René Spitz

Spitz was born in Vienna on 29 January 1887 into a wealthy Jewish family and spent most of his childhood in Hungary. He studied medicine in Budapest and qualified as a physician in 1910. He had come across Freud's writings while still a student.

Ferenczi, whose lectures in Budapest drew him towards psychoanalysis, encouraged him to seek analysis with Freud. Spitz thus became one of the first to undergo a training analysis with Freud himself, a brief didactic analysis in 1910–1911. During the First World War he served as an army doctor.

In the 1920s Spitz belonged to the Vienna Psychoanalytic Society, taking part in it from 1924 to 1928. He then moved to Berlin and joined the German Psychoanalytic Society.

In 1932 he left for Paris. Until 1938 he taught psychoanalysis and child development at the École Normale Supérieure and often attended the conferences of the Paris Psychoanalytic Society. His own research on child development began in 1935, and in 1935–1936 he attended Anna Freud's seminar on child analysis in Vienna.

Spitz emigrated to the United States in 1939 and worked as a psychiatrist at Mount Sinai Hospital in New York. After a series of visiting professorships he settled in Colorado, where he carried out much of his infant research. The International Dictionary of Psychoanalysis places him at the University of Colorado. He was president of the Denver Psychoanalytic Society in 1962–1963 and died in Denver on 14 September 1974.

His method rested on directly observing infants, recording them on film, and measuring their development with standardised tests. His chief collaborator in the 1940s was Katherine Wolf, a Viennese child psychologist who had worked with Charlotte and Karl Bühler on the Viennese baby tests and had emigrated to New York in 1941. She contributed observations and statistical work and co-authored his two principal papers of 1946.

His films include Grief: A Peril in Infancy (1947) and Psychogenic Disease in Infancy (1952).

Writing in the International Dictionary of Psychoanalysis, Kathleen Kelley-Lainé calls him the first of a small number of distinguished psychoanalysts to apply the methods of experimental psychology to child development. She notes that, unlike the behaviourists, he held that deep psychic processes could be inferred from observable indicators, and remarks: "His use of films was particularly influential."

In Hospitalism² (1945) Spitz compared two groups of infants. The first lived in a foundling home, where they were fed and kept clean but had almost no sustained contact with any one caregiver. The second lived in a prison nursery and were cared for by their own mothers.

Tested with the Viennese baby tests, the two groups diverged sharply. The developmental quotient of the foundling-home infants fell steeply, and they showed the signs of hospitalism. The nursery infants developed normally.

Spitz attributed the difference to the absence of maternal care. In doing so he reworked an older term. "Hospitalism" had been used in paediatrics since the late nineteenth century, and its cause had been sought in infection and hygiene. Spitz recast it as a psychiatric condition produced by total emotional deprivation in the first year. Its marks were a steep developmental decline, withdrawal, retarded growth, susceptibility to illness and high mortality, and he regarded the damage as largely irreversible.

The companion paper, Anaclitic Depression³ (1946), written with Wolf, described infants separated from their mothers after at least six months of good mothering. At first they wept and clung. Later they withdrew, lost weight, slept badly, fell ill more often, and declined in developmental quotient.

Unlike hospitalism, this syndrome was reversible if the mother returned within a few months. Spitz therefore distinguished anaclitic depression, a partial deprivation, from hospitalism, which was total and prolonged.

In The Smiling Response⁴ (1946), Spitz and Wolf reported what infants smile at from about the third month. They smile at a human face seen from the front and in motion, and even at a mask that keeps the forehead, eyes and nose, but not at a face seen in profile. In the second half of the first year the smile becomes selective and is withheld from strangers. The authors read it as the infant's first active turning towards a human partner and an early step in the formation of social and object relations.

Spitz built these findings into a general theory in A Genetic Field Theory of Ego Formation⁵ (1959), given as the Freud Anniversary Lecture of the New York Psychoanalytic Institute. He borrowed the concept of the organizer from embryology. At certain nodal points, he argued, separate lines of maturation and development converge into a new level of psychic organization, which he called one of the organizers of the psyche.

