Advanced Psychopathology

Monday, March 20, 2006


Freud V. Independent School of Psychoanalysis

Sara Petrasso

The British Object Relations School primarily departed from classical Freudian theory in its emphasis on the fulfillment of the baby’s quest for object fulfillment--a quest that can only be satisfied by the object’s capacity to provide a safe haven for the child’s developing ego. According to the British Object Relations school, the libido is object-driven, and not reduced to a mere, pleasure-seeking apparatus that operates off of libidinal and aggressive need gratification, as the classical analytic camp proposes. Rather, pleasure is determined by the quality of the object-relationship, thus shifting the focus toward the importance of emotional relations in the context of the infant’s environment.

Winnicott believed that the infant’s successful development largely depends on the mother’s sensitive attunement to the infant, and her ability to provide him with the ‘illusion’ that she is operating under his omnipotent control, effectively acting as though she is psychically “of one” with the infant. The infant’s ego can only successfully emerge from a holding environment where the infant was protected from trauma (e.g. brought on by the premature experience of self-differentiation, parental impingement, or neglect). Both Winnicott and Fairbairn, as opposed to Freud, exclusively attributed pre-oedipal, environmental failure/trauma as the source of future pathology. Thus, the most critical aspect of pathological development does not stem from repression of conflict at the oedipal stage, but rather, from deficiencies in early object relations. The British Object Relations School minimized inter-structural conflict (i.e., the ego repressing the strivings of the id), and emphasized crucial and formative environmental/relational influences.

Fairbairn further elaborated on developmental psychopathology proposing that schizoid and antisocial
personality disorder are reactions to pre-oedipal experiences of object/love deprivation, resulting in an infant who withdraws inwards in an attempt to preserve his wellbeing. However, this self-initiated withdrawl is a double-edged sword in that conflicts over dependence and autonomy dominate so that fears of engulfment and identity loss co-exist with fears of isolation and loneliness.
Something that still remains unclear to me is how, specifically, Freud would account for the development of schizoid personality.


The Contributions of Fairbairn and Winnicott

The Contributions of Fairbairn and Winnicott

Fairbairn’s changes to Freud’s structural model are drastic enough to consider it a distinct model of personality formation. The central distinction of Fairbairn’s theory from Freud’s is a dramatic reworking of the ego. Fairbairn focuses a good deal of attention on an expanded view of the ego and its role in personality formation in addition to extrapolated applications of repression. Through a series of shifts motivated by inconsistencies he saw in Freud's Structural Model and Klein's theory, Fairbairn replaces the concepts of id and superego with a more dynamic view of the ego itself, wherein there is a perpetually fluid energic exchange among the ego, the libidinal ego, and the internal saboteur. Thus the major contention is that the ego exists from birth not a result of redirected libidinal energy. In so doing, Fairbairn is able to account for a broad range of pathology, including more regressed pathology such as schizophrenia, as it is the splitting of the ego which is the seat of psychological disturbance.

Winnicott’s ideas represent several changes in psychodynamic theory. In the sense of a broad, formal shift, Winnicott’s moving forward from development to pathology, as opposed to moving from pathology backwards to development, in constructing a theory of personality is an important contribution, as it moves away from what tended to be an over-pathologizing of common character organization. Another major contribution, which may at first seem paradoxical, is his belief that mother-child differentiation leads to individuation, which in turn leads to integration. It is in the ability to perceive the other as separate from oneself, a paradigm formed through the development of the mother-child relationship, that allows for the accommodation of anxiety-provoking, confusing, and hurtful interactions with those who one cares about without major disruption to the overall functioning of the relationship. The integration of disparate interpersonal experiences is ultimately a reflection of intrapersonal and intrapsychic integration. The self is experienced fluidly and compassionately.


