Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  Anna Freud’s work emphasizes the importance of the environment in relationship to the child’s development, an environment which in the first instance is the mother, whom the analyst must not displace but rather work alongside. The child is understood as a being in search of instinctual gratification: this is what will drive it in its first attachments and on its all-important path to the outside world to which a series of difficult adaptations will have to be made as its ego matures.

  A wider-ranging hypothesis about the workings of the unconscious inner life of the baby was not what primarily interested Anna Freud. That pre-Oedipal, pre-linguistic world was the dramatic terrain of Melanie Klein. Her insights gave birth to an increasingly complex infantile psyche, an inner landscape which brought with it a host of new psychological tropes–such as projection, introjection, and manic defence–to describe the dynamic psychic life of the child and its object relations. A new very British emphasis within psychoanalysis was one of the results.

  Melanie Klein was born in Vienna, the youngest of four children, a late arrival to an ageing father, Dr Moriz Reizes, and his considerably younger ambitious wife, Libusa Deutsch. Her favourite sister died when Melanie was four; the brother who coached her in Greek and Latin died while still at university. These losses shadowed her. Abandoning her own aspirations to study medicine, Melanie married at nineteen, leaving university early to follow her husband, an engineer, in the various moves which eventually took them to Budapest in 1910. The couple had three children by the time Melanie decided, having read Freud and in the wake of her mother’s death, that she wanted to study psychoanalysis.

  After an analysis with the brilliant and innovative Sandor Ferenczi, she began to analyse children, worked in his Budapest clinic during the war years and participated in the early life of the profession, lecturing at meetings and congresses. In 1921, on the cusp of divorce, she moved with her children to Berlin and worked with Karl Abraham, her great supporter, who sadly died in 1925. Bloomsbury’s own acerbic Alix Strachey, wife of James, who was having an analysis with Abraham while her husband was pining in London, described Klein in a letter at this time as a vulgar Cleopatra, an ‘ultra heterosexual Semiramis in slap up fancy dress’. But she valued Klein and translated her from rather woolly German into a precise Bloomsbury English–a fact which certainly helped Klein’s eventual British reception.

  Invited to London to lecture by Ernest Jones at the Stracheys’ behest, Klein gave six lectures at the home of Virginia Woolf’s brother, the psychoanalyst Dr Adrian Stephen. The following year Klein emigrated to Britain, where she had a galvanizing impact on British psychoanalysis, sowing love and hatred, passionate affiliation and radical dissent, in a mirror image of her own dramatic view of the inner life, with its splittings, projective identifications and persecutory forces. Bloomsbury, itself constituted out of relationships and valuing their importance, continued to be kind to her. Virginia Woolf, who dined with Klein on 15 March 1939, left a telling portrait of her exact contemporary in her diary: ‘a woman of character & force some submerged–how shall I say?–not craft, but subtlety; something working underground. A pull, a twist, like an undertow: menacing. A bluff grey haired lady with large bright imaginative eyes.’

  One of Klein’s innovations was to posit that the child experienced the Oedipal situation with weaning or earlier, its world by then already riven between love of one parent, hatred of the other, an attendant guilt and fear of castration. For Klein the deprivations that weaning brings topple into those suffered by the child’s inability to stand in for the parent of the opposite sex. Such deprivations can affect a child’s toilet training, seemingly inadvertent self-injury, and ability to learn.

  At a very early age children become acquainted with reality through the deprivations which it imposes on them. They try to defend themselves against it by repudiating it. The fundamental thing, however, and the criterion of all later capacity for adaptation to reality, is the degree in which they are able to tolerate the deprivations that result from the Oedipus-situation. Hence, even in little children, an exaggerated repudiation of reality (often disguised under an apparent ‘adaptability’ and ‘docility’) is an indication of neurosis and differs from the flight from reality of adult neurotics only in the forms in which it manifests itself. Even in the analysis of young children, therefore, one of the final results to be attained is successful adaptation to reality. One way in which this shows itself in children is in the disappearance of the difficulties encountered in their education. In other words, such children have become capable of tolerating real deprivations.

