“Without being in psychoanalysis I would never have dared to become pregnant”: Psychoanalytical observations in a multidisciplinary study concerning a woman undergoing prenatal diagnostics

Abstract

As is well known, Freud described the clinical practice of psychoanalysis as the 'loam' of his cultural-theoretical work, an assessment which is shared by many psychoanalysts up to the present, including the authors of this paper. The complex interplay between unconscious phantasies on the one hand, and the real experiences arising from the new possibilities opened up by prenatal diagnostics on the other, is described with reference to a report of an intensive, long psychoanalysis with an analysand from a family burdened with a genetically transmitted illness (haemophilia). The holding and containing function of the analyst enabled this analysand, despite traumatic experiences with the miscarriage of a healthy child triggered by a prenatal diagnosis and the later abortion of a haemophiliac baby, nevertheless to have the courage to go through another pregnancy and give birth to a healthy girl. The intensive clinical investigation of the unconscious phantasies, conflicts and traumas around the prenatal diagnostics proved to be not only therapeutically fruitful for the analysand, Ms F. It also facilitated insights into those individual chances and risks which appear to be an integral part of the opportunities presented by todays prenatal diagnostics and, through them, it lead to a cultural-critical look at the ambivalence of medical-technical progress. These insights, which are only attainable through psychoanalysis, can represent a distinctive contribution of psychoanalysis to a multi-disciplinary dialogue with medical practitioners, geneticists, ethicists and health policy-makers. By referring to a large EU study on 'Ethical Dilemmas due to Prenatal and Genetic Diagnostics', this paper gives a practical example of such a discussion. Ms F. was psychoanalytically interviewed as part of this study, 16 years after the conclusion of her analysis. The summary of these interviews, which is set against the account of the treatment, offers an impressive insight not only into the long-term effects of a psychoanalysis under very particular personal circumstances, but also into the lasting consequences of decisions made in the context of prenatal diagnostics. Finally, the results of the individual case study are brought together with the clinical outcomes of the EU study, and some considerations are formulated concerning the protective and risk factors facing women during and after prenatal diagnostics. The paper is an appeal to psychoanalysts, with their specific competence in dealing with unconscious phantasies and conflicts and their high level of professionalism in dealing with traumatised patients, to get involved in fresh dialogue with prenatal diagnosticians and their patients.

The experiences and attitudes of hemophilia carriers around pregnancy: A qualitative systematic review

“…Title and abstract screening resulted in 62 eligible articles, after which 15 articles were included in this review (Figure 1, Table 1). 15,[32][33][34][35][36][37][38][39][40][41][42][43][44][45] Themes identified were divided according to each reproductive phase (Table 2). Most studies addressed HCs' experiences with reproductive decision-making and prenatal diagnosis.…”

“…Experience within the family influences decision-making 15,35,38,41,43,44 Wish for informed reproductive decisions together with specialized health care providers 15,38,43 Importance of hemophilia disclosure within the family 15 Knowing about the possibility of having an affected child is difficult 40…”

“…HCs' decisions on PND 35,43 Experiences of PND of family members influences the choice of PND 15,39,40 Preferred to take place early in pregnancy 32,39 Felt as beneficial for obstetrical care and emotional preparation for having an affected child 34,35,43 HCs who had experienced PND before, would choose it again in subsequent pregnancies 37 Negative diagnosis evoked happiness and relief 32,37,41 Positive diagnosis evoked sadness, disappointment, and concern about subsequent decisions 37,41,43 b) NIPD NIPD was valued as easy and safe, yet the impact of the result is acknowledged 32,34 Early timing was appreciated 32,34…”

The Secret Life of Secrets: Deleterious Psychosomatic Effects on Patient and Analyst

“…On the other hand, my complementary somatic countertransference reactions reflected the split-off aggression he harbored toward Renee and his mother-his inability to process in words the admixture of feelings about the secret he held for his mother concerning his unwanted sister. Perhaps he had even induced in me a concrete experience of morning sickness, the beginning labor pains, and indigestionembodied countertransference phenomena of pregnancy similar to phenomena noted recently by Leuzinger-Bohleber (2015b;Leuzinger-Bohleber and Teising 2012).…”

Editorial

“…Looking back at the wide array of papers published in 2012 it is interesting to see some emergent themes and issues that recurred throughout the year. Several submitted papers focused on femininity, including Female exhibitionism: Identification, competition and camaraderie (Kulish and Holtzman, ), The couch and the chador (Homayounpour and Movahedi, ), and articles on procreation and pregnancy (Leuzinger‐Bohleber and Teising, ; Regazzoni, ). Another interesting theme that arose was disturbances of the body, with papers such as Tattoo and taboo: On the meaning of tattoos in the analytic process (Karacaoglan, ), Reflections on a coma (Dalakaki and Mantzouranis, ), and the collection of Film Essays on Pedro Almódovar's The Skin I Live In (Di Ceglie, ; Harrang, ; Lemma, ; Sabbadini, ).…”