13646 Chapters
Medium 9781780491653

Chapter Seven - The Perinatally Depressed Couple and the Work of Mourning: A Development Imperative

Karnac Books ePub

Molly Ludlam


In this chapter, I focus on the impact of perinatal depression on relationships in families and especially on couple relationships. Such is the cumulative effect of the timing of this experience in a couple's life, I want also to suggest that their relationship itself might sometimes be considered to be “depressed”.

My interest in this subject emanates from meeting a number of couples who were expecting a child or who recently had become parents. They had come for couple psychotherapy because depression was preventing one or both partners from enjoying together life as a couple, and life as parents.

We know that a couple's relationship is most vulnerable and most likely to break down during pregnancy and their children's infancy (Cowan & Cowan, 1992; Shapiro & Gottman, 2005; Twenge, Campbell, & Foster, 2003). This is the time when the couple has to manage a number of demanding developmental tasks in order to grow as individuals and as a couple. It is generally understood that anxiety and depression are commonly experienced by new parents. The increasing recognition of maternal “postnatal depression” led, in the latter part of the twentieth century, to the development of special treatment programmes for new mothers. Nevertheless, it has recently been estimated that pre-natal depression now affects one in ten women in the UK, and that mental health problems constitute the largest identifiable cause of death in the perinatal period (CEMD, 2001). Enquiries such as Why Mothers Die (CEMD, 2001) question whether depression experienced by women during the perinatal period differs significantly in its characterisation from depressive illness at other stages in life. Thus, we might now wonder whether the term “postnatal depression” has not only served to obscure the whole nature of mental health problems in the broader perinatal period, but also whether it has fostered an undue focus on women. Furthermore, might any such focus on hormonally triggered illness have been reinforced by societal anxieties about the catastrophic consequences of breakdown in new mothers? Increasing reports of paternal depression (Cox, 2005) now add to a wider picture and might enable us to define a couple context for this phenomenon.

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Medium 9781912567126

9. The Borderland between Dreams and Actions

Meltzer, Donald Harris Meltzer Trust ePub

If we are to be faithful to the model of the mind defined bv the extended metapsychology of Klein and Bion, we must assum that the dream process is the foundation not only of our view-of-the world, and therefore of mood, but also that every dream is an attempt to solve a conflict which, while primarily an internal world matter, has implications for behaviour in the outside world. It is clear that individuals differ widely in their capacity to utilise thought as a mediator between impulse and action; some indeed seem to overreach its utility and replace action by thought, so that impulse finds no expression in the outside world. From that point of view the aim of action to modify the external world so that it more aptly meets the individual's requirements, or at least his desires, is lost in internal world modification.

In understanding the place of dreams in our lives, or rather the relation between our dream life and our total life-process, we need to address ourselves to both aspects of this problem – denial of psychic reality with its reliance on experimental action, and retreat from external reality with its many forms of withdrawal. Some where in between the two ends of the spectrum of the mediation by thought between impulse and action, lies the realm of art—science where thought is content to act in the service of knowledge of the outside world without necessarily intending its modification. There is good reason to think that lovemaking in its most developed form belongs to this art—science area. I have chosen this middle ground between acting-out and withdrawal, between excessive and inadequate transformation of dream-life into action, as the most fruitful area for investigation of the problem. But what, in fact, is the problem?

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Medium 9781855750869

34. The Dream of the Occlusive Pessary. [1915]

Ferenczi, Sandor Karnac Books ePub

A PATIENT recounted the following dream: I stuff an occlusive pessary into my urethra. I am alarmed as I do so lest it might slip into the bladder from which it could only be removed by shedding blood. I try, therefore, to hold it steady in the perineal region from outside and to force it back or to press it outwards along the urethra… . Here it struck him that in a dream fragment preceding this dream the pessary was stuffed into his rectum. Supplement: in the dream I was aware that the elastic thing would spread itself [sic] in the bladder and then it would be impossible to get it out again.

To the patient who is otherwise quite a masculine person, this dream in which he—like a woman—takes precautionary measures against impregnation seemed quite nonsensical, and he also was curious to learn whether this painful dream was a wish-fulfilment.

Asked for the actual conditioning of the dream he at once related:’ I had an assignation yesterday. Naturally it was the female partner and not I who took precautionary measures; she does actually protect herself from consequences by means of an occlusive pessary.’

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Medium 9781855758469

CHAPTER TEN: Towards a therapy without foundations

Loewenthal, Del Karnac Books ePub

Del Loewenthal

In this book, we have argued for the place of practice at the heart of psychotherapy. This aim can be seen as stretching from the time of Pyrrhonian scepticism to, more recently, the writings of Wittgenstein, where post-existentialism can be understood to be more about the activities in which we participate with our clients/patients. There is therefore an increasing body of opinion showing the futility of theory as the basis of the psychological therapies and, with it, what is currently regarded as research. But the psychological therapies are also cultural practices, and this book is an attempt to reformulate an understanding of meaning as contextual and emerging through psychological therapists and patients having social intercourse.

Thus, how we understand such emerging meaning will be mediated by cultural practices through the mixture of ideas that permeate our society in any period. This book is therefore an attempt to put the case for what is termed “post-existentialism”, by defining a potential cultural moment in contrast to the positivistic, managerialist, audit culture that currently pervades. The hope is that the implications of examining meaning, through post-existentialism, show how such enterprises can never have a foundation. The book is therefore written to increase the possibility that what is termed “post-existentialism” will help psychological therapists start with practice and will enable them to help their patients/clients. Thus, not only CBT, but any therapies whether they be humanistic, existential, or psychoanalytic, which become totalizing moves, are potentially violent. At best, such theories are secondary and, whilst they may have implications, they can never provide a foundation to the primacy of practice.

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Medium 9781855758438

CHAPTER EIGHT: “The Sleeping Beauty"-the advent of the feminine sphere in girls

Schaeffer, Jacqueline Karnac Books ePub

“That astonishing patience that allows them to wait for the moment of true love; for years on end, their genitals are both ready and silent.”

(Emmanuel Berl, Meditations on Departed Love)

Although the aphorism “one is not born a woman, one becomes one” (de Beauvoir 1949) has won universal acclaim, how and why one becomes a woman are questions that will never cease to puzzle us. Experience and clinical practice both point to the existence and destiny of a double component: the maternal feminine sphere, and its erotic feminine counterpart. Like narcissism and eroticism, they do not get on well together. Some degree of friction seems to be necessary at certain stages of development of the young girl's libido, in relation to her mother's maternal and erotic feminine dimensions. We can only hope that this friction does not turn into splitting at any point, so that some reconciliation may be possible in the girl's body and mind—the condition for her becoming one day a woman and a mother.

I deliberately intend to leave aside the whole question of what is transmitted to the young boy of his mother's maternal and erotic feminine dimensions (Bokanowski 1993). The way in which the mother consciously and unconsciously cathects the sex of her child leads, in very early infancy, to the difference between the sexes and to the vicissitudes that both boys and girls will come across as to their own sexuality. Focusing on the process by which transmission according to the female line takes place implies exploring what “passes” from the mother's mind and body to those of her daughter, that is, between two people of the same sex, one of whom is issued from the body of the other.

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