Chapter 3 – The Assessment of Normality in Childhood
Summarizer’s summary: In
this chapter, Anna Freud tries to do several things, such as combine
the libidinal (i.e. Freudian sexual stages) and object relations parallel
into trajectories of normal psychic development of the ego in children.
So, here it comes:
Early spotting of pathogenic agents: prevention and prediction:
Tracing symptoms to their origins
is different than foreseeing them in the children. Therefore, Anna Freud
promotes the idea of building a curriculum for teaching child analysts
(i.e. in dealing with the crap before it develops). For the predicting
part of the child analysis, the psychotherapist must know what is normal
as opposed to the pathological. This is in opposition to the adult psychoanalysts
who know all about what is wrong with the client.
In kids, it is harder to extrapolate
what is normal due to their progressive development from immaturity
to maturity, and by the fact that this progression is not uniform across
all axis of development.
Assessment of child for treatment:
ài.e.
child analyst must look at libidinal sequence and ego functions (i.e.
ego developmental stage). So assessing the person’s current normal/non-normal
situation is important – current situation shows persons compromise
formulas/solutions in his personality. But it does not show direction
(maintaining, improvement or lowering of performance levels)
Translation of external events into internal experience
-thre are tons of good questions
about the given child (i.e. should there be any mother substitute? When
is a good time to leave child for the first time? Breastfeeding vs.
bottle feeding? Coke vs. Pepsi (no… just kidding)? when should toilet
training be introduced? What age is good for starting nursery?
Should we circumcise, and if so , at what age? What types of schooling?
Should autoerotic behaviours be allowed? Should we allow he adolescent
to remove himself from the family as per his request? Etc….
-there are no good generic
answers to those questions, but only particular answers to specific
child. The key is not (read: NOT) to look at the chronological age but
at the person’s developmental levels. Therefore, in working with parents
who are struggling with their child, the therapist should point out
the difference between the parents’ logical explanations and the child’s
psychological reality.
Four Areas of Difference between Child and Adult
The insensitivity of those
differences between adults and children could be the source of difficulty/insensitivity
on the parental behalf.
The concept of developmental lines
-you can talk of development in the following axis:
In assessing a child, one must
look at the intersection of the libidinal, aggressive and the ego development.
In other words, we need to look at the trajectory from the id/object
determined state to ego mastery of the internal and external
world. Several such trajectories will be delineated with the aim of
showing the id vs. ego/superego development in children (i.e. food consumption
becomes an adult/rational thing and not a libidinal/emotional thingy/
move from infant “sharing” his body with his mother towards the
adolescent independence/ move from egocentricity towards empathy; and
from first erotic play on his own by means of Winnicott’s transitional
objects).
The intersection of maturation
adaptation and structuralization is seen in the interaction between
drive ego-superego development, and their interaction with environmental
factors.
| Prototype of a developmental line: from dependency to emotional self-reliance and adult object relationships: | ||
| Described here is a prototypical way of describing newborn’s utter dependence on maternal care to the young adult’s emotional and material self-reliance. The libido development (oral/anal/phallic) are the mere inborn base of this trajectory | ||
| Stage | Description | Problems in this stage |
| Biological unity between mother-infant couple | Mother’s narcissism extending to the child and child including the mother in his internal “Narcissistic Milieu”. Margaret Mahler subdivides this stage into 1) autistic, 2) symbiotic, and 3) separation-individuation phases, which specific dangers for developmental issues at each one of those stages | infringement on the mother-infant tie, while infant is at phase one of the above chart will lead to separation-anxiety (i.e. Bowly, 1960) |
| The part object (Melanie Klein) | need-fulfilling/anaclitic relationship between mom and child, based on urgency of infant’s bodily needs/drive derivatives. Object cathexis is under the impact of desires, and withdrawn when satisfaction is achieved. | No comforting object = anaclitic depression (Spitz) or individuation issues (Mahler), deprivation (alpert) “false self” (Winnicott) |
| Object constancy | Positive internal image of object regardless of whether object satisfies or dissatisfies. | |
| Pre-oedipal | Ambivalent relationship of pre-oedipal anal-sadistic stage, characterized by ego-attitudes of clinging, torturing, dominating and controlling the love object | Unstable relations to unsuitable
love objects.
