Meetings of the New York Psychoanalytic Society

October 17, 1972. THE RELEVANCE OF RECENT PSYCHOANALYTIC CHILD DEVELOPMENT RESEARCH FOR THE PRACTICE OF CLINICAL PSYCHIATRY. Edgar L. Lipton, M.D.

Dr. Lipton focused on three topics. First, the effects on personality of early physical malformations. Defects themselves are not necessarily pathogenic but the environment and the attitude of the mothering figure are crucial. Reality testing, coping with aggression, and character formation are subject to derangement. The psychiatrist must be alert to the patient's narcissistic sensitivities and keep the disability out of the treatment. When the problem is frankly explored, improvement and clarification of the self-concept results. Second, the effects of maternal deprivation and institutionalization. Here the author emphasized the importance of Spitz's work but cited evidence that not all maternal deprivation produces irreversible damage. The quality of the antecedent mother-child relationship, the adequacy of substitute care, and the constitutional endowment of the child must also be considered.

Finally, the author cited the work of Mahler and her co-workers as an example of how child observation has enriched our appreciation of the earliest mother-infant bonds. He discussed the implications of the symbiotic metaphor in the evolving, ever-changing, need-satisfying dyad. Failure of the necessary mutual cuing results in psychotic patterning in which the infant cannot use the mother to acquire a sense of reality. It is from the vicissitudes of the symbiotic relationship that the 'as if' personality, certain borderline cases, and severe narcissistic disturbances can have their roots; indeed, psychoses of adolescence and adulthood can be traced to a faulty early symbiotic relationship. Mahler's therapeutic approach gives the child another opportunity to progress through previously missed or unsatisfactory phases of development, with the aim of developing better object relationships and a firmer sense of identity.