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\n\n\n\n\n\n\n\nPreface\nix\n\n\nAcknowledgements\nx\n\n\nIntroduction by M. Masud R. Khan\nxi\n\n\nReferences\nxxxxix\n\n\nPart 1\n2\n\n\nChapter I. A Note on Normality and Anxiety [1931]\n3\n\n\nChapter II. Fidgetiness [1931]\n22\n\n\nPart 2\n33\n\n\nChapter III. Appetite and Emotional Disorder [1936]\n33\n\n\nChapter IV. The Observation of Infants in a Set Situation [1941]\n52\n\n\nChapter V. Child Department Consultations [1942]\n70\n\n\nChapter VI. Ocular Psychoneuroses of Childhood [1944]\n85\n\n\nChapter VII. Reparation in Respect of Mother's Organized Defence against Depression [1948]\n91\n\n\nChapter VIII. Anxiety Associated with Insecurity [1952]\n97\n\n\nChapter IX. Symptom Tolerance in Paediatrics A Case History [1953]\n101\n\n\nChapter X. A Case Managed at Home [1955]\n118\n\n\nPart 3\n129\n\n\nChapter XI. The Manic Defence [1935]\n129\n\n\nChapter XII. Primitive Emotional Development [1945]\n145\n\n\nChapter XIII. Paediatrics and Psychiatry [1948]\n157\n\n\nChapter XIV. Birth Memories, Birth Trauma, and Anxiety [1949]\n174\n\n\nChapter XV. Hate in the Countertransference [1947]\n194\n\n\nChapter XVI. Aggression in Relation to Emotional Development [1950-5]\n204\n\n\nChapter XVII. Psychoses and Child Care [1952]\n219\n\n\nChapter XVIII. Transitional Objects and Transitional Phenomena [1951]\n229\n\n\nChapter XIX. Mind and its Relation to the Psyche-Soma [1949]\n243\n\n\nChapter XX. Withdrawal and Regression [1954]\n255\n\n\nChapter XXI. The Depressive Position in Normal Emotional Development [1954-5]\n262\n\n\nChapter XXII. Metapsychological and Clinical Aspects of Regression within the Psycho-Analytical Set-Up [1954]\n278\n\n\nChapter XXIII. Clinical Varieties of Transference [1955-6]\n295\n\n\nChapter XXIV. Primary Maternal Preoccupation [1956]\n300\n\n\nChapter XXV. The Antisocial Tendency [1956]\n306\n\n\nChapter XXVI. Pædiatrics and Childhood Neurosis [1956]\n316\n\n\nBibliography\n322\n\n\n\n

\n\n\n

Preface

THIS BOOK collects together various contributions that I have addressed to scientific audiences.

The student will not turn to these pages for instruction in basic psychoanalytic concepts and techniques. A knowledge of these I was able to take for granted since my audience was composed chiefly of analysts. I have been concerned with putting forward my own point of view and testing out my own ideas as they came to me in the course of my clinical work.

My clinical experience has been varied. I have never cut loose from paediatric practice which was my starting point. It has been valuable to me to keep in touch with social pressure, which I have had to meet as physician at a children's hospital. Also I have enjoyed the constant challenge of private practice and the therapeutic consultation. These interests have provided me with an opportunity for applying in a general way what I have at the same time been learning through the practice of psycho-analysis proper.

My hope is that this book will show that paediatrics is one of the legitimate ways into psycho-analysis, and indeed a good one.

It has been found convenient to group the papers into three sections. In the first section are reprinted two chapters from an earlier book (Winnicott, 1931), now out of print, and in these chapters is represented my attitude as a paediatrician prior to my training in psycho-analysis. I wrote as a paediatrician to paediatricians.

The papers in the second section can be recognized as coming from a paediatrician—one, however, who has become psycho-analytically orientated.

The third section is my personal contribution to current psycho-analytic theory and practice.

1957 D. W. Winnicott, F.R.C.P. (Lond.)

Physician, Paddington Green Children's Hospital, London W.2

Physician-in-Charge, Child Department, London Clinic of Psycho-Analysis, London W.1

\nix\n

Acknowledgements

I wish to acknowledge my debt to my secretary, Mrs Joyce Coles.

I am grateful to Mr M. Masud R. Khan for compiling the index and for many helpful criticisms and suggestions.

Thanks are recorded to the following individuals, publishers, and organizations for permission to publish material that has already appeared in print: the Editor of the British Journal of Medical Psychology; the Editor of Case Conference; Mrs W. M. Davies and Jonathan Cape Limited for the poem ‘Infancy’, from The Collected Poems of W. H. Davies, which appears on p. 166; William Heinemann Limited; the Editor of the International Journal of Psycho-Analysis; the Ophthalmological Society; the Editor of Psyche; the Editor of the Revue française de Psychanalyse; the Royal Society of Medicine.

\nx\n\n

Introduction

\nM. Masud R. Khan\n\n\n

If you should ever come round to writing about me…, be sensible enough—as nobody has been till now—to characterise me, to ‘describe’—but not to ‘evaluate’.

\nNietzsche to Carl Fuchs.\n

As I look back over some 20 years of working with Winnicott, what stands out vividly is his relaxed physicality and a lambent concentration in his person. Winnicott listened with the whole of his body, and had keen unintrusive eyes that gazed at one with a mixture of unbelief and utter acceptance. A childlike spontaneity imbued his movements. Yet he could be so still, so very inheld and still. I have not met another analyst who was more inevitably himself. It was this quality of his inviolable me-ness that enabled him to be so many different persons to such diverse people. Each of us who has encountered him has his own Winnicott, and he never transgressed the other's invention of him by any assertion of his own style of being. And yet he always stayed so inexorably Winnicott.

I have advisedly started by defining Winnicott in his body-presence, because one cannot begin to understand his talent as a clinician if one is not aware that in him psyche and soma were in perpetual dialogue and debate, and his theories are abstractions of that constant happening which was Winnicott the living person and clinician. And here again Winnicott the man and Winnicott the therapist were mutual to each other and of a piece. That said, let us now consider Winnicott the theoretician. He was reared in the tradition of his people, the English. For him facts were the reality, theories were the human stammer towards grasping the facts. He had a militant incapacity to accept dogma. Winnicott was a non-conformist by upbringing; nothing was given and absolute. Each man had to find and define his own truth. What was given was the experiential spectrum. And it was towards making sense of his long encounter with the clinical realities that he devoted all his energies.

\n\n

This is a revised and enlarged version of my introduction to the French edition of Winnicott's Therapeutic Consultations in Child Psychiatry which he had wished me to write. I would like to thank J.-B. Pontalis, editor of “Connaissance de L'Inconscient” (Gallimard), the series in which that book appeared, for his persistent encouragement which enabled me to get it done. I am indebted to Mrs. Clare Winnicott for reading my text with diligent care and helping me to correct significantly certain imbalances of tone and texture.

\nxi\n

As is the wont of his people he wrote in the simplest vernacular. There is no rhetoric or intimidating jargon in his écriture. He wrote as he spoke: simply and to relate. Not to incite conviction or indoctrinate. He made his idiom so much that of the ordinary cultured and common usage that everyone was illusioned into the make-believe that they have always known what he was saying. This paradox of méconnaissance rather pleased him. Yes, he had a huge pride and his self-esteem could be daunted only by his own errors, but not the censure of others.

As I started to write this essay years flashed across my eyes. I recalled the first time I had heard Winnicott give his address from the chair at the Medical Section of the British Psychological Society: ‘Paediatrics and Psychiatry’ (Chapter XIII below). It was way back in 1948. I had listened to this strange man, speaking the King's English and telling us what was so patently clear and yet rarely spoken of. He spoke with a clarity and conviction that allowed both for doubt and debate. From then on I was determined to find out more about him and his way of working. Thanks to the late Dr. John Rickman, Winnicott allowed me to attend one of his ‘squiggle game’ consultations at the Paddington Green Hospital. Nothing could have been less like the expected medico-clinical environment. It was a true happening. If one was less generous, one would say it was a chaos held together by him. He was talking to the parents, while a child was absorbed drawing some nonsence of private and acute significance. Winnicott would shift from the parents to the child, facilitating both in their distinct attempts to share their predicament. One was tempted to think this was sheer magic. And it was certainly not magic, because magic works only through accomplices and not with witnesses and recalcitrant participants.

It was then that I was convinced that behind all the naive and wayward innocence and spontaneity of his behaviour there was a complex mind guiding the manoeuvres and constantly checking its own abstractions. The practice of Winnicott was anchored in a growing and intricate theory costing him, as he used to say quoting Eliot's verse, “not less than everything”, to evolve and elaborate, in personal and clinical experience.

Inner Reality Versus Fantasying

One cannot define the true character and nature of Winnicott's researches unless one sees them evolving in a certain phase and climate of conceptual and clinical debate in the British Psycho-Analytic Society. The decade 1928-1938 was perhaps the most vital and creative period of research in the British Society. There was Freud's sovereign presence in the background in Vienna. Freud's own work had been augmented by his hypotheses of the structure of mind in terms of Ego, Id and the Superego (1923) and his revision of the theory of anxiety (1926), which had placed ego at the centre of psychic functioning and behavioural

\nxii\nrealities. A little earlier he had also introduced the concept of the duality of instincts: life and death instinct (1921). A little further away, in Budapest, the fertile and prodigiously creative mind of Ferenczi was opening up new dimensions of clinical venturesomeness for the analysts. Alongside, Anna Freud and Melanie Klein had started their researches with child-analysis (cf. Smirnoff 1971).\n

For the British Society what turned out to be a momentous event was the invitation of its then President, Dr. Ernest Jones, to Melanie Klein to lecture and work in London in 1926. Her peculiar talent for understanding the unconscious fantasies in the young child, through play-techniques, gripped the imagination of her British colleagues, just as it had roused suspicion and resistance in Berlin and Vienna.

I must pause and say a little about the sort of persons who were significant in the British Society during this decade. They were all of liberal humanistic education and leanings. Ernest Jones was the chief governing personage. Then there were James and Alix Strachey, Adrian and Karen Steven—of the Bloomsbury background. And John Rickman, a Quaker who had travelled to psychoanalysis via work in Russia, Vienna and Budapest. And Sylvia Payne, who had been honoured for her work with shell-shocked troops from 1914-1919 war. And Ella Sharpe, who had come to analysis from teaching literature. And Joan Riviere, Barbara Low, J. C. Flugel, Susan Isaacs, Marjorie Brierley and above all Dr. Edward Glover—a great and passionate teacher, whose clarity of thought was matched only by his creative vigour.

It was to this vital group of individuals that Melanie Klein addressed her work. It was a decade of true and open dialogue in the British Society, and Klein's researches influenced everyone's thinking. She had not pushed her work to the status of apostacy as yet. Winnicott came to psychoanalysis from paediatrics in this lively climate. He was a singular being and had already established his clinical position in his book Disorders of Childhood (1931). Here he had taken a most unpopular and revolutionary stand vis-à-vis the emotional disturbance that could lead to arthritis in children. And the case of Eleanor in that book already shows us glimpses of Winnicott's unique capacity to capture in écriture his clinical encounter with a child. As his clinical work in psychoanalysis—with children and adults—actualised over some four decades, it was to become patently clear that he was as revolutionary and uncomfortable a colleague among analysts as he had been with the paediatricians.

Winnicott's was a joyous and troubled soul; and he exploited both these assets to the maximum in his life and work. He spared himself nothing. He had long personal analysis, first with James Strachey and then with Joan Riviere. He discovered himself through his personal and professional relationships. For Winnicott the human individual was an

\nxiii\nunknowable isolate, who could personalise and know himself only through the other, as he has discussed it in his paper ‘The Capacity to be Alone’ (1958b). It is to the explication of this crucial human paradox that he applied the extreme diligence of his clinical effort and acumen.\n

Winnicott presented his first statement of how he was going to look at the human person, in his paper titled ‘The Manic Defence’ at a Scientific Meeting of the British Psycho-Analytical Society on 4th December, 1935. I give these seemingly insignificant details to show that Winnicott was to run into a special sort of difficulty with his analytic colleagues, from the start—that of being politely disregarded. Though this paper was given in 1935, it was not until 1957, when he invited me to put together his first collection of papers, that I came across the typed manuscript of this paper and was surprised it had not been published anywhere for over 20 years. It was then published in the first edition of this book in 1958 (Chapter XI). In this paper Winnicott already takes up his distinctive stand:

\n\n

I have come to compare external reality not so much with fantasy as with an inner reality…it is part of one's own manic defence to be unable to give full significance to inner reality…Fantasy is part of the individual's effort to deal with inner reality. It can be said that fantasy (I would now use the term ‘fantasying’—footnote added in 1957) and day-dreams are omnipotent manipulations of external reality. Omnipotent control of reality implies fantasy about reality. The individual gets to external reality through the omnipotent fantasies elaborated in the effort to get away from inner reality.

\n\n

To these statements Winnicott added a significant footnote in 1957:

\n\n

The term ‘psychic reality’ does not involve any placing of the fantasy; the term ‘inner reality’ presupposes the existence of an inside and an outside, and therefore of a limiting membrane belonging to what I would now call the ‘psyche-soma’.

