The Signal

Vol. 16, No. 1-2 Newsletter of the World Association for Infant Mental Health January-June 2008

Infants Born of Rape

By her suffering multiple rapes. Juliet One Rwandan mother was reported
Frances Thomson Salo, Ph.D., Hopkins concludes with a discussion as saying that she would tell her son
Campbell Paul, MB, BS, of the two papers. about his conception and add that
Amanda Jones, Ph.D. and Juliet God is not angry with either of them,
The papers explore the ways that a that it happened because of war, and
Hopkins, Ph. D. baby conceived as a result of rape that God loves them (Wax, 2004).
might be affected by the psychic
INTRODUCTION - FRANCES work the mother needs to do to WORKING WITH A SICK
THOMSON SALO enable the baby to come alive in her BABY BORN OF A RAPE
These papers begin to explore a mind as a person in his or her own - CAMPBELL PAUL
painful subject that at times may right. With these babies, we need
While no expert on the tragedy of
feel almost unthinkable, that of to consider the autonomy of the
rape I offer some of my thoughts
infants who are born as the result fragile self. It is crucial to be aware
from a clinical perspective. As it is
of a rape. These papers were part of of the effects on infants and their
150 years since Sigmund Freud was
a symposium on ‘Infants and rape’ families, and to refine and extend
born, it is timely to reflect on the
presented at the World Association of therapeutic approaches. Such work
question of where we have come to in
Infant Mental Health 2006 Congress is increasing relevant given the
our understanding of human sexuality
in Paris. Campbell Paul in the context conditions in which some infants
and related issues since then.
of work with sick babies discusses and their families currently live. It
questions about self representation is, for example, estimated that in Sexual violence is an issue both
and identity when there has been Rwanda 10,000 babies were born as overwhelming in its enormity and
rape, and the defences used. Amanda a result of genocidal rape. Perhaps yet in many ways hidden. The World
Jones describes how a young, deeply it is only when clinicians can allow Health Organisation (Krug, 2002)
traumatized asylum-seeking mother themselves to hear the pain in such special publication on violence
used a psychodynamic, systemically shocking cases that these babies and details that women in a range of
sensitive, parent-infant intervention, their mothers can fully get the help countries, from 10% in Brazil to
to find a way to accept, and gradually they need. 46% in Peru1, report incidents (often
love, her seventeen month old first- repeated) of attempted or completed
born son born as a consequence of When babies are born of rape their
forced sex by intimate partners during
mothers frequently wish that they
their lifetime. Up to fifty percent of
and their babies would die. Some
women have therefore experienced
mothers are not able to mother their
something like rape or a similar
Contents babies and some give them away or
try to kill them. The whole subject of
assault within their own intimate
relationships. As infant mental health
these infants may be under a taboo of
10 Child of Hope: Sexual Trauma workers, I suspect it is an issue we
silence in their communities. Some
in Infancy rarely ask about. What does it mean
resilient babies, however, help ease
13 By the Red Cedar that so many women, presumably so
their mothers’ pain and suffering.
many mothers of the infants referred
15 Welcome to Yokohama! How a mother tells her child about
to us, have been so violated? Do they
his or her conception depends on how
16 The Spare Room by Joanna make a complete disjunction between
Murray-Smith she has been able to find a place for
these assaults and the acts of sexual
an internal representation of a good
19 Editor´s perspective union that led to the conception of
father alongside the representation
20 President´s perspective their babies? Or maybe they make a
of the rapist biological father. The
range of accommodations.
context is always important (Emde,
R, personal communication, 18.5.06). 1. Other examples are 23% in UK, 15% in
Canada.
WAIMH

