The World of Placental Possibility by Annie Pesskin

Accompanying every act of creation is a sense of awe. It socks you in the stomach, leaving you feeling a little bit sick; or is that feeling perhaps excitement?

Such was the state in which I left the International Association for Forensic Psychotherapy (IAFP) Day Conference, Shadows, Projections and Embodied Roles on a Spring afternoon in March 2025. In the garden of the peaceful Quaker Meeting House in central Oxford, the delicate narcissi were trumpeting lemon yellow, the grape hyacinths stacking up their indigo bells, and the first diffident tulips opening their cream-and-crimson petals to the world. I felt a powerful sense of unfolding, of possibility, and new beginnings. How appropriate then that the conference had us considering how the placenta is a potent symbol for creativity, for connection, and also for the work of psychotherapy.

Anna Motz, IAFP member and author of the insightful and powerful book A Love That Kills: Stories of Forensic Psychology, had invited her dear friend, Dr Siri Hustvedt, the first-rate American novelist, to join her in conversation on Zoom for the afternoon session. With her characteristic generosity and brilliance, Siri Hustvedt talked to us about her deep respect for the placenta — how it is a cellular chimera made of DNA belonging to both foetus and mother, our twin-of-the-womb that every one of us amphibians lose upon joining the world of air. Our placenta is a scapegoat, sacrificed to the bin marked clinical waste, once we take our first breath. It gets born too, but only as an afterthought — the very name ‘afterbirth’ relegating it to second-best. But yet, can we reflect on what a wonder it has been for the best part of a year? The liminal place of exchange for the mother and the baby and so essential to the survival of both that its malfunction can cause both their deaths.

You could have heard a pin drop in the room as Hustvedt explained her deep respect for this organ, not just as an extraordinary biological process but also as a philosophical position; a place where different identities commingle, where ideas swirl together, and a location in the mind which is neither me, nor you, but composed of us both. How this place of placental possibility exists every time you listen to a song, or stare at a painting, or read a novel, since no act of creation is ever made without an audience in mind, just as no link between creator and audience can exist without the creation itself.

Hustvedt’s point was that there has to be a “we” before there can be a “me”, just as in the womb there is the foetus and its placenta before there is a baby. And, as Winnicott pointed out, there is actually no baby without a mother. For a baby is born to a pair of arms to hold, rock, soothe, feed and clean them. You might say we lose a placenta at birth but must acquire another in the form of our parent(s) to survive our early years in which we are so very dependent and vulnerable. Then those functions are found in an ever-expanding circle of other arms/minds, from our grandparents to our kindergarten nursery workers, to our primary and secondary school teachers and school friends to university tutors and our first lovers. All of them busy helping us to scaffold our developing mind, to co-regulate our emotional life, before, as a fully-grown adult, we are expected to self-regulate successfully on our own.

Yet all successful adults have an emotional life which remains a shared event in countless ways. We seek co-regulation when we ring a friend to lament losing a job, or find succour from a heartbreak, or share our disappointments. We go to galleries, the cinema, or the park to find “company” in the creations of others, be that a performance art event, a horror movie, or a bunch of daffodils. But the ability to seek out co-regulation only emerges from the capacity to effectively self-regulate our emotions and it takes roughly eighteen years to achieve this in the West; it is only when we are nearly two decades old that the State considers us safe to drive, vote, have sex or marry. Underpinning the placental world of possibility is this fundamental fact: co-regulation of emotion has to happen before self-regulation can emerge as a key function of a thriving self.

Siri Hustvedt is keen to transcend binaries of all kinds which she finds limiting and restrictive. She finds the most interesting places are where the clear lines dividing things blur, but this only happens when you peer closer, then closer still. The earth from space looks blue and green, the sea clearly delineated from the land, but if you are rock-pooling on a seashore, in the inter-tidal zone, you will know how for half the day the anemones, mussels, barnacles are submerged with water. These extraordinary creatures have adapted to a life which alternates between solid and liquid environments. Nothing, when you look really closely at it, is ever singular. Think of yourself. You might imagine your skin is the boundary between you and not-you. But your body retains micro-chimera cells which formed in your mother’s womb and now live in you. Your microbiome (aka your digestive tract which starts at your lips and ends at your anus weighing just 1kg less than your entire brain) is populated by 1,000 distinct species of bacteria, composed of twenty to forty trillion individual cells, and their DNA is entirely distinct to your own. Depending on where you start from, you are not a “self” at all, but a blossoming garden of biodiversity!

Hustvedt’s point is that there is almost nothing about your body or your mind which exists independently of your wider relationship to the world; the truth of it is that where we really live is in the world of placental possibility. New thinking slowly enters the zeitgeist, then over generations it becomes axiomatic. Galileo’s truth claim that the Earth goes round the Sun was outrageous in his day and he suffered for his originality. New ideas are born but they all come from this world of placental possibility. Like babies, all creation requires making a link between two apparently separate objects (be that man and woman, artist and paintbrush, player and instrument, writer and idea) followed by a period of gestation where it can take shape in a realm of private darkness. Here, in the liminal space between conscious and unconscious, when something struggles to take shape, it does so often at great cost to its creator, either in the process of being born, or when its creator must defend its creation against a hostile world unwilling to receive it.

