Through Paediatrics to Psycho-Analysis, Winnicott (1975)
Primitive Emotional Development (1945)
Introduction
Different analyses for different patients. Different patients require different types of psychoanalysis. For Oedipal patients, the analysis can focus on their relationships to people as well as their fantasies about those relationships. For depressive patients, the analysis must also focus on their fantasies about themselves. It is possible to do analysis with pre-depressive patients.
Different transferences for different patients. We use the same analytic techniques with all three types of patients, but we must realize that the transference of Oedipal patients will be different than the transference of depressive and pre-depressive patients. The Oedipal patient believes his analyst’s work is performed out of love for the patient. The depressive patient believes and needs the analyst to understand that he believes that the analyst’s work is performed in an attempt “to cope with his own (the analyst’s) depression” (or the guilt and grief that have resulted “from the destructive elements in his own (the analyst’s) love”). The pre-depressive patient believes and needs the analyst to see “the analyst’s un-displaced and co-incident love and hate” of the patient. For the pre-depressive, therapeutic boundaries are viewed as “expressions of hate” while good interpretations are viewed as “expressions of love, and symbolic of good food and care.”
Six Month Mark. Around six months of life, the baby develops the ability for identity consolidation and object constancy: the baby “knows himself (and therefore others) as the whole person that he is (and that they are).”
Early Developmental Processes
Very early in the infant’s life, the following processes begin: (1) Integration, (2) Personalization, and (3) Realization.
(1) Integration. When babies are born, their personalities are unintegrated, much in the same way that a psychotic adult can experience a disintegrated personality during times of regression. It therefore follows that when a baby’s integration is delayed or does not fully occur, that individual is predisposed to disintegration as a regression.
Integration is made possible by two factors: “the technique of infant care whereby an infant is kept warm, handled and bathed and rocked and named” and “instinctual experiences which tend to gather the personality together from within.” The integrated baby has gained identity consolidation; he sees himself as “one whole being,” not “many bits.” Moreover, the integrated baby has developed object constancy, piecing together different sights, sounds, and smellings “into one being to be called the mother.”
Winnicott adduces a patient who “proceeds to give every detail of the week-end and feels contented at the end if everything has been said, though the analyst feels that no analytic work has been done. Sometimes we must interpret this as the patient's need to be known in all his bits and pieces by one person, the analyst. To be known means to feel integrated at least in the person of the analyst. This is the ordinary stuff of infant life, and an infant who has had no one person to gather his bits together starts with a handicap in his own self-integrating task, and perhaps he cannot succeed, or at any rate cannot maintain integration with confidence.”
(2) Personalization. Personalization is “the feeling that one’s person is in one’s body.” “Depersonalization is a common thing in adults and in children, it is often hidden for instance in what is called deep sleep and in prostration attacks with corpse-like pallor: ‘She's miles away’, people say, and they are right.”
(3) Realization. Realization refers to the individual’s ability to perceive external reality. Realization is made possible when the mother protects her infant “from complications that cannot yet be understood by the infant, and to go on steadily providing the simplified bit of the world which the infant, through her, comes to know.”
Baby-Mother Relationship
Stage of Pre-Concern. Even if the baby achieves integration, personalization, and realization, “there is still a long way for him to go before he is related as a whole person to a whole mother, and concerned about the effect of his own thoughts and actions on her.”
The stage of pre-concern is characterized by the infant’s ruthlessness toward his mother. This ruthlessness mostly shows up in play; the infant “needs his mother because only she can be expected to tolerate his ruthless relation to her even in play, because this really hurts her and wears her out.” Once the baby reaches the stage of concern, he is no longer oblivious to the “result of his impulses, or to the action of bits of self such as biting mouth, stabbing eyes, piercing yells, sucking throat, etc.”
Paediatrics and Psychiatry (1948)
Introduction. Winnicott’s thesis is that “it is possible to establish a clinical link between infant development and the psychiatric states, and likewise between infant care and the proper care of the mentally sick.” He clarifies that he’s not saying that psychotic adults act like babies but that “in the emotional development of every infant complicated processes are involved, and that lack of forward movement or completeness of these processes predisposes to mental disorder or breakdown; the completion of these processes forms the basis of mental health.”
