Motherhood Specificities With the Rorschach Method
Results of a Nonconsulting French Population in the Postnatal Phase
Abstract
Abstract. Motherhood, listed by the World Health Organization as a period of fragility and vulnerability, involves significant changes at the individual, family and social level. Becoming a mother entails a number of risk factors to take into account. It is therefore necessary to carry out studies on general populations not suffering from psychopathological disorders to better understand these risk factors linked to motherhood. This study was carried out in France with a nonconsulting population in the postnatal phase (N = 30) using the Rorschach test, as it presents numerous advantages to appreciate the psychic and corporeal transformations linked to birth. The quantitative results of the test were compared with recently updated norms (De Tychey et al., 2012). Eight values of the psychogram remained normative (F%, F+%, W%, Dd%, M, C, H%, P) reflecting the characteristics of a general population; conversely, eight other values of the psychogram (R, D%, S%, A%, RC%, m, E, Anguish Index%) differed significantly from general population norms. These results increase knowledge to help appreciate the complexity of the psychic processes at work during the postnatal period, and to prevent psychopathological disorders. It is thus possible to distinguish these disorders from those that are transitory and classically linked to the upheaval caused by the onset of motherhood.
Motherhood is a particularly sensitive period, as it involves substantial changes for the individual, her family, and society as a whole, as well as numerous psychological adjustments (Gutiérrez-Zotes et al., 2016). Additionally, it is an important phase in terms of rearrangement of identity. This period can be marked by a number of disorders, which can vary significantly in severity. The “baby blues” affect 60–85% of Western women after the birth of their child (Dayan et al., 2002), postnatal depression affects 15–20% of Western women (De Tychey et al., 2005; Evans et al., 2001), and postpartum psychosis affects 0.2–0.5% of women in France (Dayan & Graignic-Philippe, 2011). Postnatal depression, in particular, is classified among the 20 most frequent and disabling illnesses according to the World Health Organization. It has been established that the risk of psychotic decompensation is much greater immediately postpartum and if the woman is primiparous (Kendell et al., 1981).
Disorders specifically linked to maternity seem to be largely underestimated according to professionals (gynecologists, obstetricians, midwives). This is also linked to the idealization of motherhood in society, in which motherhood is perceived as bringing total fulfilment. In fact, new motherhood comprises numerous readjustments: corporeal and intrapsychic, as well as environmental and contextual. For example, during pregnancy, women experience psychic life, bodily, and hormonal mutations and transformations, which bring about alterations in sleeping and eating patterns (McConnel & Daston, 1961; Fan et al., 2009). The mother’s sleep is also disturbed during the first weeks, even the first few months, postpartum on account of the numerous feeds and responses to the baby’s needs.
Furthermore, the birth can engender a number of obstetric incidents as well as minor complaints. It can often induce a traumatic dimension in the mother and a state of posttraumatic stress disorder (PTSD; 5% after 1 month postpartum, Denis et al., 2011). Excessive worrying and generalized anxiety have been studied in primiparous women in the postnatal phase and were found to affect 32% in a sample of 68 women (Wenzel et al., 2003). A recent study of primiparous women (Georges et al., 2013) showed that 18.8% presented with symptoms of acute anxiety before the birth, and this figure increased after the birth.
Moreover, anxiety during pregnancy impairs the complete recovery of the mother and can be a factor in the development of postnatal depression (Altshuler et al., 2008). Indeed, a study (Skouteris et al., 2009) showed that women who have a high level of stress at the end of the pregnancy are more likely to develop postnatal depression. In the postnatal period, the encounter with the baby can be the source of multiple worries linked to expected parenting ability, to the vulnerability of the baby, and to its many needs and the care it requires.
The literature review indicates a lack of recent studies of the postnatal phase using the Rorschach test among a population of women with no mental disorders. Only two very dated studies (Connell & Daston, 1961; Klatskin & Eron, 1970) demonstrate results with the Rorschach test in the postnatal period. Other studies using the Rorschach methodological tool are concerned with pregnancy (Bellion, 2001), a specific psychopathological register (depression; De Tychey et al., 1997), infertility (Setan et al., 2001), or pregnancy denial (Milden et al., 1985).
Motherhood is a unique life event that mobilizes psychological work of a particularly dense and unprecedented nature. It is therefore important to observe the postnatal psychological, corporeal, and hormonal processes outside of any psychopathological context in a general population using the Rorschach test.