\n\n

The argument that Winnicott had initiated in this paper he spelt out in greater detail and in more personal idiom in his paper ‘Primitive Emotional Development’ (Chapter XII below), exactly a decade later. Here Winnicott detailed three processes that constitute the beginnings of inner reality and start very early:

\n\n

integration, personalization, and, following these, the appreciation of time and space and other properties of reality—in short, realization.

\n\n

To this he added:

\n\n

It may be assumed that at the theoretical start the personality is unintegrated, and that in regressive disintegration there is a primary

\nxiv\nstate to which regression leads. We postulate a primary unintegration.\n

And Winnicott re-introduced the concept of dissociation at this stage—a debt he owed to Glover's researches, but without ever acknowledging it:

\n\n

Out of the problem of unintegration comes another, that of dissociation. Dissociation can usefully be studied in its initial or natural forms. According to my view there grows out of unintegration a series of what are then called dissociations, which arise owing to integration being incomplete or partial.

\n\n

This line of research was to lead him to give his definitive statement about the dissociation in inner reality in his paper ‘Ego Distortion in Terms of True and False Self’ (1960). This paper is indispensible in its entirety for the understanding of his clinical work. It has to be read again and again because it is over-condensed and cryptic in its style. I shall pick out only his distinction between ego-needs and id-needs, because this constitutes a revolutionary shift of emphasis in contemporary analytic thinking and practice. The crucial passage is:

\n\n

It must be emphasized that in referring to the meeting of infant needs I am not referring to the satisfaction of instincts. In the area that I am examining the instincts are not yet clearly defined as internal to the infant. The instincts can be as much external as can a clap of thunder or a hit. The infant's ego is building up strength and in consequence is getting towards a state in which id-demands will be felt as part of the self, and not as environmental. When this development occurs, then id-satisfaction becomes a very important strengthener of the ego, or of the True Self; but id-excitements can be traumatic when the ego is not yet able to include them, and not yet able to contain the risks involved and the frustrations experienced up to the point when id-satisfaction becomes a fact.

\n\n

He then drew a very significant conclusion for our clinical practice from elaborization of this hypothesis of True and False Self:

\n\n

A principle might be enunciated, that in the False Self area of our analytic practice we find we make more headway by recognition of the patient's non-existence than by a long-continued working with the patient on the basis of ego-defence mechanisms. The patient's False Self can collaborate indefinitely with the analyst in the analysis of defences, being so to speak on the analyst's side in the game. This unrewarding work is only cut short profitably when the analyst can point to and specify an absence of some essential feature: ‘You have no mouth’, ‘You have not started to exist yet,’ ‘Physically you are a man, but you do not know from experience anything

\nxv\nabout masculinity,’ and so on. These recognitions of important fact, made clear at the right moments, pave the way for communication with the True Self. A patient who had had much futile analysis on the basis of a False Self, co-operating vigorously with an analyst who thought this was his whole self, said to me: ‘The only time I felt hope was when you told me that you could see no hope, and you continued with the analysis.’\n

In this context Winnicott considered that fantasying can become an organised way of sustaining the False Self organization in a person. He further believed that the classical technique with its bias to merely interpret the meaning of a patient's behaviour in terms of unconscious fantasy systems can in certain cases of acute dissociation in inner reality become the accomplice of a patient's False Self, and perpetuate its pathologies with interpretative annotations. He had good reason to believe this from actual clinical experience, because many a patient who had had long analyses in one form or another turned to him for help, and he was often able to change the whole inner climate of sensibility in people by enabling them to see how this specific dissociation of True and False Self operated in them.

For Winnicott it became progressively more important to define the role of imagination, illusion and playing in the transitional area and space from which all true spontaneous gestures of self-actualization are initiated and crystallised into a personal tradition of inner reality, which is more than fantasying.

From the Transitional Object to Use of an Object

Somewhere Goethe says: “I hate everything that merely instructs me without increasing or directly quickening my activity.” In a certain sense this is true of Winnicott's sensibility. He could learn from others only if it awakened him more sharply and largely towards his own self. I recall one Sunday morning calling on him, with Professor Lionel Trilling's Freud and the Crisis of our Culture, and urging him to read it. He hid his face in his hands, paused, convulsed himself into visibility and said: “It is no use, Masud, asking me to read anything! If it bores me I shall fall asleep in the middle of the first page, and if it interests me I will start re-writing it by the end of that page.” Of course he was pulling his own leg, and both of mine, and he had a puckish knack for that, indeed. But he was also telling the truth, and truth with us humans is true only through metaphor and paradox. The statistical precision is the machine's measure, but not an index to human verities.

Little wonder that this man should have given us the concept of the transitional object, phenomena and space. Only to dogmatise his abstractions from clinical experiences to the status of concepts is to distort his style of thinking. They are more exactly and wilfully, what

\nxvi\nNietzsche calls, “regulative fictions”. None of Winnicott's “regulative fictions” has received such instant acclaim as that of the transitional object.\n

This seemingly explicit and easily comprehensible notion, because Winnicott considered it no more than that himself, has a complex clinical vécu behind it.

During his time at the Paddington Green Children's Hospital and the Queen's Hospital for Children, across a span of some four decades, he had seen nearly 60,000 infants, children, mothers, fathers, parents and grandparents. The first statement by Winnicott in this rea of research is in his paper ‘The Observation of Infants in a Set Situation’ (Chapter IV below). Here he describes a certain pattern of an infant's behaviour vis-à-vis the spatula in the setting of the consultation between him and the mother. His statement about these phenomena is so important that I must repeat it here at length:

\n\n

Stage 1. The baby puts his hand to the spatula, but at this moment discovers unexpectedly that the situation must be given thought. He is in a fix. Either with his hand resting on the spatula and his body quite still he looks at me and his mother with big eyes, and watches and waits, or, in certain cases, he withdraws interest completely and buries his face in the front of his mother's blouse. It is usually possible to manage the situation so that active reassurance is not given, and it is very interesting to watch the gradual and spontaneous return of the child's interest in the spatula.

Stage 2. All the time, in the ‘period of hesitation’ (as I call it), the baby holds his body still (but not rigid). Gradually he becomes brave enough to let his feelings develop, and then the picture changes quite quickly. The moment at which this first phase changes into the second is evident, for the child's acceptance of the reality of desire for the spatula is heralded by a change in the inside of the mouth, which becomes flabby, while the tongue looks thick and soft, and saliva flows copiously. Before long he puts the spatula into his mouth and is chewing it with his gums, or seems to be copying father smoking a pipe. The change in the baby's behaviour is a striking feature. Instead of expectancy and stillness there now develops self-confidence, and there is free bodily movement, the latter related to manipulation of the spatula.

I have frequently made the experiment of trying to get the spatula to the infant's mouth during the stage of hesitation. Whether the hesitation corresponds to my normal or differs from it in degree of quality, I find that it is impossible during this stage to get the spatula to the child's mouth apart from the exercise of brutal strength. In certain cases where the inhibition is acute any

\nxvii\neffort on my part that results in the spatula being moved towards the child produces screaming, mental distress or actual colic.\n

The baby now seems to feel that the spatula is in his possession, perhaps in his power, certainly available for the purposes of self-expression. He bangs with it on the table or on a metal bowl which is nearby on the table, making as much noise as he can; or else he holds it to my mouth and to his mother's mouth, very pleased if we pretend to be fed by it. He definitely wishes us to play at being fed, and is upset if we should be so stupid as to take the thing into our mouths and spoil the game as a game.

At this point, I might mention that I have never seen any evidence of a baby being disappointed that the spatula is, in fact, neither food nor a container of food.

Stage 3. There is a third stage. In the third stage the baby first of all drops the spatula as if by mistake. If it is restored he is pleased, plays with it again, and drops it once more, but this time less by mistake. On its being restored again, he drops it on purpose, and thoroughly enjoys aggressively getting rid of it, and is especially pleased when it makes a ringing sound on contact with the floor.

The end of this third phase comes when the baby either wishes to get down on the floor with the spatula, where he starts mouthing it and playing with it again, or else when he is bored with it and reaches out to any other objects that lie at hand.

\n\n

What I want to single out for special comment here is what Winnicott calls “the period of hesitation”. Because even a cursory look at the material presented in Therapeutic Consultations in Child Psychiatry will reveal all too vividly how the essence of the squiggle game is how Winnicott creates a space, a transitional space, where this “period of hesitation” has not only full scope but is also facilitated by him to emerge towards a creative gesture, namely the squiggle itself. This is also an important concept for psycho-analytical theory in general and our clinical work with adults in particular. The concept of the “period of hesitation” adds something new to the classical concept of resistance, as we know it in Freud's work. Quite often in analytical writings one comes across interpretation of resistance to a patient where in fact the reality is that the patient is in the “period of hesitation”, or in other words the patient is groping to find “a kind of intimacy” in the analytical situation where he can gradually make his first verbal or gestural contribution. The concept of the “period of hesitation” also links up Winnicott's work with that of Hartmann's (1958) researches on the conflict-free ego sphere.

Winnicott developed this further in his paper ‘Primitive Emotional Development’ (Chapter XII below) where, discussing the baby's first experiences of the mother, he says:

\nxviii\n\n

In terms of baby and mother's breast (I am not claiming that the breast is essential as a vehicle of mother-love) the baby has instinctual urges and predatory ideas. The mother has a breast and the power to produce milk, and the idea that she would like to be attacked by a hungry baby. These two phenomena do not come into relation with each other till the mother and child live an experience together. The mother being mature and physically able has to be the one with tolerance and understanding, so that it is she who produces a situation that may with luck result in the first tie the infant makes with an external object, an object that is external to the self from the infant's point of view.

I think of the process as if two lines came from opposite directions, liable to come near each other. If they overlap there is a moment of illusion—a bit of experience which the infant can take as either his hallucination or a thing belonging to external reality.

\n\n

What Winnicott in his introduction to Therapeutic Consultations in Child Psychiatry calls “a kind of intimacy” he is here describing as the relationship in which mother and child “live and experience together”. He also added to his earlier statement about the spatula game a new element, namely, “a moment of illusion”. It is from this particular point that he was to take his next step of crystallising the concept of the transitional object and phenomena.

The concept of the transitional object itself is well known. Winnicott has discussed it and its implications in great detail in his book Playing and Reality (1971b). I shall detail here his summary of the special qualities in the infant's relationship to the transitional object.

The infant assumes rights over the object, and we agree to this assumption. Nevertheless, some abrogation of ‘omnipotence’ is a feature from the start.

The object is affectionately cuddled as well as excitedly loved and mutilated.

It must never change, unless changed by the infant.

It must survive instinctual loving, and also hating and, if it be a feature, pure aggression.

Yet it must seem to the infant to give warmth, or to move, or to have texture, or to do something that seems to show it has vitality or reality of its own.

It comes from without from our point of view, but not so from the point of view of the baby. Neither does it come from within; it is not a hallucination.

Its fate is to be gradually allowed to be ‘decathected’, so that in the course of years it becomes not so much forgotten as relegated to limbo. By this I mean that in health the transitional

\nxix\n

object does not ‘go inside’ nor does the feeling about it necessarily undergo repression. It is not forgotten and it is not mourned. It loses meaning, and this is because the transitional phenomena have become diffused, have become spread out over the whole intermediate territory between ‘inner psychic reality’ and ‘the external world as perceived by two persons in common’, that is to say, over the whole cultural field.

\n\n

The important point to note is that the transitional object is not significant because it is a thing; its thingness is crucial only because it helps the child to sustain a growing and evolving inner reality and helps it to differentiate it from the not-self world.

Winnicott himself has stated that the transitional object

\n\n

is not the cloth or the teddy bear that the baby uses—not so much the object used as the use of the object. I am drawing attention to the paradox involved in the use by the infant of what I have called the transitional object. My contribution is to ask for a paradox to be accepted and tolerated and respected, and for it not to be resolved. By flight to split-off intellectual functioning it is possible to resolve the paradox, but the price of this is the loss of the value of the paradox itself.

\n\n

Winnicott was very well aware that his concept of the transitional object had many close correspondences to some of the concepts in literature and art. For example, the Cubist collages of Braque and Picasso have distinctly the quality of the transitional object in so far as they assimilate the given to the created, the imagined to the concretely found in one space—that of the canvas—and there give it a new unity and reality. Similarly, the aesthetics of Mallarmé and Joyce's concept of epiphany are trying to discuss the same type of human activity and experience. It is for this reason that Winnicott later on towards the end of his life was much more interested in how culture and all its vocabulary of symbols and symbolic activities help the individual to find as well as to realise himself. The concept of the transitional object has helped psychoanalytical thinking to re-evaluate the role of culture as a positive and constructive increment in human experience and not as a cause for discontent.