Clinginess is because pre-oedipal ambivalence, not because of maternal spoiling |
| Object-centered Phallic-Oedipal stage | possessing the parent of opposite sex/jealousy & rivalry with the same-sex parent. Protectiveness/curiosity/bids for admiration/exhibitionistic attitudes. In girls, a phallic/oedipal relationship with mother before the phallic stage with the father. | - |
| Latency | Post-oedipal lessening of
drive urgency and transfer of libido from parents to contemporaries/community/ |
|
| Pre-adolescence | Prelude to the adolescent revolt –regression to earlier attitudes/behaviours, part-objects, need-fulfilling/ambivalent types. | |
| Adolescents | The attempts to reverse/deny infantile objects, defending against pre-genitality | |
The relevance of the aforementioned steps in important for practical questions around where the issues are along the axis of development:
Some developmental lines towards body independence
Ego starts as a bodily ego.
This matches mother’s narcissistic needs; at first infant-mother’s
body boundaries are based on subjective experiences, and the merging
with mother is based on pleasure/unpleasure – baby’s bodily needs
are inherently tied in with the mother. This does not mean that the
child will achieve bodily independence before emotional or moral self-reliance.
Except auto-erotic behaviours, early childhood’s bodily needs/impulses
and their derivatives are dependent on the environmental influences
(i.e. mother). Therefore, there must be a complex transformation in
order for the person to take charge of himself.
| From suckling to rational eating | ||
| Described here is a prototypical way of describing newborn’s trajectory from utter dependence on maternal care for food needs to the young adult’s nutritional self-reliance. | ||
| Stage | Description | Problems in this stage |
| Being nursed | Baby is nursed by demand or by clock. Difficulties: fluctuation of hunger/intestinal upset, maternal anxieties around feeding | Forced feeding or rationing lead to disturbances in positive relationship to food. Pleasure sucking may be the fore-runner or interference with the eating. e |
| Weaning from bottle | Weaning from bottle as initiated by parent or child | Could lead to child feeling oral deprivation. New foods could be welcomed or rejected: this is a fork in the road for the rest of client’s personality development: he will either become adventurousness or a tenacious clinger. |
| Transition from being fed to self-feeding | -the mother-food connection is still there. Often, quantity of food gets shifted to arguments around how to eat (table manners), how much sweets to have as a oral sucking substitute | |
| Fade of the mother-food equation | Irrational attitudes about food, based on infantile sexualized theories (impregnation through the mouth, pregnancy (getting fat), reaction-formation against cannibalism/sadism | Differential diagnosis: whether the conflict is internal-related or external-related in nature |
| Gradual fading of sexualization of eating | -this happens in the latency period where there is a retention/increase in pleasure eating, as well as rational attitudes towards food. | Any conflict at this stage is within the person’s mind and therefore considered neurotic in level |
-stages 1-4 still has a strong mother-food connection, also in mother’s mind. Any food rejection is seen by the mother as aimed at her personally.
-Anna Freud recommends substituting
a stranger instead of mother if “food-fights” need to be avoided.
| From Wetting and Soiling to Bladder and Bowel Control | ||
| We’re
talking here of a very clear issue and not drive derivatives. Therefore
the control/modification/ | ||
| Stage | Description | Problems in this stage |
| Freedom to wet/soil as he wishes | This stage will stop, not
maturationally, but environmentally – i.e. when mother decides to
toilet train for whatever reason (personal/familial/cultural/ |
|
| Shift from oral to anal stages | Opposition to toilet-training becomes stronger due to body-objects being highly cathected (emotion/object infused into the object) with libido/aggressive drives. The bodily products are thus used as weapons. There is ambivalence between the libido/aggressive drives – the live-hate not integrated. The ego side develops into curiosity about the insides of the body, pleasure in playing with the shit. | If mother in un-empathic to child’s position, due to her own positions, a large battle will ensue, and thus client’s mother’s analism will be endowed to the child. |
| Acceptance of mother/environment’s position on environment | Client identifies with mother/environment and integrates in into ego/superego. It is now internal and not externally based. By-products of cleanliness include punctuality, conscientiousness. The highly modified parts of the anal drive derivatives could become cool parts of the individual’s characters – if kept within normal bounds. | In tensions between client and mother, child might regress to have “accidents” |
| Bowel/bladder control | Toilet training becomes wholly secure àit become autonomous ego/super-ego parts, totally disconnected from super-ego | |
