THE

AUTONOMOUS
SELF
The Work of John D.
Sutherland

Edited by Jill Savege Scharff,

M.D.
Copyright © 1994 by Jill Savege Scharff

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To
Molly Sutherland
and
The Scottish Institute of Human
Relations
Table of Contents

Preface and Acknowledgments

Introduction

I OBJECT-RELATIONS THEORY
1. OBJECT-RELATIONS THEORY AND THE
CONCEPTUAL MODEL OF
PSYCHOANALYSIS
2. BALINT, WINNICOTT, FAIRBAIRN,
GUNTRIP
3. WINNICOTT
4. FAIRBAIRN’S CONTRIBUTION
5. THE OBJECT-RELATIONS THEORY OF
PERSONALITY
6. AN OBJECT-RELATIONS APPROACH
TO PSYCHODIAGNOSTIC APPRAISAL
7. OBJECT-RELATIONS THEORY AND
COGNITIVE PERFORMANCE
8. FAIRBAIRN’S CRITICISM OF BASIC
PSYCHOANALYTIC CONCEPTS

II GROUP RELATIONS
9. SMALL GROUPS, THEIR DISORDERS
AND TREATMENT
10. THE ONE-WAY VISION SCREEN IN
ANALYTIC GROUP PSYCHOTHERAPY
11. BION’S GROUP DYNAMICS
12. TWO INDUSTRIAL PROJECTS

III COMMUNITY MENTAL HEALTH

13. TOWARD COMMUNITY MENTAL
HEALTH
14. PSYCHOANALYSIS IN THE
POSTINDUSTRIAL SOCIETY
15. COUNSELLING SERVICES
16. PSYCHOTHERAPY IN COMMUNITY
MENTAL HEALTH
17. RESEARCH IN PSYCHODYNAMICS
18. THE NEED FOR A NEW PARADIGM
19. THE PSYCHODYNAMIC IMAGE OF
MAN

IV THE SELF
20. THE SELF AND OBJECT RELATIONS
21. THE AUTONOMOUS SELF
22. FAIRBAIRN AND THE SELF
23. AN OBJECT RELATIONS VIEW OF THE
GREAT MAN
24. ON BECOMING AND BEING A PERSON
25. REMINISCENCES

Epilogue

References

Credits
Preface and Acknowledgments

My thanks go first and foremost to John D.

Sutherland’s widow, Molly, who asked David

Scharff and me to look through the papers left in

her husband’s study. We found all his published

papers in order, together with some notes

extracted from unpublished papers or talks.

Molly graciously supplied photographs for a

personal touch to the theory of the self, in

keeping with Jock’s personable teaching style.

Molly put us in touch with Sutherland’s literary

executor, Dr. Alan Harrow, and his literary

executive committee at the Scottish Institute of

Human Relations, founded by Sutherland in

1970. The committee members were kept busy
carrying on the Institute’s many projects for

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training psychotherapists, providing intensive
treatment for patients and trainees, building the

institution on object relational principles, and

integrating the training of their psychotherapy

teachers with the standards of the British

Psychoanalytic Society. Still mourning the loss of

their leader, preoccupied with change, and

absorbed by the daily expression of Jock’s vision,

they were not ready to attend to the task of

presenting his work to a wider audience and

gladly asked us as series editors of the Object

Relations Library if we would be interested in

compiling Sutherland’s works. I was delighted to

be given the honor of being the editor of this

collection.

I would like to acknowledge with thanks the

cooperation of the following publishers and

institutions:

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Aberdeen University Department of
Mental Health
American Psychiatric Association
Library
British Journal of Psychiatry
British Journal of the Philosophy of
Science
British Psychoanalytic Institute Bulletin
Bulletin of the Association of
Psychoanalytic Medicine
Bulletin of the Menninger Clinic
Contact Journal of the Scottish Pastoral
Association
Edinburgh Review
Edinburgh University Department of
Psychiatry Free Association Books
Journal of the American Psychoanalytic
Association Macmillan
National Council Social Services
Psychotherapy and Psychosomatics
Routledge Kegan Paul
Royal College of Psychiatrists
Senate House Library, University of
London

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Tavistock Publications
The American Historical Review
The British Journal of Medical
Psychology
The Edinburgh Literary Review
The Hogarth Press
The Institute for Contemporary
Psychotherapy, New York
The Institute of Psychiatry, London
The International Journal of Psycho-
Analysis
The International Review of Psycho-
Analysis
The Journal of Social Issues
The Lauinger Library, Georgetown
University
The Menninger Foundation
The National Library of Medicine
The Scottish Institute for Human
Relations
The Tavistock Centre Library
The Tavistock Institute of Human
Relations

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The Washington School of Psychiatry,
Washington, D.C.

In his study, 1982

I am most grateful to J. Alan Harrow, Murray

Leishman, Mona Macdonald, and David J. Scott

for their support and collaboration. Alan and

Murray led the writing effort that resulted in the

group’s scholarly introduction and they also

helped me to mail some requests for permission

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to reprint from sources at addresses that I could

not trace from the United States. It has been a

great pleasure to renew old acquaintances and to

foster new ties with the Scottish Institute.

I would like to thank Patrick Casement and

Terttu Eskelinen de Folch for the use of their

clinical material in support of Sutherland’s

theoretical arguments.

At the publishing house, Jason Aronson was,

as usual, unfailingly enthusiastic and yet waited

patiently for the published and unpublished

papers, transcriptions, and permissions to come

together at last. It was a pleasure to work again

with Judy Cohen, a delightful, responsive, and

well-organized production editor, and with

Muriel Jorgensen, the editorial director. Diane

Turek handled the book’s promotion through the

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Psychotherapy Book News of which she is the
managing editor.

Josephine Parker cheerfully managed the

office and the correspondence in connection with

this book and Rita Leahy enjoyed the demanding

job of transcribing the audiotapes from which I

created Chapters 24 and 25. Ernest Wallwork

helped me to trace some references to works in

the field of philosophy and Ruth Selig speedily

found me some anthropological references that

were evading me. Many librarians responded
willingly: Hermi Dauker at the British

Psychological Society, Lorraine Fields at the

Senate House Library of the University of

London, and Margaret Walker at the Tavistock

Clinic were particularly helpful. Roger Shapiro

enabled me to finish the project on schedule by

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producing two books that no local library could
provide. I am indebted to all of them.

It has meant so much to me to have the

opportunity to edit this collection. Trained by

Jock as his registrar and senior registrar in

community psychiatry in Edinburgh from 1969-

1972, taught by him in his seminars on marital

and group therapy, and supervised by him on my

individual psychotherapy cases, I was imbued

with his ideas and felt especially suited to the

task of presenting them. What I liked about the

training that I got was the breadth and depth

made possible by his vision and the extensive

explanatory power of object-relations theory. I

learned by osmosis and apprenticeship more than

by reading theory. Since then I have been
interested to read of the ideas and now take great

pleasure in sharing them. Section 1 features

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Sutherland’s theoretical contributions to object-
relations theory in individual psychoanalysis. In

part 1 of section 2 I have put together papers that

demonstrate his object-relations approach to

groups and institutions, and in part 2 of section 2

those that deal with its application to community

mental health. The final section 3 moves toward a

theory of the self and represents the thinking that
would have been the basis for Sutherland’s book

on the self, had he lived to bring it to completion.

As an editor himself he headed the

International Journal of Psycho-Analysis and the

British Journal of Medical Psychology and as the

editor of books of the British Psychoanalytical

Society, he shepherded twenty-eight books to

publication for his colleagues, but he modestly

did not give his own ideas the same prominence.

He addresses the reasons for this in Chapter 25,

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where he reports on the successful self-analysis
of an inhibitory condition of his self-functioning.

The part of him that identified with his mother’s

ambition for him produced a tremendous amount

of highly regarded work, but another part that

identified with his publisher father’s pleasure in a

relaxed life kept Jock from devoting himself to

the writing of an intellectually ambitious book.

Fortunately, Jock’s self-analysis was successful in

time for him to write his biography of Fairbairn

at the age of 83. He had other projects in mind—

a biography of Guntrip and a book on the self—

but I do not think that he appreciated the

importance of a collection of his own work. I

would like to thank James Grotstein for sharing

my appreciation of Sutherland’s work and for

generously encouraging me to do this project. I

am grateful to the literary executive and to David

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Scharff for giving me the privilege of editing this
volume and therefore of doing for Jock what he

has done for so many others.

At home with Molly and Jill Savege Scharff

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Introduction

J. Alan Harrow, Murray Leishman, M.A.,

Mona Macdonald, M.A., M. Phil.,
and David J. Scott, B.A., M. Phil. C. Psychol.
A.B.P.S.

Sutherland Literary Executive,

Scottish Institute of Human Relations

Jock Sutherland’s ruling passion was the

future. He predicted a poor outlook for the world

if there were not to be an enlivening and

contributive psychoanalysis. The nearer he got to

his own death, the more he looked forward to the

dynamic impact on society of such a lively

psychoanalysis promulgated by the Scottish
Institute of Human Relations of which he was the

founder and by like-minded Institutes to which he

consulted, particularly in the United States.

Sutherland was one of the leading object-

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relations theorists of the British Independent
tradition, and, although he was most influenced

by Fairbairn’s systematic theory building, he was

not at all dogmatic. The danger of starting a

school, or worse, a cult, was always in mind.

“What matters,” he said in his opening address at

the Fairbairn Centenary Conference in

Edinburgh, 1989, “is not the promotion of

Fairbairn’s views, but the future of

psychoanalysis.”

The range in this collection of Sutherland’s

papers reflects the range of his vision, which
understood the many currents of the human

condition to be an interconnected whole. Just as

self, family, group, organization, institution, and

community are all inextricably connected so,

naturally, they are all here in this collection,

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which attempts to embody Sutherland’s visionary
purpose.

In pursuing this integrative vision, Sutherland

himself came to exemplify the manifold and

evolving self in society that he sought to identify

and to explicate throughout the 60 and more

years of his career. The psychologist and

philosopher turned to medicine, psychiatry, and

psychoanalysis; theory evolved alongside

practice. In his relationship with Ronald

Fairbairn, as his analyst in the 1930s and later as

his friend, the personal core of his

psychoanalytical self was formed and helped into

being. Fairbairn had realized that

psychopathology in the individual was the result

of lack of a good relationship, that the growth and
strength of the self was relational. The baby was

born seeking a related person, not an object of

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gratification, and the mother’s recognition of her
baby’s self enabled and mediated his personal

growth. Sutherland extended this insight to social

group functioning. His perspective on the growth

of the self in society has led to a new

psychoanalysis that is a powerful informing

force.

In an experimental unit in the British Army,

and, later, as Director of the Tavistock Clinic,

Sutherland came into contact with men like

Bowlby, Bion, and Trist who were searching for

the roots of disorders in the self in the context of

their work with groups and social forces. They

enjoyed mutual influence and inspiration as they

examined and worked with group institutional
and cultural forces. As editor of the International

Journal of Psychoanalysis among others,

Sutherland had the opportunity to expand the

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breadth of psychoanalytical investigation. In his
last 25 years this wider orientation took him

beyond his consultative involvement with the

Menninger Foundation in Topeka, Kansas, to the

Washington School of Psychiatry in Washington,

D.C., and the Institute of Contemporary

Psychoanalysis in New York, where he also

influenced and was affected by the growing

number of self theorists in the United States. The

final expression of his vision of psychoanalysis

was his founding of the Scottish Institute of

Human Relations.

Sutherland nurtured, recognized, and gave

opportunities to those who had led the field in

psychoanalysis, group work, and “socio-technical

systems.” He preferred to “mother” and “father”

brilliant prima donna thinkers rather them to

promote himself, yet his own questions were

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more extensive and his perspectives broader. His

ability to make the quantum leap into a new

paradigm often surpassed that of those he quotes.

A considerable portion of his writing

promulgated Fairbairn’s object-relations theory,

culminating in his psychobiography Fairbairn’s

Journey into the Interior, published in 1989.

Sutherland’s compassion and perspicacity bring

out the essence of Fairbairn as man and thinker;

his appraisal of Fairbairn’s significance — in
relation to Freud before him, to the
contemporaneous Klein, to Guntrip, Winnicott,

and the American self theorists—is throughout

judicious and nothing short of brilliant. In the

course of setting forth and evaluating these

various contributions, Sutherland himself

emerges as the thinker who goes further than

those whose thinking he elucidates.

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The sheer versatility and complexity of the
man were too easily obscured in the profusion of

all that he said and did in his many roles. When

the chairman of a program in which he had

presented a paper concluded the session by

saying that for years we had listened with

pleasure to Sutherland on Fairbairn, but tonight

we heard Sutherland, he might have been

acknowledging not only the burgeoning

autonomy of Sutherland the thinker, but also the

burgeoning capacity in his audience to hear and

recognize what he had been saying and doing for

a long time.

THE SELF IN OBJECT-RELATIONS THEORY

Sutherland was concerned with the concept of

the self in object-relations theory and with

establishing it at the core of a modern

psychoanalysis. Becoming aware that his own

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life was close to ending, he worked ever more
intensively, as though he wished to ensure that

the theory of the self would, through being

disseminated as widely as possible, have more of

an opportunity to take firm root in psychoanalysis

as a whole.

Chapter 21, based on a revision of his paper

“Hate and the Autonomy of the Self (1980a),

represents his current theoretical position on the

self. Here he develops his ideas on the

autonomous self using available clinical data, and
combines this with a review of the historical

development of the concept of the self. However,

his unique contribution in this paper is his

attempt to construct an overarching

metapsychology of the self based on modern

biology and open systems theory.

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Why did he think it absolutely vital that such
a framework be developed? In order to begin to

answer this question it is necessary to examine

his interest in and understanding of the theory of

open, self-organizing systems. This relatively new

paradigm in science has as its aim the elucidation

of the dynamics of interconnectedness at all

levels in the natural world (Jantsch 1980). It

represents an alternative view of the world to that

of the traditional dualistic and reductionist model

which has held sway in the scientific community
since Descartes.

OPEN SYSTEMS THEORY

Since the ’50s, the phenomenon of system —

applying in space through structure, in time

through process, in every kind of organic life —

has increasingly been charted in a multitude of

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disciplines. This has the force of a new paradigm
that is not limited to the scientific.

The characteristic state of the living

organism is that of an open system. A
system is closed if no material enters or
leaves it; it is open if there is import and
export and therefore change of the
components. Living systems are open
systems maintaining themselves in
exchange of materials with environment,
and in continuous building up and breaking
down of their components… . [von
Bertalanffy 1950b, p. 23]

Every organic form is the expression of a

flux of processes. It persists only in a
continuous change of its components. ... of
chemical compounds in the cell, of cells in
multicellular organisms, of individuals in
super-individual life units… . Every organic
system is essentially a hierarchical order of
processes standing in dynamic equilibrium.
[Von Bertalanffy 1950b, p. 27]

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Fairbairn’s model of endopsychic structure
(1944) clearly parallels emerging system thinking

very early in the field. Indeed the explosion of his

thinking in his four big papers of the early 1940s

finds an explanation in terms of systems thinking,

when the new paradigm manifests itself suddenly

in insight and gestalt awareness.

Miller (1965a,b) developed Von Bertalanffy’s

(1950a,b) general systems theory using

unfamiliar concepts from thermodynamics,

information theory, cybernetics (the science of

communication and control), and system

engineering, yet these are quite recognizable

when related to concepts of system in

philosophical, psychological, and sociological

understanding. Moreover each enhances the

meaning of the other.

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For example, Deutsch (1963) in “A Simple

Cybernetic Model” examines system, group,

organization, and learning in the light of

cybernetics. Deutsch uses the analogy of

Aristotelian teleology for any system using goal-

seeking feedback and Darwinian evolution for the

more complex goal-changing processes. These

are not new; they have belonged to natural

systems since time immemorial. The third, more

complex, form of feedback is relatively new. It is

that of human consciousness, namely self-

conscious learning inside the system. Mills and

Rosenberg (1970) add to this model concepts

having to do with the blocking and jamming of

circuits by emotional phenomena.

The concept of feedback in conscious systems

is as the concept of negentropy in general

systems theory and natural systems. In the older

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mechanistic Newtonian paradigm, the belief was

that all living organisms were subject to entropy

and naturally ran down. This was the second law

of thermodynamics. In the new systems thinking

the forces of negative entropy, if allowed to

influence the system, create the possibility of

maintaining the openness of the system, and its

growth. Freud in this sense was the biggest

exponent of the new paradigm, naturally but not

consciously, when he opened the human system

to the possibilities of change through the

negentropic feedback of unconscious

determinants of behavior.

A METAPSYCHOLOGY OF THE SELF IN THE

LIGHT OF OPEN SYSTEMS THEORY

Sutherland came to an understanding of open

systems theory through the works of Waddington,

Prigogine, and Jantsch. The new paradigm

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focused broadly on the process of change and

development rather than narrowly and reductively

on systems defined by the structural characteristic

of “equilibrium perfection, structural

unambiguity and permanence, hierarchical

control, and predictability of machine-like

structures” (Waddington and Jantsch 1976, p. 2).

Put simply and briefly, the new paradigm

emphasized the process of order through

fluctuation: random events or developments, if

given a critical level of support in the

environment, connect and become an integral part

of the existing environmental structure and its

evolution. This process can be seen to occur in

the realm of ideas; for example, traditional

Freudian drive theory clearly gained enough

critical support for it to become an accepted part

of our culture and our language. But did this

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happen because the theory was true in an absolute
sense? To us the answer is clearly no; rather it

succeeded because the theory fit clinical

observations, which in turn were themselves

affected by the prevailing scientific model of

man. Drive theory accorded well with the second

law of thermodynamics, with its emphasis on

equal and opposite forces and on equilibrium.

In keeping with the new paradigm and its

emphasis on processes rather than static

structures, Sutherland (1980) produced a lengthy
and tightly argued case for the sense of self

having evolved with the advent of homo sapiens

and in response to the survival requirement of

social connectedness. The development of a sense

of self he saw as a quantum leap in human

evolution; he thought that man’s self was his

“essential organising principle” (p. 10) which, in

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evolutionary terms, fostered “the flexibility,
resilience and persistence of human groups by

maximising the potential resources within each

individual, and did not confine communities to

rigid hierarchical organisations” (p. 25).

Sutherland conceptualized the self as an

innately patterned process that allowed the baby

to seek out personhood. Babies develop their

individuality from their interaction with

significant others in their environment. The

innate psychic tools for this task include the
concept of matching in which the baby

experiences positive affective tone when its needs

for recognition as a person are adequately met

from the environment. Stern (1985) and

Trevarthen (1980), who have observed,
developed, and experimentally validated this

process, use the term intersubjectivity. The gestalt

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term of closure also describes this process well.
Matching allows the baby to begin to develop a

sense of otherness—a sense of having a me

shape, which, through time and further cognitive

growth, becomes a primary identity. For

Sutherland, this originary self process differs

from the subsequent development of various

identities. We may experience ourselves as

having many different identities in our lives —for

example, son, daughter, mother, father, doctor,

priest —but the sense of a central me-ness, or

core self, transcends these. The core selfs status

as process rather than established content

determines its nature as a felt experience rather

than a static structure that is objectively

knowable in the traditional sense.

The central core self feeling is a gestalt, a

whole, whereas identities are components of that

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whole and develop through interactive
experiences with the environment. As the person

grows, identities change or are replaced and new

ones are generated throughout the life span. The

two concepts of self and identity are inextricably

linked but the existence of a core self in

interaction with an adequate environment remains

the necessary and sufficient condition for

adaptive identity development for the individual

in a social group.

From this evolutionary scientific perspective

Sutherland reviewed the growth and development

of the self concept in psychoanalytic theory. In
Chapter 21, “The Autonomous Self,” he outlines

the contributions of Hartmann, Fairbairn, Mahler,

Erikson, Lichtenstein, Balint, Winnicott, and

Kohut, and notes that, without exception, they all

emphasized the crucial importance of the self in

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their writings. He was concerned, however, that

many of these theorists, with the exception of

Fairbairn and Lichtenstein and later, Greenberg

and Mitchell, tended in varying degrees to view

the self as a product of drive theory, or make no

comment at till on the origins of the self.

Sutherland realized that psychoanalytic thinking

must not be hampered by continuous theoretical

cloning that could sap its vitality. The concept of

developmental tilt (Mitchell 1988) quoted by

Ghent (1992) refers to the tampering with theory

that occurs when the preoedipal baby, the baby of

object relations theory (which contains much of

the current theory of the self) is introduced

beneath Freud’s baby, without altering the

centrality of traditional drive theory. “The

traditional model is jacked up, and new relational
concepts are slid underneath” (Mitchell 1988, p.

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137). Mitchell (1988) and Ghent (1992) pointedly

note that this maneuver has the advantage of

being politically expedient. However, it threatens

the future of psychoanalysis. To survive, it must

remain an active, evolving theory that challenges

current assumptions.

Sutherland saw the issue as vital. He viewed

the traditional psychoanalytic theoretical model

as taking in new concepts and accommodating

them within its own philosophical system, but

never facilitating their separate growth and

development. Such a system, looked upon in

evolutionary terms, risked growing too large,

becoming gross, inflexible, and unable to grow or
change. Eventually it would either tear itself apart

in a forlorn attempt to integrate new concepts

(concepts like the self cannot be integrated

without losing their central essence) or be left

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behind by new thinking because of a lack of
relevance and an inability to keep up with

developments and changes in the wider scientific,

cultural, and social fields.

Stated in very broad terms, Sutherland’s aim

was to ensure that traditional drive theory was

placed within a philosophical perspective. He

attempted through his theoretical work to

establish a biosocial concept of the self and locate

it at the center of psychoanalytic theory rather

than as a spin-off of the drives. He had no wish to

eliminate drive theory since he was very well

aware of its importance in the history of

psychoanalysis: rather, he attempted to give drive

theory a self perspective and argued for its place

as the servant rather than the master of the self

process.

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Quite literally he wished psychoanalysis to
make a new “start from the center of the

personality” (1985a, p. 1). In Chapter 24, he

argues that in order to succeed in this task,

psychoanalysis requires (1) a metapsychology of

the self and (2) a metapsychology based on an

evolutionary scientific paradigm that seeks to

study process rather than structure. He attempts

to provide psychoanalysis with an evolutionary

arm, an evolutionary perspective to lock it into a

much wider and developing system of scientific

thought, and thus ensure its preservation as a

vibrant, evolving system. It is this aspect of

Sutherland’s work that is revolutionary. If it were

to be given a critical level of support,

Sutherland’s evolutionary perspective on

psychoanalysis could provide a closure concept

for psychoanalysis as a whole and a new

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philosophical foundation for the necessary
development and change to facilitate theory and

practice toward what has been termed a post-

Kleinian or third-phase psychoanalysis (Trist

1991).

SELF AND OBJECT IN THE INSTITUTIONAL

SYSTEM FOR TRAINING IN THE CARING
PROFESSIONS

“What supports the carer is not

encouragement in the conventional sense. ...
It is to be part of a learning system greater
than himself (Sutherland 1979, p. 12, and
see Chapter 19, p. 277).

Like Sutherland, Fairbairn, in the mid ’40s,

believed that popularization of psychoanalysis

was not desirable in that it could never be more

than superficially understood. Fairbairn thought
the influence of psychoanalysis would most
probably be exerted through its impact on
psychiatry and other sciences. During the last 20

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years of Sutherland’s life, he became less
interested in the possible influence on psychiatry

and more concerned with its linkage to other

sciences. He followed Fairbairn in thinking that

psychoanalysis had influenced contemporary

thought in wider fields. Popularization had taken

place through the medium of general literature

and especially through the novels. Sutherland

saw novelists and poets as the real allies of

modern psychoanalytic thinkers in the use they

made of the fairy tales and myths that enshrine

the same themes as symptoms and dreams.

Fairbairn’s theme was that psychoanalysis should

be judged by its scientific rather than by its

philosophical achievements. Looked upon in this

way psychoanalysis ceased to be merely a

method of treatment and became a method of

scientific investigation profitably employed

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within the whole group of psychological and
sociological sciences.

Practical application of psychoanalysis is

most obviously relevant to the treatment of

psychopathological states but it is also helpful in

understanding normal development and in

securing the upbringing and education of

children. At the same time, psychoanalysis

contributes to the solution of social problems

such as international conflict and social unrest:

American psychoanalysts such as Volkan (1988)

have made significant contributions to conflict
resolution in international politics. Sutherland put

his belief in the importance of applied

psychoanalytic thought into institutional form. He

achieved this in the first place as medical director
of the Tavistock Clinic, which became

internationally recognized during his

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directorship, and later as founder of the Scottish
Institute of Human Relations.

Creating an institution in Scotland (a country

in its own right) was a very different undertaking

than managing one in London surrounded by

other analysts. It involved establishing for the

first time a significant psychoanalytic culture, a

way of thinking that was well established in

London but unfamiliar to the Scots. Sutherland’s

establishment of an analytic institute in Scotland

involved on the one hand a return to his

birthplace (and final place of rest), and on the
other, the final interpretation of his own self in his

personally and professionally mature years. He

entered the richest period of creative thought

about how a self develops in the human infant

and is sustained in society.

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Sutherland’s developing understanding of the
self was based on Fairbairn’s view that the human

infant is primarily object seeking and that what

the infant (or individual) desires and seeks most

deeply is emotional contact with important

people (mother, in the first instance). This

emphasis on emotional contact with significant

others in the surrounding environment suffused

the model used by Sutherland as institute builder.

He realized that the development of an institution

had all the inherent difficulties encountered in the

infant’s relationship with mother, then father,

family, and wider social context. He put theory

into practice by considering the nature of the

environment in which the newborn institution

was to thrive and then by systematically

enriching that environment. He took the view

from the beginning that the aim of the Scottish

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Institute of Human Relations was not simply to

produce psychoanalysts to meet a Scottish

society’s emotional needs, but to create an

establishment whose primary aim was that of

spreading psychoanalytic knowledge throughout

the helping and caring professions so as to raise

the overall quality of personal health services in

Scotland.

Sutherland promoted tolerance of complexity

with clarity about goals. He used to say, “The first

business of any business is to know what

business it is in. So what is the business of
psychoanalysis?” He saw, shrewdly, that the

difficulty in which the psychoanalytic institutions

of the world find themselves arises from failing to

ask these questions. Institutes assume at their

peril that their sole business is to produce

psychoanalysts. According to Sutherland, a

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psychosocial organism with that primary task has

no social relevance. The notion of hundreds of

analysts going off merely to reproduce

themselves, making their hundreds thousands,

could not be the future. “We have instead to get

psychoanalytic knowledge of the person across to

society,” he insisted. Freud, he thought, knew that

very well and so wrote books for the intelligent

public of his day. But even that wasn’t enough —

for the simple reason that our commodity, namely

psychoanalytic knowledge, is itself disturbing. It

compels you to consider your own self in new

and unaccustomed ways. That raises deep

anxieties and in turn requires the help of other

people.

The aim of the Scottish Institute of Human

Relations from the first was to increase the level

of psychoanalytic knowledge among the caring

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professions in Scotland. Of course the training of

candidates in psychoanalytic psychotherapy was

to be a crucial and central part of that, but not the

overall task. These principles were stated from

the outset so that, for example, in the 2-year

Human Relations and Counselling Course, senior

and experienced professionals did not come for a

personal analysis but for study, reading, and

reflection on experience, in an endeavor to get

something of the psychoanalytic perspective on

their own work. As the theory and the music gets

across to them, a turbulence develops and needs

to be taken up within the course. As a result, at

the end of every year some individuals come to

the conclusion that they need to look at this

disturbance and go on to undertake a personal

analysis. Some of them will specialize as
analysts.

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Sutherland put object-relations theory into

practice in the Scottish Institute of Human

Relations. The development and maintenance of

the self requires a learning system and the

Institute is there in response to that belief, as well

as in response to the needs of the community. A

steady supply of analytic genius from the

psychoanalytic training program at the core of the

Institute’s identity is needed to maintain and

develop the skills of members who are variously

involved in education, social work, psychiatry,

and voluntary agencies. This model offers a

feedback system to the Institute and by

embodying the theory makes sense of it.

Sutherland’s image of man is that of “an open

system with a need to be valued and confirmed,

striving to integrate the separate subselves as part

of his self, and challenged by the need to deal

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realistically with a changing environment”
(Personal Communication to Murray Leishman,

1980). If the search for objects and persons is a

more basic force than the gratification of

instincts, then the setting in which this is

embodied is crucial. People in key positions in

education, medicine, and social work who are in

tune with the psychodynamic approach in their

own field are needed to keep psychoanalysis on

course. An instinct theorist on the old classical

lines could never have founded an analytic

institute on the model of the Scottish Institute of

Human Relations, or carried it through.

Sutherland took the view that the future of

psychoanalysis depended upon the development

of psychoanalytic training combined with human

relations activities in a total institution. The
specialist training in psychoanalysis would

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complement and influence a wider program of
learning. Because of its prolonged nature the

psychoanalytic method can never meet the needs

of society. According to Sutherland, its value was

to deepen our understanding of the powerful

emotions that affect our well being and

consequently our everyday lives. He believed that

if knowledge gathered by psychoanalytic research

were combined with creative resources in the

community, we could learn how to use this

knowledge in new ways and make a contribution

to improving mental health in a given

community. This was the philosophy he believed

had a future.

The creation of the Scottish Institute of

Human Relations, with its ripple effect on
Scottish culture, marks the emergence of

Sutherland’s own autonomous self. This event,

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together with his book Fairbairn’s Journey to the
Interior (1989), which he completed in his

eighties, clearly helped to release the grip of the

internal imagos of his own parents in interchange

with the authority figures in the outside world. Of

course he spoke consistently in positive terms of

admiration and respect for Fairbairn, but he left

his mentor behind. Sutherland faced Fairbairn’s

disappointment when he did not join him in

starting an analytically orientated institute in

Scotland years earlier, but chose instead to take

up the appointment as Director of the Tavistock

in 1946 after the War. It is perhaps just as well
that Sutherland went to London, for there he

applied Fairbairn’s object-relational perspectives

and learned his trade as an institution builder and

thinker in the company of such giants as Eric

Trist.

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Sutherland was the last to boast about it as an
achievement or to idealize it, but that an analytic

institute happened at all in Scotland is, like Dr.

Johnson’s dog, remarkable — an Institute

consisting of fourteen different learning projects

only one of which is the psychoanalytic

psychotherapy training but till sharing a

psychodynamic theory, in a country whose

culture is still dominated by the Protestant ethic

of bearing problems without admitting weakness

or bothering anyone else. Remarkable, admired,

envied, and denigrated, but always a force for

change, integration, and growth.

PERSONAL AUTONOMY AND

UNDERSTANDING OF THE SELF

For all his community outreach, friendliness,

humor, and sociability, Sutherland was a private

mem who would not have left among his personal

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papers anything comparable to Fairbairn’s
rivetingly interesting diaries of self-analysis and

dreams. One must therefore invoke a

psychobiographical approach to speculate about

his self-development, his insatiable curiosity

about the self, and his movement toward a new

theory of the self. Because social behavior

interacts with the individual’s inner world,

“biography is our proper mode,” he would say.

He studied John Buchan’s somber last novel, Sick

Heart River, and made a good case of its being

essentially a fictionalized autobiography (Chapter

23). But above all, in his own book, Fairbairn’s
Journey into the Interior (1989a), Sutherland
documents psychoanalytic ideas arising not

simply from clinical work with patients, but from

the growing analytic self of the analyst. For

instance, he briefly portrays Klein wrestling the

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events of her life into theory, and shows that her
subsequent paper, “A Contribution to the

Psychogenesis of Manic-Depressive States,”

written following the death of her son, had, in

turn, a creatively disturbing effect on Fairbairn,

which he used to good purpose in his own self-

analysis and theory building. In Chapter 25, he

describes the parallel growth in his own analytic

self while writing his biography of Fairbairn.

Hate and the autonomy of the self was a

principal theme in Sutherland’s later thinking.

His theoretical work provides an invaluable

perspective on his life as it reflects his struggle

for autonomy, which he achieved after taking in

his own hate. He worked toward developing and

sharing a mature capacity to handle hatred and

envy within the corporate identity of the Scottish

Institute. His dislike of establishment thinking

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and organization sprang from his democratic
intellect nurtured in the generalist philosophy of a

Scottish University. He prized Freud’s legacy not

for its power to confer a spurious esoteric status

on psychoanalysts but for its power to disturb the

sleep of society.

SUTHERLAND’S CONTRIBUTION TO
PSYCHOANALYSIS

Toward the end of his life Sutherland called

together a small study group to consider once

again the required paradigm shift in

psychoanalytic theory for expanded

understanding of the self. Wallerstein (1988) had

made it quite clear that the period of a single

theory and unified analytic enterprise was over.

At this stage in our analytic history, he said, we

are united by a shared focus on the clinical

interactions. When we look back to our

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explanatory structures, within which we
conceptualize the process of therapy, self-

functioning, and the reversed of psychopathology,

we are in a plural situation with a range of

metaphoric expressions. Sutherland, like

Wallerstein, positively welcomed the advent of a

comparative psychoanalysis expounded by

Greenberg and Mitchell (1983), that is, one in

which we discern kinds of psychoanalysis in the

new situation where there is no monolith.

Wallerstein (1988) writes, “Drive theory is linked

to the positions of Hobbes and Locke, that man is

essentially an individual animal and that human

satisfactions and goals are fundamentally

personal and individual; the role of the state rests

on the concept of ‘negative liberty,’ that the state

adds nothing essential to individual satisfaction

as such, but just ensures the possibility of

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personal fulfillment… .” (p. 18 fn), i.e., the
current philosophy of governments in the west in

this epoch.

But he continues, “Relational theory is linked

philosophically on the other hand to the positions

of Rousseau, Hegel and Marx, that man is an

essentially social animal and that human

satisfactions and goals are realizable only within

a community; the role of the state here rests on

the concept of ‘positive liberty,’ to provide an

indispensable ‘positive’ function by offering its

citizens that which they cannot provide for

themselves in isolation. Greenberg and Mitchell

state in relation to this that ‘the drive/structure

model and the relational/structure model embody
these two major traditions within Western

philosophy’ ” (Wallerstein 1988, p. 18 fn).

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At every step Sutherland insisted on bringing

to the fore these theoretical matters, always

maintaining that drive theory was putting an

impossible strain on psychoanalysis and that it

was essential to find a relational theory

perspective. Trist (1991) wrote of Sutherland,

It appears to us that Jock approached the

depressive position through the
schizoid/paranoid position as Fairbairn did,
though it is not clear that Fairbairn had the
complete and distinctive understanding of
the depressive position as originally put
forward by Melanie Klein. Sutherland did.
His original ideas which were only
incompletely formulated in his last papers,
foreshadow a psychoanalysis which is post-
Kleinian. Fundamental for him was the idea
of the individual as a person, and of the
mother/child relationship as interpersonal.
“Object relations” was really too abstract a
term for him. The interrelations were for
him multi-dimensional from the beginning.
One sees here the beginning of a new frame

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of reference which would probably have led
to a third generation of psychoanalysis, [p.
1]

In the clinical appraisal of the person and in

institute building, we see Sutherland’s view of the

person as a dynamic organization of purposes and

commitments whose behavior is governed by

conscious and unconscious motives and whose

development and functioning are inseparably

linked to his social environment. Jock Sutherland

accused himself of not devoting enough attention

to his own ideas. This is our loss, but it may well

be that his light touch, as Trist (1991) predicted,

will increase his long-range influence.

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I
OBJECT-
RELATIONS
THEORY

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1

OBJECT-RELATIONS THEORY AND

THE CONCEPTUAL MODEL OF
PSYCHOANALYSIS*

In recent years there have been two prominent

areas of development in psychoanalytic theory:

a. The advances in ego psychology, in
which Hartmann, Kris, Lowenstein,
and Rapaport in the United States
and Anna Freud in the United
Kingdom have played a leading
part.
b. The work on the role of object
relations from what has been called
loosely the English school.
Although deriving in large part from
Melanie Klein, these views have
had major contributions from
British analysts other than Klein’s

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associates, for example, Fairbairn
and Winnicott.

To British analysts it is striking how far apart

these two areas of work have remained. (For

some years it seemed that the work of Klein had

been declared an un-American activity!) There

are now signs that this situation is changing. I

believe this trend is due to a growing realization

that some of the apparent differences do not

represent incompatible lines of work, but, on the

contrary, can be seen in substantial measure as

complementary. In what follows I propose to

make use of the conceptual models that have
been developed as a result of the theoretical work

in these two areas to focus attention on where

some of the differences lie and so help to promote

a fruitful interchange of viewpoints.

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In his book, Energy and Structure in
Psychoanalysis, Colby (1955, p. 79) prefaces his

description of his model of the psychic apparatus

with some observations on the status and function

of models. Models represent one method of

describing the parts of a whole and their

organization. They are “visual aids, but they

picture only imaginative constructions of

organization.” Further notes of caution are

sounded when he points out that, although they

do not constitute a theory but merely help to

illustrate it, they are often mistaken for the

realities of which they are representations.

The complexities of the massive body of

observations and constructs that now characterize

psychoanalysis make it most unlikely that any
one model would cover other than limited aspects

of its theories, and this is probably one of the

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reasons that have led psychoanalysts to prefer
verbal descriptions of their theories.

Nevertheless, the fons et origo of psychoanalytic

theories, the psychoanalytic process, has

universally accepted features which readily

suggest the use of models. Karl Menninger

(1958), in one of the recent books on this theme,

Theory of Psychoanalytic Technique, finds a

working model of the way in which

psychoanalytic therapy operates as a helpful

device. The position may be put more strongly.

Psychoanalysis is a long-term process that is set

in motion deliberately by the analyst. He assumes

that only through it will the patient get the

necessary conditions for achieving certain

changes in his personality functioning. Moreover,

the analyst expects to control this process in

substantial measure by his activities. A statement

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in the form of a model, or quasimodel, of the
concepts used in the theory and practice that

underlie his controls is a necessity if assumptions

are to be adequately scrutinized and checked, and

hence greater power and precision achieved.

The requirements Colby lists for a model of

the psychic apparatus can be taken as a starting

point. For him a model should:

1. distinguish the variables of primary
importance from others that are
secondary or derivative;
2. show how internal biological
conditions are integrated with the
external environment;
3. allow for maturation and experiential
development;
4. provide for individual uniqueness
and societal variations;
5. indicate how it works.

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Of this list, the first one contains the crux of

the matter. What are the variables of primary

importance? I believe it is the failure to get these

right rather than the complexity of the data, that

has led to the neglect of conceptual models. Most

psychoanalysts have found the models put

forward so far to have only limited relevance to

their practice; and for those with more theoretical

interests, the awareness of this gap between

theory and practice has confirmed their lack of
enthusiasm for them.

In considering the applications of Hartmann’s

development of psychoanalytic thought, Rapaport

(1960) notes that the essential task of studying a

relationship between an explanatory theory and

the method of observation by which the data are

obtained is rarely pursued. We need to know, for

instance, “to what extent does psychoanalytic

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theory reflect human nature, and to what extent
does it reflect Freud’s methods of studying

human nature?” (p. 79). He then goes on to state

that the psychoanalytic relationship … may well

require a distinction to be made between “… a

general psychoanalytic theory which is little

dependent on these methods, and a specific

psychoanalytic theory which is greatly dependent

on them” (p. 79).

It is abundantly clear that in Rapaport’s

writings, as he himself states, he focuses on those
aspects of the theory that are not obviously

dependent on the clinical method and tries to

avoid concepts that obviously are tied to them,

like transference, interpretation, and so forth. A

noteworthy instance of this divorce from the
clinical findings occurs in Rapaport’s earlier
paper (1951) on, “The Conceptual Model of

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Psychoanalysis,” “…for reasons that lie beyond
the scope of this paper—I will not deed here with

the relevance or irrelevance of this model to

phenomena which are variously referred to as

those of conscience, ego ideal, superego, etc.” (p.

232).

I believe that some of the differences in the

two areas of work may be related to this apparent

greater distance between clinical data and theory

in the ego-psychology group as compared with

the British workers. To quote Rapaport again

(1960), “When the rules of thumb of clinical

psychoanalysis are equated with the theory of

psychoanalysis, the observations and concepts

which bridge the gap between the basic concepts

and the initial observations are inevitably
overlooked” (p. 84). What to my mind is the most

important part of this observation is the phrase

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“the rules of thumb” because it indicates that the
psychoanalytic method for him is a rather

haphazard one from the scientific point of view.

Rapaport further notes that: “The psychoanalytic

writer and practitioner is inclined to speak of

psychoanalytic concepts and theories in terms of

‘content.’” He then adds that “… Content is an

important ‘guide‘ to the practitioner,” but the

“majority of contributions to the literature tend to

dwell on content to the neglect of other guides…

. What is lost sight of—and the practitioner need

not necessarily keep this in focus or even in sight,

but those interested in theory must —is the

functional (and thus also conceptual) relationship

to which the content is a guide. … No content

yields its full meaning unless its formal

characteristics, and those of the time, place and

context of its appearance, are taken into

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consideration, that is to say, abstracted… . The
stress on content seems to be one of the main

causes for overlooking the relationship between

concepts and observables” (pp. 84-85).

Much of this stricture is arresting to the

psychoanalyst brought up in the tradition of the

British School. For him the distinction that is

being made between the content and the formed

relationships would not exist, because the focus

of his attention all the time is the study of the

relationships going on between himself and the

patient and to these content is only one guide. For

him, too, clinical data are the foundations on
which psychoanalytic theory rests. He therefore

views theories not closely related to these with

reserve; and with regard to the method, he would

not accept its status as at the “rule of thumb”

level.

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THE CLASSICAL CONCEPTUAL MODEL OF
PSYCHOANALYSIS AND EGO
PSYCHOLOGY

The classical model of psychoanalysis

appeared many years ago when Freud (1923)

formulated his structural concepts. The ego was

the part of the personality concerned with

organizing the adaptation of the person to the

external environment, regulating the means by

which he sought satisfaction for his drives (the

id) and reconciling these with a more primitive

control system (the superego), which operated

unconsciously within the ego. These structures

were finally shaped by the experience of the

Oedipus conflict according to the first

formulations. This theory permitted a

considerable advance in psychoanalytic

understanding and consequently produced a fresh

mass of observations from the widened range of

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conditions it enabled the psychoanalyst to treat

more comprehensively. It seemed to give a

foundation for so much that had been obscure,

especially the unconscious sources of resistance

and guilt. It led to an interest in the structural

parts of the personality, the ego and the superego,

and to an understanding of how the ego was

patterned by its defensive needs. The

development of the ego in its earliest phases

became increasingly important, a trend related to

the fact that data from the neuroses gained in

width and depth and also to the new findings of

child analysis.

Freud’s view of the id as a reservoir of

unorganized drive energies with the structured
ego and superego trying to regulate their

discharge was gradually perceived as an

oversimplification. Hartmann began to publish

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his well-known series of papers, many his own

and others with associates, on a new concept of

early development according to which the ego

and the id were differentiated from the first

undifferentiated phase. The ego was structured

not only by the experiences of the infant and

young child in the satisfaction and frustration of

its drives, but also by the maturation of

autonomous ego capacities, for example, motility,

perception, and so forth. As part of these

developments Hartmann took psychoanalysis to

be no longer a theory restricted to conflict or to
unconscious processes but a general

psychological theory. His additions, however, to

the theory of ego development and the concept of

autonomous ego do not alter basically Freud’s

model. For him, the id still derives from libidinal

and aggressive energies.

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The value of Freud’s model in relation to the

clinical phenomena is obvious enough and so it

should be since the component parts were

postulated to account for clinical phenomena. On

the other hand, the ego-psychology group has

tended to regard some of the conceptual usages

and developments from these theories, for

instance, the superego, as anthropomorphic

notions. To quote from Rapaport again, “In the

clinical parlance (and even in the theoretical

writings) of psychoanalysis, the explanatory

concepts are anthropomorphized, reified, or at
best presented in existential terms, giving the

impression that they refer to entities or at least

that each of them refers to a specific behaviour.

But this is not consistent with the theory. The
tendency to anthropomorphize and reify, and the

preference for hypothetical constructs, probably

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Sutherland in Vienna, August 1937

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derives from clinical practice, where there is a

premium on the ‘plausibility’ and ‘uncomplicated

everyday application’ of concepts.” (1960, p. 40)

There has certainly been a massive move here

from what Brierley (1951) has described as the

personological level of description to the terms of

process theory. Guntrip (1961) in his recent book

has dealt with some of the implications of this

move at length and I shall not devote any

attention to it other than to summarize by saying

that herein lies the critical issue. In Rapaport’s

model he combines three primary models

designed to explain action or conation, ideation,

and affect, each of which was formulated early on
by Freud. He then has to outline secondary

models, which are concerned with the

development of derivative drives. “In contrast to
the primary models, all the secondary models

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involve structuralized delay, that is to say,
progressive, hierarchically layered structure

development. The structures in question are:

defence and control structures, structures which

segregate affect charges, and the means structures

which subserve secondary action —and thought-

processes. A parallel development takes place in

the hierarchy of motivations; each step in

structure development results in a delay imposed

on motivations which in turn gives rise to new

derivative motivations and affects. The

multifaceted hierarchic development is the

development of the ego … and involves the

differentiation of the ego from the id, and the

super-ego from the ego. The id-ego-super-ego

trichotomy is the broadest structured articulation

of the mental organization and, as such, a crucial

conception of the clinical theory of

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psychoanalysis. Since it can be derived from the
models discussed, it is not an independent model

and we shall not dwell on it here” (1960, p. 33).

The critical issue as Guntrip (1961) brings out

in his discussion may be put this way. While it is

true that the eventual organizations that are at the

top of the hierarchy can be derived from previous

processes, in what sense are we to accept the

earlier processes as the primary variables that

Colby stipulated as the first requirement in a

model? Here we are up against a familiar

problem in biological thinking, of the extent to

which one may lose sight of essential qualitative
differences that supervene at the highest levels of

organization by relating these complex

phenomena to variables appropriate to lower

levels. It is not of course that Rapaport is

ignoring this problem. For instance, after noting

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the steps in psychoanalytic theory in a discussion
of the structure of the psychic system from the

adaptive point of view he goes on to say that

the fifth conception of reality, foreshadowed

by both Freud’s third conception and
Hartmann’s, is the psychosocial one
developed by Erikson….Man is potentially
pre-adapted, not only to one average
expectable environment, but to a whole
evolving series of such environments. These
environments to which man adapts are not
“objective,” but rather social environments
which meet his maturation and development
halfway: social modalities (e.g., the socially
accepted forms of “getting”) foster, select
and harness his developing modes (e.g., the
incorporative oral mode) of behavior
(Erikson 1950). This is the genetic
counterpart of Hartmann’s systematic
formulation; it is thus far the only attempt to
conceptualize the phases of epigenesis …
through which pre-adaptedness becomes
effective, and in which processes of
adaptation inseparably unite behavior

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epigenesis and environmental conditions. [p.
61]

For Rapaport, however, the inclusion of the

psychosocial point of view is “a mark of

systematic weakness, since it is merely a specific

aspect of the adaptive point of view” (p. 65). He

states that “Hartmann’s and Erikson’s theories are

too new, their implications too little understood,

and their relationship to each other too little

explored ... to permit a statement disregarding all

but systematic considerations” (p. 66).

In short, therefore, the main theoretical trend

deriving from the work on ego psychology has

thus far led to a concentration on rather limited

concepts for the functioning of the personality.

Although the relatedness of the ego to the other

parts of the personality is constantly

acknowledged amongst the ego- psychology

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group, the failure to do justice to the structuring

in the other parts, especially in that area covered

by the term the id, has led to the development of

concepts that perpetuate, or even increase, a

divorce between theory and clinical practice that

many analysts have recognized in recent years.

One of the main features in ego psychology

seems to be a need to formulate theories in terms

that are thought to be more appropriate to

science, or more accurately, to other scientists.

For analysts, however, as for others, theories

must be closely linked to their practice, and the

data of psychoanalysis do not lend themselves to

too much depersonalization.

THE OBJECT-RELATIONS MODEL

The most radical statements of object-

relations theory in Great Britain, those of

Fairbairn, and the detailed expositions of

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Fairbairn’s theories, together with his own
contributions, by Guntrip, adopt a completely

opposed standpoint in trying to create a model

that operates in a way that can be directly related

to clinical data and social interaction. This move

in the direction of adopting more

anthropomorphized structures, that is, structures

that do justice to the phenomena of interpersonal

relations, would also appear to be a direct

development of the last major trend in Freud’s

work: the structural theories and the introduction

of the superego. It is not, as I suggested earlier, a

development incompatible with the ego-

psychology work, but a development on a more

comprehensive front and one into which the ego-

psychology work can, I believe, be fitted.

Several developmental trends in Great Britain

have contributed to a particular interest in the

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structuring of the personality from the very start
in terms of the relationships between the infant

and its environment. Balint (1952), stimulated by

Ferenczi, was one of the first psychoanalysts to

make a definite pronouncement on the primacy of

object relations. Using observational data from

the feeding interaction between mothers and

young babies, he linked his inferences from these

with the findings from child analysis, the study of

psychotics, and the greatly enriched data coming

from the psychoanalysis of the neuroses

following developments in the use of the

transference consequent on Freud’s structural

theory. The work of Susan Isaacs, Middlemore

and Winnicott, and others reinforced this trend.

It was Klein’s work, however, that eventually

impinged more widely, more profoundly, perhaps
because she was the first analyst to make full use

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of the extraordinary richness and complexity of
the phantasy lives of young children. Moreover,

whatever reactions her theories may have

aroused, there was no question of her data being

too much the product of her method because

children’s phantasies can be studied in

considerable detail without analytic intervention

provided the observer is prepared to spend time

with a young child. Such manifestations required

the postulation of a relatively high degree of

structural development at early stages.

Klein and her co-workers suggested that from

the start of extrauterine existence the painful

affects of frustration and the intense aggression

associated with these feelings led to the creation

within the psyche of developing imagos of the
early objects. At first the breast was predominant,
but the internal objects rapidly extended to the

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whole of the mother’s body and her person.
These structures evoked within the child the same

feelings of persecutory relationships as had the

external object. Alongside these persecutory

imagos, there are also being laid down imagos of

the good breast-mother.

According to Klein, these inner objects are

very real and concrete in the experience of the

child. The ego grows in active relationship with

them and its successful development is governed

by the intensity of the affects in these internal

relationships. Much controversy has been

engendered on the nature of these internal objects
and their role. Because of the concrete qualities

she attributed to them, many analysts have felt

there was a strong anthropomorphic tinge about

Klein’s theorizing. Nevertheless, it does not seem

that there is anything improbable or

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unpsychological about such internal imagos
developing from the earliest stages, or that these

imagos should play a dynamic role. As Brierley

(1951), one of the most careful and objective

writers amongst British psychoanalysts, puts it,

there is no real difficulty in conceiving of an

embryonic imago of the object from the start

because of the different feelings that must be

present when the object, in this case the nipple, is

actually present (p. 50). What is of fundamental

importance is the function of this inner imago or

object. As a built-in part of the relationship

between the infant and the object, it appears that

it can be used as the object itself—Freud’s
hallucinated object —or as part of an object-

seeking system in which it patterns the perceptual

organization. This latter role is what Klein

describes as the projection-introjection system of

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object-relations development. That is to say, outer

objects tend to be perceived and responded to in

terms of inner ones. Normally, however, the outer

objects do not behave as badly as the inner ones.

When the former are introjected again they are

therefore less persecuting; social learning occurs.

When the affect within the relationship

system is too disturbing, the inner objects become

too frightening to be used in this projection-

introjection system. Relations with the outer

world can become seriously restricted. Such

systems are then split off within the psyche from

the central one in which the transactions with the

outer world are proceeding apace. The systems
which get segregated retain their bad objects and

because of the latter being relatively unmodified

by the transactions with the real objects, the

frightening qualities of these inner objects remain

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governed by the primitive affects and phantasies.

The internal bad objects for Klein are the

precursors of the superego and the severity of

superego persecution in many patients, adults and

children, supports her view that these structures

must have been laid down in very early stages.

The range of inner objects created within the

psyche means that the child in Klein’s view has

an inner microcosm in which strong affective

relations with inner objects, good or bad, are the

fundamental feature. The child’s play and most of

its developing cognitive and socially adaptive

capacities are determined by these inner relations.

The full implications of Klein’s observations

and formulations for some of the classical

theories of psychoanalysis were not followed

through by her, and it remained for Fairbairn

(1952a) to point these out in a series of papers

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beginning in 1940. Although expressing his

indebtedness to Klein’s views on the importance

of inner objects, Fairbairn developed his own

ideas in complete independence. The starting

point of his thinking was the nature of the

difficulties presented by schizoid patients. It has

long been known that these patients have

pronounced difficulties in their social relations,
but what had not been recognized, according to
Fairbairn, was the extent to which their inability

to make satisfying personal relationships

appeared to be the root of their troubles.

Moreover, he asserted on the basis of his clinical

experience that underneath the symptomatic

differences between the various psychoneurotic

conditions, there was a severe schizoid problem.

To account for the phenomena of the schizoid

disorders, Fairbairn was led to the view that it is

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the relationship with the object and not
gratification of impulse that is the ultimate aim of

libidinal striving. The cri de coeur of sill his

patients, he concluded, was for a loving mother

or father, and not for the quenching of more

limited tensions. In keeping with this longing, the

main features of the schizoid patient are defences

against the painful affects of not being loved by a

parent figure with full acceptance. The conflicts
within the primary relationship of the infant and
its mother lead to a splitting off or segregation

within the originally unitary ego of the

intolerable aspects of the relationship. Such a

split involves a division of the pristine ego into

structures each of which contains (a) a part of the

ego, (b) the object that characterizes the related

relationship, and (c) the affects of the latter.

Fairbairn therefore proposed that the libido

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theory in its classical form and the concept of
unorganized id should be replaced by concepts of

dynamic structures derived from a psychology of

object relations.

Revisionists of Freud’s theories have often

been castigated for their failure to give systematic

form to their views, and to state how their

revisions affect psychoanalytic theory as a whole.

It is also commonly said of them that they do not

grasp psychoanalytic theory fully. A careful

appraisal of Fairbairn’s writings removes the

grounds for any such criticism being applied to

him. He writes with admirable lucidity and

reveals the close relationship of his own views to

those of Freud. Thus, in his paper on “The

Repression and the Return of Bad Objects”
(1952a, p. 61) he shows in Freud’s own writings

how the nature of the repressed can be related to

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objects. Freud had noted that as well as the
internalized relations between the superego and

the ego (the relationship of the ego to its “good”

internalized objects), the superego also

represented an energetic reaction formation

against the earliest object choices of the id. The

significance of this statement, as Fairbairn points

out, is surely to imply that the repressed will be

concerned with the relationship of the ego to

“bad” internalized objects.

Fairbairn has given an outline of the

development of object relations from the

dependence of infancy to the mature relationships

of later stages. The fact that he has not filled in

this development in detail is of little

consequence, for the conceptual model of adult

behavior which he developed readily permits

Colby’s requirements to be met. Guntrip has

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described Fairbairn’s final model (1961) and here
it is only appropriate to note its main features.

These are:
1. a central ego in relation to an ideal
object directly repressing the
following structures:
2. an antilibidinal ego related to the
rejecting object (sadistic primitive
superego); and
3. a libidinal ego related to the exciting
object.

The repression of this latter structure is further

reinforced by (2).

These structures are conceived as interrelated

dynamic psychological systems, constantly in

active relationship with each other and with the

outer world. Each structure has a great

complexity in depth into which is built its history.

The particular experiences of the person will

contribute many subsystems that could, for

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instance, be precipitates of repressed relations at

the oral, anal, or phallic phases of classical

theory; but there is a tendency for these

constituent subsystems to group or to assume a

hierarchical order around the image of one

person, even if only loosely. The first

manifestations of a bad object relationship in the

course of analysis may therefore centre around

one or other of these subsystems, but as the

analysis proceeds all the components come to the

surface.

Fairbairn has retained the adjective libidinal

to describe the object-seeking tendency of the

person. I think his libidinal ego might be more

accurately described as the repressed or rejected
libidinal relationships, for while it is true that the

repressed needs are libidinal in character, not all

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libidinal relationships are “outside” the central

ego.

To minimize the intrusion of possibly

confusing theoretical stereotypes I propose to put

what I take to be the essence of Fairbairn’s

conceptual model into a series of statements and

propositions. Many of these are about behaviour

or at a first level of abstraction from the kind of

phenomena met with in human relations in
general and in psychoanalytic relationships in

particular. Where they contain inferences about

the nature of underlying processes I believe these
inferences can be clearly recognized.

(1) The person is related to his social

environment by means of a number of dynamic

psychic structures or systems, which vary greatly

in the degree to which they are in open

transaction with the social environment.

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(2) The word systems indicates that these
structures are organized and seek to effect certain

kinds of relationships. By the term transaction is

meant an ongoing relationship in which there is a

reciprocal interaction. Each person is involved in

such relationships in an active way with his or

her needs constantly affecting the behavior of the

other and vice versa.

(3) Systems vary in their mode of activity and

in their topological position within the

personality as a whole. They fall into two

important groups:
a. Those that are felt to belong to that
part of the self the individual wants
to be. These come within a central
organizing structure (the ego).
b. Those that are split off or repressed
from this self or central system.
(The words split, repressed,

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dissociated, or segregated are used
interchangeably in this context.)

The Central System, or Ego

(4) This system has assimilated and organized

much of the experience with significant people in

the early environment and hence much of the

cultural pattern in which the individual is reared.

This central organization (the ego) is

characterized by its relatively much greater

capacity to learn and by its unique feature,

namely that its integrative functions appear

closely connected with consciousness.

In the healthy adult, the main needs are

sufficiently egosyntonic and of such a character
that a manifold set of personal relationships is

sought and maintained. The relatively free

transactions between the need systems

themselves (greater communication) in the

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healthy person also means that he responds more
as a whole, is more integrated in assessing inner

and outer reality. The central ego in such a person

is therefore being enriched throughout life and

this constant enrichment provides a motivational

growth and support.

Typical of the healthy or strong ego are this

freedom of communication between different

need systems and the consonance of the main

needs over time.

The whole question of the scale and the

maturational phases of developments in the

human personality is something which only
Erikson (1956) has attempted to encompass.

Although Fairbairn discounts instincts in the

sense in which they have been commonly used in
psychology and psychoanalysis, the work of the

ethologists has shown that a more flexible and

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illuminating approach to the instinctive roots of
behaviour can be made, particularly in regard to

social behaviour and object relations. Bowlby has

made a major contribution in this direction

concerning the nature and development of the

attachment of the child to his mother. The tie

between the reproductive pair is almost certainly

mediated by a number of response and need

systems that allow for the rearing of the family

over time. It is this kind of approach that could

lay a biological foundation more in keeping with

the need for sustained object relations than is the

primary model of drives and their tensions

conceived so often in hydrodynamic terms and
requiring so many derivative structures for the

social behaviour that is basic to human survival.

The development of the relationship of the

person with himself, his identity, as consolidated

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by Erikson’s epigenetic phases, might well be
illumined by future studies incorporating an

ethological approach, particularly in revealing the

factors contributing to the development of the

need for whole person relationships from the

point of view of rearing the family. The survival

unit of the human being is the family. The

interplay of the manner in which the dependent

status of the child contributes to the building up

of the need for whole person relationships and the

extent to which these are reinforced by future

needs stemming from the reproductive

constellation within the family and of the position
of the latter within the social group, provides

endless scope for further work.

(5) The capacity of the central ego to tolerate

conflicting needs and to organize them appears to

be largely an acquired property. Certain kinds of

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early experience make or mar this capacity in a
profound way. What starts off the ego as an

adequate independent organizer, in other words,

what lays the foundations for an organizing ego,

independent of the mother who has been the first

organizer, is particularly important.

Fairbairn’s inferences about what seems to

have gone wrong in his schizoid patients is in line

with the work of many psychoanalysts. The

importance for the future functional power of the

central ego of critical phases in the early mother-

child relationship is now very familiar in phases

that have become bywords in analytic writings —

Balint’s primary love, Erikson’s basic trust,
Winnicott’s true self, and so forth.

(6) In the relationships fashioned

predominantly by the central ego the identity and

reality of the other is fully accepted, that is, the

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overall acceptance of the person raises the
threshold of toleration for unfulfilled

expectancies so that the relationship is

maintained. If the frustrations in the relationship

Eire too great despite mutual adaptation attempts,

it can be ended without destructive behaviour.

The concern for the other in adult relationships

stems from many sources, one being the

patterning of the central ego’s actions by the

tendency, even though this be very much a latent

process, to make the real relationships

approximate to that of the ideal ego with its ideal

object.

Repressed Needs and Primitive Control

Systems

(7) These systems comprise:

a. certain need systems, which may be
designated repressed aspects of
object relations, and

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b. primitive control systems (the
superego) derived from early
inhibition of certain need systems.

In contrast with those of the central ego, the

relationships sought by the repressed need

systems are relatively closed, in other words, the

objects sought are not individuals with mature

independence but are realizations of the inner

figures. In extreme cases, it can be clearly

perceived that the individual has a relation with

an inner object with whom he is virtually

completely identified, that is, who is a part of

himself. This is particularly striking in the self-
gratifying perversions—the transvestist who has

the sexually exciting relation with the woman

with a penis by finding her in his mirror image
when he is dressed up. More, often the inner

object acts as a scanning apparatus, which seeks a

potential object in the outer world. The subego of

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this system then coerces these people into the role

of the inner object. Such objects are not permitted

to have any real independence or individuality;

they have to fit the inner imago. Sadomasochistic

perversions illustrate this activity, and the ease

with which the individual can change roles in

these perversions indicates the switch from the

identification with one end of the system to the

other.

(8) The goals sought by these subsystems

represent aspects of the total relationship with the

significant figures of infancy and childhood and
range from relationships characteristic of early
infantile dependent states of development (for
example, “oral” needs) to genital behaviour.

(9) These subsystems have been split off

because their aims were incompatible with the

preservation of the egosyntonic relationship with

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the needed person. The conflict gives rise to

“pain” (fear, anxiety, guilt, depression, and so

forth) associated with their activity.

(10) They are excluded from the conscious

self by forces of varying resistance. Their

dissociation from consciousness means that little

or no adaptation or learning occurs within them.

(11) The original frustration apparently leads

to many of them containing, in addition to the

affect associated with their own aims, for

example, genital gratification, intense anger, and
destructiveness towards the person sought; in
other words they are largely sadistic in character.

(12) They are constantly seeking outlet in

ordinary relationship and/or in phantasy and

thought, that is, they have the compulsion to

repeat.

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(13) Their activity is particularly evocative of

the superego systems, that is, they are

accompanied by varying degrees of anxiety and

guilt.

(14) The resistance some of them show to

being brought back into consciousness becomes

increased:
a. By their finding hidden satisfactions
within the self (in which case a part
of the self is treated as the object to
be loved and/or hated in the
forbidden way. For Fairbairn, it is
the secret tie to the repressed
exciting object which is the
explanation of much of the
resistance to giving it up. Or
b. when their objects are projected into
other people — especially in close
relationships.

(15) A particularly important feature of these

needs is that, though there is a defensive

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tendency for the person to take them to other
people than those he wishes to maintain his close

good relationship with, nevertheless, there is an

even more powerful trend for them to come back

into any close relationship with one person. That

is to say, the repressed not only returns, but it

tends to return to the representative of the more

comprehensive relationship from which it was

originally split off.

(16) All of the psychic systems are

interrelated functionally and their relative

strengths and capacities for securing satisfaction

must be conceived as stemming from a

continuous process of interrelated development.

The boundaries between the systems vary greatly

in their “permeability.”

These statements, based on Fairbairn’s model,

describe the functioning of the person in his

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social relationships and they provide at least the
outline of a model for human interaction,

particularly for conflict in social behaviour. They

are intended primarily to meet Colby’s first

requirement, that variables should be at the right

level, and his other requirements can be readily

fulfilled also.

The study of the central ego, its functions,

and development, provide ample scope for ego

psychology. The interrelatedness of ego function

and the intrusive effects of unconscious object-
relationship needs suggest that a comprehensive

statement of object-relations theory will provide a

suitable framework for the development of

psychoanalytic theory. I am dubious, however,

about the extension of psychoanalysis to be a
general psychology. Psychology requires many

methods of study of which the psychoanalytic

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method is one. Psychology is hollow without
psychoanalysis, but it has to draw on many

methods and data other than those of

psychoanalysis.

SOME USES OF THE MODEL

The Aims of Psychoanalysis

The general aims of psychoanalysis can be

stated in terms of an object-relations model as

initiating and maintaining a process whereby

repressed relationship- systems are brought back

within the organizing system of the ego so that

they can be subjected to learning and adaptation.

The psychoanalyst secures this process by:

1. Providing a specially designed situation in

which there can be freer communication
between the parts of the self and between the
repressed systems and a special external
object, himself. He facilitates these changes
by interpreting the hidden aims of the

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dissociated relationships as these emerge in
the spontaneous behavioral and verbal
expressions of the individual towards him.

2. The personal relationship he offers enables the

dissociated systems, eventually trying to use
him as their object, to be brought into
awareness with sufficient affect as well as to
be tested against the continuing reality of his
interest. This bringing of the dissociated
need systems into the requisite kind of
awareness allows “extinction” of some needs
and learning of new objects for others to take
place again.

A greater degree of integration is sought

through a twofold process, namely:

a. Increasing the integrative capacity of the

central ego system through the overall
relationship with the analyst by establishing
a capacity to transact with people more
freely.

b. Bringing back the dissociated systems for new

solutions.

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A certain intensity of treatment and its special
setting are required for this process to be

adequately maintained and regulated.

I shall not do other here than to refer to the

“setting” of the patient’s total life situation as

creating obstacles to the analytic relationship.

Certain alterations of this may be required for the

analyst’s aims to be possible. For instance,

parents may maintain with a child or one marital

partner may exert on the other a pressure to keep

a subrelationship in being, thereby requiring the

relationship to be altered for the analysis to

proceed.

Transference and the Psychoanalytic

Relationship

Transference phenomena enter into all human

relationships so that their existence within the

psychoanalytic relationship is in no way

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characteristic. All kinds of people are made the
pegs on which the objects of repressed

relationships are hung. What is it that is specific

to the transference in the analytic relationship? I

believe the answer to this question is that the

analytic process permits a unique setting of the

reintegration of the split relationships in the self.

The affects and aims of repressed relationships

tend to be acted out by all human beings in some

of their personal relationships without the

discharge of these affects having other than a

minimal or negligible effect on their compulsion
to repeat. But the analyst, starting as a good

object, usually an ideal one, creates the essential

feature of the analytic process in that the split

relationships are reexperienced with this one

person who does not reject them intolerantly.

This is, of course, no new statement. It is

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universally agreed that it is the transference
experiences within the analytic setting that lead to

change. Karl Menninger’s (1958) model of the

analytic contract describes this process. I believe,

nevertheless, that its implications for our

structural concepts have not been fully realized.

Can we account for this crucial aspect of the

transference relationship unless it is postulated

that what is repressed, as Fairbairn has described

them, are bad aspects of an original unitary

relationship of one ego with another whole

person, the mother? In other words, can we

explain why the analytic relationship is sought

and maintained by the patient unless there is an

original supraordinate structure that is trying to

reunite within itself parts that originally belonged

to it, and whose segregation is sustained only by

constant strain within it?

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Rapaport asks if the analytic method does
justice to the phenomena of human relationships

or whether instead it creates artifacts. It would

appear that this inner compulsive striving to unite

the original splits in the ego and its object within

one relationship is not a product of the analytic

process but a general tendency of human

personality. The literature of the world points to

Fairbairn’s conception of the splitting within an

original unitary structure as a universal truth; in

short, it is the human tragedy that “each man kills

the thing he loves” — or, at least, tries it the

uttermost. But what Wilde did not know, and

what object-relation theory emphasizes, is that

the killing is not to destroy but is to make an

infantile protest from which the good relationship

will reemerge magically.

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A source of evidence with which I have had a
good deal of experience in recent years and

which is very telling in this connexion, is that

which stems from work with marital conflicts.

The commonest presenting pattern of these is as

follows. In the early phases there is an idealized

relationship, or at least what is felt to be a good

relationship. This phase may last over years and

often includes sexual relationships that are

satisfying to both partners. There then begins an

insidious process, frequently starting with more

initiative from one partner, but sooner or later
colluded in by both, through which the repressed

relationships with the original significant parent

figures are brought in. The particular pattern

follows, of course, the specific content of the

individual’s history and it is remarkable at times

how closely the settings and patterns of original

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relationships are reproduced. With these cases,

there are many complications, but the common

characteristic keeps reappearing; namely, of the

bringing into the good relationship the repressed

bad aspects of the relationships with the parents.

In marriage, processes of this kind are universal

but they are ordinarily contained by the balance

in favour of the good relationship and its

enrichment. Where the difficulties become of

such an intensity that help is sought, then a

further feature emerges. Despite the tensions and

often fairly prolonged periods of hostility and

mutual recrimination, there remains a strong

desire to get the relationship right. Often this is

reinforced by external considerations, for

example, for children, but this need is usually
present without these factors. In view of the

frustrations and sufferings of so many of these

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spouses before marriage, it would be expected

that desperate measures would be put into action

to preserve in the relationship the goodness of the

early phases. What then determines the entry into

the good relationship of the repressed bad

relationships? The most plausible theory to my

mind is that the spouses are trying to undo the

experiences of an early relationship in which the

bad aspects belonged with the good.

Unfortunately when, as so frequently happens,

both partners collude in a process of this kind the

relationship becomes one in which both are living

with their bad objects projected into the other and

they remain stuck in this position. Psychotherapy

directed towards these collusive forces in the
relationship often produces good effects in

persons who separately would be regarded as

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much more difficult prospects for individual

psychotherapy.

The Psychoanalytic Method

Under the stimulus of the object-relations

concepts as these are expressed in the writings of

Bion (1961), Rickman (1957), and Fairbairn,

Ezriel (1951) put forward a statement of major

importance concerning the study of the

psychoanalytic method. Ezriel concluded that

most doubts about psychoanalytic theories centre

on the validity of the psychoanalytic method.

Using tripartite object relation structures as

described by Fairbairn, he assumed that the

psychoanalytic situation would be dominated at

any one time by three forces corresponding to the

three systems. Thus, the central ego would seek

one relationship with the therapist, the repressed
needs would drive the individual to express

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another, and the inhibiting superego would create
a feeling of impending threat, disapproved, or

catastrophe. He proposed to conduct therapy

without making any historical reconstructions

and to confine his comments to how he saw these

three relationships determining the behaviour of

the patient. In other words, the psychoanalytic

session could be treated as an experimental

situation provided the therapist stuck to the here-

and-now forces operating in the setting.

Not only was this a way of investigating the

psychoanalytic method, but in Ezriel’s view it

provided the much needed theoretical framework

on which all interpretations should be based. The

verbalizations made by most analysts during

sessions can be very different in status and

complexity, ranging from simple affirmations,

requests to give more material, and so on. His

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thesis, however, was that the interpretation — the
crucial aspect of the analyst’s verbalizations—

must consist of bringing to the patient’s notice the

three types of relationship in the situation.

Fairbairn (1952b) also wrote a short paper

subsequent to Ezriel in which he expressed very

similar ideas. That is to say, the analyst must

account for what the patient is expressing to him

by a response in which three components are

discernible, namely: (1) When you say (or

communicate by behaviour) x, you are striving to

maintain relationship a with me; (2) but x also

indicates that you want to express another

relationship b with me, which you must not admit
to because you fear (3) relationship c in which I

shall do something disastrous to you (reject,

punish, attack, be sexual with, and so on). Thus

the unconsciously sought relationship, the

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defence against it, and the reason for the defence
are incorporated in these three parts.

Social Relations and Group Psychotherapy

Freud’s original study on group psychology

was a remarkable contribution to our

understanding of group processes. Here was one

of the early examples of theory in object-relations

terms because the group members became related

through their common introjection of the leader

as their ideal object. Kleinian theory with its

multiplicity of internal objects suggested that the

social relations created by the individual would

reflect situations comparable to those between the

ego and his inner objects. Bion (1961), Jaques

(1955), Menzies (1960) and others developed

these ideas. In a number of contributions they
showed how illuminating these primitive object

relations of the inner world could be both in

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understanding and handling intragroup tensions
and those between groups.

SUMMARY

I have outlined some features of the object-

relations theory of the personality that started in

the work of Klein and the advantages of which

have been formulated so penetratingly by

Fairbairn. Its main aim is to formulate a theory

closely related to the phenomena of human

conflict and of personal relationships. There is a

danger to psychoanalytic theory and practice in

trying to reduce the phenomena to components

that have the appearance of being more scientific

because they avoid errors of anthropomorphism.

An object-relations model can be flexible and

comprehensive with regard to the understanding

of behaviour at any one time in terms of the here-

and-now manifestations and of how these are the

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product of historical layerings. It has the added
advantage of giving a more rigorous basis for the

study of the psychoanalytic method.

Fairbairn’s formulations try to do justice to

the phenomena of human interaction and I have

suggested that the way the personality seeks to

undo its splits within one relationship is only

explicable by a theory of the kind Fairbairn has

stated, namely that these splits occurred within an

originally unitary structure that mediated the

relationship between the infant and his first

object, the mother.

DISCUSSION BY OTTO F. KERNBERG, M.D.

Sutherland has outlined a conceptual model

of psychoanalytic theory derived from the

English school of psychoanalysis. He has said in

comparing that conceptual model with the

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formulations in psychoanalytic theory derived
from developments in ego psychology, that

“Some of the apparent differences do not

represent incompatible lines of work but, on the

contrary, can be seen in substantial measure as

complementary.” I believe Sutherland’s precise

synthesis of the object-relations theory of

Fairbairn, and his elaboration of Fairbairn’s

model, are an important step in the direction of

clarifying the relationship between ego

psychology and the object-relations theory.

Melanie Klein’s contributions to a conceptual

model of object-relations theory (as contrasted to

her contributions to clinical psychoanalysis) have

been open to criticism, mainly perhaps, because
of her lack of definition of the relationship
between the ego as a whole and the inner objects
of the ego. For example, it is not clear to what

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extent in her theory the inner objects of the ego
are forerunners of the superego, to what extent

object relationships are simultaneously being

built up into superego and ego, or what the

relationship is between inner objects of the ego

and characterological structure. In connection

with her clinical work, Melanie Klein’s school

has also been criticized for what appears to many

as a rather arbitrary utilization of concepts related

to very early stages of the ego, in interpretations

given during the first few sessions to most

patients. This practice gives the impression that
her group does not take sufficiently into
consideration the later defensive processes of the

ego, or the more advanced structure of it.

Sutherland’s elaboration and reformation of

Fairbairn’s model overcomes to a great extent

this criticism of the object-relations school. He

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has described the concept of dynamic psychic

structures or systems within the ego, which are

units differing to the degree they are in open

transaction with the social environment, and

which contain an object relationship (as well as a

part of the ego, and the impulse derivative

connected with this relationship). He has also

introduced an element of historicity, of

longitudinal development, which I feel is lacking

as far as advanced ego functions are concerned in

Klein’s theory, and has also provided a link to

ego psychology as represented by Erikson’s

concept of ego identity.

Sutherland states that only Erikson has

attempted to encompass the whole question of the

maturational basis of development. The work of

ethologists, Sutherland believes, might provide a

more flexible and illuminating approach to

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instinctive behaviour particularly in regard to the

roots of social behaviour and of object relations

than that implied in Fairbairn’s subestimation of

instincts. I agree with Sutherland. Also, in

contrast to Fairbairn’s subestimation of instincts,

I believe that Melanie Klein’s contribution to

instinct theory, her impressive analysis of the

importance of aggressive and self-aggressive

archaic impulses, is a fundamental pillar of the

object-relations theory.

I would like to link the observation of

Sutherland on Erikson to one area of possible

relationship between the object-relations theory

and ego psychology, namely, that of the defensive
and adaptive mechanisms of the ego connected

with the object systems along the developmental

path of the ego.

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Erikson describes the precipitation of ego

identities out of identifications that center around

crises of development of the individual. Thus,

there are different identities in the ego, on

different levels of development, with the

possibility of fusion and structuralizations of

identities, as well as of conflicts between ego

identities of different stages. These identities are

built up of identifications which, especially as far

as very early identifications are concerned, in turn

develop out of introjections. It is my

understanding that Erikson sees introjections as

representing early adaptive and cognitive

mechanisms of the ego as well as defensive

operations, of a “diffuse” type as opposed to the

more delimited processes involved in

identification. Identifications, as contrasted with

the perceptually poor and affect-laden

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introjections, are closely connected with

autonomous cognitive processes of the ego on

one hand, with social aspects of the parental

figure on the other. Identification involves the

identification with roles, that is, with habitual

social functions accompanying the interpersonal

relationship with the object at the time at which

those identifications occur. We could say, then,

that the growth of the ego is marked by the

building of object relationships that finally

constitute ego identities that contain adaptive and

defensive mechanisms connected with these

object relationships. These mechanisms vary

along the developmental path, so that very early

object relationships introduced into the ego imply

primitive mechanisms of adaptation

(introjection), and later ones, more advanced

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mechanisms of adaptation (identification), all of
which serve defensive processes.

Melanie Klein and her co-workers have

described the importance of primitive defense

mechanisms at very regressed levels of ego

functioning connected with early object

relationships. I refer especially to Rosenfeld’s

studies of the mechanism of projective

identification and Paula Heimann’s investigation

into defensive mechanisms in paranoid

conditions. Projective identification in

Rosenfeld’s conception implies projection of an

impulse, lack of differentiation between the ego

and the external object, and the need to control

the external object. One might say that this is, for
the school of object-relations theory, an essential

mechanism “precipitating” into very early object

systems of the ego. Of course, when very

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threatening impulses (especially those of an
archaic aggressive nature) are involved, the early

object relationship which is to become an inner

object or object system of the ego is such that this

system is easily rejected by the central ego

system and thus, as Sutherland pointed out, kept

out of the influence of later integrative ego

mechanisms.

In contrast, at a somewhat later stage of

development, when autonomous ego functions of

a cognitive nature (especially perception) are

more developed, projective identification may

turn into projection. By now the ego becomes
more aware of the limits between itself and the
external objects and thus the projected impulse is

disconnected from the ego, and the need to

control the object diminishes. Also, the

development of memory functions may

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contribute to mitigate the threatening aspect of
the object. Different images of that object

throughout time can coexist, thus reducing the

fantastic nature of the fear of the object, and

again the need to control it implied in projective

identification. One might formulate this by saying

that memory development helps to overcome

splitting. What I am trying to say is that while

primary autonomous, especially cognitive,

functions of the ego develop, defensive

mechanisms connected with introjection of object

relations change, and therefore, also the nature of

the inner objects of the ego. On the other hand, as

inner objects of the ego are built up under the
influence of less primitive mechanisms, and

identification in the sense of which Erikson uses

the term are quantitatively replacing introjections

(and other related early mechanisms) as the main

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mechanisms of adaptation and defence, primitive
anxieties connected with rejected early object

relationships diminish. The ego has now

available more freedom for adaptive purposes;

this, in turn, reinforces the cognitive aspects of

the later identifications and ego identities, which

are easily taken over into the central ego. Thus

the adaptive (especially cognitive) and defensive

mechanisms of the ego might be visualized as a

kind of interstitial tissue that structures the more

definite ego identity and the advanced

preconscious and conscious functions of the ego.

Trying to reformulate the above in a tentative

spatial model, inner objects of the ego might be
visualized as precipitates of the ego around which

cognitive functions and the adaptive aspect of

defensive functions construct a secondary, stable

interstitial web. This interstitial web gives

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strength to the whole structure and preserves the
delimitation of early object relationships. On a

higher level of organization, these interstitial

structures actually give the definite form to the

ego as an organization, to the extent that even

when temporary reactivation of early object

relationships occur, for instance, in the

countertransference reactions of the analyst, the

higher structures do not break down, but keep the

form of the central ego and its advanced identity.

Thus the refined interaction with reality is

maintained, while at the same time the inner

experience can be that of the more diffuse nature

of an early object relationship.

In conclusion, I do feel that a possible

relationship between object-relations theory and

ego psychology exists, and that an analysis of the

maturational scale of defensive operations, of the

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characteristics of early precipitates of object
relationships as contrasted with those of later

precipitates of such relationships, might be

constructed. In such a longitudinal model, the

characteristics of early defensive operations and

early emotional positions connected with

primitive object relationships will have an

essential place. I believe that Melanie Klein

herself moved into this direction when implicitly

describing introjection and projection as early

mechanisms of development of the ego as well as

of defences against archaic anxiety.

A few final remarks on the implication for the

theory of the superego and the theory of the id of
this tentative, combined model. In Sutherland’s
formulation, synthesizing and modifying

Fairbairn’s concept, an advanced form of

superego structure corresponds to the centred

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ego, while a more primitive, sadistic superego is
structurally involved in the early ego systems.

This involves, I feel, a parallel conception of the

superego as being also built up of different levels

of object relationships. The sadistic primitive

superego thus represents a precipitant of very

early superego functions connected with early

inner object systems. Such a point of view would

be compatible also with Paula Heimann’s

statement that introjections occur simultaneously

into the ego and into the superego. Finally,

Sutherland’s consideration of the question of the

relative organization or lack of organization of
the id is very important. The point of view that

the id is being “structured into” the archaic object

relationships which constitute the inner objects of

the ego appears to me an interesting and

challenging viewpoint. This conception of the id

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may appear less surprising if one accepted

Kubie’s critique of the concept of psychic energy,

which implies that energy is distributed diffusely

through the psychic apparatus; what determines

different levels of energy potential are structural

elements within that apparatus and not an

external source of energy to it.

Note
[←*] Note: The discussant is Otto Kernberg, M.D.

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2.

BALINT, WINNICOTT, FAIRBAIRN,

GUNTRIP

From the requests to give talks on the work of

these analysts, I assume that the growing interest

in it is not simply historical. On the contrary, I

believe that the issues that they struggled with

have become questions of widespread concern

today for the advancement of psychoanalytic

theory and practice. The reasons for taking this
quartet as a group do not stem from any joint

work they did. They did not constitute a group in

that sense at all. Guntrip’s work is closely derived
from, and related to, Fairbairn’s; but Balint and

Winnicott pursued their paths independently of

each other and of the others, and both were rather

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superficial in their comments on Fairbairn’s
writings, as were most analysts for many years.

What gives point to their being bracketed

together is the extent to which their contributions

eventually embodied a common development.

Even in this respect, however, they preserved

their individuality, for while Fairbairn stated

clearly that his clinical findings required a

recasting of some of Freud’s central formulations,

Balint and Winnicott did not take this step.

Indeed, Winnicott (Winnicott and Khan 1953)

shared with Masud Khan the view of Fairbairn’s

book (1954b) that “if one could escape this

claim” by Fairbairn that his theory supplants that

of Freud, “one could enjoy the writings of an

analyst who challenges everything, and who puts

clinical evidence before accepted theory” (p.

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329). As Guntrip (1961) tersely observes, this is
no way to advance any science!

The independence with which their work

progressed adds, of course, to the weight of their

similar conclusions. It is remarkable, too, that all

were contemporaries, born approximately in the

last decade of last century and all dying in their

early seventies. Personally, they liked and

respected each other, though disagreeing about

their theories. I should add here that in using the

adjective “British,” I am not prompted by the

Scottish Nationalist spirit that has become

prominent in recent years. It is true that Fairbairn

carried out all his work in his native Scotland, but

I have used the more comprehensive adjective to

distinguish this group from what has been
referred to as The English School, a term

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commonly denoting Melanie Klein and her co-
workers.

While restricting this group to these four

contributors, I do not imply in any way that they

were the only ones who have developed object-

relations theories. Many others have done so.

However, I think these four have been more

fundamentally concerned with this theme and

have written more explicitly on it. The most

notable of my exclusions is obviously Melanie

Klein. There is no doubt that her work was highly

influential on all of our quartet, though perhaps

least on Balint. Guntrip, possibly because of his

position outside the formed analytic groups and

his interest in the historical development of

psychodynamic thought, never ceased to
emphasize that in his view it was Melanie Klein

who made the first major challenge to the

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foundations on which Freud’s metapsychology
rests. Her work with the inner worlds of young

children established the need to postulate the

structuring of object relations from a much earlier

stage than had been thought. Although a

remarkably gifted and courageously dedicated

research worker in this field of the earliest stages

of development, Melanie Klein lacked the kind of
intellectual rigor that enabled her to follow

through the theoretical implications of her work.

Her views therefore remained largely as brilliant

presentations of some of the phenomena we have

to take into account, phenomena which she failed

to systematize convincingly largely through her

adherence to the theoretical use of the death

instinct. In this way she seems to most analysts to

minimize the role of the external object almost to

that of confirming the fantasies produced from

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within by the activity of the instincts. She thus

appears at times to create a kind of biological

solipsism rather than a conceptual framework for

the evolution, from the earliest stages, of

structures based on experience with objects.

Winnicott (1958b) certainly acknowledges his

debt to Melanie Klein at various points, albeit

mainly in relation to specific concepts such as the

depressive position. With Fairbairn, however, her

influence was more fundamental. It was her use

of the concept of multiple internal objects along

with her object-related views of the paranoid and
depressive positions that led him to break away

from the classical position, in which the theory of

psychic development was based on the
unstructured energies of the id, in order to

account for his clinical findings with schizoid

patients.

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The independent way in which our theorists
developed their work allows us the more readily

to look at the contribution of Balint and

Winnicott separately and then to consider

Fairbairn and Guntrip as creating successive

phases of the same line of thought.

I shall be relatively brief about Balint and

Winnicott, whose work has always been better

known since both were prominent members of

the analytic movement, locally and

internationally. By contrast, Fairbairn worked

alone from his isolated position in Scotland and

so had few opportunities to discuss his work with

a wide range of colleagues. Recognition,

especially from international sources, came to

him relatively late in life. Guntrip was even more
isolated from the analytic scene in that he was not

a member of the British Psychoanalytic Society.

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A much more prolific writer than Fairbairn, his
books, however, brought him into a wide range of

contacts with analysts and analytical

psychotherapists.

MICHAEL BALINT

Theoretical preferences and styles are very

much influenced by the personalities and

backgrounds of the individual. It might therefore

be of interest to make a few remarks about each

of our subjects. Balint completed his analytic

training with Ferenczi in 1926 and along with his

first wife, Alice, concentrated entirely on the

early development of the ego. Their backgrounds

comprised biology, medicine, anthropology, and

education, and their work was intensely mutual.
Unable to accept the theory of primary narcissism

with its implication that the infant only gradually

becomes related to objects, they advanced the

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quite opposite view of the infant’s growth as
absolutely dependent on an intense relatedness,

biologically and libidinally, with its environment.

Alice Balint died soon after their emigration to

England in 1939, and Michael continued to

develop their early theories. From his analytic

work with patients who regressed deeply, he was

led to describe a condition that he termed the

Basic Fault (1968). The patients said they felt a

“fault” or “something missing” inside

themselves, rather than a feeling of something

dammed up and needing to be released; and

Balint added “basic” because its effects

permeated the whole functioning of the person.

He assumed that this fault, which in some

measure is universal, is caused by a failure of fit

between the needs of the child and the response

of the mother; but beyond his description of it as

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a fault or an “area of the mind,” he did not really
conceptualize it.

It is from this area that the Oedipus complex

develops in response to the increasing experience

with parents as maturation occurs. Alongside the

oedipal phenomena, however, he postulated an

“area of creation” in the mind in which the

individual creates objects or artistic products in a

private internal way to try to make something

more satisfying than the real objects. The basic

fault is also a precursor to the emergence of two

types of object relations: ocnophilia in which

objects are cathected with great intensity and so
clung to for security and philobatism in which the

inner world is cathected to provide a degree of

independence from the precariousness of objects.

These object relations are thus for Balint a

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defense against the effects of the failure of the
environment.

In the treatment of individuals who manifest

the basic fault regression to a marked degree,

Balint concluded that the standard analytic

method of giving only verbal interpretations was

unable to alter the stalemate produced in the

regression. The patient’s state was not one that

could be analyzed away, so to- speak. What the

patient needed from the analyst was the

opportunity to make good a deficiency. The

analyst had therefore to be the kind of object or

environment with which the patient could

discover his own way in the world of objects.

With all basic fault states, the analyst had to

convey through his relationship with the patient

that he understood his needs and that in doing so

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he recognized the patient’s own inner life and

valued his own unique individuality.

What Balint described by way of theory and

practice in these regressions is well known, and

my purpose in sketching it again is to draw

attention to the main position he reached. From

his clinical data, Balint suggests that a critical

primary developmental phase has to be

surmounted for the individual to emerge with a

general capacity to relate to objects and to

himself in a reasonably effective and satisfying

way. Although Balint eschews any attempt at

making an adequate theory, it is clear that the

individual who escapes major trouble at this basic
fault stage must have achieved a very important

structural change, a fundamental epigenetic

development. As Morse (1972) has put it, Balint

appears to have refused “to become a

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psychoanalytic heretic by attempting to formulate

the revised structural theory he needs to explain

his data” (p. 498), and because he stopped short,

he gives us a metaphorical description instead of

an explanatory theory. The new structure must

function as a very basic organization for all

subsequent development if, as Balint (1968) says,

its influence extends probably “over the whole
psychobiological structure of the individual,
involving in varying degrees both his mind and

body” (p. 22). It allows us “to understand not

only the various neuroses (perhaps also

psychoses), character disorders, psychosomatic

illnesses etc., as symptoms of the same

etiological entity, but also —as the experiences of

our research into general medical practice have

shown —a great number of ordinary ‘clinical’

illnesses as well” (p. 22).

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Balint accepts that analysts have worked out

an adequate theory and practice to encompass the

oedipal conflicts, which arise from the parental

triangular situation, as opposed to the problems

of the basic fault, which occur in the earlier

dyadic relationship. Nevertheless, he does not

attempt to show in what way, for instance, the

earlier developments might correlate with the

oedipal phenomena. Again, while the basic fault

failure leads to either a clinging to objects, which

are then introjected for support, or to creative

activities, we are not really taken much beyond

that for we are not offered any views about the

structural changes that must underlie the

development of persistent patterns of behavior

such as ocnophilia or philobatism. Also, while

hate for Balint is located in the struggle to
overcome the oppressive dependence on the

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primary object and the giving up of primitive
omnipotent wishes —and it is this struggle that

makes for the intense positive and negative

feelings in the “new beginning” phase of the

analysis when the basic fault is reached —he

makes no reference to related structural concepts,

for example, of internal objects.

Benign regression, which leads to a “new

beginning,” is contrasted with malignant states.

Characteristic of the former is the patient’s need

to feel he is being recognized and responded to as

an individual, an outcome that commonly needs

some minimal action from the analyst, for

instance, touching hands. The patient does not

wish for instinctual gratification, and for this

reason Balint implies that the need is of a holistic

“personal” nature. In contrast to the benign

regression, the patient in a malignant condition

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moves to insatiable demands for orgiastic
gratification and so drives the analysis to a “tragic

or heroic finale.” Balint does not suggest that

these different outcomes arise from different

structural features. Instead, he thinks that some

malignant regressions may be the result of

inadequate experience and skill in the analyst

with a recreation of the lack of fit between the

infant in the patient and the mother in the analyst.

D. W. WINNICOTT

Winnicott’s work (1958b, 1965, 1971) is even

more familiar than Balint’s, so again I shall
merely put what would seem to be the essence of

his position as he left it. His approach to the

earliest stages-of development draws on the

unusually rich material available to him from the

fact that he combined the role of practicing

pediatrician with that of psychoanalyst

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throughout most of his professional life. He was,
too, a great individualist who brought a

characteristic poetic and imaginative quality to

his theoretical and practical work.

His experience with seriously regressed

patients and the correlation of his clinical data

with his extensive knowledge of mothers and

young children led him to the same kind of

problems that preoccupied Balint, namely, those

around the earliest structuring of the psyche. As

did Balint, he concludes that there is a very early

split, which has profound significance for future

development. Balint’s basic fault is paralleled by

Winnicott in his concept of a true and false self, a

split that originates in a failed relationship

between mother and infant in the earliest stages.

Winnicott believes that the innate growth

potential of the infant expressed itself in various

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spontaneous manifestations. When the ordinary
good mother responds naturally to these — and

she is especially equipped to do so by a specific

development around the time of the baby’s birth,

what he termed her “primary maternal

preoccupation” — the fit between her response

and the baby’s experience gives to the latter an

“omnipotent” creative quality. Repeated

experiences of this kind establish in the infant a

sense of wholeness, of conviction about the

goodness of reality, and a “belief in” the world as

a rewarding place. This core of feeling gives rise

to a “true self because the full maturational

potential, as this emerges in its increasing

repertoire of activity, can be actualized in joyful

relations. The confidence in the mother also

permits the gradual giving up of omnipotence,

with the disillusionment this involves and its

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swings between intense love and hate. For

Winnicott this true self brings with its growth a

feeling that its core has to be intensely private,

“incommunicado” (1965, p. 187), as he put it

later. There is an obscurity about this notion in

that the core feeling of having a self appears to

depend on its being given to the infant by the

input from the good mothering, and so the

separation of an absolutely private part is difficult

to understand. It could relate to the essence of the
growing sense of the thrust of autonomy, the
sensing of an “I” as apart from the objects, an

embryonic affect for the later “I am real, I am

going to do my own thing and not someone

else’s,” and a fear of this being interfered with,

but Winnicott seems to imply some other factors

of a more primary nature.

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Frustration beyond a certain level cannot be

contained within the affective cohesion of the

experiences of the true self, especially when the

mother is felt as forcing herself on the infant, as

impinging on it, with her own responses out of fit

with the spontaneous needs of the child. This

kind of negative experience gradually becomes

organized to form a “false self,” that is, one that

complies with the mother’s attributes; and as the

mismatch between the latter and the infant’s

responses increases, so does the distortion or

stunting of development, with the true-self

potential receding more and more from its

inherent capacity for relatedness.

Like Balint, Winnicott concluded that the

experiences structured into the true and false

selves are not those of instinctual gratification.

Good experiences of the latter reinforce the true

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self, but its structuring is founded on the quality
of the relatedness between the infant and its

mother. The relationship between these structures

and Freud’s tripartite division remains

ambiguous. It is again as if Winnicott, like Balint,

stopped short of any radical confrontation

between the theories he needed and those so well

established. Thus although he refers to this early

structuring as very close to the id, he continues to

emphasize its complete dependence on the

quality of the object relations. Guntrip notes his

reverting to ego relatedness as the critical

contributing factor instead of continuing with his

almost complete adoption of the term self.
Guntrip suggests that Winnicott may have

introduced the ego to denote the part of the self

involved in relations, but concluded that this idea

could not be maintained. It is more likely that it

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represents a certain inconsistency in Winnicott’s
theorizing; and in this connection there are

various examples of that. Thus Winnicott notes

(1963, p. 83) that his account of the growth from

dependence to independence makes no reference

to the libido theory. He then adds that we can take

all that for granted and his scheme for these early

structural developments does not in any way

invalidate any statement he might have made in

terms of erotogenic zones. In till his later papers,

however, there can be little doubt that he has

moved from the classical frame of reference to an

approach of a general systems theory type, for it

is the self that operates as the organizing
principle for all future differentiation. The critical

property of the self is the creativity that takes

place within it through play. Winnicott doubts

whether we can explain this creative process,

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although we can study the very important
processes through which creative living can be

lost and hence lead to the feeling of life as unreal

or without meaning. With his descriptions of the

functions of play and creativity (1971) he gives

more specific suggestions on the development of

the self.

The concept of the transitional object was his

first stressing of an activity that occurred in this

creative “area” between the subjective and the

objectively perceived. Later he widened this area

as the one in which play, artistic creativity,

religion, and culture were developed, as also were

the contents of psychopathological conditions.

Again, too, it is in this area of playing, as in the
formation of the core self, that the process is

spoiled by the intrusion of instinctual excitement,

for example, masturbation. Playing is a form of

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doing, but of a special kind in which there is an
interplay of personal psychic reality and the

experience of control of actual objects. The

appropriate responsiveness of the mother allows

her to become a subjective object and, with

further good interaction, an objectively perceived

object; and the self differentiates as a result of the

essential role of play. The capacity for play is

very much dependent on the mother’s love or her

object-relating, at first on her active input and

later on her reliable availability, as he described

in his paper on “The Capacity to be Alone”

(1958a). It is, in other words, founded on trust.

Playing is thus the universal facilitator for growth

and social relationships and, indeed, for

Winnicott, mutual playing is the essence of the

psychotherapeutic relationship. It is only in

playing that the individual —child or adult—

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uses his whole personality in creative activity,
and it is only in being creative that he discovers

this self. The way in which the self is sensed, in

other words, its security or otherwise, has to be

mirrored back by the trusted parent. A conviction

of one’s creativity as “fun” that can be shared is

the essence of the self that can enjoy living. It is

here that theory must again take the object

relatedness of the child into account because the

emergence of play and creativity is dependent

upon the environmental provision, the quality of

the mother’s love, from the start.

A further elaboration of his views of the first

stage of development consists in what he terms
the phase of being as a necessary precursor to a
phase of doing for healthy development (1971).

In the phase of being, the first weeks, the infant

acquires from its experience of ordinary good

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mothering what is apparently a positive affective
content to its overall self-feeling. The prototype

of this good experience is the relationship with

the empathic mother and her breast, and, because

the infant is in a relatively passive absorptive

state most of the time and because only the

mother can give this experience, he terms it, for

want of a better, the female element in the self.

This phase moves on to one of doing, which he

correspondingly calls the male element wherein

the object relatedness proceeds to the

differentiation of the self and object. Although

the terms may not be satisfactory, he has clearly
separated two phases in the course of

development of the self toward its becoming a

subject in relationship with objects.

While Winnicott, like Balint, leaves a great

deal of theoretical work to be done, they have

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both reached a closely similar general position.

I have already referred to Morse’s critique

(1972) of Balint; he is equally critical of

Winnicott, considering his scheme too

inconsistent and even contradictory. The

importance of both, however, seems to lie in the

role they accord to certain basic developmental

achievements. If successfully attained, then the

individual is established with the capacity to

relate effectively to others and himself, whereas

failure means restricted or distorted development.

A fundamental organizer has been fashioned, not

from instinctual satisfactions by themselves, but
from these along with the experience of a general

fit between the infant’s overall psychological

needs and the mother’s spontaneous acceptance

of these. The implications of such a structuring as

a template for the future development of the

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person are profound, and since the same

questions arise with our other theorists we shall

hold off on answering them until later.

W. R. D. FAIRBAIRN

When we turn to Fairbairn and Guntrip we

soon sense a different quality as pervading their

thinking. Freud’s approach was profoundly

rooted in the scientific materialism of the

nineteenth century, and though his findings drove

him persistently toward the recognition of the
psychological level of the organism’s activity as

an irreducible domain, he never reached the point

of feeling it had as much reality as the

physiological. Balint and Winnicott also tended

to retain this influence, though to a lesser degree.

While they could both think of love as a human

response at a personal level, not reducible to

instinctual gratifications, they kept this “area” of

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their minds largely separated from the area which

the classical libido theory had created. Even with

Winnicott’s increasing preoccupation in his later

work with the phenomena for which he used “the

self” rather than the less personal terms of

Freud’s structural theory, he did not pursue the

wider theoretical changes his work was

inexorably foreshadowing.

The intellectual backgrounds of Fairbairn and

Guntrip were very different from the others.

Fairbairn’s first academic training was in

philosophy, from which he went to Hellenic
studies and then to theology. He intended to enter

the Church until the First World War interrupted

this plan, and by the time he finished his 4 years

as a combatant soldier he had decided to take a

medical training with a view to becoming a

psychotherapist. Freud linked his dislike of

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philosophers to their speculative

Weltanschauungen. Perhaps there was sufficient

change in the teachings of philosophy by the time

Fairbairn came to it, for certainly to him, and

even more so to Guntrip, the importance of this

influence was the discipline it imposed upon the

theorist to criticize rigorously his concepts. Thus

Fairbairn always viewed the libido theory and the

pleasure principle with the uneasiness that the

philosophical criticisms of any hedonistic theory

engendered. Also, from his role as teacher in the

Psychology Department in the University of

Edinburgh, he was influenced by the views on

Instinct in Man which had been published by

Drever (1917), the Professor there. Although

armchair in origin, these views had quite a

dynamic system nature, for example, any

structured propensity that instinct was based on

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engendered a specific emotional coloring

according to whether its aim was being achieved

or not. Another influence was gestalt psychology,

which did a great deal to reinforce the need to

think of the unique properties of the relevant

wholes in psychological processes in contrast to

the atomistic approach to these fostered by

scientific materialism. Guntrip was especially

influenced by the philosopher John MacMurray

(1961) who expounded the need to conceptualize

the personal level and who stressed that one of

the most pressing problems for philosophy was a

satisfactory conceptualization of the self because

for him the self was the essential agent in human

behavior.

The papers produced by Fairbairn during the

first decade of his psychoanalytic work show that

he had carefully assimilated Freud’s theories. It

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was from the treatment of a series of markedly
schizoid patients after this period that the primary

importance of object relationships struck him.

Their impact coincided with another powerful

influence, namely, Melanie Klein’s writings on

the inner object relations of children and adults,

and especially her 1934 paper, “A Contribution to

the Psychogenesis of Manic-Depressive States.”

Fairbairn’s geographical isolation, with its

reinforcement of the independence of his

thinking, led him to stress, however, the primacy

of the phase earlier than Klein’s depressive

position. Indeed, he came to think that depression

had played too great a part in psychoanalytic

theory. It was not, after all, a very common

clinical condition, and, moreover, much happened

in the developmental period that preceded Klein’s

critical phase.

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The clinical manifestations of his schizoid
patients convinced Fairbairn that their etiology

consisted in the mother’s failure to give the infant

an adequate experience of “being loved for

himself.” This condensed phrase is clearly a very

complex package, one that essentially connotes

the view that the foundation for subsequent

healthy development is not laid in the satisfaction

of instincts but in the imparting to the infant that

he is “a person,” valued and enjoyed as such by

his mother. When deprived of this experience, the

most serious consequences can occur. The

individual, despite his innate longing for object

relations, becomes too frightened to make them

lest his love be rejected, and so he builds up a

compensatory inner world of relationships. There

thus develops massive structural splitting within

the unitary ego, which is present from the start.

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At the time of writing his new formulations,
Fairbairn was clearly reluctant to alienate other

analysts by introducing too many new terms and

so he retained the word ego for this pristine unity.

Just as Winnicott and Guntrip found they had to

adopt the self as a more appropriate term, so

Fairbairn found it best to restrict ego to the part

of the self that is adapted to outer reality, thus

leaving the self for the more comprehensive

psyche or person. He also reverted at times to the

entitative the libido when, as he later pointed out,

it would have been more consistent had he said

that it is the individual in his libidinal capacity

that seeks objects.

Fairbairn’s explicit statement that the

development of the person from the very start had
to be conceived in terms of dynamic structures

based on experience with objects instead of these

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being derived from unstructured energies was a
major challenge to the libido theory. It was one of

those changes of standpoint that is simple in

principle and yet is soon felt by many as

extremely disconcerting. The complexities of

psychological phenomena are certainly daunting,

and it was Freud’s incredible achievement to

have provided future investigators with an

exploratory instrument. The peculiar feature of

the analytic method, however, is that the

instrument is the personality of the investigator,

informed and supported by his experience, the

latter being enlarged through training.

Psychoanalytic theory and practice are thus

uniquely interdependent, and what Freud’s

theories had given us were our only anchor points

in the uncharted seas that every patient presents.

As a result, to challenge Freud’s theories has

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usually been responded to with anxiety, as if a
sacrilegious outrage were being perpetrated. Of

course we do not change theoretical views lightly,

especially when they come from someone of

Freud’s stature. Nevertheless, his theories, as

Freud himself remarked, are the upper stories of

the edifice and not the foundations; and Fairbairn

certainly had a thorough knowledge of the
foundations, which were never in question for

him.

The reception accorded to his challenge,

which was argued in an impressively compact

and tightly logical way, was at first somewhat

patronizing, and some of this attitude has
persisted. Thus Modell (1968), while

acknowledging the value of his clinical findings,

regrets that “Fairbairn’s theory was not intended

to supplement Freud’s but to supplant if and so

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has won very few supporters. Again, “men like
Fairbairn, when faced with these problems,

would wish to rip out the entire fabric of

psychoanalytic thinking and start anew. ... It

would take a man of Freud’s genius to rival

Freud, and the history of science shows that such

men do not appear to every generation; they

scarcely appear in every century” (pp. 4-5,6).

When he was writing his papers, Fairbairn in

fact would often say that as he kept going back to

Freud’s writings he was repeatedly astounded to

find Freud constantly on the brink of taking a step

that would have cast his formulations into the

more appropriate one of keeping strictly to

psychological structure. Anyone with less sense
of rivalry or of “sacrilegious intent” than

Fairbairn would be hard to find. He was one of

the most conservative of men, a man of great

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dignity and integrity. He was, moreover, very
strongly against people attributing a new school

to himself. For him, psychoanalysis and its

development were what mattered; but he did not

shrink from suggesting a theory that he

considered did more justice to the facts, nor did

he feel apologetic in doing so. To him it was

more of a sin against Freud’s legacy to cling to

any part that might be improved than to recast it

in the light of further knowledge; and

intellectually he was well equipped to appraise

the status of the concepts needed to fit the data.
Within the past decade, Fairbairn has become

more widely recognized in the United States,

particularly through the writings of Kernberg,

who has appreciated the value of his contribution

though not agreeing with some of its tenets

(1976, 1980).

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The essentials of Fairbairn’s views on
psychopathology are briefly given with slight

modifications of his original terms —for instance,

he accepted Guntrip’s use of the self as

appropriate for the early ego (Fairbairn, 1963).

1. The human infant is object-seeking from the

start.

2. This activity is mediated by a unitary ego or

self, and the reality principle is operative
from the beginning. Impulses cannot exist
except through activation of the ego or self,
and they cannot be viewed as sources of
energy existing apart from structures.

3. Pleasure is an accompaniment of relationships

with objects, that is, it has a guiding and
selective function and is not the primary aim
of activity.

4. Aggression is a reaction to frustration and is

intense in the earliest experiences.

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5. The original anxiety is separation from the
mother and can readily be experienced as of
terrifying intensity, for example, when a
satisfying object is unavailable.

6. To cope with the unsatisfying original object

(breast-mother), this object is internalized by
a distinct psychological process and
established as a structure within the psyche.

7. This unsatisfying object arouses excitement

because it is needed, and frustration because
it rejects. With the intensification of these
experiences, the exciting and rejecting
aspects of the object are split off, along with
the part of the self related to them, into
subselves, each of which contains the object
and the part of the self related to it.

8. The main core of the internalized object then

becomes an ideal object or ego ideal, and the
part of the ego related to it is termed the
central ego (self).

9. There are thus three dynamic systems, each of

which acts like a partial self: (a) The central

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self, related to the ego ideal, which represses
both (b) the needy libidinal self in relation to
the exciting object and (c) the antilibidinal
self linked to the rejecting object.

Because the antilibidinal self is attached

to the rejecting object, it attacks the libidinal
self and so reinforces the repression of the
latter.

10.The superego covers the complex of (a) the

ego ideal, (b) the antilibidinal self, and (c)
the rejecting or antilibidinal object. These
structures are interrelated dynamic
psychological systems, subselves within the
person, and it was important to Fairbairn that
psychoanalytic theories should be couched in
purely psychological terms at the level of
personal functioning. To introduce
etiological factors at lower levels of the
organism’s functioning was to abandon the
data specific to the analytic situation as well
as to depart from the proper level.

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In place of the classical developmental

scheme of object relations related to erotogenic

zones, Fairbairn puts this progression into one

governed by the quality of dependence. The

infantile dependence at the start is characterized

by its incorporative attitudes and by primary

identification. The gradual separation from the

object throughout childhood and adolescence

constitutes a transitional period from which the

head thy individual emerges with the capacity for

mature dependence in which giving is as

important as talking and the differentiation of the

object as a separate person with an independent

identity characterizes the desired object.

The abandonment of the libido theory as a

basis for the development of object relations

inevitably means a reconsideration of the nuclear

position of the Oedipus complex. For Fairbairn,

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the origin of psychopathology lies in the extent to

which the pristine self is split. By the time

oedipal fantasies are being stimulated by

psychosexual development, the individual has a

divided self, and it is the extent to which these

divisions are present, along with the intensity of

their activity, that determines the outcome of the

oedipal conflicts. The three dynamic structures

are each modified by later experiences, and

indeed Fairbairn states that the unsatisfying

relationships have to continue into the later years

of childhood for the separate systems to become

established with the kind of rigidity that makes

for the serious psychopathological disorders. The

existence of the needy libidinal self leads, under

the pressure of the oedipal conflicts, to one parent
being put into the position of the exciting object
with the other parent as the attacking, rejecting

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one. Normally, the parent of the opposite sex
becomes the exciting object, but lack of

acceptance by either or both parents in the early

stages readily leads to pathogenic patterns in the

antilibidinal figure and so to the establishment of

the various psychosexual distortions and

inhibitions in both the boy and the girl.

Fairbairn’s dynamic structures with their

internal objects make good a defect of Balint’s

and Winnicott’s theories in that they give a

structural basis for the development of the

different psychopathological patterns from the

earliest phase. As dynamic systems, they are

constantly active. A degree of splitting of the

kind he describes is universal, though in ordinary

healthy development the central self remains

dominant as a learning adaptive system, which

can integrate in large measure the activity of the

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other systems into a more or less coherent
scheme of motivation for the self. In such

development the self is then largely co-terminous

with the ego. When the antilibidinal system is

overdeveloped, then a wide range of inhibited

behavior is the result. Severe splitting initially,

with the associated intensely frustrated

relationship needs, made aggressive and sadistic

by the pressure to satisfy them, give a good

explanatory scheme for the schizoid conditions,

while the main pathological modes of relating—

the hysterical, paranoid, obsessional, and phobic

—are also accounted for in terms of the particular

pattern of relationship with the internal objects
that become dominant at any one time. Not only

is each of the main neurotic patterns accounted

for, but the scheme also explains the common

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finding that so many patients can exhibit more
than one of the patterns at different times.

The structuring of the relationship systems

also makes clear why resistance to therapy can be

such a difficult, and even intractable, problem. In

his theory of repressed impulses, Freud took

resistance to emanate mainly from unconscious

guilt, with the lessening of which the impulses

could be brought under the influence of the ego

and given a different aim or at least made

controllable. In Fairbairn’s theory, what is

repressed is not a forbidden impulse but an

attachment of a subself to a forbidden object and

of another subself to a rejecting object which can

be frighteningly primitive if this system becomes

active. This attachment to bad objects seems at

first sight puzzling until it is realized that the

infant and child has no choice in his attachments.

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Bowlby1, in his use of ethological concepts to
give a developmental scheme for relationships,

has brought out this feature in the higher

mammals as well as in man, that is, clinging to

the mother becomes intensified the less secure the

relationship is. In other words, a bad object is

infinitely better than no object, the latter state

being that of disintegrative anxiety.

For Fairbairn, then, the baby begins with a

self system that seeks relationships as its primary

need. Within this unitary system there

differentiate two subselves in coping with the

frustrations of the environment. These two

subselves are really not independent in origin
since they are both the complementary aspects of

the frustrating situation. In other words, the

creation of a rejecting inhibiting self goes in

parallel with the forbidden relationship needs of

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the libidinal self. The subselves are maintained as
a relatively closed system since in this way the

individual seeks to have some control over the

objects he needs. The more he remains absorbed

in these relationships with inner objects, the less

is he involved with the outer world in a mature

way. Such relations with external objects as he

does try to make in these circumstances are

predominantly externalizations of his inner

world, that is, people are not individuals in their

own right and valued as such, but are figures to

be coerced into the mold of the inner object.

The overall self system is thus a reactive

matrix dominated at different times by one or

another of the self divisions. The central self or

reality ego ordinarily tries to preserve consistent

adaptive relationships with people in the outer

world; and when one of the subselves takes over,

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neurotic patterns appear. The self as a whole thus
has what Kohut (1971) has termed vertical splits.

But it also has horizontal divisions from the fact

that experience can be organized in successive

layers as well as fused. In this way each of the

self systems can expose its structure as it was at

earlier stages, though alteration in one cannot

occur without all being involved. The tendency is

for each system to acquire a characteristic pattern

by the time adulthood is reached. Thus the

libidinal ego may have created as its exciting

object a perversion which remains relatively

stable. In treatment, however, it is usually not

long before the earlier object needs can be

discerned; and, as Fairbairn further suggested,

seeking gratification of impulse tension through

part objects develops from the failure and

deterioration of object relations.

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HARRY GUNTRIP

Guntrip was drawn into a close relationship

with Fairbairn’s work especially after its appeal

led him to undergo analysis with him. The

stimulus of this experience was to start him on a

very careful study (1961) of Fairbairn’s theories

in relation to the general analytic scene and

particularly of their relationship to Freud and

Klein. Guntrip, like Fairbairn, had had a

philosophical training as part of his preparation to

become a clergyman, and his clinical work, too,

had focused on notably schizoid individuals.

