Definition of scientific phenomena should be based on the phenomena as we see them. We have no business to base our definition on ideas of what we think phenomena ought to be like. The quest for such touchstones seems to arise from a private conviction that simple laws and absolute distinctions necessarily underlie any connected set of phenomena.
C. F. A. PANTIN, The Relation between the Sciences
DURING THE PRESENT century a number of psychoanalysts and psychiatrists have sought causal links between psychiatric illness, loss of a loved person, pathological mourning and childhood experience.
For several decades the sole starting point for these studies was a sick patient. Then, during the nineteen-forties, clinicians began to pay attention to the intense distress and emotional disturbance that immediately follow the experience of loss. In some of these later studies the loss was that of a spouse; in others it was that of a mother by a young child. Although each of these three starting points yielded findings of great interest, it was some years before the way that each set of data could be related to the others began to be appreciated. A constant difficulty was that generalizations made in connection with the earlier, retrospective, set were often misleading, whilst the theoretical explanations offered for them were ill-suited to both of the later, prospective, sets.
In this volume I seek to bring these diverse sets of data into relation with each other and to outline a theory that is applicable to them all. As in the two previous volumes, precedence is given throughout to data that derive from prospective studies.
Since loss as a field for enquiry is a distressing one the student is faced with emotional problems as well as intellectual ones.
Loss of a loved person is one of the most intensely painful experiences any human being can suffer. And not only is it painful to experience but it is also painful to witness, if only because we are so impotent to help. To the bereaved nothing but the return of the lost person can bring true comfort; should what we provide fall short of that it is felt almost as an insult. That, perhaps, explains a bias that runs through so much of the older literature on how human beings respond to loss. Whether an author is discussing the effects of loss on an adult or a child, there is a tendency to underestimate how intensely distressing and disabling loss usually is and for how long the distress, and often the disablement, commonly lasts. Conversely, there is a tendency to suppose that a normal healthy person can and should get over a bereavement not only fairly rapidly but also completely.
Throughout this volume I shall be countering those biases. Again and again emphasis will be laid on the long duration of grief, on the difficulties of recovering from its effects, and on the adverse consequences for personality functioning that loss so often brings. Only by taking serious account of the facts as they seem actually to be is it likely that we shall be able to mitigate the pain and disability and to reduce the casualty rate.
Unfortunately, despite enormously increased attention to the subject during recent years, empirical data regarding how individuals of different ages respond to losses of different kinds and in differing circumstances are still scarce. The best we can do therefore is to draw on such systematic data as are available and to make prudent use of the far greater array of unsystematic accounts. Some of the latter are autobiographical but most derive from clinical observation of individuals who are in treatment. For that reason they are both a goldmine and a snare—a goldmine by providing valuable insight into the various unfavourable courses that responses to loss can take, and a snare because of the false generalizations to which they can lead. These have been of two kinds. On the one hand it has been assumed that certain features now known to be especially characteristic of unfavourable courses of response are ubiquitous features of general importance; and, on the other, that responses now known to be common to all forms of response are specific to pathology. An example of the first type of mistake is the supposition that guilt is intrinsic to mourning, and of the second the presumption that a person’s disbelief that loss has really occurred (often termed ‘denial’) is indicative of pathology. Healthy grieving, it will frequently be emphasized, has a number of features that once were thought to be pathological and lacks others that once were thought to be typical.
Since the route by which I entered the field was that of studying the effects on young children of loss of mother, it is to those data, and to some of the controversies to which they have given rise, that the reader’s attention is directed in this, the first, of five introductory chapters.
In the second I review ideas that have emerged during the treatment of patients whose emotional problems seem to be related to loss, and also outline the types of theory to which such studies have given rise. In the course of that chapter a number of key questions are identified around each of which controversy persists and for which answers are sought in the chapters that follow.
In the third and fourth of these introductory chapters I give an outline of the conceptual framework that, having first been developed in connection with this study, I now bring to the presentation and interpretation of data. The stage thus set, I embark on the body of the work.
