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Counseling Postpartum Depression

Truth In Love 421

How do we give hope and help to women who struggle with postpartum depression?

Jul 3, 2023

Dale Johnson: This week on the podcast, I have with me my friend Shelbi Cullen who currently teaches as an Assistant Professor for the School of Biblical Studies Department at The Master’s University. She completed a biblical counseling training from The Institute of Biblical Counseling and Discipleship, The Master’s University, and Southern Baptist Theological Seminary. She’s also been a member of the Association of Certified Biblical Counselors since 2005. She currently serves at Grace Community Church in Sun Valley, California, where she has the privilege of teaching women and children’s ministry and serving as part of the biblical counseling ministry team. Shelbi is also married to her best friend Sean, and they just celebrated 37 years of marriage. They have four grown children, three in-law children, and three darling grandchildren. So, Shelbi, I’m so grateful that you’re here today to talk about this very difficult but very necessary issue of postpartum depression. Thanks.

Shelbi Cullen: Yeah, thank you for having me on. I’m really excited to be here. 

Dale Johnson: Now, let me preface this by saying Shelbi was gracious enough to write one of our booklets. Our biblical solutions booklet series on this very topic, and so only so much that we can cover in a short amount of time. So, I would say I’ll recommend that to you as well, but as we get going into this, Shelbi, let’s talk about what postpartum is. So many people have questions about it, you know, maybe in a generic way what meets the threshold of postpartum, but what exactly is postpartum depression? 

Shelbi Cullen: Yeah, thank you. I mean, in short, postpartum depression are really just women who are suffering, they’ve just given birth, and they’re experiencing a form of despair, but it goes beyond just the despairing that manifests typically into them just interfering with their daily responsibilities. The medical community, interestingly enough, doesn’t even know exactly what causes it, but they do recognize at least that there’s a body-soul connection; they just wouldn’t call it that. They would say something like physical emotional, right? But most find that they struggle with extreme anxiety these women, which can manifest into things like full-blown panic attacks. Some even experience suicidal thinking so it can get into more of what the medical community would call like a psychosis, and that kind of suffering is for sure just very physically challenging for these women as well as extremely terrifying because the thought life just gets really extreme. And one of the reasons why I wanted to dive deep into this, and really research it and study it, and very thankful to Dr. Wickert for his work on this is because my own daughter went through this. And so, it was just a personal thing that I wanted to research on my own so that I could actually help her. 

Dale Johnson: Yeah, so as we talk through this you mentioned this is a common experience that a lot of ladies after having birth will deal with on some level and I think some of the things that you’ve mentioned people will question, is this a hormonal issue is, you know, the medical community at least at this point from the things that I’ve looked at and read and doctors that I’ve spoken to, we acknowledge something is happening, but we’re not really sure, but I want you to distinguish because some people will describe this as broadly as being the baby blues or something like that. And so, I want you to distinguish what we’re talking about here, maybe from this issue of the baby blues, and then talk maybe a little bit about if this is a common struggle with women in our churches. 

Shelbi Cullen: Oh, sure. Yeah. I mean, the medical community does distinguish postpartum depression. I think they categorize it into three categories, and the first one they’ll call postpartum baby blues actually, it is quite different. It’s a little bit more common among women post-childbirth, they’ll experience a form of despair, but it doesn’t actually last very long. Typically what happens is, maybe they’ll have a despairing mood, if you will, for maybe three to five days, maybe a couple of weeks at most, and I think what’s happening there, at least the medical community is acknowledging that more than likely a woman’s hormones are just getting back to normal. And then you just, you know, couple that with the fact that she’s not getting a whole lot of sleep. There’s a lot of sleep deprivation going on. We know that we’re both parents. We remember what that was like, and it can have an impact on you, but a woman who is experiencing the more severe postpartum depression, for her it lasts much longer, and what we’re seeing is, on average, it is lasting from a few weeks to a few months. And as I mentioned before, the woman is experiencing extreme anxiety. She may not have even experienced that before she had this child at all, or the despair is just lingering. And even some women that I’ve spoken with experience suicidal thinking, which is really, really concerning.

