Ep. 55 – Dr. Shahana Alibhai – Perinatal OCD: One Physicians Journey

Rachel Cram – Oh, well good morning.

Dr. Shahana Alibhai – Good morning.

Rachel Cram – Shahana, it’s good to be with you. I listened through your TED talk again this morning on my morning run and so I’m so excited to talk to you.

Dr. Shahana Alibhai – Oh, thank you.

Rachel Cram – This is going to be fun and interesting.

Dr. Shahana Alibhai – Exactly. I’m so happy to be here.

Rachel Cram – Yeah, I’m glad for that. Over the last months, perinatal and postpartum care is a topic we’ve wanted to explore and we’ve wanted to do that with a specialist who can speak both through theory and practice. So, thank you for stepping into this conversation with me today because I know it requires you to share professionally and personally, which can be a tricky mix sometimes.

Dr. Shahana Alibhai – Yeah, definitely, definitely.

Rachel Cram – Well, one of our missions for Family 360 is to shine light on specialists and artists and storytellers who are in the community, helping to connect people and to connect relationships. We’re approaching this conversation more as a storytelling episode, I think?

Dr. Shahana Alibhai – Yep, perfect.

Rachel Cram – But of course you are also a specialist, and you’ll bring that voice into the conversation as well, and you do much of your work at a clinic called the Foundry, right? Is that the right name?

Dr. Shahana Alibhai – That’s correct. Yeah.

Rachel Cram – And that’s mainly focusing on youth care.

Dr. Shahana Alibhai – Exactly. So the foundry is really a one stop shop where someone between the ages of 12 and 24 can go see a doctor, see a counselor, meet with the social worker, get help with their job application. If you think about adolescents, access is a huge, huge problem. And especially if there is parental conflict or discord, if this is something that they don’t want to be sharing with their parents, but yet they need medical help. Where are they going to turn? So I feel so privileged to work in a multi collaborative environment like that and to be a lead physician there.

Rachel Cram – In reading your work and listening to your TEDx talk, I know a lot of the concerns that come in have to do with mental health, and we’re going to get into that in a few moments. But before we go there, I would love to ask you a question that I often start with in our interviews, and I know I give you a little bit of head’s up on this. So, Shahana, Aristotle stated, “Give me a child at seven and I will show you the adult.” And I’m wondering, is there a story or experience from your childhood that you see as formative into the person that you are today?

Dr. Shahana Alibhai – I’m glad we had a chance to discuss this question prior to you asking me, so I appreciate the heads up. It’s a challenging question because I think that it’s easy to gloss over our childhood with big adjectives. It was good. It was bad. It was OK. And I think if I had to put my childhood with an adjective, it would be really good. However, I think context is everything. So it’s important to understand my story, that you understand where my parents came from and they were thrown out of Uganda by Idi Amin, the dictator at that time. And any South Asians, anybody who had brown skin for that matter, had to leave.

So my parents were very young at this time, and there were atrocities going on. There was absolute mayhem. Basically a big population had to leave with very little notice and only one suitcase.

My mum and her family got to be on the first plane out of there. They didn’t know where they were going and it ended up being Vancouver. And all they had heard about Canada was that it was really cold. Really cold.

So, my mom used to play on the equator line, like hop back and forth over the equator line because that’s where they were. She said that when they arrived, all they were met with was such welcoming people. The Red Cross cooked them Indian food on their first day here, gave them really warm jackets because all they had were shorts and T-shirts, and thus began their journey in Canada. And my mom on her first day here got a job for three dollars an hour as a waitress.

My dad had a very similar kind of story. And we have to think, you know, are we in debt to Canada? Absolutely. Although my parents never made us feel guilty about it, they certainly reminded us about how lucky we were to have been born here and to start a new life here.

So I think part of that, not that they put pressure on me, but I inherently put pressure on myself to not devalue this incredible opportunity and the sacrifice that they went through involuntarily because of the color of their skin. So those kind of themes were all very predominant for me at a young age.

Rachel Cram – I’m so glad your Mom and Dad were met by welcoming Canadians. What a horrible experience for them in their young lives! When I hear stories like this I usually think about the parents, navigating their families through such chaos and upset. It’s amazing. We have remarkable people to learn from in our country!

Dr. Shahana Alibhai – Oh, absolutely.

Rachel Cram – Well, your recent Tedx, is called Emotional Literacy For Better Mental Health.
And in your presentation, you talk about your struggles with perinatal OCD. I realize this is still quite a fresh story, so I thank you for being willing to talk about it with me today.

