Accessing the Clinical Genius of Winnicott

A Careful Rendering of Winnicott’s Twelve Most Influential Clinical papers

Teri Quatman

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780367859268
• eBook ISBN: 9781000055221
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Donald Winnicott, psychoanalyst and pediatrician, is viewed by many in the psychodynamic field as the "other genius" in the history of psychodynamic theory and practice, along with Freud. This book selects and explores twelve of his most infl uential clinical papers.

Winnicott's works have been highly valued in the decades since they were first published, and are still relevant today. Winnicott's writings on the goals and techniques of psychodynamic psychotherapy have been foundational, in that he recast Freudian- and Kleinian-infl uenced thinking in the direction of the more relational schools of psychotherapy that define current 21st-century psychodynamic practice. Winnicott's writings help us to understand the maturational processes of children, certainly. But more than that, they help us to understand how best to intervene when the enterprise of childhood leads to compromises of psychological health in later years. Yet, despite Winnicott's influence and continuing relevance, his writings, while at some level simple, are elusive to modern readers. For one thing, he writes in the psychoanalytic genre of the 1930s-1960s, whose underlying theoretical assumptions and vocabulary are obscure in the present day and, for another, his writing often reflects primary process thinking, which is suggestive, but not declarative. In this work, Teri Quatman provides explanations and insight, in an interlocution with Winnicott's most significant papers, exploring both his language and concepts, and enabling the clinician to emerge with a deep and reflective understanding of his thoughts, perspectives, and techniques.

Engaging and accessible, Accessing the Clinical Genius of Winnicott will be of great use to anyone encountering Winnicott for the first time, particularly in psychodynamic psychotherapeutic training, and in the teaching of relational psychotherapies.

1Mind and its relation to the psyche-soma

(1949)¹

Winnicott, D. W. (1949). Mind and its relation to the psyche-soma (rev. 1954). In: Through paediatrics to psycho-analysis: Collected papers (pp. 243–254). Levittown, PA: Brunner Mazel, 1992.

This Winnicott chapter is one of the cornerstones of this thinking process about the foundational elements of our being as humans. His central thesis is that our thinking apparatus as adults—our mind—is designed to be nested-in and infused with the ground of somatic experience. He says that the very first sense of our own psyche as infants is our experiencing of ourselves as physical beings. There is the physical experience, and then there is the imaginative elaboration of that experience. These, in interplay, are the initial building blocks of the human psyche. He asserts that when a baby has to adapt to certain kinds and degrees of maternal failure that exceed the growing baby’s psyche-soma’s capacities, the mind—the baby’s not-yet-ready thinking process—has to step up and take over, and prematurely organize the care of the baby’s own psyche-soma—something that the maternal environment was meant to do. This early maladaptation affects all subsequent stages of development, causing among other things an over-reliance on the (disembodied) mind, and a strong tendency to become the caretaker in intimate relationships, which comes with their having a difficult time allowing themselves to be the recipient of care in such relationships.

I’ve tried to follow Winnicott step by step here, bringing us carefully along as Winnicott weaves his thoughts for us. It’s slow and careful, but I don’t want us to miss any of the elegance of Winnicott’s contributions contained in this piece.

He begins with a quote from Scott (1949):

To ascertain what exactly comprises the irreducible mental elements, particularly those of a dynamic nature, constitutes in my opinion one of our most fascinating final aims. These elements would necessarily have a somatic and probably a neurological equivalent, and in that way we should by scientific method have closely narrowed the age-old gap between mind and body. I venture to predict that then the antithesis which has baffled all the philosophers will be found to be based on an illusion. In other words, I do not think that the mind really exists as an entity—possibly a startling thing for a psychologist to say [my italics]. When we talk of the mind influencing the body or the body influencing the mind we are merely using a convenient shorthand for a more cumbrous phrase….

(Jones, 1946)

This quotation by Scott (1949) stimulated me to try to sort out my own ideas on this vast and difficult subject. The body schema with its temporal and spatial aspects provides a valuable statement of the individual’s diagram of himself, and in it I believe there is no obvious place for the mind. Yet in clinical practice we do meet with the mind as an entity localized somewhere by the patient; a further study of the paradox that ‘mind does not really exist as an entity’ is therefore necessary.

OK. So far, Winnicott is giving us the context for why he became interested in this question. He’s intrigued with what the mind is, and where it belongs.

