Discussion of Joshua M. Perman's Article, Multiple Pregnancies in Multiproblem Families: The Chronic Postpartum Reactions

Dr. Perman's paper is based on an ongoing research first at the Department of Welfare, then at the Community Service Society, and finally at Mount Sinai Hospital in New York City.

The author describes the deplorable housing of the families observed, which permits early exposure to polymorphic perverse activities of adults, leading to parenthood during adolescence. Mostly the children live with their mother. She has relations with a number of men who then play the role of the father. The mothers are either borderline or psychotic; the children are intellectually retarded and live in an atmosphere of addiction, prostitution, perversion, or criminal activity.

Some interesting cases are presented, which show that the women's pregnancies are an escape from depression and anxiety; parturition is a narcissistic injury causing depression that leads to pregnancy again. These women, who become “pregnancy addicts,” remain fixated in the symbiotic phase of the mother-child relationship. They may develop severe postpartum psychoses leading to abandonment or killing of the child, or else to a symbiotic relationship with the child. If the symbiosis comes to an end, the mother will become pregnant again. When these women get too

old to become pregnant they encourage their adolescent daughters to do so, and the pattern is repeated. Studies of multiproblem families confirm Mahler's findings. The infancy of children from these families resembles that of the institutionalized children described by Spitz.

Perman describes the severe ego and superego defects in these women, the primitive level of ego functioning, their multiphobias, their resistance and the resulting difficulties in working with them. It requires at least two years to make them participate, and it may need work over two generations to achieve success. But on the basis of a better understanding of the psychopathology, new promising approaches have evidently brought about rewarding results.

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