PPD isn't impressed by titles or wealth

I'm one of those people who is fascinated by royalty, especially the British Royal Family. I remember watching the funeral of Diana, Princess of Wales when I was a teenager. I watched Prince William's wedding to the former Kate Middleton live (streamed it on the internet) very early in the morning while I nursed a newborn baby. I've been enthralled waiting for the arrival of the newest member of their family (who came into the world on July 22, 2013), formerly known as "the royal baby" and now (since his name as been announced) known as HRH Prince George Alexander Louis of Cambridge.

This evening, something struck me that has stuck with me in the back of the mind for the last couple of days. I got to watch via live stream (yay for smart phones) as the Duke and Duchess of Cambridge brought Prince George out front of the hospital to meet the press, the public, and - in a way, the world - before leaving for Kensington Palace. Kate said something then that has been niggling at my brain; she said that it's "very emotional".

Pregnancy is emotional. Childbirth is emotional. Becoming parents is emotional, whether it's your first child or your third. She nailed it.

But I hope - and I don't know how well I can translate my thoughts and feelings on this in to words - that she knows to watch out for the negative emotions. I hope that she is surrounded by people who know about Postpartum Depression, Postpartum Anxiety, Postpartum OCD, Postpartum Psychosis, etc., who can help her keep an eye out for it and - should she start to suffer - help her get help.

But I don't just wish this for her. I wish this for EVERY new mom out there. My hope for all of you is that you have educated yourself about the realities and symptoms of PPMD, that you are surrounded by people who know about it and who will speak up and help you get help if they notice something is wrong.

PPMD is no respecter of persons. It doesn't care who you are. It's a bastard like that. We ALL deserve to be able to get help, though. Don't think that because you don't have a title you don't deserve help or are supposed to suffer. And don't think that because you're a celebrity you have to suffer in silence and just try to push through it.  If you need help, ask for it.

We all matter.

Yesterday, I cried.

Warning: if you are currently having a rough time with PPMD, you may want to avoid this post. It contains potential triggers.

Yesterday, I cried. It wasn't a messy cry. It was a quiet, gentle, soft cry, with small tears and no snotty nose. But it was still a cry.

Why did I cry?

I cried because Cynthia Wachenheim killed herself.

The story I linked above, from the New York Times, reads:

Sometime before 3:25 p.m. Wednesday, Cynthia Wachenheim, a lawyer who was on child-care leave from her job, wrote out a note. On lined notebook paper, it ran for 13 pages.

According to a law enforcement official who has seen the note, she wrote that her infant son, Keston Bacharach, had previously taken a few tumbles, including “two shameful incidents,” a fall from a Gymini play set onto the wood floor when she walked out of the room for five minutes, and off a bed. She blamed herself, and was convinced that those falls had led to a series of concussions and seizures that aggravated or contributed to maladies that would harm him for the rest of his life.

Her friends, family members and pediatrician did not believe her, she wrote. But she noticed changes in the baby — changes that only a mother who spends all day with her child would notice. For instance, she wrote, her son had grown sleepier and cried more frequently.

She wrote that she could not bear the thought that he might suffer because she had failed to protect him. She wrote that what she was about to do was “evil.” 

She then jumped out of her eighth-floor window. She left behind the note. She did not leave behind her son, strapping him to her body in a Ergobaby carrier, bringing him down with her as she crashed to the ground, the crack sounding like a gunshot to people passing by.

Ms. Wachenheim, 44, died. But her 10-month-old son, apparently cushioned by her body, survived. He bounced out of the carrier and suffered only a bruised cheek.

“I’m sure you understand, I’m absolutely overwhelmed with grief,” her husband, Hal Bacharach, said in a brief telephone conversation Thursday from his apartment at the Sutton, a new sleek building at 147th Street and Bradhurst Avenue in Harlem, where he had lived with his wife.

“I have my son, who was lucky enough to survive, in my lap,” Mr. Bacharach said, sounding in shock as he repeated similar words several times. “It’s unbelievable. Right now my crying son is in my arms.” A child could be heard whimpering as he spoke.

Ms. Wachenheim’s leap was a jarring twist in the life of a highly educated, socially conscious woman who had been active in a women’s group in her synagogue, B’nai Jeshurun on the Upper West Side, and, according to her college class notes, had been a coordinator for a Harlem tutoring program.