Mother. One’s mental health is “laid down in infancy by the mother.” If the mother provides for the infant’s needs, the infant will develop object constancy and identity consolidation, or put differently, the infant will come “to feel himself as a whole person, and to hold his mother to be a whole person.”
In order for healthy development to occur, the mother must do the following: "She exists, continues to exist, lives, smells, breathes, her heart beats. She is there to be sensed in all possible ways. She loves in a physical way, provides contact, a body temperature, movement, and quiet according to the baby's needs. She provides opportunity for the baby to make the transition between the quiet and the excited state, not suddenly coming at the child with a feed and demanding a response. She provides suitable food at suitable times. At first she lets the infant dominate, being willing (as the child is so nearly a part of herself) to hold herself in readiness to respond. Gradually she introduces the external shared world, carefully grading this according to the child's needs which vary from day to day and hour to hour. She protects the baby from coincidences and shocks (the door banging as the baby goes to the breast), trying to keep the physical and emotional situation simple enough for the infant to be able to understand, and yet rich enough according to the infant's growing capacity. She provides continuity. By believing in the infant as a human being in its own right she does not hurry his development and so enables him to catch hold of time, to get the feeling of an internal personal going along. For the mother the child is a whole human being from the start, and this enables her to tolerate his lack of integration and his weak sense of living-in-the-body."
Infant Development. Winnicott next picks up an idea he began in Primitive Emotional Development (1945). In that essay he wrote that before the infant develops identity consolidation and object constancy, he develops the processes of (1) integration, (2) personalization, and (3) realization. Integration, he wrote in that essay, involves the infant bringing together different pieces of sensory input “into one being to be called the mother.” Personalization, he wrote, is “the feeling that one’s person is in one’s body.” And realization is the infant’s “appreciation of time and space and other properties of reality.”
In that essay he focused on realization, or the infant’s contact with reality. The infant’s first encounter with external reality is his encounter with his mother’s breast. The infant comes to have the experience of wishing for the breast and the breast then appearing. He further develops this phenomenon in the current essay, writing that by being responsive, “the mother allows the baby the illusion that what is there is the thing created by the baby.”
Application. Winnicott believes that the above mentioend principles of caregiving can be applied in the psychoanalytic treatment of some of our most disturbed patients. With one female patient he knew he had to keep “absolutely still and quiet and [say] nothing at all.” Winnicott and the woman both “knew that she was right back in the infant-mother relationship. In the quiet my patient had been lying on her mother’s lap.”
In order to help another patient he had to be ready when she came to his office. Growing up the woman’s mother had been devoted and nurturing to her twin while the patient was left to the nurse. Responding to this earlier deprivation, Winnicott made sure to be standing by the office door, “actually opening the door as the bell rang.” If he failed to do this, the woman would talk in the session but “would get no feeling of our having met.”
He also tells the story of working with an adolescent boy. The boy said very little during their first session, and as they parted Winnicott said that he expected “to see him again sometime.” One day the boy unexpectedly called on the telephone and asked if he could meet the following day, a Saturday. Winnicott felt obligated to accept the session, as in so doing, he gave the boy the illusion of creating the analyst in much the same way as an infant is giving the illusion of creating the mother’s breast.
In sum, mothers “can teach something to those who manage the schizoid regressions and confusion states of people of any age.” “The provision of a stable though personal environment, warmth, protection from the unexpected and unpredictable, and the serving of food in a reliable way and accurately on time (or even following the whims of the patient), these things might help the nursing of schizoid cases.”
Hate in the Countertransference (1947)
Psychotics are tough. Psychotics are “a heavy emotional burden on those who care for them.” When doing analysis with a psychotic (or antisocial) patient it is therefore essential that “the analyst’s own hate is extremely well sorted-out and conscious.” “However much [the analyst] loves his patients he cannot avoid hating them and fearing them, and the better he knows this the less will hate and fear be the motives determining what he does to his patients.”
So if you’re doing analysis with a psychotic, you had better have had your own analysis. “If we are to become able to be the analysts of psychotic patients we must have reached down to very primitive things in ourselves, and this is but another example of the fact that the answer to many obscure problems of psycho-analytic practice lies in further analysis of the analyst.”