Central Office
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Rape occurs in a range of settings How these infants themselves have
– what meaning does it have for fared in this context is not clear – we
the woman? What effect does it can only imagine how disruptive it Editorial Staff
have upon the human integrity of must be.
the man? I shall, however, leave
aside this question, one that is riven In statements that victims of rape Editor:
with controversy, to concentrate made to the Medical Foundation for Miri Keren
on mothers and infants. The the Care of Victims of Torture in
consequences for women are many: the UK, many women said that they
did not blame the child, whom they Production Editor:
gynaecological trauma, infections,
STDs, HV/AIDS, as well as a range saw as ‘an ‘innocent victim of war Minna Sorsa
of psychiatric and psychological (Papineni, 2003, p 362)’. While it is Tina Houghton
disturbances (depression, PTSD, not known how many infants have
suicidal ideation) - and of course the been abandoned, clearly many still
likelihood of an unwanted pregnancy. live with their mothers, who may Editorial Board:
Other social consequences can be identify with the child and also fear Susan Berger
profound: women may be blamed, the infant being described as ‘filth’ Salvador Celia
shamed and excluded from their own by the whole community. In Rwanda, Peter de Chateau
families, indeed in some communities such children are often known as ‘les Mauricio Cortina
expelled from the entire community. enfants de mauvais souvenir’, that is, Graziella Fava-Vizziello
(In Kenya, women raped by soldiers children of bad memories or ‘children Elizabeth Fivaz-Depeursinge
were, on joining the settlement, of hate’ (Papineni, 2003).
Peter Fonagy
rejected by their husbands, and set
How difficult it must be to seek help Cynthia Garcia-Coll
up their own community with their
children.) Women may be blamed for in such circumstances: the mother is Bernard Golse
bringing shame upon their families doubly aware of her shame in that she Antoine Guedeney
or partners, and justice seems so knows that she was forced to gratify David Lonie
often a totally remote concept. Rape her oppressor’s desire and she knows Tuula Tamminen
is at least to some extent a product that everyone in her community Michael Trout
of social mores, rules and behaviour, knows this as well. What does she
Elizabeth Tuters
whether these are acknowledged or believe her infant will know? What
does she glean from his eyes to her? Hisako Watanabe
not. In some communities the woman
and the baby are seen as the evil, Correspondents Report (Australian
guilty partners and are sometimes President’s Perspective:
Broadcasting Corporation 10.2.06)
killed. Rape has for centuries been addressed some of these questions Tuula Tamminen
used as a weapon of war as part of a in a program in which two Bosnian
more conscious, systematic process women discussed their dilemmas.
but can also occur in the midst of From the Red Cedar:
Safeda wondered when to tell her
severe social chaos or poverty where adopted son that his Muslim mother Hiram E. Fitzgerald
law has broken down – for example was raped by a Serbian soldier.
currently in Liberia at least 40% of Safeda was ill and about to die and The Signal is a quarterly publica-
women have been raped and fear this was in great conflict about whether
would happen to their daughters. The tion of the World Association for
to tell her son about his conception.
president, Ellen Johnson Sirleaf, is His biological mother had abandoned Infant Mental Health. Address cor-
leading a fightback and courageously him so that he had not been breastfed; respondence to Miri Keren
declared her experience of attempted he was adopted by a Muslim couple.
rape when in prison earlier on. (ofkeren(at)internet-zahav.net).
One question was whether he should
Even in the 20th and 21st centuries, try to find his mother - ‘Not really,
he has parents, there’s love from All opinions expressed in The
in the former Yugoslavia and
the adoptive parents, his mother Signal are those of the authors, not
Rwanda, women were held captive
for the purpose of demoralising and especially’. Another question was necessarily those of WAIMH’s.
destroying a community – a form of whether to tell him that he was Permission to reprint materi-
genocide - through alienating and Muslim - ‘He is more Muslim than
Christian…We will see this happen als from The Signal is granted,
shaming women, their husbands,
their sons, their fathers as well as the again. …Their children live with us.’ provided appropriate citation for
children themselves. The trauma of The second woman, who was single, source is noted. Suggested format:
the capture and sexual assault itself is was raped by soldiers and became
pregnant. She poignantly said of her The Signal, 2008, Vol 16, No.1,
then perpetuated on a daily basis as
son, ‘He’s my whole life. When I go, WAIMH.
the family is faced with the offspring
of their tormentors in their midst. he’ll be all on his own. But my son

2 The Signal January-June 2008

will be a good man.’ Even though her – her memory – sexuality – her incest and random sexual assault.)
son had a very divergent parenthood daughter, there seemed to be some Or were they disclosed to the child?
and traumatic conception, his degree of freeing that enabled her It is a complex problem: 30% for
mother was able to detach him from to provide more appropriate limits example did not discover they were
wrongdoing done to her by his father. and containment and to help her pregnant until the second trimester,
Can she talk of his father? Can she regain better self-regulation and so that termination of the pregnancy
even think of his father? As clinicians homeostasis. becomes problematic. 30% opted to
we see some mothers whose babies keep their baby, 50% had an abortion,
present with problems, who say, Helen and Sarah are doing well at 6% placed the child for adoption and
‘His father is not around’ or ‘I don’t present but there remain tensions and 12% had a spontaneous termination.
know who her father is’. Should we lacunae in the relationship between
explore this with mothers or leave Sarah’s father and mother – many CHANTELLE
things unsaid? things had never been said between
them. They have recently commenced Here I shall describe Chantelle,
Also of interest was the process of marital counselling which Helen who was born early – too early in
making the television documentary, seems to find confronting and many ways. Her mother, Kerry had
of daring to talk about a topic of helpful, but there has been some a complicated pregnancy, with high
which so many were ashamed. For freeing of Sarah from this sexual blood pressure and pre-eclampsia
these mothers, despite the inevitable trauma. leading to a semi-urgent Caesarean
traumatic memories experienced section at 34 weeks. Chantelle
by the mother or adoptive mother, What of those babies conceived in had severe respiratory distress
the child was a person in his own communities which are not in the grip syndrome and needed five days of
right – detached, as it were, from of war or equivalent chaos? There ventilation; she also had a mass in
the ‘father’, if I can use that term,. are many babies conceived in rape her abdomen and possible pre-birth
Somehow they made this dissociation in our communities whom we do not brain damage, so that her start was
possible. know about. In a 3-year longitudinal very problematic. Kerry, aged 35
telephone survey in USA about years, had also had a very traumatic
For families whom I see at the Royal trauma and health, 4,000 women were life, with many presentations to
Children’s Hospital, Melbourne, this followed up three times a year and mental health facilities and multiple
disjunction is not always possible, 6% reported rape-related pregnancies diagnoses, mainly of Borderline
as with Helen2, 28 years old, and her (Holmes et al, 1996). The context is Personality Disorder but including
5-month-old daughter, Sarah. Helen that in USA an estimated 680,000 of bipolar disorder. She had certainly
had been sexually assaulted and women more than 18 years old are been very sad and anxious about
anally penetrated by a stranger when assaulted each year but 60% of all Chantelle’s birth, fearful that she
she was alone in the street one night. rape cases are females less than 18 might not be able to bond with her or
She has suffered considerable anxiety years old, so that the figure may be able to care for her. She feared losing
symptoms and severe gynaecological much higher. Only 15% report the her baby, but was nonetheless very
and bowel symptoms with crime to the police. The researchers honest about this experience and her
intermittent pain and rectal bleeding. asked about non-consensual assault, feelings. She talked of her concerns
She subsequently became pregnant with force or threat of force (with that she had poor control of her own
to her husband, unrelated to the some sexual penetration of vagina/ anger. ‘I sometimes think of hitting
sexual assault. She found the whole rectum/mouth). 80% agreed to her – but I would never do it.’ She
process of intercourse, pregnancy interview. The results suggested a had found herself losing most of her
and childbirth very traumatising, 13.6% lifetime prevalence rate of relationships over the course of her
but managed it in a private, self- rape. In USA there are estimated early adulthood, including those of
contained way. Her daughter, Sarah, to be about 32,000 rape-related her long term foster parents who felt
had become embroiled in Helen’s pregnancies per year. For many they could no longer bear the hurtful
sexual trauma as she reminded her this means having to experience the disappointments that resulted from
of the assailant of some years before. difficulties of being a very young their attempts to keep in touch with
The baby presented with distress and teen mother. These figures are in the Kerry. She was unpredictable – one
feeding difficulties, refusing bottles context of an estimated 3 million minute she was sad and needing their
and Helen had ‘lost all confidence unintended pregnancies in USA per love, at other times angry, distancing
in her’. For Helen, as it unfolded in year. Often the offender was known and rejecting, and on rare occasions
therapy, it was hard to provide any – even well known - to the baby’s violently threatening.
sense of containing limits for her. She mother, which suggests links to
felt guilty for connecting her daughter ongoing family violence. There is a Kerry revealed that she had been
to the violence done to her. But as high prevalence (more than 45%) of a child born of rape. She never
she became aware of this unconscious multiple assaults. Many were never knew her father – her birth mother
connection: men – violence – rape disclosed to law enforcement or found it impossible to talk about
health workers. (There are different it, only that Kerry was conceived
2 Names have been changed to protect contexts: date rape, marital rape, by force, by a man she had never
confidentiality. known. Kerry found this out in her