Mind as a function of psyche-soma

To study the concept of mind one must always be studying an individual, a total individual, and including the development of that individual from the very beginning of psychosomatic existence. If one accepts this discipline then one can study the mind of an individual as it specializes out from the psyche part of the psyche-soma.

Winnicott is saying here that to study the mind of an individual—meaning our thinking apparatus—we must take that person’s development from his first days into consideration. Winnicott is saying that the mind “specializes out”—or, develops out—from the psyche part of the psyche-soma. He will explain this further, but he is positing that the very instrument we use for taking in the world around us—our mind—is, or more properly, should be intimately grounded in the psyche, which, he will explain, is intimately nested in the physical body. The word “psyche” (from the Greek word for breath, life, soul) here means to Winnicott the elaboration—via the infant’s imagination—of bodily (somatic) parts, feelings, and functions; that is, the imaginative elaboration of the infant’s physical aliveness.

He continues:

The mind does not exist as an entity in the individual’s schema of things provided the individual psyche-soma or body scheme has come satisfactorily through the very early developmental stages; mind is then no more than a special case of the function of the psyche-soma.

Winnicott is hinting at something here, but he has not explained himself fully yet. He’s hinting that when the psyche-soma (which he has not clearly defined yet) comes successfully through its very early developmental stages, then what we think of as “the mind” is simply a by-product of the development of the psyche-soma.

He continues:

In the study of a developing individual the mind will often be found to be developing a false entity, and a false localization. A study of these abnormal tendencies must precede the more direct examination of the mind-specialization of the healthy or normal psyche.

OK. Now he’s asserting that somehow it is an abnormality for the mind to develop an awareness of itself and a location of itself. He thinks this is necessary to understand before we understand how the normal psyche-soma specializes out a “mind.” In this way, his thinking process is similar to Freud’s: he wants first to understand the abnormality, the pathology, before exploring normal development.

He continues:

We are quite used to seeing the two words mental and physical opposed and would not quarrel with their being opposed in daily conversation. It is quite another matter, however, if the concepts are opposed in scientific discussion.

OK. Mental versus physical. These terms should not be thought of as opposed to one another. Here, Winnicott (in 1949) was prescient. We now know, for instance, that both the stomach and the heart—definitely parts of the body—have neurons that are in constant dynamic interplay with the emotional parts of the brain. Additionally, neurotransmitters that are manufactured by the body’s immune system are found throughout the body. Furthermore, neuropeptides which are secreted by the immune and endocrine systems have receptors in the brain (Pert, 1997). We’re following him here regarding “mental versus physical.”

The use of these two words physical and mental in describing disease leads us into trouble immediately. The psychosomatic disorders, half-way between the mental and the physical, are in a rather precarious position. Research into psychosomatics is being held up, to some extent, by the muddle to which I am referring (MacAlpine, 1952). Also, neuro-surgeons are doing things to the normal or healthy brain in an attempt to alter or even improve mental states. These “physical” therapists are completely at sea in their theory; curiously enough they seem to be leaving out the importance of the physical body, of which the brain is an integral part.

Here he’s decrying as a muddle the opposing of the physical versus the mental. He will take up more of this argument later in the paper. He continues:

Let us attempt, therefore, to think of the developing individual, starting at the beginning. Here is a body, and the psyche and the soma are not to be distinguished except according to the direction from which one is looking. One can look at the developing body or at the developing psyche. I suppose the word psyche here means the imaginative elaboration of somatic parts, feelings, and functions, that is, of physical aliveness. We know that this imaginative elaboration is dependent on the existence and the healthy functioning of the brain, especially certain parts of it. The psyche is not, however, felt by the individual to be localized in the brain, or indeed to be localized anywhere.

He speaks here of the very beginning hours of an infant’s life. He defines the word “psyche” as indicating the imaginative elaboration of somatic parts, feelings, and functions, that is, of physical aliveness. So he is saying that the very first sense of our own psyche as infants is our experiencing of ourselves as physical beings. There is the physical experience, and then there is the imaginative elaboration of that experience. These, in interplay, are the initial building blocks of the human psyche. He also observes that the psyche, while dependent, in part, on the brain’s functioning, is more than and different from the brain, and is not generally thought of by people as being located in the brain.

Gradually the psyche and the soma aspects of the growing person become involved in a process of mutual interrelation. The interrelating of the psyche with the soma constitutes an early phase of individual development (see Chapter XII). At a later stage the live body, with its limits, and with an inside and an outside, is felt by the individual to form the core for the imaginative self.

