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Infertility and its Unconscious Reverberations with Mali Mann, MD (San Francisco)

Psychoanalysis On and Off the Couch

Release Date: 02/11/2024

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Psychoanalysis On and Off the Couch

“The theme that I found with IPSO [International Psychoanalytical Studies Organization] was that there was a common theme [in psychoanalytic training].  There was an initial phase full of terror and excitement, and then a middle phase of maybe some lethargy or apathy or disillusionment. In that middle phase, many candidates found IPSO, or IPSO found them, where they found refuge. They found solace. They found community, not just at their local institutes, but at this kind of world market. Many of the candidates talk about what a timely and wonderful experience it was to be seen, to be...

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“When we reconstruct [in a patient] a possible lacking object or role or function, we  see that if the analyst himself has been able and the patient allowing him to be able to enter to a deep level the objective reality of the internal world of the patient, it can happen that some new function or position can be achieved. This is something that could be rare but it happens. This is one more reason for not blaming the length of some analytic treatments, because time is needed  for entering that internal deep area where the analytic relation can create something new. Transformation...

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“The original papers that were written about the analyst’s unconscious being attuned to the patient's unconscious  by Hyman and Racker, in both cases they talk about this phenomenon. But both of them utter a caution, which is that one always has to take into account one's own ‘mishegas’.  Essentially, what they're saying is, the unconscious is pretty individualistic and we have our own things, and we have to consider that possibly it's our own difficulties, our own unconscious, that is playing a bigger role in our countertransference reaction to the patient's unconscious.”...

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“The idea of analytic neutrality, which was more or less a cliche truth when I was training back in the 1980s, is clearly getting at something very important, which is that we mustn't try to pre-conceive where the patient's development is going to take him or her. But that doesn't mean that the development is not in a direction. Aristotle famously said that the human being is a ‘zoon politikon’, a creature who belongs in a somewhat structured society. Healthy development is in that sort of direction as we become more integrated, as our ‘ghosts become more like ancestors’, to use that...

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“There are very specific fears that people have that are specifically related to their own childhood, and I'd like to give an example. A mom with twins had a kidnapping fear. She was afraid every time she saw a car drive by her house that her twins would be kidnapped. Now this mother was herself adopted when she was a newborn, but her adoption did not become final until she was one year old. Her twins were approaching one year. I was struck by the anniversary of her fear of kidnapping, and when I asked her who she thought was driving the car that drove by her house, she blurted out, 'my...

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“The amount of guilt and the sense of alienation that people feel when they fall in love with someone who is ‘outside’, and the struggle that they have to undergo to explain that choice which they fully don't understand themselves, is a very deep conflict that my work tries to capture. The title of my book is ‘Intimacy in Alienation’, and alienation is something that is really very pregnant in the identities of these individuals who feel like aliens to their own community because their community cannot imagine why are they seeing the other as something positive but not as how the...

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Psychoanalysis On and Off the Couch

“I've had the experience of having some wonderful supervisees, many of whom have done quite fine work and where it has not been an issue of any kind of great concerns. And allowing the candidate to see what's written and also discussing it with them, obviously makes it quite easy for them to get both positive input, but also at times, input that will help them evolve and deepen their work even more.”  Episode Description: We begin by exploring the critical role of case writing in psychoanalytic training, discussing Stephen’s concept of "a fourth pillar of analytic training." Stephen...

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Psychoanalysis On and Off the Couch

“I feel so strongly about this [collective commemorative ritual]. I think that early psychoanalytic writing overemphasized the value of separation-individuation and pathologized the opposite. It's been through personal experience that I have come to see that in a different way with regard to Jewish commemorative ritual which takes place a couple of times a year. But also some experiences that I have had outside the realm of religion. The one that pops to mind was what President Biden did about a year after the first onslaught of the Covid epidemic. He had candles put all around the...

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"What Freud may have missed here is that the investment in the lost object is a much more reconstructive and integrative process. It’s one where we remember all the stories that we have heard from the lost object - the repetitive stories about the childhood of the person or how they met significant others and all these stories are within us and revived, and we have questions. We think: ‘Too bad I never asked about this or that’ and in activating these memories we also experience joy and we have a slow process of integration which is not necessarily about loss but about how continuous...

