During the second phase of treatment which lasted six months, Kathy analyzed, argued, and enacted the complex issues that prevented her from taking her spot in the sunshine. It was striking, however, how quickly she connected her wish to reclaim the special times to issues related to her brother's death as well as the abortion. She began the next hour describing a dream where she delivered the baby she aborted before her first depression. In the dream she was so happy because the baby, who was a boy, was alive and all her family surrounded the two of them. During the session, her thoughts immediately turned to how just one year ago she had, for the first time, a vivid memory of her brother on the last day she saw him before he died. It was a memory of "remorse" in which she remembered their conversation and her thoughts of wishing he would disappear so she could get some attention. They had lived in Missouri only a short time, but the whole family was unhappy there. Kathy got no attention at all. Father competed with Dan and humiliated him in front of his teen-aged friends. Dan soon found "he could get back at father" by relentlessly teasing and taunting his little sister; Kathy felt betrayed and so hurt that she sometimes wished he would just disappear.
Finally Dan talked his parents into letting him move back to another state to live with the maternal grandmother. Dan was so excited. Kathy was confused, but thought it would be better for everyone if he left. Early one morning as she slept, he came to say good-bye. Kathy thought to herself, "Good. Leave me alone. Maybe I can get some attention here soon." That was the last time she ever saw Dan. Five months later, he died in the swimming accident. Kathy's family and life felt destroyed. Mother and grandmother never recovered. Although somehow her father was blamed, Kathy had a vague and haunting idea that her wish for Dan to disappear so she could get some attention somehow made her the one who was blameworthy.
Over the sessions, as Kathy elaborated on the details surrounding her brother's death and her family's refusal to recover, she also elaborated onthe details surrounding the abortion that triggered her first serious depression. My comments focused on the link between her feelings about the abortion and her feelings about her brother's death. A puzzling sequence of events had lead up to this first depression. Recently divorced, a single mother, and working full-time, Kathy felt relieved to be freed of an unhappy marriage and was involved with a new man whom she enjoyed. Although she had tolerated birth control pills well during her marriage, she suddenly discontinued them after separating from her husband. She claimed she was concerned they might be bad for her health. She got pregnant in this new relationship due to a failed diaphragm and a battle began inside her. She had always had strong feelings about abortions: She believed in the fetus as a living being, a lost soul; she also believed in every woman's right to choose for herself. There was no way, however, Kathy could afford to have another child - neither emotionally nor financially.After the abortion, she ended the relationship with the man for what seemed a curious reason. She claimed that his lenient attitudes toward abortion made her conclude he was not right for her. At this point in the treatment, I learned that this was just the first of two abortions within several months.
Her dream about delivering the baby she aborted had been about the second abortion. Shortly after the first abortion, she began a 4-month-long, passionate romance with a man-about-the-town businessman who was fabulously exciting and put her "in the limelight." He treated her as an intellectual equal and described her as the smartest partner he ever had. She felt recognized, prized, and special. They had fabulous times together. Then one wonderfully romantic weekend she got pregnant again - the second failed diaphragm pregnancy. Kathy said, "If I were superstitious I would have believed I was being punished, because I got pregnant that fabulous weekend. It was unforgiveable to get pregnant twice and to have two abortions: The first time was bad enough; the second time was the breaking point." She ended the relationship never telling the man about the pregnancy since she feared he also would be permissive of abortion rather than seeing it as "the killing of an individual." Soon her debilitating depression began. Defining abortion as the antithesis of mothering has made every Mother's Day since that time a trauma.
The most dramatic change the depression brought was in Kathy's feelings about mothering. Although previously always intensely fulfilled by her children and her mothering, she suddenly felt intensely empty with her children. She felt resentful of what she referred to as the "surviving children ." It was so hard to mother them. Although she disliked feeling these empty feelings, she valued highly the intense vulnerability she felt which allowed her to feel alive and connected to people in ways previously unavailable to her. She became animated and out-going in her social and work worlds. Although diagnosed with a major depression, Kathy claimed, "I didn't feel depressed. I felt crazy. My hands would shake; I lost weight; my emotions felt out of control; I cried all the time. But I also played, had fun, and flirted with all these people. I felt very special. Then I would return home and feel lonely and miserable with the children. And I felt so guilty - here I had these three beautiful children I had always felt so fulfilled by and I wished I could be somewhere else."
A few sessions following the exploration of this powerful material, on the anniversary of her second abortion, Kathy revealed for the first time one of the most devastating symptoms of her current depression which was a ruminating worry. Daily, Kathy imagined, in great detail, the loss of one of her children, followed by the fantasy of how she would comfort what she called the surviving children. Then she changed which child died and which survived, the circumstances, and repeated the process. I asked when the symptom first appeared. She replied: "For some reason, as soon as my eldest son, James, was born I realized what my mother had experienced when she lost Dan, and that if that happened to me I could understand how that loss would be so devastating that she could never recover and properly mother me."
At this point in the treatment, I began to suggest that Kathy's abortions might have been a way to punish herself for harming mother, Dan and maybe even her ex-husband whom she had just divorced . Kathy began to examine how she wished her friends would be punitive and not lenient toward her regarding the abortions. She began to see how her strong reactions to her abortions served as severe punishments and how they forever changed the way she felt about herself as a mother. She also began to reflect on her relationship with her mother. She began to realize that she always felt she had "robbed" mother because of Kathy's close relationship with father. If she felt pretty or smart, she felt she was robbing mother. In her early childhood, Father was loudly critical of mother while lavishing praise on Kathy for being his "soulmate," looking like him, and being strong and opinionated like he was. Kathy watched in horror as mother deflated and collapsed into feelings of inadequacy during these attacks. As she grew older, Kathy felt disturbed by her observation that her attention from and closeness to father seemed to cause mother great harm and injury. There was one fact that had saved Kathy from believing, however, that she unfairly injured mother by the attention she got. That fact was that mother had Dan. Kathy was able to see the family as balanced because mother had Dan. These balanced alliances were crucial to Kathy's sense of fairness to her mother and allowed Kathy closeness with her father. Kathy began to explore how Dan's death wiped out this "balanced system" for her and lead her to believe that not only had she injured mother by "stealing" father but also by being somehow responsible for killing Dan and thereby further injuring mother. Attention to Kathy always seemed to hurt someone.