The lecture: The need for psychoanalysis in certain types of difficult children
In my contribution to this Symposium I want to consider the special question of those difficult children with whom various modes of psychotherapy or other measures, such as favourable changes of environment, educational influences, giving the child opportunities for play and for suitable occupation, do not achieve their purpose. Such methods, beneficial as we know they may be in some cases, fail or do not achieve lasting results with children whose difficulties are very deeply rooted.
In considering the causes of severe emotional difficulties in children, one would, broadly speaking, say that they arise from two sources. Unfavourable circumstances, especially in the very early days, have a lastingly bad effect upon the childās mind. The other source is his own aggressive impulses, which give rise to fear and feelings of guilt in his mind, since to begin with they are directed against the very people on whom he is dependent and of whom he is most fond ā first of all his mother.
Even where circumstances are favourable, the childās impulses and phantasies of a frightening nature, which necessarily develop in his mind and which are bound up with his instinctual life, may give rise to severe psychological difficulties. Again, however unfavourable the environment may be, one cannot attribute psychological disturbances exclusively to it since the childās own impulses and phantasies play a fundamental part in the effect such experiences will have upon his mind. This explains why environmental influences and changes do not always and necessarily do away with the childās difficulties. If his difficulties are due more to deep unconscious conflicts than to the external pressure of circumstances, he will not be accessible to any method which cannot go down to the sources of these difficulties. That is why certain types of disturbances can be relieved only by the specialized technique of psycho-analysis, which is able to penetrate to the unconscious causes of the childās conflicts.
From among the variety of types of difficult children who do not respond to education and other methods and with whom I think only psycho-analysis can be effective, I am choosing today as an example the case of a child who seems to illustrate my thesis clearly. Children of the type which I am singling out here, when offered friendliness, seem unable to accept it, and are incapable of real affection. They are usually extremely distrustful, though they may disguise this. They are uneducable in the true sense of the word, for though they sometimes make an apparent adaptation, they are driven to this mainly by fears and the wish to escape punishment, or in order to get certain advantages.
A boy, let us call him John, aged twelve, came to be psycho-analysed on account of inhibition in learning and character difficulties. He came from a poor and simple but intelligent family. The general impression he gave was that of a diffident and shy child, who avoided looking one in the eyes; but at the same time apt to be overbearing and inclined to fits of violence and cruelty towards other children. Though John was very keen to get on with his teachers and peers he did not manage to do so, and was definitely uncompanionable and unpopular. He was prone to lying and stealing and was generally unreliable, and did not show affection for anyone. Though hypocritical in some ways ā for instance, deceitful if he got into trouble ā he was not inclined to simulate affection but tended to withdraw from people and not to confide in them.
In analysis it appeared that John had no belief in anybodyās kindness or reliability; least of all did he trust his own good feelings, and that was the reason for his deep mistrust of others. His adaptation, as far as he achieved this, was mainly determined by fears, and the wish to avoid trouble or to get something out of it. Another important motive for his attempts at adaptation was his obsessional fear of being thought to be different from other children, and his anxiety of being laughed at and humiliated, which led him to avoid being conspicuous. He was incapable of real affection, and friendliness seldom stirred any response in him. This development had been greatly influenced by the death of Johnās mother which had occurred some years earlier. He had been very fond of her and also of his sisters but his relation to them gradually became less satisfactory after his motherās death, and he seemed to lose his affection for them. Johnās relation to his father was never really affectionate, though he was careful not to get into trouble with him.
Psycho-analysis brought out the fact that the death of his mother had not been the fundamental cause of his unfavourable development, though it made things infinitely worse. Fits of violence of a definitely asocial or even criminal type which occurred during the psycho-analytic hours were found to go back to situations in his early babyhood. Actually when a baby, he once had a quite dangerous fit of violent rage because the bottle, being too hot, had to be taken away again after he had already seen it. Intense greed, and in connection with this, very strong destructive impulses against his mother as a result of any dissatisfaction or frustration had given rise to great anxiety of having injured her ā or rather, of going on injuring her whenever hate flared up. An unbearable conflict was thus created which determined his whole later development; the same person whom he deeply loved was the one who was most exposed to his hate, because she was the one from whom he most wanted gratifications. This greedy love was also the source of his intense jealousy, since he could not stand anybody else enjoying her love or attention.
It is a characteristic of the infantās mind that aggressive phantasies, which go with destructive impulses, are felt to be a real danger to the object of them, and give rise to feelings of guilt. The strength of aggression no doubt varies with individuals, and another important variable factor is the childās ability to stand his anxieties and feelings of guilt.
If the child is not altogether overcome by them, these anxieties and feelings of guilt quite early give rise to the wish to make good and they will thus be greatly modified in the course of the development, with the help of a favourable environment. But if this deep struggle between destructive impulses and feelings of love and constructive tendencies has not for one reason or another come to a more or less satisfactory solution in the first few years of life, it influences all later relationships. In psycho-analysis however (and this is one of the means by which fundamental changes are brought about) conflicting feelings and impulses of various kinds ā love, hate, distrust, guilt, fears, and so on ā are revived in connection with the analyst, on whom they become temporarily focussed, and can thus be submitted to analysis.
To return to John: his aggressive impulses and his fears had been extremely strong to begin with, but had become modified to a certain extent later on. When his motherās death occurred however, this was felt by him to be a confirmation of his fear that his strong sadistic tendencies had been effective. As a result, his feelings of guilt increased enormously, and his trust in his own good feelings and in his constructive tendencies decreased. Moreover, he felt that he could get no more goodness in the world, since in his mind he had destroyed the source of all goodness.