Let us turn first to the data that originally gave rise to this study, observations of how a young child between the ages of about twelve months and three years responds when removed from the mother-figure1 to whom he is attached and is placed with strangers in a strange place. His initial response, readers of earlier volumes will recall,2 is one of protest and of urgent effort to recover his lost mother. ‘He will often cry loudly, shake his cot, throw himself about, and look eagerly towards any sight or sound which might prove to be his missing mother.’ This may with ups and downs continue for as long as a week or more. Throughout it the child seems buoyed up in his efforts by the hope and expectation that his mother will return.
Sooner or later, however, despair sets in. The longing for mother’s return does not diminish, but the hope of its being realized fades. Ultimately the restless noisy demands cease: he becomes apathetic and withdrawn, a despair broken only perhaps by an intermittent and monotonous wail. He is in a state of unutterable misery.
Although this picture must have been known for centuries, it is only in the past decades that it has been described in the psychological literature and called by its right name—grief. This is the term used by Dorothy Burlingham and Anna Freud (1942), by Spitz (1946b) in titling his film Grief: A Peril in Infancy, and by Robertson (1953) who for twenty-five years has made a special study of its practical implications. Of the child aged from eighteen twenty-four months Robertson writes:
If a child is taken from his mother’s care at this age, when he is so possessively and passionately attached to her, it is indeed as if his world had been shattered. His intense need of her is unsatisfied, and the frustration and longing may send him frantic with grief. It takes an exercise of imagination to sense the intensity of this distress. He is as overwhelmed as any adult who has lost a beloved person by death. To the child of two with his lack of understanding and complete inability to tolerate frustration it is really as if his mother had died. He does not know death, but only absence; and if the only person who can satisfy his imperative need is absent, she might as well be dead, so overwhelming is his sense of loss.
At one time it was confidently believed that a young child soon forgets his mother and so gets over his misery. Grief in childhood, it was thought, is short-lived. Now, however, more searching observation has shown that that is not so. Yearning for mother’s return lingers on. This was made plain in many of Robertson’s early studies of young children in residential nursery and hospital and was amply confirmed in the two systematic studies of children in residential nurseries conducted by Heinicke (Heinicke 1956; Heinicke and Westheimer 1966).3 Crying for parents, mainly for mother, was a dominant response especially during the first three days away. Although it decreased thereafter, it was recorded sporadically for each of the children for at least the first nine days. It was particularly common at bedtime and during the night. Searching for mother also occurred.
Although wishful thinking has probably contributed to the idea that a young child’s grief is short-lived, certain features of his behaviour have proved misleading. For example, after the critical phase of protest, a child becomes quieter and less explicit in his communications. So far from indicating that he has forgotten his mother, however, observation shows that he remains oriented strongly towards her. Robertson has recorded many cases of young children whose longing for the absent mother was apparent, even though at times so muted or disguised that it tended to be overlooked. Of Laura, the subject of his film A Two-year-old Goes to Hospital (1952), he writes: ‘She would interpolate without emotion and as if irrelevantly the words “I want my Mummy, where has my Mummy gone?” into remarks about something quite different; and when no one took up the intruded remark she would not repeat the “irrelevance”.’ The same child would sometimes let concealed feelings come through in songs and, apparently unknown to herself, substitute the name of ‘Mummy’ for that of a nursery-rhyme character. On one occasion she expressed an urgent wish to see the steam-roller which had just gone from the roadway below the ward in which she was confined. She cried, ‘I want to see the steam-roller, I want to see the steam-roller, I want to see my mummy, I want to see the steam-roller.’4
Another child, aged three and a half, who had been in hospital for ten days, was observed playing a repetitive game by himself of a kind which appeared at first sight to be quite happy. He was bowing, turning his head to the left and lifting his arm. This seemed harmless enough, and also meaningless. When approached, however, he was heard to be muttering to himself, ‘My mummy’s coming soon—my mummy’s coming soon’; and he was evidently pointing to the door through which she would enter. This was at least three hours before she could be expected.5
To the perceptive observer, such persistent orientation to the lost mother is evident even in much younger children. Thus Robertson also records the case of Philip who was aged only thirteen months when placed in a residential nursery. Although he was too young to verbalize any wish for his mother, the staff reported that during the days of fretting and later, whenever frustrated or upset, he would make the motions associated with the rhyme ‘round and round the garden’ with which his mother used to humour him when he was out of temper at home.