Fairbairn and Winnicott Response

The Independent School of British Psychoanalysis is an aggregate of independent theorists, with their own distinctive concepts and ideas around a general theme, yet lacking any one cohesive theory. The independent nature of this particular school was thought of as beneficial, since it allowed for open-mindedness in their theoretical development, and allowed for the ability to freely make adjustments to an idea when a challenge to that theory arose. The more general tenets of the Independents expanded on and challenged some of Freud’s central theories. While rooted in Kleinian thinking, the independent school incorporated aspects of the interpersonal relationships and the environmental effects of the developing child and their implications. Two predominant theorist in the Independent school, were Fairbairn and Winnicott, both of whom added coherent elements to the developmental process and arrest of the child, as well as technical innovations to the therapeutic process.
Two of the more generalized views of the Independent school challenged some of Freud’s theories, particularly when incorporating aspects of object relatedness. There was a shift away from the idea that libidinal drives were motivated solely for the fulfillment of pleasure and reduction of anxiety. There was also a shift away from the structural model, and instead, a focus on the different aspects of the ego, and the dynamic interactions among the ego itself was the significant factor involved with the sense of self and pathology. In addition, one major distinction between Freud’s theory and that of the independent school, is the role the environment plays on the development of the child. Freud did consider the constitutional factors involved in a child’s development, including biological predeterminants. The independent school, on the other hand viewed the environmental factors as the sole determinant in a child’s healthy or pathological development, considering nurture explanations over nature.
Fairbairn in particular challenged Freud’s ideas of libidinal drives. Fairbairn theorized that the libido is driven towards object-seeking. The pleasure gained and anxiety reduced comes secondary to object relatedness. The motivation of the libido is less so a matter of discharging energy, but more so relating to ego-objects, both internally and externally. Fairbairn also is distinguished for his notion of conflicts among the ego, challenging Freud’s structural model. The classical psychoanalytic view towards pathology, simply put, involves the repression and unconscious anxiety manifesting in intersystemic conflict which eventuates in symptom formation when that conflict is reactivated. The conflict that arises is between the id, ego, and superego functioning. Fairbairn, on the other hand, believes that pathology is a result of conflicting ego-object systems. If there is early trauma such as insufficient intimacy with the primary object, this memory will become dissociated from the ego and as a result, the ego (the self) will split among itself. This lack of integration of the ego causes conflicting multiple ego-object systems, which, for Fairbairn, is the root of pathology.
Winnicott challenges Freud’s theory on the basis of the frustration of needs and the ability of the infant to differentiate his self from his environment. Freud’s structural theory suggests that there is a frustration of instinctual wishes and this frustration cause the wishes to be repressed into the unconscious, which as described above, is foundation for pathology. Winnicott, on the other hand believes that frustration of ego needs is the significant determinant of pathology. The child’s ego needs are not met by an unresponsive caregiver, or one who is lacking good enough mothering, which causes a fragmentation of the continuity of being, leading to the disintegration of the sense of self. A False-self structure may develop to protect the fragile true self from this disintegration. The child is able to, in a sense, realize the environment is not meeting his ego needs, because he can in fact distinguish or differentiate between himself, as a separate physical entity, from the environment. This challenges Freud’s notion that infants are unable to differentiate. When there is a indication for the child that his ego needs are not being met, a false self is formed, acting as a defense or “caretaker” for the self, in order to protect the true self from further trauma.
The Independent School of British Psychoanalysis, with particular theorist s including Fairbairn and Winnicott, contributed to a more coherent theory regarding the effects of the environment and interpersonal relationships on a developing child, whether it facilitates or causes an arrest in development. There are many aspects of this theory that distinguishes itself from that of Freud’s, and even alleviates some of the controversial aspects of classic psychoanalytic theories. However, other aspects actually absorb some of Freud’s ideas such as the notion of unconscious conflict as a basis for pathology and made significant adjustments that can now be explained by empirical research. A few of these adjustments include the conflict that is among a fragmented ego, or that the developmental frustration is brought on by ego needs that are not being met due to insufficient interpersonal relations.