Relevance of the Rorschach Test and the Mother’s Psychic Life in the Postnatal Phase
During pregnancy and in the postpartum period, the interior/exterior boundaries, internal workings, and psychic life modifications of the individual are in great demand and require the mother to carry out a large amount of psychological work. The Rorschach test is an ideal tool for understanding the implications of the psychological modifications that underlie this work during the postpartum period. The Rorschach test allows us to visualize the peculiarities of the internal world and the intensity of projective movements during this period. Indeed, it promotes the updating of the internal reality of the individual, of their body image, of their representation of self and representations related to early relationships. This is all the more interesting as these elements are particularly present and at work during the postnatal phase. The cards, which are, according to Chabert (1987):
Symmetric about one axis, make demands about the body of the participant, who projects the meaning of the images. This process gives structure to the representation of the self in its primordial essence – testing in particular the solidity of its limits and the differentiation between that which is internal and that which is external. (p. 142)
During pregnancy and in the postpartum phase, the woman’s body, psychic envelope, and internal/external limits are particularly mobilized and modified, meaning that the mother carries out large-scale work on her psychic life.
The fusional relationship that unites a mother and her baby in the early period has been described by Winnicott as a very particular psychic life state sometimes approaching madness. This primary maternal preoccupation (Winnicott, 1956/1975), which is systematically accompanied by a diminished interest in social interactions, can therefore have as a corollary a decrease on the Rorschach test of the classic indicators of socialization and a simultaneous increase in human responses.
We hypothesized that in a population of women free of mental disorders and with no complications during the pregnancy and the birth, normal psychological functioning would be modified by the motherhood process. This could be assessed using the Rorschach test by comparing the quantitative results (psychogram) of nonconsulting women in the postnatal phase with adult norms (N = 310; De Tychey et al., 2012).
The norms of De Tychey et al. (2012) are representative of the general French population, divided into three age groups (25–39 years: N = 114; 40–54 years: N = 121; 55–65 years: N = 75), two sex groups (male: N = 140; female: N = 170), four groups according to marital status (single: N = 108; married: N = 172; divorced: N = 24; widower: N = 6), and three socio-professional category (CSP) groups (privileged: N = 128; intermediate: N = 62; disadvantaged: N = 120). The average age of the 310 subjects was 45.5 years (SD = 5.5).
Our exclusively female population was compared with the normative Rorschach population made up of men and women. The work of De Tychey et al. showed no statistical differences related to sex, and thus comparison with an all-female population was not necessary.
We decided to operationalize this hypothesis by estimating the effect on each quantitative Rorschach factor of the normal modification of psychic life functioning postpartum according to the description of this period in the literature and comparing this with the general population. We developed the operationalization in three ways:
- 1.Factors we estimated within the range of the normative data;
- 2.Factors we estimated to be superior to the normative data; and
- 3.Factors we estimated to be lower than the normative data.
Factors Estimated Within the Range of Normative Data
Considering that we had a population of women free of mental disorders, we expected to find a good adaptation to the external reality and thus to have the F+%, the Dd%, and the number of popular responses (P) within the norms.
Factors Estimated to Be Above Normative Data
Because of the mother–baby unit created by the birth and the encounter with the baby (Winnicott, 1956), we estimated that W%, S%, and F% would be increased. The creation of the mother–baby unit is linked to the construction of a whole and the necessity to strengthen the limits of the Ego. Moreover, because the postpartum phase is considered a more acutely sensitive and receptive period (Deutsch, 1933; Racamier, 1979), we hypothesized that color responses (C) and shading responses (E), and therefore also RC% (the number of responses to the pastel cards), would be significantly increased. Because of the presence of the baby and the regressive context of the postbirth period, we expected to obtain more animal (A%) and human (H%) responses. Finally, anxiety is habitually detected in the postnatal period (Capponi & Horbacz, 2005), thus we expected to have an increased Anguish Index. The Anguish Index (AI%) is calculated as follows: (Partial human response (Hd) + Anatomic responses + Gender responses + Blood and Sex responses)/total number of protocols × 100.
Factors Estimated to Be Lower Than Normative data
Because the mother is mobilized in her dyadic adjustments (Stern, 1985), which require an additional effort of psychic life work (Belot, 2014), we hypothesized that the psychic life functioning would be saturated and inhibited. We therefore expected to have a lower number of responses (R) and movement responses (M and m), which are three indicators of capacity to deal with internal and external excitations according to the Parisian School (Chabert, 1983). We also expected that the focus on the baby will lead to less frequent detailed location responses (D%), linked to the increase in other locations of the answers.
Method
This study was approved by the local clinical ethics committee (number: P/2019/434). It obtained all legal authorizations and was registered (research not under the jurisdiction of the French “Jardé law”: hospital certification number ISO900:v2015).
Inclusion Criteria
The participants were recruited out according to the following inclusion criteria.
- 1.Women living in a couple with the child’s father. The child was desired by the couple.
