A modern psychoanalytic approach can be helpful in ART

My reading over the summer started with Donna Tartt’s magnificent Goldfinch and thereafter has ranged from old Paul Auster novels (try them for a quirky take on life) to Professor Graham Music’s The Good Life: Wellbeing and the new science of altruism, selfishness and immorality, How to Stay Sane by Philippa Perry and most lately the rather daunting sounding Psychoanalytic Aspects of Assisted Reproductive Technology edited by Mali Mann.  The wonderful thing is that this latter collection of essays is a splendidly good read for anyone, particularly counsellors, psychotherapists and psychoanalysts, interested in the ways in which men and women manage the psychological impact of infertility and modern medicines’ ways of circumventing it.

Whilst acknowledging the importance and usefulness of Freud’s ‘principle of repetition compulsion of the unconscious mind’  Mali Mann, who is both a physician and a psychoanalyst, goes on to recognise that in order to provide the sort of  help that is going to be meaningful to people going through ART treatments today, it is vital that psychoanalysis moves beyond the concept of psychogenic infertility.  For instance, a woman may unconsciously repudiate femininity or motherhood, and this may be an interesting dynamic to work with, but plenty of women who share this phenomenon conceive naturally so it is completely unhelpful to assume that this is the cause of her infertility.  As Mann says, “We need to be careful not to confuse the correlational data with causality.”  In other words, modern psychoanalysis needs to take account of factors other than simply the workings of the unconscious mind.  That said, it is clear from the many case studies in this book that unsatisfactory early relationships with their own mother and/or a history of unresolved loss, shame or grief may well contribute to a woman leaving it very late to make the decision to have a child and then in managing the difficulty with conceiving that is a result of delayed child bearing.  Unfortunately the book does not offer similar insights into why men may delay parenthood or their difficulties in managing fertility difficulties, other than to state that both men and women may feel themselves to be ‘less of’ a man or a woman and view themselves as ‘defective’ in some way.

Although this book is about all reproductive technologies, donor conception features prominently. and for me the most important chapter in the book is by Diane Ehrensaft whose earlier book Mommies, Daddies, Donors and Surrogates, I admire enormously. The chapter is titled Family Complexes and Oedipal Circles and in it Ehrensaft describes how both parents and child in a ‘birth other’ family have to negotiate the knowledge of the donor (birth other), his or her genetic relatives and half-siblings as part of the circle they belong to…this being a much more complex form of the classic oedipal triangle between mother, father and child.  Genetic and non-genetic connections within the raising family can of course cause asymmetry between the parents, adding to the complicated geometry of families where a third party has been involved in conception.  If children are told about their donor conception early in life, and Ehrensaft makes a powerful case for doing so, then there are likely to be times during their life when they think and fantasise about the person who helped to bring them into being.  However, because their first attachment is to the people who raised them, they may feel constricted in pursuing their interest in the donor and possibly constrained in talking or even fantasising about him or her for fear of hurting their parent(s).  As Ehrensaft says, parents play a vital role in facilitating a solution to this dilemma.  “By opening up a space for a family reverie, in which parents and children together share their thoughts and fantasies about the birth other,and by allowing the children a private space to engage in their independent family romances that might include the birth other, the children will feel their parents’ support and have the freedom to weave together a tapestry that includes all the members of the oedipal circle.  In round-robin fashion the parents will in turn discover the permanence of their children’s bonds with them and the resilience of the family they have built with the aid of assisted reproductive technology.”

In other words, parents who have confidence in the decisions they have made and are not afraid of talking with their children about their thoughts and feelings about their donor/genetic relatives/half-siblings, are likely to reap the benefits of a consolidated and resilient family unit that is flexible enough to include both the reality and fantasy of the birth other.  But parents need to be ready to first deal with their own grief and baggage in order to achieve this.

The book ends with a fascinating analytic interpretation of the film The Kids are Alright where the two donor conceived offspring of a lesbian couple find and form a relationship with their donor but ultimately reject him as a disturbance to the integrity of their family.  On the one hand this film illustrates the classically wrong way to go about searching for a ‘birth other’ (taking things too fast, not including parents in the search, no boundaries etc.) but Katherine McVicar’s analysis is worthwhile and instructive, allowing us insight into the underlying motives and behaviour of all the characters.

All in all a very worthwhile read.

Psychoanalytic Aspects of Assisted Reproductive Technology, edited by Mali Mann and published by Karnac 2014



About oliviasview

Co-founder and now Practice Consultant at Donor Conception Network. Mother to two donor conceived adults and a son conceived without help in my first marriage.
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