How might any of this have anything to do with therapy, I hear you ask? Well, I am sure that therapy is also a placental process of profound creativity. Two objects come together — therapist and patient. They gestate in the therapy room where others cannot see in, much like a womb, be that for nine weeks, nine months, or nine years. In that private place, we create a special, unique thing – the therapeutic relationship – which is composed of parts of both of us and belongs to both of us. It is a precious, shared social reality where we communicate about how, what, and why people feel the way they do. This might be done through talking, or by using art, music, and/or drama. You might argue the therapeutic space is the womb, the therapist is the placenta, nurturing the foetus with tenderness and insight,contingent mirroring and attunement. Then the birth is therapy’s end when the ‘baby’, hopefully now more capable of self-regulating than they were when they arrived, sets sail for destinations unknown, onto the sea of life.

So far, so good, but this Day Conference was about people who have done terrible things when their capacity to self-regulate failed them and they broke society’s most sacred taboos. Before Siri Hustvedt, we heard from Lorna Downing, a dramatherapist who told us how in 27 years of working with forensic patients she has yet to meet a person who hadn’t had awful things happen to them when they were very small. I think this would be echoed by anyone who works with forensic patients. If the people who are put on earth to protect you are the ones who hurt you, then anything awful can happen, right? And then it does. Remember earlier when we considered that if the placenta malfunctions, the baby is profoundly compromised? When the baby loses their placental twin at birth, they need to find an equivalent in the arms of their primary caregiver. Martin Buber has a lovely German word for this, zwischenmenschliche, which roughly translates to “the space between our two bodies” or more concisely, “two-in-oneness”. But when, for reasons which are complicated and tangled, the baby does not get to live very much in this world of placental possibility and they are deprived of essential psycho- logical experiences of consistent and predictable “two-in-oneness”, the infant’s brain is instead sculpted by experiences of fear, neglect, and con- tempt. Their plastic brain adapts to this adverse environment by making them hypervigilant to threat and less responsive to rewarding experiences. This has two main consequences for their patterns of relating—they become socially isolated and/or conversely highly controlling, to ensure the other cannot repeat early experiences of abandonment.

This brings me back to how we began our day which was with Tony Gammidge, film-maker, art psychotherapist, and artist, who screened some of the extraordinary, stop-motion animation films he has enabled some pris- oners, many of them on Imprisonment for Public Protection (IPP) orders, to make, using shadow puppets, figures made from plasticine, sets from cardboard, and/or drawings with coloured pencils and pens. So many of the films, as Gwen Adshead pointed out, begin with a figure crying alone. What could be a better image for the bleak absence of placental possibility than crying alone? Surely a failure of co-regulation if ever there was one? Tony Gammidge began his talk with the James Gilligan quote about how, “All violence is an attempt to replace shame with self-esteem”. I was reminded of In Cold Blood (2005), the film in which Philip Seymour Hoffman plays the writer, Truman Capote, who befriends two young men in 1959 on death row for their brutal murder of a family in the American Midwest. One of the men (who predictably enough suffered a terrible childhood) tells Capote of the burning sense of shame he felt when the father of the family showed him a simple kindness and how he responded by stabbing him multiple times. Might we say shame operates as a signal of our exclusion from the world of placen- tal possibility, deriving as it does from predicting the m(Other) will treat our vulnerability and dependency with contempt? In other words, we could say to experience shame is to undergo the psychological equivalent of a placental rupture, a maiming of our two-in-oneness, a rupture as deadly to emerging minds as a knife in the belly would be physically.

If our childhood has been an experience of swimming in placental possibil- ity with caregivers who have been able to scaffold the development of our psychological selves by mentalizing congruently, contingently, and reliably, then lucky us. But for those who have at our core a well of shame, each drop made from a moment where we realised our prediction of two-in-oneness was mistaken and erroneous, what then? Then, we cry alone just as the shadow puppets did in the films. Or, given the right circumstances (a knife-ridden postcode, a screaming infant when we haven’t slept for months, a lover rejecting us after threatening abandonment many times), something else happens. The level of shame in the well rises up inside us, threatening to engulf our fragile sense of self altogether, and we hit upon a magical solution. This is to put the shame somewhere else, to make a scapegoat of the m(Other) by rupturing them in whatever means possible, and wow, haven’t we humans come up with a plethora of ways to hurt each other? Instead of a placental twin being the source of all the good stuff, shame converts it into its dangerous inverse. Destruction, not creation, becomes the aim.

This is when therapy can become a life-saving device by allowing the patient to dwell in the world of placental possibility once more, which has the crucial and necessary function of restoring trust in another person’s mind. When this happens, it becomes safe to know about other minds again and this restores the capacity for empathy, thus instantiating religion’s “golden rule” (the notion that every world religion holds dear: to treat others as we would like to be treated). When we sow this precious seed in our own and others’ minds, the flower we can grow is peace.