- 2.Absence of complications during the pregnancy and the birth.
- 3.Women without psychopathological disorders at the clinical interview. (The research interviews carried out by a clinical psychologist confirm the absence of proven psychopathological disorders.) Absence of psychotropic medication.
- 4.Full-term baby without acute fetal suffering, without any intrauterine growth restriction, and whose state of health at birth required no particular medical assistance.
- 5.Women having experienced pregnancy and labor without obstetrical complications or somatic illness.
Recruitment of women took place through gynecologists and midwives. The postnatal follow-up gynecologist or midwife proposed the study to the participant after verification of the strict inclusion criteria on specialized medical software. Midwives have access to a database that allows them to find out if there is a history of mental health issues. If the participant fulfilled the inclusion criteria, the gynecologist or midwife proposed the study. If agreed, the research psychologist telephoned the participant to arrange a home appointment.
A clinical research interview was always carried out before the presentation of the Rorschach test to verify the absence of psychopathological disorders. Data collection took place exclusively at the participant’s home. This allowed the participant to stay with her baby and to not travel unnecessarily, which reduced her anxiety and prioritized her organization of daily living activities, while encouraging participation in the study. A debrief interview was systematically offered to the participant after the end of the research data collection. Out of the 32 women who requested to participate, two were not accepted in the study (due to separation of the couple and social difficulties). For this study, it was important for all participants to be emotionally, socially, and relationally stable, and to be involved in a stable relationship with their husband or partner. Sociodemographic data were obtained for all patients including age, educational level, and professional status (see Table 1).
No refusal to participate in this study was recorded. All participants gave their written informed consent. The assessment was conducted from 3 to 16 weeks after the birth. As such, all the women remained very close to what is habitually called the “post-natal period” and belonged to a “general population”. In addition, follow-up of these women by midwives and the physician after the study confirmed that no participant presented with any psychopathological disorder during the year following the birth of their child.
The sample was composed of 30 French women including 18 primiparous women. All participants were between 24 and 37 years old (average age: 31). All were living as a couple with the father of the child (average age: 33) and the pregnancy was desired. All the socio-professional categories were evenly represented in our population (French CSP classification from 2 to 6) according to the current INSEE criteria (National Institute for Statistics & Economic Studies in France). All personal details were anonymized.
Each response to the Rorschach cards was scored according to the criteria and technical standards of the Parisian School (Azoulay, et al., 2012; Chabert, 1983). This approach has positive psychometric indicators in France (Azoulay et al., 2007). Initially, scoring was done by the administrator.
The most difficult responses were checked with the other projective method specialist colleagues who coauthored this article and teach the projective methods at Université Paris René Descartes. They are graduates of the Parisian School with a “Diplôme Universitaire de Psychologie Projective” (DUPP; this university diploma is a 2-year complementary training on projective methods). They are also experienced Rorschach users who have been using the test for research purposes for many years. The psychogram results of our population were compared with the current norms of the Rorschach test (De Tychey et al., 2012).
Data Analysis
SPPS version 20.0 was used in all quantitative analyses. We performed a two-tailed one-sample Student test (t) to compare our averages with the standards of De Tychey et al. (2012). We also report the Cohen’s d statistic as a measure of effect size.
Results
General Comments
A comparison between the clinical group and the adult norms (N = 30) is provided in Table 2. Of the 16 indications of the Rorschach psychogram, eight indications did not diverge from the current standards of the French population (De Tychey et al., 2012) and were not significant: These indications appear not to be modified by the context of motherhood. The other half of the indications diverge from the norms with a high threshold of significance (p < .05 for one indication and p < .01 for seven indications), showing that in spite of our relatively small group size, there is a statistical validity in our results. Some results validated what we expected with the operationalization we proposed for the examination of the psychic life functioning of nonconsulting women in the postnatal phase. Other results were surprising because they did not match our expectations.
Results That Were Expected According to Our Operationalization
Factors Within the Range of the Normative Data
We observed a number of popular responses within the norms: P = 4.47 on average in our sample for a norm of 4.83, t(29) = −1.41, p = .168, d = −0.258; a nonsignificant F+%, 65.27 on average versus a norm of 60.86, t(29) = 1.19, p = .244, d = 0.217; and a normative Dd%, 3.25 on average versus a norm of 3.13, t(29) = 0.14, p = .892, d = 0.025. These results reflect the norms of the classic nonconsulting population and confirm that our population is suitable, with a well-adjusted relationship to exterior reality.
