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There are the stories we tell out loud, and then there are the ones we keep tucked away—the ones that ache the most, because we’ve carried them with shame and in silence.
On this episode of On Health, we’re breaking the silence—and the stigma—around some of the most vulnerable, hidden experiences women carry: miscarriage, illness, identity loss, perfectionism, aging, and the shame and loneliness so many of us feel but rarely name.
I’m joined by the phenomenal Dr. Jessica Zucker, clinical psychologist and author of the groundbreaking memoir I Had a Miscarriage, and her latest book, Normalize It, which is just what we need: an invitation to stop apologizing for what we’re going through—and start talking about it.
Together, we explore:
- How grief grows in silence—and thrives in stigma
Whether it’s miscarriage, anxiety, or a private health struggle, when we don’t talk about it and feel shame, we end up carrying the weight alone. This conversation is about setting that burden down—and finding healing in honesty. - What it means when you don’t feel like yourself
Jessica opens up about the disorienting fog of anxiety and identity loss—and how unsettling it is when your mind and body no longer feel familiar. Whether hormonal, emotional, or something else entirely, it’s real. And you’re not imagining it. - Why midlife isn’t a decline—it’s a reckoning
In our 40s and 50s, something profound shifts. The world may expect us to shrink, to quiet down—but there’s power in slowing down, reclaiming our presence, and stepping into this next chapter with intention. - What being a “good girl” has cost us
We’ve been taught to be pleasing, perfect, and silent. But at what cost? It’s time to name the pressure, challenge the roles we’ve inherited, and free ourselves from outdated expectations. - Why loneliness is a serious health issue
From new motherhood to menopause, even in full homes or busy lives, many women feel deeply alone. Female friendship isn’t frivolous—it’s essential. It’s soul medicine. - Why we are more than what we do
Stage fright in midlife, memory lapses, or slowing down doesn’t make us less—it invites us into a new rhythm. We don’t always have to perform. Just being is enough. - How perfectionism is stealing our joy
From body image to birth stories, we’re fed the idea that we have to get everything “right.” But what if the real freedom lies in letting go of those impossible ideals—and embracing the beautiful mess of real life?
This one’s for all the women tired of pretending they’re fine.
Who are aching to be seen.
Who are ready to stop carrying the weight alone.
Links and Resources
- Jessica's book: Normalize It
- Jessica's Website
Join The Conversation
- Tune in to the full conversation to learn from Jessica and me
- Let us know your thoughts on this episode on social media! Tag me @dr.avivaromm and Jessica @ihadamiscarriage
- Don’t forget to share this episode with someone in your life, be it a new mama, a curious grandparent, or a caregiver who could learn about the power of nurture
Don’t Miss Out
Make sure to subscribe to On Health wherever you listen to podcasts, and if you found this episode helpful, please leave a review—it helps us reach more women like you who need this information.
The Transcript
This transcript has been edited for length and clarity.
Aviva: There are things we say out loud and things we keep to ourselves, and often it's the things that we don't say that weigh the most. The body struggles, the silent grief, the exhaustion of trying to be everything to everyone. So often these aren't just personal though there are cultural too. From the moment we're born, we're taught how to be good girls.
We absorb silent lessons about what our bodies should look like, how we should behave, and what we should want. These expectations run deep, so deep that we often don't even realize we've internalized them and yet they shape everything. Our sense of self, our worth, our relationships, even the way we process loss, illness, and trauma. We're taught to silence ourselves.
So what happens when we stop hiding? What happens when we say, here's what I've carried, here's what I still carry. What happens when we finally speak? What happens when we refuse to let stigma dictate our shared experiences? Welcome back to On Health. Today I'm joined by Jessica Zucker, PhD. Jessica is a Los Angeles based psychologist specializing in reproductive health and the author of the award-winning book, I Had a Miscarriage, a memoir, a movement. Jessica is the creator of the viral hashtag #I Had a Miscarriage campaign. Her writing has appeared in the New York Times, the Washington Post, New York magazine, Vogue and Harvard Business Review among others. She's been featured on NPR, the Today Show and Good Morning America and earned advanced degrees from New York University and Harvard University. Her latest book is Normalize It: Upending the Silence, Stigma and Shame that Shapes Women's Lives, and that's what we're going to talk about today.
Jessica, as we hopped on, you shared a piece of information with me that I know you want to share with our listeners, and when you shared that information with me, I shared with you how I had a recent podcast interview where I literally effed up the entire intro. I couldn't even articulate it. My guest, Emma Seppälä, who is a meditation teacher, started out just saying, “do you want to do a breathing practice together?” I'm really wanting to have this podcast be women connecting as if we were in each other's kitchen right now, as if we've known each other for 20 years – not that I expect you to tell me things that you would tell your best friend you’ve known for 20, but just having that real, honest, relaxed, go deep with it conversation.
And hopefully that's something that our listeners will really appreciate. I think we all need to just be able to let our hair down a little bit right now, even if mine isn't a ponytail. So welcome to On Health. It is truly a pleasure and a privilege to have you here. I've followed your work for a long time.
