HOSPITAL PRESENTATION - March 2002
Today, I was invited to speak on a subject both disturbing and sad. Ana Aeschleman, Director for a Safe Haven for Newborns, invited me to present a paper exploring the psychological make-up of young girls or women who abandon their babies after going through a full term pregnancy. Since I didn’t have a clinical example from my caseload, I gave this request considerable thought. I was initially reluctant to come here to address an audience of my colleagues on a subject I had only read about in the newspaper. Over the past few years, our community has reported several tragic incidents involving this theme. Perhaps you can recall hearing about a new born baby discarded in a gym bag at a Dade County bus stop, or a Broward infant thrown into a canal, or an Indian River infant who was found in a drainage ditch by an orange grove.
It didn’t take long after receiving this invitation for my mind to begin considering the psychological underpinnings which might prompt a teenager, college student, or young adult to engage in this act of infant abandonment often resulting in death. I wondered what caused these women to venture into this dark and murky territory and realized a multiplicity of factors had to converge to bring about this unimaginable conclusion. What could have happened to subvert the miracle of life into an experience that comes across as a callous dismissal? What made these women turn away from wanting to cherish and protect their tiny infants?
I hope to present today another way of thinking about these severely emotionally disturbed, traumatically frightened, fragile, and isolated young women. What would lead a young woman to deny the existence of her pregnancy and disavow the growing fetus inside of her? Stories in the newspaper as well as journal articles describe how these women starve themselves of nurturance, how they wear baggy clothes to hide their uncomfortable growing shapes, beside isolating themselves from family, relatives, and/or peers. Why is there a compulsive need to draw attention away from themselves if not to rid themselves of the growing evidence? If these young women actually believed in their hearts and minds that emotional support did exist for them, and that someone understood how desperate and all alone they felt, then Florida’s Safe Baby Act and Project Safe Haven for Newborns probable would not exist today. Our community is fortunate to have Mr. Nick Silverio make this his personal crusade and donate his time and money to help fund Project Safe Haven.
Several weeks ago, I learned that nineteen infants have been brought to one of Florida’s designated Safe Haven, which is either a hospital emergency room, fire station, or EMS station. For any newborn up to three days old infant, this option is a safe and anonymous solution, and for the mother it offers immunity from criminal prosecution. Although this Florida law has been on the book from two years, it seems we are just in the beginning phase of informing our local citizens. It is going to require continual grants, donations, public service announcements, and twenty-four hour hotlines to prepare the mental health community. We must educate school administrators and teachers in learning how to raise public awareness. All of which may well become the first line of defense to help these troubled young girls before they engage in their alarming solution to an unwanted pregnancy.
The question becomes, how could such an event happen, especially in this day and age of nonstop 24 hours a day telecommunications. Furthermore, over the past decade we have witnessed a remarkable increase both in voluntary and involuntary exposure to provocative and explicit sexual material on television, in movies, and music videos as well as frank talk about abstinence and prevention. Yet, ironically with all of the openness regarding sex education, these young women have somehow transformed their sexual encounter into an unspeakable taboo.
At this time, I’d like to begin with a brief historical overview. Actually, there is much that could be integrated starting with concepts from attachment theory, developmental psychology including adolescent development, dissociative disorders and trauma theory. I will restrict my talk today to concentrate on the realm of the defensive mechanisms, to highlight how these women behave in order to survive.
While killing one’s newborn is an extremely difficult subject to comprehend, murdering an infant dates back to antiquity. Reasons have included, “population control, illegitimacy, inability of the mother to care for her child, greed for power or money, superstition, congenital defects, and ritual sacrifice” (Radbill, 1968). “Neonaticide, is defined as killing of a neonate on the day of its birth.” This term is differentiated from filicide which is regarded as the murder of a child older than twenty-four hours (Resnick, 1969). Primarily, for these young women the focus has been on the sociological and legal aspects, with less emphasis on contributing factors and underlying psychopathology. These pathologies include the effects of childhood trauma, including sexual abuse, the family constellation with its dysfunction, and ways in which communication between members becomes unconsciously avoided or colluded. In the latter scenario, warning signs are not seen. In regard to the few clinical case reports, symptoms cited included massive denial, psychoses, and the dissociative disorders. Yet, the psychological research literature has been quite sparse. Brozovsky & Falit (1971) reported that in 1967, 45.7% of children murdered during the first year of life were killed in the first 24 hours. One of the most important reviews was conducted by Dr. Phillip Resnick. His article, entitled Murder of the Newborn: A Psychiatric Review of Neonaticide, reviewed the world literature on child murder from 1951 to 1968, citing thirty-seven cases of neonaticide compared to 138 cases of filicide. Dr. Resnick felt the primary motivation for neonaticide was illegitimacy, or the fact the child was unwanted, with denial of pregnancy a common accompaniment. Dr. Resnick also identified two subgroups within his study; the largest group being “sexually and emotionally immature women, under strong social or parental pressure against an illegimate child, who make no premeditated plans to kill the infant following birth.” The second group consisted of “strong-minded women who plan the death of the baby before it is born, with little moral concern for their actions.” This study has been confirmed by other researchers including d’Orban (1979) and Wilkie, et al. (1982) although as you can see these studies date back at least twenty years.
