In what I hope will be the first of many guest appearances, I am very pleased to feature the following column by my partner Chad Belicena. Relying on almost 13 years of experience in the psychiatric field (most recently as an advanced practice nurse), and an interest in all things entertainment, Chad weighs in on the recent Tom Cruise debacle, his views on postpartum depression and psychiatry in general.

Take it away Chad.

I have been following Mr. Cruise’s crusade lately against the use of psychiatric medications and his plight to convince everyone of the power of Scientology. We all know that Mr. Cruise is a follower of the Church of Scientology and its teachings, and one of its teachings is against Psychiatry. Just recently Mr. Cruise has made several unsupportive comments to another fellow actor, Brooke Shields, when she came out with a book that talks poignantly about her battle with postpartum depression and the use of antidepressant medications and therapy.

I would like to take this opportunity to point out a couple of clinical studies that have been done on postpartum depression. One study on the risk factors associated with the development of postpartum mood disorders shows that there is evidence that hormone-related phenomena are related to the occurrence of the disorder. The results go some way to support the hypothesis that the etiology for postpartum mood disorders may be related to hormonal sensitivity and that such risk factors should be included in any assessment of the risk for these disorders. (Pub-Med, June 2005)

In other related studies where the symptoms were severe, the first-line recommendation was antidepressant medication combined with other treatments (generally psychotherapy). For the treatment of milder symptoms in such situations, the researchers gave equal endorsement to a couple of different treatment methods, such as:

• psychobehavioral approaches/hormonal replacement and,
• others preferred psychotherapy to medication (during conception, pregnancy, or when breastfeeding)

In milder cases, however, antidepressants were recommended as at least second-line options and the specific antidepressants preferred depended on the particular clinical situation. The study was conducted so that that future research data will provide some direction for addressing common clinical dilemmas in women. Such results can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions. (Pub-Med, May 2001)

And in other smaller studies that have been carried out on the treatment of postpartum depression, clinicians must currently rely on general recommendations for the use of antidepressant medications as the main treatment for depression. In general practice, antidepressant medications have been shown to be effective when used as prescribed. However, research has shown that depressed patients consistently receive either no medication or consistently low doses of medication. These studies suggest a need to improve information about medication for postpartum depression. If this information is not provided, women are likely to continue to self-manage medication at a dosage that may be clinically ineffective. (Pub-Med, Sept 2004)

So in citing these documented studies, I question Mr. Cruise’s credibility in his knowledge on postpartum depression and in mental health as a whole. In his interviews, he is as knowledgeable about the science of mental health as I am of acting. To be blunt, Mr. Cruise is obviously not a woman for him to know what a woman undergoes physically and psychologically during pregnancy. As a matter of fact, Mr. Cruise is not an expert on women’s health and does not have the knowledge base behind the changes that a woman experiences through life.

In defense of Ms. Shields, her book details her numerous attempts to get pregnant via IVF (in-vitro fertilization) only to experience a miscarriage in 2003. When she finally gave birth to her daughter, she subsequently suffered a devastating aftermath to that birth. She mentioned being in a bizarre state of mind and experiencing feelings that ranged from embarrassment to stoicism to melancholy to shock, practically all at once. I personally think her work brings the disease in full view and builds public awareness about the disease. Mr. Cruise’s comments about her experiences and challenges with postpartum depression is not only dismissive but is a disservice to women and to a disease that is widely misunderstood. Mr. Cruise mentioned that Ms. Shields should have taken vitamins during her depression. We all know that vitamins may be essential in our daily nutrition but it is not considered a treatment in battling postpartum depression. In retrospect, I wonder if Mr. Cruise and other Hollywood Scientology celebrities would be interested in taking in a homeless, psychotic and non-treatment compliant individual into their church, sit right next to them and offer them vitamins as a means of treating their disease.

Hollywood, as we know is a world filled with gimmicks and sensationalism so that one can further his or her career. We are all aware that in the past 2 to 3 months Mr. Cruise has had a couple of significant changes in his life and one of these changes was that he recently hired a new agent to handle his career (a Scientology follower also) which might explain why we are witnessing this sudden change in Mr. Cruise’s behavior.

As a final note, it was quite interesting to discover that the founder L. Ron Hubbard who happened to be a genius of some sort slipped from relevance and respectability to madness and paranoia. Mr. Hubbard became a recluse and appeared to have been sheltered by his close cohorts from exposure to the outside world. Need I say more?

Chad Belicena RN, MSN
Advanced Practice Nurse
Behavioral Health & Gerontology Nursing