| From irresponsibility to responsibility in body management –perceptual/motor | ||
| -this axis is where kid starts taking responsibility for his own care | ||
| Stage | Description | Problems in this stage |
| First few months of life | Baby learns that there is an inside and external world, so aggression better be aimed at the outside. | |
| Advances in ego functioning |
|
Vulnerable if unprotected by own emerging mechanism as well as by adults |
| Voluntary endorsement of hygiene/medical necessity | Influenced by oral/anal positions | Child will still endanger himself and expect mother to “save” him |
Other lines include:
| From Egocentricity to Companionship | ||
| -this axis is the social growth of the child | ||
| Stage | Description | Problems in this stage |
| Selfish/narcissistic | Selfish outlook on objects: others do not “exist” and are not being accounted into the reality formula of the child | |
| Others seen as lifeless object | Can be pushed around with no expectation of reaction from them | |
| Other children as objects in their own right | Others’ can be admired/feared. Other’s wishes are acknowledged and the relationship has a basis of empathy | |
| Others seen as helpmates in certain tasks | ||
| Others as partners/objects in their own right | Child can admire/fear/compete/love or hate/acknowledge/respect/share on the basis of equality. | |
Note
| From the Body to the Toy and from Play to Work | ||
| Stage | Description | Problems in this stage |
| Play with body | Autoeroticism or playing with mother’s body (in connection with the feeding). No clear distinction between self/mother’s body | |
| Transfer to soft substance | Properties of mother/child’s bodies transferred to clinging to a soft body, i.e. pillow/rug/teddy-bear. Child’s first play-thinggy – i.e. transitional object in Winnicott’s words | |
| Generalization of soft thingy | Clinging to a soft toy gets generalized to liking soft toys indiscriminately. Those objects are cuddled and maltreated alternatively (cathected with libido + aggressive drive alternatively). Infant can show ambivalence towards the toy since the toy does not retaliate. | |
| Fading of toys | Fading of toys (except bed-time,
when they do serve as transitional objects in transition from the child’s
active participation in external world to narcissistic withdrawal needed
for sleeping).
In daytime, play objects become increasingly about ego activities and their underlying fantasies. Such play is to either satisfy instincts directly, or sublimated drive energies. The chronological stages are as following:
Anna Freud claims that this |
|
| Task completion | direct satisfaction of playing due to the finished product/task completion. Some claim that this stage is essential for success at school. This probably happens because of modeling/identification processes and the internalization of external sources of self-esteem | essential for success at school |
| ability to play becomes ability to work |
|
|
| Activities needed for further development | ||
| Daydreaming: when toys fade into the background and the wishes [formally expressed in play] are now mental activity | ||
| Games: stems from imaginative stage of oedipal period – becomes symbolic expressions of libido – requires some adaptation to reality and some frustration tolerance, which the child cannot do before stage 3 of companionship axis, where the inflexibility of rules is weakened. Some game equipment [as distinct from toys] are instances of the symbolic-phallic [i.e. masculine-aggressive] and thus highly valued by child. Games involve integrating many axis, i.e. physical competence, aggression in the service of ambition, positive employment of controlled aggression | ||
| Hobbies:
half-way between play and work
In common between work/hobbies:
àalso reality-adapted and planned, sometimes in light of frustration and external difficulties | ||
-ideally, physical and mental
development should be in-sync. But obviously this does not always happen,
and there are often cases of irregular development tempos/etc… (i.e.
well developed social/play axis, but underdeveloped in bodily processes).
Anna Freud recommends that one look into the reasons behind the irregularity,
whether innate or because of environmental issues.
Differences in individuals’ development
-Endowed id/temperament + accidental
environmental influences [i.e. things reinforced and un-reinforced by
mother. Therefore, some specific things get libidinized; i.e. lack of
physical contact with the child could lead to a clumsy child. Sign to
child libidinizes music. Maternal depression becomes libidinized. Therefore,
maternal contact with child could influence speech development and quality.
Applications of the ideas in this article:
So? Is the given child ready for entry into nursery? Look into the developmental level and not chronological age of the child. i.e. paradigmically speaking, a child can separate from mother at age 3.5 years old:
Beyond the developmental axis, one must also look at the id-ego interplay:
End of reading!!!