Each organizer shows itself through an indicator: the smile at about three months, anxiety towards strangers at about eight months, and the "no" in the second year. If an organizer is not established at the right time, later development rests on a faulty foundation. Spitz drew implications for pathology from this.

Eight-month anxiety, the second of these indicators, was Spitz's name for the distress an infant of about that age shows at a stranger's face. He regarded it as the first anxiety proper and as a sign that the infant now tells the mother apart from everyone else. He interpreted it as a reaction to the mother's absence. Here his reading diverges from accounts of separation anxiety, to which attachment theory later gave its own explanation.

Spitz set out the full sequence in The First Year of Life¹ (1965), written with W. Godfrey Cobliner. The book expanded La première année de la vie de l'enfant (Paris, 1958), which had a preface by Anna Freud. That book had in turn grown out of a paper on the genesis of the first object relations, published in the Revue française de psychanalyse in 1954.

Drawing on direct and filmed observation, the book divides the first year into three stages. The first is an objectless stage, in which infant and mother are not yet differentiated. The second is the stage of the precursor of the object, opened by the smiling response. The third is the stage of the libidinal object proper, which begins at around eight months and is signalled by eight-month anxiety. The "no" follows these stages. Throughout, Spitz gives a central place to the dialogue between mother and child.

The later chapters turn to the pathology of object relations. Spitz distinguishes two kinds of disturbance. Some arise from an unsuitable quality of maternal attitude. Others, the emotional deficiency diseases such as anaclitic depression and hospitalism, arise from the absence of maternal care altogether.

No and Yes⁶ (1957) is Spitz's study of the beginnings of communication. He argued that the head-shake and the word "no", which appear around the middle of the second year, are the child's first semantic gesture and first abstract concept. They mark the passage from action to communication at a distance.

The child acquires the "no", on this account, by identifying with the forbidding adult and turning the prohibition back against that adult. Spitz traced the head-shake to the rooting movement of the newborn at the breast, and the nod of "yes" to a different early movement.

In Kelley-Lainé's summary of his theory, gesture and the "no" from about fifteen months mark semantic communication and the emergence of the autonomous ego. This places Spitz's developmental work within ego psychology.

The deprivation studies drew a methodological challenge. In The Infantile Disorders of Hospitalism and Anaclitic Depression⁷ (1955), Samuel R. Pinneau re-examined Spitz's samples, tests and figures. He argued that the data did not establish maternal deprivation as the cause of the infants' decline, pointing to gaps, inconsistencies and other possible factors. The Psychological Bulletin printed Pinneau's critique together with Spitz's reply and a rejoinder by Pinneau.

Spitz's influence on John Bowlby ran in two directions. In Maternal Care and Mental Health⁸ (1951), his report for the World Health Organization, Bowlby reviewed direct observational studies, among them those of Spitz and Wolf. He described the mother as the infant's "psychic organizer", a borrowing from embryology tied to critical periods of development.

In The Nature of the Child's Tie to His Mother⁹ (1958), however, Bowlby placed Spitz among the analysts who, despite observations pointing elsewhere, gave theoretical primacy to food and warmth and treated the tie to the mother as secondary. Bowlby named Anna Freud among them as well. That paper is regarded as the first statement of attachment theory.

Later findings on the newborn's capacities for interaction also cast doubt on Spitz's embryological model of organizers. A collection of his papers, edited by Robert N. Emde, appeared under the title Dialogues from Infancy.

Spitz's two papers on early psychiatric conditions appeared in successive volumes of The Psychoanalytic Study of the Child. Hospitalism² was published in the first volume in 1945, and Anaclitic Depression³, written with Katherine Wolf, in the second volume in 1946. Also with Wolf, he published The Smiling Response⁴ in Genetic Psychology Monographs in 1946.

His book No and Yes⁶ appeared in 1957, followed by a paper on the genesis of superego components in 1958 and the lecture A Genetic Field Theory of Ego Formation⁵ in 1959. His major synthesis, The First Year of Life¹, written with W. Godfrey Cobliner, was published in 1965.