Separation-Individuation Struggles in Adult Life

Leaving Home

Sarah Fels Usher

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317218401
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoanálisis

Separation-Individuation Struggles in Adult life: Leaving Home focuses on the developmental task of separating from parents and siblings for individuals and couples who have not been able to resolve these issues earlier in life.

Sarah Fels Usher extends Mahler's theory, and includes the writing of Loewald and Modell, among others, stressing the right of adult patients to a separate life. She describes the predicament of Oedipal victors (or victims), their introjected feelings of responsibility for their parents, and their resultant inability to be truly individuated adults. Difficulties separating from siblings are also given analytic attention. Usher's experience treating couples adds a new and powerful dimension to her theory. She is optimistic throughout about the therapist's ability to help adult patients resolve the rapprochement sub-phase in a satisfying manner.

An additional, crucial question is raised when the author asks if the therapist can allow the patient to terminate treatment. Has the therapist achieved separation from their own parents—or, indeed, from their analyst? Exploring the plight of patients of the unseparated analyst, Usher describes how these generational factors rear their unfortunate heads when it is time to end therapy.

Listening to patients from the perspective of separation-individuation is not new; what is new is Usher's emphasis on how these particular issues are often masked by significant achievement in adult professional life. Separation-Individuation Struggles in Adult Life: Leaving Home will be of great importance for psychoanalysts and psychoanalytic psychotherapists working with adults, as well as for clinical postgraduate students.

Chapter 1

What we know so far

The moment Margaret Mahler, a Hungarian psychiatrist (1897–1985) met Sándor Ferenczi (also Hungarian) in high school, she was fascinated with the concept of the unconscious. She went on to study paediatric medicine in Vienna, became a child psychiatrist, and then, after an analysis with Helene Deutsch, became a psychoanalyst. And the rest, as they say, is history.

Blum (2004) informs us, from his personal communication with her, that Mahler’s mother had been murdered at Auschwitz, ‘an act she could neither forgive nor forget’. He goes on to say, ‘Feeling unloved by her mother, who had very much favored her younger sister, Mahler was highly ambivalent toward her own mother yet immensely curious concerning mothers and their infants more generally’ (p. 538).

The discussion of separation–individuation begins with Mahler’s work. When she proposed the concept of separation–individuation, she described it, first, as occurring from the end of the first year of life through the second and third years, when the baby emerges from a complete, and supposedly blissful, mother–infant symbiosis. Seeing her theories as extending those of Freud, rather than being anti-Freudian, she studied babies and preschool normal and psychotic children, and demonstrated that there is life before Oedipus, and that life is significantly and amazingly interactive.

Mahler’s results have been described in many important publications, most particularly The Psychological Birth of the Human Infant (1975), with Fred Pine and Annie Bergman, both psychologists, alive and well and living in Manhattan at the time of this writing. Mahler developed her formulations of the process of separation–individuation largely on the basis of the interplay of object relations and ego development (Blum, 2004). She defined separateness or separation as the intrapsychic achievement of a sense of separateness from mother and, through this, from the world at large. In her observations of how normal babies attain a sense of being separate individuals, within the presence of the caretaking mother, Mahler stated that the infant emerges from that blissful symbiosis through a series of steps, to become a separate human being with a sense of self and of the object. This process was referred to as ‘hatching’, calling up the image of a chick breaking free of the egg. When a baby begins to move around, Mahler said, it needs to explore the surrounding environment and yet to return to the mother for ‘emotional or libidinal refuelling’, a term coined by Furer (in Mahler, 1963). This brings the baby into the practising sub-phase – which Mahler thought started from about 10–15 months of age, and in which she describes the baby as elated. During this very important period, the baby has the excitement of exploration and mastery in the world, but still manages the feeling of being one with the mother. Importantly, for the purposes of this book, Bergman and Harpaz-Rotem (2004), working with Mahler, state that with careful filmed observation of babies and their mothers, they found that each developmental achievement of the baby changed the mother–child relationship.

