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Pregnancy and the Fear of Separation
Athol Hughes

 

Psychoanalysis can be seen as a process of bringing to life that which is damaged or dormant in the patient.  A pregnant woman in analysis may feel that what is happening in her body corresponds to what is going on in her mind.  I would like to outline some of the anxieties a woman patient in her first pregnancy experienced in relation to the birth of her baby.  They  corresponded to anxieties she experienced in relation to herself in her analysis.  She feared the birth of the baby – that is, its separation from her – in much the  way she feared separation from me in the analytic work.  Although she was very confused at times about whose baby it was she was having, hers or mine, at other times she could see that by having a baby she was demonstrating her separateness from me, she was having the baby, not me.

Mrs L was 22 years of age when she started analysis with me.  She came because she felt inadequate and was confused about many aspects of her life.  She felt that she was unable to use her intellectual abilities to their full potential.  She had come to this country from another for further studies in her field of work, which was connected to political science.  Her parents, both alive, were professional people, quite supportive of her.  She was the oldest of three children, and in her early years she had a close almost exclusive relationship to her mother.  Her father was away for most of her first two years.  When he returned from work abroad, the two year old had to adjust to his presence and then further adjustments were required of her with the birth of a brother when she was three years old.  Another brother was born in her eighth year.  She had no memory of either of her mother’s pregnancies.
     Two years after starting analysis with me she married a man a few  years older than she.  They did not want a baby in the early years of their marriage but were pleased when, after three years, Mrs L became pregnant.  By then, the extent to which she lived through others in states of projective identification, with little contact with her own feelings, was becoming more apparent to her than previously.  She had also begun to understand how she dreaded separation from those whom she lived through.  Separation threatened her with the knowledge of how empty she felt.  At times the threat of such knowledge made her feel panic stricken.  To avoid such feelings she resorted to major defences of splitting, projection and denial.

 Doubting was also a pervasive part of her personality.  It became apparent in the analytic work that the contradictions and confusions from which she suffered were the consequence of the ways that she lived through others.  This process also contributed to her intellectual inhibitions.  At times in our work she might express satisfaction about some increased understanding;  then she would start to doubt and to wonder if what she had understood was true, or was she being ‘brainwashed’ by me?  Was I imposing my analytic ideas on her?   Where did I get the ideas about her that  I was expressing?  Having gained some confidence in her own judgement, she would then spoil the knowledge by bringing in some contradictory point of view expressed by one of her friends. In addition she had a particular way of paralysing movement in the analysis.
     If she acknowledged  some understanding of her internal world  such an acknowledgement could be followed by a death-like silence. In my countertransference I experienced the silence as paralysing. I would be unable to say anything that would break it.  Rather painfully I learned that it was best for me not to say anything at such moments.  Whatever I might say would be seen by her as wrong and a niggling struggle might develop in which she would declare that I was totally inept  and had absolutely no understanding of her.  If, in the silence that followed, I should shift in my chair, for instance, she would demand to know why I had moved, was I irritated?  She projected her own irritation into me and she felt persecuted by my movement, as she had felt persecuted by movement in the analytic work.  Her acknowledgement of psychic change had demonstrated that at that moment our work had been successful, for her and for me  The analytic success demonstrated our separateness.  I was not under her control.  Her verbal confrontation was an attempt to gain control over me once more.
     Gradually, however, Mrs L became more conscious of her feelings and found it easier to acknowledge them.  By finding a genuine sense of self she was beginning to see that she could be responsible for her own thoughts and feelings, since she was beginning to know more about them.  She could appreciate that our separate existences did not mean the end of her life.  She was becoming aware that she had a life of her own and a sense of herself as a separate being.

She become more confused, however, when she became pregnant.  She was very much identified with the baby; she used the baby to represent herself – the baby inside her was her baby self inside me.  She had the phantasy that in giving birth to her baby she would be losing me as her analytic mother.
     She had pervasive phantasies that the baby would not survive its birth as she feared at times that she would not survive separation from me.  At such times she equated birth with death, a confusion which I shall discuss in greater detail below.  Here I want to emphasise how she thought that giving birth to the baby was much the same process of separation as the ending of the analysis.  She was aware that the end of her analysis would not take place for some time, but she had inklings of depressive anxieties – guilt and remorse which she had yet to work through.  She fought against anything that induced painful feelings with intense hatred and resentment directed against those who she thought induced such pain.