But the most important development in Winnicott's later thinking that resulted from this area of research was in his differentiation between object-relating and the use of an object. He gives a very succinct statement of it in his paper ‘The Use of an Object’ (1969). His summary of it is:

\n\n

Object-relating can be described in terms of the experience of the subject. Description of object-usage involves consideration of the nature of the object. I am offering for discussion the reasons why,

\nxx\nin my opinion, a capacity to use an object is more sophisticated than a capacity to relate to objects; and relating may be to a subjective object, but usage implies that the object is part of external reality. This sequence can be observed: (1) Subject relates to object. (2) Object is in process of being found instead of placed by the subject in the world. (3) Subject destroys object. (4) Object survives destruction. (5) Subject can use object.\n

The object is always being destroyed. This destruction becomes the unconscious backcloth for love of a real object; that is, an object outside the area of the subject's omnipotent control.

Study of this problem involves a statement of the positive value of destructiveness. The destructiveness, plus the object's survival of the destruction, places the object outside the area of objects set up by the subject's projective mental mechanisms. In this way a world of shared reality is created which the subject can use and which can feed back other-than-me substance into the subject.

\n\n

The implications of this hypothesis for the understanding of what happens in transference are indeed both most intriguing and complex because it gives a new dimension to the experience of destructiveness in the total climate of the clinical setting. The concept of transitional object and the differentiation between object-relation and use of an object help us to experience and examine the total behaviour of the patient in the clinical situation in quite a different way. Here non-relating by the patient is no longer a negation of relating but an attempt to move from object-relating to use of the analyst as an object. This gives the classical concept of transference, which is largely seen in terms of repetition of early object-relationships and unconscious fantasy systems reflecting archaic Id-impulses, a larger scope and range. A new potentiality emerges in the clinical space and relating for imaginative and affective realization of the self through the use of the analyst both as a transitional object and as an object which is objective object. Winnicott's emphasis here is that in this area of psychic functioning what is involved is essentially “the paradox and the acceptance of the paradox: the baby creates the object, but the object was there waiting to be created and to become a cathected object.” In terms of the transference it means that the analyst and the patient are part of a larger total process in the clinical setting, in which each is being ‘created’ and ‘found’ by the other. It is this mutuality and reciprocity that creates a new dialogic dynamism, which is more than merely object-relating in the transference. Winnicott (1970) gives a clinical account of ‘the experience of mutuality’ from his analysis of an adult 40 year old female patient, who was married and had two children. She had come to him for further treatment after six years of analysis with a female colleague:

\nxxi\n\n

The detail I have chosen for description has to do with the absolute need this patient had, from time to time, to be in contact with me. (She had feared to make this step with a woman analyst because of the homosexual implications.)

A variety of intimacies were tried out, chiefly those that belong to infant feeding and management. There were violent episodes. Eventually it came about that she and I were together with her head in my hands.

Without deliberate action on the part of either of us there developed a rocking rhythm. The rhythm was rather a rapid one, about 70 per minute (c.f. heartbeat), and I had to do some work to adapt to this rate. Nevertheless, there we were with mutuality expressed in terms of a slight but persistent rocking movement. We were communicating with each other without words. This was taking place at a level of development that did not require the patient to have maturity in advance of that which she found herself possessing in the regression to dependence of the phase of her analysis.

This experience, often repeated, was crucial to the therapy, and the violence that had led up to it was only now seen to be a preparation and a complex test of the analyst's capacity to meet the various communicating techniques of early infancy.

\n\n

Regression, Management and Playing in the Clinical Setting

\n\n

It is related of Ibn el-Arabi that people said to him: ‘Your circle is composed mainly of beggars, husbandmen and artisans. Can you not find people of intellect who will follow you, so that perhaps more authoritative notice might be taken of your teachings?’

He said: ‘The Day of Calamity will be infinitely nearer when I have influential men and scholars singing my praises; for without any doubt they will be doing so for their own sake and not for the sake of our work!’

\nIdries Shah, The Wisdom of the Idiots\n

For every one lecture that Winnicott was asked to give to one of the so-called learned professional societies, he gave at least a dozen to gatherings of social workers, child-care organisations, teachers, priests, etc. It yielded him a peculiar satisfaction to be able to talk to the ordinary people who were deeply concerned with the care of others, be they children, adults in distress, or hapless persons who were lost in a world that was beyond their means of coping. One reason for this was that he learnt more from such encounters than from debate with the prearranged intellect of his colleagues. He also harboured a horror of cleverness and the mind-game, to which, one has to admit, contemporary psychoanalytic thinking lends itself rather too readily. Furthermore Winnicott felt free to present the paradox that was him to persons that

\nxxii\nwere interested in the care, rather than the cure, of the psychiatrically ill persons: be they children or adults.\n

In no other area of his researches did the need for paradox that was so characteristic of Winnicott's sensibility actualise itself more dramatically than in his two styles of clinical work: with the children through the idiom of the squiggle playing, and in his analytic treatment of adults, whom he held through long phases of regression to dependence in the analytic situation. To the climate of “a kind of intimacy”, with its spontaneity of gesture and speech in a shared reciprocity of playing with the child in the therapeutic consulation, he counterpoised the sustained holding of a patient in regression to dependence in the analytic situation. Therapeutic Consultations gives us vivid samples of joyous clinical encounters between Winnicott and the young patients. But nowhere does one find an account of the extraordinary stillness of an awake somatic presence that was his in the clinical situation. Only those of us who have had the privilege to be his patients and in-care with him can testify to its unique quality of attention: both psychic and somatic.

Winnicott gave his first detailed clinical account of regression to dependence in an adult patient in his paper “Metapsychological and Clinical Aspects of Regression within the Psycho-Analytical Set-up” (Chapter XXII below). His basic theory was:

\n\n

… it is not useful to use the word regression whenever infantile behaviour appears in a case history. The word regression has derived a popular meaning which we need not adopt. When we speak of regression in psycho-analysis we imply the existence of an ego organization and a threat of chaos. There is a great deal for study here in the way in which the individual stores up memories and ideas and potentialities. It is as if there is an expectation that favourable conditions may arise justifying regression and offering a new chance for forward development, that which was rendered impossible or difficult initially by environmental failure.

\n\n

What needs to be specially noticed in this statement is the phrase “an expectation that favourable conditions may arise justifying regression.” Winnicott believed, and the clinical experience of others has proved this as well, that a person at the point of need to regress to dependence can never manage it on his own, or ask for it, unless someone can sense this need in him and reach out and meet it. His work with the so-called delinquent children had taught him how such anti-social acts were a way of stating need and staking a demand (Winnicott 1956b). In the analytic situation he learnt to recognise the deprived patient's inability to claim his need, not by his resistance, but by his incapacity to enter that “playing” which we call free-association. Freud had the genius

\nxxiii\nand compassion to comprehend that a patient's inability to speak his truth was not refusal but an unconscious resistance, and only revealing its sources would help the patient tell it. Winnicott added to this a new dimension: namely, that there are persons whose primary care-taking environment has been so deficient that what they need to tell happened when they had not the necessary ego-capacities to cope with or cognize it. They could only register it. Hence the responsibility of the analyst to reach out, read and meet their need.\n

In this context Winnicott makes an important distinction between the role of wishes and needs in the clinical process:

\n\n

It is proper to speak of the patient's wishes, the wish (for instance) to be quiet. With the regressed patient the word wish is incorrect; instead we use the word need. If a regressed patient needs quiet, then without it nothing can be done at all. If the need is not met the result is not anger, only a reproduction of the environmental failure situation which stopped the processes of self growth. The individual's capacity to ‘wish’ has become interfered with, and we witness the reappearance of the original cause of a sense of futility.

The regressed patient is near to a reliving of dream and memory situations; an acting out of a dream may be the way the patient discovers what is urgent, and talking about what was acted out follows the action but cannot precede it.

\n\n

Those among his colleagues who have imputed that Winnicott fostered regression in his patients have not kept this distinction in mind. Furthermore Winnicott was referring to an area of incapacity in the patient from early environmental failure which can be realised by the patient through this very specialised type of “acting out” in the analytic situation. Winnicott gives a schematic account of the processes involved as follows:

The provision of a setting that gives confidence.

Regression of the patient to dependence, with due sense of the risk involved.

The patient feeling a new sense of self, and the self hitherto becoming surrendered to the total ego. A new progression of the individual processes which had stopped.

An unfreezing of an environmental failure situation.

From the new position of ego strength, anger related to the early environmental failure, felt in the present and expressed.

Return from regression to dependence, in orderly progress towards independence.

Instinctual needs and wishes becoming realizable with genuine vitality and vigour.

\n\n

\nxxiv\n

Winnicott had modelled the arrangement of the clinical situation and the relating to the regressed patient on the pattern of “the ordinary devoted mother's” care of her infant and child. This, by definition, puts special strain on the so-called counter-transference sensibility, as well as capability, of the analyst. In his paper “Hate in the Countertransference” (Chapter XV below) he discussed this issue in some detail. I shall quote only one crucial passage here:

\n\n

If the analyst is going to have crude feelings imputed to him he is best forewarned and so forearmed, for he must tolerate being placed in that position. Above all he must not deny hate that really exists in himself. Hate that is justified in the present setting has to be sorted out and kept in storage and available for eventual interpretation.

\n\n

Winnicott was fully cognizant of the relentless ingratitude in the patient at the point of regression to need, which in the countertransference can be met not by compassion or interpretations but by dosed hate. Because here all too often denial of hate in the countertransference degenerates the clinical relationship to one of coaxing the patient with urgent concern or bullying him with verbose interpretations that add merely insults to the patient's incapacities.

Another feature of the quality of attention demanded from the analyst by the patient in a regressed state can be best described in terms of what Winnicott has called “primary maternal preoccupation” (1956a).

\n\n

If the mother provides a good enough adaptation to need, the infant's own line of life is disturbed very little by reactions to impingement. (Naturally, it is the reactions to impingement that count, not the impingements themselves.) Maternal failures produce phases of reaction to impingement and these reactions interrupt the ‘going on being’ of the infant. An excess of this reacting produces not frustration but a threat of annihilation. This in my view is a very real primitive anxiety, long antedating any anxiety that includes the word death in its description.

In other words, the basis for ego establishment is the sufficiency of ‘going on being’, uncut by reactions to impingement. A sufficiency of ‘going on being’ is only possible at the beginning if the mother is in this state that (I suggest) is a very real thing when the healthy mother is near the end of her pregnancy, and over a period of a few weeks following the baby's birth.

Only if a mother is sensitized in the way I am describing can she feel herself into her infant's place, and so meet the infant's needs. These are at first body-needs, and they gradually become ego-needs as a psychology emerges out of the imaginative elaboration

\nxxv\nof physical experience. There comes into existence an ego-relatedness between mother and baby, from which the mother recovers, and out of which the infant may eventually build the idea of a person in the mother. From this angle the recognition of the mother as a person comes in a positive way, normally, and not out of the experience of the mother as the symbol of frustration. The mother's failure to adapt in the earliest phase does not produce anything but an annihilation of the infant's self.\n

What the mother does well is not in any way apprehended by the infant at this stage. This is a fact according to my thesis. Her failures are not felt as maternal failures, but they act as threats to personal self-existence.

In the language of these considerations, the early building up of the ego is therefore silent. The first ego organisation comes from the experience of threats of annihilation which do not lead to annihilation and from which, repeatedly, there is recovery. Out of such experiences confidence in recovery begins to be something which leads to an ego and to an ego capacity for coping with frustration.

\n\n

I have quoted at length because in this very simple statement are given all the crucial crises that we run into in the clinical management of the patient at the point of regression to dependence. Here the failures in the analytic situation are invariably from our incapacity to meet the patient's need and not from the resistances in the patient. Furthermore, if we can metaphorise what Winnicott defines as the mother's role into the analyst's sensitivity towards the patient's need, then we have a useful schema to guide our behaviour towards the patient.

The clinical coping with the patient's need at the point of regression to dependence inevitably entails management, rather than interpretation. In Winnicott's work one finds three basic types of management indicated:

The quality of the analytic setting: its quiet and freedom from impingement on the patient;

The provision by the analyst of what is required by the patient: be it absention from intrusion by interpretation, and/or a sensitive body-presence in his person, and/or letting the patient move around and just be and do what he needs to;

The management that can be provided only by the social and familial environment; here the range is from hospitalization to care by family and friends.

\n\n

The important thing to note about the issue of management is that it is neither indulging the patient's whims and wishes nor avoiding meeting the demand for help by reassurance. Management, in fact, is the provision of that environmental adaptation, in the clinical situation and

\nxxvi\noutside it, which the patient had lacked in his developmental process, and without which all he can do is exist through reactive exploitation of defence mechanisms as well as his id-potential. It is only when management has been effective for the patient that interpretative work can have clinical value. Management and interpretative work often run alongside, supporting and facilitating each other in the total life experience of the patient.\n

As Winnicott's skill increased and his concepts gained in range and depth he was able to facilitate regression to dependence in symbolic forms, for example in a dream. He gives a very neat example of this in his paper ‘Dependence in Infant-Care, in Child-Care, and in the Psycho-Analytic Setting’ (1963b). Also he began to see that what the patient needed to arrive at were phases of regression and not necessarily a sustained regressive life-style. His latest statement about it being:

\n\n

I have found that the patient has needed phases of regression to dependence in the transference, these giving experience of the full effect of adaptation to need that is in fact based on the analyst's (mother's) ability to identify with the patient (her baby). In the course of this kind of experience there is a sufficient quantity of being merged in with the analyst (mother) to enable the patient to live and to relate without the need for projective and introjective identificatory mechanisms. Then comes the painful process whereby the object is separated out from the subject, and the analyst becomes separated off and is placed outside the omnipotent control of the patient. The analyst's survival of the destructiveness that belongs to and follows this change enables a new thing to happen, which is the patient's use of the analyst, and the initiation of a new relationship based on cross-identifications. The patient can now begin to stand imaginatively in the analyst's shoes, and (at the same time) it is possible and good for the analyst to stand in the patient's shoes from a position, that is, of having his own feet on the ground.