Dr. Shahana Alibhai – Yeah, sure. So I’ve done this quite a bit in talking about mental health, but I’ve never been as vulnerable as I’m about to be, so.

Rachel Cram – Well, thank you.

Dr. Shahana Alibhai – Sorry if I pause because it is still really hard to talk about. And I always ask youth who are half my age to sit in front of me and in 10 or 15 minutes, just tell me their story. But until I had to do it, I didn’t realize how difficult that was.

Rachel Cram – That’s an interesting perspective. Vulnerability feels different when you’re the vulnerable one.

Dr. Shahana Alibhai – So although I say I had postpartum OCD after the birth of my first son, I actually had OCD since the age of four. The only person that knew were my parents and they didn’t know that that’s what it was called. And my mum is still my rock. She did the best she could at the time and allowed me to talk to her, counseled me in her own way.

Rachel Cram – What could you tell her at the age of four?

Dr. Shahana Alibhai – So all I knew at that point was that I was getting what is called intrusive thoughts. So thoughts that were really disturbing to me. They caused a lot of anxiety, stress, fear. You do not want to have these thoughts.

Rachel Cram -What do they sound like?

Dr. Shahana Alibhai – So, for example, this might have been when I was six, and I might have heard a curse word somewhere, not in my house, but somewhere outside on the playground, and I knew that that was a bad word. But this is part of my temperament that everything had to be so black and white. Everything had to be so perfect, and any discretion from that was a mark against me. So in my brain, it might have been saying that swear word over and over, knowing that it wasn’t the right thing to do and then beating yourself up about it, but feeling like you couldn’t control it. It’s any thought that you don’t want to have, but you continue to have. And it’s that those two things are working in opposition to each other.

Rachel Cram – So are the type of intrusive thoughts that you have with OCD, sensitized by a person’s age or experiences?

Dr. Shahana Alibhai – So typically the types of intrusive thoughts mirror the age that you’re with. So as a young child, it might be something simple as a curse word, knowing that that’s a bad or naughty thing to do. And as you grow older, it might be in a religious connotation, if you hold that very strongly. It’s any strong belief that you might have, the counter to that is where the intrusive thoughts would come. And you can imagine if you are very religious, for example, and you were having an unwanted religious thought, that would be very anxiety provoking for you. If you weren’t, that wouldn’t be.

Rachel Cram – So when you say, “An unwanted religious thought,” it’s something that creates dissonance because it goes against your particular beliefs?

Dr. Shahana Alibahi – That’s correct, yeah. So it all depends on where your value system is at.

Rachel Cram – So when the term is obsessive compulsive disorder, is that reoccurring thought the obsession? OK, you’re nodding. And then what would be the compulsion part of that?

Dr. Shahana Alibhai – So OCD is a branch of anxiety. The reason that OCD can be very well-recognized is the compulsions, because there’s a lot of checking behavior that goes along in OCD and a lot of behavior directed towards contamination, like washing, that kind of thing.

The reason that mine was hidden is that there is a subtype of OCD, which is a much smaller percent, which you only have the intrusive thoughts, you do not have any of the compulsions. That’s why nobody noticed it for me. It was only going on inside.

So, this would come and go and rear its ugly head, and I would just do my best to ignore, suppress, distract, all the things that you know you try to do when you don’t understand what’s going on.

Rachel Cram – This is so interesting Shahana. I didn’t know your OCD story was going back into your childhood, I thought OCD started for you when you were pregnant, so now all these unanticipated questions are coming into my mind.

I’m putting myself into your mom’s shoes and thinking, I think I would be tempted to assure you that these kinds of thoughts were not unusual.

Dr. Shahana Alibhai – And my mum said exactly that. You’re absolutely right. She tried to do the first thing many parents will do is normalize. But the distress that these thoughts cause you is, its debilitating. And it makes you feel like you don’t want to be here anymore. So it’s to that degree. So it’s very difficult to normalize them. Although, I’m glad you brought that up.

There is a high degree of people who experience this. The intrusive thoughts are not what is diagnosable. What’s diagnosable is the distress caused by them. Because for most people, they can have the thought, it comes, it goes, they’re on with the rest of their day. It wasn’t until I was sitting in a psychiatry lecture in medical school, twenty some odd years later, that a slide flashed before us and it was subtypes of anxiety, social anxiety, panic disorder, OCD. And under OCD, there was a tiny bullet that said pure OCD, only intrusive thoughts. And I sat there and my heart literally must have stopped. I ran home. I called my fiancee, my now husband at the time, who knew a little bit, but it’s really hard to understand what somebody is going through when they can’t even articulate it well. And I said, “This is it. This is what I have. It has a name. I’m not crazy.”