During his analysis, feelings of love and confidence in the analyst came to the fore, alternating with violent hate and distrust; but he strongly denied both to himself and to the analyst these growing feelings of love.
One day in analysis John told me a little French rhyme about a kitten that played with grandmotherās ball of wool and tangled it. Grandmother got cross, and the kitten in a cowardly way ran off; but soon came back because he knew very well that grandmother was really very kind and patient. John then suddenly realized that in his mind the good grandmother stood for the analyst, who had been so patient with him. But this spontaneous realization of his friendly feelings towards me was soon followed by an outburst of violence in which he threw his knife (a blunt one) at me and just missed me. He then told me that he would not have minded if he had hit me, and actually he did not show any feelings of sorrow or concern. Later in the same hour in which he had made this attack on me he told me that there were two things that I must never say. These were ābeing fondā and ākillā.
His violent reaction can be explained in the following way. His becoming aware of love and gratitude towards me had had the effect of making him feel all the more that the loved mother, whom I represented to him at the time, was also the one whom he wanted to injure, because at the same time as he loved her, he hated her, first for not gratifying his very strong and greedy desires and then because fear lest she would retaliate for his aggressive intentions. [Such a fear] gives rise to increased hate, anxiety and distrust of the person whom the child is attacking in phantasy.
When he became aware that he loved me, his fears that he would destroy me ā as in his phantasy he had destroyed his mother ā were aroused. This fear led him to test, by his attack, whether he was actually dangerous to me and also whether I would retaliate. The old conflict between love and hate and the fear for the safety of the loved one had reappeared in full strength, and was overwhelming. Feeling that he was possessed of uncontrollable greed, incapable of bearing frustrations and unable to control his murderous tendencies, he could not bear to realize that he loved a person whom at the same time he felt in danger of destroying.
To illustrate this further: John used to bring sweets with him, which he saved especially for this purpose and ate during the psycho-analytic sessions. He did this partly to be able to control his outbursts of violence against me. Once, when he had set burning a great amount of paper in my room, he said afterwards, āThis would not have happened had I had sweets with me.ā He had then already come to understand that if he avoided frustrations, he could better control his aggressive impulses.
In the past, he had buried his love because he could not cope with the conflict between love and hate, for greed and jealousy were overwhelmingly strong in him. Since he could not trust himself to love anybody without endangering that person, he had therefore had to shut himself off from friendly influences. Along with this, his constructive tendencies and his belief in them became inhibited.
As I have pointed out before, very early in development, feelings of guilt as a result of aggressive impulses towards the loved object give rise to wishes to repair the damage which has been done in phantasy. These wishes to restore and to make good are at the bottom of all constructive tendencies, and influence all later creative and productive activities, and also learning and intellectual development.
John was so overwhelmed by the dangerousness of his destructive tendencies that he could not trust in his constructive ones. The fact that his tendencies to make reparation could not develop and his distrust of everybody and everything, were responsible for his incapacity to take in knowledge, for his general intellectual inhibition, and for all his other difficulties.
When the analysis touched the unconscious reasons for these difficulties, his violence gradually diminished and his capacity to learn and to be a companion, greatly improved. He became able to make good contact with others, developed real fondness for a few people and his whole general attitude altered favourably.
I want to stress two important facts, first that there is a connection between aggressive impulses and constructive tendencies; the link developing early in life between the love felt for and therefore guilt towards the object which has been injured in phantasy and therefore the guilt experienced at its injury. The second point is that this early connection may be broken off if fears and the feelings of guilt are too overwhelming.
If, in the infantās mind, a balance cannot be kept between love and hate, between aggressive impulses and efforts to make reparation ā then feelings of love and all that these imply may become entirely buried.
Good educators, being led by true psychological understanding have, of course, always known that to show trust and belief in the childās good intentions, even where these can hardly be detected, is sometimes a good way of bringing them to the fore and strengthening them. But as we also know, even these means do very often fail. If feelings of love and kindness are so deeply buried that for all practical purposes they do not exist, it is futile to appeal to them.
Moreover, in the type of case I have referred to, any approach of the kind ā anything which might be felt as appealing to the childās good feelings ā may even increase his anxieties and suspicions. For in the depths of his mind he feels that he cannot be trusted, because of his uncontrollable aggressive impulses, and that it is safer for others and also for himself if people are on their guard against him.
With a child of this type it is only by analysing his aggressive impulses and phantasies and the various anxieties to which they give rise that the psycho-analyst uncovers the feelings of guilt arising out of these impulses, and then also gains access to the buried feelings of love.
The conclusion presents itself that the specialized treatment of psycho-analysis, carried out by properly trained psycho-analysts should be made available as an adjunct to education for those children for whom it is indispensable. It is true that there are many difficulties in the way of the general application of psycho-analytic treatment. It often takes some length of time, and it can only be given individually ā to one child at a time and for several periods a week.
There are, however, cases in which a shorter course of psycho-analytic treatment can produce very far-reaching results which are unobtainable by any other method. We must also remember that much time, effort and money are now being spent on attempting to stabilize and educate children who cannot, as I have tried to show, benefit by such methods. The fact that we are not yet in a position to apply this treatment more generally should not allow us to lose sight of the fact that in some cases, which are more numerous than is yet realized, mental health and education are only possible if psycho-analytic treatment is given.
We must
[Here the first part of the document stops. Clearly Klein intended to say something further in this, her conclusion to the lecture, but the pages are now missing. However there is an additional note taking the form of some clinical material, typed in a slightly different format. We do not know whether or not Klein spoke from these notes in her lecture.]