\n\n

Across some four and more decades of intensive clinical work Winnicott gradually began to arrive at a sort of synthesis of his various clinical practices and theories. He gives a definitive account of it in his last book Playing and Reality. To him the extreme discipline, containment and reticence needed in holding a patient through phases of regression to dependence, and all that was entailed in management, and “a kind of intimacy” in consultations with children where gesture and speech were mutual and reciprocal, all these had one element in common: playing. Winnicott distinguished between “the use of play”, that is the routine clinical practice in child analysis, from playing “as a thing in itself”. And he makes a significant distinction between the noun “play” and the verbal noun “playing”. His basic hypothesis here can be given in two quotations:

\nxxvii\n\n

Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play.

\n\n

and:

\n\n

Whatever I say about children playing really applies to adults as well, only the matter is more difficult to describe when the patient's material appears mainly in terms of verbal communication. I suggest that we must expect to find playing just as evident in the analyses of adults as it is in the case of our work with children. It manifests itself, for instance, in the choice of works, in the inflections of the voice, and indeed in the sense of humour.

\n\n

It is important and imperative to bear in mind the fact that squiggle-playing is not a technique for therapeutic consultations. It is merely a means to an end, the end being the realisation of that critical moment (which Winnicott has called the ‘sacred moment’) in the consultation where the child and the therapist both suddenly become aware of the exact nature of emotional or psychic predicament the child is struggling with, and which is holding up his growth and fruition into selfhood. Furthermore, it takes a very special sort of psycho-somatic sensibility, like that of Winnicott's, to engage in such playing. Merely to imitate it would produce abysmal caricatures of what Winnicott actualised with a fun and seriousness that were as much a delight to witness and read, as they were profound in their therapeutic insight and impact.

So far, I have discussed Winnicott's clinical work largely where it concerns the management of the patients needing to regress to dependence in the analytic situation. I advisedly say “the analytic situation”, and not the transference, because there is a crucial distinction that we must not lose sight of here. To use transference as such, a patient as a person must have achieved a certain quality of maturity through his developmental and maturational processes. Unfortunately all too often analysts attribute to their patients a capacity to relate in and use the transference, which is largely their demand in order to function as analysts, but vastly beyond the patient's capacities. Marion Milner's (1969) case-history gives us a moving and exhaustive account of it. Winnicott in his paper “Clinical Varieties of Transference” (Chapter XXIII below) makes this very clear:

\n\n

Where there is an intact ego and the analyst can take for granted these earliest details of infant care, then the setting of the analysis is unimportant relative to the interpretative work. (By setting, I mean

\nxxviii\nthe summation of all the details of management.) Even so there is a basic ration of management in ordinary analysis which is more or less accepted by all analysts.\n

In the world I am describing the setting becomes more important than the interpretation. The emphasis is changed from the one to the other.

The behaviour of the analyst, represented by what I have called the setting, by being good enough in the matter of adaptation to need, is gradually perceived by the patient as something that raises a hope that the true self may at last be able to take the risks involved in its starting to experience living.

Eventually the false self hands over to the analyst. This is a time of great dependence, and true risk, and the patient is naturally in a deeply regressed state. (By regression here I mean regression to dependence and to the early developmental processes.) This is also a highly painful state because the patient is aware, as the infant in the original situation is not aware, of the risks entailed. In some cases so much of the personality is involved that the patient must be in care at this stage. The processes are better studied, however, in those cases in which these matters are confined, more or less, to the time of the analytic sessions.

One characteristic of the transference at this stage is the way in which we must allow the patient's past to be the present. This idea is contained in Mme. Sechehaye's book and in her title “Symbolic Realization”. Whereas in the transference neurosis the past comes into the consulting-room, in this work it is more true to say that the present goes back into the past, and is the past. Thus the analyst finds himself confronted with the patient's primary process in the setting in which it had its original validity.

\n\n

Winnicott then makes a statement which is typical of his way of thinking:

\n\n

The way that this change comes about from the experience of being disrupted to the experience of anger is a matter that interests me in a special way, as it is at this point in my work that I found myself surprised. The patient makes use of the analyst's failures. Failures there must be, and indeed there is no attempt to give perfect adaptation; I would say that it is less harmful to make mistakes with these patients than with neurotic patients. Others may be surprised, as I was, to find that while a gross mistake may do but little harm, a very small error of judgment may produce a big effect. The clue is that the analyst's failure is being used and must be treated as a past failure, one that the patient can perceive and encompass, and be angry about now. The analyst needs to be able to make use of his failures in terms of their meaning for the

\nxxix\npatient, and he must if possible account for each failure even if this means a study of his unconscious countertransference.\n

A detailed account of how Winnicott facilitates a patient to find his own person in the analytic situation and emerge from acute schizoid withdrawal as a way of existing to excited and lively sharing of feelings is Available in his massive case history entitled “Fragment of an Analysis” (1972c). This is an almost verbatim account of the patient's associations and the analyst's interpretations.

It is in this context that I wish to discuss in greater detail Winnicott's concept of anti-social tendency (Chapter XXV below) and its implications for analytic technique, because it constitutes the bridge between clinical work with borderline cases and what one could call normal persons who seek therapeutic help because of being ill at ease with themselves and/or aware that their lives do not thrive in terms of their potential and capacities.

Winnicott makes it explicit that:

\n\n

The antisocial tendency is not a diagnosis. It does not compare directly with other diagnostic terms such as neurosis and psychosis. The anti-social tendency may be found in a normal individual, or in one that is neurotic or psychotic.

\n\n

The aetiologic determinants of the anti-social tendency Winnicott states with conviction and clarity:

\n\n

When there is an antisocial tendency there has been a true deprivation (not a simple privation); that is to say, there has been a loss of something good that has been positive in the child's experience up to a certain date, and that has been withdrawn: the withdrawal has extended over a period of time longer than that over which the child can keep the memory of the experience alive. The comprehensive statement of deprivation, one that includes both the early and the late, both the pinpoint trauma and the sustained traumatic condition and also both the near normal and the clearly abnormal.

\n\n

How this search for the lost experience actualises in the lived space of a child or an adult Winnicott delineates as follows:

\n\n

There are always two trends in the antisocial tendency although the accent is sometimes more on one than on the other. One trend is represented typically in stealing, and the other in destructiveness. By one trend the child is looking for something, somewhere, and failing to find it seeks it elsewhere, when hopeful. By the other the child is seeking that amount of environmental stability which will stand the strain resulting from impulsive behaviour. This is a search for an environmental provision that has been lost, a human attitude, which, because it can be relied on, gives freedom to the individual to move and to act and to get excited.

\nxxx\n

It is particularly because of the second of these trends that the child provokes total environmental reactions, as if seeking an ever-widening frame, a circle which had as its first example the mother's arms or the mother's body. One can discern a series—the mother's body, the mother's arms, the parental relationship, the home, the family including cousins and near relations, the school, the locality with its police-stations, the country with its laws.

In examining the near-normal and (in terms of individual development) the early roots of the antisocial tendency I wish to keep in mind all the time these two trends: object-seeking and destruction.

\n\n

I am aware of the excessiveness of my quotations from Winnicott. I am, however, endorsed in this tyle of presenting Winnicott by a remark of the late Heinz Hartmann to me: “Everyone refers to my work but few read it.” Certain concepts are very treacherous in their simplicity. One has heard of them and thinks that one has grasped their true intent and importance. This is rarely the case.

Pursuing his argument Winnicott asks:

\n\n

Is it possible to join up the two trends, the stealing and the destruction, the object-seeking and that which provokes, the libidinal and the aggressive compulsions? I suggest that the union of the two trends is in the child and that it represents a tendency towards self-cure, cure of a de-fusion of instincts.

When there is at the time of the original deprivation some fusion of aggressive (or motility) roots with the libidinal the child claims the mother by a mixture of stealing and hurting and messing, according to the specific details of that child's emotional developmental state. When there is less fusion the child's object-seeking and aggression are more separated off from each other, and there is a greater degree of dissociation in the child. This leads to the proposition that the nuisance value of the antisocial child is an essential feature, and is also, at its best, a favourable feature indicating again a potentiality for recovery of lost fusion of the libidinal and motility drives.

In ordinary infant care the mother is constantly dealing with the nuisance value of her infant. For instance, a baby commonly passes water on the mother's lap while feeding at the breast. At a later date this appears as a momentary regression in sleep or at the moment of waking and bed-wetting results. Any exaggeration of the nuisance value of an infant may indicate the existence of a degree of deprivation and antisocial tendency.

The manifestation of the antisocial tendency includes stealing and lying, incontinence and the making of a mess generally. Although each symptom has its specific meaning and value, the

\nxxxi\ncommon factor for my purpose in my attempt to describe the antisocial tendency is the nuisance value of the symptoms. This nuisance value is exploited by the child, and is not a chance affair. Much of the motivation is unconscious, but not necessarily all.\n

Shortly afterwards Winnicott makes a statement which is of vital importance in diagnosing the true character of a patient's predicament in the analytic situation:

\n\n

In parenthesis, it is sometimes said that a mother must fail in her adaptation to her infant's needs. Is this not a mistaken idea based on a consideration of id needs and a neglect of the needs of the ego? A mother must fail in satisfying instinctual demands, but she may completely succeed in not ‘letting the infant down’, in catering for ego needs, until such a time as the infant may have an introjected ego-supportive mother, and may be old enough to maintain this introjection in spite of failures of ego support in the actual environment.

\n\n

and he concludes:

\n\n

There is one special point that I wish to make. At the basis of the antisocial tendency is a good early experience that has been lost. Surely, it is an essential feature that the infant has reached to a capacity to perceive that the cause of the disaster lies in an environmental failure. Correct knowledge that the cause of the depression or disintegration is an external one, and not an internal one, is responsible for the personality distortion and for the urge to seek for a cure by new environmental provision. The state of ego maturity enabling perception of this kind determines the development of an antisocial tendency instead of a psychotic illness. A great number of antisocial compulsions present and become successfully treated in the early stages by the parents. Antisocial children, however, are constantly pressing for this cure by environmental provision (unconsciously, or by unconscious motivation) but are unable to make use of it.

It would appear that the time of the original deprivation is during the period when in the infant or small child the ego is in process of achieving fusion of the libidinal and aggressive (or motility) id roots. In the hopeful moment the child:

Perceives a new setting that has some elements of reliability. Experiences a drive that could be called object-seeking. Recognizes the fact that ruthlessness is about to become a feature and so Stirs up the immediate environment in an effort to make it alert to danger, and organized to tolerate nuisance.

\nxxxii\n

If the situation holds, the environment must be tested and retested in its capacity to stand the aggression, to prevent or repair the destruction, to tolerate the nuisance, to recognize the positive element in the antisocial tendency, to provide and preserve the object that is to be sought and found.

\n\n

I have given Winnicott's hypothesis of antisocial tendency in such detail for the simple reason that it has helped me to change my whole style of relating to my patients in the analytic setting and has enabled me to re-evaluate what looks like resistance or negative therapeutic reaction in a positive light. It is my clinical experience that we offer (that is promise) one thing to our patients, namely the space, time and opportunity to say their hurt and deprivation in the idiom that they are capable of, and yet make simultaneously a contrary demand, namely of compliance with the rigidly organised regime of our techniques to speak to us in a way vastly beyond their means and capacity. Winnicott's researches intensify and extend the awesome therapeutic task that we inherit from Freud, namely to create an ambiance where the other, from need and incapacity, can gradually grow and learn to test and experience all that has been muted, hurt and vindictive self-cure so far, in order to transcend it towards a true capacity to be trusting of others and personalised in themselves, without the threat of either annihilation or that collusive compliance which is the ultimate dissociation from the True Self.

Freud had shown how every symptom carries wish-fulfilment in it; Winnicott extends it further to show how every antisocial behaviour carries in it the statement of the unmet need at its source.

