One can be sympathetic to this woman who has lost her ability to function because of widowhood, disability, and poverty. It is going to be difficult for her to make this adjustment, but it is not impossible to use the residual resources that she has, which are her intellectual ability and her personality. Once she develops a more realistic approach to her future, she is more likely to accept help to engage in interaction with other people such as the interaction arranged at the psychiatric day hospital. Some other organizations, not related with provision of care, could perhaps be approached for her to participate as an equal member and not as a recipient of service. Mrs. C needs to value that she can be useful as a presence not only as somebody who does a job for others or somebody who offers a service. Any expectations of her offering work would be frustrated and, therefore, unrealistic. She could value the realistic expectation of offering herself for who she is and not for what she can do for other people. She could make some people happier by just spending time with them. This, in return, could make her feel happier and more useful. This would increase her own sense of self‐worth. The doctor confirmed that Mrs. C feels better when she is with other people at the day hospital. JM asked if the local Buddhist community has any programs to engage isolated members of the Buddhist community. The doctor undertook to explore this avenue. JM also pointed out that a physical objective within her reach could be some reduction in her body weight. JM suggested that she could be put in touch with a dietician and perhaps an exercise program appropriate to her disability could be devised.
JM concluded that the central focus of a treatment would be for the treating doctor and all the staff to resolve the feeling of hopelessness and replace it with one of realistic expectations for Mrs. C. The doctor concluded that Mrs. C does enjoy interaction with other people and that she is able to come forward with ideas that make other people feel better. JM added that this experience, that she has a positive effect on other people, could be pointed out to her and encourage her that she is still useful to others, and she should not write herself off because she is appreciated by others as a person and not as a job.
References
1 Dewi Rees, W. (1971). The hallucinations of widowhood. British Medical Journal, 4(5778), 37–41.
2 Heimann, P. (1950). On countertransference. The International Journal of Psycho‐Analysis, 31, 81–84.
3 Kernberg, O. F. (1965). Notes on countertransference. Journal of American Psychoanalysis Assessment, 13, 38–56.
4 Olson, P. R., Suddeth, J. A., Peterson, P. J., & Egelhoff, C. (1985). Hallucinations of widowhood. Journal of the American Geriatrics Society, 33(8), 543–547.
5 Parkes, C. M., Benjamin, B., & Fitzgerald, R. G. (1969). Broken heart: A statistical study of increased mortality among widowers. British Medical Journal, 1, 740–743.
6 Winnicott, D. W. (1960). Countertransference. The British Journal of Medical Psychology, 33, 17–21.
7 Wu, C., Odden, M. C., Fisher, G. G., & Stawski, R. S. (2016). Association of retirement age with mortality: A population‐based longitudinal study among older adults in the USA. Journal of Epidemiology and Community Health, 70(9), 917–923.
2 Postnatal Depression
Margaret
Presenting condition
Margaret is a 28‐year‐old married housewife, mother of two (a boy aged 3.5 years and a girl aged 2 months), who lives with her husband and children in a rented subdivided room. Her infant daughter is mainly breastfed. She was referred by Maternal and Child Health Centre with an Edinburgh Postnatal Depression Scale score of 27 out of 30 in January 2018.
History of present complaint
Margaret presented with low mood with suicidal ideas. She was new to the mental health service. She delivered a baby girl on November 19, 2017, via vaginal delivery with no complications. She had multiple stressors from before her daughter's birth. These included her husband indulged in gambling and, recently, even online gambling; he would disappear for a few days a month in the past 3 years. The debt had increased to the point that the debt was paid using credit cards, and the debt now totals about US$30,000. The second source of stress was her son's problematic behavior since she became pregnant. The third source of stress is the crowded living environment. She had decided to live in the city because this would enable her son to attend kindergarten year 1 from January 2018. Margaret has limited support from her family of origin.
Margaret developed low mood, with a sense of worthlessness and helplessness. She would look at her children and become worried about their future; she felt that they were poor. Since giving birth, her mood further deteriorated, with her experiencing reduced energy and poor concentration at work. Her sleep was also disturbed by childcare. Margaret experienced appetite loss and lost 1–2 kg. She does not enjoy activities, feels the lack of money, and has no time for any entertainment; they do not even have a television set at home. Previously, she had fleeting suicidal ideas of jumping from heights, but these became less frequent since she moved to the city. In the city, her husband tended to stay at home most of the time. Margaret denied having a concrete suicide plan, had not acted on any suicidal impulses, was remorseful, and still cared about and worried for her children. Margaret denied alcohol or substance use and denied the existence of any psychotic symptoms. Occasionally, she would hit her son with bare hands or with a hanger; however, she would feel remorse afterward. There were no previous hypo‐manic or manic episodes.
Family history
There is no family history of mental illness or suicide.
Personal history
Margaret was born in the country. She is the eldest of four siblings (two sisters who are 2 years younger and one brother). Margaret graduated from secondary school. She came to the city when she was 17 years old. She had a fair relationship with her family of origin. Her mother works in the market and her father works as a casual worker.
Margaret had an unhappy childhood; her father would hit her with a belt and a hanger until she developed skin lacerations; her mother would kick her over trivial matters. Her family was patriarchal. She was physically punished by her parents until she reached high school. Her parents disliked her studying and wanted her to work and earn for the family. Margaret insisted on working part‐time and supporting her studies. She felt that she was an “extra” in her family. She had a better relationship with her younger sisters and brother.
Margaret was married at 24 years of age and moved back to the country; she would travel daily to work as a saleslady in a part of the city, which is near the country; she was the main breadwinner of the family. Her family of origin was not supportive of her marriage; they disliked her marrying and moving back to the mainland. Margaret does not “dare” to express her feelings to her family of origin and does not feel that she can ask them for support. She gave up her job in January 2018 to allocate her time to childcare. Margaret is currently unemployed and has been working as a housewife since moving to the city.
Her husband is 28 years old and from the country; he is without a city identity card. He previously worked as a waiter but became unemployed recently to take care of their son while Margaret worked and was the breadwinner. Her