I was very moved when you launched the #I Had a Miscarriage campaign because as someone who's been involved in helping women for 40 years, including through pregnancy losses, I was just like, yes, someone is speaking honestly and vulnerably and opening the door for women to be real and true and honest. So thank you and welcome.
Jessica: Well, thank you so much for having me, and thank you for this wonderful introduction. I'm so happy to be here with you.
Aviva: I feel like we could talk all about our credentials and those are important. We can share those. I can share them in an intro later or have them on the show notes, but who are we as women? And I'm here to open that space for you, so I know you're going through something right now that you want to share about. So please.
Jessica: Well, I'll just start from the beginning. But it's not the beginning of my life; it's the beginning of my career. So, as you probably know, I'm a psychologist. I specialize in women's reproductive and maternal mental health and have done so for about over 15 years at this point. And I have a background in public health. When I decided to go for my PhD and wanted to have a more clinical life, my vision was to marry my background in public health with my interest in clinical practice. At that point my vision, my interest, my sort of academic study was all theoretical. So it's like I just knew I wanted to work with women.
Had I lived through something specifically that inspired that? Not necessarily until I was 16 weeks into my second pregnancy and had a miscarriage while I was home by myself. So that sort of changed the course, of course, of my life and my work life. As you mentioned then I think two years later, I launched the #I Had a Miscarriage campaign and began talking endlessly about the topic.
Every aspect of the topic, the platitudes, people are met with the shame, the isolation, the feelings of guilt people report. The research shows that most people are blaming themselves thinking that they somehow did something to cause this, to deserve this. The list goes on and on in terms of the ramifications of culture, not talking openly about such a pervasive topic. And as you know, miscarriage, pregnancy loss, infant loss, these are not diseases. This will not be cured. So I think the ultimate “cure” is to talk more openly about it so that people aren't feeling so alienated and so alone and so isolated in its aftermath.
Aviva: Even the term miscarriage, I find, I mean it's a common term, so we use it when we're speaking and women relate to it, but I feel like miscarriage sounds like something we've done wrong, whereas I say pregnancy loss because I feel like that is much more what the experience is for most women going through a pregnancy loss. So thank you for also sharing that term as you were speaking.
Jessica: Yeah, it is interesting. It's true. I mean, you miscarry, right. So somehow it's your fault which is unfathomably not anything true about the experience of pregnancy loss.
Aviva: You blew something wide open, which isn't just talking about pregnancy loss, but it is really the silences that we live with, and these silences can be everything from an eating disorder that a woman is struggling with alone and with shame and her own.It's not just like you have the struggle, but the shame of the struggle of it or body size, image issues or career achievement issues or something you shared with me that you're going through now, which is that you're on tamoxifen.
I do feel when we talk about the term miscarriage, it's almost emblematic of the way that our culture and medical culture and beauty culture, if we want to call it “beauty,” in air quotes here, forces us to blame ourselves for either phenomena that are medical out of our control, biological or culturally driven.
So when we started this conversation, you almost started with an apology, which I want to emphasize that you do not need to apologize at all, but you shared that you're on tamoxifen, which for listeners who are not familiar with that, is for breast cancer – it's an estrogen modulating medication – and you were apologizing for saying that maybe you would have some “Chemo Brain.”
Jessica: I felt like it was sort of like a, just so you know, if I don't make any sense, it's tamoxifen’s fault. No. Well, basically what happened was after all of my work in the miscarriage space, which of course my clinical practice is still dedicated to, but I was writing and writing and writing, and that eventually led to my first book. Two weeks after that book came out in 2021, I was diagnosed with breast cancer.
So in so many ways, we are in 2025 now. It seems like so long ago. It does seem like it's in the rearview mirror. However, the beauty of breast cancer, or at least those who have to be on tamoxifen, it's a gift that keeps on giving. So unfortunately the side effects of that, it's weird. I would say for me personally, that the experience of tamoxifen is worse than all of my surgeries put together, and I had four of them. So it's like I would sooner go back and have a surgery than stay on this.
Aviva: Is it the side effects? Is it the estrogen suppression? What are you going through with it?
Jessica: I talk with my oncologist about this monthly. It feels like, I mean, I meet with her every few months, but we have a back and forth online all the time. It's like I'm always trying to figure it out. It's like, how is it that I slept from 9:30 to 6:30 and I wake up feeling like I didn't sleep for an hour? The side effects in the beginning were very different than they are now. In the beginning, I had muscle pain and joint aches, and I felt suddenly like 90 years old, or at least what I would think that might feel like. That did fade and now it's morphed into this kind of, I just don't fully feel like I have access to my DAV that I've always had my entire life.
And interestingly in my cancer, I don't use the word journey, but I don't know a better word for it right now, throughout navigating breast cancer, I was fortunate enough to not have to go through chemo, and yet I'm hearing that maybe some of this kind of heavy brain fog and even feelings of disorientation and stuff are similar to that. I went through radiation, but I did not go through months and months of chemo or anything.