In his posthumously published paper, “Delinquency as a Sign of Hope” (1973) Winnicott makes a crucial distinction:

\n\n

At this point it is necessary to see that we are talking about two aspects of this one thing, the antisocial tendency. I would like to relate one of these to the relationship between the small child and the mother and the other to the later development which is the child's relation to the father. The first one has to do with all children and the second one is more especially the concern of boys. The first one has to do with the fact that the mother in her adaptation to the small child's needs enables the child creatively to find objects. She initiates the creative use of the world. When this fails the child has lost contact with objects, has lost the capacity creatively to find anything. At the moment of hope the child reaches out and steals an object. This is a compulsive act and the child does not know why he or she does it. Often the child feels mad because of having a compulsion to do something without knowing why. Naturally the fountain pen stolen from Woolworth's is not satisfactory; it is not the object that was being sought, and in any

\nxxxiii\ncase the child is looking for the capacity to find, not for an object. Nevertheless there may be come satisfaction belonging to what is done in a moment of hope. The apple stolen from the orchard is more on the borderline. It can be ripe and can taste nice and it can be fun to be chased by the farmer. On the other hand the apple may be green and if eaten may give the boy a stomach-ache, and it may be that already the boy is not eating what he has stolen, but is giving the apples away, or perhaps he organizes the theft without running the risk of climbing the wall himself. In this sequence we see the transition from the normal prank to the antisocial act.\n

What characterises neurotic symptoms is that they contain the conflict. Per contrast antisocial behaviour tries to objectify and exteriorise ego-alien elements in the personality (cf. Winnicott 1972b). For these reasons the neurotic is his own exclusive witness, whereas the person who can experience what ails him only through acting out is always seeking witnesses. This creates very specific problems in terms of the analytic process and situation. The privacy of the analytic situation and the transference process fits the need of the neurotic to communicate what he witnesses in himself. Whereas the antisocial tendency, and its myriad subtle behavioural expressions, makes a demand that the analyst should be able to extend the range, space and scope of the analytic situation and process to include all those crucial experiences which will eventuate, from their inherent logic, outside the analytic situation. Only the toleration of this fact will create that confidence in the patients that they will and can begin to test the analytic situation and relationship in symbolic forms. Repressed wishes lend themselves all too readily to symbolic processes, whereas deprivation of needs seeks actualisation before the symbolic process can begin to operate. It is one of Winnicott's great contributions to technique that he has clarified this clinical issue for us. He discusses this issue in his paper “Classification: Is there a Psycho-Analytic Contribution to Psychiatric Classification?” (1959).

Winnicott sums up the issue of Classification as follows:

\n\n

In the case of any individual at the start of the process of emotional development there are three things: At one extreme there is heredity; at the other extreme there is the environment which supports or fails and traumatizes; and in the middle is the individual living and defending and growing. In psycho-analysis we deal with the individual living, defending and growing. In classification, however, we are accounting for the total phenomenology and the best way to do this is first to classify the environmental states; then we can go on to classify the individual's defences, and finally attempt to look at heredity. Heredity, in the main, is the individual's inherent tendency to grow, to integrate, to relate to objects, to mature.

\nxxxiv\n

Winnicott gives his own final statement about the crucial issue of breakdown of personality in psychotic illnesses in his paper “Fear of Breakdown” (1974). He argues:

\n\n

It is wrong to think of psychotic illness as a breakdown, it is a defence organization relative to a primitive agony, and it is usually successful (except when the facilitating environment has been not deficient but tantalizing, perhaps the worst thing that can happen to a human baby).

\n\n

and concludes:

\n\n

I contend that clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defence organization which the patient displays as an illness syndrome……… The search for personal non-existence can be examined in the same way. It will be found that non-existence here is part of a defence. Personal existence is represented by the projection elements, and the person is making an attempt to project everything that could be personal. This can be a relatively sophisticated defence, and the aim is to avoid responsibility (at the depressive position) or to avoid persecution (at what I would call the stage of self-assertion i.e. the stage of I am with the inherent implication I repudiate everything that is not me. It is convenient here to use in illustration the childhood game of ‘I'm the King of the Castle—You're the Dirty Rascal’).

In the religions this idea can appear in the concept of oneness with God or with the Universe. It is possible to see this defence being negated in existentialist writings and teachings, in which existing is made into a cult, in an attempt to counter the personal tendency towards a non-existence that is part of an organized defence.

There can be a positive element in all this, that is, an element that is not a defence. It can be said that only out of non-existence can existence start. It is surprising how early (even before birth, certainly during the birth process) awareness of a premature ego can be mobilized. But the individual cannot develop from an ego root if this is divorced from psychosomatic experience and from primary narcissism. It is just here that begins the intellectualization of the ego-functions. It can be noted here that all this is a long distance in time prior to the establishment of anything that could usefully be called the self.

\n\n

The Making and Becoming of a Person

\n\n

“Whoever is happy is right.”—Count Leo Tolstoi.

\n\n

Winnicott was a happy person. He grew up, an only son, cherished by his parents and two elder sisters. The Winnicotts belonged to the well-to-do

\nxxxv\nmiddle class and Winnicott's father, Sir Frederick Winnicott, was Lord Mayor of Plymouth. Winnicott became a loveable and accommodating child and did brilliantly at school. Then suddenly he decided to louse it all up, and so messed up his copybooks and did badly in examinations for a year. He was nine years of age then.\n

Winnicott was also a very robust athlete. He was champion runner for his school, and enjoyed all physical activities to the full. Although in the last decade of his life Winnicott gave the impression of being physically a fragile person, he had inexhaustible vitality and was always mobile. He was always on wheels: in childhood on a cycle, in adolescence on a motor cycle and later in cars. One has to know these ordinary facts to appreciate what made him engage in the sort of clinical work he did, and the quality of his spacious patience and his poised somatic stillness. Everything in him was mutual towards itself, and not without suffering, as well as with a sense of fun.

Freud's great achievement had been to change the status of the psychiatric patient from that of being merely a bizarre medical exhibit to that of a person with the right and wish to communicate his problems and have them understood and possibly resolved. Freud's theory-making almost exclusively addressed itself to the task of deciphering the nature of mental and instinctual processes entailed in symptom-formations. Freud took the entity of the patient as a person for granted. One has to admit the fact that the climate of neuro-physiological research at the end of the 19th century biased Freud to conceptualise human psyche and its functioning on the model of the machine: hence his theories of the psychic apparatus, energic cathexes and intra-psychic structures, where he diagrammatically traced out as the ego, the id and the super-ego; plus the topographical schema of the conscious, the preconscious and the unconscious. None of these concepts have lost validity across some 70 years of this century. But as more varieties of clinical experience with patients ranging from borderline cases to psychosis proper began to accumulate, the need to supplement the hypotheses of classical psychoanalysis became urgent and compelling.

Winnicott is certainly one of the four analysts, the other three being Melanie Klein, Heinz Hartmann and Erik Erikson, who have provided completely new conceptual additives, that both enlarge the scope and extend the range of the classical psychoanalytic conceptual framework.

Winnicott was first and foremost a paediatrician, and to my knowledge he is the only analyst who sustained across the whole stretch of his clinical work, therapeutic consultations with children parallel to his analytic work with adult patients. It is, therefore, to be expected that what engaged Winnicott's attention most were the mysteries of infant-mother relationship. During a discussion at a Scientific Meeting of the

\nxxxvi\nBritish Psycho-Analytic Society sometime in 1940, Winnicott had startled his colleagues with the statement:\n

There is no such thing as an infant, meaning, of course, that whenever one finds an infant one finds maternal care, and without maternal care there would be no infant.

\n\n

It is not my intention here to give a chronological account of how Winnicott's theory of infant-mother relationship evolved. Instead I shall only single out some of his salient concepts for comment. And I shall start with his definitive statement in his paper: “The Theory of the Parent-Infant Relationship”, given at the 22nd International Psycho-analytical Congress at Edinburgh in 1961. Three statements by him immediately establish his point of view:

\n\n

In psycho-analysis as we know it there is no trauma that is outside the individual's omnipotence. Everything eventually comes under ego-control, and thus becomes related to secondary processes…. In infancy, however, good and bad things happen to the infant that are quite outside the infant's range. In fact infancy is the period in which the capacity for gathering external factors into the area of the infant's omnipotence is in process of formation. The ego-support of the maternal care enables the infant to live and develop in spite of his being not yet able to control, or to feel responsible for, what is good and bad in the environment… The paradox is that what is good and bad in the infant's environment is not in fact a projection, but in spite of this it is necessary, if the individual infant is to develop healthily, that everything shall seem to him to be a projection. Here we find omnipotence and the pleasure principle in operation, as they certainly are in earliest infancy; and to this observation we can add that the recognition of a true ‘not-me’ is a matter of the intellect; it belongs to extreme sophistication and to the maturity of the individual.

\n\n

For Winnicott the paradox of infant-mother relationship lay in that the environment (mother) makes the becoming self of the infant feasible. Winnicott was the first among analysts to point out the obvious fact that a mother cherishes, enjoys and creates her baby: not only in the somatic inside of her womb, but also in the early stages of the infant's finding and realising of its innate givens of endowment and the person it will differentiate and actualise into in time. By the very definition of the tasks that Freud had set himself, namely the understanding of conflictual emotional, psychic and instinctual experiences of the adult patient, the emphasis had been on anxiety and all those defensive manoeuvres of the emergent ego that are inevitable to cope with the developmental crises of maturation into adulthood. Hence Freud had seen the ego pitted against two tyrants: instinctual wishes and external

\nxxxvii\nreality, and trying its best to serve them so as to ensure its own growth and survival. Winnicott had a completely different vantage point. He accepted reality as the ally of the on-going maturational processes in the infant, and examined with singular perspicacity and acumen the character of the environmental (maternal) provisions towards the personalisation of the infant's instinctual and psychic potential into selfhood.\n

The essence of an infant's experience lies in its dependence on maternal (environmental) care. For Winnicott the human infant “cannot start to be except under certain conditions”, and he believed: “the inherited potential of an infant cannot become an infant unless linked to maternal care”. Winnicott's concept for the mother's provision at this stage of infant-care is holding. The function of holding is natural to a mother from her Primary Maternal Preoccupation (Chapter XXIV below) and is based on maternal empathy rather than on understanding. Winnicott classifies infant's dependence in the holding phase into three stages:

Absolute Dependence. In this state the infant has no means of knowing about the maternal care, which is largely a matter of prophylaxis. He cannot gain control over what is well and what is badly done, but is only in a position to gain profit or to suffer disturbance.

Relative Dependence. Here the infant can become aware of the need for the details of maternal care, and can to a growing extent relate them to personal impulse, and then later, in a psycho-analytic treatment, can reproduce them in the transference.

Towards Independence. The infant develops means for doing without actual care. This is accomplished through the accumulation of memories of care, the projection of personal needs and the introjection of care details, with the development of confidence in the environment. Here must be added the element of intellectual understanding with its tremendous implications.

\n\n

At this point Winnicott adds two concepts that are important to his understanding of early development in the infant. I give his statement in his words since it cannot but lose from abridgement:

\n\n

Another phenomenon that needs consideration at this phase is the hiding of the core of the personality. Let us examine the concept of a central or true self. The central self could be said to be the inherited potential which is experiencing a continuity of being, and acquiring in its own way and at its own speed a personal psychic reality and a personal body-scheme. It seems necessary to allow for the concept of the isolation of this central self as a characteristic of health. Any threat to this isolation of the true self constitutes a major anxiety at this early stage, and defences of earliest infancy

\nxxxviii\nappear in relation to failures on the part of the mother (or in maternal care) to ward off impingements which might disturb this isolation.\n

A decade later Winnicott in a letter (1971c) to his French translator, Mme. Jeannine Kalmanovitch, gave the definition of self as:

\n\n

For me the self, which is not the ego, is the person who is me, who is only me, who has a totality based on the operation of the maturational process. At the same time the self has parts, and in fact is constituted of these parts. These parts agglutinate from a direction interior-exterior in the course of the operation of the maturational process, aided as it must be (maximally at the beginning) by the human environment which holds and handles and in a live way facilitates. The self finds itself naturally placed in the body, but may in certain circumstances become dissociated from the body in the eyes and facial expression of the mother and in the mirror which can come to represent the mother's face. Eventually the self arrives at a significant relationship between the child and the sum of the identifications which (after enough of incorporation and introjection of mental representations) become organised in the shape of an internal psychic living reality. The relationship between the boy or girl with his or her own internal psychic organisation becomes modified according to the expectations that are displayed by the father and mother and those who have become significant in the external life of the individual. It is the self and the life of the self that alone makes sense of action or of living from the point of view of the individual who has grown so far and who is continuing to grow from dependence and immaturity towards independence, and the capacity to identify with mature love objects without loss of individual identity.

