Winnicott's Theory of the Maturational Processes

Elsa Oliveira Dias

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9780367329655
• eBook ISBN:
  9780429924149
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

This book presents an in-depth, wide-ranging and rigorous investigation of Winnicott's central theory of maturational processes and its interrelation with psychic disorders. It provides the framework from which different aspects of the study of human nature can be developed.

Chapter One

Winnicott and the debate with related areas

Historical aspects of Winnicott’s intellectual background

In examining Winnicott’s conception of psychic health and illness in general, and of psychoses in particular, it is important to highlight some aspects of his professional and intellectual life that strongly influenced his theoretical positions. It will be equally useful to review the implicit or explicit debate within his work with the related areas of psychiatry, academic psychology, and traditional psychoanalysis. We may perceive the trend in the evolution of his thought through which certain concepts emerged and were consolidated as responses to the conceptions of his time which he judged to be inadequate and even unacceptable, starting with the general outlines of this debate.

At several points, Winnicott refers to the importance for his thought of his medical training. On the one hand, he had the obvious advantage of medical knowledge, which allowed him to identify clinical states with an active physical factor, which generated secondary psychological symptoms, or which allowed him to determine that a sick child was not suffering from a physical disorder, which indicated a psychological disturbance or a depression in the mother which manifested itself as an excessive concern for the child. Probably, however, his greatest debt to his medical training and practice lay in his clarity about what not to think or do in treating someone’s health. Having lived among paediatricians and psychiatrists, Winnicott experienced the inadequacy of thinking about health and illness in purely organicist terms at first hand. He seems to have realised at a very early stage that health, and even more importantly, the feeling of being alive, could not be reduced to the effective functioning of the body and its organs and that the separation of the physical from the psychic was intellectually possible, but highly artificial.

In 1920, during his medical training, Winnicott was already firmly convinced of the impossibility of diagnosing disorders of relevance to paediatrics without considering their psychological aspects. While he was still a student, he encountered a work on Freud by the Swiss pastor Oskar Pfister and was delighted with the possibility offered by psychoanalysis of approaching psychic illness and somatic disorders from a predominantly psychological viewpoint. In a letter of 1919 to his sister Violet, he enthusiastically describes his discoveries regarding the Freudian theory of the psyche (cf. 1987b, p. 1). In 1923, he became an assistant doctor at the Paddington Green Children’s Hospital, a position he held for forty years.¹ Having decided to include psychoanalysis in his training, he began analysis with James Strachey in the same year, which would last for a decade. The clinical care at the hospital gradually evolved from paediatrics to child psychiatry with an analytical orientation.

In the paediatric practice, carried out in terms of child psychiatry, Winnicott succeded in verifying that most of the problems which brought mothers with their babies and children to a clinic were due to primitive emotional disorders. Furthermore, he observed that not only children but also physically healthy babies could already be emotionally ill during the first weeks of life. He was impressed by the precocity of the disorders and by the importance of psychic factors in their emergence; at the same time, the nature of these factors was not yet clear to him and in approaching psychoanalysis, he sought the field par excellence for investigating them. He indeed located them, albeit with the proviso that he would very soon realise that he did not agree with what the established traditional theory understood as psychic.

The discovery of the existence of these precocious emotional disorders decisively influenced the evolution of his analytical thinking. As a result of this finding, Winnicott could never be persuaded of the centrality of the Oedipus complex proposed by Freudian psychoanalysis. In 1967, during a lecture in which he presented a sort of intellectual autobiography to his analyst colleagues, he noted:

When I came to try and learn what there was to be learned about psycho-analysis, I found that in those days we were being taught about everything in terms of the 2-, 3-, and 4-year-old Oedipus complex and regression from it. It was very distressing to me as someone who had been looking at babies—at mothers and babies—for a long time (already ten to fifteen years) to find that this was so, because I knew that I’d watched a lot of babies start off ill and a lot of them become ill early. (1989f, p. 574)

Marked by this evidence, Winnicott’s theoretical efforts moved in the direction of clarifying what happens to babies at the very outset of life and the specific nature of the difficulty faced by or afflicting them.² In 1935, at Strachey’s suggestion, he contacted Melanie Klein, who was already known for her interest in the more primitive anxieties of childhood. Regarding the study by Klein as being extremely important, Winnicott followed the path initiated by her, becoming her supervisee between 1935 and 1940 or 1941.³ He soon realised that Klein knew a great deal and much more than he did about the topic and even during subsequent phases, when he decisively distanced himself from Klein’s theoretical line, he always affirmed that he had learned much from her. There had nevertheless been theoretical differences between them from the start, which gradually deepened and became clearer as the basic conceptual elements of his theory became more precise, ultimately revealing a fundamental incompatibility between their respective theories. We shall examine some of these conceptual differences in greater detail below.