In the Hampstead Nurseries Anna Freud and Dorothy Burlingham recorded many cases of persistent but muted longing for an absent mother (Freud and Burlingham 1974).6 A striking example is that of a boy aged three years and two months who had already experienced two separations from his mother, the first when he was evacuated to a foster-home where he fretted and the second when he was in hospital with measles. On being left in the nursery he had been admonished to be a good boy and not to cry—otherwise his mother would not visit him.
Patrick tried to keep his promise and was not seen crying. Instead he would nod his head whenever anyone looked at him and assured himself and anybody who cared to listen . . . that his mother would come for him, she would put on his overcoat and would take him home with her again. Whenever a listener seemed to believe him he was satisfied; whenever anybody contradicted him, he would burst into violent tears.
This same state of affairs continued through the next two or three days with several additions. The nodding took on a more compulsive and automatic character: ‘My mother will put on my overcoat and take me home again.’
Later an ever-growing list of clothes that his Mother was supposed to put on him was added: ‘She will put on my overcoat and my leggings, she will zip up the zipper, she will put on my pixie hat.’ When the repetitions of this formula became monotonous and endless, somebody asked him whether he could not stop saying it all over again. Again Patrick tried to be the good boy that his mother wanted him to be. He stopped repeating the formula aloud but his lips showed that he was saying it over and over to himself.
At the same time he substituted for the spoken words gestures that showed the position of his pixie hat, the putting on of an imaginary coat, the zipping of the zipper, etc. What showed as an expressive movement one day was reduced the next to a mere abortive flicker of his fingers. While the other children were mostly busy with their toys, playing games, making music, etc., Patrick, totally uninterested, would stand somewhere in a corner, moving his hands and lips with an absolutely tragic expression on his face.
Unfortunately, shortly after Patrick’s admission to the nursery his mother contracted influenza and was confined to hospital for more than a week. Only after her discharge, therefore, was it possible to arrange for her to stay with Patrick in the nursery.
Patrick’s state changed immediately. He dropped his symptom and instead clung to his mother with the utmost tenacity. For several days and nights he hardly left her side. Whenever she went upstairs or downstairs, Patrick was trailing after her. Whenever she disappeared for a minute, we could hear his anxious questioning through the house or see him open the door of every room and look searchingly into every corner. No one was allowed to touch him; his mother bathed him, put him to sleep, and had her bed next to his (Freud and Burlingham 1974, pp. 19–20).
This case is discussed further in Chapter 23 since it illustrates vividly one of the common courses that childhood grieving can take and illumines certain features that occur typically when an adult’s responses to loss take a pathological course. Features to be noted are: first, Patrick’s persistent yearning for reunion with his mother; secondly, the pressure exerted on him by well-meaning adults to persuade him to desist from grieving and think of something else; thirdly, the tendency for his yearning none the less to persist but thenceforward to be expressed in an increasingly obscure form and directed towards an increasingly obscure goal; and fourthly, the circumstances in which he comes to enact the role of his missing mother. The latter provides, I suggest, a valuable clue to understanding the process of identification with the lost figure which Freud made the keystone of his theory of mourning.
A child’s persistent longing for his mother is often suffused with intense, generalized hostility. This has been reported by several workers, e.g. Robertson (1953) and Spitz (1953), and was one of the most striking findings in the first of Heinicke’s systematic studies. Heinicke (1956) compared the behaviour of two groups of children, both aged between sixteen and twenty-six months; one group was in a residential nursery, the other in a day nursery. Not only did the children in the residential nursery cry for their mothers more than did the day-nursery children, but they exhibited much violent hostility of a kind hardly seen at all in those in the day nursery. The targets of this hostility were so varied that it was difficult to discern towards whom it was principally directed.
Nevertheless, there is good reason to believe that in its origin much of the anger of separated children is directed towards the missing mother-figure. This was clearly so in the case of Reggie, a small boy of two years and eight months (described in the early pages of Volume II) who had become intensely attached to one of the nurses in the Hampstead Nurseries but who refused to have anything to do with her when she visited a fortnight after she had left to get married. After her visit he had stared at the closing door and in bed that evening had made plain his ambivalent feelings: ‘My very own Mary-Ann!’ he exclaimed. ‘But I don’t like her’ (Freud and Burlingham 1974).