So, at that point, I knew what it was. I had the power of a diagnosis. But medical school was a lovely Band-Aid for all of that because it kept my brain so occupied, so busy, so focused, that I didn’t have a moment to stop and think about what else was going on.

Rachel Cram – If you have a compulsive thought, then that keeps coming to your head and you know, then OK, this is normal. This happens to people. Can that be the end of itself then, or does there need to be more?

Dr. Shahana Alibhai – Yes, so it’s like having a bee sting; normalizing, it does take the sting away. It would take it away by about 30 to 50 percent. And I think even having a label, knowing that you fit within this box, that your brain is not doing all these crazy things. It actually has been shown on functional MRI’s that people with pure OCD have a loop that is slightly different than other people. So just knowing all of that and knowing this is not a ‘you thing’, it’s your ‘brain thing,’ helps to externalize it. Because where people with OCD trip up a lot is the guilt associated with that.

Rachel Cram – So, there’s guilt because the person with OCD is thinking that their intrusive thoughts are the result of lack of effort or their capacity, rather than how their brain is just wired to work.

Dr. Shahana Alibhai – And that’s exactly right. So, I would never criticize somebody with diabetes and say, What’s wrong with your pancreas? I’d never do that to them.

Rachel Cram – So why do that to yourself?

Dr. Shahana Alibhai – Exactly. So it does take the sting away.

Rachel Cram – OK, so interesting. OK, so I know we’ll hear more about this so keep going. So, you were in medical school and you realized that this does have a normalcy to it, but you hadn’t really had time to think about it. Is that what you’re saying?

Dr. Shahana Alibhai – That’s absolutely right. And I’ll be honest, part of medical school, of course, in residency is doing psychiatry rotations and I contemplated a career in psychiatry. But I would actively turn down or try to select a patient that did not have OCD because it was too triggering for me. I would happily see a bipolar patient or a depressed patient or a schizophrenic patient, all completely fine. But if I ever got handed a file that had OCD on it, I would immediately get triggered because it was too close.

Rachel Cram – What were you worried would happen when you talked to them?

Dr. Shahana Alibhai – That my symptoms would get worse and that I could become like them.

Rachel Cram – Oh, OK. Hmm. Would that have been possible?

Dr. Shahana Alibhai – It could have been because I. Oh. Because even though I knew what it was, I didn’t want to believe it. I wanted to keep it to myself. I couldn’t. I would have to see that other person as real and human, which would mean that I was real and human and that I was subjected to possibly a fate like theirs, i.e. a worsening mental health.

It just became too close, too real. My identity was not somebody with a mental health disorder. My identity was a doctor. There was a lot of significance behind that identity. There was a lot of power behind that identity. There was a lot of image behind that identity, and I couldn’t let myself down if I admitted that I had something wrong with my mental health.

Rachel Cram – You felt your role required you to be without needs, without weakness?

Dr. Shahana Alibahi – Exactly

Rachel Cram – I can see that feeling very lonely and isolating.

Dr. Shahana Alibhai – Yes, I think this is why the rates of depression, anxiety and even suicidality is so high in medical school. The barrier to get help is high because you’re the one who’s supposed to be treating other people. You can’t be down, right?

Rachel Cram – Yeah, well, you can’t be “down” if you feel that people who are meant to be ‘responsible’ can’t also be people who might have mental health struggles, right?

Dr. Shahana Alibhai – Well said, Yes.

Rachel Cram – So for whatever number of reasons, you didn’t see that those two realities could be congruent?

Dr. Shahana Alibhai – No, I think I wish. I think that would have saved part of my life if I knew that.

Musical Interlude #1

Rachel Cram – I can understand how this would be the case for physicians and, of course, it’s broader than that right. This isn’t isolated just to professionals. And I also see this for parents, when we are the ones who are supposed to be large and incharge. We need to ‘be that’ for our families. And so when we struggle as parents even, it’s hard to take the time and care to find our needs or, even as I know you’re about to discuss, to find our diagnosis.

Dr. Shahana Alibhai – For sure, and I’m glad you brought that up because for me ironically, all I ever talked about in medicine was being a mum. If anybody asks me what I really wanted to do, it was ‘I wanted to be a mum.’

And now looking back, somewhere along the way I developed this image of motherhood as, ‘You just strap on your apron, you bake some cookies, you relax with your kids at home,’ and I’m like, “I want some of that. That sounds really good.”

So fast forward to the end of my residency, I was married by then and I was expecting. And I thought, “Perfect, this is my ticket to time off. I will finally get to breathe. I will finally get to take a mat leave.” When you tell someone you’re having a baby, well, that sounds productive, doesn’t it?