So postpartum depression, believe it or not, as far as the CDC is concerned, is really the number one post-birth complication that a woman can experience. So, statistically speaking, I would say that there are so many women in the church who have struggled with this, but there’s a bit of a stigma attached to it. So women won’t share often that they are experiencing that, and I’ve interviewed women about this who have struggled with postpartum trying to understand what are the reasons why they won’t come forward and say that this is something they were actually struggling with. And many of them just tell me they’re just fearful of being judged. That seems to be the thing, or maybe accused, believe it or not, of just having little or no faith. But I’ve actually had conversations with other people who don’t even believe that postpartum depression is a real thing. And they kind of dismiss it. That’s not very caring. Or the woman is fearful of speaking out because she just feels like people are going to think that she’s just not thankful for having this little blessing, right? So there’s just so many things, so many reasons that kind of tie into maybe more of a fear of man, I would say, and it’s sad, it’s sad because we should be able to care come alongside and really biblically care for these women. 

Dale Johnson: You said several things, and I want to normalize, I don’t know if I would say normalize, but I do want us to at least acknowledge what’s happening here. A lady has been carrying a child for nine months, right? As she’s carrying this child, her life is about to alter in a dramatic way. Now there will be somebody who cannot care for themselves where she feels primarily responsible. Add to that we call the having of the child a certain word that is pretty telling we don’t call it, you know, a joyride; we call it labor, right? Because it’s difficult, and it’s very, very hard. Not only is she now giving her life toward this child to sustain this child, she’s given her body in many ways for this child; if C-section or natural birth, her body changes radically. And now, as you mentioned with sleep deprivation, I mean, a lot of things are happening. And I think there is sort of this internal feeling of shame like I should be more joyous or other people on Facebook seem to handle this a lot better than I feel like I’m handling it right now, and they minimize all the radical changes that are happening. They minimize the amount of sleep that they’re losing, and I think it becomes something that’s overwhelming. And this is exactly the way that the church needs to come alongside and to help in moments like this.

So, I’m glad that you’re addressing this, and for all the ladies out there, I would say it is so important that you know, don’t feel ashamed. Those things are really critical that you’re able to talk with some folks and to help work through all the things that are changing in you and your body, with this child now, this new responsibility that you have. And so to be encouraged to seek help and get help so that you can do the things that you want to do, which is to care well for your child.

Let’s talk, and this is maybe taking a step back in the conversation for a moment, but I think it is important sometimes when a wife is going through things like this, the husband, I’ll just fully admit, sometimes we are clueless about things and we don’t know how to handle it. We’re not sure what to do. And we’re trying to help her to get over this, or we’re trying to, you know, we’re trying to do what we can, but it gets really confusing. So I want to talk about the husbands for just a second. What are we to do with those guys who their wives are suffering through this postpartum moment or moments in their life, and what are some of the common struggles that they might go through? 

Shelbi Cullen: Yeah, I think it’s a great question to ask because, you know, there are two people in this family typically, and we do want to know how the husbands are just handling all of this. It’s really tough on them actually. I got to talk to a few husbands when I was putting my material together because I was really, really curious. I think the assumption is that they’re doing well or handling it well, but they were quite honest and very transparent. One of the dads that I spoke with whose wife experienced just severe PPD said that it was one of the most strangest and terrifying things that they’ve ever experienced in their life. I mean, from his perspective, he remembers his wife one way before the baby’s born, and then all of a sudden there’s this whole other thing going on, and it’s just shocking.

While others have told me or shared that they remember experiencing fear because, you know, like I said, extreme anxiety, suicidal thinking, panic attacks, and so, he’s wondering, is my baby even safe? You know, I mean that does go through their mind, and maybe they’re fearful to even say something like that. Some have just honestly spoken about feeling very angry or frustrated over the situation because it’s a bit out of their control, perhaps, and they just don’t know what to do or if they reach out to other brothers or somebody at church, let’s say, they don’t know what to do either. So they feel a little bit isolated, maybe, they’re left to kind of feel like I’ve got to figure this out on my own, but they don’t know what to do. Like you said, they feel clueless, but not because I want to feel clueless. It’s just there’s just no information for them. And then, of course, there’s always the men who I’ve spoken to that felt a little bit of shame because of that. They didn’t know how to handle it well, so you kind of feel like a little bit of a failure. I don’t know how to shepherd my wife through this really traumatic time. I mean, it just can be quite discouraging. So that’s why when a woman comes for counseling for something like this, I always encourage the husband to come at least the first time, so they can be part of the help, right, even if it means encouraging her to do her counseling homework let’s say whatever it is, we’re partners in this and so yeah, that’s some of the more common struggles that I’ve been made more aware of in the, you know, lately. So… 