Pine and Furer (1963) explain that, according to Mahler, normal separation–individuation takes place in the setting of a developmental readiness for, and pleasure in, independent functioning – made possible by the mother’s presence. They further clarify that separation and individuation (concepts we often string together today) were originally conceived of as two complementary developments: separation, consisting of the child’s emergence from the symbiotic fusion with the mother; and individuation, reflecting the achievement that marks the child’s assumption of his own individual characteristics.

Akhtar (1994) points out that disruption is an integral aspect of psychic development and the psychoanalytic process. He states that the onset of a differentiated sub-phase disrupts the calm of symbiosis; the rapprochement sub-phase destabilizes the euphoric self-reliance of the practising phase. Analysts become aware of the function of disruption as the treatment of these patients progresses.

In this book, the work of Mahler and her co-investigators will be applied to contemporary clinical practice with adults. It seems to me that what we need at many points in our development – particularly during puberty and adolescence, but also as we lurch into adulthood – is exactly what Mahler describes with babies: the excitement of exploration and the availability of refuelling, of touching base. If a parent can move in and out at the ‘right’ times for the growing individual – at least most of the time – then separation and individuation can take place with a productive balance of disruption and caring. When we reach adulthood, parents are still needed – albeit more in the background – to provide support and, at times, guidance.

Many of us see adult patients who are in a kind of ‘practising’ sub-phase, or who are caught up in the struggle for individuation. What Mahler called ‘ambitendency’, alternatively a wish to be on one’s own and to have mother present to provide solutions – sometimes only to reject them, the behaviour that culminates in the rapprochement crisis – can often be seen quite clearly in these adults. Bergman (1982) states that separateness not only becomes a cognitive perceptual reality but also has to be accepted emotionally. This realization results in the crisis that characterizes separation anxiety – the simultaneous wish for, and fear of, separateness and autonomy. For children, one cannot emphasize too strongly the importance of the optimal emotional availability of the mother during this (practising) sub-phase. ‘It is the mother’s love of the toddler and acceptance of his ambivalence that enable the toddler to cathect his self-representation with neutralized energy’ (Mahler et al., 1975, p. 77; last emphasis mine).

Adults who have not experienced this acceptance, and for whom these earlier tasks were not achieved, are thrust into the demands of adulthood because of their chronological age. These patients often present with symptoms of phobias – particularly intense anxiety in areas that represent separation or independence, such as flying or learning to drive, and even agoraphobias (e.g. Katan, 1951); symptoms of achievement inhibition, i.e. in being all they can be – either at work or in their romantic relationships; and significant difficulties in negotiating their adult relationship with their parents or siblings. The lack of resolution of fantasies, passions, desires, and hatred linked to the Oedipal stage of life contributes to the inability to move forward. And they are weighed down by significant conscious and unconscious guilt.

Over half of adult patients I have seen in the last ten years have had problems growing up, particularly in separating from their families – parents, and, at times, siblings. In these cases, Mahler’s later sub-phases experienced in separation–individuation seem to apply in spades – transposed to adulthood. I am thinking here particularly of the practising and rapprochement sub-phases, which lead to object constancy and self-constancy. Studying the task of boys versus girls in this arena, Bergman (1982) writes that the little boy is helped to separate by aligning himself with his father, and thereby he can more easily differentiate himself from his mother. He agrees with Freud that the boy has an extra motivator to separate from mother – that is, castration anxiety. As a result, Freud says, the resolution of the Oedipus complex may be less complete for girls. From these perspectives, we could think of our adult male patients as possibly having had an easier time of it, but we know this is not necessarily the case, especially when the father is absent and there is the opportunity for an unwished-for Oedipal victory.

A young man I saw in my practice some years ago was referred to me by his maternal aunt, who happened to be a psychologist. At 30 years of age, he was still very attached to his mother, who lived in a nearby city. His father had died when he was in his early teens, and since then his mother had made use of his empathic skills by regularly telling him about her life and her problems. Even though he had managed to move from his hometown, he was returning every weekend, or every second weekend, to see his mother who ‘needed’ him. He had no social life in either city, and certainly no sexual relationships.

