The Psychoanalytic View of the Development of Encopresis

In this schematic outline of the main points of psychoanalytic thinking on the subject of encopresis, I hope to indicate some of the considerations an analyst has to have in mind when assessing the importance and meaning of this symptom. Some of these considerations are well known, and I shall restrict my discussion to children who do not have physical abnormalities and in whom it may be assumed that encopresis is a sign of emotional disturbance. I propose to approach the assessment of the symptom from the developmental point of view, with special stress on: the gradual differentiation of mind and body; the developing relationship between the child and its mother, especially in regard to control of the child's bodily functions; libidinal drive development, especially in the anal phase, and those aspects of ego and superego development which affect the child's feelings about and attitudes towards his anal functioning. These areas of development are of special relevance to encopresis, and I shall therefore concentrate on them for the purposes of this paper. I would stress, however, that in practice an analyst would not attempt to assess the severity and meaning of such a symptom in isolation, but would view it within the total context of the child's overall development and psychopathology (cf. : Normality and Pathology in Childhood).

To take first the question of the differentiation of body and mind: in the young infant the lack of differentiation between mind and body is indicated by the infant's diffuse physical and vocal reactions to stimulation of all kinds, from the outside world or from its own body. The process of differentiation between bodily and mental experiences and reactions occurs gradually during childhood, and is probably never completely achieved, if we may judge by the frequency of psychomatic illness in adults. In young children the specially close links between mind and body mean that it is normal for a small child to show transient physical reactio