3 World Association for Infant Mental Health January-June 2008

early teens. There remained big all. Somehow there was a mockery the Children’s Hospital geographical
gaps in her memory which seemed of herself. Projections seemed to fly area we are not directly involved in
to make things worse for her – she about like missiles and in the midst her ongoing treatment. Her parents
was a person who could never know of this Kerry saw herself reflected in are her primary carers, she is now
herself. She had begun self harming her daughter’s face as bad, unwanted, one year old and her physical and
at 14 years but was, however, able to abandoned and somehow evil. social development seem satisfactory.
sustain her studies and get a job. With the huge gaps in her personal We remain concerned about her
narrative she fitted the fantasy of her emotional development. Will she
Her partner relationships had been own father violating her mother and be able to be helped out of this
many, complicated and disrupted, herself into her self concept, that she chain of intergenerational traumatic
but in recent years she had settled must be bad and unlovable, like him. projections? Kerry has been honest
with Sam, her current partner; there She also fitted this into her view of about her baby, in a protective way,
had been consistency, albeit with her daughter. even though the risk is high that she
dependency. She hated him - he had may harm her. The workers have
raped her. She had refused sexual Donald Winnicott, (1971) strong feelings about Chantelle
relations with him, but he insisted paediatrician and psychoanalyst, and have been able to work with
and forced her – she felt violated and wrote about the importance of the them. Kerry was welcoming of our
dirty. Chantelle was a result of this mirror role of the mother (and it interventions (the mental health
intra-marital rape. It was as if Kerry could be the father), whose task is service), as well as those of her own
existed without any sense of self and to enliven the baby through face- therapist, the infant-focused family
boundary, just as she fantasised it had to-face engagement (and holding of worker and Protective Services. So
happened to her mother – a repetition. the baby). In this context, ‘the baby, there is some cautious optimism.
Chantelle had medical problems: looking at the mother … sees herself
she had small brain haemorrhages reflected in the mother’s face’ For To summarise, when pregnancy
and she looked ‘odd’ but no specific Kerry, as she looks into her baby’s results from rape the family, the
diagnosis was made. Kerry said how face, she sees a shameful, damaged community, everyone has views
hard it was to care for her baby – she image of herself reflected and this is about the woman – if they know
wanted so desperately to do this but the image of emptiness that Chantelle - and about the potential baby. But
felt incompetent and unable; she felt may then see reflected back to her what does the mother feel about
she needed help with basic aspects of through what she sees in her mother’s herself and her baby, who is often
child care. Indeed the ward nursing face; she then avoids the gaze of her seen as a ‘bastard’ infant, as evil
staff were very concerned at the way mother and others. and a punishment? Can she love
Kerry bathed Chantelle, whom she her baby? I think that a critical role
let slip into the water. Chantelle was Kerry was admitted to a mother- for health professionals is to gently
very stiff and mechanical and it was baby psychiatric unit with Chantelle engage with parents and the baby in
a joyless and unsmiling procedure. for a couple of weeks, but still felt an attempt to identify the powerful
Kerry seemed very detached from unsafe to look after Chantelle, despite projections that lodge on the baby,
Chantelle who herself had persistent improved self regulation, feeding, and hopefully attempt to detach some
avoidance of direct gaze with her sleeping and containment of her of these. In the two cases here, the
mother as well as others. It was as if medical problems. Chantelle went mothers volunteered their history
Kerry, although a bright woman, had home with her parents, but Kerry of sexual assault. What of the many
no idea about her baby’s body, no was not allowed to be alone with women whose babies have symptoms
idea how to hold, mould, contain it. her on a Protective Services’ order, of a range of common infant mental
as she was unable to say that she health paediatric problems but who
She said that Chantelle being sick felt completely safe caring for her are unable to tell us about their
made her very confused and she daughter. Chantelle remains an infant assault? How can we establish
wondered whether Chantelle’s of concern, although developing a trust in such women in a way that
illness was a punishment for Kerry’s relationship with the family support is facilitating? So much depends
problems or whether Chantelle was worker who visits regularly and has on the context. These two women
being punished. For what? For being a vital role with Chantelle and her presented their babies through a
her daughter? Kerry said that when mother. non-stigmatising child health system,
she looked into her daughter’s face which may have made it easier for
she saw herself - but as a shell of a Chantelle was able to play, but them to trust. For others it may be
person, as somehow ‘bad, damaged usually began an interaction with a that a longer term relationship-based
goods’. Her past was projected tense, hypervigilant gaze, her eyes home visiting early intervention
into her daughter – or was it her reaching to the back of the eyes of program (Zeanah, 2006; Lyons-Ruth,
daughter herself, she found it difficult whoever met her, so that there was a 2006) can provide the necessary
to distinguish. She thought that shift in the way she related to people. sense of safe containment to share
maybe Chantelle was really just her Her penetrating gaze seemed to be feelings of shame and anger.
husband’s daughter and there was one of self defence. As Chantelle Agencies such as sexual assault units
none of herself in her daughter at and her parents have moved out of can play a vital role in supporting