Rachel Cram – So do you think you were feeling that you had to earn your way to rest?

Dr. Shahana Alibhai – Absolutely. I wanted permission to pause. But I thought.

Rachel Cram – You thought that having a baby would.

Dr. Shahana Alibhai – I thought that having…exactly. And you know what? And it sounds. It sounds funny. And yes, I wanted to be a great Mom and yes I wanted to have a baby. But I put so much weight in that, “I’m going to be the perfect mum.” I had binders, colour coded, because if I prepare for it, then I won’t have to feel it. Because you can’t study for motherhood, you can’t study your way out of this.

Rachel Cram – That is such an interesting line. “If I prepare for it, then I won’t have to feel it.” What scared you about feeling it? About ‘feeling’ motherhood.

Dr. Shahana Alibhai – Unpredictability.

Rachel Cram – Oh, okay. Unpredictability.

Dr. Shahana Alibhai – I wanted everything to be predictable. Because, it’s like a river bank. Some of us, when we feel out of control, move towards more chaos. That’s one side of the river, right? The other side of the river is rigidity, control. We all have a bank of the river that we flow to. I know many people who the more chaotic life becomes, they just start to let things go, they just kind of let loose.

Me, even my husband, we’re we’re rigid. We’re we’re planners. We feel like if we just textbook our way through this, it should all be fine. And it was the biggest slap in our face.

Rachel Cram – Your plans didn’t give way to that predictability?

Dr. Shanaha Alibhai – No. So I had this plan in my head that I’ll have a vaginal delivery. I won’t give formula, god forbid. And we won’t give a pacifier. No way. Within the first 72 hours, it was an emergency C-section. He wasn’t gaining weight. And the nurse stuck a soother in him because he just would not sleep.

Postpartum is the perfect breeding ground for anything that you haven’t dealt with to grow like an infection. And for me, what hadn’t I dealt with? I had stuffed that OCD down so deep and I thought, “OK, it’s down. It’s locked. I’ve thrown away the key. We’re good.” Bring on postpartum. And by the time he was about two to three months, that’s when I hit rock bottom.

Rachel Cram – You use the word uncertainty, and I think that having a child is a storm of uncertainty. Even if everything goes right, like, even if you’d had the vaginal birth and you hadn’t had to use formula. Everything becomes so chaotic, even if you’ve prepared so much. I think as you describe this, I think a lot of our listeners and I certainly feel this Shahana listening to myself. You think that you can be prepared for having a child, but you really can’t. You’re really fooling yourself because it’s so much more beautiful than you can ever anticipate. And it’s so much more difficult than you can ever anticipate. And I didn’t want to interrupt your story, but I feel like, even without a mental health diagnosis, you’re describing something that most parents can relate to. You’re not prepared for how uncertain it becomes.

Dr. Shahana Alibhai – Because suddenly there’s this new life, right, there’s this new thing that you’re supposed to be caring for, and the stakes are higher, the beauty is higher, the sleep deprivation is higher. It’s all of that, right? Everything is on as if you’ve turned up a light to its brightest intensity. Everything is so much more at its peak.

Rachel Cram – Well, and your hormones are going wild, your milk’s coming in. Your body is not your own anymore.

Dr. Shahana Alibhai – Exactly. Exactly, right? So you just, you do what you have to do.

But things started to take a really scary turn when he was about two to three months old, the OCD came back and it came back with a vengeance. And for women who have never had OCD, it’s a very common time for them to start developing OCD in postpartum. But for those who have had a history, about 75 percent will have a worsening or a relapse.

Rachel Cram – And did you recognize it as your OCD right away?

Dr. Shahana Alibhai – I did. I did. I could recognize it for what it was. But
just because I did it wasn’t like I was about to share it with anybody. So I did what I thought had worked for me in medical school. I tried to exercise my way out of it. I tried to nutrition my way out of it, which means, you know, drinking fish oil and supplements and doing all the things, and that didn’t work very well. I tried to meditate my way out of it, and there is a time when all of those things I just said are fantastic adjuncts. They can be wind in your sails but you need to first get off the ground. My parachute had punctures in it. I was laying flat on the ground. No amount of the adjunctive stuff was going to get me off the ground.

Musical Interlude #2

Rachel Cram – I wonder, those things, those wellness practices can almost backfire on you with OCD I think because you think it’s a control thing again, right? Like it can become a control of thinking, “I can do this, I can exercise, I can be mindful, I can eat well.”