She was on leave from her $122,800-a-year job as an associate court attorney in the Manhattan State Supreme Court system, court officials said. She had worked for the courts since 1997, doing legal research and helping judges write opinions.

Christian Johnson, a lawyer who lives a few doors down, said he had seen Ms. Wachenheim twice last week. There was no indication “that anything was askew in their household,” he said. “I was shocked.”

The baby seemed normal, he said. Mr. Johnson would sometimes ride the train with Mr. Bacharach, who never said anything about developmental issues. “Hal never mentioned that to me,” Mr. Johnson said.

But Mr. Bacharach’s mother, Barbara Bacharach, said that her daughter-in-law had not been her usual self lately.

Mr. Johnson said he had overheard the couple arguing — which he said was very unlike them — about two hours before Ms. Wachenheim jumped. He paused in the hallway to make sure it was nothing serious, then moved on when it seemed like a normal marital spat. “He was just asking her why she didn’t answer the phone and why wouldn’t she pick up the phone,” he said. “He just kept asking her and she wouldn’t respond.”

Several times in her note, according to the law enforcement official, Ms. Wachenheim expressed deep love for her son, referring to him as “beautiful.”

She said that she would give her life to bring his health back and that she hated herself for the first time in her life. She believed that her son’s falls might have brought about a serious medical condition, perhaps cerebral palsy or autism, which would have “lifelong consequences.”

Her belief that she failed to prevent it caused her to “crumble.” She wrote that she was depressed and could no longer socialize. She was sure that people would see her behavior as postpartum depression or psychosis.

Dr. Catherine Birndorf, a reproductive psychiatrist at Weill Cornell Medical College, said the word “evil” in the note stood out for her. “Usually these intensely lethal acts happen in the context of losing some kind of touch with reality,” she said. “What mother in their right mind would kill their kid?”

Postpartum depression does not usually lead to suicide and homicide, she said, unless it is left untreated or progresses to more serious mental illness, like psychosis. She compared it to the case of Andrea Yates, the Texas woman who was found not guilty by reason of insanity of drowning her five children in the bathtub. Ms. Yates, who had been struggling with postpartum psychosis, thought that she was a bad mother and that she was protecting her children by killing them, Dr. Birndorf said.

About 10 to 20 percent of new mothers have postpartum depression, according to the state health department, and only 1 or 2 out of 1,000 new mothers have postpartum psychosis. Postpartum psychosis is characterized by delusions, often about the baby, agitation, anger, paranoia, and sometimes commands to harm the infant. It has a 5 percent suicide rate and a 4 percent infanticide rate, according to the health department.

Ms. Wachenheim was valedictorian at Colonie Central High School, near Albany, and graduated from what is now known as the University at Buffalo, and from Columbia University Law School. In 1993, she traveled to Pakistan to work in a law office specializing in women’s rights and worked on subjects like “honor killings” of women suspected of adultery, according to an article at the time in The Times Union of Albany.

Mr. Bacharach said he met his wife on a bus to Boston and was smitten by her “innate kindness.” They were married in 2009, two years after she bought her apartment at the Sutton for $190,750, according to city records.

It is across the street from Jackie Robinson Park, where neighbors said Ms. Wachenheim took her newborn to the outdoor pool in the summer.

Randy Leonard and Sheelagh McNeill contributed reporting.

A version of this article appeared in print on March 15, 2013, on page A19 of the New York edition with the headline: Mother Knew Her Final Act Was Evil One.

I When I read this, I cried for Cynthia. In fact, I'm crying right now while I write this. I don't know that I know the exact pain she was struggling with, but I know the type of pain that leads you to think that maybe the best solution is to kill yourself. I know the kind of pain that makes you feel hopeless and like you're just hurting everyone around you. I know the pain that says "Everyone would be better off if I was gone". I know the pain of "What if I hurt my baby?".

I think it's important to note that this article does not say definitively whether or not Cynthia had a diagnosis of any type of Postpartum Mood and Anxiety Disorders, but the article does list several things that can be symptomatic of PPMD, and there's the fact that the article lists her son as being 10 months old (PPMD can rear their ugly heads at any time in the first 12 months after giving birth, and does not necessarily go away just because a mother and baby hit the baby's first birthday). I feel that it's important to note that I am not diagnosing Cynthia with anything. I'm not an M.D., R.N., C.N.M., or any other type of medical/mental health professional, and I don't know nearly enough about Cynthia and her history/situation to make that call.