Dale Johnson: Yeah, I think that’s critical because he’s going to be working with her through the week and trying to help out where he can and being able to minister to her well in a way that’s appropriate, is great. So, I love that you’re focused on that, but how might we communicate hope? This is one thing sometimes when we talk about things like postpartum depression and we have a tendency, I’ll just be honest and in the biblical counseling world to want to make something either a medical issue or a theological/spiritual issue. And I want to always say it’s both. It’s both, where even if there’s something that is distinctly medical causing something like this to happen, we still have a responsibility to now help her engage this in a way that’s God-honoring and appropriate with whatever is going on with her body. And so, how do we minister and communicate hope to someone who’s suffering through postpartum depression? 

Shelbi Cullen: Yeah, I think the first thing to think through is maybe just having a conversation about the very thing that you just said, the body-soul connection. When our bodies are not doing well physically, it’s going to have an impact on the spiritual and vice versa. So that conversation, believe it or not, has brought a lot of hope to women that I’ve spoken to. When they first come though, what I might do is give some basic hope. I want them to just understand a few things. And I think 1 Corinthians 10:13 has always been very, very helpful. I’ll open that with them, I’ll read it to them, and I’ll just go ahead and read it for us where Paul talks about, “No temptation, right, has overtaken but such as is common to man, but God is faithful who will not allow you to be tempted beyond what you are able. But with that temptation will provide the way of escape also so that you will be able to endure it.” And I open that with her, and what I’m trying to do is I’m trying to remind her of some really important truths for her soul, such as God assuring us that she especially is not the first woman to face a trial like this. You know, postpartum depression is not unique to her. It’s actually more common than she thinks. It’s also not even unique, and she is definitely not alone. So we’ll talk a lot about that, even if I haven’t experienced that myself, I am a woman and I have had children, you know, there’s a lot of other experiences where I can definitely and even a sister in Christ assure her that she is not alone in this, and it’s not unique to her, but others have come through it well, testimonies of others and that’s important even because again, they will often feel isolated and alone.

And I also think it’s important to share that God is promising really to suit her trial because I do look at postpartum is just a trial that somebody’s experiencing a trial of suffering to what she can bear or maybe just even her capacity to handle, you know. Sometimes they feel like I just can’t handle this or just the assurance that God is going to bring her out of this trial and it may not be in her timing, but it will be in His time and in His way, and she is going to actually reap the benefits of what God will do through her as she kind of walks through the trial. So I am just really trying to encourage them and hoping that they’ll understand that truth rightly and really just I think rightly believe God and His promises from His word and that will give people hope.

Now that’s just basic, but as you kind of continue to meet with someone, some really important truths that will also give hope and a person’s time of need, especially here is probably centering your hope and your counsel of hope in Scripture that has to do with God’s character. And one of the characters of God that’s been super helpful is just thinking through the fact that God is accessible and He is near to all who call upon Him and you’ve got so many wonderful truths you could open up to center her thoughts on. Like maybe Psalm 145:18 or perhaps Hebrews 4:14-16 or another one that’s just timeless is just remembering that our God is tireless. Now she might be exhausted and losing it, but our God is not that way. He is tireless, and He’s the one that’s going to sustain her and just keep her feet from stumbling or heart from failing, and I’m thinking of maybe Psalm 41:2 or something that Isaiah talks about in chapter 40:28-29, but I’m thinking through the character of God because I know that usually when a person’s pretty low that’s deficient. That’s really key. And then I’m also emphasizing just gospel truths because that can bring so much hope to a person in their time of need. So, you know, I think through that pretty carefully based on what she’s telling me. 

Dale Johnson: I love the way that you’re helping her gaze to go in the proper direction towards the Lord, toward His promises, toward His character. I think that’s critical. One of the things that you mentioned that I think is really critical is just permission to allow her to sleep. She’s not God. God is tireless. The Bible describes Him as singing over us at night. He doesn’t need to sleep. He’s very different than us, but we need it. That’s why He created the dark, and that’s a good thing. So then even encouraging her. That may lead us into talking about how do we cultivate care for her. I think that’s critical for us to contemplate, how we do that in a way that’s helpful to her, that’s beneficial to her, you know, in this pretty difficult desperate time?