It was nevertheless during this period, at the end of the 1930s, that another professional experience decisively influenced the theoretical direction of his thought. During the Second World War, Winnicott was appointed psychiatrist-consultant to the Government Evacuation Scheme of one reception area in the UK and, according to Clare Winnicott, who was a member of his team as a social worker, this position had a profound effect on him, since he found himself facing a large scale and concentrated disruption of households and a massive disintegration of family life, allowing him to observe the effects of separation and loss on children and adolescents. In addition to the global situation, there was also the fact that the children for whom Winnicott became responsible were exactly those who, having already presented difficulties at home before the war, required special arrangements and could not be introduced into ordinary households which would “adopt” them, in accordance with the evacuation plans. Winnicott further observed that for such children, war was not only secondary but beneficial, as they found themselves removed from an intolerable situation in their own homes, for which they had not found an exit and were placed in a new situation, in which they could possibly obtain help. This was the experience that provided Winnicott with material for formulating his theory on delinquency and character disorders, clinical manifestations included in what he termed the antisocial tendency. From this point onwards, certain specific theoretical aspects of an as yet incipient theory of maturational processes were gradually outlined with greater clarity, with these relating to the importance of the environment in the aetiology of psychic disorders.

Until this point, character disorders such as delinquency and juvenile violence were seen by psychoanalytic theory as manifestations of the anxiety or guilt resulting from the inevitable unconscious ambivalence between love and hate, from the conflict which arises when the desire to destroy is specifically directed at the loved person. If the guilt cannot be repaired or sublimated, the individual is compelled to act out so as to give it a concrete outline. The aetiology of delinquency basically consisted of an intrapsychic conflict. For Winnicott, data from experience again led towards another hypothesis, namely, that the environmental factor was aetiologically decisive in these issues, with this undoubtedly already a tendency of his thought. This becomes clear, for example, in Winnicott’s early texts from the 1930s, in which he describes several paediatric cases treated during the 1920s, for the elucidation of which he was already starting to use psychoanalytical theory. Although these articles point out unconscious conflicts that could form the origin of particular physical disorders, he did not fail to demonstrate the importance of environmental factors in the aetiology of the problem.⁴ In 1967, when presenting a retrospective of his intellectual trajectory to his colleagues at the British Psycho-Analytical Society, Winnicott referred to the characteristic position of traditional psychoanalysis of emphasising internal factors and neglecting environmental aspects; he noted that for ten or fifteen years, psychoanalysts were the only ones who accepted the existence of anything other than the environment and that although everybody claimed that the delinquency of a particular boy was a consequence of his father’s alcoholism, etc., psychoanalysts continued to attribute the problems to the constitution of the boy and to research into his internal conflicts (cf. 1989f, p. 577).⁵ On several occasions, Winnicott tried to talk to Melanie Klein and to some Kleinians about the environmental factor, met with complete disinterest, if not suspicion. Soon afterwards, he stated that anyone interested in the care of children ran the risk of being considered “traitors to the cause of the internal processes” (1965h, p. 126).

In 1945, four years after leaving Klein’s supervision, Winnicott wrote the article “Primitive emotional development”, in which he made a number of statements indicating that he had decided to follow his own path. While he had always been interested in the child patient, he stated that he had decided to study psychosis and that he now had much to add to the current theories and “perhaps this paper may be taken as a beginning” (1945d, p. 145), that is, the beginning of the development of his own theory. In order to present his contribution, he nevertheless had to prepare the ground and would hence try “to describe different types of psychoanalysis” (ibid., my italics). At this point, Winnicott already seemed to be aware that both the Freudian version and the Kleinian revision of traditional psychoanalysis, which sought to cover psychoses, were incapable of dealing with the type of problem present in these serious disorders, especially those of a schizophrenic nature, which required an adjustment to the theory.

The debate with paediatrics

During the 1930s, as his psychoanalitical training progressed, Winnicott undertook to persuade paediatricians to abandon certain procedures resulting from a merely organicist background and to learn about psychological aspects in evaluating disorders in children. Although traditional psychoanalysis was his main point of reference over the whole of his intellectual life, Winnicott never ceased to address paediatricians, obstetricians, nurses, and nursery specialists in order to alert them to certain discoveries, which seemed to be essential to him, regarding child care and the implementation of health. During this period, he wrote several articles, as a paediatrician to paediatricians, in which he presented the emotional disorders which could form the basis of certain clinical situations typical of childhood and urged specialists to ensure that they were prepared to investigate the psychological motivations of such disorders.⁶

Winnicott was familiar with his potential readers and the traditional conceptions of illness and health which had dominated medical theories and practices since the start of the modern era. It was not only true that paediatrics and child psychiatry concerned themselves unquestioningly with their respective and traditionally separate fields, the body and the mind, but both areas also represented recent specialisations in medicine and general psychiatry which were still in the process of consolidating their specific characters. In addition, physical medicine had always tended towards a study of the classification of diseases, regardless of the age at which these occurred. Paediatrics became a necessity and was established as a specialist discipline in the mid-nineteenth century, when it became clear that there are morbid states specific to each age group and diseases typical of childhood. Even when syndromes are common to both childhood and adulthood, age imposes a peculiar characteristic from the perspective both of the etiological circumstances and of the clinical aspect.