Perhaps from what he had learned from Fairbairn,

his therapeutic experience confronted him with

serious regression in several patients. As a result,

he began to realize that Fairbairn’s picture of the
endopsychic structuring of the person failed to do

justice to the nature of regressed states. These are

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characterized by a massive withdrawal from

relationships and a deadness that can not be

accounted for by Fairbairn’s subselves. In the

libidinal self, there is commonly, in contrast to

apathy and withdrawal, an active seeking of

libidinal relations typically sadistic and primitive

but nevertheless actively sought, while the

antilibidinal self is correspondingly activated. In

those threatened with the withdrawn states, there

is in part a desperate struggle to keep these

subself activities going as a countermeasure

against the great dread of sinking into a total

apathetic futility equated with dying. For these

phenomena, Guntrip postulated — and Fairbairn

approved — a split in the libidinal self by which

one part takes flight from all object relations,

which seemed to him to be like an attempt to go

back to the safety of the intrauterine condition.

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Besides the powerful regressive flight with its

aim of this ultimate security, these patients also

experience in analysis terrifying anxiety at the

loss of their self, a terror based on a fear of total

isolation, in which state there is nobody to hold

the self together. He thus adds force to Fairbairn’s

view that relations with internal objects constitute

a desperately needed world in which these are

figures to relate to, even though they are not

external ones. Guntrip gives clinical material to

support his view that not only the neuroses but

manic-depressive states as well have a primarily

defensive function against this basic terror—a

desperate attempt through compulsively active

internal object relations to keep the self in being.

Helping the patient to cope with this anxiety

becomes for Guntrip the ultimate
psychotherapeutic problem; and the intense

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anxieties and resistances surrounding it explain

the extremely difficult task that psychotherapy

can encounter.

In consolidating his views on these primal

experiences, Guntrip makes increasing use of

Winnicott, with whom he had a period of

analysis, which he has described (1975). He

brings Winnicott’s concepts of the origin of the

self into a comprehensive outline of the

development of the self from its beginnings with

being and doing up to maturity. His scheme gave

him a strong sense of a comprehensive

psychodynamic image of man, one that illumines

his anxieties and fears as the origins of his
manifold evasions in regard to self-knowledge.

This scheme also conveyed to him a confidence

about the scientific status of psychodynamic

knowledge, and his paper on this subject (1978)

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is of particular value to the analyst today when

there is not only the challenge to this status but

the danger of the right to pursue our research

tasks being denied.

Fairbairn’s, and much more Guntrip’s,

accounts of development and its pathology have

been thought to have dispensed too drastically

with instincts. It is rather, however, that they do

not see instincts as the basic determinants of

structure in the self. Structures derive from the

quality of the relationship experience, and

instinctual activity is merely one mode of the

activity of structures. Given distortion of the

structures, then pathological expression of
instinctual activity occurs. Their position in this

respect is akin to that of roles for those

sociologists who stress these as the structural

elements in the person. Roles are universally

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prescribed, but each individual fills them in a
manner determined by his self, in other words, by

the way that structures created out of very early

experience function.

What emerges, then, as common to this

group? In the first place, they all derived their

theories from long and testing work with very

difficult patients — patients of the kind whose

analyses so often end in stalemate or worse. In

recent years there have been many critiques of

theory and many contributions to its

advancement. Some of these have been the work

of analysts who have devoted a substantial part of

their time to academic study. These critiques and

contributions are valuable and always needed.
Our four theorists, however, all remained deeply

rooted in clinical work. What their theories may

lack in academic precision has thus to be

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balanced against the importance of the data they
have exposed and the questions these have raised.

Their immersion in clinical work helps to explain

another aspect of their approach: they all placed

the therapeutic task as paramount. They refused

to adhere rigidly to the method when they felt

that this might lose the patient. Any parameters

introduced were not such as would preclude

further understanding. To many, their work would

be described as analytical psychotherapy rather

than analysis —an issue which, as recent

discussions have shown (see Wallerstein, 1969,

1975), may well prove to be a relatively

unimportant one if our goal is deeper
understanding. Analytical psychotherapy does

not necessarily mean the unconscious is no

longer being explored.

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Balint’s description of the basic fault
highlighted a critical developmental phase. From

the way patients related to him while they

struggled with this state, he concluded that it

reflected a failure in the earliest mothering, one in

which there had not been adequate input of what

can appropriately be described as love, that is,

interest, affection, and enjoyment at the

“personal” level. Physical care can be of a high

order, instinctual gratification can be experienced,

but without this holistic response from the mother

the infant does not prosper. Indeed, as the studies

of Spitz, Mahler, Bowlby, and many others have

demonstrated, without this maternal love, future

development is greatly endangered. Balint,

however, while giving us clinical data on the

existence of the phase and how it manifested

itself plus its damaging ramifications, did not take

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its conceptualization further nor did he suggest
how it linked with future conflict.

Fairbairn also concluded that the seeds of all

future psychopathology were sown in this early

failure in the mother-baby relationship. He then

followed up with a theoretical outline of the

subsequent differentiation of dynamic structures

within the primary self system and so related later

psychopathology to the early phase with a unified

framework. His multiplicity of subselves has

been criticized, yet the criticisms often appear as

resistance to their challenge to traditional theory

rather than founded on a careful appraisal of their

nature and of the phenomena for whose

explanation they were evolved. Here it is

noteworthy that Kernberg, who has devoted so

much study to patients with marked splits in their

personalities, found Fairbairn’s approach of

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considerable value in ordering the manifestations
of borderline patients. Fairbairn did not have

Hartmann’s work available when he produced his

theories, and it is striking that two such different

endeavors were proceeding almost

simultaneously with the common feature of

dealing with the inadequacy of the concept of the

id as Freud left it. Hartmann retained the notion

of energies without structure, a quite untenable

concept for Fairbairn and, moreover, one which

hampered psychoanalytic development. General

systems theory, as it later developed in modern

biology, was of course unknown to Fairbairn,
though he was familiar with some of its

precursors, for example, gestalt psychology.

Fairbairn’s structures as he described them in his

theory of the basic endopsychic situation

represent end products. Thus, when he relates the

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different neuroses to the different patterns of
relationships with the internal objects, his

references to the latter, for example, as the

accepted or rejecting objects, imply the form

taken by these objects as they occur nearest to the

central self or ego. The complex layering and

fusion of the different stages of experience that

have produced their final form constitute much of

the analyst’s task. This endopsychic picture of the

self as an overall matrix in which there are these

internal “dramatis personae” is a conception that

is sometimes thought to be anthropomorphic and

so to take analytic theory out of the natural

sciences. Guntrip has dealt with that issue, and

we can note that one gain of abandoning

scientific reductionism and placing conflict on the

personal level is that the mutual understanding of

the writer and psychoanalyst is greatly facilitated.

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Whereas Winnicott stressed the importance of
creativity as bridging the individual to his object

relationships, Fairbairn can be said to describe

the specific structures this creativity is driven to

make according to the particular relationships the

individual is situated in.

Taking Winnicott and Fairbairn together, it

would appear that the next step they implicitly

point to is the study of the self, the

conceptualization of its origin and development

—a topic that has become central and

controversial for psychoanalysis. When Erikson

began to discuss the meaning of identity, it was

sometimes thought he was leaving the field of

psychoanalysis. Why the center of the person

should have been so long in becoming the center

of our theoretical concern is itself a fascinating

question. Lichtenstein (1977), Weisman (1965),

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and many others have remarked on the barriers

that our Cartesian inheritance has created for us,

and even today the self is commonly taken to be

too vague a concept to be a profitable line of

research. A major difficulty in the past was how

this subjective matrix could be linked to its brain;

and energy ideas, however metaphorical they

were claimed to be, have had an insidiously

persistent habit of intruding in a reified way into

our thinking. Analysts have tended to lag behind

in the assimilation of new developments,

although Bowlby (1973), Peterfreund (1971), and

Rosenblatt and Thickstun (1977) have made

efforts to reformulate theory. Insofar as their

work has gone, however, we do not yet have the

theoretical basis for the integrative organizing

center, thus raising the question whether we shall

merely get a kind of psychoanalytic behaviorism.

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Ernest Jones in his brief foreword to

Fairbairn’s (1954b) book showed his

characteristic percipience into the vital issue by

noting that Fairbairn started at the center of the

personality and described its strivings and

difficulties in its endeavor to reach an object

where it may find support —in contrast to Freud

who began with the stimulation of the nervous

system and proceeded from the erogenous zones

and internal tension from genetic activity. As

Jones concluded, “This constitutes a fresh

approach in psychoanalysis which should lead to

much fruitful discussion” (p. v).

The study of biological systems tells us that

development occurs by differentiation and every
system has to have an organizing principle in

order to keep emerging subsystems in the

required relation with each other and with the

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whole. And with biological systems we have to

include the environment as integral to the system.

As Winnicott remarked many years ago, there is

no such thing as a baby —there are only babies

with mothers (1960, p. 39n).

Development in an adaptive learning system

is inevitably morphogenic, that is, new structures

have to embody new adaptive capacities (see

Buckley, 1967). Without a structural basis it is

difficult to understand how these changes are

made. Thus Jacobson (1964), who gives an

excellent account of the later development of the

self and its object relations, nevertheless explains

the earliest developments in terms of energic
changes. But statements, for example, about

libido or aggression being turned from object to

self are meaningless without some notion of what

does the turning. Perhaps Jacobson’s reluctance

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to structure experience of object relations from
the start is reinforced by her view that threats to

identity are not predominant in the neuroses, a

view that is not shared by our theorists nor, I

believe, would it be by a growing number of

analysts. Angyal (1965) was one of the first

psychotherapists to give a conception of personal

development based on the systematic
organization of experience. For him the autonomy

of the individual, a powerful inherent impetus

from the start, relates to this central organizing

principle, while the constant necessity for the

interaction with the social environment, if the
organism is to survive, he termed its homonomy.

No consideration of the person made sense

without these two being taken together; no

autonomy is possible without homonomy. It is the

organizing principle, however, we want to know

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more about. We have learned a great deal about
the mature organism, and, as Angyal says, we

have to know its structure before we can

understand the embryo.

Mischel (1977) comments that the task of

understanding what it is for a person to be an

agent is a conceptual rather than empirical one. I

doubt if we can make this separation, though

there is clearly a formidable conceptual task. We

know the stimulus-response views of the

behaviorist cannot do justice to the way the

person is activated by his own meanings,

purposes, and goals. It is the latter that play the

main part in determining what makes a stimulus,

and they are developed as the person internalizes

a map or model of his environment. What
Fairbairn’s endopsychic situation tries to do is to

represent this environment as it is structured

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internally by the subject. Psychoanalysis has
gathered an enormous amount of knowledge on

how this inner world gets built up, but what was

missing was a more holistic dimension. Fairbairn

suggests how this inner world is created to make

good the deficiencies of the outer one, while

Guntrip has taken this further in his view of the

ultimate analytic problem as the nature of the

unbearable threat to his existence when the

person cannot achieve enough homonomy,

enough psychic metabolism with his social

environment. In connection with this theme,

Guntrip (1969) makes the intriguing suggestion
that mankind has clung to the belief in a

frighteningly powerful impersonal nature within

us, the death instinct, for example, or at least an

aggressive energy, because of the fear of facing

up to the feelings of intolerable helplessness and

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weakness that characterize the infant, especially
in an experience of deprivation.

To imagine an organizing principle at work in

the self does not necessarily take us into innate

forms or Aristotelian entelechies. What our

theorists have brought out is that while the future

growth of the person, his creativity, his use of

particular talents, and so forth, entail

unpredictable emergents from the experiences

and opportunities he meets, nevertheless, the

potential for this growth is not created without a

“personalized” input. The infant at the start

presumably fashions from the good enough input

an affective field that predisposes it to pursue

with interest and enthusiasm its exploration of the

world. This is what Winnicott (1971) seems to be

saying with his concept of the female element.

Yet, however ill-defined the content of this

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central experience is, it seems to have a quality
that we can appropriately describe as a beginning

toward being personified. One recalls here

Sullivan’s (1953) personification of the self

system, and there sure clearly affinities. The full

nature of the dynamic properties of the system,

however, are missing from Sullivan’s account,

especially as the development of the self-object

awareness proceeds, for it is at this stage that, all

our theorists agree, the roots of intensely

aggressive and violent feelings are laid down.

It is when the self system becomes patterned

by its dominant relationship modes that the term

identity comes to the fore. Lichtenstein (1977)

suggests that an identity theme gets imprinted on

the self at this stage, a pattern determined largely

by the unconscious wishes the mother has for her

infant’s future, and that this remains as a virtually

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unchangeable template, an invariant for future
development, though naturally the particular

clothing put onto the skeletal pattern will vary

with experience. But whether Lichtenstein’s view

of the virtual irreversibility of this pattern is akin

to imprinting is probably an open question.

Fairbairn’s view, and this would be reinforced by

Guntrip’s conceptions, would be that a pattern for

the self would be carried by the internal object

structures and, though the task of change can be

formidable, it may not be irreversible as our

knowledge is enlarged. As in most fields of

knowledge, a certain stage is reached when new

concepts are proposed. The problem of the self

has become emergent and already many

responses have been appearing independently,

with Kohut’s (1971, 1977) work perhaps best

known.

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Our four theorists have found, as analysts
have done under the stimulus of Freud’s work,

that developments in our theoretical

understanding must inevitably be reflected in

technique. For all, the parallel between

therapeutic requirements and the needs of the

infant in its relationship with its mother was more

and more forced upon their attention. The gap

between theory and practice may well underlie

some of our therapeutic limitations and failures,

and especially our diagnostic appraisals.

The position of the self for Hartmann and ego

psychology has been rather in the background,

with the ego given all the prominence, albeit

restricted to an impersonal group of functions.

Nevertheless, if we take the important
consideration of who or what is the agent in our

actions, the self appears as the most likely

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candidate. Chein (1972) in a careful discussion of
this issue considers the claims of Freud’s three

structural entities along with the self and the

body. The essential psychological human quality

for him is “the commitment to a developing and

continuing set of unending, interacting,

interdependent and mutually modifying long-

range enterprises” (p. 289). In such a

commitment, all the entities constitute one

system, “the person,” and so he takes the person

to be the actor or active agent at the personal

level (compare also Schafer, 1968). Although he

chooses the person rather than the self, his

decision appears to be based upon his difficulty in

envisaging a structural basis for the self. In the

ordinary way we use the self it would seem to
cover just that overall integrated system he takes

as the person — and certainly it is this integrate

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that our object-relations theorists are speaking
about and for which they all envisage or imply a

dynamic structure. As a supraordinate structure

(Saperstein and Gaines, 1973) of great flexibility

and perhaps in the nature of a “field force,” its

primary function is to contain and organize

motives from all the subsystems that have

differentiated from it. The higher-level

organizations we might call the subegos and their

related internal objects all fall within its

influence.

The ego or centred self is that part of the total

system that is most related to realistic action, that

is, to the recognition of others as independent
persons with their own characteristics. The course

of ordinary development is such that this system

has a high overlap with the supraordinate one.

The value of the self conceptualized as the

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overall dynamic structural matrix is that we can
give underpinning to the personal level of action

as “I” and yet allow for the self to be dominated

at different times and in different situations by

any of its subsystems, such as the superego.

What all of our theorists have come to is the

view that the innate developmental potential has

to be activated by an input of loving empathic

care from the mother for it to become the

proactive matrix with the positive enjoyment that

developmental activity requires. To be able to

love and enjoy, the baby has to be loved and

enjoyed. It is as if a “positive field of force” is
patterned as the core of the self system by the

effects of the positive self feeling at one pole and

the expectation from a supporting figure at the

other, at first external, then internalized. The

environment continues to add to the structural

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differentiations, and a degree of correction of
early deficiency may be attained. But as Bowlby

mentions (1973, p, 336), drawing upon the

biologist Waddington who introduced the theory

of epigenesis, there is a general organismic

tendency for the individual to maintain whatever

developmental pathway he is already on, partly

because the internal structural features influence

the selection of the environment and partly

because the environment, especially within the

family, also tends to remain unchanged.

SUMMARY

What I believe to be the essential contribution

of this group of analysts may be summarized as

follows. The role of object relations has always

been a prominent theme in analytic thought and

has become much more so in recent years.

Instead of grafting the implications of relations

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onto a theory that started from a different

standpoint, what the British group has done is to

show that the development of the person has to

be conceived as the progressive differentiation of

a structure from a unitary matrix that itself

interacts at a holistic personal level from the start.

While Balint noted clinical data that required this

step, he did not put forward a theoretical scheme.

Winnicott, who suggested more specifically how

the infant’s relationships at the earliest stages

patterned its whole subsequent personal

development, also refrained from following

through the theoretical logic of his observations.

Fairbairn was the first analyst to expose the

questionable logic of a developmental scheme

based upon the energic concepts that Freud

retained as his theoretical base. Fairbairn’s

scheme, however, did not account adequately for

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the earliest developmental stages as these were

inferred from the study of regressive states.

Guntrip, making full use of Winnicott’s views,

has sought to make good this limitation.

The British group does not presume to have

made anything like an adequate conceptual map

for the development of the psyche. The

theoretical problems are far too complex for that.

They have, however, shown a fruitful direction

and have influenced many areas of contemporary

psychoanalytic thought.

Note
[←1] Although Bowlby’s work makes him a major contributor to
object-relations theory in the British scene, his position in
relation to the present group will not be definable until the
completion of his current task. What he has published so far
(1969, 1973) gives considerable support to the general line
of the present group, especially to Fairbairn’s views.

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3.

WINNICOTT*

The British object relations theorists Balint,

Winnicott, Fairbairn, and Guntrip were all

concerned with identifying and understanding a

primary developmental failure in the central

organizing capacity of the person —that is, in the

ego. (Winnicott in his early writings used the

terms ego and self interchangeably.) Patients
described this developmental failure as

something lacking rather than as conflict, and it

emerged only after a good deal of ordinary

analytic work had been done with oedipal and

sadistic themes. Balint adopted the term the basic

fault, Fairbairn and Guntrip the schizoid split, and

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Winnicott the true and false self split for this
stage. All concluded that when the nature of the

developmental failure had emerged, the important

therapeutic work relied far less on interpretation

than the creation of a relationship in which the

analyst could be sensed as concerned with and

responsive to a need that could only be described

in holistic terms, such as being recognized as a

person, or liberating his true self. This need was

not the seeking of instinctual gratification. On the

contrary, there was frequently a negative attitude

to such thoughts. It was a powerful need to feel at

one with an inner person who was not the

constricted person they had been.

Winnicott’s terms, in contrast to those of the

other object-relations theorists, have become a

part of our everyday analytic vocabulary — such
concepts as the transitional object, and the true

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and false self. However, it is doubtful that his
work has had as much impact on analytic theory

and practice. One speculation is that this is partly

because his idiosyncratic approach made him

something of a psychoanalytic maverick, and his

almost playful quality of thought resulted in

many inconsistent views being expressed with the

fuller implications being passed lightly by.

WINNICOTT’S FRAMEWORK AND SOME OF

HIS TERMS

Winnicott believed that the most difficult

behavior, and even illness, in the quite young

baby was rooted in what was happening in the

mother-infant relationship. The ongoing mother-
infant interaction established a central

organization that governed the well-being of the

infant’s growth in a profound way. When he

listened to what was supposed to be going on in

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the baby, talked about as an entity, he protested
on more than one occasion that there is no such

thing as a baby —there are only babies with

mothers! In this respect he was very much a

modern biological systems theorist.

On review, we note there is often confusion in

reviewing Winnicott’s writings (which were

spread out over 40 years) about the various ways

he designated his central concern. He variously

referred to the development of the ego, the

psyche, the psyche-soma, the self, the true self.

At times the initial self and true self are

synonymous, though in most of his writings the

true self is that part of the self that has not

become the false self.

Though Winnicott uses the ego and self as

interchangeable in his earliest writings, self is

preferable since he means the full developmental

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potential of the infant to become a person.
Winnicott (1960a) commented that if he were to

relate his concepts to classical theory, he would

have to say that the true self was close to the id

since it comes from “the aliveness of the body

tissues and the working of body functions” and

from the infant’s “spontaneous gesture” (p. 148).

However, since the true self rapidly acquires

integration, personalization, and an embryonic

reality sense, this would place it more in the ego

category; and on this basis Winnicott may be

classified an ego psychologist who does not

really differentiate ego and id at the start.

Winnicott used the term integration to refer to

the gradual merging of separate existences into a

continuity of being, and to locating the self in the
body. Its opposite is not disintegration but

unintegration which he seems to have adopted

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from Glover’s ego nuclei. Disintegration refers to

a pathological state arising subsequent to a degree

of integrative development.

EGO RELATEDNESS

In pursuing the concept of ego relatedness,

Winnicott insisted on the need to see the infant-

mother as the essential system. He describes the

infant’s innate potential as including two main

divisions — “the instincts” and the rest. The

instincts are the appetitive ones, hunger and sex.

Apart from these he refers to ego needs, that is,

responses that are required from the mother for

an adequate development of a joyous sense of

being and for security and confidence toward the

social and physical environment. He expressly
states that basic ego security does not rest upon

instinctual satisfaction, but rather upon the

integration and growth of the ego to its full

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potential. This depends on the appropriate
responses from the mother to the spontaneous

actions of the infant that are in a broad sense

“instinctive” (those associated with hunger and

love). After six months of such good maternal

interaction, the baby becomes “personalized” (a

term Winnicott drops in his later writings).

Winnicott believed, as does Bowlby, that the

core of the development of the self does not rest

on the feeding relationship having a uniquely

important role. The instinctual satisfactions have

to be experienced within a self that can

experience them as part of itself in action,

otherwise they can be used for the development

of satisfactions split off from the central

developing core. The assimilation into the self of
experiences of good mothering give a start to a

secure kind of independence which Winnicott

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suggests can be seen in the capacity to be alone.
This is not related to the internalization of good

figures in later experience.

Winnicott was preoccupied with what the

baby’s experiences were and how they were

organized. His speculations were based on the

analysis of a number of borderline and seriously

disturbed children and adults as well as on his

pediatric experience. He observed that

psychoanalysis had little to offer for a theory of

positive personal health. Winnicott believed that

the mother’s ordinary spontaneous empathic

response to the infant’s gestures established a

basis for a secure independent personalized

individuality. The state of absolute dependence

was one of primary identification of mother and
infant. The move to independence implied that

the earlier state, in which the object is a

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subjective one, must be replaced by the objective
perception of the object as external. Here we are

perhaps involved in the most difficult of all our

conceptual tasks, but Winnicott was convinced it

had to be tackled.

Winnicott began with Freud’s concept of the

hallucinated breast, the essential event being the

meeting of the infant and mother in a shared

experience. He assumed that for the infant the

experience was a moment of illusion which could

be either of his hallucination of the breast or of a
thing belonging to external reality. Winnicott was

fascinated by illusion, and he felt it was at the

root of all self development. Good mothering

meant the essential opportunity for this

experience by which the baby could feel that it
had created its own personal environment. Thus

the most real contact with reality began on the

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basis of this illusion. Yet, paradoxically, it was
the security engendered in this experience that

enabled the child to proceed with disillusionment,

as in weaning. What could be described as

omnipotent or magical control could be given up

by an infant whose confidence in the external

world had been maintained so that he could go on

discovering its riches without any loss of the

sense of self. It was from this experience of

illusion that the transitional object could be

created and later art, religion, and culture.

TRUE AND FALSE SELF

Winnicott worked with the notion of the false

self before he turned his attention to the true self.

It stemmed from some of his patients’ describing

a major life-long inner state of always feeling a

kind of false existence. The false self originates

not as a defense against instinctual impulses, but

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as a response to the mother not meeting the needs
of the innate developmental potential of the self

or ego and therefore not allowing them to have

their spontaneous omnipotent expression. The

true self is the living reality that grows with the

mother’s success. The inner activity “joins the

infant to the object” (1960a, p. 146). With the

failure of the mother’s adaptation, the disjunction

between the inner and the outer shows itself in

functional disturbances such as general irritability

in the infant. A seduction of the infant then takes

place with the development of a compliant false

self which accepts the environmental demands.
This process can make an impression of

“success” in that the child grows up to be good,

“just like mother,” and so forth. Imitation rather

than real growth becomes permanent. The false

self acquires one of its main functions — to

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conceal and protect the true self. Later it becomes

enmeshed with defenses against internal objects

and many find ways of allowing the true self to

find expression in psychopathology.

Winnicott’s idea that the false self served a

defensive protective function against

impingement on the true self led him to the idea

that the true self has a powerful need to preserve

an inviolacy, to remain perpetually

“incommunicado.” Since the growth of the true

self is founded on the relationship with the

mother this would seem to be an inconsistency.

Winnicott explains the retreat of the true self into

isolation as reactive to intrusive impingement of

the mother and reflective of the need to survive.
He also emphasizes that though the healthy self

seeks and enjoys communicating there is in

everyone an intense need to be secretly isolated

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that is so intense that violation of this core is the

ultimate terror. At the same time the universal

dilemma is how to preserve this isolation without

insulation. He also suggested that there is

communication between the true self and

subjective objects that is felt as real because it is

from the true self. He thus indicated that in

healthy development there is a split between the

part of the self that does this silent

communicating and the part that relates to the

objective world.

TRANSITIONAL OBJECT, CREATIVE

IMAGINATION, AND OBJECT RELATIONS

The theoretical importance of Winnicott’s

transitional object lies in its representing the

creation of something from the unique processes

underlying the human imagination. It is the

prototype of all art and culture. Three lines of

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thought developed from this concept: (1) the role

of creative imagination in the establishment of

the self; (2) the way in which mature object

relations develop; (3) application of this concept

to some of the puzzling phenomena of

transference.

Winnicott was interested in understanding

more of the process of experiencing through

which every individual separates, yet keeps a

close relation between inner and outer reality.

Omnipotent control over the transitional object is

gradually abandoned and the transitional object

just fades away. Control through omnipotence is

replaced by control through manipulation. Here
we have the use of the illusory object being

transferred to the objective object. This bridging

is only possible through the continuity of

maternal care.

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Winnicott saw play as a basic source of
development. Play within the mother-child

relationship leads to the subjective object being

repudiated and then being reaccepted and

gradually perceived objectively. It is exciting not

because the instincts are involved, but because of

the precarious interplay between the omnipotent

psychic reality and the experience of control of

actual objects. If instinctual excitement becomes

too great, play can become frightening because it

can no longer contain its own experience. For this

reason, the presence of adults is necessary when

young children are playing.

The natural developmental function of

playing also enables us to see how therapeutic

work at times can go ahead without any
interpretative work. Psychotherapy is indeed for

Winnicott two people “playing” together and

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when this is not possible it is the therapist’s task
to enable the patient to “play” —to associate

freely. Indeed, Winnicott makes a plea for a much

greater withholding of interpretations in order to

allow the patient to develop his capacity to play

— to do creative analytic work.

Winnicott viewed creativity as the universal

process underlying everyone’s approach to

external reality as distinguished from the

commonly associated idea of producing works of

art. However deeply hidden it may be, there

cannot be a destruction of anyone’s creativity.

Here again, he believed that the capacity for

creativity and being an individual were both

ultimately related to the quality of the mother-

child relationship.

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MALE AND FEMALE ELEMENTS AND THE
USE OF AN OBJECT

Winnicott described a middle-aged man he

treated who impressed him as talking like a girl

describing penis envy. Winnicott believed that

this had nothing to do with homosexuality.

Exploration led to the conclusion that as a baby

the patient was seen as a girl by his mother. This

understanding was followed by the patient

developing an infection which Winnicott took to

be the “girl’s” resistance to releasing the man,

that is, the intense defensive protection of the true

self. He pointed out that it was this split-off

female element that established primary unity

with him and so gave the patient a new start in

living.

Speculating about the male and female

elements in regard to object relating, he suggested

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that the female element relates to the subjective
object, to the baby becoming the breast —a

process he again emphasizes is not determined by

instinctual drives. This relating arises entirely

from primary identification and is the foundation

of the sense of being. The male element, which

occurs later, introduces an object relating or

doing based on growing feelings of separateness

accompanied by id satisfaction and anger from

frustration. To summarize Winnicott’s views

about object relating and female and male

elements, he believed that object relating in its

first stages (female element) had nothing to do
with instinctual drives. The classical libidinal

stages all belong to the later stages of the male

element.

From this position Winnicott made his final

statement about object relating. He believed that

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object relating developed from a stage of
experiencing the object as a vehicle for the

subject’s projections to a stage in which the

object is “used.” In order to be used the object

has to belong to a shared reality and be a thing in

itself. “Used” is the opposite of exploitation. The

capacity to use objects is not inborn but only

develops within a facilitating environment. This

change whereby the object is placed beyond the

subject’s omnipotent control implies, according

to Winnicott, the destruction of the object

followed by its survival and, importantly, survival

means not retaliating. It is as if the subject says,

with the experience of disappearance and

reappearance, “I destroyed you; I love you, and

you have value for me because you have survived

my destruction of you.” This position can only be

reached through the repeated experience of the

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object becoming real through being destroyed.
Thus though we have traditionally conceived of

the reality principle as involving anger and

reactive destruction, for Winnicott it is the

destruction that places the object outside the self,

that is, makes reality. The subject, in other words,

finds externality through the destructive drive.

The therapeutic implication is that changes in

this basic attitude to reality in borderline patients

arise from the analyst’s nonretaliatory survival of

attacks, and from the survival of the analytic

situation which operates like the mother’s

primary holding. The analyst is thus experienced

as separate and outside the patient’s omnipotent

control. His survival of this destructive

externalization enables the patient to “use” him.
In the sequence that Winnicott is describing, there

is no anger but rather joy at the survival of the

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object. The patient’s dependence and
destructiveness during these phases can be

extremely testing for the analyst, and it is of great

importance that he should not hand the care of the

patient over to others at this stage if it can

possibly be avoided. Winnicott here again

stresses that the significant mechanisms for object

relating are not drive determined.

CONCLUDING SUMMARY

Dr. Sutherland concluded by summarizing

Winnicott’s contributions as follows:

1. He conceived of the self or ego as a highly

dynamic structure with its own needs. It is
not an impersonal structure that can be
defined as Hartmann suggested by its
functions, but is a highly personalized self.

2. The development and personalization of the

ego from absolute dependence to a growing
independence with a secure capacity to relate

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to both subjective and objective objects is
entirely a product of the shared experience of
the mother and infant. Its effective autonomy
is greatly reinforced by instinctual
satisfaction but does not rest primarily on it.

3. The successful realization of full

developmental potential leads to the
establishment of a true self.

4. Without this fit between the infant’s needs and

maternal input a false self develops through
which the individual seeks to comply with
the needs the mother has imposed on him.
Once this split is established, the false self
adopts an intensely defensive function
against the exposure of the true self, and
often much analytic work is required to make
therapeutic contact with the true self.

5. Many analyses become interminable because

of the failure to get to the primary level of
trauma which involves identifying the true
and false selves. Winnicott did not advocate
new therapeutic techniques, but relied on the
analyst being guided by his increased

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understanding of these early developmental
phases.

6. There are close links between his work and

that of Balint, Fairbairn, and Guntrip.

7. Winnicott tried to understand the nature and

origins of the unique creativity of the human
mind. Instead of a reductionist stimulus-
response psychology proposed by
behaviorists, he put the human problem
nearer the real situation, that is, he reversed
the behaviorist approach by attempting to
understand what responses create our most
significant stimuli.

DR. EUGENE MAHON’S DISCUSSION

Dr. Mahon focused on (1) the “early” as

opposed to the “deep” in Winnicott’s

contributions; and (2) the technical modifications

in classical psychoanalytic techniques warranted

by Winnicott’s work.

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He cited Winnicott to clarify the distinction
between early and deep: Deep implies

“unconscious fantasy or psychic reality; the

patient’s mind and imagination are involved”;

“deeper and deeper takes us to the instinctual

roots of the individual, but this gives no

indication of early dependence and dependence

which has left no trace on the individual,

although these characterize early life”; a human

infant must travel some distance from early in

order to have the maturity to be deep; depth

implies conflict, structures, telescoping of

memory, and so forth, that the concept of early

could never contain— for obvious reasons.
Winnicott argues that the early etiological trauma

of borderline patients “goes back behind the

Oedipus complex and involves a distortion at the

time of absolute dependence.” He emphasizes

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influences on the ego that are not instinctual,
downplaying id instinct theory and emphasizing

ego needs in his definition of early.

Winnicott suggests that “the early” is reached

in analysis not by lifting repression but by

creating a new setting in which the trauma can be

experienced as a projection and interpreted. Dr.

Mahon expressed the view that alongside this

interpretative approach Winnicott seemed also to

be advocating a corrective object-relationship

approach. To support this view he cited

Winnicott’s asserting that after years on the run

the true self settles on the couch. Its appearance is

perhaps manifested by silence or a gesture. To

interpret this as resistance of the false self to

continuous revelations would be a reenactment of
environmental trauma. However, to recognize it

as the first stirrings of spontaneity and aliveness

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of the true self promotes individuation and
development. Mahon seems to be saying that

Winnicott’s advocacy of recognition without

interpretation is an example of a corrective

object-relationship approach. As an additional

support for the view that Winnicott advocated a

corrective object-relations approach, he pointed

out that Winnicott made abundantly clear that the

analyst must fail in his holding capacity, and

believed that it was the genuine expression of

anger by the patient to these failures that made a

fake analysis real.

Dr. Mahon went on to cite other authors, who

disagree with Sutherland’s and Winnicott’s views

that no deviation from classical psychoanalytic

technique is required in the treatment of

borderline patients. He believes that this issue is

at the heart of current psychoanalytic controversy.

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He cited Cooper, who believes that two different
theories of psychoanalytic treatment are required

to adequately contain all data; Greenacre, who

feels that residues of preanxiety remain even after

being understood in analysis, though they are

tolerated better; Kernberg, who believes that

many borderline patients require a modification

of technique; and Freud, who in Analysis

Terminable and Interminable implied that early

contributions of constitution, instinct, and trauma

are well nigh impossible to correct through

analysis though he agreed with Winnicott that of

these factors the contribution of trauma to early

ego formation had perhaps the best prognosis.

Mahon went on to point out that there is also

a great deal of disagreement among

psychoanalysts about the related issue of how

much of the early can be recaptured in the

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transference and analyzed. Winnicott can be

criticized for overemphasizing the central role of

early object relations to the neglect of drive

theory. He tempered this criticism by pointing out

that Winnicott often asserted that since

acceptance of Freudian drive theory is so firmly

established in our analytic identities we can

therefore purposely omit it in order to focus on a

more object-relations way of describing the

phenomena of infancy and dependence. Mahon

concluded by agreeing with Sutherland that at

times a genius may seem to neglect a certain

essential proposition in order to better explicate

others.

Note
[←*] Discussant: Eugene Mahon, M.D. Reporter of this talk by
Dr. Sutherland: Marvin Wasserman, M.D.

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4.

FAIRBAIRN’S CONTRIBUTION

THE SIGNIFICANCE OF FAIRBAIRN’S

CONTRIBUTION

Fairbairn played such a prominent part in my

life that any judgments I may make about the

significance of his work for the development of

psychoanalysis may be unduly influenced by this

personal factor. I should like to emphasize,

however, that Fairbairn was not by nature a
zealous proselytiser. His appeal to me rested from

the start upon his integrity as a good human being

who never lost the primacy of his interest in the

well-being of people and this concern was never

separated from his thinking about the nature and

origin of psychological distress and how it might

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be alleviated. He communicated these interests
readily yet his enjoyment in sharing his ideas was

always expressed in open dialogue. In his

writings he habitually gives his reasons for

suggesting amendments to the views of others.

Indeed it is this characteristic of respecting the

other person that almost certainly played a

fundamental part in shaping his thought around

the person in contrast with Freud whose

preoccupations became dominated by the

impersonal forces of nature. Noteworthy in this

connection, too, is his choice as the title for his

book: Psychoanalytic Studies of the Personality.

It was this open- minded attitude toward the

understanding of the person that also attracted

Guntrip who fashioned his own thinking from the

stimulus of Fairbairn’s views.

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Fairbairn’s academic training in philosophy
naturally added to his ability to examine critically

the principles upon which conceptual schemes

were based. For him, if these were unsound then

the theoretical structures erected upon them not

only became progressively divorced from clinical

findings, but they inhibited the expansion of the

latter by the constraints they imposed upon the

analyst. In its early history, challenges to his

theoretical principles led Freud to exclude the

prominent dissidents from the psychoanalytic

movement. These challenges, however, were

accompanied by clinical work that abandoned

what Freud deemed to be the essential core of

psychoanalysis: “Any line of investigation which

recognizes these two facts [of transference and

resistance] and takes them as the starting-point of

its work has a right to call itself psycho-analysis,

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even though it arrives at results other than my
own” (1914, p. 16). Proceeding from his own

metapsychological principles, Freud formulated

his structural theory of the personality which

brought a period of outstandingly productive

cohesion. As in all scientific work, developments

inevitably exposed limitations, mainly in the

understanding of the ego. Anna Freud (1946),

then Hartmann (1958) along with his colleagues

in a surge of fresh thinking filled out a

conspicuous gap in the structural theory with

their creation of ego psychology. Preserving

much of Freud’s metapsychology, this line of

thought was widely adopted as part of a
mainstream development. A different fate befell

the work of Klein despite her repeated emphasis

that it too was evolved directly from Freud’s

theory of the death instinct. Her findings proved

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so disturbing that there were early reactions to
them as not falling within the scope of

psychoanalysis. Thus the suspicion arose at times

that inclusion within the analytic fold was to be

determined by theoretical conformity to Freud

rather than by the careful appraisal of new data,

even though the method of gaining these was the

psychoanalytic one.

The impact of Fairbairn’s papers, published

during and immediately after the Second World

War, was minimal and this disregard has

continued increasingly in the United Kingdom,

though progressively less so in the United States.

It is particularly striking in that it was he who

introduced the term object relations theory to

describe views that challenged Freud’s basic
principles. Moreover, it was soon afterwards used

widely to cover the work of Balint, Winnicott,

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and Klein since she too stressed her work as

coming within this category. Many factors

contributed to this neglect which, I hope to show,

has been a serious loss in the development of

psychoanalysis.

It was on the self and its vicissitudes that

Fairbairn built his general theory of the person.

His first observation, that the baby has to be

loved for itself, implies an innately structured
potential which has to be personified by parental

figures responding lovingly to the infant as a

person. To do this in a way that matches the
innate needs, the mother and father have

themselves to be good prototypes as persons.

Although the breast gives an especially vivid

experience, he rejects the atomistic approach of

building the whole from parts. Instead, he asserts

the baby’s innate sense of the wholeness of the

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mother and her subjective state from the start;
and research studies confirm this view. The

feeding of itself does not lead to a thriving infant.

Thenceforward, the self via its component

instincts builds up a multiplicity of substructures

all of which are fitted into what strives to be the

coherent whole. It would seem that the innate

whole exercises its influence through its affective

state. When the environment is deficient, then the

resultant state evokes responses whose function is

to remedy these. When things go well a

personalised self is recognisable from a few

months old by observers. The inevitable

comment from persons with serious personality

problems is that “I never felt I was allowed to be

myself.”

A first point is the commonly raised issue of

the separateness of the infant self from the

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mother. The autonomy of the self has a powerful
dynamic from the start. Frustration of the bodily

needs produces manifestly aggressive protests.

What we have to recognise is that the same

response follows deprivation of relationship

needs. Lack of responsiveness from the mother,

even though she is present, is felt as rejection and

so at this stage frustration and deprivation are

synonymous. Even in the absence of frustration,

the infant is assertively its own self as is familiar

in the way the nursing couple adapts mutually.

The self’s autonomy requires a sense of its own

boundaries. The question of differentiation is, I

believe, confused with the constant closeness the

infant needs. Bowlby’s work (1969) has fully

established the need for an attachment to the

mother to be structured in the baby’s self; but

attachment is not fusion or merging. It gives the

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affective security in the self and the close
interactions necessary for personalisation. These

later needs may or may not be met by the

appropriate input from the parents.

The physical dependence of the infant on the

mother brings out the great paradox in the

development of the self. The autonomy of the

adult implies the opposite of separation from

persons. Indeed there is no stage when the self

does not need to be related to others for its

maintenance and effective functioning. The

autonomous self develops from what Fairbairn

describes as the state of infantile dependence to

that of adult dependence. As mentioned, there is

perpetual “autonomy within heteronomy.” The

adult self enjoys the autonomous feeling of being
one’s own agent with freedom of choice. But

freedom is within the organism’s limitations

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mentally as well as physically, and to be isolated
from others is not a choice for the normal adult.

Freud’s conception of the adult’s instincts in an

adversarial relationship with his society rests on

his inadequate view of the instincts. It can

happen, of course, that a particular culture

conflicts with them but he must be of the same

culture. As has been stressed, Fairbairn’s more

modern outlook deals with this by adopting the

concept of the instinctive potential having been

evolved to be a genic inheritance that can only be

realised in relatedness.

With this conception of the self as a

perpetually dynamic autonomous system needing

appropriate relationships, then, since deprivation

or prolonged frustration is a threat to its

autonomy, that is, to being alive, such a threat

instinctively arouses aggression to the point of

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violence, of a ferocity leading to murderous rage.
Freud’s death instinct thus becomes for Fairbairn

the fight of the self to survive. At this point it is

significant to recall that in the adult when the

attachment to the ideal object has matured to

include the ideals of the group, then attacks on

these are tantamount to threats of death. It is in

this connection that when Freud could not

account for the origin of such primitive rage, he

ascribed an elementary character to it in the

instincts of death.

In Fairbairn’s view, deprivation of mother’s

enjoyable responsiveness, her loving care, or
other frustrations, leads to a split in the self at a

very early stage. The pristine personality then

establishes an imago of this unsatisfying mother,

which is split into a desired, or exciting, imago

and a rejecting, or “bad”, object; but, in varying

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degrees, both are changed by phantasies. They

also form part of a relationship system within the

self. They can moreover be identified with the

self. Fairbairn takes the first splitting to be that of

the object while a second stage splits off the part

of the self related to the object. The splitting in

both stages is an active process mediated by

hostility from the central part of the self.

(Splitting and repression are used

interchangeably.) The object relationship that the

residual or central self must have is with the good

or acceptable aspects of the mother made into an

ideal object. These developments constitute a

basic endopsychic situation in which there is a

self containing the unmet urges for the satisfying

mother, needs that Fairbairn terms libidinal, and

attached to an imago that would meet these
needs, that is, a libidinal self seeking a desired or

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exciting object. Correspondingly there is an

antilibidinal self linked to the imago of a bad or

rejecting mother, and a central self with an ideal

object. The two split off subselves have the

dynamic properties of the original unified self

and so are constantly seeking satisfaction. They

retain in large measure intensity of pressure, that

is, the more pressing the needs of the libidinal

self, the more hostile is the antilibidinal self

response. The repressed systems, although barred

from consciousness, remain within the dynamic

self. Because they are excluded from the

transactions occurring in the central self, they do

not change in the way that the central self does.

The effects of deprivation of the needs of the

whole self are manifested by a progressive

withdrawal of investment in external objects and

a turning to satisfactions from the inner world,

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that is, the schizoid personality is created. This

does not necessarily interfere with an effective

though partial realisation of self potential by

building up special interests and competencies.

Such success, however, even when rewarded by a

great deal of recognition, often does not alter the

deeper emptiness arising from the lack of close

personal relations and detachment from people.

The inability to love because they feel unlovable

is at deeper levels a profound conviction causing

wide inhibition.

When activities do not meet the self needs

sufficiently, then Fairbairn made an important

distinction between depression and the feeling of
futility engendered. The futility is commonly

described as depression but it is important that

this affect be distinguished from melancholic

depression originating in guilt. Futility is the

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expression of a loss of trust in others, what in
more extreme degrees becomes the despairing cry

from the schizoid patient — “What’s the point?”

The turning to the inner world is also

accompanied by an increase of omnipotence,

though this may be covered over.

The less prominent, though equally

devastating, characteristic of the schizoid

personality is the hate engendered by the

frustration of the autonomy of the self, of its right

to have a reasonable security and self-confidence.

Fairbairn was criticised by Klein for not giving

due weight to hate although he makes quite clear
that he fully recognises its presence in his theory.
Klein’s view perhaps had some foundation in that

he did not bring out adequately in his earlier

papers its clinical significance or manifestations.

Fairbairn could not accept the death instinct,

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which Klein took to be an essential postulate. For
him, what was encountered clinically was

personal aggression and hate in response to

frustration or deprivation of the urge in the self to

secure autonomy. The situation was not one of

abstracted force, but of persons in an internecine

war. And with the frustration felt as a threat of

destruction of the self, so was the most violent

hatred often evoked. Its persistent presence,

moreover, did not require the postulation of the

impersonal biological death instinct to account

for it being manifest widely, for with the rejecting

object being built in, the rage was perpetually

activated. It was his rejection of the death instinct

that seemed to evoke Klein’s rejection of

Fairbairn’s standpoint. Her expressed

disagreement, however, was not given with any

reasons.

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The fundamental role attributed to the
depressive position by Klein does not feature in

Fairbairn’s scheme because he did not meet it

often. Klein relates it to the development of the

capacity to perceive the mother as a whole, and to

create this whole despite the feeling of

abandonment at the weaning stage. However,

such recognition can only develop in a self that is

sufficiently a personalised whole, that is, when

the primal splits are not still precluding its

establishment. An aggregate of parts cannot

perceive the wholeness of anything else for that

needs another whole. Only a gestalt can perceive

a gestalt, as Pankow, the philosopher-biologist,

states. In my own experience, what I have found

is that schizoid personalities, as they gain more

freedom from the bad mother, do go through a

phase in which there are recurrent dreams of a

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destroyed world out of which they cannot
extricate themselves. As the badness of the

internal mother recedes, this massive destruction

fades out and compassionate reparative feelings

emerge to give a good wholeness.

Despite the existence of the split subselves,

the self never ceases to have an overall

orientation to itself and to the outer world. The

holistic functioning of the self is readily studied

in projective tests such as the Rorschach. There

the ambiguous stimulus is perceived selectively

by all the sections of the self, even though their

nature and aims may be unconscious. In short,

while the outer world is being scanned by the

conscious central self, the subselves are

simultaneously searching for opportunities to get
into action. The central self nevertheless strives

to preserve as much integration as possible. And

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we have always to remember that it is the whole

person who shapes his neurosis.

The structure of the self as described by

Fairbairn is analogous to Freud’s tripartite

structure. The principles underlying Fairbairn’s

conception are, however, radically different.

Freud’s basis is in part a nonpersonal psychology

founded upon the energies of the biological

instincts and the erotogenic zones. Fairbairn’s

rests on dynamic structures evolved from the

experience of the innate potential of the self with

the persons this potential needs for its realisation.

It will be seen that although he does not specify

the nature of the holistic innate potential, it
embodies a manifold group of structures seeking

an object, yet with each component fitting

affectively into the whole sense of itself.

Lichtenstein (1977) has commented on this

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potential self in relation to the concept of

narcissism. The urges to relate come

paradoxically from the narcissistic position of the

primal self. He has suggested that the mother

imprints, so to speak, upon this primal potential

self a shape it is seeking to encounter. In so far as

her personality is responsive to the needs of her

baby as a person, so does the infant acquire a

reasonable cohesion. When she imposes an

identity on the baby from her own needs, or

denies its spontaneous expressions, the stage is

set for the various distortions of the personality.

The endowment of the infant we now know to be

such that much of its perceptual activity is much

more organised and more holistic than was

traditionally conceived. Thus the subselves and

internal objects all become personalised, at times
with different figures to represent them. The self

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then comes to contain a cast of characters
constantly interacting and changing. It is this

scene from which dreams are created and the

wish fulfillment there seems to be part of the urge

to integration. This urge in Fairbairn’s view is

also what gives rise to the repetition compulsion,

namely, to bring the bad objects back to the

central self with the hope of lessening their

threats to the integration of the self.

With the rising pressure of sexuality and the

central self being inhibited from its mature

expression in personal relationships, the self falls

back on greatly increased activity in the split

selves. The frustrated libidinal self now becomes

much more sadistic toward its object as also does

the attack on it from the rejecting object and its

associated self. The total situation between these

subselves is increasingly repressed by the central

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self so that it becomes much more markedly split
off. No external personal object can be

approached because of the fear of rejection or of

attack, with the result that these two subselves

can become locked in a sadomasochistic

relationship to provide a degree of gratification

by the relief of tension. Pleasure is greatly

intensified when instinctive tensions are

discharged with depersonalised objects especially

in autoerotic or perverse sadistic activities. When

relations with the outer world are severely

compromised then little or no joy is experienced

at a personal level in sexual relations thus

producing a depleted self feeling. With the

satisfaction missing, the urge to repeat
depersonalised pleasures can become an

addiction within a closed system with highly

secret or repressed gratification. The resistance to

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these processes being brought within the
consciousness of the central self verges on the

intractable. The absence of deep relationships

with good objects entails the self clinging

desperately to the bad objects, for having no

objects means unbearable emptiness or the loss of

the self, that is, disintegration into madness.

The individual who seeks analysis

nevertheless wants to be free of the bad internal

objects. To succeed, he has to experience the role

of all the defensive positions evolved to protect

his self against the deep fears of losing his self by

giving up all the false self structures he has

hidden behind. The various psychoneuroses
become for Fairbairn defences against the

disintegration of the self. To account for the

origin of the different conditions he suggested

that different topological distributions of the

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inner objects could do this, for example, by
projecting or retaining the good or bad objects. In

the course of development the self makes

perpetual use of the processes of projecting parts

of the self, either to be free of them or to alter

them by taking them back in a more tolerable

form following an external object having

contained them.

I believe there is a general resistance to the

conceptualisation of the self as our central issue.

It seems easier to resort to an impersonal nature

for the destructiveness and evil within us than to

accept its personal origins. For this means that we

have to take full responsibility for these
frightening and hated aspects of ourselves. And

for our analytic work we need enough freedom

from these deeply repressed infantile

relationships in ourselves before we can

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empathise with them in others, and to empathise
is to sense the experience of the patient as

essentially that of a person in a relationship.

I hope I have given Fairbairn orientation

through the basic principles he put forward,

which gives us a start toward a theory of the self

maturing as a person through the realisation of its

innate potential in its relationships. The theory of

object relations would be termed accurately a

theory of the self, the agency that fashions the

relations. We encounter here, however, the fact

that the acceptance of the deep implications of

this theory for practice is to take us into areas in
the past unconscious only recognised by the

analyst having come to terms with them in

himself.

Fairbairn’s theory does not stand alone in its

explanatory power, but it constitutes the most

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systematic statement of a psychoanalytic theory
of the personality in nonreductionistic terms. He

was inspired by Klein’s concepts of the

structuring of the inner world, yet he believed

that her retention of Freud’s instinct theories

hampered the full development of her seminal

contributions. For him, the individual was

motivated by the need for relatedness, not for

instinctual discharge. Fairbairn’s theory is not a

handbook for the future. Its value lies in the

opening up of directions that would appear to be

eminently productive for expanding our

understanding and, especially, for resolving some
of the blocks that have tended to keep

psychoanalysis tied to its past. There is a general

acknowledgment, outside the United Kingdom at

least, of the value of his views. I believe they thus

form an essential basis for the formulation of

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what could become the unifying perspective for
the next phase in the development of analytic

knowledge.

Commemorative plaque outside the Fairbairn

residence. “W. Ronald D. Fairbairn, Edinburgh,
1926-1940.”

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5.

THE OBJECT-RELATIONS THEORY

OF PERSONALITY

The classical model of psychoanalytic theory

appeared over seventy years ago when Freud

(1923) formulated his structural concepts. The

ego was the part of the personality concerned

with organizing the adaptation of the person to

the external environment, regulating the means

by which he sought satisfaction for his drives (the
id) and reconciling these with a more primitive

control system (the superego), which operated

unconsciously within the ego. These structures

were finally shaped by the experience of the

Oedipus conflict. This theory permitted a

considerable advance in psychoanalytic

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understanding and consequently produced a fresh
mass of observations from the widened range of

conditions that the psychoanalyst was enabled to

treat. It seemed to give a foundation for much

that was obscure, especially the unconscious

sources of resistance and guilt. It led to an

interest in the structural parts of the personality,

the ego and the superego, and to an

understanding of how the ego was patterned by

its defensive needs. The development of the ego

in its earliest phases became increasingly

important, a trend related to the fact that data

from the neuroses gained in width and depth, and

also to the new findings of child analysis.

Freud’s view of the id as a reservoir of

unorganized drive energies with the structured
ego and superego trying to regulate their

discharge was gradually perceived as an

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oversimplification. Hartmann (1964) began to
publish his well-known series of papers, many his

own and others with associates, on a new concept

of early development according to which the ego

and the id were differentiated from the first

undifferentiated phase. The ego was structured

not only by the experiences of the infant and

young child in the satisfaction and frustration of

its drives, but also by the maturation of

autonomous ego capacities, motility, perception,

and so forth. Hartmann’s additions, however, to

the theory of ego development and the concept of

the autonomous ego do not alter basically Freud’s
model. For him, the id still derives from libidinal

and aggressive energies.

The relatedness of the ego to the other parts

of the personality is constantly acknowledged

amongst the ego-psychology group. The failure

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to do justice to the structuring in the other parts,
especially in that area covered by the term id, has

led to the development of concepts that

perpetuate, or even increase, a divorce between

theory and clinical practice that many analysts

have recognized in recent years. One of the main

features in ego psychology seems to be a need to

formulate theories in terms that are thought to be

more appropriate to science, or, more accurately,

to other scientists. Nevertheless, for analysts, as

for others, theories must be closely linked to their

practice, and the data of psychoanalysis do not

lend themselves to too much depersonalization.

Object-relations theory, as described by

Fairbairn (1952a) and Guntrip (1961, 1969),

adopts the standpoint that the psychological
difficulties of patients do not arise basically from

the frustration of instinctual impulses, but are the

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by-products of the individual’s failure to develop
an adequate capacity to make satisfactory

relationships. This capacity for good relationships

with others is the end-product of successive

stages of development from infancy onwards.

During infantile dependence, the infant needs

to be loved unconditionally, to be cared for, fed,

and responded to as a unique individual by all the

loving, encouraging stimulation that good

mothering gives. Growth to more independence,

with the capacity to tolerate frustration, is

accompanied by the consolidation of an imago of

the good mother when she is not there. This

representation of the good mother forms one pole

of a dynamic structure or system gradually

established within the matrix of the mind. The
inner mother in the system serves to stimulate an

effective basis for the development, at the other

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pole, of the self as an I who can do many things

to maintain the good feelings that she provided.

This dynamic structure as a whole (System A)

thus mediates the pleasure and confidence with

which the individual expands his rapidly

maturing resources, for example, in motor skills

and in speech, during the process of becoming an

autonomous person. An extension of this system

is evolved later from the relationship with the

good powerful father who readily becomes

another inner supporting figure. This inner father

has a special importance in the general drive

towards individuation of the self from the

original fusion with the mother.

The foundation of good affective experience

which is associated with this system enables the

growing personality to distribute appropriately its

satisfactions between inner fantasy relationships

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and activities with the outer world. It also creates
an effective balance between satisfactions that

need to involve people and those that are derived

from creative interaction with the physical

environment.

In contrast with what happens as the result of

good experiences, two other kinds of inner

figures or object-relations systems are established

within the mind from feelings of rejection and of

weakness and inadequacy, or later, when the

individual feels his drive to autonomy or his

emerging sexual interest are responded to as

“bad.” These systems are:

System B: The frustrated self, with needs made

“exciting” because their satisfaction is
forbidden, and with representations of the
parents or parts of them (e.g. breast or penis)
that could gratify these needs.

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System C: Imagos of parents threatening the self
by withdrawal of love or punitive retaliations
if the needs in System B are expressed. This
system, a precursor of the later oedipal
superego, operates as a powerful controller
and inhibitor, “forbidding” expression of the
repressed needs.

Since the affects associated with the

frustrated yet exciting needs evoke anxiety from

the activity of the controlling system, both of

these systems become incompatible with the

positive relationships sought by the central self

(System A), namely, to be accepted and loved as a

person. The resultant segregation splits the

original unitary matrix of the self into subselves,

each of which seeks another person in the role of
the object created in the inner world. This early

splitting, which appears to occur through the

innate properties of the affects, is of a different

order from that which takes place in later stages

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of development, for example, by repression under
the influence of more developed relationships

with the parents when the oedipal superego is

formed. For our purposes, however, we do not

need to differentiate these stages and the terms

segregated or repressed systems can be used

interchangeably. Also, the term object refers to

the imagos of persons, or parts of persons, which

represent the nonself pole of the inner

relationships.

The segregated systems have at one pole the

self, or more strictly the self in a certain state, and

at the other pole the corresponding object. This

bipolar structure introduces into the systems the

important property that the relationships they

represent are reversible. The self can be the
frustrated person seeking to find the object it
needs; but because the object is internalized in

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the mind, the self can also feel identified with,
and hence play the part of, the inner object. Thus

the individual can be the dependent baby seeking

mothering, or he can adopt the role of being the

bountiful mother giving devoted care to himself,

or to another person with whom his frustrated self

is identified. With increasing experience and

maturation, and aided by his own body in

providing gratification, he can enact these

relationships in fantasy and play with growing

richness in thought and feeling. Moreover, the

frustrated longings are commonly fused with

other reactive feelings, for example, anger, hate,

triumphing, controlling. Similarly, the

disapproving or hostile parental imago comes to

have all the intensity of the child’s aggressive

feelings, thus leading to severe anxiety, guilt,
humiliation, depression, and despair. Frequently,

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the control system fuses with repressed needs so
that, for example, sexual gratification is fused

with a punitive aggressive relationship leading to

sadistic or masochistic behaviour. Thus the

characteristics of the inner objects in the

segregated systems, while derived from the

experiences with the real parents, are selected,

compounded, and added to by fantasy, conscious

and unconscious, into unique constructions.

What happens in these internal relationships

is interrelated in the closest way. From the start,

the central ego develops as that part of the central

self that seeks to integrate and adapt to reality the

various relationships and activities that provide

the most satisfying patterns for living in the

individual’s environment. With its capacities for

learning, the central ego modifies some of the

frustrated needs by finding more acceptable

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satisfactions leading to a diminution of the

retaliatory fantasies. A number of the

unacceptable needs remain, however, with a

constant tendency to seek gratification. To cope

with this inner situation, the ego adds to the

defensive function of the primitive superego a

variety of other controls —the familiar

mechanisms of defence. As a result, many of the

segregated needs are completely barred from

consciousness and others are recognized only in

part or only at certain times. When segregated in

this way, these needs fall largely outside the

learning processes of the central ego, and they

seek to enact the inner relationships, not in a

realistic way, but by forcing reality to match the

inner needed object. They operate as closed

systems in contrast to the open adaptive
relationships of the central ego.

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As adulthood is reached, the personality is

thus structured by a range of dynamic systems,

each mediating a relationship with an interned

object:

System A: The central self which is related to its

ideal objects. It attempts to come to terms
with systems B and C, which are segregated
at varying “distances” from consciousness.

System B: The frustrated need system containing

the unsatisfied needs of earlier phases and
therefore immature in character. In it the self,
or more accurately a part of the self, seeks to
realize the inner exciting object relationships.

System C: The primitive controlling system

constituted by the threatening parental
imagos forbidding the expression of System
B needs.

These relationship-systems constitute the

dynamic units of personality functioning. Every

individual acquires a unique inner world from the

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varying content and strengths of these systems.

His fantasies and feelings, thoughts and interests,

are determined by their activity and their

interaction. As action systems, they create

relations in the outer world which are largely a

reflection of those in the inner world.

Individuals of widely different personality

patterns can live effectively and with adequate

satisfaction. In the functioning of the person,

boundaries between the so-called normal and the

neurotic are notoriously unclear. In

psychotherapy we are concerned with those

whose functioning has become inadequate to the

point of motivating them to seek help, and for the
task of appraising such dysfunction it is

convenient to adopt two broad types (leaving

aside the psychoses):

1. Normal or mature functioning;

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2. Pathological functioning (as in the
psychoneuroses and character disorders).

Within the central ego system, inner object-

relationships are represented by flexible

structures related to ideal objects and ego-ideals

which are constructed from those highly valued

aspects of parental and other relationships with

which the person wishes to identify. Ideals

embody an imago for the self to be realized in

relationships with these ideal figures. In the

mature person, ideal objects are not so much
fixed imagos of particular figures as more
generalized representations comprising good

values attached to earlier figures. These

abstracted values can be related to actual others,

thus making the value systems or ideals much

more realistic, in other words, the standards

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expected from others and those set for the self are
within normal capacities.

In the course of healthy development, much

of the intensity of the segregated systems, both of

those concerned with control as well as those

containing frustrated needs, is diminished by

absorption into the central self. The adaptive

compromises thus achieved contribute many of

the specific attitudes and character features of the
individual or the minor eccentricities and
irrationalities in his behaviour. For instance, a
latent need to be defiantly assertive through being

messy may be dealt with by the central ego

adopting tidiness as a general character trait while

retaining some activities in which untidiness is

expressed. Leisure activities also constitute an

important adaptive outlet for repressed needs.

With this kind of development, the repressed

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needs cease to be sources of major conflict and
are adopted as relatively benign parts of the self.

The functioning of a mature person in terms

of the dynamic object-relations systems can be

described as follows:

1. A wide range of relationships and activities,

involving both the social and physical
environments, and appropriate to the phase
of the life cycle, is spontaneously sought and
maintained. These relationships and
activities reflect an investment in living.
Most activities and relationships are enjoyed,
because satisfying affects are freely
experienced in personal relationships.

2. In close relationships, and particularly in those

concerned with the reproductive cycle,
satisfactions are found in treating the loved
objects as whole persons. The identity and
reality of the other is fully accepted, raising
the threshold of toleration for unfulfilled
expectations and thus increasing the capacity

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to maintain stable relationships with others,
especially in marriage and bringing up
children. These mature relationships are
transactional, that is, the individual
constantly influences and is influenced by the
other in a mutually adaptive way.

3. In general social attitudes and relationships,

the individuality of people is accepted and
their way of life and their feelings are
respected. The normal constraints and
demands of the social environment are
accepted with understanding. The needs of
others, for example, when they express
criticism, or when authority or responsibility
has to be accepted, are met in a realistic
manner.

4. The free activity of good object-relation

systems in the personality maximizes the
resources of the central ego by facilitating
both the gaining of experience and its use.
Perception of reality is relatively free from
the distortions that powerful repressed needs
induce. Energies are readily available and

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constantly mobilized. The patterns of
personality functioning in thought and in
action in major life roles are integrated and
consistent. This integrated and consistent
quality is not rigid, however, and changes are
met by a flexible use of resources.

5. There is a need to participate in the shared

social tasks that constitute work and to
achieve a socially meaningful status through
the contribution made. Work is accepted as a
positive relationship with the environment,
physical and social, and is therefore
maintained with interest as a means of self-
realization. Career aspirations and
performance match resources.

6. Alongside family, work, and recreational

needs, is the whole complex of what might
be described as “higher or supra-individual
values,” a tendency to generalize about life
and give it meaning. Social improvement,
artistic endeavour, religious beliefs, and so
forth, could be said to represent the attempt
in man to improve the human lot and give

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meaning to life. This complex probably
provides for the individual a trend towards
the highest level of integration he can
achieve among his needs and experience.

7. Being spontaneously involved in the world,

the mature person acquires a background of
confident self feeling without excessive self-
reference. His activities engage him with
satisfying affects so that he ordinarily loses
himself in them. When he does appraise
himself, his rich and positively felt
experience with others permits him to be
realistic and accepting of his own assets and
liabilities. Where difficulties arise from
external sources, affects aroused are those
which are appropriate to good solutions, for
instance, extra effort, or aggression for
mastery. Negative affects such as anxiety,
guilt, grief over loss, humiliation, and so on,
are not unduly marked or prolonged.

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PATHOLOGICAL FUNCTIONING

In the neurotic patient, by contrast, the

conflict between the repressed needs and those of

the central self stamps his relations with himself

and others. While satisfaction of repressed

relationships may often be obtained by fantasy

activity, they retain their tendencies to act out, to

coerce the external person into the role of the

inner object in such a way that the other is not

permitted to have much independence or

individuality. With relationships based on the

repressed need systems there is also the powerful

tendency to project the self pole of these

relationships and to treat the other as this part of
the self. For example, the individual may be a

sadistic self towards a masochistic object or he

may occupy the masochistic position himself,

giving a sadistic role to the other.

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As with the repressed needs, the control
system also operates both in fantasy and by

seeking external relationships. The individual

may play the role of the harsh or severe controller

towards another who is treated as, and often

provoked into behaving like, the unacceptable

part of himself. Again, he may manoeuvre

authority figures into restrictive relationships of

power and control over him.

With the pressures to make the object fit the

repressed systems along with the tendency to
reverse roles, relationships with others tend to be

restricted or unstable. Frequently these

relationships have inappropriate affects as in
excessive hates and loves. Again, the inability to

enter into a relation of full mutuality with the

other can lead to sexual interest and gratification

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being more localized in part-objects rather than
linked with the total person.

Because frustration has played such a

dominant part in development of the neurotic, he

tends to feel the demands of reality as unpleasant

constraints. For instance, the role of authority

figures or the demands of work arouse a

preponderance of negative feelings, a defensive

indifference or a degree of resentment.

Perception is distorted, either by blind spots

when strong repressed needs have to be inhibited,
or by erroneous constructions when they

dominate ego functioning. When stability is

tenuously achieved by extreme restriction of the

environment, underlying insecurity is often

exposed by an inability to adapt to changes with

normal flexibility. Available energies and the

sustaining of effort are also erratic.

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The most striking effects of dominant
repressed systems are usually to be seen in the

area of self-feeling. The self is divided with the

result that there is little consistency or confidence

in self-feeling. Self-appraisal is not in keeping

with reality, in other words, the psychoneurotic is

often self-depreciating, and at other times self-

exalting. The familiar affective consequences of

conflict — anxiety, guilt, and inferiority feelings

—are prominent.

The distorted character formations evolved by

many patients to deal with strong repressed

systems may not show interferences so much

within the person as between the person and

others. In this kind of development, the central

self fails to develop an interest in the
individuality of others and a capacity for

obtaining satisfaction from a free and flexible

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range of transactions with them. Instead, it
becomes subservient to the dominant segregated

needs. Perception of, and relations with, the

environment involve a distortion similar to that in

the neurotic patient, but the central ego

functioning is more stable within the restrictions

it has to maintain. Self-feeling, too, although

distorted, for example, by over-estimation, tends

to be consistent, and the negative affects may not

be noteworthy. In self-selected environments

such people may function well and consistently.

Their limitations emerge only when changes are

forced on them by conflicts or failures in the
outer environment, for example, from the lack of
response by others, or from a growing feeling

that they are “different” or are “missing

something.” When environmental “failure” leads

to the breakdown of this type of defensive

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functioning, more devastating affective disorders,

for example, depression, can follow.

THE PROCESS OF PSYCHOTHERAPY

Since the functioning of a person is governed

by complex interactions of inner object-relations

systems, and by their interaction with the external

social and physical environment, breakdown can

be seen as an outcome of multiple causation.

Sometimes a person is able to recover his

functioning by temporarily withdrawing from the
disturbing activities or circumstances, or he

might be able to make use of the ordinary help,

sympathy, and support available. For many

people, however, the pressure of these systems,

which causes maladaptive relations within the
self and with others, drives the individual to seek

treatment. More specific measures are then

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required to alter the properties of the segregated
systems in relations to the central ego.

From the object-relations viewpoint, the task

of psychotherapy is one of enabling the

individual to experience the nature of his

segregated systems so that they can be brought

within, and modified by, the adaptive powers of

the central ego. This goal is achieved by the
therapist inviting the patient to talk spontaneously

about himself. What is then communicated by the

total behaviour of the patient reveals
progressively the relationships of his inner world.

The skill of the therapist lies in gradually

exposing the aims of the segregated relationships

and the defences adopted to control them. The

central ego then reexperiences in the relationship

with the therapist the affective patterns of the

forbidden longings and the fears that led to their

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being split off. A new reality is tested in which
the longings can be freely felt and expressed

without the previously feared consequences being

realized. Thus, learning can take place, needs

given up or modified, or new solutions found for

their regulation.

To pursue this process throughout the

layering of the personality is a major endeavour

and one that requires the intensity and length of

psychoanalysis. In psychotherapy, the aim is less

ambitious and restricted to achieving only a
moderate modification of the segregated systems
so that the person’s capacity for good

relationships is eased from the conflicting aims

that have hitherto interfered with this potential.

When the therapeutic process is under way,

the individual is thrown into a much more open

state than previously. Repressed needs begin to

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be released with the affects and relationships
within them. In the early stages, positive affects

from feelings of increased freedom, especially in

sexual relationships, may predominate. Negative

self-feelings with anxiety and guilt may follow,

however, from the activity of the repressed

controlling system. Relationships with others and

within the self are more labile and intense during

this phase.

After the termination of psychotherapy, a

period of consolidation is often required for the

individual to achieve a stable position with the

new relationships he has been enabled to make.

The overall effect should be a change towards

mature patterns of functioning, with more

investment in living and more positive affect

experienced in general. Better acceptance of the

constraints of the social and physical

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environment also contributes to better self-
feeling. Undue dependence on others, or

withdrawal from them, should be replaced by

mature social relationships and independent

activities. The individual who has experienced

the process of becoming conscious of much of his

unrecognized inner life is, however, different

from the ordinary normal person in his greater

awareness of, and attention to, the inner world.

Although he may achieve a satisfying

involvement with the outer world, this increased

self-awareness tends to remain.

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6.

AN OBJECT-RELATIONS
APPROACH TO
PSYCHODIAGNOSTIC APPRAISAL1

Psychotherapists hitherto have not devoted

much attention to the problem of quantitative

assessment. It occurred to us that recent

developments in ego psychology, the concept of

the self and the theory of object relations might

enable a fresh approach to be made, and in this

paper we describe some exploratory work in the

hope that it may stimulate fresh contributions to

this important task.

Psychodynamic appraisals are concerned with

the needs that the patient seeks to satisfy in his

relationships. Normally when a relationship need

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is being sought and expressed, the form of the
associated behavior is appropriate — the posture,

gestures, choice of words with their feeling tones,

and the manner of speech are of a piece. The

resources of the ego established through past

experience determine a form of behaviour that

expresses the dominant feelings or needs in the

most appropriate and integrated manner.

Conflicting motives or affects, by contrast, are

noted when they create various kinds of

incongruous or inappropriate features within the

behaviour that fits the consciously sought

relationship; and although the ego tries to
maintain a control whereby motor behaviour is
appropriate to the main relationship it seeks, the

conflicting needs are seldom completely blocked

from some behavioural manifestations. The total

behavioural form thus reflects the interplay of the

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competing relationship needs activated in the
person.

Speech, which is one of the more refined

forms of behavioural expression, reveals the same

close relationship between its formal aspects and

the range of dynamic systems actively associated

with it. The choice and arrangement of the

expressive words match the underlying affects

and can be used to detect the harmony, or

otherwise, of these feelings. The role of intrusive

conflicting relationships is most familiar in slips
of the tongue, but there are clearly many ways in

which the formed aspects of verbal

communication can be influenced by such

conflicts, for instance, in blocking, inhibited

phrasing, choice of inappropriate words, the free

or restricted use of affective words, and so forth.

A good example of studies in this area is one by

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Lorenz and Cobb (1953). When, therefore, a test
situation is used which demands a specified form

of verbal response concerning the individual’s

experience and mode of relating to others, then

the way in which the specified form is met will

give information about the relevant strengths of

the ego and conflicting systems. Analysis of the

form of the response can give a more

standardized and quantitative assessment of these

competing systems in the functioning of the

personality. Furthermore, relating the form to the

content helps to identify the interfering systems

and to appraise the resources of the ego in

achieving a synthesis or otherwise.

In such a test, the stimuli to be presented

should be those that are particularly evocative of

relations existing between parts of the self and

between the self and others. Words and pictures

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have both been profitably used in the past as
stimuli. We chose to work first with words

because a series of stimulus words could be

prepared much more readily than a series of

pictures.

Since we assumed that the basic mode of

relating to the self, to others, and to the physical

environment is reflected in the syntactical unit of

everyday speech, namely the sentence, we

decided, in contrast with the traditional use of the

word-association test, to ask for the spontaneous
personal reaction in the form of a sentence. The

sentence has a subject interacting (transitive verb)

with an object, or else it depicts a state of being

or activity by the use of an intransitive verb. The

quality of affect in the relationship is often

further indicated by the use of qualifying words,
adverbs, and adjectives.

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AN EXPLORATORY TEST

Choice of Words for the Stimulus Series

The stimulus words were chosen to

emphasize the various roles in a range of human

relationships and their associated affects.

Preference was given to words that could elicit a

variety of relationships through different

meanings, for example, BEAT, MEAN, PART.

Approximately one-third of the words referred

primarily to a person (or part of a person) in the

role of subject or object in a relationship, for
example, MYSELF, PATIENT, FRIENDS,

BOSS. Another third of the words referred to the

content of the relationship between the main

figures (subject and object), for example, NEED,

LOSE, and TEAR. The remaining third of the

words were concerned primarily with affects, for

examples, EMPTY, EXCITED, AFRAID. An

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attempt was also made (a) to cover relationships
at the major stages of human development —

infancy, early childhood, later childhood,

adolescence, adulthood —by such words as

DEPENDENT, CAREER, MANAGE; (b) to

include words relevant to the major areas of

living, such as family, work, and social life, for

example, HOME, PARTY, BELIEVE; (c) to have

approximately the same number of words in

positive, negative, and neutral affect categories.

In ordering the stimuli the words from the

categories mentioned above were spread as

evenly as possible throughout the series. An

attempt was also made to ensure that the two

halves of the 100-word series, when considered

separately, were roughly comparable. Each half
of the series (1-50 and 51-100) was begun and

ended with the less disturbing words, that is, was

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started with a few such words to “warm up” and a
few at the end to affect a feeling of “closure.”

(The final list of stimulus words is given

below in Table 1.)

The Form of Response Required

As stated, personal reactions were required in

the form of a sentence because a sentence with its

subject, verb, and object reflects the relationship

evoked by a stimulus in the test situation. As the

smallest unit expressing a relationship, the

sentence provides information of a greater range,

within better-defined boundaries, than is possible

with the traditional associational words or

phrases. Compare, for instance, the following

four responses to the stimulus word submit. The

first two would be typical of traditional word

associations. The last two represent the majority

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of responses under instructions to respond with a
sentence: (1) Failure. (2) Headmaster. (3) I

usually do. (4) One must submit to higher

authority.

The statement about the self-sufficiency of a

unit of analysis is, of course, a relative one. Often

a sentence leaves many questions unanswered.

But in our view the most useful approach was to

obtain a large number of brief responses to a wide

range of stimuli and thus make it possible to

assess quantitatively the functioning of the ego in

a large variety of relationships.

We found it convenient to ask for written

responses and to administer the test in a group

setting. The words were printed on large cards

and exposed one at a time at intervals of 15

seconds. This time proved suitable to get at the

first spontaneous reaction of the subjects and to

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detect defensive recovery after initial
interference.

Selection of Subjects

The most important test of the efficacy of an

instrument designed to detect changes in

personality functioning will come from studies

with the same patients at different stages of

treatment —before, during, and after. Analytical

psychotherapy, whether conducted through group

or individual settings, takes usually 3-4 years to

produce substantial effects. As an interim

measure, however, comparable groups at different
stages of treatment could give sufficient evidence
to establish the value of the approach.
Satisfactory evidence of reasonable diagnostic

power would be obtained if the following results

were achieved, (a) Significant differences should
exist between patients and “normails.” (b)

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Comparable groups of patients at different stages
of treatment should show a progression towards

normality.

We therefore studied the responses of four

groups matched for age, sex, intelligence,

occupation, and verbal competence,2 the groups

representing a series of stages towards “normal”

functioning.

Group A: new patients. Twenty patients at the

time of their application to an outpatient
clinic.

Group B: patients in treatment. Ten patients

currently in weekly analytical group
psychotherapy for at least 2 years and rated
by their therapist as showing some
improvement.

Group C: patients after treatment. Ten patients

who for at least 3 years were in weekly
group psychotherapy before its termination 2

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years ago or earlier, and rated by their
therapist as improved.

Group D: nonpatients (“normals’). Twenty

adults from nonclinical settings, excluding
those who scored highly on a neuroticism
inventory. These subjects included staff of
industrial management, social workers,
teachers, and so forth —all actively
interested in psychological studies.

Analysis of Responses and Results

In developing a scoring scheme,

considerations as described in the early sections

suggested a number of variables concerned both

with the content and the form of the responses.

Some preliminary work on less well-matched

samples of patients and nonpatients helped in

making our final choice.

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Dimension I: Form of Expression

Briefly, this dimension classified each

response as inhibited (blanks or single words),

phrase, or sentence (complete or incomplete).

The ability to respond freely with a sentence

indicated that the subject was responding with the

ego as the predominant source of relationships.

Conversely, failure of the ego to regulate a

repressed need evoked by the stimulus word

would be shown in the disturbed form of the

required response.

The results (Figs. 1, 2) show that new patients

give more inhibited responses and fewer

sentences than the “normal,” and that the treated

groups show a progression in the expected

direction. (A table of results along with the

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Fig. 1. Inhibited responses

Fig. 2. Sentences

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statistical significance of differences is given in
an Appendix.)

Dimension II: Syntactical Use of the

Stimulus Word

The aim of this dimension was to compare

those responses in which the stimulus word was

used as the subject of the sentence, and those in

which it was used as the object of the sentence.

(In this, and subsequent dimensions, responses

which did not fit a category were left

unclassified.) In making it the subject of the

sentence, the individual would show a

spontaneous acceptance of, and absorption in, the

stimulus by placing it in the first part of his

response and by making some kind of statement

directly about it, for example, WORK —“Work is

very enjoyable.” In contrast, the stimulus word is

placed in a subordinate, more distant position, as

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the object of the sentence when some other
interest intrudes into the responding dynamics

and displaces it from its position of primacy

within the sentence, for example, WORK —“I

can enjoy my work.”

In Figs. 3 and 4 it will be seen that new

patients use the stimulus word less often as

subject and more often as object of the sentence

than do the nonpatients. The use of the stimulus

word by the treatment groups is similar to that of

new patients.

Dimension III: Self and Other References

Responses in this dimension were scored as:

(1) those referring to self, and (2) those referring

to others only.

It was expected that nonpatients would be

spontaneously more concerned with thinking and

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Fig. 3. Stimulus word as subject

Fig. 4. Stimulus word as object

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feeling about others, and would reveal this
interest in others by making more frequent

references to them. Conversely, because strong

repressed needs create more anxiety about, or

preoccupation with, the self, there would be more

reference to self in a new patient.

Figs. 5 and 6 show that new patients make

more references to themselves and fewer to

others compared with nonpatients. Treated

patients show a trend towards more self-

reference. Although some such increase was to be

expected because of the introspective nature of

the therapeutic process, the actual amount of

increase is surprisingly large. It would seem that

the process of becoming conscious of one’s inner

life as the result of psychotherapy inevitably
leads to greater attention to the self. However,

within the self-references, treatment should lead

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Fig. 5. Reference to self

Fig. 6. References to others

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to a decrease in the proportion of negative affects
(see dimension V).

Dimension IV: Mode of Communication

The responses were classified as follows:

a. Generalizations. Statements in the form of

generalizations were put into two categories:
(i) those expressing a sound, evaluative
judgement — “adaptive” generalizations',
and (ii) those involving a biased, inaccurate
judgement — “maladaptive"
generalizations.

b. Personalized statements. Statements referring

to self were classified as: (i) those expressing
a positive or constructive attitude —
‘‘adaptive” personal statements', (ii) those
expressing feelings of inadequacy, or
antisocial attitudes —‘'maladaptive”
personal statements.

In making a generalization the individual is

expressing the “learning” from a number of

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situations in which the self has come to terms

with the conflicting feelings present in

interpersonal experience. Such a generalization

would reflect shared reality. Thus, painful

experience relating to criticism can lead to a

reflective generalization indicating that the

individual has learned the role of criticism in

relating to others, for example:

CRITICISM —“Criticism can be helpful at

times.”

CRITICISM —“One has to accept criticism

in order to improve.”

In contrast with an adaptive generalization, a

maladaptive one is indicative of a failure to come

to terms with major conflicts and associated

painful affects involved in living closely with

others, for example:

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CRITICISM —“Critics should be banned.”

BOSS—“Bosses are a real problem.”

Figs. 7 and 8 give some of the results.

Nonpatients make more generalizations than do

the new or the treated patients, and nonpatients

also show that a greater percentage of their

generalizations are adaptive. The treatment

groups do not show a progressive trend towards

the normal pattern either in the total number of

generalizations or in the percentage of adaptive

ones. In contrast, in the percentage of
maladaptive personal responses the three patient

groups show the expected trend of improvement.

Dimension V: Affective Tone

In this dimension each response was scored,

as far as possible, by affect alone, without

considering its form or other aspects of content.

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Fig. 7. Total generalizations

Fig. 8.
—, Percentage adaptive generalizations;
- - -, percentage maladaptive personal statements

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When an affect was clearly expressed in a
response it was scored as positive or negative.

When the presence of affect was doubtful, or

when its positive or negative quality could not be

ascertained, the response was left unclassified.

Affect was scored only on twenty-eight selected

words that were particularly evocative of

affective expression.

The scores on this dimension are given in

Figs. 9 and 10. The balance of positive to

negative feeling shows a consistent trend in the

expected direction for all the four groups. It

would thus appear that psychotherapy is most

effective in this area of self-feeling. Presumably

the change in self-feeling follows from the

diminution in the strengths of the conflicting
systems in relation to the central self.

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Fig. 9. Positive effect (on twenty-eight selected
words)

Fig. 10. Negative effect (on twenty-eight

selected words)

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Dimension VI: Specific Affective
Reference in Four Key Areas

In this dimension those responses were

counted which constituted a simple, direct

reference to dependence, aggression, sex, or fear.

In three areas —dependence, aggression, and

sex —the results (Figs. 11-13) are in agreement

with our expectation. A new patient experiencing

difficulties in these areas is often locked in a

conflict about the expression of these feelings. A

patient in treatment necessarily goes through a

phase where such feelings find more direct
expression. With the termination of treatment,

and as a stabilized position is reached by the

passage of time, the repressed experiences in

these areas are integrated into the central ego

organization and preoccupation with them

decreases to the normal level. As Fig. 14 shows,

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Fig. 11. Reference to dependence

Fig. 12. Reference to aggression

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Figure 13. Reference to sex

Figure 14. Reference to fear

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the situation concerning fear is somewhat
different. Apparently, the expression of anxious

feelings is lessened by the security felt in the

relationship with the therapist.

Reliability of Scoring

A set of 100 responses was scored

independently by five psychologists. With their

more objective system of scoring, dimensions I,

II, and III showed a very high level of reliability

(over 90 percent in each case). Other dimensions

involved a subjective component in judgement

and first comparisons led to a relatively low level

of agreement. With more practice and sharing of
experience in using them, reliability showed

considerable improvement and rose to over 80

percent agreement.

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Influence of the Clinical Setting

In comparing patients with the nonpatient

group the question arises of differing motivations

towards the test situation. This question is clearly

a complex one and could not be satisfactorily

answered within the design of the present study.

However, a partial check on the influence of the

clinical setting was made as follows. The
nonpatient Group D was selected from those

subjects who, amongst a larger number tested,

scored within the normal range on a neuroticism

inventory (the Eysenck Personality Inventory).

From the same pool of nonpatient subjects, we

selected another group who had high neuroticism

scores, that is, who indicated in their test
responses the presence of many neurotic

symptoms. The responses of this group to the

stimulus words were compared with those of our

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other groups. In spite of not being in the category
of patients, their performance resembled much

more that of the new patients than the nonpatient

Group D.

CLINICAL USE OF THE TEST: A CASE

STUDY3

The following case study illustrates the use of

the method in formulating the main

psychodynamic aspects likely to be involved in

treatment.

Mr A. is a married man of 35, separated from

his wife. When applying for treatment he

supplied in unusual detail a personal history. In it
he said: “Basic to my condition is a fundamental

negativism, a pessimistic assessment of my

capabilities, and an uncertainty about precisely

what I want to do. Although the drugs help a lot

to make life bearable, the underlying groundswell

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of insecurity remains. The roots of all this in my
childhood are not hard to trace. My current

difficulties, however, are clearly connected with

the recent break-up of my marriage, which,

together with the marriage itself, was

symptomatic of my condition.”

In the initial psychiatric interview he said that

his wife was a good mother to his son, though she

tended to smother him with kindness. For a large

part of the marriage sexual relations were “a flop”

because of impotence or premature ejaculation.

Later, however, they were “satisfactory.” More

recently he experienced impotence with a girl,

and agreed that he was worried by the

competition for this girl and by the feeling that

she was testing him out.

Before his operation for undescended testes

when 14, a doctor had remarked, in front of

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students, that he had a very small penis, which
had greatly embarrassed him. The psychiatrist

discussed his wish for a satisfactory relationship

with a woman, his feelings that he was not

entitled to such a relationship, and his fears of

reprisals from men so that he took a submissive

position and avoided competition, though

underneath, as in his political life and thinking,

he rebelled. It was suggested that in his case an

active interest in left-wing politics had enabled

him to feel safe, with “comradely” support, in his

rebellion against authority. The competitive

feelings with his son were seen as a factor in the

final break-up of his marriage. The patient readily

agreed with these interpretations.

Study of Word-association Responses

The patient’s responses to the stimulus series

are given in Table 1. In studying these, the only

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Table 1
(The patient’s alterations and
punctuation are reproduced. Words
which were deleted are shown in
brackets.)

1. FRIENDS I haven’t many friends. Those I have I like

very much.
2. WORK I enjoy work on the whole.
3. DRINK I don’t drink much these days.
4. LOSE I tend to lose confidence in certain situations.
5. DEMAND Demand is the converse of supply (!).
6. ANIMAL I don’t like animals much.
7. IDEAL Ideals[m] are essential.
8. CLOSE Some People tend to be very close.
9. COLD Coldness can be countered by wrapping up.
10. BEAT “Beat” people don’t wash!
11. CLOTHES Clothes are status symbols
12. TRUST “Trust-busting” was an important US
occupation.
13. TOUCH Touch is the most import cult sense (in a way).
14. EMPTY
15. CARE One should take care.
16. HEAD Heads are better than hearts (?).
17. MANAGE I usually manage to get through the month.
18. LONG I long for security.
19. WOUND Wounding people with words is easy.
20. CRITICISM Criticism takes many forms.
21. HUSBAND Husbands [can’t]
22. SCHOOL School should be reformed.
23. EXCITED Excitement is often sought after.
24. DESTROY The H-Bomb may well destroy us all.

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25. MEAN Meanings can be of several kinds,
(etymological, etc.)
26. Daughters' are nice to have.
DAUGHTER
27. INTEREST Interest is a function of saving.
28. BIG Big people
29. AFRAID I used to be afraid of the dark.
30. PRIVATE Privacy is [use] essential but probably over
rated.
31. FATHER My father was not very close to me.
32. PLAY Plays at present aren’t up to much (?)
33. FACE One must face up to things.
34. GUILTY I often feel guilty
35. STRAIN Work is sometimes a strain —So are other
things.
36. My childhood was on the whole unhappy.
CHILDHOOD
37. ADMIRE I admire integrated people.
38. NEED I need stability and affection.
39. DEAD My father is dead.
40. BARE Bareness is socially taboo in the West(!)
41. PATIENT Patience must be cultivated.
42. WARM Warmth is comforting
43. CHANGE Changing for dinner is getting old-fashioned
44. SAD Many things make me feel sad.
45. Examinations make me very nervous.
EXAMINATION
46. BOSS I always fear my boss
47. SECURE I wish I felt secure.
48. ORGAN Bach [on t] played on the organ is superb.
49. HURT I often feel hurt —without tangible reason
50. PART Parting can be hurtful.
51. MASTER I should like to master political philosophy
52. FUN Fun must/can be had spontaneously

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53. PRIDE Pride is socially bad
54. LONELY I often feel lonely.
55. SOFT Softness is connected with sleep
56. MATE Mating is very common in animals!
57. Responsibility should be encouraged
RESPONSIBLE
58. My favourite occupation is reading
FAVOURITE
59. GREEDY Greedy people eat too much
60. SECRET Secret thoughts often hurt.
61. HOME Home should be happy.
62. BELIEVE I believe in humanity — I can’t say why!
63. COUPLE Couples are natural social units.
64. HATE [The] I don’t hate many people.
65. SUBMIT I often submit to others.
66. SON My son is the only … person I really love.
67. PARTY Parties are fun. Political parties especially.
68. POWER Power is what most politicians seek.
69. ASHAMED I rarely feel ashamed — perhaps I should.
70. DOUBT Philosophical doubt is important.
71. MOTHER My mother is kind & good.
72. STAND One must make a stand about things in which
one believes.
73. DEEP Still waters rarely run deep (in people).
74. FAIL Failure is a constant worry.
75. BURN Burning is not pleasant.
76. BODY Bodies contain minds.
77. RICH Richness is a quality.
78. DREAM I don’t remember many dreams I have.
79. TEAR A tear usually means unhappiness,
80. One is dependent on other people’s emotions.
DEPENDENT
81. MYSELF I think about myself too much
82. SERVICE Service to others is commendable.

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83. BED Bed is great. Sleep is refreshing.
84. WEAK Weakness
85. TROUBLE Troubles are often imaginary.
86. FINGER Fingering is important in music.
87. LIKE I like to talk & think.
88. MOULD One is moulded by society, largely.
89. WORRY I worry unnecessarily.
90. UNFAIR Most societies are “unfair.”
91. WIFE My wife & I are separated.
92. CAREER I wish I knew for certain about my career.
93. CONTROL Control over others is finally impossible.
94. DIRT Dirtiness is deplored.
95. BREAK Cups break if dropped (!)
96. DOCTOR Doctors are fine father-figures
97. SATISFIED I am rarely satisfied.
98. KEY The key to the Universe will never be found
(!!).
99. DARK Darkness used to frighten me now I rather like
it.
100. HABIT Most things are habitual.

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information provided for the psychologist was
age, sex, and marital status.

Analysis of Scores

Table 2 shows the patient’s scores compared

with the scores of the average patient and of the

average normal.

1. Form of expression. He writes ninety-six

complete sentences, an unusually high
proportion, suggesting verbal fluency and
great effort to meet the requirements of the
test. The four responses that show marked
inhibition in their form must therefore
indicate that these stimuli have aroused
particularly strong conflicting feelings:
No. 14. EMPTY —
No. 21. HUSBAND — Husbands
[can’t]
No. 28. BIG—Big people
No. 84. WEAK —Weakness

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Table 2

Patient’s Average for Average for

score patients normals
(1) Form of expression
Blanks and single 2 16 4
words
Phrases 2 29 27
Sentences 96 55 69
(2) Syntactical use of
stimulus word
As subject 55 13 28
As object 9 16 9
(3) Reverence to self
and others
Self 34 42 20
Others only 23 14 24
(4) Mode of
communication
Generalizations
Adaptive 46 12 30
Maladaptive 7 5 6
Personal Statements
Adaptive 9 7 10
Maladaptive 19 23 3
(5) Affective tone
Positive 27 22 31
Negative 39 45 17

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These responses suggest feelings of
inadequacy, in particular masculine
inadequacy.

2. Syntactical use of the stimulus word. The

patient uses the stimulus word as subject
twice as often as the average nonpatient. This
high score suggests too close an
identification and excessive involvement
with issues raised by the stimulus word, and
may indicate his insecurity in maintaining
the boundaries between himself and others.

3. References to self and others. The patient’s

scores in this dimension are between the
average of patients and nonpatients for
selfreference, and close to the average of
nonpatients for reference to others only. He
is, therefore, on the surface somewhat less
preoccupied with himself than the average
patient, and much more able to direct his
response to others. His normal amount of
reference to others appears to go along with
his intellectualizing tendency, as shown in
dimension IV. This interest in others may

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also have common roots with the compulsive
involvement mentioned in the previous
dimension.

4. Mode of communication. The main

characteristic of his responses is that in spite
of an unusually large proportion of adaptive
generalizations, there is a relatively high
number of maladaptive personal statements.
This contrast suggests that his apparent
adaptation may be based on a defensive
intellectualizing position, which is his way of
avoiding pressing personal difficulties.

5.Affective Tone. The balance of positive and

negative affect is fairly close to that of the
patient sample. The presence of so much
negative affect in relation to the adaptive
efforts shown in dimension IV further
suggests that these efforts are compulsive
and defensive in nature.

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Personality Functioning from Form and
Content of Responses

Dimension IV is the most suitable for

examining all the patient’s responses in terms of

content, yet within formal categories.

1. The fifty-three generalizations may be divided

into three groups:
a. Twenty-eight responses to highly
evocative words are in the form of
intellectualizations in which the
affective values are neutralized in
large part, for example, no. 9:
COLD — Coldness can be
countered by wrapping up; no. 13:
TOUCH —Touch is the most
important sense (in a way).
b. Eighteen responses show a need to
conform to standards and a
tendency to be critical of failure and
pretence, for example, no. 7:
IDEAL — Ideals[m] are essential;

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no. 33: FACE —One must face up
to things.
These forty-six responses together show
the extent of his intellectualization and
strong superego pressure to conform.
c. Seven responses show his sensitivity
and insecurity, for example, no. 60:
SECRET — Secret thoughts often
hurt; no. 80: DEPENDENT—One
is dependent on other people’s
emotions.

2. Of the nine adaptive personal statements, four

stress intellectual aspirations, for example,
no. 51: MASTER —I should like to master
political philosophy. The other five responses
show a more interpersonal concern, mainly
in a qualified form, for example, no. 2:
WORK —I enjoy work on the whole.

3. The nineteen maladaptive personal statements

are direct expressions of personal inadequacy
and insecurity, for example, no. 46: BOSS —
I always fear my boss; no. 54: LONELY —I
often feel lonely.

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4. The remaining nineteen responses, though
made mostly to highly evocative words,
show marked avoidance or inhibition of
feeling.

The restriction or avoidance of emotional

responses by intellectual effort or denial is a

dominant characteristic of the record. Intellectual

effort is used also to compensate for feelings of

inadequacy as a man, and his lonely insecurity.

By it he attempts to maintain a self that is

effective, conforming to high standards, and to

am extent constructive and reparative. On the

other hand, he expresses feeling when directly

portraying his insecurities and when indirectly

angry at pretence in authorities. Expressions of

enjoyment and achievement are few and usually

accompanied by reservation or qualification.

The contrast between intense needs directly

expressed and tight control of feelings suggests

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the possibility of compulsive acting-out
behaviour.

Object Relations in the Content of

Responses

The main object relationships can be

examined from the content of responses.

Relations with Men

His relationship to men, particularly those in

authority, has three main components:

1. On his own, he adopts a position of fear,

inadequacy, and submission, for example,
no. 46: BOSS —I always fear my boss; no.
65: SUBMIT —I often submit to others. He
avoids situations involving physical
aggression or hurt, for example, in the
following responses “physical” connotations
of the stimulus words are denied: no. 10:
BEAT—“Beat” people don’t wash!; no. 19:
WOUND—Wounding people with words is
easy.

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2. He can criticize authority, but only is an
intellectual form, for example, no. 68:
POWER —Power is what most politicians
seek; no. 90: UNFAIR —Most societies are
“unfair.”

3. As part of his conflicting feelings towards

authority, there is also a longing for a good
relationship with the father figure, for
example, no. 31: FATHER —My father was
not very close to me; no. 96: DOCTOR —
Doctors make fine father-figures.

Relations with Women

4. He has a strong need for a relationship with a

woman (mother), but this is expressed in
infantile, dependent terms, for example, no.
42: WARM —Warmth is comforting; no. 55:
SOFT — Softness is connected with sleep;
no. 71: MOTHER —My mother is kind and
good. But he is unable to maintain a
reciprocal, give- and-take relationship, as is
indicated by the following responses where
interactional aspects of stimulus words are
ignored: no. 5: DEMAND — Demand is the

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converse of supply (!); no. 12: TRUST
—“Trust-busting” was an important US
occupation.

5. Just as he avoids physical, aggressive

connotations of stimulus words (see (1)
above), so he avoids also sexual connotations
of most words, for example, no. 48: ORGAN
—Bach [on t] played on the organ is superb;
no. 63: COUPLE —Couples are natural
social units. However, one or two responses
contrast sharply with the above by their
direct sexual expression: no. 40: BARE —
Bareness is socially taboo in the West (!); no.
56: MATE —Mating is very common in
animals! This split in his sexual attitudes, his
inferiority as a man and his need to test
himself would be expected to lead to sexual
acting-out.

6. In spite of this conflict, there are indications

that he also wants to establish a good
relationship with an idealized woman, for
example, no. 71: MOTHER —My mother is

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kind and good; no. 26: DAUGHTER—
Daughters are nice to have.

Relations to Self

7. He feels a sense of guilt, but tends to deny

shame, for example, no. 34: GUILTY —I
often feel guilty; no. 69: ASHAMED —I
rarely feel shamed — perhaps I should.

8. There is a need to comply with the demands

of his ego ideal, for example, no. 72:
STAND —One must make a stand about
things in which one believes; no. 82:
SERVICE — Service to others is
commendable.

9. Intellectual achievement, particularly in the

realm of politics and affairs, tends to be both
critical and constructive, and it gives him a
sense of power over others, for example, no.
51: MASTER —I should like to master
political philosophy; no. 88: MOULD —One
is moulded by society, largely.

10. His use of exclamation marks and other

unusual punctuation suggest his need to

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display his intellectual prowess.

11. He experiences, though is little able to

express, basic trust in and concern for others,
for example, no. 62: BELIEVE —I believe
in humanity— I can’t say why!

Summary of Findings from the Test Data

The diagnostic picture that has emerged is

one of a character disorder in which the

predominant problems are oedipal. His duty-

driven intellectual effort seeks to dominate,

control, and improve others, while avoiding any

close emotional ties with them. He thereby

attempts to manage his feelings of inadequacy

and loneliness. He separates idealized relations

with women from his sexual relations in which
the woman is treated as faithless and potentially

belittling of him. So far his defences have

allowed him only vicarious satisfactions in
intellectual mastery and in identification with

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political causes. There are some suggestions in
the test that his underlying anger and contempt

towards men and women may find more direct

but guarded expression in compulsive acting-out

behaviour.

Within the tightly woven character structure

two kinds of defensive failure can be seen. The

first, illustrated in his blank and single-word

responses, and later emphasized in the more

detailed examination of form and content, is

associated with his feelings of impotence and his
inability to maintain secure dependent or sexual

relations with women. Thus he feels empty,

weak, lonely, and depressed, and is driven to seek

treatment. The second centres on a compulsive

testing out of his potency in self-display,
intellectual dominance, and active political

interests. With women this testing-out also

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involves a contempt of them as sexual objects
and a denial of any possibility of a close ongoing

affectional relation with them. But he gives

evidence of a basic trust in others and in his own

capacities for good relations with them.

With regard to his ego resources and

therapeutic potential, the following points can be

noted: (a) his strong motivation to get help, as

evidenced by his response to the test

requirements; (b) his readiness to express his

difficulties as shown in his maladaptive personal

statements; (c) his basic trust in good

relationships, as seen in the reparative effort
implied in many of his generalizations; (d) his

intellectual aggressiveness, which is largely

object oriented, and is not rigid or aloof in a

paranoid fashion.

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While he will use his intellectual resources
widely as agile defences, he has some access to

his feelings. This, together with his strong

pressure to test himself out with others, should

ensure that his problems come into the open in

group psychotherapy. Therapeutic work will have

to concentrate on: (i) his ambivalence to men in

authority and especially his denied belittlement of

them; (ii) the split between his dependent and

sexual feelings towards women; (iii) his use of

intellectual defences to avoid feelings.

Summary of Therapist’s Report

The psychiatrist who saw the patient in initial

consultation and who subsequently treated him in

a therapeutic group was asked to make an

independent report after a year.

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The patient joined the group a few weeks

after it started. At his first attendance he told the

group all about himself in a rather exhibitionistic

manner, although he was tense and anxious. Later

he questioned the other members intimately, often

prodding them in a jocular manner. Soon he set

himself up as the therapist’s assistant and was

very submissive towards him, but he attacked

authority outside the group. He frequently

projected his anger, and after provoking another

member into a rage, he would become smug and

self-satisfied.

He used his intelligence in an analytical,

obsessional manner, but his excessive need to
control often interfered with his understanding of

other members’ problems. He seemed determined

to find a solution for his conflicts, and although at

times very critical of group therapy he attended

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regularly and made use of the insights gained. He

began to recognize his intolerance and resentment

of the relationship between his son and his wife,

which he had tried to resolve by leaving them.

He worked hard in the group, progressing in

stops and starts and sometimes suddenly bringing

out painful material with courage. He described

affairs with married women which culminated in

their husbands’ attacking them and threatening

him. He would then abandon the wife, and,

though terrified, seek to establish a “friendly”

relation with the husband whom he hoodwinked.
In these episodes he reported no feelings of anger

or violence, though he roundly derided both the

husband and wife concerned. He also referred to

a longstanding affair with a single woman. When

tired of her, he would send her away and then

throw himself into work as a way of avoiding his

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guilty feelings. When this failed he would

rationalize his resolutions in regard to her and

reembark on a period of uninhibited sexual

activity which would again end in rejection of

her.

Although ambitious and wanting to write, his

achievements were restricted because of oedipal

guilt. The exhibitionistic gratification he got from

teaching also made him guilty. At times,

especially when his obsessional defences failed,

he became quite depressed. His motivation to find

a solution to his difficulties and to establish better
relationships has remained strong and over the
year he has changed considerably. In the group he
accepts others more seriously, is less of a prima

donna and participates more deeply and more

sincerely. He has become more assertive, timidly

and anxiously at first, but more confidently of

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late. While previously he would contradict
himself and decide the therapist was right in the

group, he is now able to disagree with the

therapist.

With women he has become more dissatisfied

with his sadomasochistic relations and has nearly

ended the longstanding, but intermittent, relation

referred to earlier. He now expresses the desire

for a more settled life with a more suitable

woman, in which the quality of the relationship

between them would be the important thing, and

he is making attempts to establish such a

relationship. Whereas he had been deeply

depressed over periods for many years, some

months ago he stopped taking antidepressant

drugs, though occasionally he takes tranquilizers

when he cannot sleep. He spends more time with

his son and is better able to handle their mutual

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antagonisms. He has taken practical steps to help
his son in various difficulties.

He has completed his first published article

for many years and his writing and teaching

activities seem to be coming closer together. In

the group he has largely stopped pursuing his and

other people’s problems in a detached intellectual

manner and takes much more account of

emotional factors as he has grown to understand

them.

SUMMARY

An approach to quantitative appraised of the

factors involved in psychotherapy is described.

Using the form and content of expressive verbal

behaviour in giving a spontaneous personal

reaction in the form of a sentence to a series of

stimulus words, differences were shown between

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patients and nonpatients, and to a lesser degree
between new patients and patients in, or after,

treatment. These initial findings are sufficiently

encouraging for further development of this test

by including other stimuli such as pictures to

increase its discriminative power. With a more

comprehensive and sensitive instrument of this

type, used before and after analytic treatment, it

should be possible to demonstrate objectively the

changes resulting from treatment. It should also

be possible to compare the effects of different

psychotherapeutic approaches and to show the

difference between these effects and symptomatic

changes produced by other methods or occurring

without treatment.

A test approach, such as this one, can also

provide objective confirmation of observations
based on clinical work. Thus even in the present

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initial form, and in treatment occurring only once
per week, the test confirms the familiar clinical

observation that dependent, sexual, and

aggressive expressions are heightened during the

early phases of treatment. The expression of

anxiety, however, does not increase concurrently,

presumably because of the support provided by

the therapeutic relationship. Again, the

psychoanalytic view that difficulties in relating to

others play a central part in psychopathology is

supported by the fact that the most discriminating

words in our stimulus series turned out to be

those that made a direct and unavoidable
reference to interpersonal demands —

CRITICISM, WORK, FRIENDS, NEED,

SUBMIT, CONTROL.

With regard to its clinical use, the study of

individual cases has shown that test findings

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closely parallel those that emerge during

treatment. Thus, the present test approach seems

suitable for delineation of conflict areas, study of

the nature and stability of defences, and the

assessment of therapeutic potential, an approach

that can be of help in the selection of patients for

treatment in its different forms. Also, since the

patient can see his responses to this test as

relevant to his problems it should be easier to

make a test of this kind a part of the initial

consultation.

Notes
[←1] This chapter was co-authored by H. S. Gill and H.
Phillipson.

[←2] On the Mill Hill Vocabulary Scale —definitions.

[←3] This is one of the several cases from our sample who went
into treatment and whose test findings are being compared
with reports from their therapists.

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APPENDIX

Differences between groups

Dimension and A group B group C group D group
category (N = 20): (N = 10): (N = 10): (N = 20):
new patients in patients non
patients treatment finished patients
average/ average/ treatment average/
subject subject average/ subject
subject
I. Form of
expression
1. Inhibited 16 13 10 4
responses
2. Phrases 29 31 24 27
3. Sentences 55 56 66 69
II. Syntactical
use of the
stimulus word
1. Stimulus 13 9 13 28
word as subject
2. Stimulus 16 17 21 9
word as object
III. Self and
other references
1. Reference to 42 52 50 20
self
2. Reference to 14 11 15 24
others only
IV. Mode of
communication
1. 12 6 14 30
Generalizations,
adaptive
2. 5 4 5 6

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Generalizations,
maladaptive
3. Personal 7 8 11 10
statements,
adaptive
4. Personal 23 25 19 3
statements,
maladaptive
V. Affective tone
(28 words)
1. Positive 3 6 9 9
affect
2. Negative 17 14 10 6
affect

Total no. of Total no. of Total no. of Total no. of

references references references references
VI. Specific
affective
reference
1. 11 26 4 2
Dependence
2. Aggression 13 20 4 4
3. Sex 40 80 26 28
4. Fear 36 34 18 11

•In Groups B and C the total numbers are double to make them
comparable with Groups A and D.

Statistically significant differences*

Between groups A and D Between groups A and C
Dim. I Cat. 1 Dim. V Cats. 1 and 2
Dim. II Cats. 1 and 2
Dim. III Cats. 1 and 2 Between groups B and C
Dim. IV Cats. 1,1 +2, and 4 Dim. IV Cats. 1 and 1 +2

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Dim. V Cats. 1 and 2 Dim. V Cats. 1 and 1
Dim. VI Cats. 1, 2 and 4 Dim. VI Cats. 1 and 2
Between groups B and D Between groups C and D
Dim. I Cat. 1 Dim. I Cat 1
Dim. II Cats. 1 and 2 Dim. II Cats. 1 and 2
Dim. III Cats. 1 and 2 Dim. III Cats. 1 and 2
Dim. IV Cats. 1,1 +2, and 4 Dim. IV Cats. 1,1 +2, and 4
Dim. V Cats. 1 and 2 Dim. V Cat. 2

•Minimum level of significance = 0.05. Mann-Whitney U test for

Dimensions I to V. Chi-square test for Dimension VI.

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7.

OBJECT-RELATIONS THEORY AND

COGNITIVE PERFORMANCE

THREE CASES OF ANXIETY AND FAILURE

IN EXAMINATIONS

Some time ago I was asked to help three male

students who had failed repeatedly in

examinations although their capacities were

sufficient for success and all had devoted

adequate time to study. At first none of them

mentioned any difficulty other than the failures,

yet each was convinced that the trouble was due

to a weakness in his personality. Two of them

experienced panic feelings during the

examinations, and an emotional basis for the

failures was suggested by the fact that these two

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did worse in successive attempts at the same
examination despite steady application. Acute

symptoms of this kind are of interest to the

medical psychologist because they would be

expected to provide, on investigation, some

insight into the determinants of examination

anxiety in general, a strain frequently blamed for

the onset of neurotic illness. They are also not

without importance to the educational

psychologist, since such factors diminish the

validity of examinations as measures of

knowledge or capacity in these cases. Before

making any general observations a brief

description of the cases is given below.

Case A. A young man, aged 23, was

depressed by having struggled in vain for 4 years
to pass the first of his professional examinations.
His intelligence as measured was not superior, a
fact which he appreciated, but in view of the
energy he devoted to his studies he ought to have

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succeeded in the usual time of 1 year. As a rule
he worked with fair progress until an
examination approached, whereupon he would
become anxious. Inability to recall the essence of
what he had read would begin to produce a
feeling of panic followed by further agitated
attempts to memorize. Finally, during the
examination he became so excited and confused
that nothing could be reproduced. He blamed his
failures on various faculty deficiencies such as a
bad memory, poor power of concentration, or a
lack of will power. Nevertheless, he realized that
his memory for certain subjects was good, while
in reading general literature he concentrated
readily, and in the grim determination with which
he worked he showed no deficiency of will
power. It was clear that the examination was
associated with an increasing emotional
disturbance that blocked completely a normal
flow of thought.

In his first years at school he had a period of

difficulty, which was followed by several years
of good progress, his class position being always
in the upper third. At adolescence his
performances deteriorated to such an extent that
he was usually near the foot of the class, a

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humiliation that he lessened by taking an active
part in sport and other social activities.

He began his first session by remarking that a

friend who was familiar with psychoanalytic
treatment had told him about associating and had
asked him what the word “murder” suggested. To
the patient’s amazement he had a vivid picture of
a man throttling a woman. Next he spoke of how
he had been an only child until he was 10 years
old when a brother was born. This brought to
mind a series of games he used to play in his
early childhood with a girl. In these he played
“the doctor,” a role which appealed to him
because of his strong desire to know about the
female body. Even then he felt this interest to be
a sexual one.

These first associations as usual referred to

his dominant unconscious conflicts. It is
interesting to note the association of his brother’s
birth with the concern about the female body, for
Klein (1932) and Schmideberg (1938) have
suggested that anxiety over phantasied attacks on
the contents of the mother’s body may lead to
various intellectual inhibitions. Later, A
expressed sadistic impulses towards his mother
more openly in associations to a dream wherein

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he felt identified with a man who murdered a
woman. Adolescent sexual conflicts alternated
with his work failure as the main themes of the
early weeks of treatment, with great emphasis on
the failure as the cause of his unsatisfactory
personality development. He began to masturbate
when about 14, and 3 years later was in a state of
constant guilt and anxiety over this. He felt that
this worry impaired his health and was the cause
of a ruptured abscess of the appendix, which
almost cost him his life. Subsequent associations
suggested that unconsciously this operation was
regarded as a punitive castration. For instance, he
feared that the surgeon who treated him would
think he had a very large penis, doubtless due to
his guilty practices; he also thought that
circumcision might cure him of the masturbation
so he secretly consulted a doctor about this.

While recovering from the operation he

developed obsessive fears of contamination by
germs and dirt, which have persisted although
much diminished. He resolved to expel from his
mind all sexual ideas and to work incessantly for
the entrance examination to his professional
course. It took him 2 years to pass this
examination, in other words, four attempts, by

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the end of which period he had become a very
shy inferior person. He was nervous and hesitant
in answering anyone and envious of his younger
brother’s self-confidence which he felt sure made
his brother their father’s favourite. These
personality troubles were attributed entirely by A
to his failures, as he thought he had successfully
conquered his sexual impulses. Gradually,
however, a different picture was revealed. For the
past few years he had been disturbed at nights by
erections associated with anxiety dreams from
which he would awaken with a shout. Each night
was dreaded on account of these unpleasant
dreams, and his strong guilt over them was seen
in his alarm lest anyone should hear what he said.
Another besetting dread was that some violent
death might overtake him at any moment. When
it was suggested that he was still afraid of
punishment for his sexual impulses, he suddenly
recalled that at the height of his adolescent
conflicts he thought he had given himself a
venereal disease and planned suicide to escape
from the shame. It was with great relief he
learned that his fear of such infection was
unfounded, but the fright reinforced the intense
counteractivities from which he decided never to
relax, “for any relaxation was dangerous.” Thus

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work was compulsive activity to keep these
sexual thoughts out of his mind.

The patient’s reaction to this interpretation of

the function of his work brought forth several
confirmatory ideas. Despite his repeated failures,
he felt he could never give up work because it
was “the only thing he had to hold on to,” “he
must keep up a high standard of work and
morals.” He had considered at times a career that
did not involve study, but this seemed to be far
too dangerous. Often he had bemoaned the fact
that as long as he was such a failure he could
never marry, so he withdraw quickly from any
friendships he made with girls. The failures could
therefore be regarded as a defensive measure
against all sexual behaviour. He must fail in
examinations because success meant exposure to
the dangers of relaxation and possible marriage.
The failures also served as a self-punishment for
the bad impulses he still possessed. This
interpretation led to several references to great
disturbances going on during sleep and more
dreams were remembered. In the past his
unconscious processes had not only given rise to
dreams, but also to frequent somnambulistic acts,
for example, he would often find that he had

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locked his bedroom door, or put a light on, or
that some piece of furniture had been moved, and
such acts now occurred more often. Many
dreams contained an evil figure, which
represented a force interfering with his work and
which was too powerful to fight. Later it became
a less disguised symbol of his sexual impulses.