She became aware, too, that the birth of the  baby would  force her to face inevitable changes and the passage of time.  Early in her pregnancy she dreamt of a baby that was blind in one eye.  The baby lacked binocular vision.  Her baby was forcing Mrs L to confront a three dimensional world, that is the physical world of the baby inside her and her own internal psychic world that we were involved with in the analysis; Both of these worlds concerned the passage of time  She was terrified of the process of becoming more aware of her internal world, and wanted to remain stuck in a two dimensional one (Meltzer, 1975).  This resulted in her clinging to the outer surfaces of things and prevented her from exploring depths, including the depths of her own personality.  So, too, she saw me as blind in one eye, so that I could only see things from one point of view, my own.  Our respective points of view were not seen by her as uniting to help her see varied aspects of herself from different points of view

Another instance where her difficulties were projected on to the inside baby was a phantasy that the baby would emerge from her womb in bits and pieces.  Such a disastrous birth was a consequence of how she fragmented her mental processes by splitting and projection.  She feared and despaired of integration.  Her lack of expectation of a healthy baby lay in her fears that she could not survive separation from her primary object.
     However, in becoming more aware of her impulses and feelings she began to develop a genuine sense of self.  She could imagine leaving the analysis without dying.  She was beginning to appreciate that separation did not mean the end of life.  She could leave the analysis as a whole more integrated person, not in ‘bits and pieces’.

Her tendency to doubt led her at time to doubt that she was pregnant.  She did want to have the baby and did want to differentiate that baby from her own baby self.  As she gained understanding of her ambivalence, her doubting diminished but her hate could at times lead her to wish to kill off my fertility and she might, for instance, withhold information. Then she would think that I retaliated by killing hers, and so the baby was dead.  Her omnipotence lessened and she was reassured when the baby moved inside her.

I would like to give extracts from a session which shows ways in which she equated the baby’s birth with her own psychological birth.  It shows, too, how she equated birth with death.  The baby was expected on the weekend after this session which was on a Friday.
     She started talking about how she was angry and upset.  Nothing seemed right between her and her husband.  She said that the baby would probably come over the weekend.  ‘I feel so tired, my husband became angry when I said so, but then I got angry when he said that I should rest.  Who is he to tell me that … it is all no good’.  And her voice trailed off and she wept.  ‘Furthermore,’ she said, ‘I feel that I should not have the baby over the weekend, you will not know whether it has come or not, and whether to expect me on Monday’. 
I said that she was angry and upset that she did not know if she would be here on Monday or not, that she was tired and wanted the baby to be born but its birth would keep us apart .She felt she would have no contact with me externally nor internally at the birth of her baby.  Having been able to express feelings of an unsupportive, unhelpful inner object, Mrs L voiced  anxieties concerning labour.  She feared falling part when the baby emerged; the doctor would be there to catch the baby, but who would be there to catch her? Possibly she had experienced the mother of her infant self as unavailable to her.  Did her mother, unsupported by an absent husband, not accept the infant Mrs L’s projections, which lead to later feelings of  abandonment, of falling apart.  So now she felt that the help that she had had was not available to her – the help and support that I and her husband had given her were of no use.  She had difficulty in internalising a helpful object, one who was there to catch her, to support and help her to cope with all the changes in her life.
     I spoke of her anxieties of losing contact with me when she was having the baby and consequent fears of collapse and of death.  She confirmed this interpretation by saying that having a baby was like dying :  ‘There are kind, helpful people around like the doctor and my husband, but they just stand there and say : “get on with it, have the baby”, in the same way they would say, “Go ahead and die”’.  I said how alone she felt if I were not in it with her.  I was not having the baby, she was.  She and I were not one and the same.  She felt completely cut off from the help she had had and angry that we offered help but did not offer to have the baby with her.  The kindness and helpfulness of those around her were of no avail.  In fact we only emphasised that we were not in it with her.  If we were in it with her, we would not be available to help her.  In accepting help she was forced to recognise the need was hers, hers alone.

The baby was not born that weekend, but ten days later.  By then Mrs L. was in a state of mind that could tolerate more loving and helpful feelings for the baby and for herself and she became more able to accept help.  She became upset if someone said that the baby was ‘overdue’.  It was not overdue, she said, it would come when it was ready.  The baby would come independently of her, she had not stopped its birth by her fears of separation.  It was not trapped in her, it could come out when it was ready.  So, too, I could be separate, that is. see things independent of her, from my own point of view, with binocular vision, and help her understand herself from a perspective different from the one she had  had before.