In later chapters there is much further reference to the anger that is so commonly elicited by the departure of a loved person, whatever the reason may be that he has gone.
As in the case of a bereaved adult who misses and longs for a particular person and so cannot find comfort in other companions, so does a child in a hospital or residential nursery at first reject the ministrations of those caring for him. Although his appeals for help are clamant, often his behaviour is as contradictory and frustrating to the would-be comforter as is that of a recently bereaved adult. Sometimes he rejects them. At others he combines clinging to a nurse with sobs for his lost mother. Anna Freud and Dorothy Burlingham have recorded the case of a little girl of seventeen months who said nothing but ‘Mum, Mum, Mum’ for three days and who, although liking to sit on the nurse’s knee and to have the nurse put her arm around her, insisted throughout on having her back to the nurse so as not to see her.
Nevertheless, the complete or partial rejection of the strange adult does not continue for ever. After a phase of withdrawal and apathy, already described, a child begins to seek new relationships. How these develop turns on the situation in which he finds himself. Provided there is one particular mother-figure to whom he can relate and who mothers him lovingly he will in time take to her and treat her almost as though she were his mother. In those situations, by contrast, in which a child has no single person to whom he can relate or when there is a succession of persons to whom he makes brief attachments, the outcome is different. As a rule he becomes increasingly self-centred and prone to make transient and shallow relationships with all and sundry. This condition bodes ill for his development if it becomes an established pattern.
In the paper ‘Grief and Mourning in Infancy and Early Childhood’, published 1960, in which I first drew attention to these observations, I pointed to the striking similarities between the responses of young children following loss of mother and the responses of bereaved adults. The number and extent of these similarities had not been emphasized before. This was in part because the traditional pictures of how children and adults respectively are thought to respond to loss had greatly exaggerated such real differences as exist, and in part because there was little understanding of the nature of attachment behaviour and its role in human life. Since the similarities between childhood and adult responses to loss are central to my thesis they are examined fully in Part III. ‘Meanwhile’, I had concluded in 1960,
since the evidence makes it clear that at a descriptive level the responses are similar in the two age-groups, I believe it to be wiser methodologically to assume that the underlying processes are similar also, and to postulate differences only when there is clear evidence for them. That certain differences between age-groups exist I have little doubt, since in infants and small children the outcome of experiences of loss seem more frequently to take forms which lead to an adverse psychological outcome. In my judgment, however, these differences are best understood as being due to special variants of the mourning process itself, and not to processes of a qualitatively different kind. When so conceived, I believe, we are enabled both to see how data regarding the responses of young children to a separation experience relate to the general body of psychoanalytic theory and also to reformulate that theory in simpler terms.
This line of argument was pursued in the two subsequent papers7 in which I emphasized especially that
The mourning responses that are commonly seen in infancy and early childhood bear many of the features which are the hallmark of pathological mourning in the adult (1963, p. 504).
In particular, I drew attention to four pathological variants of adult mourning already described in the clinical literature and to the tendency for individuals who show these responses to have experienced loss of a parent during childhood or adolescence. The four variants, described here in the terms now preferred, are as follows:
A sharp controversy followed these early papers. Of the many issues debated one calls for immediate comment: namely, the use of the term ‘mourning’.
As explained in the original series of papers, it seemed useful to employ the term ‘mourning’ in a broad sense to cover a variety of reactions to loss, including those that lead to a pathological outcome, because it then becomes possible to link together a number of processes and conditions that evidence shows are interrelated—much in the way that the term ‘inflammation’ is used in physiology and pathology to link together a number of processes, some of which lead to a healthy outcome and some of which miscarry and result in pathology. The term ‘mourning’ was selected because it had been introduced into psychoanalysis in the translation of Freud’s seminal paper on ‘Mourning and Melancholia’ (1917) and had for many years been in wide use by clinicians.
My thesis met with strong opposition, however, especially from psychoanalysts who were close to Freud and those who follow in that tradition.8 The difficulties they raise are in part matters of substance and in part terminological. To enable us to identify the points of substance let us deal immediately with the problem of terms.