4 The Signal January-June 2008

communities if they provide a safe, lead to parents avoiding an intimate there was the couple I had seen
supportive setting in which terrible relationship with their child. So I on the wall. The room was a tip.
events can be disclosed to someone believe it is important to be receptive Daniel was throwing toys around
who will sensitively listen. Perhaps to such stories and secrets – the time in a mindless way. When I greeted
through these means we can help of the new baby’s life is one of great them Fatima did not look up at me,
the mother see that her baby’s own change, flux and of promise. nor did Daniel. I started to lead them
story must develop, separate from towards the room. Daniel ran ahead,
the narrative of the rape that resulted In summing up communication unsteadily, as if he knew where he
in the conception – that her baby between infant and mother, Winnicott was going. On this brief journey
becomes an independent person. wrote, speaking for the baby: down the corridor, he fell over
I find you three times. Not once did he look
For clinicians seeing mothers before backwards to his mother for help. He
they have made disclosure of sexual You survive what I do to you as I literally fell into the room. Although
abuse, when we ask a mother if recognize you as not-me; I did not know it at the time, in those
her pregnancy was ‘planned’, we I use you; few moments, Daniel revealed his
are asking a lot. It is not an easy internal object relationship with his
question. For a woman who has been I forget you; mother: she was not there in his
sexually assaulted, especially within But you remember me; mind as a mother he sought help
her partner relationship, it can be a from; he split off and denied any
crucial question. She would be wise I keep forgetting you; awareness of wanting a response
to assess us well before answering I lose you; from her or indeed of wanting contact
this question – if she does divulge the or help from any adult. Yet, in the
fact of rape leading to conception and I am sad. tripping, he demonstrated how he was
the baby she is consulting us about. continually falling to pieces and then
She needs to know that we – and the So I hope that we are all able in our having to gather himself together.
system we work in – can support her different contexts to help babies and
in a containing, non-judgemental their parents find – lose – and find Fatima sat down. She did not remove
way. But if she feels safe to tell us, again – each other, be sad – and then her coat, or Daniel’s. As the family
I believe that there is a remarkable happy all over again. The baby can support worker tried to take Daniel’s
opportunity to help enliven the become a person. coat off, he hit her face. Within
baby. By speaking of it, the mother minutes the room was trashed.
may be able to begin to consciously RAPED IN UTERO - Daniel tipped over all the boxes,
disconnect any poisonous projections AMANDA JONES3 pushed everything off the table,
there may be onto her baby. She may I met Fatima and Daniel when Daniel and threw a box of crayons at me.
feel better able to see her son, her was seventeen months old. The I felt as if something unstoppable
daughter - as a separate person. memory of my first sight of them is was going on. I felt besieged. My
vivid. As I was walking towards the emotional response suggested that
The baby whose very existence clinic early in the morning I noticed powerful projective identificatory
means violence can be seen by his a young African mother sitting on processes were in play between this
mother as always a reminder of the a wall with a screaming toddler mother and son.
violence – he is the embodiment, positioned across her lap whilst she
literally, of the perpetrator and at the changed his nappy. It was a cold It was hard to know how to start.
same time the embodiment of herself morning. The mother’s face was very I did not know how to talk about
as a victim. To look at him can be still; she was also painfully thin. I parent-infant therapy to a woman
painfully distressing. But WE can did not realise this couple was the who had clearly come from a
look – we can meet and greet him as new referral I was due to meet an situation where therapy would be an
a new person, we can engage him, hour later. A support worker had alien concept. I fumbled and said
and help his mother more by possibly made the referral and had described that the support worker had told me
seeing him NOT as a representative a depressed mother who was finding that Fatima seemed very low, and
of hate but one of hope. It seems her son’s behaviour hard to manage. that I knew it was hard to care for
a unique opportunity since it may The support worker asked if she and a small child when a mother was
prove impossible for a mother to talk an interpreter who knew the mother unhappy and lacked support. Fatima
of this again until in the midst of the could accompany Fatima to the first still did not look at me, but I could
intensity of her baby’s adolescence, appointment. I agreed. see tears rolling down her cheeks.
it having been a dark secret for so Daniel registered his mother’s tears.
many years. If the mother can talk When I went to the waiting room A few seconds later he picked up a
of it, this can prevent some of the 3. A modified version of this paper was wooden object. Quick as a flash he
build up of sadness, self loathing, subsequently published in the Journal of Child went over to his mother and, with
hatred and detachment that can occur. Psychotherapy as Levels of change in parent- a blank expression, hit her across
At other times a shallow defence of infant psychotherapy, 2006 Vol 32 pp 295-311, the head. Her bodily response was
denial of the rape and its impact can publishers: Taylor and Francis,
http://www.tandf.co.uk.