The origin of his intense sexual guilt was now

directly related by A to feelings dating from early
years. As a child he had always felt that
something evil went on between the sexes. Once
he found his parents inside their room with the
door locked and immediately he became greatly
perturbed. On getting into the room he felt in a
vague way that his worst fears were confirmed
when he rushed to the bed and saw impressions
indicating that they had been on it, an experience
that produced a strong hatred and envy of them
on account of their secret enjoyment.

The revival of these early feelings was

followed by severed very emotional dreams. In
one a scene took place in which A got into a
murderous rage with a man who stole his
overcoat. This dream brought many associations
of aggressive feelings towards various people
with whom he connected his father. In his

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seventeenth session a dream was described in
which the patient experienced vividly the conflict
he had in examinations. He was required to apply
knowledge he had, but which he could not recall,
whereupon he became excited. This scene was
immediately associated with an actual occasion a
few years ago when he had got upset in the same
way. His excitement in the examination had
grown as he stared at a girl in front of him and
had culminated in a seminal emission. The
recollection of this incident had passed through
his mind in previous sessions but was deemed
too unimportant to mention! Later he added that
his examination excitement almost always ended
in a sexual feeling. The length of time taken to
mention this matter indicated the strength of his
defences against the significance of his
examination difficulties, and with the penetration
of these defences a great amount of affect was
released. He became embarrassed by the way in
which sexual topics displaced his work anxiety.
Wildly aggressive phantasies developed
accompanied by impulses to tear people in
pieces, especially for their sexual misdeeds. As
already mentioned, he harboured strong
aggressive impulses towards his parents for their
sexual relations from which he felt excluded.

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Thus he dreamt he was made to sit on the bumper
of a car while his parents “rode” inside. Later he
remembered sleeping at the foot of his parents’
bed when about 7 years old and being awakened
by the sound of the bed creaking and shaking; he
knew they were “up to something wicked.”
Again, he dreamt of a light at a bedroom window
of a nearby house being extinguished. This
suggested an elderly couple preparing to go to
bed to enjoy sexual relations. When he awoke
from this dream he found that he had knocked
over his own bedside lamp. From another dream
connected with parental intercourse he awoke
beating his fists on the bed.

There now began a series of dreams dealing

with his father. A felt he could never emulate his
father because the latter had “resources” that he
could never possess. By this term he thought of
intellectual and personal qualities, but the
immediate associations of guilt over his large
penis showed the unconscious determinants of
this inferiority. His attitude to his mother was
also brought into his material at this time.
Although she always seemed to be emotionally
cold to him, he felt identified with her.

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A few days before his next attempt at the
examination he had a terrifying dream in which
he enacted his difficulties. At first he thought he
knew how to answer all the questions but then
noticed he was short of time and getting
unnerved as he hurried from one question to
another. Two students near him began to distract
his attention by a quarrel. One was a licentious
youth with whom he felt identified, while the
other was an old school friend who finished his
paper in good time and then reproached the rake
for his immoral behaviour. A felt the whole scene
to be frightfully real, and as he watched this pair
he had an emission which he hoped no one
would see.

His first associations to this dream produced

the usual naive explanation that he had got
excited by the feeling of hurry and it was this that
produced the emission. The rake was a fellow-
student who was often ragged about having a
large penis, a feature which the patient applied to
himself. The other represented the ideal person,
and A remembered that this youth’s father
followed the profession that A himself wished to
pursue. These two figures had actually been
friends until the ideal one turned against the other

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on account of his sexual behaviour. The dream
was interpreted as introducing another motive in
the patient’s conflict. His ideal self, identified
with his father, was opposed to his sexuality.
This was gratified, however, in such a manner
that not only was A punished by his failure, but
he procured a revenge upon his father at the same
time. A was reluctant to accept this view of his
behaviour until the dreams which followed
overcame some of his resistance. In one of these
he had to lead his football team after the captain
was injured. Then there was a partially repressed
scene in which he flirted with a friend of his
mother, and from the associations to this dream
his Oedipus situation emerged clearly. In another
dream the theme of his brother’s birth and his
mother’s body returned. He and his brother
climbed through a tiny hole into a cupboard
under a staircase where they tried to catch mice.
A felt he must not allow any to get out and
became anxious at the thought that he might not
be able to escape himself. He associated this with
the feeling that he had no way out of his work
difficulties — his work made him a prisoner.
That it dealt with the problem of the arrival of
other babies, and in particular of his brother, was
made clearer in his next dream. In this he left a

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house wearing a girl’s hat and carrying a dog,
which he took without asking the permission of
the woman who owned the house. The dog was
associated at once with his brother.

When actually on the way to his examination

he became obsessed with the thought of sexual
intercourse, which made him so anxious that he
almost turned back. He noticed he had an
erection, and when he saw some girls at the door
of the examination room he felt he was about to
have an emission. This increased his panic until
he suddenly thought of the interpretation of his
recent examination dream, whereupon he soon
found himself writing the answers without much
difficulty. Afterwards he reported his success in a
grudging fashion, attributing it to the use of
better study methods although these had not been
changed.

In his short treatment of about sixty sessions

little alteration was made in A’s very poor
personality development. The deeper trends seen
in many of his phantasies, for example, his
identification with his mother and passive
homosexual attitude to his father, were not
interpreted, as he intended to stop treatment after
the examination. Sufficient progress was made

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nevertheless in the interpretation of the motives
of his failures in their superficial layers for him
to be able to adopt a less compulsive attitude
towards his work. Thus he was able for the first
time in several years to spend one night a week
on some recreation, and though thereby devoting
less time to study then previously he succeeded
in passing his examination.

Case B. This case presented many of the

features of case A. A male student, aged 21, and
of average university intelligence, had done
progressively worse in three attempts at an
examination despite hard work. His personality
showed several obsessional trends by which he
was able to stifle all emotions because these were
sinful to him. At first he discussed his conflicts in
a detached manner and only showed strong
feeling after a sexual dream occurred. This
produced many associations about his painful
masturbation guilt, which made him execute
various unpleasant tasks and self-denials as an
expiation. His failures had often struck him as
being like a punishment from God. Another
source of conflict was his future, for though he
wished to go abroad he felt it his duty to return
home after his training was completed in order to

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support his mother, his father being dead. The
prospect of marriage also worried him, as he
found it difficult to accept his sexuality. The
possible evasion of these problems by his failures
was suggested, and he was successful in his next
attempt at the examination. As B was seen on
twelve occasions only during the three weeks
preceding this attempt, it was not possible to gain
more knowledge of the deeper motives at work.

Case C. Male, aged 21. A quite different

picture was presented by this case. In his first
years at the university he had shown outstanding
ability, but by the time he reached his final year
his performances in class examinations became
such that failure in his degree examination was
regarded by his teachers as inevitable. There was
no lack of energy as an active intellectual and
social life was maintained, though any attempt to
study for examinations immediately aroused an
intellectual “wanderlust.” He managed to do a
certain amount of preparation, but found that he
became flurried when answering the questions. C
was distressed by his difficulty and sought help
when he found he could not overcome it.
Contemptuous of the cultural standards of his
fellows, he was also very aggressive towards the

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Calvinistic values under which he had been
reared at home. His mother was a very bigoted
person, and his ambivalent feelings towards her
gave rise to spells of mild depression. This
conflict over her was an old one, and in his
associations on this theme he remembered being
deeply impressed when she told him some years
before that she had never been able to satisfy him
as an infant. Throughout childhood he had many
nightmares in which villainous witch figures
threatened him. His father had died when C was
a child, and, as with case B, he was torn between
pursuing his own interests and making reparation
to his mother on whom he felt very dependent
despite their many quarrels. There was no doubt
that he had a savage hatred of her which he tried
to conceal from himself, and it was likely that his
impending failure to get into a position whereby
he could help her was an expression of this
aggression. When this was interpreted he began
to work better and stopped treatment after a few
sessions. Probably his deep unconscious
aggressive impulses, the intensity of which
suggested that he might eventually develop a
serious breakdown, were about to prove
intolerable.

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From the account of these cases there is little
doubt that the failures are motivated acts, that is,

they serve to gratify various unconscious wishes

that are unacceptable to the conscious mind, and

thus they are in the nature of neurotic symptoms.

Certain motives are apparent in all cases, for

example, an unconscious aggressive attitude

towards a parent and a self-punishment for this.

In the first two cases the failures seem to be
designed to prevent the subjects assuming the
emotioned responsibilities of manhood while at

the same time acting as a punishment for bad

sexual impulses. Naturally one cannot generalize

on the data from so few subjects, but it is

interesting to note that in the cases of

examination anxiety reported by various

psychoanalysts during the past 10 years the same

motives of renunciation of manhood, the need for

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punishment, and revenge upon a parent, occur
almost without exception.

The unconscious motives giving rise to such

disturbances provide, of course, the answer to the

problem of why the examination situation is so

commonly an anxiety situation and is so readily

exploited by an unconscious conflict. Flugel

(1939) has already given an excellent review of

the psychoanalytic literature on examination

anxiety, and he shows how the history of the

examination system confirms Stengel’s view that

the examination has the unconscious significance

of an initiation rite. Their occurrence in our
society at the threshold of manhood would give

examinations this function and, as mentioned, the

conflict over the acceptance of manhood appears

to be the important source of anxiety in most of

the cases. Some degree of anxiety is to be

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regarded as usual because of the real importance

of the situation; failures are costly in prestige,

time, and money. And a little anxiety is not like a

little learning. If often acts as a stimulus to

adequate preparation and may possibly raise the

efficiency of the subject in some cases. The fear

of the consequences of failure will obviously

provide rationalizations, however, for deeper

anxieties of unconscious origin. Frequently the

degree of anxiety varies with the form of the

examination, for instance, it is usually said to be

greater with oral than with written examinations,

while oral examinations arouse different amounts

of anxiety according to the reputation of the

examiner. To some extent these differences have

a reality basis; thus the majority of students find

it easier to make the most of a limited amount of
information in a written examination. The

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unconscious factors can nevertheless be

important in these differences. Stengel (1936)

points out the cunning way in which a candidate

in an oral examination will expose his weak spots

in order to satisfy his need for punishment,

especially for forbidden exhibitionistic impulses.

Little pieces of information added to an answer to

impress the examiner often lead the latter to

follow up a topic on which the candidate is

poorly informed. This situation involves the

unconscious motives of the examiner which will

alter the candidate’s anxiety according as the

examiner derives pleasure from being the loving

helpful parent, or from making an aggressive

attack upon the unfortunate candidate. (Guilt over

unconscious exhibitionistic impulses is probably

an important cause of anxiety in interviews and in
being examined medically.)

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In support of the contention that the
examination signifies an initiation rite to the

unconscious mind, Flugel quotes many of its

irrational features. It implies the testing of a

younger by an older person and so provides a

situation onto which various conflicts over

parents may be projected. Hence, no doubt, the

almost universal presence of some amount of

irrational anxiety. If the testing of knowledge

were its sole function, then on rational grounds

the test should be repeated periodically to ensure

that the knowledge is being maintained — a point

especially applicable to the professional

examinations in medicine. Examinations only

became systematized with the development of the
universities into organized bodies, and it is

probable that the degree ceremony grew out of

the much more informal initiation among student

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groups. The ceremony usually involved some
bullying of the student, then a welcoming of him

as a comrade, and finally a feast must be provided

at his expense. Flugel suggests that the first two

features contain the castration and guilt motives

of all initiation ceremonies and are seen in many

of the rituals still preserved in some degree

ceremonies. A more readily appreciated irrational

feature of all academic degree examinations and

initiations which he mentions is the extortion of

money, which persists no matter how much the

other aspects of the ritual may have become

unrecognizable.

The very low incidence of acute examination

difficulties does not warrant any

recommendations on the desirability of

abolishing examinations. The reliability and

validity of well-constructed tests are high. It will

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be noticed, however, that a subject who is always
anxious in examinations will not lower the

reliability since his performances will be

consistently bad; but the validity of the measure

in such cases will be low. The unconscious

significance of the examination as initiation rite

suggests that perhaps many features of the

examination system in its present forms are

retained to gratify the aggression of the fathers

towards the sons rather than to improve its

function. In this connexion one thinks of the

practice of conducting short oral examinations on

knowledge that has already been tested

extensively in written papers, a practice to which
examiners in the medical curriculum seem to be

especially prone. Another feature of this

curriculum, which appears to be maintained by

the same motivation, is the habit of teaching all

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clinical work by having one student examine a
case while others watch. The time taken in

dragging answers from the initiate would

certainly be much more efficiently used by the

teacher were he to demonstrate the case himself,

bring out the main points, and then leave the

students to practice the elicitation of these. This

unconscious meaning must also be considered as

the probable cause of examination worry being

blamed for neurotic illnesses, but the cases

described, and those of all other writers, show

that severe disturbances over examinations are

associated with longstanding and usually serious

personality disorder. Treatment of these

underlying conflicts is naturally a long slow
process, yet it was gratifying to find in the cases
described that enough insight into the symptom

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could be gained in a comparatively short time to
enable the students to break a very vicious circle.

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8.

FAIRBAIRN’S CRITICISM OF BASIC

PSYCHOANALYTIC CONCEPTS

Freud’s metapsychological theories were, as

he repeatedly stressed, his speculations on how

the phenomena of psychological conflict could be

explained keeping in mind not only his clinical

findings, but also his knowledge of the central

nervous system and of contemporary biological

thought. The most striking clinical fact he had to

contend with was the intensity of the pressure

with which impulses or ideas, discovered to be

sexual in nature as a rule, sought discharge

against the wishes of the individual. The

discharge of these foreign elements

characteristically relieved tension, usually

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accompanied by a feeling of gratification. He
therefore thought he had to account for drives or

forces of a peculiarly impelling kind in these

impulses and for the repression of their origins

and nature from consciousness. The final forms

his theories took were his concepts of the id, the

ego, and the superego. Freud included the

instincts in the id, but they were not regarded as

giving the id an organization. The id was a

chaotic seething cauldron of excitement that

acted as a reservoir of energy. Instincts for him

did have objects and aims, nevertheless they were

so plastic in man that what seemed to matter most
for him was the “drive” in them. He therefore

retained as the sources of this drive the libido or

sexual energy and the destructive energy of the

death instinct, both of these psychic energies

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being derived from transformation of the
activities of body cells.

In relating energy to structures in the psychic

apparatus in a way that would account for the

specific manifestations of psychological conflicts

and behaviour, Freud had eventually to create the

dynamic structures of the ego and the superego.

At birth there was only the id with its plastic

instincts determining relatively unstructured

behaviour. Within the next few years there

developed from it as a result of the experiences of

the child the two dynamic structures, the ego and

the superego, and the energy for their functions

was taken over respectively from “desexualised”

libido and the death instinct.

As Fairbairn (1956a) indicates, these concepts

present difficulties that can be looked at from two

angles, namely, their consistency with the general

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scientific and biological thought of today and
their value in clinical work. These two angles are

naturally closely related yet, as in other branches

of science, gaps and even inconsistencies

between pure and applied theory can exist until

certain facts demand changes in one or both.

Fairbairn states that changes are now demanded

on both grounds.

On the general grounds, it would be widely

accepted that the notion of a free energy with an

aim is out of step with the views of energy in

physical sciences; and from general biological

considerations it seems unlikely that the

constellation of instinct patterns in man would be

so relatively unorganised as is assumed in the id

concept and the libido theory. But, as Fairbairn
points out, it is the unsatisfactory picture of

behaviour given by the libido theory that is more

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important. It implies that conflicts arise from the
need to seek pleasure, an affect which Freud

related to the conditions under which id tensions

were discharged. There is here, however, a gap

between pure metapsychological theory and

working clinical hypotheses, and because the

level of abstraction of the libido concept is so

different from that at which the psychoanalyst

works, the difficulty has been largely ignored. At
the clinical level, the phenomena of conflict
between conscious and unconscious motives are

in fact interpreted largely in terms of object

relationships. It is incompatibility between the

urges to do certain actions with objects, and in
particular the conflict between loving and hating

relationships, that constitutes the core of

analytical work. Thus, most psychoanalysts

would accept Fairbairn’s view that conflict is

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essentially related to interpersonal factors. In

other words, in accounting for the nature of

conflict at the clinical level Freud’s divorce

between energy and structure hardly enters into

consideration. It is, for example, the libidinal or

the aggressive impulses towards the mother or

father that matter rather than the operation of the

hypothetical libido or death instinct. Indeed many

analysts do not accept the theory of a death

instinct. Instead, their instinct theory resembles

one that would be more in keeping with instinct

theory in animals, that is, it involves impulses to

specific actions with objects. At the same time, it

would not be true to say that the present instinct

theory of the id is not without its influence on

clinical work, and here Fairbairn’s plea for a
more systematic object-relations theory, that is,

one in which all drives are conceived as having

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specific aims with objects, is in my view justified
not only in the interest of logical tidiness, but also

to alter concepts that may be impeding advances

in theory and practice. The fundamental nature of

the issues he raises makes it difficult to do justice

to his views in a brief statement, and the

following points are merely a few of the

considerations his views have suggested to me.

1. The large bulk of evidence regarding the

nature of neurotic conflict shows
increasingly that unconscious motives are
unconsciously sought relationships; they
represent desired relationships with internal
objects, which the individual wishes to
achieve in the external world. The work of
Klein and her associates, Fairbairn, and
others has shown that analysis as an
instrument of investigating unconscious
activity can be increased greatly in power
and scope by the use of a more systematic
object-relations theory. Thus, if we take the

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phenomena of autoerotism and narcissism,
these were formerly, under the influence of
the libido theory, regarded as precluding
analysis when present in an intense degree
because they represented objectless
discharge of libido. Klein’s work, however,
has shown that even severe schizophrenics
with markedly narcissistic withdrawal can be
kept in an analytic relationship by the
constant interpretation of their behaviour in
terms of relationships with objects of the
most primitive kind. A meaning can be given
to the autoerotic and narcissistic behaviour
when it is regarded as deriving from the
earliest internalised objects, the nipple and
breast, and such interpretations permit the
subject, at least for a period, to make more
externally directed relationships.

2. An object-relations theory is the most useful

one in accounting for the most characteristic
phenomena of the analytic relationship,
namely transference, and for the effects of
interpretations. There is a widespread
agreement that it is chiefly when the

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individual experiences towards the analyst
the aims of his unconsciously sought
relationships that changes in the intensity of
these occur and hence fundamental changes
in the personality. Yet the full implications of
this well-known observation have not been
adequately related to the psychoanalytic
theory of the personality.

3. A libido type of theory, that is, one in which

drive is regarded as divorced from structure
in its origins, is still used by some
psychiatrists as the basis of their clinical
action, but the clinical findings do not
confirm the value of the theory. Thus it is on
the basis of this type of theory that changing
the balance of the sexual hormones, or other
biochemical processes, is thought to hold out
a means of altering some of the sexual
perversions, because through such somatic
interference it is hoped to change the
libidinal tension. No substantial or consistent
changes, however, in the pattern of sexual
behaviour have been obtained in this way.

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4. The great lack in the theory of personality at
present is a framework with which the chief
determinants of behaviour can be formulated
and assessed. The identification of the main
unconsciously sought relations would give a
good account of the forms of relationship
with people and things that the individual
seeks in the external world, and with clearer
identification, it should be possible to make
even rough quantitative assessments of the
strength of these relationships. With such a
scheme, better predictions than we are able
to make at present could be achieved,
especially in regard to the course of events to
be expected during analytic treatment where
they could be tested. A description of the
personality in such terms would also permit
of more precise meaning being given to such
notions as ego strength. Hitherto analyses of
very disturbed patients have at times had to
be given up, or have not been undertaken, on
the grounds that the ego was too weak for the
unconscious forces the patient had to control.
Concepts of ego strength, however, have
never been very satisfactory in relation to

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clinical work and general theory. An object
relations theory can make more specific what
is missing, usually the structures derived
from the normal good experiences of the
child. When such relations with good
internalized objects are too impoverished,
there arises the problem of whether or not the
analysis can proceed without some
replacement experience. A few analysts —
Winnicott and severed American analysts—
believe that such patients need to be
permitted to make a relationship with the
analyst in which the latter can be felt more
directly as a person, for example, by his
being in limited ways more “active.” Most
analysts at present do not share this view,
and only further clinical work with more
adequate means of assessing changes in the
dynamics of the personality will throw light
on this issue.

Fairbairn’s case for a psychology of the

personality in terms of its object relations is

therefore in my view important and timely. His

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formulations have clearly sharpened his clinical

observations and these have been widely

regarded by many psychoanalysts as constituting

an important contribution. With regard to his

particular psychic structures, it is perhaps

premature to comment on their value as such

views require considerable testing out in practice.

It is interesting to note, however, that Winnicott’s

independent formulations of a true self', that is, a

self that can give free expression to feeling, and a

false self that is, a self that conforms to the

inhibiting pressure of the outer environment,

closely resemble Fairbairn’s structures.

While the libidinal and antilibidinal egos may

represent the outcome of the attempt of the

personality to reach maximum integration, these

structures give the impression of a greater degree

of organisation than appears to be the case, at

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least in some patients. If we take the antilibidinal

ego in many severe hysterics, clinical findings

would suggest that this has active substructures.

Thus, in order to secure libidinal gratification,

such persons may identify predominantly with

one parent and be persecuted by the attacks of the

imago of the other, and then at other times

reverse the predominance of the identification.

Interestingly enough, too, a common remark of

such patients is that they do not really know

“who they are,” that is, they have no feeling of a

stable constellation in either of these larger

structures of Fairbairn’s.

A last point may be made concerning

metapsychology and internal objects. There can
be little doubt that it was the inadequate nature of

the means at his disposal for relating energy to

structure that prevented Freud from solving this

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problem more to his satisfaction. Had he had

available the concepts of modern physics and

neurophysiology, he would have been freed from

the restricting effects of what Colby (1955)

describes as his “hydraulic metaphors.” When the

cathexis energy of ideas, and so forth, in the

psychic apparatus can be related, as Colby has

done, to the frequency period, synchrony and

dysynchrony of pulsations, then the structural

nature of drive can be much more readily

illustrated by a model. As a prelude to the

description of his model, Colby makes almost the

same criticism of the classical id, ego, and

superego theory as does Fairbairn. A critical

point is that he considers that drive structures

must incorporate the notion of purposive aims

and the imago of an internal object must be
closely related to the aim of a drive schema. The

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development of Colby’s ideas will therefore be of
considerable theoretical interest. He is careful to

point out that his model merely serves at present

as a basis for relating energy and structure, and

that there is inevitably a considerable gap

between his metapsychological theories and

clinical application. Nevertheless, and this is

Fairbairn’s main thesis, the more the theories at

these different levels are in harmony, the better it

must be for clinical progress.

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II
GROUP
RELATIONS

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9.

SMALL GROUPS, THEIR

DISORDERS AND TREATMENT

INTRODUCTION

The rapid spread of interest in recent years in

the small group is perhaps due to the

development of new methods of studying it rather

than to a new awareness of its contribution to the

growth and maintenance of the person. Each
approach has produced an enormous volume of

research, for example, the field theoretical studies

of Lewin and his pupils, the large number of

researches stimulated by Moreno’s sociometric,

psychodramatic, and sociodramatic methods, the

interaction studies of Bales and his colleagues;

and alongside these are the great many

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descriptive observations from the group
therapists.

Faced with this vast volume of research, it

seemed to me that the best thing I could do for

people like ourselves who have to help

individuals in groups was to explore the

emergence of unifying concepts — those ideas

that make sense of the interrelatedness of the

individual being shaped within his family group

and then maintaining his growth through his

subsequent group memberships. For this purpose

I shall consider first the individual in the group,

next the group and its task, and then the process

of therapy and change in the group.

THE INDIVIDUAL AND THE GROUP

The dynamics of the interaction between the

individual and the group present us with the

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problems for whose solution the lack of an
adequate theoretical framework is most apparent.

On the one hand we have to account for the

fundamental needs of the person for

belongingness with others in significant ways. He

needs his identity, his achievements, and his

value to himself and others to be affirmed by the

members of the groups with which he is most

related. On the other hand, there are also to be

understood the various conflicting attitudes and

relationships, at times intensely emotional and

irrational, between members, and between

members and the group leader or leaders.

Perhaps many of our difficulties in finding a

set of concepts we can use to bring order into this

complexity stem from the way in which we

perseverate in our view of the individual as the

unit from which we start, isolating him and

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building up his future social modes from inferred
instinctive endowments and other properties of

the organism. If we conceive of the individual as

having built into him from the start the properties

of the social system in which he is reared, our

task of relating him subsequently to the groups in

which he functions is greatly simplified.

It is, of course, nothing new to draw attention

to the roles of the family in the growth of the

person. Nevertheless, the implications of the way

in which the family structures the person have not

been systematically considered in our theories of

the personality, its development, and in its mode

of functioning socially. The most helpful

concepts are those that are emerging in what is

known as the object-relations theory of the
person. This theory develops the view of dynamic

structures inside the personality built on

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representations of parental figures on whom the
child is dependent. Although the superego, the

best known of such internal structures, has

proved an indispensable concept in

psychoanalytic thinking, it has often been

regarded as a theoretical weakness that such an

“anthropomorphic” notion has to be imported.

The phenomena it relates to, however, are usually

admitted to be most aptly described by a highly

“personalized” structure of this kind, which

operates as an inner parent. For the understanding

of the nature of the individual’s social

interactions I believe, as Fairbairn has suggested,

that we must surmount our tendency to cling to

speculative neurophysiological notions and

postulate more boldly the kinds of dynamic

psychic structures our theory needs. Theories of

this kind have been developed by several

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sociologists, notably G.H. Mead (1952), and they

have had their most thorough-going and rigorous

expression in the recent writings of Parsons and

Bales (1955). It is of particular interest that this

latter group of some of the most eminent

sociologists of to-day, starting from their need to

account for the phenomena of family and social

interaction, are developing concepts that are of

the same kind as those being formulated by some

psychoanalysts to give meaning to the

phenomena of the individual’s relations with

himself and with others as these are seen in the

consulting room.

Because the most far-reaching object-

relations theories of the personality have been

developed in Great Britain, especially by Klein

and by Fairbairn, I shall draw on their

formulations. It is not the work of any particular

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individual or group I wish to present for your
consideration but rather to take from this work

what seems to be its common essentials. I

propose to outline its form in a way that indicates

the comprehensive effects of these in-built

relationships in all social behaviour.

The Object-Relations Theory of the

Personality

From the time he leaves his mother’s body,

the emotional experiences of the infant lead to the

segregation of their associated imprints in such a

way that constellations grow around “good” and

“bad” feelings. The earliest good experiences

make an idealised good object or imago of the
mother who supplies care and satisfaction of

needs unconditionally. (The dominance of the

infant’s experiences with the breast lead in some

workers, especially Klein and her school, to the

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concept of the earliest imagos being more related
to part-objects such as the breast, rather than to

the mother as a whole.) Correspondingly, painful

frustrations and the intensely aggressive feelings

associated with the violent attempts to get rid of

these pains, begin to build an inner object, which

appears to threaten the developing self with

devastating disintegration and destruction.

Between these two poles of idealised blissful

fusion with the good mother and the dread of loss

of the self, associated with an attacking mother

imago, there grows what can be termed the

central self in which the more reality-based

differentiation between the self and the mother

takes place.

Whatever the mechanisms are which

contribute to his attachments, the infant by the

second half of the first year exhibits a

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differentiated relationship with his mother.
Ethological research may well add new insights

here to be considered alongside the inferences the

psychoanalyst makes from the study of fantasy

and behaviour within the psychoanalytic setting

(see Bowlby, 1960). For the present it is sufficient

to appreciate this first crucial qualitative change,

namely, that an interrelated internal and external
social system has been established, and that there

is a high degree of interdependence between the

relations going on in this inner world and those

that are made with the outer world. The infant’s

resources for tolerating frustration grow because

he can now use this inner world in which the

inner good mother is part of himself. He can feel

that he is playing the part of his own desired

mother and so fulfil his longings in fantasy or in
play with his own body or with his rudimentary

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toys. It is the satisfactions from his real mother,
of course, that consolidate the inner imago.

Should his tensions become painful, he tends to

feel he is the object of a fantasy attack, which can

be terrifying at times, from the internal

persecuting mother. Ordinarily, the experiences

with his real mother, especially in times of stress,

will keep the effects of the threatening

experiences within manageable limits. A

preponderance of painful tensions, however, will

induce too frequent evocation of this frightening

inner figure with desperate attempts to defend

himself against what are felt as its attacks. By

projecting it outside he can secure a fantasy

safety, perhaps reinforced by a clinging to the

idealised internal object as well as by the

development of the defence of avoiding the

objects onto which the frightening figures have

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been projected. But the price of this phobic
defence is that the outer world becomes the place

where his dreaded objects are located and so his

interaction with it becomes restricted. Again, in

managing his interactions, he may tend to assume

the role of the attacking imago and turn his anger

on himself and his own longings.

An immense range of possibilities exists for

variation in the patterns that may get consolidated

according to the different properties of the

particular infant interacting with his particular

mother. It would appear that although relations

with his mother may be centred around a variety
of activities and bodily contacts, the common

pleasurable affective and erotic experiences

create the generalised image of her as a whole

person. Similarly, the common affective elements

in painful experiences seem to fuse these so that

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what may be termed a generalised “bad” mother

imago develops.

With the movement from complete

dependence to increasing autonomy, a process in

which weaning and the development of

locomotor abilities and speech play central parts,

the father begins to play a second major role. A

similar development takes place leading to the

creation in the inner world of structures

mediating the relationships with the good

powerful father who readily becomes the

prototype of independent achievement. And, as

before, an idealised father along with a more

threatening one are also differentiated in the inner
world. The addition of these father imagos

permits of a great range of inner relationships and

identifications and the appearance of sexual

interests and fantasies makes for the most intense

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use of these systems. Sibling relations and

identifications with other figures in later

childhood, often from stories as well as from

objects in the real world, also add to the

population of the inner world.

The Inner World and Social Relationships

The multiplicity of these inner object

relations and the variety of needs which go into

them do not require elaboration here. Of most

importance to us are the ways in which the adult
seems to function in his social relations as a

result of their creation. The following summary

account puts in condensed fashion some of the

main concepts.

1. The individual personality is patterned by its

growth within the family into a number of
dynamic object-relations systems which seek
to effect certain kinds of interaction with
others (that is, they are personal need-

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systems). Each of these systems represents a
part of the self related to an inner object
which defines in varying degrees the “other”
in the sought relationship. The presence of
the internal object within the system has two
consequences. First, it can be taken as an
object for part of the self so that the person
can in fantasy play the dual roles of self and
object thereby dispensing with the
uncertainties of the real external object.
Second, the internal object can be used as a
mould for selecting people who will fit into
it, or for coercing others into it by various
manipulations. Thus, the husband who
unconsciously wants to settle old scores in
regard to his sexually rejecting mother will
pursue a course of conduct with his wife that
will lead her to frustrate him even though she
is a tolerant and sympathetic partner, that is,
he will fit her into this unconsciously needed
role. Again, in the therapeutic group, a
number of passive dependent members will
often collude actively to get one member to
monopolise the therapist’s interest before

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they make resentful complaints about being
put into the rejected position.

2. These systems vary in their mode of activity

and in their degree of consciousness
according to their position within the
hierarchial organisation of the person.

3. Those which are felt to belong to that part of

the self the individual wants to be, come
within a central organising structure of the
self, the part we usually refer to as the ego.
This overall system leads to a range of
relationships being sought and maintained
and it is characteristic of these relationships
that they are largely reality based, that is, the
different identity and reality of others is
accepted and mutual adaptation and learning
takes place within these relations. The
internal objects of this central system appear
to be very plastic in keeping with the
acceptance of the differentiated identity of
the other person.

4. Two sets of relationships systems are

separated from this central part of the self:

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(a) those containing certain repressed needs
and (b) those concerned with primitive
control.

5. Repressed relationships contain drives to

satisfactions that were sought within the
original comprehensive relations with parent
figures but which were incompatible with the
preservation of these relationships. Because
they brought threats of parental loss or
retaliation, of varying severity and hence
associated with different intensities of
anxiety, these relations are segregated by
different degrees of “psychic distance” from
the central part of the self. They also tend
because of the original rejection of their aims
to have angry and destructive components.
Their separation from consciousness means
that little or no learning occurs through their
activity. They are, however, constantly ready
to go into action. Normally their aims are
realised in hidden substitute ways but more
direct expression tends to emerge in close
ongoing relationships with individuals or in
groups.

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A particularly important way of realising their
aims is by the mechanism of projective

identification. That is to say, the others who are in

ongoing relationships are used not only as

potential objects of repressed needs, but they can

also be manipulated to play the part of the self

that wants the forbidden relationship. For

example, an aggressive individual in a group may

be apparently unwittingly provoked and

encouraged by the others in order to express their

hostility to the leader; or a dependent person may

similarly be unconsciously pressed into the role

of the “sick one” to give vicarious satisfaction to

the dependent needs of members. The boundaries

of “the person” at these times have to include

“the other.”

The personality can therefore be regarded as

an overall system that maintains its continuity

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and consistency, its identity, through social
interactions. (The results of the sensory

deprivation experiments show how readily the

organisation of the personality can be disturbed

and acute anxiety experienced when the normal

constellating inputs are removed. Those

exceptional individuals who can withstand

prolonged isolation appear to do so because they

maintain a relation with an inner object, or

substitute object such as a social or religious

ideal. Even in these cases, there are at least

transient periods when the fight to keep sane is

nearly lost or abandoned.)

The central ego in the person is normally

engaged in a process of unceasing growth.

Concepts of homeostasis in regard to the

individual are apt to lose sight of the fact that the

person embodies the need to progress through a

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life cycle with changing achievement goals. In

other words, the future is a constant reference

point affecting behaviour.

The fundamental structures of his being

represent needs for attachment and for

achievement, and for defining himself in

cooperative relations with others. These needs

require membership of different groups for their

satisfaction and also that the social climate of the

groups permit their satisfaction.

The integrity and value systems of the central

self for most people are achieved only by some

degree of splitting off of the inevitably conflicting
aims of repressed needs. The common range of
defence mechanisms does not succeed as a rule in

extinguishing these needs and there is an

unconscious compulsion to re-create social

relationships in which they can be satisfied. This

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leads almost universally to the selection of others

in groups for appropriate partial identifications.

Each person tends to choose a number of

members to whom he is attached in this way and

these choices reflect Moreno’s concept of the

social atom that each individual patterns for

himself in his groups.

Repressed relationships are to be seen

particularly clearly in therapeutic groups. When a

need in several members combines around one

individual who is detected as prone to realise it,

he is perceived as willing to take the lead in this

respect. This member is then cast in the

appropriate role, for example, the antileader or

“the sick one.” If the expression of the need

arouses too much guilt or anxiety, then the

member being used can be attacked or ejected as

a scapegoat.

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Whatever the mechanisms involved, group
situations appear to release at times less inhibited

ways of relating, which can have both positive

and negative effects. Most investigators are

against postulating any hypothetical “herd

instincts” and this parsimony would appear to be

justified on the grounds that innate social

response mechanisms would have been released

and structured within the person during the early

stages of his development within the family.

Relations with the Leader

The most striking group relationships are

those evoked towards the leader, and many

speculations have been made as to why this
should be so. Here again the situation in the

group seems to tend towards the reactivation of

some of the patterns in the family when the

immature individual is uncertain of his

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acceptance and status and of his powers of
control. In this connection it is of considerable

interest that Bales’s work has shown, and

sociometric studies tend to confirm, that many

groups function best with two leaders, the

instrumental leader who maintains the efforts of

the group to meet the demands of its task and the

emotional-expressive leader who accepts the

emotional needs of members while at the same

time supporting the instrumental leader.

Bion (1961), whose brilliant descriptions of

phenomena observable when the group has no

conventional “external” task to perform,

postulated certain primitive patterns which he

called basic assumptions. At first he implied that

these ways of responding derived from a specific

primitive mental system brought into action in
the group situation. Theories which try to relate

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such phenomena as Bion described by his basic
assumptions to innate mental systems or

mechanisms would certainly have to consider

evidence from group behaviour in cultures widely

different from western societies. Later Bion

suggested that basic assumption behaviour was

related to the earliest object relationships made

by the individual, that is, with the prototypes of

the leader. The theories used by Foulkes and

Ezriel to account for phenomena in therapeutic

groups also support the primary role of

unconscious object relations with the leader.

These concepts of the intra- and interpersonal

dynamics in the group clearly apply only to the
small group which is continuing with its structure

and culture over time. The small group is usually

thought of as comprising approximately five to

fifteen members and it may be that the term face-

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to-face group provides a link with object-
relations concepts in regard to these numbers.

Below a certain number there may not be enough

differences amongst the members to provide for

the projective identifications each individual

needs. It really does take all kinds to make a

world for the individual’s needs. Above the limit

quoted, the projections may get so diffused that

their connections with the self get lost. The term

face-to-face certainly has an implication of one

identity in relation to another, and only when the

identity of others can be perceived does it seem

that the individual feels his identity affirmed.

Some exploratory studies by Rice and Turquet in

larger groups (thirty to fifty) suggest that

individual behaviour in these groups becomes

more disorganised than in the small group, as

though individual responses were made

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anonymously. Apparently to counteract this
tendency to loss of identity, the large group tends

to break up into small groups of fluctuating

boundaries.

THE GROUP AND ITS TASK

The performance of the work group has been

the object of an enormous amount of research in

which a sociological approach is used, that is, the

behavioural manifestations are studied without

reference to what is going on inside each

member. Various effects on members’ behaviour

and attitudes through their group attachment and
group role have been established, but most

writers surveying these contributions have noted

that these effects have not been related to the

dynamics in the group by any coherent set of

concepts.

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Much work has centred around the
contribution of the leader and the effects of

different ways of filling this role. Older

approaches in terms of the leader’s personality,

usually implying an authoritarian relationship

between the leader and the group, have tended to

be superseded by functional considerations. Thus,

although a formal leader may be designated,

many studies show that the most effective work is

maintained when the leader can allow his

function to be shared at times by members so that

the latter feel that their needs for status as mature

autonomous persons with creative potential are

recognised and valued.

A most important line of thought in this area

is to be found in the attempts being made by Trist

(1963) on the basis of a deeper understanding of

the group process to link the structure and

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organisation of work groups with the member’s
emotional needs. This development is of

particular interest in industry because these

studies were initiated to dead with the high

incidence of stress manifestations in the groups

concerned.

A brief example of this work shows how an

organisation based on technological

considerations may not match the personal needs

of the group members. Traditionally, the task of

coal getting had been carried out by a self-

selected group which had a high degree of

responsible autonomy in carrying out their
difficult and often dangerous job. Under the new

methods, these groups were divided so that each

group had only a limited section of the total task

with coordination supplied by an external

management. One result was the creation of

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harmful tensions between and within these

groups. After prolonged explorations, a different

social organisation was evolved which, while

retaining the new technical methods, retrieved

some of the “self-regulating” features of the

traditional group. That is to say, it permitted the

psychological tensions thrown up by the human

interactions around the carrying out of this

particular job to be handled in an effective way.

The members were allowed once more to be

responsible people planning their own

contribution and relating it to what other groups

did. Careful comparisons showed that the new

social structure led to a fall in the total absence

rates, mainly due to sickness and accidents, from

20 percent to 8.2 percent, and also to a substantial

increase in productivity.

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The Concept of the Sociotechnical System

To provide a conceptual framework for

understanding and handling these situations in

which the pattern of group functioning required

by the technical procedures for the task must be

related to the personal and emotional needs, Trist

introduced the term Sociotechnical System. Every

group organised or existing for a job or task can

be regarded as such a system and I think this

notion can illumine much of our work with

groups other than those we are accustomed to

think of as work groups. In particular, I believe it

to be a valuable notion in dealing with the

tensions raised in the family group, faced with its
ever-changing tasks as it proceeds with its

developmental schedule over the years.

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As an example I should like to refer to a
family described by some of my colleagues in

one of their recent publications (see Pincus

1960).

In a middle-aged couple the marital

relationship had become the vehicle of
primitive projections rather than a
collaborative endeavour. This change had
become unbearable when the elder child, a
daughter, reached adolescence and began to
show manifestations of sexual interest. It
could be said that this family had “worked”
while dealing with young, and in the
parents’ view sexless, children and failure
developed with the appearance of the new
task of coping with sexuality in the children.
Unable to meet the new task, there was an
upsurge of primitive anxieties, which led to
mutual projections, especially by the wife,
of her intolerable feelings about sexuality.
From being a collaborative group concerned
with the natural development of the
children, the primary task in the family,
mainly under the wife’s leadership, became

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the banishment of sexuality. In the few years
before they were seen, the wife had
increasingly withdrawn from her husband in
proportion as she felt he was little more than
“dirty sexual needs.” In response the
husband had reacted by resorting to
evenings in the pub with men friends. The
daughter in an outburst of resentment with
the mother’s repressive attitudes over her
going out with boys left home.

This kind of situation, of course, can be

described in many ways and the value to my

mind of putting it into the framework of the

sociotechnical system concept is that by so doing

we see how similar disturbances can be created
by a wide range of new tasks. The family moving

to a new environment, should one or more of its

members fail to adapt, can begin to show the
same kind of change, namely, a stirring up within

the family relationships of primitive feelings and

anxieties when the previous equilibrium state is

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upset. Effective help requires the elucidation and
linking of the “external” and the “internal”

factors before new solutions can be achieved, a

process which can be painful and protracted.

THERAPY AND ORGANISATIONAL CHANGE

IN GROUPS

The questions all psychotherapists must ask

when pondering particular developments in

understanding groups will naturally focus on how

these help us with our tasks.

Group Therapy

As with the study of small groups in general,

the enormous literature on group therapy contains

relatively few of what Berne (1963) describes as

“creative ideas,” the kind of illuminating

framework that comes from “creative meditation

about nature.” Such ideas do exist, though, as he
notes, they tend to be ignored by professional

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researchers because of their “informal character.”
The significant contributions which he selects,

those from Moreno, Burrow, Bion, Foulkes, and

Ezriel, reassured me because I found I had made

almost identical evaluations. It seems to me that

in their formulations of the group process, these

writers have in common much of what I have

described by the term the object-relations theory

of the personality.

The particular value I attach to this view is

that it can help us formulate the essential task of
psychotherapy whether this is carried out within

the dyadic relation with the therapist, in the

analytic therapeutic group, or in a psychodrama.

The essence of this task consists in the provision

of a setting in which the repressed relationship
need systems can be brought back within the

organising system of the ego where they can then

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be used for new learning and adaptation. Many

analysts have asserted that what is done in

therapeutic groups is not to be identified with the

therapeutic process in psychoanalysis. I cannot

accept this view when we restrict our attention to

essentials. Some of our concepts have perhaps

contributed to our inability to see the common

core of our task, particularly such concepts as

“aggressive energy” and transference.

Psychotherapists frequently write of transference

interpretations when they point out emotions, for

example, angry feelings in the patient. Is this,

however, enough? Object-relations theory tries to

do justice to the crucial aspect of transference

phenomena, namely, the need to bring the

repressed relationship back to the one person

relationship from which it was split off. In this
way the individual is able to repeat in the here

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and now of his therapeutic relationship the
pattern of the original “there and then” situation

and hence he has the possibility of making a new

solution. As Ezriel (1950) has put it, object-

relations theory requires that interpretations

should present to the individual three components

in the following form: (1) When you say (or

communicate by behaviour) “x”, you are striving

to maintain relationship “a” with me, (2) but “x”

also indicates that you want to express another

relationship “b” with me, which you must not

admit to because you fear (3) relationship “c” in

which I shall do something disastrous to you

(reject, punish, attack, be sexual with, and so

forth). Thus the unconsciously sought

relationship, the defence against it, and the reason

for the defence are incorporated in these three

parts.

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In the group situation, the way in which the
unconscious relationships are expressed is

naturally different. The therapist is, nevertheless,

the central figure to whom these unconscious

relationships are directed and any therapeutic

work that ignores the constant reference of the

group towards him is in danger of missing the

important dynamics. As a rule, the relationships

sought by each member at any one time can be

inferred from the common theme occupying the

group’s interest. The defences adopted by

members are different in the group setting,

especially through the use of projective
identification into other members. The manifold

roles, which members fulfil at different times for

each other, may make the interpretation work

difficult for the therapist, nevertheless, when the

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therapist is alerted by these considerations his
work is facilitated.

The therapy of natural or primary groups such

as the marital relationship or the family has

become more popular in recent years perhaps as a

consequence of our growing appreciation of the

embeddedness of the person in his closest social

relationships. Here again, various degrees of help

can be given by the mere fact of a therapist

making a relationship with the family and

through which there is some facilitation of

communication. More intractable difficulties,

however, can often be helped only when the
unconscious collusions and projective
identifications can be brought into awareness.

The aggressive demanding husband in conflict

with his dependent passive wife has to be seen in

terms of the right unit-the total system constituted

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by their mutual interaction. The husband and wife
may not contain the difficulties within their

relationship and then we have to bring in other

members of the family.

Organisational Change

Reference to the task of trying to deal with

tensions within family relationships brings me to

the implications of trying to effect change within

the systems established in small groups. If we

remind ourselves that the characteristics of each

system have been evolved to deal with the

threatening tensions within it, then we will be
prepared for the consequences of trying to change

it. All of us are familiar with the anxieties

aroused within the individual when he begins to

alter his defence systems and it is inevitable that

such alterations within the defensive patterns of a

social system will also release anxiety and a

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degree of acting out. Social systems, like
therapeutic groups, can create special difficulties

during the change process, but it is also true that

they offer considerable positive features in the

support that members can give each other. When

the group we are trying to help is part of a larger

social system, then the effects of the larger

organisation on the group have also to be taken

into account and vice versa.

New satisfactions have to be experienced and

accepted before the old ways can be given up and

during this process the role of a therapeutic

person or group of persons has a close parallel

with the role occupied by the therapist for the

individual (See Menzies, 1960, and Sofer, 1961).

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THE SMALL GROUP IN MENTAL HEALTH
PROGRAMMES

The recognition of the role of group

membership as a requirement for personality

functioning has stimulated much of our efforts to

provide social settings for our patients to which

they can either continue to belong or from which

they can gain resources to participate in other

groups. This topic does not need comment here

but in developing more positive mental health

programmes two points may be noted.

First, because it has become part of our way

of life to live in a rapidly changing environment

— and in recent years the psychiatric
consequences of dislocation have been a

prominent feature in most parts of the world —

we may ask if there are ideas which can help to
forestall and to equip people to meet these

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changes. Much useful knowledge has been
gained and I merely wish to draw attention here

to the role of the family again. Many sociologists

have commented on the way in which the family,

and especially the marital relationship, are having

to bear increasing stresses. The more the family

is separated, the more has it to try to resolve by

itself the inevitable powerful tensions within its

relationships. Appropriate group memberships

for the various members at the different stages of

their development obviously relieve these

stresses and bring increased resources to all. The

healthy family itself is probably the best training

ground to equip the individual to meet change

because it is coping with constant growth and

change in the role and status of all its members.

We must therefore devote much more attention to

the family as our most important unit of study

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and I have suggested that the object-relations
concepts would seem to be most promising.

The second point concerns the role of the

work group. Since participation in work groups

plays such a large part in our lives, we have to

learn much more about making these contribute

to the enrichment of the person. The changing

nature and role of “work” under the advances of

automation will also demand much new thinking.

Fortunately, progressive management is moving

in the direction which we, as promoters of mental

health in the widest sense, want to follow. We as

psychotherapists have, however, also a duty to

help by elucidating the phenomena of interaction

and human needs. I have tried to indicate how the

object-relations concepts are illuminating the
dynamics of group process in ways that permit

social and industrial administration working with

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the social psychologist to evolve methods of
combining our production needs with small group

structures that foster the individual’s personal

growth and well-being.

SUMMARY

Much recent work in psychoanalysis and in

sociology points to the value of the object

relations theory of the personality for

understanding social interaction in the family and

in small groups. This theory tries to account for

the development of structures within the

personality based on the central social

relationships that have been experienced. These

structures mediate a variety of needed personal
relationships, both conscious and unconscious.

The theory sheds light on the way in which the

individual distributes these needed relationships

in the groups to which he belongs and it therefore

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bridges the gap between personality theory and
group process.

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10.

THE ONE-WAY VISION SCREEN IN

ANALYTIC GROUP
PSYCHOTHERAPY *

ADVANTAGES AND DISADVANTAGES OF

USING THE ONE-WAY VISION SCREEN

The use of the one-way vision screen in

analytic group psychotherapy stems from the

need to provide students and research workers

with a firsthand experience of the phenomena

occurring in psychotherapeutic relationships. An

alternative practice to the use of the screen is the

introduction into the room with the therapist of

one or two trainees assuming the roles of (i) a co-

therapist, (ii) a participant observer, or (iii) a

nonparticipant observer. A co-therapist is

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involved in the therapy as actively as the group
therapist. The division of the patient’s feeling

between the two therapists, however, proves to be

a negative feature in the treatment situation, since

the crucial point for psychotherapeutic change

seems to be the bringing together of the patient’s

ambivalent feeling towards the same therapist.

The discrepancy in skill, moreover, between a

trainee and an experienced therapist introduces

further complications. A participant observer in

group therapy intervenes only occasionally,

remaining silent or taking notes most of the time.

A nonparticipant observer takes no part at all in

the group’s discussions and, unlike the participant

observer, sits clearly separated from the group. In

comparison with having observers present in the

therapy room, observation through a screen has

distinct advantages to offer: (i) more trainees can

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be accommodated, (ii) new observers can easily
be introduced during the course of severed years’

therapy without creating recurrent disturbance in

the group, and (iii) it is possible for senior

therapists to observe each other’s technique in

occasional sessions.

A therapist making use of the one-way screen

for training purposes is confronted with two

kinds of questions: (a) those pertaining to the

ethics of the situation, and (b) those concerning

the possibly deleterious effects on the treatment.

The ethical questions concern the therapist’s

professional responsibility not to betray the

patient’s confidence, and have been met in

various ways. The patients are given a free choice

in the situation: they are told about the screen and

the demands of training; and, in the case of an

objection, an alternative group is made available

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to the patient. The responsibility for proper
selection of the observers rests with the therapist;

he exercises control over admission to the

observation room and only bona fide professional

workers are permitted to observe. With these

safeguards it is hard to believe that the use of the

screen shows less respect for the patient than

does the situation in out-patient clinics where an

interview may be conducted in front of medical

students and allied staff.

While the objections arising from ethical

considerations can be met, no easy answers have

been possible to questions about the effect of the

screen upon therapy or about its dynamic

significance for the patients. Prejudgements are

common on this matter. The present study was
conceived in an attempt to clarify some of the

issues involved and to suggest hypotheses based

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on a careful examination of the tape records
available for a therapy group.

Questions concerning the effect of the screen

on the therapist, though highly relevant, could not

be considered in this study due to insufficient

data. The questions that the study hoped to

consider were as follows:

General Effects

1. Does the screen exert an overall effect on the

group situation?

2. If so, what is the nature of the effect? Thus:

a. Does the screen act as a general
distraction such as a constant
unpleasant noise might?
b. Does it have a general inhibiting
effect, for example, by making the
members more self-conscious or by
inhibiting the expression of more
personal and intimate feelings?

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c. Does it become a dynamically
significant feature of the situation,
the effect of which is more complex
than either distraction or social
inhibition tend to suggest? For
instance, would those disturbed by
the screen be using it at least in part
as a resistance?

3. Does the screen have a selective

psychodynamic effect in evoking certain
clusters of phantasies in the group as a
particular Rorschach card might, for
example, paranoid fears?

4. Are the effects manifested in an obvious form

so that concern about the screen is a
conscious one, or are they indicated less
directly, for example, in dreams?

Differential Effects

5. Does the screen affect only certain patients?

6. If so, how do the effects vary amongst those

affected?

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a. Do some patients show more intense
reaction to the screen than others?
b. Do patients vary in their mode of
response, for example, are some
affected mainly consciously while
others resort to more indirect forms
of expression?

7. Are individuals with certain kinds of difficulty

or make-up more prone than others to be
affected?

Effects of Group Process

8. Do the effects vary at different times?

9. If so, are they associated with any external

characteristics of the group situation, for
example, times of holiday breaks?

10. Does the prevalence of certain feelings in the

group lead more readily to the screen
becoming a topic of concern, for example,
feelings of dependence or depression?

11. When one member refers to the screen, what

purpose does it serve at the time?

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12. On each reference, does the screen become a
group theme? If sometimes it does and at
others it does not, how can these different
developments be explained?

It will be clear that many of the above

questions are basic to the whole process of group

psychotherapy, and answers to them will have an

application beyond the screen per se. Such is the

case with question 12, for example, which is

concerned with differentiating between the times

when an issue becomes and when it does not

become a group theme. Questions of wider

significance for the understanding of group

processes have accordingly been given more

attention.

While several of the hypotheses suggested

might be applicable to group processes in

general, some of them might not hold true for all

kinds of group structure or where the technique

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of therapy differed widely from the one used. The
present study is exploratory in character and is

based on the limited data provided by a single

therapeutic group taken by the senior author. The

group is described below, along with a brief

account of the psychotherapeutic approach

commonly used at the Tavistock Clinic.

The Group

The group consisted of four men and four

women, ranging in age between 30 and 40, all of

superior intelligence and of similar educational

background. The difficulties for which they had
sought help included the common psychoneurotic
symptoms and character problems, for example,

inadequacies in social relationships and in work,

claustrophobia and exhibitionistic anxiety,
obsessional behaviour, and psychosexual

difficulties. In all cases, the symptoms were of

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many years duration; three patients had had in-
patient and two of them out-patient psychiatric

treatment.

One of the women dropped out of the group

after 4 months, so that by the time of the second

screen reference in Session 21 there were only

four men and three women patients in the group.

The group room was a small one with a

screen, 6 feet long by 3 feet high, on one of the

longer walls. Two microphones were suspended

from the ceiling about 5-6 feet from the floor

over the centre of the group circle.

Sessions of 1½ hours were held weekly.

The Therapeutic Method

The therapeutic approach used in this group

was the one developed at the Tavistock Clinic

and based on the work of Bion (1961) and Ezriel

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(1956-57). With this approach, the therapist’s
attention is focused on the transference, that is,

the conscious and the unconscious relationships

that the patients make with the therapist and with

each other in the here and now of the group

interaction. The group is allowed to develop

spontaneously and the therapist uses the content

of the discussion and the behaviour of the group

to bring out:

a. The conflicting feelings and motives

expressed within a common theme, such as
anger with the therapist or longings for a
special, intimate relationship with him, along
with inhibiting fears such as rejection by the
therapist or humiliation before other group
members.

b. How each individual tries to deal with the

common tensions underlying a topic, that is,
the particular defences adopted.

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DATA

Typescripts based on tape recordings were

available for the 2-year period when the group

met behind the screen as well as for ten additional

sessions after it had moved from the screen room

into the therapist’s office where no observers

were present. The typed records were read

independently by the two investigators, and all

instances were noted where either a manifest or a

latent reference to the screen was made by any

member of the group or by the therapist. There

were, in all, thirteen such references, each of

which has been summarized below, along with an

abridged account of the context in which it

occurred. There are also brief notes on the
general happenings within the group during the

intervening periods. Every summary is followed

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by brief comments in which are indicated the
significant points emerging from each instance.

Sessions 1-5 (October-November)

In the early weeks the group was absorbed in

learning how the sessions would be conducted

and in getting to know and trust the therapist and

each other. A woman member (Miss S) became a

preoccupying concern because her compulsive

monopolizing of attention and aggressive

nagging were difficult to tolerate or alter.

Competitive feelings for the therapist’s attention
with consequent fears of rivalry and of
unsympathetic attitudes from other members

emerged. At the end of the second meeting Miss

C asked for a private session to discuss

something which she could not bring out in the

group. She was told it would be better to try to

bring it up there. During the next few sessions

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she started a practice of sitting beside the
therapist where in addition to being close to him

she had her back to the screen.

Reference 1. Therapist’s initiative.

Session 6. Miss B absent

Towards the end of session 5, the members

had discussed whether or not they were a group.

Miss C was most expressive of her feelings in

saying they were not a group: “Everybody is a

separate entity who is only interested really in

their own problems. ... I don’t feel part of a group

at all.” In response to a comment by the therapist

about the members’ need to be accepted and

loved by him, she stated that she was getting into
a “state” and that she did want to be loved by

him.

At the beginning of Session 6 a member

pointed out how Miss C had turned to the exit

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door instead of towards the therapy room. Miss C
remarked it must have been automatic and invited

the group to discuss it if they liked. The group,

however, ignored her and took up a suggestion

that they should use their forenames. This move

towards achieving some degree of group

cohesion did not last because of Miss S’s need to

control the proceedings. Later the group became

concerned with the way in which strong feelings

such as depression and inadequacy tended to

overwhelm them and here again Miss S took the

lead in exploring these feelings and in

questioning others about them.

The therapist commented on how the group

members reacted ambivalently to Miss S. On the

one hand they resented her need to monopolize,
but on the other they colluded to put her into this

position. He went on to interpret the role of each

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member in some detail and in connexion with
Miss C referred to her difficulty in feeling a part

of the group and her concern over not getting his

exclusive attention. Perhaps, too, she felt he was

more interested in people behind the screen

because she had made a point of sitting close to

him with her back to the screen. This reference to

the screen was not taken up by any member of

the group during the rest of the session.

Comment

In this session the therapist took the initiative

in referring to the screen. This arose partly from

Miss C having reacted strongly in a preliminary

inquiry on possible objections to joining a group
that would be observed through the screen. She

had then stated that she would be worried about

being watched but would accept the situation. In

addition, she insisted, rather assertively, on taking

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the chair next to the therapist, and the one with its

back to the screen. She had sought a private

interview with the therapist and had declared that

she did not feel a part of the group, implying that

the other group members (and perhaps also the

observers) were in the way of her securing a

relationship with the therapist.

The reference to the screen was brought in as

a part of a comprehensive comment about the

group theme and the role of each member in it.

The group members seemed too preoccupied with

what was going on inside the group, particularly

their feelings about Miss S’s domination, for the

observers to become a theme of immediate
concern.

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Sessions 7-20 (November-March)

The hostility to Miss S gradually became

more open, as also did the group’s collusion in

allowing her to continue her domination as the

“controlling mother.” After she left (Session 15),

there was a good deal of guilt worked through

over her departure.

Rivalry situations and social difficulties then

began to be discussed more directly. Miss C

frequently described the triangular situations she

got into with other women in her office over their

relationships with the boss. The nature of the

sexual conflicts in the group became more

manifest and fears of uncontrolled sexuality
began to be expressed.

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Reference 2. Therapist’s second
reference. Session 21. All members
present

In the previous session, the last before a

holiday break, Miss O had told the group about a

novel she was writing. The story depicted a near-

incest situation, in which a man and woman fell

in love without knowing that they were a brother

and sister who had been separated. Later in the

same session dependent feelings of several

members, aroused by the break, became
prominent. The next day Miss O had such tense

feelings that she called the Clinic to ask if the

therapist could see her but this was not possible.

In the first session after the break Miss O

referred to her disturbed episode and later the

group went on to discuss the incest theme in her

novel. A few members brought memories of

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oedipal phantasies from childhood. The therapist
pointed to the disturbing thoughts and feelings

associated with the incest theme and suggested

that the group was perhaps resentful with him for

exploring them as well as for heightening such

feelings by the break.

Following these comments, there was a short

discussion about the significance of the break.

Then Miss C mentioned her difficulty in

participating in the discussion about incest. She

went on to describe her worries about a party
where “people will talk about subjects that are

beyond me.” The therapist pointed out that her

difficulties and worries seemed to relate to the

incest theme. This was illustrated by the fact that

right from the start of the group she had wanted

to have a special relationship with him, for
example, she came and sat beside him in every

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session. There she sat with her back to the screen,
perhaps to forget the observers and to cover up

her guilt.

The therapist’s reference to the screen was

completely ignored by Miss C and by the group

during the remaining 20 minutes of the session,

and there was no reference to it in the next

session.

Comment

The holiday break had increased the tensions

arising from the oedipal phantasies. The
resistance to recognizing the sexual longings

underlying these phantasies was particularly

striking in the case of Miss C, the patient whose

acting out of the oedipal situation in the group

had begun to irritate the other members. This

second reference by the therapist to the observers

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was intended primarily to breach her massive
resistance to recognizing her need to be “the

boss’s woman.”

The group ignored the reference to the

observers and remained preoccupied with the

impact of the incest theme. To have allowed the

screen to assume importance, even had its

significance been restricted to Miss C, would

presumably have meant admitting embarrassing

sexual phantasies about the therapist in the here-

and-now situation.

Sessions 22-29 (April-June)

Angry frustrated feelings with the

disappointment over magical expectations about

treatment became more open. Mr W brought the

problem of having become attached to a girl who
was homosexual. Oedipal rivalries within the

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group, in triangular conflicts outside, and with
inner parental figures, now featured prominently.

In Session 29 Mr W surprised everyone by

describing a period of several days in which he

had experienced a striking change in himself,

namely, affectionate longings for the therapist

along with compulsive locking of cupboards,

turning off of taps, and so on. The homosexual

nature of these feelings and his defences against

them were interpreted and discussed.

Reference 3. Miss O’s anxiety about

observers. Session 30. All present

Discussion developed on the theme of how

people draw attention to themselves. Miss O

described an amateur dramatic group in which

she was passed over when parts were being

allocated. Interest continued in the question of

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how some people grab the parts while others are

left out.

The therapist interpreted that they were

expressing their own competitive feelings in the

group. In the subsequent discussion the rivalry

theme was dropped and several members began

to talk of their feelings of depression and

inadequacy. Miss O said at this point that she

knew that some of her colleagues might be

coming to the Clinic as part of a social work

course. She would hate to have colleagues

listening and would be relieved if she were

forewarned. In discussing her feelings, some

members remarked that it was extremely unlikely
that her friends would be there. Miss O stated she

really knew this, but she still had a strong feeling

of being watched.

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The therapist remarked that the concern about
the observers stemmed from a fear of humiliation

and punishment, which were appropriate to

wanting a special relationship with him at the

expense of the others. The interpretation was

followed by some remarks about how they hated

being laughed at, Miss O adding, “especially

behind my back.” The therapist commented,

amongst other remarks, that Miss O seemed to

feel that if she brought her longing to him, he

would go off with the people behind the screen to

laugh at her. Miss O said that she had often

wondered whether any observers were actually

there, and another woman replied that one night

they were heard laughing behind the screen. One

of the men (Mr L) added in a casual way that the

only thing to do was to develop a sense of

humour. A third woman (Miss B) said she did not

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bother about the screen and asked if this was a
peculiarity of hers. Mr T remarked, with obvious

tension in comparison with the others, that she

was very lucky not to care, and Miss O wondered

if she was pretending to herself about this

indifference. It was said that if the people behind

the screen did laugh at them they would be very

unprofessional. Mr T commented that when they

felt inadequate, other people might not really be

laughing at them at all and added, “Somebody

might have fallen off the chair in there” (that is,

behind the screen).

Comment

The questions of interest are why one

member brought in the observers and why, in

contrast to the previous references, they became

the object of the group’s concern.

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Miss O’s introduction of the screen
presumably represented a displacement of anxiety

caused by rivalry with members of the group to

external rivals, since to continue the discussion

with direct reference to her interest in the

therapist would have brought into the open the

painful rivalry situation in the group. The group’s

response to the observers indicated a sharing of

Miss O’s need to displace anxiety from the group

to the feared rivals outside. In the early part of the

session, there had been a withdrawal from the

longings for the therapist (the sexual aspects of

which had been commented on by the therapist at

this period), and the group had shared the

feelings of inadequacy which the sensing of the

inevitable frustration of these sexual longings had

brought—“there would be no good parts in the

play for them.” By using the observers rather

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than the other group members as the rivals, Miss
O provided them with a new opportunity to

express their rivalry. For most of the group,

however, the thoughts and feelings they described

themselves as having in relation to the observers

were more influenced by reality than was Miss

O’s phantasy-determined image of them.

Reference 4. Mr L’s Phallic phantasy

about the microphones. Session 31. All
present

A discussion started about Christianity,

morality, and sex, and the questions of freedom

and control in sexual matters were then taken up.

The therapist commented that the group was

anxiously concerned about what would happen if

sexual thoughts and feelings were to continue to

be freely aired without the group observing the

various taboos and prohibitions.

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After a brief silence, a group member asked
Mr L if he had any views. Mr L said that he was

sorry, his mind was distracted, and, pointing to

the microphones, he added: “Actually I was

wondering what on earth these two balls hanging

there are. I am sorry I was not paying attention.

Perhaps they are phallic symbols.”

The group ignored Mr L’s reference to the

microphones and went on to discuss further the

questions of religion, sex, and morality.

Comment

Although the microphones were obviously

there to let the observers listen, Mr L’s response

to them was, as he himself implied, more to be

related to sexual phantasies stirred up by the
discussion than to the observers with whom any

manifest connexion seemed remote. The directly

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sexual nature of his reference may also suggest

why any latent feelings the group had about the

observers had to be suppressed. Sexual feelings

could only be brought in as a general topic and,

moreover, in the context of how they should be

regulated. For the observers to have become an

open concern in this context would have meant

the expression of sexual thoughts about the

therapist and possibly sexual phantasies about

him and the observers — themes which were

only beginning to emerge and to which there was

still strong resistance.

Reference 5. Miss O’s implication of

continuing tension over the
microphones. Session 32. All present

As the group entered, they talked of how they

tended to sit in the same places. After they sat

down Mr W noted the fact that they had all taken

their usual seats and Miss O and Miss B agreed

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that they had. Miss C, however, asked if Miss O

was sitting in her usual place and Miss O

answered that she preferred the seat she had,

though as a rule she came in too late to get it.

Miss B remarked that it was much more

comfortable in the waiting room and Miss C

added that perhaps the chairs in the waiting room

were more comfortable. Miss O pointed to

another difference: “No microphones there.”

After a brief silence one of the women (Miss B)

said that the group ought to continue the

discussion started in the waiting room.

The therapist commented on how they had

preferred the waiting room, including Miss O’s
observation on its lack of microphones, to the

therapy room where he exposed their secret

sexual phantasies.

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The reference to the observers was not taken

any further by the group.

Comment

It was again Miss O who made the second

explicit reference to the observers. Strong rivalry

feelings had become apparent in the discussion

about seats. Miss B wanted to get away from

these unpleasant rivalries by her reference to the

pleasanter atmosphere of the waiting room. Miss

O, also wanting to avoid group rivalries,
attempted to displace her resentment onto the

observers. For Miss B the observers were too

close to the group situation to be allowed into the

discussion, so she again brought in external

situations.

With regard to why the group did not take up

the observers as a common theme on this

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occasion, it may be noted that there had recently
arisen anxious and aggressive feelings resulting

from the frustration of repressed sexual wishes

towards the therapist, especially amongst the

women, and their anger had been displaced to

external situations. To have become more openly

resentful of the observers and their presumed

relationship with the therapist would have

entailed too explicit a confrontation of their guilt-

laden sexual longings for the therapist, their

dangerous hostility to the “rival woman” (the

observers) and their humiliated position as

rejected “little girls.”

Sessions 33-47 (July-November)

More intimate feelings were now pressing for

expression with associated anxieties about how

these feelings would be received by the group.

During this phase dependent longings also

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became more prominent. The frustration of these
longings began to be expressed in lateness,

apathy, and despair. Oedipal dreams and some

oedipal acting out formed much of the content

with the open expression of sexual phantasies.

Reference 6. Miss C’s reference to the

higher microphones. Session 48. All
present

During the first few minutes Miss C was the

only woman present with two men. Her opening

remark was: “The microphone is higher tonight,”
but there was no response from the men. After a

short pause she continued, “I came in feeling very

depressed. I feel a bit more cheerful since I

arrived. Must be me.” There was again no

response to her remarks and she went on to refer

to her depressed fits. One of the men rather
ostentatiously ignored her by proceeding to
discuss with the other man the reasons for the

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latter being absent for several weeks, and the
other members joined in when they arrived. For

the rest of the session, the discussion was mainly

about the size of the group, a theme stimulated by

the fact that in this session all members were

present after a few weeks of smaller attendances.

Some felt better that everyone was around, others

felt that more got done when there were fewer

people in the group. The whole group became

interested in the issue of crowds, how one

avoided them, and how one asserted oneself in

them.

Comment

Miss C’s early reference to the microphones

was, at the manifest level, associated with her

depression. The instruments were at most only a

few inches higher than usual, yet she appeared to

associate this stimulus with a lightening of her

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depression. With no further elucidation it was not
clear what the symbolic connexion with her relief

was. Possibly it was a feeling that the

“persecuting mother” was further away, a relief

that may also have derived from the fact that the

other women were absent at the start.

The lack of group response to the

microphones in this session seemed

predominantly related to the intense triangular

situation in the group. One of the men was

particularly hostile to Miss C at this period and

expressed this feeling by his deliberate ignoring

of her. The other man present at the start was also

critical of her. The subsequent discussion about

the size of the group revealed the continued

presence of rivalry feelings in the group.

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Sessions 49 and 50
(Second year—November to Christmas
break)

There were several references to outbursts of

anger with bosses and parents which were

associated with the coming Christmas break. Mr

W, who had been abroad for some weeks,

returned in Session 49. The group members made

no comments about his return and later he tended

to be contemptuous of the therapist’s reference to

dependent feelings. He thought he would now
give up the group or might well do so after the

break. He did not come to the last session before

the break and 3 days later he arrived at the Clinic

in considerable agitation. As the therapist was

unavailable, he was seen by another doctor.

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Reference 7. Mr W’s disguised reference
in a vivid dream. Session 51. Mr T absent

It was the first group meeting after the break.

Miss O talked of her dependence upon her

mother and whether or not it would be possible

for her to live separately from her. This theme

was kept going by others questioning her about

steps she might take. The therapist interpreted

that the group’s interest in her dependence on her

mother expressed their own feelings of

dependence, as stirred up by the break. This led

Mr W to talk at great length about his vacillation

between attitudes of independence and

dependence. In this context he related a dream

that he had had before Christmas, and which he

said had greatly disturbed him. In it he was

attending a ceremony in the chapel of a university
where he was employed. At the end of the

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commemorative sermon a group of “mass
observation observers” turned up to ask the

university staff questions about the brands of tea,

coffee, wine, and so forth, that they drank. Mr W

objected to the introduction of this commercial

element into a religious function and refused to

answer any questions. The secretary of the

university got annoyed and asked him to quit the

job. Mr W begged and cried but to no avail, so he

decided to kill the secretary by using a long case-

opener and then to poison himself before he was

caught.

When he finished telling his dream the group

members started discussing Mr W’s attitudes of
independence versus dependence. Miss C soon

interrupted to tell the group about a quarrel with

her landlady who had let people move into her

room to redecorate it without obtaining her

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permission, or even informing her. She talked of
her anger with the landlady about this intrusion,

and there was some discussion of how this kind

of incident should be handled.

The therapist’s interpretations focused on the

group’s dependent feelings as related to the

break; thus, the two women spoke of angry

“mothers” intruding on them, while Mr W

resented the university secretary bringing him to

the chapel and then subjecting him to a mass-

observation quiz. Mr W perhaps felt that he was

merely another “case” for the therapist to play

with in front of the screen.

The group did not take up the interpretation

but went on to discuss Miss C’s episode with the

landlady and a similar humiliation experienced

by Miss O at her work. There was no further

allusion to the observers.

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Comment

Mr W’s upset before the break had revealed a

large breach in his habitual rigid defences. On his

return from his trip abroad he must have felt

rejected by the group as well as by the therapist,

and at first he tried to deny these feelings by

professing independence to the extent of

believing he could do without the group. Missing

the last session appeared to be a defiance of the

therapist, who had been stressing the group’s

dependent feelings. In keeping with his strongly

defensive detachment, the breakthrough of his

feelings for the therapist on the night of his

defiant absence could appear only in disguise in a

dream.

There was no general response on the part of

the group to the observers. Instead the discussion

switched to external incidents, and the turning

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away from Mr W’s experience was striking. This
move away from his experience could be viewed

as an attempt to escape from the intolerable

dependent feelings for the therapist. To have

taken up Mr W’s dream and the links with the

depriving observers would probably have

confronted the other members with conflicting

feelings about the therapist that were too painful.

Sessions 52-56
(Second year: January-February)

Delayed resentment about the break and

dependent feelings began to be expressed in the

form of increasing references to depressed

feelings that derived from the release of

destructive phantasies towards the frustrating

therapist (parent). The strong feelings for the

therapist, bosses, and parents required a good

deal of working through before these feelings

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could be accepted. In Sessions 55 and 56 there

were several expressions of resentment with

members for taking up too much time.

Reference 8: Miss 0’s anxiety over the

unknown observers. Session 57. Mr L
absent

The session started with Miss C coming alone

into the room ahead of the others, followed soon

by Miss O, who also preferred to walk ahead

while the others were waiting downstairs for the

elevator. This was in some contrast to the usual

practice of the group, which was to come to the

room together.

Miss O said that coming to the group made

her anxious that evening. She found it hard to talk

of a certain problem from her past. If she failed to

bring it up in the group she would have to ask for

a private session with the therapist. Several group

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members tried to persuade her to talk of it in the
group and she eventually remarked: “I don’t mind

the lot of you being here but goodness knows

who is behind the screen, people I might get

involved with in my work.” The group then

attempted to reassure her about the observers, by

such remarks as: “You have talked about so many

things with the other people behind there that it

should not matter any more.” “They can be big

hearted enough to realize that all flesh is human.”

Despite these pressures, Miss O said she did not

think she could get it out.

The therapist then pointed to the collusion

between Miss O and the rest of the group in

developing a situation of coaxing her to speak.

They all had feelings that they did not wish to

talk about and by fastening on to Miss O they

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were trying to treat these reluctant bits of
themselves.

Following this interpretation Miss O readily

described her concern about a homosexual phase

in her adolescence and its recurrence in her

twenties after a broken engagement. The

“analysis” (as she referred to the sessions) had

brought this worry about the past back again. The

whole group then became absorbed in the theme

of homosexuality.

The therapist commented that Miss O was

turning to homosexuality as a result of

disappointment and frustration with the male

therapist. He also pointed out how the group’s

interest in continuing the discussion on this

theme revealed their own concern over similar

feelings towards the therapist. He went on to

interpret the interest in the people behind the

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screen as representing their curiosity about “the
other parent.” The reference in this interpretation

to the observers was “ignored” by the group in

their subsequent discussion, which concerned

Miss C’s description of a new feeling she had

experienced in the last week or two, namely, an

aversion to men.

Comment

Miss O’s anxieties about her unconscious

drive to get the therapist’s exclusive interest had

apparently stirred up her dread of the rival

“mother” and also her homosexual solution to

this situation. The danger of rivals within the

group was still too great to bear and led to a
displacement to the observers, her phantasy again

being that her colleagues would be watching her.

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As long as the group felt the observers were
being discussed only in relation to Miss O, they

gave expression to their feelings about them.

When the therapist interpreted later on that the

group shared the homosexual phantasies to which

Miss O had turned as the result of disappointment

with the male therapist, then interest in the

observers ceased. To have continued would

presumably have meant being confronted with

homosexual phantasies in the here and now of the

group and they preferred instead the less direct

expression of feeling by talking about incidents

outside the group.

Sessions 58-62 (March-April)

The freer communication of phantasies about

the therapist led to a more active interaction in

the group. Guilt and anxiety related to early

parental memories appeared.

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Reference 9. Mr W’s second dream.
Session 63. Miss C absent

It was the second last session before the

Easter break. At the beginning of the session Mr

W brought up a dream in which he was a child

taken to a doctor by his mother. “The doctor got

out a stethoscope and proceeded to put it against

me, but instead of putting the other ends in his

ears — the two sort of earpieces — he plugged

them into the wall. ... I said to my mother, ‘This

man is a phoney. I don’t believe he is a doctor at

all….’ I said, Well, I know a doctor who is better

than that,’ having in mind Dr Sutherland … and

then, as we were walking along, much to my

surprise, I saw you, Dr Sutherland, on the other
side of the street. ... I waved to you several times

but you were so busy examining the house

numbers that you took no notice of me.”

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The group went on to discuss various aspects

of Mr W’s feelings towards his mother, his father,

and the therapist. The therapist interpreted that

Mr W and the other group members felt the

coming break as a rejection. They were all

interested in Mr W’s dream, which presented two

versions of the therapist: “There is one who hides

behind all the paraphernalia of medicine, the ‘me’

that you feel resentful with, because I am

inhuman, impersonal. I plug the stethoscope into

the wall ... it sounds like some reference to the

observers or to the fact that I tun just using you as

specimens, that they can watch your feelings, as

it were, or listen in to them…. The other ‘me’

that Mr W was trying to get at was also rejecting

because I seemed to be so concerned with all the

other members and missing him. This feeling too

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was similar to one Mr W had brought in his

dream at the time of the Christmas break.”

The interpretation was followed by a long

silence. The therapist commented that the thick

silence was perhaps due to his having raised the

question of dependent feelings and that the group

seemed to be making a concerted effort to sulk

and to have nothing to do with him.

The group again ignored the therapist’s

comments and went on to discuss one of the

women’s (Miss O) feelings of inadequacy and

depression when rejected as a child by a school

teacher.

There was no mention of observers in the

remaining part of this group session nor in the

next.

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Comment

This session was reminiscent of session 51,

when Mr W described his first long dream. Here,

too, his feelings about rejection were stirred up

by the break, and again they appeared in a vivid

dream. On this occasion, however, Mr W’s

experiences were not ignored. The group

explored them in considerable detail, but as

though they were something external to

themselves. There was no reference to the

observers, because it might not only have brought
in the humiliated rejected feelings but also anger

and resentment over the rejection, feelings which

would have created too much anxiety.

Sessions 64-66 (April-May)

Depressed feelings concerned with hostility

towards the rival oedipal parent developed and

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hostility continued to Miss C for her chronic
tendency to monopolize the therapist’s interest.

Mr T, who had said he might not continue,

evoked a good deal of pressure from the others to

stay.

Reference 10. Mr T’s anger. Session 67.

Mr L absent

The group members began by inquiring after

Mr T’s difficulty in bringing up his problems for

discussion in the group. The therapist commented

that their great enthusiasm to get Mr T to speak

was a substitute for speaking about themselves

and especially for expressing their resentful

feelings to him and to each other. Mr T said that

he was angry because he was forced to struggle in

order to get to the group on time, because he had

to travel a long way, give up an evening, and so

on. He needed to come but he resented the

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position of having to come. He added that he
resented most the therapist, because he was the

head of the group and, to him, the “instigator.”

The group showed surprise at finding in Mr T

a strong need to come to the group as it had been

their impression that he had no such need. The

therapist pointed to the similarity between Mr

T”s feelings about the group and the feelings of a

child towards its parents. One cannot do without

parents. One is furiously angry with them at

times, yet one is tied to them and continually
hoping for something better from them. When Mr

T was asked by other members what it might be

about the group situation that he resented so

much he answered: “Merely that I am forced into

this position of having to come here. It seems to
me to be humiliating ... I know Miss O is always

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worried about her friends being behind the glass
and so on, and I sense other people are too.”

The group ignored this reference to people

behind the screen and continued instead to

discuss Mr Ts angry feelings towards them as

well as towards the therapist.

Comment

Although in the past he had reported that

attendance at the group had made him aware of

intense pent-up, angry feelings, this was the first

occasion on which Mr T brought them directly to
the therapist and the group. Just as the fears of
what his angry feelings would do had led to his

keeping away, so now, when eventually brought

to the group, he could only allow them to be

directed at first towards the therapist. It seemed
that he could not include the group in the angry

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feelings he revealed towards the therapist, and
had to bring in the observers in place of the group

members as more remote objects of his hostility.

The group, however, inferred from his past

aloofness that he also resented them and begem

to question him about these feelings.

Reference 11. Miss C faces screen.

Session 68. Mr L absent

Mr V came in first and took the seat next to

the therapist. Miss C, who normally occupied it,

took a chair facing the screen, smiled at Mr V and

remarked, “A switch around —it feels funny

facing the screen —it is the first time I have faced

the screen for about a year—I feel self-conscious

now.”

Miss C next asked Mr V why he had taken

her chair. He did not know and inquired whether

she felt it was her chair. She answered that she

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did, and then went on to describe a dream in

which she was travelling in an aeroplane with her

family and fighting as if for her life with the

feeling that the plane was going to crash. The

therapist commented on the fight going on in the

group itself. He recalled Miss C’s concern about

being watched from behind the screen and made

some further comments about her need to

monopolize him. The group ignored the mention

of the screen and went on to discuss their

interrelationships.

Comment

Here again Miss C seemed to use the

observers for the displacement of her hostility

from the group. Her resentment was primarily

with Mr V for taking her usual chair. The group

felt resentment with her and preferred to take up

their interrelationships more directly.

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Sessions 69-80 (May-October)

Anger and frustration with the therapist over

disappointed oedipal longings and oedipal

dreams continued to be worked through. The

homosexual solution of oedipal rivalries and at

times the aggressive manifestations of rivalry in

the group became more intense. The summer

break on this occasion was 2 weeks longer than

usual because the therapist had to be abroad. This

fact probably contributed to its provoking

stronger feelings than hitherto, with denials at

first and then recognition of the role of the

dependent longings.

When the reactions to the break had been

discussed, the therapist announced that the group

would end its period in the screen room and

change to his office in 2 weeks’ time. There was

no response to this announcement until the end of

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the last session before the change, when on his
reminding them of the new room for the next

week’s session, one of the men (Mr V) asked if

that meant the group would no longer be

observed.

Reference 12. Change from, screen room.

Session 81. Miss C and Mr T absent

The members did not arrive together and,

unlike the usual pattern, the therapist said good

evening to each member individually as they

entered his office, and then inquired after the

health of one of the men who had been ill. Mr V

thought the therapist was “slightly more

personal” and that the room had a certain air of

domesticity. Miss O reflected: “I am wondering
whether the sort of pictures and basins and things

are going to be distracting.” While the group was

engaged in nothing the differences in the

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therapist’s attitude and in the two rooms, Mr V
pointed to the additional difference that there

were no more people behind the screen.

Miss O said she would have feared being

observed by a group of social workers visiting the

Clinic that evening (actually a group attending a

seminar). Mr V had seen a girl from his office in

the Clinic and there was a brief discussion about
his concern lest she be admitted as a patient in

this group. The therapist commented on the fears

about being watched coming, as before, from
inside themselves, perhaps increased by the

feeling of a closer relationship with him. When

they were free from the screen observers, the

watchers still came in, colleagues from a course

or people with whom they worked.

Miss O said that the new group room was on

the same floor as the old one, and that coming

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here involved the same number of floors on the
lift. She went on to say that her claustrophobia

was as bad as ever and the group got engaged in

discussing her symptoms. The therapist

commented that despite the new room the group

were finding themselves up against the same old

symptoms and difficulties.

Mr V described feeling depressed about his

work situation as he had been unable to get away

from his malevolent boss to a more satisfying

job. Miss B discussed her difficulty in deciding

whether or not to take a certain part-time study

course. All this time Mr W had been very quiet

“because I am sleepy.” The therapist pointed out

how the various group members, in talking about
indecision with regard to taking a study course or

changing a job, or in feeling withdrawn from the

situation, seemed to express their concern about

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continuing to attend the group, feeling perhaps
that the therapy course was not worth it.

After a long silence one of the men who had

been very quiet (Mr L) reinitiated the discussion

about the change in the therapist’s attitude,

namely, the intimate and friendly feeling that had

been present at the start. The therapist

commented that as he continued to make the

usual kind of interpretations, the wishful thinking

for a more friendly therapist with the change of

room had receded, and that they now wished to

recapture this close relationship.

Mr L remarked on how the therapist

reminded him of his father. He added: “The more

you love them, the more you fear for them that
something may happen, that in some way the

relationship may be broken.” Mr V pointed out

that concern about someone’s safety often

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concealed a wish for his death. Next, Mr V

described how at the moment he was “very

conscious of the outside world in this room, of

people creeping about upstairs and laughing and

fooling around in the corridors. I seem to be

much more conscious of them here than I was in

the other room….” The group went on to discuss

the differences in quietness and in privacy

between the two rooms. Then there was a long

silence, which was interrupted by one of the

women (Miss B) raising once again the problem

of her inability to decide whether or not to join a

study course. Mr V commented irritably that he

could not focus his mind on the kind of problems

that she presented and blamed her for bringing in

extraneous issues.

In his next interpretation the therapist pointed

out how the group’s expectations in the new room

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of finding in him a more affectionate, a more

loving, fatherlike figure were frustrated when he

did not conform to this role. The group had felt at

the beginning that he was more intimate, more

personal, but were later disillusioned when he

continued to play the same old role. There was

concern about losing him, which Mr V felt might

represent an expression of anger and a wish for

his death. In his reference to people creeping

about outside the room, Mr V was perhaps

revealing his fear that some retaliating figures

would open the door and interrupt the close

relationship they wanted with the therapist.

There was no further mention of the

observers in the remaining part of the session.

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Comment

On this critical occasion of the group’s move

from the screen, a striking feature was the

transience of “relief” feelings. The new room,

with its more personal furnishings and the more

friendly greeting of the therapist, reinforced the

longings for a more intimate relationship with the

therapist. These forbidden longings, however,

soon reactivated the inner fear of rivals, with the

result that the initial good feeling of closeness to

the therapist gave way to increasing tensions

about “inner observers.” Thus Mr V, who was the

first to comment on the newly found intimacy,

had to note that the external observers were
absent, and soon afterwards he gave more direct

expression to his fears about observers by

describing his concern about a colleague joining

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the group. Miss O also showed a similar fear in
her comments about her colleagues.

After Mr L had reverted to the earlier theme

by declaring his strong feelings for the therapist,

it seemed that Mr V’s phantasies of the dangerous

rivals in the group were intensified but displaced

to potential intruders from the corridor outside

the room. The limited success of this manoeuvre

was seen in the irritability that he expressed

towards Miss B for her attempt to divert the

discussion to external incidents.

Reference 13. Curiosity about screen

room. Session 82. Mr T absent

Miss C, returning to the group after her

holiday, started to describe fits of acute

depression she had had recently. She then
mentioned that she had walked into the old room.

Miss O admitted having waited near the

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observers’ room and added that she was “dying to
peep and see what was going on.” Mr V reported

that he too had looked into the observers’ room

where a film was being shown and so he had

quickly withdrawn. Miss O then confessed that

she had actually looked into the room and was

surprised to see it in darkness.

Miss C reverted to her depressed feelings and

described how she had felt isolated from her

companions on holiday. The discussion about her

feelings continued for some time and Mr V
observed that the group had become very

depressed — “everyone is looking as if they were

going to burst into tears.” Shortly afterwards, Mr

W noted the apparent contradiction between what

had been happening to Miss C on her holiday and
the way in which she was monopolizing interest

that evening. Several members went on to

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compare the amount of attention that she was
able to command in the group with the little

recognition she got from others on her holiday.

In his interpretation, the therapist referred to

the group’s depression as being intensified by the

feeling that the new room had not changed

anything. The depression had in turn led to their

concern about Miss C, who seemed to represent

for them a mother inside the group who had taken

possession of the therapist.

There was no further reference to the

observers in this or in subsequent sessions.

Comment

Miss C’s going to the old therapy room was

perhaps due to the fact that the change of room

had occurred when she was still on holiday, but

the entry of Mr

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V and Miss O into the observation room
dearly stemmed from their intense curiosity about

the observers. The unconscious motivation

behind their curiosity could have involved a

variety of phantasies that remained unexplored. It

was clear, however, that there was an element of

latent excitement in their phantasies about what

went on behind the screen, as though they felt

they would now share the same special relation

with the therapist as the observers had done

formerly. This excitement died down rapidly with

the realization that the possessive mother (Miss

C) was back in the group to deprive them of the

therapist.

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DISCUSSION

General Effects

The first point to emerge from the data is the

limited number of references to the screen. The

ninety group sessions reviewed, covering a

period of more than 2 years, produced no more

than thirteen screen references, seven of which

were limited to single comments by individuals

and evoked little response from the other group

members. The group’s reaction to the screen

remained minimal, in spite of the fact that the

therapist was particularly interested to point out

any significant impact of the screen on the group,

and in fact had taken the initiative in the first two

instances to comment about the seat taken by a

group member in relation to the observers behind

the screen.

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It would thus appear that the screen did not
constitute to an appreciable extent either a

constant source of distraction or a persistent

cause of inhibition. What happened instead was

that occasionally a group member would

complain of distraction (Mr V in Reference 12)

or of inhibition (Miss O in Reference 8 and Mr T

in Reference 10). All such episodic complaints

could be understood in terms of the dynamics of

the situation at the time and are best seen as

equivalent to other sources of defence or

resistance during psychotherapy. Mr V’s

distraction by “people creeping about ... in the

corridors” represented a resurrection of the

observers (when the group had moved out of the

screen room into the therapist’s office) and
conveyed his fear that a retaliating figure would
open the door and interrupt his relationship with

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the therapist. Miss O’s stated inability to talk of
her problem in the group because of the presence

of observers disappeared when the therapist

interpreted the nature of her defence; she then

proceeded to talk freely about her homosexual

difficulties. Mr Ts reluctance to speak because of

people behind the screen was another instance

where the screen was used as a temporary peg on

which to hang his resistance, a resistance that was

related to his major symptom of exhibitionistic

anxiety.

It would therefore seem that when members

of the group refer to the screen as either

distracting or inhibiting, their references are best

understood as a means of resistance and are as

amenable to effective interpretation as any other
significant feature of a psychotherapeutic

situation.

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While the screen could conceivably be used
as a means of resistance in many ways, it is seen

in this study that there are a limited number of

typical forms that this resistance tends to assume.

A common feeling is that it is difficult or

humiliating to talk of personal problems in the

presence of people behind the screen who are

unknown to the patients, or who might judge

them harshly or be unduly critical of their

motives and behavior. An allied concern is the

fear that the observers might make fun of the

patients’ problems and difficulties, and that the

therapist might join with the observers in
laughing at them behind their backs. Another
common reaction is to see the observers as

stealing the therapist’s attention away from the

group, so that the patients feel that the therapist’s

interest in them is subordinate to his primary

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interest in teaching the observers. Along with
such fears and anxieties, the observers are also

made the object of interest and curiosity.

It would thus seem that the feelings projected

onto the observers are typically those related to

phantasies about the role of the other parent. The

activation of the internalized conflict with the

rival parent can be seen in References 12 and 13
when, in the absence of observers, the group

members were unconsciously impelled to re-

create the feared observers in a variety of ways.

It is clear from the data given that the group’s

concern about the screen could be expressed

either in a conscious or in an unconscious form.

The feelings about the observers in References 7

and 9 were manifested in the first instance

through the relating of dreams. Miss C’s concern

about the intrusion of the observers was also

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revealed indirectly through her description of a

quarrel with her landlady who had let people pry

into her room. In addition to these instances of

indirect expression, 2m unconscious component

could be seen in the more direct references to the

screen also. For example, Miss O’s stated

inability to talk of her problem because of the

people behind the screen in Reference 8 was

shown to be unconsciously determined and

projective in character by the ease with which she

talked freely of her homosexual difficulties

immediately following an interpretation.

Differential Effects

The screen had an effect on each group

member, though this differed in intensity as well

as in mode of response, and was directly related

to the particular character structure or
symptomatology of each person. The response to

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the screen of two group members Mr L and Miss
B, was minimal. Mr L indicated his concern

about the observers only once when, in Reference

3, the group were expressing their fear about

being laughed at and he joined in to remark: “The

only thing to do is to try to develop a sense of

humour.” His only other comment, about the

microphones, in Reference 4, was ambiguous in

meaning, suggestive more of sexual phantasies

about the therapist than of any direct reference to

the screen. Both of these comments are consistent

with his character structure, a prominent feature

of which is submission to the sexually potent and

powerful father. Miss B never mentioned the

screen herself, and when it was brought up she

professed to be indifferent to it. In her lack of

comment about the screen a process of defensive

denial (in keeping with her major character

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defence of denial) was noticeable on more than
one occasion: when the observers were referred

to by other group members she manoeuvred

towards external topics, which led the discussion

away from the observers. At one point, her

attempt to deny the effect of the screen was

noticed and pointed out by group members

themselves (Reference 3).

In direct contrast to the minimal response

from Mr L and Miss B, two other group

members, Miss O and Mr T, showed intense

concern about the screen. Miss O experienced

recurrent anxiety about being watched by her

colleagues. The reality basis for her fear was that

she knew that some members of her profession

attended seminars at the Clinic. It was entirely a
phantasy on her part, however, that such groups

would be behind the screen. Her concern about

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being watched became acute when her feelings of
oedipal rivalry were at their strongest. The

oedipal theme was a particularly dominant one

for this patient and had appeared in her

relationship with her mother over the last few

years, following her father’s death. It is of

particular interest to note that after the group

changed from the screen room, and when Miss O

was no longer able to use the observers as her

feared rivals, she developed an almost unbearable

hostility to Miss C. She sought a private

interview with the therapist to tell him that she

had become friendly with Mr W, but that she

could not possibly mention this when Miss C was

present. It took many weeks before she was

eventually able to discuss this intense rivalry.

Mr T expressed his anxiety about the

observers in Reference 3 by his questioning of

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Miss B’s stated indifference to the screen, and in
Reference 10 by referring to Miss O’s anxiety

about being watched from behind the screen.

Though less direct in mode of expression, Mr T’s

anxiety about the observers appeared to be as

intense as Miss O’s. The responses of both Mr T

and Miss O seemed to involve a projection of

persecuting inner figures onto the observers, a

projection that was in keeping with the fact that

both of them suffered from intense phobic

anxieties, Miss O experiencing claustrophobic

panics, and Mr T having attacks of anxiety in

“exhibitionistic” situations (for example, in

public speaking). The more intense reaction to

the screen of these two members perhaps

indicates the existence of a close link between

symptoms of phobic anxiety and fear of screen
observation.

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Unlike Miss O and Mr T, for whom the
phantasied observers were frightening, Mr W

perceived them to be depriving rather than

persecuting, and expressed anger about them

rather than anxiety. His mode of response was

also radically different, in that both of his

references to the screen (7 and 9) appeared in a

symbolic form in his dreams. He presented a

highly defended intellectualizing front, valued his

emotional independence from people, and

continually expressed his contempt for the

unscientific nature of the therapist’s

interpretations. However, his repressed longing to
be loved by the therapist showed a striking

tendency to recur in dreams at the time of breaks.

For him the observers represented the other

parent responsible for his deprivation. It is

interesting to compare his mode of response to

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the observers with his initial statement in his

letter of acceptance when the group was first

proposed to him. He wrote: “I would probably be

interested in joining the group and I have no

conscious objection to one-way screen” (our

italics).

Mr V’s response to the screen was somewhat

similar to that of Mr W. Ordinarily, neither would

initiate discussion about the observers and when

someone else raised the topic, both of them

would react to it at the reality level, making

rational comments, such as, “It would be

extremely unlikely …” that Miss O’s colleagues

would be listening behind the screen (Reference
3); or “I wouldn’t let that inhibit you from

speaking” (again concerning Miss O’s reluctance

to speak because of observers in Reference 8).

However, under conditions of heightened feeling,

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both showed intense reaction to the presence of

observers. Mr W responded in a symbolic form

through his dreams. Mr V experienced anxiety

regarding the “people creeping about ... in the

corridors” when he felt he had a more intimate

relationship with the therapist and feared that

some retaliating figure would come in to interrupt

this relationship. His comment about the screen

was consistent with his problem of repressed

passive homosexual phantasies along with a great

fear of the retaliating rival parent.

Finally there was Miss C, the one amongst

the group who most strongly demanded a special

relationship with the therapist. Right from the

beginning she asked for private interviews (which
were refused), and sat beside the therapist in a

position that also enabled her to keep her back to

the observers. When, before the start of the

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group, she was told about the screen she had

shown sharp concern about “being watched and

listened to by an unseen audience.” In spite of

this strong initial reaction, however, her later

comments about the screen remained minimal. In

the first two references it was the therapist who

had referred to her usual sitting position in

relation to the screen. In Reference 6 she had

simply referred to the microphones being higher

that evening. In Reference 11 she had been

blocked from sitting beside the therapist and was

left facing the screen, which prompted her to

speak of her mild discomfort in that position.

Like Miss O, Miss C also had strong oedipal

transference feelings to the therapist. Unlike Miss
O, however, Miss C engineered in the group (as

she also did in external social life and work

situations) a self-punishment in which she got

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isolated and rejected by other group members. It
would appear that under the circumstances, Miss

C did not “need” to bring in criticism of the

observers; for her the observers were much more

remote than her rivals within the group itself. The

group, in turn, perceived her as striving to

possess the therapist and to exclude them. It was

perhaps in keeping with the group’s perception of

her as an immediate rival that on each occasion

when she initiated a reference to the observers,

the other members were unable to express their

feelings about these more distant rivals behind

the screen.

Effects on Group Process

The above examination of differential effects

concentrated on the role of intrapsychic factors in

determining the intensity and the mode of

response to the screen and pointed mainly to the

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differences existing among the diverse screen
references. The effects on group process will now

be considered in order to elucidate the role of

interpersonal and group situational factors, and

this will perhaps clarify the common or shared

meaning of the group’s concern about the screen

as seen in the various references.

Among the group situational factors

examined were: (1) the size of the group, that is,

the number of members present in each session;

(2) the duration of time for which the group had

been in treatment at the time of each screen

reference; and (3) the time around the various

holiday breaks. Of these, the size of the group

showed no relation to the frequency of the

occurrence of references to the screen. The
duration of time since the start of the group

appeared also to be unrelated to the frequency of

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references. A priori, it would be expected that
most references to the screen would occur when

the screen was first introduced, or when another

change was made. References 12 and 13 in fact

occurred when a change was made and the group

was moved away from the screen room.

However, reference to the screen did not develop

into a group topic until Session 30. That the

screen did not become a topic of concern to the

group for so long was probably due in part to the

following three factors: (i) The process of

overcoming initial anxieties about the situation

inside the group was relatively slow because

most of the members were inhibited in making

social relationships. (Of eight people aged 30-40,

only two were married.) (ii) The unusual

domination by one member (who left after

Session 15) made the initial situation a

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particularly difficult one for this inhibited group
to handle, (iii) The screen was present from the

start, and by the time mutual knowledge and trust

had developed it was part of a familiar setting.

The holiday breaks, on the other hand, were

seen to be related to the references to the screen.

A reference was judged to occur around a holiday

break if it was made after the therapist’s

announcement of the break, or if made during the

group’s first meeting at the end of the break. Out

of the eleven relevant references (References 12

and 13 being a direct consequence of the group’s

move from the screen room into a nonscreen
room), only four occurred at a time other than

just before or just after a holiday break.

The holiday breaks are perhaps significant

because of their impact on the group’s

relationship to the therapist. The separation, or

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prospect of it, tends to heighten the group’s

longing for the therapist. This, in turn, tends to

activate the internalized conflict with the rival

parent, the observers constituting a convenient

peg on which to hang the phantasies associated

with the role of the rival parent. Disappearance of

the therapist is felt perhaps as a triumph for the

observers. When all members of the group seem

to share a common deprivation in relation to the

therapist, it is difficult to use any member within
the group as a successful rival.

The impact of the holiday breaks upon the

group’s feelings towards the therapist leads

directly to an examination of the nature of

feelings prevalent in the group that tend to elicit a

reference to the screen. These feelings were of

two kinds: (a) feelings of dependence, or of

frustration of dependent longings, and (b) sexual

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feelings associated with oedipal phantasies and

strong rivalries. The screen acts as a powerful

stimulus when it becomes involved in phantasies

about the therapist’s relationship with the

observers, who then assume significance as

people having close links with the therapist and

stealing his attention away from the group.

We can see from the data given that most of

the direct initial references to the screen were

made by individual members in an attempt to

displace the uncomfortable rivalry experienced in

the group itself onto the observers. But whether

or not other members took up the screen as a

group theme depended on the presence or

absence of certain conditions, which are given

below:

1. The group are concerned with their

relationship to the therapist.

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2. This concern is expressed directly in the here
and now.

3. The quality of their relationship to the

therapist is triangular, in the sense that their
frustration with, or deprivation by, the
therapist activates phantasies about rivals.

4. The group are passing through a common or

shared experience of their relationship to the
therapist, so that all of them are in the same
position and find it difficult to use members
within the group as rivals.

To illustrate from the data, Miss C’s attempt

to displace the rivalry onto the observers failed in

References 6 and 11 because the group were

preoccupied with their perception of her as an

immediate rival within the group itself. A similar

situation existed in Reference 10 when the group

were engaged in discussing Mr Ts angry feelings

directly in relation to them and the therapist, and

they could not go along with Mr Ts attempt to

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displace his anger to people behind the screen. In
References 2 and 5, the screen failed to become a

group theme because the group were unable to

face directly the guilt-laden sexual phantasies

about the therapist. In contrast, Reference 3

depicted the group as completely absorbed in

discussing their feelings about the observers,

since the group were concerned about their

relationship to the therapist in the here and now,

and shared common feelings of inadequacy,

making it difficult for them to find a rival within

the group itself.

SUMMARY

The main points emerging from this

exploratory study are:

1. A one-way screen does not appear to act as a

constant source of distraction or inhibition
for patients in a therapeutic group.

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2. The feelings projected onto the observers are
typically those related to phantasies about the
role of rival figures.

3. The group’s concern about the screen is

expressed both in a manifest and a latent
form.

4. The effect of the screen on each group

member varies in intensity as well as in
mode of response, and is related to his
particular character structure or
symptomatology.

5. Reaction to the screen is influenced by certain

factors in the group situation, such as holiday
breaks, the significance of which can be
understood in terms of their impact on the
group’s feelings towards the therapist.

6. The initial reference to the screen is often

made by an individual member in an attempt
to displace an uncomfortable rivalry
experienced in the group itself onto the
observers, but whether the screen becomes a
group theme is a function of the following

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situation: The group members are concerned
with their relationship to the therapist in the
here and now, and are sharing a common
feeling of frustration or inadequacy, making
it difficult for them to “seek” a rival within
the group itself.

In short, the data from the study of one group

suggest that a one-way screen acts as a projective

stimulus, the significance of which is determined

by both the intrapsychic and the interpersonal

dynamics of the group situation.

Note
[←*] This chapter is co-authored by Harwant S. Gill.

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11.

BION’S GROUP DYNAMICS

PERSONAL RECOLLECTIONS

During 1940-1941, the darkest days of World

War II for Britain and her allies, I was a

psychiatrist in a hospital for the war neuroses. It

was my good fortune to be working closely with

W. R. D. Fairbairn (hitherto the only

psychoanalyst practising in Scotland) during this

period when the pressure of his creative ferment
was coming to full fruition. Inspired by Melanie

Klein’s writings —his contact with her before the

war had been limited because of his geographical

isolation in Edinburgh and was now nil — and by

the impact of several markedly schizoid patients,

he was recasting psychoanalytic

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psychopathology. Instead of Freud’s foundations
on the vicissitudes of instincts, Fairbairn

described the development of the personality

from a state of infantile dependence to the mature

dependence of the adult on the basis of the

structuring of experience within personal, or

object, relationships. To put it into the terms Bion

was to use later, he had moved from Freud’s

vertex with its penumbra of nineteenth- century

energy concepts in which the second law of

thermodynamics was virtually the ultimate truth

in nature, to one from which the person at the

personal or psychological level could be viewed

as an organism perpetually requiring, and

seeking, personal relationships for his

development and maintenance.

The war neuroses had been a valuable

stimulus to Fairbairn in consolidating his views.

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By the end of 1941, the change in the war
situation to one of lessened demand on the

psychiatric hospitals along with an urgent effort

to build up the armed forces led to my being

asked to join an experimental unit in the army

whose task was to evolve a model procedure for

the selection of candidates to be trained as

officers. Located in Edinburgh, there was a small

staff of experienced army officers along with

three psychiatrists to provide a professional

psychological component. The three of us were

analytically oriented and, since I had been a

psychologist before training as a psychiatrist, I
acted as the psychologist for the first few months

until Eric Trist could join the unit. My two

colleagues were Eric Wittkower, later Professor

of Psychiatry in Montreal, and who had been

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working in Edinburgh, and Wilfred Bion, whom I
had not met before.

From the start we all got along well

personally and our shared orientation to the task

made work very congenial. Since Eric Trist

(1985) has described the contribution Bion made

within these early months, I shall confine myself

to a few personal impressions, some of which
will inevitably overlap with his. Bion had the

great advantage of an imposing military presence.

He was a large man wearing the ribbons of his
distinguished record as a soldier in World War I

— the British Distinguished Service Order and

the French Legion of Honour. Apart from this

visible record which, in the senior member of the

technical team, was of enormous value in

facilitating our acceptance in face of the

widespread suspicion and underlying anxiety

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with which psychiatrists were generally received,
he quickly made an impression on everyone of

“power” in the best sense. He was quietly spoken,

unfailingly courteous and attentive to others, and

always sensitive and thoughtful about their

views. His remarks were usually brief and

penetrating and he had the most delightful sense

of humor expressed in dry pithy phrases along

with occasional amusing personal anecdotes to

make a point.

As Trist describes, there were at times

tensions between the technical and the military

sides in the early days when the latter, for

instance, found it difficult to accept that an

apparently competent man would be rated too
low in the intelligence tests for the arm of his

choice or when some psychiatric features were

uncovered that cast doubts on the man’s stability

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despite an apparently good impression. The

shared work helped to lessen those difficulties

within the unit group, though they would emerge

when groups of senior officers came to see the

new methods at work. At one such meeting a

visitor questioned somewhat sarcastically our low

estimate of the intelligence of a candidate who

had been the successful trainer of some well-

known racehorses. “How could we account for

that discrepancy?” Bion replied with a twinkle in

his eye that “perhaps the man thought like a

horse!” Bion’s strength, however, would appear

when he felt a criticism had a malevolent tone.

Challenged about a psychiatric opinion on a

similar occasion, he replied with considerable

acerbity that he did not propose to defend the

professional status of himself or his colleagues,

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whereupon the retreat was both rapid and
apologetic.

At that time, it was the common practice in

applied psychology to think of a vocational

selection task as requiring on the one hand a job

analysis from which the qualities required could

be identified and, on the other, the devising of

tests to measure these traits or qualities. Such a
view had little appeal to those of us who had

come to understand personality functioning in a

very different way. When Trist joined us he
conceptualized the selection task as, first,

describing the basic features of the candidate’s

personality with all its uniqueness and, second,
matching this picture of the man with the

demands of the army. An underlying philosophy

of this kind had been there from the start and,

indeed, had been one of the reasons for the

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psychodynamic psychiatrists being recruited.
When I went with Hargreaves and Rodger,1 to

discuss with the Adjutant-General, Sir Ronald

Adam, and the General Officer in Charge of the

Army in Scotland, General Sir Andrew Thorne, I

had been deeply impressed by the wisdom and

acuteness of their minds. They were fully alive to

the complexities of appraising people. Sir Ronald

Adam said we must not be daunted by the

complexity of the job; it was of the greatest

importance and if we were not in time to win the

war, the work might help to win the peace.

General Thorne emphasized that no methods
must go after stereotypes and so deprive the army

of its eccentrics. It was clear to both of these top-

ranking generals that a great range of

personalities could not only make valuable

officers but was necessary for creative

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developments within such a multifarious
institution as the army.

Trist’s conceptualization of the task

highlighted the problem of how to get data on

what was basic in the officer. The technical side

could go some way towards this goal through

their interviews and psychological tests; the

military members had more difficulty in getting

data on which to make an opinion. It was here

that Bion’s genius showed up. I knew well that

Bion had been wrestling hard from the start with
this problem. Although he was a very private

person, as Trist says, he kept remarking on the

need to judge the “quality of contact” the

candidate had with others. With his reserved way

of communicating his ideas, and the highly

condensed, almost cryptic, way in which he
spoke of them, it took me some time to get at

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what he was after. I had learned early on that his
terse statements stemmed from a great deal of

hard thinking. He wanted to get at a crucial

quality which was as his later words put it, “a

man’s capacity for maintaining personal

relationships in a situation of strain that tempted

him to disregard the interests of his fellows for

the sake of his own.” There was no doubt that his

experience as a combatant officer in World War I,

under the greatest of stress at times, was now

fusing with his psychotherapeutic understanding.

The popular way of trying to get some evidence

on this general question, what kind of man was

the candidate, was to ask in interview what he

would do in certain imaginary situations. Bion’s

solution was the Leaderless Group method.

Before it acquired this name, he tried it out by
asking small groups to have a discussion. At first

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he was alone with the group, then he invited us
one at a time to join him as observers. I can recall

vividly how stunned I was by the simplicity of

the notion, and yet what a stroke of genius it was

to create in this way a living manifest sample of

personal relationships in a situation in which the

conflict between self-interest and a concern for

others was an active reality. This was the man in

actual open relationships with others and not

within the constriction of the formal interview or

test situation. As Trist points out, it had the added

merit of making a radical change in the mode of

working for the whole team because everyone
could now relate opinions from a basis of shared

experience of the candidate in spontaneous

interaction. From the discussion group, the

method was quickly used with other situations,

especially with practical tasks out of doors as the

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kind of setting with which the military staff was

most familiar.

When the unit moved to near London to

facilitate the training of staff for the many new

Boards being set up, Bion was naturally hoping

he would have more opportunities for training

and developing the work. The blow he received

(see Trist 1985) when he saw how he was to be

cramped by the administrative arrangements

angered him intensely. He felt there was a “sell-

out” of the real importance of the development of

the work by a special staff group in its own

experimental unit. The staff who had been

involved were now to be more like “sales
representatives” or Inspectors, visiting other

Boards to help them to use the “right technique.”

This was intolerable to Bion, who had to have his

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own thinking rooted in constant interplay with

practice.

It was very difficult to understand why it had

all happened. There were, of course, all the

factors of the kind Bion was alive to, the envy

and fear of creative ideas, and so forth. At the

same time one had to ask whether he had

contributed to the situation? There was only one

way in which he may have done so; namely, in

his own uncompromising attitudes on issues of

this kind and in a reluctance to expand on the

implications of his ideas so that it was not easy

for the administration to work out their

implementation with him. This is a very difficult

issue on which to pass judgment. If the
“establishment” of an institution, the term he was

to adopt later in relation to the acceptance of new

ideas, is not ready for innovation, then it crushes

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the disturbing source in one way or another. Not

infrequently one argument used is that the

creative innovator cannot be trusted to be

“practical” about the changes or to deal

effectively with the people who would be

affected.

Bion may have been labelled in this way

before the Research and Training Unit left

Edinburgh because there had been a growing

strain between him and the President there. The

latter had begun to complicate his own role by

behaving increasingly like an “amateur

psychiatrist” — the term used by the soldiers as a

cautionary “what not to do” in their own role —
for example, in wanting various “experiments”

tried out to which Bion objected on the grounds

that they were using technical staff time in

unprofitable work. His rather self-contained

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attitude may also have made the central
administration feel uncertain of how he would

operate if given full scope. Rees and Hargreaves

had had Bion as a colleague in the prewar

Tavistock Clinic and may have thought from this

experience he was not “extroverted” enough to

win the support of the wide range of senior

officers the occupant of the senior post in the new

unit would have to meet. He was certainly totally

uninterested in, if not actively hostile to, playing

politics. Such doubts, however, were an

inadequate justification for thinking that he might

not have been a realistic manager of a project
with which he was so identified, and particularly
in view of his previous record as a combatant

officer. Perhaps if his thinking about all those

aspects of groups related to power and the

resistance to innovation had been more advanced,

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some of the sabotage meted out to his creative
and courageous endeavours might have been

obviated.

For Bion, there was a limit to compromise if

the new ideas were to be given an adequate

opportunity, and his extraordinary sensitivity to

the unconscious negative forces around him had

convinced him that nothing would mitigate them

enough short of debasing his work, whose urgent

importance at this stage in the war he appreciated

with deep passion. In other situations he would

have been tolerant of such resistance as he met. I

am reminded, for instance, of meeting him once

in a corridor of the Tavistock Clinic after the war

when various members of staff were “taking

groups,” ostensibly following his inspiration. We
were outside the door of a room in which a great

deal of laughter was to be heard from a

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therapeutic group. Sensing the superficial use of
his work that could be made even by close

colleagues, Bion remarked, “Now that’s a ‘good’

group —not like mine!”

I had been close to Bion during the whole of

1942; then, for the next 3 years, my contacts with

him were few. The loss of his first wife in 1944

after the birth of a daughter was a dreadful blow.
One felt fate was now carrying on the cruel

experiences he had had. When he got his work

established after the war he acquired a small
house in the country with a housekeeper to look

after the child. Though not an ideal arrangement,

it gave him some quietness to find himself again
and soon his extraordinarily resilient creative
urge could be seen.

