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

I was impressed by the seriousness and poignancy of the problem Dr. Perman presented. His attempts to delimit the psychopathological conditions underlying it represent a serious effort both in the scientific aspects of the question and in the search for a solution. In a few pages, he presents a wealth of pertinent material and a thorough study of the psychopathology of these mothers, from various angles. In spite of the complexity of the subject and the numerous factors at work which he considers, he manages to make himself easily understood.

I have had some experience in studying families with multiple pregnancies, but my patients did not suffer the degree of material insolvency and psychopathology which constitute the object of Dr. Perman's study. I present my comments only as reflections which, I hope, may be useful to deepen understanding of the complex problem which he has so truthfully and eloquently described

and about which he has given us some conceptual delimitations. In the picture the author presents one can discern a variety of factors at work. It is difficult to isolate and give justice to all of them and I shall limit myself to those which have struck me most.

Throughout the paper, the problem of deprivation looms as one of the most fundamental, as Dr. Perman points out repeatedly. The term “chronic postpartum reaction,” which he proposes, seems to refer to a cluster of variables, all of which pertain to the early mother-child relationship. It seems that the same facts could be interpreted in terms other than the ones he employs, though this does not mean that the alternative descriptions would necessarily be better ones or more faithful expressions of the same facts. I would be inclined, rather, to regard them as complementary and as an expression of the fact that psychic reality is so complex that it can never be exhausted with but one description of it, however accurate.

To refer to one example, one wonders whether the interpretation of the need of