Sunday, March 19, 2006


Freud, Fairbairn, and Winnicott

Freud, Fairbairn, and Winnicott
The Independent school of British psychoanalysis produced such theorists as Fairbairn and Winnicott. Following the direction of Balint, these theorists believed that the desire to be loved was primary, unlike the Freudian concept of primary narcissism, which theorized that infant self-love precedes object love. In the Independent school’s view, the infant views itself as undifferentiated from the love object, which exists to serve or to love the infant. The infant’s ego experience is one of omnipotent control over the object. As long as the object is available and under the infant’s control, it is viewed as being loving.
A further difference between Freudian theory and the Independent school was articulated by Fairbairn. He viewed the libido as being primarily object-seeking, versus being primarily pleasure-seeking. In his view, pleasure is a secondary gain of object relatedness.
Both classical Freudian theory and the Independent school view adult psychopathology as reflecting some early trauma. The classical model applies to conflicts that arise during the oedipal phase of psychosexual development (3-4 years of age). The Independent school’s theory applies to pathologies that arise before the oedipal phase. Both Winnicott and Fairbairn view schizophrenia as the result of a total lack of a maternal care while the infant still is dependent upon the mother, viewing her as an undifferentiated part of himself. Personality disorders, according to Winnicott, result from having had a “good enough mother” who then was lost (deprivation).
Fairbairn also identified certain pathologies as originating during infancy. Schizoid personalities result from an infant viewing his love for his mother as being destructive. Depressive personalities result at a later stage when the infant views his aggression was destructive of the mother.
The dialectic view of the infant is a final difference between the Independent school and classical theory. Freud viewed the infant as being unable to differentiate the self from the environment. However, Winnicott viewed the infant as perceiving itself as a separate physical object.


Robert's Reaction: Winnicott, Fairbairn

Fairbairn and Winnicott propose many theoretical innovations that diverge dramatically from Freud’s developmental theory, adding new concepts to the psychoanalytic literature. At the same time, their infancy-centered theories revitalize some key Freudian concepts, including the ego, drives, and ambivalence.

Fairbairn and Winnicott seem to eschew, or at least sidestep, two key elements of Freudian theory: structural theory and psychosexual stages. For the British Independents, drives are present, as are parental influences that delimit experience and impart rules, but explicit mentions of the id and superego are nowhere in sight. Drives are no longer pleasure-seeking, but object-seeking: high-quality interactions with the object bring pleasure and relief from anxiety. The ego is the paramount psychic agency for Fairbairn and Winnicott. It is the job of the caregiver, they believe, to facilitate healthy ego development. Winnicott’s belief in the psychogenic primacy of infancy led him to abandon Freud’s psychosexual stages. Winnicott seemed to believe that psychological health or disorder arise NOT from the child’s handling of oral, anal, and oedipal conflicts, but instead from the sense of self founded by early dyadic interactions. The child’s “true self” begins in infancy, as he moves between experiences of fusion to experiences of independence, between experiences of “me and not me.”

Fairbairn’s and Winnicott’s emphasis on early environment ascribes more influence to caregivers than Freud. An adroit caregiver must be able to facilitate (and tolerate) a range of emotional states in the infant. On the one hand, the mother’s affective mirroring, anticipation, and “comprehension” of the infant’s affective state help to create the infant’s self-esteem. On the other hand, inevitable failures to anticipate baby’s needs and wants (a) present opportunity for reparation (b) let baby know that he and mom are separate, and not a fused, omnipotently-controlled pleasure machine and (c) give the baby chance to make “creative gestures” (like distressed crying in response to discomfort). Both Winnicott and Fairbairn highlight the importance of caregiver’s regulation of the baby’s ambivalence – his primal fears of losing himself when he’s dependent and of isolation when he’s independent. This dyadically regulated ambivalence differs from Freud’s depressive ambivalence, which is a cycle of unsuccessful, sexually-charged cathexis, repression, and introjection.