My contact with him resumed with the end of

the war when the Tavistock Group2 began to plan

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its future. Bion’s deep commitment to pursue his
understanding of human behaviour began to

surface through his mourning. He asked me to

join Rickman and himself in a trial “study group”

(as it would be described later) with a

membership of ten drawn from senior

management in industry and other organizations

by A. K. Rice, who was then working for the

Industrial Welfare Society. Here I experienced

Bion in action with a group that had few

inhibitions about expressing its feelings, mainly

very sceptical, for many months. Rickman and I

felt ourselves lagging behind Bion’s comments,

yet we could appreciate how much his thinking

had been developing. In spite of the denial

mechanisms in the group, the impact was

profound; two members got duodenal ulcer

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symptoms before the group finished and three

decided to have personal analysis subsequently!

These effects served to bring out the depths of

Bion’s sensitivity and the validity of his

conception of the close relation between the

physical and mental at the primitive levels

prominent in the group. His role was a stressful

one much of the time and Rickman and I were

not sufficiently on his wavelength to take the
pressure off. He referred frequently in the group

to the striking splits and denials in the perception

of what was happening, splits that he was relating
in his mind to the earliest levels of development.

It was in this group I first heard him comment on

the irrational attitude to time so typical of the

basic assumptions. The keenness of his

sensitivity was all the more remarkable for a man

still coming to terms with the loss of his wife and

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the absence of a normal home background. Thus

while he habitually kept his painful feelings to

himself, I well recall a very poignant occasion at

this period when he was visiting my home. He

said quite spontaneously, “You think you are out

of it; then there is a day when everything brings it

all back and you relive it all again.”

On leaving the army, Bion resumed his

training as a psychoanalyst at the London

Institute. He continued to work with groups in the

Tavistock Clinic though he did not wish to

continue as a staff member, especially as it was to

become a unit within the National Health Service.

He had every reason to be chary of bureaucratic
control and he seemed to be eager to give priority

to his psychoanalytic work, for he did not stay

within the independent Tavistock Institute either.

His personal circumstances fortunately took a

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very favourable turn soon after he completed his
analytic training. In 1952 his marriage began a

sustaining relationship that brought him deep

happiness. Also, he acquired the support of a

group of Kleinian colleagues who, if not all

sharing his interest in groups, did respond with

active cooperation in his working out of some of

the primary developmental processes in the

individual. His creativity was very much the

product of his own struggles and a group of even

the most desirable colleagues could impose a

certain pressure upon him, especially when he

sensed there was a wish to keep him as a leader

with the obligations that entailed. At any rate,
that was the gist of some of the very last remarks

I had from him shortly before he left for

California in 1968. It may have been one

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element, if only a minor one, in the many that led
to his decision to leave England.

Before turning to his work on groups, I

should like to comment on Bion’s apparent

departure from the group field. It has often been

thought that he gave up his interest in groups for

the study of the individual in the psychoanalytic

situation. I do not believe there was any break for

him. Many years later he talked about Freud’s

remark on the “caesura of birth” —that there is

much more continuity in development than the

impressive act of birth would have us believe.

The change was essentially the next step he felt

his work required.

Bion’s Switch from the Group Back to the

Individual

As with Freud, Bion’s dedication was to the

human condition, as can be seen from the extent

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to which he was steeped in history and
philosophy. What he observed in the group and

within the psychoanalytic situation constituted a

binocular vision of the same phenomena. The

basic assumptions in the group crystallized for

him replicas of the emotions with which the

infant related to the mother and, later, the family.

He emphasized that, while they provided a

convenient way of ordering some of the

phenomena in the groups, they were the product

of complex fusions of emotions and ideas. That

they derived from the earliest levels of

psychological development he inferred from the

strength and the quality of the emotions, along
with the fact that the psychic and somatic

expressions were closely interlocked. There was

also the striking avoidance of any learning that

they induced when they were dominant. The

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group revealed these primitive developmental
phenomena with great clarity. Indeed, Bion stated

that he knew of no situation in which the hatred

of learning was more striking than in the group

when in the grip of these basic emotions.

Nevertheless, for the elucidation of the factors

from which the basic assumptions were created, it

was for him the microscopic vision of the

intrapsychic that would be most productive.

Accordingly, it was eminently understandable for

him to transfer his attention to where these early

phases of development could best be studied,

namely in the psychoanalytic pair. This change of

focus certainly coincided with an increasing
absorption in the earliest stages of psychological

development because of his own analysis with

Melanie Klein. When he came to review his

group papers about 2 years after he had written

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them there was such a marked linking of his
previous views with Klein’s theories that it was

sometimes thought her work had influenced him

too much. This opinion has to be assessed against

a background of several considerations.

In the first place, Bion’s decision to have

Melanie Klein as his analyst was based on a

considerable knowledge of her work. She had

made a revolutionary impact on the

psychoanalytic scene in London before the war

and his first analyst, John Rickman,3 had had a

period of analysis with her, although he never

became a “Kleinian.” Her writings on the child’s

inner world of phantastic objects (parents and

parts of parents), both good and bad, its intense
emotional idealizations as well as its ruthless

destructiveness, and the psychotic or splitting

mechanisms used from the start in coping with

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the associated anxieties and impulses, could
certainly make a profound appeal to someone all

too familiar with the human scene from his

psychotherapeutic experience, his knowledge of

history, an intense involvement as a combatant in

the most destructive war man had ever known,

and now confronted with group behaviour, whose

severance from reality made it describable only in

terms of psychotic disorder. The splitting

processes she stressed as characteristic of the

earliest relationships with the breast-mother, with

their projections and introjections, certainly fitted

the savagery of the human scene. She also
illuminated the way in which primitive
internalized objects were projected into parts of

the body, which then became the source of

tension and anxiety leading to hypochondria and

psychosomatic disorder. In short, her experience

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of these early processes as revealed in the
phantasy play and behavioural difficulties of very

young children matched closely what Bion felt

when in contact with the primitive processes in

groups.

Alongside her penetration into the role of the

instinctive drives in the development of the

infant’s object relations, Melanie Klein in her

writings had described the effects of disturbed

emotional development on the child’s

epistemophilic instinct, her term for the dynamic

origins of intellectual growth in relation to reality.

The earliest object relations greatly affected the

child’s capacity to use symbols and so were

crucial in facilitating the child’s general

intellectual development, its whole ability to

learn from an enriching experience with reality.

To Bion, it was the activation of these earliest

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emotions in the group that blocked learning and

development. Klein had made her advances

through the analysis of the play of young children

whose phantasy life was vividly open to the

interested student, as well as being much less

overlaid with the experience of many years of

ever-widening involvement with reality. In her

first formulations, chiefly concerned with the
factors causing inhibitions in intellectual growth,
she did not elucidate the processes in the normal

acquisition of knowledge. In her use of the term

psychotic mechanisms, however, she stressed a

mode of relating to reality that was dominated by

universal processes belonging to the inner world.

While these are modified in the course of
ordinary interaction with reality, they persist
openly in the schizophrenic as the result of

various mismatches between the strength of the

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instincts and the failure of appropriate responses

to them by the mother and, later, the family.

Moreover, this persistence of psychotic

mechanisms was much more widespread than

was realized. Indeed, they were for Klein the

chief underlying factor in the neuroses and

character disorders, although commonly missed

in the analysis of these conditions because of the

degree of covering-up to avoid the intense

anxiety associated with them.

In short, Melanie Klein’s theories had a high

degree of validity and relevance for Bion apart

from any undue influence she might have exerted

through being his analyst. It is true that her own
pioneering courage and single-mindedness,

qualities that appealed to Bion, were reflected in

her associates, in whom she fostered inevitably a

proselytizing zeal. Those qualities are necessary

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if new ideas are to be spread and developed,

though the obvious danger is that there may be

too little scrutiny of them. Bion was much too

powerful and independent a person and a thinker

to take up ideas without a deep critical evaluation

of their relevance in making order out of the

confusing phenomena of the earliest levels of

psychological development. His appraisal of her

views was his own and based on his own data.

There is one aspect that is at least of historic

interest. He told me on the last occasion I saw

him, not long before he left England, that, during

his analysis and subsequently, he had felt Klein to

be out of sympathy with, if not actively hostile to,
his work with groups. She thought he was being

diverted from more important psychoanalytic

work. He could scarcely have convinced her, of

course, of its value as a field for the study of

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psychotic mechanisms, bearing in mind her

complete lack of clinical involvement with group

phenomena —and, indeed, her tendency to

underplay the role of the social environment in

her theorizing. At any rate, Bion was not deterred

from writing his Experiences in Groups!

When Bion did turn to the early levels of

development, he soon focused on those around

learning from experience problems for which

there was no adequate psychoanalytic theory. The

hatred of learning when the basic assumptions

were active had struck him as a major

impediment to work activity in the group, and

further progress with his group studies would be
held up because of this lack.

The readiest means of studying the most

primitive emotions was in those adults in whom

they overwhelmed ordinary rational thought,

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namely, schizophrenics. Bion accordingly took
into analysis a few patients whose degree of

disturbance had led to them being certified as

psychotic. As he said later, had he known more of

what he was going to be in for he would probably

have decided against this course. His own

epistemophilic drive, along with his extraordinary

capacity to retain a sharp and objective sensitivity

to what these patients were experiencing, saw

him through in face of all his lonely doubts.

BION’S FIRST STATEMENT

Bion’s account of his experiences with groups

falls into two parts. The first contains the
description of his method of work, the

phenomena he noted by its use, and his tentative

theories evolved to understand these. While he

regards his views as an extension of Freud’s, his

whole thinking has a quite distinctive character.

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Like Freud, he refers frequently to very different
entities by the word group, for example, to

organizations, or institutions such as the church

and the army, and to such an ill-defined grouping

as “the aristocracy.” These social references

introduce so many complex factors that they are

best left aside from our immediate concern. The

fundamental features of human relationships are

embodied in all social groups so that there is no

question of the relevance of his references. His

theories, however, stem from his observations in

his “laboratory,” the small group, and it is against

the background of this “pure culture” that we
have to appraise them.

Taking the origin of the group as the carrying

out of its purpose, we note that he refers to two
groups, each with a different task as perceived by

the members at the start. In one, composed of

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“nonpatients,” the accepted aim was to study
group behaviour. In the other, the members were

patients seeking help from a medical clinic. The

actual situation was that, after an interview, the

psychiatrist explained to each patient thought

suitable that an understanding of their conflicts in

personal relationships could help in the

amelioration of their symptoms, because these

conflicts were known to be at the root of many of

these difficulties. Such understanding was

facilitated by meeting in a group in which

relationships could be studied as they developed.

(Most of the psychiatrists involved had worked

with Bion in some of his groups. There is thus a
rather tongue-in-the-cheek disingenuousness in

some of his remarks about the staffs beliefs! His

serious point, however, is that the latter were not

always subjected to the questioning that he

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himself felt they should receive.) It is not always
clear at the start which of these two groups he is

describing, although their stated tasks are

different. To Bion, the use of his approach, that

is, one in which the sole activity of the leader or

therapist is to make interpretations of the

phenomena in the group as these developed,

made any difference between the groups

irrelevant. The different expectations of members

in the opening phase, however, are reflected in

the groups. In fact his main references are to the

therapeutic groups in which a strictly group-
centred stance is stressed.

We readily recognize that the development of

his method was in itself a major achievement.

With a remarkable courage from his convictions,

he showed that a psychoanalytic approach

permitted the exposure of unrecognized,

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irrational, and powerful relationships that were
specific to the group situation. Bion was explicit

on the highly subjective nature of his method,

especially in its use of countertransference

feelings and in the detection of projective

identification processes wherein the therapist

picks up the feelings of the members through

what he senses they are projecting into him. As in

psychoanalysis, the observer learns to attend to

two levels of mental activity: the manifest

conscious and the latent subconscious and

unconscious. It is its subjectivity especially of

this degree that arouses so much antipathy in

those who consider that “scientific” research into

human relationships can rest only on behavioural

data, albeit the ephemeral impingement of many

studies of this latter type is in notable contrast

with that of Bion’s findings. That he had

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described something that illuminated the depths
of group phenomena was clear from the

remarkably rapid and widespread interest in his

observations. There was little doubt that his work

had made a profound stir in the new field of

“group dynamics.” Nearly four decades later it

continues to be as evocative as it was at the start

— and a short scan of the history of theoretical

views in psychology and the social sciences

during the century readily shows that to be a

quite unusual distinction.

To sustain the efforts of any group around its

task requires in the first place a readiness to
cooperate, which, for Bion, is a sophisticated

product from years of experience and training.

Next, the mental activity required to further the

task must be of a particular kind, because

judgments about the nature and origin of actual

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phenomena and actions designed to overcome
difficulties presented by them have to be tested

against constant interaction with reality. In short,

as opposed to any magical solutions, it must

involve rational thinking with consequent

learning and development, that is, ego activity. It

is this capacity to sustain task-focused activity

that the unorganized group greatly alters through

the persistent interference from competing mental

activities associated, in Bion’s view, with

powerful emotional drives. These conflicting

forces at first seemed to have little in common
except to oppose the task by creating a group that

would satisfy the emotional needs of members as

these become prominent. This state of the group

Bion termed the group mentality, and the way in

which it might express itself, for example, to find

another leader, he described as the group culture.

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These concepts, however, he soon found did not
clarify sufficiently what his further experience

perceived, namely, patterns of behaviour that

gripped the group into a relatively specific group

mentality in opposition to the work activity. Bion

named these patterns basic assumptions (ba’s), of

which he identified ba D (dependence), ba F

(fight/flight), and ba P (pairing). In the dependent

group, the basic assumption is that one person is

there to provide security by gratifying the group’s

longings through magic. After an initial period of

relief, individuals tend to react against the

assumption because of the infantile

demandingness and greed it engenders.

Nevertheless, when he confronted the group with

the dependence assumption taking over, Bion

noted that a hostile response to any intervention

by him frequently revealed more than a

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resentment against his refusal to provide the
magical pabulum. A longing for a more

permanent and comprehensive support was to be

seen in the raising of religious themes, with the

group feeling that its “religion,” in which the

therapist is a phantasied deity, was being taken

from it. Fight and flight appeared as reactions to

what the group wanted to avoid, namely, the

work activity that forced it to confront the need to

develop by giving up primitive magical ideas.

The ineffectiveness of these solutions led at times

to a different activity, for which Bion postulated

the assumption of pairing. Pairing occurred

repeatedly in his groups in the form of two

members, irrespective of sex, getting into a

discussion. To his surprise, this was listened to

attentively, with no sign of the impatience from

members whose own problems usually pressed

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them to seek the centre of attention for

themselves. There seemed to be a shared

unconscious phantasy that sex was the aim, with

reproduction as a means of meeting a powerful

need to preserve the group as a group.

As mentioned, the group dominated by an

assumption evolves an appropriate culture to

express it, for example, the dependent group

establishes a leader who is felt to be helpful in

supplying what it wants. Moreover, the

assumptions can be strong enough for members

to be controlled by them to the extent of their

thinking and behaviour becoming almost totally

unrealistic in relation to the work task. The group

is then for each member an undifferentiated

whole into which he is pressed inexorably to

conform and in which each has lost his

independent individuality. The individual

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experiences this loss as disturbing, and so the

group is in more or less constant change from the

interaction of the basic assumptions, the group

culture, and the individual struggling to hold on

to his individuality.

Basic assumptions originate within the

individual as powerful emotions associated with a

specific cluster of ideas that compel the

individual to behave accordingly and also to be

attracted to those imbued with the same feeling

with an immediacy that struck Bion as more

analogous to tropisms than to purposive

behaviour. These bonds Bion termed valency

because of this chemicallike nature of the

attraction.

As primed motivating forces, the basic

assumptions supply a fundamental thrust to all

activity, yet the drive towards interaction with the

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real environment remains the more powerful

dynamic in the long run, for, without that

adaptive urge, survival would not be possible.

The difficulties of reality interactions, however,

are great. The physical environment may present

insoluble problems; but it is the social factors that

become prominent in their effects on the

capacities of the individual when work demands

cooperation with all the give and take that entails.

The frustrations in sustaining work activity are

thus perpetually liable to induce the regressed

behaviour of the assumptions. The more the

individual becomes identified with a basic
assumption, the more does he get a sense of

security and vitality from his fusion with the

group, along with the pull back to the shared

illusory hopes of magical omnipotent

achievement inherent in the phantasies of the

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assumption. From all these sources there is
derived what Bion described as a hatred of

learning, a profound resistance to staying in the

struggle with the reality task until some action

gives the experience of mastery of at least a part

of it, that is, until development of new inner

resources occurs.

The appeal of each assumption rests in the

associated emotion, which gets a characteristic

quality from the specific phantasies and ideas it

involves. The assumptions do not conflict with

each other. Instead, they change from one to

another and conflict occurs only between them

and the work group. When one ba is combined

with work activity, however, the other ba’s are

suppressed. A further observation Bion made was

the way in which the ba group could change to its

“dual.” Thus the dependent group under the

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frustrations of the leader’s failure to gratify its
longings could reverse roles so that the group

treated the leader as the one in need of help. In

this connection, he also noted the tendency of the

dependent group when left to its own devices to

choose as leader the most disturbed member, as if

it could best depend on someone of its own kind,

as dependent as itself—the familiar “genius,”

madman, or fanatic.

The interrelations of the ba’s, plus the

tenacity and exclusiveness with which the

emotions and ideas are bound together in each ba,

led Bion to what he felt was a theoretical

impasse, which no available psychological
explanation could illumine. He therefore

postulated a metapsychological notion that

transcends experience in the form of a

protomental system in which the prototype of

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each ba exists “as a whole in which no part can
be separated from the rest.” The emotion in each

individual that starts the ba progresses to the

psychological manifestations that can be

identified.

The physical and the mental are

undifferentiated in the basic levels of this system,

a feature that led to his suggestion that certain

illnesses, those in which a substantial

psychosomatic component has long been

recognized, might well be diseases of certain

conditions in groups. To test such ideas needed

much larger populations than the small group

could provide, but he hoped it might be done in
order to establish the basic assumptions as

clinical entities.

Bion’s concluding observations become

increasingly concerned with aspects of group

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dynamics in general, for example, the oscillations
in attitudes to the leader as leader of the

assumption group or of the work group, or splits

in the group, according as members wished to

cling to either of these groups. On the

relationship of the individual to the group, he

agrees with Freud that a group instinct is not

primitive and that much of his groupishness

originates in his upbringing within the family.

Bion adds to these, however, from his

observations, the view that, while the group adds

nothing to the individual, certain aspects of

individual psychology cannot be explained

except by reference to the matrix of the group as
the only situation that evokes them. The

individual loses his distinctiveness when he is in

a basic assumption group, that is, one in which

his individuality is swamped by the valencies in

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these. Such a group has to change when it has to
deal with realities, or perish.

Earlier I noted that most of Bion’s references

were to his therapeutic groups, and he states how

he believes their aim is furthered. His first and

most emphatic view is that any help the

individual may get from the group situation
towards understanding himself more fully rests

on the extent to which he can recognize himself

as one torn between the pull of the basic groups

and his membership of the work group that

represents his ego functioning. For this reason,
any interventions from the therapist directed to

the psychopathology of the individual must be

avoided because they are destructive of the

experience of the basic group. He concluded that,

by adhering strictly to his standpoint, individuals

do become less oppressed by basic group activity

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within themselves. In other words, what he
asserts is that by showing the group the ways in

which it avoids its task through regressing to

dependency, fight/flight, or pairing, it can become

more work oriented and so further the

development by learning of all members.

Much of the subsequent criticism of Bion’s

approach as a psychotherapeutic method arises, I

believe, from a failure to keep his aims clear and

especially to avoid the confusion which the use of

the word therapeutic, and especially

psychotherapeutic, has engendered. To those
seeking to use the group situation in a

psychotherapeutic way, that is, to cope with the

enormous diversity of neurotic behaviour and its

unique configuration in every individual, then
work has to be based on our understanding of
psychopathology. The group processes must

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therefore be directly relatable to the latter. Bion’s
approach in fact originated in the problem of

neurosis as a social one, that is, how does the

large organization cope with the failures of its

members to comply with its work task. The

opening sentences in his book make plain that,

for him, group therapy can mean the therapy of

individuals in groups, in which case neurosis is

the problem of the individual, but in the treatment

of the group it has to be a problem of the group.

His conception of group therapy may then be

put as follows. The individual contains within his

innate endowment certain potential patterns,

which are released in the unorganized group. This

unorganized group is not a special kind of group
identifiable by its external features, but a state of

mind that can overtake any group. Once elicited,

these patterns or basic assumptions bond the

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individuals together to give security by

preserving the group as a unity and by seeking a

course of action for it governed largely by

magical phantasies. These patterns remove the

individual’s distinctiveness, that is, his overall

modes of dealing with his purposes as fashioned

by his learning from the experience of reality.

Because these modes, his ego functioning in

short, are always present in some measure, a

conflict between his ego and absorption in any

basic assumption behaviour is never absent. Such

group-determined behaviour is a serious

limitation to the individuals in any group when

faced with an unfamiliar task, because they then

tend to feel in an unorganized group state and

find their capacity to tackle that realistically as a

group to have become quite unreliable. (The
commonest remarks after intensive exposure to

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the unorganized group situation at Group

Relations Conferences run on the Tavistock

model are those describing feelings of being “de-

skilled.”) To have developed a method whereby

these group dynamics can be experienced in

adequate depth, and to have shown some of the

requirements in the leader for the application of

this method, is an extremely valuable

contribution to the whole study of group

dynamics. His findings can assist those

responsible for groups coping with tasks to note

when their effectiveness is impaired by bad

behaviour, and this kind of experience features

prominently in many management training

schemes.

It is a quite separate issue, however, to

appraise the value of the principles underlying

Bion’s work in relation to the use of groups for

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analytical psychotherapy. The distinction between

the study of group dynamics and group therapy

has become a clear one in the courses developed

by A. K. Rice and his associates, as was seen, for

instance, in the staff attitude to any individual

who got into serious personal difficulties during a

conference. The staff naturally arranged to get the

help needed, but it would not confuse its own role

by attempting to provide psychiatric or

psychotherapeutic help, especially when

psychiatrists or psychoanalysts were members of

the staff. The strict use of Bion’s approach has

never in fact been widely adopted by analytical

psychotherapists, not even in the Tavistock
Clinic. Many have, however, made more

systematic use of the group situation in their

interpretations than have most other therapists, in

the sense of trying to base these strictly on the

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here-and-now dynamics in the group situation as

a whole.

Although we can agree on a separation of

these two tasks, we are left with many unsolved

questions that affect our understanding of both.

To state that the individual’s groupishness is an

inherent property in his makeup as a social

animal has not really carried forward our

understanding of its nature and origin. Are the

phenomena of the basic assumptions as specific

to the group situation as he asserts? There is no

question that, when activated by them,

individuals can show a remarkable capacity to

abandon their distinctiveness. The group gives a

prominence to these responses by intensifying

them, yet they do not appear to be different from

the primitive relationships that can be seen in

individual treatment, especially in the light of our

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further knowledge of the earliest stages of the
development of the person.

One feature of Bion’s thought that is

unrecognized by him, I believe, is his underlying

adherence to concepts of energy as in the

classical psychoanalytic theories of Freud. Thus

basic assumptions originate as emotions, which

are viewed as sources of energy, and Bion is then

puzzled by the specific clusters of phantasies

around them. Phantasies are of imagined

relationships, and if we take emotions to be the

effective colouring accompanying any

relationship, then their specific quality is
determined by the specifics of the relationships.
The dependence and pairing assumptions are

much more complex in this respect than the

others. They can be readily seen as the prototypes

of human relationships, for example, as infantile

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dependence in which the self and the object are
not differentiated, becoming the more

differentiated clinging or attachment to a

differentiated object in ba pairing. Fight and

flight are the basic responses of all animals to the

situation that evokes pain or the threat of danger.

Bion seems to sense the problem of the individual

and the group as needing a good deal of further

clarification, and the choice he made for his next

step was to turn his microscope, to use his own

metaphor, back to the earliest stages of individual

development. This move leads to a major

amplification in his understanding of the

dynamics of all groups.

THE REVIEW OF THE FIRST STATEMENT

In his review of the dynamics of the group,

Bion (1961) “hopes to show that in his contact

with the complexities of life in a group the adult

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resorts, in what may be a massive regression, to
mechanisms described by Melanie Klein as

typical of the earliest phases of mental life.” This

task of establishing “contact with the emotional

life of the group … would appear to be as

formidable to the adult as the relationship with

the breast appears to be to the infant, and the

failure to meet the demands of this task is

revealed in his regression” (pp. 141-142). Two

main features of this regression are, first, a belief

that the group exists as an entity that is endowed

with characteristics by each individual. Distinct

individuals become lost and the group is treated

as if it were another person. Second is the change

within the individual that accompanies his

regressed perception of the group. For this

change Bion quotes Freud’s description of the

loss of the individual’s distinctiveness, with the

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addition that the individual’s struggle to retain it
varies with the state of the group. Organization

helps to maintain work-group activity, and indeed

that is its aim.

In the work group, individuals remain

individuals and cooperate, whereas in the basic

assumption group they are swept spontaneously

by the valency of identification, the primitive

gregarious quality in the personality, into the

undifferentiated unity of the group in which inner

realities overwhelm the relationship with the real

task.

Although starting his review with the

regression in groups as their most striking

feature, he emphasizes again the fundamental

dynamic of the work group, which also has its
combination of emotions and ideas, especially the

idea that development and the validity of learning

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by experience is the impetus in the individual to
possess the autonomy of his own mental life. It is

as if there was a recognition “of the painful and

often fatal consequences of having to act without

an adequate grasp of reality.” Despite the

dominant influence of the basic assumptions over

it at times, work activity is what takes precedence

eventually — as it must. Freud, following Le

Bon, believed the intellectual ability of the group

was reduced, but Bion disagrees. His experience

is that, even when basic assumptions are active,

the group shows high-level intellectual work in

the assimilation of interpretations. Although this

work goes on in a segregated part of the mind
with little overt indication, its presence has to be

assumed from the way in which interpretations,

ostensibly ignored, are nevertheless worked upon

between sessions with subsequent reports from

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individuals of how they had been thinking of
them, though they meant nothing at the time they

were made. It is only in activity of the work

group that words are used normally, that is, with

their symbolic significance. The basic assumption

groups, by contrast, he thinks, use language as a

mode of action and are thereby deprived of the

flexibility of thought that development requires.

When he relooks at the basic assumptions,

there is considerable amplification in what he

now discerns as presenting them. This

development is apparently related to his much

greater familiarity with primitive mental

processes and their detection by an increased

responsiveness to projective identification as
described by Melanie Klein. He believes this
method, which requires a psychoanalytically

trained observer, is the only one that can detect

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the important subjective processes. Conclusions
based on its use have to be appraised by the effect

of interventions and by the experience of many

observers over time.

In the dependent group, he adds to the

expectation of treatment from the therapist a

much more primitive phantasy of being literally

fed by him. At a less primitive level he again

stresses the presence of a projected deity who is

clung to with tenacious possessiveness. The

sexual phantasies which characterized the pairing

group, with the possible implication of

reproduction as preserving the group, are now
taken to be the result of a degree of

rationalization. Nevertheless, oedipal sexual

phantasies are present much of the time in all of

the assumptions. They are not, however, of

Freud’s classical type, but of the much more

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primitive nature described by Klein. According to

her, the phantasies of very young children show,

as the self is emerging in relation to its objects,

themes of the parents mutually incorporating

parts of each other with the hungry sadistic urges

that the child attributes to one or both figures by

its identification with them. The child can then

experience a psychotic or disintegrative degree of

anxiety from the fear of being the object of

retaliatory attacks and so it splits off the part of

its self involved in the relationship with an

attempt, then, to get rid of it by projective

identification. These primitive oedipal

relationships according to Bion are distributed in
various ways among (i) the individual; (ii) the

group felt as one fragmented individual with (iii),

a hidden figure, the leader, used here by

detaching him from his role as leader of the work

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group. A further addition to the oedipal figures,

one ignored in the classical formulation, is the

sphinx —a role carried by the therapist and the

work group. The curiosity of the individual about

the group and the therapist evokes the dread

associated with the infant’s phantasied intrusions

to get at and to devour what is inside the mother

and what goes on in the phantasied primal scene.

The anxieties inherent in the primitive

phantasies, sexual and other, are instinctively

responded to by an attempt to find “allies,”

figures with whom the feeling of a close contact
can bring reassurance. Bion accordingly suggests

this need as a powerful stimulus to the creation of

the pairing group. Another factor in its

establishment and maintenance, also operative

with no regard to the sex of the pair, is the feeling

of hope, not a phantasy of a future event, but a

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“feeling of hope itself.” This feeling he takes to

be the opposite of all the strong negative feelings

of hatred, destructiveness, and despair, and it is

sustained by the idea of finding a saviour, a

Messiah essentially, an idea that must never be

realized.

The fight/flight groups are, as would be

expected, much less associated with complex

phantasied relationships, since they have the

relatively simple aim of getting rid of the threat

of danger when no other assumption or activity

seems appropriate. On this group Bion makes,

almost as an aside, what I find to be a remarkable

statement: “The fight/flight group expresses a
sense of incapacity for understanding and the

love without which understanding cannot exist”

(my italics). I do not think its full implications are

taken up by Bion in regard to the emergence of

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any of the assumptions and to the role of the
leader, topics to which I shall return.

Recognition of their more specific contents

leads Bion to reconsider the status of his notions

about the basic assumptions. There was no doubt

they were helpful in ordering the chaotic

manifestations in the group, but, in view of the

primitive phantasies related to them, they now

appeared as derivatives of these more

fundamental processes. All the assumptions drive

the group to find a leader, yet none of them is felt
to establish a satisfactory state in the group.

There is consequently perpetual instability with

changes from one assumption to another with all
those remaining opposed to learning and

development. For all these manifestations, and

for their very existence, Bion could find no

explanation. The exposure of primitive phantasies

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and the anxieties they induce now made it clear
that the basic assumptions were derivatives

whose function is to defend the group against

these anxieties becoming too intense. As

defences, however, they are all inadequate

because of their segregation from any reality

testing. For Bion, the dynamics of the group

could now be adequately experienced and

understood, therefore, only by the working out of

these primitive primal scene phantasies as the

factors underlying the basic assumptions and

their complex interrelationships.

With these developments in his thinking,

Bion has moved back to the nature of the

individual and his groupishness. The new views

brought him again closer to psychoanalysis and it
is perhaps significant that their original

publication was in The International Journal of

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Psycho-Analysis and not Human Relations with
its social science readership. They were, of

course, sought out, but their crucial position as

the culmination of his work on group dynamics

did not become widely manifest until 10 years

later, when they appeared in his book. The time

lag did not affect those students of group

dynamics in close contact with his thinking. It

helped to perpetuate, I believe, the separation of

psychoanalysis and group dynamics when both

disciplines needed each other. The obstacles to a

wider acceptance stemmed from more profound

sources. At the time of their appearance, Kleinian

views were resisted among psychoanalysts in

general, especially in the United States, and this

rejection was scarcely needed to reinforce

amongst nonanalysts what they were eminently

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prone to do by their disturbing unconscious
resonances.

Bion always kept Freud’s views on groups in

mind, and so he now looked at where he stood in

relation to these. Leaving aside the references

both made to complex social organizations such

as the church and the army, he reasserts his

agreement with Freud in rejecting the need to

postulate a herd instinct. For him the individual is

a group animal by nature, yet at war with the

group and with those forces in him that determine

his groupishness. The latter is in no way created

by the group; it is merely activated and exposed

by it. The impact of the group on the individual’s

distinctiveness springs from the state of mind in
the group, that is, the degree to which its lack of

organization and structure fails to keep work

activity, a contact with reality, the dominant

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activity. In the organized group the bond between
members is one of cooperation, whereas in an

unorganized state the bonds become the valencies

of the basic assumption states. Bion sees

McDougall’s criteria for the organized group as

the conditions that suppress the basic assumption

trends in the members by keeping them related to

reality. Freud’s statement that the individual’s

emotions are intensified in the group while his

intellectual functioning is lowered is not

acceptable to Bion. For him the apparent

intensification is the effect of tension due to the

suppression of the basic assumption emotions.
Bion’s comment, however, hardly applies to

Freud, since he is referring mainly to mobs in

which the primitive instincts are released from

normal controls.

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The bonding from valency is a more primitive
process than that from libido, which Bion takes to

operate only in the pairing group. Freud’s view of

the bond to the leader as almost entirely an

introjection of him by the ego (Bion does not

mention Freud’s ego-ideal as a separate structure)

is again only part of the relationship to a leader.

For Bion, Freud does not recognize the much

more potentially dangerous bonding that arises in

the assumption groups. Here the individual does

not introject a leader who carries power for him

through his contact with external reality. The

leader in the basic assumption exhibits features

that appeal to the assumption state in the

members, who therefore projectively identify

with him. This leader is thus as much a part of the

assumption state as the members and just as

divorced from external reality, so that he leads as

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often to disaster as not. Freud’s view of the leader
as the ego-ideal led him to see panic in military

groups as following the loss of the leader. Bion

thinks this account is not right, for panic arises

when the situation might as readily give rise to

rage as fear. Intense fight/flight behaviour may

resemble panic, but for Bion the group can well

be still related to the leader on such occasions.

Panic occurs when a situation arises completely

outwith the purposes of the group and its

associated organization.

Bion thus adds to Freud’s views rather than

refuting them. Freud saw in the group the kind of

relationships present in the family when the

individual has developed to the stage of the

traditional Oedipus complex, that is, its emotional

features were neurotic in character with the main

sources of anxiety being the fears of loss of love

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or of being castrated. Bion saw them as deriving
from much earlier phases in which the fears are

of disintegration, that is, loss of the self or

madness. His belief that the only feasible

therapeutic help in the group lies in the individual

experiencing its primitive emotions and attitudes

to him is again maintained. Here we are into

debatable issues which I shall return to when the

aims of therapy can be considered.

Much as Bion has contributed, we are left

with what seem to be the crucial questions about

groups unanswered. What does the individual’s

groupishness rest on? We have Freud’s libidinal

bonds supplemented by valencies from primitive

projective identifications with a great deal about

“mechanisms,” all manifested as the individual’s

distinctiveness is removed. This regressed state,

moreover, can come and go with a high degree of

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lability. For Bion, this distinctiveness is placed in
opposition to the groupishness conceived as the

expression of emotions with which the individual

has to be at war. Freud, on the other hand, sees

the conflict as between the id and the culture of

the individual’s society internalized in his

superego and ego-ideal. Adult or mature

groupishness, if we might put it that way, rests for

Bion on cooperation, the sophisticated product of

years of training. That is to say, it is like an

activity imposed on the freedom of the individual

to be “doing his own thing” and accepted more or

less reluctantly. How can such an achievement

vanish within a few minutes in the unorganized
situation of Bion’s groups? Both Freud and Bion

from their psychoanalytic studies have

emphasized that individual and group psychology

constitute the same field of study. If we accept

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that position we are a long way from
understanding it. The intimate interrelatedness of

the individual with his social field strongly

suggests to us that we are dealing with the

individual as a highly open system maintained in

his organization by appropriate input from a

social field itself structured to provide this input.

The phenomena seem to require the organization

concepts of open systems, which neither Freud

nor Bion had.

Freud, however inadequate his theorising may

have been, as it was constrained by the scientific

climate of his day, is universally recognized as a

brilliant observer. I propose therefore to look

back to what he said to see what can be taken

from his observations.

Having eliminated the need for any such

notions as a social or herd instinct, Freud (1921)

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stated that a psychology of the group had to
answer three questions:

1. What is a group?

2. How did it acquire the capacity for exercising

such a decisive influence over the mental life
of the individual?

3. What is the nature of the mental changes

which it forces upon the individual?

The latter is the one that is best studied first, and

it is the one with which observers of group

phenomena such as Freud and Bion are most

concerned. Freud’s data were largely the writings

of Le Bon, McDougall, and Trotter, which he

related to his own knowledge and experience of

social behaviour, especially from the phenomena

of transference. Groups brought together for the

specific task of direct psychoanalytic observation

had not yet occurred.

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The changes made by the group were

described by Freud in two different ways. At first,

apparently influenced by Le Bon’s description of

mobs, he sees individuals in the group released

from the inhibitions of civilization, with the

consequent emergence of the unbridled instincts.

He recognizes, however, that the same conditions

can activate intense effort and self-sacrifice for

the group’s ideals. In other words, the group can

convert the individual into one identified with all

its members in the regressed expression of the

repressed, or with its opposite, the repressing

structure of the superego, although the latter can

scarcely be regarded as regressed, at least in the

sense used about the id. These changes do not fit

well into any notion of a social instinct, or

behavioural system, activated or inhibited by a

social stimulus. They represent more of an

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organizational change in the personality from the

normal degree of integrated functioning to one in

which intense emotions are prominent and shared

by the group and in which identification is a

dominant mode of relating.

On how the changes are made, Freud rejects

the concept of suggestibility as tautological and

brings forward his libido theory, libido being his

hypothetical instinctive energy that impels people

into all the relationships commonly described as

love. In using this theory, Freud has moved away

from loose aggregates or mobs to highly

organized, lasting groups in which he points out
that role of leader is paramount. Thus in the

Christian church or in an army, each individual

has a bond of love with the leader and

consequently all have a bond of identification

with each other, that of brothers within the

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leader’s family. The leader, moreover, may be

replaced by an idea or an ideal. This move to the

group with a leader alters the description of the

changes forced upon the individual to the

following: “the individual, outside the primitive

group, possessed his own continuity, his self-

consciousness, his traditions and customs, his

own particular functions and position, and he

kept apart from his rivals. Owing to his entry into

an ‘unorganized’ group he had lost this

distinctiveness for a time” (Freud 1921, p. 86).

Freud uses these two examples to bring out

differences in the relationship with the leader and

the associated characteristic of the behaviour

when the group disintegrates. In the military
situation, the loss of the leader can release “a

gigantic and senseless fear” progressing to a

panic, a reaction that cannot be interpreted as

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always due to the increase in external danger. The

religious group, with a corresponding loss or

threat to the leader or his ideals, does not produce

fear. Instead a ruthless hostility is mobilized to

those not sharing the group’s ideals.

While the role of the leader is undoubtedly

central, the nature of the libidinal bonds between

him and the group remained for Freud rather

mysterious. He was struck by their close affinities

to hypnosis as a libidinal bond without conscious

sexual trends to the powerful father, yet he also

recognized the paralysed feeling of helplessness

in the hypnotic bond as closely resembling the

submission of the child to its parent. And beyond

that, the “extreme passion for authority in the

group” seemed to bring in the archaic residues of

the dreaded father in the primal horde. With the
bond to the leader being of the same nature as

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that of an idealized object, Freud defines the
primary group as one in which the leader is put

by all in place of their ego-ideal. The leader thus

embodies the group ideal and is inextricably

mixed with the aims of the group, both as the one

who defines the task and as the one who will lead
the group towards its successful resolution. The

psychological situation within each member of

these groups, however, is different. The soldiers

are dependent on the actual presence of the leader

for the survival of the group. On his

disappearance, each member becomes totally

disorganized and disconnected from everyone;
and though this state may be seen as the response

of any individual to an inescapable external

danger, Freud points out that it happens in this

group only as a result of the loss of the bond with

the leader. This bond consisted in the replacement

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of their ego-ideal by the leader and we cannot but
conclude that the organization of what is bonded

to the leader in this situation resembles that of the

young child to its parents in the quality of the

powerful dynamic nature of the dependence on

omnipotent parents. Without their manifest

presence when stress has reached a critical point,

the disintegration feared by the child increases

with the terror of isolation. The inner situation of

the group members, in short, is here that of a

structured replica of this dependence which is too

immature for them to function autonomously

once it is not maintained by the reinforcement of

the real external support. The ego-ideal has thus

an immature status as well as the ego.

The bonding in the religious group has a

different content according to Freud. Here the

members are not only related to the leader or the

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ideal through these replacing their ego-ideal, they
are also identified with him. The personality

organization that is here tied to the leader has a

more developed character in that it has

assimilated the ideals so that they have become a

part of this organized self. Moreover, the

presence of the ideal is felt to be a matter of life

or death in that its preservation has to be fought

for at all costs, whether by the group or by the

individual alone. The individuals in these two

groups, as well as having different bonds, are in

different situations externally and internally.

What we see in the soldiers is a response from a

group in which their distinctive identity has

already been systematically diminished so that in

the situation Freud described there is a

predisposed state of immature dependence.

Functioning is conditional upon the support of a

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highly personalized relationship with the leader.
The religious group is promised great rewards for

a course of conduct prescribed by the ideals and

so enhances the individual’s distinctiveness,

albeit in conditional ways. Freud does not

elaborate on the implications of his observations,

yet he has made fundamental comments on the

integration of the individual and its maintenance.

He has shown that the individual keeps his

distinctiveness by having built into the structure

of his personality an imago of his parents, that is,

an internalized representation of his social

relatedness. Moreover, this inner imago has an

open interchangeable relationship with external

figures or ideas. The groupishness of the
individual is thus placed as a dynamic within him

which has developed from an early phase of

almost complete dependence to one less

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comprehensive. Though stressing the highly
tentative and limited status of his study of groups,

Freud has reached conclusions of great

significance. He has made it clear that what

happens in any group is a particular instance of

the relationship between the individual's inner

world and his social world. Thus he has answered

his questions about the group by expanding an

answer to the unstated question of what is an

individual. He had to advance the theory of the

ego and its relationships by showing that a

subsystem within the ego, the ego-ideal, entered

into relationships that differed in character from

those of the ego. Moreover, the most striking

feature from his conclusions is the open and rapid
dynamic transactions that can occur in the group

whereby the individual, sensing his own inability

and that of the other members to act effectively,

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can promptly alter the boundary of his self to
internalize the leader as a part of it and so to

surrender his previous distinctiveness in favour of

a less mature organization of his self. Viewed in

terms of Freud’s metapsychology, and the

metascience available to him, with the dynamics

of the person based upon the redistribution of

psychic energies, the phenomena could not be

adequately conceptualized. We are clearly

confronted again with problems of the

organization of the individual as a highly open

system in an environment that reacts with him in

a correspondingly open way. Individual and

environment are structured by, and within, each

other.

To account for the group phenomena, both

Freud and Bion have gone back to the dynamic

structuring of the individual. Both have left many

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questions unanswered. Freud pays little or no
attention to the individual’s relationship to the

common purpose other than to bring in

McDougall’s requirements for the organized

group as the way in which he best furthers his

contribution. Bion sees the grip of the reality task

for the work group, like Freud’s soft voice of the

intellect, not resting till it has gained a hearing.

His basic assumptions take over from the effects

of valency, likened to a tropism, yet establishing

a group mentality which has a much more

purposeful quality than would arise in any

lemminglike way. Both, of course, had views of

the individual conditioned by their times. Recent

trends in psychoanalysis, while not providing an
agreed account, do give a different perspective on

the dynamics of the individual in his groups. Of

crucial importance for our evaluation of Bion’s

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views in regard to therapy is how the experience

of the individual’s groupishness relates to the

psychotherapeutic task for which the therapist

has suggested his joining the group. For this

purpose, I give in the next section a very sketchy

and brief outline of the nature of his groupishness

and of how his psychopathology enters into the

group situation.

RECENT TRENDS IN PSYCHOANALYTIC

CONCEPTIONS OF THE INDIVIDUAL AND
HIS SOCIAL RELATEDNESS

Clinical work and child-observation studies

of the last few decades have shown that the

personality acquires the capacity to make
effective relations with others only when there

has been early experience of being treated as a

“person” by the mother, and the father later, with

stimulating encouraging interactions conveyed

with joy. The satisfaction of physical needs has to

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be supplemented by a social input that meets the

need “to become a person.” There appears to be

from an early stage an overall gestalt that gives to

the potential self a feeling of “things being right

or not.” Bodily sensations and the affects

accompanying many specific behavioural systems

all contribute to the affective tone in the self, yet

a general malaise, even to the point of death, can

follow from a failure in “being personalized” by

appropriate mothering. Child studies show the

dramatic results under certain conditions of

deprivation, for example, when a consistent

maternal relationship is absent (see Spitz 1965).

Clinical findings from the more seriously

distorted personalities emphasize lifelong
feelings of never having been valued for

themselves as with cold or indifferent mothers or,

more frequently, with mothers experienced as

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imposing preconceptions that denied powerful

urges to develop autonomously (see Lichtenstein

1977). The self-system is thus structured by the

internalization of the relationship with mother

and child, undifferentiated at the start then

progressively separated throughout the long

period of human dependence.

Early structuring of the personality is

inevitably dominated by the physical closeness in

which the mother’s attitudes are communicated

through innumerable signals in her whole

handling of, and responses to, her child. The

emotional experiences are gradually cohered by

consistent reliable mothering into a “primary or

centred self.” This integration is a labile process

with threats to it producing at times intense

anxiety and aggression. Negative feelings from

the inevitable frustrations are separated from this

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primary self, but with ordinary care these
divisions are diminished so that a sufficiently

coherent, resilient self becomes the dominant

mediator in relating to the environment. The

primary self remains the visible self, the one

adapted to the mother. Should the latter have

failed to facilitate development sufficiently well,

this primary self acquires distortions of its

capacity to relate, and when negative experiences

have been strong enough, substantial divisions

within the structure of the self-system are formed.

These subselves embody frustrated needs,

especially for unmet recognition as a valued

person, and the aggressive reactions to the

frustrating mother linked with fears of her talion
retaliation. The self-systems each retain a self

pole and an object pole, with an imago of the

kind of parent desired or feared and hated. The

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primary self relates to the outer world and so

learns from its expanding experience. The

subselves, while remaining highly dynamic as

portions of the original self, have to find covert

outlets —the processes described in the whole of

psychopathology — because their aims have to

be hidden from the feared parental attacks.

Defences or control measures are evolved by

the central self in keeping with its reality

pressures and incorporated into its patterning.

When the urges cannot be managed in this way
then they constitute a secret self in conflict with
the central one. Stabilizing factors such as family
and work, or selected social groups, all assist in

their control though the precarious balance shows

when the functioning of the central reality-related
self is altered as by drugs or by changes in the

social environment. The central self ordinarily

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copes with changes in sections of the latter but
removal of security-pinnings from it rapidly leads

to the emergence of subsystem dominance.

When the imagos constituting the object poles

in the inner relationships are facilitative, then the

impact of infantile sexuality is worked through

without undue trouble. Marked divisions in the

self make for serious difficulties because the new

urges to closeness are dealt with in their terms,

for example, hostile imagos evoke anxieties

about rejection and retaliation and so lead to the
fusion of aggression and sexuality in sadistic and

perverse expression in which the object becomes

in varying measure depersonalized.

The essential change in this way of

conceiving the person is from one based on

theories of psychic energies to one dealing with

the organization of experience of relationships in

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an open system interacting with the social
environment. Because of the incomplete

differentiation of self and object, relations in the

primary self are characterized by identifications

and urges to have omnipotent magical control

with regressive clinging to objects for security

against the threat of “going to bits.” With

growing appreciation of reality and

differentiation of self and others, the primary self

is progressively superseded by a strengthened

definition of the self through satisfactions from

talents and skills. Attachments to others changes

to relationships based on shared activities. Goals

and purposes become organized, and values add

to the integration of the self. The personality

acquires its characteristic configuration, that is,

its identity (see Erikson 1959), and in keeping

with the uniquely evolved patterns from its

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specific experience, the individual requires
constant affirmation from the social milieu. The

constant need for this “psychosocial metabolism”

in maintaining a normal degree of effective

integrated functioning is readily exposed when

sections of the environment are removed, quite

apart from any interference with the biologically

rooted sexual and procreational needs.

Populations displaced from their usual cultural

setting show widespread indications of

disorganization as in the rise of illnesses of all

kinds, not only psychiatric. Again, when

individuals lose a feeling of personal significance

in their work, similar stress manifestations occur

(see Trist and Bamforth 1951). These

deprivations disorganize the most developed

adaptive functioning of the social self leading to

the increased dominance of the primary self with

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its insecurities and more primitive compulsive
relations. Such regressive disorganization is

almost universal. With individuals whose

subsystems are a constant threat, the loss of their

usual sources of relative security confronts them

with the extra dangers of their “secret” selves

being exposed.

The origin and nature of the individual’s

groupishness is thus no problem. From the very

start he cannot survive without his needs for

social relatedness being met.

As happens so often, Freud makes a

remarkable description of the individual in
relation to the group. He notes McDougall’s

conditions for the organized group as (1) a

continuity of existence; (2) the individual should
know the nature, composition, functions, and

capacities of the group; (3) the group should

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interact with other groups partly similar and
partly different in many respects; (4) it should

possess traditions, customs, and habits, and

especially such as determine the relations

amongst members; and (5) the group should have

a definite structure, exposed in the specialization

and differentiation of the functions of its

constituents. As stated previously, Freud (1922)

takes these as precisely the features that

characterize the individual and which are

removed by the unorganized group. In short,

although he could not fit it into his theories, he

apparently sensed that the group and the

individual structure each other in the closest

possible way.

There is no phase in the life-cycle in which

man can live apart from his groups. Bion’s

statement that the individual is at war “with

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himself for being a group animal and with those
aspects of his personality that constitute his

‘groupishness’ ” therefore has to be examined.

GROUP DYNAMICS AND GROUP

PSYCHOTHERAPY

Group Dynamics

From the view of the individual I have

sketched, the important questions about groups

are those devoted to the conditions that take away

the factors in the social environment that

ordinarily keep his self-system in its normal

integration. Bion stated that the basic

assumptions are states of mind the individuals in
the group get into. He then described these states

and what seemed to constitute them. What he

uncovered was the emergence of the primary

mechanisms of relatedness, those of the

developing infant to the breast-mother, and it is

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the intense anxieties associated with these
mechanisms that drive the group into the

assumptions. The individual’s state of mind in

them, however, remains a more developed

organization than would pertain exclusively to

their earliest phase. In the latter, differentiation of

external objects hardly exists, whereas in the

assumptions there are intense needs to relate to a

leader and to each other. The phase in

development that appears to be activated here is

that of separation- individuation (Mahler 1975).

As described earlier, this phase extends over

several years, and a range in the depth of

regression is to be expected. The dominant

characteristic of this early self is its primal

“instinctive” type of relationship, the precursors

of the maturer ones in which the external reality

of others is appreciated. The more the

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developmental elaborations around the earliest

structures are put out of action the more primitive

the levels that are exposed. Ba dependence can be

interpreted as the reemergence of this stage in

which the need for closeness gives to

identifications a considerable urgency and

immediacy; and the phantasy clusters around

them represent the ways in which this is evoked,

for example, by being fed, or protected, or held in

parental security. Fight/flight responses similarly
show this level of identification to provide
security. As Bion described, the urgency of the

identifications can make the whole group an

undifferentiated object within which the greatest

security is to be found. Pairing is clearly a more
developed state in which more precise definition

of the self is sought in the relationship with one

other. At the deepest levels it can activate the

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mother-child pair, in which case the attraction

affirms the existence of the self. As he puts it, an

ally against the dreads of isolation in face of

mounting anxiety is then provided. The fact that

the rest of the group preserves it by giving the

pair their rapt attention suggests that for them it

has become their security, either from the

primitive relationship or by this combined with

the parental sexual couple, by identifying with

the pair.

Regression to these stages represents the

removal of the influence of later structuring and

an inability to recover it. The awareness of the

group remains in its regressed form because the

group is there and so restrains further

disintegration which would be tantamount to

psychotic states, an eventuality that the early

structuring of the self also resists desperately. The

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problems of group dynamics thus become those

of how the normal affirmations of the self-system

are removed. The situations of groups in this

respect are of almost infinite variety. Thus when

Bion said that certain illnesses might originate as

diseases of the group, he thought specific

illnesses might prove to be linked to specific

states of the group. So far this has not been

established, though there is much evidence now

to show that disruptions of some areas of their

normal relatedness, as in groups displaced from

their familiar environment, lead to increased

illness of all kinds, physical and psychological. In

view of this complexity of factors, it is best for
present purposes to consider Bion’s groups only.

Here the most prominent stem from the task.

Although there may have been some nominal

description such as “to study group processes,”

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none of the members has any clear notion of what
that task involves. There is therefore immediately

a considerable loss for the self of its ego

anchorage in reality. Important also is the

realization that the task, in whatever form it

emerges, will involve members in some exposure

of their private and even hidden self. This factor I

believe to be important in the “group dynamics”

group, although much more so in the therapeutic

one. Since the origin of the secret self was its

unacceptability, there is a great deal of anxious

suspicion among members, alleviated only as

each member demonstrates his participation in

the task by the freedom with which he expresses
some of his feelings about the situation. Likewise

the intense curiosity about the leader derives from

wondering how he is going to help them with the

task at its reality level and from the fears of what

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he will “read into their minds” and how
persecutory or rejecting he will then be.

What characterized Bion’s method of work is

his waiting for developments to occur

spontaneously no matter what the pressures on

him “to help.” There is no doubt his stance

exposed the regressed basic states with, at times,

considerable intensity and persistence. For him it

is imperative that members should experience the

primitive nature and power of these states, and to

have contact with these layers of his personality

contributes a great self-integration in that the

boundaries of his self understanding are thereby

extended. By focusing exclusively on the group,

however, it is only those features in the shared

assumption states that are noted. Such
recognition is essential, but to learn more about

how they are brought into being is as important.

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Freud had noted early in his experience how
individuals will only with the greatest reluctance

give up a source of gratification. The group’s

hatred of learning has this quality for Bion when

he confronts them with clinging to assumption

behaviour instead of learning to cope with reality.

In emphasizing this reaction we have, however,

to balance it with the impetus to develop, the

impetus which in the work group Bion notes as

eventually overcoming the irrational resistances

to it. We may then ask if Bion fosters an

exaggerated degree of basic assumption

behaviour by not giving help sooner. This is a

question not easily answered. I referred earlier to

his almost incidental remark on love as a

necessity for understanding, that is, in this

context, some fostering assistance. Bion was an

extremely caring person and so one is left

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wondering whether he was in part fascinated by
the assumption behaviour to the neglect of this

aspect of how much help from the leader the egos

of the members required to be reasserted for the

learning task.

The assumptions made about the leader’s role

is that the group will by itself progressively learn

to tackle the reality of the task through the leader

pointing out what it is doing. Since, however,

much of the overt behavior is determined by the

need to avoid unrecognized feelings, these must

require more explicit interpretation than Bion

gives. Interpretations would seem to need more

of a because clause (Ezriel 1952) —an attempt to

identify what it is that is feared. Without this help

the work group cannot function effectively. A
group met to study its dynamics is like any other

task group, a sociotechnical system, and here, as

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elsewhere, the technical job has to come into the
sphere of the ego’s resources for mastering and

using it. The specific complexity of this situation

is that undoing the depersonalizing of the

members because of their lost ego-involvement is

itself the aim of the “technology.” A degree of

understanding does go on much of the time, but it

has to be asked whether it is at optimal

proportions; especially when once in the grip of

the basic assumptions it is all the more difficult to
get back to normal ego-functioning. It thus seems

that, as in analytical psychotherapy, a

simultaneous relationship with the members’
egos and the regressed state has to be kept alive.

When Bion referred to the struggle of the

individual against his groupishness, we can put
this in another way. The groupishness he

describes is clearly that of the regressed

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separation-individuation stage from which the
individual has developed to inhabit his adult

distinctive identity. This new development,

however, has its own needs for group relatedness,

namely, in groups in which his identity is

affirmed and enriched by the extent of the ego’s

reality involvement in them.

The situation created in Bion’s groups takes

away the anchorage of the adult self-identity and

it has to be asked then whether the groupishness

that is resented is so because of this loss. The

self-identity requires identification by others of

its ordinary status plus the engagement with the
task in a meaningful way. The organization of the

group has to match the nature of the work, and if

the latter presents a puzzle the group does not see

how to cope with, then the leader has the task of

both dealing with the tendency of the group

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members to regress as well as enabling them to
see that their belief that they have no resources is

not entirely founded in reality. The experience of

the latter, that is, of regaining ego-function,

brings back the work capacity.

Group Psychotherapy

As Bion mentions at the start of his book, this

term is itself ambiguous as to whether it means

therapy of the group conceived as an entity and

so concerned with facilitating the group to

overcome barriers from its internal conflicts to its

effectiveness as a work group or whether its
purpose is therapy of the individuals comprising

it. In practice, the latter purpose would be more

accurately described as analytical psychotherapy
in groups.

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When Bion says that his method of work

cannot be called psychoanalysis, he means that

the fundamental principles of psychoanalysis do

not apply to it. There is here a source of

widespread differences of view even amongst

analysts. Both the classical and Kleinian analysts

believe that a comprehensive exploration of

unconscious processes is possible only in the

traditional setting with the analyst preserving a

somewhat distant stance in the interests of

objectivity, maintaining a certain intensity in the

conduct of the process, usually five times per

week, and avoiding any other activity than the
analytic one, for example, no reassurances of any

kind nor advice and only offering understanding

of the unconscious solely by interpretation. The

value of this approach is not in question. What is,

however, is the common assumption that other

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less intensive and rigorous approaches are

relatively poor substitutes and, in short, “not

analysis.” Analytical psychotherapy on a less

intensive pattern than the standard

psychoanalytical one has in recent years altered

this view considerably to the extent that it is

widely practised by analysts themselves with the

conviction that it can be of considerable help for

the individual. Many unconscious factors in the

personality can be exposed and their disturbing

effects ameliorated in a range of patient-therapist

settings. The critical factors are not so much the

latter as the therapist’s understanding of the

unconscious and the extent to which he focuses

on that.

The general aims of analytical psychotherapy

are the same as those of psychoanalysis, namely,

to bring into consciousness the unconscious

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relationships structured from early experience

and then segregated within the self with varying

degrees of emotional distancing from awareness

because they are not permitted by the opposing

parental imagos reinforced frequently by further

rejection by the ego. The work of treatment is to

bring out in the transference relationship with the

therapist both the forbidden aims and the

defences against them. Because these conflicts

are structured into divisions within the self from

very early phases, the personality as a whole is

damaged by them. Their roots cannot be

extirpated or exorcised. We do not talk of cure

but of achieving degrees of freedom for the

person by lessening their power in relation to the

central self. All psychotherapy, therefore, from
intensive analysis over years to much less

intensive and shorter-term treatments is

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ameliorative to varying extents. There is at

present no accepted means of appraising the

functioning of a personality in a comprehensive

objective way, such as would be comparable with

the assessment of the physical state of the person

that the doctor makes by his examination of the

main bodily systems. Careful interviewing can

give some assessment of change, but even here

the particular bias in any judge of what is

important in the person limits the status of the

findings. The important point about these familiar

comments is that beliefs about what is and is not

adequate therapy have to be evaluated by broad

considerations.

The psychotherapeutic factor in Bion’s

method —again to be recalled as directed towards

group dynamics —can be considered if we take

one of his examples, the events in a group

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occasioned by a woman talking about a fear of
choking in restaurants or, on a recent occasion, of

her embarrassment during a meal in the presence

of an attractive woman (Bion 1961, p. 182).

About half of the group responded by saying they

did not feel like that, and the others were

indifferent. Bion notes that in analysis such a

statement would have evoked various possible

interpretations, none of which he felt could be

regarded as appropriate to the group. What he did

point out to the members was that the woman’s

difficulty was also theirs, although in repudiating

it they made themselves superior to her.

Moreover, in doing so they made it difficult for

any member to admit any problem because they
would then be made to feel more inferior and

worthless. From an analytic point of view he

appreciates that the woman got no help and is left

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in discomfort because in fact group treatment is
the wrong treatment. He then adds that her

manner of speaking suggested that she felt there

was a single object, the group, that had been split

into pieces (the individual members) by her

eating and that being the recipient of the

members’ projective identifications was her fault

and so reinforced her guilt which, in turn, made it

difficult for her to grasp how the actions of the

others had affected her. For the other members,

they have not only rid themselves of the woman’s

troubles as part of their own, but they have also

got rid of any responsibility for her by splitting

off their caring parts into the therapist. The result

of this process is akin to a “loss of individual
distinctiveness” through the basic assumption

state of dependence. The group dynamics are

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clear; the psychotherapeutic effect is not only nil,
it is negative.

The question then is why Bion could not have

made an interpretation along the lines he

indicated in this reflection about the situation, at

least to the extent of conveying the woman’s

hunger (perhaps felt as greed), destructive to the

group, with the latter attacking her, as they did to

these feelings in themselves. Also, by treating

each other’s problems in this way they were

perpetuating the feeling there was no help to be

had from the group, only from the therapist. The

precise interpretation is not so important as long

as enough of the underlying dynamics of the total

situation are articulated. By focusing exclusively

on the group as a whole, certain awareness of

group attitudes is made possible. Has that been as

helpful as it might have been for the development

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of each individual? Kleinian analysts frequently
use the term “the correct interpretation.” It is

doubtful if such an achievement is ever possible,

especially in the group situation, so that a degree

of metaphoric latitude helps to catch some of the

wide range of processes going on in each

individual. Psychotherapeutic change is a

developmental process requiring considerable

time, and Bion mentioned, as evidence of

intellectual work going on in spite of its covert

nature, the fact that patients came back to his

comments in later sessions. In other words,

reflection on what is happening in the group with
delayed assimilation is a necessary part of the

individual’s “work” activity. The therapist’s task,

I believe, is to further this by giving each

individual as much awareness of all sides of his

responses in the group situation, including

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especially the apparent reasons for abandoning
his “distinctiveness” when faced with his

intolerance towards his own unconscious

processes. In my own experience with groups

over 30 years, I have never ceased to be

impressed by the importance that members attach

to their group meetings, even though only once

per week. It is common after only a few months

for them to remark that what goes on in the

session plays a prominent part in how they feel

for the rest of that week. By commenting along

the lines I believe Bion could have done in the

light of what he described, he would have

avoided in some measure in at least some of the

members the depressing feelings of the badness
of the group as almost inevitable.

In regard to pairing, he again warns against

concentrating on the possible unconscious

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contents of the pair interaction. Here too,
however, it is not at all difficult to comment on

the group’s interest in this interaction and in what

this interest might consist. I have heard reports

frequently in groups that certain sessions with

marked pairing on which interpretive comments

were made, were recalled vividly for long periods

as having been particularly helpful.

Bion likened the problem of the individual

coming to terms with the emotional life of the

group as closely akin to that of the infant in its

first relationship, namely, with the breast-mother.

In his later analytic work he spelled out the nature

of the infant’s task in overcoming frustration, that

is, when instead of the expected breast there was

a “no breast” situation. For this achievement he

took the mother’s role as a “container” to be

crucial. This is perhaps an inadequate term for the

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active contribution of the mother in making her
comforting and encouraging presence felt. It

could readily be said that, for the group therapist,

Bion advocates a role of considerable

withholding.

The importance of Bion’s strictures can be

granted and that the essential aspect in all these

issues is whether or not enough of the total

dynamics in the group are being brought to notice

when an individual is being referred to. Basic

assumption behaviour occurs in groups, whether

the task is explicitly therapy or not. But when the

aim is therapy, the individuals need to understand

much more of themselves than the tendency to

regress to the primal self of their separation-
individuation stage of development. I have

stressed that the paramount consideration is much

more our understanding than using an assumed

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correct technique. Understanding the unconscious

is notoriously subject to individual bias.

Increasingly over recent years my “bias” has been

a much greater focus on the state of the self that

underlies the particular expression of the

unconscious motives. Thus, to revert to the

example just quoted, one can ask whether Bion’s

reluctance to use the individual in the group

situation is influenced by the Kleinian view of

greed as stemming from a high degree of oral

sadism. I want to emphasize at once that Melanie

Klein is far from ignoring object relationships,

yet she retained the view that aggressive

phantasies were mainly the product of the death

instinct. If one takes the view that the most

profound aggression arises from the universally

desperate struggle to maintain the self— a view

that Freud took, as I mentioned earlier—then the

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greed of the patient might well be seen as a

primitive expression of her attempt to get

possession of the object she needs to maintain a

security in her self. In this case the social

relevance of her symptoms, and hence its

importance for the group is different from that

were her greed to be taken as a problem of

excessive oral sadism.

The need to cope with anxieties over the self

can be seen in another of the examples he quotes

(Bion 1961, p. 144). The members discuss a

suggestion to use their forenames — three are for

it as a good idea that would make things more

friendly. Of the other three, one doesn’t want her

name to be known because she dislikes it, another

suggests pseudonyms, and the third keeps out of

it. I do not want to make unjustified use of the

example, especially as Bion mentions only

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certain aspects of the episode to make his point.

What he takes up is the way the group seems to

regard friendliness or pleasant emotions in the

group as a means of cure, as a contribution to

their work group. Perhaps more immediately

relevant to the work group are the anxieties about

whether or not the self of the three dissidents will

be secure if it begins to be looked at by the

others.

The disadvantages of groups as a therapeutic

medium are well known. They do, however, have

severed advantages. The sharing of humiliations,

shame, and guilt is a different experience for

many when they receive sympathetic
understanding from other members. Also,

whereas the projective identification of self-

objects from the segregated systems has to be
done mainly one at a time with the therapeutic

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pair, the projection of several around members of
the group is active much of the time and its

recognition can be used by all.

The individual in psychotherapy has to learn

about his split-off relationships, his wishes, from

maternal love for the infantile self that felt

deprived to the full repertoire of sadistic coercion

to get power, gratification, or revenge, and all his

anxieties and despair about these inner situations.

This task can become a life-long one for every

individual. Therapy, as in other learning, has to

give enough capacity to carry on the work.

Psychotherapy in groups has to make much more

of a contribution to this capacity than can be done

through confining attention solely to the group
dynamics equated with the basic assumptions.

Bion, like so many creative thinkers, confined

his study of the work of others to relatively few.

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Perhaps he felt, as Winnicott once said to me, “I
did not pay close attention to Fairbairn as I was

too absorbed in my own pregnancies at the time.”

I never heard Bion discuss Foulkes, and I do not

think he knew much about his work because he

had left groups by the time Foulkes was

publishing his accounts of it. He was not given to

disparaging the work of others if it differed from

his own; for him, experience would eventually

find its survival value. Foulkes was convinced the

total group interactions had to be used in therapy,

and I believe that Bion, had he done more group

therapeutic work, would have accepted that

position though he would have insisted on what

might be loosely put as more rigour and more

depth, more attention to the primitive

relationships.

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None of Bion’s Tavistock colleagues engaged
in group therapy, in contrast with those concerned

with group dynamics, adhered to his view about

the sole use of the latter in their work. Ezriel’s

formulation (1950) of using a common tension in

the group once it could be identified as coming

from the wish for a specific relationship with the

therapist, and adding to its exposure by showing

how each individual dealt with it, was considered

to be more appropriate. Revisiting both led me to

conclude that Ezriel’s views could not account

for the group dynamics in general, and I believe

our understanding of the individual should be

such as to account for both. It has seemed to me

for some years that a theory of the organization of
the self is the emerging task for psychoanalysis

and so I used my own rather rough and ready

gropings in this direction. Analytic group

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psychotherapy has usually been considered by its
users as a valuable therapeutic medium in spite of

the negative findings of Malan and his colleagues

(Malan 1976). Perhaps we expose here the

inadequacies in our concepts of the nature of

psychotherapy as well as our means of assessing

change. Because of my interest in the self as an

independent variable in the therapeutic task, Gill

and I (1970) carried out an exploratory trial using

spontaneous sentences as an indication of

conflicts within the self system (see Chapter 6).

Significant changes in patients after 18 months of

treatment were found, so Malan’s criteria seem to

have referred to different processes.

For me Bion has always been the preux

chevalier making his doughty forays into the
confused tangles of psychoanalytic thought and

the complexities of human relationships. His

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power to look at phenomena with fresh
challenges remains a permanent questioning

legacy. I started out by referring to Fairbairn as

one of the first analysts to seek a conceptual basis

for psychoanalysis that freed it from the shackles

of nineteenth-century science. Fairbairn and Bion

met on several occasions in Edinburgh, though in

the circumstances of war with little chance of

much sharing of work. It was a strange chance for

so much creativity in psychoanalysis to be

germinating in that city, so remote from Vienna

and London and, in spite of its brilliant
intellectual traditions, with a climate of opinion at

that time not a little hostile to the new

understanding of man that was being furthered in

psychoanalysis. It is perhaps even stranger that

the contributions of each can be seen now as

needing that of the other and each, with its tough

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theoretical work, drawing its inspiration from the
intuitive genius of Melanie Klein.

Notes
[←1] The former from the Tavistock staff, and now the major
innovative mind in the War Office psychiatric group under
Brigadier J. R. Rees, and Rodger, a socially oriented
psychiatrist with whom I had worked in Glasgow and now
the psychiatrist to the Army Command in Scotland.

[←2] The term applied to those members of the prewar Tavistock

Clinic Staff who had been most involved in the development
of the psychiatric services in the army along with a few
recruits to the group who had no previous connection with
the Tavistock, mainly Trist, Bowlby, and myself.

[←3] Rickman had a keen interest in field theoretical concepts in

his understanding of the individual. He had been in a
Quaker ambulance unit in Russia in the latter part of World
War I, where, although a noncombatant, he had been on the
point of being shot after the Revolution started. They were
both large impressive men who shared many attitudes and
views, although I doubt that he was a major creative
influence on Bion’s thought; he was more a kindred soul. He
had a more maternal component in his personality than
Bion, which often made me think of him as the father of all
mother figures, and Bion as the mother of all father figures.
He published many psychoanalytic papers and collaborated
with Geoffrey Gorer, the well-known anthropologist, in
writing a book The Peoples of Great Russia.

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12.

TWO INDUSTRIAL PROJECTS*

There is a growing tendency for industry to

look to social science for assistance in personnel

and training problems. Indeed, it might be said

that in Britain at least, industry more than any

other community group is likely to be a consumer

of social scientific advisory services in the next

few years. This together with the production

crisis in Britain, which requires the rapid

development of new production methods, makes

industry a field of crucial importance for the

application of social science.

One of the difficulties of collaborating in the

solution of industrial problems is that the

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problem for which help is sought is so frequently
only a symptom, an outer manifestation, of more

deeply rooted difficulties. Autocracy or

paternalism, for example, produces adverse

effects whose causes are seldom recognized, and

as these effects become increasingly severe, leads

to attempts to cope with the difficulties by

improving physical conditions, welfare services,

personnel selection, and so forth, while the

central problems remain untouched. Working in

industry, therefore, requires that the social

scientist maintain a position in which he is free to

assess the total situation in a factory before

proceeding to introduce special techniques to

solve this or that isolated problem. Just as when a

patient comes to a doctor with a headache it is the

doctor’s responsibility to find out what is causing
the headache before prescribing aspirin, it is

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equally the social scientist’s responsibility to find
out what are the causes of trouble in a factory

before fulfilling a request, for example, to

introduce time-and-motion studies to step up

production. It may well be necessary, however,

once having diagnosed the problem, to work step

by step towards the solution, proceeding from

more symptomatic to more radical forms of

treatment.

The two projects that follow are described

merely to illustrate some of these problems. The
first, on dealing with a morale problem among

young textile workers, is presented to indicate

some of the difficulties involved in coming to

grips with more basic problems when one is

called in to deal with a symptom. The second

deals with the manner in which success in

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handling one project may facilitate grappling
with industrial morale problems at deeper levels.

MORALE PROBLEM IN YOUNG TEXTILE

WORKERS

A wool mill situated in a village a few miles

from a large town was faced with the serious

problem of labour shortage. For the previous

century it had been the chief source of livelihood

in the village, but in recent years, because of the

drift of population to the town, the supply of

young workers had become inadequate. The

possibility of moving large sections of production

to more populated areas was considered but it

was felt that less drastic steps might be taken by

making work conditions more attractive. The firm

had advertised widely in mining areas about 40-

50 miles away and had been successful in
attracting a number of young girls. A great deal

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of effort had been spent on making a hostel for
these girls and in organising recreational

activities for them. Despite these efforts the girls

seemed to be unresponsive; their work

performance was mediocre, there were frequent

differences with the foremen, and the native

population seemed to be rather hostile to them.

One of the directors, a student of industrial

problems, persuaded the Board to call in an

adviser. The adviser was received well and made

good personal relationships with the top

management. He spent two days talking to

management at the different levels and to many

of the workers. The general opinion of the lower

levels of management appeared to be that the

girls were all rather a poor type, the typical
irresponsible pleasure-seeking youth of today.

The top level management leaned more to the

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view that possibly the working conditions were

not all they might be, and thought better welfare

might improve their attitude. The adviser after

assessing the local situation concluded that a

sufficient labour supply would have to be

recruited from outside. He also interpreted the

drift to the town as possibly an end product of a

century of dependence on the mill-owners who

had inevitably occupied what was tantamount to

a feudal role. It was well known in the village

that several large fortunes had been made from

the mill in the past, and the latent hostility among

the villagers was revealed by an instance in

which property presented by the mill-owners to

the village as a gift was demolished by the village

shortly afterwards for no really good reason. The

adviser suggested that improvement in welfare

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would not be enough but that more radical steps
should be taken to secure worker participation.

The effect of the interpretation, which was

not inaccurate, was to produce a sharp negative

attitude in the top management. It is of the first

importance that a development of this kind in the

situation should be as fully understood as

possible. It is likely that the latent guilt in the

owners who were still the top management was

exacerbated by the implication that the workers

were now able to realise their wish to become

independent of the traditional “benefactors.”

More important perhaps was the fact that the

suggestion for radical changes to secure workers’

participation raised anxiety, because the owner-

managers sensed the feeling that they had not

only ceased to be “good” but further were

incapable of so providing for their flock that the

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latter would willingly stay. Anxiety aroused in
executives seems to be most frequently expressed

as hostility, and the situation is closely analogous

to the reaction of the patient under analysis who

has been given an interpretation beyond what he

is able to experience as immediately throwing

insight on his problem.

The “patient”-adviser relationship might

easily have ended at this point except for the fact

that the director who had introduced the adviser

appreciated what had happened, and as the result

of his efforts the directors agreed to meet the

adviser along with a second adviser to discuss the

problem afresh. The second adviser having been

acquainted fully with what had happened

proceeded with extreme caution and made a point
at this meeting of trying to undo the anxieties

aroused previously. Attention was focused on the

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fact that there were strange girls coming into a
close-knit system consisting of the villagers and

the owner-managers and that it was probably in

this area that the management could take a lead in

getting the girls to feel part of the community. In

this way a process of growth could be started that

did not deviate too much from their traditional

role although there was no doubt that once started

developments would proceed beyond what was

envisaged at this early stage. The managers,

having now sensed a positive role, welcomed the

suggestion that the second adviser should go to

the mill and speak to the girls. The adviser would

make it plain to the girls that he had been sent as

an outsider on behalf of the management to find

out what they felt about working in the mill. As
an outsider it was likely that the girls would talk

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more freely and they could be consulted on what
points they would like reported back.

The second adviser thus started with strong

positive support from the management. This

support was reinforced probably by the fact that

any doubts they may have had about an outside

investigator were canalised onto the first adviser.

Indeed, this phenomenon of ambivalent attitudes

expressed as doubt against one adviser and trust

of a second has led us to the motion that it is

probably useful to work in pairs. Whenever this

has been done it has become clear that one person

collects most of the negative attitudes, while the

other becomes highly regarded, and can therefore
proceed more effectively with the work.

On visiting the mill the second adviser got

much the same impression as the first had gained
about the total situation. There was benevolent

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paternalism at the top and hostility in the lower
levels of management because of their complete

lack of insight into the problems of their girls.

The adviser was told that the best way of seeing

the girls would be to go to their hostel, which he

did. He was warned beforehand that it would

probably be difficult to get the girls to speak or

even to stay in the hostel as all they were

interested in was going to the cinema. When he

arrived at the hostel he met a few girls in the

common room and explained to them that he had

come as an outsider on behalf of the management

to find out what they felt about working in the

mill and what their ideas were about improving

things. The girls called in the others and in a few

minutes the room was packed with over thirty

girls. Having explained again to all his status, the

girls began a nonstop tirade of their grievances. It

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was abundantly clear that very high degrees of

tension existed and that little or no opportunity

had been available for the expression of the

grievances. The adviser did not say a word while

this process of catharsis was going on and his

expectations were confirmed when the process of

reaction set in. The expression of grievances had

reached a fantastic point when, for example, the

girls were suggesting that the Company should

take them on charabanc drives two afternoons a

week. From this point more responsible attitudes

began to be asserted. There then followed a

period, still of complaints, but complaints

accompanied by suggestions as to how the
conditions could be improved. A long list of

useful contributions was noted. A second wave of

massive hostility against the Company developed

but much less intense than the first. When the

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girls were asked at this point why they stayed in

the mill when they felt all these grievances a

number of them replied that the mill would go

bust if they left.

The suggestions made by the girls were

divided into three groups dealing with:

a. Working conditions

b. Conditions in the hostel

c. Relations with the village

The girls were then asked which points they

would like reported back. They unanimously
asked for all to be reported with the addition that

some suggestions should be printed in capitals.

It was painfully clear after this discussion,

which proceeded at a high level of activity for

over 2 hours, that the major source of tension was

that the girls were mistrusted. They complained

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of being divided amongst the local workers, of

having recreation organised for them, and of

being ignored by the local community. The

contrast between the attitudes to themselves and

to local girls was a recurrent theme. They

reported that the only representative of the

community who had visited them in their hostel

was a priest. They were indignant at the attitude

of the villagers which indicated that they were all

hooligans. They admitted freely that there had

been one or two girls who had misbehaved

themselves, but added that if they had had their

way these girls would have been sacked on the

spot instead of which their dismissal had lingered

on for weeks. The recreation organised by the

management was resented. They felt that if they

had to play games with the foremen blowing the
whistle, they might just as well be staying on at

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work. This attitude was particularly interesting as
one of the chief complaints of the foremen had

been that the girls were so irresponsible that

although the foremen went to a great deal of

trouble to organise recreation for them there was

very little response. The girls made many

suggestions as to how they would discipline

themselves in the hostel, such as having older

girls look after younger girls. Their appreciation

of the firm’s responsibility for them when living

away from home was extremely good. It was
interesting that when they were asked if they

could manage their own hostel with a committee

their first response was a negative one with the
addition that they would fight too much amongst

themselves. That is to say although they were

clamouring for more acceptance, they were

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anxious lest they might be faced with too much
responsibility.

A full written report of the discussion with

the girls was given to the management. The effect

of this report on the management was most

satisfactory. The statement that the girls had a

kind of instinctive loyalty to the firm was very

reassuring to them and the wealth of their
suggestions was a great surprise. The

management were astonished at the capacity of

the girls for making sensible suggestions and of
taking responsibility to a degree hitherto quite

unappreciated.

Six months later one of the directors reported

that the girls had elected a committee in their

hostel, which met regularly with a representative

of the management, and that many of their

suggestions had resulted in a great improvement

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in their morale. Indeed the situation amongst the
incomers became such that the local girls put

forward a petition that they should have chances

of developing group activities of the same kind

and that there should be joint activities for

making suggestions regarding working

conditions.

SELECTION OF MANAGEMENT TRAINEES1

The initial contact in this case was a personal

one between the Medical Officer and the

Personnel Officer of the firm. The latter had
learned from the Medical Officer about the

developments in the Army of selection

procedures for Officers and had been eager to

hear more about this, as he was faced with the

task of selecting from a large number of

applicants a small group of men suitable for

training to fill, eventually, top management posts.

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After an informal discussion in which the
selection problem was explored and ways had

been suggested for the Personnel Officer to

overcome some of his difficulties, the latter

discussed the position with his seniors and

obtained permission for the adviser to work with

him in making a survey of the problem. As usual

the question of cost was one of the difficulties.

The industrial pattern demands a cost estimate in

advance whereas the psychological adviser

cannot easily meet this demand, for he does not

know how much work is involved until he is in

the problem. His position is analogous to that of

the physician who cannot tell beforehand what

the complications in the treatment of an illness

may be. It was agreed, however, that the plan

should be to make a survey, which could be

costed in advance; then, if agreed, to make an

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experimental trial over a period of say 3 months,

this also to be costed in advance; and finally,

according to the experience from the trial, to

decide what continuing assistance was desirable.

The selection problem presented many interesting

factors. The main steps were to provide the

Personnel Officer with a satisfactory method of

screening a large number of applications so that

he could send forward to the Selection

Committee the best material and at the same time

as much relevant information about the

candidates as possible. The Personnel Officer had

been carrying out this screening by careful

interviews. Applicants were given appointments

as soon as possible with the result that he was
having to devote a great deal of time to

interviewing and most of his days were being

occupied by the arrival of applicants. As many

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applicants were not available for interview except

within a narrow time limit, there was no

alternative to this procedure. A scheme was

worked out, therefore, whereby the applicants

could be grouped as far as possible and

psychological assistance was provided for the

administration and interpretation of written tests.

The Personnel Officer was given further

diagnostic equipment in the form of experience in

handling group discussions prior to his interview.

The impressions from group discussion enabled

him to gain a better “man-to-man” comparison

and also, when linked with the results of the

psychological tests, enabled him to economise on

his interview time. For the Selection Committee

stage a similar extension in diagnostic equipment

was provided so that judges felt more satisfied

with what they had learned about the candidates.

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In this case selection was a big problem by
itself, but inevitably its link with other personal

problems emerged. Thus a recurrent dilemma at

Selection Committees was what could be done

with candidates about whom the Committee had

learned a great deal although they were not

finally chosen for the specific vacancies as

management trainees. Interest in the total

recording policy was heightened and suggestions

developed as to how it could be improved. More

important perhaps, the amount of diagnostic

material collected led to a rising concern with the

quality of training and how specific opportunities

could be given to the candidates accepted to give

them the best chance of development. Shortly

after the selection procedure had started its tried

run it was felt that some of the principles in the

selection methods could be used in training and

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the adviser was asked to collaborate with the
Personnel Officer in an experimental training

period. This proved to be a great success and

further problems in morale began to be put before

the adviser, including consultation on an overall

education policy for the company.

The importance of the collaboration in the

selection procedure cannot be over-emphasised.

The Personnel Officer in particular felt that each

day he gained something from his contact with

the adviser. He became increasingly

understanding of the complexities in personnel

problems and correspondingly creative in

deeding with them. Moreover after an initial

period in which his uncertainties about his

capacity to handle situations were outlived, he

felt secure in his relationship with the adviser.

The joint discussions of problems had made it

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plain that the adviser was not a magician from
without who “knew all the answers” but that

sound answers could only be reached when the

Personnel Officer’s experience and knowledge

were used.

After the trial run had been completed, the

Personnel Officer and the directors from whom

the Selection Committee was drawn were

sufficiently satisfied to make an arrangement

whereby any senior member of the staff of the

firm could call in the adviser on any problem. As

a result of this the Institute has been called in to

help solve a morale problem in one of the allied

companies. This project, now in the survey stage,

is not sufficiently advanced to report. The

progression, however, from acceptance of help in

relatively straightforward selection problems, to

request for assistance in coping with deeper and

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more complex problems of morale and human
relations, is of interest. This point is mentioned to

illustrate the fundamental importance of the

social science technician getting his relations

with the client’s representative right.

Traditionally the pattern has been all too common

for the expert to be called in and then leave after

submitting a written report. The building of a

sound collaborative relationship on the initial

problem led in this case to the revelation of many

other problems and to the continuing of a joint

effort in tackling them.

In both these cases the actual techniques used

and changes implemented were extremely simple.
However, the establishing of a sound working

relationship was not so simple, and it is felt that

any success in instituting even simple procedures

revolved around the degree of success in allowing

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those concerned with the problem to develop new
and more creative roles. This showed particularly

clearly in the second case where contact was

through the Personnel Officer. Although desiring

assistance, he naturally felt threatened by the

entry of outside social scientists into the field.

When this problem was successfully worked

through and he realised that it was our aim only

to collaborate with him and strengthen his own

hand, resistances disappeared, and he is now

championing improvements in other parts of the

company based on the utilization of social

science techniques, and is himself engaged in

breaking down resistances in his own colleagues
to the use of these techniques.

Notes
[←*] This chapter was co-authored by Isabel Menzies Lyth.

[←1] H. Bridger collaborated on this project.

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III
COMMUNITY
MENTAL
HEALTH

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13.

TOWARD COMMUNITY MENTAL

HEALTH

That “mental health” was emerging as a new

goal comparable with some of the master-values

that have inspired various eras in our history, was

suggested by Dicks (1950) 40 years ago. Since

then, the subject has become part of our scene

with a proliferation of associations and

programmes devoted to improving mental health
and, above all, with television bringing home to

the public the great range of the psychiatric

disorders and of the endeavours to treat and
prevent them. This greater familiarity, however,

is far from the acceptance of mental health as a

master-value. On the contrary, there is a

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persistent and widespread tendency to restrict its
import to those matters traditionally the concern

of psychiatrists and the caring professions. It is

for this reason that many have wished for another

term. Yet, in spite of innumerable attempts to find

an alternative, mental health has remained,

perhaps reflecting an unconscious appreciation

that these are the right words in spite of the

common narrowing of their meaning—that they

do signify a master-value.

The aspirations within the larger concept are

plain. Can man, with the knowledge he has

gained of how he grows and is maintained as a

person in his society, put this knowledge to use so

that he may realize more of his potential? Early

gains in the first decades of our century raised

many false hopes — ludicrous

oversimplifications, from the retrospective

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standpoint of today. Understanding has
progressed steadily and perhaps our most

valuable advances are in a greater realism about

the complexity of man’s personal nature. Our

increased knowledge is also shedding light on

some of the thorniest of the problems in this task,

namely, the resistances to the acceptance of

man’s nature —what Bion (1962) has referred to

so arrestingly and yet with such depressing

accuracy as our “hatred” of learning about

ourselves. In this conflict, we have seen, oddly

enough, science and religion with all the

institutionalization of their stereotypes, as Dicks
puts it, united Canute-like against the tide of the

facts. But the voice of reason eventually gets its

hearing. One of our sharpest theologians, Dr. Ian

Ramsey, the Bishop of Durham, in a lecture

(1970) described critically the devastating

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contrast that he noted between an ineffective,
harsh theology like a polished cistern that

contains no living water, and the knowledge and

skills of the Behavioural Sciences that seem to

minister so obviously and creatively to the spirit

of man. Almost at the same time, and from the

key position in British psychiatry, Sir Denis Hill

(1970) challenged psychiatrists and psychologists

on their restrictive views of science and their

exclusive concentration on mechanisms

underlying behaviour while ignoring the whole

phenomena of meaning and its manifestly central

role in man’s personal behaviour.

If the urgency of our need to know more of

ourselves as persons has been denied by our

individual and institutional resistances, the
technological revolution going on apace is

breaking through these barriers in disturbing

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ways. The current changes in our society are
great enough to warrant the sociologists’

description of them as a movement into a new

“post-industrial society.” In a penetrating analysis

of its implications for the individual, Trist (1968)

remarks that the steps we take with regard to the

welfare and development of people during the

next few decades will be critical. What is most

characteristic of the society into which we are

now moving is the entirely new degree of

interdependence of individuals and organizations.

This vastly increased interrelatedness is leading

to situations that inevitably challenge existing

beliefs and values within the core of the

individual and in the institutions that shape him

and are in turn shaped by him. For instance,

organizational philosophies are shifting the

emphasis from competitive relations and separate

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objectives to collaborative relations with linked

objectives. Above all, this new interrelatedness

leads to the perception of many social problems,

such as poverty and crime, as major integrated

problems requiring central planning rather than as

an aggregate of separate elements to be tackled

piecemeal. Central appraisals lead to “ecological

strategies” in which, for instance, crises are

anticipated rather than responded to; measures

are comprehensive with participation and

confrontation of conflicts instead of being

specific, requiring consent and covering up

conflict. These new features forced upon us by

the technological revolution demand that the

individual move from such values as
independence, achievement, and self- control to

those of interdependence, self-actualization, and

self-expression; from being one who endures a

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good deal of personal restriction, tension, and
stress because of internal and external barriers, to

becoming one who has a fuller and freer capacity

for enjoyment.

In such a social scene, the relatively static

notions of welfare as keeping people up to the

standards needed by the industrial economy have

to be complemented by the ideal of making

personal development as rich as possible. The

emphasis on the self in these emergent values is

noteworthy. The self is the term we use for that

core of the personality that preserves continuity

in change and its integrity is what makes change

acceptable. If this integrity of the self is

threatened, change is resisted — often violently,

as befits the defence of our most precious
possession.

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Several years after Dicks’s paper, Marie
Jahoda (1958) clarified some of the basic aspects

implied by the term mental health. She also

brought out the different meanings it could have

for different people and in different cultures.

Nevertheless, we are on firmer ground than the

considerations of cultural relativity might

suggest. The new theoretical trends in

psychoanalysis that had been initiated by Melanie

Klein, and systematically developed by Fairbairn

in his object-relations theory of the personality,

were helping to bridge the conceptual gap

between what went on in the inner world of the
individual and in the culture in which he and his

family were embedded. It was the great merit of

this approach that it conceived the structuring and

functioning of the personality in terms of

personal relationship systems. As with so many

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shifts in theoretical standpoints in the history of
science, the new views could be seen as one

expression of a fresh Zeitgeist. Other

psychoanalysts, from their detailed studies of

profound disturbances in the capacity for

relationships, were independently reaching

similar conclusions, for instance, Balint and

Winnicott; and there was the exciting support this

relationship-systems approach began to receive

from the ethological theories of animal behaviour

stimulated by the work of Lorenz. These concepts

have been notably applied to the psychoanalytic

theory of child development by Bowlby. On the

sociological side, the internalization within the

person of the relationships he experienced in the

family became a feature of the thinking of

cultural anthropologists. Cultural patterns were

thus seen sis interdependent with child rearing

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practices, and so cultural values and their
influence on the adult could be appraised on a

more dynamic basis.

In the work of Parsons, Shils, and their

colleagues, the structuring of the personality by

the interactions within the family represented a

most striking synthesis of the knowledge

provided by the psychoanalyst and that from the

social scientist about the forces from the social

milieu that impinge on the development of the

person.

The way in which these independent lines of

thought confirmed each other is remarkable, and

gives a reassurance that appropriate theoretical
frameworks can be evolved for ordering this most

complex area of the individual as a person, with

all that this means, in his society. The essence of
all this work is the emergence of an adequate

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model of the development and functioning of the
person and of how culture mirrors and is mirrored

by the inner world of the individual.

The impetus towards synthesis, springing

equally from those psychoanalysts alive to social

factors and from those social scientists who

accepted the full importance of psychodynamic

factors in the individual, has become a creative

force in the theory and practice of mental health

programmes. Those who share in this trend seek

active relationships with sections of the

community in which they may occupy a role

closely analogous to that of the analyst in his
psychotherapeutic relationships. That is to say,

the efficacy of the part they play in any change

process arises from what they help to release,

from the removal of inner blockages to growth,

and not from what they impose on the thinking

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and actions of others. The criticism that such

socially active psychiatrists and allied colleagues

take on omnipotent powers is for the most part

based on fantasies of the same kind that attribute

almost unlimited powers of suggestion to the

analyst in his psychotherapeutic work. (Most

analysts have wished at times that they did have

such powers to influence behaviour in the relief
of suffering!) The fact is that change processes
within community institutions and ways are apt

to evoke the same kind of anxiety as arises in the

individual who seeks to alter his established

patterns of relating to himself and others.

The belief that the psychoanalyst and social

scientist have an influential role in community
mental health endeavours is not as yet widely

shared amongst psychiatrists partly because few

psychiatrists have the necessary training. For

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those who do, their contribution, though vital, is

only one component in an “ecological strategy.”

The comprehensive nature of what must be

tackled is well expressed by Trist (1968):

... at the higher level of complexity which

characterizes the transition to post-
industrialism a higher quality is required in
all primary social units. By primary social
units is meant the set of concrete social
resources which exist in the life-space of the
individual, i.e. the people and institutions
with which he directly interacts and to
which he contributes his own resources: his
family, his work-place, the school his
children attend, the particular community in
which he resides, the services and amenities
actually available to him: in sum, all those
entities which compose his primary social
world. The quality of those resources, in his
case, determines for the individual his
“quality of life”, on which his welfare and
development alike depend. The objective of
taking the active role is to bring into being
ecological systems able to maintain primary

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social worlds of high quality throughout a
society. How to do this has now become the
over-riding question as we move towards
post-industrialism, [pp. 17-18]

Because of the extraordinary pressures our

psychiatrists are subjected to in providing

services to relieve the more urgent suffering in

our society, the image of psychiatry has become

too much associated with the attempts to mitigate

personal pain by drugs. Few psychiatrists are

really satisfied with this role. Only when our

society begins to grasp the real nature of its

mental ill health, however, will there be the

opportunity to make adequate endeavours

towards richer and healthier personal
development for all.

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At the W.H.O. conference on community
psychiatric services, Peebles, Scotland, 1970

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14.

PSYCHOANALYSIS IN THE
POSTINDUSTRIAL SOCIETY

Our changing society has become a byword,

and the nature of the changes are such that

sociologists view these as representing the

emergence of a new social order. Because the

most influential changes stem from our new

technological resources, and especially because

the energies of most people will cease to be

absorbed in the processes of production, the new
social order has been termed “the post-industrial

society” (see Bell 1982). This changed order is

only in the process of birth; but there can be no

one who has been unaffected by what is already

taking place. Striking are the changes in the

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existential quality of life for the individual. The
traditional frameworks of control are being

replaced by an enhanced permissiveness, a trend

that evokes a rather widespread uneasiness

because it outruns at times the complementary

demands for increased responsibility on the part

of everyone. Perhaps more disturbing are the new

responses amongst whole sections of society,

especially of violent protest and of a marked

sense of alienation. Gaps between various groups,

especially when these relate to the perception of

privileged opportunities, are now felt much more

provocatively — largely because of the rapid and

vivid means of communication that television

provides.

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PSYCHOANALYSIS AND THE DEMAND FOR
PSYCHOTHERAPEUTIC SERVICES

Closer to ourselves as psychoanalysts are

those changes for which we have been in large

measure directly responsible. It has been said that

the face of the world was changed when Freud

published his first five case histories.

Psychoanalytic knowledge has permeated almost

every sphere in which man’s development and

functioning as a person is the major concern. As

this knowledge increased, our understanding of

the psychological disorders, their enormous

incidence and range, has become more widely

recognized. Moreover, the intimate relationship
between culture and personality is reflected in

new symptoms. Our art and literature, and with

their impact greatly intensified by the mass
media, have made commonplace the vagaries of

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sexuality and the unbridled destructiveness which
can be let loose in man. Our patients accordingly

come less troubled by conflicts over instinctual

impulses than by the bewilderment of a divided

self. They present the schizoid futility of people

alienated from those committed and responsible

relationships to others, to themselves, and to their

achievements, that give zest to living, and

satisfaction and happiness at each phase of the

life cycle.

Parallel with the increased awareness of the

psychological disorders has been a great rise in

the demands for help from those under stress. In

the last decade the surging movement to create

widely available mental health services is indeed

an arresting feature of the more advanced
societies. The psychotropic drugs have enabled

psychiatrists and doctors to make life more

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bearable for countless numbers —and to permit
many who would formerly have been long-term

inmates of our psychiatric hospitals to manage in

the outside world. Nevertheless, the main

endeavour in the mental health services has

centred on the provision of more and more

groups of professional and semiprofessional

personnel, or less highly trained groups of

counsellors, who have developed experience and

skill for helping persons in need towards a greater

understanding of themselves and thereby,

hopefully, increasing their well-being and

effectiveness in the pursuit of their goals.

In this wide range of activity, psychoanalytic

knowledge has been assimilated, often only in a

very broad and general way, by the helping
professions, and their skills have evolved in

keeping with the extent to which they have been

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able to use this knowledge. Many of their leaders
through their own personal analysis have raised

the skill levels within their professions, have set

new levels of expertise for others to emulate.

These groups thus give help of a much more

adequate nature than was previously available,

usually in terms of support, advice, or

exhortation. Amongst the social work

professions, the evolution of skills has been

conspicuously influenced by a further

contribution from psychoanalysts, namely their

involvement as consultants, often over long

periods, in regular case seminars. Psychoanalytic

knowledge differs from most other branches of
knowledge in that its assimilation and use

normally require some personal adjustment in the

users. The collaboration of the analyst has

permitted a substantial degree of working through

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of those restrictive attitudes, anxieties, and
defensive traits that operate against the emotional

freedom in the person necessary to transmute

knowledge into personal skills; and it is only with

such improved skills that these allied colleagues

can gain sufficient trust from their clients for the

latter to communicate more of their conflicts.

The stimulus of psychoanalytic understanding

has not been confined to the kind of work just

described. It has had a very great effect on the

social sciences leading to a vast array of research
into social behaviour. Most relevant in our

present considerations have been the advances in

our knowledge of, and skills in handling, the

dynamics of small groups and the interactional

processes within the family —advances which

have added whole new dimensions to our
resources for alleviating the stunting or crippling

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effects of certain conflicts in personal

development and functioning.

SOME DANGERS

While psychoanalytic knowledge forms the

core of much of this work, and although many

analysts have played an active part in its

furtherance, various dangers have inevitably been

perceived (see Wallerstein, 1968). We are now

less troubled by the justifiable concern of analysts

about the early overfacile transfer of their insights
into “wild analysis”; yet it is useful to consider

some of the present dangers as aspects of the

community’s responses which have to be faced.

The first concerns the nature of the help

which can be given by others and in settings

different from that in which the analyst works. It

would be universally agreed that the kind of

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therapeutic work that a social caseworker or other
professional helper can carry out appropriately

does not attempt what the psychoanalyst does.

This limitation need not be further considered

because what is normally attempted by others has

its own validity as well as being so often the only

help available. It must, however, be admitted that

the attitudes sometimes conveyed by

psychoanalysts that this kind of work is a poor

substitute for what more thoroughgoing analysis

might achieve, is more a professional fantasy

than an established fact. For many, psychological

help, and particularly in crisis situations, is

probably best given by the kind of relationship

the good social or other professional worker can

make —one in which the whole person with his

own resources and those of his life space are kept

firmly as the focus of concern. The main danger

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here is thus not in the nature of the new facilities
provided by well-trained professional groups. It

consists in their too rapid expansion in response

to public demand —with a dilution of standards

and attempts to assert that less help than is really

needed constitutes adequate services.

A few other trends are also noteworthy. The

question of responsibility, especially in relation to

medical considerations, was a highly sensitive

issue years ago when the developments described

were starting. It has now receded as a major

source of interprofessional contention, largely

because settings have been created in which

medical and nonmedical groups can work

together with the interests of the individual

safeguarded. I should like to return later,
however, to this question because it may well

arise again as the personal welfare services

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expand on the scale foreshadowed by the present
signs.

Another concern may be seen to emerge,

somewhat paradoxically, from the influence of

psychodynamic thought on the social sciences.

We might perhaps put it as follows, albeit with

rather gross oversimplification. Because

personality development and functioning are

closely interrelated to such social factors as

family and group membership, and the culture in

which the person grows and is maintained, there
has arisen a widespread reaction against the slow

and painstaking process that characterizes the

psychotherapeutic model as a means of assisting

the individual. The biological roots and the

structuring of the personality then seem to get

discarded in favour of what societal processes can

do. There is no question that his social milieu can

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disrupt the individual’s effective functioning,
whether it is active through pervasive features of

the culture in which he lives, or whether the

noxious factors are confined to sections of his

social environment, for example, his work

situation. All research work on group functioning

has demonstrated the constant need of the

individual to have what we might term an

adequate psychosocial metabolism. We know,

too, that without such constant maintenance from

the social milieu, highly developed, creative

effective persons can with surprising speed be

degraded into almost unrecognisable, and even

irreversible, remnants of what they were. The

horrors of the concentration camps made this fact

so painfully manifest that it is still difficult for us

to assimilate.

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The failure here is that of not separating two
groups of conditions, namely, (a) developmental

anomalies leading to maladaptive structuring of

the personality; (b) deficiencies in the social

environment causing functional disorder. These

two are, of course, closely interrelated, for

example, certain cultured patterns of child rearing

may be more pathogenic than others; but it is

necessary to separate them if remedial action is to

be appropriate.

While this danger of assuming that social

action by itself is sufficient to deal with

psychological disorder may come mainly from

the ameliorative concern of social planners and
administrators, yet it also permeates the efforts of

those in the helping professions. Thus in our

mental hospitals, the valuable advances in

creating a therapeutic community are often taken

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as sufficient in themselves to meet the need for

psychotherapy. There is a fairly common

assumption that getting patients into groups will

of itself be adequately helpful to them. It does not

apparently matter whether the professional leader

has any psychodynamic training or not; all he has

to do is to get people “communicating more

freely” — one of the cliches of today, as

fashionable as it is often devoid of articulate

purpose. The support and reassurance, and often

the changes in attitudes that patients can achieve

from participating with others in a permissive

setting, are manifestly of considerable benefit.

But a psychotherapeutically trained observer of
these situations cannot but be struck by the
difficulties of patients which might be given more

effective treatment if some of their less conscious

origins could be exposed in a therapeutic way.

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The psychoanalyst has clearly a fundamental

contribution to make in the social movements

today. He is already making a substantial one in

many ways, particularly in the expansion of our

welfare services. Indeed, that to be involved in

this activity is “in the air” can be seen from the

fact that close to 80 percent of the younger

analysts in England have part-time posts in some

kind of community mental health service —and

this pattern is common in many countries.

In addition to participating in the

development of community services,

psychoanalysis has a long record of involvement

with many areas affecting the development of the
individual — above all, in child development.

This whole theme is clearly much too large to

receive other mention than to remind ourselves of

its history and its present scale.

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IMPLICATIONS OF PSYCHOANALYSIS

If we are to make our contribution more

telling, I believe that we have to give much more

thought to the whole theme of the relationship of

psychoanalysis to society. We have, moreover, a

moral obligation to do so. From the very

beginning of its growth, psychoanalysis has never

fostered a sect whose knowledge has been kept

within its professional boundaries. We have

constantly attempted to influence our society and
some of the most profound changes in it can be
laid at our door. It is with a view to improving

our contribution that I am venturing some

reflections on this dauntingly complex, yet

urgently pressing theme. In doing so I propose to

take three aspects: (1) the nature of the society

into which we are moving and its implications for

personal welfare services; (2) the contribution of

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the analyst to the personal welfare services; and
(3) the contribution of the analyst to a central

feature of this new society, namely, the concept

of personal development with a capacity to meet

change as distinct from what we have

traditionally subsumed under the term, the

welfare services.

THE NATURE OF THE POSTINDUSTRIAL

SOCIETY

In turning to the nature of the society we are

entering, I mentioned at the outset that the social

transition upon us is of a nature that warrants the

conception of these changes as moving towards a

new order. These changes are familiar to all of us;

but their familiarity does not remove the need for

us to try to make more specific their nature and

hence to take more appropriate actions to manage

constructively their effects. Change almost

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always evokes anxiety and one of the greatest
contributions of psychoanalysis was to create the

first setting in which the individual could change

himself systematically, that is, with the possibility

of the change process being understood both by

the analyst as the person managing it, and the

analysand as the individual achieving it. The

changes made by the psychoanalytic method,

however, have traditionally been within a

relatively stable social environment. It may be

that for this reason analytically induced changes

have sometimes been rather pejoratively referred

to as helping the individual to adjust to his

circumstances. The issue at stake today is what

we have to offer, by contrast, to people

experiencing movement and change as part of

their milieu.

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In making some observations about this task,
I shall borrow extensively from the writings of

two social scientists, Trist and Emery (Emery

1967; Emery and Trist 1965; Trist 1968). As

these writers remark, although we are acquiring

the knowledge with which the current social

transition could be managed, the availability of

such knowledge does not ensure its use. Clearly,

however, the steps we take in regard to the

welfare and development of people during the

transition, that is, during the next few decades,

will be critical.

The most noteworthy development in

concepts about personal welfare lies in its being

bracketed with programmes related to personal

development. It is not merely that these are
related because they are both desirable values; it

is the nature of the current social changes that

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puts them together as a necessity for adaptation
and survival. Briefly, it is a new degree of

interdependence of organizations in society that

creates these new features. Such problems as

poverty, water supply, and sickness or social

deviance are now perceived by a community or

society not as deriving from aggregates of

subelements that can be dealt with piecemeal, but

as integrated major problems requiring central

planning. In this increased interrelatedness, the

autoregulative mechanisms that were held to be

adequate in our traditional industrial society

(laissez faire) are no longer effective. This

change, according to Trist (1968), affects the

requirements of welfare and development in a

new way.

a. Welfare or well-being, to continue to

function well, refers to states of a system
under conditions which maintain the steady

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state…. This set of terms, therefore, is
concerned with the “statics” of adaptation
— with stability (not to be confused with
stagnation which is a state of ill-fare) and
with the regulation and maintenance of
stability.

b. Development, or progression, to continue

to advance, refers to processes by which a
system reaches higher or steady states of a
more adaptive nature…. This set of terms,
therefore, is concerned with the “dynamics”
of adaptation —with positive change
leading to the establishment of widened and
preferred orders…. Development involves
discovery and innovation. It is concerned
with the regulation of growth, [pp. 10-11]

Trist then describes how in preindustrial

societies welfare was maintained by the

autoregulative processes operating through the

kinship system. When these failed, development

processes involved the taking of an active role by

coercive methods, for example, autocratic

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regimes with armies. Development here was thus

a function of welfare.

With industrial societies, the more dynamic

environment created by technological change

involved welfare becoming a function of

development. Development was autoregulative,

operating through the market process; but the

welfare of more and more people required active

or planned intervention because it was no longer

autoregulative, being dependent on overall,

economic developments.

With the society into which we are moving

welfare and development became interdependent

functions. The best welfare secures development

and, conversely, adaptation of a society now

depends on the ecological regulation of the

interdependencies of the innumerable social

subsystems that characterize large societies

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undergoing rapid but uneven change. If
subsystems do not develop, they fall into states of

ill-fare. But because of the interdependence, ill-

fare in a few subsystems can produce widespread

disruption. Thus the values and behaviour of one

section of young people can cause major damage

to others. Autoregulative processes such as the

remedial efforts of other local organizations can

no longer cope adequately with welfare or

development in these highly complex situations,

and so an active role, that is, a centrally planned

and integrative type of intervention, involving the

society as a whole, becomes necessary as a rule.

Two options are then possible according to
Emery (1967). One, modelled on the physical

sciences, moves towards an engineered society.

The other, more related to the behavioural

sciences, seeks a more organic society. It seeks a

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higher quality in all primary social units (as
contrasted with this higher quality primarily in

the control parts). To quote again from Trist:

At the higher level of complexity which

characterizes the transition to post-
industrialism a higher quality is required in
all primary social units. By primary social
units is meant the set of concrete social
resources which exist in the life-space of the
individual, i.e. the people and institutions
with which he directly interacts and to
which he contributes his own resources: his
family, his work-place, the school his
children attend, the particular community in
which he resides, the services and amenities
actually available to him: in sum, all those
entities which compose his primary social
world. The quality of those resources, in his
case, determines for the individual his
“quality of life,” on which his welfare and
development alike depend. The objective of
taking the active role is to bring into being
ecological systems able to maintain primary
social worlds of high quality throughout a
society. How to do this has now become the

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over-riding question as we move towards
post-industrialism (1968, pp. 17-18).

The concepts of welfare and development

relate to social values and do not originate in

science. They belong to what Trist groups as

ideo-existential phenomena. These include (1)

such entities as ideals, philosophies, beliefs and

values, and so forth, as make up the forces

shaping the way in which the world is construed;

(2) the activators of behavior—goals, aspirations,

emotions, and so forth; (3) social practices and

processes and social perceptions.

These phenomena are interdependent and,

most important for the management of change,

are the gaps that develop from the slowness with

which beliefs and values change compared with
the emerging social realities. This characteristic

lag on the ideo side makes for great difficulty in

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effecting changes in core values and in the basic
shape of institutions for conscious and

unconscious reasons. This lag also presents

serious problems in regard to the achievement of

the kinds of thinking required for the conceptions

of welfare and development adaptive to the

conditions of postindustrial society.

In the industrial phase of our development,

the state took an increasing role in providing

welfare services for the sick and the poor—

though in connection with the latter there was a

conflict between this aim and the Protestant ethic.

Moreover, a variety of preventive, as distinct

from remedied, measures had to be instituted to
cope with infectious diseases. Other state

measures included what can be termed social

defences, for example, to control the dangers of

lawlessness or drunkenness. Social security

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measures were begun. A third welfare concept
also emerged from the necessities of the ongoing

changes, and one which began to relate welfare

and development as interdependent. This was the

concept of improvement, for example, by public

utilities in the physical environment and on the

personal side by education, better conditions of

work, and so on.

The predominant values, however, created

conflicts around these issues, especially the cost

of the welfare function of the State.

In our current scene, these conflicts in values

evidently persist. Yet, as stressed earlier, what the
social scientists are establishing is that personal

development as well as welfare is an inherent

requirement besides being a desirable value if the

new society is to survive. Actually there is
already in the more affluent countries an

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impressive array of improvement activity
especially in the field of higher education. Within

these countries welfare rights are starting to be

perceived also as development rights. Emphasis

is no longer so much on minimum standards as

on the realization of potential, both for the sake

of the individual and for society —though the

conflicts carrying over through our traditional

ideas and values make for crises through very

uneven acceptances of change, and the means

with which to achieve the new goals.

Trist sets out some of the inevitable changes

in emphasis of social patterns as follows:

Thus, Cultural or Ideo-existential Values are changing

From To
Achievement Self-actualization
Self-control Self-expression
Independence Interdependence
Endurance of distress Capacity for joy

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Organisational Philosophies
From To
Mechanistic forms Organic forms
Competitive relations Collaborative relations
Separate objectives Linked objectives
Own resources absolutely Own resources as belonging to
their own society

Ecological Strategies
From To
Responsive to crisis Anticipative of crisis
Specific measures Comprehensive measures
Requiring consent Requiring participation
Short planning horizon Long planning horizon
Damping conflict Confronting conflict
Detailed central control Generalized central control
Small local gov. units Enlarged units
Standardized admin. Innovative administration
Separate Services Coordinated Services

Many of these considerations are not new. As

I have said, however, a comprehensive grasp of
all these changing features is necessary if the

psychoanalytic contribution to their transition, a

process now in being, is to be an effective one.

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WHAT IS PSYCHOANALYSIS TO DO?

If we assume that the changes in our society

have the characteristics outlined, then we can

reflect upon their implications for psychoanalysis.

(I use this term as a convenience to cover the

toted activities and influence of psychoanalysis,

that is, through the effects of its knowledge upon

our society, the use of the psychoanalytic method

itself, and all the ways in which analysts might

facilitate the application of psychoanalytic

principles by all those making practical use of

them.)

The concept of welfare and development as

interdependent, while representing a new aspect

at the social level, has, in relation to the
individual, characterized psychoanalysis from the

start. The whole process of psychoanalysis was

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conceived as releasing the individual from forces
holding back his development and treatment was

judged to be successful in proportion as it

enabled the individual to achieve full use of his

resources. The intensely individual nature of

psychoanalytic treatment has, however, been a

major factor against the development of

ecological strategies which could widen the use

of psychoanalytic principles in the welfare

services. Any therapeutic endeavour that can be

used only for a privileged few is liable, in our

current society, to evoke resentful turbulence

when its existence is widely known. I believe it is

this reaction that underlies such views as were

recently expressed in an article in Time (March,

1969), when psychoanalysis was described as on

its “way out” while all kinds of other methods

were being acclaimed as answers to meet the

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clamorous need for more mental health services.
We would all agree that the classical

psychoanalytic method has never been “in” as a

practical procedure in community services. If

psychoanalytic views about people, their

development, conflicts, and functioning, have the

validity we believe they have after these 90 years

of constant and progressive work, in what sense

can psychoanalysis be on the way out? We are, of

course, accustomed to this kind of rejection of

psychoanalysis. In the past we have relied on the

autoregulative processes of a free market in the

acceptance of ideas to deal with these “attacks.”
The social situation now presents another

problem. Community mental health services are

emerging as an ecological issue so that they will

tend to be planned with a growing degree of

integration and on a wide scale. It is in relation to

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this dynamic in the social field that
psychoanalysis could be on the “way out.”

We have to ask ourselves if we are really

keeping psychoanalytic knowledge in step with

the times. Our understanding of human behaviour

can be formulated at different levels of

abstraction — from the personal to the more

impersonal forces we postulate in our

metapsychology to explain some of the problems

at the personal level. There is a great deal in

common amongst the various psychodynamic

schools of thought as long as we remain at the

personal level. It is differences in

metapsychological theories that lead to what the

intelligent outsider can only see as “religious”

wars. And in regard to our own metapsychology,
we really have to examine the degree to which it

may now be anachronistic. We must ask

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ourselves whether or not it is out of line with
modern behavioural science —and keep in mind

that not all our critics have only resistances as the

determinants of their thought processes.

A lack of congruence with the current

scientific world is fostered by the organizational

forms of psychoanalysis. These consist almost

entirely of training institutes, and even though

several of these conduct research programmes,

the latter are frequently confined to the data

obtained within the psychoanalytic situation.
(Notable exceptions are child development

studies.) Here I wish to emphasize that the basic

task for psychoanalysts is, and remains, the
improvement of their theory and practice, and to

train practitioners to the highest level possible.

The application of psychoanalytic knowledge to
community problems is an additional role.

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Nevertheless, in so far as analysis takes this as a

vital task, I believe the gains to its own

fundamental work will be large.