As the therapy progressed, he revealed that he was most worried about a brain tumour, diagnosed in his mother about ten years previous. He thought that she could die at any time and imagined that his going home frequently would save her from this fate. When the time was right in the therapy, I asked him to find out the type of tumour she had. His mother brushed off his question at first, then finally gave him a complicated medical term. When he returned to treatment, we consulted my medical dictionary together and discovered that it was, in fact, a type of benign, non-life-threatening tumour. At this point in our therapy, my patient had begun to understand the function that this tumour was serving for him, and how the collusion with his mother ensured he would not have to face adult life. He allowed that bit of research to change his life. He moved through the emotions of relief, then anger at his mother, and then sadness for her, who had only her tumour – and him – to hang onto. He stopped visiting her so often and encouraged her to go out and start her own life. This story has a happy ending: my patient began dating in the city in which he lived, and married some time later (as evidenced by a photo he sent me), and his mother continued in her life. This patient’s willingness to let go of the idea of his mother’s tumour spoke to his own, previously buried, need to be free of that part of their relationship and to start his own life. His resolution of the rapprochement crisis had a good result for both of them.

In this example, the father was no longer available, and my patient became ‘the man of the house’, charged with the care of his mother. As we know, a father does not have to die for this to happen. Fathers can be unavailable through work, illness, or through not wanting contact with the mother or children. Also, a passive father who does not fight for his wife and his place in the family during his son’s Oedipal time, and afterwards, can contribute to this kind of situation, as can an overly needy mother who does not have her husband’s attention.

Still, Bergman (1982) and Mahler agree that separation–individuation is usually more difficult for girls. In reporting on research on the practising sub-phase in toddlers, Bergman (1982) found that girls have greater difficulty in resolving the rapprochement crisis than do boys. Boys were more able to turn away from the struggle with mother and invest their energy in the outside world; girls, on the other hand, became more enmeshed in the struggle – preventing them from focusing fully on the outside world. For girls, father has to be in the picture, says Bergman, but they must also hang onto their identification with mother. ‘It is my impression that the girl’s femininity and the impact on her of the sexual difference are closely connected with the mother’s sense of herself as a woman and her feelings about her daughter as a girl … in subtle ways, she communicates to her daughter what she wishes [needs] her to be’ (p. 67). The old adage that a son is a son until he takes a wife, while a daughter’s a daughter the rest of her life rings hauntingly true in terms of the expectations of both genders.

Clinical vignette 1.1

Sue, a 35-year-old handicapped woman, who came for treatment because she had been suffering from panic attacks, was the first person to introduce me to the expression ‘dutiful daughter’. Her parents had taken special care of her because of her handicap. Her mother did not trust her to organize her own apartment, or to be alone in the kitchen, and of course had never taught her to use make-up. Like many impaired people, Sue had figured out a way to satisfy her intellectual curiosity early on and completed university, eventually with a graduate degree. She had moved to a different city, but her mother came to ‘take care of her’ at least once a month. Sue also was the designated offspring to help her parents when they needed it, as her older brother was married and ‘busy’. The panic attacks had started when her father had a heart attack. She feared he would die and then that her mother would not be far behind.

As Sue talked more about her family, she described herself as feeling like ‘a sack of potatoes’, as they planned who would drive her places and how she would fit into situations. The therapy was long and complicated, but in the area of separation, Sue made great strides. In the first phase, she allowed herself to become enraged at her parents for not trusting her competence, and soon did not want to see them at all; much later, she was able to enjoy seeing them and to look forward to their visits, which were less frequent than they had been in the past, and briefer, and were no longer for the purpose of taking care of her (her mother enjoyed shopping in the city). When we first talked about dating, Sue said she would have to ‘move to Australia’ to meet a man. One of her later fantasies involved meeting a man, getting engaged, and calling his parents, who could be heard cheering over the phone. They would not tell her parents, as she expected a cool reception. As she moved forward, Sue was able to see that, like her parents and her brother, she, too, was entitled to meet someone. When she came to one session with the song ‘Defying Gravity’ on her mind (she had printed out the words for me), we knew we were well on our way. In our understanding of her earlier fear (and panic attacks) regarding her parents’ death, we were able to gradually bring the wish into consciousness, as she remembered an incident of her father exposing himself to her. Interestingly, Sue’s resolution of the rapprochement crisis with her parents came before, and more naturally than, the resolution with her older brother. This will be elaborated in Chapter 4.

