Reading Winnicott

Lesley Caldwell, Angela Joyce, Lesley Caldwell, Angela Joyce

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781136701191
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychothérapie

Reading Winnicott brings together a selection of papers by the psychoanalyst and paediatrician Donald Winnicott, providing an insight into his work and charting its impact on the well-being of mothers, babies, children and families.

With individual introductions summarising the key features of each of Winnicott's papers this book not only offers an overview of Winnicott's work, but also links it with Freud and later theorists. Areas of discussion include:

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• the relational environment and the place of infantile sexuality
• aggression and destructiveness
• illusion and transitional phenomena
• theory and practice of psychoanalysis of adults and children.

As such Reading Winnicott will be essential reading for all students wanting to learn more about Winnicott's theories and their impact on psychoanalysis and the wider field of mental health.

1
THE OBSERVATION OF INFANTS
IN A SET SITUATION (1941)

OTHER WRITINGS

The Set Situation paper was published 15 years after Winnicott’s first publication in the British Journal of Children’s Diseases in 1926 (Winnicott and Gibbs, 1926). The first book Clinical Notes on Disorders of Childhood (1931) was aimed mainly at children’s doctors and already showed the application of psychoanalytic thinking to medicine. Melanie Klein had published The Psycho-Analysis of Children in 1932 before he was supervised by her for his child case. His membership paper for the BPAS, ‘The Manic Defence’ (1935), which remained unpublished until 1958, reflected his interest in her ideas and followed her own paper on ‘A Contribution to the Psychogenesis of Manic-Depressive States’ (1935). In 1936 Winnicott had read ‘Appetite and Emotional Disorder’ to the Medical Section of the British Psychological Society (BPS), a setting in which he would give significant papers throughout his career. In 1939, his first discussion of Aggression was given to teachers, establishing his ongoing commitment to the dissemination of psychoanalytic ideas beyond psychoanalysis itself.

A. Aichhorn had published Wayward Youth in 1925 which Winnicott refers to in ‘The Antisocial Tendency’ (1956, in C. Winnicott et al., 1984). Klein had given a paper to the Medical Section of the BPS ‘On Criminality’ in 1934 in which she had remarked on the ‘common tendency to overestimate the importance of unsatisfactory surroundings’ in understanding delinquency. She further claimed that ‘the best remedy against delinquency would be to analyse children who show signs of abnormality’ (pp) – a position with which Winnicott would eventually disagree. In 1940 John Bowlby published his paper ‘The Influence of the Early Environment in the Development of Neurosis and Neurotic Character’ (IJPA) and in 1944 his study on ‘Forty-Four Juvenile Thieves’ (IJPA) which would lead him to take up a radically different position from Klein’s.

EDITORS’ INTRODUCTION

This early paper of Winnicott’s continues to attract historical debate (Aguayo, 2002; Reeves, 2006) among contemporary theorists for its attempt to establish the conditions for a scientific study of early infantile processes and the emotional foundations of infant mental health. It has been seen as containing the bases for much of Winnicott’s later work (Davis, 1993; Reeves, 2006) but as also demonstrating a distinctively Kleinian approach (Likierman, 2007). It is a significant paper in the history of psychoanalysis because it is willing to conjecture about psychic processes on the basis of consistent empirical data and to hypothesize about the close links between the psyche and the physiological processes discernible in the infant. It was first given at a meeting of the BPAS in April 1941, with the title ‘Observations on Asthma in an Infant and Its Relation to Anxiety’ (Reeves, 2006: 292, n. 3). The paper was revised for later publication in the IJPA, and both Rodman (2003) and Reeves (2006) argue for Melanie Klein’s close involvement in the final version. Without an original version, however, these readings, though convincing, remain part of wider speculative debates tracing Klein’s influence. Although the child with asthma appears in the published paper, the brief is much wider, and the paper is centred on the accumulated data from Winnicott’s paediatric practice and his development of a common consultative procedure for all mothers and babies attending his clinic at Paddington Green.

Winnicott was always convinced that children’s symptoms – shyness, eczema, asthma, enuresis – are never exclusively physiological but always a response to conflicts; this is illustrated here in the two clinical vignettes, but it is there from his first book, Clinical Notes on Disorders of Childhood (1931); another statement of it appears in the paper, ‘What Do We Mean by a Normal Child? ’ (1946), and a later paper, ‘Symptom Tolerance in Paediatrics: A Case History’ (1953).