However, a dream she had the week before the baby was born shows the persistence with which she fused with her object in projective identification:  she dreamed that two women were stuck together like Siamese twins.  They were to be separated by an operation but the operation might kill one or the other or both of them.  It was very dangerous. The two women were curled so that the back of one was to the front of the other. This represented aspects of the death-like quality of her perversely sticking to me, back to front.  In fusion with her objects, where split off parts of the self are projected, she lost contact with the dependent relationship that would produce life, not death.  She tried  to deny our separateness aroused by the impending birth of the baby. We were  Siamese twins joined together  back to front.  In being able to represent in a dream the death-like quality of her hatred of a separate me, Mrs L was more in a position to differentiate her baby’s birth from her own separateness from me. The baby was more of a separate being with its own needs and vulnerability.  She said, for instance, ‘I shall try to be gentle with it, when it is being born.

The close connection between birth and the terror of death has been recognised since Freud first drew our attention to it. (1926, p 93)  Birth is ‘the first great anxiety-state’  (1923b).  Both mean the final abandonment of previous relationships. 
Freud asked,  “when does separation from an object produce anxiety, when does it produce mourning and when does it produce, it may be, only pain?” 
(Inhibitions, symptoms and anxiety,  page 169.) 
My patient was terrified that separation would lead to death, she had not as yet adequately mourned that which she had to give up. 

Menzies Lyth, in her paper on  Thoughts on the Maternal Role in Contemporary Society (1975), speaks of the close connection between birth and death :  “The mother has to deal with death and mourning both in her feelings and reactions to the baby, and in his feelings and reactions to her.  Birth is a reminder of death because it is the opposite of it, the final establishment of a new life”.  She stresses the relationship of death and mourning with the need for mothers and babies to deal with fears about physical and mental survival.
     Birth is a reminder of death because it involves the physical separation of two people and thus serves as the prototype of all separations, including that of death.  Those who have not dealt with the inter-relationship of love and hate are not in a position to deal with the inter-relationship of birth and death.  Those who desire fusion with objects in projective identification (Klein 1946) are threatened by feelings of hatred and persecution at times of change and development.  Pregnancy is one such time.

Joseph (1981),  in her paper Towards the experiencing of psychic pain, describes a certain type of borderline patient who tries to avoid awareness of separateness by extensive use of projective identification, using their objects as if living inside them.  She suggests that women who do this may be liable to breakdown when their first babies are born, since they are deeply identified with the baby.  Thus they can be comparatively comfortable and free from anxiety during pregnancy but the birth or period immediately after delivery is frequently traumatic.  The patient’s own problems of being outside and born have never been adequately worked through.

That my patient did not break down after her baby’s birth might be attributed to her gaining some understanding that her phantasy of the death-like dangers of separation (as expressed in the dream that the operation to separate the Siamese twins could result in death to one or the other or both) pertained to her relationship to me in the analysis, and not to an identification with her baby.  She was starting to have some idea of herself as emerging from the idealised ‘inside’ baby self and so did not confuse that process with the baby’s separation from her at its birth.  Her internal world was not destroyed and fragmented, the baby did not come out ‘in bits and pieces’.

Summary

I have described how, in her pregnancy, my patient became more aware of the finality of both giving birth to her baby and of the finality of separateness in the psychoanalytical process.  She began to understand  that she needed to give up the ways in which she lived through others in projective identification.  She could then become better able to withstand the pains of separation that are inherent in giving birth.  Separation had been seen by her as leading to death. She had expressed her anxieties about pregnancy and delivery in terms of fears of separation from those in her internal world on whom she depended for survival.

References

Freud, S (1923b) The Ego and the Id SE 19 pp 19-66

 _____    (1926)  Inhibitions, Symptoms and Anxiety SE 20 pp 87-174

 Joseph, B (1981)  “Towards the experiencing of psychic pain” Psychic 

     Equilibrium and Psychic Change.  Ed Spillius, E and Feldman, M. 

     1989 London: Routledge

 Klein, M (1946)  “Notes on some schizoid mechanisms”.  The Writings of

     Melanie Klein, vol. 3, Envy and Gratitude and Other Works,  London: 

     Hogarth Press (1975)

 Meltzer, D (1975)  “Dimensionality as a Parameter of Mental Functioning”

     in D. Meltzer, J. Bremner, H. Hoxton, D. Weddell and I. W. Wittenberg

     Explorations in Autism.  Strath Tay: Clunie

 Menzies-Lyth, I. E. P.  (1975)  “Thoughts on the Maternal Role in

     Contemporary Society”.  Journal of Child Psychotherapy.  Vol. 4. No. 1 

Athol Hughes  December 2006

Copyright © 2007The Melanie Klein Trust