PUERPERAL PSYCHOSES

Derived from the Latin puerpera ("woman in childbirth"), puer ("child"), and parere ("to give birth"), the term puerperal psychoses conventionally comprises all the psychiatric conditions with onset during pregnancy and in the year following it. In a more restricted sense, the same term is used as the equivalent of postpartum psychoses, in which case it concerns only major, acute problems that occur during the days or first month immediately after delivery.

Puerperal disorders have been known since antiquity (Hippocrates, Galen). Puerperal psychoses were singled out in the mid-nineteenth century, with the work of Jean-Étienne Esquirol (1838) and Louis-Victor Marcé (1858). Still relevant from that time are questions that treat the specificity of these morbid states: Are they an autonomous clinical entity of which childbirth is the causal agent? Or, instead, is childbirth merely an event that precipitates the emergence of a psychiatric syndrome in an already vulnerable woman?

Psychoanalysis very early on became interested in this pivotal stage in a woman's life. Paul-Claude Racamier, in "La mère et l'enfant dans les psychoses du postpartum" (Mother and child in the postpartum psychoses; 1961), defined puerperal disorders as accidents in the psychoaffective "process" of mother-hood—a process that can be understood in light of concepts developed by Sigmund Freud: the castration complex, its impact within narcissism, and its clinical consequence, penis envy, which becomes the desire to have a child by the father during the oedipal phase. Above all, Freud discovered the strength of the bond uniting the little girl with the preoedipal mother and its articulation with the central problem of identification.

Beginning in the 1970s analytic understanding of the processes of motherhood and its avatars was opened up to contributions from other disciplines, such as developmental psychology, ethology, or the practice of observation. A number of theoretical and/or clinical concepts have since become available: primary maternal preoccupation (Donald Winnicott), the capacity for maternal reverie (Wilfred Bion), projective identifications (Melanie Klein, Bion), behavioral and fantasmatic mother-child interactions, transgenerational transmission (Mary Ainsworth, Serge Lebovici), or the motherhood constellation (Daniel N. Stern).

Odile Cazas

See also: Infant observation (therapeutic); Parenthood; Postnatal/postpartum depression.

Bibliography

Ainsworth, Mary D. Salter, Blehar, M. C., Waters, E., and Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.

Cazas, Odile, Dhôte, Alain, Bouttier, Daniel, and Ginestet, Daniel. (1990). L'hospitalisation conjointe de la mère et de son nourrisson dans un service de psychiatrie adulte. Psychiatrie de l'enfant, 33 (1), 635-674.

Esquirol, JeanÉtienne. (1838). Des maladies mentales considérées sous les rapports médical, hygiénique et médico-légal. Paris: J. B. Baillière.

Lebovici, Serge. (1983). Le nourrisson, la mère et le psychanalyste. Paris: Le Centurion.

Marcé, Louis-Victor. (1858). Traité de la folie des femmes enceintes, des nouvelles accouchées et des nourrices et considérations médico-légales qui se rattachent à ce sujet. Paris: J. B. Baillière.

Racamier, Paul-Claude. (1961). La mère et l'enfant dans les psychoses du postpartum. L'Évolution Psychiatrique, 4, 525-570.

Stern, Daniel N. (1995). The motherhood constellation: A unified view of parent-infant psychotherapy. New York: Basic Books.

Winnicott, Donald W. (1958). Primary maternal preoccupation. In Collected papers, through paediatrics to psycho-analysis. London: Tavistock. (Original work published 1956)