Regardless of whether or not Cynthia was suffering from a PPMD, she was obviously hurting and struggling with a great burden. I've never met Cynthia but I know that she was so upset and hurting so much in some way that she decided the best thing for her and her baby was for both of them to die, that that was the best way to protect them. I can't say that I can't imagine what she was going through, but I think I can, just a little bit.

Cynthia is the reason why I blog. Her baby, who could have died with her but didn't, is why I blog. Her husband and the rest of her family and friends are why I blog. They are why I cry now. The world is such a cold hard place and for some people that is more true than it is for others. And when I hear about stories like this, it makes my heart hurt. I wish I could go to New York a few days ago and hug Cynthia. I wish I could tell her "It's okay, Cynthia. You're not a bad mom. You need help, let's go talk to a professional. I'll go with you and hold your hand so you're not alone. But you don't have to do this.". I wish I could save her, save all the people she leaves behind. But I can't. All the wishes in the world won't change that. All I can do is hope that she is at peace now and pray for those she leaves behind.

I can't save Cynthia, and as much as I want to, I don't have the technology to be able to go back in time to tell her those things. But I can tell you. And so, I am.

If you are out there reading this and you are hurting, let me help you. If you feel hopeless, please know that there is hope. There is always hope, even when you can't see it. If you feel like you can't go on, you can, and I will go with you. I HAVE BEEN THERE. I was hospitalized twice after my first daughter was born for that very reason. I have survived Postpartum Depression, Postpartum Anxiety, and Postpartum Obsessive-Compulsive Disorder. Cynthia's story is how mine could all too easily have ended if I hadn't gotten help.

You do not have to go through PPMD alone. Let me walk with you. You are not alone and you are not a bad anything. You are the most beautiful and fantastic you that could ever exist.

If you need help, let me help you.

Please.

WebMD's baby tracker app talks about PPD

I've written several posts about webpages and programs that have posted various things about PPD that made me angry, whether it's an alleged miracle cure for Postpartum Depression or a website using PPD as a marketing tool for nursing clothing. Today, though, I'd like to talk about a website that is getting something very right in the PPD arena.

During pregnancy, I have a few "pregnancy tracker" applications that I download to my iPhone. One allows me to track my appointments, weight, and symptoms. The other two are from What To Expect and Babycenter and give me countdowns to my EDD and weekly/daily information on my pregnancy, the baby's development, articles about various pregnancy and childbirth topics, and a plethora of other information. These apps have been very informative and helpful to me throughout my pregnancies and I really enjoy reading about the changes my body and my baby are going through that I can't see.

After Aaron was born, I had the idea to check and see if there were any apps that would allow me to track the growth and progress of my children once they were no longer inhabiting my uterus. Lo and behold, there's an app for that (there really is an app for everything). Best of all, it's free! I downloaded WebMD's baby growth tracker not really expecting anything too terribly spectacular because it was a free app; this was one occasion when I was very happy to be wrong.

The app allows me to switch between multiple children, put in their height and weight (and then calculates their growth chart percentile according to the World Health Organizations growth charts), put in milestones, has a "Baby Book" function, gives me a weekly reminder to take a picture of my baby so I can look back over the first year and watch him change, and a myriad of other useful and helpful functions, as well as having a very large selection of articles on a variety of baby, children, parenting, and health related topics.

It was while I was browsing the articles that I found what was (to me) the crown jewel. I was reading through a section for moms (there's also a section labeled for dads) when I discovered an article about Postpartum Depression! I thought "Oh cool, they have PPD info, I wonder what they have to say". I can't tell you how happy I was to discover that the information they have in the app is concise, well-written, educational, easy to understand, and emphasizes that it's nothing to be ashamed of and encourages women to talk to their doctors and seek help if they think they might have some symptoms of PPD. They even talk about Postpartum Psychosis and the differences between PPP and PPD, as well as symptoms of PPP.

This application was a wonderful find. It makes me so happy that someone at WebMD took the time to put effort into putting information about PPD in this app; information that is written in a manner that new moms can really understand and in a tone that is non-judgmental. I smile every time I think about it. THIS is the type of approach that I wish more companies and websites would take. WebMD, thank you, from the bottom of my heart.