  Even if the psychoanalytic world itself was small, particularly so at the time in Britain, Klein’s focus gradually spread into a wider social arena through her prominent analysands. England provided fertile ground for Kleinian ideas, helped by the abiding English interest in the child, a legacy of Romanticism made vivid in a thriving and altogether uncontinental children’s literature. By the mid-1920s, Christopher Robin and what would become the classical ‘transitional object’, Winnie the Pooh, were already alive and well. And their little Freudian friend, James, James, Robertson, Robertson, Weatherby George Dupree, was taking ‘good care of his mother, though he was only three’, and knew very well that she must never go down to the end of the town without ‘consulting me’.

  The Kleinian baby is a dramatic creature, a site of internal warfare between aggressive and libidinal demands. Attached or distant from the breast–its focus of attention, or object–this babe inhabits a world of dark and extravagant passions, full of sucking and biting and kicking. The mother, meanwhile, is mostly breast, at best compliant and ever available, unhampered by her own moods and needs which are inevitably instantly communicated. This breast stands in for the whole of the babe’s world, site of satisfaction, or lack, and when lacking, taken in as attacking and therefore demanding retribution. The baby internalizes, or ‘introjects’, this good and bad breast as separate forces. The split between the two cannot be reconciled as ambiguity or into a single whole person until later, if ever. The good is idealized, loved, mostly unattainable. The bad is persecutory. Primitive warfare between the two is fundamental and can be re-enacted at any difficult point in an individual’s life. Indeed, a Kleinian analysis usually takes the patient back to this early pre-sexual world of fears, guilt, anxiety and retribution, so fundamental they are tantamount to original sin.

  Klein recounts the case of a five-year-old boy who used to pretend he had all sorts of wild animals, such as elephants, leopards, hyenas and wolves, to help him against his enemies. They represented dangerous objects–persecutors–which he had tamed and could use as protection against those enemies. But it appeared in the analysis that they also stood for his own sadism, each animal representing a specific source of sadism and the organs used in this connection. The elephants symbolized his muscular sadism, his impulses to trample and stamp. The tearing leopards represented his teeth and nails and their functions in his attacks. The wolves symbolized his excrements, invested with destructive properties. He sometimes became very frightened that the wild animals he had tamed would turn against him and exterminate him. This fear expressed his sense of being threatened by his own destructiveness (as well as by internal persecutors).

  Kleinian anxiety is a fear of annihilation, which exists in the unconscious together with a life force: the mother’s breast, the first bit of reality the child meets, represents both:

  first the mother’s breast (and the mother) becomes in the infant’s mind a devouring object and these fears soon extend to the father’s penis and to the father. At the same time, since devouring implies from the beginning the internalisation of the devoured object, the ego is felt to contain devoured and devouring objects. Thus the super-ego is built up from the devouring breast (mother) to which is added the devouring penis (father). These cruel and dangerous internal figures become the representatives of the death instinct. Simultaneously the other aspect of the early super-ego is formed first by the
internalised good breast (to which is added the good penis of the father) which is felt as a feeding and helpful internal object, and as the representative of the life instinct. The fear of being annihilated includes the danger lest the internal good breast be destroyed, for this object is felt to be indispensable for the preservation of life. The threat to the self from the death instinct working within is bound up with the dangers apprehended from the internalised devouring mother and father and amounts to fear of death.

  The Kleinian child has a punishing, sadistic super-ego which comes into being through that deprivation which is weaning, or even earlier–certainly far sooner than Freud or Anna had postulated. Ordinary pleasure, for Klein, seems most often to be a way of avoiding psychic pain. In the child’s inner world, which is already a version of the others it has come up against, the super-ego attacks it for having murderous thoughts about the people who gradually come into three-dimensional focus as first mother, then parents. In this process, the omnipotent (and utterly helpless) babe moves out of the initial struggle for survival and begins to recognize what were ‘part objects’ in its own world as people on the outside, or ‘whole objects’. This relational element is the foundation of the Kleinian world–hence the world of ‘object relations’ as this kind of analysis came to be called.