So anyway, all of that to say that there are times now where I have a new sense of anxiety coming into conversations, coming into even social situations, and I did try to include that in the book. I did not want this second book. I was approached to write the second book. It's not a memoir. I do include breast cancer on purpose, and I mentioned that I went through it, but I don't go into my details so much in the book, but it's definitely, it seems that it's changed the course of my life.
Aviva: Did it throw you into menopause?
Jessica: Oh, right. So that's what I was going to say. So see, I lost my train of thought for….
Aviva: No, it's okay. It's all good, girl. You are not the only woman who loses their train of thought in this podcast or in life. I promise.
Jessica: I know. I mean, because I didn't have to do chemo. I wasn't thrown into menopause, and I actually do still menstruate. So that's what is even more confusing and confounding for me. It's like, are some of these side effects, actual side effects, or are they perimenopause? Would I be feeling this way even if I stopped taking tamoxifen?
Aviva: Yeah, that's tricky to sort out, isn't it?
Jessica: It's very tricky and I feel you're playing with fire when you think about going off of a life, a potentially lifesaving drug.
Aviva: Let's talk about this feeling that you're having – not to equate anyone who is going through normal natural menopause with someone who has had a breast cancer treatment and is on tamoxifen. The parallel is the anxiety around the speaking and the brain fog.
When somebody looks at the trajectory of my work since I was 18 years old and teaching publicly and had my first book come out at 26 or 28 getting up, I always used to joke, if I were to go to a concert at Carnegie Hall and see Lauren Hill, which happened, I did go and see Lauren Hill.
Jessica: Lucky.
Aviva: I know. But say the opening act just couldn't show up, and they saw me sitting in the front row and they're like, you get up here. We need an opening act. Just talk about women's health. I would've been like, all right, I'm up there. And I wouldn't have thought twice about it. I would've just felt so confident in my physical presence, in my speaking ability, in my communication.
And then in the last year, I have found myself really struggling with getting on camera, speaking direct to camera without a script. I'm really working through what these menopausal changes are and really understand that anxiety, maybe mine is different than yours, but I'd love to talk more about this because from my work as a midwife and physician working with women in menopause, even just going to a menopause conference recently, how many of the menopausal women got on stage and in some way actually did start with an apology. If I trip over my words, dah, dah, dah….
And I think we're not actually doing it as much as we are more self-conscious about it, and that can exacerbate it. That makes it worse too. What is your experience and why do you think, I think we need to talk about this more for women who are going through it, but also for younger women to be compassionate about it and also understand it, they're going to get there someday too.
Jessica: Yeah, I couldn't agree more. I mean, for me, the process has actually been, well, it's anxiety producing because as you just said, I would've jumped to the stage at 20 something or even 30 something or even 40 something. I was diagnosed at 47, I believe it was, and now I would probably run out of the concert hall if they asked me to get on the stage. And the thing is though, when I do it right now, I'm totally comfortable.
I feel so present. I feel so connected to you and your words and what you're sharing. It's the anticipation. I think it's that anticipatory anxiety that's ratcheted up in the last couple of years for me. And you're right. Yet another thing that we're not talking enough about in culture, and so for me, it's actually resulted in anxiety, but also sometimes feelings of depression because it's like a loss.
Where has that sense of me gone and will I ever get it back? I feel like I'm too young to be like, okay, that's gone. So it's like I ask my oncologist half joking, but just like, is this dementia? It's like to the point where I'm trying to understand if I were to go off this drug, would I recover that energy I've had my entire life?
Aviva: Yeah, that's hard and that's really hard. And I wonder, could you go off of it for a month or a week or just to give yourself that glimpse and say, okay, a week I can do this for one week. I mean, I'm not suggesting that you do. Obviously talk with your doctor, but just like what would that be just to see does it creep back up. And then there's a placebo, so it's a little hard to know. Right?
Jessica: Right. Well, I'm actually glad that you as a physician just said that. I am in talks with my oncologist about going off between now and when the book comes out because it's like in order for me to show up to all of these experiences and events and I want to mean I'm so used to doing radio and TV and podcast, it's like that's where so much of the joy comes from in communing with women on these topics. So I don't want to cut myself off from it. So I may take a tamoxifen break to see how I'd feel.
Aviva: As you're saying this, I'm working on a book right now on menopause. It's called Force of Nature. It's not coming out until the fall of 2026. And I was actually thinking about this a couple of days ago and I was like, oh my God, I'm going to be 60 when that book comes out and thinking about some of this anticipatory anxiety and all the things. And as I'm hearing you and as we're sharing this space together, first I could just cry.
The honesty of it is so beautiful and profound for me as well. A really significant number of women that exit the workplace in menopause because of feeling like they're aging out and they're going to get replaced by, and I'm doing quotes here you guys, air quotes by a “younger model.”
