The Good Doctor

This must be the fifth or sixth posthumous book by the English psychoanalyst D.W. Winnicott to appear since his death eighteen years ago. The appearance of these ghostly volumes is curious; it is not explained in them why so much material was left unpublished or why it has come out so slowly. Moreover, there is something denatured about these books, lacking as they do the living authorial voice behind them, and on the whole what was published during Winnicott’s lifetime is more interesting.

The publishers say on the jacket that this is the most important of the posthumous books, and Human Nature is certainly an ambitious title. The book is put together, in rather confusing order, from lecture texts that were frequently revised, and was definitely intended by Winnicott to be a statement of his entire theory. But it lacks the illustrations from sessions with his patients that were scattered about in his earlier papers, and lacks also the unpredictability and fun that made him such a fine lecturer in the flesh. But—for clinicians chiefly—the outline of his theory about how human beings develop and function is all here.

Why should American psychoanalysis and psychology take notice of him? Mostly, I think, because he goes beyond conventional psychoanalysis to a concern with “being” itself—that is, with how a baby learns to feel that it exists and that, separately, the world outside exists. Winnicott sees this as important not only because many patients come to therapy with a shaky sense of self but because these very primitive concerns remain part of our mentality throughout life—indeed, they are central in philosophy and to much of introspective twentieth-century art. Kafka is writing about them, and Beckett; but the starting point of psychoanalytic explanations in general is the young child with an already solid sense of self. Psychoanalysis’s future, perhaps, lies in going back to earlier stages.

Of course Winnicott’s schema is speculative, and often far-fetched. But he was in a better position to explore this hinterland than most psychoanalysts because of his long experience as a pediatrician and consultant in a children’s department, and also because he sometimes took patients of a psychotic type (not always with success, he explains).

One of Winnicott’s first postulates is that birth, and even prenatal experiences, are registered by the baby’s brain and remain important unconscious memories (it is interesting that erstwhile fashionable LSD experiments seem to have found a wealth of perinatal material that were relived under the drug). This may have implications for therapy; elsewhere he has described child and adult patients who seem to regress to birth experiences during their sessions. In fact Otto Rank raised this question as long ago as 1924 in The Trauma of Birth, but without any therapeutic consequences. Freud himself called birth “both the first of all dangers to life and the prototype of all the later ones that cause us to feel anxiety.” In view of the worldwide use of rebirth as a religious symbol, perhaps there is a very real reservoir in the mind of memories, fears, and longings. Winnicott’s practical remarks about birth management—the newborn baby should be held skin-to-skin rather than washed and dressed—anticipate by many years the work of writers such as Michel Odent.

Winnicott’s account of how the newborn baby then acquires the sense of self and not-self and how this affects the experiences of a life was more accessible in his collection of essays reviewed here several years ago (Home is Where We Start From, 1986).¹ In Human Nature it is more theoretically extended. To acquire this foundation for being a human being he sees as a considerable achievement, not always successfully completed (the brochures of encounter groups regularly promise to “find out who we are”). The whole puzzle of the outside world’s reality is summed up in the famous Berkeleian limerick:

There once was a man who said “God
Must find it exceedingly odd
If he finds that this tree
Continues to be
When there’s no one about in the quad.”

(The deist answer, of course, is that “the tree / Continues to be / Observed by yours faithfully, God.”) There is no proof that what we see is permanently there; but, Winnicott says, the baby who has had reasonably good experiences

grows up to say “I know that there is no direct contact between external reality and myself, only an illusion of contact, a midway phenomenon that works very well for me when I am not tired. I couldn’t care less that there is a philosophical problem involved.”

Babies with slightly less fortunate experiences are really bothered by the idea of there being no direct contact with external reality. A sense of threat of loss of capacity for relationships hangs over them all the time. For them the philosophical problem becomes and remains a vital one, a matter of life and death, of feeding or starvation, of love or isolation.

The baby’s faith in a self within a boundary, and a reliable world outside it, has to be allowed to develop simultaneously and in an unhurried way; separations, and precocious pressures, both disrupt the process. It would be interesting to know how varying child-care practices, from the close and easy one of a third world village, to the clock-bound training of thirty years ago, to the present return to demand feeding and a carrying-sling, actually affect this process. Though there is psychological disorder in every culture, there is a sense of being lost in a strange world that does seem to be specific to the twentieth-century West. It would be interesting too to study differences over the centuries in the Christian icon of mother and male child—differences in posture and gesture in the relation between the two figures.

