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Winnicott has two tools, either of which may be denied to the rest of us. He has unique empathy with the nursing couple, and he is through and through a scientist in intention. Since he is moreover not just a doctor but also a physician and paediatrician, the subtitle of his collected papers, 'Through Paediatrics to Psycho-Analysis', is well justified.
Winnicott's achievement is that for close on thirty years, as a lone voice, he has stressed the importance for prophylaxis of the mother's rôle in earliest infancy. His interest begins in the area where, for good scientific reasons, scrupulous writers like Anna Freud, Mahler, and Spitz have left off; fearing, for lack of observations, that they would merely be speculating.
Discussion of narcissistic trauma in infancy stopped at reconstruction because attempts at observation have for the most part been frustrated. Either, as with Klein, the infant is assumed to have psychological processes at work from birth and then reversibility of the processes can be assumed and attempted, or, as with Anna Freud, narcissistic trauma when diagnosed is accepted as a fait accompli. If this is done constitution is invoked and limited access for treatment is accepted.
This second approach to narcissistic trauma is that of descriptive psychiatry as well as of psycho-analysis generally speaking: for both disciplines it is an empirical fact that psychosis is not per se amenable to analytic measures. This is not to say that its consequences and individual psychotic defences cannot be better or worse handled. Unlike neurosis, where the conflict can be resolved, psychosis has to be lived with. Winnicott is interested in the disturbances left after neurosis is relieved. He thinks some of these disturbances can be handled by extra-analytic measures: what he calls 'management, within the psycho-analytic setting'. He bases his theoretical position upon the concept of primary narcissism which he sees as at first a biological a