Father Christmas, Spock and the Dirty Old Tramp: The Inner Life of a Disturbed Four-Year-Old Boy

This paper is offered as a case report of a severely disturbed boy in intensive treatment from the age of three-and-a-half to five years. Its usefulness lies in the opportunity it provides for examining in statu nascendi the relatively early stages of a grave disturbance. In particular, the pre-stages of defences and their ensuing development are traced in their impact on the personality. Additionally, the struggle to gain self-object differentiation is highlighted.

John was originally referred at the age of two by his playgroup leaders who believed that he was a child at risk because of his disturbed mother, and that he could make good use of our Nursery School. He was offered a place for the following year and seen in the meantime in the Well-Baby Clinic. John was initially thought to be developing adequately, but it was noted that he did not once turn to his mother throughout the forty-five-minute period. Mrs A. made an odd impression, talking repetitively and in clichés. She appeared to be rather dull, isolated, and eager for contact, but we saw later that the massive anxiety with which she was constantly confronted had masked a rather good intellect. It was after the first visit when John did not want to leave the waiting room that observers witnessed Mrs A's helpless rage in which she threatened John and handled him roughly.

When John was almost three, concern was expressed that his development was not proceeding. He was easily distracted and his play was described as like that of an eighteen-month-old. His affect seemed generally flat with perhaps a mild bewilderment. He was preoccupied with dirt and it was thought