The terminological difficulties stem from the restrictive sense in which some of my critics interpret Freud’s statement that ‘Mourning has a quite precise psychical task to perform: its function is to detach the survivor’s memories and hopes from the dead’ (SE 13, p. 65).9 The term ‘mourning’, these critics insist, must be applied only to psychological processes that have that single outcome: no other usage is permissible.
Such terminological rigidity is alien to the spirit of science. For, once a definition is laid down, it tends to straitjacket thought and to control what the worker permits himself to observe; so that, instead of the definition being allowed to evolve to take account of new facts, facts not covered by the original definition are neglected. Thus, were we to accept the injunction to restrict the term mourning in the way proposed, we should have to limit it to psychological processes with an outcome that is not only predetermined as an optimum but which we now have good reason to know, and as Freud himself rightly suspected, is never completely attained see (Chapters 6 and 16). Processes leading to any variation of outcome would by definition be excluded and would thereby have to be described in other terms.
A restricted usage of that kind is unacceptable. One of the major contributions of psychoanalysis has been to help integrate psychopathology with general personality theory. To use different terms for a process or processes according to whether outcome is favourable or unfavourable endangers that integration. In particular, intractable problems would arise were it thought necessary to define at an early stage where healthy processes end and pathological ones begin. Should such a definition prove later to be mistaken confusion would reign. That, in fact, is what has occurred in our field.
Since I judge these considerations to outweigh all others, the usage adopted in the earlier papers is retained. Thus, the term ‘mourning’, with suitable qualifying adjectives, is used to denote a fairly wide array of psychological processes set in train by the loss of a loved person irrespective of their outcome. Even so, an alternative term already in broad usage is ‘grieving’ and arguments can be advanced for employing it instead of ‘mourning’. In addition to its avoiding controversy over the restricted usage of mourning discussed above, it would avoid also another and quite different tradition of specialized usage stemming from anthropology which restricts mourning to the public act of expressing grief. Because public mourning is always in some degree culturally determined, it is distinguishable, at least conceptually, from an individual’s spontaneous responses. (That usage is encouraged in Webster’s Dictionary of the English Language and is adopted in a review by Averill 1968.) Yet a further reason for employing grieving in a broad sense would be that, as we have seen, it has already been so used by prominent psychoanalysts and there is therefore no dispute that very young children grieve.
Nevertheless, there are good reasons for retaining the term mourning and using it to refer to all the psychological processes, conscious and unconscious, that are set in train by loss. First, it has for long been so used in psychopathology. Secondly, by employing it thus, the term grieving is freed to be applied to the condition of a person who is experiencing distress at loss and experiencing it in a more or less overt way. Not only is this common usage but it is especially convenient when we come to discuss the paradoxical condition known as absence of grief (Deutsch 1937). To denote the public expression of mourning we can use ‘mourning customs’.
Once we recognize differences in the use of the term mourning much of the controversy melts away. For example, as Miller (1971) points out, there is now widespread agreement among clinicians that, when loss is sustained during childhood, responses to it frequently take a pathological course. Nevertheless, we are still left with substantial points of difference.
The most important is whether a pre-adolescent child is capable in any circumstances of responding to loss of parent with healthy mourning which we can define, adapting a definition given by Anna Freud,10 as the successful effort of an individual to accept both that a change has occurred in his external world and that he is required to make corresponding changes in his internal, representational, world and to reorganize, and perhaps to reorient, his attachment behaviour accordingly. On the one side of the controversy are a number of influential analysts who, impressed by the many patients they have treated whose response to a childhood loss had taken a pathological course, have concluded that a pathological form of response is inevitable and have sought to explain the alleged inevitability by postulating that a child’s ego is too weak and undeveloped ‘to bear the strain of the work of mourning’. This view, first advanced by Deutsch (1937), has been followed with minor variations of emphasis by many others, including Mahler (1961), Fleming and Altschul (1963), Wolfenstein (1966) and Nagera (1970). On the other are psychoanalytically trained students of the problem who, as a result of their observations, insist that, given support and honest information, it is possible for even quite young children to mourn a lost parent in as healthy a way as can an adult. This view, advanced by Robert and Erna Furman (R. A. Furman 1964a; E. Furman 1974) and also by Gilbert and Ann Kliman (G. Kliman 1965), is supported by descriptions of a number of children, aged from two years upwards, whose mourning for a lost parent was observed and recorded.