5 World Association for Infant Mental Health January-June 2008

startling: she brought both arms him; his mother seemed surprised. week. I described this to Fatima,
up to shield her face, and turned Through the interpreter, I put into and how I would be available over a
away from Daniel. He froze, hand words what it might feel like to feel sustained period of time. I suggested
in the air, as if poised to hit again, so full of terrifying feelings. that the family support worker join
and she remained frozen. She made us for the first few sessions, as she
no attempt to limit Daniel, nor did Fatima continued and described in was clearly important to Fatima. The
she make any sound throughout the a monotone voice how she escaped interpreter said she would be able
interaction. from the prison and after her arrival to work with us on a regular basis.
in the UK, having had no antenatal As far as was possible, we made a
This brief sequence captured a care, gave birth to Daniel. She had regular therapy space. Fatima agreed.
repeating behavioural pattern, a tried to leave the hospital without I could not get them out of my mind.
pattern which enacted in actions a him. Somehow – and it is not
mix of memories and feelings that clear how – she ended up taking The next few sessions were suffused
could not be ‘remembered’ and put him back to her bed and breakfast with Fatima’s prison experiences,
into words. Contact between them accommodation. She said she had horrifying material that affected us all
seemed catastrophic. Somewhat wanted him aborted or removed from profoundly. I could see how it was
disorientated, I said to Fatima that her. impossible for her to think of Daniel
I imagined she had gone through as a small child in need of help. I
quite a journey to get to the UK: For the first nine months of Daniel’s learnt quickly the ways Daniel
what would it be important for me life he spent most of his time in a managed distress, mostly by banging
to know? It was incredibly hard to room with a deeply depressed and his head on the floor. It was not easy,
follow her story. I realized there traumatized mother who described but whenever this happened, I would
had been a civil war in her African feeling terrorized by his cries. She interrupt his mother and find ways to
country of origin and she had been felt unable to touch Daniel, let alone ensure we attended to Daniel’s state.
imprisoned for seven months. Fatima hold him, when he showed distress. Fatima could feel angered by this.
managed to convey how during this Then a woman took pity on them and
time she was interrogated, beaten and offered to let them sleep on her floor Daniel was hyperactive and a poor
gang raped, sometimes on a daily in our service area. This woman sleeper and eater. I can only describe
basis. I could see scars on her neck. encouraged Fatima to go to the local him as pushing himself into or onto
Like many of the other women, she health clinic with Daniel where the objects in a mindless way. He was
expected to die from her injuries, or family support worker had noticed incredibly clumsy, always falling
be killed. This was not a fantasy: signs of attachment disturbance and down and hurting himself, and then
many of her fellow captives did not referred to our service. hitting his head hard on the floor to
survive. Fatima’s affect was flat, soothe his hurt, whilst his mother
as if she had felt forced to recount Towards the end of this first two hour remained still. Fatima could admit
details of her rape ordeals on many session I asked Fatima about life that she did not want to help Daniel,
occasions. before her imprisonment. She looked or touch him. Again and again she
at me in a confused way. She did spoke of how she would have given
As Fatima spoke of being raped, I not know what I meant. Again I felt him up for adoption at birth had she
started to realise that Daniel’s father disorientated, but persisted, saying I been given the choice. It was hard to
was likely to have been one of the wondered about her parents, her early hear such hostility but I think it paved
military men. As I conceived this life. She said she had no memories. the way for other feelings to emerge.
terrible thought, Daniel was banging Then she mumbled that her parents Fatima knew she could tell me if she
an object noisily on the table. The had died when she was a child, in an no longer felt able to parent Daniel.
sound frightened his mother; she accident. I asked how old she had In the context of her hatred being
covered her ears. Daniel came up to been; she could not remember. I said taken seriously, more benign feelings
me and screamed, lashing at my face. that the horrifying circumstances she started to grow.
Fatima made no move to touch him, had recently been through might have
but she managed to push a bottle of also opened up the wound of that loss As the full horror of Fatima’s
milk towards him. Daniel tried to hit which, for a child, would have felt imprisonment emerged, as well as
her head with it, creating yet another incomprehensible and cruel. She her neglect of Daniel’s emotional
startle response. He then ran and sat nodded. I describe this because of needs, I became more and more
in a corner and sucked on the bottle. how, amidst the violence and trauma, preoccupied with how Daniel too had
As his mother continued to talk, tiny seeds of information were being been imprisoned in two situations.
Daniel slowly came nearer to me. I offered that gave me reason to think Firstly, when in utero during his
hung my hand down from the chair this young woman might be able to mother’s assaults and secondly, in
and, to my surprise, felt his head use therapy, and make an attachment the first months of his life, Daniel
start to push rhythmically against to me. had been trapped with his mother’s
my hand, as if stroking himself. He state of mind. In the present, we
stayed there, facing the wall, but As I was so alarmed by Daniel’s had to endure repeated experiences
he had made contact. I talked to behaviour and his mother’s state of of feeling trapped in an enclosed
mind, I offered to see them twice a

