After the Second World War, Winnicott lectured not only to analysts and professionals, but with increasing prominence and frequency to social workers, childcare organizations, teachers and priests. A member of UNESCO and WHO study groups, his thinking fed into public policy and, through his BBC broadcasts, helped shape public opinion. Not only his focus on, but his understanding of, the mother–child couple slipped into common knowledge. It seemed both ‘natural’ and ‘commonsensical’, its theoretical status veiled by Winnicott’s felicitous common English.
So what was this mother–infant relationship that made the good-enough mother so decisive in the infant’s development? If Winnicott took from Klein her description of the infant’s inner world, he corrected it by grounding it in the ordinariness of mother-love, that unconditional acceptance by the mother of the child’s early ‘ruthless’ needs. The child’s attempts to hurt the mother in nursing or play–to bite, stab, kick, yell and generally to wear her out–are his primitive form of love. Only a mother can tolerate such needs; her acceptance, indeed her continuing presence and survival, are essential to the child’s development.
If the mother does not have the capacity to accept this ruthless love, to be a good-enough holding environment for it, and to emerge unscathed by the infant’s attacks, later problems or delinquency can emerge. Indeed, from his psychotic patients, Winnicott learned that it is the mother who takes the infant through from a primary stage of ‘unintegration’, in which the self is not yet anchored to the body and its various parts. By handling, bathing, rocking, naming, she gathers the baby’s bits together, integrates him. Gradually through that continuum of sight, sound and smell, which she provides, she also becomes a whole being in the world outside the baby’s fantasy. The breast gives the infant the capacity to conjure up–to hallucinate–what is available, while its continuing reappearance provides the relief of the real, which limits fantasy. The sense of unreality, the disintegration which is part of psychoses, are caused by a rupture or failure in early mothering or by the mother’s depression–as Winnicott had learned from his wartime evacuees and patients.
Winnicott posited a ‘primary maternal preoccupation’ as a necessary state for infant health. This was in part a response to Anna Freud’s insistence that to blame ‘neurosis on the mother’s shortcomings in the oral phase is no more than a facile and misleading generalization’, since ‘disappointments and frustrations are inseparable from the mother–child relationship’. For Winnicott the tiny, utterly dependent infant is not susceptible yet to disappointments and frustrations, which only later become emotions. Needs can only be met or not met, but their meeting is crucial. And when she is in that state of ‘primary maternal preoccupation’–a kind of heightened sensitivity or fugue, a ‘normal illness’ which lasts through the last period of pregnancy and through the babe’s early weeks–the mother meets them. Her lulling attention, her feeling herself into the child’s place and letting the ruthless child have his way with her, is all-important.
A good enough environmental provision in the earliest phase enables the infant to begin to exist, to have experience, to build a personal ego, to ride instincts, and to meet with all the difficulties inherent in life. All this feels real to the infant who becomes able to have a self that can eventually even afford to sacrifice spontaneity, even to die.
On the other hand, without the initial good-enough environmental provision, this self that can afford to die never develops. The feeling of real is absent and if there is not too much chaos the ultimate feeling is of futility. The inherent difficulties of life cannot be reached, let alone the satisfactions. If there is not chaos, there appears a false self that hides the true self, that complies with demands, that reacts to stimuli, that rids itself of instinctual experience by having them, but that is only playing for time.
An awful lot hangs on a few weeks in a mother’s life in which the all-important breast needs to be presented in the right intuitive way so that ‘it is of a piece with the child’s desire’ and enables him to build up ‘the basic stuff of the inner world that is personal and indeed the self’. If the rapport between herself and the child is not in place, if she is depressed or inattentive, or has a ‘strong male identification’, the babe may experience a ‘threat of annihilation’, or begin to develop a false, compliant self which eventually feels futile and breaks down. Later development will in any case be impaired: may result in thieving or delinquency, or that psychosis which Winnicott characterized as a ‘deficiency disease’. The risks attending mere ‘good-enoughness’ are huge. A believer in spontaneity, Winnicott’s hypotheses hardly leave the mother much room for either artful or artless meeting of the babe’s needs. Luckily the analyst, by replicating the good-enough environment, could sometimes make good the mothering lacks the child had undergone.
