit our Miry’s List campaign page and make a donation. It's that simple and no sum is too small. Truly.

Follow! Be sure to follow us on Instagram and our blog throughout the month of November. We will be reflecting on what it means to be welcomed, received, and known.

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A little about Miry’s List:
Refugee families come to the United States seeking a safe haven from violence and persecution in their home countries. They leave behind family and friends, as well as virtually everything they own. Many Americans, seeing these families in their communities, wonder: What can I do to help? Miry's List provides a mechanism for people to directly help new arrival refugee families with the things that they need to get started in their new lives – from diapers to beds to cleaning supplies and toiletries. To learn more, visit miryslist.org.

My Grandmother: An Inspired Role Model

March 29, 2019

In remembrance of my Grandmother who died earlier this year, I wanted to reflect during this Women's History Month on just how much impact a seemingly ordinary woman can have.

She could be easy to overlook given her humble lifestyle, and although she never earned fame or notoriety, she was certainly well-known and deeply respected within her communities. She had an impressive capacity for care, kindness, compassion, and endurance. She was one of 12 siblings, 8 of whom fought in WWII, and she grew up in rural Pennsylvania fighting her own way out of a sometimes stifling small town. She imagined more for herself - a life with a far greater reach.

She had many wonderful years as a student and a missionary, starting her own family on international missions. She had an amazing faith and ability to go with the swing of things. I think she was truly shocked and devastated when she found herself abandoned as a single mother of 6 children, at a time when her youngest was just barely starting school and they had all moved to a new city. Despite the many challenges that came with raising children alone, she managed to find a way to put herself through nursing school while working three jobs, and somehow maintained closeness and connection to her kids.

It has always struck me that despite how hard she worked, she always seemed so emotionally available and generous with her time. She prioritized her family, and showed up in times of need. I'm sure I also learned some questionable things from her including how to evade student loan debt (it doesn't really work), but it never seemed to keep her down and she was able to keep her relational priorities straight. I think she was truly happier for that, and for the risks she took.

This is not an uncommon story, many women and mothers rise to their maternal duties. She lived her life as a member of the working poor and ultimately devoted herself to work with the church of the Salvation Army. This is not exactly a 'pull-yourself-up-by-your-bootstraps' success story, but celebration for her comes from the fact that she carried on working diligently while never surrendering her values or losing her sense of humor, humility, or self. She managed to continually lift-up others and was an inspiration for the many women in our family to own their sense of independence, hold on to their opinions, and speak-up against those trying to keep them down.

My Grandma certainly faced hardships that I will never know, and I can only hope that some fraction of her enormous strength has been passed down to me. To some she may seem like just another lady who slipped through life unnoticed, but to me and to my family we know just how many lives she touched. She was an inspired role model of determination, sturdiness, and above all - love.

Failure is a Guidepost

February 11, 2019

“When faced with failure, I try to remember that growth is not linear, and success is not always so clearly measured.”

I’ve experienced a sense of failure when the difference between where I am and where I would like to be feels much greater than I had hoped. The journey suddenly feels longer, and I become exhausted, ashamed, upset with myself, and I start to contemplate giving up or changing course. These feelings don’t help me reach my goals or accept myself for who I am when it gets to the point that I avoid the challenges or begin to let my inner sense of failure infiltrate the rest of my psychic being.

When faced with failure, I try to remember that growth is not linear, and success is not always so clearly measured. I try to practice self-compassion without letting myself off the hook or continuing to avoid the painful feelings I must wrestle with to keep moving toward my goals. Maybe this time they are more realistic or appropriate and are not as concerned about what others think. Maybe more self-compassion and kindness will make me more open to feedback and help along the way.

In the past, accepting failure and telling myself that I am just not “good enough” or “smart enough” has been a slippery slope when it comes to having the confidence to move forward in areas where I am indeed better suited. I still feed this struggle sometimes, feeling like I have failed if I am still suffering from some of my same old defenses that no longer serve me. Rather than feeling consumed by guilt, shame, and inadequacy when I recognize my growing edges, I must have more compassion for my own healing journey and know that I am committed to the process with all its inevitable failures and follies. Failure is never easy, and some failures hurt more than others, but failure can also serve as guideposts to where real growth can begin as long as we keep our heads up high enough not to miss the trails.

Women are Bold

December 16, 2018

“All humans are capable of bold acts, but being a woman requires it daily. ”

Erika Mitchell, MA — Photo by Even Keel Imagery - Miriam Brummel

Being a woman means many different things to the wide-world of self-identifying women. For me, being a woman takes a certain amount of boldness to be oneself and to honor the unique value of our more feminine traits, even in the face of misogyny and patriarchal structures. Bold may not be a word that readily comes to mind for some people when they think about women, especially considering that historically women have been considered more submissive, polite, and accommodating. However, inherent in being bold is a courage to take risks and be seen.

Without getting too political, I must say that bold was a word that came to mind after listening to the Kavanaugh hearing as I considered the enormous risk that Christine Blasey Ford was taking to have her voice heard. As a therapist and someone who has made a career of listening to people’s stories, I was particularly struck by the bold conviction she had to be heard and to voice injustices against women that can be all too cavalier. To speak of justice at the hearing of a supreme court justice nominee was a bold decision. Despite facing public ridicule and overwhelming threats on the safety of her and her family, she boldly went forward in a room full of predominantly high-powered men and spoke her truth.

This act of boldness reminded me of the everyday struggle for women to be heard, to be accepted as ‘credible,’ and to be themselves in a societal structure designed to make them fight for their rights time and time again. The risks we take every day even in deciding what to wear in a world that has been known to blame survivors of sexual assault based on their personal expression of style, takes an inborn boldness to carry on and demand that we be treated fairly. All humans are capable of bold acts, but being a woman requires it daily.

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Give! Visit our Dressember page and make a donation. It's that simple and no sum is too small. Truly.

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