Revising Psychoanalytic Understandings of Perinatal Loss

During the past 20 years, there has been a flood of papers in the medical literature examining the impact of perinatal loss and documenting dramatic changes in the medical management of this loss. Although Bourne and Lewis (1992) have provided an annotated bibliography of nearly 400 papers concerning stillbirth and neonatal death alone, barely a trickle has come from psychoanalytic quarters. Unspoken allegiance to some traditional psychoanalytic beliefs that are increasingly viewed as outdated may impede applying contemporary psychoanalytic frameworks to understand perinatal loss. Four tenets of psychoanalytic theory—the unborn child experienced as solely a fantasy, mother's symbolic equation of her child primarily with the penis, unconscious causation of perinatal loss, and the ubiquity of unconscious ambivalence underlying parental guilt—are all critically evaluated and revised to introduce a contemporary psychoanalytic understanding of perinatal loss. Because a multidimensional psychoanalytic model has been described in detail elsewhere (Leon, 1990, 1992b), it is not elaborated here.