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More Episodes

"The genetic asymmetry [with sperm donorship] will create issues and complications -  it puts a strain on the relationship, i.e. who is excluded; who has more rights to this product? In other words, if the sperm donor is from a stranger,  the father feels ‘am I really adequately or sufficiently related that I could claim fatherhood’?”

 

Episode Description: We begin by acknowledging the erroneous assumption that  unconscious conflicts over becoming a parent are etiologic for what had been called 'psychogenic infertility.' Correlation is not causality. We review the widespread use of assisted reproductive technologies, with up to 750,000 babies born per year through these methods. Mali presents a composite case of a 48-year-old woman who went through many arduous IVF cycles before appreciating the degree of omnipotence and denial that characterized her approach to this problem, as it had toward many other issues in her life. She shares with us the common experience of infertility representing a sense of defectiveness and guilt. We consider the many challenges of sperm and egg donorship, including who one chooses as a donor as well as when one should tell children of their biological origins. We close with Mali sharing with us her recommendations to rejuvenate the field of child analysis.

 

Our Guest:

Mali Mann, M.D, is a Training and Supervising psychoanalyst and Child Supervisor at the San Francisco Center for Psychoanalysis. She is a clinical professor Adjunct at Stanford University School of Medicine, Department of Psychiatry and Behavioral Science.  Some of her published papers include, "Immigrant Parents and their Emigrant Adolescents: The Tension of Inner and Outer Worlds;" "Shame Veiled and Unveiled," "Aggression in Children: Origins, Manifestation, and Management through Play," Adolescent Psychoanalysis book chapter. "The Formation and Development of Ethnic Identity." Her edited book, Psychoanalytic Aspects of Assisted Reproductive Technology, won three awards: 1) Pinnacle Book Award, 2) International Book Awards in Family and "Parenting and Family" category in 2016, 3) Finalist for Book Vana Award in 2016. She has published two books of poetry: Whisper, Forget Me Not, and A Path with No Name. Her latest book, My Pony, Keran, is a semi-autobiographical children's book. She has been a member of Flying Doctors for nearly three decades (Los Medicos Voladores). She and her late husband, Dr. William James Stover, traveled to the Orphanages in  South America and Mexico to offer medical help to children and their families. In her spare time, she paints abstract expressionism and figurative; her art has been exhibited in US galleries and won several awards. 

 

 

Recommended Readings:

Allison. G. H. (1997). Motherhood, motherliness, and psychogenic infertility. Psychoanalytic Quarterly, 66: 1-17

 

Ludden, J. (2011) A. F. (1961). A new openness for donor kids about their biology. NPR:

Making Babies: 21st Century Families.(17 September).

 

Bibring, G. L.’ Dwyer, T. F., Huntington, D.S., & Valenstein, A. F. (1961). A Study of Psychological Process in pregnancy and the earliest mother and child relationship. Psychoanalytic Study of the Child, 16: 9-72

 

Ehrensaft, D. (2008), When baby makes three or four or more, Psychanal. Study Child, 63:3-23.

 

Freud, S. (1914). Remembering, repeating, and working through. (Further recommendations on the technique of psycho-analysis II.) S.E., 12.

 

Inderbitzin, L. B & Levy, S. (1998). Repetition Compulsion revisited: Implication for Technique, Psychoanalytic Quarterly. 67:32-53

 

Lester, E. P. & Notman, M. (1986). Pregnancy, developmental crisis, and object relations: Psychoanalytic considerations. Int. J. Psychoanal., 62: 357-366

 

Notman, M. & Lester, E. P. (1988). Pregnancy: theoretical considerations. Psychoanl. Inq., 8: 139-160

 

Pines, D. (1982). Relevance of early development to pregnancy and abortion. Int. J. Psychoanal., 61: 311-318

 

Zallusky, S. (1999). Infertility in The Age of Technology, Journal of American Psychoanalytic Association, 48: 1541-1562