  Simultaneously the child also begins to recognize its dependence on mother and see that what it both loves and hates is one and the same person. The mother it hates and attacks is the loved object and, conversely, loving her means loving what is hated and feared. The child feels guilty about the hatred, though this guilt is not as ferocious as that persecution the earlier super-ego inflicted. It also fears that the mother will abandon it as a result of its aggression. Depression, or the ‘depressive position’, comes with this sense of loss. During this phase, the child may either defend against the sense of loss or mourning by being ‘manically’ busy or cheerful; or it may try to repair the damage its own aggression has caused, thereby paving the way for good future relationships or indeed for the various creative tasks which it may later undertake.

  Inescapable as a force, essential, the Kleinian mother has little of an individual person about her apart from her task of mothering. But the mothering is what serves as a spur to the child’s eventual recognition of a world separate from itself, a world of objects or others, to which the child will relate in the manner which these first of relations set down. In the helpless infant’s grappling to form links with the real, those eventual ‘object relations’, its inner life becomes filled with dark phantasies. These phantasies form the basis of later ‘projections’ on to others. With the same infantile literalness that makes the breast the world, they also resemble and form the root of later psychoses.

  In Klein’s savage scenario of developing infant and appended mother, the latter can be as helpless as the child in bearing the brunt of murderous attacks and emotions which, because of their very unspeakability, feel far more violent than Freud’s postulated Oedipal attacks on the father. Within the world of psychic illness, Kleinian ideas had a distinct impact on the treatment of psychotic conditions and on the care of patients, child or adult, immured in their own imaginations, with little link to the outside real. In the culture at large into which Klein’s complex hypotheses gradually fed in a simpler form, her sense of the mother as both utterly passive and infinitely responsible helped to induce in women a feeling of lingering culpability with regard to their children. Everywhere in the postwar magazines, paediatric services and childcare manuals, the business of raising children became something so difficult as to drive both mothers and children if not altogether mad, then certainly to seek out help.

  D.W. Winnicott (1896–1971)

  Donald Woods Winnicott, a paediatrician by initial training, forged a crucial link between the medical and the psychoanalytic care of children in Britain and, through his many books and articles, much further afield. Winnicott made babies interesting. There is more to a baby than blood and bones, he reiterated in any number of ways. His status as a male and a doctor gave the contention a great deal of weight.

  Born into a prosperous Plymouth family, Winnicott studied medicine at Cambridge, then interrupted this to serve as a probationer surgeon on a destroyer in the First World War. Having completed his medical studies, he began to work at the London Queen’s Hospital for Children in Hackney and at Paddington Green Hospital in 1923, the very year in which he started a ten-year analysis with Freud’s translator James Strachey. His interest in psychoanalysis had been spurred by his reading of Freud’s Interpretation of Dreams in 1919, which opened him up to a new way of thinking–one he wanted instantly to redescribe in English. In 1927, the year that Melanie Klein arrived at the British Psychoanalytical Society, Winnicott began his psychoanalytic training. Klein became his supervisor. In 1936, fully trained, he nonetheless began a second analysis, this time with Joan Riviere, Klein’s foremost champion and her talented translator: Klein’s insights permeate Winnicott’s thinking. That said, he was ever a rebellious sceptic about theoretical formulations, whether (Sigmund or Anna) Freudian or Kleinian. He preferred to pioneer his own course, and steered a very British one through the ‘continental wars’ between the two women, insisting on that plain speech which the BBC listening public, not to mention doctors, could readily understand. During the so-called Controversial Discussions of 1943, in which Klein and later arrival to Britain, Anna Freud, and their respective followers battled over Freud’s legacy–a controversy which almost tore apart the British Psychoanalytical Society–it was Winnicott who pointed out that while the verbal salvoes were being fired, there were actual bombs falling overhead.

