Img: Proserpine (Dante Gabriel Rossetti, 1874)

COCAP Blog: Children's Minds in the Line of Fire
Medically Assisted Procreation and Mothering Alone During the Pandemic
Author: Katy Bogliatto

Since the development of Artificial Reproductive Technology (ART) in the 1980s, progress in the bio-medical sphere has allowed better understanding and better care of biologic causes of infertility. 
We nowadays recognize that the trajectory of the desire for motherhood is multifactorial. It stems from the first years of life of the little girl and is a long developmental path anchored in deep internal psychic processes.  These include the processing of representations of internal object relationships with parental figures as well as primary feminine bodily representations represented phantasmatically (J. Sandler & A-M. Sandler, 1998) and with intersubjective processes and relational patterns with parental figures and the nurturing environment. (T. Benedek, 1959; R. Balsam, 2012). Biological factors such as age and the hormonal cycle as well as the woman’s’ life experiences and socio-cultural elements are also influential factor (D. Pines, 1993). 
For several decades, single women have had recourse to the help of ART to fulfill their project of motherhood. Each woman has a singular life story and psychosexual trajectory underlying her request, such as the pressure of ‘the fertility-clock’, felt as a female biological emergency. This includes all the intra-psychic conflicts and effects of strain in the difficulty of establishing a stable relationship with a partner, or alternatively the expression of a desire for pregnancy, bearing and raising a child alone and separating it from psychosexuality and the wish for a relationship with a partner, or linked to environmental and cultural reasons, … and the list is not exhaustive! Indeed, the reasons for a pregnancy can be as ‘few or numerous, as similar or as varied for a woman mothering alone as for a woman who is not alone’ (M.K. O’Neil, 2022).
In the medically assisted reproduction center where I work, my colleagues and myself meet every woman with a mothering alone request with or without an infertility grounding. These meetings can be unique or repeated over time. They give the occasion to the woman to unfold her parental project which led her to choose the path of medically assisted reproduction and have a preventive function. They open a field of psycho-dynamic investigation and give an idea of the quality of the relationships surrounding the woman (family/friends/ or loneliness).  
The SARS-CoV-2 pandemic has impacted the ongoing processes in ART with the addition of new sanitary procedures to the already complex medical trajectory. This can intensify the anxiety present, but felt differently, in all women living this experience. Hospital rules prohibiting patients to be accompanied by another person also impacted the trajectory of the future solo-mother, banning support from an external significant other (mother, sibling, friend, …).  This imposed sanitary distance, throws the prospective solo-mother back on her psychic symbolic resources of mother and father representations and capacity ‘to or not to’ lean on an internalized mother. One visible result of this psychical resource being her capacity ‘to rely or not to rely’ on her close relational environment. 
Under these new circumstances of uncertainty and social distancing, the place given to the danger of the pandemic in the motherhood project takes a new significant place. The articulation between conscious and unconscious motivations of their maternity project highlights an increased importance of denial of Covid danger. Indeed, even if these women, (and not only the women involved in a mothering alone project), recognized the real danger of the pandemic, many of them shared their hope more intensely than other women to succeed in mothering alone and to give birth to a healthy baby sometimes regardless of the dangers and consequences of an eventual infectious impact on themselves, the pregnancy and/or their environment. 
This real danger was not felt consciously as ‘a real interference’ in their desire for motherhood and was emotionally put at a distance and unconsciously treated with a ‘healthy- adaptive denial’ defense mechanism, which is to be differentiated from the psychotic denial of external reality. The function of this ‘tempered’ defense mechanism of denial is to keep at a certain distance the emotional storm which is linked to the intense psychic work accompanying this unique life experience of the perinatal period. This tempered defense can allow a woman to keep a variety of ambivalent feelings, fantasies, and perceptions originating from bodily changes and their bodily psychic representations at an unconscious and preconscious level. These issues are articulated with different patterns of mother-girl relationships (intrapsychic and intersubjective) and their internal representations of the imaginary baby. 
How can we understand the function of denial - concerning the real danger of the pandemic and the reality of death risk - and its relation to the desire for motherhood during this challenging period of uncertainty? And what would be the economic issues of this defense mechanism with its intimate oscillations between one side of the coin, the hopeful phantasy of becoming pregnant and giving birth to a healthy child - a life drive and fantasy turned towards giving life - and the other side of the coin keeping death drive and death fantasies in the shadow? 
In the wake of these questions, can we recognize and include in our listening to the unconscious fantasies of the desire of mothering alone during the pandemic- a determined position the woman takes? Such a stance could be related to the psychic struggle to defend oneself against the uncertainties of life that are particularly put to the test nowadays adding to the tempered denial every woman experience when considering pregnancy.
The contemporary definition of denial (B. Penot, 2003, G. Vaillant, 1992), describing the effect of this defense mechanism on the functions of the Ego’s capacity for representation and apprehension of reality through the "reality test" helps us better understand and describe the double consequence of this mechanism on the Ego. The first consequence is that of a ‘blurring’ impact on internal psychic representations, and the second is the ‘blurring’ of subjective perceptions of external reality by an alteration of the capacity to apprehend the veracity of the perception processes. 
Denial can come to the aid of the Ego, to help to ease anxious torments, but at an extreme, denial can also become pathological.
Despite variation in life events and psycho-dynamic factors, one common factor, that we can find in the line of fire during pandemic times is that denial intervenes when the Ego is confronted with moments of painful emotional intensity and conflicting impulses. It is thus at this moment that denial comes to the aid of the Ego, which can help one to get through this emotional time, but which can also become pathological, when the risk of danger is real. It is therefore important to be aware not only of the potentialities and resources of women mothering alone, but also to be aware of their specific needs that will inevitably come to the surface as they try to better their own and their child’s future.

Balsam, R. (2012), Women’s Bodies in Psychoanalysis, Routledge.
Benedek, T. (1959), Parenthood as a developmental phase – A Contribution to the Libido Theory, J.Amer.Psychoanal.Assn., (7):389-417.
O’Neil, M.K. (2022), Mothering Alone. A plea for Opportunity, Phoenix Publishing House.
Penot B. Figures du Déni, 2003. Ed Eres Version PDF, 2012.
Pines, D. (1993), A Woman’s Unconscious Use of Her Body. Routledge. London & New York., 2010.
Sandler, J., & Sandler A-M. (1998). Internal Objects Revisited. London: Karnac.
Vaillant, G. (1992). The Historical Origins and Future Potential of Sigmund Freud’s Concept of the Mechanism of Defence.  Int. Rev. Psycho-Anal., (19) :35-50.

Dr Katy Bogliatto
Child-psychiatrist, Training Analyst Belgian Psychoanalytical Society
Consultant in the medical assisted service of Chirec Hospital, Brussels, Belgium.

 Back to Children's Minds in the Line of Fire Blog