Adaptation and Individuation: an lllustrative Casey

In two previous studies of depression in children (Sandler & Joffe, 1965; Joffe & Sandler, 1965), conducted as part of the research programme of the Hampstead Index, we have been concerned with investigating particular types of response to painful mental states in children. Two major types of response have been considered in some detail—the depressive response, and the progressively adaptive response which we referred to as individuation. Both these types of response could occur at any age, and within a wide variety of different personality types. They could be discerned in children who differed markedly in their symptomatology, and were also thought to be characteristic of so-called ‘normal’ children of all ages.

Since the completion of the original depression studies a number of individual case histories of children who have been treated psychoanalytically at the Hampstead Clinic have been examined in detail in order to test further the clinical applicability of the concepts of mental pain, depressive response and individuation. In addition, we have attempted to discover what further light can be thrown on clinical material as assessed in the diagnostic and therapeutic situations. Of particular interest have been those cases which, in spite of thorough investigation, have continued to pose special problems in regard to evaluation, and in which our existing dimensions of assessment appear to need supplementing. One such case has been chosen for presentation here. The child, whom we shall call Cecily, appeared to respond to very poor mothering with what was called precocious ego-development and ‘independence’. In sharp contrast to her apparently active and progressive adaptation (some observers felt that this was highly suspect), her brother, 20 months older, showed major developmental problems, passivity and depressive features. A great deal of well-documented information was available on Cecily: the referring physician's notes, Nursery School reports