Anna Freud remained unconvinced about the direction the new object-relations school of psychoanalysis was taking. The ‘false generation’ missed the essence of psychoanalysis, she noted, looking back in 1974, missed the ‘conflict within the individual person, the aims, ideas, and ideals battling with the drives to keep the individual within a civilized community. It has become modern to water this down to every individual’s longing for perfect unity with his mother, i.e., to be loved only as an infant can be loved. There is an enormous amount that gets lost this way.’
The Piggle
Few of Winnicott’s published case histories are longer than examples within a text. One of these is the moving case of Gabrielle, or the Piggle, as her endearing nickname has it, a highly intelligent and talkative little girl who came to Winnicott at the age of two years and four months. Her parents were known to him and the mother in a sense co-authors her daughter’s case: her letters describing Piggle’s state and progress are exemplary descriptions by a woman who is both psychoanalytically informed and optimistic about therapeutic success. She is in some ways the best existing mother in Winnicott’s work: alive to her daughter’s state, interested in her fantasies and childhood weirdness and alert to her progress. Though it is never stated, one can only imagine that her early mothering was ‘good-enough’, and that the happy resolution of Piggle’s problems, partly the result of that common enough occurrence, the birth of a sibling, is an indication of this. We can only speculate that this may be one of the reasons Winnicott decided in the last year of his life to prepare the case for publication.
Extracts from the mother’s two initial letters to Winnicott, which precede the first consultation on 3 February 1964, reveal her sensitivity to her child and to what is amiss in her. They also reveal an astute sense of what this particular analyst needs to know. This analysis is, in some ways at least, a double act. In the first letter Winnicott is given a sense of the normal progress of nursing, Piggle’s great poise and inner resources, her passion for her father and her ‘high-handed’ attitude to her mum; then the sudden change in her at the arrival of a sibling when she was twenty-one months, when she became ‘bored and depressed’ and very conscious of her relations and her identity. Piggle also developed an intense and troubling fantasy life, which had her scratching her face and waking with nightmares:
She has a black mummy and daddy. The black mummy comes in after her at night and says: ‘Where are my yams?’ (To yam = to eat. She pointed out her breasts, calling them yams, and pulling them to make them larger.) ‘Sometimes she is put into the toilet by the black mummy. The black mummy, who lives in her tummy, and who can be talked to there on the telephone, is often ill, and difficult to make better.
The second strand of fantasy, which started earlier, is about the ‘babacar’. Every night she calls, again and again: ‘Tell me about the babacar, all about the babacar.’ The black mummy and daddy are often in the babacar together, or some man alone. There is very occasionally a black Piggle in evidence.
The astute mother is worried about the present. She also has the very Winnicottian worry about the person Piggle may become if she ‘hardens’ herself against her distress, erec
ts defences against pain. In the second letter, the mother points out that the Piggle is worse: she no longer plays with any concentration or admits to being herself at all. ‘The Piga’, who is now black and bad, has gone away to the babacar. When told that her mother has written to Dr Winnicott who understands about black mummies and babacars, the little girl asks twice to be taken to him.
Much is astonishing in Winnicott’s account of the Piggle. Although in its progress it is clearly a psychoanalytic case, one which extensively probes the child’s unconscious fantasy life, Winnicott doesn’t see the Piggle daily. In fact, between the start of the treatment and the final session when the Piggle is five, he sees her only fourteen times and does so ‘on demand’. The family live far from London. Like Anna Freud and unlike Melanie Klein, Winnicott also engages the parents in the treatment process. He does more. He emphasizes that the ‘on demand’ model has contributed to the unfolding of the case: too often the frequency of analysis means that the parents give the child over to the doctor and assume that everything in the ‘rich symptomatology’ she presents is part of her illness. ‘It is possible for the treatment of a child actually to interfere with a very valuable thing which is the ability of the child’s home to tolerate and to cope with the child’s clinical states that indicate emotional strain and temporary hold-ups in emotional development, or even the fact of development itself.’