Dr. Shahana Alibhai – So, so well said because OCD and eating disorders often go hand in hand. It’s not about the food and it’s not about the intrusive thoughts, it’s about the control. Right. That’s what those two things have in common.

So you’re right, it could be a very slippery slope. Telling somebody with OCD to do more of that can actually be detrimental too.

Rachel Cram – Oh, so tricky

Dr. Shahana Alibhai – Yeah. And I do want to stop and say that the hard thing and the hard thing is. “Oh, what is OCD look like in postpartum?” Because I still at that point didn’t know that there was a postpartum version of OCD or that it could get worse in the postpartum period.

Rachel Cram – When you say that it got worse, was it the intensity of the thoughts you were having that got worse, or the subject of the thoughts?

Dr. Shahana Alibhai – So I still felt very alone in the types of thoughts I was having. And a lot of the times the thoughts were related to ‘Could I ever harm my child?’

Rachel Cram – That would be very distressing. To have thoughts like that ruminating in your mind on top of all the other confusion of being a new parent.

Dr. Shahana Alibhai – Yeah. They are so distressing. They are so devastating to a mom, a dad. Seventy percent of new parents will have thoughts like this. And the only reason I bring this up is that somewhere your listener, might be pregnant, might know somebody who was pregnant, might know someone who’s postpartum. Don’t let them go without having the safe space to tell someone these thoughts.

Rachel Cram – Can you give an example of how someone, even you as a physician, would you start a conversation like that?

Dr. Shahana Alibhai – Yeah, sure. So in my experience, no postpartum woman is going to voluntarily tell you that they’re having these thoughts. So as a physician, what I’ve started to do now, is just screened for it. So ask them, saying, “It’s very normal in the postpartum period to have thoughts that you might cause harm that you do not want to cause to your child. Have you ever had a thought like that?”

So if you were a close family member, a spouse and you see your partner or close family friend or a member suffering with anxiety or depression, you can gently ask them a question like that.

Rachel Cram – Well, I think so many times in our life we can feel so alone because we think no one else can relate to what we’re going through. And that’s a really hard place to be at, especially when you’re at a pivotal point in your life, of something like having just given birth to a child. Very difficult.

Dr. Shahana Alibhai – And, when you’ve held it to such high esteem, when you’ve set the expectation that you, in your mind are going to be the best mother, you know, because I think I was telling this to someone the other day, let let’s be honest, nobody wants to fail at motherhood. Like, we all have this instinct that we want to be a good parent. Part of the reason is that you think that there’s something primal and instinctual, that will take over. But sometimes that’s a little bit delayed, right? Cause, sometimes the baby is delivered, but your identity as ‘Shahana the mom’ takes a little bit of a time to catch up right? And that’s ok.

Rachel Cram – Yeah, of course it does. Yeah.

Dr. Shahana Alibhai – Right? But we put so much pressure on ourselves to just get it all right the first time. We should do this, we should do that, we should be parenting. And I had a counselor once tell me, she’s like, “Shahana, you’re shoulding all over yourself, right?” And that’s a great expression for people. Catch yourself with the shoulds.

Rachel Cram – For a parent listening, when do intrusive thoughts become OCD?

Dr. Shahana Alibhai – It is when A) you start to avoid things because of the intrusive thoughts. You start to avoid carrying the baby, bathing the baby, spending alone time with the baby. B) You need somebody to always be with you because you are afraid that you might act out. C) You start taking behaviors in terms of mitigating the risk; hiding things around the house, getting rid of the knives, things like that. So you’re actually so scared that you’re taking all of these actions to stop yourself because it is causing you so much distress. So it’s the behaviors around that that is the key?

Rachel Cram – So is that the compulsion? Are those behaviors the ‘compulsion’?

Dr. Shahana Alibhai – No, not necessarily. So with postpartum OCD, covert compulsions are much more common than compulsions that you see. So if you were to have a compulsion, it might look like “I need to wash my hands 10 times and then my baby’s going to be safe.” Those types of compulsions aren’t as common. You might see some religious compulsions. “I have to pray for this long in order to keep my baby safe.” That might be something like that that you might see. They might even have symmetrical compulsions. If I organize my bed this way or if my sheets are folded this way, that symmetry, if it’s done like this, then my baby will be OK. Like, those are some types of things that people might see. But once again, postpartum OCD is more intrusive thoughts than it is actually the compulsions. The behaviors, though, can be a giveaway as to how are they trying to protect the child because they are so scared.

Rachel Cram – So, postpartum OCD is more about being distressed by intrusive thoughts than it is the compulsive behaviors. So, the distress is kind of like the compulsion?