Why has this very deeply disturbing facet of human nature not received as much attention? Perhaps, because it is so rare. Yet as a society we too reenact the family trauma and turn a blind eye in order not to see what needs to be seen. What would lead a young mother to act with unimaginable destructiveness and transgress the sacred realm of the infant-mother dyad? Although it is hard to imagine, we need to try to comprehend what factors lead to this terrible conclusion. What are the unconscious factors and motivations? Or, what led to the loss of rational thinking, the disinhibition and splitting of conscious reality in order to engage in a delusional act? How could what was conceived in a moment of romantic or idealized love, heightened passion, or raw sexuality become subverted and perverted in this twisted, and destructive persecutory fate? One can certainly propose that there must me a myriad of reasons leading a woman down this tormented path of separation, loss, isolation and alienation, along with unbearable feelings including anxiety, fear, shame, and guilt. What might constitute the fears of these young women; is it the fear they will disgrace and dishonor their families by acknowledging and exhibiting their pregnancy? Is it their terrifying fear of rejection and abandonment, that their family will be unsupportive and unforgiving, abandoning them? If so, perhaps this is then transferred and displaced onto the unborn child? Or, could it be their disgust at themselves for losing self-control and succumbing to unbridled temptation? Perhaps it is a result of their utter rage that their bodies betrayed them for guilty pleasure at the moment they wanted secrecy from their family and world? Could cultural and religious factors heighten their fears and hatred for this unplanned and unwanted outcome? Perhaps some women yearning desperately for love, not realizing their act for an idealized union could potentially lead to procreation. Whatever their unconscious motivations were, their mind’s defensive structure became solidified in such a pathological manner that enabled these women to carry on physically and psychically this painful burden for nine months. And a secret so shameful and guilt-ridden that paradoxically becomes both dissociated and consumed in their minds and bodies waiting for the time when the fetus/object can be expelled. No matter what the intrapsychic dynamics, early childhood experiences, or repressed traumatic events as well as external factors (i.e., unsupportive family relations, religious upbringing, moral beliefs, etc.) somehow play a role in the resulting disturbed phenomenology. They all converge into one overriding reaction: which is what leads these women somehow all arrive at a decision that their survival is based upon eliminating or ridding themselves of their own infant.
And so, in the remaining time, I would like to address the defense mechanisms as they give insight and clues into the pathology and observed symptomatology of these young women.
PRIMITIVE DEFENSE MECHANISMS:
These young women learn to live with the tormenting horror of their unacknowledged act by relying on a constellation of primitive defense mechanisms as a way of coping with what they cannot bear. Defense mechanisms protect or defend the individual against some kind of threat or danger hence the term “defenses.” In other words, these individuals need to defend against some unacceptable or “repressed wish, idea, or feeling that has been associated with some real or fantasized punishment” (Moore & Fine, 1990). Additionally, due to the fact the individual cannot bear the painful anxiety, shame, guilt, or depression, these unacceptable thoughts and feelings are kept from erupting into consciousness. Hence, the defenses operate unconsciously, meaning there is no awareness these are being employed to ward off the danger. The defenses I will refer to today are considered “primitive” or less mature. These less sophisticated defenses operate globally and “involve the boundary between the self and the outer world.” (McWilliams, 1994); whereas the higher order defenses deal more with internal boundaries (such as what is going on intrapsychically, between ego and id or between the observing ego and experiencing ego). The primitive defenses include denial, primitive withdrawal, omnipotent control, repression, projection, and introjection, and splitting. I will discuss each in the context of how they are adapted to seemingly protect yet also alienate these young women.
Denial – This involves the refusal to accept what has happened. Here the ego avoids conscious awareness of an aspect of reality because it fosters too many unacceptable feelings. The persistence of denying one’s pregnancy over nine month time frame constitutes a serious problem. Ignoring the stark reality of one’s pregnancy is very dangerous, as this entails not participating in prenatal care, but also in regard to the absence of an emotional and mental attunement to the developing fetus developing inside the mother.
Repression – This involves somehow expelling, withholding, or forgetting the accompanying idea or feeling. What was once experienced is now no longer in one’s conscious mind. For example, symbolically delivering the baby could be unfortunately equated with the desire that the mother finally was able to expel the unwanted child (aka) perhaps perceived as a foreign object (it is put in those terms, as the mother would be emotionally detached from the infant’s humanness) and would finally be rid of what she could not bear to think or feel.