We know that women in their 50s feel a tremendous amount of pressure to do things that change their physical appearance, facial changes with Botox or filler or surgery to actually look younger to state what is perceived as relevant in the workplace, but also the workplace becomes a different struggle when you have the perception That you are not the same when you have the perception that you're being looked at differently or the perception that culture has put on that we've become irrelevant or the fears that we may be articulating differently. And what I'm thinking of is I'm having this image of a council of elders, of women who are in their late 40s and beyond, mid 50s and beyond.
I'm 58, I'm kind of imagining this kind of age group and maybe something happens that until menopause, we are presenting ourselves in a way that keeps up with the masculine energy of the workplace, the masculine energy of the world. We're articulate, we're on it, we're sharp, we're like a certain way, and then this change happens and we feel out of it and self-conscious, but maybe it's actually, it's just time for more relaxed, honest conversations like this.
Jessica: I think for me, I'm still in this wrestling with it. I feel like I'm in the boxing room just being like, no, I won't let this go. Because to see a version of yourself just a few inches away that you can no longer fully embody is like, no one told me this was going to happen. No one talked about this. I mean, you can read the literature on brain fog and various aspects of menopause, but for me, I think, and I would imagine a lot of women, it's the identity piece. Absolutely.
Aviva: For me, that's the biggest piece. I have a friend who is by any standards just gorgeous and tall, and she is a very fit athletic woman, and we've been doing salsa class together once a week and we were in class and we were getting ready to start dancing, and she made a disparaging comment about having to look in the mirror the whole time that we're in class. There's giant mirrors up front, and she was saying how she can't believe it.
She looks at pictures, she's 58 also, and she looks at pictures of herself from two years ago and has that feeling of physically what happened to that woman. And it is that I read something recently that said, nobody told me how fast it would happen once you're in it, how fast.
And I want to just clarify for women who are listening who aren't in perimenopause, it's not all gloom and doom, but like becoming a new mother or becoming pregnant and realizing you're losing the autonomy you had, or going into puberty and realizing that you can't just necessarily run around in the school yard without a bra if you've grown boobs and not get attention that you don't want.
These transitions are not discussed and this transition into, I think the transition into puberty like, oh, I'm a woman now. The transition into motherhood – that's socially validated and celebrated, but the transition into this is not something that we are prepared. So I think what you're saying is you're in the boxing ring right now. It doesn't mean we're going to stay there, but it, it's a reckoning with something new and this transition.
Jessica: Well, it's interesting too though. I think that's a wonderful point and one we could unpack further. It's like, because even the transition to adolescents, I have a daughter who's 11. There's so much, and Carol Gilligan's amazing writing and research topic is so profound and life-changing really. It's not easy.
And then the transition to motherhood, or let's go back and say even pregnancy – so many people as you know are struggling with depression, anxiety during or after pregnancy. And so it's almost in most of these, if not all of these transitions, we somehow do feel alone. Cultures say, just do it. Get your old body back, get your original body back after you have bounce back. Yeah, you should be able to just be glowing and do it on your own. And like, maternity leave is vacation time.
Women are reporting feeling so isolated and so alone despite the fact that a majority of people do have children. And so, what is that? That goes back to what you said about getting the elders together. I would love to sit around with these elderly women looking back, telling us, and I mean even more elderly than us, being able to impart some wisdom.
What are we doing wrong? What can we do differently? And of course, I don't think in my time on the planet I'm going to somehow truly change culture, but I want to be part of changing it. And I'm just so curious and driven to understand the roots of this.
Why can't we turn it over? Why can't we somehow figure out a way, for example, for girls to know what they know, as Carol Gilligan says, without sort of bopping up against this wall or this kind of ceiling at that age that makes them question who they are or takes a part of themselves sort of underground and begins to have self-doubt and start judging themselves and become very self-conscious of the bodily changes.
I don't know that we have answers to these things.
Aviva: But I think we have insights though. First, I just want to say when I saw that you studied with Carol Gilligan in your bio as I was getting ready for this podcast, I went a little fan girl. Carol's work was incredibly influential to me as a young mom, and also I did my undergraduate work in women's health studies. My mentor, my primary mentor in that undergraduate work was a woman named Anita Landa, who was a colleague of Carol's. So Carol's book Meeting at the Crossroads was I think the earliest one I read.
One of the things that really struck me, that kind of sticks with me now, 30 something years later, is that she did studies or looked at data on the shift in girls in mathematics and science once they start menstruating and the self-silencing and the upper limiting that happens in that transition through puberty. Do you know much of that? Do you feel like you can talk to that a little bit?
Jessica: Well, you just did it perfectly. I mean, that's exactly what I've read. I am very keen on her book. The book that I know about that I read as a young person, I think I was 18, was In a Different Voice.
Aviva: I read that one, too.
Jessica: Very powerful. It just gave me chills when I thought about it. It's like this idea that culture begins to again, consciously or not, but begins to sort of create a level of self-consciousness that previously wasn't there.
Aviva: Well, this is what was coming to me as you were saying, where is this coming from? And so what kind of comes to me is that as we start going through these various transitions, things are happening in our bodies, whether that is menstrual blood, which can mean odor. If you haven't had a minute to change your pad, you've been in class all day, or it can be leaking through your pad.
