Between these extreme types are ranged people who display innumerable shadings and degrees of psychological development. Some cope satisfactorily with their life situation because that situation is neither difficult nor beyond their capacity for adjustment. Others need a little bolstering up now and then to bridge over the gap between the demands made upon them and their ability to meet these demands. Still others have to be literally carried when disaster overtakes them, or they break down.
As might be expected, our ability to stand the big tests or strains that may come to us; our manner of meeting them and their effect upon us depend very largely upon how we have habitually met the lesser trials that have come to us previously, how we have habitually adjusted ourselves to the experiences of life. For after all the test of life is a measure of one’s capacity for adaptation to these experiences and to surroundings.
The strain that measures our ability to adapt ourselves may be one big stroke or it may be a long drawn out trial which would be of small consequence were it of short duration. It is the persistency and the monotony of a lesser care that so often wears away the rock of our endurance.
If a strain proves to be too much for our adaptive capacity, and we break down under it, our manner of breaking will be characteristic of us, or an accentuation of what might have been called our bendings under lesser difficulties in the past.
The expectant mother is no exception to these general principles. She does not develop nervous breakdowns either more or less frequently than the non-pregnant woman who is under an equal strain. She is merely a human being whose adaptive capacity is being tested. But the test is severe for there is, perhaps, no greater strain upon the adaptive capacity of a human being than that to which a woman is subjected during pregnancy, confinement and the months directly following the birth of a child. She may be expected to meet this strain just as she would meet another equally great demand upon her adaptive capacity.
Otherwise, pregnancy of itself does not affect the brain or the mind, any more than it affects the kidneys, for example. But like the kidneys, the brain or the mentality may have difficulty in coping with the additional strain that is put upon it during pregnancy, and if the strain is greater than the ability to function in either case there is likely to be a breakdown.
It is now generally believed, therefore, that there is no psychosis which is typical of pregnancy. But that during pregnancy one may see all types of neuroses and psychoses which are frequently associated with other severe strains upon the individual. We see depressions, excitement, paranoid trends, delusional and hallucination states, hypochondriasis, obsessive fears, anxiety attacks, hysterical manifestations as well as the so-called “neurotic vomiting.”
Aside from the delirium-like experiences often associated with the toxemias of pregnancy, none of the above mentioned conditions are referable to any disturbance of the physiologic or metabolic functioning of the patient, so far as science can demonstrate. They are merely accentuations of poor habits of adjustment to difficulties, which the patient has betrayed all her life.
The psychoses of pregnancy and the puerperium require skilful handling and the nurse is not called upon to care for them except under the constant supervision of a physician.
She is, however, constantly brought face to face with facts of fear and worry and conflicting desires which play a tremendous rôle in the well-being of the patient during the months of pregnancy and confinement. The chief source of happiness and of unrest is the mother’s attitude toward the coming of the baby.