Although there are numerous articles and books about postpartum depression, few are psychoanalytically informed, and the psychodynamics of women suffering from postpartum depression are overlooked in most of these publications. Psychoanalytic reports concerning postpartum depression are few, but clinical experience and the literature suggest that a triad of three common, specific emotional conflicts is typical of many women who develop postpartum depression. For simplicity, these are dependency conflicts, anger conflicts, and motherhood conflicts. The dependency conflicts typically have a counterdependent form, the conflicts over anger characteristically include a great deal of guilt and inhibition, and there are often problematic identifications with the woman's own mother (and father) with associated conflicts about motherhood. The frequent counterdependent attitude tends to limit participation in extensive psychotherapy, contributing to the paucity of psychoanalytic contributions on this subject.
Physicians want to do good. Physicians also have high rates of burnout, depression, and suicide. These 2 facts are closely associated. As a psychiatrist and psychoanalyst who has treated many physicians, I have repeatedly observed that the need to do good derives in part from hidden guilt and has substantial effects on how physicians experience themselves and their work. Among the many motives for wanting to be a physician, the one that applicants to medical school most commonly mention is wanting to do good. Medical literature on physician burnout, depression, and suicide, however, has focused on structural and cultural problems of medical practice and has paid little attention to physicians' emotional lives. 1 The hidden guilt and need to do good can facilitate the practice of medicine, but they also make an important, and perhaps unrecognized, contribution to physicians' vulnerability to burnout, depression, and suicide.Dictionaries define the emotion of guilt as "a feeling of having committed wrong or failed in an obligation" 2 or "a feeling of responsibility or remorse for some offense, crime, wrong, etc, whether real or imagined." 3 In fact, people commonly feel guilty when they have actually done nothing wrong. All sorts of experiences in childhood, such as deaths in the family, illnesses, traumas, abuse, divorce, and problematic relationships can saddle a person with an unrecognized burden of guilt. This guilt may be hidden for a
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