Sometimes people just do bad things.

Over the last few days, two news stories in particular have been coming across my news feed a lot. One is about Terrence Tyler, a 23 year old Marine (no longer in the Corps) who shot and killed two fellow store employees before killing himself at a New Jersey supermarket. According to the news story, 

"Tyler, formerly of Brooklyn but living in Old Ridge, served in the U.S. Marine Corps from 2008 to 2010, a Marines spokesman said. Tyler was a lance corporal and rifleman, who received two medals and never served overseas, the spokesman said.". 

I have not been able to find any information as to what kind of discharge he received (Honorable or otherwise). The news story also states that, according to a law enforcement source, 

"Tyler may have had a history of depression or mental illness".

Naturally, plenty of reactions seem to be "He must have had PTSD". Another opinion I've seen floating around is that "He couldn't have had PTSD, he never deployed". These are both inaccurate. As to the first, no, he does NOT have to have had PTSD. For one thing, if it's true that he had a past history of depression//mental illness, why could it have been that instead? Are we assuming that since he served in the military any mental issues that caused something like this have to automatically be PTSD?

As to the second, PTSD is not something that is reserved specifically for troops who deploy to combat, it's not something exclusive to overseas military service. PTSD stands for Post-Traumatic Stress Disorder. We usually hear about it in the news most often in relation to servicemembers and veterans but it is hardly exclusive to the military community. PTSD can come about as a result of any traumatic event. Rape and abuse survivors, vehicle accident survivors, someone who was caught in a fire, people who are onlookers witnessing an event that is traumatic to them, people who have lost a loved one, anyone who experiences anything that is traumatic to them can suffer from PTSD. PTSD can occur after a woman has a childbirth that was traumatic to her. Someone living with a spouse or loved one with PTSD can develop their own PTSD. According to PostPartum Support International,

"Approximately 1-6% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth. Most often, this illness is caused by a real or perceived trauma during delivery or postpartum. "

Women who have survived a PostPartum Mood Disorder can struggle with PTSD as a part of the aftermath. 911 personnel can develop PTSD due to the situations they may be put in as part of their work. PTSD is not exclusive to any one community, nor is it limited to a specific type of situation. If Terrence Tyler experienced something that was traumatic to him during boot camp or any part of his time in the U. S. Marine Corps, he could most certainly have developed PTSD and it is certainly possible that that could have been linked to his actions in shooting and killing two others in addition to himself. The thing is, we just don't know.

The other story I've been hearing a lot about it that of Tiffany Klapheke, a woman arrested after her 22 month old daughter died, apparently from extreme neglect. Her other two children, a 3 year old and a 6 month old, are currently in the hospital, apparently also suffering from the same. And of course, as is the norm when a mother is responsible for the death of her child, many people are jumping straight to "Oh, well, since it's a mom who killed her child, it must be PostPartum Depression".

NO. It does NOT have to be PostPartum Depression. Again, it could be another mental illness. It could be totally unrelated to mental health altogether and be the result of bad parenting or other factors. Just because a mother is responsible for the death and/or injury of her children does not mean it's automatically a PPMD. This isn't even getting deep into the fact that most of the time, when people refer to "PPD" as the reason a mother kills her child (usually citing the cases of Andrea Yates and/or Otty Sanchez), they are actually referring to PostPartum Psychosis, another PPMD but a separate and different illness than PostPartum Depression. PPD and PPP are not the same and can not/should not be used interchangeably. If you're going to toss around "So-and-so must have *insert mental health problem*, please, at least know what it is you're actually talking about.

But beyond that, it is injurious and unfair to automatically assume that someone who does something bad must be suffering from a mental illness. It makes it harder for people who are suffering to ask for help. To focus specifically on servicemembers who are dealing with PTSD, it's already incredibly difficult for them to go talk to someone about it. Among other things, they fear being seen as weak, as not being able to do their job, as not being good Soldiers/Airmen/Marines/Sailors/Coasties. They worry that if they speak up about their problems, they will automatically lose their security clearance, be reclassed to a different job, be discharged from the military altogether. They worry about being mocked and made fun of by their coworkers, about being looked down on and told to "Suck it up and stop being a pansy" and of being seen as malingerers by their Chain of Command. They already fight these stigmas, concerns, and myths. People automatically jumping to the conclusion that servicemembers who do bad things must be the result of PTSD add another layer of fear to it: the fear that they may be immediately seen as a threat and a potential monster. This is all aside from whatever internal pain and traumatic events are causing them to suffer in the first place.