The second point of controversy concerns the nature of the responses that occur after loss of a parent during the first year or two of a child’s life. It turns, among other things, on the question of when during development a child becomes capable of maintaining an image of his absent mother. This raises issues both of cognitive development and also of socio-emotional development. They are discussed in Chapter 25, with reference to the concepts of person permanence and of libidinal object constancy.
In regard to these and other controversies the views expressed in this volume are not very different from those expressed in my earlier papers. Such differences as there are arise mainly from consideration of the evidence, published since those papers were written, concerning the influence on his responses of the experiences a child has with parents and parent-substitutes before, during, and after his loss. These and other matters are discussed in Chapters 15 onwards.
Meanwhile, it may help the reader if his attention is drawn to the two complementary themes that run through this volume. One is that, as emphasized in the earlier papers, the responses to loss seen in early life have a great deal in common with responses seen in later life, and that sharp distinctions are both unwarranted and misleading. The second is that, as widely agreed, certain differences exist which call for detailed examination. At different points in the exposition one or other of these themes is given prominence; but it is hoped the reader will never forget the importance of both.
Before closing this introductory chapter I wish to return to the third of the three phases into which Robertson and I have divided a young child’s response to the loss of his mother-figure, namely the phase we have termed ‘detachment’. This phase, already described in the opening chapters of the earlier volumes (Chapter 2 of Volume I and Chapter 1 of Volume II) but so far not discussed, is regularly seen whenever a child between the ages of about six months and three years has spent a week or more out of his mother’s care and without being cared for by a specially assigned substitute. It is characterized by an almost complete absence of attachment behaviour when he first meets his mother again.11
This puzzling phenomenon was observed with especial care by Heinicke and Westheimer (1966) in their study of ten young children, aged from thirteen to thirty-two months, who spent a minimum of twelve days in one of three residential nurseries.12
On meeting mother for the first time after the days or weeks away every one of the ten children showed some degree of detachment. Two seemed not to recognize mother. The other eight turned away or even walked away from her. Most of them either cried or came close to tears; a number alternated between a tearful and an expressionless face.
In contrast to these blank, tearful retreats from mother, all but one of the children responded affectionately when they first met father again. Furthermore, five were friendly to Ilse Westheimer as well.
As regards detachment, two findings of earlier studies were clearly confirmed in this one. The first is that detachment is especially characteristic of the way in which a separated child behaves when he meets his mother again, and is much less evident with father; the second is that the duration of a child’s detachment from mother correlates highly and significantly with the length of his time away.
In nine cases detachment from mother persisted in some degree throughout almost the first three days of reunion. In five children it was so marked that each mother complained, characteristically, that her child treated her as though she were a stranger; none of these children showed any tendency to cling to her. In the other four, detachment was less pronounced; phases during which they turned away from mother alternated with phases during which they clung to her. Only one child, Elizabeth, who was the oldest and whose separation was among the shortest, was affectionate towards her mother by the end of the first day home.
When a mother does not receive the natural responses she expects from her child she finds it both puzzling and wounding. Even when he is hurt he is likely still to make no attempt to seek her comfort and will even spurn her attempts to provide it. To anyone familiar with young children this behaviour seems very extraordinary. Some years ago Robertson observed it in a small boy who had been admitted to hospital at the age of thirteen months and had remained there for three years. During the month following his return home, during which he remained wholly detached, he burned his hand in the fire. Instead of howling and seeking comfort like the ordinary toddler, he smiled and kept to himself. (Reported in Ainsworth and Boston, 1952.)