Winnicott (1990), a contemporary of Mahler, identified three categories of growth: absolute dependence, relative dependence, and towards independence. Evoking his now-famous phrase describing the processes of the infant as constituting a state of going on being, he writes that the mother’s natural task is to protect this state in her baby. But relative dependence, he says, must include a gradual failing of adaptation. ‘It is part of the equipment of a majority of mothers,’ he states optimistically, ‘to provide a graduated de-adaptation, which is nicely geared to the rapid developments of the baby’ (p. 87). With healthy growth, ‘what the infant needs is just what he usually gets [if he is lucky], the care and attention of someone who is going on being herself’ (p. 88). Like Mahler’s separation–individuation phase, Winnicott’s stage of towards independence identifies the healthy child as gradually able to meet the world and all its complexities. He ends stating, ‘Adults must be expected to be continuing the process of growing and of growing up, since they do but seldom reach to full maturity’ (p. 92).

Meanwhile, John Bowlby (1907–1990), a British child psychiatrist and psychoanalyst, a young contemporary of Mahler, was observing how emotionally disturbed children’s relationships with their mother affect their social, emotional, and cognitive development, and how children experience intense distress (crying, clinging, frantically searching) when separated from their mothers. He explicated his now well-known, and still much used, attachment theory, first in a report for the World Health Organization in 1951, defining attachment as a deep and enduring emotional bond that connects one person to another across time and space. In 1962, when the World Health Organization next focused on child care, Mary Ainsworth wrote a report that described and elaborated attachment theory. She set up a laboratory in which an artificially created situation – which she called ‘the strange situation’ – allowed for the observation, and then differentiation, of attachment patterns between mothers and infants: secure, anxious-resistant, and avoidant attachment behaviours. Her method has become an internationally recognized standardized method for evaluating the infant–mother relationship in terms of attachment.

Blum (2004) states that both Mahler and Bowlby had personal motivations for their research into separation and attachment: both had experienced maternal insensitivity and rejection. Mahler’s personal influences were described earlier. Bowlby lost his nanny at 18 months, his governess at age 4, and was sent to boarding school at age 11 – all of which contributed to his later interest in problems of attachment, separation, and loss. In comparing separation–individuation theory and attachment theory, Blum (2004) states that both theories were initially regarded as diverging from traditional views. However, while Mahler remained loyal to the classical formulation and regarded her contributions as complementary to libido theory, Bowlby saw his theory of attachment as different from Freudian theory, independent of traditional biological instinct theory, psychoanalytical instinctual drive theory, and nutritional hunger. Mahler assumed attachment to the primary object, which she regarded as intrinsic to the process of separation–individuation. In comparing the two theories, Blum points out that attachment theory does not account for the essential development of separation–individuation, which is of prime importance for the promotion of autonomy, independence, and identity.

Blum agrees with Mahler that the path to object constancy, the final sub-phase of separation–individuation, is a major developmental milestone. He adds, further, that this concept, and Mahler’s formulation of the process of separation–individuation, is not diminished by the importance, more recently, of attachment. ‘Secure attachment in later life and object constancy are two sides of a complementary development … Attachment alone, without separateness and the formation of self- and object-representations, if at all conceivable would lead to developmental arrest’ (2004, p. 546).

In his later work, Bowlby described attachment as characterizing human behaviour over the complete lifespan. Adult attachment research grew naturally from child research, with the Adult Attachment Interview being devised to measure adult attachment styles. This d...