6 The Signal January-June 2008

space which quickly became filled In the first phase of the work with to cause him to cry out. She was
with terrifying anger and pain. I Fatima and Daniel I did not mention relieved, I think, no longer in the
was continually worried as to how the use of video. It was hard to position of terrorized victim. Fatima
the therapy room could be felt as imagine using it with an interpreter, then proceeded to pile up bricks
imprisoning for him. Daniel’s and with Daniel who could become in Daniel’s lap, which covered his
stress response system was primed so hard to handle. I also thought genitals.
to perceive all of us as potential Fatima might feel intruded upon,
attackers to be fought off. His early raped again, if I filmed her. But I SOME THOUGHTS ABOUT
neglect rendered him vulnerable felt I was observing a behavioural THE INTERACTION
to feeling assailed by any intense pattern that it might help Fatima to At first, there was contact in the play
feeling coming from within or see for herself: namely, her profound and the play was about telephone
without. He coped with this by startle response when Daniel hit communication. When Fatima
trying, particularly through his or approached her face, and then broke it, cutting the line so to speak,
hitting, to get rid of such feelings. – swiftly – I observed her move perhaps she needed Daniel to be in
Over and over again I witnessed him into become taunting or aggressive touch with the theme of something
mindlessly approaching his mother’s with him. The movement between unwanted. She had not wanted to be
head and hitting it. But his mother aggressed and aggressor flipped filmed. I think Daniel felt a primitive
contributed to the pattern and it was incredibly quickly between them. experience of catastrophic loss: in
my task to help her consider this this instance initiated by me, enacted
dimension: to add new perspectives When I explained to Fatima that
by his mother, and experienced
to her experience of being a helpless it could help sometimes to watch
by him. He felt the disconnection
victim. together what happened between
and mood, he felt unwanted - his
parent and child she cried, saying she
deepest trauma - and threatened,
During this early period of the work, would not know how to play with
and he hit out at her. He induced
Fatima remembered my question Daniel. I said I realized that finding
in her, fleetingly, a feeling of pain
about her parents. She often spoke of ways to reach one another was
and terror which she seemed to
how she wished her father could have painful, and that the video might give
experience as an assault by a grown
protected her from what happened to clues as to what works and what goes
up, not a small child. Then Fatima
her. We moved in and out of talking askew. Fatima agreed, but I think she
adopted the aggressive position,
about the imprisonment and how, as did so out of a sense of obligation to
creating in Daniel a diluted version
a child, she had also felt imprisoned me, not because she wanted to see
of the humiliation and helplessness,
by feelings she did not understand. herself.
the kind of feelings she possibly felt
The wish for her father’s protection
So in the sixth session I filmed a when raped or tortured. Daniel then
was, I think, critical in terms of some
three-minute interaction. In it, Daniel ended up in the vulnerable position
affection slowly starting to come
picked up a plastic phone and spoke with his penis under bricks.
alive for Daniel. It implied that there
was, as Serge Lebovici described, a into it. His mother responded, as if
At a deeper level still, Fatima seemed
fantasmatic baby in her unconscious: answering him. I think Daniel was
to repeat the experience of loss:
the want to give her father a baby. thrilled at the potential play between
them. His body was tense with loss of a potentially responsive,
Thus her want for maternity was loving figure. Her feelings about
already present as a small child. In anticipation. Then Fatima broke
contact, she looked to the floor. the traumatic loss of her parents
her core internal world there was a were, at this stage, heavily defended
creative parental couple. The fact Daniel froze. Then he lunged at
his mother’s head, hitting her with against. Daniel too experienced
that she had managed to care for loss of a responsive parent in these
Daniel’s basic needs implies a strong, the telephone. She pulled back, as
if she had been beaten by a grown moments of daily abandonment. I
previously unconscious, commitment helped Fatima talk about her feelings
to care for a baby, predicated man. Within a few moments, Fatima
recovered and – under the duress towards me filming her, and how
probably on the fact that she had been my power and the power of the
loved as a baby. of the film – attempted to continue
some form of play with Daniel. military men became confused. I
In the transference with me, I But her play was impregnated with think she felt she lost me as a helpful
occupied many positions, but often I anger. She taunted and humiliated figure during the filming and this
felt Fatima experienced me as if I was him by holding a small toy just out contributed to the enacted rupture of
a father-figure, a paternal presence. of his reach. Daniel tried to grasp contact.
I offered hope and protection and it as she brought it nearer to him,
When Fatima watched this interaction
yet also, continually, the reality of then just as he was about to grab
in the following session, she
absence and what felt like harsh it, she lifted it high again. After
physically flinched again when she
limitations. I was aware of the depth several thwarted attempts, Daniel
saw Daniel hit her. Fatima asked
of Fatima and Daniel’s growing cried out in frustration. At this point
to watch it twice. She said how she
attachments to me. Fatima smiled, as if unconsciously
triumphing at having the power

