Fajardo B
Psychoanal Rev. 1987 Spring;74(1):19-43.
This paper is an examination of the long-term parenting experiences of parents who have given birth to CNS damaged infants. In particular, the focus is on the mourning, regression, rage, and depression that frequently attend these parents throughout their lives and can become pathological and pathogenic interferences with the provision of good-enough parenting. Several clinical vignettes were presented, each of which illustrated the usefulness of different psychoanalytic clinical theories about normality and pathology of parenting and parent-child interaction. The now-classical contribution of Solnit and Stark (Mourning and the Birth of a Defective Child, 1962) is reviewed along with Benedek's and others' psychoanalytic theories about normal parenting. The thinking of these writers is within the framework of structural/libidinal theory and seems to be useful in describing certain parenting problems that concern the mourning and regressive aspects of parenting. However, it was proposed that some of the adaptive coping and pathology encompassed by Solnit and Stark's explanations is not comfortably illuminated by the structural clinical theory of conflict and drives. Freud's discussion (1917) compares mourning and melancholia, which he differentiated as related but dynamically distinct clinical phenomena. This work is briefly recalled as an earlier point in theory building where structural theory was not sufficient to explain clinical depression and rage that exceeds normal mourning (as in Freud's melancholia). It is felt that an additional theoretical perspective on parenting provided by self psychology can fill in some of the gaps left by structural theory explanations. The self psychology perspective is particularly helpful with understanding the rage, ambivalence, and chronic depression often experienced by parents of damaged children. According to this perspective, the damaged child is a disappointing selfobject for the parent, and the parent's self organization will give him the resources to cope adaptively or to develop narcissistic pathology. Three types of intrapsychic problems for a parent are described: mourning the lost object, the fantasied perfect child; experiencing and recovering from regression to early identifications with his own parents; withstanding tension and regulating one's self (experiencing chronic depression and rage) when confronted with a great disappointment in a selfobject (represented by the damaged child). It is important when designing intervention strategies in a hospital or pediatric clinic setting to clarify which type of problem is the major focus of the parent's struggle.(ABSTRACT TRUNCATED AT 400 WORDS)
本文探讨了生育患有中枢神经系统损伤婴儿的父母的长期育儿经历。具体而言，重点关注这些父母一生中经常经历的悲痛、退行、愤怒和抑郁，这些情绪可能会成为干扰提供足够好养育方式的病理性和致病性因素。文中呈现了几个临床案例，每个案例都说明了不同精神分析临床理论在育儿及亲子互动的正常与病理方面的实用性。回顾了索尔尼特和斯塔克（《哀悼与缺陷儿童的诞生》，1962年）的经典贡献，以及贝内德克和其他人关于正常育儿的精神分析理论。这些作者的思想处于结构/力比多理论的框架内，似乎有助于描述某些与育儿的哀悼和退行方面相关的育儿问题。然而，有人提出，索尔尼特和斯塔克解释中所包含的一些适应性应对和病理情况，结构冲突与驱力的临床理论并不能很好地阐明。弗洛伊德（1917年）的论述比较了哀悼和忧郁症，他将两者区分开来，认为它们是相关但动态上不同的临床现象。这项工作被简要回顾，作为理论构建中早期的一个点，当时结构理论不足以解释超过正常哀悼的临床抑郁和愤怒（如弗洛伊德的忧郁症）。有人认为，自体心理学提供的关于育儿的额外理论视角可以填补结构理论解释留下的一些空白。自体心理学视角对于理解受损儿童的父母经常经历的愤怒、矛盾情绪和慢性抑郁特别有帮助。根据这一视角，受损儿童对父母来说是一个令人失望的自体客体，而父母的自我组织将给予他适应性应对或发展自恋性病理的资源。描述了父母面临的三种心理内部问题：哀悼失去的客体，即幻想中的完美孩子；经历回归并从与自己父母的早期认同中恢复；当面对自体客体（以受损儿童为代表）的巨大失望时，承受紧张并调节自我（经历慢性抑郁和愤怒）。在医院或儿科诊所环境中设计干预策略时，明确父母挣扎的主要焦点是哪种类型的问题很重要。（摘要截选至400字）