Winnicott’s theoretical perspective also suggests a clinically helpful addition to Freud. Thinking about patients’ utterances and patient/therapist interactions as creative gestures makes form – how and when patients speak, for instance – as important as content. Attention to form (e.g., timing, affective tone) might be especially helpful when working with inarticulate or disorganized patients.


fairbairn, winnicott, and dear old freud

The Independent School of British psychoanalysis, including Fairbairn and Winnicott, made major contributions to theories of early development and psychopathology with respect to their move away from a structurally-driven model to one much more relational in nature, creating a theory of “selfobject” and positing a dynamic interaction of complementary internal and external objects that comprise one’s self organization.

Rather than view it as a complete departure from Freud’s libidinal theory, I tend to see the ideas of Fairbairn and Winnicott as deepening the exploration into the unique elements that make up interpersonal interactions, particularly those between mother and infant, and how these interactions affect both intra- and extrapsychic representations thereby determining one’s sense of self as well as the way one behaves in certain situations. Freud viewed the infant as a pleasure-seeking, isolated entity; Fairbairn and Winnicott challenge this notion by seeing the infant as a relationship-seeking, social being, affected by the social environment in which he lives. As environments are ever-changing, the theory involves a sense of dynamicism about relationships, as well as the representations thereof, that allows for socialization as an adaptive measure for various circumstances.

The theories of Fairbairn and Winnicott, while logical and insightful, largely stem from notions of environmental factors exerting great influence on development and potential pathology. This beckons the question of causality, which seems to be somewhat lacking from these theories. Indeed, upon further inquiry into the nature versus nurture debate, in this case, biology seems to win out, with studies of twins reared in separate homes demonstrating that pathology may arise regardless of good or bad environment. Therefore, it is essential that any theory of object relations use the idea of temperament as a starting point from which to describe the influence of social interactions. In that respect, the theories of Fairbairn and Winnocott are perhaps best viewed, not as complete upheavals, but rather as complementary additions to the biological framework of Freud.


Sheila's Reaction: #5

The emergence of the Independent School represented a movement away from the classical structural theory pioneered by Freud toward a “self-object” theory. While wishes remained a focus, the interaction was now between different parts of the ego, or “self”. Fairbairn and Winnicott were particularly influential figures who emerged from the Independent tradition, making significant contributions to developmental theory.

In his writings, Fairbairn highlighted the role of emotion and the self, and saw them as inseparable; an individual cannot have one without the other. His theoretical framework characterizes libido as object-seeking, while Freud’s libido is driven by pleasure seeking. In Fairbairn’s view, pleasure and the reduction of anxiety is more closely related to the quality of an ego-object relation. The goal is maintaining relatedness, not the release of energy. If the desired level of intimacy with a primary object is not attainable, the self will split. Fairbairn is perhaps best known for positing that psychopathology is not a product of conflict among systems but a result of lack of integration. Thus, we see repression fading into the background as the focus shifts to “incompatible ideas”. While Freud’s emphasis was on conflicts occurring during the oedipal stage, Fairbairn and his contemporaries in the Independent School saw disorders of the self as emerging from trauma occurring before that stage. He posits that serious trauma at this early age is not repressed, but actually “frozen” or dissociated from the “functional self”.

Winnicott took issue with the Freudian idea that the infant is initially incapable of differentiating the self from the environment. He believes that indeed, infants can do so and there is a substantial body of research that supports his claim. Like Fairbairn, he does not see the infant as subject to uncontrollable, unconscious urges. Instead, the infant is seen in close relation to the mother and the focus is upon the quality of the “holding environment” that ideally the “good enough” mother provides for him. In this environment, the mother displays a special sensitivity to the infant’s moods and mirrors his affects, so much so that for a time the child believes she is under his control. Eventually, Winnicott writes, the “good enough” mother’s failure is unavoidable, but it is this failure that actually facilitates healthy growth and development. Fonagy writes that Winnicott’s work shows a particular understanding of the therapeutic process. One might say that the therapist in a sense supplies a similar “holding environment” for patients, a safe space in which they can integrate and learn to tolerate feelings of ambivalence.