Factors Significantly Different From the Normative Data
As expected, we noticed that some factors were significantly weaker than in the general population: D%, mean 49.61% instead of the expected 57.24, t(29) = −3.71, p < .001, d = −0.677; small movements, Sum m = 1.87 on average versus a norm of 3.82, t(29) = −8.36, p < .001, d = −1.527; and R, mean 23.47, instead of the expected 28.16, t(29) = −2.91, p = .007, d = −0.531. The quantity of representations mobilized within this group is therefore reduced. The RC% was significantly higher in our group, 39.7 on average versus a norm of 35.94, t(29) = 2.23, p = .03, d = 0.407, as was the S%, 3.98 on average versus a norm of 1.99, t(29) = 3.41, p = .002, d = 0.622. Finally, the index of anxiety (Anguish Index%) was very clearly higher in our population: 25.77 on average versus a norm of 13.3, t(29) = 4.65, p < .001, d = 0.849.
Results That Were Not Expected According to Our Operationalization
Factors Within the Range of the Normative Data That Were Expected to Be Significantly Different
Contrary to what we expected, the number of human movement responses was not lower than but was close to the norm, Sum M = 2.33 on average versus a norm of 2.42, t(29) = −0.28, p = .781, d = −0.051. The W% score, 41.54 on average versus a norm of 36.83, t(29) = 1.63, p = .115, d = 0.297, was likewise normative, as were the H%, 15.42 on average versus a norm of 15.85, t(29) = −0.23, p = .822, d = −0.041, and the F%, 60.81 on average versus a norm of 57.81, t(29) = 1.01, p = .322, d = 0.184, while we had hypothesized that these factors would be increased. We also noted a normative number of color responses, Sum C = 2.92 on average where the norm is 3.36, t(29) = −1.12, p = .271, d = −0.205. This result is surprising because we hypothesized that the hypersensitivity of the subjects in our group of postpartum mothers would increase this index.
Factors Significantly Different From the Normative Data and Contrary to What We Expected
Finally, two indications differed from the norms but were in contrast to our expectations. We thought that the shading responses and A% would be increased. The significantly lower number of (E) shading responses is a surprising result given the mother’s state of sensitivity in this postnatal period, 0.28 on average in our sample for a norm at 1.04, t(29) = −6.63, p < .001, d = −1.210). Another unexpected result was the diminished value of A%, 36.29 on average compared with a norm of 42.55, t(29) = −2.79, p = .009, d = −0.509, while we had hypothesized that the postnatal period would be conducive to psychic life regression regarding animal content.
Qualitative Results: Response Contents Without Normative Data
Even though we did not specifically operationalize the response contents because there are no normative data with which to compare them, we were surprised to find specific contents in numerous protocols. Anatomic responses appeared clearly and in large numbers. We counted 21 responses with “uterus” and “cervix,” 16 “pelvis” responses, two “sonography” responses, and 10 “birth-giving” responses. They are of a “sexual” or “visceral” type, but “object” responses related to sonography were also given.
The non-symbolized nature of the anatomic responses concerned 14 of the 30 protocols. The responses ranged from “less symbolized” in the majority of the protocols (visceral and sexual responses) to “highly symbolized” in four protocols, with responses such as “the passage,” “a cavity open at the top and closed at the bottom,” “a cavern with an entrance,” “symbolic opening and closing,” example, “a zip.” The non-symbolized responses observed for the Rorschach test mostly concerned primiparous women. Indeed, 11 out of the 18 primiparous participants gave more of this type of response than other types of response. Some of the response contents were specific and were directly related to the conception phase and to female anatomy (22 responses concerned the “female sexual organ” and 17 responses included “ovaries,” “fallopian tubes,” or “vagina”). Blood responses were quasi-nonexistent, while the sexual responses, “vagina, uterus, cervix, ovaries, labia, period,” were predominant. We likewise noted a strong prevalence of visceral responses in the protocols “inside of a belly, heart, lungs, inside the body, organs, etc.”
The theme of birth (animal or human) concerned 18 of the 30 protocols. Conception and implantation were also evoked: “a baby in its mother’s belly” (eight responses). The real presence of the baby was evoked (17 “baby” responses, eight protocols).
Finally, even if the number of shading responses (E) was low, we noted that when this type of response was present, it concerned texture shading. We only noted one diffusion response on Card III: “smoke rising from the pot there.” All other shading responses were texture shading, for example: Card I, ”a hairy black butterfly”; Card III, “two birds with their feathers”; Card IV, “a kind of hairy beast”; Card V, “a beast with lots of hair”; Card VI, “a rug-shaped animal skin.” Texture responses characterize tactile sensitivity and indicate the reactivation of very early experiences in relationships, particularly the quality of the infant environment. Also, the presence of this type of response shows that new motherhood is indeed a context linked to early childhood reactivation.