Dr. Shahana Alibhai – Exactly, yup.

Rachel Cram – If a parent finds themself in that situation, what’s one of the first steps that they can do to address it?

Dr. Shahana Alibhai – So this is one of those things, and I’m glad we brought that kind of checklist up before, is that, yes, the thoughts are normal, but if you’re starting to have a change in your behavior, you need to speak with a healthcare professional. You need to find a counselor who is specialized in OCD.

Rachel Cram – I think many of us are familiar with postnatal depression, but postnatal OCD is a newer term. Do they fall under the same umbrella for counselling?

Dr. Shahana Alibhai – Well, OCD and depression can start to look very similar. But realizing with OCD that it’s fear that I could do something to harm my child, whereas with depression, it could be that my child will never love me. I will never be a good enough mother. See, those are two types of intrusive thoughts. One is OCD. One is depression. But they commonly coexist.

So when I went in for therapy, the CBT part, the ‘cognitive behavioral therapy’ part can help with some of the anxiety you might have just around being a mum and not feeling good enough. That works wonderfully, but you have to see somebody specialized for the OCD. I didn’t know that until I went through this journey. So you can find those practitioners and then it’s a very good idea to see your family doctor because a referral to reproductive psychiatry is the way to go. These are psychiatrists who are trained in the perinatal period before, during and after pregnancy.

Rachel Cram -Yeah, it’s finding the time and space to do that though. In the months after I had my first child, I remember waking up in the morning thinking, my goal for today is I got to cut my finger and toenails and I get to the end of the day and be like, “Darn, I never got to doing that,” because you’re just so consumed.

So when you add on, now go find a therapist and go for therapy, I can see myself being tempted to think, “I don’t have time to do this, so I’m just going to hope that I’m going to grow my way out of this, that it’s just going to go away over time.”

How likely is that to happen if you leave it?

Dr. Shahana Alibhai – Very unlikely. You have more of a chance of it going away if you didn’t have a diagnosis of OCD coming into it. However, if you had a diagnosis of any mental health condition going into the perinatal period, the chance that things are going to improve or get better in such a stressful time period is slim to none.

But I did exactly what you said. Here I am. I have the training. I’m talking to other people actively, but yet I ignored it. I thought it would just vanish and fly away, and everything would be well.

It wasn’t until the point that I was actively feeling that it would be better off, that I wouldn’t be here anymore, that I realized that that is the same conversation I have with my youth when they come in to see me for suicidality.

And if that is a feeling that brings me ease versus distress, that is a problem. So it took to that degree of despair. And still, I didn’t see my family doctor because I was too proud, because I was too scared. I called an anonymous physician helpline; anonymous being the key word because I didn’t want to share anything about myself. So I remember I told the counselor on the other end my full story. And they said, “OK, thank you for sharing. You know that you’re going to need to start some medication and you know you’re going to need to see a psychiatrist.”

And I said, “No, I feel so much better. Thank you so much. I think this session has been great. I feel much, much better.”

Rachel Cram – And what did they say to that?

Dr. Shahana Alibhai – They just laughed because of course, they knew that I’m obviously not thinking straight, but they they worked with me and we took it slowly, very slowly, and I did everything that they talked about.

Rachel Cram – What did that include?

Dr. Shahana Alibhai – So medication was a huge piece for me, even though that’s taken me a long time to admit, but it saved my relationship with my kids. It allowed me to become a mom, a second and a third time. And it allowed me to have a better quality of life.

Rachel Cram – Medication is such a hot topic, when to take, what to take, even thinking in the case of somebody who’s just had a baby, can you still nurse when you’re on medication?

Dr. Shahana Alibhai – Excellent question. And because it is such a common issue nowadays of postpartum perinatal mood disorders, they are now finding the untreated mental health consequences are higher than the medication side effects.
So, for example, if you’re having a woman who has high degrees of perinatal anxiety, anxiety while the baby’s in the womb, that can actually cause a higher risk of things like ADHD. So we can’t underestimate the consequences of untreated mental health on the child and on the mom baby diad.

Rachel Cram – So for the sake of the baby’s health, it’s worth the risk of the medication is what you’re saying.

Dr. Shahana Alibhai – Exactly, yeah, and they are much safer medications that don’t get transmitted at all into the breastmilk.

Rachel Cram – That is so interesting. We’ve brought in dads a few times, could dads experience this as well, this postpartum depression, or postpartum OCD? How common is that?