Freud vs. Winnicott & Fairbairn

Both Fairbairn and Winnicott are major contributors to the British / Independent school of psychoanalysis. Theorists from this school departed from Freud’s libidinally driven, structural idea of development towards a self-object model. Emphasis was maintained on unacceptable desires and wishes however, parts of the self/ego came to be viewed as interacting with each other, corresponding with internal and external objects.

Fairbairn’s greatest contribution to modern psychoanalytic theory is the concept of splitting. Here, insecure attachment to primary caregivers generates conflicting ego-object systems, resulting in psychopathology. Another Fairbairnian contribution is the idea that emotion does not exist separate from the self. As a result, the libido is primarily object (not pleasure) seeking. From this perspective, if the developing child has strong ego-object relationships, he/she will have greater pleasure and greater anxiety reduction. This contrasts Freud’s belief that discharge of libidinal energy causes anxiety reduction.

Winnicott emphasized the individual’s desire to develop a sense of self and the human capacity to conceal or misrepresent portions of the self. According to Winnicott, the mother-child interaction is critical and is comprised of three primary functions leading to healthy development: holding-integration, handling-personalization, and object-relating. The first and second actions refer to a mother’s ability to literally and emotionally hold an infant, leading to the solid, organized construction of sensorimotor abilities. The latter interaction describes a mother’s heightened state of awareness to herself, her body, and her infant, facilitating the infant’s view of the mother as an extension of him/herself and his/her wishes. Another important contribution made by Winnicott is the idea of transitional objects – items used by an infant to assist in achieving independence. Transitional objects help infants navigate the distance between “me and not-me” as they become aware of the separation between themselves and their mothers.


Desiree-Freud v Winnicott & Fairbairn

In contrast to classical Freudian theory, both Fairbairn and Winnicott’s theories concerning early development center on the dynamic interaction of emerging parts of the self and their relation to and interaction with the ego (itself) as well as external objects. Fairbairn argued that infants are hard-wired to seek gratification and pleasure through ego-object relations and that the foundation for the development of pathology is set when difficulties arise within the course of the infant’s interactions with the primary object. Unlike Freud, Faribairn’s object relations theories did not consider narcissistic unconscious libidinal drives to be the primary driving force for the infant’s progress throughout the course of development. Sufficient levels of nurturing and proper “mirroring” interactions appear to constitute the foundation of Winnicott’s “good-enough-mothering” theory. In this theory, he posits that the mother’s ability to attend to the infant’s needs while simultaneously frustrating the child encourage the development of successful adaptation to the external environment and allow the child to appropriately perceive the mother as a separate other whom the child can relate to but does not have omnipotent control over.

Deeply rooted in Fairbairn’s object relations theory is the notion that early severe trauma during critical ego development stages sets the foundation for the development of pathology. In particular, he saw the presence of the schizoid reaction of withdrawal as being directly linked with feelings of being unloved or unacknowledged from the primary love object, resulting in a defensive need to withdrawal from environmental stimuli or future interactions with others in order to defend against repeated object interaction failures. In close agreement, Winnicott’s model for the development of pathology centered on the idea of having mostly positive and nurturing interactions with the primary object and thus he saw the onset of disorders such as schizophrenia as the result of having had a primary love object who then had been lost, causing the child to feel forever maternally deprived. Both Fairbairn and Winnicott’s theories emphasize the importance of positive object interactions and contrast Freudian notions of pathology resulting from repressing intrapsychic conflicts encountered during psychosexual stages of development.