Discussion
A Psychic Life Functioning That Remains Adapted
Despite the recognized habitual phase of primary maternal preoccupation, our participants presented an adequate relationship with external reality (normative F+%) and maintained normal perceptual control (normative F%). The adequate number of popular responses (P) shows that we are studying a population where the socialization is no different from that of a classic general population.
The nonsignificantly reduced number of human movement responses (M) demonstrates the preservation of thinking capacities among the women. Psychological work and reflexivity remain proficient, but nevertheless more difficult for certain criteria. In effect, a high kinesthesis score clearly reflects the presence of a transitional space and the participants’ capacities for development of their psychic life via the Rorschach (Chabert, 1983). The normative human responses (H%) show the participants’ capacities for creation and mentalization. These results confirm the fact that we are indeed dealing with a general population.
With regard to F%, we believe the presence of formal control demonstrates efforts to master the reality linked to the desire to control instinctual impulses. It also shows how much these women put up internal boundaries to guarantee the integrity of the Self.
We also note the relatively high number of human movement responses, normative (M), whereas the small movements (m) were seemingly absent in our group. This is interesting because it shows that in these women in the postnatal phase, the intensity of the underlying and identifying investments is turned more toward the human, rather than toward the animal or objects. Finally, all of these indications remain normative and confirm that we are dealing with a nonconsulting population that does not suffer from any proven psychopathological disorder. This population does, however, show aspects of fragility of the psyche that should be taken into account.
Specificities That Should Be Taken Into Account in the Postpartum Period
General Indications
We draw attention first and foremost to the reduced number of responses (R) of our group, which was significantly lower than the norm. The work of putting ideas into words that is required by the presentation of the Rorschach cards was more difficult for this group of participants in the postpartum phase. We hypothesize that confrontation with the Rorschach test mobilizes archaic elements not yet formulated in words and shareable representations. Primary maternal preoccupation (Winnicott, 1956) hinders the mother’s psychological work (her available psychological representations are weaker). The R translates the quantity of the representations available. In the postpartum period, in fact, the number of responses to the Rorschach is significantly lower. The archaic elements are more present during the postpartum period. This is visualized in the Rorschach by the significantly lower “Sum m and Sum E” indications and by a significantly higher RC% index. We observe dominant regression processes with the significantly higher index S% (Dbl) as well as the RC%. The regression phenomenon is also proven with the significant weakness of the Sum m and E indications. These indications also show the weakness of psychological work.
Our clinical experiments among women who had given birth recently showed us that the psychological work is more laborious during this period. The representations are therefore more difficult to express, which explains the significantly reduced number of R responses. The intensity of the transformations that occur in this phase of life (Belot, 2014) confirms a context of saturation in terms of the mother’s psychic life, a weaker investment in external reality, and a centering on the internal world.
Although we observed a lesser investment in the activity of representations (significantly low R), the number of responses to the pastel cards (RC%) increased significantly. In effect, the average of the RC% of our group highlights an increased permeability compared with the norm and the hypersensitivity of the participants in our group of postpartum mothers. However, the number of color responses (C) remained within the norms. Women in the postnatal phase are very sensitive to situations that encourage regressive tendencies without leading to psychic disorganization, as shown by F% and F+%, which are normative.
The earliest and most archaic material brought to the surface by the Rorschach is expressed by the shading responses named “E.” For this operation, the flexibility of the psychological apparatus is brought into play. The texture shading we described in the qualitative results clearly indicates the mother’s sensitivity and investment in corporeal experiences, such as skin-to-skin contact with her baby. We assume that this result is related to the difficulty of psychological work and the reduced availability of mothers during this period – they are very concerned with the concrete and constant care for their babies. The shading E responses appear later because the archaic materials later manage to make their way through the psyche.
Modes of Approach
Although the W% is within the norms we observe a sensitivity to emptiness and to absence, shown in the significantly higher number of S% responses. The increase in this type of response can be connected to the increased feeling of emptiness after the birth of the baby. The aspects of fullness and completeness in the final stages of pregnancy end brutally with the birth of the baby and loss of the fetus. Moreover, encountering and adjusting to the baby can also present the mother with new difficulties, which can relate to the unknown.
The significant increase in S% responses can also be connected to mourning for the imaginary child and the reactivation of the infantile in the mother, or the necessity of regression to adjust to the needs of her baby and the newness of the relational experience.
Certain defense mechanisms, such as isolation, are reduced (number of D responses in our protocols was smaller than in a classic population). These aspects can be linked to a defense against reactivation of undesirable instinctual movements but can also be related to the specific nature of the primary maternal preoccupation and the mother–baby unit in the postnatal period.