In that sense Winnicott’s treatment is an aid to good-enough parenting, and the written exchanges between himself and the Piggle’s mother are exemplary of a mutual process. The case itself is a fascinating narrative as much for the door that it opens into the consulting room as for the magic of the child’s relations with Winnicott, as she plays her way out of her fears and worries and into an understanding that Winnicott, who had become part of her once black and rapacious inner world, can be left and still continue to exist independently of her, liking her, even if she hates. Along the way, the Piggle clarifies her confusions and imaginings about babies, comes to terms with her little sister and her Oedipal jealousy of her father, and puts together her primitive split-apart good mother and black mother. ‘Black mummy as a split-off version of mother, one that does not understand babies, or one who understands them so well that her absence or loss makes everything black,’ Winnicott observes, in a text which is filled with an array of brilliant observations.
Perhaps the most riveting aspect of the case is the way it illuminates what Winnicott means both by play and by treatment. The first is no half-hearted pretence, but integral to the relationship the child and doctor form. The many anecdotal accounts of Winnicott’s clinical skills become visible in The Piggle. Winnicott really is down there on the floor with the child, the toys and the roles the child attributes to him. He provides a consistent environment in which she can feel safe and ‘held’. He is hard at play, that process which amongst much else is an unconscious enactment of the bits and pieces within the child’s inner life, their taking apart and putting back together again. Importantly, mutual play is entrenched well before any interpretations are offered.
The Piggle’s father, who brings her, sometimes participates in the play. (Indeed, Winnicott writes to express his admiration for the way he allows himself to be used without quite knowing what is going on.) If needs be, Winnicott continues to play even after the toys have been tidied up (though sometimes, when the Piggle is almost better, she can afford to leave a mess behind her): ‘I stayed where I was, being the black angry mummy who wanted to be daddy’s little girl and was jealous of Gabrielle. At the same time I was Gabrielle being jealous of the new baby with mother. She ran to the door, they went off and she waved. Her last words were: “Mother wants to be daddy’s little girl.”’
As for the treatment, Winnicott suggests its success is in large part really up to the child and the parents. The doctor is there to facilitate, to be available, not to interpret too quickly according to theoretical rote. Winnicott is careful to stress his ‘not understanding what she has not yet been able to give me clues for’. Only the Piggle knows the answers, and they cannot be provided for her. ‘When she could encompass the meaning of the fears she would make it possible for me to understand too.’ She does.
After the fifth session, Winnicott writes to the Piggle’s mother: ‘The Piggle is a very interesting child, as you know.’ He adds wryly, ‘You might prefer that she were not so interesting, but there she is, and I expect that she will settle down into being quite ordinary soon. I think a great number of children have these thoughts and worries, but they are usually not so well verbalized, and this in Piggle’s case has a lot to do with your both being rather particularly conscious of childhood matters and tolerant of childhood questions.
The Piggle is an interesting child and she shares her interesting thoughts and worries with a great number of children. Her exemplary nature lies in her ability to articulate these thoughts which, here, if not always elsewhere, Winnicott attributes to her good-enough mother and to that father who is so often absent from his writings.
John Bowlby (1907–90)
Another analysand of Joan Riviere’s and a supervisee of Melanie Klein’s was to become instrumental in the focus on the mother–child couple and to give it a wider bearing in that psychology which came to govern everyday life outside the consulting room. The son of Sir Anthony Bowlby, head of the Royal College of Surgeons, who had organized the treatment of the wounded in the First World War, and the patrician Maria Mostyn, John Bowlby had easier access than any immigrant psychoanalyst to the centres of British institutional power. His ideas about ‘maternal deprivation’ as the cause of a child’s problems and his emphasis on ‘attachment’ between mother and child took root quickly. Alongside Winnicott, and with more institutional connections, Bowlby played a major role in shaping the postwar establishment consensus on parenting. Bowlby was also one of the few clinicians to play an influential part both within British psychoanalysis and in the setting up of the National Health Service after the war–something Winnicott, fearing regimented standardization, opposed.