Psychotics need to feel our hate. Winnicott goes on to write that “the patient can only appreciate in the analyst what he himself is capable of feeling.” Thus, the obsessional patient tends to think of the analyst “as doing his work in a futile obsessional way.” and the neurotic “tends to see the analyst as ambivalent toward the patient.” The psychotic “is in a ‘coincident love-hate’ state of feeling” and assumes that the analyst is similarly “only capable of the same crude and dangerous state of coincident love-hate relationship.” If the analyst were to show love for the psychotic patient, he would “surely at the same moment kill the patient.”
Hate in analysis is perfectly normal. There are many times in analysis in which our hate is justified. He talks about an obsessional patient he worked with for several years whom Winnicott found “almost loathsome to me for some years.” He felt bad about these feelings “until the analysis turned a corner and the patient became lovable, and then I realized that his unlikeableness had been an active symptom, unconsciously determined. It was indeed a wonderful day for me (much later on) when I could actually tell the patient that I and his friends had felt repelled by him, but that he had been too ill for us to let him know. This was also an important day for him, a tremendous advance in his adjustment to reality.”
Even mothers hate their infants. There are many reasons why mothers at times hate their children. “The baby is a danger to her body in pregnancy and at birth. The baby is an interference with her private life, a challenge to preoccupation… The baby hurts her nipples even by suckling, which is at first a chewing activity. He is ruthless, treats her as scum, an unpaid servant, a slave. She has to love him, excretions and all, at any rate at the beginning, till he has doubts about himself. He tries to hurt her, periodically bites her, all in love. He shows disillusionment about her… He is suspicious, refuses her good food, and makes her doubt herself, but eats well with his aunt. After an awful morning with him she goes out, and he smiles at a stranger, who says: ‘Isn't he sweet?’”
The analyst of a psychotic patient is like this mother. “When deeply regressed the patient cannot identify with the analyst or appreciate his point of view any more than the foetus or newly born infant can sympathize with the mother.” He continues: “A mother has to be able to tolerate hating her baby without doing anything about it. She cannot express it to him… The most remarkable thing about a mother is her ability to be hurt so much by her baby and to hate so much without paying the child out, and her ability to wait for rewards that may or may not come at a later date.”
The analyst should wait before telling his patient he hates him. “If all this is accepted there remains for discussion the question of the interpretation of the analyst's hate to the patient. This is obviously a matter fraught with danger, and it needs the most careful timing. But I believe an analysis is incomplete if even towards the end it has not been possible for the analyst to tell the patient what he, the analyst, did unbeknown for the patient whilst he was ill, in the early stages. Until this interpretation is made the patient is kept to some extent in the position of infant—one who cannot understand what he owes to his mother."
Aggression in Relation to Emotional Development (1950-5)
If society is in danger “it is not because of man’s aggressiveness but because of the repression of personal aggressiveness in individuals.”
Pre-Concern Stage. Aggression exists at the very beginning of life. “A baby kicks in the womb; it cannot be assumed that he is trying to kick his way out. A baby of a few weeks thrashes away with his arms; it cannot be assumed that he means to hit. A baby chews the nipple with his gums; it cannot be assumed that he is meaning to destroy or to hurt. At origin aggressiveness is almost synonymous with activity.”
The young infant is not yet aware that what he “destroys” when excited is the same object that he values “in quiet intervals between excitements.” Aggression here is part of the infant’s love, as his “excited loves includes an imaginative attack on the mother’s body.” If the infant at this stage is not able to be aggressive, he will lose some of his capacity “to love, that is to say, to make relationships with objects.”
Concern Stage. At this stage the child realizes that some of his aggression has caused damage, and the infant consequently feels guilty. In an ideal situation, the mother helps the child “discover his own personal urge to give and to construct and to mend.”
Growth of Inner World. The child grows to become concerned with not only how his actions affect his mother but also how his inner experiences affect his own self. Sometimes he feels good, and sometimes he feels bad, seeming to “be filled with what is bad or persecuting.” “These evil things or forces, being inside him, as he feels, form a threat from within to his own person, and to the good which forms the basis of his trust in life.”
Responses to Bad Things. The child might respond to these bad things he feels inside by projecting them onto the world and then fighting those things in the world. The child might internalize bad things from the external world; for example, he might witness his parents quarreling. The child could then respond in a number of ways — e.g., becoming depressed, tired, or sick; behaving “as if ‘possessed’ by the quarreling parents” and acting aggressively toward others; or engineering quarreling “in the people around him, then using the real external badness as a projection of what was ‘bad’ within.”
