Anxiety in Children

Ved P. Varma, Ved P. Varma, Ved Varma

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317403272
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Throughout the world – and particularly in developed countries – anxiety is one of the problems of modern living. It is not only adults who experience this problem, indeed, anxiety is often evident during periods of rapid change and since childhood is the period during which we develop most rapidly, then a strong case can be made for anxiety being especially prevalent in children.

Originally published in 1984, Anxiety in Children gives a broad discussion, by well-known experts, of the issues of anxiety in children, focusing particularly on what those involved in mental health, paediatrics and educational and clinical psychology, can do to help. This book will still be of interest to all such professionals.

1	A PSYCHOANALYTIC APPROACH TO ANXIETY IN CHILDHOOD
	Susanna Isaacs Elmhirst

Most adults experience some conscious anxiety in their day-to-day lives, usually they can call to mind some of their own childhood fears. Yet there are a few grown-ups who are not at all aware of suffering fear or nervousness in situations when such a response might very well be expected. This unawareness would generally be recognised as abnormal. An extreme example is a woman who was quite unperturbed by being afflicted with paralysis of one limb. It is possible that some people would regard such lack of response as courage and congratulate the victim. But most of us would support a friend in such a plight in seeking help, even perhaps from a psychoanalyst, if no organic cause could be found for the loss of limb power. If recovery of movement was accompanied by the regaining of emotional mobility, as with one of Freud’s¹ early patients, both changes would ordinarily be welcomed as signs of improved mental health. Yet there are many adults who seriously believe that anxiety in children is all pathological and preventable. It follows that people who hold this view are pleased, not concerned, when a child shows no fear in frightening circumstances. The motives of these adults are, of course, complex. An important source of their inability to see anxiety when it is obviously manifested by children is their praiseworthy wish to make young people happy. Such an aim is not uncommonly linked with an adult’s wish to feel him or herself to be a good and kind person.

Children manifest their anxiety in ways which are often the same as in adults and which would ordinarily be recognised in, and by, adults. They say they suffer and tell us, in words, why. They want to run away or escape somehow. They will tell us so or try to achieve their aim, freedom from fear, sometimes even to the point of destroying themselves. They quake or tremble, weep, wet themselves. They may vomit or go very pale. People who cannot see that children behaving in one or more of these ways are suffering from fear are going to be in greater difficulty when it comes to the more subtly revealed manifestations of a child’s unconscious anxiety. But of course adults who are so blind to children’s fears will not see that they, themselves, are in difficulties. They may even say or imply proudly, like the headmistress of a school attended by one of my patients, ‘we don’t have any unhappy children in this school’.

When he embarked on the ‘talking cure’ Freud found that if his patients could express themselves freely in words he could perceive themes and motives of which the sufferers were unaware. In the setting that he provided Freud perceived that these feelings were spontaneously concentrated upon him. He also found that when he described, in words to the patient, what he could see of the emotional patterns and their origins, the patient could sometimes comprehend as well. A further finding was that the self-knowledge obtained by Freud’s ‘analysis’ of the sufferer’s communications could, on occasion, give relief to the patient. But relief of anxiety and of mental pain led to the release of more emotional experiences of which the patient had been previously unaware. These too were then available for study. As these more deeply hidden feelings emerged they also were liable to cause the patient conscious, and at times intense, mental suffering. Freud then came to realise that the original symptoms were often an attempt by the patient to protect himself from unbearable emotional experiences. But that protection was gained at such a cost that all search for relief had previously proved unsuccessful.

During the early part of his long working-life as a psychoanalyst Freud was impressed by the intensity and diversity of childhood sexual feelings that were re-captured in his adult consulting-room, with himself as their object. He described these patients as ‘transferring’ their feelings, from the original people who had stimulated them, on to himself as analyst. Many adult patients felt and thought that they had in childhood been sexually seduced by adults. For a time Freud also believed that they all had actually had such physical experiences. Then he began to see that the vivid sense of such an experience could also arise in the imagination; in other words in the ‘fantasy’ life of the patients. From then on Freud was even more fascinated and absorbed by the workings of what he called the unconscious mind. Not only was it a store-house for memories of real, external events and justified rational feelings, but also a treasure trove of fantasies, some of which had obviously been active since early childhood, which were different from the conscious day-dreams of which we all know. So Freud widened the concept of the transference to include fantasies, as well as memories, directed towards the analyst. Susan Isaacs² introduced the term phantasy to distinguish unconscious from conscious fantasy but it has never come into general use, perhaps because there is no rigid barrier between conscious and unconscious, especially in young children.