\n\n

I have discussed earlier Winnicott's concept of True and False Self. Here I shall pick out his concept of impingement for special discussion, because it changes the classical concept of defence in a significant way and also corrects the Kleinian School's over-emphasis on the role of anxiety in early infancy. Winnicott gave his first detailed account of the types of impingements that an infant inevitably experiences in his paper “Birth Memories, Birth Trauma and Anxiety” (Chapter XIV below). The first important factor to grasp in this context is that, for Winnicott, “human organism” from the foetal state across infancy is in a well accommodated ambiance of environmental care. That, of course, is the ideal equation. All the same for Winnicott nature has allowed for graduated failures, that result as impingements on the newborn, in the on-going process of growth and maturation. Even the so-seeming traumatic experience of birth is accommodated by matural preparedness in the foetus to emerge into the status “infant.” Though Winnicott states:

\nxxxix\n\n

It will be understood, Freud having pointed it out, that birth experience has nothing to do with any sort of an awareness of a separation from the mother's body. We can postulate a certain state of mind of the unborn. I think we can say that things are going well if the personal development of the infant ego has been as undisturbed in its emotional as in its physical aspect. There is certainly before birth the beginning of an emotional development, and it is likely that there is before birth a capacity for false and unhealthy forward movement in emotional development; in health environmental disturbances of a certain degree are valuable stimuli but beyond a certain degree these disturbances are unhelpful in that they bring about a reaction. At this very early stage of development there is not sufficient ego strength for there to be a reaction without loss of identify.

\n\n

But to this Winnicott adds a rider:

\n\n

… in the natural process the birth experience is an exaggerated sample of something already known to the infant. For the time being, during birth, the infant is a reactor and the important thing is the environment; and then after birth there is a return to a state of affairs in which the important thing is the infant, whatever that means. In health the infant is prepared before birth for some environmental impingement, and already has had the experience of a natural return from reacting to a state of not having to react, which is the only state in which the self can begin to be.

This is the simplest possible statement that I can make about the normal birth process. It is a temporary phase of reaction and therefore of loss of identity, a major example, for which the infant has already been prepared, of interference with the personal ‘going along’, not so powerful or so prolonged as to snap the thread of the infant's continuous personal process.

\n\n

Hence birth is not an impingement if “active adaptation from the environment” fits its demands, or to be more accurate, it is not an impingement that disrupts the on-going process: “in the non-traumatic birth the reaction to impingement which birth entails does not exceed that for which the foetus is already prepared”.

Inherent to the concept of impingement, in Winnicott's thinking, is “the need to react”, because it is this latter that sets up, if it is persistent, the armature of the False Self organisation: “the infant that is disturbed by being forced to react is disturbed out of a state of being” (also cf. Winnicott 1972b). The essence of Winnicott's argument is that:

\n\n

In order to preserve the personal way of life at the beginning the individual needs a minimum of environmental impingements

\nxxxx\nproducing reaction. All individuals are really trying to find a new birth in which the line of their own life will not be disturbed by a quantity of reacting greater than that which can be experienced without a loss of the sense of continuity of personal existence. The mental health of the individual is laid down by the mother who, because she is devoted to her infant, is able to make active adaptation. This presupposes a basic state of relaxation in the mother, and also an understanding of the individual infant's way of life, which again arises out of her capacity for identification with her infant. This relationship between the mother and the infant starts before the infant is born and is continued in some cases through the birth process and after. As I see it, the trauma of birth is the break in the continuity of the infant's going on being, and when this break is significant the details of the way in which the impingements are sensed, and also of the infant's reaction to them become in turn significant factors adverse to ego development. In the majority of cases the birth trauma is therefore mildly important and determines a good deal of the general urge towards rebirth. In some cases this adverse factor is so great that the individual has no chance (apart from rebirth in the course of analysis) of making a natural progress in emotional development, even if subsequent external factors are extremely good.\n

According to Winnicott it is the reactions to impingements that count and not the impingements as such. Failures of mother's adaptation to the infant's need produce “phases of reaction to impingement and these reactions interrupt the going on being of the infant. An excess of this reacting produces not frustration but a threat of annihilation.” This specific affect of anxiety for Winnicott constituted the true predicament for the patient in a state of regression to dependence.

In his paper “Aggression in Relation to Emotional Development” (Chapter XVI below) Winnicott discusses the whole issue of reactions to impingement in relation to motility and emergent experiences of aggression, and he details three patterns of such experiences:

\n\n

In one pattern, the environment is constantly discovered and rediscovered because of motility. Here each experience within the framework of primary narcissism emphasizes the fact that it is in the centre that the new individual is developing, and contact with environment is an experience of the individual (in its undifferentiated ego-id state, at first). In the second pattern the environment impinges on the foetus (or baby) and instead of a series of individual experiences there is a series of reactions to impingement. Here then develops a withdrawal to rest which alone allows of individual existence. Motility is then only experienced as a reaction to impingement.

\nxxxxi\n

In a third pattern, which is extreme, this is exaggerated to such a degree that there is not even a resting place for individual experience and the result is a failure in the primary narcissistic state to evolve an individual. The ‘individual’ then develops as an extension of the shell rather than of the core, and as an extension of the impinging environment. What there is left of a core is hidden away and is difficult to find even in the most far-reaching analysis. The individual then exists by not being found. The true self is hidden, and what we have to deal with clinically is the complex false self whose function is to keep this true self hidden. The false self may be conveniently society-syntonic, but the lack of true self gives an instability which becomes more evident the more society is deceived into thinking that the false self is the true self. The patient's complaint is of a sense of futility.

\n\n

Winnicott considered that it was the aggressive drive that led the infant to discover “the Not-me object or an object that is felt to be external”.

In Winnicott's researches the examination of reactions to impingements led to the discussion of the role of illusion and Transitional Object. He states it clearly in his paper “Psychoses and Child Care” (Chapter XVII below). Without the ability to use illusion the infant would be unable to establish contact between psyche and environment.

It was thus that Winnicott gradually began to see how the early maternal environment provisions, through capacity for illusion and transitional phenomena in the infant, linked up with the adult's creative use of the cultural givens. He gives his definitive statement in “The Location of Cultural Experience” (1971b).

Aloneness and Concern in the Location of Cultural Experience

\n\n

In the depths of my being I remain convinced that my dear fellow creatures—with few exceptions—are a wretched lot.

\nFreud to Lou Andreas-Salomé (28.7.1929)\n

Ah! nous avons trop présumé de I'homme sous le masque!

\nSt. John Perse: Amers.\n

Freud had looked into the heart of man and found him a meagre being, existing precariously all the time. He had looked at what was man's unique creation, human culture, and found “discontent” and subterfurge everywhere (Freud 1930). None could deny the harsh veracity of Freud's announcements. And yet there is more to human living somewhere than a mere acceptance of “common unhappiness” (Freud 1895) and discontent. Deriving from a different cultural and religious tradition, though using Freud's instruments of thought, Winnicott arrived at a different evaluation of the human individual's situation in life. Winnicott saw in the very vulnerability of man his true potential for relating

\nxxxxii\nto others, from need and desire, and not merely for the autonomous gratification of compelling id-impulses through complicity with others. He sensed a mystery, only he called it paradox, and tried to define it, instead of explaining it away. This is what gave his work with children its unique quality of wonder and surprise (Winnicott 1971a). One can claim for Winnicott that he was of Montaigne's persuasion: “Wonder is the foundation of philosopy, enquiry its progress, ignorance its end.”\n

Across his long stretch of clinical years Winnicott had encountered a vast range of human suffering and dismay. Winnicott was never an opaque clinical interpretative machine. His work was an integral part of his self-experience. In spite of all the pain and hopelessness that he had experienced in and with others, Winnicott saw the human individual's destiny in a joyous light. To him the human person in the ambiance of culture alone was a viable and creative being. Even though in certain respects Winnicott was a true solitary, he was a solitary who included others to increment his experience of himself, just as he enriched their lives through their encounter with him. Little wonder then that during the last years of his life he should have given the two crucial issues of human experience, aloneness and concern, his deepest thought and attention.

Across centuries sages, mystics, poets and philosophers have idealised the solitary isolate state of the noble human individual and glorified the suffering it entails. In Western Christian cultures perhaps the most compelling image of it is Christ on the Cross. Winnicott looked at the aloneness of the human individual in a novel way, and his statement (1958b) on this account is both economic and explicit:

\n\n

It is probably true to say that in psycho-analytical literature more has been written on the fear of being alone or the wish to be alone than on the ability to be alone; also a considerable amount of work has been done on the withdrawn state, a defensive organization implying an expectation of persecution. It would seem to me that a discussion on the positive aspects of the capacity to be alone is overdue.

\n\n

Some two hundred years earlier Jean-Jacques Rousseau in Les Rêveries du Promeneur Solitaire (1776), had written an ecstatic apologia of his rejection of all human relationships and society towards his final possession of his own Self. Nowhere can one find a better example of what Winnicott refers to as that aloneness which is “the withdrawn state, a defensive organisation implying an expectation of persecution”.

Friedrich Nietzsche, some hundred years after Rousseau, in his last book Beyond Good and Evil (1885), tried to give the characterology of the noble alone man, who wishes and chooses his aloneness:

\n\n

The spiritual haughtiness and disgust of every human being who has suffered deeply—how deeply human beings can suffer almost

\nxxxxiii\ndetermines their order of rank—the harrowing certainty, with which he is wholly permeated and coloured, that by virtue of his suffering he knows more than even the cleverest and wisest can know, that he is familiar with, and was once ‘at home’ in, many distant, terrible worlds of which ‘you know nothing!’…. this spiritual, silent haughtiness of the sufferer, this pride of the elect of knowledge, of the ‘initiated’, of the almost sacrificed, finds all forms of disguise necessary to protect itself against contact with importunate and pitying hands and in general against everything which is not its equal in suffering. Profound suffering ennobles; it separates.\n

Winnicott (1958b) offers us a third alternative:

\n\n

Although many types of experience go to the establishment of the capacity to be alone, there is one that is basic, and without a sufficiency of it the capacity to be alone does not come about; this experience is that of being alone, as an infant and small child, in the presence of mother. Thus the basis of the capacity to be alone is a paradox; it is the experience of being alone while someone else is present.

\n\n

Thus Winnicott not only humanises aloneness but renders it an ego-related experience positively involving the other person. He argues:

\n\n

Personally I like to use the term ego-relatedness, which is convenient in that it contrasts rather clearly with the word id-relationship, which is a recurring complication in what might be called ego life. Ego-relatedness refers to the relationship between two people, one of whom at any rate is alone; perhaps both are alone, yet the presence of each is important to the other. I consider that if one compares the meaning of the word ‘like’ with that of the word ‘love’, one can see that liking is a matter of ego-relatedness, whereas loving is more a matter of id-relationships, either crude or in sublimated form….. It is the main part of my thesis that we do need to be able to speak of an unsophisticated form of being alone, and that even if we agree that the capacity to be truly alone is a sophistication, the ability to be truly alone has as its basis the early experience of being alone in the presence of someone. Being alone in the presence of someone can take place at a very early stage, when the ego immaturity is naturally balanced by ego-support from the mother. In the course of time the individual introjects the ego-supportive mother and in this way becomes able to be alone without frequent reference to the mother or mother symbol.

\n\n

Winnicott considered ego-relatedness “the stuff out of which friendship is made. It may turn out to be the matrix of transference”. Winnicott concludes his argument:

\nxxxxiv\n\n

I think it will be generally agreed that id-impulse is significant only if it is contained in ego living. An id-impulse either disrupts a weak ego or else strengthens a strong one. It is possible to say that id-relationships strengthen the ego when they occur in a framework of ego-relatedness. If this be accepted, then an understanding of the importance of the capacity to be alone follows. It is only when alone (that is to say, in the presence of someone) that the infant can discover his own personal life. The pathological alternative is a false life built on reactions to external stimuli. When alone in the sense that I am using the term, and only when alone, the infant is able to do the equivalent of what in an adult would be called relaxing. The infant is able to become unintegrated, to flounder, to be in a state in which there is no orientation, to be able to exist for a time without being either a reactor to an external impingement or an active person with a direction of interest or movement. The stage is set for an id experience. In the course of time there arrives a sensation or an impulse. In this setting the sensation or impulse will feel real and be truly a personal experience.

\n\n

The climax of ego-relatedness is ego-orgasm. This is a new concept that Winnicott introduces here, and he equates ego-orgasm with ecstasy. He contrasts ego-orgasm with “a physical orgasm of local excitement”. Hence Winnicott distinguishes ego-relatedness and ego-orgasm from id-relationships and instinctual orgasm. This distinction is bound to prove of great importance in our clinical work. It is only in the theoretical frame of reference of ego-relatedness which “refers to the relationship between two people, one of whom at any rate is alone” that we can discuss Winnicott's concept of the capacity for concern.

Since Freud's paper “Mourning and Melancholia” (1917) and Karl Abraham's (1924) significant researches in depressive and melancholic states, the role of guilt (unconscious) has been seen to be crucial in the aetiology of emotional and personality disorders. This was deepened and extended to its maximum by the researches of Melanie Klein (1935, 1957).

Winnicott had been tutored in the Kleinian tradition of theorising. But as his own clinical experience gathered its veracity and momentum he began to question the absoluteness of the Kleinian emphasis on the role of guilt in early psychic development, as is evident from his two papers “Psycho-Analysis and the Sense of Guilt” (1958a) and “A Personal View of the Kleinian Contribution” (1962). Eventually he was able to state his own view of the situation in his paper “The Capacity for Concern” (1963c). This paper is crucial not only for our understanding Winnicott's mature vision, but also for the assessment of where psycho-analytic researches are leading to, today.