The paper represents an evolution in psychoanalytic ways of thinking, and both Freud and Ferenczi are important predecessors for the ideas expressed. The development of first-generation thinkers emphasizes the essential relation of child and adult as the condition of the child’s relation with himself or herself, and there are clear parallels with Freud’s account of the fort/da game based on observations of his grandchild. But Winnicott describes a situation formally set up with a much younger baby as the basis for his own hypotheses about human infants. This involved putting a spatula on a table near the baby and observing the baby’s reactions. Like Ferenczi, Winnicott sees the infant coming to assume the capacities of a human subject through the encounter first with others, and then with the self that emerges through those encounters and their internalization. Davis offers a reading of this paper as transitional between a medical and a psychoanalytic model (1993: 65) even as she locates the seeds of most of Winnicott’s developed theories and concepts here.

The emphasis on a methodology based on invariant procedures, empirical observation, a large sample, and a replicable situation with consistent elements provides a link with later work. The concentration is on the normal situation and what constitute deviations from it across a deliberately loose age range, about 5 to 13 months, accounted for by known facts about infant development: at 5 months infants grasp an object, but it is not till 6 months that they drop it deliberately. The upper age limit refers to the baby’s widening interest in the world around him: while the anxieties are still evident, the baby’s positive interest encompasses too many things, and any information deriving from his interest in the spatula is less clear.

Every encounter with the spatula involves:

(a) Consistent elements

1. The setting and the mother, and what they show of family dynamics and the mother’s approach to mothering.

2. The child, and what he does at different moments in the encounter.

(b) A series of three stages

1. The baby displays interest but restraint, what Winnicott calls ‘the period of hesitation’. This is accompanied by physiological changes, and Winnicott hypothesizes about these bodily changes, which cannot be known exclusively by observation, from a psychoanalytic perspective.

2. The baby’s desire for the spatula can first be observed physically, in changes in the mouth, the tongue, and the saliva, then the infant mouths it, engages in free bodily movement, and plays with it.

3. The process of losing interest: the baby may drop it, as if by mistake, then deliberately; he may get down on the floor with it or lose interest.

Winnicott makes a claim about the psychic processes in operation and about the physical links with emotional development, which represent a step forward on two related levels. He insists on the importance for normal development of all the stages. In ‘Appetite and Emotional Disorder’ (1936) he describes a child whose only response belongs to the throwing-away stage. Davis (1993) links this with the antisocial tendency and its importance in the work with evacuated children in the 1940s.

In his play, the baby shows a rudimentary awareness of the distinction between inside and outside but also seems to be enjoying a process that actually involves completion. In his extended discussion of the riddance stage, Reeves (2006) disputes the parallels between Freud’s account of the fort/da game (1920) and the younger child’s ultimate loss of interest in the object that previously fascinated him. He suggests that the baby’s final loss of interest in the spatula in this last stage – ‘the leaving behind is everything’ (Reeves, 2006: 278) – is very different symbolically from Freud’s attention to his grandchild’s capacity to lose and retrieve the cotton reel repeatedly. He proposes that Winnicott’s assimilation of his own account to Freud’s owes much to Klein and her reading of Freud’s example as support for her theory of early infantile states (2006: 281).

Winnicott does describe this phase in terms of a model of internalized objects, where the child gains reassurance about the fate of his internal mother and her attitude, but he argues that there is a complex relation between symptoms, anxiety, physiological processes, and unconscious states which demonstrates the baby’s realization of the existence of a world outside himself. The mental conflicts produced by the desire for the spatula and a fear of retaliation or prohibition by another about that desire – that is, a fear of an anticipated external situation that appears to be present internally whether the actual mother is disapproving or not – can nonetheless be dispelled by the experience with the real mother. The expectation of disapproval may echo Klein’s account (Likierman, 2007), but, even at this stage in the evolution of Winnicott’s own thinking, the early primitive superego forms the basis for a rather different emphasis in the matter of infantile fantasies. Its corollary, the infant’s assumption about the mother and her insides, can produce a concern for her that leads to a relation between whole persons. This emphasis on the baby’s fantasies prioritizes the idea that the development of the baby’s rudimentary sense of self and his relations with more than one person are dependent on the distinction between external and internal as given by the real relation with the baby’s real mother or caregiver. Winnicott’s insistence that infant behaviour cannot be accounted for except on the assumption that the infant entertains fantasies that are full of content, but not attached to word presentations, offers a different approach to fantasy.

These processes have been further elaborated by psychoanalytically informed developmental researchers who have given the names ‘social referencing’ (Emde, Klingman, Reich, and Wade, 1978), ‘secondary intersubjectivity’ (Trevarthen and Hubley, 1978), and ‘the domain of intersubjective relatedness’ (Stern, 1985) to the moment when the baby is said to make a quantum leap in acquiring a sense that the mother, and therefore the baby himself, has a ‘mind’ with potentially interesting mental contents. Interest in the mother’s expression and its meaning to the baby replaces the prospect of persecution that Winnicott notes. The beginnings of the acquisition of a ‘theory of mind’ observed and described here are developed further in ‘Primitive Emotional Development’ (Chapter 2, this volume).