7 World Association for Infant Mental Health January-June 2008

seemed so scared. She asked: how A moment of intimacy happened and his as-yet unrepresented feelings
could such a little child frighten the video was able to capture a new of terror and rage in the context of
her so much? Then she was able to movement. The next week, when feeling abandoned. As Daniel started
notice how she became angry. This we watched it, Fatima told me how to find his mother, he became more
was a critical moment. Fatima’s it was the first kiss, and she wept as vulnerable. He started to use me, as a
noticed how she retaliated. I am not she felt sorrow for Daniel. This was relatively robust third figure, to help
sure this could have been thought the first expression of feeling for him. him express a particularly desolate
about, with the same speed, and in She also noticed how bewildered experience. In one session, when his
the same way, without the visual aid. Daniel was when she had pulled back mother was unwell, he hid under the
from him. She saw how his eyes desk for some minutes, as if trying
Throughout the rest of the session, looked painfully bewildered when to find a safe space. Her physical
after Fatima had seen and felt the she had stilled in response to his fragility frightened him. As I was
visual interaction, she was able to put hesitant, and yet determined, attempt speaking to Fatima, Daniel suddenly
into words more clearly how Daniel to make contact. She could see his came up beside me and grabbed
terrified her, how she felt him to be confusion and distress. She was in my hair. He hung off it; it was
a huge military man, and how his a different, observer position and painful. When I managed to look in
needs felt like the soldiers’ needs: could see Daniel’s experience from a his eyes, they were blank. I did not
she hated having to attend to them, different perspective (Britton, 1989). have a sense of Daniel trying to hurt
she felt she was submitting. It was me. I felt he had disappeared into
hard to listen to yet somehow she This helped Fatima to describe a dissociated space in which he felt
managed to hold Daniel on her lap how her head and face had been nothing but I felt, and experienced,
both whilst she watched the tape, traumatized during the beatings when his need to cling, as if for his life.
and whilst she free associated to it. in prison. She could see how Daniel This pattern manifested again and
Although what she was saying was reaching for her triggered a startle again over the ensuing weeks. I
distressing, Daniel rested against her. reaction, and then how this confused lost handfuls of hair because Daniel
He was calm. him. At this point I said how it was could not let go. The interactions
as if she was starting to feel that they were hard to handle. But over the
The next week, after these had both been brutalized and raped. months we worked on understanding
connections, something surprising This contributed a new narrative: Daniel’s need to cling and Fatima and
happened. In the midst of all of Fatima and Daniel as a mother and I spoke of it as his capacity to cling.
the previous, very entrenched, baby who had both suffered. The trigger his mother and I realized
fight-flight-freeze responses, a new was always when he felt dropped or
intimacy was allowed to develop. I The kiss, held on film and in our abandoned.
filmed, without knowing it, the first minds, provided a transforming
time Daniel was ever allowed to kiss moment. Thereafter, Daniel was not This case has left me wondering
his mother’s face and mouth. During automatically equated with a raping about the transmission of unconscious
the interaction Daniel was on her lap. penis; he started to become a little forces between the generations. Out
baby, traumatized too. In a way, this of such circumstances, how can
THE KISS was a new moment of conception for we explain Daniel’s determined
At one point their eyes met. Fatima Daniel. It helped Fatima build up a capacity to cling, shown both when
pulled back but Daniel persisted in sense that she was his mother, who in utero, and then vividly through the
reaching with his hand to touch her had chosen to try and help him, and scenes with my hair? Perhaps the
cheek. She could let him. Then, she could be effective in protecting unconscious force of his maternal
with both hands, he pulled their faces him. grandparents was, at some level,
closer and opened his mouth wide. always being transmitted. That
From my perspective, Fatima’s force has now found a way into
Fatima closed her eyes. Daniel’s tendency to use automatic defensive
mouth touched her jaw line. Fatima consciousness and words, and it
processes – especially projective shows now in the close physical and
flinched but somehow managed to identification – started to change. By
stay still. A small smile started to emotional contact he and his mother
owning her own wish to retaliate and can now enjoy.
emerge; her face softened. Daniel hurt, and putting such feelings into
registered this non-verbal invitation words, how she behaved changed. It
and grabbed her shirt. He kissed the I think Daniel’s first kiss was a
would take longer for Daniel. transformative moment. Fatima and I
side of her face clumsily, beautifully,
and she moved her mouth towards became the new parental couple who
In the next phase Fatima and I could love him and want him as he
him. He then, very gently, made lip- worked together like a parental
to-lip contact with his mother. Her was. The men who brutalized Fatima
couple to help Daniel with his were propelled by complex and tragic
face broke into a full smile; so did tendency to violently eject distressing
his. Then, as if the intensity needed unconscious forces. In the present
states of mind. Fatima began therapy something of Fatima’s
diluting, he slipped off her lap and to understand Daniel’s bodily
started to play on the floor. parents came alive again and allowed
violence as a way of getting us, and the two of us, although both female,
particularly his mother, to experience

