Am J Psychiatry 1992; 149:1464-1472
Copyright © 1992 by American Psychiatric Association
The psychoanalytic conceptualization of perinatal loss: a multidimensional model
IG Leon
Department of Psychiatry, University of Michigan Medical Center, Ann Arbor.
Much has been learned about perinatal loss over the past 20 years through
clinical investigations and quantitative research. However, a review of
studies over the past decade reveals that perinatal loss is increasingly
being seen in the same way as a death of any other member of the family,
rather than as a unique bereavement. A comprehensive understanding of
perinatal loss anchored in a theoretical framework of pregnancy is lacking.
This article offers a multidimensional model for examining this loss by
applying four psychoanalytic interpretations of pregnancy. 1) From the
perspective of pregnancy ushering in the new developmental phase of
parenthood, perinatal loss becomes a developmental interference, disrupting
a significant milestone as well as causing isolation from peers. 2) In
light of the usual recapitulation of earlier conflicts during pregnancy as
noted by drive theory, perinatal loss may lead to an intensification of
intrapsychic conflicts. 3) Understanding pregnancy as the creation of a
specific person in an object relations model highlights the importance of
mourning after perinatal death, as well as the need to tend to associated
unresolved grief from earlier losses. 4) Finally, a model of narcissism
describes how pregnancy reorganizes self-esteem, thereby delineating the
intense narcissistic injury and rage that often follow perinatal loss.
These multiple frameworks help to explain the many repercussions of this
loss as well as to account for individual differences. Research findings
are selectively reviewed to support the validity of this model. Conversely,
this model may productively guide future avenues for research.
