Life of the mind: Good mum/bad mum

I have a patient who is breastfeeding her first child. I take glowing (though unwarranted) credit for this. A year ago she wasn’t sure she wanted a baby, thought she might hate him or her. She said she didn’t feel pregnant and was going straight back to work after the birth. Basically, she has spent most of her life trying as hard as possible to be a man. Now she was facing up to being a female mammal and she didn’t like it. Understanding why seemed gradually to allow her to accept being female.

For the birth she went abroad to stay with her only female friend, mainly so she could avoid her abusive mother. The older friend was nurturing and my patient allowed herself to be looked after for the first time in her life. During the Skype sessions we had while she was away she even looked different—softer in the face and, basically, more feminine. A month later, back at home, she was very lonely, desperately missing her friend at the same time as fighting her mum.

I suggested to her that she was thinking in very black and white terms about the women—one idealised mother who was perfect in every respect and one demonic mother who was solely destructive. Lurching into appalling unprofessionalism (I imagine my poor supervisor wringing his hands; talking theory to a patient never helps) I told her about Melanie Klein’s good breast and bad breast. The baby, unaware that these two items belong to the same person, hates the withholding breast that doesn’t come when he or she is hungry and loves the nice milky one that does feed him or her. Realising that these are two aspects of the same person and managing to feel ambivalent is a huge developmental hurdle, one that many people never make. (People who see the world in a binary way—for example, remaining convinced of their narrow views and certain that anyone who opposes them is evil).

The following session, she told me about her baby. “He isn’t feeding,” she said. “He will feed from the right breast, but not from the left breast.” I was astonished but stayed silent. “Actually, at night he feeds from both,” she said. “But during the day if I try to give him the left breast he screams as though I am trying to poison him.” She was very upset and I gave some trite interpretation; “You feel you are giving him something toxic in your interaction with him.” I probably should have given a transference interpretation—interpreting everything as a communication about our relationship: “I think you feel that half of what I say is toxic.” She continued to talk about how she was trying to work from home at the same time as looking after the baby with no help.

We were both aware of how surreally literal the theory seemed to have become and realised between us that the patient really was good mum/bad mum for the baby since she had gone back to work. At night she was slumbery, sweet, soft, peaceful mum, the more feminine person she’d been at her friend’s house. By day she was now more brittle, her work voice probably unfamiliar to baby, her body less receptive to him. She had become two separate people and baby had a) noticed and b) expressed his preference.

When I had the same feeding problem many years ago someone suggested honey. I couldn’t help myself. “Of course, part of you wants me to give you practical solutions like putting honey on that breast, while another part of you wants me to help you understand what’s going on.”

Later in the week but before the next session she emailed me. “Honey worked!” But I suspect it was a combination of honey and understanding.