By Dinora Pines. First published by Virago Press1993. Reprinted 2010 by Routledge. Paperback. 206 pages.
Reviewed by Dr Robert Gillen
This paperback re-publication is a collection of Dinora Pines papers reprinted from various psychoanalytic journals. The chapters are organised to follow the female life cycle from the cradle to old age and her work with patients who survived the traumatic effects of the Holocaust. Born in Ludsk, in what is now Poland, Dinora Pines was the daughter of two doctors and had brothers who were also doctors. Initially reading modern languages, she switched to studying medicine during the blitz on London.
The first chapter in her book is entitled “Skin Communication” and shows how she initially observed the effect of the hospital environment on the healing of women’s weeping skin disorders. ”Where the hospital setting could be seen as representing the primitive holding environment, where transference and countertransference feelings could be experienced by doctor and patient alike".
When she was working at the Elizabeth Anderson Hospital she met Hilda Abraham the daughter of Karl Abraham and developed a life long interest in psychoanalysis. From working with women with skin diseases she learnt that “these patients adapting to their mothers’ inability to contain their emotional distress, and having had such extended periods of bodily soothing, find an alternative means of communication. They learn to translate psychic pain into visible bodily suffering and so arouse concern and care again. In this way they learn to bypass the psychic process of suffering intolerable pain. It follows that the physical treatment of women patients by women doctors in the hospital setting, re-enacts the most primitive and soothing contact of mother and baby.” And so she learnt about transference.
She quoted Pearl King ”A true understanding of transference phenomena includes the knowledge not only the knowledge of who or what the analyst is representing but what also are the affects that a person or object from the past is felt by the patient to have had towards the patient, as well as those affects that the patient had towards those significant figures from his past especially during his infancy and early childhood.”
In chapters on adolescent promiscuity, pregnancy and motherhood, adolescent pregnancy and motherhood, the relevance of early psychic development, pregnancy miscarriage and abortion she writes about not good enough mothering, particularly in the pre oedipal phase, of having such a wide range of sequelae. She writes that “My countertransference was an important tool enabling me to understand these problems. At first my response was to feel angry and outraged by these mother’s cruelty to their children. I felt acute discomfort at such unusually intense anger with my patients and at my strong condemnation of their behaviour, I was aware of an urgent desire to restore my own psychic equilibrium by punishing them. Yet careful monitoring of my reactions and of my strenuous attempts to work through these feelings in order to maintain an analytic stance, led me to believe that what was being repeated was the patient’s activation of my own maternal feelings.”
In a chapter on “Emotional aspects of infertility and it’s remedies”, she writes,”In my view the crisis of infertility highlights fixation to an earlier phase of development. A young woman’s experience of her own mother and of her capacity to mother and the way her own mother has dealt with her own femininity is of prime importance in establishing her own mature feminine identity.”
The book ends with two chapters on the Holocaust, entitled. ”Working with women survivors of the Holocaust: Affective experiences in transference and countertransference.” And “The Impact of the Holocaust on the second generation” She makes us aware of young women who had survived the concentration camps, the longing to become pregnant and the wish to bring a new life into a world no longer dominated by sadism and psychic death is overwhelming. Babies for these women were an important concrete manifestation of the restoration of normality from a psychotic world and the reestablishment of family life that had been destroyed.” To these women infertility was an inconsolable burden to them.
The sensitivity of Dinora Pines is so apparent as she writes of her attempt to understand them. The book ends with the statement that, ”We must have the strength to bear the unbearable countertransference that mirrors what is secret in every human being – the impact of the fragility in patient and analyst alike, which tries to defend against a greater evil: man’s inhumanity to man “
The way this book is structured makes reading it a pleasure. Each chapter is introduced by a summary of theories, with a minimum of jargon and a clarity of theme. This is followed by clinical examples and ends with conclusions drawn from her experiences. This gives the reader an appreciation of an expert clinician at work, whose honesty about admitting to herself her feelings in her countertransference, lead to such a deep understanding of her patients, which in turn helped them to become conscious of their unconscious behaviour.
This is a rare, beautifully written and instructive book which should be read by a much wider audience than psychoanalysts.