That actually happened to me in sixth grade, and then it happened to me once in perimenopause, thankfully the second time was in my house, the first time was in a classroom and an older girl classmate saw it and wrapped her sweatshirt around my waist and escorted me to the bathroom very kindly and had a pad with her.
I didn't think, oh, when you get those irregular periods early on, your body does things at these various junctures that society has deemed taboo. I mean, we didn't even show the color red in menstrual pad commercials until recently. It was just blue water. And so I think that there's, the silence suggests that it's something that we should be embarrassed about.
Jessica: Right?
Aviva: And so there's that, we're embarrassed. We're not talking about it. So we don't know if we're the only ones who have that odor or have that cramp, have that symptom. And then on top of it, as women, we're kind of taught to put a happy face on it and not complain. It feels like complaining or overly self-conscious rather than just like, this is normal shit we're all going through. Let's just talk about it and get real.
Jessica: But it's true that when you get your period, I mean, not everybody's getting their period at the same time. Not everybody is having the same symptoms. Not everybody's families are talking openly about it at home. So it's like I think that that creates even more sort of stigma and shame and silence that bleeds into, no pun intended, the next phase of one's life.
And I think it's so true what you said about this pressure to remain a good girl. So it's like even if you're in pain, or let's say you have endometriosis and you're going through excruciating pain and none of your friends are, nobody's talking about it, you feel forced to put on a smiley face or at least continue to be attentive in class. There isn't room for these things that women go through including let's say miscarriage leave.
You lose a pregnancy, and in my case, second trimester pregnancy. I mean, I'm a small person. It was very obvious to my patients that I was pregnant. It was 16 weeks along. It's obvious when I'm like six weeks. So giving birth, being postpartum, having milk come in, bleeding, but not having a baby to show for it is profound. And no one's talking about that.
I mean, I understand from a medical perspective that it's so common, it's a normative outcome of pregnancy, miscarriage, early miscarriage especially, but that doesn't make it less painful emotionally, and it doesn't make it less confounding when it comes to the psychological sequelae.
Aviva: Yeah. Well, I run a program called the Mama Pathway, and it's an online perinatal education class really about advocacy and having the birth that you really want, and that can be home birth, hospital, birth, birthing up, really trying to be really empowered about it.
We have a support group every two weeks, which is live, and what's fascinating is how many women have asked me the question – when is it okay to tell people that I'm pregnant? And it's all around this issue of what if I miscarry? And when I was pregnant with my first, I remember distinctly my mother saying, well, don't tell anybody until you're five months. That's kind of like a Jewish tradition thing, but this isn't in many, many worldviews. And that to me just speaks to this. Don't tell anyone you're pregnant because you might have a miscarriage. You're not going to want to tell anybody. And that means you just live with it alone.
Jessica: And it means that that's right. The messaging is do not share about your fears of miscarriage until you're quote out of the woods into the second trimester, which any of the listeners who have experienced later losses know that there is no such thing as out of the woods. But why should we not share our news now? It's one thing if you want to be private about it.
Aviva: Exactly.
Jessica: I mean, I don't think everybody has to put ultrasounds on Instagram, but I do think that if people aren't sharing because of the fear that if they lose the pregnancy, then they have to keep it to themselves. I mean, it's so backward.
Aviva: And then they're living through a potentially three-five months of a subsequent pregnancy, keeping that one to themselves and now living with all the anxiety that women who have had a previous pregnancy loss compounded in the next pregnancy, it's horrible.
Jessica: Exactly.
Aviva: When you had the pregnancy loss, did you actually feel shame and embarrassed? How did you feel? And then I'm curious not to lump them together, but also when you were diagnosed with breast cancer, because a lot of women feel shame as if they brought it on themselves or they did something wrong. And I wonder if you went through those feelings at all.
Jessica: No, I did not feel the shame luckily. But what I did feel was incredibly alone despite being surrounded by a community of incredible women, family, friends, colleagues. So it's like I think that pain and the hormonal shifts too can create this sense of alienation even when you have wonderful people at your fingertips. So it's just an interesting thing that I do think happens in these traumatic transitions.
Aviva: It's that dark cloak of cloud of grief that makes us self-isolate, I think.
Jessica: Exactly. It's like, and also just because the platitudes come rushing in, even from your best friend, even from your mom, people who you think get it, and you thought you got it, but you had never been through it until now, and then you're like, oh, did I ever say something like that to somebody who had a miscarriage?
I understand why people get it wrong, because everyone's just trying to be loving and supportive and helpful, but saying stuff like at least you're young, you know, can get pregnant or God has everything happen for a reason, all of these things. And then when I was diagnosed with breast cancer, no, I did not feel a sense of body hate or shame, and I do hear a lot about my body failed me. I didn't feel that way at all with my miscarriage, especially. In fact, I felt like, wait, my body knew that there was a chromosomal abnormality and therefore ended the pregnancy. And so that almost felt like it made it easier on me. I didn't have to be the one to make a decision because I was going to have an amniocentesis two weeks later.