It has gradually become clear that the hallmark of psychoanalysis is the study of patients’ transferred experiences, coupled with the verbal expression to the patient of what has been understood by the analyst. The specific linking of the present response, to the analyst, with past fantasies and memories is called a ‘transference interpretation’. There are multitudes of therapists and therapies aiming to relieve people suffering from mental conflict. Some therapists get called, or call themselves, analysts. But unless they focus their attention upon the processes of the transference their techniques are not the same as those of psychoanalysis and therefore their results are not comparable.

A common criticism is that Freud in particular, and psychoanalysts in general, ignored outward reality in their concentration upon studying the inner, unconscious fantasysing aspect of the mind. Schreber³ was a distinguished German lawyer of the last century who wrote and published an account of his sufferings and elations when he was a patient in a mental hospital. Freud⁴ was not consulted by Schreber but became interested in his document, approaching it in search of clues as to the origins of Schreber’s, and similar, disturbances. Writing 60 years ago he took the view that Schreber’s fears and elations had previously been alive in his unconscious mind but had become unmanageably, and apparently spontaneously, conscious. Freud concluded that Schreber’s father had been the original subject of many of these experiences. Obviously many of them were fantasies or had a fantastic component. It could not have been simply a memory of purely physical events which led Schreber to believe, as he did at the height of his distress, that his stomach or genitalia had disappeared. Schreber never acknowledged even the possibility that any of his adult anguish could have been a re-experiencing of childhood responses to parental cruelty nor did he consciously recall his father’s method of upbringing. However in his book Soul Murder Morton Schatzman⁵ describes aspects of Schreber’s childhood which were not known to Freud, or consciously to Schreber himself. Schreber senior was a paediatrician consumed with a determination to root out from all children, including his own, their curiosity and questioning, all signs of originality or rebellion. He believed these were the ‘bad’ aspects of children and thus of human nature. Therefore he felt justified in using not only parental psychological domination but even mechanical physical restraints, such as the one which pulled the child’s hair if it dared to bend or turn its head. Many of the pains and torments which Schreber experienced in adult life, without physical cause, were similar to those he must have endured at the hands of his extraordinary father.

In addition to his criticism of Freud’s approach Schatzman does include the following quotations:

It remains for the future to decide whether there is more delusion in my theory than I should like to admit, or whether there is more truth in Schreber’s than other people are as yet prepared to believe. (Freud⁶)

Anyone who was more daring than I am in making interpretations, or who was in touch with Schreber’s family and consequently better acquainted with the society in which he moved and with the small events of his life, would find it an easy matter to trace back innumerable details of his delusions to their sources and so discover their meaning … (Freud⁷)

That the reviewers almost unanimously ignored Schatzman’s appreciation of what Freud did see is an indication of how much active hostility there still is to the possibility that Freud could ever have been right in any of his observations or conclusions. As early as 1909 Freud⁸ commented ‘when we cannot understand something we always fall back on abuse’. He also once said, protesting mildly at the obloquy which was his lot, that he had not personally created the unconscious but had merely hit upon a way of studying it.

Freud was concerned with investigating that aspect of the individual mind which had previously been ignored by all but the poets. In the course of a prodigious amount of work he opened the way to further study of many fundamental problems, among them the relationship between memory and fantasy in the developing human being. He himself saw that a logical extension of his work on the continuing influences of childhood experiences in adult life, would be the psychoanalytic study of children themselves. At first he thought that children’s emotional problems could only be treated indirectly, through their parents. In his one personal experience of child analysis, which was clinically successful, he used this method. His advice was sought, by a former adult patient and her husband, about their

-year-old son because the little fellow had developed such an acute terror of horses that he was unwilling, and at times unable, to go out of the house. Freud encouraged Hans’ father to allow the child freedom to talk about his feelings and to write down the discussions so that Freud could advise the father on what to say to the child. Freud’s account of the work⁸ makes very interesting reading to this day. Indeed this is true of almost all that Freud wrote, even though some of his theories have of course been modified or superseded, often by himself. In 1909 Freud thought that no-one but a father ‘could possibly have prevailed on the child to make any such avowals’. Freud gradually changed this opinion.

Then in 1926 Melanie Klein⁹ began to give her child patients small toys, pencils and paper, string, etc., to assist them in revealing what was going on in their minds. She found that children used these materials in a way which is exactly comparable to that in which adults reveal their unconscious as well as their conscious feelings by ‘free association’, that is by saying whatever comes into their minds. Children’s activities in the privacy and confidentiality of the consulting-room were also found to be comprehensible in the way that dreams are. So further unknown areas of the child mind became accessible for study.