Winnicott states his position with his customary abrupt clarity:

\nxxxxv\n\n

The word ‘concern’ is used to cover in a positive way a phenomenon that is covered in a negative way by the word ‘guilt’. A sense of guilt is anxiety linked with the concept of ambivalence, and implies a degree of integration in the individual ego that allows for the retention of good object-imago along with the idea of a destruction of it. Concern implies further integration, and further growth, and relates in a positive way to the individual's sense of responsibility especially in respect of relationships into which the instinctual drives have entered.

Concern refers to the fact that the individual cares, or minds, and both feels and accepts responsibility.

\n\n

Winnicott sees the capacity for concern emergent before the Oedipal triangular situation becomes possible for the child. He considers the capacity for concern as “a matter of health”, and resultant from good-enough infant-care. It further implies “an ego that begins to be independent of the mother's auxiliary ego”. At this point Winnicott introduces an important new distinction in the infant's total experience of “the object-mother” and “the environment-mother”:

\n\n

It is helpful to postulate the existence for the immature child of two mothers—shall I call them the object-mother and the environment-mother? I have no wish to invent names that become stuck and eventually develop a rigidity and an obstructive quality, but it seems possible to use these words ‘object-mother’ and ‘environment-mother’ in this context to describe the vast difference that there is for the infant between two aspects of infant-care, the mother as object, or owner of the part-object that may satisfy the infant's urgent needs, and the mother as the person who wards off the unpredictable and who actively provides care in handling and in general management. What the infant does at the height of id-tension and the use thus made of the object seems to me very different from the use the infant makes of the mother as part of the total environment.

In this language it is the environment-mother who receives all that can be called affection and sensuous co-existence; it is the object-mother who becomes the target for excited experience backed by crude instinct-tension. It is my thesis that concern turns up in the baby's life as a highly sophisticated experience in the coming-together in the infant's mind of the object-mother and the environment-mother.

\n\n

The implications of this statement for our clinical differentiation of how a patient relates to us in the transference are indeed momentous. But to return to Winnicott's argument, as it rises to its climax:

\nxxxxvi\n\n

In favourable circumstances there builds up a technique for the solution of this complex form of ambivalence. The infant experiences anxiety because if he consumes the mother he will lose her, but this anxiety becomes modified by the fact that the baby has a contribution to make to the environment-mother. There is a growing confidence that there will be opportunity for contributing-in, for giving to the environment-mother, a confidence which makes the infant able to hold the anxiety. The anxiety held in this way becomes altered in quality and becomes a sense of guilt……Instinct-drives lead to ruthless usage of objects, and then to a guilt-sense which is held, and is allayed by the contribution to the environment-mother that the infant can make in the course of a few hours. Also, the opportunity for giving and for making reparation that the environment-mother offers by her reliable presence, enables the baby to become more and more bold in the experiencing of id-drives; in other words, frees the baby's instinctual life. In this way, the guilt is not felt, but it lies dormant, or potential, and appears (as sadness or a depressed mood) only if opportunity for reparation fails to turn up.

When confidence in this benign cycle and in the expectation of opportunity is established, the sense of guilt in relation to the id-drives becomes further modified, and we then need a more positive term, such as ‘concern’. The infant is now becoming able to be concerned, to take responsibility for his own instinctual impulses and the functions that belong to them. This provides one of the fundamental constructive elements of play and work. But in the developmental process, it was the opportunity to contribute that enabled concern to be within the child's capacity.

\n\n

The wheel has come full circle and the infant-in-care can now start to care and be concerned. This is the beginning of that larger existence which is man in human culture, living and sharing his life with others, in a mutuality of personal ambitions and other-directed concerns.

Here I would like to interpose briefly Winnicott's statement about adolescence, since it is adolescence that bridges the child in the care of his family with the adult in society. In his paper “Adolescence: Struggling through the Doldrums” (1971d) Winnicott states:

\n\n

… if the adolescent is to get through this developmental stage by natural process, then there must be expected a phenomenon, which could be called adolescent doldrums. Society needs to include this as a permanent feature and to tolerate, it, but not to cure it.

\n\n

So we arrive at Winnicott's testament of faith “The Location of Cultural Experience” (1967 [1971b]). I quote his main thesis:

\nxxxxvii\n

The place where cultural experience is located is in the potential space between the individual and the environment (originally the object). The same can be said of playing. Cultural experience begins with creative living first manifested in play.

For every individual the use of this space is determined by life experiences that take place at the early stages of the individual's existence.

From the beginning the baby has maximally intense experiences in the potential space between the subjective object and the object objectively perceived, between me-extensions and the not-me. This potential space is at the interplay between there being nothing but me and there being objects and phenomena outside omnipotent control.

Every baby has his or her own favourable or unfavourable experience here. Dependence is maximal. The potential space happens only in relation to a feeling of confidence on the part of the baby, that is, confidence related to the dependability of the mother-figure or environmental elements, confidence being the evidence of dependability that is becoming introjected.

In order to study the play and then the cultural life of the individual one must study the fate of the potential space between any one baby and the human (and therefore fallible) mother-figure who is essentially adaptive because of love.

It will be seen that if this area is to be thought of as part of the ego organization, here is a part of the ego that is not a body-ego, that is not founded on the pattern of body functioning but is founded on body experiences. These experiences belong to object-relating of a non-orgiastic kind, or to what can be called ego-relatedness, at the place where it can be said that continuity is giving place to contiguity.

\n\n

He so quietly develops the concept of “transitional phenomena” of infancy to include “the potential space” of adult's life in culture.

Towards the end of his life Winnicott addressed himself more and more to an understanding, not only of what makes humans ill, but what makes them thrive in each other's keeping, amidst the culture's givens.

Winnicott was one such the like of whom I shall not meet again.

\nxxxxviii\n\n\n

References

\nAbraham, K. (1924). ‘A Short Study of the Development of the Libido in the Light of Mental Disorders’ in Collected Papers of Psycho-Analysis (London: Hogarth Press)\nErikson, E. H. (1950/63). Childhood and Society (New York: Norton; London: Hogarth Press)\nFreud, A. (1946). The Psycho-Analytical Treatment of Children (London: Imago/Hogarth Press: New York: International Universities Press)\nFreud, S. (1895). Studies on Hysteria in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 2 (London: Hogarth Press)\nFreud, S. (1917). ‘Mourning and Melancholia’ in Standard Edition, Vol. 14\nFreud, S. (1921). Beyond the Pleasure Principle in Standard Edition, Vol. 18\nFreud, S. (1923). The Ego and the Id in Standard Edition, Vol. 19\nFreud, S. (1926). Inhibitions, Symptoms and Anxiety in Standard Edition, Vol. 20\nFreud, S. (1930). Civilization and Its Discontents in Standard Edition, Vol. 21\nGlover, E. (1968). The Birth and the Ego (London: Allen & Unwin)\nHartmann, H. (1958). Ego Psychology and the Problem of Adaptation (London: Imago/Hogarth Press: New York: International Universities Press)\nKlein, M. (1935). ‘A Contribution to the Psychogenesis of Manic Depressive States’ in Contributions (1948)\nKlein, M. (1948). Contributions to Psycho-Analysis (London: Hogarth Press)\nKlein, M. (1957). Envy and Gratitude (London: Tavistock Publications)\nMilner, M. (1969). The Hands of the Living God (London: Hogarth Press; New York: International Universities Press)\nNietzsche, F. (1969). Selected Letters of Frederich Nietzsche. Edited by C. Middleton (Chicago: The University of Chicago Press)\nShah, I. (1970). The Wisdom of the Idiots (London: Octagon Press)\nSmirnoff, V. (1971). The Scope of Child Analysis (London: Routledge & Kegan Paul)\nTrilling, L. (1955). Freud and the Crisis of our Culture (Boston: the Beacon Press)\nWinnicott, D. W. (1931). Clinical Notes on Disorders of Childhood (London: William Heinemann)\nWinnicott, D. W. (1951). “Transitional Objects and Transitional Phenomena” in Playing and Reality (1971b)\nWinnicott, D. W. (1958a). “Psycho-Analysis and the Sense of Guilt” in Maturational Processes (1965)\nWinnicott, D. W. (1958b). “The Capacity to be Alone” in Maturational Processes (1965)\nWinnicott, D. W. 1959 [1964]). “Classification” in Maturational Processes (1965)\nxxxxix\nWinnicott, D. W. (1960). “Ego Distortion in Terms of True and False Self” in Maturational Processes (1965)\nWinnicott, D. W. (1961). “The Theory of the Parent-Infant Relationship” in Maturational Processes (1965)\nWinnicott, D. W. (1962). “A Personal View of the Kleinian Contribution” in Maturational Processes (1965)\nWinnicott, D. W. (1963a). “Psychotherapy of Character Disorders” in Maturational Processes (1965)\nWinnicott, D. W. (1963b). “Dependence in Infant-Care, in Child-Care, and in the Psycho-Analytic Setting” in Maturational Processes (1965)\nWinnicott, D. W. (1963c). “The Development of the Capacity for Concern” in Maturational Processes (1965)\nWinnicott, D. W. (1965). The Maturational Processes and the Facilitating Environment (London: Hogarth Press; New York: International Universities Press)\nWinnicott, D. W. (1969). “The Use of an Object and Relating Through Identifications” in Playing and Reality (1971b)\nWinnicott, D. W. (1970). “The Mother-Infant Experience of Mutuality” in Parenthood: Its Psychology and Psychopathology. Edited by E. James Anthony and Therese Benedek (Boston: Little Brown)\nWinnicott, D. W. (1971a). Therapeutic Consultations in Child Psychiatry (London: Hogarth Press: New York: Basic Books)\nWinnicott, D. W. (1971b). Playing and Reality (London: Tavistock Publications; New York: Basic Books)\nWinnicott, D. W. (1971c). Letter to Mme. Jeannine Kalmanovitch in Nouvelle Revue de Psychanalyse, Vol. 3.\nWinnicott, D. W. (1971d). “Adolescence: Struggling through the Doldrums” in Adolescent Psychiatry. Vol. I. Edited by Sherman C. Feinstein, Peter Giovacchini & Arthur A. Miller (New York: Basic Books)\nWinnicott, D. W. (1972a). “Basis for Self in Body”, International Journal of Child Psychotherapy, Vol. I, No. 1.\nWinnicott, D. W. (1972b). “Mother's Madness appearing in the clinical material as an Egoalien factor” in Tactics and Techniques in Psychoanalytic Therapy. Edited by Peter L. Giovacchini (London: Hogarth Press; New York: Science House)\nWinnicott, D. W. (1972c). “Fragment of an Analysis” in Tactics and Techniques (see 1972b)\nWinnicott, D. W. (1973). “Delinquency as a sign of Hope” in Adolescent Psychiatry, Vol. II. Edited by Sherman C. Fernstein & Peter Giovacchini (New York: Basic Books)\nWinnicott, D. W. (1974). “Fear of Breakdown”, International Review of Psycho-Analysis, Vol. I\nl\n\n\n","document":"\n1975\n\nThrough Paediatrics to Psycho-Analysis\nInternational Psychoanalytical Library\nLondonThe Hogarth Press and the Institute of Psycho-Analysis\n100\ni-l\nThrough Paediatrics to Psycho-Analysis\n\n\n\n\n

\n\n\n

Preface

THIS BOOK collects together various contributions that I have addressed to scientific audiences.

My hope is that this book will show that paediatrics is one of the legitimate ways into psycho-analysis, and indeed a good one.

The papers in the second section can be recognized as coming from a paediatrician—one, however, who has become psycho-analytically orientated.

The third section is my personal contribution to current psycho-analytic theory and practice.

1957 D. W. Winnicott, F.R.C.P. (Lond.)

Physician, Paddington Green Children's Hospital, London W.2

Physician-in-Charge, Child Department, London Clinic of Psycho-Analysis, London W.1

\nix\n

Acknowledgements

I wish to acknowledge my debt to my secretary, Mrs Joyce Coles.

I am grateful to Mr M. Masud R. Khan for compiling the index and for many helpful criticisms and suggestions.

\nx\n\n

Introduction

\nM. Masud R. Khan\n\n\n

If you should ever come round to writing about me…, be sensible enough—as nobody has been till now—to characterise me, to ‘describe’—but not to ‘evaluate’.

\nNietzsche to Carl Fuchs.\n

\n\n

\nxi\n

Inner Reality Versus Fantasying

\n\n

To these statements Winnicott added a significant footnote in 1957:

\n\n

integration, personalization, and, following these, the appreciation of time and space and other properties of reality—in short, realization.

\n\n

To this he added:

\n\n

It may be assumed that at the theoretical start the personality is unintegrated, and that in regressive disintegration there is a primary

\nxiv\nstate to which regression leads. We postulate a primary unintegration.\n

And Winnicott re-introduced the concept of dissociation at this stage—a debt he owed to Glover's researches, but without ever acknowledging it:

\n\n

He then drew a very significant conclusion for our clinical practice from elaborization of this hypothesis of True and False Self:

\n\n

From the Transitional Object to Use of an Object

\nxvi\nNietzsche calls, “regulative fictions”. None of Winnicott's “regulative fictions” has received such instant acclaim as that of the transitional object.\n

This seemingly explicit and easily comprehensible notion, because Winnicott considered it no more than that himself, has a complex clinical vécu behind it.