Assault/abuse survivors may already be wrestling with unnecessary guilt over "Was this my fault? Could I have done something different to prevent this?", or with people being suspicious that they somehow brought it on themselves or are lying about what happened to them. People who are dealing with PTSD as a result of anything other than military service may not even be aware that PTSD could be something they face, or they may worry that people will laugh and bring the exact attitude of "You're not military, you weren't deployed, you don't have PTSD". Women who are struggling with PTSD after childbirth face those who have the attitude that "Childbirth couldn't possibly be traumatic" (and yes, I have personally heard/seen that said and that attitude thrown around).

With regards to a PPMD, I can't stress enough how terrifying it was to be suffering from PPD. To feel like I wasn't in control of my emotions and, to some extent, my actions and reactions, to have thoughts that popped unbidden into my head of hurting/killing myself, to constantly feel numb and dulled and in a fog and not even know why, to feel those waves of anger and sadness, to know deep down inside that something was wrong but not know what or why, and to feel like it must have been something I was doing wrong. It was beyond scary. Once I realized that I had all the symptoms of PostPartum Depression and NEEDED to get help, that was a whole new dimension of fear. Fear that it meant I was a horrible mom and a failure as a wife and mother, fear that it meant I was a monster, worry that when I went in and said "I need help, here's what I'm dealing with" CPS would be called in to take my baby girl away so that I couldn't try to kill her. After I was released from the hospital I dealt with the concern that if I told anyone what was going on, they would look down on me, mock me, laugh at me, judge me, criticize me, not trust me, and assume that I must be like Andrea Yates, that I must be on the verge of killing my child in some horrific manner.

These stigmas and fears are perfectly normal for anyone who is dealing with PTSD, PPD, or any other mental illness. These stigmas are exactly what I and so many others are trying to fight, why we work so hard to educate people, why public discussion, education, and advocacy are so vital. Steps in the right direction are being taken and forward progress is being made. However, sadly, when people hear about stories like this and start talking about what mental illness must have caused the person in question to have done whatever they did, it is a step in the wrong direction, movement backwards, and adds to those stigmas and myths we all work to combat and dispell. It's not harmless to toss around these attitudes and assumptions, it hurts people who are dealing with these issues and makes people who need treatment more afraid to ask for help. It hurts the loved ones who are tying to support them and see the pain they're going through. It hurts everyone who has suffered, is suffering, and will suffer.

It also does a disservice to those who are doing the spreading. You don't deserve to believe false things, you deserve to be educated and knowledgeable about these issues that society is dealing with. You deserve to know what the symptoms of PostPartum Depression is and exactly how many women suffer. You deserve to have the confidence to be able to ask for help if you need it someday instead of ignoring your own problems because you believe the stigmas you've helped to perpetuate and spread.

Today, you're the one saying that Terrence Tyler must have had PTSD or Tiffany Klapheke must have had PostPartum Depression. But remember, one day you could be the one dealing with your own inner demons and not wanting to reach out for help because you don't want to be seen as the monster you have labeled Andrea Yates and Otty Sanchez as. It could be your son who comes back from combat with more wounds on the inside than the outside or your daughter who can't find her way out of the darkness after she has a baby. It could be you who suddenly has to fight the very attitudes you've helped foster. Why not do yourself and your loved ones a favor and take some time to educate yourself about the causes, symptoms, victims, and survivors of the various mental illnesses you think you know so much about? Educate yourself, educate your loved ones, educate the world, and maybe as that happens you'll help someone who is suffering to get help before they become a news story.

PostPartum Depression, PostPartum Psychosis, it's all the same thing, right?

There's a saying that goes "You say po-tay-to, I say po-tah-to...". I've never heard it actually used specifically in reference to the pronunciation of the word "potato"; instead, it is usually used as an illustration or argument that although two things may sound different, they're really the same thing. Sometimes this is a legitimate point. Sometimes, however, it is quite the opposite.