  Needless to say, Winnicott became the leader of what emerged as the so-called Middle Group, the Independents within the very British compromise that postwar training within the British Psychoanalytical Society offered, with its A (Klein), B (Anna Freud) and Middle Groups. He served for two terms after the war as the Society’s president, and for twenty-five years as the head of its training institute’s Child Department.

  Winnicott’s preoccupations reinforced the emphasis on the nursing couple of mother and child, and further removed from the terrain of analytic concerns consideration of any indecorous sexuality that might involve actual coupling rather than childhood fantasies. For Winnicott, as the much cited phrase has it, there was no such thing as a baby, since wherever you found a baby, you would always find someone else, most notably, a mother. The phrase astonished him when it first slipped from his lips, but he realized what he meant by it was that the two must always be considered as a couple. One might almost conclude, to take his daring thought to its logical end, that for Winnicott there was rarely enough such a thing as a woman, since she existed entirely as part of the mother–child dyad.

  During his forty years at the two hospitals where he worked, his ‘psychiatric snack-bar’, Winnicott saw some sixty thousand children and their mothers, fathers and grandparents. Unlike many of his psychoanalytic contemporaries, he was prepared to engage in brief psychotherapies with his patients. This not only had the potential of disseminating psychoanalysis more widely, but helped to bring a new way of thinking into the medical arena. Winnicott believed that since illness and cure were rarely altogether to do with physical factors, doctors should have some knowledge of the unconscious and its mechanisms. He would have liked this knowledge to be largely intuitive and spontaneous. He had an optimistic sense of human possibility, an idea of an authentic self and creative potential instilled by the relationship with a ‘good-enough mother’. This romantic sense coexisted, perhaps paradoxically, with a predilection for Klein’s tormented agonist of an infant, born to the terrors of an inner world split into warring good and bad.

  His work as psychiatric consultant to the government’s wartime Evacuation Scheme in Oxford, where he managed several hostels, had underscored the importance of the mother’s role for him. The child who had not had good-enough mothering couldn’t adapt to his placement. A failure in
early mothering could lead to later delinquency. The ‘curable’ kind was often instigated by a failure in mothering or a separation from mother which occurred after the child’s ego was already integrated. Antisocial activity for Winnicott is an expression of the delinquent child’s sense of loss, a rupture of an earlier integration the child carried within him, as he carried his entire early environment. The fact that there was ‘activity’ was itself an expression of hope: what had been lost would be found again by freeing a development that had been stopped too soon. Winnicott also recognized that a continually dependable environment helped the problem children as much as therapy.

  This underscored his postwar sense of therapy as only partly to do with Kleinian deep interpretations which insisted on the underlying, Oedipal meanings of the child’s play and utterances. Therapy, equally and increasingly, became for Winnicott a question of providing a ‘holding environment’, of allowing a constant and reliable space in which the troubled child could express the worst without fear of punishment. Therapy, particularly with the seriously damaged, was a question of ‘managing’ the transition from the terrible fantasies and omnipotence of the babe’s inner world–so akin to a psychotic’s–to an acceptance of a reality beyond the child’s magical/diabolic control and all the guilt and anxiety that attended this control.

  The therapist became ‘real’ for the child when she could hate him without destroying him, move from ‘illusion’ to ‘disillusion’ and perhaps to ‘reillusionment’. The therapist, in other words, was a later version of a ‘good-enough mother’ ferrying the child into the real. Freud had once said he was uncomfortable when asked to take on the mother’s role in transference. Not so Winnicott. Even if Freud had not written much about the maternal function, ‘it turned up in his provision of a setting for his work, almost without his being aware’. The analyst, like a mother, would always be reliably there, alive and breathing. The shift–in terms of the mind doctors’ practice–is from Freud’s form of analysis which deals largely with neurosis, to a therapy which can also deal with psychosis, since it probes back to the earliest pre-verbal relationships.