Transitional Objects and Transitional Phenomena (1951)
Special Blankies. Winnicott talks about the infant’s first not-me possession. We can observe how an infant will initially put his hand in his mouth and in time start to put other objects in his mouth: a blanket, a teddy bear, a doll, a toy. The infant might be experiencing “oral excitement and satisfaction,” but something more is happening. The infant will often become deeply attached to such an object.
Such an object “or a word or tune, or a mannerism” often “becomes vitally important to the infant for use at the time of going to sleep, and is a defense against anxiety, especially anxiety of depressive type.” The child might hold onto the object as he ages, “the original soft object” continuing to be “absolutely necessary at bed-time or at time of loneliness or when a depressed mood threatens.” The parents get to know the object’s “value and carry it around when traveling. The mother lets it get dirty and even smelly, knowing that by washing it she introduces a break in continuity in the infant’s experience, a break that may destroy the meaning and value of the object to the infant.”
Illusions. Winnicott uses the terms “transitional object” and “transitional phenomena” to denote objects or experiences “that are not part of the infant’s body yet are not fully recognized as belonging to reality.” These phenomena take on the properties of illusions, as they exist between the child’s inner reality and the external world, between the child’s subjective experience and that which he objectively perceives.
More Clarification: Internal and External Objects. The transitional object “stands for” the breast or the mother. The object is neither an internal object nor an external object. The transitional object’s existence depends on the goodness of the internal object (which must be “alive and real and good enough,” and the internal object’s goodness depends on the goodness of the external object (the actual mother must also be good enough). “The transitional object is never under magical control like the internal object, nor is it outside control as the real mother is.”
Illusion in Infancy. The good-enough mother initially adapts almost completely to the infant’s needs. This complete adaptation creates an illusion, giving the infant the belief that he is omnipotent. All he needs to do is feel hungry and desire the breast and then — voila — the breast appears.
Disillusionment in Infancy. Once the mother has been completely adaptive and thus allowed the infant to develop the illusion of his own omnipotence, she can begin to disappoint him. She does not adapt as completely as before, and in time she starts to wean the infant. The infant in turn feels frustrated that his needs are not met like they were before. But because of the mother’s previous adaptation, the infant is now strong enough to become disillusioned and endure these new frustrations. The infant, in other words, is now strong enough to face reality.
Needed Illusions. So the infant is initially given the illusion that external reality conforms to his desires, and in time the infant is confronted with some uncomfortable truths of reality. However, the “task of reality-acceptance is never completed,” as “no human being is free from the strain of relating inner and outer reality, and that relief from this strain is provided by an intermediate area of experience which is not challenged.”
Winnicott seems to be saying two major things here. First, transitional phenomena ease the infant’s journey from pure illusion to the hard knocks of reality. Second, living in pure reality all of the time is difficult for even adults, and so we all need some illusion to make life possible. The child will grow to abandon his transitional object, but he will put in its place things like religion and the arts.
Regarding adult illusions, he writes: “We can share a respect for illusory experience, and if we wish we may collect together and form a group on the basis of the similarity of our illusory experiences. This is a natural root of grouping among human beings. Yet it is a hall-mark of madness when an adult puts too powerful a claim on the credulity of others, forcing them to acknowledge a sharing of illusion that is not their own.”
Psychoses and Child Care (1952)
Winnicott writes that “some degree of psychosis in childhood is common.” When the child does not have a good-enough environment in early infancy, he is forced to develop defenses that continue to distort his view of reality and resemble psychosis.
Good-enough environment. In the good-enough environment, the mother is preoccupied “with the care of the infant. The word ‘devotion’ can be rid of its sentimentality and can be used to describe the essential feature without which the mother cannot make her contribution, a sensitive and active adaptation to her infant's needs — needs which at the beginning are absolute. This word, devotion, also reminds us that in order to succeed in her task the mother need not be clever.”
Depressive Stage of Development. Failure in the pre-depressive stage can cause “disturbances which can be recognized and labeled as psychotic.” The pre-depressive stage is the time “before the child has clearly become a whole person capable of total relationships with whole persons.” Success in the depressive stage presupposes that the child has had success in the pre-depressive stage. The depressive stage occurs during the weaning period, approximately when the child is between 9 and 18 months old. During this stage the child develops “[t]he capacity to feel concerned, to feel grief, and to react to loss in an organized way.”