In addition, we know that the increased internal and external excitation during the postnatal phase can engender difficulties to think in mothers. The mother’s internal psychic life reality is subjected to great pressure on account of the internal and external modifications she faces. The mother accepts the birth event from multiple angles. Several studies (Belot, 2014; Belot et al., 2016) show the weakness of the maternal excitation barrier system because the mother must adapt to a new lifestyle and simultaneously manage the emotional regulation of her baby.
Not only does the new mother encounter her baby but, prior to this, she lived through a pregnancy, the modifications of her body image, and the testing experience of childbirth, which can be classified as ordinary trauma. This succession of events can produce the effect of psychological paralysis.
The reduced presence of small movements can demonstrate both difficulties in the psychological work and a lack of ability to let go with regard to certain cards, and the difficulty for mothers to deal with solicitations encouraging regressive tendencies in psychological terms. (Regression as we consider it here concerns a topical regression linked to different states of the psychological apparatus – unconscious, preconscious, conscious – a temporal regression, as it concerns the recovery of anterior psychological formations, and finally a formal-type regression, as the modes of expression and figuration in this context are more primitive.) The divergences here are the greatest in our study and we believe they are linked to the intensity of underlying instinctive reactivations, which the participant seeks to control.
Anxiety Indication
Concerning the anxiety indication (AI%), which was significantly higher in our population, we observed a majority of non-symbolized responses, sexual representations, and notably responses related to female sexual anatomy (“vagina,” “labia,” “uterus,” “ovaries”), which were present in 16 protocols out of the 30 studied.
Response Contents
We observed a significant decrease in A% responses (36.29 while the norm is 42.55). This result can be explained by the increase in attention to the human and a parallel deficiency in the contents of animal responses. Furthermore, the state of primary maternal preoccupation can weaken the indications of socialization. The mother is indeed completely dedicated to her baby and its care.
The number of human responses was slightly lower (15.42 for a norm of 15.85) without being statistically significant. However, the human responses were interesting, as the majority centered on “baby” representations and the experiences of mothering, as if motherhood was directly reflected in the Rorschach responses. It is therefore relevant to inquire as to the other contents of responses.
The anatomic responses reflect the impact of the corporeal event of childbirth, and may even reflect earlier preoccupations linked to the state of pregnancy. Preoccupations linked to the body are central at this time of life and appear more or less directly. The intensity of psychological and corporeal readjustments can interfere with the activities of symbolization and secondarization and reveal more numerous emergences of primary processes without, however, modifying these participants’ connection to reality (normative F%).
Among the findings resulting from the research with Rorschach tests, it appears that the psychic life functioning processes that are the most flexible and accessible to regression are those that offer the easiest access to motherhood.
Conclusion
This preliminary research demonstrates the nature and amplitude of psychic life modifications inherent in the postnatal period, which are clearly demonstrated by the Rorschach test. These periods of profound adjustment and of psychological vulnerability in mothers, habitually described in the literature, are given here a pertinent as well as unexpected and complex reading.
Even if the sample may seem small (N = 30), the results of this study show that among a sample of women coming from the general population and not suffering from any psychopathological disorders, there exist psychological resonances and particularities specific to the postnatal phase. Of the 16 usual psychogram indications in the Rorschach test, although eight remained normative (adaptation to the outside world, quality of mentalization, human representations, indication of socialization, and relationship with reality), eight other indications diverged significantly from the norms of the general French population. Thus, the psychological upheaval in the postnatal phase operates subtly and with regard to certain values only. Improved knowledge of the different phases of motherhood can aid professionals in the prevention of disorders specific to pre- and postpartum (baby blues, post-natal depression, and postpartum psychosis) periods.
The psychological factors involved at the time of pregnancy, birth, and the arrival of the infant necessitate further in-depth investigation to enable the provision of care that is both appropriate and preventive, in order to reduce disorders. These disorders can be linked to the postpartum phase, but may also emerge prepartum. Effectively, the great vulnerability existing during this period requires improved knowledge about the psychological impact involved in the experience of new motherhood.
Indeed, it appears necessary to increase the size of our sample in a subsequent study. We are currently conducting a longitudinal study to better understand the impact of psychic life and bodily transformations before the birth, in particular for primiparous women. This research is being duplicated internationally to compare intercultural differences with the experience of motherhood.
Limitations
The absence of psychological disorders among the women encountered was evaluated according to three essential criteria: strict adherence to the inclusion criteria, absence of proven depressive disorders (confirmed during the clinical interview), and the absence of use of psychotropic medications (confirmed during the clinical interview). We envision subsequently consolidating these criteria with the use of a self-assessment questionnaire (to evaluate depression and anxiety as well as levels of stress) within the framework of a new study.
