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 âphysicalâ 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 heâs 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 infantâs life. He defines the word âpsycheâ 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 brainâs 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 Winnicottâs words, âinterrelated.â Notice that âimaginative elaborationâ 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 senseâcomfort, 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 âvast opportunityâ for compromises of what should be the natural course of development.
And then he makes this riveting statement: âwhatever applies to very early stages also applies to some extent to all stages, even to the stage that we call adult maturity.â Heâs 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 heâll 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: âcontinuity of being.â The psyche-soma proceeds well in its developmental trajectory as long as its âcontinuity of beingâ is not disturbed, and for this, the newborn requires âabsoluteâ attunement. What is âcontinuity of beingâ? 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, âAt first the need is absolute,â and should be absolutely protectedâthe infantâs need for this undisturbed âcontinuity of being.â 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, âperfectâ environment is one wherein some personâusually the motherâmakes 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 âbadâ environment is one that forces the infant to react to it, i.e., impinges on the infant in such a way that the infantâs âcontinuity of beingâ 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 infantâs 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 Winnicottâs lovely words, âheld and generally tended.â
He continues:...