Dr. Shahana Alibhai – It’s actually extremely common, but we don’t have accurate numbers because the rates of reporting are so low. But we know even anecdotally that these fathers are suffering. But yet a lot of the attention, rightfully so, is given to the mothers. But if you think about it, the same kind of life disruption, the same kind of sleep deprivation, the same kind of uncertainty is all going on in the male’s side of things too. And the male brain has shown changes in testosterone when a baby cries. So if we can see hormonal changes when an infant or baby cries, we know that there is a first degree link between what that postpartum period entails and the male side of things and the biological side of things. So there definitely is a link. But once again, I think it’s important for family doctors to ask a new dad, “How are you feeling? Tell me more.”

If we’re the ones normalizing it and asking the questions, it makes it that much easier for them.

Rachel Cram – Yeah, as I’m hearing you say that, I’m just thinking, it’s so challenging because we go into having children with such anticipation, and it’s often an incredibly difficult time in your relationship as a couple and these anxieties complicate it even further.

Dr. Shahana Alibhai – Exactly. My husband and I use the analogy of an emotional backpack. You’re coming into your relationship, with all of your experiences and all of this stuff that you bring into the relationship, and suddenly you’re now supposed to intermingle this and you’re supposed to grow, hopefully at the same time when the growth is needed. That’s very difficult to do.

So if you don’t take ownership of what you come into the relationship with, it’s really hard then to add a third player to your team and expect to co-parent in the same way.

Rachel Cram – And then many of us add fourth and fifth players to our family team with more children. Even more tricky.

Musical Interlude #3

Thanks for listening to family360 and our conversation with Dr. Shahana Alibhai.

Our next episode is the first of our third season of family360 and to kick us off, we are doing something a little different.

I’m stepping out of the production room to interview Rachel on a topic she knows and loves, Social Development.

Yes, how we grow our capacity for relationships in our children and in ourselves.

Join us for episode 56, and the beginning of a new year and a new season together on family360!

Yay!!

And now back to our conversation with Shahana as she offers practices for activating our parasympathetic nervous system so that we can rest, digest and come at our days more calmly.

Rachel Cram – So, Shahana, to continue with your backpack analogy, and also, as we start to head toward a wrap up to our conversation, I’m wondering if we can create a kind of call to action kind of ending based on what you’ve discovered and what you know from your work at the Foundry?

Dr. Shahana Alibhai – Ok.

Rachel Cram – So, when our emotions or thoughts are overflowing that backpack, and it may be because of an undiagnosed disorder, or it may be because life can just be really overwhelming and challenging sometimes, can you give a few suggestions for taking ownership of our backpack?

Dr. Shahana Alibhai – Yeah, perfect. So there’s a couple of things, so I can break that down. And then I’ve got a couple of tools that people can use when they’re in the eye of the tornado, so we can go through that too. And I’ll interject a couple of stories and that should be about it.

Rachel Cram – Wonderful. Let’s do that.

Dr. Shahana Alibhai – So, a very simple acronym you can remember is called BET’s B. E. T. S.

Rachel Cram – Oh, I was hoping you would do this. These are great techniques.

Dr. Shahana Alibhai – Yeah, a lot of these techniques are to help increase your parasympathetic nervous system; your rest and digest force, and these techniques decrease your sympathetic; your fight, flight or freeze force.

So breathing is one of the only links we have into our autonomic nervous system. I can’t tell myself, “Calm my heart rate,” that’s really hard to do. Your breath is your dial that you can play with that at.

There is a great breath technique that mimics a physiological sigh. So if you’ve ever really cried your heart out, you will have done this unbeknownst to you. You will do a sharp inhale twice and then exhale. A sharp inhale twice and exhale. The reason for that is to balance your carbon dioxide levels and stimulate your parasympathetic nervous system. Doing that a couple of times, two sharp inhales, one long exhale.

And please note that your heart rate takes longer to catch up, even though you’re starting to feel calmed down, it takes an additional 30 seconds for you to see your heart rate start to calm down.

There’s so many breathing techniques out there. If you have one you like, do it. If not, this is my favorite one.

Rachel Cram – So that’s the B of B.E.T.S. is breath?

Dr. Shahana Alibhai – That’s the B of B.E.T.S. Is this ‘physiological sigh breathing’.

The second one is E and it stands for your eyes. Up until now, we thought our breath was the only thing that could stimulate your parasympathetic nervous system. But we have another dial. And it’s called your eyes. So part of your brain is actually pushing through your cranial skull and that’s called your retina? And if you stimulate your retina in a certain way, it activates your parasympathetic nervous system.

So case in point, when you are laser focused, when you have somewhere to be. When you’re driving and you’re already late for that meeting, are you looking around going, “Oh wow, look at the view. Looks so great?” Or are you laser focused on that person in front of you who is driving 20 kilometers an hour below the speed limit? You’re looking at that person in front of you. You are sharp and laser focused.