Trist’s three areas of emphasis, the cultural or

ideo-existential, the organizational, and the

ecological, provide a good framework for looking

at this task of bringing psychoanalysis into an

effective relationship with the needs of the

community.

PSYCHOANALYSIS AND CURRENT IDEO-

EXISTENTIAL ISSUES

The extent to which psychoanalytic views are

accepted by the innovating sections of the public
as relevant to the current ideo-existential

problems will determine the use of these views in

general measures for improving personal

development, and in creating welfare services.

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Taking the changing emphases for the
individual, we see him as moving from an

independent, self-controlled, achieving person

who has to endure a good deal of restriction —

both from his outer and inner environments, with

associated tensions and distress —to one who

will be much more interdependent, more self-

expressing and self-actualizing, and with much

more freedom as a result to enjoy living. To me,

the most noteworthy feature of Trist’s aspects is

the use of the word self.

It may be a reflection of the interrelatedness

of what is going on in society that this is the area

now recognized amongst psychoanalysts as the

one in most need of study. The self is the term we

use for that core of the personality that preserves

continuity in change —its preservation is what

makes change acceptable. If the integrity of the

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self is threatened, change is resisted — often
violently, in keeping as it were, with the defence

of our most precious possession. With so much

change in the fabric of society, it seems highly

likely that it is the threat to the self that is most

closely related to the many manifestations of

anxiety that we see around us.

The self as a central issue for psychoanalysis

is familiar enough, but we need a great deal more

specific knowledge of what creates a good core to

the self and what are the social settings required

to maintain it in such a way that the individual is

constantly enriching it.

The formulation of a good account of the

development and functioning of the self would be

of major value in helping society to cope with

some of its current ideo-existential problems. A

whole area that is pressing for more clarification

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is the study of the dynamics of the ego-ideal. Our
patients have perhaps led us, understandably

enough, to be preoccupied with the ego, the

superego, and the instincts. The ego-ideal is as it

were at the interface between much of our self-

feeling and the values in society which are

congruent with it.

In the anxious striving for more

understanding of man as a person, for knowledge

of how his positive attitudes are fostered as well

as of the conditions which release his unique

potential for losing his person-directed conduct

and replacing this with sadistic and destructive

behaviour of a kind unknown in the animal

world, the existentialist philosophers have offered

an appealing approach. Although it is difficult to
discern a conceptual framework in their writings

that does justice to the dynamics of the biological

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processes underlying human behaviour, they have
with their phenomenological descriptions

reinforced the view that psychoanalysis does not

have at present an adequate psychoanalytic

theory of the self. Here, however, we expose a

paradox in the current psychoanalytic scene. As

Weisman (1965) has put it, existentialists are

concerned with the “hiatus between the

formulations of psychoanalytic theory and the

problems with which individual men are

involved” (p. 10). The value of existentialist

thought is to stress those subjective features that

relate “to a unique responsible person from the
inside of his experience, and which defy

conventional categories and descriptions” (p. 11).

That the nature of man as a person has

become a focus of psychoanalytic interest in the

last 20 years is reflected in the widespread

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reference in our literature to such terms as the
ego, identity, and the self. It must surely be

important for us to devote more of our attention

to the response to these ideas in various sections

of the community. Allied professional groups can

use our writings directly, and it behooves us, for

instance, to ponder on the very wide assimilation

amongst these groups of Erikson’s studies on the

problems of identity, so much so that the phrase

“identity crisis” has become as popular as the

“oedipus complex” became a few decades ago.

Similarly, the object-relations theorists such

as Fairbairn, Winnicott, and Guntrip have also
made a very ready appeal to the mental health

professions in Great Britain. Unlike those of the

Culturalists, their views represent an evolution

from classical psychoanalytic concepts. These

writers retain the fundamental importance of the

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very early structuring of the personality in the

mother-infant interaction, and hence the interest

in their work cannot be said to be dominated by a

rejection of the importance of infantile sexuality

and aggression. Their appeal seems to lie in the

more direct relationship to the problems of

intrapersonal and interpersonal conflict than is

apparent in much of our writing couched in

traditional metapsychology.

The relevance of these theoretical

developments to current ideo-existential concerns

is intuitively grasped by our writers and

dramatists — the main transmitters to society of

any new insights. Writers do not propagate our

conceptual views; but when deeply affected by
the human problems they illumine, they create

archetypal characters who embody the

preoccupations of the age. The mass media, and

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above all television, have immensely expanded

the scope and rapidity of their influence so that

they stimulate a restless dynamic in the social

field. Writers, too, can have a remarkable

sensitivity in regard to appraising psychodynamic

theory —they respond to what makes sense

amongst the inarticulate gropings of most people.

Underlining these responses in various

sections of the community emphasises the

dynamic properties of the social field. It is when

we ignore the fact that the social field is itself
changed by psychoanalytic ideas that we get such
absurdities as the extrapolations that are made in

relation to psychotherapeutic needs in the

community. Thus one still hears the following

kind of statement. One analyst can treat say 10

patients: there are x thousands potential patients

in the community and so we need x/10 analysts

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—a statement made even when the size of x/10 is

ridiculous. Such extrapolations really assume a

view of society as composed of separate self-

determining individuals.

The social dynamic aroused can be illustrated

by various actions within sections of the

community to give help to many whose troubles

are either not met by current resources or who are

not adequately relieved by them. To many of

those involved in community mental health

services, the disturbing issue recurs of how the

growth of expertise in a therapeutic method tends

to be accompanied by an increasing narrowing of

its range of applicability. Movements such as
Alcoholics Anonymous, The Samaritans, and so

forth, come into being not only to fill a gap but

also because the “experts” say so many people
are unsuitable for their “treatment.” These

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movements then tend to be ignored by the more
highly trained psychotherapists—but may it not

be that there are important aspects in the

therapeutic relationships that these movements

foster? At any rate, they are worthy of the

psychoanalyst’s interest.

We do not have to be the reformers of society.

Our psychoanalytic model for the management of

change is a unique one in relation to the ideo-

existential problems of the age —for in our own

work, our patients take their own destiny into

their hands when we can assist them to learn

more of themselves. It is a model that can be

adapted by society in its own ways.

We may have to contemplate being more

involved in creating opportunities for sections of

the public to learn more about psychoanalytic

knowledge — and the mass media make quite

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new possibilities in this respect. It is particularly
important that psychoanalytic thought should

permeate to a far greater extent than at present

our views on education. Instead of being

pejoratively linked in the public mind with

neurosis, is it not timely for its “image” to be

more identified with personal growth and

development, that is, with education. This whole
question, however, is so large that I cannot do

other here than to bring the essential aspect

before us, namely, that the nature of our

relatedness to the social scene of today has a new

dynamic and one on which we must reflect very

purposefully.

THE PROVISION OF PSYCHOTHERAPEUTIC

SERVICES: ORGANIZATIONAL
PHILOSOPHIES

In contrast with the as yet scarcely developed

contribution that psychoanalysis might make to

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the ideo-existential problems, I believe that we
are much clearer in regard to how we can assist

with the expansion of facilities throughout the

community for offering psychotherapeutic help

(Sutherland 1964, 1968).

The situation in the field is one of widening

awareness of the nature of psychological stress

and one that is now prompting remedied action.

We have also to keep in mind that increasing

permissiveness will mean more need to seek

professional guidance. Thus freer divorce

measures will inevitably entail more responsible

and constructive steps in relation to each partner

in the marriage and to the welfare of children,

that is, there will be a greater demand for good

counselling services. Psychological disorders

vary greatly in their severity and in the ways in

which the underlying conflicts may be expressed.

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A large range of agencies can therefore be
appropriate as the first ports of call for help, or

the first place wherein an underlying

psychological problem will be exposed, for

example, the family doctor, social work agencies

of all kinds, the courts, the clergy, and so on.

The uppermost need within these agencies is

to increase understanding and skill. We have now

had a good deal of experience in methods of

doing this; Michael and Enid Balint, for instance,

have written extensively on this subject (M.
Balint 1957; Balint and Balint 1961). The

essential step here is to have consultants meet in

regular seminars with the various professional

groups. Conducting these seminars is best done

by consultants who combine psychotherapeutic
expertise with experience of group work as the

group reactions can often be used to give a direct

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experience of how emotional difficulties interfere

with the tasks people have to do —in this case,

learning.

Although different agencies may be created in

the community, these cannot remain discrete.

They inevitably have to become integrated parts

of a sociotherapeutic system —along with the

specialist psychotherapeutic and psychiatric

centre. In each agency, staff are constantly testing

the limits of their skills because it is in the nature

of much psychological disorder that a presenting

difficulty, once it is brought under scrutiny,

reveals more complex issues. The staff of each

agency has therefore to have free and welcomed
access to the specialist centre when they need

further help. Again, a proportion of people using

one agency as their first source may have to be

transferred to another for a variety of reasons, for

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example, the other may be more appropriate for

special problems uncovered. Such

interrelatedness can only become effective in

practice when the various units share a common

core of understanding about human problems in

addition to any special function each unit may

have. Furthermore, the community has also got to

share increasingly in this common understanding

if the helping services are to be perceived as

concerned with the welfare and development of

its members. I believe the essentials of this

common framework can be formulated in the

vocabulary of everyday speech —or at least with

very few technical terms.

With this kind of interrelated mental health

service becoming available, we can see the

position of the psychoanalytic/psychiatric centre

as a pivotal resource for the whole. The most

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disturbed individuals are its concern and the staff
therefore acquires more comprehensive and

deeper knowledge about psychological disorders.

Inevitably the staff groups within the specialist

centre are looked to for helpful support and for

the opportunities to increase understanding and

skill.

The boundaries to what agencies can do will

be pressed outwards all the time. This is in the

nature of the work and in the situation. The staffs

in many of the field agencies, particularly the

social work ones, will have to become

increasingly responsible in the professional sense.

They cannot develop unless they see themselves

as creating independent professions fulfilling the

criteria of being a professional body, that is, (1)
building up their own body of knowledge with
constant scientific scrutiny of their working

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principles; (2) formulating these principles for
training; and (3) creating a code of professional

behaviour. The social work groups lean very

heavily upon psychoanalytic knowledge, but they

have their own specific tasks. The psychoanalysts

within centres, however, can be invaluable

sources of support to them in their professional

growth — and conversely, analysts, can learn

much from their work.

When the specialist centres take on this

supportive and educative role, appropriate

activities on their part are required.

Psychoanalytic work has to retain its status

within them as its detailed study of personal

growth and functioning is our basic laboratory. In

contrast with private practice, however, the

psychoanalysts in a community-related centre

should try to make special studies of current

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social problems, for example, of drug addiction
or some such problem prominent in their area. It

is only in centres with a group of analysts that the

optimal conditions for such studies are normally

available, especially the opportunity to integrate

the study of intrapsychic with social factors.

Additional to psychoanalytic work, the

special centre has also to use therapeutic methods

akin to those usable in the field agencies. Thus it

should develop considerable expertise in group

psychotherapeutic methods, in marital and family

therapies. With its resources of highly trained

staff, it has to be able to offer consultative help to

the other agencies in which these methods will

play a prominent role. Moreover, within the

specialist centre, it is particularly useful when

representatives of all the relevant professions are

engaged in this work. Thus, it facilitates the

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growth of the social work professions when these
groups can relate to a member of their own

profession as well as say to the psychoanalyst in

the specialist centre.

I remarked earlier that these developments

may raise again questions of professional

boundaries, and such issues as when is someone

“ill” (see Szasz, 1961). In our field illness is a

term that has originated more out of professional

rather than scientific roots. It may well be that it

is the meaning of “medical responsibility” that

has to be reexamined. As I see it, what is specific

to the doctor are those people in whom there is
(a) a somatic manifestation that needs
elucidation; (b) a degree of disturbance that can

be made more manageable with the aid of

psychotropic drugs; (c) a severity of disorder that

needs special inpatient care. Naturally many

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people will present difficult decisions in regard to
who is to take primary responsibility. Such

decisions should become much easier to reach as

the whole network of service agencies builds up

active collaboration. Faced with the anxieties of

changing professional roles, interprofessional

tensions will be inevitable. It is salutary to keep

firmly in mind that, if there is one field of work in

which there will be no redundancy problems, it is

ours —the field of mental health in which

demands are going to grow all the more as

services become available.

THE RELATIONSHIP OF THE MENTAL

HEALTH SERVICES TO THE COMMUNITY:
ECOLOGICAL STRATEGY

A widespread network of therapeutic services

will clearly be of the utmost significance in the

community’s striving for constant betterment.

The people seeking help represent those who for

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a great variety of reasons are unable to function
as they would wish in their community. The data

available in all the of the therapeutic agencies

must therefore be fed back to those in all key

positions concerned with the improvement of our

society. To do so involves much further work, for

example, to elucidate some of the general

processes underlying the very complex array of

specific manifestations of disorder. The

knowledge gained in the therapeutic centre about

the intrapsychic factors in “breakdowns” has to

be subjected to the expertise that social scientists

can bring so that the social forces affecting the
community can be identified. This could be
achieved by having the specialist therapeutic

centre as one unit in a complex—a group of units

whose overall mission could be described as the

study of human relations. The resources of this

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larger complex would be such that studies could
be made of an appropriately comprehensive kind.

This complex would, in addition to maintaining

active internal scientific exchange, seek

relationships with the relevant sections of the

community, especially with those concerned with

the planning for the main services affecting the

social and physical environments.

SUMMARY

I have tried to show what I perceive to be the

forces coming into more prominence in our

society, and which are impinging upon us with
increasing urgency. Far from being on the way

out, psychoanalytic knowledge could, and should,

be more than ever on the way in. It is incumbent

upon psychoanalysts, especially those in

specialist centres, as many of us now are, to study

the current scene as carefully as we can and to act

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constructively to the best of our ability. I believe

that, if we do not innovate in regard to our own

roles, our mental health centres will shrivel and

hence the welfare and development movements

will be impoverished.

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15.

COUNSELLING SERVICES

SOURCES OF THE COUNSELLING

MOVEMENT

Like most social phenomena the sources of

the counselling movement are many, and they are

clearly interrelated. I believe the major initiating

stimulus was the result of Freud’s discoveries.

Freud made sense of what in people was dark,

mysterious, irrational and, above all, frightening.

He showed how the psychological disorders in

the person could be correlated with failures in his

social development. In the light of his views, the

traditional moralistic attitude towards much

human behaviour, suffering, and weakness could

not be maintained. Strange thoughts, feelings,

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and actions could be understood, and if these did
not vanish after their nature and origins were

elucidated, they could often be managed better.

The process of help, moreover, was located

firmly within the personal relationship between

the helper and the person in need.

Although psychoanalysis is the most

intensively developed way in which this process

is carried out, it was very early recognised by

social workers and others that they could make

use of the new understanding in a way

appropriate to their setting. It was a criticism of

the adoption of psychoanalytic views by social

workers that in these early endeavours they

followed the model of the psychoanalyst much

too closely —a situation that was also fostered by
the psychoanalysts who offered them consultative

help. The social workers, however, gradually

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emerged with more confidence in their own ways
of working and, correspondingly, the analysts

became clearer in regard to how they could offer

“training.” The great step forward for the social

workers lay in their regained confidence in

working with the family on the basis of this

enlarged understanding; and this was their usual

“therapeutic unit,” if one might use this term,

rather than the individual.

Freud’s views also had a profound impact on

the social sciences, which in time began to bring
new knowledge of how social forces affect

behaviour. The result has been that the study of

psychological disorders now emphasises what is

happening in the family, at work, and in other

sections of the individual’s social environment.

We know that even the most healthy people need

certain satisfactions from the transactions they

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have with others. If deprived of too many of
these, they can, with surprising speed, begin to

show various stress manifestations or even to

deteriorate into almost unrecognisable shells of

what they were.

In short, well-adapted healthy persons are the

product of a successful development in the

various stages of their growth and then of

continuing their inner satisfactions through their

experiences in a good social milieu. Just what

satisfactions are needed change with the different

phases of the life-cycle. What appears to be the

fundamental aspect is that, given enough

satisfaction, people have an ongoing sense of self

as “somebody’s somebody” and so of “being”

somebody. It is when this self-feeling is
threatened that stress is felt and when, often

enough, help is needed.

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In the past, it was one of the great functions
of the churches to affirm the sense of self,

especially at times of crisis —the recurrent crises

of sickness and death, of birth and marriage. The

changes in the social fabric with industrialisation

and urbanisation greatly increased the stressful

situations, and these new situations along with

the development of scientific knowledge,

especially in biology and the human sciences, led

to a recession in the use of the churches.

The need to care, however, was in no way

diminished, and the new understanding of people

and of social forces gave a new appeal. As

Professor Halmos (1966) shows, the fall in

church attendance has been paralleled by a rise in

the size of the caring professions. This

development was not institutionalised except in
so far as certain professional groups developed

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organisations to safeguard their work and to train

new members. As he further points out, it was

inevitable that the counselling ideology, the belief

that people could use a caring relationship in

which to explore the nature of their difficulties

with a view to enriching their own resources for

managing these, should lead to most of the

existing helping professions acquiring more

understanding and skill in human relationships.

Out of this early development came two new

professions: the psychoanalyst and the

psychiatric social worker. Both of these groups

had major influences on other professions with

whom their work brought them in contact, for
example, psychiatrists, general practitioners and

other doctors, social workers of all kinds,

teachers, the clergy, and psychologists. When the

new knowledge spread through the community,

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the scale of need and the range of psychological
disorders were exposed as very large, and in

thinking of counselling strategies, it is therefore

basic to keep in mind this great and diverse

incidence. Thus, all estimates show that anything

from 15 percent to 30 percent —some people put

it at 40 percent —of people have their

functioning as good human beings seriously

impaired by inner conflict. These figures bring
home the tragic loss of human creativity and
human resources going on in our society. There is

not only the scale and range of severity of the

effects of psychological stress, but the

multiplicity of ways in which it can manifest

direct psychological disorder, from inhibited

withdrawing attitudes to the infinite variety of

impulsive and conflicted behaviour.

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One result of the growth of knowledge and
the urge to meet the emerging demands was that

the professional workers devised additional

methods of increasing their contribution, for

example, through group work. Group work,

however, is not a kind of “poor man’s

psychoanalysis”; it has a validity and value of its

own. But there are other consequences of the

growth of the helping professions that have

caused concern. As skills have developed, the

professionals have become more “professional.”

Skills can become a way of helping some, but of

not helping other people. If the person does not fit

one’s skill, one cannot do anything, or one does

not want to do anything. Another effect is that as

skills get more expert, the work of giving

psychological help gets more technical; it seems

even to get “technologised.” As Professor

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Halmos points out, the professional begins to get
absorbed in the technicalities of the work and can

lose sight of the fact that the fundamental and

basic factor in giving personal help is the concern

of one human being for another. Related to the

acquisition of more professionalism has been the

understandable caution on the part of the groups

with more developed skills towards the groups

with less skill, and a good deal of intergroup

rivalries appeared. I remember 25 years ago (that

was the time, as many of you will recall, when

you could find several different social workers or

agencies all at work on one family) how difficult
it was to get creative collaboration amongst the
different groups. Such difficulties arise most

readily when groups are uncertain of what they

are doing. Anybody who is in the counselling

field, from the Samaritans to the psychoanalysts,

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is uncertain or confused some of the time. For
free collaboration, the limits of understanding

and skills have to be readily acknowledged

without any sense of failure. At times

professional and other groups have behaved as

though they were going to be put out of business

when their limits were exposed. Fortunately, this

insecurity is disappearing as the scale of needs is

appreciated, and as the value of many sources and

kinds of personal help is recognised.

Great developments were stimulated when

the National Health Service came into being.

Needs became more pressing and the
psychoanalysts became concerned to share skills

with others. More striking was the way in which

various groups of nonprofessionals began to

appear to fill the many gaps in the services, a
response influenced by the knowledge about

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human problems that was being transmitted to the
public by our writers, dramatists, and artists, and

especially by the mass media. The Marriage

Guidance Council had been established before

the war, but it began to develop its services

rapidly. Counsellors also appeared in the schools.

A new force was the self-help groups, such as

Alcoholics Anonymous.

SOME DANGERS

The recognition of the scale of needs for

personal help and the swell of personal services

to meet these have not been without their

counterforces. Two of these, I believe, have to be

watched. On the medical side, the whole training

of doctors is to define the problem, and the great

advances in medical knowledge have enabled

them to do this in much of their work. The nature

of the illness is to be identified and the treatment

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then follows. This has led doctors to think of

personal problems and needs in the same way.

Along with the almost impossible task of giving

people with problems sufficient time to talk about

them, there is a resultant tendency to treat human

problems as something best dealt with by a drug,

a de-tenser of some sort. And, of course, there is

a great pressure from the public for the doctor to

take this stance because of the powerful wishes

for magical solutions rather than facing the

realities that underlie our psychological makeup.

The forces in the situation that drive us towards

expedient measures would be serious enough as

obstacles to the doctor giving adequate personal

help without a further, and perhaps more

dangerous factor, namely, the adoption of what

might be termed a pseudoscientific view about
human nature. In this respect the doctors are not

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alone, for many psychologists and others also

share this outlook. People who are involved in a

caring relationship with others find it very

difficult to adopt this sort of simplistic approach.

When studying isolated bits of human behaviour,

the value of a reductive approach is very

appealing, but the plain fact is that people are

complex, that being a person and operating as a

person, functioning on a personal level, requires a

conceptual framework that does justice to these

immensely complex forces. As a nuclear scientist

said to one of his psychological friends when he

had been watching a child at play, “My work is

child’s play compared with the study of child’s

play.”

We have got to watch these kinds of dangers

because they can be part of a value system about

people, which it is asserted is a scientific

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approach and hence the only one likely to give us

true knowledge. Knowledge of people at this

unique personal level can and must be checked

and tested but this is not to assume that the best

ways of helping people should be those based on

experimental methods. To be concerned about

others, the essence of simple help, is not a

scientific activity. It is a human relationship in

which validated knowledge about people can be

used.

I have recently become apprehensive about a

danger of another kind of which signs are visible

at times in the social work world, particularly

with the statutory provision for expanding the
social services. The problems of giving help, of

being concerned about human beings, of having

the complexities and especially the dependent

needs of people put upon one, are so disturbing to

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some, and this inner threat is reinforced by the
external task of providing help on an adequate

scale, that they wish to get rid of this task to

promote, instead, social change. The assumption

then becomes that casework and counselling are

not really necessary if we get social conditions

improved. This is again, to my mind, a dangerous

oversimplification because it begs the whole issue

of what is a person and what is personal help.

Clearly I cannot pretend to answer these highly

complicated questions; but at least we can keep in

mind the important factors we do know about

persons. The value of the psychoanalysts’

contribution comes from the fact that here the

“counsellors” have studied people in detail and in

depth to find out something of what they are
about. They have, moreover, maintained these
relationships over long periods and through

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phases when negative feelings could all too easily
have led to the helping effort being abandoned.

Working theories are naturally governed by the

mode and setting of the investigating tools and a

danger for the psychoanalyst is that he may refer

too many things to what is going on inside the

individual and not enough to what is happening

in his social environment. The important thing for

our understanding of others is to keep in mind

these two sets of variables. There are the inner

factors, our biological endowment and the

structuring of the personality on this basis and the

experiences of the individual during his growth.

The other set is the social forces impinging on the

person from his direct, close relationships to the

more intangible pressures of the culture in which

he is embedded and its values. These two are

constantly interacting and any thinking about the

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social environment that ignores the inner personal
factors is just as unrealistic as the converse.

THE NATURE OF THE PERSON

No individual reaches adulthood with a

personality that is a coherent, completely

integrated system. We all are split into

subsystems of which three are Freud’s familiar

ego, id, and superego. I believe it is more useful

to think of these systems not in this rather

impersonal “scientific” language but in more

personal terms because they operate in us as
subselves. Instead of the ego, we can envisage a
central self, the self that relates to others, that

enriches us by learning from experience.

Correspondingly, the id can be regarded as the

part of our personality containing the frustrated

relationships of our past. This part drives us to

realise those goals that have become inbuilt from

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early experience, to seek relationships in which
the other is someone to be coerced into the roles

we wish, to dominate or to be dominated, to

depend on in infantile ways or to be mothered,

and so on. The superego part contains a range of

primitive control systems with inner figures

threatening us in varying degrees of severity with

retaliation if we try to enact the frustrated needs.

This tripartite structuring of the personality

has long been regarded as a useful framework

against which to understand the human being.

(Spirit, mind, and body as the great spheres in
man have much in common with the systems I

have been suggesting.) If the central self is

founded securely on the basis of the individual

having been loved and wanted, he has a core of

security and confidence that can meet the

uncertainties of the external world. In such

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persons, the conflicting needs and controls do not

dominate behaviour by maladaptive clinging to

ways of relating evolved to meet past needs. The

subselves here can be realised in large measure,

either by fusion with the activities of the central

self as in adopting a particular career or in leisure

pursuits. When the subselves are too strong

relative to the central self, then we have people

who become driven from within along certain

lines and against all logic, although they may, as

is well recognised, try to provide rationalisations.

Here, for example, we may get a strong desire to

follow a career, or to step out of one, in order to

make a protest against a dominating parent rather

than for more realistic aims.

Because the central self is founded in

relationships, the continuation of our sense of

well-being rests on our continuing to be involved

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in significant relationships and activities. The

right foundations in the core of the self enable the

individual to keep a strong sense of continuity of

self while at the same time changing constantly

as the different phases of life enrich personal

experience. Change and crisis become challenges

rather than situations in which to feel threatened

to the point of losing our identity, of going to bits.

In meeting change, however, the adaptive growth

of the individual is normally anchored to the self-

affirmation provided by sharing.

WHEN THE SELF NEEDS HELP

Needs to share uncertainty and threat may

very enormously in their scope and intensity. For

our present purposes it is useful to separate two

kinds of problem for which this need commonly

arises. The first stems from the major change
points in ordinary growth, phases in which there

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are new experiences to be assimilated and
adapted to —for example, learning to walk, to go

to school, the bodily changes at adolescence,

career, marriage, becoming a parent, retirement.

The self is a dynamic organising system whose

core we can describe only from subjective

experience. It is what we mean when we use the

word “I,” and we cannot reduce this basic aspect

of every person. The self has a constant forward

reference; there is always a sense in which people

are oriented to the future. At points of major

change, if people do not see where they are going

to fit, then they need to test out this area of

uncertainty by talking to someone who has been
there, who knows what this new world is like,

and from whose experience one can affirm or feel

oneself ahead in time. This seems to be the

essence of the kind of help a counsellor gives at

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these normal turning points. It has been
characteristic of our society to deny or keep away

from the emotional needs in people at these times

within our formal institutions. Perhaps the

economic uncertainties of the industrial

revolution led us to become obsessed with work,

with achievement, and with acquiring knowledge

or skills of commercial value. Our youth,

however, is rightly protesting against the denials

of the power of feelings in human development;

and our greater affluence with increasing time to

contemplate our lives is also pressing us towards

the fuller recognition of what is going on inside

ourselves.

The second kind of problem involves more

than the need to share the new tasks of the future,

although this group of problems may emerge at

the great phase changes in development. The

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difficulties here are seriously affected by failures
in the earlier stages of development. The

individual has not a secure or strong enough

central self and, indeed, what security he has in

this part of himself is diminished by a threatened

rise in the relative strength of his subselves. Such

imbalances are most commonly seen at

adolescence, but they may be precipitated by

many later changes. To go to the other end of the

life cycle we are all familiar with the person who

goes to pieces on retirement, or with the loss of a

spouse or the loss of some especially valued

possession. In the adolescent, it is the drive

towards new relationships occasioned by the
development of sexuality that evokes profound

anxieties leading to massive withdrawals from

others or to impulsive, ill-adapted attempts to

cope with the new tensions. With our older

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examples, we see individuals who have managed
to cope with rather immature dependent needs by

the particular people or jobs they could use.

When these props are removed, the central self

becomes overwhelmed by loss and often it

requires special and intensive measures to redress

the inner situation.

Now the great difficulty for counsellors is that

presenting problems are often a mixture of these

rather broad kinds of psychological situations,

and, worse, not easily distinguished in advance.

When developmental failures have been serious,

the manifestations of difficulty are frequently

plain enough to identify the problem as one of
psychopathology rather than development crisis.

In these cases the individual can be appropriately

referred for specialist psychological help. What is

to be done when the nature of the problem cannot

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be identified in advance, when we cannot say the
individual should go for help to counsellor A in

one kind of service rather than to counsellor B in

a different type of agency? To make matters more

complex, it is not only the counsellor who does

not know what a problem entails. The individual

himself may be quite unaware of the forces in

himself. Take, for example, the student who is

finding in the early stages of his university career

that he is becoming increasingly unable to study

effectively. He may wonder if he has chosen the

right subjects, or if he should be applying himself

in some different way. As he talks about himself
it may soon strike the counsellor that the lack of

the student’s success is rooted in intense conflicts

with parents, conflicts whose intensity is quite

unrecognised by the individual. Counselling may

then have to move into more prolonged

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psychotherapy, that is, into a longer relationship
in which the conflicts can be exposed by the

adequate understanding and skill of the

counsellor who will now be described as a

psychotherapist. There is thus no sharp line

dividing these two activities. Counselling and

more specialised psychological help merge into

one another and it is certainly not always possible

to say in advance what a particular individual will

need.

One of the most successful pieces of

psychotherapeutic work I ever did was in fact one

hour’s counselling. This concerned a successful

man, aged 51, who was facing a critical decision

in his career and who was referred to me because

in the past such situations had usually been

followed by bouts of physical symptoms for

which he had had a great range of medical

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treatments. He happened to be a fairly insightful
man and we were able to bring out the recurrent

pattern of his crises as related to a conflict

between him and his parents. Beforehand, the

history had led me to expect that I should be

recommending him for probably fairly lengthy

psychotherapy and instead he was able to make

such good use of our talking together that he

went ahead from one success to another. (These

success stories, I need hardly remind you, are

sadly infrequent!)

ORGANISING THE COUNSELLING

SERVICES

How then in the light of these complexities

and uncertainties can we proceed? We must start

from the fact that since personal problems arise in

such diverse ways we must have a large range of

different kinds of counsellors. We need people in

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roles or agencies whose image will be readily and

hopefully associated with certain kinds of

problems, for example, the school counsellor,

marriage guidance, the probation officer, a social

worker, the family doctor, and so on. Once inside

the door, the counsellor may then find a situation

for which effective help needs more expertise

and/or time than he can give. This uncertainty is

bound to be there and any system we may devise

to improve the effectiveness of our counselling

provisions must start from this fact. It is also the

case that by the time an individual has talked

fairly extensively about his problems, he will

have become attached to this counsellor and too
abrupt a reference elsewhere may be felt as a

rather damaging rejection.

These kinds of complication are in the very

nature of counselling and they suggest that any

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organisational system of our counselling services

will require quite special flexibilities. In the first

place all those in counselling services must feel

they are sharing in a coordinated endeavour. They

need a sufficiently common frame of reference to

permit appreciation of what each component is

doing, a common understanding of the main

determinants of the effective and satisfying

functioning of people. For instance, can we have

a counselling movement making the progress we

want if specific parts confront the individual with

incompatible views? If, for instance, one agency

has been trying to get the student I mentioned

earlier to understand his difficulties, is it good

enough that he may be told by say a family
doctor that he should not fill his head with “all
that introspective stuff? What he needs is to snap

out of it and get on to the sports ground, or to

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take these tablets for a few weeks! Again, what

are we to do if say the clergyman also adopts a

similarly antipsychological standpoint, but

instead of a medical treatment suggests a “moral

welfare programme” of exhortation to support a

repressive attack on the inner sources of the

disturbance. Naturally, I have taken rather

extreme instances to make the point.

Nevertheless, although they represent attitudes

that are disappearing they are still to be found. It

must be a task for any group concerned to

advance counselling services that they can assert

with conviction the kind of framework we need

to do justice to persons without reducing them to

oversimplified mechanisms. In this endeavour,

counsellors have to be prepared to confront critics

who seek to “blind with science,” with masses of
figures and data—all of them often irrelevant to

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the job the counsellor has to do. Research in the

human sciences, and especially in the area of

personal conflict, is too often conducted by

people who have never had to talk to a human

being in distress as part of their professional

training. Indeed, they have not infrequently been

told to avoid such “unscientific” situations.

Within a system in which free communication

can be encouraged between the different units, a

second major requirement is the way in which

learning can be built in as a permanent process.

Counselling is a personal relationship in which

counsellors use their own experience of

themselves to help their clients to enlarge their

understanding—and so to make better decisions.

The process of counselling is an educational

activity for both parties, and each encounter is

unique. The training of counsellors is therefore

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designed to give them more understanding of
themselves, an objective which relies on

appropriate opportunities for them to share

experiences. Intellectual knowledge of

personality development does little by itself to

equip counsellors. Such knowledge has to be

assimilated with recognition of the relevant

processes at work in them if it is to be of effective

help in the counselling task. Learning is best

facilitated when we are up against a difficulty, a

blockage in our understanding of what a client is

bringing. What is needed then is an opportunity

for counsellors to describe their difficulty within

a trusted group. They have got to feel free to
expose their confusions and secure enough to

accept the implications for their own personalities

of the comments that others will make. This

sharing of experience is best done in a group of

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colleagues with the assistance of a consultant,
someone with more experience than the members

of the group. It is essential that all counselling

services should provide for this continual

learning process by arranging for regular

seminar-discussion meetings. How frequently

these may be held will be governed by various

circumstances, but the essential feature is that

they are maintained regularly. There must be no

question of them being regarded as a fringe

benefit or luxury. If the helping of others is to be

given the serious status it deserves, then the

ongoing learning of all must be built into the

whole endeavour as a first priority in planning

our programme.

PEOPLE AND INSTITUTIONS

In considering our services for the welfare

and development of the person we must parallel

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any effort to assist inner growth by one that
examines what is happening to people within the

institutions concerned with their development,

particularly, our educational ones. The data to be

obtained from the counselling services are

unique. People do not reveal some of the most

significant factors influencing their behaviour

except in a situation that offers help.
Questionnaires or questionings cannot go below

the surface, for often the person does not

appreciate what is there. The knowledge gathered

by counsellors must be made available to those

who are responsible for our institutions. In the

society into which we are moving, now known to

the sociologists as the postindustrial society, new

values are replacing the old. A compulsive drive

towards individual achievement is becoming less

acceptable to our youth who are much more

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attracted by the values of self-realisation. More
leisure time and activities will make people more

critical of existing institutions and the values that

have inspired them. In this society, the result of

the technological revolution, sociologists put the

dilemma thus. In the greatly increased

interdependence of all the sections of our

environment, change has become much more

unpredictable and planning has to play a far

greater role than hitherto. For such an

increasingly planned society we have two

choices; an elite group planning for the large

majority or, as the Western democracies have

chosen, planning as a process in which everyone

must participate at some level. It is our belief that

we enrich people best when they share in their

destiny, in what is being planned.

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For the creation of such a society, with its
need to have till individuals realise to the full

their potential, there must be widely available

counselling services for all stages of the life cycle

and at the same time, a constant scrutiny of the fit

between our institutions and the kind of person

we want them to produce. Thus we have to ask,

what kind of schools and further education

establishments will equip people to make this

new society, in which the price of permissiveness

is inevitably greater responsibility and concern

for each other? Are their structures appropriate

for this task or are they functioning on the basis
of outmoded values? Can an institution in which

there is an inbuilt hierarchial order imposed from

without, a structure that assumes that only when

the chief executive in the institution is appointed

by some external body can the community rest

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assured that the staff will be properly supervised
and controlled, really practise in a genuine way

the exercise of responsible participation amongst

its staff? And, if not, can a staff under these

conditions be expected to educate others towards

the kind of mature and independent persons we

want?

These are the kinds of questions we must ask

and I believe that those with counselling

experience have a unique role in helping to

answer them, for it is in the counselling situation

that we pick up the frustrations and stresses that

people are experiencing. There is no opposition

between counselling services and the

management of institutions. These two activities
are more than complementary; they are necessary

to each other.

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16.

PSYCHOTHERAPY IN COMMUNITY
MENTAL HEALTH

Although the term community psychiatry has

proved difficult to define acceptably, the ideas

behind it are now initiating active programs in

almost every country. The basis of this movement

is an increased understanding of the person, not

as an isolated individual, but as a being whose

functioning must be viewed against the networks

of social interaction in which he grows and lives.

This “third revolution in psychiatry” is a logical

development from the second one that was

introduced when Freud showed that the

psychological disorders of the adult could be

correlated with failures in his social development.

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These views had a profound impact on the social
sciences, which in turn began to bring new

knowledge of how social forces affect behaviour.

The result has been that the study of the

psychological disorders now stresses what is

happening in the family, the work situation, and

the community. Correspondingly, the task of

creating adequate therapeutic and preventive

measures in a community has to be conceived

and planned comprehensively from a wide

background of knowledge and with the expertise

of many disciplines.

In this collaborative endeavour, the

psychotherapeutic clinic must play a fundamental

role and in what follows are some brief

observations on this role based on experience at
The Tavistock Clinic over 20 years.

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As Medical Director, The Tavistock Clinic,
London, 1947-1968

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PROVIDING PSYCHOTHERAPEUTIC
FACILITIES FOR THE COMMUNITY

To appraise the task of providing adequate

therapeutic facilities, we have to remind

ourselves of some of the essential features of the

psychological disorders.

a. By “disorder” is meant a condition in the

individual in which his functioning is felt by
him, or by others, to be impaired in a way
that needs the help of a specially skilled
person to remedy it. In any comprehensive
psychiatric service, many different
therapeutic methods will be valued. However
much physical methods facilitate matters, the
need for psychotherapeutic help remains in
practically all cases. By this term, I refer to
the personal relationship with a professional
person in which those in distress can share
and explore the nature of their conflicts and
possibly change some of the determinants of
these through experiencing unrecognized
forces in themselves. Further, I shall use

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“psychotherapeutic clinic” not necessarily as
a separate institution, but also as the
psychotherapy component in a
comprehensive psychiatric service.

b. The psychological disorders comprise a wide

range of complexity and severity with regard
to their underlying causes and treatment.
Various levels of skill can therefore be
appropriate. The highest level of skill is
ordinarily available in the psychotherapeutic
clinic where the specially trained
psychotherapist is based. Less specialized
psychological help is given in many other
professional roles.

c. The incidence of psychological disorders is

widespread and demands for help are likely
to increase as awareness of their
manifestations grows.

d. Breakdown is governed by an interplay of

both individual and social factors, and it is
therefore particularly liable to occur at
“crises” or points of change in the “life
space.” Help must be available at these times

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because the opening up of inadequate
defensive patterns can often permit new
growth processes to take place, both in the
individual and in the family.

e. The nature of much disorder manifests itself

indirectly. Help is frequently sought on the
wrong basis and the source of help may
collude in the avoidance of the important
issues.

f. Many pathogenic social situations are

unrecognized or denied, for example, one
member of the family in the disturbed role
hides the trouble elsewhere.

g. Even when recognized, resistance to changing

dysfunction, both in the individual and in
social groups or organizations, is a specific
problem requiring special procedures.

Such considerations, and they are by no

means exhaustive, force us inescapably to certain

conclusions about how the task must be tackled.

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1. There must be a large number of readily
available sources of help throughout the
community. The specialist psychotherapeutic
clinic is not and cannot be the only source of
skilled help.

2. These sources must comprise a range of

different settings and roles. Psychological
disorder is commonly manifested in a
specific section of the individual’s life. Help
is therefore sought by “knocking on one or
more of many doors” according to the nature
of the trouble, for example, the family
doctor, the probation officer, or the Family
Planning Clinic.

Many different professions and agencies

are already involved in helping individuals
and families and their great advantage is that
they are the most acceptable doors for those
in trouble especially at times of crisis. The
important issue here is, therefore, the extent
to which these groups can increase their
contribution in quality and quantity.

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3. More skilled contribution from the various
professional groups, and especially as their
work concentrates on the family and its
social setting, entails progressively more
cooperation among them and between them
and the specialist centers. One or more
workers will often be involved at one time
with one family. Initial therapeutic work may
lead to more serious problems being
uncovered with the need to get help from the
specialist center. This help may take the form
of consultation enabling the field workers to
handle the problems themselves; or it may
mean that the treatment is taken over by the
center. In this latter case it is clearly
important that the process through which
people get help should be felt as preserving a
continuity. The specialist center must not be
perceived in the community as doing
something quite different in character from
other agencies.

4. Optimal collaboration and flexibility in the use

of resources must be achieved and this can
be done only by fulfilling certain conditions:

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a. All the professional sources of help
must share the framework on which
the work is based. All personnel,
including the specialist center, have
therefore to formulate and
communicate their working
hypotheses in terms of the data of
human relationships. No single
theoretical system needs to be
adopted, but all must know the
significant phenomena that have to
be considered and what is involved
in treating these.
b. Consultative relationships between
the specialist center and sections
must be maintained.
Psychotherapeutic relationships, at
whatever level of skill, impose
uncertainties and stresses on till
professional personnel who get
involved with the strong emotional
pressures of others. Increasing their
skills is a constant aim of all, but
unlike the acquisition of

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instrumental skills, learning in this
field, like the psychotherapeutic
work itself, needs ongoing personal
relationships of trust within a group
of colleagues, and between them
and the groups on whom they rely
for consultation. An active
commitment to a permanent system
of collaborative endeavour must
therefore come from the centers of
highest skill.

5. The fact that the kind of help given by the

various professional groups for the
psychological disorders has the common
factor of dealing with conflicts in human
relationships, and that this work begins to be
perceived as closely connected with what
goes on in the specialist psychological
clinics, is of vital importance in getting the
community to be more accepting of the
nature and scope of human conflicts — and
of the resources that people have for doing
something constructive about them. All those
in familiar, respected, and trusted roles must

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be involved in a manifestly joint endeavour
with the treatment of psychological
disorders. Otherwise those figures are
colluding in, and are seen to be colluding in,
the defenses by which our society splits off
and denies the recognition of what is
happening psychologically to its own
members. Resistances to the explicit
awareness of the psychological nature of so
much ill health and stress are a notorious
obstacle to the development of the very
services the community needs. Campaigns to
popularize mental health knowledge have
had only limited success in attaining their
objectives. The helping professions have a
crucial role in overcoming these traditional
attitudes by bringing their work into a much
more obvious relationship with each other
and with what the specialist
psychotherapeutic services are about.

6. In short then, when those needing

psychological help are seen as breakdown
products from the complex of the interacting
social systems of which they are part, the

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services for giving them help have to
function as an organized system itself related
in comprehensive ways with the community.
This organization, while requiring on the one
hand administrative linkages with the
relevant institutions, must on the other hand
embody the internal means of maximizing
the overall output and level of its technical
contribution. For this purpose a permanent
system of multiple relationships must be
developed for the sharing of knowledge and
skill.

WHAT CAN BE DONE WITH THE ALLIED

PROFESSIONAL GROUPS?

From what has been outlined, a key role of

the specialist center is the training of allied

professional personnel. Assisting these groups to

increase their knowledge of mental ill-health has
long been a widespread activity of psychiatrists,

and one that is not productive, because

resistances to awareness of the psychological

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nature of so much ill-health and stress are a
notorious obstacle to the development of the very

services the community needs. Campaigns to

popularise mental health knowledge are apt to

have only limited success in attaining their

objectives as the Cummings (1957) have

demonstrated. The helping professions have a

crucial role in overcoming the attitudes by

bringing their work into a more obvious

relationship with each other and with what the

specialist psychotherapeutic services are about.

That means sharing skill as well as knowledge.

To teach an appropriate psychotherapeutic skill
has not been a major effort, partly because

effective practicable methods have not been

available and partly because such an expansion of

skills has raised many issues of professional

policy. In the early stages of psychoanalytic

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psychotherapy there was great reluctance on the
part of its practitioners to have their knowledge

applied in any “diluted” form — a concern that

was justifiable as the traditional caution of a

professional group.

The development of therapeutic or mental

health teams inside the child guidance clinics has

shown that psychotherapeutic skills can be shared

when a setting is found in which the interests of

all parties can be protected. There are, however,

important differences when the latter are in

independent roles in other settings, in particular,

the critical issues of responsibility and the kind of

skill to be taught. The specialist psychotherapist

in the clinic is not in a position to know the ways

in which psychotherapeutic skill can best be used

in the settings of various professional groups. It is

our view that responsibility for what the worker

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undertakes in his own professional capacity must

rest with him, not only because it is impracticable

for the psychiatrist to take it, but because the

worker cannot acquire skill without assuming

responsibility. To take the clinic model for

psychotherapy, especially the orthodox analytic

psychotherapeutic one, would be manifestly

unsuitable. For instance, most of the relationships

that the family doctor has would introduce the

complications of close physical and social

contacts with the patient and his family. Again,

the family social worker has usually to deal with

more than one member of the family, and has

often to give practical help in a variety of ways.

We have found the training method developed

and fully described by Balint (1957) to be an

eminently practical one for allied professional

groups and it has been used by us extensively for

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many years. He thought that what was needed

was not theoretical knowledge, but personal skill,

and its acquisition entails a limited, though

considerable, change in the personality. In this

method, the workers meet weekly in groups of

ten to twelve over a period of about 2 years for

discussions of their ongoing attempts to give

help. The sessions are not allowed to become

therapeutic meetings, but making the group aware

at times of how it reacts in tackling a member’s

account forms an essential part of the procedure.

Understanding of how conflicting needs are
expressed in human relationships thus goes hand

in hand with the personal experience of

experimenting with the relationships the

members make with their own clients. Discussion

of situations in which they feel blocked brings for

all members opportunities to scrutinize their own

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attitudes, and to modify these. To go back to

further sessions with their clients, and to bring

the consequences for subsequent discussion,

maintains a dynamic learning process, which

combines new insights and skills with what is

appropriate to the setting in which these are used.

A 2 year period appears to be adequate for

most members to work through the excitements

of new powers, the “depression” of coming up

against their limitations, and then to reach a stage

at which they can feel at ease with themselves in

the new problems they tackle. To have benefited

repeatedly from the inevitable self-revelation that

is entailed in seeking advice on the handling of
cases creates both a readiness to continue using

consultative help and a model for their own work.

Specialist psychotherapists in the clinic, who

take on this kind of commitment to the

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professional groups in its area, must have
expertise in a range of psychotherapeutic work

with individuals and families and in group

dynamics. Our experience has shown that

considerable skill can be acquired by all

professional groups in the mental health field

when they are given the kind of training outlined,

and sire provided with a setting in which it can be
practiced with free access to the staff of the

specialist clinic whom they have come to trust.

The boundaries that a professional worker will

set with regard to the complexity of the problems

he will treat will expand with experience. The
availability of regular consultation services

enables him to advance under conditions of

safety for all parties.

We have also found that a common

framework for understanding the psychological

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problems of individuals and families has been of
great value in facilitating the sharing of cases and

families and accepting the work of members of

other groups. Rivalries and tensions between

members of different professional groups tend to

be magnified when the nature of the skills that

each group practices is not known to the other, or

is of such a personal and intuitive kind that

members of one group cannot communicate

either within their own groups or with colleagues

in other groups.

Consulting services of this kind soon acquire

a multiplier effect for senior caseworkers, both in

the clinic and in other agencies, who with good

experience and training can themselves act as

group leaders for their less experienced

colleagues. With groups for group leaders, the

clinic staff can help in improving training skills

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as well as keeping in close touch with a widening
range of basic skill training.

As a result of such steps, The Tavistock

Clinic has had a training program in which about

500 professional personnel have been attending

weekly meetings during each of the last few

years. These groups have included family

doctors, specialist doctors working in other

services —for example, for children, or in Family

Planning Clinics—health visitors, social and

family caseworkers of all kinds. Other groups

were drawn from the staffs of approved schools

and correctional institutions, the clergy, and

others.

For this whole endeavour, the staff time

required has been the equivalent of about two

full-time psychiatrists and three full-time senior

caseworkers.

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DEVELOPMENTS ASSOCIATED WITH
INCREASING PSYCHOTHERAPEUTIC
SKILLS IN THE ALLIED PROFESSIONS

Increase of more intensive psychological

work by the professional workers in the

community carries immediate implications for

the conditions and administrative arrangements

of the work. The size of caseloads has to be

reduced, and arrangements for regular

consultative sessions within their own groups and

with specialists have to be built into the working
conditions and not left as a spare time “luxury.”

More comprehensive casework also brings, as a

rule, the need for flexibility in regard to the type

of case accepted.

When professional agencies adopt training

programs as described, the staff of the clinic may

have to play a part in ensuring that the

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implications are fully examined by all those
affected. New skills for the field workers often

change the relationships between them and their

seniors, and between all the professional staffs of

an agency and its administrative authorities. As a

rule it is essential for the clinic staff to participate

actively in discussions of these matters with the

senior administrators of the services.

Questions may arise whether or not the right

professional roles are available. Thus, while the

role of the family doctor has tended to get lost
with the rapid development of medical

technology, all experience confirms his uniquely

important role because of his involvement with
the family at times of most stress. It has been an

impressive experience to my colleagues and

myself to see how many of our family doctors

want to acquire psychological understanding and

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skill in family problems. The acquisition of many
powerful therapeutic measures for the common

illnesses has fortunately appeared to increase

rather than decrease this interest. With new skills

for helping emotional troubles, the general

practitioner role may recover some of its appeal,

for these skills can bring deep satisfaction from

his greater contribution as a family caretaker.

And this acquisition allows him to communicate

more effectively with other professional groups.

Caretaking functions through ongoing

relationships with the family, independently of a

particular member seeking help, have assumed

much more importance today with the

detachment of so many families from their usual

connections. The clergy, for example, have
special opportunities of this kind, for example, in

times of grief and mourning, and at marriage.

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Their role, if they acquire the necessary training,
enables them to offer guidance and help that

otherwise might not be given.

Most important in this connection are those

services that have prolonged contact with the

individual such as education. The growth of

counseling functions within the schools and

universities creates the same needs for ongoing

training and close collaboration with the clinic.

The spread of facilities within the community

may also expose a need for new types of service
either within existing agencies or by creating new

units. The Family Discussion Bureau was

developed as a new type of agency after a group

of social workers asked our Clinic to train them

to deal with the recurrent marital problems they

encountered in an agency that offered an advice

service to families. In the first stages the social

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workers had to work together with the
psychiatrists to define some of the problems, to

work out an adequate conceptual formulation of

their nature, and then to develop methods of skill

training, along with the kind of conditions

required. After a few years there emerged a

casework agency that embodied a workable

pattern for a service for marital problems — an

essential feature being regular weekly discussions

with their psychiatrists or consulting

psychotherapists.

This model attracted considerable attention

and it soon had to devote a large share of its

effort to training staffs in other social work

agencies. It showed that trained social workers,

by creating a group that provided its members
with support in the inevitable stresses and strains

imposed by intensive casework, could acquire a

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very useful level of skill in handling the quite

complicated marital interactions that were often

presented.

Administratively it may fit our arrangements

at present to organise separately the mental health

services within the fields of medicine, education,

and social welfare. Functionally, they cannot

remain apart, and in my view the necessary

collaboration to meet technical needs must

correspondingly be represented by appropriate

organisation.

The furthering of developments in skills and

knowledge will require the professional services
in an area to be coordinated by some kind of local

Mental Health Council. The psychotherapist

should play a key role in such a body. In doing so

he should demonstrate by his own mode of

participation in the common endeavour how

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constructive solutions to problems may be
reached. Sensitive recognition of the

interpersonal and intergroup tensions that are

inevitably exposed at times, and a genuine

mutuality in pooling knowledge and skills, must

be his regular contribution; his training in the

psychotherapeutic process of working with

people rather than doing things to them remains

his model.

THERAPEUTIC WORK IN THE CLINIC

When the clinic becomes a focal point in the

services to the community, its own therapeutic
work has to develop to match the new situation.

Demands for psychotherapy increase enormously

as services are created outside, not only because

of referrals but also from greater awareness that

“something can be done” for much disorder.

Analytical group therapy can become a major

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psychotherapeutic method with many assets other
than its contribution to therapeutic resources. It

serves as a training component in group

dynamics — mentioned as necessary in

conducting training groups. The experience it

provides of neurotic interaction in relationships is

also invaluable in handling similar behaviour in

work with disturbed marriages and in the family.

The choice of the family as the focus of

therapy with children and adolescents is now

taken as the rule. In recent years this approach for

patients who are being returned from the hospital

to their families, even with the more serious

schizophrenic illnesses, has been shown to be an

important advance. We have found, too, that for a

considerable proportion of adult psychoneurotic
patients with common symptoms and character

problems, apparently “individual” in nature, it is

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useful to examine the marital situation. With
many patients the intolerable parts of themselves

are collusively projected into the partner and are

never brought into treatment. To deal with the

contribution of both to what is happening can

frequently end a source of resistance that makes

work with the individual difficult and, at the same

time, will mobilize the therapeutic resources of

both.

This new emphasis on family interactions is

in our view an important advance in

psychotherapeutic work. It becomes essential

when the psychotherapist is engaged in

consultative services with groups whose main

work is with families. Unless the clinic’s staff is

keeping ahead in work which is similar to that of
the allied professional services, the clinic cannot

provide the expertise that these groups need. As

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was mentioned earlier, the mental health team
comprising different professional skills becomes

of paramount importance, with the therapeutic

skills of all members being maintained at a high

level.

Work with families also highlights the need

for the consultant psychotherapist to understand

intergroup as well as intragroup dynamics. When

he works with staffs of residential institutions,

knowledge of intergroup dynamics is

indispensable. The specialist psychotherapist in

the community clinic has therefore to acquire a

much broader experience than has been the
common pattern in psychotherapy. It may be

added that we have found this broader experience

sharpens appraisal in doing focal therapy with

individuals.

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In this task of creating more
psychotherapeutic facilities in the community, I

therefore suggest that the crucial matter is the

creation of a “sociotherapeutic system” amongst

the helping professions in which the

psychotherapeutic centre has to play a

fundamental part. The present skills of the

helping professions derive almost entirely from

the psychodynamic understanding that followed

Freud’s work. The psychotherapist in the

specialist centre must continue in a joint

collaborative endeavour with these professions to

keep the skills of all growing.

AETIOLOGICAL THINKING AND THE ROLE

OF THE SPECIALIST PSYCHOTHERAPIST

To describe the role of the consultant

psychotherapist in the mental health services, we

must start from the situation in regard to

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psychotherapeutic needs in the community and

the kinds of resources that can be mobilized to

meet them. I should make it clear that when

referring to consultant psychotherapists in the

psychotherapeutic clinic I assume that optimally

these specialists would be part of a

comprehensive psychiatric service. For

convenience I shall use the term

psychotherapeutic centre to allow for the location

of the psychotherapeutic services to vary

according to circumstances in any one area. Also,

although I shall speak often of the

psychotherapist as though his was a rather

separate contribution, I want to stress that this is

partly a reflection of the present situation. Much

of what I have to say about his role must become
increasingly a part of the work of all

psychiatrists.

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Compared with his traditional role, the

specialist psychotherapist in the community

centre has, therefore, to acquire a much broader

experience of different psychotherapeutic

endeavours. He has also to learn much more of

how the community is served by the centre

functions. In understanding the individual, he

must marry psychodynamic knowledge of the

inner world with a sociological sensitivity to the

outer.

Three main areas of thought are now affecting

our concepts of the psychological development

and well-being of the person. Although

psychotherapeutic theory and practice is
responding in part to these influences, they have
to be made explicit because their associated fields

of knowledge must become, particularly for the

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psychotherapist in a community service, part of

his training.

1. The stimulus that psychoanalysis gave to the

social sciences has led to an enormous
amount of research into the social
development of the child and to the ways in
which adult behaviour is governed by social
relationships. The findings have provided a
greatly enriched background on which
thinking about the growth and functioning of
the personality has to be based.

2. Parallel with these developments is the

profound movement in our culture through
which the whole orientation of people to
society is in a state of flux, with marked
effects on the functioning of the family and
the individual.

3. Thirdly are the new studies of animal

behaviour focused on the relations of innate
behaviour patterns with the maturational
environment, and the applications of this

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work to man’s social development and
functioning.

It is not uncommon now amongst

psychotherapists to view the splits in the person

as more like a number of incompatible subselves

rather than as divisions arising along the lines of

the familiar ego, superego, and id. In this

development, it is thought that the subselves can

be more usefully described in terms of system

theory, each system having its own type of

personal relationships as its inbuilt goal.

Symptom pictures have begun to alter as our

society has exchanged its traditional values and

its social conditions. Thus the disorders broadly

subsumed under the notion of oedipal conflicts
are emerging as manifestations of earlier and
pervasive pathology. Our art and literature and
our mass media have made commonplace the

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vagaries of human sexuality and aggression, so
that our patients come, now, not only troubled by

repressed instinctual impulses, but presenting the

bewilderment of a divided self and the schizoid

futility of people alienated from those committed

relationships to others, to themselves, and to their

achievements that give excitement to living and

satisfaction and happiness for each phase of the

life cycle.

As treatment of the person as a whole has

proceeded, analyses have become longer and

longer, and the place of such long-term treatment

may appear even more difficult to envisage in our
mental health services. Nevertheless, I believe it
to be essential that some intensive long-term

analytic treatment should be carried out in our

National Health Service units. While

acknowledging our very great indebtedness to the

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brilliant intuitions of our gifted analysts, it is
doubtful if the conditions of private practice,

where analysis is virtually exclusively carried

out, should continue to provide the only setting

for many of the developments we need. The

importance of the study of the self and its identity

—its intimate relatedness to the social

transactions which constellate it and maintain its

boundaries — makes it increasingly likely that

detailed psychoanalytic work on the intrapsychic

properties of the individual will have to be

matched with equally intensive work into those

social transactions that are essential to being a

person.

In this endeavour the psychotherapist has a

unique contribution, and I think this can best be
realized in the setting of clinic or hospital.

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Interactional processes are the essence of
analytical psychotherapy with individuals, yet I

believe that the understanding of individual

psychotherapy will be enriched when those who

make it their primary task bring to it a wider

experience with the therapy of families and

groups such as the clinic can offer.

Again, the development of the psychiatric

hospital as a therapeutic community should be an

area in which the psychotherapist can contribute

to the ideas of his psychiatric colleagues. Much

of the splendid work here is felt by many

psychiatrists and others to lack a depth

component that might well enrich its

contribution. When there is the opportunity to

work together, practical methods for introducing
interpretative methods can be evolved.

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I have elaborated the task of “aetiological

thinking” because of its fundamental role for all

mental health endeavours. It will be greatly

advanced, however, when the specialist

psychotherapeutic contribution is integrated into

the work and thought of all psychiatrists that

must go on in every psychiatric centre. Only then,

too, will the general body of psychiatric trainees

get the opportunity they need for acquiring

psychotherapeutic understanding.

THE TRAINING OF THE SPECIALIST

PSYCHOTHERAPIST

Just as the roles of the consultant

psychotherapist must match the needs of the

community situation in regard to psychotherapy,

so must training equip the consultant

psychotherapist to fill these roles. I have

suggested that inside the clinics and hospitals we

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must have an ongoing proportion of intensive

psychotherapeutic work done with the highest

level of skill we can get. Only then will

understanding and practice develop as they

should both inside and outside the clinic.

The first requirement of the psychotherapist is

to have training in intensive psychotherapy to the

best available levels. This entails the following:

1. A personal analysis over some years.

2. Treatment under supervision of at least two

cases, one of which must be continued for 2
years. It is usual for this stage to be begun
after 2 years of personal analysis.

3. Theoretical and practical seminars over 2 to 3

years.

It is common for young psychiatrists who

wish to specialize in psychotherapy to

contemplate undertaking this training after 2 to 3

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years of general psychiatric training, by which
time they have obtained certification in

psychological medicine. Should they proceed to

the more advanced psychiatric qualification

requiring a longer period, it should still be

possible for trainee psychotherapists to start their

personal analysis at about the same stage in their

careers.

When the trainee begins supervised cases, it

becomes appropriate to concentrate on

psychotherapeutic work of various kinds, for

example the treatment, under supervision, of

analytic groups, families, and marital interaction.

Towards the end of this phase, there must be

added experience in providing consultation

services to a range of allied professional groups

and to getting familiar with the handling of

community problems.

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This phasing of the different parts of training
need not be regarded as in any way rigid. The

main point is the total ground to be covered.

Theoretical courses for the sociological

background to the psychotherapist’s work are at

present difficult to describe, as much work has

yet to be done on evolving the best content for

these courses. Particular emphasis needs to be

given to the sociology and psychology of the

family, to the dynamics of small and larger

groups and organizations. In the future, much of

this background in the social sciences may be

incorporated partly in the undergraduate and

partly in the postgraduate period of the training of

all psychiatrists. One aspect of the training should
be stressed, namely, that a considerable

proportion of it should be common to the

postgraduate qualifications for all of the mental

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health professions. Working with the other
professions in therapeutic and consultative tasks

will be a major part of the psychotherapist’s

future activities and bringing these various

groups together for common parts of their

theoretical training has great advantages for the

fostering of future cooperation.

Within the psychiatric services, the consultant

psychotherapist has thus a particularly important

part to play in establishing a collaborative

“sociotherapeutic system” whereby all the mental

health services can be functionally related.

This expanded role needs training in

psychotherapy to the level of the psychoanalyst

and theoretical and practical training in the

sociological aspects of community mental health
with special reference to the dynamics of the

family, of small and large groups, and of larger

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organizations and institutions. An adequate
overall training and experience can be achieved

in the usual 8-10 years of the preconsultant

phase.

CREATING CONDITIONS FOR OPTIMAL

DEVELOPMENT AND FUNCTIONING OF THE
PERSONALITY: PREVENTION

Access to many powerful forces in the

personality is only to be obtained when the

person is in the security of a therapeutic

relationship. Accordingly, the role of the

psychotherapeutic clinic in providing a laboratory

for the study of the development of the individual

personality, and hence for knowledge on which

primary measures could be based, is well
recognized.

That a much wider relationship must be

developed by the clinic to more general problems

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of prevention and the development of positive
mental health measures becomes clearer the more

social factors are studied in their effects on the

functioning of the person.

To illustrate this theme I shall take some

recent findings on work stress and work

satisfaction. When they investigated the high

incidence of stress manifestations in certain

groups of miners, Trist and Bamforth (1951)

showed that a new technology in the mines had

broken up the traditional working groups. These

were replaced by work roles and groups based

primarily on the machines. After prolonged

working through of the various implications of
change, a new social organization was then

designed, which retrieved the old self-regulating

patterns for small work groups and which was at

the same time appropriate for the demands of the

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machines. The result was a marked fall in
sickness and absenteeism rates, a recovery of

work satisfaction, and a rise in productivity.

Further work has emphasized this need to view

the work group as a sociotechnical system, to use

Trist’s term, that is, as a system in which the

social and personal needs of the worker must be

satisfied by a work setting that simultaneously

meets the technological requirements.

Responsible participation in social tasks appears

to exert a major influence on the feelings of

security and competence in the individual.

Again, the study of Menzies (1960),

investigating the high wastage rate in training

nurses, suggested that the pattern of the nurse’s

work that has developed in recent years

represents a social system evolved to operate as a

powerful defense against the emergence of what

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are treated as uncontrollable feelings. In this
particular case the defense not only denied the

feelings involved, the emotions inevitably

associated with the “nursing relationship,” but the

system also deprived the nurse of the necessary

reassurance that the task could give in response to

these feelings. In other words, the system failed

with the primary anxiety and created a secondary

anxiety from frustration and the inhibition of

creative development.

This kind of study, and an enormous mass of

other findings, raises many aspects of the relation

between psychotherapy and the social sciences.

Affinities between the clinic and the social

sciences have become clearer as group methods

have been used by the psychotherapists. It is not

only small groups, however, that can be described
as microsociological. Detailed psychotherapeutic

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work shows that the study of the person can also

be categorized in this way, for his personality

carries within it a series of dynamic object-

relations structures mediating a range of social

relationships with figures in his inner world, and

the patterns of relationships with people in the

outer world. These theories in turn have led to

several creative lines of thought on the

functioning of small groups both in regard to the

deeper forces influencing relations between

members, and between members and the leader.

Leading sociologists, for example, Parsons and

Bales (1955), have interestingly enough reached

similar conclusions.

Personality theory must account for the range

and quality of the needs for belonging in various

groups, for achievement, and for defining and

maintaining a satisfying identity and self-feeling

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in cooperative relations with others on significant

activities. Clinical work suggests that the

integrity values of the central self are achieved

for most at the expense of splitting off parts of

the personality that embody repressed

relationship needs. In spite of the familiar defense

mechanisms, many of these needs remain as

unconscious compulsions to re-create

relationships in which they can be satisfied. For

these relationships, objects are often selected

from the groups in which people live or work.

Such relationships may possibly underlie the

“social atom” that Moreno (1956) has found to

characterize group relatedness. Again, the need to

exert some mastery over these inner relationships

may have a close relationship to the kind of

satisfaction many people require in work, for

example, the feeling of being a responsible

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member of a self-regulating group. As

automation progresses, new means of satisfying

social needs will have to be evolved. And to all

these problems, the psychotherapeutic clinic has a

unique contribution to make.

In our modern world change has to become a

normal and positive experience. Administrators

and social scientists on the whole have been

much more able to diagnose what has to be

changed than to manage a successful change

process. If we remind ourselves that the

characteristics of a social system have been

evolved in substantial measure to deal with the

threatening tensions within it, then we will be
prepared for the consequences of trying to change

it. All psychotherapists are familiar with the

anxieties aroused within the individual when he

begins to alter his defense systems. It is

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inevitable that such alterations within the

defensive patterns of a social system will also

release anxiety and a degree of acting out. Social

systems can create special difficulties during the

change process; but members can also give each

other considerable positive support during

change.

New satisfactions have to be experienced and

accepted before the old ways can be given up,

and during this process the role of a therapeutic

person or group of persons has a close parallel

with the role occupied by the therapist for the

individual or the family. Our experience has

therefore been that the social scientist who

wishes to be involved in change processes has to

acquire, in addition to knowledge, skill that

maintains the professional relationship while

these processes with their inevitable anxieties and

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acting-out are being initiated and worked
through. Such skills naturally have to be evolved

with special experience, but the

psychotherapeutic relationship, especially in

analytic group therapy, can provide a valuable

basic model. Some social scientists may seek

personal analysis as a foundation, but where this

is not adopted, experience, even as observers of

therapeutic groups over a long period, is

extremely useful as a foundation for professional

skills.

The whole conceptual basis for research and

development into the tasks of improving the

social environment has fundamental problems

that are common to the psychotherapist and the

social scientist, and close collaboration between
them must be a part of the activities of the

psychological clinic. The psychotherapeutic

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clinic has a unique role as a control mechanism
picking up critical data on damage being done

within the current social processes. Use cannot be

made of this role, however, unless the clinic is

integrated with a wider group of institutions in

the community, and especially those which can

value its findings and on this basis initiate

changes. In other words, while a comprehensive
mental health service may undo some of the

rejection by society of its psychological

disorders, there is a danger that such services may

merely develop “within” the community instead

of getting into the integrated relationship with

key institutions that is required.

The location of the clinic within its social

space therefore assumes a new importance. It

would seem that it has to become one component

in a constellation of units —an institute or school

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of human relations — which together share the
task of advising on the means to a better society.

SUMMARY

Expanding community mental health services

entails new roles for the psychotherapeutic clinic.

Its staff have to initiate and maintain a large-scale

training program whereby the psychotherapeutic

skill of all the helping professions can be raised.

The clinic has then to remain a focal point in

maintaining an increasing level of competence

throughout this system. Inside the clinic,

psychotherapeutic practice, as well as preserving

the traditional role of providing long-term

individual treatment for some, must comprise
work that closely parallels much of the work in

the community. In particular, high expertise must

be maintained in the treatment of the family and

in group therapy and group dynamics. Lastly,

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because of the clinic’s role in picking up the
breakdowns from the current social processes, it

occupies a unique position to act as a

servomechanism that must be integrated with key

institutions concerned with evolving

comprehensive knowledge for the management

and development of the community.

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17.

RESEARCH IN PSYCHODYNAMICS

THE PRESENT POSITION

The provision of treatment for the

psychologically ill is a task for the National

Health Service, and it is a responsibility of all

psychiatrists concerned to examine something of

the nature of this task and what can be done about

it.

In regard to the psychoses, our society has

now accepted the provision of at least “an

asylum” for most of these patients; but for the

psychoneuroses and the character disorders, the

existing facilities over the country as a whole for

other than palliative treatment are almost

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negligible in face of the size of the needs.
Nevertheless, the psychological illnesses despite

their historical separation, form a continuum both

in their manifestations and in the problems they

present for treatment and prevention, and I

propose, therefore, to have in mind the whole

range of psychological disorders in looking at our

task.

A little reflexion on the scale and cost of

psychological illness is salutary.

1. In England and Wales there are approximately

150,000 people in mental hospitals.

2. Fraser (1947) and his colleagues showed that

approximately 10 percent of the industrial
population had suffered from definite and
disabling neurotic difficulties, and a further
20 percent from minor forms of neurosis,
during the course of 6 months…. Neurotic
illness caused between a quarter and a third
of all absence from work due to illness;

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neurosis caused more absence than colds and
influenza. Of the total available working
days, 1 percent in the case of men and 2.4
percent in the case of women are lost
annually from psychological illness.

3. Such estimates as exist would tend to show

that about a third of most general
practitioner’s work is concerned with illness
in which the psychological factor is
prominent.

The human suffering that this represents gives

ample reasons for serious efforts. But if, in

addition, we reckon the cost of these disorders,

both the direct cost of their treatment and the

indirect cost of the loss in productivity, a

conservative estimate of the national bill for
psychological disorders must be £100m. per

annum. It would therefore appear that the need to

take effective therapeutic and preventive action is

urgent.

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WHAT ACTION IS TO BE TAKEN?

Naturally a great deal of therapeutic effort is

being expended on the more serious illnesses,

especially in the mental hospitals. Furthermore,

in preparation for an expansion of therapeutic

services for the psychoneuroses, the Ministry of

Health sponsored Dr. C. P. Blacker’s valuable

survey on Neurosis and the Mental Health

Services (1946) in order that a comprehensive

description of the psychiatric out-patient facilities

would be available as a first step towards

improving these. The essential points in Dr.

Blacker’s recommendations were:

1. The creation of more psychiatrists who would

have had training at Teaching Psychiatric
Centres for out-patient work.

2. A great increase of therapeutic facilities

(including beds) for the neuroses.

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However, when we look at our existing
therapeutic activities we become less enthusiastic

about these recommendations. It is no

exaggeration to say that almost all actions taken

at present for the psychological disorders,

whether therapeutic or preventive, are completely

empirical and palliative. All kinds of treatments

are practised and incompatible measures are

proposed for their prevention. The

psychoanalysts and allied groups are perhaps the

only therapists who would claim that their

treatment is radical or rational in its aim, but their

contribution to therapy must remain small

because of the small number of cases who can be

treated by their methods.

Now, although it should be unnecessary, I

believe that the limited status of empirical

methods needs to be emphasized in psychiatry to-

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day, both in treatment and prevention. In treating

any illness about which we know little, till kinds

of theories may be acted upon, and any treatment

that relieves suffering is justifiable when rational

treatment is either unknown or unavailable. From

a coordination of all the available knowledge and

experience, however, there soon emerge some

general conclusions that limit the likelihood of

some views on the nature and the origin of the

illness, while at the same time they give to other

lines of work a greater probability of reward. Any

approach to illness that does not take into account

these general findings is what we normally mean

by an empirical one, and because it denies or

ignores some of these findings, we imply that it is

most unlikely to lead to the kind of knowledge
upon which sound treatment and preventive

measures can be based. It is my view that much

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current psychiatric treatment is empirical in this
sense, and certain questions must therefore be

faced. For instance, it has to be asked whether or

not a problem of the size of psychological

illnesses to-day must go on being treated almost

entirely on empirical lines and whether or not it is

justifiable to swell the number of psychiatrists

when all they can do is to continue to expand this

empiricism. Surely, our first priority is an
acceptable approach to aetiology; we need some
scientifically established principles and

knowledge on which effective therapeutic and

preventive action can be based.

The inevitable answer to this suggestion will

be that we cannot get a sound aetiological

approach without more research. That is to say, it

is asserted that in psychiatry we are still at that
stage where no general conclusions about the

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phenomena of mental illness can be accepted as
setting limits to the probability of certain broad

hypotheses regarding aetiology. Two points,

however, must be noted about this reply. In the

first place, a large amount of research has already

been carried out in psychiatry during the last 50

years, and secondly, if it is true that more

research is needed, one cannot but wonder why

there is relatively so little of it in face of the scale

and cost of the psychological illnesses. It is

inconceivable that any enterprise with an annual

loss of at least £100m. from say some kind of

“wear and tear” should spend as little on

investigating the cause of this loss as is being

spent at present in this country.

Clearly, then, it may repay us to examine

these questions of why current psychiatric

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research is so inadequate in both quantity and
effectiveness.

THE INADEQUACIES OF CURRENT

PSYCHIATRIC RESEARCH BOTH IN ITS
SCALE AND EFFECTIVENESS

The main reason to my mind for the

unsatisfactory state of affairs in regard to the

amount of psychiatric research being conducted

at present, lies in the fact that as a group

psychiatrists have not yet been able to abstract

from the available findings of psychological

illness commonly agreed broad aetiological

principles that group the phenomena in patterns

related to the underlying dynamic processes.

But if we cannot show such an integrated

approach, how can we expect the nation to

support research on an appropriate scale?

Naturally we do not know all the answers, but is

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it surprising that we are failing to convince the
intelligent laymen, in particular our

administrators, that we really could make a

workmanlike attempt at finding some of the

answers?

It cannot be said that psychiatrists are

indifferent to the situation I have described.

Every few years some fresh empirical approach

to treatment leads to fairly widespread hope that

an important gain has been secured, and a crop of

papers follows from a surge of enthusiastic

workers in hospitals scattered throughout the

country. Here, however, history almost always

repeats itself; the chimerical nature of the

widespread hopes slowly emerges and the

chilling fog of our ignorance descends once

more. In contrast with this picture, the radical

approach of dynamic psychology certainly

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presents a body of knowledge that is steadily,
though slowly, being consolidated. However, this

knowledge, which has been mainly derived from

the work of the psychoanalysts, has not been

placed upon a sufficiently scientific basis for it to

be widely accepted and used as a scientific

contribution.

The main reason for the ineffectiveness of

most of our research would appear to me to be

the lack of methodological clarity in much of the

research going on in our field, and the absence of

a thoroughgoing logical analysis of what is being

attempted. It may be that it is because we are so

much under stress from therapeutic pressures that

we are not thinking enough about these problems.

It certainly seems that recent psychiatric research

has not only failed to help us adequately, but also

that the lack of logic makes it such that much of

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it cannot possibly lead to that knowledge which

would help us to take effective action in our

situation.

This is a grave charge; I believe it,

nevertheless, to be true. Any individual worker

has the right to research on any topic he chooses

if he can find the time and money. The vital
question, however, is what lines of research are
most urgent for the National Health Service if it

is to deal in a practical effective way with the

psychological disorders? I believe that this

question is a very serious one indeed for the

whole future of psychiatry and psychology in

Britain. This will be seen if we put it in another

way, namely, what lines of research should we
have in mind and, if possible, what proposals

would be put forward to secure these research

aims, to obtain the most rapid advance along the

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most effective lines in our understanding of the

development of personality both in its normal and

pathological features.

A CRITIQUE OF CURRENT PSYCHIATRIC

RESEARCH

It will help us if we look critically at the

research that is going on to-day in the light of

available knowledge.

Two basic methodological criticisms can be

made against most of this work.

(a) The most serious scientific shortcoming in

current psychiatric research is the widespread
tendency to state antecedent conditions in static
or classificatory terms, that is, in terms referring

to aspects of the individual that are not essential

to the dynamic interaction of the individual and

his environment. There is a conspicuous lack of

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appreciation of the fact that research designed to

explain psychological illness has to formulate the

possible causes of the problem, not merely as

antecedent conditions to be correlated with a

certain end-result, namely mental ill-health, but it

has to demonstrate the dynamic interaction of the

various antecedent conditions leading to this

result.

If, for example, we take the fact that studies

demonstrate that constitution and environment

are factors that play a part in mental ill-health,

then it is virtually of no use whatever to correlate

constitution in static terms, for example, asthenic

physique, with the end-result that is called
schizoid personality or schizophrenia. A

satisfactory theory must state the antecedent

conditions in dynamic terms on the appropriate

dynamic plane. Only then can we demonstrate the

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interaction between constitution and environment
that leads to the result we want to explain, that is,

mental ill-health.

Let us take the treatment of this problem in a

popular psychiatric textbook. (Although I have

borrowed my illustration from one textbook, in

fact all current textbooks are similar in this

respect and I have therefore not specified this

particular one lest it should be taken that it was

exceptional.) In the chapter on aetiology, there

are listed three types of causal factor: (i)
constitutional, (ii) physical, (iii) psychological.

We hear, for instance, that a man with a

certain depressive constitution which can be

inferred from the family history, who in addition

has influenza and who is unemployed, falls ill
with a depressive illness. On the other hand,
while unemployed several years ago, but when

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the physical factor of influenza was absent, he did
not fall ill.

Here there are three causal factors listed in

static terms, but there is no statement of how a

certain constitution plus certain psychological

stresses plus a physical illness interact in order to

produce this particular condition that, it is

claimed, is their outcome.

The unsatisfactory nature of this approach

becomes apparent when we ask whether it is

really claimed that whenever a similar family
history (the only criterion used for the assertion

of a depressive constitution consists of the

presence of certain features in the relatives), plus

unemployment plus influenza occur together they
will cause a depressive breakdown, that is,
whether it is claimed that these are logically

sufficient conditions to account for their supposed

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effect. It is only too easy to cloud this issue by
stating these supposedly aetiological conditions

in nondynamic terms.

The absence of any attempt to demonstrate

the interaction between the antecedent factors

leading to a certain condition puts psychiatric

research in the state of claiming to have

“explained” the aetiology of a condition by

making statements which, if applied to the field

of infectious diseases, would sound like this:

“there is some external agent (not further defined)
and some undefined state of the body of a

particular individual which interact in some

unknown way to produce, say, typhoid fever.”

Naturally it is not possible at present to formulate

these factors in detail with regard to particular

mental conditions the aetiology of which we want

to explain, but we must not give the impression

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of having solved the aetiological problem. This
will not be achieved unless our research is

conceived in such ways as to allow the

formulation of these factors in specific dynamic

terms.

(b) My second methodological criticism is the

following one: Hypotheses are formed from

isolated observations without a thorough

appreciation of the characteristics of the whole

field. For instance, many studies in the physical

sphere seem completely to ignore the fact that at
least in our everyday life we are not indifferent to

psychological experiences as dynamic agents in

our own behaviour.

One result of these partial approaches is that

there are impenetrable barriers between the rival

schools, most of which perpetuate their own

inadequacies. There are many reasons for this

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one-sided development. Foremost, I think, we

must place the completely inadequate training of

most workers in our field. On the one hand, most

psychiatrists have had little or no opportunity to

acquire adequate experience and understanding in

the principles of what is surely their basic

science, namely, the science of behaviour or

dynamic psychology. (In their training and in the

qualifications demanded for most psychiatric

posts at present, the place of psychology is at best

a very uncertain one.) On the other hand, the

contributions of psychologists to the problems of

personality and the behaviour disorders are too

often “academic,” that is, of marginal relevance

in practice — an unavoidable outcome as long as

psychologists are kept apart, or keep themselves

apart, from some of the most significant data
underlying human behaviour and which are only

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accessible within the therapeutic relationships in

the clinic.

In such a situation, it does not matter how

brilliantly each group of workers develops its

own special skills and knowledge, for the lack in

each group of an effective knowledge of those

other factors relevant to the understanding of

mental disorders remains as a major obstacle to

successful dynamically orientated research.

Inevitably the methods of any one group are

expanded into ways of dealing with the total

phenomena, and because they cannot give a

dynamic account of the specific features of

psychotic and neurotic behaviour, especially in its

apparently irrational aspects, the need to give

such an account is lost under a cover of static

formulations that can never explain the essential

happenings in mental illnesses, and can therefore

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never be of value either in therapy or prevention.
Thus, though few psychiatrists would admit to

ignoring psychological factors, nevertheless, a

very substantial part of current research and

treatment seems to be based largely on the theory

that they are at bottom irrelevant and that the

important factors are organic derangements of the

centred nervous system caused by some

intoxication or by some constitutionally

determined disturbance in metabolism or by

physical agents introduced from outside. Again,

the psychologist, from the restricted nature of his

background, has perforce concentrated upon

attempts to develop refined measurements and to
make statistical analyses of variables that have

little or no dynamic significance and that can only

be used to classify patients.

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Perhaps we might avoid these pitfalls, of
working with static concepts or of building up

aetiological hypotheses on isolated observations

that are contradicted by others, if we survey

briefly the relevant findings of the most important

lines of research carried on at present and if we

try to evaluate their observations. This survey

will necessarily be brief and it makes no claims

to be comprehensive. I have made it essentially as

a demonstration of what must be done in a much

more exhaustive manner by others.

ORGANIC THEORIES OF MENTAL

DISORDER

Let us examine first research based on organic

theories. The first important problem is whether it

is possible to correlate specific physical agents

with specific mental syndromes. A tremendous

amount of energy has been devoted to attempts to

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describe specific syndromes, for example, as
alcohol hallucinations, drug intoxication, the

grandiose delusions of general paralysis of the

insane (G.P.I.), to quote but a few. Further

investigations, however, have established beyond

doubt that it is impossible to correlate any

specific psychosyndrome with any specific

external physical agent. Bleuler (1951) has

brought out this point particularly well.

Three other questions interest us here:

1. Are lesions in the brain necessarily

accompanied by psychopathological
symptoms?

2. Can specific psychopathological symptoms be

correlated with brain lesions of specific
localizations?

3. If so, is this possible for all symptoms or only

for some?

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G.P.I. is often quoted as a proof that
psychopathic manifestations are the direct

expression of lesions in the brain, and in this case

we know the spirochaete as the external physical

agent that causes the brain disease. Some

psychiatrists even use this example to point out

the futility of a search for a psychological

aetiology of the psychotic reactions

accompanying G.P.I. For instance, Curran &

Guttman (1949) say “no plumbing of

psychological depths can bring to daylight the

(unconscious) invasion of the brain by

spirochaetes.”

In spite of the assertion that psychological

factors play a part in the aetiology of mental

disorder, the implication in this case is that the

psychologist cannot explain the occurrence of the

delusion that is taken to be a direct expression of

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the brain damage by the poisons of the
spirochaetes. It seems to me, however, that the

keeping up of the organic hypothesis is only

possible inasmuch as organically minded

psychiatrists think of G.P.I. as a disease entity in

a psychological sense because we happen to

know a specific external agent that causes the

disease of the brain. If we study the

psychopathological pictures in G,P.I., the

syndromes show a variation through the whole

gamut described in any mental disorder. The only

constant psychopathological change is the

deterioration of the patient’s intelligence and

cognitive functions, that is, the individual’s
psychological adaptive equipment that allows

him to perceive and order his perceptions into

meaningful relationships in space and time and to

integrate them with past experiences and with his

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expectation of the future based on them. (I am
distinguishing this equipment from the conative

and affective aspects of the personality based on

needs, and drives to satisfy them, and which

make use of the cognitive equipment for this

purpose.)

The fact that the only constant symptoms of

G.P.I. are the deterioration in intelligence and

cognition forces us to conclude that the only

psychopathological features that could be

considered as the direct expression of the lesion

caused by the spirochaetes is the deterioration of

the intellectual and cognitive equipment.

As far as the explanation of the inconstant

psychological symptoms goes, for instance, the
psychotic pictures that may or may not

accompany the deterioration of the cognitive

functions, we have therefore to look for other

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aetiological factors. I should like to draw your
attention to the study by Hollós & Ferenczi

(1925) who tried to demonstrate that the

psychotic pictures, when present, can be

explained as the psychological reactions of

correspondingly predisposed personalities to the

perceptions of their waning intelligence and to

the conscious and unconscious meaning of the

venereal disease. We thus find the manic denial of

his deficiency, or depressive self-accusations, and

so on. It is therefore not merely the content of

delusions and other psychotic symptoms for

which we have to take recourse to psychological

explanations. The very existence of the delusions

cannot be explained by the brain disease as such

but only by invoking psychological factors. It is

in keeping with this fact that in the majority of
G.P.I.’s, where the brain disease occurs in fairly

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well-balanced pre-G.P.I. personalities, no

psychosis develops. There is merely the simple

deterioration in intelligence, and the most

common form of G.P.I. is, as would be expected,

simple dementia.

These findings are fully confirmed by the

study of chronic circumscribed lesions like brain

tumours, the results of which are well

summarized in Bleuler’s paper. They are:

localized lesions in the projection areas may lead

to “isolated” psychopathological symptoms,

namely, hallucinations, which, we may note

again, belong to the cognitive sphere. It is

essential, however, to realize that they need not

lead to any involvement of the rest of the
personality, that is, there need be no psychosis.

Apart from such lesions localized in projection

areas, circumscribed lesions in the brain in any

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locality need not produce any psychopathic

symptoms; and if the latter do appear, they cannot

be correlated with any specific localization of the

lesion. It is therefore impossible to consider

psychopathological symptoms as direct

expressions of lesions in the brain and we have to

look for other aetiological explanations.

Space does not allow a detailed discussion of

confusional states in acute intoxications of the

brain, but delusions and hallucinations, which can

be observed in such states, can again be explained

as secondary phenomena based on a primary

disturbance of the individual’s cognitive

equipment, which cuts him off from the

controlling interchange with external reality and

allows him, as it were, to dream while he is

awake. In keeping with the findings from other

organic states mentioned before, we have again

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only to assume the disturbance of cognition as the

only direct result of intoxications. In spite of this,

the similarity between the pictures in acute toxic

states and the not infrequent confusional states at

the onset of schizophrenia or other psychoses is

apparently the mainstay of the approach of many

organically minded psychiatrists who put forward

the hypothesis that all psychoses are expressions

of intoxications, especially those caused by

disturbances of metabolism. This seems a very

uncritical generalization, which neglects the

psychological differences between the acute

confusional state and the gradually developing

psychoses. In the confusional states of acute

intoxications we always find disturbances of the

total cognition; we never find clinically isolated
psychological disturbances like delusions

appearing as a direct result of intoxications or

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morphological lesions when the general cognition

is otherwise undisturbed, for example, when

orientation in space and time are retained. In

addition, no one has been able to produce the

clinically isolated delusion of a paranoiac with

otherwise undisturbed cognitive powers through

administration of chemical substances as one can

produce acute confusional states through acute

intoxication.

If we go further into psychological studies of

these phenomena, we can see periods of the

classical picture of depressive psychosis

alternating with schizophrenic pictures, states of

persecutory delusions alternating with states of
idealization, and so on. And in the analysis of

psychotic patients these changes can be shown in

a particularly impressive way to be the reactions

of the patient to various anxiety-laden situations

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in his private world. The most improbable and
complicated assumptions would have to be made

to explain such phenomena on an organic basis,

yet such hypotheses continue to be advanced

even though they are usually introduced by their

author as “speculations,” not intended to be

tested, and in spite of the incontrovertible

evidence that makes them so improbable.

A similar discussion can show that

pathological impulses are just as difficult to

explain on the basis of an organic theory alone; it
is difficult to imagine, for example, a biological

hormone that could account for the object that is

of sexual interest to a shoe fetishist.

CONSTITUTION AS AN EXPLANATORY
FACTOR

Let us turn to another set of observations that

appear to be isolated from other data and then

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given an undue importance — the investigations
into constitution.

Such investigations are carried out mainly as

statistical investigations of twins and familial

incidence with regard to mental ill-health. There

are, however, a number of basic methodological

criticisms.

a. The statistical units used are not defined. It

seems strange to be presented with
correlations based on a supposedly precise
percentage of schizophrenia or manic-
depressive illnesses when the same authors
often start their reports by pointing out that it
is hardly possible to draw hard and fast lines
between the conditions under consideration.
Every clinician knows that the “mixed”
forms are more frequent than the so-called
pure ones. In his recent paper Bleuler
particularly emphasized this point.

b. This lack of examination of the

psychopathological details of the syndrome,

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and of the exact definitions of the mental
pictures being referred to, leads to similarly
unjustified claims as in the supposedly full
explanation of the psychoses that may occur
in G.P.I. through the discovery of the
spirochaetes that cause the brain disease. The
oft-quoted classical example of a fully
constitutionally caused mental disease is
Huntington’s chorea. It is said that it is a
mental disease and that it shows a 100
percent dominance in its inheritance. It is
then assumed to be a complete proof for the
view that some mental diseases are nothing
but the expressions of physical changes in
the brain, and that their causation is
explained solely by hereditary factors.
However, if we examine which features are
constant and which tire frequently absent,
and further, what kind of mental disorders
we find in these cases, we discover just as in
G.P.I., that the only constant feature in
Huntingdon’s chorea, apart from the physical
choreic symptoms, is the diminution of
intelligence. The psychopathological
symptoms may be completely absent, or they

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may vary through the whole range known in
psychiatry. Again, as in G.P.I., we come to
the conclusion that it is the diminution of
intelligence that can be considered as the
direct result of the damage to the brain while
the physical explanations fail us in regard to
the psychological symptoms that may or may
not occur. And for their explanation, we are
again thrown back on the premorbid
personality and its reactions to the
psychological meaning for the individual of
his physical disease and of the diminution of
his intelligence.

Three further methodological points may be

referred to briefly:

c. Constitutionalists show a conspicuous lack of

appreciation of psychological environmental
factors. Especially in identical twins is it the
case that environment can work both to
create identical attitudes and extreme
differences. Where the environment operates
to create identical emotions, this would

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account for a lot of what is attributed to
constitution.

It is a striking feature of many case

records quoted in twin studies to find the
whole environment up to the age of
adolescence or early adulthood dismissed in
a sentence or two. With virtually no
appreciation of what constitutes the
psychological environment for the young
child there is naturally little or no awareness
of the tremendous range of differentiation
possible in the psychological environment of
siblings and of twins.

The observations reported by Sandford

(1952) and others on the dramatic
repercussions of the mothers’ conflicts in the
behaviour of their infants and young children
illustrate the kind of phenomena that seem to
be entirely unknown, or at least
unassimilated.

Furthermore, recent work on the effects of

foetal stimulation on behavioural
development, for example, that quoted by

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Ashley Montagu in the Symposium on the
Healthy Personality (see Senn, 1950)
suggests that environmental factors influence
much of what has been attributed to
inheritance.

d. The claim that identical twins are always

psychologically so similar is, as Hartman’s
study (1933, 1935) shows, not borne out on
closer investigation.

e. Finally, it must be asked whether statements

about constitution made in static terms have
much value when our aims are concerned
with what factors make for change. To state
that somebody’s neurosis has a 10 percent
constitutional factor, or that he is
leptosomatic or cerebrotonic, or has an
inherited factor of neuroticism, does not
enable us to take practical action other than
to label patients. That there is a constitutional
factor we know anyway; as diagnostic
indicators a Rorschach test or a clinical
interview give us far more relevant
information about the forces at work. Can

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statistical methods, and especially factor
analysis, yield us anything other than
nondynamic correlations? Or put another
way, will they ever reveal to us the dynamic
laws of interaction we need to know? In
order to be useful, research into constitution
has to be designed in such a way as to give
results in dynamic terms. If, for instance,
some of the physical bases of our
psychological constitution could be related to
specific chemical substances whose effects
on the nervous system could be ascertained,
then action could be taken.

However, allowing for these methodological

deficiencies, even the studies of the most ardent

constitutionalists provide foolproof evidence

against the assumption of the fully constitutional

nature of the functional psychoses. The classical

investigation of Rosanoff, Handy, Plesset, and

Brush (1934) on identical twins, and the many
subsequent studies of this nature, showed that

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only in about two-thirds of identical twins is there
concordance with regard to schizophrenia. This is

conclusive proof against a purely constitutional

theory.

Our attempts at integrating the findings in

organic brain lesions with the existing studies on

constitution therefore leave us with incomplete
hypotheses regarding the aetiology and

pathogenesis of mental disorder. The organic

theories seem to explain the deterioration of

intellectual and cognitive processes as a direct

expression of physical damage to the brain, but
leave unexplained the emergence of varying

psychopathological syndromes. The

constitutional investigations make likely the

existence of a constitutional factor and an

environmental factor without either indicating the

nature of the constitutional factor or whether the

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environment is a physical or a psychological one.
If we assume that the environmental factor is

physical, this would lead us back to an organic

theory the inadequacy of which has been

mentioned. We must therefore conclude that the

environmental factor is psychological.

This is confirmed by statistical evidence.

Kallmann and colleagues (1949) quotes that

nonconsanguineous step-sibs of schizophrenics

show 1.9 percent incidence of schizophrenia, that

is, twice as much as in the general population. It

can only be the psychological environment of

these families that raises the incidence of

schizophrenia to twice as much as that in the

general population from which these foster

children originate. The same is borne out by
another of Kallmann’s findings, namely, that

separated identical twins showed only 77 percent

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concordance in development of schizophrenia,

while nonseparated ones show 91 percent.

PSYCHODYNAMIC THEORIES

Turning now to psychodynamic theories,

what do they contribute to the problem of

aetiology? (I shall refer mainly to psychoanalysis

because it is the best known example of this

class.) The most important finding is that the

infant in his attempts to satisfy his biological

needs encounters frustrations to which he reacts

with aggression and in turn anxiety. Whenever

such anxiety becomes intolerable some of the
associated feelings and strivings get split off from

the main or central part of the growing

personality. Later, this process is the one usually

referred to as repression and its aim is to prevent

the recurrence of painful emotions by means of

“defence mechanisms,” which form the basis of

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his personality traits. If these prove inadequate,

then the repressed breaks through as symptoms.

Psychoanalysts have shown that

environmental differences explain to a large

extent the development of different personalities,

both balanced and disturbed. In the final analysis,

however, they meet facts that suggest that

different individuals must have reacted with

different intensity to dynamically similar

situations in earliest infancy, that is, they have to

assume constitutional differences.

From time to time these constitutional factors

have been stated in psychodynamic terms such as

various sets of instincts differing in intensity from

one individual to another, or as the ego’s ability
to master anxiety, and so forth. The growing

influence of field theory makes us think of other

types of factor as the important innate

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differences, for example, thresholds for

frustration tolerance that seem closely correlated

(as observations of infants have shown), with the

individual’s innate excitability. A child with a

high degree of excitability reacts with more anger

and subsequent anxiety to frustration than a

placid child.

A further difference could be introduced by

differences in the rates of the maturation of

various functions. Differences in intellectual and

physical equipment lead to differences in ability

to cope with situations. One child may therefore

find a situation frustrating while another copes

with it. It would thus appear that biochemical and

physical research might be more fruitful if it

picked up these suggestions from dynamic

psychology and tried to discover the physical

basis of psychological constitution, for example,

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of excitability. We shall expect to find
quantitative differences between various

individuals in the first instance, and in view of the

fact that a kind environment may do a lot to

offset a constitutional handicap, and vice versa,

we should not be surprised sometimes to find a

comparatively balanced person with high, and a

schizophrenic with low, excitability. On

theoretical grounds, research into such dynamic

organic factors in our constitution appears

promising, but most present attempts of

organically minded psychiatrists to discover the

supposed metabolic disturbances underlying

schizophrenia appear doomed to failure because

they seek to correlate a highly complicated end-
product produced by a multiplicity of intervening

factors with a physical factor that could make for

all kinds of development. It is, therefore, not

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surprising when Dr. McCowan (1952), in his
presidential address to the Royal Medico-

Psychological Association last summer, had to

state with openly expressed disappointment, that

in spite of the painstaking work done by many

workers, surprisingly little has come out of

biochemical, biophysical, and endocrinological

research in psychiatry.

It is obvious that the discovery of the

biochemistry underlying excitability would open

up fascinating possibilities of preventive action in

infancy. However, even if we could affect this

factor, is there any justification to believe that

once an individual has developed his distorted

personality, mere change of his physically

determined psychological constitution will be

able to cope with his personality disorder?

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I wish to emphasize here what All port (1949)
calls the functional autonomy of the traits of the

personality. There is good evidence to suggest

that these traits and symptoms are defences

against the emergence of unconsciously

determined anxieties, parts of psychological

systems that have arisen out of the individual’s

infantile experiences and that are laid down in his

nervous system in the form of highly complex

“gestalten” apparently involving all areas of the

brain. Once this has taken place, mere change in

metabolic, perhaps glandular, processes that

underlie the psychological constitutional factors

that enter into the formation of personality in
infancy can no longer materially affect the adult

personality whose physical basis lies essentially

in the brain. It is true that chemical substances

may not only affect internal glands, but also the

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brain directly. However, the findings from
organic brain disease lead us to expect that only

the cognitive equipment will be affected. Equally,

it is impossible to imagine any longer that

psychological processes such as ideas and beliefs,

which are based on all the areas of the brain, can

be affected selectively by physical means.

Both the findings of organic brain disease and

of physical treatment confirm this view. Without

going in detail into the evidence from physical

treatment, we have only to remember that the

basic personality traits reappear unchanged

whenever we stop the administration of chemical

substances. Stilboestrol, for instance, may stop

the sexual urge of a fetishist during the period of

administration but his perverted sex interests

reappear as soon as we stop the drug.

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The same holds for attempts to remove
specific traits or symptoms by means of brain

surgery. Klein’s (1952) recent study of

posdeucotomies shows this very well. The

psychological effects seemed to correlate with the

degree of brain damage. As expected, delusions

and other pathological thought processes

remained after leucotomy; in other words, the

functional autonomy of the personality was

preserved. On the other hand, comparatively

slight damage of brain substance expressed itself

in the most subtle disturbances of cognition, that

is, in the individual’s inability to integrate the

present with past experiences and future

expectations. The patient was thus reduced in this

respect to the mental level of a child who lives

entirely in the present. More severe disturbances

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created stronger disturbances of cognition, that is,
amnesias.

It is not surprising to hear that though

symptoms persisted after leucotomy, the

“successfully” treated patients felt less worried

by them. An individual who loses the ability to

worry about future real danger would also lose

his fears of imaginary dangers.

So far I have only spoken about those

psychological effects of physical treatments that I
believe to be the direct expression of organic

changes brought about by drugs or surgical

lesions. However, we must not forget their
psychological meaning to the patient. Although

only scanty investigations are available there tire

enough observations to prove that a great deal of

what is often considered as a direct effect of the
drug or lesion are in fact psychological reactions

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to the meaning of treatment, like E.C.T. or
leucotomy representing punishment, symbolical

suicide, killing of internal objects, and so forth.

In addition, very often a better psychological

environment is created for these patients.

Although we shall not get a fuller understanding

of the psychological processes accompanying

physical treatment until such patients are

analysed during its administration, I have

presented a hypothesis which is in keeping both

with facts observed in these patients and with our

knowledge of organic brain diseases. It therefore

seems unjustifiable to me to put forward

hypotheses that contradict these facts and that try

to perpetuate an untenable belief that psychoses

are the expression of metabolic disturbances.

I must repeat that I do not wish to give the

impression that I am opposed to all physical

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treatments if no other is available; but I should

like it to be appreciated that it would appear to be

partly a disguised form of palliative and

uncontrolled psychotherapy, and partly,

especially in leucotomies, psychologically

nonselective damage of the brain which, by

reducing healthy aspects of the personality, may

also reduce pathological features.

An evaluation of all the known facts thus

shows that the only therapy of mental disorder

that would appear likely, selectively and

radically, to remove pathological aspects of

personality without harming the rest is a

psychodynamic psychotherapy, and it is
noteworthy that recently psychoanalysis has

successfully dealt with some psychoses.

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FUTURE POLICY

The Need to Integrate Psychiatric Research

on a Psychodynamic Basis

I have put forward some considerations that

must govern how we deploy our resources in the

task for psychological medicine in the National

Health Service. I have shown the paramount

importance of research into the psychodynamic

causes of the psychological illnesses. However, I

have also pointed out that medical psychologists

must do more than claim a larger piece of the

research cake than we have been getting.
Especially in times of economic pressures, it is

attitudes of this kind that make the cake

disappear. Cutting research grants is a familiar
response of governments in critical times. But to

be fair to our administrators, I believe that they

only do that in the sincere belief that the research

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that suffers is a luxury. Now it is my opinion that
a large amount of current psychiatric and

psychological research would fall rightly within

this category, because it is completely

nondynamic in character and therefore not likely

to make any effective contribution to our task of

treating and preventing psychological illness. On

the other hand, it must be shown that the present

situation is the very time to concentrate resources

on likely lines of approach.

Many psychiatrists, especially those trained in

psychotherapeutic work, may feel “in their

bones” the truth of all that I have been saying

about nondynamic theories; but what is vital for

us to grasp is that that feeling, however widely

held, has no dynamic effect in our situation as
long as it merely lies there —ossified. We must,
as doctors, present to ourselves and to those

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responsible for administration that compelling
logic that comes from the careful analysis of our

situation and which is the essential precursor of

effective action. Certainly the inexorable logic of

the present situation in psychological medicine

cannot go on being avoided as is happening at

present. For example, Bleuler’s review contains a

sharp challenge to the organic school; but it is

disturbing to get the impression that its

implications are, and will continue to be, ignored.

Are there any signs that these views, which in

varying degrees are not at all uncommon, are

being modified in order to establish an integrated

body of basic psychiatric principles? Or are we to

go on as at present with each school creating

bodies of mutually incompatible theories? In such

a situation how can any administrative body be

well advised?

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There is only one reality and to do justice to it
there can be only one psychological medicine. It

is my contention that we have enough evidence

already on which to found a single integrated

science of human behaviour, the basic science for

psychiatry. It is no longer inherent in the situation

that completely incompatible schools should be

perpetuated. Furthermore, progress towards an

integrated approach to the problems of

psychological illness could be achieved rapidly.

Reorientation of Effort

I have tried to establish as essential for our

task the combination of psychodynamic research

along with the correlated research into the

organic basis of such dynamic constitutional

factors as excitability, frustration tolerance, and

so forth. To my mind psychiatry will flourish or

wither according to whether or not it accepts this

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view. If this view cannot be controverted, there
must be a reorientation of our efforts.

I want to stress that I am not advocating that

organic research is of little value. On the contrary,

but it is essential to integrate it with

psychodynamic work. Equally, I feel that the

static nature of much psychological research into

personality must be replaced by research into

dynamic variables. I do not wish to attempt any

kind of programme of research priorities in

psychodynamics. Others, including myself, have

made statements of this kind already. I should

like, however, to refer briefly to what I consider
to be some of the important tasks.

a. There must be an effort by the psychoanalysts

and allied schools to state their theories in
more strictly scientific terms. It is a valid
criticism that these theories have not been
stated in terms that are widely

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communicable. Even our most interested and
benevolent friends find difficulties that are
not all due to resistances. More important
perhaps, for the advancement of our
understanding, our hypotheses are not stated
in a form that can be tested in a scientifically
valid way. I do not believe that the forces we
deal with in our therapeutic tasks fall outside
the province of the natural sciences, for
example, as Walshe (1950) suggested. The
forces in psychological illnesses are very
much present in the therapeutic relationship
and they have been greatly clarified by what
has come to be known as the unconscious
object-relations theory of the personality. By
the development of here-and-now
techniques, many of these forces can be
stated in precise communicable terms.
Moreover, I think there are already
developments that point to ways of making
our dynamic interaction with the patient the
subject of a strictly experimental approach
without in any way sacrificing our
therapeutic aims (see Ezriel 1951; Fairbairn
1952).

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If work along these lines can be
developed by a number of dynamic
psychologists, then our progress should be
rapid in the creation of an acceptable and
widely usable theory of the personality,
healthy and otherwise.

b. The psychoanalytic method is particularly

suitable for the study of the way in which
environmental factors, especially the earliest
ones in the family, act in favourable and
pathogenic ways because it allows insight
into the interaction between the
psychological constitution of the individual
with his early environment.

Knowledge in this field is obviously vital

to the development of preventive measures.

c. Most psychological tests of personality factors

have not proved of great value to
psychiatrists. With better dynamic
formulations, the development of more
useful tests would be made possible with a
gain in our work because of their help in

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assessing personalities and changes in them
more precisely.

d. The extension of the psychoanalytic method to

groups, again with an emphasis on studies
using an experimental approach, opens up
possibilities of studying such environmental
factors as are transmitted through the
medium of the family from society, and of
investigating the way in which the
difficulties of an already established
personality are increased and diminished in
groups such as at school, work, and so on,
and what steps can be taken to keep these
difficulties minimal.

Implementation within a National Health

Service

If these are our views, what actions are we to

aim at?

a. To return to Blacker’s suggestions, there

would appear to be no useful purpose served
by adding substantially to the ranks of
psychiatric specialists unless we approve of

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the roles they are to fulfil —unless we can
answer satisfactorily, psychiatrists for what?

It would surely be a waste of money to

add to our ranks large numbers of these
specialists merely to provide treatments
which, if we are to be honest, are so often of
a purely palliative nature; and I include here
much of the physical treatment of mental
illnesses.

The apparently bottomless pit of needs for

treatment must be handled by making
widespread use of all possible therapeutic
agencies. The psychiatric clinic must nourish
and equip parents, teachers, managers, social
workers, doctors, the clergy, and so on with
more effective knowledge. And the more we
apply our existing knowledge of pathogenic
factors, the more will the preventive aspects
of these steps appear in the oncoming
generations.

b. Instead, money should be invested on a large

scale in research by the creation of groups of
psychiatrists and allied workers who have

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adequate facilities. Again, however, we must
ask, and answer satisfactorily, research for
what? It must be along the psychodynamic
lines suggested if the barriers that are
keeping the rival schools apart are to be
overcome. Money invested in this way will
reduce the Health Service costs in the future
by the effects of making available sound
preventive knowledge.

c. Concern may be felt at the suggestion that

large sums of money should be spent
annually on research. What is large in this
connexion depends on one’s point of view. I
suggest as appropriate the modest sum of
one-tenth of the £6m. spent on placebo drugs
last year, or less than 1 percent of the annual
cost of psychological illnesses.

d. To give any attempt at a blueprint for

implementing this policy is too large a task
for an individual. It is one for discussion by
groups that would include all the relevant
knowledge including those who have to
administer the National Health Service.

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e. Suffering is the only motive that renders
people at least partly willing to permit the
exploration of the intimate regions of the
mind and to reveal what really matters in
human behaviour and in human relations (see
Jones 1940). It is no accident that dynamic
psychology developed from clinical work
and in my view psychodynamic research is
only possible within the therapeutic
relationship to which people come with their
needs.

But we must not allow all psychiatrists to

be overwhelmed by the demands for
treatment. We must have groups of
psychiatrists at work on such therapeutic
tasks as can be handled under conditions
which permit scientific investigation of the
problems presented. We need clinics that can
also be laboratories.

f. Such truly Clinical Psychological

Laboratories ought also to be rooted in their
local communities to get access to the
therapeutic problems set by the various

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groups of which the individual is a member
—school, work, marital, family, and so on.
And such clinical psychological laboratories
will have to draw on the resources of all the
relevant human sciences. I think there might
well be such a clinic, probably best
associated with the facilities of a University,
in many hospital regions. Again, however, it
must be stressed that the present pattern of
staffing University departments in psychiatry
with far too few senior staff will prove futile.
The necessary knowledge and conditions for
progress will be likely to occur only when
such clinical psychological laboratories have
a substantial group of whole-time senior
workers.

Although I imply that dynamic psychological

work will contribute fundamentally to many of
the troubles in our midst, it is not at all necessary

to fear that the psychiatrist or psychologist must

become a kind of supertechnocrat. The model of

his relationship with the community was shown

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in my experience in the War Office Selection

Boards where the psychiatrist and psychologist

were in a purely advisory role helping those

officers whose job it was to take responsibility for

such actions as they thought wise.

This relationship is in contrast to what would

really be one of neurotic collusion were we to go

on providing more and more therapy. In this latter

situation we should be allowing our society to

park out its problems on us without once making

it face up to its own sickness. Every psychiatrist

knows the future of such a relationship to be the

demand for more and more treatment.

I have managed to get near the end of this

long paper without referring to the latest arrived

in our field —cybernetics. However, it comes to

my mind here as perhaps enabling us to describe

the proper role of the clinical psychological

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laboratory and its staff as an ideal

servomechanism, which would constantly pick up

a sufficient sample of the flaws in our current

social process and which would then, if our work

goes ahead, “feed-back” the data for remedial

action to its social administrators.

Many psychiatrists may feel that I have

focused attention on what is really a dead horse,

but even a brief survey of the tides of British

psychiatric papers will show the extent to which

psychiatric research goes on being impeded by its

methodological confusions. I have pointed out

already that this paper was not intended to be a

comprehensive survey. It grew from an attempt

some of my colleagues and I made to clarify our

views on certain prominent psychiatric issues. I

shall feel it has amply fulfilled its aim if it

stimulates many other psychiatrists and

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psychologists to make much fuller clarifications
in the issues I have touched upon. I believe that a

clear logical statement of our tasks in the light of

available knowledge would be enormously

productive. Let me conclude by quoting you a

passage from Robert Lynd’s Knowledge for

What? (1940) (in the original this passage refers

to social science but by substituting in one place

“psychiatry” for “social science” the quotation

loses none of its point):

The controlling factor in any science is the

way it views and states its problems. Once
stated, a problem can yield no further
insights than are allowed by the constricting
frame of its original formulation; although,
in a negative sense, the data discovered may
serve to point to the inadequacy of the
original frame of reference. The current
emphasis in psychiatry [social science] upon
techniques and precise empirical data is a
healthy one; but, as already noted, skilful
collection, organization, and manipulation

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of data are worth no more than the problem
to the solution of which they are addressed.
If the problem is wizened, the data are but
footnotes to the insignificant. In a positive
sense, such data may be vicious, in that their
very perfection may mislead others into
regarding as important the problem to which
they relate; for in science, too, “Apparel oft
proclaims the man.” If science poses
questions within an unreal and mistaken
framework, data and rival schools of
thought begin to pile up behind the two
sides of these questions, and the questions
assume unwarranted dignity and
importance, [p. 202]

I do not think that my eyes are on the stars

when I state that a rapid advance in the

integration of psychological medicine is possible.

If a group of experts comprising the main

disciplines relevant to our task were to make a

critical evaluative statement of our knowledge

and our methodologies, it would make it very

difficult for what Professor Broad (1937) has

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called “silly” theories about behaviour and its
disorders to go on hampering our work. It would,

instead, reorient the contributions of all

psychiatric skills and special knowledge towards

a common goal.

Training psychotherapists in the National Health

Service with Paul O’Farrell and Jill Savege,
1971.

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18.

THE NEED FOR A NEW PARADIGM

Confronted with the task of reexamining

some of the fundamental principles that inspire

their work, institutions are possessed by a lengthy

process of reflection, review, resistance, and

change. In this chapter, I reflect upon my

experience of such a process at the Menninger

Foundation, which I had visited since 1964 as a

consultant for periods of 3-4 weeks most years

for a quarter of a century. The length of this
relationship affords an unusual opportunity for

study. Clearly there were strong bonds on both

sides to have kept it, at least for myself, as fresh

as when it started; and this vitality could only

have had its source in shared ongoing

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development. There is, of course, a highly
personal side in my becoming involved in many

varied roles and so I felt I should give a brief

account of the background from which I

responded to the perpetual challenges.

My first knowledge of the Foundation came

from meeting Dr. Will and Dr. Karl at the end of

the last war. I was a member of a group that had
been formed in the British Army to help with

several of its psychological and social problems.

Its original members had come from the

Tavistock Clinic in London, whose medical

director, Brigadier J. R. Rees, had been appointed

chief psychiatrist to the British army, and all of

them were eager to apply what they had learned

about psychological stresses from their

psychotherapeutic experience. As they became

more involved with groups and organisations,

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they recruited severed psychoanalysts,
psychologists, and social scientists who were

sympathetic with their point of view. (Because of

its origins the group became known as “The

Tavistock Group” although most of the later

members, including myself, had not worked at

the Tavistock Clinic.) The group functioned

closely with senior army officers in devising

some strikingly innovative measures, for

example, for selecting trainee officers, for

rehabilitating returned prisoners of war, and for

the hospital treatment of some psychological

disorders. Dr. Will, in his capacity as chief
psychiatrist to the American army, was keenly

interested in this work and he sponsored a visit to

its centre by a panel of eminent American

psychiatrists one of whom was Dr. Karl. From the

great encouragement of these visitors, the

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Tavistock Group decided to stay together and
accept an invitation to reshape the Tavistock

Clinic as a unit within the impending National

Health Service and to establish an associated

independent body to be known as The Tavistock

Institute of Human Relations, which would

continue the study of groups and organisations.

The planning work continued to be done by the

whole group and within a few years various

practical contributions emerged along with the

formulation of the theoretical principles on which

these were based. I was elected by the group to be

medical director of the Clinic in which role I was

soon engaged in the rapid development of

psychoanalytical group therapy along with

participation in the organisation and planning of

both Clinic and Institute.

