Book
Collected Papers: Through Paediatrics to Psycho-Analysis
Collected Papers: Through Paediatrics to Psycho-Analysis is the first collection of D. W. Winnicott's papers, published by Tavistock in London in 1958 and reissued in 1975, with an introduction by M. Masud R. Khan, as Through Paediatrics to Psycho-Analysis. It gathers twenty-six papers written between 1931 and 1956, and its title traces Winnicott's own route: a physician at Paddington Green Children's Hospital who trained as a psychoanalyst, he brought what he observed in many thousands of consultations with mothers and infants to bear on psychoanalytic theory, and brought psychoanalysis back to paediatrics. The earlier papers are addressed largely to doctors. They argue that much of what paediatrics treated as physical illness — fidgetiness mistaken for rheumatic chorea, disorders of appetite, ocular symptoms — expresses anxiety and emotional conflict, and that anxiety in a child is often normal and to be tolerated rather than removed. In "The Observation of Infants in a Set Situation" (1941) Winnicott describes how infants on their mother's lap deal with a shining spatula left within reach: the hesitation before seizing it, the mouthing and play, the dropping. Departures from this sequence reveal the infant's anxieties, and the consultation itself can be therapeutic. Other papers describe a child's precocious liveliness as reparation directed at a mother's depression rather than at the child's own guilt, and consider when a child's illness can be managed by the family at home. The later papers, most of them given to the British Psycho-Analytical Society, set out the theory for which Winnicott is known. He starts from Melanie Klein's work on the manic defence and the depressive position, which he recasts as the normal achievement of a capacity for concern, and increasingly places the environment — the mother's adaptation to her infant — at the centre of early development. "Primitive Emotional Development" (1945) describes integration, personalization and the realization of external reality emerging from an original unintegration. "Hate in the Counter-Transference" (1947) argues that the analyst, like the mother, must be able to recognize hate without acting on it. "Mind and its Relation to the Psyche-Soma" (1949) treats an overactive mind as a substitute for care that failed. "Transitional Objects and Transitional Phenomena" (1951) introduces the first "not-me" possession and an intermediate area of experience between the subjective and the objectively perceived. Papers on regression (1954) argue that patients whose earliest care failed may need to regress to dependence within a reliable analytic setting, which comes to stand for that care. Among the last papers are "Primary Maternal Preoccupation" (1956), on the mother's heightened identification with her newborn, and "The Antisocial Tendency" (1956), which reads stealing and destructiveness in deprived children as signs of hope.
Main ideas
- Many complaints that paediatrics treated as physical, such as fidgetiness, appetite disorders and ocular symptoms, express anxiety and emotional conflict; a measure of anxiety in childhood is normal and should be tolerated rather than removed.
- In the 'set situation', an infant's hesitation before seizing a spatula, its mouthing and play, and its dropping of it reveal the infant's anxieties, and the observation can itself be therapeutic.
- Working from Melanie Klein, Winnicott describes the manic defence as a denial of inner reality through flight to external reality and omnipotent control, and recasts the depressive position as the normal achievement of a capacity for concern, which depends on the mother surviving the infant's attacks and receiving its reparation.
- Early emotional development moves from an original unintegration towards integration, personalization (the psyche's dwelling in the body) and the realization of external reality, and the mother's adaptation allows the infant the illusion that it creates what it finds.
- Both the mother and the analyst feel justified, objective hate; recognizing it without acting on it is necessary, especially in the treatment of psychotic and antisocial patients.
- Birth can be experienced as an impingement that interrupts the infant's continuity of being, and traces of such early trauma can be relived in analysis.
- When early care fails, the mind can become overactive and take over the function of care, setting itself up apart from the psyche-soma.
- Transitional objects and phenomena, beginning with the first 'not-me' possession, belong to an intermediate area of experience between the subjective and the objectively perceived; its paradox should not be challenged, and it underlies play, art and religion.
- The good-enough mother first adapts almost completely to her infant's needs and then fails it gradually, allowing disillusionment and the acceptance of external reality.
- Aggression is at first part of motility and primitive, ruthless love, prior to concern; fused with erotic impulses and meeting opposition, it helps the infant discover a world that is not itself.
- Patients whose earliest environment failed may organize a false self as caretaker and need to regress to dependence within a reliable analytic setting; regression then carries the hope that the original failure can be undone.
- Primary maternal preoccupation, a heightened sensitivity of the mother in late pregnancy and the first weeks, lets her meet her infant's needs; and the antisocial tendency arises from deprivation, the loss of something good once had, so that stealing and destructiveness express hope of recovering it.
What it shows
- 1956
Donald Winnicott introduced Primary maternal preoccupation
Gallery
Cover of D. W. Winnicott's Through Paediatrics to Psychoanalysis, Karnac Books paperback edition, 1996