A graduate of Dartmouth Naval College, a dab hand with a yacht, a devoted ornithologist, Bowlby studied natural science and psychology–a newly inaugurated discipline–at Cambridge in the twenties, then medicine, though he didn’t complete his degree until after he had taught disturbed children in a Norfolk school. It was this experience which led him to a psychoanalytic training, first with adults, at the same time as he completed his medical degree and specialized in psychiatry. He worked first at the Maudsley Hospital as a clinical assistant, then at the London Child Guidance Training Centre, and after the war became head of the Department of Children and Families at the Tavistock Clinic.
In 1937, partly influenced by Klein’s The Psychoanalysis of Children, he decided to train as a child analyst with her. The supervision was not what he had hoped.
His first child patient was a 3-year-old boy, who was very hyperactive and allegedly out of control. Bowlby thought that his mother was very anxious and disturbed, and that this was one of the key factors in the little boy’s wild behaviour. At the Tavistock Clinic he would have been able to take the deteriorating state of the mother into account, but Melanie Klein seemed to him only interested in the boy’s play and the reports of the sessions. His relationship to his real mother did not seem to interest her. After a few months the mother had a psychiatric breakdown and was moved to a mental hospital. The treatment had ‘inconveniently’ broken down. What upset Bowlby was that Melanie Klein seemed to refuse even to discuss the effect that the mother’s illness and behaviour might have had on his child patient.
All of Bowlby’s experience had made it clear to him that the child’s environment, in particular the kind of mothering he or she received, caused and shaped any later psychopathology. Already in his paper of 1940 for the International Journal of Psychoanalysis, he was alert to the effect of intergenerational repetition:
For mothers with parenting difficulties, a weekly interview in which their pro
blems are approached analytically and traced back to childhood has sometimes been remarkably effective. Having once been helped to recognize and recapture the feelings which she herself had as a child and to find that they are accepted tolerantly and understandingly, a mother will become increasingly sympathetic and tolerant towards the same things in her child.
This kind of insight, though familiar to Anna Freud in whose wartime nurseries one of Bowlby’s key postwar researchers, James Robertson, trained, was hardly calculated to please or interest the Kleinians, with their intense focus on the child’s inner world.
During the war, Bowlby served as an army psychiatrist and a member of the medical corps. As part of the War Office selection boards, he worked with psychological and social researchers. This collaboration would have a marked effect on the postwar therapeutic communities and civil resettlement units; and indeed on the Tavistock Clinic’s social agenda, and on his own research. Statistical work, unlike that which the psychoanalytically trained usually conducted, fed into Bowlby’s postwar book on delinquent children, Forty-Four Juvenile Thieves: Their Characters and Home-Life. Various articles, one in the magazine The New Era in a special issue on the emotional problems of evacuation, had already broached his thesis about the effect separation from the mother had on a child. He would argue the thesis throughout his life, focusing in on maternal deprivation, or the later attachment. Here he argued that prolonged separation of small children from their homes and their mothers led in many cases to the development of a criminal character.
On the strength of these findings, Bowlby was asked by the World Health Organization, concerned about homelessness, to prepare a report on the mental health aspects of postwar displacement. For six months in 1950, he travelled to Switzerland, France, the Netherlands, Sweden, the USA and around Britain and gathered evidence from care professionals working with disturbed children. The resulting report, Maternal Care and Mental Health, appeared in 1951 and went into numerous printings in many languages, making of Bowlby a world authority. The report called passionate attention to the grave medical and social significance of the long-term institutionalization or maternal deprivation of the child. It was essential for mental health that an infant and young child experience a warm, intimate and continuous relationship with his mother or her permanent substitute. The child who didn’t would be likely to show signs of partial deprivation–excessive need for love or revenge, or depression. Complete deprivation could lead to utter listlessness and retardation.
Mad, Bad, and Sad: A History of Women and the Mind Doctors Page 35