At the same time, paediatrics limited itself to the physical and physiological aspects of growth. The paediatrician was a somatist whose specialisation was above all in terms of physiology. It was very hard, Winnicott observed in 1958, to find a paediatrician who did not restrict himself to the physical aspect. His background obliged him, for example, to be aware of the mental illnesses deriving from the rubella contracted by the mother during the second month of pregnancy, of orthopaedic malformations, of blood incompatibility between the mother and the baby, or of the damage caused to the meninges as a result of a delayed birth, etc. In the 1950s, many things had already changed in paediatrics theory and practice. These modifications, which included an incipient interest in the psychological aspects of development, were due in part to progress in research, to public sanitation, and to a general improvement in living conditions, which released doctors from a complete dedication to the study and treatment of primary diseases. Indeed, Winnicott conceded, until that point much specialised work had been necessary. In the mid-nineteenth century, he reported, the situation was even worse and the urgent task for the whole pioneer generation of paediatricians in the United Kingdom was to ensure an appropriate classification of the various physical illnesses peculiar to childhood and to try to eradicate them:

In those days there was not much time or place for the consideration of health as such, nor for the study of the difficulties that beset the physically healthy child through the fact of growing up in a society that is composed of human beings. (1988, p. 9)

This quotation includes one of the main elements of Winnicott’s conception of health and illness, a topic of his discussion with the entire medical field, from which important theoretical positions derived: the idea that health is a complex state which carries its own demands and must be conceived in its own right. Both in paediatrics and in psychiatry, health is generally conceived as the absence of illness, with Winnicott finding this negative definition grossly inadequate. On the other hand, illness was regarded as an evil to be eradicated. In the article “A note on normality and anxiety”, Winnicott held that although from a purely physical viewpoint any deviation from health could be regarded as abnormal, “[…] it does not follow that physical lowering of health due to emotional strain and stress is necessarily abnormal” (1931b, p. 3). Reporting the case of a boy aged two and a half who had a strong adverse reaction to the birth of a brother, Winnicott stated that if the baby had not been born, the child would have been spared but would nevertheless have missed out on a real experience at an appropriate age. Such an occurrence, he continues, “justifies the statement that it can be more normal for a child to be ill than to be well” (ibid., p. 4).

The quotation highlighted above not only indicates the need to consider health as a state with its own profile but also contains the statement which permeates the whole of Winnicott’s thought and has more extensive implications than may be apparent at first sight, namely, that, from the outset, life itself is difficult and the task of living, of continuing to be alive, and of maturing is a permanent struggle. It is thus necessary to study the difficulties that beset the physically healthy child through the fact of growing up in a society that is composed of human beings (1988, p. 9).

Furthermore, although paediatrics and child psychiatry began to take account of the psychological aspect of these phenomena and their specific character according to the stage of development, all of this refers to childhood from when children can already speak and not to babies. Neither specialisation viewed the baby as a human being capable of emotional states and of being affected by the environment. At birth, it was seen merely as an organism. Despite having observed babies becoming ill precociously, Winnicott himself admitted to having taken a long time to see them as human beings. He became capable of this through his own analysis, stating that this was indeed the principal result of his first five years of analysis with Strachey. In 1957, the author stated that he had observed an evolution in the attitude of health specialists towards babies and small children. Perhaps, he said, parents had considered the baby as a person for longer than specialists had done, sometimes seeing in him much more than was actually there, a potential little man or woman. This had initially been neglected and even rejected by science and, for a long time, children were considered as beings that were hardly human until they started to speak, but that recently, “it has been found that infants are indeed human, though appropriately infantile” (1957d, p. 107).

The contribution of psychoanalysis...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• CONTENTS
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• PREFACE TO THE ENGLISH EDITION
• PREFACE TO THE SECOND EDITION
• PREFACE TO THE THIRD EDITION
• INTRODUCTION
• CHAPTER ONE Winnicott and the debate with related areas
• CHAPTER TWO Basic concepts of the theory of maturational processes
• CHAPTER THREE The primitive stages: absolute dependence
• CHAPTER FOUR The stages of relative dependence and independence
• FINAL CONSIDERATIONS
• REFERENCES
• INDEX