Primitive Withdrawal – Here the woman removes herself from social and interpersonal situations, and instead retreats into a world of fantasy to cope and self-soothe. Shrinking from personal contact may be one of the hallmark characteristics of a defense used by these women. Yet, hiding from the world forecloses the opportunity to either ask for or receive help, but it does not eliminate the problem. While these women may feel this is a necessity, their reality becomes a distorted nightmare as these individuals console themselves by retreating from others rather than reaching out at a time when they need it most. Their fear that the world is an unsafe place becomes reinforced as they wind feeling all alone and unsupported.
Repression is known as “motivated forgetting.” Doesn’t it make sense that these women are indeed motivated to mentally expend a tremendous amount of energy in order to forget their sexual encounter and the resulting outcome. These individuals are tormented and need a way to erase their past actions. Since they cannot bear the harsh reality, they have to block all available memories from consciousness.
Dissociation – As reported in the literature, dissociation is an understandable reaction to trauma. If someone has been traumatized or has witnessed a life-threatening experience, the unimaginable pain and/or terror experienced can prompt a dissociation. We know young children learn to dissociate following repeated incidents of abuse as it enables them to stop feeling the emotional pain and overwhelming fear that accompanied the event. In the context of being faced with an unwanted and unacceptable pregnancy, the advantage of dissociation is obvious as it cuts off the individual from the unbearable emotional distress that otherwise would be experienced. However, being dissociated from one’s feelings can greatly affect one’s personality, and under extreme duress can lead to delusions, hysteria, and possibly psychosis especially if contact with reality is lost.
Projection can be a difficult concept to explain, as it is subjectively experienced. It is based upon a disowning of one’s attitudes to where they are somehow seen or regarded as another’s perceptions and beliefs. However, this is a gross misperception. In this context, the pregnant woman may subjectively feel as if her unbearable negative feelings of shame, guilt, dishonor are really coming from others around her rather than realize the thoughts and feelings are coming from within her own mind.
Introjection often involves an indentification, and in this context, it is an identification with an aggressor. By that, the young woman tries to master her pain and feelings of fear and helplessness by taking on qualities of some aggressive figure in their life, and in doing so, redirects the anger and hostility against herself as an unconscious self-punishment. It is as if the woman feels she should suffer for what has occurred and she deserves whatever emotional torment she puts herself through. Here she treats herself the way she expects she would be treated if discovered.
Splitting of the ego is a fundamental defense mechanism as it is used as a way to make sense of complex situations that appear both confusing and frightening. Here the events are converted into situations that are either “good” or “bad”. Being able to use this defense is an effective way to reduce anxiety and maintain one’s self-esteem (McWilliams, 1994). However, it also creates an unfortunate disturbance and distortion, leading to all kinds of interpersonal and intrapsychic problems.
Pathologically, what ensues in these circumstances, is that the young woman feels herself either to be fragmented due to not having a secure sense of self based upon prior experiences in her life. Rather than being able to draw upon her own emotional resources to ease her distress and become her own source of support reassurance, she is unable to effectively soothe herself. This is due to the events in her past where caregivers either were unempathic, unpredictable, or emotionally unavailable to help the individual adequately transform painful experiences into adaptive ways of coping. Thus, one of the conditions leading to the use of splitting as a defense is the unavailability of an external support system that cannot be internalized to provide a similar function.
In this overview, it is hoped that you have a better appreciation and understanding of the phenomenological characteristics of these disturbed pregnant women based on theoretical evidence. As you can see these individuals need to be treated with great sensitivity and care since they would be very reluctant and resistant to believe in the authenticity of a caring human being who wishes to be of some help.
Therefore, in order to assist in the prevention of infant mortality, we need to be proactive in raising the level of public awareness. Teachers, neighbors, parents, friends, mental health professionals, all need to take a more proactive, yet sensitively attuned stance to enlist the trust and confidence of these young girls. Foremost, these terrified females need the protective guidance of another who can lend a helping hand to extract them from the hell they have descended into. Of course, the families need to be better educated regarding the warning signs and communicating with their offspring about sexual education and prevention. At this time, it is up to other well meaning and caring individuals to come forward and assist each deeply emotionally and mentally disturbed young pregnant girl.
Furthermore, once the psychopathology is identified, psychotherapy is essential as a tool to aid in assessing, diagnosing, and treating the manifest symptoms and underlying psychopathology. Once in treatment, the role of the family needs to be incorporated in either family or marital therapy. A component of the parent’s therapy can include outreach to assist in their daughter’s prenatal care, parenting classes, as well as helping her not forfeit her education; as well as help her sort through and consider constructive alternatives.
Yet, in the absence of treatment, these young girls who become pregnant, yet cannot accept this reality, are destined to wind up in purgatory from which there is no escape.
