Academic journal article Pre- and Peri-natal Psychology Journal

Perinatal Depression in Four Women Reared by Borderline Mothers

Academic journal article Pre- and Peri-natal Psychology Journal

Perinatal Depression in Four Women Reared by Borderline Mothers

Article excerpt

ABSTRACT: As we become more familiar with the continuum of disturbances that are understood as Borderline Personality Disorder, we have come to know more about how the illness affects-and is affected by-other family members. Much less clear is our understanding of what can be expected in the life course of a person reared by a borderline parent. This paper offers a glimpse of that world, by way of reporting on the extreme anxiety and depression experienced by four women-each of whom appears to have been the child of a borderline mother-upon the birth of their babies. Characteristics of the families of origin, the story of each patient's struggle to announce her pain and to seek help (usually surreptitiously, by way of proclaiming worries about the baby), problems in treatment, and risks to the infants will be described. Especially noted will be the ways in which the vicissitudes of life in a borderline family may create not only an unusually attuned mother but also one unable to give credibility to her vague sense that something was terribly wrong in her family of origin-and that it is about to repeat itself in her care of the new baby. The role of the baby as a transference object for self will be seen as critical not only to the assessment of the peculiar qualities of these perinatal depressions, but as a useful element in treatment.

The DSM III criteria for Borderline Personality Disorder are specific, and include eight characteristics: impulsivity; unstable, intense interpersonal relationships; identity disturbance; affective instability; intolerance of being alone; commission of physically self-damaging acts; chronic feelings of emptiness and boredom; and inappropriate, intense and poorly controlled anger. Clearly, not all patients who qualify for the diagnosis exhibit all eight characteristics, and there is a marked lack of clarity in the literature regarding the exact parameters of the diagnosis. Practicing clinicians often acknowledge a kind of borderline continuum, along which patients fall by virtue of their present functioning, capacity to engage in treatment, and the presence or absence of related or secondary disturbances. (Other diagnostic considerations often include major depressive disorders, and histrionic, narcissistic, paranoid and dependent personality disorders.)

Clinicians in the field may first recognize such patients on the basis of the intense countertransferential reactions they evoke in the therapist-". . . using suicide threats, unreasonable demands, and a wide variety of other coercive behaviors to draw the therapist out of a position of psychotherapeutic neutrality and into the roles of caretaker, parent, persecutor, and adversary." (Waldinger et al., 1987, p. 6).

While there seems to be consensus about the critical developmental period involved in the formation of the disorder-the "rapprochement" subphase (Mahler et al., 1975, pp. 76-108) during which the infant struggles simultaneously for separateness and for assurance of the availability, at any moment needed, of reunion with the primary caregiver-there is not universal agreement about how the disorder then forms. Masterson sees that the borderline's primary caregiver was not able to tolerate such movement toward separation and, therefore, gave messages to the child that emotional supplies would be withdrawn if the efforts at separation continued (Masterson et al., 1975). The interpersonal problems the patient experiences, then-as well as the transferences in treatment-reflect real experience (in infancy).

Others suggest that the disorder-and the related transferences in therapy-may reflect gross distortions of childhood experiences by primitive defenses (Kernberg, 1975; Gunderson, 1984) or other deficits: in ego structure, as a result of utter failures in early gratification (Giovacchini, 1979); and in holding-soothing objects, resulting in extreme vulnerability to terror and panic, with no ability to evoke soothing images (Buie et al. …

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