8 The Signal January-June 2008

to have a deep enough therapeutic representations of their fathers in Frances Thomson Salo, Royal Women’s
relationship such that Daniel could in their mothers’ minds will create Hospital & Royal Children’s Hospital,
a way be conceived and born again. enormous difficulties in forming Melbourne and Hon Principal Fellow, Dept
an identity, as Campbell Paul has of Psychiatry, University of Melbourne
DISCUSSION - JULIET described. Amanda Jones has brought Campbell Paul, Infant Mental Health Group,
HOPKINS us the detail of her therapy work, a The University of Melbourne, and
What these papers convey is deeply psychoanalytic approach. She Integrated Mental Health Service, Royal
truly shocking. The therapists did not offer this depressed mother a Children’s Hospital, Melbourne
have protected us from the full prescription or tackle her symptoms
Amanda Jones, PhD, North East London Mental
impact of their patients’ horrifying of PTSD, or give her a behavioral
Health Trust, Loxford Hall, Loxford Lane,
experiences by the containment of program for her tyrannical toddler as
Ilford, Essex 1G1 2PL
their understanding and the hopeful might have been done but by most
sensitively working with the couple’s Juliet Hopkins Ph.D., The Tavistock Clinic, 120
outcome of their cases but horror
unconscious projections she was Belsize Lane, London NW3 5BA
must remain with us at the sadistic
act of rape and its most tragic and able to help them to begin a positive References
lasting consequences. relationship. Australian Broadcasting Corporation. (10.2.06).
Correspondent’s Report.
Campbell Paul has referred to the I think the two points that Amanda
Britton, R. (1989). The missing link: Parental
condemning attitude to rape in Jones illustrates particularly well are
sexuality in the Oedipus complex, In: R.
many different countries but as Britton, M. Feldman, E. O’Shaughnessy
1. The value of enabling the patient to
therapists we are caught up in our (Eds). The Oedipus complex today: Clinical
reach back behind the recent trauma
own emotions and cultural values in implications (pp 83-101). London: Karnac
and to reopen emotional contact
this subject, too. What challenging Books.
with loving figures in the patient’s
issues therapists deal with and what
past, in this case Fatima’s parents, Holmes, M. M., Resnick, H. S, Kilpatrick,
decisions would we have made?
tragically lost in her childhood. Jones D. G., Best, C. L. (1996). Rape-related
Campbell Paul reminded us of the
could do this because she recognised pregnancy: Estimates and descriptive
significance of the mother in the
from Fatima’s developing positive characteristics from a national sample of
child’s mind. In view of the shock
transference to herself that she must men. American Journal of Obstetrics &
and horror surrounding rape, it is not
have had a good enough beginning. Gynecology. 175(2), 320-324.
surprising that there is a dearth of
research on any outcomes for babies 2. The value of thinking in terms of Krug, E. G. (2002). World Report on violence
of rape. The anecdotal evidence the third position, the position that and health. World Health Organization.
shows that many are aborted or Jones took as the third party, able Lyons-Ruth, K. (2006). Contributions of the
abandoned at birth by mothers who to accept both mother’s and son’s mother-infant relationship to dissociative,
refuse to look at them, and among projections and to mediate in the borderline and conduct symptoms in young
those who are kept by their mothers, space that she had created between adulthood. Presented at the 10th World
girls vastly outnumber boys. them, a position that enabled Fatima Congress of the World Association of
to see Daniel increasingly from Infant Mental Health, Paris.
a new and much less threatening Papineni, P. (2003) Children of bad memories.
Amanda Jones has shown how
perspective. The Lancet. 362, 825-826.
Daniel’s approach was a trauma
trigger for Fatima but the evidence, I would like to end by paying tribute Wax, E (2004). Loving the children born of
particularly from Bosnia, suggests to the magnitude of the therapists’ hate. Insight, The Age, 4, 6.
that girls cannot escape being trauma work. The emotional burden that has Winnicott, D. W. (1971). The mirror role of the
triggers either – she has described a to be carried in cases like these is mother and family in child development.
refugee mother who kept her daughter enormous. I think it is crucial to have In: Winnicott, D. W. (Ed.), Playing and
of a war rape but remained obsessed colleagues to help to bear the pain Reality. London: Tavistock.
by her child’s vulnerability and the and anxiety – and in addition to the Zeanah, C. (2006). Attachment disorders in
continuous challenge of protecting support of colleagues, the necessity family and social context. Presented at
her. Babies of rape inevitably to balance each therapist’s caseload the 10th World Congress of the World
grow up unable to understand to protect us from insensitivity and Association for Infant Mental Health,
the fear that they arouse in their burnout. It can also help to have Paris.
mothers; a disorganised attachment had a psychoanalytic training which
must develop with its underlying supports the therapist in the value
expectation of catastrophe. In order of containing intolerable emotions,
to achieve coherence the infant may so that they can be thought about as
develop irrational fears or become possible communications and so can
aggressive as Daniel did, projecting be used to further the therapy.
his own fear while trying to make
sense of his mother’s fear of him.
And as these children grow up the

9 World Association for Infant Mental Health January-June 2008