Brozovsky, M., & Falit, H. (1971). Neonaticide: clinical and psychodynamic considerations. Journal of the American Academy of Child Psychiatric, 10: 673-683
D’Orban, P.T. (1979). Woman who kill their children. British Journal of Psychiatry, 134: 560-571
McWilliams, N. (1994). Psychoanalytic Diagnosis. Guilford Pres: New York, NY. Pp. 96-115
Radbill, X. (1968). History of Child Abuse and Infanticide. In Hefler, R.E. Kempe, C.H., Eds.: The Battered Child. Chicago: University of Chicago Press.
Resnick, P. (1970). Murder of a newborn: a psychiatric review of neonaticide. American Journal of Psychiatry, 126: 1414-1420
The American Psychoanalytic Association (1990). Psychoanalytic Terms & Concepts. Eds., B. Moore & B. Fine Eds. The American Psychoanalytic Association and Yale University Press: New Haven, CT.
Wilkie, I., Pearn, J., Petrie, G., et al (1982). Neonaticide: infanticide and child homicide. Medicine, Science, and the Law, 22: 31-34
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|Shields Speaks Out on Postpartum Depression
After the birth of her child, Brooke Shields sank into depression, but she got help after a year of struggling.
By Beth Levine
The Stamford Advocate
The Herald, Tuesday, May 31, 2005
Brooke Shields has it all: Beauty, a successful career as an actress and model, wealth, brains, a great husband and now a darling daughter, Rowan, 2. Even though Shields has been in the public eye since infancy, she has avoided the drug-alcohol-legal problems that have derailed so many former stars.
So why is this Princetown grad now struggling for composure as she describes what she calls her year of hell on Earth? What should have been the most joyous event of her life, the birth of her daughter, led to her struggle with one of society’s major taboos: postpartum depression?
Shields always wanted to be a mother. She and her husband, comedy writer Chris Henchy, struggled very publicly with infertility treatment and were elated when Shields finally became pregnant. “I had a blissful pregnancy,” Shields says. So it was all the more shocking to her when she sank into depression and despair after giving birth.
At a news conference in New York to publicize her book, Down Came the Rain: My Journey through Postpartum Depression (Hyperion, $26.98), Shields described her ordeal: I felt worthless and couldn’t stop crying. I knew something was horribly wrong but to express what I was feeling was impossible. I tend to power through things, soldier on, so to admit to what I thought was weakness was horrific to me. I felt so ashamed and guilty.”
In today’s society, where mothers are expected to be supermoms, PPD is often considered a luxury afforded only to whiny, pampered women. In fact, PPD is biological, affecting 10 percent of new moms. This is not the normal “baby blues” that 80 percent of women encounter after giving birth.
The difference is severity and duration, says Norma Kirwan, director of outpatient behavioral health services at the Dorothy Bennett Behavioral Health Center at Stamford Hospital in Connecticut. “Many women have a mild depression after delivery. These symptoms generally go away after two to three weeks and don’t require treatment. The symptoms of postpartum depression are similar but with greater intensity and may last up to a year. It really gets in the way of the mother’s ability to function.” Symptoms include crying, irritability, exhaustion, mood swings, changes in appetite and difficulty concentrating. The mother sometimes fears she will harm her baby or herself. The most extreme – and very rare – form; postpartum psychosis is a medical emergency signaled by agitation, bizarre behavior, insomnia, hallucinations and delusions. Andrea Yates, the Texas woman convicted of drowning her five children, suffered from an untreated case of postpartum psychosis.
Postpartum depression is caused by a variety of factors: the drastic decrease of progesterone and estrogen, lack of sleep, lack of social supports and stress. Women with personal or family histories of depression are at greater risk.
Something chemical is happening in the woman’s body that she can’t just reverse by willpower,” says Dr. Devra Braum, a psychiatrist in Greenwich, Conn.
And here’s the rub: Help can only come if the woman knows what to ask for whom to go, how to find the words to describe the maelstrom within. She must rise above paralyzing shame and name the unnamable – not easy considering the ways in which motherhood is glorified. To admit depression can make affected mothers feel weak. “People tend to look at postpartum depression as a moral or character flaw rather that a biological illness or disorder that needs to be treated,” Kirwan says.
As Shields says, “If you had asked me if I was depressed, I would have said ‘no.’” She was too ashamed to ask for help.
The tragedy? PPD is treatable. “Assessment must be done on an individual basis but there are many options such as antidepressants, psychotherapy, support groups, education and lifestyle changes,” Kirwan says.
When Shields sought help after a year of struggle, she responded immediately to psychotherapy and antidepressants. Hence, Shields’’ mission to educate women. “Don’t be ashamed and don’t disregard what you are feeling,” she writes. “I recovered only because I got help.”