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My first visit to the Foundation in January
1964 was devoted almost entirely to teaching

group psychotherapy. The Tavistock approach

had been stimulated by new psychoanalytic

concepts about the fundamental part played in the

development of the personality by early

relationships with mother and family. From these

experiences the individual’s inner world was

formed with imagined figures and relationships
amongst them, which had a great influence on the
capacities for future social behaviour. These

concepts, loosely referred to as the “British

Object-Relations Theories,” were not acceptable

at that time to most of the American
psychoanalytic “establishment” and so I

presented their essential features in a paper to the

Topeka Psychoanalytic Institute, which

responded with open-minded interest. Their main

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impact was upon those doing group

psychotherapy, and especially upon Dr. Otto

Kernberg who made considerable use of them in

his subsequent important contributions to

psychoanalytic theory and practice.

On this visit I also met with a lively curiosity

about the organisation and administration of the

Tavistock Clinic, especially within a state service.

When I returned 2 years later, group

psychotherapy was again my focus. Interest in it

had grown, but I was struck most forcibly by the

changed atmosphere within the Foundation. Dr.

Karl’s retirement was imminent and Dr. Will had

a fated illness. There was a widespread gloomy
preoccupation about these losses and the future of

the Foundation. The remarkable abilities and

energies of the two brothers had established a

leadership in the professional field for the

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Foundation along with an administrative structure
that largely freed the staff from what professional

workers so often regard as chores that interfere

with their work. From the fact that the postwar

Tavistock had grown from a similar situation I

was asked to talk with many informed groups

about its history. Any information I gave could

not, however, remove their anxious insecurities

— intensified by the growing realisation that they
had become dependent upon a leadership that was
most unlikely to be repeated. And crucial

decisions and changes would have to be made

soon.

There was a gap of about 3 years before I was

asked back by Dr. Roy, who was now president.

That in itself was significant because it implied I

would be engaged in wider concerns than the

group psychotherapy teaching for which my

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previous invitations had come from the school
side. I had by this time retired from the Tavistock

Clinic and I believe this added to the readiness

with which I identified with him and the staff in

their tasks. Tensions that had been held down

were now erupting around the themes of

leadership, authority, and responsibility. Formal

authority had been given to Dr. Roy by the

trustees of the Foundation. His responsibility was

to earn personal authority and he had made it

clear that, in keeping with the times and with

what he felt about his own capacities together

with the staff, he wished to achieve a leadership
rooted in full participation with them. I felt that

staff reactions were mixed. Some regarded the

change as what they had hoped for. Others

appeared to me to be somewhat intimidated by

the realities. Genuine participation can only come

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from the “gut” adoption of sharing in the destiny
of the organisation as a fully personal

commitment. Senior staff would not be concerned

merely in decisions on practical matters but

would have to be responsible for creating the

ferment of ideas on which the success of an

organisation such as the Foundation, with its

reputation for high quality services, research, and

training, relied absolutely. This creativity would

be the wellspring to inspire the total overall effort

and it must draw as widely as possible from the

personal resources of the whole staff. The full

implications of effective participation were slow

to be realised. Inevitable frustrations and

disillusionments about their own capacities led in

several to a resurgence of the underlying

dependence that had struck me previously. I

would repeatedly hear that “this place needs

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leadership.” For many others it was a painful
experience to realise that they had to wear the

hair shirt of torturing struggles with the problems

along with the vagaries of personal behaviours

that are invariably exacerbated in groups that

have not yet formulated and assimilated what

their tasks demand. It was readily understandable

to myself that the learning the president and the

staff would have to experience together would

have to be sustained over several years; but I was

reassured by “having been here before.”

Investment in the work of the units went on

steadily enough. What made for considerable
tensions at times was the all too human difficulty

in accepting that each unit belonged to a larger

whole of which all were vital parts. The status of

the whole was what brought the support from

outside individuals and bodies for the training

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and research that a leading centre must maintain;
and this overall image of the Foundation was also

what played the major part in the supply of

patients.

Workable management structures were

eventually achieved over the next few years after

much sturm und drang, though it then had to be

learned by all that such structuring has to be

constantly adapted to changing situations.

Planning as an ongoing process is the reality, and

not plans treated as fixed guides for the future.

Thus when the financial situation was becoming

more difficult, the corresponding component in
management was felt to be overweighted. That
challenge, however, was more readily adapted to,

I believe, than was the case with the threat of an

infectious invasion into the clinical philosophy of

the Foundation by external trends, above all by

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the spread in general psychiatry of the use of

physical methods almost to the rejection of the

psychodynamic, and hence humanistic, concern

for the patient as a person. From its start, a

principle inspiring the Foundation was the belief

that patients were to be accepted and treated with

the respect due to all human beings and, as feu*

as possible, this would apply to severely

disturbed individuals. A paramount place in the

values of the Foundation was thus to give care

with all its implications. Professional care has, of

course, to merge this humanistic concern with the

best understanding available; and the

psychoanalytic approach adopted by Drs. Karl

and Will was to them the one that provided the

basis for facilitating a regrowth of the person.

Such a therapy is inevitably slow and uncertain in
its results. The word treatment had come to

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signify in medicine something the doctor could

administer to the patient irrespective of what was

involved. Here what was offered were personal

relationships within which a redevelopment could

take place —a vastly different matter. The

staggering advances in medical technology were

unfortunately reinforcing the ever-present wish

for short treatments, especially those that avoided

the fears of looking inside oneself. Combined

with the immediate appeal of reduced costs, and

hence the reluctance of the insurance companies

to cover long-term psychotherapy, the situation

was at times a serious threat.

A more disturbing aspect of this

development, however, were the beliefs about

human nature that the physical methods tended to

bring in their train. There was no question of the

benefits to the increased therapeutic resources

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these advances could provide. But there was

equally no doubt that the gains were limited for

they were essentially ways of reducing tensions

and not of understanding the nature and origin of

the psychological disorders. Such is the fear of

coping with our inner worlds that at times the

transient gains from these methods were used in

medicine to support philosophies that

dehumanised man to the status of a machine. The

split in the intellectual and academic worlds

between those who would find reassurance in

such a belief and those who could accept all the

complexities and apparently insoluble problems

that characterise human nature with its

autonomous creativity and freedom to choose
deepened. The reductionist views of man’s nature

were also supported amongst substantial sections

of the rapidly growing body of clinical

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psychologists in their advocacy of behavouristic
methods.

The threat here was potentially a profound

one for the Foundation whose philosophy had

attracted and held staff for whom the humanistic

view of man carried convictions that could not be

abandoned. There was not, however, a

widespread understanding amongst

psychoanalysts of the theoretical issues here. It

was sad, too, that the psychoanalytical movement

as a whole had not given them much attention,

especially when enough knowledge was available

to deal with them. Hence, when I say that I felt

the Foundation senior staff might have done more

to assert its position against the rising flood of

doubt, if not overt hostility, in the academic and
professional worlds about their approach, I must

emphasize that this lack was almost universal

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amongst psychodynamic groups. It stemmed in
my view from a deeper malaise to which I shall

return presently. The absence of an active

counterstatement was most noticeable in the

public relations staff who in their job of seeking

support from the outside world were not being

given the arguments that could convince the

sceptic of the reasons why an institution like the

Foundation must be supported especially in face

of this rising tide of scientism.

Despite the pervasively unfavourable climate

that built up in the ’70s, the staff held fast to its

beliefs and fortunately we are to-day seeing a

gradual recession in the so-called scientific

methods as the modern biological views on the

nature of the living organism as a self-regulating

open system become more established. And at the

grass roots, discontent amongst patients with

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what to them was a too ready resort to these
mechanistic or placebo treatments is now

increasingly manifest.

Linked with the philosophical challenge, and

the misleading simplifications about disorders of

the personality, there was a concomitant pressure

from the other mental health professions for

greater autonomy in their work. The greater

responsibility given to relatively junior medical

staff was often resented by highly experienced

members of the other professions. Here again I

thought that more clarifications of these issues
was needed especially in relation to the position

of the Foundation as an institution for which

certain responsibilities were mandatory because

of its medical status. In fact the issues raised

could only be coped with at the level of the

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national professional bodies; and a year or two
later this process was going on.

The complex psychological forces influencing

all groups became of great interest during the

’60s and ’70s. To assist the staff in appreciating

their nature, the president arranged for many

members to attend the Group Relations

Conferences sponsored by the Tavistock Institute.

This experiential learning facilitated the

development of group methods within the

hospital and other units working with outside

organisations. From observation of group work in

many psychiatric hospitals I had been struck by

the failure to use it for illuminating unconscious

forces, focusing instead on the superficial content

of what was happening. There seemed often to be

no attention paid to the etiology of the

psychological disorders, with a manifest ignoring

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of the crucial processes so far as concerned the

improved understanding of these by the patients.

Often, indeed, one felt group consensus about

behaviour was replacing more adequate

diagnosis. In these hospitals I attributed this

deficiency to the fact that the staff had little or no

psychodynamic training. When the group work

began in the Foundation the senior staff, most of

whom had had psychoanalytic training, were

clearly operating in a way to be expected from a

well established psychoanalytic tradition. By the

later ’70s, however, the work had become

distinctly changed to a more superficial level with

most of the staff participating irrespective of the

differences in their training. For groups whose

task was discussion of day to day issues that was

fine; but when the aim was to increase patients’
understanding of forces not ordinarily

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recognized, it seemed to me there was little

awareness of these powerful etiological factors;

and again, consensus seemed to be the touchstone

for judging progress. Of course these views were

impressionistic, but checking informally with

staff confirmed them. The origins of this change

were soon obvious — there were fewer staff in

the senior hospital positions who had been

psychoanalytically trained. Indeed, by the end of

the ’70s there were very few senior analysts in

the chief posts within the sections. When I had

first visited in 1964, almost all these senior posts

were filled by analysts, several of whom were at

the same time training analysts within the
Institute at the Foundation. Around this time I
also felt a growing lack of the excitement that

should ordinarily be found in some sections of a

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large hospital from the challenges of the
therapeutic tasks.

What was happening, I asked myself, in this

hospital that was hitherto a leading centre in its

contributions to the theory and practice of

psychoanalytically based therapy? Hospital

patients had been the main stimulus for a lively

atmosphere whereas it now seemed that they

were no longer felt to be so. There were many

external factors making for this situation, for

example, the greater financial rewards in other

places where private practice could be combined

with the hospital work. There was also the great

pressure in the Institute resources forcing more of

the seniors to devote increasingly large parts of

their time to training. I felt, nevertheless, these

external sources were not adequate to account for

a kind of pervasive intellectual staleness. People

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were working hard and senior analysts acted as
consultants to hospital sections, yet there was a

distinct atmosphere of the work having become

routine as far as analytic thinking went. Again, I

want to emphasize that these were impressions

that could well be regarded as highly subjective;

but, as before, talking informally to individuals

and to small groups I had them confirmed. Thus

some senior analysts would remark, “We are

needing some leadership here.” I must confess I

felt at times impatient with what I thought was an

avoidance of a rather awkward situation. I asked

on one occasion whether or not I was being told

that the staff was incapable of producing ideas of

their own. There was no awareness of what might
be amiss and I was baffled. About 5 years ago I
had some experiences that disturbed me and it

was from reflecting upon these that a new

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perspective formed in my mind about an
unrecognized yet apparently powerful factor that

had had a stultifying effect throughout the

Foundation for the previous decade. What had

vitalised the institution in its first decades was

usually thought of as coming from the

outstanding personalities of Dr. Karl and Dr. Will.

There was little or no distinction made, however,

within the term leadership between charismatic

personal qualities and the ideas that had inspired

them. I now became convinced that what was

missing was the creative enthusiasm that comes

when the challenges of the work are felt to be met

by the ideas available. What had gone was the

inspiring lead given by concepts that offered

exciting illuminations of the clinical problems

now encountered. The specific experiences that

crystallised my conviction were what happened at

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a few case conferences in the adult hospital. A
few successive patients were all described as

“difficult,” by which was meant that they were

persistently destructive to the therapeutic work of

the staff. Indeed, all of them had been previously

discharged from a few hospitals because the

staffs could not tolerate the intensely stressful

relationship these patients seemed motivated to

create. The negativity was all too manifest and all

too intractable. To account for such conditions

psychiatrists commonly invoke innate factors, in

this case too much aggression, a tautology

designed to remove the problem. The impotent

exasperation these patients aroused in the staff
was striking as also was the absence of any

consideration of the serious deprivations these

patients had suffered. Not that the parents abused

them. The deprivations arose often from such

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events as separations because of illness or,
perhaps more frequently, from parental attitudes

that frustrated the normal assertiveness of the

healthy child. The new way, in which the

patients’ behaviour could be understood as the

expression of hate and resentment because of the

chronic frustrations of their natural assertive

behaviour, now vitalised the whole staff. To the

child, parental preoccupations and withdrawal of

interest at times created a chronic rage that had to

be split off into a separate part of the personality

because it was so highly incompatible with all the

good experiences from these same figures. The
need to protest about his deprivations had never
been accepted and he was now venting this hate

on all those in close contact with him as though

they were evoking the original situation.

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Put in this way, the episodes seem extremely
banal as examples of what I felt was the source of

a pervasively deadening impasse. When we

realise, however, the general position of

psychoanalysis at this time it could readily be

seen as an indicator of the deeper strains there.

These patients could only be understood in terms

of a divided self that is, in splits of a holistic

organisation that determined behaviour from the

start at the personal level. Despite the advances in

ego psychology, the basic assumptions for the

explanation of personal behaviour, for motivation

and conflicts within the person, rested on the
modes of regulation of the discharge of
biologically conceived instinctual energies or

drives. What these patients exhibited was in

essence a bitter entrenched resentment that they

had never felt responded to from the start with

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the joyous acceptance of the activities of their
autonomous selves. Instead they experienced a

coercion into being someone different from what

all their inner pressures asserted as “being

themselves.” The framework of drive theory was

deeply ingrained in the whole psychoanalytical

movement especially in the U.S.A. It had a

powerful grip because it had given so much

insight into the unconscious functioning of the

personality; yet there was wide recognition that

its metapsychological assumptions had been

largely laid aside, especially as more analysts

treated serious personality disorders. The
classical view was that the bulk of those

conditions was not suitable for psychoanalysis.

Clinical advances, nevertheless, were steadily

disproving this belief and new theoretical

concepts, affecting both theory and practice, were

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emerging. Resistance to potentially radical

challenges to any widely accepted paradigm is

the rule, and wisely so, until new data can carry

conviction. To my mind it was unusually strong

in the U.S.A. because of the nature of the

“psychoanalytical establishment.” The climate of

opinion in Britain was a much more open one so

that new ideas had been discussed openly

alongside the traditional ones. In short, the

intellectual flatness in the Foundation was a
general one throughout the psychoanalytically
oriented hospitals and academic departments in

America.

The cases referred to illustrated the critical

issue. The disorders in so many hospital patients

were producing a sense of inadequacy in the staff

from the rigidity with which their theoretical

tools constrained their creativity. I got the strong

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impression that with this frustrating, and in some

measure depressing, situation not being

recognized, there was a “silent” withdrawal of

most of the experienced analysts from it. Here I

must emphasize again that I did not believe this

drift reflected any lack of talent. This staff group

was in the grip of forces typical of any group that

has lost its confidence in tackling its task. The

classical psychoanalytic paradigm had been in

existence for decades and its very successes were

adding to the reluctance to reexamine it. The

adoption of a new one was certain to be a slow

process for it was comparable to what any work

force experiences when its old tools are

threatened with new ones, or individuals are

subjected to major attacks on their ideologies.

Within the years following the case

discussions mentioned there was an increased

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interest in the hospital in treating the hitherto

daunting problems presented by the compulsive

negativity in so many patients. Though not a

dramatic change it was a profoundly significant

one reinforced fortunately by a new director of

the hospital who grasped the need for a change

extremely well. The focus now was on the

development of the self as the central agency

embodying the capacity for good social relations

and a satisfying investment of the creative

resources of the person in the business of living.

Apart from its appeal in regard to the therapeutic

work, there was also a growing awareness that

the importance attached to the internalisation into

the inner world of the experiences in early

relationships illuminated human nature in a new

way. It facilitated communication between the
specialist staff in the Foundation and other mental

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health workers and with the outside world. There

was a salutary emphasis on the inherent

relatedness of the individual to others at all stages

of the life cycle. The personality develops well

and maintains its selfhood or identity effectively

only through its facilitating experiences with

others, a very different position from such

achievements resting on the satisfaction of

instinctual energies —a philosophy that had

certainly contributed to the “cult of narcissism”

with its disturbing implications for both the

person and his society.

I now felt that the wellspring of the

Foundation’s professional morale could begin to
flow strongly again. No area of psychopathology

could be of greater importance than the growth of

the self. It was also one that would require for its
development a great deal of team work. The old

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pattern was for the analytic treatment of patients
to be conducted completely apart from the staff

of the unit who cared for the patient in “the other

23 hours of the day.” I have long believed that a

primary factor sustaining those who have to be

close to the stressful impact of powerful

emotional conflict is the opportunity for

constantly enriching themselves through a

deepening understanding of those they are

helping. Psychotherapeutic work with divided

selves demands especially such an ongoing

learning. The splitting of the self into good and

bad —loving and hating—parts induces

intolerable tensions if the staff do not have the

opportunity to discuss the particular ways they

are disturbingly cast at times in the role of “all

good” or “all bad” figures with the intensity of
infantile demandingness or destructiveness. The

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senior staff therefore have to keep the whole team
learning of the full nature of the patients’

conflicts. This, of course, does not break the

confidentiality of an analytic relationship; what

has to be shared by all is an understanding of the

overt relationships the patient is making with the

staff, consciously and unconsciously. Without this

overall collaborative involvement in the therapy

the patients can avoid getting an appreciation of

what they do to others and to themselves because

of the compulsions from their inner worlds and

especially the insecurities that are concealed by

their destructive attitudes. It is this understanding

that has to characterise a psychoanalytically

informed approach to the use of groups and the

whole social milieu of the hospital. The necessary

study of the origins of love and hate and violence

is obviously an urgent concern for society as well

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as for the staff. The scale of the complexities in
this task with the interdependence of biological,

social, cultural, and personal factors is enormous.

Nevertheless, a new paradigm for psychoanalytic

theory in terms of relationships would seem to be

one that will facilitate a new level of

collaborative thinking amongst all the relative

disciplines and between them and society. And

the hospital is uniquely placed to inspire the work

needed, especially research into the adequacy of

our guiding concepts, for the selves of the

patients are living witnesses to the nature and

origin of what can go wrong at crucial stages of

their formation.

I have given a highly selective and sketchy

account of my experiences with the Foundation
over many years. What then has my role really

been? I can only describe it as being that of a

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caring colleague who from his knowledge and
objective appraisals tries to clarify with the staff

what is happening. Above all, he makes a

commitment to stay with the “family” while it

works through doubts and blocks about their

goals and the progress towards them; and by so

doing he imparts his conviction that they have all

the resources to do this. Some of the brilliant

colleagues whom I was so fortunate to have had

at the Tavistock had a gift for the apt slogan. Two

that have remained as perpetual texts for myself

are, first, “there is nothing so practical as a good

theory,” and the other, “no research without

therapy,” by which we believed that no one

should try to understand the inner conflicts of

others without the latter being personally

enriched by the relationship. There is also

implied here that only within a therapeutic

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relationship can individuals describe the most
significant features of their inner life. Hence

therapeutic settings are uniquely important for

understanding people. No other method can reach

the most crucial forces in the person. I think that,

while the Foundation may not have used these

mottoes in their work, the extent to which I felt it

shared all that I believed in about

psychotherapeutic institutions was what

maintained the enrichment that gave so much to

me in our bond; and I could only feel that if I

sensed that, my friends must also have shared in

what I gained.

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With Eric Trist and John Bowlby at Menninger
Conference, “Challenge to Psychoanalysis,”
1985

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19.

THE PSYCHODYNAMIC IMAGE OF

MAN

To be invited to give this first Malcolm Millar

lecture is a great honour that I deeply appreciate.

The psychodynamic approach of Malcolm Millar

(Crombie-Ross Professor of Mental Health,

University of Aberdeen, 1949-1976) inspired a

practice and teaching that made a notable

contribution to British psychiatry at a time when

that approach was virtually denied scientific

respectability. It is also a great personal pleasure

as he and I shared a period of work together

during the last war so that I got to know well his

concern with providing care. It seemed

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appropriate, therefore, to choose a theme related
to this concern.

A PHILOSOPHY FOR THE CARING

PROFESSIONS

“A Philosophy for the Caring Professions” is

a large assignment so I shall select a few broad

issues that I believe to be crucial for the future of

our work. There is an infinite range of care-giving

activities, most of which I shall take for granted.

In the present context I want to focus on care

devoted to the development and well-being of the

person —to those factors that equip and maintain

the individual in the business of living with a

sense of wholeness and responsible autonomy; of

feeling “somebody” and being “a somebody” to

others; and of fulfilment in the use of his talents. I

shall return to this question of what we mean by a
person and also by caring for him at the personal

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level. At the risk of oversimplification, let me put
it at this point that my interest is care related to

what goes on at the centre of the person, where he

is, or should be, in himself as a responsible free

agent, rather than with what he might present at

his boundaries.

A few remarks are also necessary on my use

of the word psychodynamic. Most of the insights

about the person that have proved useful to the

caring professions have come from the

psychoanalysts. This knowledge, however, has

been expanded by many groups outwith the

formal psychoanalytic organisations, so I have

adopted the more general term to cover the broad

approach based on an understanding of the

person in psychological terms and which
emphasises the role of unconscious motives.

Psychodynamic views have been widely

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disseminated and indeed are now part of our
culture. In this process they inevitably get

attenuated and distorted so that their full

significance, and the way in which they are being

developed, tends to get ignored. I shall thus try to

emphasise what I see as important current trends.

Providing help for personal problems are

several professions along with a great variety of

counselling services. There are doctors and

nurses, social workers, the clergy, and in recent

years an increasing number of psychologists. To

complicate matters, there is also a range of

therapists practising one or other of the many

methods evolved to help with personal problems,

that is, Gestalt therapy, transactional analysis,

encounter groups. True, these methods are mostly
used by the professions, but there has been a

trend for people both within and outside the

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professions to take a “training” in the method and
then to set up as practitioners without an adequate

experience in dealing with psychological

conflicts. I shall confine myself to the professions

because I believe that they must constitute the

vital core of our overall endeavour to provide

articulated knowledge and responsible practice.

Professions imply a corpus of knowledge and

skills shared by their members. When duly

recognised, they give to society an assurance of

competence and its responsible use; and they
maintain a steady research and development

endeavour to keep enlarging their competence. In

providing help for personal stresses there are

good reasons why professional resources should

be supplemented by agencies in which the
expertise is not as specialised. We could not

possibly cope with the demands without them;

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and in respect of the quality of their work, the

best of our voluntary services maintain close

collaboration with relevant professional groups

so that the interests of all parties are protected.

There is also another reason why a large

voluntary movement is desirable, namely, that

society is thereby confronted with the scale of

stress and so can initiate steps towards its

alleviation. It is the professions, however, who

have to take a lead in helping all the allied

services to keep adding to their expertise.

When we survey till these activities, we

cannot but be struck by their diversity in theory

and practice. A rough continuum can be based on
the degree to which the approach is manifestly

personal in depth. At one end we can place the

intensive analytical psychotherapies, the

distinguishing feature of which is coping with

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unconscious motives. There would then be a
range of methods involving personal interaction

at a conscious level. The groups operating in this

way are by far the largest as they include

voluntary counselling services as well as the

professions. Next might come the relatively

recent behaviour therapies in which the focus is

on overt behaviour rather than on the inner world

of the person. Lastly would be the “physical

methods,” which attempt to alter the mental state

by changing the underlying physiology as, for

instance, by drugs or other methods.

The increased facilities for personal help

reflect the great rise in demands for it. The

origins of this situation are complex. Many

believe that changes in society are precipitating
the demands. On the other hand, the nature of

psychological stresses is more widely known. It

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is, therefore, difficult to ascertain whether there is
a real increase in the incidence of stress or

whether requests for help are more readily made.

One thing certain is that the presenting

complaints have changed towards a great rise in

feelings of general personal malaise, for example,

feelings of “depression” or futility, of loss of

purpose, of not feeling sure of who or what one

really is.

These features emphasise the point that we

cannot consider the person apart from the society

in which he has grown and is now functioning.

There is no doubt at all that within the last few

decades there have been very great changes in

our social patterns and values with the result that

appraisal of personal stress has become more
complex. The assumed primacy of social factors

led many young social workers some years ago to

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express vociferously the view that provisions for
personal problems were useless —if not a

bourgeois attempt to keep people adapted to

society. What was needed was social change.

There is no question that sections of the social

environment can be unduly stressful and

therefore every effort should be made to improve

these. Nevertheless, there is no society in which

individuals do not have problems of a primary

personal nature. Personal conflicts are a product

of the interaction of the social and the personal

and we have to separate as best we can the

contributions of each for remedial action. Also,

we all have to keep in mind that society is not an
entity as an agent of action. Changes in it come

from the individual and our efforts must be to

foster the kind of growth that increases his

creativity.

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THE SOCIAL AND THE PERSONAL

This theme of the social and the personal is so

crucial that I want to enlarge on it to get a proper

appreciation of the role of the caring professions.

I believe important changes are occurring in this

role in parallel with what is happening in society.

For this purpose I shall draw upon the writings of

two of my former colleagues, the social scientists

Emery and Trist (1973). They describe the

extraordinary technological advances of recent

decades as having produced a profound change in

the fabric of the social environment, especially in

the modern Western nations. From a loosely knit

laissez faire regulation of local and relatively

autonomous social service and production units,

our postindustrial society has changed this pattern
to one of a tightly interwoven texture. This new

interrelatedness gives a highly turbulent or

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unpredictable quality, because technological
change can produce extremely rapid and

extensive effects in large sections of our

production system. Larger groupings result both

in these systems and in the social services to

create the necessary resources. The environment

thus becomes more and more man-made with

major problems not involving man versus nature

so much as man versus man.

The survival of any society can rest on the

maintenance of a steady state through established

institutions and customs. Modern societies,

because of external impingements and internal
forces, are such that, unless they become adaptive

learning systems, they perish. They must

constantly develop, that is, meet challenge with

creative changes in their internal structures. Such

changes, on account of the high degree of

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interdependence amongst the component

systems, have to be made increasingly by

centralised planning for the society as a whole —

and here we come to the greatly divergent

philosophies of the modern world. Two options

are available. One is the engineered society,

modelled on the physical science, in which

planning is done by a special section or elite

group. This is the choice of the totalitarian

countries. The other, the apparent choice of the

Western democracies, rests more on the life

sciences. It seeks to develop all members of

society by a higher quality in all the primary

social units, that is, the individual, the family, the

work place, schools, the community and the

services and amenities it provides. Securing the

highest quality of life has now become the

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overriding question as we move towards

postindustrialism.

The trends in these directions are manifest in

the changing concepts of welfare. In the

industrial era the state had to take an increasing

part in providing welfare services for the sick and

in providing measures against disease in order to

maintain the work force. Gradually a new

concept of welfare can be identified, namely, that
the best welfare is secured by personal

development, for example, by improvement in

the physical environment and in personal
resources through education, better conditions of

work, and so forth. Today in the more affluent

countries, emphasis is no longer on minimum

standards for health and growth but on the

realization of potential, both for the individual

and society.

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These concepts of welfare and development

do not, of course, belong to the world of science.

They are values or choices by which we shape

our aspirations and goals, our social perceptions

and practices. Our adaptive strategy is now

increasingly towards the adoption of values that

promote the optimal realization of individual

potential. What is happening is far from a

homogenous change since many of our old values

persist even though detrimental to the newer

ones. How then do we identify the adaptive

values? This can be done by appraising the

spontaneously emerging responses to what is

sensed as inimical to development. Within

organisations we have noted more collaborative

groupings — changes from separate objectives to

linked ones. In personal values, there is a very
mixed array. Thus, as a reaction against the

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dehumanising effects of common situations at
work, there have been movements against some

of the hallowed values of the Protestant ethic, for

example, from achievement to self-actualisation;

from undue independence to interdependence;

and from “grin and bear it” to a focus on joy.

Contrasting with these ideals are changes that

seem to have been initiated by the insidiously

dehumanising influences of technology. Toffler
(1970), for example, has vividly portrayed in his
book Future Shock how our attitudes to the

expendability of consumer goods have spread to

human relationships, a change that does not

appear to be adaptive for personal growth and

development.

Older men with their family responsibilities

have naturally not been leaders in finding more
self-expression. The counterculture impetus has

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come from young people with the consequent
disadvantages of their inexperience. To want to

“do one’s own thing instead of someone else’s” is

eminently understandable, but it can be a

disruptive social philosophy, especially when

human nature is viewed in an alarmingly

superficial way. Envy, hate, and destructiveness

were what the establishment had, or did to you.

The beautiful people would achieve love. But

with no realistic commitment of one person to

another, love soon became essentially pleasure-

seeking. Gratification and kicks became the goals

as this “new narcissism” flourished. Although the
excesses within these movements have abated,
we have been left with a residue of belittlement

of the person in some of his aspects. Thus at

times sex therapy seems to get more emphasis

than the need to improve personal relations. It is

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little wonder that a counterreformation has
appeared in attacks on this Cult of Self Worship,

or Psychology as Religion, as Vitz (1977) entitles

his book.

A seriously disturbing aspect of these trends

was the backing taken from the writings of some

of our prominent intellectuals such as Sartre,

Marcuse, and Norman Brown. The philosophies

propounded, especially by Marcuse and Brown,

were based on what they claimed, not without

some justification, to be the essence of Freud’s
image of man, that is, the fundamental role of

pleasure seeking from the satisfaction of the

sexual instincts.

THE ROLE OF CARE IN THE OPEN SOCIETY

Assuming that the development of each

individual is our accepted social philosophy, the

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role of the caring services must then be directed
to this end. At first sight this may not seem much

of a change but I believe it is. The traditional

position of the carers has been very much one of

ameliorating the lot of those extruded from the

system, either temporarily or permanently, by

picking them up in a net of charitable and

philanthropic agencies. Beyond attempts to alter

grossly harmful features of the environment, their

main function was to keep those needing care out

of the way until, hopefully, some could be

returned to useful roles. Deviant behaviour too

difficult to manage was treated with more active

defences, for example, it had to be isolated or

literally walled off. Such policies helped to

preserve the status quo of existing institutions

and their values, but only for a time.

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True, we have now advanced a long way from

that situation in regard to state provisions. I do

not think, however, we have sufficiently

considered the changed role of the caring

services.

An open social system whose primary task is

to develop all its members has to adopt a quite

opposite attitude to disorders or deviance. The

existence of everyone in trouble, whether ill-

health, psychological disorder, or in a

maladaptive group such as the poor, or in crime,

now raises the question, how has this happened?

What is going wrong in the system? From being

largely a charitable endeavour with little

expertise and almost no learning function built

into it, caring is now at the centre of the social

system. It becomes a servo-mechanism whose

feedback is critical in evaluating how much

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people are not in a state of developmental well-

being. A caring system becomes an essential

component in all the main institutions of our

living and so a built-in requirement in all social

planning. The fundamental concern with

development also means that we cannot separate

education from the caring system in our overall

considerations. In the United States, the

administrative triad of Health, Education, and

Welfare is a political recognition that

development is the best form of welfare.

THE NEED FOR A DEVELOPMENTAL VIEW

OF THE PERSON

The next question that arises is: do we have a

concept of development of the person that can

help us to realise our general philosophy? Our

aim is not tied to a utopia nor to any specific
ideological programme. It is the essence of open

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system development that its ongoing spontaneous
creativity will make for unpredictability —both

in the individual and in society. We can thus aim

only at making the adaptive capacities of both as

effective as possible so that action can be planned

in the light of maximum knowledge of what is

happening in all sections of society and in the

environment. And when growth and development

are paramount values the future is always in

mind. Gaining relevant knowledge does not

guarantee that we shall use it, yet at least it can

guide those who wish to promote optimal

planning.

For a congruent educational and caring

endeavour there must be a shared view of the

nature of man as a constantly developing person.

We must have a framework that relates what

happens at each phase to the next, and for

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matching what happens in the different sectors of
the life space of the person. We cannot expect to

foster responsible adults for instance, if we treat

people as such in one sector and at the same time

deny responsible participation in another.

I believe a useful image of man’s nature is

now being formulated amongst analytical

psychotherapists, and following Chein (1972), I

have preferred the term image to the word model

with its mechanistic connotations and because the

term image resonates with the unique feature of

persons, namely their creative imagination.

The spontaneous trends that were noted all

highlighted the importance of self-feelings: self-

actualisation, self-esteem, self-expression. It is

striking that contemporaneously the self is also
appearing as a focus of study in several sections

of our professions. What we most need is an

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adequate conceptualisation of the self. We have
several incompatible claims here, for example,

the Christian, the Marxist, the Behaviourist, and

the Psychodynamic, and clearly we must examine

and appraise their implications.

THE PSYCHODYNAMIC IMAGE OF MAN

Taking the psychodynamic first, the image of

man left by Freud was of a titanic struggle

between the powerful instincts of life and death

and the need to control them. Personal

development was governed by the vicissitudes of

the instinctual drives, especially the sexual

instinct with its progression through the zonal

stages. The core developmental achievement was

the surmounting of the oedipal complex —the

child’s conflicts from his sexual fantasies about

his parents. The personality was structured in

terms of the instincts or the id, the ego or the

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system adapted to reality, and the superego or
internal image of primitive parental figures

controlling the id. The general theory of man was

thus couched in such scientific abstractions as

energies, mechanisms, and functions together

with a quite different level of functioning,

namely, an internalised version of a relationship

with “parents.” There has been in recent years a

growing dissatisfaction with this formulation and

there have appeared attempts to bring the person

into focus, notably those of Erikson with his

concepts of self and identity. The word self has

become more frequent in the titles of books and

articles in psychodynamic journals, and the views

of a number of British analysts have become

specifically concerned with this topic, for

instance; Balint (1968), Winnicott (1971),

Fairbairn (1954b), Guntrip (1969, 1978). What

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they established from their work with persons
having serious difficulties in coping with life was

that in the very early development of the infant a

basic psychological structuring takes place that

determines the whole of its future development.

They postulate that there is a unitary system from

birth that is the potential self and that this system

is personified, so to speak, into an “I” by the

experience of a good fit between the personal

care and love of the mother and the infant’s

needs. Instinctual satisfaction of bodily needs

reinforces the development of this self system but

it is not the essential factor, which is the

experience of being loved for itself. The self then

acquires a feeling of being integrated with the

outer world in a way that promotes positive

interaction with it —an attitude of “belief in” that
gives zest to living and to the rapidly developing

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exploratory interactions of learning about the
world. Development takes place by

differentiation of subsystems or subselves within

the original unitary matrix. Painful emotions are

unavoidable even in the best mother-infant

relationships, and “good” and “bad” — or

pleasant and unpleasant — experiences cohere

into the first divisions within the self, namely, a

“good” mother/world system and another “bad”

one. Further development follows a double path.

The good self occupies a central position that

enables it to be enriched by all the learning

experiences within the powerful impetus towards

independence. Simultaneously, frustrations lead

to the creation of an inner world in which the self

relates to a range of figures representing aspects

of the frustrating situations. Thus, some have a

frightening persecuting quality while others are

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excitingly gratifying. These inner relationships
are imaginative creations that are actively

expressed in play and fantasy in childhood. When

the foundation self is established with security

and confidence, the inner world is progressively

modified towards the real external one in the

ongoing interactions of the ordinary good family

in which father and other members play a more

and more prominent part. In the early phases,

intense love and hate, and magical omnipotence,

characterise the inner relationships in keeping

with the dominance of the intensity of the child’s

feelings. Infantile sexuality is assimilated into the

self-systems with the establishment of a sexual
identity —one which is finally consolidated after

adolescence.

When relationships with parents continue to

be unsatisfactory, then these relationships acquire

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distorted or compliant patterns —as if the

manifest ones are maintained with an outer layer

of the self while the inner relationships are

intensified to provide satisfaction in fantasy, both

loving and hating. And the most primitive

violence belongs to this area of having to fight to

maintain one’s self in a state of adequate

autonomy against what are felt to be the parents’

intrusive attitudes and lack of trust in the

spontaneous expressions of the emergent self.

The inner relations then operate in a maladaptive

way by unconsciously dominating the relations

with people in the outside world. The latter are

responded to, not as they really are but as they are
perceived through the patterns of the inner

figures. Thus imagos of a frustrating “bad”

mother that are too powerful may turn the later

adult male away from women, or in marriage lead

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to his wife gradually being treated as this hated

mother, so that she can do no right. Or his wife

may find herself being progressively cast in the

role of a mother who has to minister to the needs

of a little boy. If father is built up internally as a

persecutor we may later get the man who is afraid

of all authority or who compulsively fights it. The

permutations of these inner relationships are

endless but it is their dominance over ordinary

realistic relationships that gives rise to the infinite

range of irrational attitudes and conflicts.

With normal good experience, the inner

relationships are merged into patterns for relating

to others as they really are, for enjoying the

“otherness” of others. Such a person is not

tortured with doubts about living and he enjoys a

spontaneous creativity in his everyday activities.

No one is free from conflict arising from the

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inner cast of figures with whom he is identified

but conflicts are ordinarily manageable.

Normality means this capacity to give and take

freely with others on a basis of realistic appraisals

of oneself and others.

The self is thus seen as a dynamic matrix with

a predominant central identity though liable in

certain situations to change its centre point to one

or other of its inner figures — states we reflect in
such simple remarks as “I was not myself then,”

“I was beside myself with rage,” or “I was out of

my mind.” The self is established in relationships
and preserves itself only by an ongoing

psychosocial metabolism, so to speak, from

constant relatedness. With growth, the

relationship figures of early times become
transmitted into wider and much less personalised
goals so that we can describe or define a mature

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person, as Chein (1972) puts it, as, “one who has

a commitment to a developing and continuing set

of unending, interacting, interdependent and

mutually modifying enterprises” (p. 289) —the

latter, of course, referring to personal

relationships as well as activities of other kinds.

Cut off this relatedness and the whole person,

mind and body, begins to fragment or deteriorate.

Extreme manifestations of this state were made

visible to us all in the tragic manifestations of the

concentration camps and have now been studied

more experimentally with periods of isolation and

environmental deprivation. Less dramatic, but no

less striking, is the fact that when people lose

their main source of relatedness or significance,

as with displaced people, or as happened in

periods of chronic and despondent

unemployment, the incidence of every kind of

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illness rises (Wolff 1960). As the familiar words
of Yeats put it:

The falcon cannot hear the falconer:

Things fall apart:
The centre cannot hold:
Mere anarchy is loosed upon the world.
(W. B. Yeats “The Second Coming”)

The failure to establish a primary self-system of

relatedness gives rise to the most serious

consequences ranging from withdrawal from the

external world to a great variety of tenuous

adaptedness on the basis of a veneer of

compliance. People who experience the

reemergence of these earliest states feel as if “the

power is switched off; nothing has any meaning”;

a pervasive apathy supervenes, which removes

even instinctual excitement. These states
understandably pose the most serious therapeutic

problems.

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But while we encounter such states as a rule
in people whose self-system has been severely

crippled, we have to keep in mind that all the

later structures of any self that mediate a

satisfying and fruitful life can be overwhelmed if

the social milieu does not support the

maintenance of the vital core.

The psychodynamic image of man is thus one

of the progressive organisation of relatedness.

The foundation layer of this system, the primal

organiser that holds the developmental

differentiation together, is established effectively

only when the relatedness is of love and care and,

without a later input of that kind in maturer

patterns, it becomes difficult to maintain the

system as a whole.

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THE PSYCHODYNAMIC IMAGE AND CARE

In the light of this image of the person let me

revert to the word care. Care is one of those

primal words whose antithetical meanings

aroused Freud’s interest when he was struggling

to understand the strange phenomena of dreams.

It means both the burden that weighs on people

and also relieving the person of this load. It also

signifies the relationship that fosters growth and

development. The caring relationship has thus a

pattern of reparenting, which allows new growth.

This suggestion as the prototype of care

commonly arouses negative attitudes on the

grounds that it implies infantilising people,
making them dependent. Further thought,

however, shows this to be a quite unfounded view

since the aim of good parenting is the very

opposite, that is, to secure independence. What

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the caring professions have to appraise is whether
or not their actions are appropriate to a

philosophy that does justice to man’s full nature

as a person. If such an approach is shared, then

they are, whatever their particular activity, part of

a coherent endeavour. It is also one that can

provide vital data on what society might be doing

that is inimical to optimal development.

In being part of such an overall endeavour the

carers also deal in substantial measure with what

gives them care in coping with distress. The word

support is frequently used in this connection yet

we do not get its essence spelled out. To my mind

what supports the carer is not encouragement in

the conventional sense. Instead, it is to be part of

a learning system greater than himself. Anxiety
from puzzlement, and often a degree of feeling

overwhelmed by human problems, are best

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alleviated when we understand what is going on.
Here, as elsewhere, “there is nothing so practical

as a good theory,” as Kurt Lewin remarked. The

opportunity to learn from discussion with others

who take learning seriously is itself an experience

of caring and being cared for—as in all good

education.

The psychodynamic image of man thus puts

care for the person as essential for growth and our

maintaining well-being. We are not dealing with

a sentimental value. Care is a necessity in our

philosophy and a necessity established on

scientific evidence.

SOME CURRENT IMAGES IN RELATION TO

OUR PHILOSOPHY

Our image may be only a sketch map at

present but I believe it is even now good enough

to keep us away from directions which can, at

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best, take us into a no-man’s-land but which may
lead us into areas in which man cannot survive as

the free creative agent we value. Let me take a

brief look at the different approaches to personal

problems —an array that bewilders the outsider.

In practice, the various approaches seldom

draw on a single philosophy. This makes difficult

the task of disentangling what assumptions are

being made, yet I think we can see the important

issues clearly enough. With the great middle

range of the rough continuum I suggested, that is,
those therapies that use personal interaction in tin

empirical way and largely avoid deeper

motivation, we have no great problem. They all

have their contributions. Their serious drawback

is that, without a conceptual framework about the

full nature of the person, they can become

“techniques” applied at times by professionals

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and others with little knowledge of what they are
dealing with. They thus do relatively little or

nothing to advance our basic knowledge, and the

failure is reflected in the common fate of

“techniques,” that is, they gradually disappear

because they are boring to both therapist and

client.

At the other end of my continuum I placed

the physical methods. Here again there is no

question about these being useful when used with

adequate discrimination. Although few would
now advocate a position held by some extremists

in the past, one still meets the assumption that

these methods, by altering an abnormal

functioning of the brain, are “scientific” in

contrast with approaches that assume that what

goes on in the mind is the important question in

the vast majority of psychological disorders. It is

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from this view, whether held openly or covertly,

that the recurrent fantasies arise of the drug that

will really do the trick —the wonder

breakthrough.

We are here involved in a basic issue about

what is scientific knowledge in this whole field of

phenomena at the personal level. The danger of

this kind of belief is that instead of understanding

and development, we can readily produce a

massive societal addiction certainly comparable

with all the dangers of alcohol. The Office of

Health Economics (1972) published a short report
on Medicine and Society produced by a team of

social scientists. Having shown the staggering

rise during the previous decade of the use of

drugs for psychological symptoms, they noted

that much medical care was now concerned with

symptoms that appeared to be of social or

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psychological origin. In many cases there was no
scientific evidence that the prognosis could be

improved. Devoting increasing economic

resources to the application of medical

technology in such cases could actually diminish

rather than improve well-being. They concluded

that it was not yet possible to define specifically

the role of the health services in handling these
new (social and psychological) problems.

I must emphasise that I do not put the sole

responsibility for this situation on to doctors.

Large sections of the community expect a

magical solution for their problems and if not

given one would merely move to the doctor who

would —or, worse perhaps — resort to available

drugs such as alcohol. There is clearly a collusion

going on which can only be altered by massive

educational programmes. Medical technology is

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no solution to the need for a personal growth-
promoting care. Caring is far too deeply

ingrained a human trait for us to believe that

carers holding such beliefs do not care. It seems

to be more a situation of people, possibly under

the great pressure of too many demands, getting

caught up in an unwitting drift towards

substituting technology for care. Such trends

must be watched.

This question of what is scientific knowledge

in this whole field of behaviour at the personal
level is raised sharply by the behaviour therapists.

It is their contention that the analytical

psychotherapeutic approach, as well as being
ineffective, is also unscientific because in practice

it is so subjective as to be incapable of offering

testable hypotheses. Instead of starting from the

exploration of all that might underlie a

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behavioural symptom such as a phobia, the
behaviourist focuses on the external

manifestations which he then tries to modify by

specifically designed procedures based on

theories of behaviour patterns as learned. There is

thus a theoretical underpinning for what is

attempted.

Again there is no question that useful changes

in overt behaviour can be achieved and, indeed,

more effectively at times than with other

methods. Experience has led many behaviour

therapists to become very interested in the

characteristics of the personal relationship that

develops between the client and therapist and so

some of the initial simplistic notions are being

modified. The issue is not so much the changes
that can occur, for there are few approaches that

do not produce some change, as what the

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implications of the underlying philosophy are for
the individual and society. Many critics have

dealt with the behaviourist standpoint and suffice

it for me to refer to Barrett (1979), one of

America’s most distinguished philosophers. He

has recently responded to its major implication,

namely, that we can develop through such an

approach a technology of behaviour, as Skinner

has described it, with which we can shape the

future of man. The important belief here is that

man would be much better developed, not

through our ideal of the free and self-governing

personality — for Skinner, that is a pernicious

belief that has blocked progress —but through a

really scientific programme for his advancement.

Such a programme would, of course, be designed
by the few who “know” what is best for the rest

of us. Barrett remarked that when Dictatorship

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acquires this kind of science then the revolution
according to Marx had become the society

according to Pavlov.

The pluralism in approaches thus reflects a

situation not so much of stimulating differences

within a healthy enterprise as of one with serious

and potentially dangerous contradictions. If the

caring and educational endeavours are to take

their proper place in a society whose primary

value is the development of its people as creative

responsible individuals, then we must resist

philosophies founded on scientific reductionism,

that is, on the belief that the complex processes at

a higher level of the personal organisation can be
explained by the properties of lower order

activity, that the whole does not have properties

that cannot be accounted for with knowledge of

the parts. Such beliefs lead us towards an image

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of man as a machine or a puppet programmed and

controlled by an elite group or constantly

searching for the magical drug that will remove

human conflict.

The basic question we have to pose is how do

we conceive of the person at the personal level.

The Cartesian legacy, which separated the mental

from the physical, still persists with extraordinary

tenacity. The conceptualisation of the person, or

the self, is now thought by several philosophers

to be their major task. If we regard the inner

world as not belonging to the real world, that is,

the world we can study objectively, then we

inevitably adopt a reductionist position. We
believe the real processes governing our lives

even at the personal level to be those that are

reducible to neurochemical processes, or as some

concession to the reality of emergent phenomena

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to processes at the level of stimulus-response

organisation. The self or the person does not then

require to be taken seriously, that is, as mediating

emergent phenomena inexplicable by lower

levels of organisation.

In facing reductionist beliefs we must ask

ourselves, “Is anything more real for us than our

‘self as a free agent?” Nevertheless it is

extraordinary how this reality of the self is

ignored or denied. I have to emphasise here that I

am not asserting the correctness of any particular

psychodynamic theories. It is the legitimacy and

the necessity of its approach that have to be

accepted. Guntrip (1978) has argued this whole
issue with great clarity. He points out that even if

we accept Popper’s criterion of falsifiability as a

requirement for scientific theories, Popper’s
belief that “because psychoanalytic theories are

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not falsifiable, they cannot be scientific” is simply

not true. Freud discarded his theories at various

times when the evidence no longer supported

them and this process has gone on constantly.

What has to be appreciated is that the falsifying

data in regard to a psychodynamic theory may

take several decades to accumulate.

Research into the realities of the self cannot

be studied by the experimented method.

Bronowski (1965) recognised these realities but

concluded they could only be studied in

literature. Such study, however, is not a firsthand

one of the psychic self at work, the phenomenal

reality on the top of the hierarchy of existence!
The self can be studied directly in action only

within a therapeutic relationship. This most

fundamental knowledge for man is thus the

unique privilege of the caring professions. To

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quote Weisman (1965), another analyst,
“Psychoanalysis is not a delusion, practised by

the fanatical and perpetrated upon the gullible;

nor is it a mere recital of psychodynamic litanies.

Its basic fact is the encounter, which ... is an

effort to meet the patient as a unique being, with

respect to himself, his world, and other people….

The encounter is the fact of being in analysis for

the purpose of the analysis of being’ (p 105).

Therapeutic relationships are not scientific

procedures, whether in general medicine or in
psychotherapy. The scientific component resides

in the kind of knowledge we use. We have to

formulate our understanding of what happens in
these encounters in the best way we can to do

justice to the phenomena and to be open to

constant checking against fresh findings.

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As with the drift in medicine from care to
technology, there can be a drift into reductionist

standpoints without a full recognition of what is

taking place amongst those helping with personal

problems. Professions such as social workers and

the clergy are much less prone to reductionism

because they cannot use the “scientific” methods

associated with it. They can, however, as can
psychotherapists, become dominated by

“techniques” and so lose the openness that should

constantly develop practice and theory.

It is in our academic centres for psychiatry

and psychology that there is the greatest need to

have these issues examined because they are the

prestige influences for our whole caring

endeavour. Although most centres would deny an

overall reductionist position, certain trends are

ominous enough to warrant scrutiny. Thus, most

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students attending psychology courses in our
Universities are greatly disappointed by failure of

these courses to give a framework for

understanding the individual or the family at a

personal level. And we have only to survey the

research output of psychiatrists and psychologists

to see that an incredibly small proportion of their

effort goes to a study of the dynamic processes

underlying human relationships —those

processes that constitute the essence of the

therapeutic encounter. It seems to matter little

how much the data studied are “trivialised” so

long as the methods of using them, usually

statistical, are of the requisite sophistication. By

“trivialisation” I mean either the isolation of

limited, or almost subpersonal, sections of

behaviour or else the choice of what one might

term the superficial indices of the underlying

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dynamics. What can one really do in a therapeutic
situation with measures of a hypothetical entity

such as “aggression,” or masculinity-femininity,

or a list of the roles family members commonly

take in the “good” family? Is there not a

concealed assumption that we have got

“scientific” “data” or “facts” that we can

“administer” to the client like a medical treatment

and which should then lead him to alter his

behaviour?

The reductionism here is compounded by the

transfer of the traditional medical model of doing

something to the patient whereas with personal

conflicts we can only provide a relationship that

lets the individual recognize his own nature.

When we deal with subsystems of the organism
that can be isolated and defined, we naturally

have much more control; and this model has

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given us marvellous therapeutic resources for

many conditions. With problems at the personal

level this cannot be done. To revert to our caring

prototype, it is noteworthy that we do not hear

much of techniques of parenting. When we do, it

is usually from those whose experience of

“parental technique” has created their situation as

patients. What they almost invariably describe is

the lack of being treated as a person. The pressure

to do this so-called scientific research is arguably
one of the greatest drawbacks at present to the
development of the therapeutic understanding and

skills that are so much needed. The commonly

expressed claims in academic centres that we

have got to be scientific are seldom accompanied
by an appropriate consideration of the meaning of

this word —and why the assumptions made in

using it are either not exposed or are denied.

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There is also the fact that therapy as a goal is

not a part of science. It is an act of human

concern. Its effectiveness, however, rests on the

adequacy of our validated knowledge.

The practice of analytic psychotherapy, with

the time it takes and the highly specialised

training its adequate use requires, of course

precludes it from being an available therapy. Its

value is in the knowledge it gives, knowledge

which is already being wisely used in a great

range of more practicable ways. The concepts it

has provided underlie much of such widely used

approaches as group and family therapy,

counselling, and the therapeutic community.

True, it may press people to face up to what

are painful aspects of themselves, but it does so

on the well-founded belief that when they do so

they are thereby maturer and richer personalities.

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When used well, psychodynamic knowledge is
assimilated into the personality of the carer who

then is that knowledge in his relationships; it is

not a technique like a piece of gimmickry stuck

on to the surface of the person.

In what I have said about the psychodynamic

image, you may be thinking I have left out one of

the great areas of experience, namely, religion.

Obviously, I cannot embark on that theme here.

Let me say, however, that Freud’s views on

religion as they were described over 50 years ago

in “The Future of an Illusion” cannot be taken as

representative of psychodynamic thought today.

Freud at that time was greatly impressed by the
role of infantile dependence in the creation of a

God based on a needed father— a view

reinforced by the images and metaphors of

institutionalised religion. In recent years there has

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been much more detailed study of the
development of the internal representation of God

and the relationships, both mature and immature,

with that inner figure.

As his consciousness of his situation in the

universe expands, modern man cannot readily

accept the old modes of representation.

Nevertheless, we retain our powerful need for

non-visible but meaningful realities capable of

containing our potential for imaginative

expansion beyond the boundaries of the senses

(Rizzuto 1979). In this sense, religion is no

illusion. For many, the position of feeling the lack

of appropriate expression fits with Einstein’s
view of himself as a deeply religious unbeliever

(see Pruyser 1974). An adequate psychodynamic

image can help to separate what are personal

stresses that originate from conflicting processes

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of development from those that may arise in a
mature self reflecting on his relationship with

something beyond what science can deal with.

That there is a need to get these personal stresses

distinguished from religious questions is seen, I

believe, in the confusion several young

clergymen experience over whether they should

become social workers rather than stay in the

ministry.

The psychodynamic image is thus not an

antireligious image of man, though it may

support a search for expressions that are

congruent with the rest of our consciousness in

the modern world.

To summarise what I have said:

1. Our current social philosophy is that the best

hope for mankind is to foster the optimal
development of the individual. To further

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that aim we must have society functioning as
an open adaptive learning system.

2. Such a system has to monitor constantly what

is happening in its various sections and this
is the vital function of our caring and
educational endeavours.

3. To fulfil that function there must be a shared

philosophy on the nature of man as a person.

4. I have suggested that the psychodynamic

image of man is the best guide we have at
present.

5. I have stressed that caring and educational

procedures based on a reductionist view of
man can foster dangerous dehumanising
trends and must be combated.

6. In this overall task of developing our image of

man we need the caring professions,
education, the Church, and all the other
creative thought we can muster to realise the
importance of their role and to fulfil it
responsibly and assertively.

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Our concern today must be less with “The
Future of an Illusion” and more with “The

Illusion of a Future.”

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IV
THE SELF

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20

THE SELF AND OBJECT

RELATIONS*

The self constitutes such an overriding

challenge to psychoanalysis that it must remain

the ongoing central issue for the next phase in the

development of the whole field. Clearly, when

one raises such far-reaching questions as the
concept of the self introduces, one can only —

almost absurdly— oversimplify. However, I risk

oversimplifying because the implications of the
concept of the self are so important. For many

years, the absence of the essential nature of the

personal from Freud’s metapsychology has

imposed more and more strain on psychoanalysis,

creating an increasing need for a psychological

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theory of the self. In my own experience, I
(1980b) have been greatly influenced by my

British colleagues, especially Balint (1968),

Fairbairn (1954b), Guntrip (1969), and Winnicott

(1971), all of whom have contributed to the

understanding of the self by advancing the theory

from where Freud left it. I have been impressed

by how much their work now has in common

with that of many American analysts, for

example, Erikson (1959), Kernberg (1976), G. S.

Klein (1976), Kohut (1971, 1977), Lichtenstein

(1977), and Schafer (1968). The emergence of

such agreement from independent sources is

particularly important in psychoanalysis.

In this presentation, I shall first outline my

work with a patient over severed years to focus

critical issues in a way that relates to your own

clinical experience and so keep before us the data

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on which to frame the questions to be studied.
Then I shall draw some general features of this

patient’s difficulties that seem to require a change

in our theoretical standpoint. In a third section, I

shall sketch how the self might be conceptualized

in its development and maintenance. Lastly, I

shall reflect on some implications these views of

the self have for the future of psychoanalysis.

Again, I wish to stress that I offer no tidy theory.

I hope, however, that you will share my interest

in working toward a better understanding of the

person.

CASE EXAMPLE: LENA

The patient, a middle-aged widow whom I

shall call Lena, had had a difficult relationship
with her mother from birth because of allergies,
feeding difficulties, and fits for which she was in
and out of the hospital much of her first year.
From the time Lena can remember, she has
believed that her mother hated her; her father just

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withdrew. Throughout her childhood and
adolescence, her life was one long battle with her
mother, and she also became more and more
combative with the world.

Lena was bright intellectually and qualified to

become a social worker. Soon afterward, she
married a rather psychopathic man, who was
killed in an automobile accident about 2 years
later. Before he died, the husband was overseas
most of the time, and so the marriage was hardly
a relationship at all. Yet, in spite of the poor
relationship, her husband’s death intensified
Lena’s feelings that she was no good and there
was no point in living. These feelings led to an
attempted suicide and several months in a
hospital. Lena was labeled depressive, although
at times she experienced disordered thoughts
with hallucinations, which suggested that she
might be schizophrenic. She recovered
sufficiently to manage her work for many years
and sought help when she felt some of her
lethargic, apathetic symptoms returning. She also
became increasingly dependent on tranquilizers
and alcohol.

Lena appeared constantly on the defensive

against almost all close relationships, which she

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warded off either by withdrawing abruptly from
people or by behaving aggressively toward them.
Consequently, she became increasingly isolated.
For example, her relationships with colleagues,
the only people with whom she had much
contact, were characterized by alternately
thinking they were “not so bad” to more
frequently thinking they were about to invade
her. She achieved closeness with few co-workers,
although she did establish responsive empathic
relationships with her clients.

Lena believed that she had missed something

in her childhood. Thus, she longed to get and to
give affection, but she dared not express any lest
she be “exploited.” Her turbulent relationship
with me brought out her destructive attitudes, not
only as a defense but as a revenge —a quite
prominent theme. For several years, Lena’s
treatment involved a struggle against her
extremely tenacious clinging to an outer
aggressive self, not only to avoid relationships
but to ward off a greatly dreaded loss of herself
such as had occurred during her breakdown. Her
mistrust of finding a better world was almost
total. It took her years to believe that I was
concerned about her and thought she had good

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qualities to offer others. Moreover, she slowly
realized that, by frequently attacking me, she was
trying to destroy her treatment. Her treatment
was made even more difficult to cope with
because of her splitting off into a secret inner
world a hidden self, with its rich fantasy world
and its invulnerability and omnipotence.

The primitive nature of Lena’s lack of a

cohesive self behind her negative identity was
evident during periods of particular stress. At
these times, she became so disorganized that she
would forget the meanings of familiar words —a
serious handicap to her spare-time activity of
writing freelance articles for the press. Words
became just “sounds.” Because of this loss of
meaning, reading was impossible. Lena also
believed that .the words could jump out of the
page as if to attack her.

Lena said that her body felt detached and

strange, with little or no integration of either
physical sensations or mental processes. She had
difficulty speaking about the sense of self-loss
because she feared that I would reject her for this
“craziness.” However, when she realized that I
was trying to understand her experiences as
repetitions of past terrifying experiences of being

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totally out of touch with any trusted figure, she
was able to describe these feelings in spite of the
intense anxiety and humiliation they aroused.
Although she felt at her worst in this total chaos,
she believed that she could regain an integrated
self if someone made her feel that he thought she
could do so. At the same time, I sensed her
confusion and understood that she was desperate
to “explode” something out from inside herself,
namely, the intensely hated persecutory world.
Perhaps most striking was the way she created in
the outer world a replica of her inner world, that
is, a world full of hate. At best, she perceived the
outer world as being unconcerned about her,
leaving her omnipotent in her secret fortress and
ensuring inner survival as a person with a self.

CENTRAL ISSUES IN THE FUNCTIONING OF

THE PERSON

Although some of these problems are specific

to this individual, I believe they represent the

central issues for most, if not all, patients. The

following prominent features can be noted,

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leaving aside any claims to comprehensiveness or
their relative importance.

1. Such patients are greatly preoccupied with

insecurity about how other people accept and
value them. Their powerful need for a
positive response from others, frequently
manifested in exhibitionistic components,
may be hidden under extensive negativistic
denials such as Lena employed. Even she,
however, constantly hoped that people would
see behind her aggressive front a self
wanting to be valued. Psychoanalysts must
identify the nature of how their patients want
to be valued by others and how these needs
arise. They certainly concern a “whole,” “the
self,” which cannot be broken down into
components without disappearing. The
nature and origin of this whole simply have
to be understood as a gestalt.

2. Whether or not the self is a coherent unity in

its earliest stages, it soon acquires divisions,
or subselves, that are kept apart in their
functioning by the incompatibility in the

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relationships each part seeks with the other
parts. The splits clearly originate in the
environmental mismatches. Nevertheless, the
initial unity remains active in the awareness
that the subselves are parts of the one self.
However, there is a perpetual strain because
of these divisions and because of the
fluctuating struggle to integrate the splits.
This strain, of course, is a powerful motive
for seeking psychotherapy.

3. The subselves contain needs that press to be

accepted as vital parts of the self, and, as
such, these needs cannot be rejected; they are
derivatives of the innate givens of the
organism. But some of these needs are
unacceptable to an infant’s parents and
therefore lead to painful consequences if
expressed. Thus, the child has to cope with
them away from the parents, for example, by
fantasy activity or, later, by secret
expression.

4. The integrative pressure brings out a basic

feature of the self-system, namely, its active,

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initiating role with the environment. The
self-system constantly strives to interact and
establish compatible and reciprocal
relationships with its surroundings.
Underlying Lena’s negativistic exterior was
her almost intolerably painful feeling that
everything she had ever given was rejected,
and so she seldom offered herself to others.

5. One part of the self becomes dominant in the

development of a visible self. The subselves
are kept apart from this dominant one with
varying degrees of splitting and repression;
yet in many activities they are merged with
the dominant self to achieve some
expression, albeit unconsciously.

6. The activity of subselves creates symptoms,

which may be relatively localized, as in
perversions, or more general in their effects,
as in Lena’s lethargy and fears of
disintegration. They cannot, however, be
explained solely in terms of repressed
impulses. They represent the solutions an
original unitary self finds to express at a

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personal level its unmet or actively rejected
needs.

7. From an early age, the self can be seen as a

complex system that has internalized the
important figures of the external world,
divided according to their different aspects.
The inherent social relatedness of the self as
a whole is manifest from the start. The
instincts do not have their own internal
templates to fashion the actual patterns of
behavior that will satisfy them. These
patterns come from the adaptive action of the
self in its relationships with the real figures at
hand, along with its inner-world figures and
relationships, which can be manipulated with
imaginative play.

8. I cannot go into all the intricacies of the

numerous possibilities this inner world
provides, for instance, by establishing
relationships with objects that are fantasied
as objects or by identifications with the
objects, some with considerable stability,
others with much more lability. These

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developments have been described in detail
by Melanie Klein (1932), Fairbairn (1954b),
Winnicott (1971), Kohut (1971, 1977), and
many others. A primary patterning of the self
is established in the earliest relationships, in
which the acceptance of the self as a person
is intimately involved with bodily needs, and
in which the self and its objects are still
incompletely differentiated. This primal
patterning of the ways the self behaves to
gain security and acceptance remains a
powerful determinant of future development,
particularly in social relationships. In
keeping with the incomplete self-object
differentiation, relationships in these early
stages have a strongly compulsive character.

9. The primary patterns of the dominant self are

elaborated by inner maturation and by
increased experience of the world. In
particular, the sexual instincts are fitted into
these primary self-patterns in the evolution
of the sexual identity, as originally described
by Fairbairn (1954b).

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10.Once a dominant self is fashioned and
implemented, it forms what can be described
as the individual’s identity, that is, the self he
makes visible because of its reality
involvement and because others “identify”
him by it. Thus, it is relevant to recall that
Erikson (1959) at first chose the term ego-
identity, an apt choice because it suggests the
close connection of the visible self with
reality relatedness. The concept of the ego as
an independent entity, especially in
motivation, seems unnecessary (G. S. Klein
1976). All the autonomous functions
Hartmann (1958) described are employed by
the self in action. Action, however, is
controlled by the self-system, which is most
active in relation to the environment. Lena’s
case is a striking example of how the self,
especially in regard to its positive
acceptance, can dramatically alter the
individual’s whole capacity to think and to
hold on to meanings, that is, the structured
layers of past experience. Her anxieties
frequently prevented reality thinking because
she had withdrawn from the real world.

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Confidence in the mother’s love seems to
provide the foundation for the capacity to
keep experience — and hence thought and
understanding—continuous.

11. When the dominant self is established as an

identity, a person clings to that self with the
utmost tenacity no matter how restricted or
distorted it may be because the dominant self
is not only the visible mode of relating, it is
also the cover for the whole invisible self in
its closed world of secret inner relationships.
As the individual’s mode of surviving, the
dominant self exhibits a profoundly
aggressive attitude toward any attempt to
take it away, even when the wish to alter that
self brings the individual to treatment.

12. The ferocity with which the identity is

defended calls attention to a puzzling
phenomenon, namely, how this very
structuring can be removed by a field change
as opposed to a direct personal challenge.
For instance, Lena’s intense hate was
aroused when she felt that I was forcing a

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different identity on her; yet she could lose
her dominant self or identity when the
external world felt empty of any source of
reassurance to the self.

SOME GENERAL COMMENTS ABOUT THE

SELF AS AN OPEN SYSTEM

Since Freud sought to keep psychoanalytic

theory on a firm biological base, a few

observations from this standpoint are helpful

regarding one’s perspective on any concept of the

self. Freud’s biological speculations, insofar as

they impinge on clinical understanding,

concerned mainly the origin and nature of the

drives. It was inevitable that he should have

reductionist science deeply rooted in him. Even
when he had to give up the “Project for a

Scientific Psychology” (1950) because of

problems in dealing with the psychological, he

remained wedded to his energy notions and to the

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second law of thermodynamics, which was then
virtually the ultimate reality. However, advances

in biology, cybernetics, and theories of open

systems (such as living organisms, that is, those

in which the system interacts incessantly and

adaptively with an environment that in turn may

show similar adaptive responses) enable analysts

to establish a more appropriate basis for their

views of both the psychological and the social

and how their mutual relationships create the

individual.

Apart from all the gains in psychoanalytic

understanding, these developments liberate the

thinking that is needed from the constant attack

that psychoanalysis is outside “natural science.”

Prigogine (1976) and others (see Jantsch 1980)
have now worked out the principles and

associated mathematics of such open systems, in

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which there is the necessity for constant
interactional developments, with structural

changes to embody the “learning” that has taken

place. Thus, predictability has a limited role in

regard to open systems because unpredictable

creativity in relation to unpredictable

environmental change is the characteristic feature

of these systems. Living systems survive by

being negentropic, that is, they live outside the

entropic principle inherent in closed systems.

Death is not a running down of the machine but a

“planned” event required by evolution. Concepts

such as the death instinct must be appraised

against the view that reactive aggressive behavior

is required for survival. Within the evolutionary

process, there is the thrust toward more and more

freedom from environmental constraints. Man is

not the blind, passive victim of chance and

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necessity Monod (1971) describes, for, as Jantsch
(1980) puts it, “We are not the helpless subjects

of evolution —we are evolution” (p. 8).

The evolution of man has taken him to his

present place through his unique mental

capacities, and in this development his

simultaneous social evolution has been a

necessity. The development of the individual and

his resources and adaptive capacities is clearly

inseparable from the social milieu which evolved

in parallel. It certainly sounds platitudinous to

make that remark and yet, as we are all aware,

until recently, psychoanalysis has not paid

adequate attention to the dynamic way in which

social and general environmental relationships

are built into the person. These relationships
structure his eventual personal properties to

create a system that cannot survive without

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appropriate responses from the environment

which, in turn, has to change with developments

in people. Man’s relatedness to his environment

depends on his unique capacity to transcend it by

making a reproduction of it inside his mind,

where he then manipulates possibilities, from

which stem his creative alterations of it. As a

result of this evolutionary process, a remarkable

freedom from the uncertainties of the physical

environment has been achieved. It is generally

agreed that corresponding adaptations in the

social world have lagged far behind. One change

that has emerged, however, is the entirely new

importance attached to the self. The individual

has acquired a new status in Western democratic

social and political philosophies, one in which the

full realization of his personal resources is a
requirement (Emery and Trist 1973). On all

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fronts, then, the individual, his self, and his

identity have become central concerns, and it is

no accident that these concerns have developed in

psychoanalysis. The self as the controller of

perception and action has become the focal

concept in relating the individual to his

environment.

In studying development, it is useful to have

in mind its outcome. How, then, do analysts view

the optimal condition of the individual? I believe

that the starting point must be his “intentionality,”

his purposes, that is, the long-term relationships

he wishes to make with his environment. Chein

(1972) gives a useful description of this aspect
when he states, “The essential psychological

human quality is, thus, one of commitment to a

developing and continuing set of unending,

interacting, interdependent, and mutually

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modifying long-range enterprises” (p. 289). Love
and work are central for the survival of these

enterprises, but man’s expressive needs,

especially art and religion, must also be

considered. The dynamics of these needs do not

stem from the instincts alone. With the capacity

to transcend the environment, they seem to

represent a need to give meaning and significance

to life and to move toward what can only be

described as “betterment” — perhaps an

expression of the thrust of evolution in relation to

environmental stresses. When such commitment

is within a self whose main aims are adequately

integrated with reality, there is the foundation for

a creative, satisfying, and enjoyable mode of
living.

How are the self, its development, and its

functioning to be conceptualized? The patient I

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have sketched and others who are similar, as well
as the writings of other researchers, suggest the

following diagrammatic outline.

Just as anatomical growth with all its

differentiation appears to be ordered by an

organizing ground plan operating as an overall

gestalt, so the development of the self must have

a parallel gestalt integrating its interactions with

reality. However coherent its unity may be at the

start, the self-system rapidly acquires divisions or

subselves resulting from the incompatible affects

associated with experiences. Even with all the

limitations of present knowledge, the self can at

least be regarded as an overall system in which
experiences are brought into cohesion. The

gestalt appears to have a “desired” state of

positively toned affect that accompanies the

interactions between the organism and the

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environment, with each affect having its own
specific quality according to the particular

features of any relationship. Innate behavioral

systems have their own affective expectancies so

that when the infant “needs” something that

matches the “shape” of this need, the appropriate

object gives the self the feeling that things are

“right.” It is now known that these innate

expectancies include, in addition to the bodily or

appetitive ones, powerful independent needs to

satisfy the impetus toward autonomous

psychological development. Adult patients all too

often express the feeling that “something is

missing” in their self from very early times, when
these needs were not met. In short, the inherent

“form” or “shape” that the gestalt “needs” is to be

a person. The crucial factor for an infant’s

optimal development is an input of enjoyment

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from the mother that reflects her love and care for
the child as a spontaneously developing,

autonomous person. This experience imparts to

the embryonic self a feeling of being a secure and

“right” part of a world which is represented by

this welcome into it. The self-system needs to be

“personalized” by being treated as an

autonomous person by other persons. The child

sees and feels who he is by what is put into him

by the mother and then by the other family

figures. This process is a much more active one

on the adult’s part than is indicated by terms like

“mirroring” or being a “container.” This process

needs all the shared experiences from
encouraging stimulation and play that occur in

everyday “tender loving care.” In this mutuality,

the child plays a decidedly active and evocative

role toward the mother’s responses.

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Thus, the self-gestalt has to be viewed as
becoming a proactive system, structured by an

internal replica of its specific relationships with

the outer world. The differentiation of the self

and its objects in this inner world is a familiar

process, and the inevitable incompatibilities

between some of the infant’s self-needs and the

parents’ responses to them create divisions within

the self. As Lena’s case illustrates, these divisions

contain both the infant’s unmet or rejected needs

and parallel structures of the controlling, rejecting

parents. These divisions remain permanently

because they are parts of the whole, stemming

from the innate makeup of the child. Within the

overall system, these divisions establish a

complex set of processes, such as providing

fantasy objects with which fantasy relationships

can be enacted as substitutes for reality failures.

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These divisions also provide a great range of
different imagos with which the self may be

identified to varying extents and with varying

stability. Because they are unacceptable for open

expression, these divisions remain undeveloped

by experience with reality. They persistently seek

relationships with the outer world because they

need people, but because their aims have

remained unadapted to the outer world, the latter

has to be coerced to fit them. A dominant reality-

related self, in keeping with the gestalt nature of

the overall system of which it is a part, tries to

manage the activity of these subselves by

merging them with selected reality relationships

— the process Waelder (1960) describes as the

“multiple functions” of most behavior. Should

there be a regression in the integration of the self
— which can happen with various environmental

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stresses — then the primary qualities in these
subself relationships (for example, the lability of

self and object differentiation) show in

compulsive relationships and in identifications

with the different inner objects.

In the early stages of the developing

configuration of the self, the autonomous striving

toward greater independence from the first

symbiotic phase is characterized by labile

fluctuations. On the one hand, there are

regressions to the omnipotent and compulsive

relationships and identifications of the
undifferentiated phase, and, on the other hand,

there are more mature patterns in which sharing

with independent others for mutual gain replaces

taking or wanting things for oneself. What might

be termed a primal self is patterned in the early

transitional stages of object differentiation, when

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the child acquires a feeling of the “shape” of the

self he is free to have. In these early stages, the

failure of the mothering and family relationships

can create major distortions, either from

deprivation of basic self-needs or from the not

uncommon imposition of a parent’s self-pattern

onto the child. Early parental failures from

accidental disturbances can often be overcome, at

least in part, but all too often relationship failures

are reinforced because of limitations in the

parental personalities.

Lichtenstein (1977) suggests that this first

personalization has a fixity in its patterns

comparable with the early ethological concept of
“imprinting.” This first personalization certainly

is extraordinarily persistent in the way it creates a

scaffolding for future developments. Lichtenstein

contrasts the development of the self in man with

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the situation in animals. Self-development is

necessary for man to relate to his environment,

while in animals instinctual equipment gives an

inner Umwelt with which they can readily adapt

to the particular environment for which their

equipment has been evolved. Man with his man-

made environment has to have his world

internalized in a more complex and adaptive way.

An organization liberated from the stabilities

of the instinctual systems has to pay a price for

this freedom by losing the guaranteed, if

inflexible, stability that instinctual systems

provide. In the face of perpetual change, a sense

of continuity is required for adaptive capacities.
Also, with a structuring developed to cope with

and anticipate the future in its own society, the

affective tone of the self-system —its self-esteem

— has to be maintained by affirmation.

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Lichtenstein (1977) suggests that, because the

integration of the self is so important, an

important inherited reinforcer of the self may

have evolved in the form of nonprocreative

sexuality. Such a function could explain the

prominence of autoerotic activity for those selves

that do not establish free relationships with

reality, that is, most patients.

Affirmation normally comes from a range of

social interactions. When reality freedom has

been severely inhibited, the individual creates an

inner world in which he compensates for this lack

by omnipotent control of fantasied relationships.

This inner world can become a serious
maladaptive factor in the eventual self, for such a

world is a distorted one with which to mediate

relationships with reality. These relationships,

instead of being established and enjoyed freely,

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become a safeguard of this inner world, where the

individual protects his real self in a kind of

fortress. Lena put up a hostile front to keep all

possible intruders away from her secret world,

where she felt at times an almost frightening

omnipotence. Pure fantasy activity is seldom

sufficient, and so the inner world has to coerce

the outer to fit its requirements —a rather
incompatible basis for adaptive relationships.
This development is also the source of some of

the most difficult negative therapeutic

reactionships. The analyst is perceived as a

menacing intruder to be fought off at all costs,

even though little or no satisfaction is gained

from the restricted mode of living this situation
permits.

Although he has not elaborated the point,

Lichtenstein (1977) suggests that work seems to

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be a highly important area within the wide range
of interactions that provide affirmation. The

instinctive roots of work are manifold, for

example, its relation to physical survival, to

provision for the family, and to satisfactions that

skills and achievements bring. Personal needs,

however, are centred. Thus, many studies of work

(see Emery and Trist 1973) have shown that

unless personal needs are satisfied, there is a
disintegration of the self, which is manifested in
poor performance, high absenteeism, and high

sickness rates. Such manifestations are also

characteristic of groups that have lost their social

connectedness, for instance, displaced

populations. When expressive or ideo- existential

needs are not met, effects of such deprivation are

seen in the loss of the self-system’s effectiveness,

as in widespread apathy or “depression” or in

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violence by protest groups that arises from the
loss of a sense of significance or meaning to life.

With much of this kind of stress, it is often not so

much the absence of ideologies, religion, or

values that deprives the self of a sense of

meaning as it is the dissonance between the inner

image of man that is thought right for particular

groups and the one that is proclaimed with

intrusive force. Ideo-existential needs carry a

considerable loading from the segregated

subselves, and deprivation in regard to these

needs exerts a disintegrative effect, both by

weakening the reinforcing affirmation the
dominant self needs and by altering the status of
the dominant self in managing the subselves.

When the self reaches adulthood, its

relationships with the social environment have

patterned its identity — the characteristic visible

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way in which the individual functions. When I
suggested earlier that a primal self could be

described that was fashioned in the phases of

infantile dependence, I was distinguishing its

form from that of its later social identity, in which

various accretions have been assimilated; and

because of its intimate links with social

interaction, this later self in its social identity

seems particularly dependent on a requisite social

connectedness.

Thus, it is not difficult to recognize the

fundamental role that the dynamics of perpetual

relatedness with society play in maintaining the

integrity of the self. This relationship of the
individual to groups naturally attracted Freud’s

(1921) interest, and he advanced his theory of the

ego by postulating the separate function of the

ego-ideal in binding the individual to the leader.

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In characterizing the distinctive identity of the
individual outside the primitive or unorganized

group, Freud described him as possessing “his

own continuity, his self-consciousness, his

traditions and customs, his own particular

functions and position, and ... [as keeping] apart

from his rivals” (p. 86). Moreover, Freud noted

that an individual would seek to preserve this

identity against any negative impingement, with

even a readiness to express hatred and

aggressiveness, to which he ascribed the

elementary character that he found in the death

instinct. Since he believed that this identity was

preserved by narcissistic libido, it is remarkable

that he described the individual’s distinctive

identity on the basis of McDougall’s (1920)

conditions for the organized group: (1) the group

should have a continuity of existence; (2)

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individuals within the group should know the
nature, composition, functions, and capacities of

the group; (3) the group should interact with

other groups partly similar and partly different in

many respects; (4) the group should possess

traditions, customs, and habits, especially those

that determine the relationships among members;

and (5) the group should have a definite structure,

exposed in the specialization and differentiation

of the functions of its constituents (see also Freud

1921).

Bion’s (1961) studies with actual unorganized

groups show that, faced with a reality task the

members cannot grasp, and given no help with

this task by the leader, such a group rapidly

regresses into what he called the “basic

assumptions” of the group. He accounted for
these states in terms of Melanie Klein’s (1932)

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primitive mechanisms, yet the individuals
showed a cohesion in regressing to their basic

assumptions. Such behavior can be viewed as

stemming from the loss of social identity and the

emergence of the individuals’ primal selves (see

Chapter 17).

IMPLICATIONS FOR THE FUTURE OF

PSYCHOANALYSIS

These somewhat discursive comments are

intended to emphasize that the self cannot be

conceptualized except as an open system

developing and maintaining its identity through

the social relatedness essential to it from the start.

It must be questioned whether or not the classical

psychoanalytical theory of the person and his

development and functioning does justice to this

fact. Therapeutically, the analyst’s task is to

achieve greater integration in the self-system by

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reducing the separateness of the subselves. I have
no doubt that what has been encountered as a

negative or rather partial therapeutic reaction

frequently derives from the way the individual

divides part of his self into a subself to be kept in

virtually a secret fortress, with the rest of his

relationships distorted to preserve this situation.

This inner state, however, is entirely a product of

his relationships within the family, and, even

when he seems most cut off, the essential factors

are the failed relationships and the terror of

disintegration that remains. I have avoided using

the term narcissistic because it has been

connected for so long with the biologically

oriented view that states of failed capacity to

relate have their origin in the development of the

libido rather than primarily because of failures of

the social environment.

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The implications of a comprehensive theory
of the self and its personal (object) relations are,

of course, much wider them the therapeutic

problems. Although, as Freud (1926) pointed out,

it is not the business of psychoanalysis to provide

a Weltanschauung or ideology, it is the concern of

psychoanalysis to offer understanding of how the

individual relates to reality and to himself. The

inexorable thrust of evolution keeps man

constantly seeking to improve his situation in

relation to his environment, and the image of man

within a society has a profound influence on his
behavior. The psychoanalytic image, I must

stress, is not of where man should go. Rather, it is

an image of the way his functioning as a creator

of guiding images for himself is determined by

the properties of his self and its perceptions of the

world. The image of man in this sense will be

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used by social philosophers, and there is already
evidence of what can happen when man is seen as

being created by his drives and their satisfactions

(Brown 1959; Marcuse 1955).

By trying to belong to the “natural” sciences

as they have been conceived following Descartes,

psychoanalysts have alienated themselves in large

measure from the humanities, and at the same

time they have made even less impression on the

“hard science” philosophy underlying medicine

today. I do not believe that psychoanalysts have

the right friends for making an effective

contribution to the present climate of opinion.

With a due importance attached to the self and its

inner world as the mediator of social behavior,
the works of the great writers and artists as well

as developments in the social sciences should

surely figure much more in psychoanalytic

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thinking. The human sciences badly need the

kind of understanding of human relationships that

psychoanalysis can contribute. Only in that way

will the prevalent gap between psychoanalysts

and other scientists be bridged. I also believe that

the newer notions about evolution may well make

it possible for psychoanalysts to be less

dismissive of man’s religious quests. Again, it is

not a matter of saying “what should be,” but of

illuminating the nature and function of the great

human expressive needs. When religion is seen as

being rooted in man’s innate striving to

understand himself in his environment, its origins

cannot be reduced to infantile dependence.

Nevertheless, the mode in which it is expressed
may have to be freed from these early influences

and matured to fit man’s expanding knowledge

and understanding.

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In a time of such turbulence as the present,

with endless superficial remedies and treatments

for personal problems, the psychoanalyst’s task

must be to get an account of the person that does

justice to his full nature. This turbulence (Emery

and Trist 1973) has resulted from the remarkable

growth of the physical sciences with their

technological advances, a growth that has

reinforced the wish for “scientific” cures. In the

view of many people for a long time,

psychoanalysis has not been considered a science

because of the failure to recognize that persons

are complex, open, developing systems. I believe

that this position is about to change radically

throughout the scientific field, and that

psychoanalysts must respond by putting people

with all the subjectivity governing their actions to

the front. I find it encouraging that in a recent

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book on ethology, Robert Hinde (1982), one of

the leading scientists in that field (and,

incidentally, John Bowlby’s guide in his

ethological thinking), states that it would be

wrong to pretend there is extensive common

ground between ethology and psychiatry. For

Hinde, the psychiatrist’s proper concern is

subjective experience. This view constrains what

ethology can offer psychiatry, although its

indirect contribution in conjunction with the other

behavioral sciences is great. The self is surely the

heart of the matter regarding the organization and

functioning of subjective experience.

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DISCUSSION

Leonard Horwitz, Ph.D.

Dr. Jock Sutherland has a unique and highly

valuable dominant self. The first part of his

presentation, a beautifully concise clinical

description followed by a series of clear

formulations about the use of a concept of self in

understanding the patient’s struggles to survive,

could easily stand on its own as a clinical and

theoretical presentation. But Dr. Sutherland is one

of those rare clinicians who views the clinical

enterprise as rooted in a social order, part of an

open system which requires our informed input
about the scientific and philosophical basis of our

work. A major difficulty we clinicians encounter

with society is that we are not always clear

ourselves about our own identity, where we have

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been, where we are going, and what we stand for.
Indeed, we are obliged to articulate our own

image of man as a first step in being persuasive

and convincing about the validity of our efforts.

Insofar as we suffer from professional identity

confusion, we are in danger of losing our own

anchoring as well as the confidence of those who

should support us.

Dr. Sutherland’s value to the Menninger

Foundation over the past two decades has been

his ability to impart a clear vision of what he

believes we stand for and what we should aspire

to become. Like all outstanding leaders, he brings

needed perspective to our work, provides clarity

about our scientific and therapeutic mission, and

inspires enthusiasm in the pursuit of our

professional goals.

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By this time, you may have gathered that I
hold the man and his views in high esteem. Let

me first underline my agreement with his major

ideas.

First of all, despite the difficulty most writers

on the self have in clearly defining this concept, I

believe that psychoanalytic theory requires an

overarching concept of self that accounts for

man’s proactive, integrating activities. It also

embodies such basic universal needs as the wish

to be valued, the desire to be affirmed as a

significant person in the lives of others, and the

need to be attached in varying degrees of
closeness to others while also being capable of

autonomous functioning according to one’s own

internal standards. I believe that the present

concepts of ego and superego do not sufficiently

embody these important functions. However

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important the structures of ego and superego are
in embodying necessary mental functions, present

structural theory needs updating to deal with the

accumulating body of evidence on the centrality

of earliest relationships and identifications.

Intersystemic and intrasystemic conflicts within

the mental apparatus are not sufficient to explain

all deviations in development. The first months

and years of life 'give rise to a greater or lesser

degree of cohesiveness in the sense of self, that

is, one’s identity and human relatedness. The self

is a basic building block for all other mental

structures.

Second, a useful and necessary concept is the

view that splits in the self comprise subselves that

express hidden or forbidden wishes, which often

must be kept invisible and protected. Much of the
goal of therapy, as Dr. Sutherland reminds us, is

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to help the person integrate the visible, dominant
self with the hidden and shameful subselves.

Third, the healthy cohesive self is first

nurtured in its earliest phases within a symbiotic

dual unity of mother and child in which

gratification and love predominate over

frustration and anger. These internalized good

objects require some degree of reinforcement

from the environment throughout one’s life. And,

in passing, I would call your attention to a small

gem our speaker dropped regarding the self and
the negative therapeutic reaction: the self-

disordered person tries to safeguard his true self

by keeping others away from his secret fantasy

world. The analyst is felt as a menace and an

“intruder to be fought off at all costs, even though
little or no real satisfaction is gained from the

restricted mode of living this situation permits.” I

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am not certain that a formulation of this kind

about an important clinical phenomenon could be

made without a theory of self, particularly

Winnicott’s (1960a) concept of true and false self.

Object-relations theorists and self theorists all

have to reckon in some way with the dual instinct

theory. I subscribe to the view expressed by most

of these writers that instincts and affects must be

conceptualized within a framework of the self-

object internalized relationship. More simply put,

the search for objects or persons may well be a

more basic motivating force than the gratification

of drives. Thus, I wonder whether Dr. Sutherland

is implying the same solution recommended by
his mentor, Ronald Fairbairn (1944), who

reduced the instincts to mere “instrumentalities.”

In my view, the roles of libido and aggression

still need to be reckoned with as significant

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motives, however influenced they are by a matrix
of internalized relationships and relationship

needs. I am aware that I am touching on an

exceedingly complicated question, which is far

from satisfactorily resolved. The problem of

integrating instinct theory and self theory

represents one of the exciting challenges of the

future for psychoanalysts.

A corollary to the above point is to describe

art and religion as expressions of the creative

self; they reflect the universal human need to
affirm and validate a healthy sense of self. Once

again, I would not wish to subscribe to a

reductionist view that religion is nothing but the
sublimation of drives. Winnicott (1953) may have

been on the right track when he described

religion, art, and other cultured products as

transitional phenomena, which are characterized

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by a partied retreat to an earlier desired
relationship in which the pressures of reality and

the strains of separateness are temporarily set

aside. I am not certain that these creative

expressions of the self as viewed by Winnicott

are relational in a noninstinctive sense. Religion

links the individual to his primary objects, but

sexual and aggressive drives are important

components of one’s relationship to a loving and

punitive God.

I have been privileged over these two

decades, through a close association with our

speaker, to learn and assimilate the major views

expressed in his paper. I agree with him that it is

important to enrich our present theory with a

superordinate concept of the self in order to
appreciate better our patients’ inner worlds and

struggles with reality. Whatever solution

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eventually emerges concerning the issues raised
here, the specific content of the evolving theory

will be less important than the thrust of the

thinking we have heard this morning. Dr.

Sutherland has presented us with an image of

man as an open system with a need to be valued

and affirmed, ever striving to integrate disparate

and contradictory parts of his self and challenged

by the need to deal realistically with a changing

environment. This view clearly makes the

mission of the mental health field one of fostering

the process of human growth and development

through understanding difficulties in personal

relatedness. If developmental arrests have
occurred, we try to use our scientific knowledge

and human empathy to encourage growth to

resume. In the mental health field, where a broad

spectrum of therapeutic approaches beckon at

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every turn— particularly the simplistic ones
promising quick solutions to complex problems

—it is easy to lose sight of how our knowledge

about human growth can best help our patients

get back on the developmental track. I am

indebted to Dr. Sutherland for what he has taught

us in the past and for his enlightening statement

today of the essential nature of human

functioning.

Ramon Ganzarain, M.D.

Dr. Sutherland questions “whether or not the

classical psychoanalytical theory of the person

and his development and functioning does justice
to … [the] fact” that the self is conceptualized “as

an open system developing and maintaining its

identity through the social relatedness essential to

it from the start” (italics mine).

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He briefly describes a case with negative
therapeutic reactions, which derive

from the way the individual divides part of

his self into a subself to be kept in virtually
a secret fortress, with the rest of his
relationships distorted to preserve this
situation. This inner state, however, is
entirely a product of his relationships within
the family, and, even when he seems most
cut off, the essential factors are the failed
relationships and the terror of disintegration
that remains.

I was reminded of similar features in the famous

case treated by Kohut (1979), “Mr Z,” and the

vicissitudes of his two analyses. During the first

one, his failed relationship with the sadistic,

psychotic mother was kept entirely hidden in a

secret fortress.

After Dr. Sutherland tells analysts that they

“have alienated themselves in large measure from

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the humanities, and at the same time they have

made even less impression on the ‘hard science’

philosophy underlying medicine today,” he

declares that “the human sciences badly need the

kind of understanding of human relationships that

psychoanalysis can contribute.” He suggests that

the mathematics of open systems requires

constant interactional developments with

structural changes to embody the “learning”
that has taken place. Thus, predictability has
a limited role in regard to open systems,
because unpredictable creativity in relation
to unpredictable environmental change is
the characteristic feature of these systems….
Man is not the blind, passive victim of
chance and necessity … for, as Jantsch
(1980) puts it, “We are not the helpless
subjects of evolution —we are evolution.”

As an illustration of such unpredictable

creativity, the dramatic story of the Birdman of

Alcatraz [Gaddis 1955] came to my mind. How

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could a man rise from being sentenced to life in

prison for several murders to become a world-

famous ornithologist, beginning by caring for a

wounded bird that had fallen onto his window

ledge? This man’s wish to help a little creature

began a new trusting relationship with his jailer

that gradually allowed the prisoner to develop

into a full-fledged scientist.

Dr. Sutherland continues: “Man’s relatedness

to his environment depends on his unique

capacity to transcend it by making a reproduction

of it inside his mind, where he then manipulates

possibilities, from which stem his creative

alterations of it.” Psychoanalysts seem to be
reaching a psychology beyond determinism and

developing concepts that may enable them to

study mental phenomena beyond the unconscious

repetition-compulsion phenomenon.

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Dr. Sutherland calls psychoanalysts to arms,

stating that we “must respond by putting people

with all the subjectivity governing their actions to

the front … [because] the psychiatrist’s proper

concern is subjective experience.” He concludes:

“The self is surely the heart of the matter

regarding the organization and functioning of

subjective experience.”

Dr. Sutherland’s remarks reminded me of

Zilboorg’s (1941) criticism of the attempt by

Kraepelinian psychiatry to classify mental illness

in the same way the botanist Linnaeus classified

plants. In so doing, Kraepelin and his successors

erroneously attempted to achieve an objective
diagnosis of every mental patient. Psychiatrists

have not proclaimed emphatically enough that

psychiatry, and particularly psychoanalysis, deals

with the subjectivity of people, not with objective

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diagnostic categories. In every patient, analysts
may help the important subselves abandon their

secret fortresses. Patients may overcome their

schizoid fear of psychotic disintegration by

establishing a reliable, personal relationship with

the analyst; analysis thus becomes a parentinglike

labor of love and not a mere technical endeavor

of deciding which button to push —when.

The concept of the self as a complex open

system gives psychoanalytic technique a

relatively new perspective. The old image of the

analyst as a blank screen is exchanged for the

picture of the patient-analyst relationship as an

interaction. The fact that the analyst reacts to his

patient —without necessarily losing his neutrality

— is acknowledged and studied; attempts are
also made to use such responses.

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Racker (1957) did a meaningful review of the
classical concept of countertransference. He first

described the countertransference neurosis as a

natural development within the psychoanalytic

setting and then described two main types of

countertransferences, concordant and

complementary, whose significance and

understanding he systematized by studying

patient-analyst interactions from the viewpoint of

projections and introjections. Grinberg (1962)

contributed to the subject with his concept of

“protective counter-identification.”

Physicists acknowledge that material,

physical phenomena cannot remain unaltered
when someone observes them and that causality

relationships between subatomic phenomena

cannot be established with certainty because

particles of matter respond unpredictably when

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under observation (Heisenberg’s [1930]
“uncertainty principle”). Psychological subjective

phenomena, such as affects, transference, and

unconscious fantasies, obviously are even more

difficult to observe “objectively.” Predictability

remains only a probability, never a certainty, both

in physics and in psychology. Thus, unpredictable

psychotherapeutic developments can sometimes

occur.

Psychoanalysis consequently becomes a

“growth” experience, with a “hatching” of still

unformed subselves that have been hidden in

secret fortresses or that are still in germinal states

inside their shells. Thus, analysis is like a trip

toward spiritual achievement, a road to

completion and perfection with quasireligious
undertones, in search of a better integration of the

self, almost a la Carl Jung.” The analyst,

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therefore, views his technique more as an
“artistic” endeavor than as a “scientific”

enterprise. It requires an intuitive, creative

attitude to promote — without undue interference

— the best possible growth of a given patient,

who is a unique individual in his own right.

Dr. Sutherland states that these concepts of

the self give the individual “a new status in

Western democratic social and political

philosophies, one in which the full realization of

his personal resources is a requirement.” I
personally believe that such “full realization of

his personal resources” ideally should be an

individual’s right, granted to him by mother,

family, and society. It should be stressed,

however, that such realization is also the
individual’s responsibility. Increased autonomy

and freedom of choice entail heightened

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correlative answerability. Such responsibility is

important specifically in psychoanalytic theory

and practice because it acknowledges the

person’s own (relative) power to shape his

destiny and to modify and influence his

relationships with the persons around him.

Mental patients have a tendency to forget their

active participation in shaping their fate,

“disclaiming” it (Schafer 1976), while blaming

instead “not good enough mothering” or another

“faulty” environmental element. There is a risk of

oversimplifying and forgetting the essential,

constant interactional quality of the self that deals

with the environment. Some analytic schools of
thought offer “deficit theories” of poor mothering
to explain the psychopathology of the self, while

other schools minimize the role of human

environment in the infant’s development. Both

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extreme conceptual positions forget the essential

interactional quality of the self within its human

environment. Both of these diametrically opposed

theoretical postures inspire exaggerated analytic

techniques that risk limiting therapeutic

effectiveness.

Note
[←*] Discussants are Leonard Horwitz, M.D., and Ramon
Ganzarain, M.D.

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21.

THE AUTONOMOUS SELF

Sutherland believed that a distinct self is

present from birth, and that an innate organizing

principle guiding development of the self is

present from the beginning. The

conceptualization of the self as, at birth, a

dynamic structure that plays a crucial role in

development challenges the theoretical

assumptions of classical psychoanalytic theory,
particularly drive theory. Psychoanalysis lacks a

theoretical account of the person as inseparably

interwoven with the fabric of society. Clinical
evidence from disorders in the self that develop

in later life, as seen in seriously disturbed

patients, strongly suggests that effective

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development of the self rests on a joyful,
empathic responsiveness from the mother. The

infant can readily tolerate various limited

frustrations of particular behaviors if the overall

feelings communicated by the mother, and later

the father, come from their genuine unqualified

joy in the baby as it is.

In the late 1980s, Dr. Sutherland shared this

paper with a small group of analytical therapists.

He had been encouraging us to write up the cases

we were presenting to him, and to use them as

clinical examples of the kinds of pathology of the

self he was describing. In the British tradition, he

wanted us to criticize and debate his ideas so that

we might clarify our understanding. Although Dr.

Sutherland’s emphasis in this paper is on the self,

he strongly believed in the dynamic unconscious

and the important place of dreams in

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psychoanalysis. The task of fully integrating the
many aspects of psychoanalytic theory —drive

theory, ego psychology, object relations theory,

and the psychology of the self— still lies before

us.

— Introduction by Stuart C. Averill, M.D.

EARLY THEORIES OF THE SELF

Several trends have contributed to the recent

emergence of the self as a central issue within

psychoanalysis. Common to all these trends has

been the growing awareness that the fundamental

assumptions of psychoanalysis did not do justice

to new clinical findings. In contrast with the

classical theories — which based development on
the instincts and their vicissitudes, and from

these, the tripartite structuring of the mind —

more recent theories have increasingly seen

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psychopathological manifestations as being
involved with the person as a whole, that is, the

self. This self developed those disorders when it

lost a core integration that had hitherto been

referred to by such phrases as “an intact ego,” or

as a strength derived from a sufficient degree of

cohesion in managing the instincts. Instead, the

individual presented conflicts within the self or

“identity.” Divisions within the self caused

doubts “about who one was” and other disturbing

existential phenomena. Psychoanalysts were thus

confronted with serious questions that exposed

the inadequacy of current theory, which was

considered to depersonalize individuals and

especially their motivation. This belief was

confirmed by what was happening in society, as

poets and writers all too frequently expressed.

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In Freud’s first theorizing, he took for granted
the personal level of conflict in the repression of

painful ideas and feelings because of their

incompatibility with the values of the central self.

The “I,” as Freud termed it, was clearly the self in

all its subjective richness of meaning. A

progressive depersonalization of this “Ich”

seemed to begin when the instincts and their

biological energies were conceived of as playing

the dominant role in the unconscious psyche.

This trend persisted for the next half century and

was reinforced, as Bettelheim (1982) was driven

to stress a few years ago, by the translation of the

German “Ich” into English as the neutral word

“ego” (p. 80); but its perpetuation almost

certainly drew on the pervasive and tenacious

influence of scientific materialism. Freud’s

genius, however, could not be wholly constrained

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by this limitation. In spite of holding on to this

philosophy as part of his thinking until his death,

he introduced into the self the personalized

structures of the ego-ideal and the superego from

his study of group behavior and the psychoses,

while in the ego there was personification by

identifications. When the tripartite theory

emerged, there was thus a scheme of

development starting from the drives of the

impersonal biological instincts and proceeding

with the formation of a person through

interaction with the social reality of the family.

This atomistic buildup of parts, however, fails to

do justice to the uniqueness of the self as a
functioning whole, especially in light of the

growing awareness of existential issues that

emphasize its central role. Nevertheless, as Franz

Alexander maintained when the tripartite theory

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was formulated, there was now “a psychology of
the total person.”

The new formulation proved to have

enormous appeal as well as great heuristic value.

A wider range of disorder was investigated in

depth to an extent not thought possible, and Anna

Freud and Wilhelm Reich advanced the

understanding of ego and character formation.

The most radical development came from the

work of Melanie Klein, who pursued the

implications of Freud’s views on the importance

of early development by boldly and rigorously

applying the psychoanalytic method to young

children. The consequence was the rather

startling finding of the rich content of children’s

inner worlds, worlds populated by a range of
figures in fantasied loving and hating

relationships with each other and with the ego.

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Because of the extreme violence and sadistic
destructiveness in some of these relationships,

Klein postulated that they were direct reflections

of the instincts, and especially the death instinct.

The destructive impulses aroused intense

anxieties, which Klein related to a dread of

disintegration of the ego, or to a loss of the

cohering function of the internalized good

mother. To lessen these inner terrors, the ego split

into parts so that the dangerous impulses could be

separated from the good figures. Impressed with
the salient power of the instincts, Klein did not

pursue the theoretical implications of her findings

about the structuring of the self as vividly
personalized in the inner relationships, except to

assume that the ego must be a unity from the

start. Thus she did not examine how perception

and action were influenced by simultaneous

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dynamic effect from more than one of the internal
objects. (At that time, the ego and the self were

interchangeable terms, and they remained so until

Hartmann separated them as a theoretical

necessity.)

In contrast with the Viennese analysts, who

gave Klein’s ideas a hostile reception, the British

analysts were divided in their response. A

substantial group believed that her data warranted

careful appraisal and assimilation. From this

group, some became enthusiastic followers while

others were stimulated to create their own lines of

thought. Among these, the best known were

Balint, Fairbairn, and Winnicott. Each was a

highly independent thinker, yet all shared the

attribution of a fundamental role in shaping the
personality to the actual earliest experiences of

the infant in its personal interaction with the

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mother and the family. From this common
emphasis, they became known as the object-

relations theorists, and many analysts

subsequently developed their views further. For

our immediate purpose, the most significant

feature of their initial work was that they arrived

at the need to conceptualize the self. Only

Winnicott took the step of adopting the term,

although, like the others, he did not formulate a

systematic conceptualization. Fairbairn

acknowledged, in his later years, that although he

would have preferred to use the term, he believed

it was more appropriate to retain the common

psychoanalytic vocabulary at the time of his
writing.

Balint’s virtual arrival at the concept of the

self is evident in his description of patients who

regressed during analysis to a state in which the

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interaction between them and the analyst was
dominated by its preverbal quality. Verbal

interpretations then had little effect; instead, the

patients responded to the experience of being

“recognized.” By this statement, Balint clearly

implied a reaction of the person as a whole,

whose unique feelings were being empathically

understood and accepted by another person. The

holistic quality of such an experience cohered in

a relationship between two selves. Winnicott

concluded that many, if not all, patients to some

degree had a split in the self and its sense of

being that led to a separation of the “false” or
compliant self from the “true” self. (This

repressed or “hidden” self became a central focus

for Winnicott’s pupil, Masud Khan, in his later

clinical studies.) This split arose from a mismatch

between the infant’s needs and the mother’s

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perception and reception of these needs, either

through the mother’s failure to recognize their

nature by faulty empathy, or by an intrusive

response based on her own conception of what

the infant’s needs should be. Whatever its origins,

this division bedeviled the whole development of

the individual; and it was extremely resistant to

change because it had evolved as a defense

against the dread of loss of the self, that is, of

madness. Winnicott’s work eventually had a

growing impact on analysts because of the new

way in which it illuminated many

psychopathological manifestations.

Despite the genius quality in his work,

Winnicott did not propose a revised

metapsychology. Instead, he believed that Freud’s

libido theory and his own concepts could coexist

as parts of the psychoanalytic understanding of

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the person. Greenberg and Mitchell (1983) found

Winnicott’s attitude toward his own theoretical

contributions so bizarre that they devoted about

five pages to its elaboration. They clearly found it

difficult to understand his almost obsequious

claim to be merely expanding some of Freud’s

ideas, while in fact he was emphasizing the

crucial role of the earliest mother-infant

relationship in shaping the structure of the

personality. In their view, Winnicott’s need to

avoid challenging Freud’s assumptions led him to

concoct a viewpoint that differed from Freud’s,

and then to accept the simultaneous operation of

two incompatible explanatory schemes. The

Greenberg-Mitchell account of this anomaly is of

special interest because of Winnicott’s irrational

attack on Fairbairn’s confrontation of this issue.
Instead of recognizing that Fairbairn was in fact

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spelling out, with remarkable conviction,

evidence for what they were both advocating,

Winnicott reacted as though Fairbairn had

personally attacked Freud.

Fairbairn differed from most psychoanalytic

theorists in having had philosophical training

before he studied medicine and psychoanalysis.

From his early years, he had shown a strong

interest in identifying the basic principles

underlying processes and making his own

appraisal of these principles when applied to his

own clinical findings. This attitude was

reinforced by his geographical isolation from the

other British analysts, which freed him from the
pressures within the analytic movement toward

strict conformity with Freud’s writings. His

thinking was thus individualistic, yet suffused

with a disciplined critical approach, which led

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him to prospectively reject the views of others
until he matched them against his experience. For

Fairbairn, reaching conclusions that differed from

others might be the greatest respect he could pay

them, because it was from their work that he

started.

After close study of a group of patients with

schizoid personalities, Fairbairn summed up their

psychopathology as resulting from failure by the

mother to convey a feeling that she loved and

valued them as persons in their own right.

Fairbairn assumed an innate need in the infant

that had to be met by the mother’s emotional

attitude toward her child. This need was thus

unusual, as he conceived it, for it was a purely

psychological holistic one arising in the self. It
was not an appetitive bodily need to be gratified

with pleasure as tensions terminated, as were the

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instincts in Freud’s scheme, but rather a need for
an ongoing personal relationship. The infant

clamored for joyful, stimulating interchanges, as

in playful baby talk and games, quite

independently of the care ordinarily given in

response to physical needs. For Fairbairn, the

infant was thus “personalized” by being

spontaneously responded to as a person right

from the start, first by the mother, and later by the
father and other family members. It was this
welcome into the world of social relations that

laid the foundation of the security essential for

the development of potential personal resources

through the resultant readiness to establish these

relationships.

Because future personality structure was so

closely determined by the quality of these early
experiences, Fairbairn asserted that

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psychoanalysis would advance only by changing
its underlying assumptions. Specifically, the

crucial role attributed to the vicissitudes of

instinctual energies and their satisfaction must be

replaced by a theory of how the personality was

structured as the consequence of its experiences,

especially in the earliest stages of development.

Fairbairn called this view an object-relations

theory, a term that has stuck even though he later

believed it would have been more appropriate to

call it a personal-relations theory. Object,

however, was the usual word for the aims of the

instincts when these were conceived of largely as

needs for which body parts might be the object.

CONTINUING EVOLUTION OF THE SELF

Despite the increasing inadequacy of the

tenets of scientific materialism to explain the

phenomena of living organisms, and even though

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the theory of open systems was developed to
account for their properties, the grip of

materialism has continued to exercise its

influence. We have only to note the great

reluctance to move away from concepts of drives

as though they are biological energies pumped

into the psychic apparatus and hence essential for

any explanation of motivation. In this

perspective, the evolution of an ego is an

organization of experience forced on the person

to cope with the id and its perpetual pressure to

action in the outer world. Moreover, because the

instincts constitute the supply of energy, they

drive the organism to homeostatic constancy and

eventually to the state of maximum entropy (that

is, death). Fairbairn, on the other hand, postulated

a holistic ego right at the center, which was

structured from experience. Such a notion was in

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no way a naive separation of mind from body, but

it employed the current biological concepts of

holistic organizing principles. It also emphasized

that new levels of organization invariably

produce new properties that cannot be predicted

from knowledge of the parts. No amount of

knowledge about the hydrogen and oxygen atoms

would let us predict that combining them results

in a colorless liquid — water.

Fairbairn’s line of thought, although starting

from the clinical data provided by his schizoid

patients, was also influenced by his antipathy to
the atomistic approach that materialism
engendered and by contemporary theories of

embryology. The dominant concept was of a

ground plan within the organism that controlled
the emergence of its differentiated structures and

maintained their interdependence. There was

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little understanding of how such an influence

could be mediated, but Fairbairn’s notion of a

latent holistic force was supported by the growth

of Gestalt psychology. During this period, the

question of a holistic force independent of the

instinctual drives was gripping the attention of

other psychoanalysts. Hartmann made the first

prominent contribution to this development.
(Fairbairn and Hartmann were actually evolving
their theories at the same time, but the outbreak

of World War II prevented any mutual influence.)

The problem that Hartmann considered to be

unsolvable, in terms of instinctual forces driving

the individual to seek the pleasure of discharge,

was how such motives alone could lead to the

essential property of the ego —namely, the

capacity to delay action by anticipating greater

gains through knowledge and planning. For

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Hartmann, this capacity required an autonomous
ego whose development had to be seen as that of

a variable, independent of the instincts, with its

own innate endowments governing its

maturation. It also had to be distinguished from

the whole person, which Hartmann held to be the

self (that is, what was cathected in narcissism). In

commenting on Hartmann’s theoretical

formulations, Lichtenstein (1977) noted that

Hartmann saw the need for a radical rethinking of

psychoanalytic theory if that theory were to

rightfully claim the title of an evolutionary

approach to human mental development.

Hartmann, however, did not get beyond the
concepts associated with ego functions, partly

because of his adherence to mechanistic

principles. Nevertheless, Lichtenstein followed

up some of their implications. Thus, by assuming

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that “the whole person” was cathected by libido
in narcissism, we have to ask whether this

organizing principle is distinct in origin and

function from a structure synthesized from the

other psychic structures. What we observe of the

“whole person” are the bodily and psychological

transformations during the life cycle. The

invariant self as a whole is the constant thread

that gives the feeling of being the same person.

Yet it cannot be derived from the parts. Thus we

are aware of unrealized potential, of complex

relationships, as in amnesias when the self-

perception is changed, or when it is maintained in

an unstable state against a feeling of not being the
“true self.” Lichtenstein believed that Hartmann’s

“third force,” or independent variable, within the

psyche must be invoked. As Masud Khan (1964)

observed, “the discussion of ego-pathology has

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extended to the larger issues of identity formation
… and the establishment of self” (p. 273).

The theme of identity is associated with

Erikson, who located the development of the ego

within the social relatedness of the person.

Throughout his thinking, he has always

integrated the biological with the cultural, but his

scheme, unlike the theory of libidinal

development, covers the whole life cycle. The

epigenetic phases he postulated in development,

from infancy to old age, have now become a part

of culture. What we must note is that an identity

principle, a biological organizing principle,

underlies these phases. Indeed, Lichtenstein
asserted the establishment and maintenance of

identity as the principle that defines the concept

of living and the survival of life. In animals, as in

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man, this principle commands absolute priority
over any other need.

In the lower animals, identity is largely that of

the genotype, which is fashioned to a high degree

by the genic endowment within a predictable

environment. High up on the evolutionary scale,

the saurian’s development takes place entirely

under the impetus of the innate behavioral

mechanisms. The human being, in marked

contrast, has prolonged gestation followed by

years of nurturance from adults, without which

the infant cannot survive. Spitz showed that the

infant dies if no one gives enough love and care

to set up a self, or organizing principle, that wants
to live. The evolutionary endowment in the infant

and in the mother is thus of a completely different

order from that of the lower animals, one

presumably evolved to cope with human survival

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through membership in groups. Humans also
pose the problem of the plasticity of the

phenotype. The behavioral characteristics of the

adult human being vary greatly from culture to

culture, within the same culture, and, to some

extent, within the single individual when

required. Any organizational principle is

therefore concerned with the emergence of

identity from potential forms of characteristics

that are shaped by the experience in upbringing.

What Erikson described as identity was the

objectification of the self into a person with a

sense of being a “somebody” aware of personal
history and whose self had been organized into

patterns laid down by peer social groups. The

person recognized by others was the identity as

objectified, while the inner sense of being this

person reflected this identity, although the

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existential awareness was absolutely unique to
the individual. This inner core, which was

distinguished from the public identity, could be

carried only by an ongoing structure that

psychoanalysis had not specified, although, as

Lichtenstein said, an adequate knowledge of who

a person was could never be inferred from what

the person was.

Lichtenstein, from his remarkably

comprehensive and penetrating considerations of

the problem of identity, was one of the first

psychoanalysts to offer a metapsychology of the

self. Starting by assuming the existence of an

innate organizing principle, he did not agree that

this principle can be derived from the other
metapsychological constituents. Spitz assumed its

independent status from the work of the

embryologists. Spiegel, however, accepted it on

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the psychological basis of its being the self. It
acts from the beginning as a frame of reference

against which experiences are judged. Sandler,

although postulating an organizing activity that

appears very early, saw it as a reflection of the

synthetic function of the ego. For Lichtenstein,

however, this latter conceptualization is a rather

advanced ego property that would operate only

later.

THE SELF AS “ORGANIZING PRINCIPLE”

The confluence of psychoanalytic thought

represented by these brief references reflects a

rising dynamic toward the recognition of the self

as an independent variable. Couched in the

tentative expression of “organizing principle,”

this force nevertheless has the most fundamental

role in the very survival of the person as the agent

responsible for the integration of experience. The

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abstract term “principle” indicates that although it

determines the development of the future person,

the only formal characteristic that can be

attributed to it is that of coordinating the

experiences from the rapid developments in

bodily resources, the maturation of the innate

behavioral systems, and their interactions with

the mother, the father, and the family. To give

more form to this potential, Lichtenstein

suggested that, at birth, the infant’s experiences

with the mother start a transformative structuring

or patterning into what he called a primary

identity. This conclusion is inevitable, and all

clinical experience confirms it. For this reason, I
believe we must regard this variable as the self.

The potentialities are clearly plastic in that

they determine what might be analogous to the

trunk of the tree from which all the future shape

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— with its infinite possibilities in regard to the

branches, the foliage, and the flowering for

procreation — will emerge from the specific

features of the environment that nourished it. The

process of becoming is that of development with

all the unpredictable distortions that may be

induced by an unpredictable environment—either

in pathological structuring in place of the normal,

or in reactive deformations in the whole, to make

good the absence of what should have been an

available environmental constituent.