Pre-Depressive Stage of Development. The first figure below shows how the good-enough environment allows the child to exist in “undisturbed isolation.” The environment does not impinge on this child, and he is able to make a spontaneous movement, he is able to discover the environment without losing his sense of self. The second figure shows how the not-good-enough environment impinges upon the child. This impingement causes the child to return to his isolation, and he is not able to develop his sense of self.
The first figure shows how in a good-enough environment, one’s persecutors “become neutralized” by “the mother's loving care, which physically (as in holding) and psychologically (as in understanding or empathy, enabling sensitive adaptation), makes the individual's primary isolation a fact.” The second figure shows unintegrated child and how he keeps persecutors at bay “by non-achievement of unit-status. In a relation with this kind of child one floats in and out of the inner world in which the child lives, and while one is in it one is subjected to more or less of omnipotent control, but not control from a strong central point. It is a world of magic, and one feels mad to be in it. All of us who have treated psychotic children of this kind know how mad we have to be to inhabit this world, and yet we must be there, and must be able to stay there for long periods in order to do any therapeusis.”
The depressive position is an achievement. It is an achievement to reach the depressive position, which occurs during the weaning period, generally around the sixth through twelfth months of life. In order to reach this stage, the baby must first “become established as a whole person” and “be related to whole persons as a whole person.”
The infant is initially ruthless. Before reaching the depressive position, the infant is ruthless. The infant at this stage is “carried away by crude instinct,” using his mother as a means to his own instinctual ends and not considering the consequences of his actions. Moreover, the infant is not aware “that this mother who is so valued in the quiet phases is the person who has been and will be ruthlessly attacked in the excited phases.”
A good-enough environment leads to object constancy. If the baby receives a good-enough environment, he will in time come to see that the mother he values in the quiet times is the same mother he exploits in his excited times. Winnicott refers to the achievement of this object constancy as “the survival of the mother.”
The baby then experiences depressive anxiety. The baby feels anxiety because he believes that in his ruthlessness he has injured his mother. Evidently referring to nursing, he writes “there is a hole, where previously there was a full body of richness.” The baby may also feel anxiety because he himself feels differently inside. In feeding, the baby consumes the milk. “This stuff is felt to be good or bad according to whether it was taken during a satisfactory instinctual experience or during an experience complicated by excessive anger at frustration.”
The baby starts to feel guilt. The baby feels guilt when he “becomes able to tolerate the hole (the result of instinct love),” meaning when he has attained objet constancy and recognizes the results of his ruthlessness. Thus, “[t]he healthy child has a personal source of sense of guilt, and need not be taught to feel guilty or concerned.” If a child does not reach the depressive position, he will not have this experience and will “have to be taught a sense of right and wrong.”
The good-enough mother gives her baby the chance to make reparation. “The infant that is blessed with a mother who survives, a mother who knows a gift gesture when it is made, is now in a position to do something about that hole, the hole in the breast or body, imaginatively made in the original instinctual moment. Here come in the words reparation and restitution, words which mean so much in the right setting, but which can easily become clichés if used loosely. The gift gesture may reach to the hole, if the mother plays her part.”
Metapsychological and Clinical Aspects of Regression within the Psychoanalytic Set-up (1954)
Three Types of Psychoanalytic Patients
(1) Oedipal Patients. These patients “operate as whole persons” and their difficulties “are in the realm of interpersonal relationships.” The patients are best served by traditional psychoanalytic techniques. Analysis with these patients involves three people, “one of them excluded from the analytic room.”
(2) Depressive Patients. In these individuals “the wholeness of the personality only just begins to be something that can be taken for granted,” and the analysis pertains to the events immediately following “not only the achievement of wholeness but also the coming together of love and hate and the dawning recognition of dependence.” We use traditional analytic techniques with these individuals, but “some new management problems do arise on account of the increased range of clinical material tackled.” The “idea of the survival of the analyst as a dynamic factor” becomes prominent. Analysis with these patients involves two people, as “there has been a regression of the patient in the analytic setting, and the setting represents the mother with her technique, and the patient is an infant.”