Then with breast cancer, it was determined that I have a gene, not the BRCA gene, but another gene check to that people don't seem to know a lot about, and it's in my family, but I am the first woman to have breast cancer in my family. So that's why it was so surprising.
So learning about the gene actually helped me not feel any of the shame or self-doubt, or did I drink too much during the pandemic or did I have too much coffee or whatever people seem to think can create either pregnancy loss or cancer, whatever. I didn't go down those roads luckily, but I found that all of this warrior language that came my way when I was diagnosed with fighting breast cancer.
Aviva: Yes, yes, I know.
Jessica: What are we talking about? I'm not a lawyer. I'm showing up to my appointments. This isn't a choice. So I think it's interesting, and again, this came from mostly women, but I think we so badly don't want to see our loved ones suffer. We too do not want to have to imagine losing that person. Just like with pregnancy, we want to think, oh, you'll get pregnant again. Of course you will.
And it's interesting though, because the language that surrounds it sort of diminishes the intensity or the complexity of the situation. So you're a warrior as if you're going to battle with your body.
I have a lot of feelings about all of that language, and it doesn't resonate with me at all because if anything I've found that I needed to choose to kind of lean into this time in my life, not into cancer, not letting it take over my body, but meaning I need to be really present for this, and I don't want to think of it as a fight.
I want to think of it as I'm going to do the things that I need to do to be well, and I want to rest and actually take care of myself through this arduous process. I find the language antithetical to what we really need. I think what we really need is nurturance. We need emotional intimacy. We need connection, and we need to break this pattern of silent stigma and shame so that we can actually love ourselves through these challenging times.
Aviva: You talk about female friendship deeply in this book, and another really important piece of this is the loneliness. And we know from studies now that loneliness for women is more significant, a predictor of a heart attack, first or a second heart attack, then diabetes, smoking, obesity combined. This is big. So talk to us about female friendship and loneliness and the intersections of those.
Jessica: Oh, wow. Yes. So in the book I include, and these are all sort of, you could say fictitious patients. They're not based, I mean, they're based on…
Aviva: I call them amalgamations.
Jessica: Exactly. And I'm sort of talking in the friendship chapter about when connections go a little awry, what do we do? And that can even be, they can be historical friendships or it could be somebody has close friends in a particular city and then moves across the country for a job, and then they're sort of, yes, you can FaceTime, but you can't really go out to dinner on FaceTime.
So it's finding new community and establishing that and how the loneliness can eat us up. And again, this can bleed into motherhood, right? Because in motherhood, even if you've had this sort of longstanding cadre of women in your life, motherhood can kind of consume you to the point where you're home all the time or you're not able to go out, or you're breastfeeding or you're sleep deprived, all the things that make it difficult.
So yes, I think that female friendship – can we dare to when things don't feel good in those relationships that mean so much to us that are the core of our existence at so many points in our lives – can we talk about it? So, it's like my hope with this book is to normalize talking about the things we don't talk about.
And one of those things is the complexities of relationships and daring ourselves to be vulnerable enough to say, Hey, I love you and here's all the reasons why. And when you said you're a warrior, you're going to get through this. Here's why for me, that doesn't sit well. Or I mean, maybe that's not how one would say it, but I'm just trying to think of an example and see where that takes us. Because see, my hope is that we can change culture just ourselves, just with our friends, just with our families, just in our small groups by doing these very things.
Aviva: I think friendship is so interesting. The friendships that I forged when my kids were little and we were raising kids together were so powerful. I mean, I can just call up so many different images of a friend bringing me food after a baby was born, or me being there with a friend during her birth or the kid having a fever and calling the friend because all the things then some of those friendships are still active in my life, but in some of them circumstances changed. I moved, they moved.
And it can feel like a failure, but also recognizing that you can have somebody who you hold really dear in your heart and in your memories, and you'd still drop anything from them if they called you and they needed you tomorrow, but who aren't necessarily active in your daily life anymore. And that that's not actually a failure. That's sort of like a…
Jessica: …natural evolution.
Aviva: It is a natural evolution, and especially in a culture where many of us do move and things are more transitional.
Jessica: I think the problem comes when maybe we don't have enough emotional intimacy that's accessible to us. And we do begin to feel this incredible crushing loneliness.
Aviva: And I do think it takes effort. I live in a place now, and I've lived here for 12 years now, but when I moved here, my kids were already grown and out of the house. So, it wasn't like we moved into a community where my kids were in school and were not part of any religious affiliation. So it wasn't like we were joining a church or a synagogue or mosque.
And so forming friendships has to be intentional in a different way often for many of us at a certain age. And what happened for me interestingly, was I actually read Barbara Ehrenreich’s book, and I apologize, I don't remember the name of it, but she wrote it in her later years about how when she got to a certain age, her 70s and 80s, she had a group of women that she was close with. They did something together once or twice a year in an away trip. But by that age, quite a number, not to be morbid, but quite a number of their husbands had passed already, or partners had passed, usually their male partner. That is common for women to outlive a male partner and how those friendships were the rock in her life.
