Article
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.
Main ideas
- Protest, despair and detachment, the child's successive responses to separation from the mother, are three phases of a single process. Protest raises the problem of separation anxiety, despair that of grief and mourning, and detachment that of defence. Bowlby now prefers the more descriptive "detachment" to his earlier "denial".
- The child's tie to the mother rests on instinctual response systems, mostly non-oral. When they are activated and the mother figure is temporarily absent, separation anxiety and protest follow. When she stays unavailable, grief and mourning set in. This elaborates the late view in Freud's Inhibitions, Symptoms and Anxiety: anxiety answers the danger of losing the object, and pain answers its actual loss. Since the infant cannot yet tell temporary absence from permanent loss, a prolonged absence becomes a bereavement.
- "Mourning" should name the whole range of processes set off by losing a loved object, whatever their outcome. Keeping one term for healthy and pathological courses preserves psychoanalysis's integration of psychopathology with general personality theory. "Grief" names the subjective states that accompany mourning. "Depression" names a normal affect, as distinct from depressive illness. "Responses to loss" also covers forms such as caring for a vicarious object or manic excitement.
- Drawing on Lindemann's and Marris's studies of the bereaved, Bowlby groups adult mourning under five heads: orientation to the lost object, hostility, appeals for help, despair and disorganization, and reorganization around a new object. Persistent clinging to the lost person, such as the sense of the dead husband's continued presence reported by half of Marris's widows, confirms Freud's observation that a libidinal position is never willingly abandoned. Bowlby finds "disorganization" more useful than "regression" for describing the middle phase.
- Separated young children show the same pattern. They protest loudly in the hope of the mother's return and remain oriented toward her, even when the longing is muted. They show diffuse hostility, sometimes against the mother herself, rebuff substitute caretakers as a bereaved adult rebuffs comforters, and sink into apathy when hope fades. Apart probably from their consequences, these responses differ in no material respect from adult mourning.
- Against Anna Freud's view that grief at this age is short-lived and ends once a substitute is available, Bowlby cites Heinicke's systematic study, Robertson's observations and Helene Deutsch's 1919 case of a two-year-old. Mourning commonly lasts into the third week, even when familiar substitutes are present. Children accept food and comfort long before grief ends. Loss of the mother, not the strange setting, is the main variable.
- Anna Freud denied true mourning before the second year, on the ground that the young child is still governed by the pleasure principle and cannot test reality or master id tendencies. Spitz called his infants' syndrome anaclitic depression rather than mourning, because it was not self-limiting. Bowlby replies that ego regulation begins in the first year, and that Spitz underestimates the pain and disturbance of normal mourning. Both confuse the stage after which grief is felt with the much later stage after which mourning tends to end well; years separate the two.
- Two theoretical commitments explain why the long phase of attachment, and the reality of early mourning, were so long overlooked: primary narcissism and orality. Calling the loss of the mother a "severe injury to infantile narcissism", as Abraham did, misses its meaning as a true bereavement. Bowlby notes that the words grief and mourning are absent from the indexes of many standard psychoanalytic texts.
- There is a paradox in the literature. Abraham, Jacobson, Spitz and Sullivan saw how damaging the disruption of a whole-object relationship is in early childhood, but did not identify what follows as mourning. Bernfeld and Klein's school recognized infantile mourning, but fixed on part objects, the breast and weaning in the first year.
- Bowlby scrutinizes the clinical basis of Klein's view that oral sadism peaks at weaning and that the depressive position belongs to the first months, namely the early cases Erna, Trude and Rita. He finds the data meagre, shaped by expectations taken from Abraham, and blind to the normal intensity of attachment in the second and third years, which Klein treated as pathological fixation. He also questions Winnicott's stretching of "weaning" and "breast" to cover all of mothering up to eighteen months.
- The direct evidence on weaning, from Kluckhohn's study of Navaho children and Albino and Thompson's study of Zulu children, cannot separate loss of the breast from loss of the mother's attention. In both, weaning coincided with a new baby, the mother's absence or her rejection of the child. When weaning is gradual and the mother's attitude unchanged, responses are usually mild.
- Bowlby's thesis is that the significance of losing the breast has been exaggerated, and that a principal trauma potentially present in early childhood is the loss of the mother, or of her love. The processes connected with the depressive position extend from about six months into and beyond the fourth year. At this age mourning all too readily takes an unfavourable course. Later papers are to argue that personalities prone to depressive and other psychiatric illness are best understood as sequelae of pathological mourning.