The anxiety present in certain women in our sample population corresponds to the norms in a general population of women in the post-natal phase. However, a detailed evaluation of anxiety, including its intensity and frequency, would have allowed us to create different and more relevant subgroups. In the same way, although the birth took place with no apparent difficulties in the case of all the women in our population, a more careful examination of the circumstances surrounding the birth should be taken into account in our subsequent study.
An additional Rorschach protocol in the antenatal period is necessary for a subsequent study. This will enable us to observe changes longitudinally and more closely. Furthermore, studies of longitudinal cases from the beginning of the pregnancy to just after birth and the postnatal period would allow us to measure the extent of the changes throughout the pregnancy, the birth, and motherhood.
We would like to express our very great appreciation to Claire Giboudeaux-Baumes, translator–revisor, University of Franche-Comté, and Jennifer Dobson, translator and clinical research administrator, Besançon University Hospital, for the proofreading of our manuscript.
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Summary
Motherhood, listed by the World Health Organization as a period of fragility and vulnerability, involves significant changes at the individual, family, and societal level.
Becoming a mother entails a number of risk factors to be taken into account. Although the extremely widespread psychopathological disorders (“baby blues,” pre- and postnatal depression, puerperal psychosis, denial of pregnancy) are well known, they remain largely underdiagnosed.
It is therefore necessary to conduct studies on general populations without psychopathological and obstetric disorders to better understand all the risk factors associated with motherhood. The literature review indicates a lack of research on motherhood and the Rorschach in a general population at low risk.
This study was carried out in France with a nonconsulting population in the postnatal phase (N = 30) using the Rorschach test, because this tool has many advantages for assessing the mental and bodily transformations linked to becoming a mother.
We compared the quantitative results of the test with the recently updated standards (De Tychey et al., 2012). We made specific operational assumptions for all of the psychogram indices based on our knowledge of the postpartum period. Some assumptions were validated, others were not. Eight values of the psychogram remained normative (F%, F+%, G%, Dd%, K, C, H%, Ban) and reflected the characteristics of a general population, whereas the eight other values of the psychogram (R, D%, Dbl%, A%, CR%, k, E, Anxiety index%) differed considerably from the norms of the general population. These periods of deep adjustment and psychic vulnerability in mothers, which have been generally described in the literature, are revealed by a relevant, unexpected reading with the Rorschach.
These results increase our understanding of the complex psychic processes that occur during the postnatal period, and make it possible to identify the areas of weakness associated with access to maternity more precisely. They also make it possible to distinguish proven disorders from transient and classic disorders linked to the upheavals caused by becoming a mother. They can help prevent psychopathological disorders, which are too frequent in the perinatal period.
Résumé
La maternité, répertoriée par l’OMS (Organisation Mondiale de la Santé) comme une période de fragilité et de vulnérabilité, implique des changements conséquents au niveau individuel, familial et sociétal. Devenir mère comporte un certain nombre de facteurs de risques à repérer et prendre en compte.
Si les troubles psychopathologiques extrêmement répandus (baby-blues, dépression anté et post-natale, psychose puerpérale, déni de grossesse) sont bien répertoriés, ils restent encore largement sous-diagnostiqués.
Il est donc nécessaire de mener des études sur des populations générales qui ne souffrent pas de troubles psychopathologiques et obstétriques pour mieux appréhender tous les facteurs de risque liés à la maternité. La revue de la littérature indique en effet l’absence de travaux de recherche sur « maternité et Rorschach » auprès d’une population « tout venant » à bas risque.
La recherche est menée en France sur une population non consultante en phase postnatale (N = 30) à l’aide du test de Rorschach, car cet outil présente de nombreux avantages pour apprécier les transformations psychiques et corporelles liées au « devenir mère ».
Les résultats quantitatifs du test ont été soumis à une comparaison avec les normes récemment mises à jour (De Tychey & al., 2012). Nous avons émis pour tous les indices du psychogramme des hypothèses opérationnelles spécifiques en fonction de nos connaissances sur la période post-partum. Certaines sont validées, d’autres non. Huit valeurs du psychogramme restent normatives (F% - F+% - G% - Dd% - K - C - H% - Ban) et reflètent les caractéristiques d’une population générale, à l’inverse, huit autres valeurs du psychogramme (R - D% - Dbl% - A% - RC% - k - E - Indice d’angoisse%) diffèrent considérablement des normes de la population générale. Ces périodes d’ajustements profonds et de vulnérabilités psychiques chez les mères, habituellement décrites dans la littérature, sont révélés par une lecture pertinente et inattendue au Rorschach.