And I was living in this community, and because my work is very national and because I have lived a long life where I have friends from other places I live who are my “ride or die” people, even if they had become more… we Zoom regularly, we talk on the phone regularly, we text all the time. I hadn't built that local community of deep friends.
I woke up in the middle of the night one night and was really struggling with my husband's 10 years older than I am. Not to say he would pass before me, but statistically I would live longer. And I live rurally. And I was having a little bit of, I wouldn't say panic attack, but an overwhelming sense of dread about this. I actually got up and I got out my journal. I actually had this thought of, oh, it's miserable….
I'll be up at three in the morning. And then I was like, no, wait. Buddhists say that the best time for meditation is at three in the morning. And a lot of monasteries, people get up and meditate at three in the morning. So I'm like, all right, I'm going to use this time intentionally.
I got out my journal and I wrote pages and pages of presenting the problem to myself, not… but presenting my feelings to myself as if I were my best friend and saying, okay, what can you do about this? And I became deeply intentional about reaching out to and spending time with the women in my community who I had formed a relationship with to intentionally deepen those relationships.
And yes, sometimes it meant I didn't feel like going out in the evening after a full day of work and teaching and seeing patients, but I needed to do that.
Jessica: Yes.
Aviva: And boy, it has really been transformative in my wellbeing to have done that.
Jessica: That is so wonderful. And to have that realization and then to act on it is so…. Well, I look forward to doing that at some point when my kids are not here. I know because my son is 16, I actually think about this a lot because I can feel his graduation at my fingertips, and I want to really make the best of now and make sure to do all the things before he leaves for college.
And I also find myself thinking about looking forward to more time with my husband as well, because once there's kids in the mix, I mean, I have found such a change, obviously in the relationship in terms of you become kind of co-managers or totally or whatever. And so I look forward to having that sort of unencumbered time where we can just play and be together.
Aviva: It's really sweet to have that. It's pretty special. And now we've had 10 years of it or so more so it's funny. I mean, we so love it when the kids come home and they're home for however extended, we're like, we love it. I go right into mom mode and I'm cooking and I'm suspending all my work. I just want to be present with them. And then when they go, we're like, Ooh, we're back to ourselves. And we kind of love that. It's fun.
I would love to dive into something that I've talked about quite a bit on the podcast probably because I think that not just so many women do experience this, but I am not even a recovering perfectionist. I like to pretend I'm a recovering perfectionist, but it's something that definitely impacts me. And perfectionism shows up in so many ways. It's body image. Our body's perfect.
Did I have the perfect pregnancy? How is miscarriage a reflection of our perfectionism? How is having breast cancer? I've had patients who have had breast cancer and had a mastectomy, even a lumpectomy say, I don't feel like a woman anymore because I don't have what is considered parts of a perfect woman.
Jessica: Definitely.
Aviva: How do you experience perfectionism? Or I'm assuming you do since you wrote about it in the book.
Jessica: Well, that's an deep and important question. I have to think on that. Do I struggle with perfectionism? I feel like from the dynamics of my family, I think that I wanted to be the good kid. My sister was a bit of a more rebellious type, I guess, and she's older than me.
Aviva: …The hellion of the family.
Jessica: She isn't now at all, but way back then. So I think in looking at that and seeing my family's response to it, I think inevitably I sort of fell into a role of I'm not going to make waves. I'm going to make it easier. I'm going to comfort people. I mean, I guess it's no wonder this is my job, but I guess that could be seen, I guess, as a version of perfectionism. I think motherhood has humbled me to no end.
And just in terms of I'm never going to do this perfectly. And my goal in motherhood, to be honest, and I evaluate this a lot with myself, it's like my aim is to do better than my parents did, and to have them know that they are unconditionally loved and that I am here to talk about anything. So it's like, yeah, once in a while I'll raise my voice if my son isn't listening or I'll still find myself doing things that I'm not proud of.
Aviva: Things? You mean human mother.
Jessica: Yes, like the human mother thing. But I really try to come back to does he feel loved through and through? Does he feel confident and comfortable coming to me to talk about anything? It seems he does. I mean, you just don't know, but I feel like how do we sort of wrestle with perfectionism?
Aviva: What made you include it in the book as a chapter, a primary chapter?
Jessica: Well, because I think in our culture, it is one of the most antithetical to our mental health, to our own personal thriving. We are told from the get go, we see images on billboards, on Instagram, on TikTok of the we're supposed to have, of the faces, we're supposed to have the outfits, the lifestyle, the whatever.
And so I think that whether it's born out of family dynamics and feeling a pressure to be a certain way or cultural pressures, it's ubiquitous. I mean, I feel like we're hard pressed to find girls who don't sort of veer in that direction even for a time. And even with my own children, my son is not hard on himself the way my daughter can be. And so she'll get upset that she got one word wrong on a spelling test.
And I'm like, is this coming from, I don't say out loud, but I'm just like, why is she expecting herself? Why does she have to get it right all the time? And so I try to understand it in her, is it from looking at me? Sure as f hope not. And is it sort of environmental? Is it what she's seeing at school? Is it what she and her friends are talking about? And could it be the pressure from her female teachers? It's so hard to know.