The same behaviour was noted in one child of the Heinicke and Westheimer series (pp. 112–58):
Owen was aged 2 years and 2 months at the start of what proved to be an eleven-week separation. Both during the journey home with his father and after he had entered the house and met mother he remained characteristically numb, silent and unresponsive; in fact it was fifty minutes before he showed the first flicker of animation. Then, and during the next couple of days, he began sometimes to turn to his father; but his mother he continued to ignore. During his second day home he bumped his knee and, when he seemed about to cry, mother at once offered comfort. Owen however passed her by and went to father instead. Not unnaturally mother felt this as a cruel rebuff.
Clearly many different views can be taken of the phenomenon of detachment and it has already been the subject of some debate (A. Freud 1960; Bowlby 1963). The view I took in my earlier papers is that detachment is an expression of what in the psychoanalytic tradition has always been referred to as a defence or, and better, as the result of a defensive process. The suggestion I made is that defensive processes are a regular constituent of mourning at every age and that what characterizes pathology is not their occurrence but the forms they take and especially the degree to which they are reversible. In infants and children, it appears, defensive processes once set in motion are apt to stabilize and persist.
The thesis I have advanced, therefore, is that in a young child an experience of separation from, or loss of, mother-figure is especially apt to evoke psychological processes of a kind that are as crucial for psychopathology as inflammation and the resulting scar tissue are for physiopathology. This does not mean that a crippling of personality is the inevitable result; but it does mean that, as in the case, say, of rheumatic fever, scar tissue is all too often formed that in later life leads to more or less severe dysfunction. The processes in question, I have suggested, are pathological variants of some of those that characterize healthy mourning.
Although this theoretical position is closely akin to positions taken by others, it appears none the less to be different from them. Its strength lies in relating the pathological responses met with in older patients to responses to loss and threats of loss that are to be observed in childhood, thereby providing a possible link between psychiatric conditions of later life and childhood experience. In the latter half of the following chapter and in more detail in Bowlby (1960b) this formulation is compared to some of its predecessors. Whether or not it proves a useful way of ordering and understanding the data and, if so, what modifications or elaborations may be called for are questions to which this volume addresses itself.
1 Although throughout this work the text refers usually to ‘mother’ and not to ‘mother-figure’, it is to be understood that in every case reference is to the person who mothers a child and to whom he becomes attached. For most children, of course, that person is also his natural mother.
2 See Volume II, Chapter 2.
3 Particulars of Heinicke’s studies are given in the first chapter of the second volume of this work.
4 For further discussion of how Laura responded during and after her stay in hospital see Chapters 23 and 25.
5 This observation, made by James Robertson, is reported in Bowlby, Robertson and Rosenbluth (1952).
6 Reports of observations made in the Hampstead Nurseries were first published during the war in the U.K. (Burlingham and Freud 1942, 1944) and in the U.S.A. (Freud and Burlingham 1943). They are now reprinted in a volume of Anna Freud’s collected works (Freud and Burlingham 1974) and page references given in the text are to that publication. In the account that follows the pseudonym Patrick, used originally in the 1943 edition but changed to Billie in 1974, has been retained because in earlier publications of my own in which the case is referred to (e.g. Bowlby et al. 1952) Patrick is the pseudonym used.
7 ‘Processes of Mourning’ (1961b) and ‘Pathological Mourning and Childhood Mourning’ (1963).
8 See the three critical articles, by Anna Freud, Max Schur and René Spitz, that are printed in Volume 15 of The Psychoanalytic Study of the Child (1960) following the first of my three papers: see also Wolfenstein (1966).
9 The abbreviation SE denotes the Standard Edition of The Complete Psychological Works of Sigmund Freud, published in 24 volumes by Hogarth Press Ltd, London, and distributed in America by W. W. Norton, New York. All quotations from Freud in the present work are taken from this edition.
10 ‘The process of mourning (Trauerarheit) taken in its analytic sense means to us the individual’s effort to accept a fact in the external world (the loss of the cathected object) and to effect corresponding changes in the inner world (withdrawal of libido from the lost object, identification with the lost object)’ (A. Freud 1960, p. 58).
11 It should be noted that this use of the term ‘detachment’ differs radically from that of workers who use it to refer either to a child’s tendency to explore away from his mother or to the increasing self-reliance he shows as he gets older (a theme discussed in Volume II, Chapter 21).
12 The précis of their findings that follows is taken from the first chapter of Separation: Anxiety and Anger.