Ces résultats augmentent les connaissances pour apprécier la complexité des processus psychiques durant la période postnatale et permettent de discriminer plus finement les zones de fragilités liées à l’accès à la maternité. Ils permettent également de distinguer les troubles avérés de ceux transitoires et classiques liés aux bouleversements provoqués par l’accès à la maternité. Ils peuvent favoriser la prévention des troubles psychopathologiques, trop répandus en périnatalité.
Resumen
La maternidad, catalogada por la OMS (Organización Mundial de la Salud) como un período de fragilidad y vulnerabilidad, implica cambios significativos a nivel individual, familiar y social. Ser madre implica varios factores de riesgo. Si los trastornos psicopatológicos extremadamente generalizados (melancolía, depresión prenatal y postnatal, psicosis puerperal, negación del embarazo) también están bien documentados, todavía están en gran medida sin diagnosticar.
Por lo tanto, es necesario realizar estudios en poblaciones generales que no padecen trastornos psicopatológicos y obstétricos para comprender mejor todos los factores de riesgo asociados con la maternidad. La revisión de la literatura indica la ausencia de trabajo de investigación sobre “maternidad y Rorschach” en una población de “todos los que vienen” con bajo riesgo.
Esta investigación se lleva a cabo en Francia con una población que no consulta en la fase postnatal (N = 30) utilizando la prueba de Rorschach, porque esta herramienta tiene muchas ventajas para evaluar las transformaciones psíquicas y corporales vinculadas a “convertirse en madre”.
Los resultados cuantitativos de la prueba se sometieron a una comparación con los estándares recientemente actualizados (De Tychey y otros, 2012). Hemos emitido hipótesis operativas específicas para todos los índices del psicograma basados en nuestro conocimiento del período posparto. Algunos están validados, otros no. Ocho valores del psicograma siguen siendo normativos (F% - F+% - G% - Dd% - K - C - H% - Ban) y reflejan las características de una población general, por el contrario, otros ocho valores del psicograma (R - D% - Dbl% - A% - CR% - k - E - Índice de ansiedad%) difieren considerablemente de las normas de la población general. Estos períodos de ajustes profundos y vulnerabilidades psíquicas en las madres, generalmente descritos en la literatura, se revelan mediante una lectura relevante, inesperada con el Rorschach.
Estos resultados aumentan el conocimiento para apreciar la complejidad de los procesos psíquicos durante el período posnatal y permiten discriminar más finamente las áreas de debilidad vinculadas al acceso a la maternidad. También permiten distinguir trastornos probados de trastornos transitorios y clásicos relacionados con los trastornos causados por el acceso a la maternidad. Pueden ayudar a prevenir los trastornos psicopatológicos, que son demasiado comunes en el período perinatal.
要 約
WHOは、母性を脆弱性の時期として挙げている。そしてそれは、個人、家族、社会レベルで大きな変化を伴う。母親になることは、考慮すべきおおくの危険因子を伴う。極めて広範な精神病理的障害（“マタニティブルー”、出生前及び出生後のうつ病、産褥期精神病、妊娠の否定）はよく知られているが、それらは、ほとんど診断されないままである。
したがって、母性に関するすべての危険因子をよりよく理解するために、精神病理的障害や産科的障害のない一般集団を対象とした研究が必要である。文献を精査してみると、リスクの低い一般集団における母性とロールシャッハに関する研究が不足していることを示している。
この研究は、ロールシャッハ・テストを使用して、このツールが母親になることに関連した精神的・身体的変化を評価するために多くの利点があると考え、産後期の非相談集団（N=30）を対象にフランスで実施された。
テストの定量的な結果と、最近更新された基準（De Tychey ら, 2012）と比較した。われわれは、産後期間に関する知識に基づいて、全てのサイコグラム指標について特定の運用上の仮説を設定した。いくつかの仮説は支持されたが、他の仮説は検証されなかった。サイコグラムの8つの値（F%, F+%, G%, Dd%, K, C, H%, Ban）は、標準値と変わらず、サイコグラムの他の8つの値（R, D%, Dbl%, A%, CR%, k, E, Anxiety index%）は、一般集団の基準とはかなり異なっていた。一般的に文献に記載されている母親の中にある深い適応と精神的脆弱性のこれらの期間は、ロールシャッハを使った意外な読み方に関連させることによって明らかにされた。
これらの結果は、産後期に起こる複雑な精神的プロセスの理解を深め、より正確に母性に立ち入る際の弱点領域をあぶり出すことが可能になる。それらはまた、明らかとなった障害を、母親になることによって引き起こされる激変に関連する一過性および古典的な障害と区別することを可能にする。それらは、周産期に頻繁に起こる精神病理学的障害の予防に役立つ。
