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In this paper, Dr. Perman offers some clinical material, a few technical suggestions, and an abundance of general observations he has come to over 12 years of treating multiproblem families.
He emphasizes the need for patience and the importance of long continued individual relationships between patient and therapist. He recounts in detail the many therapeutic thrusts which he has found ineffective.
He states in the summary, “Knowledge of the psychopathology based on psychoanalytic concepts has suggested technical approaches that influence this insidious sociological problem.”
Unfortunately this optimism is not sustained by the evidence he presents. It is not clear what makes these families unique. Certainly not his description: “It is rare to find both parents an integral part of the family. The mother generally has lived in common-law relationships with a number of men. …” One might even argue that these and similar characteristics are more frequent in families of higher or highest income.
There is diagnostic confusion. The clinical material suggests that Dr. Perman speaks of borderline states in which the patients react idiosyncratically to pregnancy as they do to other major events in their lives. He, however, suggests the term “chronic postpartum reaction,” and it is not clear how he would define the concept.
There is, finally, a more subtle and more troubling quality to the paper exemplified by: “their ego lacks the ability to control their impulses”; “they are ruled by their emotions”; “their belief in magic and superstition [is preserved]”; “logic and the promise of better things … are not adequate for them.”
Such descriptions in truth apply to all our patients—and, indeed, even to those of us affixing the labels. One would hope that these comments reflect merely an unfortunate vagueness and that they do not, as they seem on first reading, serve as pejoratives added to the burdens of our unfortunate fellow citizens.