(3) Pre-Depressive Patients. The analyses of these individuals “must deal with the early stages of emotional development before and up to the establishment of the personality as an entity, before the achievement of space-time unit status.” With these patients, much effort is put into management, “and sometimes over long periods with these patients ordinary analytic work has to be in abeyance, management being the whole thing.” Analysis with these patients involves one person, as there is “a further state of regression in which there is only one present, namely the patient, and this is true even if in another sense, from the observer's angle, there are two.”
Regression
Winnicott discusses a female patient who had developed a false self. Given this, in order for her treatment to be successful, “there had to be a regression in search of the true self.” Winnicott started the regression, and it took three to four years “before the depth of the regression was reached, following which there started up a progress of emotional development.” To be more specific, the patient’s false self had become a caretaker self, “and only after some years could the caretaker self become handed over to the analyst, and the self surrender to the ego.”
Freezing of the Failure Situation
People can respond to an early environmental failure in a number of ways, one of them being to freeze the failure situation. This is similar to the concept of the fixation point. Analysts have long believed that a frustrating experience in the pregenital phase “can create fixation points in the emotional development of the individual. Winnicott does not want to abandon this idea but wants to look “at it afresh.”
Responding to an environmental failure in this way is a normal and healthy defense. “Along with this goes an unconscious assumption (which can become conscious hope) that opportunity will occur at a later date for a renewed experience in which the failure situation will be able to be unfrozen and re-experienced, with the individual in a regressed state, in an environment that is making adequate adaptation.”
Freud
Freud’s patients were neurotics, meaning they had not experienced environmental failures in early infancy. “His own infancy experiences had been good enough, so that in his self-analysis he could take the mothering of the infant for granted.” He subsequently assumed that his patients had had similar early mothering experiences, and this assumption “turned up in his provision of a setting for his work, almost without his being aware of what he was doing.”
Freud’s work can be divided into two parts. First, there is the technique of psychoanalysis. “The material presented by the patient is to be understood and to be interpreted.” Second, “there is the setting in which this work is carried through.” Freud’s analytic setting involved these features: the analyst shows up on time; the analyst expresses love by taking interest in the patient and hate by finishing on time and charging for the session; the analyst tries to understand the patient and communicate this understanding to the patient; the work takes place in a quiet, properly lit, comfortably warm room; the patient lies on a comfortable couch; the analyst refrains from making moral judgments; the analyst abstains from sharing information about his own life; the analyst is reliable, being punctual and restraining his impulses; the patient can express aggression toward the analyst in fantasy (e.g., in a dream) and the analyst is not hurt (the analyst survives).
There “is a very marked similarity between all these things and the ordinary task of parents, especially that of the mother with her infant.”
Psychotics
Winnicott summarizes his thoughts about psychotics.Development: environmental failure early in life leads to psychotic illness; the psychotic experiences a sense of futility and unreality that causes him to develop a false self to protect his true self. Analytic Setting: the analytic setting replicates the “earliest mothering techniques” and “invites regression by reason of its reliability.” Regression: in his regression, the patient returns to the state of early dependence and primary narcissism, primary narcissism being the earliest stage of development, a stage in which the patient is undifferentiated from his environment. Reexperience of Environmental Failures: now returned to the state of primary narcissism, the patient’s true self (because he’s regressed to the time before he had a false self) encounters “environmental failure situations,” and the patient does so while feeling a new sense of self. Environmental Failure Situation: the environmental failure situation is unfrozen; the patient, now possessing more ego strength, feels and expresses anger over the early environmental failure; the patient returns to independence and realizes his instinctual needs and wishes “with genuine vitality and vigor.”
He then discusses some specifics on the treatment of psychotics.
The analyst must be adaptive. The psychotic patient’s wishes are needs. “If a regressed patient needs quiet, then without it nothing can be done at all. If the need is not met the result is not anger, only a reproduction of the environmental failure situation which stopped the processes of self growth. The individual's capacity to ‘wish’ has become interfered with, and we witness the reappearance of the original cause of a sense of futility.”
Punctuality is essential. “Or take the detail of being on time. The analyst is not one who keeps patients waiting. Patients dream about being kept waiting and all the other variations on the theme, and they can be angry when the analyst is late. This is all part of the way the material goes. But patients who regress are different about the initial moment. There come phases when everything hangs on the punctuality of the analyst. If the analyst is there ready waiting, all is well—if not, well then both analyst and patient may as well pack up and go home, since no work can be done.” If the patient himself is late it is probably because “there is not yet established any hope that the analyst will be on time. It is futile to be on time.”