Aviva: Yeah, it is. And it's interesting too because you were saying that in your family you took on to simplify it, kind of the good girl or the peacemaker role. I think that for each of us, sometimes our families of origin, our stories of origin push us into these roles. And for some people it is the peacemaker. For some people it's perfectionism.
Jessica: Yes,
Aviva: There are these sort of different survival modes, if you will, that we get into that kind of shape our lives. I'm wondering, I mean, you do a lot of really deep and profound work in perinatal psychology, women's psychology.
What are some of the themes that you feel right now are kind of putting wind in your sails that you feel like, wow, I'm seeing this over and over and I would love to see women be able to not feel this way or heal this or the strengths that you're seeing?
Jessica: I mean, the truth, it's like every single topic we've touched on today, I mean, it's like for me, the most disheartening is the shame after pregnancy loss or the shame in perinatal and postpartum mood and anxiety disorders. I don't know. I'm just like, no, this can't persist.
Aviva: I was at a conference teaching a few years ago when I got there. There was a whole line of young mamas and women waiting to meet me and have me sign their books. It was very sweet and very lovely. And one of the mamas in that line, I'll never forget, she came up to me. She had a six month old baby.
She started crying, and she said she was in a natural mama online group, and she had a long and difficult labor, chose to have an epidural and ended up with a cesarean, and she was kicked out of the mom group. She was kicked
Jessica: Out. No, I mean, it just makes me enraged. And yet, it's not surprising, but this is where I get sort of like, what are we doing when women are turning on women? I mean, that's a whole book in itself, but it is, it's like this binary view of birth has got to stop, right? It's like, oh, natural or not natural. It's like, wait,
Aviva: Well, there's a value signaling or virtue signaling. The part that I struggle with is we do know that there is a significant overuse of intervention. There is a significant overuse of cesarean. How do we educate and talk about that without adding to shame or adding to the binary? And why does it have
Jessica: To be shameful?
Aviva: It doesn't. It shouldn't be.
Jessica: And it's like to not want to physically be in pain is a choice. Somebody wants to make that choice, let them, and if they call that a natural birth still, then it is. And I don't know, I think all this pressure around having an unmedicated birth or feeling ashamed of a C-section
Aviva: Success around breastfeeding
Jessica: Using that term success. Exactly, exactly. It's interesting because with my son, I had thought I wanted an unmedicated birth. And then the Pitocin, it got too intense and I wanted the epidural, and it was fabulous. And again, I mean this is sort of a trigger warning, but I don't use that phrase, but in case anybody's listening that doesn't want to hear this. So my miscarriage was home by myself.
The fetus came out and my OB, GYN, instructed me how to cut the umbilical cord myself over the phone. I was too scared to call 9 1 1 and have fire people, men running through my home that I didn't know with my pants down and whatever. So it was too sort of intimate a situation. I didn't want that if I could avoid it. And then my husband came home and we got me to my doctor's office, and I had to then undergo an unmedicated DNC.
Months later when we decided to try again, it did become very important to me to have an unmedicated birth with my next child. Again, though it was a personal thing. It wasn't because it was like, Ooh, interventions are bad. Or like, Ooh, I'm not successful if I don't, whatever. It just became for me this way of, I went through the pain of an unmedicated DNC, and that was an ending.
And I wanted this next sort of pain to be about a beginning, and I wanted to feel as present for it as I could. Not that the medications make you feel not present, but I just wanted to physically be fully there. And that happened. But I never think of my births in this binary way. Like, ooh, the one with my son was unsuccessful and the one with my daughter was successful. I just think that we are creating more silence, more stigma, more shame.
Aviva: I want to have a whole other conversation with you someday about retelling our stories and how we can use storytelling for healing.
Jessica: Yes.
Aviva: But you are a real doctor, as am I, and you have patients in meetings and things to get to. But I want to ask you one question before we go, because I asked this of all my guests, and I have this dream of this compilation of these questions. And so here's the question. If you could tell your younger self anything, how old would she be and what would you say?
Jessica: Wow, you've stopped me in my tracks sometime in the teen years, like 11 or 12 or something, I think, and I don't know. I'm going to get emotional. Like what? My first thought is to say, you're going to go through hard stuff, but you will persist. But it's like, I think the main message is really stay true to what you believe in.
Stay the course in terms of trying to make this world a better place and do what you can to make a dent in the cultural problems that even then I sort of identified. And I think I am doing those things in my career now. Luckily.
Aviva: Thank you. And this conversation and your honesty and your transparency, and for all so many women, you're helping to realize that they're not alone.
Jessica: Thank you so much for having me. This has been wonderful.
Aviva: An absolute pleasure. Thank you for joining me, everyone, for this powerful conversation about not living in silence and shame and for creating spaces where we can normalize talking with each other. And I'll see you next time. I hope you enjoyed this episode, that it helped you to feel seen and heard, and perhaps that it even brought you some aha moments.
