Grief and Mourning in Infancy and Early Childhood

Bowlby's paper, published in The Psychoanalytic Study of the Child in 1960, follows his papers on the child's tie to the mother (1958) and on separation anxiety (1960), and is the first of several planned papers on grief and mourning. In the separation anxiety paper he had described the young child's response to removal from the mother as a sequence of protest, despair and detachment. (He now uses "detachment" in place of his earlier "denial".) He linked protest to separation anxiety, despair to grief and mourning, and detachment to defence. Here he proposes that grief and mourning occur in infancy whenever the instinctual responses that mediate attachment are activated and the mother figure remains unavailable. He defines mourning broadly, as the psychological processes set off by the loss of a loved object, whatever their outcome. Winnicott wanted to reserve the term for favourable outcomes; Bowlby rejects this, because separate terms for healthy and pathological courses would split psychopathology off from the general theory of personality. Following Elizabeth Zetzel, he treats depression as a normal affect and distinguishes it from depressive illness, or melancholia. The first part compares accounts of adult bereavement with observations of separated young children. The adult accounts are chiefly Lindemann's study of acute grief and Marris's interviews with seventy-two widows. The child observations, by James Robertson, Heinicke and others, are of children roughly six months to three years old who had been separated from their mothers. Bowlby groups the adult responses under five heads: - thought and behaviour still directed toward the lost person; - hostility toward the lost person, others or the self; - appeals for help; - despair, withdrawal and disorganization; - reorganization of behaviour around a new object. He finds each of these in the separated child: an early protest buoyed by hope of the mother's return, a persistent orientation toward her even when muted, diffuse hostility, rejection of would-be comforters, and despair once hope fades. He concludes that young children's responses to the loss of the mother figure differ in no material respect from adults' responses to bereavement, except probably in their consequences. Such mourning also lasts well beyond the few days Anna Freud had supposed. The second part reviews the literature. Anna Freud and Dorothy Burlingham recognized grief in their wartime nurseries, but their theory of ego development led them to deny that children under about two can truly mourn. Spitz called the syndrome he observed anaclitic depression rather than mourning, because it was not self-limiting, and explained it as aggression turned against the self. Bowlby argues that both fitted new observations into existing theories of primary narcissism, bodily need and melancholia. Both also confused the age after which grief is felt with the much later age after which mourning is likely to end well. He traces the theme back to two sources: Abraham, who tied melancholia to early disappointments in love yet never spoke of mourning, and the closing pages of Freud's Inhibitions, Symptoms and Anxiety, which the paper sets out to elaborate. He then turns to Bernfeld, Melanie Klein, Winnicott, Fairbairn and Erikson, who did recognize early mourning but located the decisive loss in the breast at weaning. He examines Klein's cases (Erna, Trude and Rita) and weaning studies of Navaho and Zulu children, and finds the evidence thin and mixed up with the loss of the mother's attention. He concludes that the significance of losing the breast has been exaggerated. The principal potential trauma of early childhood is the loss of the mother, or of her love. The processes Klein placed in the depressive position stretch from about six months into and beyond the fourth year, and in this period mourning readily takes a course unfavourable to later personality development.