The Relation between Tachystoscopic Pictures and Neurotic Postpartum Depression: The Building of an Instrument (1990)

ABSTRACT: Research is presented based upon perceptual defence theory relating to the possibility of detecting the risk of postpartum depression in pregnant women. The authors develop a tachystoscopic method and report on a study using the method on a sample of 43 French Canadian women. The method involves testing identification and reaction times to photographic stimuli related to perinatal issues. Our research is based on the theory of perceptual defence. This theory proposes that pictures or words related to emotional topics have recognition thresholds that are different from the ones of neutral material. Many classical experiments as reviewed by Dixon (1981) and Bowlby (1980) have shown that most subjects take longer expositions to recognize anxiety-provoking or threatening stimuli. While there is some controversy concerning the specific underlying mechanisms of this phenomenon, most authors agree that perceptual defence is a psychophysiological manifestation of a psychological defence against some disturbing stimuli. A few researchers have applied perceptual defence theory to clinical situations. For example, Williams and Quirke (1972) have shown significant differences in perception thresholds related to different types of psychopathology whereas Kragh and Smith (1970) have studies the relationship between several defence mechanisms and the perception of tachystoscopic pictures. However, to date, Uddenberg (1974) is the only author to have worked with pregnant subjects in a way that could lead to early detection of post-partum depression. In a longitudinal study with 89 pregnant subjects, Uddenberg (1974) projected through a tachystoscope the image of an obviously pregnant woman. He demonstrated that the time to correctly identify the image was positively and significantly related to: a) an abnormally long duration of labor at delivery and b) the occurrence of a neurotic postpartum depression. These findings point to an interesting possibility of the early detection of postpartum depression through a nonintrusive and generally pleasant technique resting on a measure of perceptual defence to pregnancy-related stimuli. A FEW WORDS ABOUT NEUROTIC POSTPARTUM DEPRESSION Almost all authors agree with Pitt's (1968) definition of this depression as characterized by crying, tiredness, emotional lability, decreased libido, feelings of incompetence and guilt related to the maternal role, irritability towards the baby and the spouse, anxiety and hypochondriacal preoccupations. Suicidal ideas are rare and rarer are suicidal attempts. Woman suffering from neurotic postpartum depression remain in contact with reality and generally take good or adequate physical care of their baby. There is however a tendency for those women to be unresponsive or psychologically absent to their baby's intimate needs. The most frequently reported rate of this kind of depression is around 20% (see Uddenberg, 1974; Hayworth et al, 1980; Paykel et al, 1980; Oakley, 1980; Kumar, 1982; Atkinson et al, 1983; Saucier, 1986), although the range varies from 7% (Dalton, 1971) to 45% (Tonge, 1986). The rate of neurotic postpartum depression is very different from the one of psychotic postpartum depression (or postpartum psychosis) which is found in 2 or 3 cases out of one thousand, and of the one of postpartum blues which is the most frequently observed phenomenon after delivery. It is important, as we see it, to detect as soon as possible, the vulnerability to postpartum depression because of the long-term effects on all the family (the mother, the baby, the spouse) of this state. Different authors have observed long term effects of this depression on the affective (Alexander et al, 1982; Cox et al, 1982; Weissmann, 1981; Zaticek et al, 1979), cognitive (Brockington, 1985) and sometimes physical development of the child (Sameroff et al, 1982). We decided to study, beginning by a pilot experience, the possible relationship of postpartum depression scores to the perception of tachystoscopic perinatal stimuli in women having delivered three or four months before their participation in the study. …