Shelbi Cullen: So you know, when you’re coming alongside a person, you’re not just taking them to the Scriptures. I mean, that’s going to be super important, but we’re all part of just the body of Christ, and there’s going to be some real practical ways that we can care for a person, but I think just in terms of just step one. I mean, just the willingness to impart your life to her that actually just is so beneficial and it speaks volumes just her knowing that you care at all and that you’re even willing to step in and help her. That just takes a load off. I mean, even like what you were saying, even having a conversation that I’m coming over because I care about you, so I can hold the baby while you’re sleeping. It’s okay, it’s okay, It’ll be fine.

Acknowledging that she’s a sufferer is important. You know, postpartum depression can be very difficult, and there really is a physiological component to it. And although I wouldn’t advocate and say that her body is causing her to sin or a thing like that but sympathizing with what she’s experiencing does show that you care because she is suffering. I think listening is a very important one. That is one way to cultivate care for a person. You don’t want to presume upon a person. You don’t want to give foolish counsel. You actually want to move towards her. You want to share in her struggles. You want to give wise counsel based on what she’s actually telling you. Prayer is very, very, very hear me again, very important. So many times you’re holding her hand, you’re praying with her, you’re weeping with her, that’s just prayer is just huge. But even on the more practical side, I know how helpful it is to get other women in the body involved in creating like a meal. I forget what we call it exactly but we provide meals for women, you sign up, you’re involved in her life. You’re bringing a meal that takes such pressure off. You’re offering to come and help with the baby so she can rest, just like you mentioned. We’re offering to come and even do chores. That’s super helpful. Even offering to, you know, you’re at the grocery store is something that most of us are just involved in doing anyway, and you know, texting her, is there something I can pick up for you, something I can drop off? That would be helpful to her. But overall, really, you’re just trying to make sure she knows that you’re there for her, that she doesn’t have to go through this trial alone, and ultimately God cared about her, right? Because we’re just His hands and feet, and He’s the one that cares for her. And the body of Christ, when they come alongside and help, we’re just that tangible means of grace, really. But He is the ultimate One that cares about her, and she can cast her anxiety upon Him in the end. 

Dale Johnson: Well, I want to move to talking about the biblical counsel that we would give, but I don’t want to miss what we just talked about that’s so important that I think bolsters the biblical counsel that we would give to someone is you’re talking about weaving in and meshing your life into the life of this lady and caring for her genuinely. So you’re not only going to give her biblical counsel, but you’re going to try and demonstrate what the care of Christ looks like in her life. And I think that’s a very tangible thing and a very useful, helpful way to think about how biblical counseling thrives the best. But we do have to give some counsel here. So what’s some of the biblical counsel that you might give to someone in a situation? 

Shelbi Cullen: Yeah, thank you. You know, I think it depends on what she’s actually sharing with me. That, of course, comes through all of the difficult, the many questions that you asked, but primarily because she’s often battling her thought life, my counsel will be to kind of dig into that pretty deeply. And this is just an example. I don’t want to make it sound like this is a blanket statement, but these are just some common thoughts that I’ve come across when I’m dealing with someone that suffering in this way.

But one big one is, they’ll often think, you know that I’m alone and that no one understands me whatsoever. And so I’m going to concentrate when I hear her thinking like that because your beliefs are part of your inner man, your thinking. When I hear a person say that, I’m thinking, okay, we need to concentrate on her view of God here. And just desire on my part just to help her to see that, you know, according to God’s Word, He will never leave her nor forsake her because she’s one of His, and He Himself is going to be her helper. So we might concentrate a little bit on that. She doesn’t need to be afraid, you know, Scripture is very clear, and it doesn’t just say that in Hebrews 13:5 that’s actually in many, many, many places in Scripture, but that’s a good start. You know. It’s going to be an important to Scripture for someone like her who’s thinking like that. She needs to learn to hold her thoughts captive to the obedience of Christ in that sense.