In the formation of identity, Lichtenstein

attributed much more innately structured action

to the infant than is usual. This assumption

receives support from the subsequent studies of

infant development. (From his philosophical

training, Lichtenstein suggested that the

theoretical barriers to linking the inner subject

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with the outer world have been created by

entrenched Cartesian dualism.) Thus, from von

Eüxkull’s concept of an innate scheme in the

embryo of the more primitive animals (wherein

their drives have their object imprinted

sufficiently for their behaviour to be directed to it

from the start), Lichtenstein suggested that the

infant self innately expects to find the

constellation of a mother responding to it, and it

responds at once to the mother as the object that

completes its inner tension. Correspondingly, the

mother begins to personalize the infant. It is the

particular model that comes from her own needs,

conscious and unconscious, that gives identity to

the child. This initial “shaping” of the self

operates permanently as “an identity theme” that

persists throughout life, although modified by

subsequent experience into many “variations.”

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Lichtenstein concluded that identity evolves

into the structure through which the individual

will perceive and interact with the world, and

thus become responsible for survival as a human

being. He further stressed that the identity must

be constantly maintained against any tendency to

regress, a task normally effected by membership

in various groups to which the individual

belongs. The two basic features of the self are

thus brought to the fore — namely, its autonomy

and its concurrent membership in a community.

As a self-organizing, dynamic open system, the

self places paramount emphasis on its autonomy,

which is synonymous with survival.

Nevertheless, as Angyal noted in his

conceptualization of the person in terms of

systems theory, the self must retain an autonomy
within a homonymy of relatedness. Threats to the

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self evoke the defensive ferocity of the animal
faced with a lethal predator.

In this connection, Freud (1921) discussed the

libidinal ties among members of the group,

noting the spontaneous intolerance to strangers

that has to be overcome:

This self-love works for the preservation of

the individual, and behaves as though the
occurrence of any divergence from his own
particular lines of development involved a
criticism of them and a demand for their
alteration. We do not know why such
sensitiveness should have been directed to
just these details of differentiation; but it is
unmistakable that in this whole connection
men give evidence of a readiness for hatred,
an aggressiveness, the source of which is
unknown, and to which one is tempted to
ascribe an elementary character, [p. 102]

In a footnote to this passage, Freud referred to his

recent linking of the polarity of love and hate

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with the opposition between the instincts of life
and death.

Lichtenstein’s contributions thus clarified the

position that the self should occupy in the basic

assumptions of psychoanalytic theory. Although

representing a radical change in theoretical

principles, Lichtenstein’s synthesis is a model for

establishing the evolutionary status of the self

from many trends in clinical thinking within

psychoanalysis during the decades prior to his

book, The Dilemma of Human Identity, in 1977.
The importance of these principles is perhaps

best indicated by Lichtenstein’s (1977) comment

concerning Hartmann’s recognition that the

“pressures of needs and drives appear as

manifestations of personal will” (p. 235).
Lichtenstein further reinforced this perspective by

noting Hartmann’s (1958) prediction “that the

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psychology of will-processes is destined to play a
role in the psychoanalytic psychology of the

future” (pp. 74-75).

The contributions of Lichtenstein and

Erikson, because of their focus on the

development of the self into an “identity,” tend to

be considered in isolation from their fundamental

postulates regarding the development of the self.

Both of these writers describe how the adult self

is shaped by its identifications and

internalizations. Erikson assumed the existence of
the self as the central structured potential from

which the eventual identity of the adult emerges.

Lichtenstein suggested that this self-structure is
so constructed that it “expects” from birth to be

treated like a person. As he made clear,

conceptualizing the self to be at birth a dynamic
structure that will play a crucial role in

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development challenges all the assumptions of
classical theory. Erikson had considered that the

libidinal phases, as Freud described them,

developed alongside the epigenetic stages in the

formation of identity. Such a view, however,

cannot be sustained because the libidinal theory

accounts for the development of object relations

in terms of the phases of libidinal development.

RECENT THEORIES OF THE SELF

Within the past few decades, the self has

become the explicit focus for several analysts

whose writings have in turn made it an issue of

widespread interest. Prominent contributions,

much influenced by Hartmann, have come from

Mahler and Jacobson, and from Otto Kernberg
(originally influenced by Fairbairn), who also

acknowledged a debt to these two writers. These

three, although accepting the self as a structure

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separate from the id, ego, and superego,
nevertheless have held that their findings —

thought by some to require an autonomous self of

independent origin —can be accounted for in

terms of classical theory.

Mahler’s studies of young children, both

observational and clinical, are now an integral

part of the development of psychoanalytic theory.

In contrast to Hartmann, who had left the self as a

rather ill-defined entity, Mahler introduced a

concept of the self as the whole person, which
emerged as a coherent identity as the result of

development through phases of differentiation

from a symbiotic matrix. The experiences of the
infant with its mother during the earliest phases

had a crucial effect on the future personality.

However, as Greenberg and Mitchell remarked,
Mahler struggled to retain the role of drive theory

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in the face of evidence from later research
strongly suggesting that the infant possessed

independent resources and separateness from

birth. Mahler did this by denying that what she

had described was a metapsychological theory; it

was essentially only a descriptive

phenomenological account. It was the organizing

function of the ego, as specified by Hartmann,
that created the self through its representations
within the ego becoming cathected by libido.

Nevertheless, Mahler had moved away from the

oedipal relationships as the foundation for “a

totality of tenderness, security, and pleasure that

is experienced in a full relationship with another

person” (Greenberg and Mitchell 1983, p. 303).

Jacobson’s seminal writings have

demonstrated that she clearly saw some of the

limitations of the drive theory. Her intensive

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work with very disturbed patients forced her to
recognize the need to include the consequences of

early relationships in the formation of the self. In

her first theorizing, she adopted Hartmann’s

position of regarding the ego as a system of

functions and the self as existing within the ego

through its representations. She nevertheless

concluded that the self contributed an

independent dynamic influence; for instance, she

believed that the ego acquired a likeness to the

love object only by introjecting aspects of it into

the self. The desire to be like the object

contributed to differentiation of the self.
Jacobson’s acceptance of the fundamental

importance of relationships led her to broaden the

classical concepts. Thus orality for her included

what the mother is for the infant in all aspects,

and it operates to organize the manifold

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experiences. Here, too, Jacobson viewed affects,
not as deriving from discharges of tensions, but

as including the quality of the experience (that is,

the factor added to it by the specific relationship).

Of course, this line of reasoning raises a key

question about the drive theory —namely, how

the energies of the drives can account for the

great spectrum of experiences. Jacobson believed

that this is possible along the lines she suggested.

This issue is unavoidable for any theoretical

scheme, and we see it again in Kernberg. Prior to

the impact of Mahler and Jacobson, he was
greatly stimulated by Fairbairn, a debt he

acknowledged after his views on borderline

patients had become established. Although he

explicitly adopted the stance of an object-

relations theorist, he disowned Fairbairn’s

position insofar as the latter asserted it to be

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incompatible with drive theory. For Kernberg, it
is from the drives that representations of the self

and objects are developed into internalized

relationships. Because of this aspect of

Kernberg’s theoretical work, Greenberg and

Mitchell have classified him as belonging to the

current trend of “theoretical accommodation” that

attributes much of the structuring of the ego and

the self to a social origin apart from the drives.

They added, however, that those who have

adopted these theories, yet who also hold to the

drive theory as essential for a metapsychological

component in any psychoanalytical theory, fail to

realize that in doing so they have constructed a

theory that is quite different from Freud’s.

Kernberg has postulated the internalization of

dynamic systems with a self-image linked to an

object. The introjection of the object, however, is

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not entirely at the behest of oral impulses. At this

early stage, self and object are poorly separated

and affects can be intense, especially in violently

negative feelings. With maturity, the relationships

of similar affective tone build up into

identifications and eventually form the ego

identity. The drives thus play an initial part in

providing the affects from which the subsequent

organization of the person is built. The self

remains essentially as a phenomenological term

in the experience of relationships and their

subsequent organization by the ego.

Kohut is by far the most prominent writer to

advocate a radical view of the self as the active

agent in the initiation and organization of

behavior. He conceptualized the self at birth as

largely a potential only —one that is required to

merge with the mother to function in a

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progressively organized way and with a sense of

constancy and spontaneity. The essential dynamic

system is thus that of a self with a self-object, or

undifferentiated mother, operating in the earliest

stages as an ego. As separation proceeds with

development, the self becomes more autonomous

and effective; but a tie to others remains

throughout life even when the self fully

recognizes the separateness of others. The

closeness of the self with the self-object is such

that it is the subjectivity of this latter to which the

self mainly responds. With ordinary good

parenting, the self works through two critical

phases for its effective development. First, the

mother, as the main influence, has to respond
empathically to the infant’s presence and
achievements. From this experience, the self

gains a sense of omnipotence and grandiosity

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that, in due course, through interaction with

others, is transformed into a reasonable sense of

security, self-esteem, and achievement from

abilities. As this earliest structuring of a

grandiose self is taking place, a second

structuring begins from the internalization of the

admired parents as ideals. At first, the idealized

parents exist as undifferentiated self-objects, and

are then replaced by more separated ideal figures

that function as the ego ideal and superego. The

behavior characterized in terms of the libidinal

phases does not originate from fixations at the

libidinal stages, but from “oral, anal, or oedipal

disorders” in the parents.

Kohut’s theory replaces the drives with

factors arising from the experience of

relationships. The analytic process does not

reside in the interpretation of drives and defenses,

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but in the intersubjective field constituted by the
analysand and the analyst. In his first

formulations, Kohut stressed that he was not

replacing classical theory, but was instead

advancing a view wherein the dynamic

structuring of the self can be considered

alongside the independent processes of the

libidinal stages and the drive theory. In keeping

with this position, he regarded disorders of the

self as separate from the neuroses, which are

derived from conflicts between the drives that

develop later. Some years later, Kohut concluded

that the concept of “drive” was quite

unsatisfactory, but he then decided to avoid

breaking with tradition to preserve the sense of

continuity of our science. Such an attitude from

one purporting to make advances in a scientific

theory cannot but remind one of Galileo recanting

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from fear of the Inquisition! It is the more
extraordinary in that Kohut asserted, like

Fairbairn, that the sexual and aggressive

impulses, so prominent as symptoms, derive from

disorders in the self and not from independent

energies.

If we leave aside these “accommodations” as

dictated by political rather than scientific

considerations, Kohut certainly placed the

conceptualization of the self in the forefront of

psychoanalytic debate. His voluminous writings

contain many valuable clinical observations.

Nevertheless, he seems to present an

oversimplified view that distortions in the bipolar

structuring of the self, around the early grandiose
needs and the attachment to idealized objects,

explain all the major pathological developments

of the self. He also underestimated, in the opinion

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of many analysts sympathetic to the object-
relational focus, the ever-present manifestations

of aggression aroused when the needs of the self

are frustrated. But the essential limitation in

Kohut’s conceptual scheme is the lack of a

convincing metapsychology, one that links the

psychological to the biological factors that must

be present for the evolution of a structure of such

comprehensive responsibility for behavior.

Summarizing the progressive intrusion of the

self into psychoanalytic theory over the past few

decades, we note its growing prominence for

theory and practice. The influence of ego

psychology, so powerful among American

analysts, has led to unresolved differences. The

importance of conceptualizing identity formation

emphasized the central role of early relationships

and of subsequent relationships in the

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maintenance of identity. Only Lichtenstein,
however, of those closest to ego psychology,

favored the postulation of the self as an

independent variable from which the identity is

fashioned out of its relationships. Yet he stopped

short of a theory of the origin of the self, even

though he saw that the innately structured

potential self must be the start of a

metapsychology of the self. It is this problem of

conceptualizing an adequate metapsychology of

the self with biological roots that seems to have

deterred most of those theorists inspired by

Hartmann from moving from their acceptance of

the essential role of early relationships in
fashioning the personality on to a developmental

origin independent of the biological instincts and

the drive theory. It is this problem to which we

must turn our attention.

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I wish first, however, to refer to
considerations from outside the clinical situation,

because we seem to have created a major barrier

by confining ourselves to it. Historically, Freud

maintained that psychoanalysts should look to

literature to learn what writers have to say about

the psychological puzzles confronting us. As

observers of the individual within society, writers

are inevitably faced with the impact of various

movements—intellectual, scientific, artistic, and

sociopolitical — on the culture that in turn affects

the individual. They can thus identify the features

that bestow persistent personal characteristics.

SOME EXTRAANALYTIC CONCEPTIONS OF

THE SELF

Just as we can see Freud’s discoveries about

the unconscious as only one manifestation among

many related turbulences in the cultural scene of

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the Western world a century ago, so with the
recent interest in the conceptualization of the self.

From this complexity, I believe that some aspects

of the fields of literature, philosophy, the social

sciences, and psychiatry have crucial significance

for psychoanalysis because it has claimed,

following Hartmann’s work, to be the path to a

general psychology of the person.

From the start of his psychoanalytic studies,

Freud was greatly influenced by what the poets

and writers said about the nature of human beings

as an essential source of insight. Masud Khan,

although regarded as Winnicott’s principal
disciple, has made particularly relevant

contributions. His unusual combination of a

literary cast of mind and psychoanalytic training

have enabled him to offer acutely sensitive

observations of the phenomena within the

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psychoanalytic encounter. His observations are
also relatively free of the insidious theoretical

prejudices that accompany the use of technical

jargon. In the opening chapter of his book of

essays entitled Hidden Selves (1983), he quoted a

passage from Trilling’s Freud Anniversary

Lecture of 1955 that goes right to the heart of our

concern (p. 11):

The first thing that occurs to me to say about

literature, as I consider it in the relation in
which Freud stands to it, is that literature is
dedicated to the conception of the self
[Trilling 1955, p. 17]. ... In almost every
developed society, literature is able to
conceive of the self, and the selfhood of
others, far more intensely than the general
culture ever can. [1955, p. 19]

And, we might add, more intensely than

psychoanalysis does. Khan’s initial theme in his
essay is the emergence in European culture of

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modernism, a trend a characteristic of the literary,

in contrast to the scientific, mind. He perceived

Freud as not really a literary mind because he

always wrote about writers and poets as an

external observer. The feeling of writers when

they produced their work was something Freud

never conveyed. Instead, Freud fused a partly

literary mind with a scientific one, and it is the

analytic objectivity of the latter that is required to
work out the origins of phenomena as

experienced by others. The infinitely complex

interdependence of psychological, social,

political, economic, and other factors could not

be studied by the psychoanalysts. They might,

however, have been more interested in the
striking psychological phenomena that emerged,

for these were clearly determined by a serious

change in the psychic economy of the person.

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There were, for instance, the diminished

commitments to essential relationships such as

marriage and the family, and the substitution for

these of sexual gratification separated from love

in personal relationships —the “cult of

narcissism” as it was styled —and a rising greedy

demandingness from the welfare state.

Psychoanalysts were not indifferent to these

developments. It seemed that the development of

their work within the isolated privacy of the

consulting room had reinforced an underlying

lack in their theoretical account of the person as

inseparably interwoven with the fabric of society.

Their research could be restricted to people

regarded as closed systems within the boundary

of their skin. Put like that, such a view would be

vehemently rejected, especially today when the

focus of the analytic relationship is on what

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happens between the patient and the analyst. This

change, in fact, underlies what is perhaps the

missing component. For this change has now

shifted the center of our concern from the way in

which drives and their derivatives are defended

against (that is, hidden from the self and others)

to the nature of the self that has to contain these

conflicts.

For Freud, a scientist in the tradition of the

nineteenth century, the whole problem of the self

was scarcely conceivable, although its reality

could be recognized. Even today there is a

powerful tendency among scientists to view the

individual as a machine, or at best to recognize
the unique properties of the mind and then

consider its study as being outside the purview of

science. The core problem is the age-long one of

how an immaterial mind can be related to its

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material body. If we approach that problem head-

on, we inevitably encounter insuperable blocks.

What we can do, however —if we accept the

central role of the self as the agent that embodies

the organization of our experience and hence

controls the effectiveness of our behavior — is to

study its mode of developing and some of its

functioning; and these we observe from within

ourselves and through the inferences we make

from observing others, including their accounts

of their inner world.

Existentialism naturally highlighted the

problem of the self in relation to changes in the

culture, and its contribution greatly influenced
literature. Its effect, however, seemed to be

mainly to sharpen and emphasize the

phenomenological descriptions. The impact on

psychoanalysis was limited, perhaps because of

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the inadequate attention given to unconscious
processes. Among psychodynamically oriented

psychiatrists, especially in Europe, existentialism

aroused a widespread interest in directing therapy

to understanding the individual’s existential

conflicts. Laing combined his training in

psychoanalysis with a profound and extensive

knowledge of the phenomenologists and

existentialists to brilliantly expose the deeper

conflicts in the self. Nevertheless, although he

was widely acclaimed by writers and

psychiatrists, his impact on psychoanalysts has

been limited. His original data came from the

treatment of schizophrenic patients, and his
etiological factors were held to be psychosocial

forces within the family. Because of their

entrenched views linking the deepest

disturbances in the personality to the libido

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theory, the analysts may have felt uneasy with
theories involving only the dynamics of

psychosocial interaction, and thus separated from

the powerful biological origins of the instincts. In

other words, it seemed that the Cartesian tradition

might still be holding sway. Perhaps it would be

more accurate to suggest that even though the

framework of classical metapsychology might

need replacing, it nevertheless attempted to root

the personal level in the biological in a way that

had a deep appeal. Even though Laing pointed

out the failure of psychotic patients to achieve an

“embodied” self, there was no ready way by

which the self could be given a specific biological
foundation.

The Self within Society

When we put together these impressions from

some extrapsychoanalytic sources, we are

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confronted with direct references in much of our
literature to an autonomous self as a structured

entity that exerts a central control over personal

behavior. This self is fashioned from early

experience into an identity —the unique grouping

that each individual has of character, abilities,

and social relationships into a cohesive

organization that preserves a sense of continuity

throughout the life cycle. This identity or self is a

dynamic structure in constant interaction with the

social environment and its culture. When the

latter no longer provides the affirmations the self

requires, then the self tends to disintegrate, with
widespread disturbances in the sense of well-

being and hence various pathological reactions.

An investigation by my former colleague, E.

L. Trist, and his associates contributed to an

understanding of the nature of this deterioration

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in the maintenance of the well-being of the self.
The study was carried out in response to a request

to examine what was happening to coal miners

who had been organized into work groups in

which till the men had very restricted work tasks

designed from a “time and motion” study of the

job. Each group would take over from another

group operating in one of three shifts into which

the 24-hour day was divided. Coming to the

situation with a psychodynamic approach to the

whole person, Trist and his co-workers found, in

free exploratory discussions with the men, a

universal feeling that the job gave rise to a great
deal of irritation, boredom, and frustration.

Sharing tasks created little cohesion in the work

groups because supervision was focused on the

contribution of each man and each group

separately. No sense of responsibility or

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autonomy was fostered in the groups, so that
friction was prevalent within and between

groups, especially because no regard was paid to

how a group could assist the next one when it left

the coal face. By switching to an allocation of

responsibility for each group, to an overall

sharing of the task, and to an organization of

work related to both the human needs and the

technical constraints, there was a significant

change in what can only be seen as responses of

the men as whole people. Absenteeism and sick

leave diminished significantly and production

increased. In short, the workers as a whole

functioned better when the quality of their self-

feeling improved from a recognition of their

autonomy.

Another study also suggests that an unstable

environment has a negative effect on a person’s

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overall organization. Wolff, a physician
concerned with community health, studied the

health records of a large sample of people who

had been displaced from their home countries to

another. He found that the incidence of almost

every kind of illness — physical as well as

psychiatric — was higher than normal in the

period following the change.

Whether or not a specific biological

foundation can be established for the self, these

findings strongly support the conviction among

the most discerning writers that when the self is

not functioning well, whether because of

pathological development or current

environmental stress, then the consequences of

what Balint termed “the basic fault” can be seen,

probably over the whole psychobiological

structure of the individual, involving both mind

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and body in varying degrees. How, then, is this
structure, which is crucial to the person, to be

conceived of if we are to do justice to its origin

and nature? It is clearly an open system, that is,

one whose organization is maintained only when

its interactions with the environment are

appropriate to the needs of the human being—

physically, socially, and creatively. This is the

question to which both clinical and other sources

of evidence force our attention.

THE NATURE OF THE HUMAN ORGANISM

IN THE LIGHT OF MODERN EVOLUTIONARY
BIOLOGY

The basic assumptions of Freud’s thinking

were those of scientific materialism and its view

of what is “retd.” It is from these that the “drives”

are made essential to subsequent theoretical

development. As Greenberg and Mitchell (1983)

emphasized in their excellent account of the

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mainstream of theoretical thinking in

psychoanalysis in the past few decades, there is a

striking paradox in the fact that, increasingly, the

theory is recognized as inadequate to account for

the person in his or her most characteristic

aspects—namely, the autonomy of the self. The

self, as the central agent controlling personal

behavior, develops from its experience in

relationships and its indispensable role as a

dynamic structure that constantly maintains a

process of interaction from which

transformations take place. Moreover, despite the

perpetual changes resulting from experience, the

continuity of the individual self is preserved. This

concept requires a different scientific paradigm.

The science in which Freud was reared

sought to reduce “the human world to the

equilibrium perfection, structural unambiguity

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and permanence, hierarchical control, and

predictability of machine-like structures” (Jantsch

1976, p. 2). Freud never exclusively adopted all

these beliefs, yet much of their spirit pervaded his

thinking. The current biological paradigms offer

some different lines of thought, but there is an

overall change to a process-oriented

understanding instead of one employing rigid

system components and structures composed of

them. In adopting what I find the most
appropriate paradigm to fit the problems
presented by the self, I have borrowed much from

the views of Waddington and Prigogine, which in

turn have inspired Jantsch to pursue their

implications for the human sciences. The new
perspective is, above all, a direct result of

assimilating the fundamental place of evolution

in considering living organisms. All present

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forms of life have originated from earlier forms,

and what we must account for are such

characteristics as self-organization and self-

regulation, with nonequilibrium and

unpredictability of differentiation in the

development of new structures from interaction

with the environment. What is real in these

continuous self-renewals and self-expressions are

the self-bounding processes rather than the

changing structures. Although evolution has led

to many organic subsystems that maintain an

equilibrium, this “homeostasis” does not obtain

for the organism as a whole. There, equilibrium

means death because it ends the never-ceasing

processes of self-transformation and self-

organization that constitute life. As said by Sir

Julian Huxley, our perspective must be sub specie
evolutionis rather than sub specie aetemitatis.

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Although the bodily structures have not
changed much in humans since they acquired

their distinguishing features, there have been

relatively enormous developments in the human

nervous system. The most significant feature of

this development is that the brain structure of the

saurians, the earliest animals in the most relevant

level of the evolutionary scale, has proceeded to

the later ones by the addition of two organizing

structures. Each of these has mediated what we

might term quantum leaps into a quite different

level of flexibility in behavior from that of the

previous level. The changes, of course, although
resulting in enormous differences, are the end
product of very long-term evolutionary processes.

The result is that human behavior in its eventual

mature form is influenced by these underlying

earlier modes of responding to the world.

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Clearly, we can refer to this evolutionary
process in only the sketchiest diagrammatic way.

But because the human position in the

evolutionary scale is crucial in understanding

human nature, even such a limited reference must

be in our thinking. The first consideration,

however, must be to note the characteristics of

the living creatures associated with the quantum
leaps into quite different modes of behavior

compared with the earlier phases. The most

relevant evolutionary stages for present purposes

are those of (1) the land-dwelling reptiles, (2) the

lower mammals up to the higher apes, and (3)
homo sapiens. The crucial feature is the

development of the brain achieved at these three

stages.

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Behavioral Evolution of the Self

Before considering brain development, the

nature and organization of the behavior of the

animals in each of these stages must be noted,

because the behavioral changes evolve in parallel

with structural additions to the brain that mediate

the new behaviors. We assume, of course, that

evolution is the means through which a given

species increases its capacity to exploit the

environment more flexibly and more creatively,

so that its constraints are progressively overcome
until the point is reached, with humans, where
they largely determine the environment.

Evolutionary theory has changed in recent

years from crude Darwinism, with its survival of

the fittest (a distortion of what Darwin

suggested), to the need to consider the population

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or communities from which genetic variations are
selected. We then have to appreciate how the

behavior of the phenotypes, or existing forms of

the adult animal, as a factor independent of the

particular genic inheritance, can decisively affect

the latter. This view, as developed originally by

Waddington, has shown how behavioral

characteristics developed in various ways by the

animals can lead to changes in the transmitted

genes and so bring experimental evidence to

justify the widely held view that evolution could

not rest on chance and necessity in the blind way

it was once held to operate. According to this

view also, the genic inheritance increasingly

allows the environment to play a greater part as

the evolutionary scale is ascended.

What we must keep in mind is that an

unconscious primitive organization, or “self,”

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appears to continue to exercise an influence on
brain functioning and thus on our behavior when

the later evolutionary modes are overwhelmed.

As we move up the scale to humans, the

enormous complexity of the brain is difficult to

appreciate, yet we must do so if we are to

comprehend the human self, the essential

organizing principle, in an evolutionary

perspective comprising the distinctly human

acquisitions. Assuming that the brain has evolved

to provide for their growth and development, we

must list these acquisitions as accurately and as

comprehensively as we can. The following six
elements are a tentative attempt at such a list and

are intended wholly as a basis toward elaborating

an evolutionary perspective.

1. The unique property of the human mind is

consciousness of “the self” and the capacity
to transcend itself, to look at itself in its

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relationship with aspects of itself, with
others, and with the physical environment.

2. The dimension of complexity refers to many

different functions. Thus, compared with the
nearest animals, the higher apes, the
cognitive capacities permit an infinitely
greater storage of information. There is also
the unique degree to which humans evolve
an “inner space” in which to create
representations of themselves interacting
with other figures and with things in their
world. Also, these creations can be close to
reality in form or completely changed to fit
fantasy wishes.

3. While the “I” in these imagined relationships

can have a representation to express its
feelings in any particular relationship, there
is ordinarily a continuity of feeling that it is
the individual’s own self within the changed
character.

4. The self, or “I,” is the agent responsible for all

its varied motivations. This is the sense of
autonomy of the self that is a normal

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characteristic. Although not in awareness
most of the time, its perpetual immanent
presence is at once revealed when it is
threatened or ignored.

5. The autonomous self is the direct successor of

the organizing principle in the embryo. After
birth, however, it seems to act as we might
imagine the reptilian brain mediating a sense
of unity, that is, with peremptory action at
the behest of the innate behavioral systems,
only one of which (for example, hunger, sex,
or attack) can assume a dominant position at
any one time.

6. Although a primitive form of organizing

principle may operate at early evolutionary
stages, this principle is restricted by those
genes that have been active up to that period.
They have initiated the development of the
behavioral systems required for the adult
animal, which can then survive in the
environment for which they have evolved.

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Social Evolution

When we reach humans, there is a radically

different situation. Humans have evolved to

become social animals who can survive only in

small groups —at the Neanderthal stage, and

thereafter only in communities that rely on a high

degree of control of the environment virtually to

the point of creating it. Paramount in this

development are the means for keeping the

community organized into a functional whole; for

protecting it and its resources against attack, a

danger coming almost exclusively from other

communities; and for creativity in adding new

ways —especially technological ways —of
increasing resources and then of transmitting this

acquired knowledge.

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To fulfill these functions as well as others that
arise with new situations, evolution has created

homo sapiens, and for present purposes we can

single out only some of the characteristics that

would appear to be crucial in human

development: (1) the essential nature that makes a

social being and how it is developed and

maintained; (2) how instrumental resources

develop; and (3) how, with the capacity to see

themselves as actors within the world, that is, to

experience and reflect on the existential situation,
humans cope with the new situation of pondering

the “meaning” of all that they are now aware of.

Lower forms of life evolve highly elaborate

and effectively organized communities on the

basis of simple innate patterns, with individual

members carrying out prescribed functions. The
whole thrust of evolution, however, has been to

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foster the flexibility, resilience, and persistence of
human groups by maximizing the potential

resources within each individual rather than to

confine communities to rigid hierarchical

organizations.

By social being, we refer to the human

consciousness of being a unique person aware of

one’s own identity and boundaries in relation to

others. We have noted how gradually and

reluctantly the concept of an autonomous holistic

organization has been recognized as necessary to

account for the experience and behavior of the

person. We also must recognize that its

structuring is an ongoing process. Our

experiences are encoded, ordered, and used to

build up and apply knowledge, a process that
seems to be required in an active intentionality of

the whole. The self is more than a computer,

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although many of the activities of the brain make
great use of such processes. But the outer world

is a vast array of possible data from which the

mind of the person selects and organizes, and our

clinical and observational studies ail suggest that

the basis for this creative selection resides at first

in the powerful innate impetus to make

“personal” relationships with the mother and then
others. The experience with the ordinary good

mother seems to be a basic requirement for the

development of the active exploratory behavior

that the infant is equipped to release. Above all,

human relatedness rests on each person being
governed by a self that can be created only by

other selves.

This development has complex roots. The

genic equipment prompts the groping, but the

effective behavior then has to be learned. Therein

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lies one of the great breakthroughs in our
understanding of the nature/nurture controversies

that gave rise to deep, bitterly defended schisms

in the scientific world until a few decades ago. In

mammals, the fertilized egg is kept inside the

female, to be followed after birth by the closeness

from the adult to equip the child to fit in with the

environment it will inhabit. Although humans

lived in the ape-man stage as a social animal with

resources for communication with others, the

evolution of language made them capable of a

very different interrelatedness. Language made

selves known to other selves. Suckling the young

also introduced a new factor into development,

namely, the giving and receiving of tender loving

care. Prior to this, attachments were made, but the

complex feeling of “love” now appeared for the

first time.

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It may well be thought that I am recounting

what is all too familiar. It is, and yet it seems so

familiar, so much taken for granted, that its

significance for the evolutionary perspective on

the functions of the self is often overlooked. To

account for the incredible resources that humans

have acquired in controlling their environment,

psychoanalysts have been satisfied with

extraordinarily simple ideas, such as the ego

developing to satisfy the instincts by an atomistic

buildup from experiences. I believe all the

evidence points to what appears to be a logical

necessity —namely, a much more prepared

foundation within human inherited endowment.

We know that humans are now born, whatever

their race or culture, with the vocalizations

necessary for language, and that the particular

language they learn will be that of their culture,

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transmitted by their caretakers and then their
family and peers. The experience of nurturance

“completes” the self by personalizing it. The self

is then permanently related to others because

others have been built into it, with the intense

need for changing from infantile dependence to

that dependence between autonomous adults. In

this later feeling is the need to belong, to which is

added the role of sexuality, which itself expands

to the creation of the family.

In place of the hunter-gatherer life, the place

of “work” is difficult to specify because of the

change in its character and function, especially

with constant technological advances. The

significance that work once brought has been

disturbingly exposed, as technology removes its

deeply felt role. What seems to be present among

the effects of unemployment is much more than

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the loss of wages. With no prospects of work,
people feel lost in a personal way, and the rise in

explosions of violence seems to express a degree

of frustrated rage, as though an attack or insult

was being perpetrated on adult selfhood. It is

perhaps noteworthy, too, that not only is a

positive need denied satisfaction, but the

autonomy of the person is also undermined by

enforced dependence on the community. As well

as apparently satisfying a need to be involved as

a contributor to the community, work gives a

great deal of expression to instrumental talents

and skills.

Although these points are in no way meant to

be a systematically ordered listing, I believe they

are sufficiently indicative of the functions that the
individual self has to fulfill if humans are to

survive. The functions conspicuously

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characteristic of humans depend heavily on
language. Social animals lower in the

evolutionary scale use various sounds and signs

for communication in specific situations, as in

warnings of danger, in mating calls, or in shared

contacts of limited scope. Language, however,

represents what has already been described as a

quantum leap in the capacity to share. In the first

place, it is not learned by an atomistic buildup

from sensory elements. It is assimilated from the

communication of the subjective state of the

mother with that of the child. Stern quoted

Vygotsky as maintaining that the essential

problem of understanding language acquisition is

how meanings enter the child’s mind through the

process of mutual negotiation. This achievement

follows the capacity to have representations of

things by imagining them and so to use them as

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symbols. Imaginative play with symbolic objects
and with words when these become the symbols

permits enormously increased development in

knowledge of the world and in the

communication of subjective states and

intentions. All these make possible the degree of

sharing between minds that the constant close

relationships of living in communities entails.

The continuity of self-feeling must be maintained

if this experience is to be preserved with a

cohesion of vastly enriched organization. Only a

unity could act as the agent employing all this

knowledge in planning action; and with its
consciousness, this gestalt is the self.

Early Development of the Self

The first preoccupying activity of the self is

learning how to relate effectively with the
mother. Feeding, of course, is dominant but not

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exclusively so. Sucking is mediated by a mother
who, with the infant, fits the joint behavior into a

successful pattern. The infant must be innately

equipped to incorporate from the breast and to

take in from the world, with a hunger originating

from both sources, needs that can be recognized

and responded to by the mother. At first, the self

does not need to be conscious of itself in the

manner of the adult. In an environment that is

actively anticipating and providing for the needs

of the self, the organization of experience can

proceed by a sentience that monitors and

distinguishes what feels “right” or “good” from

what does not meet the tensions of need and so is
affectively frustrating—that is, “bad” or “wrong.”

The growth of self-awareness, however, must

begin early to develop the capacity to be alert to

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the attitudes of others by recognizing their

emotional states.

The clinical evidence from disorders in the

self strongly suggests that effective development

of the self rests on a joyful, empathic

responsiveness from the mother. Various limited

frustrations of particular behaviors can be readily

tolerated if the overall feelings communicated by

the mother, and later by the father, come from a

genuine joy in the baby as it is. Such an attitude

puts no pressure on the baby’s spontaneous

maturational achievements to match

preconceived images the parents may be using as

molds into which, often unconsciously, the baby
is to be fitted.

Good-enough mothering gives the first

“layering” in the structuring of the self as a

person. At this stage (I do not think we can be too

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specific in terms of age), the main achievement is

a self that can feel secure and ready to explore

and incorporate the world as physical and

psychological capacities and talents emerge.

From the start, an immense amount of experience

with the social and physical worlds is rapidly

acquired. A “person” seems to be being

established at first without much differentiation
of gender, even though babies are responded to
somewhat differently according to their sex. The

next main structuring is for this person to become

more specifically a male or female. It would seem

from disorders of the self that the relationship

with the father now becomes of critical

importance. The growing assertiveness of the boy

must be responded to as before by the mother’s

joyful acceptance, but the father’s acceptance

now needs to be available as well for both the girl

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and boy infant. I have also concluded that, for the

eventual integration of the self, the relationship

between the parents and their joint attitudes

toward the child are almost as critically important

as that of each parent separately.

In the earliest months —the traditional oral

stage —there seems to be no question that orality

represents a more general incorporative need for

which the alimentary function is the prototype.

The infant needs to incorporate the mother in a

personal way, that is, as having the significance

of a whole object and not one confined to the
feeding activity. The affective qualities of the
physical and psychological incorporations,
however, seem closely linked at this initial phase,

if we are to explain how greed for food or drink

is so often substituted later for personal

deprivation. In addiction there is, of course, as

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the physiological result of the intake, the ensuing
feeling of relaxation, of general loss of tension

from frustrated social needs, and eventually of

being in a state of some euphoria.

The question of how much the infant self is

differentiated from the mother has tended to be

regarded as settled by the assumption that there is

a phase of nondifferentiation. This belief has

been related to the phenomena of merging and

identification, and also to the amount of

differentiation or perception of a separate figure

that would be possible with what is known of

neurophysical development. Stern (1985)
strongly advocates a recognized differentiation of
the infant’s own boundaries as present from birth,

based partly on the grounds that it is difficult to

see how two separate psyches could be

undifferentiated, but mainly based on the findings

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from the infant-mother studies. From what we
have stressed about the operation of an innate

organizing principle, it would entail from the start

in any organism a powerful assertion and

maintenance of autonomy and of the integrity of

its wholeness.

It is not at all fanciful to imagine such a

powerful autonomy being present, yet covered

over by the closeness of the attachment of the

infant to the mother. When a self is postulated as

the realization, from experience in relating to the

mother, of a potential in the form of an innate

gestalt that has the “shape” or “feel” of a person

built into it, and that is strongly motivated to

encounter this shape in the outer world, then a

phase of undifferentiation is neither necessary nor
conceivable. Such a gestalt would be activated

not by energies external to it, but by its own

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nature to seek completion from the appropriate
sources in the environment. This assumption

implies nothing different in principle from the

other innate behavioral systems, for example,

seeking the breast and “knowing” when it is

found. There is no doubt that the ordinary mother

(and, indeed, adults in general) is highly and

innately motivated to respond to the infant from

the earliest stages as having this “potential

person” quality.

We know, too, that sucking from the breast is

not the action of a passive infant being supplied

with all it needs. The infant shows a pronounced

dynamic of its own to regulate the feeding

process to match its own feelings, to train its

mother, so to speak, in what is a relationship of
mutual satisfaction. When things do not go well,

there is marked disturbance in the infant’s whole

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state. It is also well recognized that although
various physical factors may cause difficulties,

problems also commonly arise when the mother’s

attitude differs from that of the ordinarily

spontaneously responding mother. Serious

frustrations are then felt with great intensity, as

witnessed in the infant’s increasingly desperate

signals that things should be put right. The self-

feeling in these circumstances is undoubtedly one

of disturbed security, with inhibitions in the

readiness to relate to the external world socially

and in instrumental inhibitions of various kinds.

We also need to note Spitz’s (1965) finding that

meeting the bodily needs for food does not

necessarily keep the baby alive. There is a hunger

for stimulating exchanges with the caretakers that

must be satisfied to foster a vital dynamic to go
on living.

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We cannot deal with all the specific features

of the rapidly changing situation of the infant

with its mother. I simply wish to indicate that

autonomous reactions — either positive, in which

case the dynamic of the self is encouraged, or

negative, when it meets with varying degrees of

deprivation, from the less intense to violent

expressions of aggressive behavior—all point to

affective experience and responses that constitute

an independently operating infant self. The

infant’s recognition of the boundaries of its own

body at quite an early age also suggests that this

differentiated self is present then (as in Stern’s

striking data on Siamese twins).

Intentionality

The existence of a subjective sense of the self

and its conscious intentionality is strongly

suggested by the observational data on infants

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approaching the end of their first year. The infant

also “understands” the mother’s subjective state

about this time (for instance, see Stern on infant

and mother “pointing,” and the “visual cliff”

data). By the end of the second year, the

subjective sense of self, and of the self as agent in

creating imagined relationships to gratify

fantasied relationships, is clearly established.

Stern’s account of the emergence of the core self,

the subjective self, of each of these with “the

other,” and finally the verbal self and the

narrative self presents a convincing picture. What

I believe to be one of its most fundamental

implications is the role of holistic patterns from

the start. Particularly important is the discovery
of the innate organization of transmodal

perceptions with integrated modes of response.

We cannot conceive of such integrated holistic

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activity without assuming an integrated whole
that mediates it. Although not so confidently

established, it seems to me of great importance

that Stern virtually accepts Trevarthan’s belief in

the existence of an innate capacity for the shared

awareness of human subjectivity. Moreover, I

find highly plausible Trevarthan’s view that this

developmental leap represents the differentiation

of a coherent field of intentionality.

Intentionality has recently become very much

a focus of philosophical concern. Its existence is

much more difficult to conceive and to establish

when we do not take into account the
evolutionary development of the self; and, of
course, for the physically minded theorists, it is

thought to be a vitalistic notion. Thus, assuming

the absolute necessity of the organism to maintain

interchanges with the environment — an

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assumption so obvious when bodily processes are
considered —a necessary condition for the

survived of homo sapiens, the social animal par

excellence, is the constant outreach to grapple

with and overcome the limitations of the

environment, both social and physical. The

cognitive explorations required here would alone

make for a perpetual intentionality, but the innate

dynamic of the person at all stages, apart from the

need to relate to others, has this need to keep

realizing the self through the incessant urge to

know more. That was what the Romantic poets

sensed in their appraisal of the pleasure from

knowledge and the deep identity of truth and
beauty. What evolution has created so far is this

innate organization that, out of its experiences,

evolves the personalization of the organizing

principle in a creative interplay between the child

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and its family, and subsequently between
individuals and their culture. The subjectivity of

the person is an incredibly sensitive monitor for

regulating personal well-being, a sense of being,

and with the further sensing that this feeling is

only “right” or “complete” when it incorporates

the innate need for “being” to be always

“becoming.” This truth is proverbial in almost all

cultures, and I shall mention only this saying in

the Gaelic culture of Celtic Scotland: “Joy of

seeking, joy of never finding!”

It is from the interplay of the self with its

culture that Erikson’s epigenetic phases evolved.

Characteristically, his phases are not tied to
libidinal zones, but to changes in the quality of

the dominant self-feeling in its relationships with

its society. The patterns of relatedness thought to

be derived from the libidinal zones are there. As

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Stem stressed, these patterns do not constitute a
succession of stages, with each replacing the

predecessor. What we now see to be covered by

“orality” is the behavior determined by the

intense incorporative needs to secure the

appropriate intake from the environment, bodily

and personally, for the developments urged by the

genic inheritance. The resultant oral structuring is

one that maintains a permanent process in the

continuing of the self-process. Our clinical work

demonstrates daily the labile balance of the

appropriate give and take in social relations. With

the good-enough mothering experience, this

balance is maintained from everyday
transactions. Where this experience has been

lacking, we see greed and infantile dependence

reemerging as the regression to more primitive

modes of “taking in” to make good the

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deficiency. Early stages never disappear but
remain as modes of relating that can be

reactivated by various environmental factors.

Intersubjective sharing, as mentioned earlier,

is the means through which individuals can relate

with rapid appraisals of intentions and affects in

others. This sharing develops from the

simultaneous acquisition of self-awareness and

the knowledge of the self-states of others. In

short, the person is created from interchanges

with other persons. Infant development research

shows the progressive gains and their

extraordinary rapidity from the latter part of the
first year onward. The period of the most intense

socialization has been described by Bowlby and

his colleagues in terms of bonding and

attachment theory. The attachment phenomena

are very real, but I do not think these terms are

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adequate for the ongoing inner processes. The
period of intense closeness that lays the

foundation for attachment is used by Mahler as

the one for the symbiotic relationship from which

individuation evolves. For myself, I find it

clinically much more useful to see the closeness

as necessary behavior for the gestation of the self.

Far from being undifferentiated, the self is being

formed steadily, and any interference with this

self-determined dynamic elicits intense

aggression. Not unexpectedly, the embryoniclike

state of the self needs the closest contact with the

mother’s “self” as well as her care.

The concept of an innate dynamic gestalt

underlying the formation of the person resembles

Lichtenstein’s organizing principle, which

constitutes the potential self that is then

personalized by the earliest relationships with the

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mother. Moreover, this potential being
personalized by this specific experience becomes

the unique identity of the person. I have

suggested that this potential be conceptualized as

an inherited gestalt that seeks to become a person

by finding the “expected” encounters. (Such a

possibility is fairly readily conceivable today

with the discovery of such holistic fields of force

in the organism as are revealed in holograms.)

The fitting of a particular gestalt with its

environment is a process going on all the time.

Postulating a central agent implies a view of

development proceeding from this center by

differentiation, with the creation of various

subsystems.

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22.

FAIRBAIRN AND THE SELF

In their superb account of the central issue in

the development of psychoanalytic thought

during the last few decades, namely, the dialectic

between the drive theory and object relations, Jay

R. Greenberg and Stephen A. Mitchell (1983)

describe Fairbairn’s contributions as having “a

lasting place and a seminal role in the history of

psychoanalytic ideas” (p. 176). Probably only a
small proportion of analysts could evaluate such

a judgment, because this work has been largely

ignored. Apart from Guntrip’s (1961) enthusiastic
advocacy, few careful appraisals have been made,

the most notable exception being that of

Greenberg and Mitchell. They give various

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reasons for this neglect amongst which is the fact
that he never produced a coherent and

comprehensive theory but left a series of papers

he described as “the progressive development of

a line of thought” (1952, p. x). It occurred to me

that a useful way of paying tribute to his work

would be to consider the position at which he had

arrived and then to suggest one direction in which

his line seemed to be heading. Obviously this is a

speculative exercise on my part; nevertheless I

believe that an assimilation of his work and his

personality lead one to ponder where

psychoanalytic theory might go in furthering its

development.

Like many thinkers, Fairbairn often stressed

the importance of factors in the personality that
would influence the form of his creativity. In
formulating an alternative to the metapsychology

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underlying Freud’s structured theory, I wish to
refute Winnicott and Kahn’s (1953) suggestion

that Fairbairn’s motives were in any way “to

knock Freud.” Fairbairn’s attitude to Freud was

never other than reverential, but he made a clear

distinction, which Winnicott blurs by referring to

the person and not his theories. For a cultured

scholar, to challenge seriously the views of

another thinker is the highest tribute that can be

paid to him. Moreover, Fairbairn, while he

naturally wished his contribution to be

recognized, was dedicated to the development of

the psychoanalytic endeavour as a whole. He

rejected at once any attempt to make a distinct

school from his views. He regarded his own work

as a part of the developing understanding that he

believed to be an urgent need in the current

theory.

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The essential personality features that fired
his thinking were, of course, the main motives,

and especially the unconscious ones, that

determined his perceptions within the analytic

situation. The following brief notes on his

personal development will provide data for an

appraisal of some of these forces.

FAIRBAIRN’S PERSONAL DEVELOPMENT

Fairbairn was the only child of middle-aged

parents in whom the formalities of conduct had

all the prominence given to them in the later

stages of Victorian Britain. His father was a
valuer whose background was socially limited

and with the harsh religious Calvinistic values

that were upheld with the particular sternness
prevalent in Scotland since the Reformation.

Attendance at Church twice on Sundays was

maintained rigorously.

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His mother, a surprising choice of wife for a
strong Calvinist, was English and an Anglican.

She came from Yeomen stock who had farmed

their land in Yorkshire since Norman times. Any

freer attitudes from her religion were

overshadowed by her controlling nature; she was,

in fact, somewhat of a martinet. Both parents

provided devoted care but in an atmosphere from

which much of the joyful spontaneity of the

ordinary family was missing. A nanny, however,

gave their son some of the vital quality. On the

positive side, they encouraged him in his

intellectual development, allowed him to share in

their social life, and his father took him to places

of interest. An important experience was the

frequent holiday visiting of relatives and friends

where he mixed with cousins and other children.

Several of these families had close links with

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Anglican clergymen who introduced him to a

very different picture of life within the Church

groups, one in which there was a good deal of

lively spontaneity.

Behind the social exterior, however, there

were disturbing and puzzling forces. His father

could not urinate unless all the rest of the

household were out of sight. This difficulty,

however, was painfully confused for him by an

incident in a train. The family was travelling to

go on holiday in the north of Scotland. There

were no toilets on the train and the father got into
a great state from a compulsive need to urinate.

This was done in the carriage with Ronald sitting

opposite his father, holding up a newspaper as a
screen from his mother and other ladies while his

father urinated on the floor in obviously great

distress. This incident left a profound mark on the

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boy then 8 years old. Also about this period was a
traumatic experience with his mother. He had

seen some blood-stained diapers in a pail and

expressed his curiosity to his mother. She flew

into a frenzy of rage, beat him, and locked him up

for several hours. She became preoccupied in

these early years with a need to stop him

touching his penis, a proscription that was

accompanied by threats of the awful things that

could happen to men who did this or who went

with bad women. She thus became an extremely

frightening figure in regard to the assertion of his

masculine sexuality, while his father remained a
mystery in this respect.

As the only child in this setting it was

inevitable that he should turn to his inner world

with a great deal of fantasy life. Nevertheless, he

was not a social isolate. At school he held his

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own with others, largely relying on his
intellectual interests, but never liked school

because of a feeling he did not possess their

ability to assert themselves in games and in

sexual exhibitionism in adolescence.

His inner imaginative life, however, was

responded to, and that a positive self-feeling was

being established was seen in the way he adapted

to the constraints of his environment. Amongst

his interests he began to respond to the Church

attendance by appraising the sermons and

assimilating the Christian gospel. His early

adolescence was beset with torturing conflicts

about the emergence of his sexual feelings and

the now perpetually active internalised mother

keeping him under observation. The denied of his

physical masculinity had inevitably left residues

of hate and resentment tied to his internalised

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parents, the savage mother who had attacked him
and the father who had failed to establish himself

as a strong loving figure supporting his natural

development. This sense of deprivation and the

aggression associated with it had earlier roots,

however. He seemed not to have felt an overall

loving encouragement from his mother’s

controlled attitudes and, though there is a very

early memory of a helpful father, he became

mainly a part of the parental couple who

excluded him. A reference to an early bed wetting

scene that Fairbairn made later appeared to be

associated with attacks on this parental

relationship.

By the time he was about to enter the

University, he had evolved an internal change
that in many ways was an ingenious constructive

solution to all these conflicts. He decided to

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become a clergyman. This choice was acceptable
to his parents and, at the same time, it permitted

him to aspire to owning his masculine sexuality

within the confines laid down by the Church and

in his immediate life, to explore intellectually

what had become a powerful urge, namely, to

understand the phenomena of conscience, sin,

and guilt, which seemed to him so bound up with

sexuality. Through this ego-ideal he could release

the pent up forces in his repressed masculine

assertive self. Through a relationship with God as

his loving and beloved son, he could abjure hate

and make reparation to his parents through the

strong altruistic drive to help others in their

psychological stresses. The intense confusion

induced in his boyhood by his mother’s branding

of his penis as a potential source of so much evil

was now replaced, in consciousness at any rate,

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by its acceptance for procreation. The resolution
of his oedipal situation was, nevertheless, a

complicated one. He had chosen to take the

degree in philosophy before he went on to

theology in the hope that he would clarify the

moral issues his sexual feelings had raised. Also,

as it was in the philosophy department of the

university that psychology was taught, he would

learn about sexuality as an innate propensity in

man in an academic way freed from the irrational

views he had encountered at home. However, a

conflict between his parents now arose over his

going to the university. His mother, who had
become progressively ambitious for him, socially

and professionally, wished him to go to Oxford.

For his father, this was not to be contemplated.

For one thing, it would be expensive and, if he

had to go to the University at all, there was a

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highly reputable one on the doorstep.

Furthermore, Oxford was overrun with so many

Anglican clerics who were morally lax and part

of an episcopacy. This negativity was greatly

resented by Fairbairn, and it stirred deeper levels

because it was felt to be part of a long-standing

disposition to deny him opportunities. The result

was that, while his father accepted Edinburgh

University, Fairbairn now felt his mother to be his

ally and his father the castrating parent in regard

to the thrust of his life.

Intellectually he was in his element at the

university and socially he took part in various

student societies devoted to scholarly issues or to
social causes. The inhibition of his sexuality,

however, was to be seen in the absence of any

emotional relationships with young women

though he made the acquaintance of several. His

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practical Christianity, which was sincere and

deeply rooted, found expression in his work with

youth groups in deprived areas. Though

essentially introverted he had many friendships,

mainly with people who shared his interests, and

several of these were maintained throughout his

life. With those with whom he felt at ease, he

could be lively and entertaining, although the

outer layers of reserve and formality were there.

His dominant interest, however, in human and

social problems usually focused on the need to

understand the essential principles underlying the

presenting behaviour; and he was sharp in his

critical appraisals of the assumption made.

Appropriate conceptual rigour was an absolute

requirement for him as a basis for action. It

represented a demystification about what was

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being felt by people, in other words, an undoing

of his early experience with his parents.

The university teaching was a great

disappointment in one respect when he found

almost as much evasion over the issues of

conscience, guilt, sin, and sexuality as he had

found at home. The intellectual discipline,

however, was congenial with its strengthening of

his self-confidence in the intellectual field. The
avoidance of open discussion of the issues that

were so important to him may well have urged

him when he completed his philosophy degree to
spend a year on Hellenic studies with visits to

some of the European universities.

In the autumn of 1914 when he was 25, he

began the theological training in Edinburgh

University. The First World War had recently

begun so that there was the question of joining

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the armed service. His mother tried to keep him
at home but he settled the conflict by joining the

Royal Artillery the following summer. It was not

until 1917 that his unit went to Palestine where a

few months later he took part in the triumphant

entry into Jerusalem. While in the army he had

become keenly interested in the “new

psychology” developing from the writings of

Freud and Jung, and within a few weeks of his

discharge from the army at the end of 1918 he

had begun to study medicine with the aim of

becoming a psychoanalyst. The determinants of

this change were many, including an aversion that

had grown towards preaching and the positive

motives of acquiring sound understanding of

human conflict along with the means of offering
practical help. In the middle of his medical
training he began a personal analysis with E. H.

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Connell, an Australian business man who had
moved to Edinburgh to become a medical

psychotherapist. He had had analysis with Ernest

Jones so that his experience had been in the

Freudian approach. After gaining his medical

qualification in 1923, he did a short spell in

general practice and then proceeded with training

in general psychiatry. In 1924 his father died

unexpectedly from septicaemia and Fairbairn

seemed to be liberated by this event. He arranged

expeditiously for his mother to be established in a

new home, and he began his private

psychoanalytic practice in 1926.

In the spring of that year he met a young lady,

a medical student, with whom he rapidly formed

a close relationship and they married in the
autumn. She came from an old landed family and

was used to a more social life than Ronald. He

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joined in this pattern for a period that ended with
the birth of a daughter in 1927.

Despite the radical changes in his life

situation his intense investment in his

psychoanalytic work grew steadily. He was

brought into contact with Jones and Glover and

with the latter he became quite close friends

though they could meet only occasionally. To

them Fairbairn was clearly a good recruit to the

movement with his manifest knowledge and

dedication. He considered a move to London, but

with no suitable post available, he remained in

Edinburgh. Appointments to the departments of

psychology and psychiatry were very helpful, for

though financially they were of little value, they

gave what to him was of great importance,

namely, membership in the academic world. His

broad education in the humanities, theology, and

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then the medical sciences had given a greater
definition to his profound impetus to further his

understanding of the person. Intellectually, he had

become completely convinced that scientific

materialism and atomistic approaches could not

account for the unique qualities of the individual.

The psychological field was, for him, the study of

the human being at the personal level, a view that

assumed the personality to act in a holistic

manner.

Fairbairn’s devotion to the understanding of

human nature was thus closely similar to Freud’s.

Unlike Freud, he was also imbued from his own

early unhappiness with the therapeutic aim of

relieving the suffering caused by psychological

distress. For him, however, this motive in no way

detracted from his scientific concern. To study the

person at the personal level with all his

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subjectivity had to be the essential focus.

Concepts that reduced personal phenomena to

impersonal processes were not acceptable to him,

a philosophical stance which, from his student

days, he retained uncompromisingly all his life.

In his first clinical paper, written in 1927 though

not published until 1952 when he included it in

his book, interestingly enough is a study of some

features in the religious phantasies of a woman

patient. He relates the patient’s sexual feelings

and phantasies to the classical oedipal situation

and the libido theory, but there is at the same time

a recognition of these and her religious

phantasies as attempts to meet the need for a
missing personal relationship with her father.

In the next few years he made an intense

study of Freud and Jung for his postgraduate

thesis on a comparison of Freud’s concept of

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oppression with Jones’s views on dissociation.

Although he strongly favours Freud’s line of

thought, he criticises some of his concepts,

especially that of the id compared with those of

the British psychologists and philosophers who

regard the innate propensities as structured by

experience. As he mentioned later, he felt that he

had now mastered the principles upon which his

work was being based.

A second clinical paper was written in 1931,

again on a woman patient, but with a physical

genital abnormality. He was now particularly

impressed by the multiplicity of personification

she showed, and he was again critical of Freud’s
tripartite theory as not doing justice to the

complexities of the structuring within the

personality. He recognizes functioning structural

units corresponding with Freud’s theory yet in

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each there were components from all three of
Freud’s schemes. Each of these units operated as

a separate self even though they were largely

unconscious. Furthermore, he found that the

common patterns of the neuroses, for example,

hysteria, obsessional neurosis, phobias, and

paranoid features, all appeared in the same

patient at different stages of the analysis. He

therefore concluded that- these conditions were

not nosological entities each related to a

particular fixation at a libidinal stage of

development but were labile defences adopted to

deal with the unresolved conflicts from the
schizoid or depressive positions.

This paper was read by request to the British

Psychoanalytical Society. It made a highly

favourable impression with the result that he was

elected to associate membership of the society so

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that he was now formally recognized and
accepted as a qualified psychoanalyst. At this

period he was also becoming greatly interested in

Melanie Klein’s views. She had come to stay in

London a few years earlier so that her work had

become well known to the London analysts. He

was particularly stimulated by her picture of the

inner world populated by a range of internalized

figures fashioned by the child from the

experiences with his parents.

The personal and professional situation in

Edinburgh for the first few years of his

psychoanalytic career had been very favourable
for his productivity. He was happily married with
a young family so that any deep anxieties about

his masculine gender from his mother’s early

persecutions were not manifest. The fact that he

had rather belittled his father as unsupportive was

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also prevented from arousing disturbing guilt by
the approval of the university professors in

psychiatry and psychology of his growing

standing professionally.

Sadly, there began in 1932 some changes that

caused him considerable stress. A new professor

of psychiatry had arrived who was hostile to

psychoanalysis. A somewhat autocratic person,

he soon made it plain that Fairbairn was not

welcomed as a colleague. Simultaneously, the

professor of psychology, a person who was

widely respected and with a kindly disposition

that aroused a good deal of affection, began to be

deeply disturbed by his closer contact with the
psychoanalytic viewpoint that he was

increasingly encountering as they worked

together on the cases seen in their Child

Guidance Clinic. He distanced himself

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professionally from Fairbairn who was eventually
forced to resign from both of his university

appointments. Although not showing much,

Fairbairn was rather depressed by this loss of the

support he had enjoyed; but a much more

distressing situation was developing in his

domestic situation. His wife was becoming

increasingly hostile to his psychoanalytic work,

which isolated him not only during the day but in

many evenings when he would retire to his study

to clarify his understanding of the clinical

problems he was identifying. Despite the strain,

he remained deeply attached to his wife and

family and he did his best to maintain a
manageable compromise. There was, however, no

question of his withdrawing from his work. From

the time he had formulated his life purpose, his

dedication to it was the paramount cohesive force

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in his being. To have given it up would have been
an emasculation of his self with, almost certainly,

psychic death.

By 1935 there were recurrent outbursts of

acute hostility from his wife and there was now

manifest a symptom that had restrictive effect on

his freedom to travel. He developed the urinary

symptom that his father had had: difficulty

urinating in the presence of others. None of his

friends or colleagues knew of it until after his

death. Fortunately, there was no inhibition of his

intellectual work. In addition to the stresses

mentioned there seems also to have been some

unconscious disturbance as his work became

more and more involved with the earliest stages

in the development of the personality and with

Melanie Klein’s views that he was progressively

assimilating. Her paper on the psychogenesis of

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manic-depressive states (Klein 1934) had made a
great impact on him in the way she brought out

the powerful dynamics of unconscious phantasies

of relationships between various internalised

figures and between them and the central self or

ego. (The effect of this paper was a startling one

in the way it split the British Psychoanalytic

Society and, indeed, threatened the unity of the

movement in Europe and, years later,

internationally.) Her views had a profoundly

stimulating effect on Fairbairn and almost

certainly facilitated the crucial observations that

he made during the next 5 years of a group of
notably schizoid patients. This paper appears to

have disturbed Fairbairn by stirring up phantasies

of the destruction of the parental couple by

urinary sadistic attacks. It did not, however,

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interfere with his clinical work and the creative
thinking engendered subsequently.

For 5 years after Klein’s seminal paper,

Fairbairn seemed to be assimilating her theories

against the background of his growing

experience. He wrote a brief clinical paper in

1936 in which he described the reactions of some

of his patients following the death of George V

and which supported Klein’s views of the nature

and origin of some of the phantasies evoked by

this event. Other papers in this period, though not

using clinical data, did make extensive use of her

ideas. It was not until a year after World War II
broke out that he gave the first indication of a
major creative thrust that had gained momentum,
and produced a series of papers in the next 5

years embodying the essentials of the new

theoretical position that he considered to be an

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essential change from the assumptions underlying

the classical psychoanalytic etiological principles.

It was unfortunate for the reception of his views

that the restrictions imposed in the United

Kingdom by the war prevented the publication of

his first paper for it was here that he described the

crucial clinical data on which he founded his

radically new position. This paper eventually

appeared in 1952 when he brought it together

with other papers that had appeared in journals

during the later years of the war.

The first paper was entitled “Schizoid Factors

in the Personality,” and though not generally

appreciated at the time, it indicated his holistic
approach to the understanding of the person. A

notable exception to this lack of understanding

was the response of Ernest Jones who notes in his

Preface that, in contrast with Freud, Fairbairn

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starts from the centre of the personality, the ego,

and from there considers the vicissitudes of its

attempts to relate to the external figures essential

for its survival. Freud’s theories were largely

founded on the vicissitudes of instinctual

gratification driven by the search for the pleasure

that ensued and so he had to construct the self

from these instinctual activities. This foundation

had given rise to his theory of narcissism in

which the libido, or energy of the sexual instincts,

was invested in the ego whence it was

progressively moved to external objects. Schizoid

personalities were assumed to have failed to

progress to this externalisation and, instead, to

have remained with most of their available libido

narcissistically positioned in the ego. They were

on this account unsuitable for analysis because of
their virtual incapacity to make emotional

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relationships with others. Melanie Klein had

shown that such personalities had a rich inner

world of relationships that, however, were largely

used to compensate for the absence of

relationships with others, and that their failure to

make such relationships was caused by the

anxieties associated with them. Fairbairn,

working on this basis, found that when the

origins of these anxieties were analysed, these

individuals showed their longing for good

emotional relationships with others and their

capacity to make these.

Adults with marked schizoid personalities

have three prominent characteristics that may be
so successfully concealed that they are only

discernible as analysis proceeds. These are: (a) an

attitude of omnipotence; (b) an attitude of

isolation and detachment; and (c) a preoccupation

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with inner reality. Of these, it is plainly the last

that is the basic feature with the others stemming

from it. It is also clear that these are the attitudes

of a whole person and, since they have roots in

the earliest stages of development, they suggest

that this whole is present from the start. Fairbairn

terms this original unity the ego though it would

have been more appropriate to have used the self.

The function of this self is the adaptation of

primal instinctual activity to outer, essentially

social reality. Perceptions of reality have to be

integrated and behaviour matched accordingly,

and with his capacity to make imagined relations,

these have to be distinguished from the outer

world. Such integration of experience can only be

effective through the agency of a system

operating from the start as an organized whole.

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Psychoanalysts have long related the
development of the ego or self as the infant’s

relationships within the family and to link

distortions in development to the oral stage.

Fairbairn accepts that what happens in these first

relationships plays a crucial part in shaping the

future personality. In considering this question he

makes a radical departure from the classical

position.

FAIRBAIRN’S ACHIEVEMENT

When I ask myself what the significance is of

Fairbairn’s contribution to psychoanalysis, my
answer will strike most analysts as making

grandiose claims. I believe, nevertheless, it is

entirely accurate to say that he was the first to

propose in a systematic manner the Copernican
change of founding the psychoanalytic theory of

human personality on the experiences within

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social relationships instead of on the discharge of
instinctual tensions originating solely within the

individual. In short, he replaced the closed-

system standpoint of nineteenth-century science

with the open-system concepts that were evolved

by the middle of the present century to account

for the development of living organisms, in

which the contribution of the environment has to

be considered at all times.

His viewpoint is receiving increasingly

sympathetic and careful appraisal. Here I wish to

stress that his specific theories about the

structuring of the personality will certainly be

amended, but such advances will be made by the

adoption of his basic assumptions.

In judging the importance of his work, it is

appropriate to comment first on his challenge to
the fundamental assumptions upon which Freud’s

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classical theories were based and which he
retained until his death. Having asserted the

vicissitudes in the personal relationships between

the infant, his mother, and his family, as the

primary consideration for the development of the

personality instead of the instincts, there was, of

course, no question of the instinctive endowment

being ignored. The issue was how the interaction

of the innate factors and the environment was

conceived. Fairbairn was highly critical of the

way in which instinctive energies were reified,

one could almost say deified, in early

psychoanalytic theory. Guntrip, following on this

lead, has been interpreted as dispensing with “the
instincts,” and at times he can give this

impression. Like Fairbairn, however, he was in

no way a naive thinker. What they both felt

strongly about, and it was this aspect of

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Fairbairn’s writings that attracted Guntrip in the
first instance, was that the concept of “drives,”

the motivating forces originating in the instincts,

was being used to create a quite inadequate

picture of human nature.

The danger they reacted to was the insidious

dehumanization of man with no adequate account

of his nature at the personal level. With Guntrip’s

background as a clergyman it was easy to

“explain away” his arguments, though these were

put forcefully. (It was not so widely known that

Fairbairn had started out to become a clergyman

and had retained an active membership of the

Church, otherwise he, too, might have had an

even less serious reception.)

The accepted theory of the instincts had,

therefore, to be questioned as an appropriate
foundation for the understanding of the conflicts

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underlying the presenting problems. Though that
was naturally of the first importance, there were

also dangers from its influence on social and

cultural values. The pleasure accompanying the

satisfactions of instinctive needs did not lose its

importance; it was essential in selecting and

maintaining relatedness. When pleasure seeking

became the foremost motive, however, this was

the result of a deterioration in the essential

relationships, a failure in the attainment of the

capacity for rich and mutual relations with others

in which the individuality of the other provides a

deeper satisfaction them the use of him or her to

provide gratification. The unfortunate

consequences of adopting Freud’s instinct theory

as making gratification the aim could be seen

when the writings of social philosophers like

Herbert Marcuse (1955) and Norman O. Brown

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(1959) were taken to justify sexual indulgence as
something with little or no restraint — for

“kicks,” as the saying went. Fairbairn was not

concerned with moral values here. The biological

importance of his views stemmed from his

conviction that the family is the crucial agency in

the development of healthy, creative individuals.

For it to fulfil this function, sexuality is an
essential component in the maintenance of the
optimal relationship between the parents and

between them and their children.

Both Fairbairn and Guntrip were trained in

philosophy. Other philosophers, Yankelovich and

Barrett (1970), gave a highly pertinent critique of

psychoanalytic theory. While neither was a

practising analyst, both were well informed and
deeply convinced of the importance of

psychoanalysis for the human sciences in general.

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Their concern was to further its acceptance and
development by getting its basic assumptions

right, for in their view no science can progress

unless this is done, and they thought those of

psychoanalysis were wrong. Despite a great deal

of discussion with a group of distinguished

analysts in Boston in the USA, they make no

reference to Fairbairn, presumably because his

book was not made known to them. (Elizabeth

Zetzel, a leading figure of the psychoanalytical
establishment in the Boston area, may have

contributed to this neglect. In her article “Recent

British Approaches to Problems of Early Mental
Development” (1955) she treated Fairbairn’s

views as an ingenious intellectual exercise,

without seeing the fundamental challenge that his

powerful clinical data had forced upon him.) I

have always felt this was a great pity, because

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these thinkers reached conclusions closely similar
to his and so might have added to the impact of

all of them. They propose as a fundamentally

required step the replacement of the id by one of

developmental. These are the dynamic structures

that are formed when instinctive activity interacts

with critical experience at specific stages in the

life cycle. Their concepts derive from a wide

consideration of human development, social,

cultural, and biological, and their arguments add

up to conclusions that cannot be ignored, the

more so when placed alongside those reached by

Fairbairn 25 years earlier. Nevertheless, their line

of thought has had little effect upon

psychoanalysis. The response to their book

reassured me that the reluctant recognition of

Fairbairn’s views could not be justified by the

commonly expressed superficial reasons.

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The issue that they and the “object-relations”
theorists had introduced has been a preoccupying

one amongst analysts for the last 50 years. In an

admirably critical and comprehensive account of

its history, Greenberg and Mitchell (1983) have

described this dialectic as showing the

progressive encroachments of the object-

relationships viewpoint into the drive theory.

These challenges have been met by a succession

of accommodations made by tenacious analytic

thinkers, which bring out the increasing strain of

defending an untenable position. In their

constructive critique of the psychoanalytic view

of human nature, Yankelovich and Barrett (1970)

describe a similar process with which they draw a

parallel in the development of astronomy, with

the constant addition of epicycles to the

traditional scheme of the solar system.

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As an evaluation of Fairbairn’s views, I

believe that that of Greenberg and Mitchell

(1983) is quite unusual in its scope and

penetrative accuracy. They note that the

abstractness of his language can mislead the

reader into thinking that, in his stress on libido as

object seeking rather than pleasure seeking, these

are somewhat Talmudic and arcane distinctions.

What Fairbairn is suggesting, according to them,

is really a fundamentally different view of human

motivation, meaning, and values. The orientation

of the infant to others is there from the very

beginning because the infant has adaptive genic

roots for his biological survival. Moreover, this

urge to seek and maintain interaction with others
is characteristic of adults at all stages of life.

Development begins in the total dependence

of the infant, at which stage a security is normally

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established that lays the foundation for the later

transformations towards the normal personality.

Fairbairn’s views of the transitional stage

between this infantile dependency and maturity

are not spelled out, and this is a weak feature of

his developmental theory, though this lack is

easily remedied from the wealth of data on

childhood and adolescence. He does stress,

however, that the earliest structuring from the

experience in relationships forms a basic pattern

that shapes the future patterns of relationships.

Clearly Fairbairn has left much that needs to

be expanded, and what he ended with points to

tasks for a more complete theory of the self as

fashioned from relationships. His primary text, so

to speak, is that the individual from the very start

has to be loved for himself by the unconditioned

loving care of (at first) the mother. This loving

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care has then to be continued by the father as

well, and adapted within the family to the specific

behavioural stages brought about by maturation

and the cultural environment. In all development

and in maturity, persons have to be in satisfying

relationships for their own survival together with

that of their groups.

Assumptions about the infant not having any

ego or self at the start contributed to the long

period in which the self was scarcely mentioned.

Freud’s “Ich” had the significance of the personal

self until, as Bettelheim (1983) suggested, the

absorption in instinct theory led to it being

replaced by the impersonal “ego.” When
Hartmann (1958) found it necessary to postulate

an autonomous ego, he described the self as the

separate structure that was cathected in

narcissism. He did not elaborate the concept of

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the self, however, because of his inability to free
himself from the traditional drive energies, even

though he realized these were making a

theoretical impasse.

If we take Fairbairn’s basic statement we have

clearly got to conceptualize a potential structure,

operating as a whole, that only becomes

functional, in the effective way for which it is

designed, through certain experience with the

mother, the father, and the wider society. It

“seeks” to become the organizing agent of a

conscious “person” who remains aware of the

continuity of his past with his present and of the

future as immanent, and with a unique sense of
himself as having an identity in relationship with

other persons.

As mentioned earlier, Fairbairn accepted that

self is a more appropriate term in most of his

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considerations, since it refers to the whole from
which subselves are split off. The ego is useful

for the central self, that is, the dominant part of

the self that incorporates the main purposes and

goals of the individual in his relationships with

the outer world and with which consciousness is

usually associated.

Along with his humanistic and philosophical

background, the understanding of the personality

for Fairbairn had to be firmly based upon its

evolution, that is, its biological roots. A modern

image of man must illumine his essential

properties, and for this I find Chein’s (1972)

definition invaluable. I have already referred to

this but it will bear repetition. “The essential

psychological human quality is, thus, one of

commitment to a developing and continuing set

of unending, interacting, interdependent, and

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mutually modifying long-range enterprises” (p.
289). When we start with a modern biological

outlook, we depart from Freud, for whom the

science available allowed only the Newtonian

base with its emphasis on the second law of

thermodynamics. Chein concludes that man’s

motivation is a unique development. As a living

organism, man is removed from the closed

systems characterized by entropy, and this focus

has to be replaced by a commitment to

accomplish something—even if only the survival

of his family in the environment.

As an open system, the living organism is

negentropic, a feature maintained by its perpetual
incorporation of energy. All organisms are

created from other organisms. (For a modern

perspective on evolution I am indebted to Jantsch

[1980] and Waddington and Jantsch [1976].)

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They are wholes that cannot be made from the
aggregation of parts. Their constant exchanges

with the environment mean that constant

transformations are proceeding, despite which

they maintain their own characteristic form by a

process of self-regulation. What is essential in

these continuous self-renewals and self-

expressions are the self-bounding processes

rather than the changing structures. While

evolution has led to many subsystems in the

organism that maintain an equilibrium or steady

state, this homoeostasis does not obtain for the

organism as a whole. At this level, equilibrium

means death, because of the ending of the never-
ceasing interaction with the environment in

which processes of self-transformation and self-

maintenance constitute life. As Sir Julian Huxley

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said, our perspective for man must be sub specie
evolutionis rather than sub specie aetemitatis.

In the lower levels of the evolutionary scale

the form of the animal along with its behavioural

repertoire is directly determined by the genic

inheritance. Thus, given that the dinosaurs lay

their eggs in places that provide the appropriate

environment, and with some early protection

against external dangers, the embryo can emerge

and fend for itself. An organizing principle within

the fertilized egg provides for successful

maturation under these conditions. Life can be

lived in an action mode with learning restricted to

the limited skills required to feed, to fight, and to

mate. Evolutionary development does not greatly

require increased adaptive capacities as long as

the environment provides what is needed. Their

huge physical bulk could evolve along with a

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relatively small brain being adequate for
perceptual-motor learning and the coordination of

all the bodily parts by the organizing principle its

nervous system carried. Clearly this organizing

principle is of the greatest importance, since it

embodies the management of the life process as a

whole. In the lower animals we can conceive of it

carrying out this function on the basis of an

affective field that controls the fitting together of

sentient experiences from bodily and

environmental changes according as the overall

state is within the range of what feels “right” or

not “painful.” Innate patterns for finding the
objects required for survival can be transmitted

by the genic inheritance, as they are in the human

infant in “desiring” and seeking the breast. In an

unchanging environment little need for complex

information storage arises. Any threat to its

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autonomy is a threat to life and so is reacted to
ferociously and the individual and the species-

group survive.

When man is reached, an extremely complex

behavioural equipment has been evolved. In

brief, he has become a social person who

survives not only by adaptation to, but largely by

the creation of, his environment. Social animals

survive by the evolution of innate mechanisms to

keep them together, thereby gaining protection

against predators and facilitating the rearing of

the young. The common mode of achieving this

grouping is by innate mechanisms creating

attachment to dominant members. With the

enormously increased psychological resources
and creative capabilities required to cope with life

in human communities, there has been an

evolutionary development in which these are

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maximized by each individual acquiring a high

level of autonomous creativity. The innate

equipment for each has to provide for such

development and the relatively huge cortex in

man’s brain emerges to meet it. As well as the

behavioural systems providing for basic actions,

there is now a great range of behavioural

properties required for community living,

especially for the amount of activity that has to

be shared if optimal creativity is to be achieved.

Relationships are mediated by holistic features in

each human being, the essential character of

which we describe as “becoming a person.” The

individual becomes aware of having a self and,

moreover, a self which can transcend itself in

order to observe and appraise its inner processes

and its position in the world. When this
subjectivity can be shared an enormous

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facilitation occurs for cooperative action in joint

plans and purposes. Homo sapiens has emerged

with ail his unique characteristics. Added to the

innate equipment that provides for the specific

behaviour survival requires, there is now much

behaviour that has innate components sufficiently

influential to ensure its emergence, although not

such as to restrict too narrowly the fit with the

environment. The adaptive behaviour is then

given a final pattern by training within the family

and its society. Thus, what has been evolved in

the genic inheritance is not the complete

structural basis for the required behaviour, but a

“potential” for it, as in the acquisition of

language.

The notion of inherited potential was thought

by many biologists until recent years to be a

somewhat vitalistic notion. Critical evidence

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came from the Cambridge ethologist W. H.

Thorpe in the 1950s when he and his colleagues

showed that while the basic song units in

chaffinches were inherited, the young birds could

not perform the adult song unless they heard this

from the adults. The possession of the song as

shared by all members of the species is critical

for survival. Learning from experience provided

by the parents or adults had thus entered the

process of evolution. With the mammals,

prolonged parental care has become a necessity

for dependent young. In man this care becomes

loving care, and powerful love feelings have

evolved as the great means of creating and

maintaining the most vital human relationships,

those in the family and in the group. (In

connection with this outline see also Artiss 1985.)

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Yankelovich and Barrett (1970) quote from

Cantril’s (1955) study of functional uniformities

in widely different cultures, which suggest a list

of innate potentials in the individual for

behaviour at the human or personal level. The

potential has to be realized within a specific

culture, and in this way great variation exists in

specific characteristics such as in languages.

Language plays an essential part in many other

acquisitions in which a rich range of

communication amongst adults and between

parents and children is required, while its

symbolic function underpins creativity and the

extremely flexible use in the development of

tools and shared skills. Other innate potentials

seem to be the attaining of food and shelter,

getting security in a territorial and emotional

sense, a need for ordering the data from

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environment, the need to seek new experiences,
for procreation and safeguarding the future, the

capacity to make choices, to experience a sense

of the individual's own value to himself and

others, and the need for a system of values and

beliefs to which he can be committed and even

sacrifice himself.

All these potentials, when realized, have to be

fitted together and in an overall way that is

managed by an autonomous self. As Angyal

(1965) put it, it is paradoxical that this autonomy

can only be attained within the heteronomy of

being raised in, and belonging to, the community.

In short, optimizing creativity in the individual
can be achieved with a simultaneous bonding of

the self to the group. This list is not quoted to be

a comprehensive one of essential capacities, but

to bring out how the highly complex task facing

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the individual in his development towards being a
mature member of the community can be seen

from an evolutionary standpoint. These

attainments are all expressions of what we mean

by becoming a person, that is, of having a mature

self. Without these innate potentials and their

development within the group to which persons

will belong, or enough of them in sufficient

measure, and without the integration or cohesive

functioning that only a whole can offer, the

individual cannot become a person.

Several specific capacities have been listed,

but the critical feature has been left, namely, how
the “person” is formed as an essential unity. To
put these capacities together in various ways does

not add up to being a person. Indeed, to learn to

fulfil most of them, the individual has to be a

person in the first instance, for it is the sense of

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autonomous agency that determines the learning.
Moreover, much learning, for example language,

needs a shared subjectivity between mother and

child (see Stern 1985). An intensely dynamic

potential power in the self is thus what motivates

the sustained purposiveness of the individual to

contribute to the well-being of himself and the

group.

The answer to how the whole is formed can

be given as the simple one that it is there from the

start, a view adopted by Lichtenstein (1977). All

organisms are wholes, and they create other

wholes for survival. Fairbairn long felt critical of

the atomism of so much analytic theorizing. He
himself found no difficulty in assuming the
existence of wholes. That the infant gives the

strong impression of being a whole “person”

from a very early stage is certainly vouchsafed by

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all parents and most infant-mother research
workers. Kohut (1971) quotes the way adults

react instinctively to babies as persons and treat

them as such, usually with expressions to indicate

their pleasure in responding to this quality, as

strong evidence in favour of a whole self being

actively present. It is not difficult to conceive of

this potential being present in the innate

endowment and giving rise to the “expectation”

to be treated in this way; and this does not only

occur at the infant stage. The person at all stages

of the life cycle resents not meeting this response

from others, with intensities of feeling covering

the whole range of aggression.

To return to Fairbairn, it is very much this

trend of thought that can be seen in his

conception of a unified self that is an autonomous

potential, at first, and which is then suffused with

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a sense of being a person in proportion as the
mother’s loving care is assimilated. It can also be

inferred that frustrations that interfere with this

autonomous development are reacted to as with

the animal fighting for its life, for the self is the
living centre of the individual.

Since being a person, that is, having a self

that is autonomous yet preserving its autonomy

or identity by means of its matrix of

relationships, is the essential resource for

effective enjoyable and satisfying living, the

nature and development of the self is the

paramount issue for general psychology as well

as psychoanalysis. For the latter, the immediate
concern is the role of the self in psychopathology.

Fairbairn attributes all psychopathology to the

splitting of the self in early experience, and

Melanie Klein also adopted this position.

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Winnicott’s therapeutic studies, together with
the observation of mothers and babies in his

paediatric work, fully supported Fairbairn’s

assertion of the primacy of personal relationships

for the development of the self. He spelled out

the mother’s empathic responsiveness as

establishing a positive attitude to others and to

the outer world. This attitude characterized the

child’s “true self” in contrast with the conforming

self that emerged to maintain the relationship

with mother on her terms if not allowed enough

scope to express his own. Bowlby (1960, 1969,

1973) has amply confirmed by his careful
research studies the psychological necessities in
the mother-child relationship. His theory of

attachment stresses, so far, the conditions for the

essential development of the self rather than the

nature of the processes of the latter. He fully

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recognizes the complex developments involved
in that process, a research area now receiving the

attention of psychoanalytically trained workers

(see Stem 1985).

Clinical data suggest that, while the mother’s

initial influence establishes security or otherwise

in the sense of being a person, the interaction

with the father seems to be essential in the

realization of the full autonomous potential.

Winnicott (1971) referred to “male and female

elements” needing to be combined, and Fairbairn

mentioned the need for a father. It would thus

seem that while Fairbairn came to view the

Oedipus situation in its relationship with infantile

sexuality as a social situation and not a
fundamental one for development as Freud had

portrayed, there is another dimension to the

importance of the relationship with the father in

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the maturation of the self. Indeed, Fairbairn’s

symptom can be seen as an attempt to bring back

to life the father he had destroyed in phantasy, a

need greatly increased when the imago of the

castrating mother was revived by his wife’s

negative attitude to his work.

While it was the formation of splits in the self

that formed the start of Fairbairn’s line of

thought, the defensive reactions against this

situation suggest that the original self has

retained a holistic dynamic within which these

incompatible demands are dealt with, either by

repression or by finding some substitute mode of

satisfying the need. The structuring of these
internal relations is much more complex than is

apparent at first sight. Some of the internal

objects have a relatively separate structure which

is recognized as such, for example Freud’s

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superego. The variety of objects and their

topology seems to be quite large. Thus, Fairbairn

regards dreaming not as wish-fulfilment but as

the spontaneous “imaginative” playing out of

relations amongst them. The person, in short,

emerges as a cast of characters, each related to a

specific kind of object. These systems of self-

object relationships have constant dynamic

effects on each other and are also in perceptual

contact with the other world, so that when it

presents a situation that fits what an inner split

self is seeking, then the latter can become

activated to the point of taking overall control of

the self. We see here the mode of action in

compulsive relationships when the activation is
intense.

These subsystems, like the self as a whole, do

not require to borrow energy from separate

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“drives.” They operate in the quite different way

that systems under cybernetic control do. The

strength of the drive exhibited is governed by

what is switched on by inner releasing

mechanisms. The power of the whole self to

manage behaviour with optimal adaptiveness is

thus the resultant of the integrity of the whole self

against the pressure from subselves, and these

two sets of forces vary according to the past

history of the person and the nature of the

external environment to which behaviour is being

directed. The outer world is frequently the main

releaser of action, but more important are the

internal goals and imagos embodied within the

self, again with varying “distances” from the

central self. All of these carry a dynamic of

internal origin into the world to mould it, even
with considerable coercion, to attain its goals.

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With a subself becoming dominant, it is
difficult to specify where the “autonomy” of the

self is then located. Even under strong

compulsions, there is usually an awareness of the

situation of being “possessed,” as though the

observing self remains intact though powerless to

exert enough control over it.

The compelling power of subsystems is not

confined to instinctive action from sexual or

aggressive arousal. Though less dramatic, it

seemed that Fairbairn’s ideal self could separate

itself from these pressures and retain its own

motivation in the sustaining of his creative work.

Freud met this problem when he discussed the

ego ideal and when he put civilization into an

adversarial relationship with the autonomy of the
self. His position is a complex one. On the one

hand, he felt the individual has to accept tiresome

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constraints, yet he observed that with the
development of the ideals shared by the group,

the individual acquires an identity for his self that

he defends against any threat. Furthermore, he

does this with a ferocity that has to be conceived

as coming from an elemental force, one he linked

with his postulation of the death instinct. In short,

if we adopt a theory of aggression as a reaction to

danger, then threats to the autonomy of the self

readily suggest the origin of hate; and its relative

permanence follows from structured internal

threats.

A comprehensive theory of the self will have

to fill in the areas that are largely left out of

consideration by Fairbairn. The whole of

Fairbairn’s transitional phase can be seen as

occupied with the final structuring of the self

under the influence of the realization of the

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various potential aspects, such as those listed by
Yankelovich and Barrett (1970). In this

development, Erikson’s (1959) contributions at

once seem to fill in the gap, with the epigenetic

phases presumably deriving from the maturation

of developmental potentials in the experiences

that each culture seeks to provide at the

appropriate period. Fairbairn gave a theory of the

basic structuring that arises from the experiences

in the earliest stages of mismatch between the

child’s needs and the parental responses. The

schizoid split has a far-reaching influence

because of the early highly formative stage in
which it operates. Subsequent stages, for example
the phallic-masculine-gender complex, can be

more restricted in the disturbance they engender

when the schizoid position has been free of

deprivation. This freedom from inner constraints

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is especially important when the investment of
the self becomes so much focused in the deep

satisfaction of using special talents, for example

in the acquisition of knowledge and evolving

specific goals for the self. The split-off

internalized objects can have a great range in the

degree to which they deform development, and

here we note whole areas in which much more

research is needed. When mention was made of

Fairbairn’s relationship with his father, it seemed

as though his father, at least as a sexual figure,

had remained very much separated within his
self, though very much present despite his
repression.

When we take an evolutionary perspective for

the development of the self as a fundamental

characteristic structure, then the understanding of

the dynamic of the ego ideal becomes much more

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plausible than that offered by classical theory.
Thus in his introduction to Chasseguet-Smirgel’s

study, The Ego Ideal (1985), Lasch adopts her

account, with all the richness of her observations

of its development. Her basic assumptions,

however, are strikingly rooted in a closed-system

perspective from which all the commitments of

man are seen to stem from his fear of death and a

longing to reestablish a sense of primal unity with

the natural order of things. Evolution, in contrast,

can be seen as providing man with powerful

innate potentials enabling him to strive

purposefully, and not as a passive victim of

chance and necessity, to alter this natural order.

The prospect of death, moreover, is surely altered

when it is seen as a planned necessity for the

“progress” of life that evolution appears to

embody. The Socratic injunction to examine

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one’s life can thus focus on what has been given
to life by the individual.

Jantsch (1980), in his view of the role of

evolution, brings in the relevance of myths in

man’s awareness of his condition. For him, the

striving after the “steady state” of an imagined

perfection is reflected in the myth of Sisyphus.

The evolutionary perspective on the other hand

sees him as Prometheus. From our consideration

of the self the vultures would then perhaps

represent the deep hate over the frustrations of his

autonomy —or the death instinct for Melanie

Klein. It seemed to me that Fairbairn was always

far more profoundly motivated by the

“developmentals” in Cantril’s list than by a

longing to return to the “perfection” of the

intrauterine state. If evolution has a thrust in it “to

evoke,” it is not too fanciful to imagine that man,

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or a proportion of men, get something of it within
their nature. Hitherto his religions may have been

one of its main expressions. Now he has to find

ways in which selves in their groups do not need

to eat each other, as the lower forms of life did,

for survival. The development in social animals

of the submissive action when a fight for

domination has ended exemplifies evolutionary

possibilities.

Fairbairn’s emphasis on relationships started

in his suffering from bad ones. His potential for
an ideal self seized on Christianity as a means of

realizing it. He then discovered, as Freud did, that

only more knowledge of the self would in the

long run sustain him towards his goals.

In the formation of commitments, the internal

object may occupy a very different position in

that it may be suffused in its influence by an

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assimilation into the central ego. We get a strong
impression that Freud was internalized in this

way following upon the similar internalization of

Christ. The situation is then extremely complex

when what was the bad mother becomes the

adopted model after a change in her attitude from

castration to active encouragement of a masculine

autonomy. I am reminded here of Freud when

puzzled to account for an instinctual demand

being “tamed” when brought into the ego. His

solution was to seek help from the Witch

Metapsychology and I wonder if it was his “bad

mother” who unconsciously prompted this

suggestion (Freud 1937, p. 225). Fairbairn

recognized the therapeutic problem here because

of the deeper hate being overlain by so much
gratitude that was felt later for the support of the

realization of his masculine ideals. When he

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referred at various points to the intense resistance
aroused by the therapeutic process, this seems to

centre on the fear for self-structures that have

become so important. In these later

internalizations, there is also the problem of the

relation between the parents being internalized, as

when he felt in later adolescence he was in a

secret collusion with his mother against his

father. This enactment of the interparental

conflicts within the self, with parts identified with

each parent, is extremely common, highly

destructive, and highly resistant to exposure

because of the threat to the integration of the self.

In this rather personal version of where I

believe Fairbairn would have continued his

journey, a particular area is outlined, because I

believe that the whole tenor of his work was

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steadily moving to the conceptualizing of the self.
It was, after all, where he started.

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23.

AN OBJECT RELATIONS VIEW OF

THE GREAT MAN

Early psychoanalytical studies of creative

men have been criticized as reductionist. That

certain unconscious fantasies might have played a

fundamental part in what was created, both in

determining its nature and in providing the

relentless drive of genius, was not denied. What

was seldom traced were the links between
fantasies that were not unique in their pattern to

the great man and the specific process whereby

he fashioned his innovative thought and action

from these primal motives and his later

perceptions of his own and others’ needs.

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With Young Man Luther Erik Erikson (1958)
established a new kind of study of the great

historical figure. In it he combined the insights of

the psychoanalyst with an appraisal of relevant

historical factors to illuminate how the mind of

the great man made him capable of leading his

contemporaries from a major impasse.

I will explore these links in my discussion of

the development of the self as I reconstruct it

from the life and work of two great men,

Mahatma Gandhi and John Buchan.

GANDHI’S TRUTH

In Gandhi’s Truth: On the Origins of Militant

Nonviolence, Erikson (1969), shows how the

great man early in life evolves a special mission,

a direction that must lead to all or to nothing.
Such a structuring within his personality remains,

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however, a “developmental probability” whose
subsequent realization is conditioned by an

enormous range of influences from the social

environment during the successive phases of

development. The questions to be considered,

then, embrace at least the following. What gives

the developmental probability of the great man its

specific content? That is to say, we want to

understand how the essentials of his mature

mission were shaped from his experience within

his early family and social milieu. Allied with

this question is that of the source of the necessary

drive if his mission is to be transmuted into major

social action. A third question takes us into his

later experience. How does he, on the basis of his

compelling potential, fuse his inner needs into an

instrument that provides for others a way they

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intuitively sense as realizing what they have been
unable to articulate and activate?

To appraise the theories offered about the

origins of Gandhi’s achievement we have to look

at its nature. Here we note that Erikson is not

making a comprehensive study of Gandhi’s

political life but is concerned specifically with his

Truth, that is, the political tool he developed —
satyagraha, or militant nonviolence as it has

become known. Erikson is fully aware of the

varying evaluations of Gandhi’s activities for
India and of the blood bath that flowed from the

hatred constantly simmering between the Hindus

and the Muslims. It is poignantly ironical that the

last serious eruption from this chronic source

occurred in Ahmedabad itself, the town in which

Gandhi finally tempered his political instrument.

Such occurrences do not remove the value of

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Gandhi’s Truth; they are among the issues that it
was evolved to tackle. A comparison of Gandhi’s

instrument and Freud’s method is one that

Erikson makes, and we do not ignore Freud’s

achievement because of the limitations of the

psychoanalytic method. Satyagraha as used by

Gandhi on occasion clearly carried inconsistent

restrictions stemming from conflicts in his

personality, which he managed not by

understanding but by severe moralistic

prohibitions. We can assume, however, with

Erikson (1969, p. 32), and with Romain Rolland,

whom he quotes, the greatness of a method that

“stirred three hundred million people to revolt”

and that “introduced into human politics the

strongest religious impetus of the last two

hundred years” (Rolland, 1924 pp. 3-5).

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Gandhi’s Truth as a method of conflict

resolution involved various steps, some of which,

though now taken for granted, were revolutionary

half a century ago —for example, obtaining the

full study of the facts including those factors that

influence public opinion and making a genuine

attempt at arbitration with the clear

announcement of actions to be taken. It is over

the meaning of the Truth for the contenders that

Gandhi’s views have provided a disturbing

challenge. For him the clash between the

inevitable relativities of the truth as discerned by

each party would only be overcome by a truth

that transcended both. In reaching such a truth

Gandhi’s assumption was that no harm was to be

done. Erikson suggests convincingly that in

translating ahimsa we have to accept Gandhi’s
meaning as no violation to the essence of the

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other person. Without such a respect for the
other’s truth we merely get violence and

counterviolence. In the situation for which

arbitration produces no acceptable solution, the

test of truth in the campaigners is the conviction

that they will suffer for their goal to the point of

death, while holding to the code of nonviolence.

A satyagraha campaign therefore has to convince

its participants of these requirements, and it was

Gandhi’s extraordinary charisma that he did this

on such a scale. For him it was the leader’s task

to decide on the “true” course, and here we can,

with Erikson, allow for the rather special

historical condition that determined Gandhi’s

individual power in reaching such decisions and

the cultural features that gave such significance to

actions like fasting. As Erikson points out, if truth

is actuality it has to be achieved in each situation

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by fresh action and never by a mere repetition of
ritualized acts.

The aspect of Gandhi’s method that has

aroused the most doubt is his belief, at least for

himself, that its critical use demanded the

abandonment of sexuality. It is here that an

irrational manifestation of personal conflicts has

taken over. His whole attitude to sexuality from
early manhood was one of compulsive moralism

against its “badness.” It was a drain on the

sources of the powers that man needs if he is to
reach more mature ways. Erikson indicates that

while Gandhi’s personal choice in this respect

does no justice at all to the role of sexuality in

loving relationships, he was pointing to our need

to understand more of what primitive phallic

sexuality contributes to man’s propensity to

violence. For Erikson, Gandhi intuitively grasped

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that in situations of serious conflict each party
must extend the boundaries of his self-feeling to

include that of the other’s. This was the essence

of his drive and of his success. His capacity to

speak for others down to the pariahs of his

culture must spring from the fact that so much of

his thought and action drew upon the deep and

universal affects of mankind. What his failures

have brought home is not the presence of basic

error but his (and still our) lack of knowledge by

which he could obviate the most urgent problems

posed for mankind. It is here that Gandhi’s

method needs what psychoanalysis might help to

supply. Erikson has been one of the most notable

psychoanalytic thinkers —at times almost getting

himself regarded as deviationist — trying to

isolate at least some of the questions we have to

study in regard to human violence, if not

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providing the answers. He likens Gandhi’s
contribution, admittedly with acknowledgment of

the speculative flight, to an attempt in man to

evolve a method of ritualizing aggression

comparable with the instinctive inhibitors in most

species. He has made it very clear that we cannot

talk of aggression in the hydraulic metaphors of

the nineteenth century. Neither can we account

for violence with the conventional notions of

instinct. Erikson, more than any other

psychoanalyst, has stressed the need to

understand what we mean by such terms as

“identity” and “the self,” for it is in these areas

that violence is released. (Arthur Koestler has

stressed that for many centuries wars have been

ideological, not basically economic.) For Erikson

it is the emergence in man of what he calls a

“pseudo-species” mentality that is the lethal

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product. The ethologists have shown us how
intraspecies rituals have allowed species to

survive their aggressive potential. The creation of

human identity, a richly plastic potential for

increasing adaptive powers, has been very largely

“pseudo” in the sense that it neither embraces the

species nor gives stability to any section of man.

Its unstable integration needs others into whom

are projected the inner forces that cannot be

managed. In such a situation only destruction or

subjugation of the threatening others is felt to be

the safe solution. Gandhi’s mission was to create

a method by which such impasses might be
overcome, by the anticipatory development of

more inclusive identities (Erikson 1969).

Though Gandhi studied the New Testament,

his Truth was always intended to keep political

action and religion inseparable. What was felt to

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be right had to be so central to man’s sense of his

self that he would gladly die for it. For him as in

Christianity martyrdom included concern for the

aggressor, but it was not to be invoked until all

conceivable attempts had been made to replace

the situation wherein “they know not what they

do” by one in which both sides might see more

clearly all the actualities —political, economic,

and personal. By the time he ends his book

Erikson confirms more than he expected his
original intuition that Gandhi’s Truth had much in
common with the thoughts of psychoanalysis.

What emerges is that Gandhi’s method cannot be

expected to solve conflicts that are the end

product of too long-established pseudoidentities
in man. Gandhi himself was notoriously unable to

practice his method within his own family and at

times within his ashrams, even when allowance is

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made for the fact that he was in middle age

before he fashioned it. The aim of his method and

much of its means are a legacy we cannot afford

to ignore. Modern dynamic psychology — itself

developed from a method in which a nonviolent

endeavor to understand the other replaced a

moralistic assault —is perhaps not so much

required in the situations for which Gandhi

sought a creative solution as for preventing the

growth to the position in human identity

formation where anxiety and fear preclude the

capacity to enlarge the selfs boundaries to admit

the validity of the other.

Whatever value is given to Gandhi’s Truth

today, we cannot but admire and wish to

understand what made him a great man of his

age. Two questions are posed on this issue: what

were the origins of his particular mission, and

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what gave it its consuming energy? In answering

the first the speculative possibilities are endless.

Great men, however, seem to convey a sense of

their destiny so that data about their early

characteristics can be assembled. Oedipal

conflicts, the favorite resort in the past, can

readily be detected, but psychoanalysis itself is

passing beyond the stage where these conflicts

are regarded as fundamentals to one in which

they are seen as outcomes of much that preceded

them. Erikson recognizes these early influences

but does not make use of the extent to which

primary structuring of the person by internalized

object relationships has been described by those

stimulated in varying degrees by the work of
Melanie Klein. Thus much of what dominated

Gandhi’s mission incorporates a strong drive to

make reparation. A difficulty for the Western

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analyst in speculating about the fantasy systems
that Gandhi developed undoubtedly arises from

the special setting of the Indian child in the

extended family, with its compressed world of

parental relationships complicated by the wider

network in which they exist, the many children in

the immediate environment, and the constantly

impinging intensity of so many relationships with

all degrees of intimacy in the closely packed life

space. Nevertheless, Gandhi’s fantasies of being

the powerful father along with his reparative

devotion to his father are prominent. The oedipal

fantasies of Western culture are not ordinarily

confronted with a father thrusting sexuality upon

the boy in early adolescence, and Gandhi

resented his arranged marriage most of his

subsequent life. The closeness of his parents and

the fact that he enjoyed an intensely affectionate

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relationship with them, as they did with each
other, appears to have produced in Gandhi a most

pronounced identification with the united and

idealized good parents. But their relationship was

to be freed from what he must have fantasied as

dangerous sexual relations. As Erikson notes, no

great man has so explicitly avowed his wish to be

a good mother to others. Nor is this striking

component of his personality associated with the

giving up of his masculine self. In all the

challenges he accepted he displayed all the

courage and toughness of any male leader. A

complex personality such as Gandhi’s—and his

inconsistencies in action, in his relationships, and

in his moods were ever prominent —is obviously

structured by a great range of fantasy systems.

Erikson makes a good case, however, for giving a

centred role to this theme of keeping the harmony

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of the parental relationship in the evolution of
Gandhi’s personality, in its earliest phases and in

later life when he arrived at his method in

Ahmedabad.

Erikson recognizes that place he gives to

what he calls the Event in Gandhi’s life is likely

to arouse skepticism. Gandhi’s disavowal in his

autobiography of its importance is rebutted

readily enough, for every psychoanalyst is all too

familiar with the defensive processes that can

belittle critical events. What may be asked by the

reader is whether the fascination exerted by the

Sarabhai family on the author has influenced his
judgment unduly. Gandhi was certainly arrested
by the situation in which a brother and sister,

devoted to each other, were the protagonists in

the struggle. Equally, there is no doubt that

Erikson’s experience of being in the ambience of

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this family, now greatly extended, and of being
able to talk to each of them in the place where the

drama had occurred, might have stimulated his

rich imagination to exaggerate the Ahmedabad

happenings. (As one who has shared this

experience in Ahmedabad, I have no hesitation in

raising these possible effects!) Erikson’s account

to my mind survives this criticism. The Event

was a deeply formative experience for Gandhi,

and the evidence adduced in spite of all the

difficulties carries conviction.

Our second question as to the source of the

drive that was transmuted into social action is one

that Erikson does not answer, and no one else

could in the light of our present knowledge.

Erikson’s probings, however, are surely pointing
the way to where the answers lie. For what he is

bringing out is that certain early experiences can

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create fantasy relationship systems that give an

intensity of feeling to the self and that establish a

constant inner pressure to reproduce their patterns

within a constantly adaptive actualization.

Cybernetic models will no doubt fill out from the

data of the neuropsychological substrates of

affective experience as well as its psychology

what we cannot do at present, that is, account for

the compelling intensity of certain emotional

systems when they are combined.

JOHN BUCHAN’S “SICK HEART”

That Sick Heart River was notably different

from Buchan’s other novels was manifest from

the start. “So unlike him, so introspective,” was

his secretary’s comment as she began to type it.

Memory Hold-the-Door, however, was far from

being an autobiography “though he might later

try to weave his experiences into a personal

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religion and philosophy.” The outcome was Sick

Heart River finished shortly before his death.

Always resistant to the direct communication

of his inner self, Buchan resorted again to his

fictional characters as though unable to depart

from his habitual medium of telling a tale. Pride’s

Purge was an earlier choice for a title and at once

we ask, what had this so admirable man to purge?

His life was such an ideal and full one with

extraordinary talents realised in so many fields

along with the great joy he had in his family life

and in his innumerable friendships. Nevertheless,
there was for several of his friends a puzzling

uncertainty about who was the real Buchan. His

son, William, in his sensitive memoir (1982),

describes being baffled by his father who was a
mysterious person behind all his openness, and

Buchan had said of himself in Memory Hold-the-

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Door that as a writer he must inevitably keep the
best of himself for his own secret creative world.

This unpromising prospect in regard to more

understanding of his personality is less bleak

when we recall Trilling’s (1972) study of

Sincerity and Authenticity in which he quotes

Wilde’s dictum: “Man is least himself when he

talks in his own person. Give him a mask and he

will tell you the truth” (p. 119). Buchan created

an unusually rich array of masks through which

he projected different aspects of his self into the

dramatis personae of his tales.

His story telling had long struck me, because

of the energy that went into its regular output
along with the sustained pace of the action in

each tale, as coming from powerful unconscious

urges. It also seemed that this stream of activity

constituted a segregated part of his self that had

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its own life. Moreover, the stories felt much more
rooted in vivid dreams with all the compulsive

intensity of that deeper process rather than being

the products of the more superficial meanderings

of daydreams. Their prominent unconscious

themes were not uncommon or bizarre, though

their variety was carried by a separate character

thereby defending both dreamer and reader from

the disturbing tensions of all being contained

within the one person although this fragmentation

naturally made the characters lack the

roundedness of whole persons. The oedipal

triangle was to the fore in the early romances

while the thrillers suggested more primitive

levels at which the hero had to contend with the

ruthless omnipotence of the villains driven by

their wish to control the world. To resist them

evoked violent sadistic retaliation against which

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the hero had to protect himself, and his wife and
family at times, by a secret flight. The villains did

not remain solely a repository of primal sadism;

they came to possess many of Buchan’s own

attributes as in the cultured interests of the

characters Lumley and Medina. Pointing, too, to

earlier levels of unconscious structuring than

those of the oedipal stage was the way in which

Medina’s omnipotent realisations were shared

with his blind mother. Her massage to induce the

hypnotic submission of Hannay was not felt

entirely by him as a soft feminine touch. Behind

the airy touch of her plump hands was “a hint of

steel as if they could choke as well as caress”
(1924, p. 80).

There seemed therefore to be a separate part

of Buchan’s self that surged with a strong

emotional pressure. What was most striking was

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the way his conscious ego, though heavily
committed in his busy life, could transmute these

imperative unconscious themes so readily into

exciting adventures told with his vivid

relationship with the countryside as a constant

background. Readers could identify at once with

the characters and the resolution of the sharply

etched dramatic conflicts. Little suffering here

from paralysing inhibitions or tortured guilts. No

question either of Buchan seeking the costly

process of psychoanalysis to alleviate their

intrusion into his competent working self. On the

contrary, he made his potential neurosis, so to

speak, reward him handsomely. The integration

of his ego must have been extraordinarily toughly
welded by ideals embodying in his inner world

the legacy from highly supportive loving parents.

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These speculations that his stories drained off
disturbing conflicts would also account for his

own attitude towards his writing. He enjoyed

telling a tale without ambition to be regarded as a

writer; and he steadfastly avoided being any part

of the literary scene. To have written novels of

significance he would have had to unite the

gamut of the human passions and their conflicts

within the single person. For him, it appeared that

he had to separate and then externalise into his

“puppets,” as he termed them, what he could not

accept as latent parts of himself. The bad figures

had to be conquered by the good ones who could

then return to their idealised pastoral lives. The

therapeutic function of his writing for himself

served, however, to discharge tensions rather than

to resolve their origins. They inevitably had to go

on being repeated and their deep appeal, beneath

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the entertainment, gained them a sustained
popularity.

The unique character of Sick Heart River

stems from a very different state of mind in the

author. The purpose and the impact of the story

are no longer felt as entertainment as in the past.

We are deeply moved by this journey of Leithen,

a scarcely disguised representation of Buchan’s

ambitious and reflective self, into his own

interior, albeit via his relationship with the

separate figure of Galliard set in their struggle

with the rigours of the Arctic.

When I first read this story I was much

preoccupied with the newer concepts entering
psychoanalysis about the self and its

development. It seemed to me that a conception

was cohering from these contributions, which
resonated with Buchan’s story. On rereading it,

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Sick Heart River was like a translation of this
new line of thought into the medium of the novel.

Writers have long familiarised us with divisions

in the self. Explorations of the nature and origins

of the phenomena, however, are absent as a rule

as though close contact with them becomes too

frightening to one’s own integration. At any rate,

the analytic pioneers who had gained access into

these earliest experiences, at first only in very ill

patients, had to work through considerable

reactions in themselves, often over several years

before they could understand some of the basic

processes. It was thus of unusual interest to me to

find Buchan’s intuitive insights not only depicting

the deep origins of the divisions in the self but

also the terror of madness that a confrontation

with them evoked. Furthermore, the essence of
the therapeutic help necessary for achieving the

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integration that early experience had fragmented

was there in the completion of his story. Instead

of a final tragedy or an unreal ending there was a

simple account of the power of unconditional

care inspired by the understanding acceptance of

the full intensity of madness threatening the self

when its autonomy has given way to a total

infantile dependence.

I propose now to outline the story and then to

suggest from Buchan’s history some powerful

unconscious themes that gave it its form. Since

these will inevitably strike some as the far-

fetched fantasies of psychoanalysis I next quote

from the story various features which to me

confirm them. And in a final brief section I
describe in bare outline a psychoanalytic theory

of some aspects of personal development for

which the story gives support.

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The Story

Leithen, having been told he has not long to

live, accepts a request to find Galliard, a brilliant

New York financier who suddenly disappeared

leaving only a note to his wife saying he is very

sick in mind and will come back when cured. On

learning that he belonged to an old French

Canadian family, from which he had become

disconnected, Leithen concludes that Galliard has

gone back to his roots and with a guide, Johnny,

he tracks him to the far Northwest. Galliard

started out with Johnny’s brother, Lew, as his

guide. Johnny explains to Leithen that Lew must

have become possessed by one of his mad streaks

to find the valley of Sick Heart River, which, in

Indian mythology, cures the ills of the soul. He

has pressed on at a pace that has left Galliard

behind and the abandoned man crawls into their

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camp injured and crazy, a state familiar to Johnny

in those impelled by fantasies about the North.

His obsession with Lew convinces Leithen that

he will only recover mentally in a reunion with

Lew. Leithen therefore goes off with an Indian

porter only to find the valley to be almost

inaccessible because of its mountainous sides.

Descending a steep cleft they slip and career to

the foot. Leithen is knocked unconscious and

recovers to find the Indian trying to bring him

round.

That night Leithen faces his religion and the

feeling that all his achievements are pasteboard.

Next day he goes alone to meet Lew and faints

from exhaustion in front of him. On regaining

consciousness he finds Lew has put him to bed
and is tending him like a mother. He tells Lew
that Galliard is very sick and in need of him. Lew

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is desperate to get away because he has found the

valley to be a place of death. On the return

journey, Lew’s devoted care changes Leithen’s

stoical sense of duty over the undertaking to a

warm personal concern for Galliard along with a

deep experience of God’s mercy in the world. He

sees Galliard, tortured by guilt and remorse for

what he has done to his family and driven to

atone, the more so as he had been involved in the

industrial development that had destroyed its

heritage. Leithen tells him of his brave wife

awaiting his return yet he realises that Galliard

must get on terms with the North before he can

leave it and get well. When news is brought that

the local Indian tribe is succumbing to a suicidal

apathy, Leithen finds inspiration for its

rehabilitation through the care he received from

Lew and Johnny, care that he feels to be an

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expression of beauty and tenderness concealed by
the iron front of nature in the North. Sure that

Galliard can find salvation from this reparation,

Leithen evokes a new hope in him by getting him

to participate in it. Leithen dies in serenity as the

Indians recover. Galliard rejoins his wife to find

again his great joy with her and to express his

feeling that his life cannot be long enough to

make up for all the suffering he has caused her.

Buchan’s Early Development from a

Psychoanalytic Perspective

While symbolic significance at many levels

can be readily attributed to the story, its moving

impact suggests that it resonates with universal

emotional struggles in the evolution of the self
towards a mature integration. To identify some of

these conflicts in Buchan’s psychological

development, the inner depths he drew upon, we

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have to examine his history, especially the
uniquely formative experiences in his infancy and

childhood. Janet Adam Smith’s excellent

biography provides a number of clues which,

along with the descriptions of the family life in

his sister Anna’s (O. Douglas) books, permit us to

make reasonable inferences. I believe these carry

a convincing picture of inner factors that shaped

the future man and his writing.

Buchan was a fragile-looking infant who in

his own words was “a miserable headachy little

boy” (1940, p. 81) until he was about 5 years old.

Since his subsequent achievements, physical and

mental, suggest no major flaws in his

constitutional endowments, this early condition
points strongly to a seriously disturbed

relationship with his mother. Barely 18 when he

was born, and admittedly a very inexperienced

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mother, she also had a managing, controlling
personality. Thus she would not have found it

easy to provide the relaxed trusting attitude that

allows a baby to make a spontaneous contribution

to the patterns of its maternal relationships and so

lay a foundation of security for independence

with confidence in its autonomy. Any lack in his

mother’s personality must have been
compounded during these first 5 years with the

constant preoccupations to which several external

events subjected her. She had been precipitated as

this very young woman into the role of a

minister’s wife with her pregnancy following

almost simultaneously. Then a few months after

Buchan’s birth, her husband changed his church

so that she had to organise a move of their home

to another part of the country and within the next

year she became pregnant again. Furthermore,

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she had to cope with all those demands plus a
husband who, though devoted to her, was a rather

unpractical man in everyday domestic affairs.

It is hard to imagine any infant or child in this

situation not being affected by gaps in the reliable

availability of his mother with a joyful

responsiveness most of the time to the assertion

of his needs, bodily and psychological. We

should also anticipate from psychoanalytic

experience, that her possessiveness and the

ambitions she had for her children, along with her

puritanical upbringing, would inhibit the normal

expressions of childhood masculine assertiveness

and sexual curiosity, especially in a highly gifted

boy. Some confirmation for this view is had in the
fact that of her four children who survived to 30,
Buchan was the only one to marry; and sexuality

is scarcely in evidence in the idealised women of

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his novels. A considerable aggressive resentment
against this intrusive controlling mother was

highly likely to have been a main factor in his

condition.

These psychoanalytic forebodings would be

apparently made fanciful because of the way in

which this miserable self was transformed into a

zestful boy with boundless energies and

enthusiasms. However, this striking change does

not confirm the common belief that it was simply

a case of “growing out of it.” It was occasioned
by a quite unusual and unexpected experience.

Towards the end of his fifth year he sustained a

fractured skull through a fall from a carriage.
Instead of being separated from his mother by

hospitalisation, as would have happened today, he

was at once immersed in intensive care at home

with his mother, aided by a friend, doing the

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entire nursing while he recovered during the next
year. When we recall all the tasks she had to

perform with her exacting standards, we cannot

but be impressed by her as a powerhouse, an

indefatigable manager, yet amply endowed with

maternal devotion. From this surfeit of loving

care the little boy emerged with a new self. Inner

images of his early frustrating “bad” mother were

no longer dominant with their depressing effects.

They had apparently vanished into his

unconscious and kept there by the almost saintly

figure of a mother who had miraculously given

him an exciting new sense of being. There was no

question, however, of their early relationship

structured over the five most formative years in
the development of his personality having

dissolved away. All psychoanalytic experience

would be against that. It would stay although its

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effects would be covered over according to the
amount of good experiences, especially

immediately afterwards, and the effectiveness of

the compensatory structuring from these.