The psyche of the baby, therefore, ideally

becomes something that has a position from which to become related to external reality, becomes a thing with a capacity to create and to perceive external reality, becomes a qualitatively enriched being able to go further than can be explained by environmental influences, and able not only to adapt but also to refuse to adapt, and becomes a creature with what feels like a capacity for choice.

First comes an invaluable faith in the continued existence of the tree in the quad; then the child can imagine trees, give them a name, draw them, think of magic beanstalks and Christmas trees. The only psychologist who has experimentally studied these stages of imagination is Piaget in his early books. He has innumerable confirmatory observations of his children, from the time when they assumed a bottle put behind a cushion had vanished forever, till they could reach behind the cushion and find it, till they could invent games of their own with imaginary objects. Winnicott elsewhere describes a clinic where he handed a spatula to each baby and watched its reactions. One young infant leaned forward and offered imaginary food to all around.

These speculations of Winnicott’s about infancy are not airy or unrelated to ordinary life; he makes it clear—having learned it, presumably, from his patients—that all the stages in this apprenticeship to reality remain constantly present. Shock, exhaustion, ecstasy, alcohol, drugs obviously threaten the whole structure; creativity and inspiration, in the arts or anything else, are closely related to it.

Another concept that Winnicott extracts from his theory of early development is that of the “false self”—a phrase that has been much bandied about, perhaps because everyone suspects it is to some degree true of themselves. He postulates a split between an obedient conventional self and a secret hidden one that feels much more real; patients then turn to the analyst because of the feeling that everything is meaningless and lifeless. He has much to say about feelings of aliveness and un-aliveness, “unintegration” and disintegration, feelings about the quality of actual being. Did the patients of Freud’s day have these experiences, I wonder, and lack the language to express them in, or has there been a real change in the nature of consciousness?

Human Nature has a great deal more theory about later development in childhood, of course. A section, “The Depressive Position,” is an account taken over from the controversial psychoanalyst Melanie Klein, which proposes that babies feel angry at the breast (an irritating term when most babies are fed by bottle), guilty about their anger, and anxious to make amends. This sounds more likely to be true of two- or three-year-olds who are learning about naughtiness and goodness than of babies. The chapters on childhood sexuality to me suggest what a muddle psychoanalysis was (or is) in about women. Each description of a stage in development starts with an account of the little boy, and then goes on rather lamely to fit in girls’ development. Women’s “penis envy” is described, and at the bottom of the page there is just: “Note for revision: Corresponding male envy of female to be stated.” This is particularly strange coming from a man whose working life was based on his acting as a bountiful mother.

Winnicott did put his ideas about the unbearable fragility of being into practice with his patients, and his belief that regression to its early stages was healing. There are two interesting accounts in print of analytic treatment with him. The English psychoanalyst Margaret Little has described how, though she herself was in practice as an analyst, she was able to “go mad” with Winnicott in order to make a deep recovery; years of previous treatment had been of no help.² Winnicott spent many months simply sitting by the couch holding her hands while she raged or slept; when she felt too ill to go out to his house he came regularly to hers. Before his summer holiday he asked her to go temporarily into hospital, and took her there. “On the station platform he found that I was clinging to the edge of his raincoat, terrified. He took my arm in his, and when we arrived he said, ‘You’re being very brave.”‘ She says she feels she owes her life to him (though he was human, and “perfection would have been useless”). Much lip service is paid to Winnicott’s ideas, in Britain at any rate, but I do not know how many analysts carry them out in practice as he did.

Harry Guntrip, another English therapist, was not in such a dramatic collapse; his sessions took place only on monthly visits to London, but he felt they went straight to the heart of his troubles as his previous analysis had not done.³ Winnicott grasped, he says, the partly dead quality of his life, his inability to stay still for fear of annihilation, which went back to the death of a younger brother. Winnicott said: “You can’t take your ongoing being for granted. You have to work hard to keep yourself in existence. You’re afraid to stop acting, talking or keeping awake. You feel you might die in a gap like Percy.” The news of Winnicott’s death, after the sessions were over, started a series of vivid dreams which led him back to the original terrors. “What gave me strength in my deep unconscious to face again that basic trauma? It must have been because Winnicott was not, and could not be, dead for me, nor certainly for many others.”

Nevertheless he is dead; and it is an eerie experience reviewing the posthumous books of the analyst of whom one was bereaved eighteen years ago. So voluble in print and so silent to me! An astral voice (or internalized-good-object) whispers, “Give it up.” I shall.