You might be asking "What do sayings about potatoes have to do with PostPartum Depression?". Something that I hear a lot is people talking about "She killed her child because she has PostPartum Depression". This often comes up in discussions that reference Andrea Yates and/or Otty Sanchez. Currently, I'm hearing it tossed around in reference to Chevonne Thomas, a mother with a history of mental illness and drug use who decapitated her 2 year old son and then killed herself. I would like to note, I have not read anything indicating that the cause of her actions has been determined through investigation/diagnosis by medical professionals to be a PPMD. The only diagnoses I'm seeing are coming from people around the web who are immediately jumping to the conclusion that since she was a mother and killed her child, it must be a PPMD.

Without even getting into the issues that come with immediately assuming that someone who does something bad MUST have a mental illness, and specifically that a mother would only kill her child if she had a PPMD, the issue I'd like to focus on is the misuse of the term "PostPartum Depression". Otty Sanchez and Andrea Yates did not have PPD. They were both suffering from PostPartum Psychosis.

What far too many people don't realize is that PostPartum Depression and PostPartum Psychosis are not at all the same thing. They are both PostPartum Mood Disorders but they are two separate PPMD. The terms get used interchangeably (usually, in my experience, with people substituting PostPartum Depression for PostPartum Psychosis) but that is not as it should be. It's no more accurate to think/claim that they are the same thing than it would be to say someone has Breast Cancer when what they actually have is Lung Cancer.

The Mayo Clinic lists the following as symptoms of the two:

Postpartum depression symptomsPostpartum depression may appear to be the baby blues at first — but the signs and symptoms are more intense and longer lasting, eventually interfering with your ability to care for your baby and handle other daily tasks. Postpartum depression symptoms may include:

• Loss of appetite
• Insomnia
• Intense irritability and anger
• Overwhelming fatigue
• Loss of interest in sex
• Lack of joy in life
• Feelings of shame, guilt or inadequacy
• Severe mood swing
• Difficulty bonding with the baby
• Withdrawal from family and friends
• Thoughts of harming yourself or the baby

Untreated, postpartum depression may last for a year or more.

Postpartum psychosisWith postpartum psychosis — a rare condition that typically develops within the first two weeks after delivery — the signs and symptoms are even more severe. Signs and symptoms of postpartum psychosis may include:

• Confusion and disorientation
• Hallucinations and delusions
• Paranoia
• Attempts to harm yourself or the baby

When I was being admitted for my hospitalizations for PPD a few years ago, they specifically asked if I was hearing voices or seeing things/people. I've known some people who said that when they were suffering PPP, they had an overwhelming feeling that there was a demonic force waiting to snatch their baby. Some think that they are hearing from God to kill their baby to save it from some disastrous fate. With both PPD and PPP, although there are guidelines, markers, and symptoms that health professionals look for to diagnose a PPMD, there is no guarantee that all mothers will feel an entire checklist or experience the symptoms in the same way or at the same time. In my opinion, the unpredictability is one of the things that makes PPMD so difficult. You can't just assume that someone with a PPMD will look, act, or talk a certain way. There is no one face of PPMD. There is no "This is what a PPMD always looks like or acts like".

Katherine Stone of PostPartum Progress (yes, linking to my favorite PPD blog again) has a couple of excellent posts about the Symptoms of PostPartum Anxiety and Depression and the Symptoms of PostPartum Depression. These lists are written in "Plain-Mama English". They make the symptoms a lot easier to understand and relate to, as well as getting a lot more in-depth than most symptom lists on the internet. If you're wondering about the differences between PPD and PPP, I highly recommend going to those two posts and reading what she has to say.

PostPartum Depression and PostPartum Psychosis are both horrible illnesses. They can both be completely debilitating and, if left untreated, have long-lasting and tragic consequences and implications for the new mother, her baby, her family, her friends, and any number of people. They are both illnesses that I hope someday soon will be the topic of more research and public education campaigns. Neither of them are anything I would ever wish on my worst enemy and they are both something that, in my wildest dreams, I would love to somehow see totally eradicated from the face of the earth. Yes, they have some similarities and some shared symptoms, but that doesn't mean they are the same thing or that they should be referred to as the same thing or the terms used interchangeably. Please, educate yourself on the differences between the two and then spread your knowledge on to other people. Educating ourselves and others, and being willing to speak up and say "Hey, you realize that's not accurate, right?" when we see/hear someone using the terms incorrectly is a good place to start on fighting the stigmas and combating the ignorance that surrounds PPMD.