Gradually, the physical experience and the imaginative elaboration of that physical experience become, in Winnicott’s words, “interrelated.” Notice that “imaginative elaboration” is not the same as thinking. It precedes thinking. It is the use of something of the spirit or core of the emerging human to appreciate what s/he is experiencing in a purely physical sense—comfort, discomfort, restfulness, urgency, touch, warmth, holding, movement. Gradually, over time, the individual gains an awareness of the inside versus the outside of his/her body, but this is a developmental accomplishment. The body is felt by the individual to be core to or the core of the imaginative self. Winnicott is saying here that the experience of the body is the ground of our being. He continues:

The development to this stage is extremely complex, and although this development may possibly be fairly complete by the time a baby has been born a few days, there is a vast opportunity for distortion of the natural course of development in these respects. Moreover, whatever applies to very early stages also applies to some extent to all stages, even to the stage that we call adult maturity.

In other words, the first hours and days, which are foundational, afford a “vast opportunity” for compromises of what should be the natural course of development.

And then he makes this riveting statement: “whatever applies to very early stages also applies to some extent to all stages, even to the stage that we call adult maturity.” He’s saying that in each successive developmental stage, there is a natural course of development, but also that there are vast opportunities for what should be happening not to happen, and therefore, developmental (and often permanent) compromises ensue.

Theory of mind

On the basis of these preliminary considerations I find myself putting forward a theory of mind. This theory is based on work with analytic patients who have needed to regress to an extremely early level of development in the transference. In this paper I shall only give one piece of illustrative clinical material, but the theory can, I believe, be found to be valuable in our daily analytic work.

OK. So Winnicott is suggesting here that, although he is writing about early, early development, it may also be found to be valuable in work with adult patients in psychotherapy. He says he’ll illustrate this with a piece of clinical material later in the paper, but he asserts that what he has to say in this paper can be valuable in our daily work as clinicians. He has our attention. He continues:

Let us assume that health in the early development of the individual entails continuity of being. The early psyche-soma proceeds along a certain line of development provided its continuity of being is not disturbed; in other words, for the healthy development of the early psyche-soma there is a need for a perfect environment. At first the need is absolute.

OK. Winnicott is here introducing a new concept: “continuity of being.” The psyche-soma proceeds well in its developmental trajectory as long as its “continuity of being” is not disturbed, and for this, the newborn requires “absolute” attunement. What is “continuity of being”? The words he chooses have a certain poetic sound to them. They suggest a lack of disturbance, the presence of comfort, of being protected, of being OK. He emphasizes this. He says, “At first the need is absolute,” and should be absolutely protected—the infant’s need for this undisturbed “continuity of being.” He then explains:

The perfect environment is one which actively adapts to the needs of the newly formed psyche-soma, that which we as observers know to be the infant at the start.

Ah. So this crucial, at first, “perfect” environment is one wherein some person—usually the mother—makes this active adaptation to the needs of the newborn happen.

A bad environment is bad because by failure to adapt it becomes an impingement to which the psyche-soma (i.e. the infant) must react. This reacting disturbs the continuity of the going-on-being of the new individual.

And the “bad” environment is one that forces the infant to react to it, i.e., impinges on the infant in such a way that the infant’s “continuity of being” is disturbed or disrupted. OK. We can certainly imagine this in its extremes, which indeed some infants must endure. Also, in his language usage, he tells us to be aware that what we see from the outside as an infant, plus whatever we project upon that infant’s thinking process or sense of awareness, the newborn is in truth a somatic-experiencing-being rather than a thinking being.

In its beginnings the good (psychological) environment is a physical one, with the child in the womb or being held and generally tended;

This is important to understand. At first the need is a physical one: the need of the infant to be, in Winnicott’s lovely words, “held and generally tended.”

He continues:...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Acknowledgments
• Credits
• 1 Mind and its relation to the psyche-soma: (1949)
• 2 Primitive emotional development: (1945)
• 3 Hate in the counter-transference: (1949)
• 4 Transitional objects and transitional phenomena: A study of the first not-me possession
• 5 The antisocial tendency: (1956)
• 6 Primary maternal preoccupation: (1956)
• 7 Ego distortion in terms of True and False Self: (1960)
• 8 The aims of psycho-analytical treatment: (1962)
• 9 Notes on ego integration in child development: (1962)
• 10 Mirror-role of mother and family in child development: (1967)
• 11 The use of an object: (1969)
• 12 Fear of breakdown: (1974)
• Author references
• Index