There are very few parents who can tolerate having their offspring’s most intense feelings revealed to them. Parents are normally most distressed by their own children’s suffering. Many of a child’s emotional experiences are originally bound to be about its own parents, since they are among the few people with whom a young child has contact. With reference to little Hans Freud wrote ‘a neurosis never says foolish things, any more than a dream’. Parents, like any human beings, may find it too hard to see the impact of their behaviour on those they love most. A failure to recognise what one cannot bear to perceive is a well-known human defence mechanism. Investigation of the various manifestations of this defence was begun by Freud, though he was not the first to perceive it.

There is another aspect of the problem of who should help children overcome their fears. The young are very dependent on their parents. Melanie Klein first studied how the child’s most intense and often most irrational feelings lead it to be uncertain as to whether what it is experiencing is fact or fantasy. Therefore most children cannot endure their fears of permanently losing their real parents nor their parent’s expected recrimination, revenge or reproach when fierce fantasies are revealed to them. A child’s capacity to express its feelings can also be powerfully inhibited by mental pain caused by the contrast between its love for the real, concerned parents and its own fantastic views of them. In addition these incomprehensible contrasts can be spontaneously experienced as mental breakdown, as madness, even by very young children. Yet little Hans did talk freely to his father about his fears, feelings and fantasies. And Hans’ father had much wider limits of tolerance than most parents can achieve, even today. He listened and recorded, thought about, and consulted Freud about, his small son’s mental experiences. Although there were unhelpful and confusing aspects of Hans parents’ behaviour which they could not change, little Hans’ terrors did, as Freud wrote, ‘direct his parents attention to the unavoidable difficulties by which a child is confronted when, in the course of his cultural training, he is called upon to overcome the innate instinctual components of his mind’.¹⁰

Little Hans’ mother had previously been helped by Freud and, though the child did not consciously know this, the fact of it obviously played a part in producing a family attitude of trust. Nevertheless it was not until Hans saw with his own eyes that Freud did exist in reality, and not just in his father’s imagination, that he made significant progress and became much more readily able to describe contradictory and unrealisable wishes. In Freud’s words ‘the little patient summoned up courage to describe the details of his phobia … and take an active share in the analysis.’¹¹ He went ‘forging ahead’ and ‘the material brought up … far outstripped our powers of understanding.’¹²

Hans knew that Freud, called ‘the Professor’ in the family, was working to try to understand his fears. On one occasion Hans and his father were discussing the boys’ complex feelings towards his baby sister.¹³ He had feared that his mother would drop Hanna in the bath and kill her. But as they talked Hans contributed that he himself had really wanted Hanna to die, ‘because she screams so’. His father said ‘and then you’d be alone with Mummy. A good boy doesn’t wish that sort of thing, though.’ Hans, not yet 5, ‘But he may THINK it.’ Father, ‘But that isn’t good.’ Hans, ‘If he thinks it, it is good all the same, because you can write it to the Professor.’

This exchange reminds me of another such occasion in my own work when I kept a 5-year-old patient waiting some minutes for her session. She expressed fury both in her face and in her movements as she flounced upstairs and stamped into the consulting-room. Once there she seized a mug and drank several mugs full of water. I commented that she was showing how angry and starved she felt by me keeping her waiting. Lottie promptly replied, ‘Well, you see, I’m thirsty of the truth.’

Both children, Hans and Lottie, 60 years apart in time, support Freud’s view that ‘children are more inclined to a love of truth than are their elders’. He did not mean to imply that adults do not love the truth, but that they are at times unable to welcome or recognise unpleasant truths about themselves even though such recognition may bring relief and an appreciation of the beauty that lies in the truth of a pattern perceived.

Hans once laughed at an explanation of his father’s about where chickens come from, a much needed preliminary to telling Hans how babies are made and born. When asked why he laughed Hans answered, ‘Because I lik...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Copyright Page
• Dedication
• Table of Contents
• Contributors
• Introduction
• 1. A Psychoanalytic Approach to Anxiety in Childhood
• 2. Recognition and Monitoring of Anxiety by Means of Psychometric Tests
• 3. Recognition and Treatment of Anxiety in Children by Means of Psychiatric Interview
• 4. The Contribution of Projective Techniques to the Recognition and Monitoring of Anxiety in School Children
• 5. Anxiety in Children: A Cross-cultural Perspective
• 6. Family Dysfunction and Anxiety in Children
• 7. Anxieties about Death: Theory and Therapy
• 8. Spiritual Anxiety and its Cure in Children
• 9. Understanding and Coping with Anxieties about Learning and School
• 10. Anxiety Relating to Illness and Treatment
• 11. Psychological Treatment of Childhood Neuroses
• 12. Psychotic Anxiety in Children and its Treatment
• Index