\n\n

\nxvii\neffort on my part that results in the spatula being moved towards the child produces screaming, mental distress or actual colic.\n

At this point, I might mention that I have never seen any evidence of a baby being disappointed that the spatula is, in fact, neither food nor a container of food.

\n\n

Winnicott developed this further in his paper ‘Primitive Emotional Development’ (Chapter XII below) where, discussing the baby's first experiences of the mother, he says:

\nxviii\n\n

\n\n

The infant assumes rights over the object, and we agree to this assumption. Nevertheless, some abrogation of ‘omnipotence’ is a feature from the start.

The object is affectionately cuddled as well as excitedly loved and mutilated.

It must never change, unless changed by the infant.

It must survive instinctual loving, and also hating and, if it be a feature, pure aggression.

Yet it must seem to the infant to give warmth, or to move, or to have texture, or to do something that seems to show it has vitality or reality of its own.

It comes from without from our point of view, but not so from the point of view of the baby. Neither does it come from within; it is not a hallucination.

Its fate is to be gradually allowed to be ‘decathected’, so that in the course of years it becomes not so much forgotten as relegated to limbo. By this I mean that in health the transitional

\nxix\n

\n\n

Winnicott himself has stated that the transitional object

\n\n

The object is always being destroyed. This destruction becomes the unconscious backcloth for love of a real object; that is, an object outside the area of the subject's omnipotent control.

\n\n

\nxxi\n\n

\n\n

Regression, Management and Playing in the Clinical Setting

\n\n

\nIdries Shah, The Wisdom of the Idiots\n

\nxxii\nwere interested in the care, rather than the cure, of the psychiatrically ill persons: be they children or adults.\n

\n\n

In this context Winnicott makes an important distinction between the role of wishes and needs in the clinical process:

\n\n

The provision of a setting that gives confidence.

Regression of the patient to dependence, with due sense of the risk involved.

The patient feeling a new sense of self, and the self hitherto becoming surrendered to the total ego. A new progression of the individual processes which had stopped.

An unfreezing of an environmental failure situation.

From the new position of ego strength, anger related to the early environmental failure, felt in the present and expressed.

Return from regression to dependence, in orderly progress towards independence.

Instinctual needs and wishes becoming realizable with genuine vitality and vigour.

\n\n

\nxxiv\n

\n\n

The quality of the analytic setting: its quiet and freedom from impingement on the patient;

The management that can be provided only by the social and familial environment; here the range is from hospitalization to care by family and friends.

\n\n

\nxxvii\n\n

\n\n

and:

\n\n

\nxxviii\nthe summation of all the details of management.) Even so there is a basic ration of management in ordinary analysis which is more or less accepted by all analysts.\n

In the world I am describing the setting becomes more important than the interpretation. The emphasis is changed from the one to the other.

\n\n

Winnicott then makes a statement which is typical of his way of thinking:

\n\n

\nxxix\npatient, and he must if possible account for each failure even if this means a study of his unconscious countertransference.\n

Winnicott makes it explicit that:

\n\n

The aetiologic determinants of the anti-social tendency Winnicott states with conviction and clarity:

\n\n

How this search for the lost experience actualises in the lived space of a child or an adult Winnicott delineates as follows:

\n\n

\nxxx\n

In examining the near-normal and (in terms of individual development) the early roots of the antisocial tendency I wish to keep in mind all the time these two trends: object-seeking and destruction.

\n\n

Pursuing his argument Winnicott asks:

\n\n

The manifestation of the antisocial tendency includes stealing and lying, incontinence and the making of a mess generally. Although each symptom has its specific meaning and value, the

Shortly afterwards Winnicott makes a statement which is of vital importance in diagnosing the true character of a patient's predicament in the analytic situation:

\n\n

and he concludes:

\n\n

\nxxxii\n

\n\n

Freud had shown how every symptom carries wish-fulfilment in it; Winnicott extends it further to show how every antisocial behaviour carries in it the statement of the unmet need at its source.

In his posthumously published paper, “Delinquency as a Sign of Hope” (1973) Winnicott makes a crucial distinction:

\n\n

Winnicott sums up the issue of Classification as follows:

\n\n

\nxxxiv\n

Winnicott gives his own final statement about the crucial issue of breakdown of personality in psychotic illnesses in his paper “Fear of Breakdown” (1974). He argues:

\n\n

and concludes:

\n\n

The Making and Becoming of a Person

\n\n

“Whoever is happy is right.”—Count Leo Tolstoi.

\n\n

Winnicott was a happy person. He grew up, an only son, cherished by his parents and two elder sisters. The Winnicotts belonged to the well-to-do

\nxxxvi\nBritish Psycho-Analytic Society sometime in 1940, Winnicott had startled his colleagues with the statement:\n

There is no such thing as an infant, meaning, of course, that whenever one finds an infant one finds maternal care, and without maternal care there would be no infant.

\n\n

At this point Winnicott adds two concepts that are important to his understanding of early development in the infant. I give his statement in his words since it cannot but lose from abridgement:

\n\n

\nxxxviii\nappear in relation to failures on the part of the mother (or in maternal care) to ward off impingements which might disturb this isolation.\n

A decade later Winnicott in a letter (1971c) to his French translator, Mme. Jeannine Kalmanovitch, gave the definition of self as:

\n\n

\nxxxix\n\n

\n\n

But to this Winnicott adds a rider:

\n\n

In order to preserve the personal way of life at the beginning the individual needs a minimum of environmental impingements

\n\n

\nxxxxi\n

\n\n

Winnicott considered that it was the aggressive drive that led the infant to discover “the Not-me object or an object that is felt to be external”.

Aloneness and Concern in the Location of Cultural Experience

\n\n

In the depths of my being I remain convinced that my dear fellow creatures—with few exceptions—are a wretched lot.

\nFreud to Lou Andreas-Salomé (28.7.1929)\n

Ah! nous avons trop présumé de I'homme sous le masque!

\nSt. John Perse: Amers.\n

\n\n

Friedrich Nietzsche, some hundred years after Rousseau, in his last book Beyond Good and Evil (1885), tried to give the characterology of the noble alone man, who wishes and chooses his aloneness:

\n\n

The spiritual haughtiness and disgust of every human being who has suffered deeply—how deeply human beings can suffer almost

Winnicott (1958b) offers us a third alternative:

\n\n

Thus Winnicott not only humanises aloneness but renders it an ego-related experience positively involving the other person. He argues:

\n\n

Winnicott considered ego-relatedness “the stuff out of which friendship is made. It may turn out to be the matrix of transference”. Winnicott concludes his argument:

\nxxxxiv\n\n

\n\n

Winnicott states his position with his customary abrupt clarity:

\nxxxxv\n\n

Concern refers to the fact that the individual cares, or minds, and both feels and accepts responsibility.

\n\n

\nxxxxvi\n\n

\n\n

So we arrive at Winnicott's testament of faith “The Location of Cultural Experience” (1967 [1971b]). I quote his main thesis:

\nxxxxvii\n

For every individual the use of this space is determined by life experiences that take place at the early stages of the individual's existence.

\n\n

He so quietly develops the concept of “transitional phenomena” of infancy to include “the potential space” of adult's life in culture.

Winnicott was one such the like of whom I shall not meet again.

\nxxxxviii\n\n\n

References

\nAbraham, K. (1924). ‘A Short Study of the Development of the Libido in the Light of Mental Disorders’ in Collected Papers of Psycho-Analysis (London: Hogarth Press)\nErikson, E. H. (1950/63). Childhood and Society (New York: Norton; London: Hogarth Press)\nFreud, A. (1946). The Psycho-Analytical Treatment of Children (London: Imago/Hogarth Press: New York: International Universities Press)\nFreud, S. (1895). Studies on Hysteria in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 2 (London: Hogarth Press)\nFreud, S. (1917). ‘Mourning and Melancholia’ in Standard Edition, Vol. 14\nFreud, S. (1921). Beyond the Pleasure Principle in Standard Edition, Vol. 18\nFreud, S. (1923). The Ego and the Id in Standard Edition, Vol. 19\nFreud, S. (1926). Inhibitions, Symptoms and Anxiety in Standard Edition, Vol. 20\nFreud, S. (1930). Civilization and Its Discontents in Standard Edition, Vol. 21\nGlover, E. (1968). The Birth and the Ego (London: Allen & Unwin)\nHartmann, H. (1958). Ego Psychology and the Problem of Adaptation (London: Imago/Hogarth Press: New York: International Universities Press)\nKlein, M. (1935). ‘A Contribution to the Psychogenesis of Manic Depressive States’ in Contributions (1948)\nKlein, M. (1948). Contributions to Psycho-Analysis (London: Hogarth Press)\nKlein, M. (1957). Envy and Gratitude (London: Tavistock Publications)\nMilner, M. (1969). The Hands of the Living God (London: Hogarth Press; New York: International Universities Press)\nNietzsche, F. (1969). Selected Letters of Frederich Nietzsche. Edited by C. Middleton (Chicago: The University of Chicago Press)\nShah, I. (1970). The Wisdom of the Idiots (London: Octagon Press)\nSmirnoff, V. (1971). The Scope of Child Analysis (London: Routledge & Kegan Paul)\nTrilling, L. (1955). Freud and the Crisis of our Culture (Boston: the Beacon Press)\nWinnicott, D. W. (1931). Clinical Notes on Disorders of Childhood (London: William Heinemann)\nWinnicott, D. W. (1951). “Transitional Objects and Transitional Phenomena” in Playing and Reality (1971b)\nWinnicott, D. W. (1958a). “Psycho-Analysis and the Sense of Guilt” in Maturational Processes (1965)\nWinnicott, D. W. (1958b). “The Capacity to be Alone” in Maturational Processes (1965)\nWinnicott, D. W. 1959 [1964]). “Classification” in Maturational Processes (1965)\nxxxxix\nWinnicott, D. W. (1960). “Ego Distortion in Terms of True and False Self” in Maturational Processes (1965)\nWinnicott, D. W. (1961). “The Theory of the Parent-Infant Relationship” in Maturational Processes (1965)\nWinnicott, D. W. (1962). “A Personal View of the Kleinian Contribution” in Maturational Processes (1965)\nWinnicott, D. W. (1963a). “Psychotherapy of Character Disorders” in Maturational Processes (1965)\nWinnicott, D. W. (1963b). “Dependence in Infant-Care, in Child-Care, and in the Psycho-Analytic Setting” in Maturational Processes (1965)\nWinnicott, D. W. (1963c). “The Development of the Capacity for Concern” in Maturational Processes (1965)\nWinnicott, D. W. (1965). The Maturational Processes and the Facilitating Environment (London: Hogarth Press; New York: International Universities Press)\nWinnicott, D. W. (1969). “The Use of an Object and Relating Through Identifications” in Playing and Reality (1971b)\nWinnicott, D. W. (1970). “The Mother-Infant Experience of Mutuality” in Parenthood: Its Psychology and Psychopathology. Edited by E. James Anthony and Therese Benedek (Boston: Little Brown)\nWinnicott, D. W. (1971a). Therapeutic Consultations in Child Psychiatry (London: Hogarth Press: New York: Basic Books)\nWinnicott, D. W. (1971b). Playing and Reality (London: Tavistock Publications; New York: Basic Books)\nWinnicott, D. W. (1971c). Letter to Mme. Jeannine Kalmanovitch in Nouvelle Revue de Psychanalyse, Vol. 3.\nWinnicott, D. W. (1971d). “Adolescence: Struggling through the Doldrums” in Adolescent Psychiatry. Vol. I. Edited by Sherman C. Feinstein, Peter Giovacchini & Arthur A. Miller (New York: Basic Books)\nWinnicott, D. W. (1972a). “Basis for Self in Body”, International Journal of Child Psychotherapy, Vol. I, No. 1.\nWinnicott, D. W. (1972b). “Mother's Madness appearing in the clinical material as an Egoalien factor” in Tactics and Techniques in Psychoanalytic Therapy. Edited by Peter L. Giovacchini (London: Hogarth Press; New York: Science House)\nWinnicott, D. W. (1972c). “Fragment of an Analysis” in Tactics and Techniques (see 1972b)\nWinnicott, D. W. (1973). “Delinquency as a sign of Hope” in Adolescent Psychiatry, Vol. II. Edited by Sherman C. Fernstein & Peter Giovacchini (New York: Basic Books)\nWinnicott, D. W. 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Contents

Preface

Acknowledgements

Introduction

Inner Reality Versus Fantasying

From the Transitional Object to Use of an Object

Regression, Management and Playing in the Clinical Setting

The Making and Becoming of a Person

Aloneness and Concern in the Location of Cultural Experience

References

Contents

Preface

Acknowledgements

Introduction

Inner Reality Versus Fantasying

From the Transitional Object to Use of an Object

Regression, Management and Playing in the Clinical Setting

The Making and Becoming of a Person

Aloneness and Concern in the Location of Cultural Experience

References

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