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KMID : 0381219760080050275
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Journal of RIMSK
1976 Volume.8 No. 5 p.275 ~ p.289
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The Psychodynamic explanation for the post-abortive and post-partum mental disorders in Korea
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Abstract
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This paper is to help practicing obstetrician-gynecologists and psychiatrists deal with women in conflict with abortion or delivery, and with whom having unfavorable psychological sequelae following abortion or carrying out their pregnancy, The purpose of this article is also to
establish psychodynamic explanation to the adverse psychiatric sequelae following abortion or delivery in Korean women who were treated in the Dept. of Neuropsychiatry, Chung-Ang University, School of Medicine during the period from Jan. 1973 till Jan. 1976.
The 32 cases of pregnant women ranging in age from 20 to 49 years, consisted of the sixteen cases of post-abortive mental disorders and the sixteen cases of post-partum mental disorders were selected for this study and the result is as follows:
1. Most of the cases, showing psychiatric sequelae, occured in the decade of twenties and thirties when the greatest reproductive and sexual activity exsisted, and their mean age was 33.4.
The post-abortive cases were most distributed in the thirties when frequent abortion existed, but the post-partum cases were most distributed in the twenties when smooth control of mothering role play was needed.
About three quarter of cases, it occured within one year, and their mean duration of onset was 14. 2 months. The post-abortive cases were predominantly occured within 1 year and insidiously progressed, but the post-partum cases were abruptly breakdown within 3 months, the puerperal period.
2. Among 32 cases of pregnant women, 31. 39o had showed previous post-partum psychiatric sequelae, and 62. 5% was primipara at the time of appearing initial paychiatric sequelae.
Of the 200 times of pregnancy in the 32 patients, each cases had been experienced 6. 3 times of pregnancy, consisted of 2. 6 times of normal full-term delivery, 2. 8 times of abortion, induced or spontaneous, 0. 8 times of atypical pregnancy.
The post-abortive cases had been more chance above 2 times of pregnancy and 1. 9 times of abortion comparing with the post-partum cases.
3. Among 32 pregnant women who showed psychiatric sequelae following abortion or con-
tinuation of delivery, they were dignosed as neuroses (43. 8%), depression(40. 6%) or schizophrenia (15.6%), and showed various personality disorder such as the passive aggressive (37.5%), the hysterical (21.9%), or the schizoid (12. 5%).
Majority of these women exhibited neurotic profile of MMPI (3-1-2 type), and complained of low back pain (78.1%), anxiety (75.0%), hypochondriasis (75.0%), lower abdominal discomfort (71. 9%), premenstrual tension (68.8%), insomnia (65.6%), fatigue (65.6%) or leukorrhea (65.6%).
The post-abortive cases were more diagnosed as neuroses with hysterical personality and were more complained of phobic or hysterical symptom manifestations, but the post-partum cases were more diagnosed as schizophrenia with schizoid personality and were more complained of fatigue, hypochondriasis, lower abdominal discomfort, or vaginal itching sensation.
4. As to the result of extensive psychodynamic explanation of the psychiatric sequela after abortion or continuation of pregnancy, it was suspected that these women with conflict about or fear for pregnancy exhibited ambivalence for the choice of abortion or delivery in the face of the various stresses to threaten feminine biological function, such as familial stress including pathogenic parental attitude (rejecting parents), loss of significant father figure, or small size of family (few child and few siblings); marital stress, including marital discord, inlaw syndrome; or sexual conflicts; or internal conflicts including psychodynamic forces of repressed hostility, chronic rage, or shame. We have found it convenient to devide pregnant patients whom we see into three groups, the first group to deny feminine role play were carried out premature termination of pregnancy, the second group to deny mothering role play were carried through to term regardless of the conflict involved, and the last group who showed relief after abortion or delivery were satisfactory adjusted in their feminine and mothering role play.
5. For the pregnant patient in conflict about abortion or delivery, it was concluded that the following 3 categories were presumed caqsative psychodynamic factors.
A. Abortion The hysterical personality Phobia Insidious onset Neuroses Neurotic symptoms including phobic or hysterical symptom. ; Post-abortive mental disorders.
B. Delivery The schizoid personality Frustration Sudden onset Schizophrenia Somatization of psychological conflict; Post-partum mental disorders.
C. Abortion or continuation of pregnancy The passive agressive personality Object
loss Shame or guilt Self -punishment Insidious onset Depression Hypersensitivity to pain center, and Gynecological symptoms; Post-abortive or post-partum mental disorders.
6. Since majority of the Korean pregnant women were tended to gratify passive masochistic needs through somatic discomfort in order to repress their emotional expression, it was suggested that the following characteristic dynamic factors were occupied major role of psychiatric breakdown in Korea.
a) The repressed hostility, chronic rage, various phobia, or shame were more important psychodynamic factors.
b) The inlaw syndrome, the superstitious belief, and the search for delivery of son are major threatening forces for the feminine or the mothering role play in Korean woman.
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