Bed-wetting. “Another point is that regression to dependence is part and parcel of the analysis of early infancy phenomena, and if the couch gets wetted, or if the patient soils, or dribbles, we know that this is inherent, not a complication. Interpretation is not what is needed, and indeed speech or even movement can ruin the process and can be excessively painful to the patient.”
The analyst’s words. When working with psychotics, the analyst must be prepared to tolerate some acting out. In time, however, the analyst must put into words what happened. The following sequence transpires. (1) The analyst tells the patient what happened and also what “was needed of the analyst.” (2) Based on what happened, the analyst now understands and verbalizes “[w]hat went wrong in the original environmental failure situation.” (4) The patient feels some relief but also anger. Perhaps for the first time, the patient feels angry about what originally happened to him. The analyst himself might “have to take part by being used in respect of his failures rather than of his successes. This is disconcerting unless it is understood. The progress has been made through the analyst's very careful attempt at adaptation, and yet it is the failure that at this moment is singled out as important on account of its being a reproduction of the original failure or trauma.” (5) Ideally, the patient next experiences a new sense of self
Primary Maternal Preoccupation (1956)
Winnicott describes primary maternal preoccupation as follows: "It gradually develops and becomes a state of heightened sensitivity during, and especially towards the end of, the pregnancy. It lasts for a few weeks after the birth of the child." He continues: "This organized state (that would be an illness were it not for the fact of the pregnancy) could be compared with a withdrawn state, or a dissociated state, or a fugue, or even with a disturbance at a deeper level such as a schizoid episode in which some aspect of the personality takes over temporarily." Even many good mothers are not achieve primary maternal preoccupation, “are not able to become preoccupied with their own infant to the exclusion of other interests.”
The good enough mother is adaptive to the infant’s needs, thus preventing the infant from being disturbed by impingements. When an infant experiences an impingement, he is interrupted from his “going on being.” Excessive impingements can lead to annihilation anxiety and corresponding defense mechanisms (e.g., false self).
“In other words, the basis for ego establishment is the sufficiency of ‘going on being’, uncut by reactions to impingement. A sufficiency of ‘going on being’ is only possible at the beginning if the mother is in this state that (I suggest) is a very real thing when the healthy mother is near the end of her pregnancy, and over a period of a few weeks following the baby's birth. Only if a mother is sensitized in the way I am describing can she feel herself into her infant's place, and so meet the infant's needs.”
Sometimes the antisocial tendency can be “treated very easily” if the treatment is supplemented with “specialized environmental care.” He tells the story of a mother who compulsively stole. Winnicott suggested that the mother make the following interpretation to him: “Why not tell him that you know that when he steals he is not wanting the things that he steals but he is looking for something that he has a right to; that he is making a claim on his mother and father because he feels deprived of their love.”
The mother later sent a letter to Winnicott. She reported that she had told this to her son. “I [then] asked him if he thought we didn't love him because he was so naughty sometimes, and he said right out that he didn't think we did, much. Poor little scrap! I felt so awful, I can't tell you. So I told him never, never to doubt it again and if he ever did feel doubtful to remind me to tell him again.” The mother then talked to the boy’s teacher and “explained that the boy was in need of love and appreciation.” The mother “gained her co-operation although the boy gives a lot of trouble at school.”
Winnicott clarifies that the antisocial tendency is not a diagnosis and that it can be found in a psychotic, neurotic, or normal individual. “The antisocial tendency is characterized by an element in it which compels the environment to be important. The patient through unconscious drives compels someone to attend to management.”
The antisocial tendency is the result of “a true deprivation (not a simple privation); that is to say, there has been a loss of something good that has been positive in the child's experience up to a certain date, and that has been withdrawn; the withdrawal has extended over a period of time longer than that over which the child can keep the memory of the experience alive.”
When the child with the antisocial tendency steals something, he is “looking for something, somewhere, and failing to find it seeks it elsewhere. When the child with the antisocial tendency destroys something, he is “seeking that amount of environmental stability which will stand the strain resulting from impulsive behaviour.”
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