Primary Maternal Preoccupation: Disturbance in Pregnancy and the Postpartum

A mother in the throes of extreme postpartum depression and anxiety cried out to me, “I feel like I am dying.” Winnicott’s annihilation anxiety came to mind, and I realized how much she was feeling like an infant who was experiencing a threat to its personal existence. She was overwhelmed by the impingements of her emotional states and the needs of the baby, and needed from me, a direct and consistent responsiveness to her terror and distress. It was only much later that she told me that she had slept with the window open in her bedroom hoping to be kidnapped as she wanted to get away from what felt like an unbearable situation with the baby. Another mother with postpartum depression later described how she felt traumatized by her infant and that in her sleepless nights, she felt that she was in a long, sustained nightmare. Caring for him felt like a struggle, something she wanted to do, but felt it was just too much.

Pregnancy and the postpartum period can be times of significant emotional upheaval and disturbance, particularly when women are in severe depressive and anxious states, states that often reverberate with early losses and deprivations. Both Winnicott and Bion think about the period of early infancy, with an interest in the mother’s states primarily from the perspective of the infant’s experience, the developing mind and sense of self. They both went on to build important aspects of their theory from this period of mother and infant.

In this paper, I would like to explore how they characterized the mother’s states of mind and functioning, and other psychoanalytic ideas about what allows for a woman to become a mother psychologically and emotionally. I will elaborate on how depression, anxiety and early difficult experiences interfere with a mother’s development and capacities. In thinking about the treatment of these women from a psychoanalytic perspective, I hope to show how these ideas are useful in characterizing the therapeutic work, and I will discuss