The symbolic aspects of the spatula and the important difference represented by saying the spatula stands for a breast, and/or that it stands for a penis – or rather, what the baby later knows as a penis – are both understood in this approach as a quality of the mother, that leads to a sense of people more generally, a taking in of the world of others. Winnicott emphasizes the spatial connections involved in the initial recognition of persons and their interrelation, and behaviour is not reduced to symbolic equivalences, though that dimension is also present. Awareness of the existence of external reality is seen as offering a limit to what is possible in a fantasy world where, in the most primitive state, the object works according to magic: if it vanishes when not wanted, this can mean its annihilation, a terrifying situation to which Winnicott refers in relation to the link between not wanting and being satisfied. Importantly, fantasy is not what the individual creates to deal with frustration; this he calls ‘fantasying’, an activity that is intent on going nowhere. The distinction between fantasy and fantasying refers to the centrality of illusion in his account. This is further developed in the paper on transitional objects and transitional phenomena (Chapter 5, this volume) but its most sustained discussion is to be found in the paper, ‘Dreaming, Fantasying and Living’, Chapter 2 of Playing and Reality (1971d). There he links fantasying to a paralysis of action deriving from an early environmental failure to provide a sufficiently adequate going on being for the infant to manage instinctual demands in their internal and external manifestations.

The adult lacks a capacity for living creatively and for dreaming. ‘Fantasying’ here involves a lack of spontaneity, a paralysis of action. The idea of ‘fantasying’ highlights what is involved in the possibility of using both the mind and the body (and, importantly, their inter-relation) as a creative function.

The baby’s encounter with the spatula as a whole experience in the controlled conditions of the set situation forms one basis for Winnicott’s understanding of what happens in analysis and the importance of regularity and reliability as the condition for richness of experience. His link between spatula and interpretation as glittering objects, ways of approaching the patient’s greed, anticipates his interest in play and his questioning of interpretation as the central factor of psychoanalytic treatment.

The Observation of Infants in a Set Situation¹
(1941)

For about twenty years I have been watching infants in my clinic at the Paddington Green Children’s Hospital, and in a large number of cases I have recorded in minute detail the way infants behave in a given situation which is easily staged within the ordinary clinic routine. I hope gradually to gather together and present the many matters of practical and theoretical interest that can be gleaned from such work, but in this paper I wish to confine myself to describing the set situation and indicating the extent to which it can be used as an instrument of research. Incidentally I cite the case of an infant of seven months who developed and emerged out of an attack of asthma while under observation, a matter of considerable interest in psychosomatics.

I want, as far as possible, to describe the setting of the observations, and what it is that has become so familiar to me: that which I call the ‘Set Situation’, the situation into which every baby comes who is brought to my clinic for consultation.

In my clinic, mothers and their children wait in the passage outside the fairly large room in which I work, and the exit of one mother and child is the signal for the entrance of another. A large room is chosen because so much can be seen and done in the time that it takes the mother and her child to reach me from the door at the opposite end of the room. By the time the mother has reached me I have made a contact with her and probably with the child by my facial expression, and I have had a chance to remember the case if it is not a new patient.

If it is an infant, I ask the mother to sit opposite me with the angle of the table coming between me and her. She sits down with the baby on her knee. As a routine, I place a right-angled shining tongue-depressor at the edge of the table and I invite the mother to place the child in such a way that, if the child should wish to handle the spatula, it is possible. Ordinarily, a mother will understand what I am about, and it is easy for me gradually to describe to her that there is to be a period of time in which she and I will contribute as little as possible to the situation, so that what happens can fairly be put down to the child’s account. You can imagine that mothers show by their ability or relative inability to follow this suggestion something of what they are like at home; if they are anxious about infection, or have strong moral feelings against putting things to the mouth, if they are hasty or move impulsively, these characteristics will be shown up.

It is very valuable to know what the mother is like, but ordinarily she follows my suggestion. Here, therefore, is the child on mother’s knee, with a new person (a man, as it happens) sitting opposite, and there is a shining spatula on the table. I may add that if visitors are present, I have to prepare them often more carefully than the mother, because they tend to want to smile and take active steps in relation to the baby – to make love to him, or at least to give the reassurance of friendliness. If a visitor cannot accept the discipline which the situation demands, there is no point in my proceeding with the observation, which immediately becomes unnecessarily complicated.

THE INFANT’S BEHAVIOUR

The baby is inevitably attracted by the shining, perhaps rocking, metal object. If other children are present, they know well enough that the baby longs to t...