Another one that’s just going to be calm, and you can imagine why a woman would think this is going through this, but she is thinking to herself, often: this is forever. “I just can’t do this anymore. I can’t endure this anymore. When is this going to end?” And you know, I’m thinking okay, based on that, she needs a lot of encouragement. I’ve got to come alongside. I’ve got to encourage her with counsel that, you know, she is going through something really hard, but really it’s just going to be for a season, and my God will give her the strength to persevere. So, I might follow up with 1 Peter 5:10, which is just an amazing verse because Peter is writing to suffering believers anyway. He says and “After you’ve suffered for a little while, the God of all Grace who called you to his eternal glory in Christ, will himself restore, strength, and confirm, and ground you.” I mean, how incredible is that? And so, the Scripture, which is sufficient for everything we need for life and godliness, is just full of counsel that we can give to someone like her. We don’t need to be afraid to counsel a woman like this. We have everything we need to help her, but I think the key is listening well, asking good questions, trying to really dig in deep, and understand how she’s thinking, that’s been really key. And that I think will guide you to where you need to counsel her in the Scriptures. 

Dale Johnson: Well, in any time that we struggle in this type of way, you know, in for ladies just can be in postpartum, but we encounter as human beings, we encounter points where our finiteness and our inability and our limits are exposed. And I think this is one of those places where our human weakness it’s demonstrated and all the things we wish we could do maybe we can’t accomplish all those things in the way that we wish. And there’s no shame in that. I think it’s important for us to embrace our weaknesses in moments like that so that we can see the glory and the power of Christ. So, let’s bring out of that biblical counsel and talk about some of the heart themes that you see that are fairly consistent or that we need to be aware of as counselors when engaging postpartum.

Shelbi Cullen: Yes, we always want to get to the heart of the matter. Of course, we want to be aware of that and there are some common things that I have seen and, you know, I don’t want to sound like everybody’s the same and we have this sort of one-size-fits-all counsel, but there are some common heart themes that I’ve run across that you’ll run across when you ask great questions. One of the heart things I’ve come across is just this idea of wanting to be in control, and this is where she is struggling with the attitude that she doesn’t even need anyone to help her. And I think that probably what’s happened there, and you had mentioned social media a bit ago. But I think that prior to the birth of the baby, it’s possible that she’s influenced by something on social media with what it looks like to be a mom or the standard she’s created in her mind of what a biblical mom is, something like that. Some kind of expectation, and ultimately that’s what she’s worshipping, you know, just imagine that’s where you’re at, and then this happens to you, and this thing that’s happening to her is completely out of her control, completely, she didn’t ask for it, she didn’t bring it on herself. This is just something that’s happening to her. And so that desire to be in control that is really something they’re fighting as well as a heart theme of perfectionism, which I think is kind of tied into control, quite frankly. But again, you know, here is a mom that just kind of maybe had all of her ducks in a row. She just kind of had this vision, this idea about what motherhood is going to look like, and then suddenly, this happens to her. She’s not able to live up to a standard of motherhood that she’s created in her mind that often times to be quite honest isn’t even biblical right?

Perfectionism, you know, being similar to control, I think that’s going to be something to look out for. But part of the counsel for either thing is really just going to be to put off this desire to be perfect or to be in control. And I’ve been trying to counsel my ladies to think more about being faithful. I know Jesus says that you’re to be perfect as our heavenly Father is perfect, but I think He said that because that drives us to Him. but the call for the Christian is each day to be faithful with what God has given us. So, that’s the counsel that I usually get when I’m hearing things like that. But overall just trying to help to nurture a dependence upon the Lord during their time of trial so that in her sadness she will turn from herself, the self-focus that she has and she’ll turn to our Triune God for help.

Dale Johnson: Shelbi, this is so great. Thank you for the conversation and so many more things that we could dive into here but a lot of things to flesh out. Thank you for being here on the podcast. I do want to mention that Shelbi wrote a booklet, a biblical solution series booklet on “Postpartum Depression: Stopping the Spiral with His Sufficient Word,” and Shelbi, I want to commend you. This is one of the most popular booklets that we have. So, this is a topic that people want to know about and how to address this from a biblical perspective. I think the things that you’ve mentioned here and the things that you flesh out further in the booklet are going to be helpful for any of our listeners. So, I commend that to you and Shelbi; well done.

Shelbi Cullen: Thank you so much.

Helpful Resources:

Click here to find Dr. Cullen’s booklet on post-partum depression.