When you are on, I can’t even imagine traveling right now, but if you’re lucky enough to have traveled to Mexico or Hawaii, are you just looking at one spot on the ocean or are you looking everywhere? Is it panoramic? It’s panoramic, right? That’s why we talk about that as you’re happy space. That entire visual field.

To stimulate your parasympathetic nervous system is really easy. You keep your head and neck relaxed, you keep your eyes pointed forward, and you try to take in as much of your peripheral vision as possible. What are you seeing around you? And just breathe into that space, start to notice things around you.

There is perspective. There’s more in your surrounding. Breathing into that actually helps stimulate parasympathetic. That’s E.

Rachel Cram – As you were talking about it, I know you were doing it with your eyes and I was doing it with mine as well at the same time, which is kind of fun. And I feel as I do that, I feel my whole body relax; my face relax. To be able to get that peripheral vision I have to do that. I have to sort of let my face muscles drop and my shoulder muscles drop, which is so interesting.

Dr. Shahana Alibhai – And it’s the jaw, right? That’s for me. It’s all in your jaw, your neck. A lot of us wear our shoulders as earrings, right because they’re just up here all the time.

Rachel Cram – Yeah. But it was interesting because I’ve never heard this about your eyes before, but I was trying to relax my eyes to take it in. And that is automatically what had to happen to do that. And I was watching you do the same thing. So, so interesting.

Dr. Shahana Alibhai – We’re mirroring each other, exactly, right? T is for temperature. So a very interesting ‘cool’ as a pun, technique is to take an ice pack. You put it on your wrists and you’re actually focusing in on the cold sensation on a sensitive part of your body. That shift in temperature, that distraction, often is like someone pressing the reset button on your brain. And I use it for youth that I work with, often if they’re having an acute panic attack.

Rachel Cram – Good to know. Ok, T; Temperature.

Dr. Shahana Alibhai – Yeah. Another one in the ‘T’ section is Tap. Cross your arms at your chest and tap from side to side. So your left hand is tapping your right shoulder, your right hand is tapping your left shoulder. And stimulating both parts of the brain starts to mimic the technique of EMDR, which is a common trauma technique that specialists or counselors use. But my counselor would use it all the time before going to the dentist. Very simple, easy, breathe as you tap.

Rachel Cram – So for all of these, if I can just do a quick recap, so for B.E.T.S., bets, ‘breathe’ carries through all of these. So breathe, eyes, and then T is temperature or tap was the other T.

Dr. Shahana Albhai – Exactly. Yes. And then, last but not least, ‘sound,’ another trick to fake your brain into thinking that you are more rested, is humming.

Humming stimulates the vagus nerve and can cause you to be in more of a rest and digest or parasympathetic. So hummmmm, humming to yourself is a great way to help relax you. This is why music is so powerful, but that vibrational tone on the back of the roof of your mouth actually is quite relaxing. So, yeah, you can give that a try.

Rachel Cram – That’s interesting because I often think when you think of meditation, the classical meditation has got that hum in it. That Ommmm. And so that’s part of it, I guess.

Dr. Shahana Alibhai – So many of these ancient practices actually were rooted in a lot of science. We just took a couple thousand years to catch up.

Rachel Cram – Yeah, that’s fascinating, isn’t it? Because obviously they didn’t have the science at that ancient time either, but they just knew within their bodies, they were sensitive enough to know the power of that.

Dr. Shahana Alibhai – It was so intuitive, right? Yeah.

Rachel Cram – I love seeing wisdom threaded throughout history like that, and that B.E.T.S, B.E.T. S. was really good.

Dr. Shahana Alibhai – Oh, ok, so tangible right?

Rachel Cram – So tangible. And it’s great to end on tangible. Ok, well let’s end here. We’ve got plenty of material for a full episode.

Dr. Shahana Alibhai – Perfect.

Rachel Cram – And I thank you so much for your time with me today. I’ve really enjoyed this conversation. There is so much that I could have dug into with you and I had to just let it go for the moment. But I love the story that we’ve created together today. Thank you so much.

Dr. Shahana Alibhai – Thank you. Oh, it’s been my pleasure. Thank you for your gentle way of asking questions and creating such an open environment. Honestly. Really appreciate it.

Rachel Cram – Thank you so much.

“To be nobody but yourself
in a world which is doing its best
day and night
to make you everybody else…
means to fight the hardest battle
which any human being can fight;
and never stop fighting.”
e.e.cummings