reaction paper #5

How does a child’s mind develop?
The main factors impacting child development may be described as a continuum where drives and inner conflict are on one hand and relationships and environment are on the other. Winnicot and Fairbairn built on other theorists like Klein and Bion and shifted their interest towards increasing emphasis on relationships and attempts to understand development as a unit in interaction. Therefore, they shift away from Freud’s conceptualization of development. Winnicot and Fairbairn emphasize object relations as being more crucial in their impact on the development of mental structures and functions. Freud’s theory of development, as we all know by now, emphasized unconscious intra-psychic factors (such as instincts and fantasy) as the main forces which impact mental structures. Thus, for Freud, relationships are secondary to instinctual drives and limited to only one sort of object relations: the one that evolves out of ungratified drives.
The Independents no longer restricted themselves to a libidinally driven structural model and developed a self-object theory. In this theory, although drives and whishes play some role in the development of mental structures, a new explaining system, where parts of self are seen in “dynamic interaction with each other and complementary internal and external objects”, is taking a major role.
For Winnicot, who worked with mothers and their infants as well as severe adult psychopathology, very early relational experiences with real behaviors (holding, handling, good enough mother, non-intrusive) and real parents (mainly the mother) are crucial for healthy development of the true self. Freud on the other hand, didn’t emphasize early childhood experiences or real environmental determinants.
Fairbairn pointed out that the basic desire is not for pleasure but for relationships (“object seeking”). Moreover, attainment of desired relationships reduces anxiety. Thus the root of psychopathology is not a consequence of unconscious content but of lack of intimacy in early relationships that resulted in multiple self-object systems.


Matt: Fairbairn, Winnicott, Freud

The biggest difference between Freud and the British Independents lies in the latter’s focus on variations in the environment as a source of both normal development and psychopathology. To simplify somewhat, Freud is concerned with the infant’s intrapsychic conflict and treats the parents as though they are almost static figures, playing a biologically determined role. Winnicott and Fairbairn are more interested in the minutia of how the parents fulfill their role, and detail the impact that this has on the developing child. It’s all about relationships for these guys. In stark contrast to Freud, Fairbairn sees the trauma of not being understood, recognized, and loved as the basic root of psychopathology. Winnicott spent his career examining the mother-infant relationship in minute detail. For him, psychopathology is caused by flaws in this relationship—especially in the mother’s responses to her infant’s dependence and then emerging independence. (He overdid it on this point, even to the extent of denying a role for constitutional (genetic) factors—another area where he differs from Freud). His ideas on the centrality of the self are precursors to Kohut and self-psychology, even to the extent of viewing the role of psychoanalysis as a kind of re-parenting experience.
The writings of the British Independents are both an elaboration of Freud’s theories of development and a challenge to them. While Winnicott and Fairbairn were in fact building on Freud’s concepts, using them as a point of departure, they put their emphasis on very different concerns. A day in the consulting room with Dr. Freud would look a whole lot different from one with Dr. Winnicott.


Reaction #5

The Freudian notion of id gratification shaping infants is abandoned by the British school, namely Fairbairn and Winnicott. For Fairbairn, the infant is not seeking pleasure. It seeks an object for relatedness. Anxiety and displeasure are not soothed by the discharge of energy, but by the quality of relatedness to an external object. Fairbairn talks not about repression and the unconscious, but about deprivation of intimacy leading to potential pathology. If needs with the primary object are not met, “splitting” of the ego can arise. Ultimately, ideas will lack integration and Fairbairn posits that this is precisely how pathology develops.

Ideal developmental circumstances between Freud and Winnicott seem quite similar. For Freud, parenting is a balancing act where the parent should not be overly harsh and dominating, but should also not be too indulgent. For instance, in toilet training the parent should not constantly scold a child for making mistakes. Yet, the parent should also avoid being overly praising for a job well done. In either situation, an unrealistic ideal can be internalized by the child and negatively impact personal development. Winnicott’s idea of ‘good enough mothering’ seems to compliment Freud’s idea of optimal parental involvement. Winnicott assumes that shortcomings are inevitable in parenting. These shortcomings should be embraced, as they become the primary motivator for growth. For Winnicott, development is primarily concerned with achieving autonomy. The infant’s idea of the caretaker being ‘magically omnipotent’ gets challenged and selfobject differentiation ensues. Like Freud, this process should not be too abrupt and should follow a series of steps: holding-integration, handling-personalization, and object relating. The struggle in parenting, according to Winnicott, is a balance between privation and deprivation. With privation, the infant is too overwhelmed to recognize an external object. While severe deprivation can lead to mistrust in the caretaker and early object loss.


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