Fortunately, there was now in addition to what he

got from his mother the rich relationship with his

father, loved and admired for enchanting his

children with endless stories and his love of the

old Scottish minstrelsy. The joy in imaginative

play from his fascination with these tales during

his long illness and later must have been a

creative experience of rare quality —one,

incidentally, shared by the two other great

Scottish story-tellers, Scott and Stevenson.

After his recovery, his enormously enriched

and consolidated new self maintained a lively

investment in his intellectual abilities both at

home and at school. By adolescence the exciting

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world he had learned about, one he now loved
intensely, was making the home environment too

restrictive for his sophisticated ideals and

aspirations. Little or no overt parental opposition

was expressed, yet to pursue them must have

entailed a sense of guilty betrayal, if not of

rebellion, against what his beloved parents stood

for. His longing for a more gracious and inspiring

world was crystallised by the impact of Gilbert

Murray, then a professor at Glasgow, and his

fascinating aristocratic wife. Further

encouragement from Murray saw him to Oxford.

There his close friendships with a group of

brilliant young aristocrats, of the mind as well as

society, reinforced his goals for the future; and

his literary talents allowed him financially to join

their world. Yet he kept up active relationships
with his family and his old friends of all kinds

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throughout his life. Buchan’s attachment to this
world was no snobbery. For him it was the

appropriate environment for the realisation of his

Greek ideal of the philosopher gentleman if not

king. This was the road he had to follow. It was

also the one that took him far from any threats of

the return of a painful early past.

His gifts for outstanding intellectual

competence and the ability to produce quickly

with it, in literary and political reviews, and in

legal and administrative matters, soon led to

offers of important work. He never gave the

impression of being rushed and he pursued his

love of the country along with a lively social life.

His genetic endowment was obviously superior,
but the use he made of it conveys a sense of deep

identification with his “second” mother whose

highly organised energetic output was unceasing.

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His father, an intensely dedicated and evangelical

preacher, was also perpetually driving himself in

the service of others. Indeed his otherworldliness

led to an ineffectiveness in everyday affairs such

that his wife and family, in their great affection,

assumed the role of watchfully looking after him.

As Buchan’s early model for manhood, his

father’s scholarship, his love of the old ballads,

and his dedication to the welfare of others had a

great influence. Later, his father’s parochial

outlook in intellectual issues generally led

Buchan to have some patronising feelings to him,

but with no diminution of his affection.

Overt attitudes to sexuality in the manse

were, as would be expected, both Victorian and

Puritan so that interest in the opposite sex and

adolescent love affairs were strikingly missing in

all the children. The family, of course, could

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hardly avoid the subject with their constant

closeness to farm life and the familiar earthiness

of the love life of Burns plus the perpetual

biblical references. Furthermore, Buchan had the

uncommon experience through being the first

child of a very young mother of having the last

two of her five succeeding children arrive when

he was in his fourteenth and nineteenth years.

Even here this last birth evoked considerable

surprise in him when it happened. Romantic love

thus inspired his first novels written while he was

a student and they have all the stamp of the

adolescent still constrained by the oedipal

triangle and the almost excessively strong ties

within the family group.

He was 30 when he first fell in love. Susan

Grosvenor was closely related to a wide range of

the upper strata of the London aristocracy and

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unusual in that her family had a large circle of

friends within the literary and artistic worlds.

Their relationship thus brought to Buchan a great

deal of what he admired and aspired to. After

about 18 months he was offered a directorship in

Nelson’s the publishers and with this economic

security he was able to propose marriage. There

was no doubt that, however much his ambitions

might be regarded as primarily for worldly

success, they also included an ideal love

relationship and this he realised. He was deeply

devoted to her, his only love, and one which

never faltered.

The successes of his later self, rooted in the

miraculous therapeutic relationship with his

mother, are remarkable when the serious

insecurities of his first years are pondered. That

pressures from the now hidden self had not been

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obliterated can be inferred from various aspects
of his life, above all as the wellspring of the

fictional side of his writing. Although he did not

adopt his mother’s ambitions for him to enter the

ministry, he incorporated into his ideal self a

strong intention to be involved in social affairs

and to serve society from levels which he could

exercise significant power; and he remained a

staunch and devoted member of the Church of

Scotland. Politics appealed and when he entered

this field he impressed several of the political

leaders sufficiently for him to be thought of as a

future Prime Minister. Several of his friends

eventually saw, however, that he was too “nice” a

person to achieve the highest positions there. He

himself felt that he was best placed as a number

two in the leadership of public affairs. Here there

was a characteristic noted by his friends, namely,

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that he could not readily “tick off people.” That
his deep ambitions, perhaps not fully conscious,

to assume power at the top were curbed from

within can hardly be better seen than in his

becoming the monarch’s deputy, with all the

ritualised respect and acclamation accorded to the

king. He was appointed for 2 successive years as

the Lord High Commissioner in Scotland and

then as His Excellency, the Governor General of

Canada, a position for which he had to be

elevated to the peerage. We may wonder to what

extent omnipotent grandiose fantasies from early

phases were competing with more realistic

ambition for which his friends felt he never used
fully his talents; or whether an unconscious guilt

kept him from triumphing over his father.

Writing became an essential activity for him

from boyhood. Creative urges were fuelled from

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the ambitions and ideals within his centred self
and from the ceaseless activity of his unconscious

inner world. As described already, his great

investment in the human scene and its history

could pave the way for an entry into the

influential commentators on current issues. From

the split off self came a second group —the

themes of his fiction. That this had potential

dangers from its primitive destructive impulses

and grandiose omnipotent aims was plain in the

fantasies that surged up like dreams. Yet his

central self, so firmly modelled from his parents,

could always emerge as the dominant force. His

leisure activities were also a great strength in the

defence against the disturbing aspects of his

secret self. His love of nature was of passionate

intensity. In his descriptions of explorations into

the countryside even in boyhood, there is a

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feeling of the child being close to his beloved
mother, perhaps in the way he had missed in his

beginnings. The quality of this feeling matured

into his attachment to nature, which stayed firmly

as an integral part of his self. This feeling also

included his home and garden, his family and the

servants, giving a depth of caring concern that

obviously played a large part in his great gift for

making and keeping his innumerable friends.

A third main grouping in his writings is his

biographies. Perceptive and respected for their

scholarly quality they include studies of men who

challenged existing injustices yet who had tended

to be negatively judged by history. His sympathy

with their cause and his emphasis on its validity

seems to draw upon his own struggle and to say

something in defence of his hidden self and

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perhaps to achieve some integration of it with his
centre.

Control over the constantly threatening

tensions from the unconscious memory of his

“bad” mother was reinforced by two other

processes. He held on to the “good” mother who

had saved him with a compulsive attachment, a

familiar sequel to early insecurity in these

relationships. There were ample grounds for

feeling a great love and gratitude towards her, but

a sense of compelling need to keep her presence

perpetually there strikes us from the way he kept

her in his mind. He wondered always what she

would think before he made decisions. From

adolescence they seemed to know each other’s
mind without anything said. No matter what

pressures were on him he kept her regularly

informed of his activities; and it may be more

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than coincidence that one of the worst spells of
his recurrent gastric trouble occurred in the

months after her death at the end of 1937. There

was a contributing factor too in the close way his

mother was involved with him.

The reference to his gastric illnesses

introduces what was perhaps the most threatening

and painful manifestation of the tensions from his

hidden self. Becoming intrusive about the time

when the relationship with his future wife began,

spells of severe gastric pain drove him

periodically to retire to bed for nursing care with

the common regime which converts adult diet

into what is much more like food for the baby.

Recurrent attacks persecuted him for the rest of
his life, defying all medical treatment including

an operation for duodenal ulcer in 1917. This

common trouble in men who live under too much

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stress is usually attributed to overwork and there
was no doubt Buchan had periods when he was

grossly overworked by ordinary standards.

Nevertheless, he was a person who greatly

enjoyed work for which he had an enormous

capacity and competence. Often the source of

such stress is to be found in the unmanageable

interpersonal tensions at work rather than in the

work itself. Here again, Buchan was seldom in

that position with others.

That deeper psychological factors must have

been involved was eventually decided by his

medical advisers who in 1921 arranged for him to

enter the clinic of a psychiatrist in Germany.

After a few weeks of the usual remedial regime,
inspired by physiological rather than

psychological assumptions, Buchan was declared

by him to be “free from frustrations, or crippling

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inhibitions and neuroses.” His son William

describes having long been unimpressed by this

opinion. Apart from the disbelief it conveyed, the

expansive tone of the doctor’s pronouncement led

him to conclude that his father had completely

outwitted any attempt to get below the surface of

his self. In fairness to the doctor, I do not think

there would have been much of a battle of wits.

He had no understanding of unconscious factors

and even endless questions would only produce

information from which little or no emotional

insight could be developed by either doctor or

patient. This lost opportunity to have helped

Buchan was regrettable especially since he was

sympathetic with the psychoanalytic approach to

the mind. For someone of his sophistication, the

doctor would have had to convey an
understanding of what was beneath the surface of

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Buchan’s personality before the patient could feel

an evocative trust. The sick heart hidden within

the tortured body had to be taken in hand.

Psychosomatic conditions have long been

shown by psychoanalysts to have a meaning for

the individual, that is, to express a hidden conflict

within some infantile relationships. Avoiding
guesswork about specific factors, we can say that
certain stresses in his outer world could awaken

in Buchan at a deeper level a feeling that his

“good” mother was becoming lost to him. His

illnesses then became miniature repetitions of the
treatment that had worked so miraculously in the

past, namely, the intensive care of devoted

nursing when in the state of the dependent child.
He felt better after these spells in bed but always

this reassuring effect wore off.

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In short, then, we can note ample cause for

the creation of serious splits in Buchan’s self and

evidence of their persistence. As he faced the

decline in his vitality he was drawn to a profound

introspective look at himself in which some

synthesis had taken place in those last years of

his life. From this inner change, I believe he

intuitively sensed some of the origins of the

lifelong conflict in his self. This unconscious

conflict was transformed by his rich imagination

into Leithen’s pursuit of Galliard, a man driven

into his remote past, and then to effect a

reparation by both for the destruction in their

inner worlds of beloved parental figures. The

question now concerns the evidence of this
repressed conflict in the story.

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Patterns of Early Experience in the Story

Leithen has been widely taken to be a central

aspect of Buchan himself, and particularly so in

this novel. He is, however, only one mask,

namely, for his central reflective self, or ego, that

has carried out his professional and intellectual

achievements and which is now engaged on the

most difficult of all appraisals, his total self, at a

point in life where inner self-defensiveness is

scrutinised. To the psychoanalyst, Galliard is just

as much Buchan as Leithen, though embodying

an alienated part, the secret self fashioned from
the frustrated miseries of the little boy. Though

described as extremely delicate by his mother, the

boy would be all too capable of a violently
protesting urge to get rid of the “bad” mother and

have her replaced; for lack of manifest

responsiveness in times of need can only be felt

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by a child as hostility. The wonderful
transformation from finding a new mother behind

what had been to him an ungiving front had

produced an identification with her endlessly

driving energy. To preserve this new relationship

both internally and externally he maintained a

compliance with her, which now made the

achievements Leithen was referring to

meretricious. Buchan, with unconscious wisdom,

sets his story with Leithen in poor health to start

the journey into his own interior, a regression to

his own early condition. The setting drew on the

great impression the Canadian north had made
upon him. There was the beauty of the landscape

and for him the idea of great riches under the

surface. In the early years after he found his new

self it was his exciting relationship with the

environment, especially the hills and the woods,

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that he wrote about in Memory Hold-the-Door as
his earliest memories.

I deferred speculation about the origins of

Buchan’s ulcer trouble, which can now be made.

It is not too fanciful to suggest that in his poor

state, colicky abdominal pains were a not

infrequent experience. Whether or not, it is surely

not “by chance” that Leithen’s quest is instigated

by Blenkiron, the American in Greenmantle with

the bad duodenal ulcer. It was he who took part in

the struggle against the dangerous fantasies of

Hilda von Einem to scheme for omnipotent

control of her world and to possess the freedom-

loving Sandy Arbuthnot in whom Buchan seemed

to have put his youthful longing to be a scholar-

gipsy. And Galliard is married to Blenkiron’s
niece. Galliard’s career has a close fit with

Buchan’s. He had broken away from the

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constraints of his family though only after a
violent quarrel with his father who died not long

after. His relatively late marriage is also a

devoted one though the impression is given that

for one part of himself it was the peak of his

aspirations because of the glittering world his

wife inhabits. She is described by others as

possessive and ambitious for him and so we feel

that her love could threaten him. The life longed

for in his youth, with freedom from the family’s

impoverished situation, was now after its

realisation not only felt as a hollow one, but one

that in his inner world had become a cancer

eating into his soul. The past was reliving itself in

one part of him so that to continue to submit to it

would be to go to pieces under the pressure of the

frustrated rage of the gifted child’s desperate

struggle for his autonomy. Unconsciously, the

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inevitable violent infantile sadistic fantasies
against frustrating parents become intolerably

frightening with the anxiety and intense guilt

from what one part of the self wants to do to all

that in the central self is so precious. To lose his

mother and his father spells terrifying isolation to

the child. In Buchan, to attack his mother would

have destroyed what she had put together and

sustained for him, a feeling giving rise to

unbearable anxiety and guilt. Though there is no

open recognition of this destructive rage in

Galliard yet we know that sadistic fantasies had

been in Buchan’s mind in the past. About the

time his gastric troubles were becoming

troublesome he wrote the short story The Grove

of Ashtaroth. The central figure, a bachelor,
creates a home of idealised perfection in a
beautiful situation in South Africa. It has a grove

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in which there is an ancient phalliclike tower. He

is eventually driven periodically to go in the

middle of the night, naked and bearing a large

knife, to the tower round which he performs a

ritual dance. He returns covered with blood from

self-inflicted lacerations like the devotees come

to worship the goddess Astarte who demanded of

them self-castration as they worked up to a

frenzied orgy. In his first thriller, The Power

House, Leithen had also to find a man who has

left his wife without leaving any trace of his

whereabouts lest she come to harm from the

malevolent group pursuing him. The 39 Steps,

which was written soon afterwards, opens with

the dread of a man who has penetrated some of

the secrets of a mysterious group plotting to take

omnipotent powers and who are now trying to

kill him. In spite of Hannay’s efforts to help him,

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he is found on the floor stabbed through the heart.
This fantasy gives some idea of the terror induced

in the primitive infantile levels of the mind by the

inevitable violent retaliation in kind from the

hated figures.

From the unconscious dread of his destructive

urges, there was only one choice in Buchan’s

mind, namely, to banish them into a segregated

self where they could be hidden. It is a similar

situation that has apparently built up with

growing tension in Galliard until he has to take

panic flight. This will protect his wife, and he

will end the torture from an unconscious hate of

her, perhaps evoked by a sense of her controlling

ambitions for him, by a journey of atonement and

reparation. Simultaneously he will assert his

masculine independence in penetrating that

forbidding land that his ancestors had possessed

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and find thereby the magic of a mother’s
acceptance of his manly self. This inner need,

persisting so insistently, has made all his

achievements a disillusionment and to be

despised. When the feelings from this level return

with self and mother merged together at times,

and then in an unstable separation, Galliard gets

the terror of being engulfed by a retaliatory

mother. There is only one choice. He must flee

and with little thought for his wife left in

ignorance of his emotional state and where he is,

and having to cope with her fears for him along

with the pain of wondering where she failed him.

This solution, though intended in one part of his

self to protect her, inflicts very great pain. In a

deep sense it is tantamount to murdering her. The

violence here can be inferred from the intensity

of Galliard’s later guilt over his flight when he

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feels the rest of his life will be spent in
atonement. Leithen regrets the absence in himself

of simple earthy masculinity, such as Buchan felt

to be the core of the Border shepherds he almost

idolised, the men who had peopled his mother’s

world. For Galliard it was the courage and

freedom of the men in his family who explored

the North that he envied. For Buchan, there had

been no instillation of this zestful self in his

beginnings. Galliard had had a much more

dramatic deprivation for we are told, in an almost

casual passing reference, that his mother had died

at his birth — perhaps a vivid expression of what

Buchan’s early misery felt like at times.

Before Leithen can get to the core of his inner

situation he has to surmount some of its
frightening nature. Galliard has been abandoned

and cannot survive in this cold world in which he

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is a helpless babe. When he reaches Leithen’s
camp he is totally exhausted, injured and with his

mind in a disintegrated madness. The guide

Johnny takes his condition with a calm

recognition of what it is about. Galliard is one of

those travellers who go to the North with a

fantasy of it being “a pretty lady” and then

finding “it can be a cruel bloody-minded old

bitch” (p. 95). These are strong words for Buchan

which must have echoed his early misery and

hate. Johnny says Galliard “wants nursin’ and

quiet, and a sort of feel that he’s safe, and for that
you need four walls” (p. 99). Leithen cannot
understand how Galliard, after the way Lew

treated him, is still obsessed with getting back to

Lew, “like a child crying for his nurse” (p. 100).

Johnny explains that “That’s the way it works”

(p. 100). Galliard does not know his troubles are

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“all Lew’s doin” (p. 100). The terrifying
loneliness has made him claw on to anything

human, but if that were all, Leithen or Johnny

might have taken Lew’s place. Lew, however, has

possessed Galliard’s mind with “his Sick Heart

daftness” (p. 100), the place where Lew and he

will be put right; only the finding by Galliard of

Lew in his right mind will change Galliard’s

mental state. In short, it is not “any” nurse who

will do; it must be the one who induced this

madness of his abandoned feelings —the one

who is now merged in his deeper feelings with

his mother.

Leithen now becomes possessed by this

mission to find Lew and get him back whatever

his state of mind. Johnny is greatly moved by his

courage.

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Buchan refound his good mother after he was

precipitated unconsciously into her intensive care

by a fall from a carriage in which he was being

taken with her to a picnic. Leithen’s journey with

one of the Indians, agonising for him in his weak

state, takes him eventually to the edge of the

steep mountainous sides of the Sick Heart valley.

Getting down looks impossible until he finds a

cleft which they descend despite the risk. The

Indian slips and both are plunged to the foot of

the icy slope. Leithen, rendered unconscious,

recovers to find the Indian massaging him. That
night his mind is turned inwards. His

achievements he had always known were

pasteboard and he was now alone with God. Next

day when he confronts Lew he falls unconscious

from utter exhaustion. On coming to, he sees that

he has been carried into a shelter in which Lew

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cares for him with great maternal tenderness. A

remarkable detail is given at this point. Leithen is

startled by Lew’s hair, “as flaxen as a girl’s” (p.

117), and by his piercing brilliant blue eyes —for

both of which features Buchan’s young mother

had been well known and which would be deeply

significant to the baby. Leithen gets from Lew the

loving care and tenderness that had got lost

behind Buchan’s mother’s preoccupied and

frustrating front. He becomes a changed man,

elated by a sense of God’s mercy hidden beneath

the iron front of nature. Having assimilated it in

the upper levels of his self, he is then able to feel

more strongly the necessity for Galliard to repeat

the same experience in depth with Lew, the one

who in his driven obsession became identified

with the mother who had abandoned him. No
reproaches are uttered to Lew for what he did to

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Galliard nor to Galliard for what he did to his

wife. Instead there is an understanding

acceptance of what has driven them. Galliard,

like Leithen, appreciates the care, but for him it

re-creates only his bodily strength. Leithen sees

he must also create in Galliard’s sick mind the

only thing that will cure him, namely, a core self

which has carried out an act of great reparation

for what his destructive self has done. This act

will give him the experience of restoring in his

inner world the destroyed mother to her good

state. Leithen takes him through this task by

inspiring his participation in the rehabilitation of

the Indians. And, though of a different tribe, the

mother of Lew and Johnny was an Indian; she,

too, had died at Johnny’s birth. Leithen dies on

the completion of their task in peace and serenity
under the devoted care of the Oblate Father who

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served the little chapel for the Indians. Galliard is
reunited with his wife. He feels that Leithen will

live on inside him and the rest of his life will be

needed for making reparation to the wife he

cruelly abandoned.

Before leaving these observations on the

repetition of his childhood experiences a brief

mention should be made of the two guides. Apart

from the more dramatic role played by Lew who

has many aspects of Buchan’s mother, Johnny,

the younger brother, is an appreciative

representation of the devoted care from his father

as well. Aspects of each parent are mixed in the

two men with the dominance of his mother

reflected in Lew yet without effacing Johnny, the

father who depended so much on his partner;
Buchan had parts of both parents in his

personality in much the way that the relationships

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amongst Leithen, Galliard, and the two guides
have been depicted. Galliard and Lew link the

deep threatened self with his mother while

Leithen and Johnny bring together the solid

virtues of his father. The unconscious family

situation also seems to determine the close

relationship between the guides as brothers

whose father came from Border shepherd stock,

the epitome of what Buchan greatly admired. The

simplicity of the guides’ attachment to their

country of origin, their unhappiness when they

left it and their need to return to what they fitted

into so well, are contrasted by Leithen with
people like Galliard and himself, whose abilities
and ambitions for a spacious life beyond that of

their parents, drove them inexorably to

achievement in the wider world, success which

he now questioned.

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Buchan, through Leithen, seemed to have
attained a profound resolution of inner conflict.

He had started Memory Hold-the-Door about a

year after his mother’s death. He had now

finished the personal autobiography and within a

few months he died in his sixty-fifth year the

same age as his father.

The Writer and the Psychoanalyst

My main purpose in presenting these

reflections on John Buchan’s last book is to share

some suggestions about the unconscious themes

that I felt illuminated the close connections
between the novel and his own early history. It

seemed to me that it was this wellspring that gave

the novel its unique character amongst his
writings. As a result of the particular impact it

had on myself I was prompted to offer some brief

thoughts on the relationship between the writer

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and the psychoanalyst. Poets and writers are our
main source of knowledge of the deeper forces in

the inner worlds of man; and for certain of these

urges, for example, his responses to the changing

image of himself in his world, they still have a

unique role. They seldom, however, get to the

origins of what they confront us with, as if that

becomes too difficult, perhaps too frightening, for

the single mind. This understanding has become

more and more urgently required as man has

expanded his awareness of himself and his

responsibility to be evolution rather than the

hapless victim of chance and necessity. If he is to

manage more of his destiny effectively, he must

have validated knowledge, especially this

critically important knowledge of how he can

direct the development of his personality — the

instrument with which he appraises all. Here we

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have moved, as Braque put it, from the function

of the artist to disturb us to that of the scientist

who can reassure. For this task, he must articulate

and validate knowledge of ourselves and so make

it usable in our power to manage ourselves.

Freud’s theories, evolved to their familiar

form 60 years ago, made an epochal change in

man’s image of himself. It is still all too common

to equate psychoanalysis today with these

classical views. His lasting legacy, as he himself

so often stressed, was not his theories —as in any

scientific endeavour these must be constantly

changing—but a method for exploring the

unconscious processes in our inner worlds. It has
in fact been one of my main aims to show how it

is the recent changes in the perspectives of

psychoanalysis that make Sick Heart River such a

fascinating work. The rejection of psychoanalysis

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as unscientific, especially from the professional

and academic worlds, is for the most part a

demonstration of a widespread defensive

ignorance and fear of psychoanalysis. The

psychoanalyst in his practice is not primarily a

scientist who can reduce and subject his data to

the experimental constraints of the laboratory. He

undertakes a commitment to develop with

another human being a unique relationship in

which to relieve as best he can the sufferings of

his partner in a mutual endeavour. He cannot

progress without making theories to organise and

communicate what he finds; but some of the

validation of these general hypotheses he seeks
must come from the work and methods of others
if they are to belong to science, that is, to tested

knowledge. Writers in their descriptions of man’s

inner conflicts with himself and his society are in

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an obviously complementary role. They, too, use
their insights, coming often in the intuitions from

dreams and fantasies, and especially into man in

his holistic aspects. Also, their commitment to

their work must have a lot in common with that

of the analyst as the relationships with his

analysands develop.

As I said earlier, it was an impressive

experience to me to find Buchan reproducing the

essentials of the therapeutic task in the serious

disorders of the self. His account of Galliard’s

psychotic distress and his rehabilitation after

finding the concerned care in people behind their

apparently unempathic surfaces was a striking

confirmation of analytic work. Buchan’s good

fortune was to have had an extraordinarily intense

compensatory relationship with his mother after

what must have felt like one with a “cruel old

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bitch.” The security with which he had
established his second self was a buttress for the

full realisation of his latent talents. The

satisfaction from all his fulfilments was manifest

though it never lessened the dynamic pressure of

the early miserable one. It seemed as he faced

death, his fear of the destructive aspects of his

early self were now less of a threat and so he

could let the unconscious levels come forward to

be transmuted in a creative synthesis by his

brilliant talents. The unique acts of creation in the

production of the writer’s work and its

communicative power have essential elements

beyond the psychoanalyst’s resources. The

existential position of man in his constant latent

evolutionary thrust may well always be in this

“beyond.” That is where the artists’

preoccupations are; yet their contribution will

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always need to be nourished by the advancing
knowledge carefully established from the work of

the analyst. Their unique contribution, especially

with the newer views of the analysts, can serve to

facilitate this mutual enrichment.

To make clearer the change in psychoanalytic

theory from its assumptions of instinctual

energies as the biological foundation for human

development to a paradigm based on modern

biological views of open systems, that is, living

organisms and the transformation in their central

organisation through interactions with the

environment, I add a sketchy outline of the recent

trends in self-psychology. I hope this may take
those interested into the study of such writings as

those of Bowlby (the most thoroughgoing and

comprehensive), or Kohut, the American analyst,

or of Ronald Fairbairn, the Edinburgh analyst

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who formulated about 50 years ago the first
systematic attempt to move into modern science

in contrast with Freud’s adhesion to nineteenth-

century assumptions about the nature of reality.

Psychoanalytic Notes on the Development

of the Self

The adult self can be regarded as a system

that has organised its progressive experience with

the environment in such a way that the person

manages the business of living with competence

and a satisfying significance. Clinical experience

and systematic studies of infant-mother

development have now established beyond doubt
that this successful development has to be

founded upon appropriate experience from birth.

The unit of study in this field is clearly that of the

infant within the ordinary expectable family
environment. The word “expectable” is crucial,

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for the infant has a surprisingly rich repertoire of
activities which have an inbuilt goal that is at

once felt as right when it is encountered. These

inbuilt needs are not only around the bodily

processes. There are just as urgent ones from the

expanding psychological equipments to be met

with the emotional equivalent of the “good feed.”

When a good measure of satisfactions is

experienced and the mother communicates her

joy in sharing the infant’s achievements, it seems

that a quality is established within the self as a

whole of having a faith and trust in others, and

consequently in himself. As wider relationships
follow with father and other family members the

secure self can cope with the instinctual forces of

sexuality and aggressive assertiveness as these

become more prominent.

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When the environment fails the infant
emotionally the potentials for all kinds and

degrees of distorted development are laid down

mainly in the form of excessive divisions within

the self. A central self has to preserve a

relationship with the mother for survival almost

irrespective of the degree of any deprivation.

When the latter is severe then the person has little

or no security in his relations with others, though

this inadequacy may be covered over by the

acquisition of a compliant behaviour with no real

conviction that this is what should be happening.

There is little or no sense of the essential
autonomy in doing “one’s own thing” because it

is essentially someone else’s thing that has been

forced upon the self. The experiences of

frustration, however, do not disappear nor even

wither. Instead they group to form the core of

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subselves whose aims have some of the dynamic
urges of the primal self. Because they arise in

opposition to the environment they must on no

account be revealed. To do so would incur what

is felt as the frightening hostility of parents or of

their withdrawal of love. There is then a turning

into an inner world in which the growing

imaginative powers can fashion figures that will

provide exciting substitute satisfactions. There

are also, however, parallel figures which are

hated for their frustration and dreaded because in

the omnipotent magical modes of early mental

processes there will be terrifying retaliation from

them. Though these inner figures are created to be

the objects of the repressed aims they are also in

the mind and so are identified with. Thus, one

part of the self comes to hate some of its

repressed needs as a means of avoiding the

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dangers of their expression. The person becomes

a cast of inner characters whose interactions are

the source of our dream life, and of the main

conflicts in relationships.

What has proved most striking about this

inner world of the self is the intensity of the

hatred with which the self responds to the

parental figures who failed it. Also, the tenacity

with which these inner relationships are clung to

despite their maladaptive nature reflects a

desperate need for the self to be attached to
parental figures, no matter how bad they may be,
to maintain any cohesion. When these
attachments are threatened as in traumatic
external happenings or in analytic work with their

origins, then the anxiety aroused can be

indescribable because isolation is felt as the dread

madness or loss of the self. It is the difficulty in

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reaching these levels of development within the

analytic relationship, and then usually only with

seriously disturbed personalities, that made for

the long delay in exploring these regions. What

has emerged is that when the analyst has enough

understanding to accept the intensely destructive

hatred towards him when he is felt by the patient

to be like the depriving mother, then working

through the terrors of this relationship leads to the

analyst being felt as reliable and concerned. An

inner security is then established with a capacity

to love in contrast with the permanent distortions

of relationships that early deprivations leave

especially when parent-child relationships remain

bad.

While there seems to be a general pattern of

the kind outlined, there is an infinite range of

compensatory developments from better

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experience at later stages according as the talents

of each child find a supportive expression from

the parents and the family. In Buchan’s

development, the serious early deprivation was

covered over by the extraordinary combination of

the subsequent intense devotion of his parents,

his unique talents fully encouraged, and

energetically pursued, and a highly supportive

family group. Nevertheless, his primal self

remained unconsciously seeking the integration

every child must achieve if its autonomous

strivings, through their acceptance with parental

joyous responsiveness, are to become

transformed into good relations with others.

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24.

ON BECOMING AND BEING A

PERSON

In recent years, I have got rather obsessed

with the problem of the self because of what I

feel to be the clamorous need for a new paradigm

in psychoanalytic theory. One of the unfortunate

features of psychoanalysis is the awful

subservience to the tablets the master brought

down from the mountain. Nobody dares say any
thing that would criticize Freud —he was

regarded as the last word. I think it’s terribly

unfortunate that there isn’t more openness.

I’ve chosen as the title for my theme: On

Becoming and Being a Person. The agency of
human motivation and conduct is the self, and

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we’ve got to understand more and more about its
nature, its origin, and its functioning.

It has been remarked frequently that classical

metapsychology has failed to do justice to the

essential personal quality of the individual in its

account of human nature. Moreover, I believe

that it is the failure to give an acceptable

theoretical basis for the personal level of behavior

that has created the most prominent feature of the

current psychotherapeutic scene; namely, a

pluralism in theory and practice, with consequent

confusion and uncertainty in those trying to

appraise its various claims. Now, this

development has been of concern to analysts in

recent years. They’ve become concerned lest

their work and its importance for society
becomes discredited.

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Three years ago the president of the
International Psychoanalytic Association, Dr.

Robert Wallerstein, entitled his presidential

address “One Psychoanalysis or Many?” —a

paper (1988) in which he provided a masterly

survey of this aspect of the current scene. There,

Wallerstein considers the anomaly of very

different theoretical ideas being associated with

comparable practice by analysts remaining within

one professional body, the International

Association. So they must feel that there is

something common that keeps them and holds

them together, and that can be recognized and

evaluated.

The anomaly of this situation, with different

theoretical ideas associated with comparable
practice, led him to put forward some ideas based

on thoughts from Joseph and Ann-Marie Sandler.

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In the early history of analysis, challenges to his
theoretical principles led Freud to exclude the

prominent dissidents from the psychoanalytic

movement, because their views were associated

with clinical work that abandoned what he

deemed to be the essential core of

psychoanalysis. Yet, in Freud’s view, any line of

investigation that recognized the two facts of

transference and resistance, and took them as the

starting point of its work, even though it arrived

at results other than his own, had a right to call

itself psychoanalysis.

That was fair enough. Proceeding from his

own metapsychological principles, Freud

formulated his structural theory of the

personality, which brought a period of
outstandingly productive cohesion. As in all

scientific work, developments inevitably exposed

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theoretical limitations, and in psychoanalysis
these were plainly in the understanding of the

ego. Anna Freud, followed by Hoffman and his

colleagues, in a surge of fresh thinking, filled out

a conspicuous gap in the structural theory with

her creation of the psychology of the ego and so,

in some measure, introducing a more holistic

view of the person. Preserving much of Freud’s

metapsychology nevertheless, this line of thought

was widely adopted as part of what has become

known, certainly in the United States, as the

mainstream development of Freud’s work.

A different fate befell the work of Melanie

Klein, despite her repeated emphasis that it, too,

was evolved directly from Freud’s theory of the

instincts, especially his later concept of the death
instinct. Her findings proved so disturbing that
there were early reactions to them as not falling

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within the scope of psychoanalysis. Thus, the

suspicion arose that inclusion within the analytic

field was to be determined by theoretical

conformity to Freud, rather than by the careful

appraisal of new data, even though these were

gleaned by the psychoanalytic method.

Now, the impact of Fairbairn’s papers,

published during and immediately after the War,

was minimal, and this disregard has continued

increasingly in the United Kingdom, though

progressively less so in the United States. It’s

particularly striking that it was Fairbairn who

introduced the term object-relations theory to

describe views that challenged Freud’s theory of
the instincts radically. Many factors contributed

to the neglect of his contribution, despite the fact

that he was a devoted and highly sophisticated

adherent to psychoanalysis as Freud had wished

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it to be. Indeed, it was soon after his first paper
appeared that the term he introduced for his

views—namely, an object-relations theory —was

being used widely, for example, to cover the

work of Balint and Winnicott as well. The views

of Klein, who in her earlier writing stressed the

importance of the influence of relationship, were

also regarded as coming within the object-
relations theory category. For myself, I believe

the neglect of Fairbairn has been a serious loss in

the development of psychoanalysis because of the

closer links his views made with the person, links

that he felt strongly were required.

Let me return to Wallerstein’s address. He

suggested that the anomaly of these different

views being associated with acceptable practice

could be resolved in large measure by the

adoption of the Sandlers’ suggestion that we

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distinguish a present unconscious from a past
unconscious Q. Sandler and A-M. Sandler 1984).

The present unconscious includes the derivatives

of the past unconscious that are closer to

experience, for example, the mechanism of

defense. We deal with the past unconscious when

we deal with the infant that is hidden by the

infantile amnesia within the person. The nature of

the past unconscious is inferred from its perpetual

intrusion in fantasy and transference in the

analytic situation.

The Sandlers point out that the understanding

we gain about this part of the personality rests on

creative acts of reconstruction. They make the

further suggestion that in fashioning a general

theory of infantile development, the different
accounts are couched in metaphors, rather than in

the real realities. When a metaphor captures

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enough real realities, then dynamically similar
factors can follow from very different metaphors.

Wallerstein is somewhat pessimistic about

achieving a widely acceptable general theory of

development because the true factors lie too far

beyond the realm of empirical study and

scientific progress. He grants that this position

will change, but he is not optimistic about

achievement in the near future. The use of

metaphors, Wallerstein reminds us, is common in

all scientific endeavor at certain stages, when
they are virtually indispensable, but the great

danger they introduce, especially in the human

sciences, is that the metaphorical factors all too
readily become regarded as realities. When

they’re felt to fit aptly and closely with the

phenomenon, they gain a powerful grip, both

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from their heuristic value and from unconscious
sources.

Now, when confronted with the growing mass

of new clinical data, along with the fact that

modern evolutionary biology has advanced

understanding to a point where the Newtonian

principles of the science of Freud’s day can no

longer be regarded as a tenable foundation for

comprehending the phenomena of living

organisms, then Freud’s metaphoric base for the

understanding of human nature and motivation

must be reappraised, despite the extraordinary

tenacity with which the id metaphor has
persisted. In his last contribution, “An Outline of

Psychoanalysis,” Freud (1937) opens his chapter

on the instincts with the statement that the power

of the id expresses the true purpose of the

individual organism’s life, namely, to satisfy its

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innate needs arising from the force of the
instincts.

The International Congress in 1987 started

from Freud’s paper, “Analysis Terminable and

Interminable” (1937). Exemplifying the tenacity

of the id metaphor Andre Green, the French

analyst, in his paper at this conference, expresses

the view that it is Freud’s concept of the

instinctual nature of the unconscious that has

given rise to significant reservations, both in

regard to the specific instincts postulated and

their mode of functioning. Yet there is a great
reluctance to face up to this issue. When he lists

some of the alternatives proposed, he selects,

first, those who radically reject the concept of

instinct in favor of the theory based on object

relations. He then names primarily Fairbairn and

Guntrip.

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It seems to me that Green’s way of putting

things is totally misleading. Fairbairn regards

instinctive endowment in man as an obvious

necessity in accounting for development. What

Fairbairn rejects is Freud’s concept of the

instincts as somatic energies that, in his phrase,

give the ego a kick in the pants to get on with

some activity, as a means of arousing action to

discharge tension, rather than as an innate

potential motivating an organism to seek

relationships. The subsequent proactive

transactions between organism and environment

—that is, between the infant and mother

primarily — give rise to the dynamic structures

required for the organization of experience. They,

thus, constitute the embryonic ego; for no

learning can take place without such structures
being involved from the very start.

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The arguments of nature versus nurture, of

instinct theory versus object relations, to me are

thus largely irrelevant, as is also the adversarial

relationship between society and the individual

stressed by Freud. Instinctive endowment only

becomes identifiable through its realization in the

object relations it meets and seeks.

The viewpoint of modern evolutionary

biology is radically different from the science

available to Freud. In his day, the organism was

described from a paradigm taken from

mechanistic engineering in which the

preservation of the structure is of foremost

concern. The primary concern is how it maintains

its equilibrium as a basic condition for achieving
this, and the answer is found in homeostasis as

the cybernetic mechanism.

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Now, in the theory of open systems that

constitute every living organism, the dynamic

phenomenon of development and maintenance of

life are conceived as permanent processes in

which positive feedback is characteristic — not

negative feedback, but positive feedback—that is,

not coming back to the previous equilibrium, but

breaking out of the boundaries of that to evolve

new structures.

Now, from the original state of wholeness and

order within the innate components that initiate

the appropriate transactions with the

environment, self-adaptation in a self-organizing

whole preserves its identity, despite constant
transformations. Such living systems cannot be

built up from the aggregation of parts, but start

from their living progenitors. Each organism

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contains an organizing principle that determines
the potential shape of the adult organism.

I found myself many years ago using the idea

that the organism’s innate potential has some

shape and characteristic activity. Activity, which

is the constant motivation of the organism,

ensures that it reaches outward until it meets in

the environment something that fits the shape.

In her book on autistic children, Frances

Tustin (1972) describes the dreadful, tragic

situation of children who have failed to make a
relationship with their mother or caring figures,

and so fail to develop a self. But it’s very striking

that these autistic children have an intense

interest in shapes, and circles appeal to them

greatly, perhaps because a circle signifies a
mother figure. My old idea of the potential

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having shape is not such a fanciful notion after
all.

Holograms within the central nervous system

demonstrate that shapes of the holistic form of

the organ and of the structure can be contained in

a potential form that permeates the whole

structure. So the whole mind/body problem has

changed radically since the days when Freud tied

his theory to the prevailing science of chemistry

and physiology.

I want to stress that living organisms cannot

be built up from the aggregation of parts. They

have to start from their living progenitors. Each

organism contains an organizing principle that

determines the potential shape of the adult

organism. Development within an organism,

which is an open system necessarily, demands an

autonomous urge to maintain this wholeness of

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the shape; otherwise, the organism dies. A threat
to the autonomy of the organism is tantamount to

a threat from a lethal predator. To survive it has to

assert itself autonomously at all times with

varying degrees of force, up to the point of

maximum ferocity. Paradoxically, its resources

for doing so, however, have to be developed —

and to an increasing extent as we ascend the

evolutionary scale — from its relatedness with

the adults. The organism’s life becomes the

dynamic process of preserving its autonomy

within the heteronomy of relatedness with its

social group and the physical environment.

In summary, the first principle to start with

and grasp firmly is that the living organism has
this inherent shape and that it is an open system.

That is, it grows with organizing principles

forming its interactions with the environment and

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transforming these into the shapes needed so that
the adult form of the organism is reached.

The lower down the evolutionary scale we go,

the more the behavioral patterns that mediate

survival are ready-made. The tadpole can get off,

swim away, and feed itself, and so on. It doesn’t

need a great deal of support from the adults.

Dinosaurs are said to have done something

similar, and recent evidence rather suggests that

adult dinosaurs did do more than just protect the

young. They could communicate to the young

how to anticipate dangerous situations of a

nonmanifest kind.

Resources for achieving this potential have to

be developed. It’s characteristic that, as we go up

the evolutionary scale, the innate potential has

more and more plasticity, more of a potential,

rather than an inherited specific pattern. And the

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potential to reach adult development has to be

realized within the framework of relationships

with adults.

Based on the findings of human evolution, I

conclude that the innate potential has to be highly

complex and plastic because the human organism

has become a social animal and its survived takes

place only within social groups. In the lower

levels of the evolutionary scale, the cohesion in

the group is fairly largely concerned with

protection, and so the group is tied together by

attachment to the dominant male. In the human

group things are very different. It seems here that

to provide for the plasticity required to exploit the

environment—and, indeed, as evolution has gone

on, the capacity for man to make his environment

— then we need very different resources.

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Freud’s method of reaching his views about

the instincts was to make inferences from the

neuroses of individuals; and, hence, sex and

aggression were taken to be the dominant drives

in man. But human nature was thus conceived as

derived from forces internal to the organism,

rather than through creative structuring from the

interaction of a plastic potential with the

environment.

The evolutionary value of a social approach

to human development is evident; for a human

group, a social group that got established in a

certain environment, naturally needs its young to

grow up with knowledge of and familiarity with
the features of that environment. There is an

immense need for communication, and so

capacities for thought developed, with the

associated requirement for language. The

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relatedness of the individual is increasing in
depth, as well as extent, all the time.

From experience of encounters with the

environment, the ego was created on the surface

of the id, as Freud originally put it, although he

later saw that id and ego could not be

differentiated in the earliest stages of

development. With greater importance attached to

the role of the environment and to the importance

of aggression, investigators find that the instincts

appear to be much more complex and holistic—

not so much a matter of ethologically proscribed

behavior, but striving towards and reaching an

end state —rather than following specific

behaviors.

All embryologists, when starting their work,

prepare themselves with a thorough knowledge of
the adult or the mature organism to which

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development is headed. So if, rather than looking
at individuals, we take the view of ethologists

looking at what happens in species, then we ask

what are the behavioral characteristics that large

groups of animals have in common. If these can

be shown to be relatively free from

environmental influence, then they are not the

products of training, and presumably we are

dealing with innate potentials that underwrite

those broad clustered features of behavior.

I doubt whether any valid generalizations

about instincts can be made from clinical data,

simply because the history of the environmental

influence upon individuals is completely

unknown. It’s only when you’ve got a population
to study that you can eliminate the specific

features of individual experience.

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Yankelovich and Barrett (1970), in their book
Ego and Instinct, have a remarkable critique of

the basic principles of psychoanalysis. Two

philosophers, one a social scientist as well, took

such social studies as were available — namely,

those of Cantril (1955), the social psychologist —

of more than a dozen utterly different cultures,

and they asked what were the common features

of people in the groups? Rather than seeing

individuals whose motivation is founded on

instinctive forces of a totally impersonal kind

driving the organism to seek pleasure, they found

from the study of the social group quite a

different collection of patterns that lead to a
different theory of human motivation.

What they found in all thirteen cultures were

characteristically human features that go beyond

individual requirements, as follows: the quest for

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satisfying the needs for food, shelter, territorial
security and for an individual security, and the

procreation security for the future; a need for

order, certainty and form to give assurance that

experience could be repeated; a need beyond

adaptation to the environment by a search for

new experiences and a hunger for knowledge; the

capacity to make choices, the freedom to do so,

and the responsibility for acting upon the

decision made.

(Most philosophers agree that freedom of

will, the capacity to make a freely determined

decision, is a characteristic feature of human

beings preferable to their being compelled by
instinctive patterns all the time.)

They go on to enumerate other characteristic

features: a need to feel his own security and

identity, and to have it maintained within his

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culture —that is, to be valued by others; the hope
that the future of his society will fulfil his

aspirations; to have a system of values and beliefs

to which he can commit himself and even

sacrifice himself. And then to facilitate all of

these, he has the need for language. The

characteristic that is new in the evolutionary scale

is sharing, and individuals cannot share unless

they can communicate what they are feeling and

thinking. Language becomes a requisite for

development of that kind (Yankelovich and

Barrett 1970, p. 400).

From this list we can also infer the need to

conceive a central organizing system of self,

which not only mediates its internal organization,

but which can communicate its thoughts and

other mental activity freely, so that sharing with

others can be carried out. The self is also

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facilitated in its functioning by the unique
property in the animal world of being able to

transcend itself to appraise its function. It can

look at itself. When motives are conflicting, the

self considers the conflict.

Now, the conception of a human nature that

seeks to meet these needs is a very different one

from the manifestation of instincts in the

traditional form. As Isadore Chein (1972), that

distinguished philosophical psychologist, puts it,

the essential psychological human quality is one

of commitment to a developing and continuing

set of unending, interacting, interdependent, and

mutually modified long-range purposes. The
development of such commitment starts from the
innate potential in the infant in constant

transactions with the carers, chiefly the mother

and family, transactions that are determined in the

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earliest phases by the innate factors in the
organism, and also by the parallel evolutionary

development in the mother, which equips the

mother to take the right moves toward the needs

of the infant at the right time.

So we can equate the human person with

having a self. The development starts from an

innate potential that finds its shape within

constant transactions determined in the earliest

phases by the innate factors in mother and child,

and later with the carers in the family and in that

particular culture, all of which, therefore, play an

increasing part in the evolution of man.

The full development of this commitment to

human group goals or end-states is what

characterizes a mature person. Failure to achieve
such development means that the person is not

fully realized, though the potentiality to become

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so may well be there. But this realization needs

an appropriately responsive environment from

society to give the growing organism the care and

concern that it needs for its evolution.

The function of the self, or the person, is to

integrate a developing series of differentiated

substructures within what has been an integrated

whole to cope with various specific needs, but a

structure that retains its holistic quality. I

postulate an autonomous self.

You might object and ask how I can talk

about a self before experience starts? Well, you

get into a rather vicious circle about the cart and

horse there. It doesn’t seem to me that it’s a

problem nowadays, because if we conceive of the

organizing principle, not as a content of behavior,

but an affective tone that informs the organism

that this is right or not, then we can see a

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monitoring system for development. If the infant

is getting the right input of food, fine. If it isn’t, it

protests. It uses various specific methods for

protests. But the same is true in regard to its

psychological needs: if it’s not being treated as a

self, the infant protests. And that, indeed, may be

the strongest argument for the existence of some

innate holistic structure.

The developmental psychological work in

recent years confirms this view that the infant

behaves as a whole, and behaves as a person, and
adults respond to the infant as a whole person.
The infant has the inherent quality that it is going

to become an adult human being, and that quality

is responded to and fostered by the community.

This ability to transcend itself, to look at itself

and appraise its existential situation, is unique to

humans in the animal world.

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Our development is dependent on a certain

affective tone: a sense that we’re doing all right,

that our self feels till right, that we don’t feel

deprived, and we don’t feel we’re doing the

wrong thing. That affective tone is a plastic

monitor for a wide range of different activities.

The baby is given the innate impulse to grope for

the breast. The baby doesn’t know what it’s going

to find. All it has is this innate groping activity.

When the mother puts the breast in front of the
baby’s mouth, the baby’s feeling right away is,
“This is what I’ve been looking for all my life,

and here it is.” So then you get experience

beginning to be structured; but you can’t learn

without some previous structuring of the search,

the groping, and the experience.

Freud himself and Melanie Klein introduce

the ego and the self, but mostly ego, because

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“self” was regarded as a kind of nonword in

scientific discussion, it was so subjective. But it’s

rather striking how both of them say “the ego

does this” or “the self does that.” In other words,

the selfs value as the agent of behavior is

assumed, referred to, but never studied as such. It

never becomes separated as a concept in the

earlier stages of development.

In contrast, it was on the central place of the

self that Fairbairn’s work started; and this, I

sometimes think, is not referred to enough. You

cannot have an object-relations theory without a

self. It’s only a self that relates to other selves. As

one of the philosophical biologists has said, it
takes a gestalt to relate to a gestalt. An aggregate

cannot produce this holistic quality of responding

to what is essentially the quality of the whole in

the organism, so that you have to have these

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holistic gestalts — that is, the self — developing
in this way.

Now we know, of course, that from the

structural potential the self grows rapidly, and we

have a fair idea of what takes place there

nowadays. When we see the work of the child

development researchers like Daniel Stem linking

up with the clinical studies of the analyst then we

see a bipolar situation. The infant developers are

starting from day one, working forward. The

analyst starts from the adult end, working

backwards. It’s going to be like the Channel

tunnel — hopefully, the two ends will meet. The

two areas of study are absolutely complementary,

and we need both. The infant developmentalists

cannot, without knowing the features of the adult
self, appreciate what is going on completely.

Whereas, if we study only the adult self, we’re

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apt to make theories about fantasy possibilities or
to deny possibilities that are there.

There is no question, when you review

classical analytic theory and psychological

theory, that the whole potential of the infant is

grossly underrated. The capacity of infants to

smile knowingly, to recognize a human face, and

to play is quite amazing. When you see

videotapes of the early development of infants

just a matter of a week or two old, it’s astounding

to see just how personalized they are.

Fairbairn started from the particular group of

patients he was concerned with, schizoid

individuals whose difficulties were that they

couldn’t make relationships. His conclusion

about the common factor was that these people

had never had their self developed because they

were never loved for their own sake. Now to

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understand him when he states that the infant has
a unique self that grows only when it is loved for

its own sake, we’ve got to have some idea of

what is the innate self and what we mean by love.

And besides, it’s only in man, you could say, that

the particular quality and duration of nurturance

establishes what we call love and care. We don’t

get socially related comprehensive love until we

reach man. There is something like love in

animals’ protection of their young, but it does not

extend to their injured. I suppose it was too

dangerous to stay back with a sick one, because

of the risk of predators. Only man deals with the

injured of the species. Only man has care and

concern for the survival of the person, the self.

This conception of human nature, then, is

very different from the classical one. The

defining characteristic of the human being is now

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seen as the capacity for commitment to a
developing series of unending, interacting,

interdependent, and mutually modifying long-

range purposes. In other words, instinctual

satisfaction, the quick-fix, is not adequate as the

sole feature of motivation. Motivation has to keep

the animal directed toward concern for the total

community, for its survival, for the building up of

experience and knowledge, and for its

transmission. These are all part of the instinctive

potential.

This was known quite early on. Malinowski

(1927, 1929), the anthropologist, pointed out that

the Western idea of primitive sexuality amongst

savages was completely misleading. Sexuality

was part of a highly social, organized behavioral

complex to ensure the preservation of the group.

The more we seek to exploit the environment, to

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control the environment, and to be self-
actualized, the more we need learning,

organization, and experience.

The more you think of the self, the more you

realize that object-relations theory has acquired a

misnomer that has given it a misleading status.

It’s really a theory of the self. The self makes the

relationships, and the self is made by the

relationships; the two interact, and the self is the

agent of action. Now we all know clinically that

neurosis is constructed by the person. It doesn’t

just happen. Symptoms don’t just happen. They

are created by the person as a whole.

If we study projection tests like the

Rorschach, we can see that it is a total self that

governs the perception because, while the self

organizes a holistic precept, at the same time the

substructures perceive details and interpret them

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in some other way. But the important point I
think is that the total self is always in action.

What we call the ego, I’m suggesting, is that bit

of the self that is most developed around

experience with the real world.

Although Wallerstein has difficulty with

metaphors in analytic theory, I don’t think we
have that difficulty when we deal with the self. Is

there anything more real than saying “I feel this”

or “I think that”? In other words, what the self

does is synchronous with reality in human

contact.

Freud’s concept of id postulates that while we

appear to be one way in reality, really we are a

mass of all these powerful instincts below the

surface. There’s increasing feeling, certainly

amongst philosophers, that we’re kidding

ourselves here. This so-called real reality is a

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fantasy construct, simply because we have
believed sufficiently in the fact that the higher

levels of organization always produce a new

repertoire of power in action, a new set of

properties, which do not belong to any lower

level and which are unpredictable. It doesn’t

matter how much we know about hydrogen and

oxygen: no one can predict that the resultant

product is the best additive to Scotch! These

qualities are unique and emergent. The same

thing is going on in the organism: properties are

emergent till the time.

A common difficulty has been the theory that

the infant at the start can’t possibly have a

separate self. It must be merged with the mother’s

as a kind of extension of the mother’s self. Now,

that is not what behavioral observation suggests.

Watching the nursing couple, we note that, right

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from the start, a baby is a highly determined little
creature that knows what it wants and gets it, and

makes the mother adapt. So we’ve got to

postulate this highly autonomous urge.

In his self-object theory, Kohut describes the

need for a close, mirroring figure to maintain the

sense of self. Without that, there’s a
nonfunctioning structure in the infant. But, to me,

the self is not a passive extension to the mother’s

self. There’s an autonomous, competent self there

in the infant. The frustration of this highly

autonomous quality sets the ground for most

psychopathology.

Perhaps the autonomy of the self has been

obscured because of the physical dependency of

the infant and its need for closeness to the mother

much of the time. Bowlby’s work on attachment

has given a widespread idea that attachment is the

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thing. I cannot see that attachment is anything
other than a precondition for the development of

the self. It’s the first step. The baby has to

become attached to the mother, to cling to, to

hold onto the mother, and to find security there;

and it’s out of all the constant experience of being

in attachment that the infant builds the self.

Bowlby himself speaks of the self being evolved

from the attachment situation by increasing

modeling.

You can see that we are dealing, certainly,

with a highly dynamic whole self with a powerful
sense of autonomy. Certainly it needs to be

developed by the input of loving models; but it

also has its own capacity for fantasy, for play by

which it can try out modes of behavior and build

up possible self attitudes.

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Psychoanalytic experience certainly suggests

—and behavioral researchers would agree —that

the inner security to do this, to set up an active,

exploratory attitude to the world at large, comes

from the experience of being loved. The plain

fact seems to be that the infant has a powerful

urge to get to the right experience, provided it’s

made reasonably available. So by denying the

ordinary caring attention, we create intense

situations of frustration that lead to splitting of

the object and the self.

All I want to stress is that we’ve simply got to

take as the basic feature in metapsychology the

autonomous struggle of the self. Rather than the

vicissitudes of instinct, let’s think of the

vicissitudes of the self in the relationships it

finds.

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With daughter Anne, first grandchild Phoebe,
and Molly, 1973

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Being a grandfather, 1979

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Now I’ll quickly give you two cases, the first
from a British Independent point of view and the

second from the Kleinian perspective, both of

which bring out the kind of problems that have

haunted us. I’ve also used these cases and two

other cases of Fairbairn and Betty Joseph to

elaborate upon my argument (Sutherland 1989)

but here I’ll confine myself to two cases by

Patrick Casement (1990) and Terrtu Eskelinen de

Folch (1988). First, I’ll quote a case from Patrick

Casement’s book On Learning from the Patient
(1990). It’s always a good thing to quote from

somebody else, because then I can’t be accused

of quoting evidence I’ve created.

A young woman, Miss K, was referred for

help with compulsive eating of several years’
duration. She described her mother as
manipulative and intrusive, preventing her from
having any real independence. The mother had a

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flamboyant enjoyment of breast feeding, which
could well have fostered an oral fixation. When 2
years old, a sister was born, and her mother
withdrew to the pleasures of the nursing
relationship, leaving the patient for several weeks
with a nanny. Miss K then developed a highly
seductive relationship with her father, which
ended with his death when she was 17. Feeling
bereft and empty, she dealt with her grief and
depression by overeating. The intensity of her
attachment to her father led her to feel that her
sexuality was bad. Young men said she was
devouring. Her mother’s sexual orientation and
her unusually seductive behavior with both her
and Miss K’s sister confused Miss K.

Miss K’s overeating also derived from her

mother’s ambition to make her slim and
beautiful, which was so possessive and
overpowering that Miss K ceased to feel herself
to be a separate person. Eating asserted an
independence from the mother’s control, yet she
clung to her mother, despite the feeling that the
mother was like a permanent cancer inside
herself. The guilt she felt about her sexual
contacts with men also added to her eating,
which she thought would chase the men away.

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Miss K had had a previous therapist before
she had come from abroad to England, and he
had fostered her dependence on him by offering
extra sessions and physical comfort. Casement’s
attentions in the form of interpretations were
taken by her as an attempt to control her. It
became clear that her experience had led her to
feel that all relationships were manipulative.
When Casement resisted her demands for more
and more of this and that, she reacted
aggressively by having other treatments, outside
of analysis, especially with her brother-in-law,
who was a family doctor. These posed a serious
problem at times. For instance, she got
antidepressants secretly, and later had her jaws
wired, despite which contraption she managed to
feed herself with triumph. These measures
intensified the hatred of her mother, which
emerged as biting sarcasm to those who angered
her. A behavioral therapist then repeated the
physical acting out she had with her first
therapist, until her sexual excitement frightened
her away from him.

Casement interpreted these other treatments

as enactments of the relationships she wished to
make with him, but had to keep apart from him

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to maintain him in the image of the nonintrusive
mother and the nonsexual father. Intense
ambivalence evoked Miss K’s wish to protect her
mother against her murderous feelings. That, of
course, is the primary reaction to frustration of
the self: intense rage with murderous ferocity.

Some confrontations with the mother about

her attitudes on a visit that the mother made to
England improved the relationship. After a year
in analysis, she began to free herself from her
mother, but remained overweight, lest her mother
and her brother-in-law could think they had been
responsible for her progress. In her last session
before leaving London, after about 18 months,
Casement was impressed by her statement, “I am
becoming my own version of myself.”

Casement describes being made often to feel

helpless and destroyed. He believed it to be
essential that he had let Miss K come to her own
realization of her unconscious need to experience
the freedom to be destructive with no intrusion
from him. The essential dynamics of the
treatment, therefore, he took to be the
opportunity to survive her intensely destructive
efforts to wreck it and him. As

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Winnicott put it, when the assertive strivings
of the baby are repeated in analysis, the critical
thing is that the analyst should accept all these
and survive, because that’s what the ordinary
mother does, thereby, of course, giving the deep
physical instinctive proof that mother can take it.
The very substantial change in becoming her
own person was seen a few years later when
Miss K wrote, telling him of how she had
discovered her creative abilities with a newfound
confidence.

Using a classical formulation, her behavior

would have been reduced to an oral fixation
under the influence of oedipal guilt, while the
Kleinian perspective might be that she had
regressed due to preoedipal factors such as
intense oral sadism from the death instinct.
Casement, however, adopts another way of
looking at Miss K’s conflicts. We cannot but
agree with him that Miss K’s symptoms are
pressing because of other, more complex
purposes of the self than drive satisfaction.

The value of that case for my purpose is that

it has all the drive manifestations from which

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Freud made his classical theories—oral, anal, and

the next thing. But what seems to be the best

explanation, the most plausible one, the one that

is the best fit for the total situation, is simply that

her mother had deprived her of a feeling that she

was doing her own thing in her own way.

The other case that I would like to quote from

was described by a Kleinian analyst, Eskelinen de

Folch (1991). She notes —and, I thought, very

sharply — that if the unresolved clinical

problems prompting Freud to write “Analysis,

Terminable and Interminable” are still with us,

then our present-day explanatory capacity is not

sufficient to resolve them. She then focuses on

the analyzability of certain concealed nuclei of

the personality that appear to be remote from the

analytical relationship. Such patients, even after

long analysis, have great difficulty

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acknowledging destructive impulses, such as
hatred and envy, as belonging to them. They are

terrified of disintegration, a dread that Klein

described as aroused by primitive terrifying

objects that are deeply repressed. Eskelinen de

Folch believes that it is not necessary for these

patients to be in a crisis for these primitive

objects to appear, as she illustrates from a clinical

case.

The patient, a brilliant academic man held in

very high regard, had come seeking treatment
because he felt something lacking in his
relationship with his wife and in fife generally.
He was burdened with a sense of impending
disaster. In analysis, he began to have dreams of
terrorists who set fire to book shops: sometimes
he is the terrorist, yet he maintains he has nothing
to do with it. Early in analysis, he dreamed of a
small boy in danger of falling from a balcony. He
then saw himself in a diver’s suit, taking a
shower and becoming excited. In the third part of
the dream, he was carrying his own dead body to

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the little boy’s mother, asking her for a death
certificate, the cause of death being something
like “death by annihilation.”

He kept impersonalizing his relationship with

the analyst, which made her think that his
terrifying object had come actively into their
relationship and had to be defended against. In a
subsequent session, he was intensely anxious,
and said, quite unusually for him, that he felt
some intense rage against her when he realized
they might speak of important things. On the way
to the session, he had seen one door of the lift
labeled “exit,” while the other opened into the
void; and this idea related to his silences after
moments of some true contact. He was horrified
that the image of himself as warm and
understanding, the goody-goody, was not at all
accurate. He then had a silent period, after which
he was surprised by how indifferent he felt. Just
as the session was about to end, he revealed he
had forgotten to tell the analyst that he and his
wife had decided to have a child.

In discussing such material, Kleinians see the

dangers of hate, but they account for that, as

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Freud did, by postulating an instinct of
destruction within the organism, whereas people

interested in relationships, like Fairbairn, see the

hate and the aggressive phenomena as a violent

reaction for the survival of the autonomy of the

self. In Winnicottian terms, I might say that the

patient had become an academic through a false

self forced upon him by mother. In his dreams of

the arsonists who came in and set fire to book
shops, I might see a tremendous resentment that
began to come out about his mother not allowing

him a spontaneous self.

In response to that dream and the theme of

death by annihilation, Eskelinen de Folch applies

Kleinian ideas. With regard to instincts, ego

structure, and object relations, she notes that:

a. highly destructive defence mechanisms are

fuelled by the death instinct;

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b. impulses to split are related to objects internal
and external and to the analyst in the
analysis. The patient may acknowledge these
impulses after prolonged analytic work as his
own but

c. he may then find himself caught in a painful

repetitive experience from which he may
derive a sadomasochistic satisfaction that
seems to have a life of its own and which he
strongly resists giving up.

Eskelinen de Folch then brings in some of

Bion’s ideas about a particular form of repetition

compulsion, namely the fragmentation of objects

that lead to intense persecutory anxiety by the

objects into which they have been projected. The

person makes a pact with these objects, which,

while lessening the persecution, leads to

compulsive acting out. The objects terrify the

person while another part of the personality

establishes other normal relations. Eskelinen de

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Folch thinks that this part of the personality that
is struggling with psychotic anxiety is shaped not

by love but by the strength of the death instinct.

The possibility of changing these object relations

is limited by the violence of the splitting process

and by the amount of satisfaction derived from

the situation.

Quoting work on this type of problem by

Betty Joseph and Elizabeth Spillius, Eskelinen de

Folch refers to serious countertransference

problems. Through the exploration of

countertransference, the underlying internal

object relationships can be recovered. Eskelinen
de Folch concludes that the concepts of the death

instinct and the repetition compulsion can help us

build our theory. The death instinct implements

the splits while the integrative character of the

life instinct acts as a counterpoint. The concealed

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nuclei of the personality appear as a sinister result

of the action of the death drive. According to

Eskelinen de Folch the repetition compulsion,

however, may represent attempts to deal with the

primary trauma in a less catastrophic way. This

primary trauma arose because the death instinct

was not mitigated by an appropriate external

object — the good breast or the good mother.

I am impressed by Eskelinen de Folch’s

penetration into the primitive self levels, based on

a highly developed sensitivity to the expression

of early relationships in the transference created

by a correspondingly sensitive use of the

countertransference. It seems to me that this is
where the advances made by Klein and her

students lie.

Wallerstein notes comparable work with the

present unconscious among analysts of different

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persuasions, but I do not want to underestimate

differences among the various schools of thought

in psychoanalysis. The identification of what is

going on in the present unconscious in Eskelinen

de Folch’s case is to me of a different order than

occurs in non-Kleinian analyses. She attributes

her work to recognition of the impersonal death

instinct along with mechanisms operating at a

personal level, mainly projective identification

and envy.

For Eskelinen de Folch, the concealed nuclei

of the personality are intensely repressed object
relationships, as a non-Kleinian might think. But

the Kleinian concept of internal object

relationships is based in instinct theory.

Early in analysis, Eskelinen de Folch’s patient

dreamed of a little boy falling from a balcony,

then being excited by the prospect of engaging in

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deep diving, and then demanding from his mother

a certificate of the cause of his death by

annihilation. From my own object-relations

perspective, I would conclude that he felt that his

mother had annihilated his self. His manifest self

was one of great academic success and

popularity, but with failure in his close

relationships. This suggests to me that his success

came from a self adopted under his mother’s

pressure, a false self in Winnicott’s terms. This

self is inevitably identified with the mother that

he wishes to destroy because of what she has

done to an essential part of his self, namely the

part that could have permitted him to make close

relations with others. From his dreams of
terrorists who set fire to bookshops, I suspect a
denied, enraged self that attacks what his mother

has made him into. To admit this, he would have

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to overcome the terrifying anxiety of a vengeful
destruction of his mother who has given him

what he lives by. More important than any guilt

over this action, however, is his fear of

disintegration if he carried out this murderous

attack —a fear of falling into space with nothing

to support him. I suggest that this rage burst out

against the analyst when he thought that she

might expose his secret intentions and he was

shaken to feel that this might now destroy her.

To account for this patient’s personality and

his difficulties, I need a structural theory founded

on the self and its needs, a theory that recognizes

that failure to meet these needs in the earliest

stages of development evokes intense aggression

from the very beginning.

A crucial feature of working with the self as

the agent in its presenting difficulties, is that we

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deal very little in metaphors. The selfs experience
is an ultimate factor, the thing in itself, and not

requiring hypothetical realities other them itself.

The immense contribution of the Kleinians

has been that their understanding of early

phenomena has given them a capacity to use

these manifestations in the analytic situation,

working with transference, countertransference,

projection, and projective identification; and
that’s been an enormous gift for psychoanalysis.
But I don’t think the theory is a help here. I don’t
think we need Klein’s death instinct. What we

need is a protesting organism.

SUMMARY

The complex issue of the self is a widely

ramifying theme. For me it’s such a critically

important one. I think that the future of

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psychoanalytic theory will certainly rest on
getting the self properly conceptualized. What

I’ve tried to do is to give an evolutionary

biological background to where the self is needed

in the evolutionary scheme, to share my ideas as

to how it could have evolved in that way, and to

describe some of its properties and its necessity

for man as a social animal, especially an animal

that is self-organizing and able not only to adapt

to, but to make its own environment. These, I

think, are possible only through the development

of this highly integrative structure, which can

permit us to internalize the world, play with it

inside, and make innovating possibilities: the

autonomous self.

DISCUSSION

Male Questioner: In your extensive lecture,

you talk about self that transcends itself.

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In other words, the self becomes critical
of itself and objectifies itself. Will you
discuss a little more what factors help
the self to objectify itself?

Dr. Sutherland: The most obvious way to

check up any subjective excess is to
share it with others. They can then cut it
down to size and so on. Individualism
has tended to dominate in our culture,
“keeping yourself to yourself.” But the
group could be very helpful, not
attacking, and not belittling to the self.
We’ve got to learn more and more, and
use more and more, the phenomena of
group relatedness in shared activity and
study how to foster maximum freedom
within that situation. That’s how to
address the problem of objectivity of the
self.

Male Questioner: Dr. Sutherland, I wonder

if you would agree or disagree that a
future direction for psychoanalytic
object-relations theory, in keeping with

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what your closing remark was, might be
in the development of a dialogue with
moral philosophy?

Dr. Sutherland: Paramount in groups, of

course, is an active concern for others
and respect for the individuality of
others, so that certainly there’s a high
overlap with the moral philosophers.
Charles Taylor, the professor at Oxford,
has written a stunning book on the
resources of the self. But some of the
philosophers are ignorant of
psychoanalytic developments. We can’t
expect them to know more — we’re
fumbling for our own knowledge. But if
we can get our views of the self
clarified, sharpened up, and presented in
the literature so that philosophers could
really absorb it more readily, then I think
the dialogue will increase in its value
greatly. But I would certainly say that
it’s an area where a coming together
would be most helpful.

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Male Questioner: I would say that the self is
really a fiction, although a useful one,
and that self is always in the context of
relatedness, or in an open system. And if
that’s true, the self isn’t at all
divorceable from the ongoing
relatedness. You can’t convey the open-
ended nature of what’s needed and then
talk as if the self is something that
knows exactly what it needs once and
for all, as in your example of the infant
getting the breast, because that’s already
abstracting the self from the context of a
workable relationship with the mother or
the mothering one.

While I’m in line with what you’re

saying, I propose that to speak of an
autonomous self, or a simple sense of
self, without a lot of ongoing dialogue
and reflection about what’s happening
with it and what the qualities of
experience are, is reifying the concept of
the autonomous self.

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Dr. Sutherland: Well, I must say quickly
that I don’t accept that position because
what is inherited in the potential is an
affect, not a content. There’s nothing
specific psychologically in regard to the
knowledge of the environment. What is
inherited is a feeling tonicity, and if
things are not right, then protest and
reaction take place.

Now, the great philosophical

argument at present, as I understand it, is
this: is there anything corresponding to a
self that’s inherent in the organism, or is
it all created by social relatedness? I
don’t think you can get social
relatedness without this core, which is
the monitoring, discriminating agent for
what feels good or bad, or right or
wrong, or painful or pleasant. So I think
there is a core of a very plastic nature
that is largely a kind of innate affective
tone.

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Dr. David Scharff: It seems to me that
Fairbairn wrote about the object world
with the assumption that it was the self
reaching out to it; but he didn’t talk
much about the self that he assumed.
And what you’re talking about is that
which remains undescribed and
undefined. It seems to me that a balance
will be found when we are able to talk
about both poles of self and object and
the way in which they are absolutely
inextricable. Obviously, the self is not a
fiction. It is the thing that keeps on
going, keeps on being, has to be, has to
do, and yet that cannot be without the
object world.

Within its scientific and

environmental background, you really
bring to life in all its elegance the thing
that keeps us going, including our
practice of the science or art of
psychoanalysis: the autonomous self.

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25.

REMINISCENCES*

Dr. David Scharff: We want to plumb the

depth and breadth of Dr. Sutherland’s
experiences with object-relations theory,
its founder Ronald Fairbairn, and its
major theorists—Harry Guntrip,
Michael Balint, Donald Winnicott, and
the Kleinians Wilfred Bion and Melanie
Klein—whose contributions we value
and about whom we’re so curious. So I
hope this will be an evenhanded balance
between high-minded theory and low-
minded gossip.

Dr. Sutherland: There’s nothing so

interesting as gossip. I never undervalue
gossip. The trouble with gossip is it so
often becomes malicious, but it’s not

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necessary to behave that way with
gossip. You could enjoy it as fun.

Dr. Gordon: In your book, you ask what

took Fairbairn into psychoanalysis as a
career and what sustained it in him.
What I would like to do is turn the tables
and ask you those questions of yourself.

Dr. Sutherland: Well, I can never remember

at all being consciously ambitious to
make a certain goal, and yet I must have
been driven by something, because I
subjected myself to terrible privations. I
went through the medical course while I
was teaching in the psychology
department, because you couldn’t
become a psychotherapist then unless
you were medical, you see. Fairbairn
told me that. So I took 6 years to do that
course because I had to keep my full-
time job. I had no money then. As a
result, I think I finished up the worst
qualified doctor in Britain, but I was in

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on the right racket as far as I was
concerned.

When the war started, I was asked to

go to the hospital for war neurosis. They
expected psychiatric casualties on a fair
scale, and they took over this vacant
building that had been used as a hospital
for what were then called criminal
lunatics. They didn’t mince words in
those days. It was out in the country in a
kind of mordant place.

Then Fairbairn was asked to come as

a part-time consultant. Fairbairn did a lot
of his thinking there about the return of
the bad object. These war veterans had a
terrible, traumatic experience, where
their outer world really fitted their worst
inner fantasies. Fairbairn was struck by
that and also by the quality of infantile
dependence that he found. These men
couldn’t face being away from home.
Fairbairn concluded that infantile

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dependency was often associated with
the development of war neurosis.

Well, I had only been there about 2

years when I was asked, “Why don’t
you come into the Officers Selection
unit?” Maybe they thought that I had the
potential to rise to the top, but my army
career was quite different. I started at the
top and worked down. Before I had a
uniform on, I spent 2 days with these
two top-ranking generals in the British
army, discussing the set-up of this unit.
This is where I was absolutely stunned,
because these men had vision and
intelligence: they were so unlike the
Punch cartoons of the regular army
officers.

Well, then, after the war, a group of

us planned to restart the Tavistock Clinic
—a group of very powerful people. I’m
not being funny here. I think this is
realistic. I could never understand why
they asked me to be chairman of the

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group. Then it dawned on me that I was
the only non-prima donna. The others
were all prima donnas with dedicated
interests, and so they were a bit
frightened of each other in some ways.
But they had worked together during the
war, and they could stand each other’s
faces.

Remarkably few people ever have the

chance of going into an institution where
the total staff in charge is self-selected.
It was an extraordinarily creative group.
We knew we would have to divide into a
clinic and a group to study
organizations. From early on I was the
chairman of both efforts. By the end of
the war, we had been visited by all sorts
of people, including a team of American
psychiatrists, who had heard about us
through Will Menninger who was head
of psychiatry in the United States army.
The thing about our Tavistock group
was that, having come from
psychotherapy, we were interested in the

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social relatedness of psychiatry and
institutions. Our staff was very good at
grasping the principle that the most
creative thing to do for people is to give
them the chance to grow. The staff had
outgrown the bureaucratic, authoritarian
solutions that were characteristic of the
army and had learned that there’s
nothing that crushes individuality and
talent more, as Russia has found out at
long last. Eventually it came time to
form two divisions: the Tavistock Clinic
and the Tavistock Institute of Human
Relations. I chose to become chairman
of the clinic. I think I was a bit
frightened of the industrial and
organizational side. So I was chairman
of the clinic and my title was Medical
Director. That’s a funny story, the tide of
that role. My accurate title should have
been “Medical Directed” because I did
what the group decided. If I differed
from the group, then I had to argue
inside, till we had consensus. But the
Health Service insisted, “No, no, we

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don’t want this Bolshevik nonsense. We
want to pin the responsibility on
somebody. Your title will be Medical
Director, and you’re responsible to us.” I
said, “Well, that’s all very well, but then
it’s up to me to bring the staff opinions
fused together.”

As an institution, I must say,

compared with other places, it was a
remarkably successful, democratic unit.
The clinic decisions were made by the
staff together with the unusual help from
colleagues in the Institution of Human
Relations who were studying
organizations, their structure, and modes
of functioning, and their ideas rubbed
off on us. When I was chairman of the
clinic John Bowlby was the deputy in
the children’s department. He’s very
different from me. He’s an upper-class
Englishman. I’m very attached to John.
The work he does is terrific, and he’s
very dedicated to his own research. At
the same time, he contributed

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enormously to the Tavistock Institute of
Human Relations and to the British
Psychoanalytic Institute. I have
tremendous admiration for John and his
capacity because, beside him, I felt a
blundering idiot. He was so efficient.

There was a magic, serendipitous

influence over me all the time, I felt,
because things kept on coming,
opportunities to do this and that, and
meet people like Karl and Will
Menninger and their team, which came
to visit us at the end of the war when we
were still in the Army. They had a very
highly powered team, six international
stars, and they were all very impressed
with the creative institutions that they
visited, places like units for the interned
prisoners of war coming back to civil
life. Returning prisoners of war got
special units set up where they lived
within their own boundaries under self-
government. Then they made
relationships with local industry. The

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men were allowed to go out and look at
the different places to see what it felt
like to get back to work before having to
support themselves, because they had a
big adjustment problem to overcome. As
you know, when they came back from
the war, they had enormous fantasies
built up of getting back to life; and then
it was very different when reality came
along. So they needed therapy groups
and these civil resettlement units.

These were great learning

opportunities for working with social
problems. The common pattern for
industrial consultants —I think in many
places it still is —is that they come in
and go around the business, and then
prepare a very elaborate, detailed plan,
and then you’re just left with it. But the
Tavistock rejected that from the start and
said, “No. We don’t know that you even
know your own problems.” We got them
to look at the real problems and then
worked through to the solution with

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them. Sophisticated, professional
consultants operating as facilitators.

That became known as the Tavistock

approach to organizational work and it
influenced a tremendous amount of
organizational thinking the world over.
My colleague Eric Trist eventually
became chairman of the Wharton
Business School. A number of the senior
people left. The economic rewards were
pretty thin, you see. We were fairly
dedicated. We didn’t starve ourselves,
but we didn’t take huge salaries or
anything like that. That’s fine when
you’re young. When you get nearer the
fifties and you’re looking out for the
future, then people like A. K. Rice were
enticed out into jobs.

Eliot Jaques was the first person to

leave the Institute. That caused a bit of
conflict because he had been working
with this firm as their task worker, and I
think people initially felt he was bought,

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and we felt that he was a traitor. He
deserted the company. Now, looking
back, of course, we don’t see that at all.
We’re much more tolerant. If you feel
there’s an opportunity coming, you’re in
a very difficult choice. O.K., you’ve just
got to do what you feel is right for
yourself.

The group hung together pretty well

for about 10 years, but there was a
growing separation as it got bigger and
more involved in various projects, so
that it lost that very nice early feel,
which I look back on with pleasure —
and what a tremendous help it was to me
in till sorts of ways. Still, it was all in
the context of the National Health
Service. When I first went to Menninger,
they were talking about their
administration and asked about ours. I
said, “Well, you don’t want to know
what we do in our ‘communist’ health
service, do you?” Then it came out, of
course, that their problems were almost

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identical to ours but their controls were
insurance companies. Ours were just set
limitations laid down by the region, but
we had, in fact, a very high degree of
freedom.

The regional administrators got the

feeling that we were serious about our
job, because we thought about clinical
policy. The policy of most hospitals is
you take whom you get and you have as
many beds as you can pay for and get
them filled up. In other words, you don’t
see yourself as having to look to the
outer world. But studies were just being
made on the incidence of neurosis, and it
was quite clear from the studies that
something like 40 percent of the people
who consulted their family doctor were
really needing psychological help. Well,
when you looked at the scale of the
problem, you realized that the last thing
that’s of any help is to think of
producing a large number of therapists.

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I always remember the one analyst
who hadn’t a clue. I, myself, learned to
think socially about the issues, really to
see the social dimensions in a realistic
way. He just sat down and he worked
out that by the year 2050, we needed
about 500,000 analysts. He had worked
it all out! I thought, “This man needs to
see a psychiatrist.” It was totally out of
touch with reality.

So we had this very interesting

notion, which was to set up a thing
called a psychiatric clinic where
psychotherapy was going to be free.
What do you do? We didn’t quite
envisage a queue stretching down
toward Buckingham Palace. We saw
ourselves out on the street grabbing
people to keep up the patient load,
saying, “What you really need is….”

As it turned out, we did have more

people than we could cope with, but we
had to evolve a policy. Now there are

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two things you can do there. You can
narrow the number of people you treat
or you can expand your therapeutic
methods. That was where Bion’s group
work came in. Of course, the group
work was an enormous success, and I’m
still very sad that analytic group therapy
has not maintained a wider grip and
been regarded with the seriousness it
deserves because to me it’s a very
powerful therapeutic weapon. One
difficulty is you’ve got to stay together,
but the real trouble with group therapy
—well, the same thing goes on in
psychotherapy, doesn’t it? You get too
many ill qualified people coming in. In
British psychiatry, of course, they’re not
taught any psychoanalysis at all, nothing
really. The primary value system is the
brain. In Britain, as one of my
colleagues at times has said, “The mind
is a kind of dirty spell around good clean
neurons.”

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So you have to contend with a
tremendous cultural opposition there.
But in these early days, I think there was
great enthusiasm for group work. At that
time, of course, we had Bion and Ezriel.
We all did one or two groups. By the end
of the ’50s, we were running fifty
therapy groups, which was a quite
considerable help in justifying ourselves
as a service institution.

There were two or three other out-

patient clinics in our regional group and
that posed problems because we were
compared with them, you see. We were
regarded as rather a Rolls Royce place.
In one of these other clinics, there was
an odd man, a bit of a rogue, who prided
himself on seeing about 600 patients a
week with about one and a half
psychiatrists. I worked out that he was
really spending between five and ten
minutes on each person, so I just said to
our management committee, “If that’s
the help the patients are getting, then

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why pay an expensive psychiatrist
because he can’t possibly give any more
help than a much cheaper level of
employment would do?” At our clinic,
we treated lots of people in groups, and
the other thing we did was to see a few
patients in as much detail as we wanted.
That was our laboratory. We would do
that as our research effort, but I don’t
regard that as a contribution to the
community problem. The contribution to
the community problem is the
knowledge we get from that with which
we can think of other methods. The
group thing was one. Well, this is my
spiel on the business of psychoanalysis.

Psychoanalysis had assumed that its

business was the training of
psychoanalysts. By the time the ’50s
came, that was all that psychoanalysts
thought they were about, and that got
more and more restrictive, because, not
only did you have to conform with the
theory, but you weren’t a psychoanalyst

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and you couldn’t help anybody if you
hadn’t gone to the Institute for so many
years and if you weren’t signed, sealed,
and delivered. That might be alright in
the Viennese society or the British
society of 1900, when society consisted
of individuals. But the social fabric is
much more interlocked nowadays, and
people can’t survive in that isolated way.
Now, Freud had the idea then, quite
understandably at that time, that what he
was learning was important for society.
So he wrote books about his knowledge,
and they sold as well, because he was
such a good writer. He thought he was
helping society.

It was only many years later that we

realized that you can’t expect that to be
Jill that helpful, because psychodynamic
knowledge is not like any other
knowledge. You can talk about
computers, you can talk about motor
cars, you can send out a book of words,
and, by and large, people can learn. You

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cannot do that with psychodynamic
knowledge because it upsets the reader.
The instrument that receives the
knowledge is disturbed by the receipt of
the knowledge. When you learn about
psychodynamics, it’s as if you were a
kind of instrument that itself had to be
treated. You have to have a personal
experience that enables you to use
psychodynamic knowledge. It’s taken a
long time for this to get across.

But the situation that intensive

psychotherapy had set up was a very
tantalizing one, because the practitioners
became more and more insistent on their
intensively trained settings and
membership groups and rather
contemptuous of others. A year ago I
was talking to counselors who told me
that analysts were saying, “Well,
counsellors, of course, they’re awful.
They make such a botch of it.” And I
thought, “That’s terrible, not to
recognize their worth.” So they make a

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botch, but is a botch always harmful?
John Bowlby used to say he was a firm
believer that a little knowledge is not
always dangerous. It’s better than no
knowledge.

We could see ways of setting up

systems or helping clinics to set up
systems, but if we think our business is
purely to train people like ourselves
inside these walls and if we don’t take
the use of our knowledge seriously, then
we’ll be redundant. This is why the
psychoanalytic business is almost going
out of business —because it sets such
rigid conditions, such rigid
methodology, with the attitude that
nothing else is any good.

Well, it’s more and more difficult to

get people willing to do the training and
certainly more and more difficult to get
people who can afford to pay for the
treatment. Although they are publicly
patronizing to anything that isn’t the real

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thing, privately analysts are practicing
psychotherapy like the very devil. The
bulk of their patients are being seen
twice or three times a week. Very few of
them have got a practice based on five
times a week. So there’s a lot of
hypocrisy going on here.

Well, what is the solution? To me, the

real business we’re in is not creating
practitioners. That’s a fundamental
component of the business, like creating
certain machines. Our real business is
the export of knowledge. If we want
society to look at itself more
constructively and develop mental
health objectives, then we are the most
powerful source of knowledge for the
variables that are important. Of that
there’s no doubt. It’s only when people
seek help that they reveal what is wrong.
You can give people questionnaires ad
nauseam, and you finish up with
meaningless answers and a behavioral
approach to them.

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The danger a few years ago was the
world according to Marx. Now the
danger these people are presenting us
with is the world according to Pavlov.
And that is really dangerous, because the
philosophy underlying behavioralism is
a controlling one, treating people like
machines. Now, who is going to decide
what kind of machine they should be?
The Western social trend toward
maximizing the resources of the
individual creates the strongest prospect
for adequate creativity.

I remember a book that came out a

few years ago, “The Rise and Fall of the
Great Powers” by Paul Kennedy (1987).
The striking theme to me there was that
in the Middle Ages, the Ottoman Empire
and the Chinese were infinitely more
wealthy, had more educated people and
resources and so on, than the West
where there wasn’t an emperor or some
tyrant who said, “Stop that research.” So
Western societies got ahead with gun

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powder and technological weapons,
which just destroyed the others in no
time. So creativity and fostering the
resources within the group is what gives
the real power for survival.

People have got to be free from

internal blockages in the development of
their resources. That’s a political
problem. The problem for us to be
concerned with is: What promotes
maximum freedom of the use of
resources? Now, that’s the kind of
knowledge that we’ve got to provide in
an established way. We’ve got to
validate our knowledge as best we can,
and then let the community use it.

Now, the community will find ways

of using it, I have no doubt about that.
They’ll find all sorts of ways. Some of
them will be a bit California, but that
will change as soon as they discover that
primal screams and encounter groups
have a fairly limited success when

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you’re up against the intractable
resistance of the unconscious. They
don’t take the time to know what people
are about. That was the trouble with the
hippie movement. The great love-in had
no realization whatsoever how much
hate existed in people and how you’ve
got to treat it, not run away from it,
pretend it’s not there, or dismiss it. How
do you think we might help people to
cope with this? Not get rid of it. How
will we manage it?

Increasingly, I think the proper

setting of a clinic like this is to be a
component within the wider issue of
human relations. That’s what we did in
Scotland when I went back there from
Tavistock. I was greeted by a number of
senior psychiatrists, clergy, teachers, and
social workers of all kinds, everybody
on whose door somebody with a
personal problem might knock for help.

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What a lot of these people don’t
realize is that, when you take on
personal problems, the stress can be very
damaging. So, medicine became more
captured by technology and a
mechanistic view. You didn’t need to get
mixed up in that mind stuff, you see,
because you’ve got the wonder drugs.
This is still around. We won’t say that
that’s a bad thing. Anything that
removes suffering has got to be taken
seriously, and medication can be a
perfectly useful contribution. The
trouble is that when people find
something that relieves tension, they
then draw the inference that you don’t
need to bother finding out any more
about it; you just kill it. That’s what
happens. Medication becomes an
explanatory philosophy quite soon, and
not just a mode of helping.

So who is it helping? Bion had this

cryptic way of talking, in nuggets you
see. He had a discussion with me about

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all this drug business, and he just
chipped in with his remark, “Well, the
doctors need the drugs if they’re going
to get sleep at this point.” That’s the
point. Who is the medicine for? The
patient or the doctor?

It’s a good idea to reach beyond

medical people to senior social workers
and educators. Helping them was one of
the big things in our platform at the
Scottish Institute of Human Relations in
the ’70s. We had three activities: we did
clinical work; we did research and
training; and we helped the allied
professional and volunteer groups to
increase resources in the community. We
spent roughly a third of our time on
each. It didn’t mean that everybody
shared everything, but the total
personnel resources roughly added up to
that division of labor.

Well, there’s no doubt in my mind

that the crossfertilization of the work, of

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us being involved with people in the
outer world and social work
organizations is quite a good thing. We
need to be in touch with the poet’s voice
and the artist’s vision. We meet with
them and we listen. It’s just being able to
hear that matters.

I’ll interrupt this with a little vignette

I can’t resist telling you. One of the
young presidents of a big superhospital
was stuck with a difficult suicidal
patient. He was a man who had come to
specialize a bit in what they call difficult
patients. These would be patients who
had been kicked out of about four or five
other hospitals who couldn’t cope with
them because they were so destructive
on the treatment. This young woman,
who was about 28, had been a persistent
suicidal since she was 16. She had
undergone 14 attempts, which made me
wonder if she really meant business.
Anyway, they had a job because she had
to be watched night and day, and she

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was very negative and very difficult. She
was the bad object. Her doctor asked
me, “Would you see her with me?”
That’s a tricky situation because, if you
say something, the patient might use you
to put down the staff there. Of if you say
nothing, then you look a fool. Everyone
wonders, “Why did you bring that man
in?”

Well, this girl, she started talking to

me and she said, “This place is a zoo.
The patients are all animals and the
shrinks are worse. Why can’t I commit
suicide if I want to? I want to do it. It’s
my life. It’s terrible. Nobody’s worth
looking at, talking to, or anything.” Just
a stream of invective that went on for
about half an hour. So she went on, and I
just nodded my head at all this abuse,
but I was included in it too. “You’re
another of them. I can see.” Well, I
suddenly stopped her. I was getting
tired, and I said, “I’m told you write
poetry.” Well, she looked around and

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said, “Um,” but then turned away. I said,
“Well, that’s interesting to me. When
Freud started this kind of work, he was
always interested in what the poets and
writers said because it’s poets who have
told us most about human misery and
the depths of the inner life of people. I
wonder if your poems, you see, are not
something you’re trying to say to us.”

She seemed so totally devoted to

destruction and self-destruction, but this
bit of her that wrote poetry was
somehow calling out for a response.
Well, we had to finish off, and I met the
doctor the next day, and he said, “Oh,
that woman. She thought you were
God!” I said jokingly, “Oh, well, I know
that. Tell me something new.” He told
me that she had made what I thought
was a lovely remark. I had been sitting
like this and she was there, and after I
left, she had said to the doctor, “Does
God wear a hearing aid?” I think that’s
the poetical remark of all time. I

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thought, by golly, that girl’s not so
hopeless as she makes herself out to be.

Going back to the Scottish Institute,

we had our members who were qualified
mental health professionals and then we
made up an associate membership of
people who were not qualified to do the
specialist jobs that were being done, but
were interested. So we got a link with
the field, the relevant field. Then we
said, “We will rely on you to bring in
things that are coming up in the field,
and then we’ll just talk together about
what can be done for it.” So we made a
social connectedness with a large group.
When you work together, the others may
feel a degree of envy —life is not a bed
of roses —but at least they see that the
specialist psychotherapy role is one that
is helpful and might be one worth
training for themselves.

The thing of value is to have an

endless activity out into the community.

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So we have our therapy groups and
application groups for the learned
professions, social workers, teachers,
lawyers, family doctors, poets, anybody
who could want the group.

Of course, it was in this field that I

think that Michael Balint made one of
the most powerful contributions to the
use of psychodynamic knowledge, when
he took on the family doctors. He was a
very able fellow, Michael Balint, a very
trying chap at times. He was the one
who said to me, “Well, don’t worry. If
you’ve got a Hungarian as a friend, you
don’t need an enemy.” That was true
enough. But he really was, he was a
remarkable, creative man. He and Enid
were quite a great pair together. I was
very fond of him. I was very sorry when
he died. He was a good fellow.

Coming from Middle Europe, of

course, where they were used to old-boy
networks and secret things, they didn’t

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really grasp the democratic process. In
the British health service, if you’re
going to ask for anything, you think of
the number of committees you’ve got to
go through, preparing your case, and this
sort of thing. He thought you just rang
somebody up, and it could be arranged.
He was demanding more staff from me,
and he said, “Ring them up, ring them
up.” I said, “I can’t do that. It doesn’t
work that way.” “Ah, you’re no use at
all,” he complained. So I said, “Michael,
you’ve convinced me I’m an
administrative genius. I tolerate bastards
like you.” He jumped up and
immediately took me around the neck.
“Now we can be good friends,” he said.
Balint said that what the family doctors
or social workers are trying to learn is a
skill of how to work with personal
problems and that learning that skill
requires at least a minimal personal
change in your own attitudes, because
you’ve got to give up wanting to give

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advice. You’ve got to learn to listen —
and he was very good with it.

I was talking about responding to

demands from the field. There’s another
side to that. In turn, the professionals
have got to be initiating toward the field.
Well, Balint thought doctors might be
ready, so he just put an advertisement in
the local medical journal, saying that we
were starting a pilot group for 10 weeks
to explore the possibility of helping with
the psychological problems of general
practice. He said to the doctors right
away, “Look, I don’t do your job. I don’t
know how we can help, but the one
thing I’m not going to do is give you
lectures on psychopathology. I’m going
to ask you to bring up a problem —
anyone in the group —bring a problem
that’s bothering you, something you’ve
got stuck with, and we’ll talk about it
together.” Of course, the groups were a
big success, because the members all
began to look at themselves to see how

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their attitudes were conditioned or fixed.
It was a very powerful method, but it’s
kind of faded out of the British scene.
There is always a regressive tendency
against growth. People don’t always
want to keep up because it’s easier for
the doctor to give them the drug
sometimes. It’s all very well criticizing
general practitioners handing out
tranquilizers, but the patients demand
them. It’s not just the doctor who wants
to give them. The patients are as
resistent to looking at the inner aspects
of a personal problem as any health
professional would be because, when
you get into the inner world, you enter
into a complex relationship with your
helper.

The Scottish Institute has grown, and

I’m very pleased. The teachers have
their problems and that sort of thing, but
they’re working away. They’ve been
given a sense of developing their own
skills and resources, and they’re going at

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it. There is a demand on their services.
They don’t make a lot of money, but
there are enough people from the
professions or industry who can afford
private fees to offset that. They don’t
advertise the low-cost clinic. It’s the
staff that’s the low cost, but they get
enough now to keep the overheads
going.

Dr. Gordon: I’m turning to another aspect of

your career. During the time you were
editor of the British Journal of Medical
Psychology and, later, of the
International Journal of Psychoanalysis,
journals that published some of the most
important papers in the history of
psychoanalysis, what were your
experiences of reading these papers and
which ones in particular stand out as you
think back?

Dr. Sutherland: Well, you’ll be amused, if

not horrified, at my first confession. It
involves John Rickman, who,

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incidentally, was Bion’s analyst
originally. Rickman and Bion were huge
men, both of them. I used to say, “Look
at that pair. Now who’s the mother of all
father figures? Who’s the father of all
mother figures?” Between them, they
contained all the figures that ever lived.
They were huge. They were about 6 feet
tall and about this wide. Rickman was a
Quaker with a very good sense of fun.
He had been in Russia at the time of the
revolution, and was about to be shot at
one point, being a Quaker there. He was
interested in the British Journal of
Medical Psychology, and I got to know
him well. He came to me one day, and
he said, “Look, will you take over the
British Journal of Medical Psychology?”
I said, “Any but the Journal, John. I
don’t even read the damn thing.” Then
he shook me; he said, “What better way
of reading it?” So I started it. That’s my
first confession.

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When I think of what goes on at the
Menninger Bulletin, it seems to me that
they have a staff of a hundred doing
their editing. But we did it on a
twentieth of my time, if that. I used to
take the papers home. I was a great one
for reading out of doors in the sun, if
there was any, and so I used to say that
the number of papers was directly
correlated with the number of sun-hours
a day!

The British Journal of Medical

Psychology had room for various points
of view, but most of the papers that
came in were psychoanalytic and they
did not have to conform to a certain
point of view. The International Journal
of Psycho-Analysis — just one of many
now —used to be one of the places to
publish, even for people in the United
States. We didn’t have to tout for papers;
there wasn’t a terrific number of outlets
anyway. It always seemed to me that
good papers were never much of a

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problem. You recognize fairly readily a
thoughtful writer who has some
objectivity. But when it comes to fringe
papers, if one of them has come from
Timbuctoo, rather them New York, we’d
take it, because one function of a journal
is to stimulate effort in the professional
groups. I really see a journal as having a
broader function than broadcasting
ideas. Let’s face it, what percentage of
the papers really are new ideas? At the
same time, they’re valuable because
often they make the way for new ideas
coming.

Dr. Gordon: I’d like to turn now to Fairbairn

who was your analyst in the 1930s for, I
gather, about 5 years. I wonder if you
can bring us into his consulting room,
and tell us what Fairbairn was like. He’s
known to us as a theoretician. What was
he like as an analyst?

Dr. Sutherland: Well, he was in his whole

personality slightly formal, with an

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aristocratic type of bearing. He wasn’t
without a sense of fun naturally along
the way, but there was a certain
formality about him anyway. I would
think if he lived today, he would find it
not very easy to be anywhere without a
tie. I could put it that way. Not that he
looked stiff or starchy, no, but there
were certain standards. “This is what the
gentleman does,” and he did it.

The way he talked about people was

what attracted me in the first instance to
him. He never proselytized. What
converted me to his point of view was
the way he talked about people. He was
obviously concerned about their
suffering. He remained very bothered
about the recession of the therapeutic
emphasis in psychotherapy. It was
almost as if Freud said that the success
of the treatment didn’t matter, as long as
the analysis worked. Fairbairn took the
other view. His concern was, “If I’m not
getting these people a bit better or into a

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state of less suffering or torment, then is
what I’m doing wrong?” That was of
foremost interest to him, and to me.

In his analytic approach, he didn’t

say much. He didn’t work in anything
like the way a lot of analysts would do
who were influenced by the Kleinians.
Nowadays, if I have a patient who is
silent or tense, I speak up to take a hold
of this person. I grab and I hook him.
You remember that girl in the Institute,
who wrote poetry —I thought, this girl
has gotten to be taken hold of in some
way, and I took up her poetry to try to
get her to talk, to reach the split
somewhere in her self. But none of the
old analysts operated that way. They left
everything to the patient. That was
standard.

When I went to London, to Tavistock,

I joined the British Society. I had to have
another analysis. I said, “Look, I want
somebody like Fairbairn.” They said,

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“That’s no good. You’ve got to go to a
real analyst.” I went to Sylvia Payne.
Unlike many Kleinians, she didn’t have
that view. She seemed to me very
similar to Fairbairn. She was quiet,
waited, not asking, but just commenting
what she thought. It was all very
subdued. Things happened, but I don’t
think as much happened as might have
happened.

One was always aware that Fairbairn

was a concerned human being. When I
look back on what I got out of analysis
with him and with Sylvia Payne, I would
have to say that my analysis really began
when I began to think of my self. My
analysis started about 10 to 15 years
ago. That’s when I really got the notion
of looking at the inner self.

One of the things I noticed about my

self was that I had permanent trouble
with intellectual work. I could always
sense the quality of papers, which were

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good or not, but I couldn’t articulate
why. I suddenly realized that I had been
avoiding work for years by distracting
myself all the time, and I realized that
this should have been up for analysis. I
mean that was the kind of analysis that
people didn’t seemed to do.

One of the nicest things about the

National Health Service was you could
take on an impossible patient if you
wanted to. There was no question about
the fee. If you thought there was
something interesting, you could do that.
I had a few fairly difficult characters for
a very long time, so I was able to start
looking at the development of their
selves over time, and the development of
my own self over the same time period. I
could always see the splits in them, but I
didn’t think of my self in those terms.

Once I started to look at my self, I

saw the split self there, too. I never
realized that I suffered from this sort of

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thing. I had always been interested in
gardening. But not when I was a boy.
My father was a keen gardener and, of
course, if you sensed you were being
coerced into gardening, it’s not a popular
pastime with boys, so I wanted nothing
to do with it.

But as I got older, I found that I was

very interested in gardening. Early on, I
just liked it. I didn’t become a great
authority, but I liked our garden. Sitting
in the sunshine, this was good. I was
allying myself with my father. My
mother was the ambitious figure in my
life, and all this academic stuff I was
doing was really under her pressure.
What my father did was rather enjoy
himself. There was that tension between
them. They weren’t abusive, they didn’t
batter each other or anything like that at
all, but I could sense a tension, and I
could see that whenever I was
confronted with serious intellectual
work, I was tempted and inevitably

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seduced into doing some distracting
thing, like thinking, “I’ve got the garden,
I’ll do some gardening.” I found I was
really wanting to say, “To hell with what
you want me to do, Mother. I’m going to
enjoy myself with Father.” I became
clued in to this, and the insight changed
me considerably.

So, whereas in the past, I would go to

Eric Trist and say, “Eric, I know what
we should do. I know this is right, but
you’ve got to tell me why. Why am I
right?”, now I began to get these things
together, think them through for myself,
and this had to do with the work I did on
myself.

I mention that to say that there’s hope

for all. Even if you start at 70, there’s
hope for all.

I do think the formulation of self-

knowledge is much more usable on
one’s self than trying to struggle with
impulses, which is what Fairbairn said

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all along. He said, “What can you do
with impulses?” But you can do
something with yourself, your agent,
choosing your activities.

As an adolescent schoolboy with his father

Well, I realized, of course, that I had

never had any ambition. Now where did
that come from? I was obviously being
driven by something. The role of images
in childhood is very powerful. You
know, a little boy wants to become a

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train driver or something. It’s as if the
in-and-out person who is there is
seeking a guiding image. Kohut
mentions this quite a bit. You are
striving toward that image, and the
person-you-might-be is not articulated,
but it’s there. Images are very powerful
in that way, and I can think of various
examples. There was one image — I can
remember as a boy a figure who made a
great impression on me was David
Livingstone, the missionary/explorer.
You probably don’t know him, but, of
course, he was very much respected in
Africa. He was the first white man
among so many tribes and they took to
him. He made real contact with them.
He didn’t go in selling the gospel, and
telling them what to do, or saying they
were sinners. He just went in and taught
them, helped them to fight their political
battles, and saw to their needs. So he
was enormously respected, as well as
having this missionary zeal.

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And talking to Roy Menninger one
day, I said, “Good God, Roy, that’s what
it is —I’ve become a medical
missionary!” In a sense, I had. Why had
I gone through this medical course? I’m
sure that the guiding image of that was a
kind of ideal self that had been way
down. That sort of thing never came out
in 10 years of analysis. Why? It must
have been a secret of mine. As Fairbairn
says, the relationship between the
internal objects is kept secret in case
these interfering parents take it away
from you. So there’s my second
confession.

The more we learn to work on self

images, the more people could go on in
life with relatively little help from
therapy.

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In his beloved garden, 1980

Dr. Corrigan: In your book Fairbairn’s

Journey into the Interior (1989a) you
give a compelling picture of the
interaction between Fairbairn’s inner
and outer worlds. You remark that

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Fairbairn often commented on the
intimate interplay of theoretical
preference and personality features. This
question picks right up on what you’ve
just been saying. How do you reconcile
the intransigence of Fairbairn’s neurotic
symptoms with the continuous flow of
his creative activity?

Dr. Sutherland: I’m very glad that came up.

We have got into the way of thinking of
the internal objects as rather crisply
separated figures there, and that isn’t
really what happens, because they
pervade the central self. Fairbairn’s
mother had been helpful with his career.
His father questioned whether he should
go to the university, or start doing
something real and be earning money.
But his mother was much more
ambitious for him. So he developed
negatively toward his father and,
positively, ganged up with his mother.
Well, I think that the problem there is
that the central self has become so

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pervaded by the controlling mother, who
is no longer felt as that bad. You come to
accept that you are that person now. You
can identify with that very much. So to
start working on that is to threaten
serious disintegration. You’re confronted
with Winnicott’s false self. When you’ve
got to give that up, there’s a deep threat
because you are existing on that. That’s
what’s holding you together. There’s a
serious threat, and it takes the
reassurance of trust in the therapist
before you can begin to break that open.

Now, there was nobody Fairbairn

could go to. So, I think, he just wrote all
these notes to himself. It was a terrible
problem for me. I thought, “Dare I use
these notes? Have I betrayed him?”
These were private, self-analytic notes.
But they were so enlightening. Also,
there was the other fact: he had written
them and he had kept them 25 years.
They were preserved. If he had been
bothered about them —his last year or

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two, he was getting pretty old, he knew
he was winding up —he could have
destroyed those things easily or told his
wife to destroy them, but they had been
kept. So I have a feeling that perhaps he
did think they might be used to
understand things.

I think he tried to work it out himself,

but I don’t think he could get at enough
of the destructive force toward the
mother, the controlling mother. You see,
Klein’s depressive position is something
that we need to do a lot more work on
because she is talking about the mother
becoming a whole person. Now, what
she doesn’t point out is that the mother
cannot become a whole person unless
the self is becoming a whole self in a
different way, because it takes a gestalt
to talk to a gestalt and understand it. So
there’s an inherent self-development
toward wholeness going on with
differentiation of the self and self-
consciousness of the self as a self. These

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are the things that the infant developers
have discovered. These changes take
place especially dramatically in the
second year. There’s an awareness of the
feelings of the other.

Now, there must then be a phase of

awareness of self struggling free from
mother. Now, if that’s been a loaded
struggle, it has a highly aggressive,
destructive component. If when the child
is in a raging tantrum, the mother does
not say, “There, there, it will be O.K.
Don’t worry,” but is very tense or
alarmed about it, then it is felt to be very
bad.

Fairbairn’s mother was experienced

as a martinet, and people who knew her
said she was. She was a very formal
person: tuxedos for dinner and that sort
of atmosphere. I would think there was
great anxiety. Dedication to his work,
his hold on his work, was what kept
Fairbairn’s self together. No matter how

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chaotic his external life might be, the
immense dedication with which he
pursues the work to completion is a sign
of a man’s creativeness, the wholeness
that’s needed. I don’t think we
understand a half, a fraction, of what all
these things are about, but we’re
beginning to see what the important
issues are.

I would say Fairbairn’s first wife was

a very dependent woman. She had been
brought up in a family of the country
gentry and her only brother was a
regular army officer. She had lived in
that world where men provided the
social life. When she found she was
married to somebody who was absorbed
with work, I think she was lost. She
couldn’t make a life for herself, and
that’s the tragic thing. Imagine —she
had what nowadays would be a
homemaker’s dream: she had a nanny to
look after the kids; she had two maids to
do the domestic work; she had nothing

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to do but go ahead, and she could have
pursued her own interests several hours
each day. But she didn’t do anything like
that. She really wanted to be in on
Fairbairn’s mission, not wife to
somebody who engaged in this horrid
profession, closeted up with these bad
creatures, his patients. It’s often been
said that had Ronald Fairbairn been
Princess Di’s gynecologist, Mrs.
Fairbairn would have been in her
element. She could have parties all
around. All that was denied. All she
knew was people moaning and groaning,
awful people, patients around. He was
the sort of man to whom marriage is a
sacrament, and he wouldn’t have
thought of divorce or leaving the family,
so he stayed. He did the best he could,
you see, to make life possible, but she
took to drink, and that was that.

Fairbairn had put his father into the

role of bad object, and now without the
support of his wife, his mother’s support

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really, I think he was searching for
something that was missing. And, he
refound the bad object. Of course, when
he brought back father as an important
internal object he brought him back with
his symptom. Fairbairn identified with
his refound paternal internal object, and
inevitably with the symptom. That’s my
speculation.

There was nobody that he felt he

could have gone to. I can think of one
therapist that he might have gone to. He
might have gone to Melanie. Who
knows? But obviously he didn’t want to
get into darkest Melanesia. Needed safer
territory for decent Victorian behavior!

Dr. Gordon: Clearly, Fairbairn saw himself

as taking Kleinian theories to their
logical conclusions; but Melanie, on the
other hand, seemed to feel he was going
to absurd extremes. Phyllis Grosskurth
comments that Klein was undoubtedly
resentful that Fairbairn was developing

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concepts on his own and wasn’t
beholden to her. She even states that
Klein may have felt competitive with
Fairbairn and was spurred on to get her
ideas out before he did. How do you
view her difficulties with Fairbairn?

Dr. Sutherland: Fairbairn was always very

courteous. I often wonder if maybe he
didn’t exaggerate it, but he was a
gentleman in every sense. He was very
considerate and thoughtful about people,
and very appreciative, and he had a great
admiration for Melanie’s contribution.
He never had anything but a reverential
attitude to Freud, but to him the best
way of paying tribute to Freud was to
look at what he was saying, examine it,
probe it, and develop it. Classical
Freudian instinct theory suggested that
the evil inside one’s self was something
that we were afflicted with, not
something for which we were
responsible. He didn’t see himself in
opposition to Freud, but he thought that

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his theory would have to change. But
Melanie wasn’t like that. Melanie wasn’t
a scholar. She was intellectually
untrained. By temperament, I think she
was more of a flamboyant, exuberant
girl in the European-Hungarian style. A
very beautiful woman when she was
young, very beautiful, a real sex kitten.
Not like Anna Freud, who never seemed
to get out of these hopsack skirts.
Melanie stayed true to Freud’s instinct
theory, especially elaborating the death
instinct. Fairbairn was a great admirer of
Melanie and what she had done to
understand the infant’s object relations,
even though her theory had an
instinctual basis. But when Fairbairn
rejected the death instinct and her notion
of the instincts, he tampered with her
safety measure.

Freud had stirred up the hostility of

the world by bringing the unconscious in
and confronting sexuality. Then this
woman Klein came along saying we

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were all murderers, we were full of
violence and destruction. I think it was
too much for the analysts to take. In the
modern world, it’s taken the media
working hard, night and day, to confront
us with violence so that we have to see
that it is all around. People have gotten a
little more used to it, but at that time it
was frightening I think in a personal
way.

Guntrip said that there was a

resistance in our culture and in analysis
to the acceptance of the destructive part
of ourselves, because it was
uncomfortable. Our defense was to keep
it as something impersonal with which
we were afflicted. I have a feeling that
Melanie was happier with something
like that too. When Fairbairn was
writing his papers, her glamorous
daughter Melitta had really told Melanie
to go to hell, told her she was a bitch. So
Melanie was confronted: she had lost a
son in a tragic accident but she also had

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this daughter who couldn’t stand the
sight of her, so she was in no mood to
take responsibility that the parents might
have something to do with it, as
Fairbairn thought. That has been a
constant criticism of her thinking, that
she uses the words about the parents, but
none of the music, I think, because of
this powerful factor in her own life.

Dr. Corrigan: In your book, you’re very

respectful of Harry Guntrip as a friend
and theoretician. Fairbairn accepted,
later in his life, Guntrip’s idea of a
regressed ego. Greenberg and Mitchell,
however, are quite strong in their feeling
that Guntrip’s emphasis on the regressed
ego led to a distortion of Fairbairn’s
emphasis on object seeking.

Dr. Sutherland: I never understood that

remark. What Guntrip says is that the
object-seeking tendency, if you blank it
out enough, retreats. That seems to me a
perfectly ordinary phenomenon. If you

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don’t mother it psychologically, it just
shrinks. The self has no vitality going
on, and you get death in a lot of cases.
Well, that seems to me just a biological
phenomenon, a fact. Guntrip has come
in for a certain amount of the negative
that people wanted to say about
Fairbairn, but Fairbairn’s writing was so
timid they couldn’t do it. Guntrip was
looser, but Guntrip was no fool. He was
a very sharp thinker, and that article he
had which I published posthumously
about science and psychoanalysis (1978)
was very good. He had a very well
trained, philosophical mind, Guntrip. He
was a different man from Fairbairn
altogether, of course. He was a rather
intense chap, Guntrip was. He was
always bustling — you felt he was
driven all the time. Fairbairn never did
have that attitude. Oh, he was active, but
he had had some — not much, but just a
whiff—of the enviable gentlemanly
nonchalance that nothing is so important
that you need to be bustling about it.

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Guntrip was much more driven and
responsive and concerned and that sort
of thing. A very active mind all the time.
But inside he had a dead child part of
himself. He wrote about seeing his
younger brother dead on his mother’s
lap. I think he saw his own destroyed
self, and there was a sense of saying to
his mother in his theory: “that’s what
you did to me.” So he wanted that
destroyed self, or regressed ego,
included in Fairbairn’s theory. Guntrip’s
mother was really pretty awful. Even I
got into trouble with her.

Although he didn’t preach a word in

the church for many years, Guntrip
never gave up his ordination, and he was
popular among the clergy. He took a
very great interest in the clergy learning
about psychotherapy in the cure of souls,
and his writing appeals because he
doesn’t polarize religion against
psychiatry. He doesn’t do that, unlike
Freud. Freud, by talking about the future

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of the religion, left us bothered by the
religion of the future. It was really
terrible. Guntrip and Fairbairn didn’t
polarize religion and psychoanalysis, but
they both dismissed the concept of
human motivation as originating in the
bunkers of energy that come out of the
soul.

Dr. Corrigan: Your theory of the self, to me,

has a Winnicottian flair.

Dr. Sutherland: Winnicott carries the notion

of the bad object into the central self by
the creation of a false self. Fairbairn
wasn’t enthused about the false self,
because he thought that it wasn’t a good
enough way of expressing the theoretical
position. But he admired Winnicott’s
clinical work.

Winnicott was a maverick chap

always. I did some supervision with
him, and he was very informal. The first
time I went, he walks into the room with
his razor, shaving himself. That was the

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first thing. Then there was a plant on the
window sill. He said, “Oh, somebody’s
just given me a plant. Bring me the pot.
Now well see who lives longer —your
patient or the plant.” He had a buoyant,
boyish sense of fun. He was a
tremendously intuitive person really.
Again, he wasn’t such a disciplined
thinker as Fairbairn. Fairbairn’s thinking
was almost excessively disciplined.
That’s why people found his writing
style so condensed, because it seemed to
be a philosophical treatise for the
scholar, not for the humble therapist.

Dr. Corrigan: What did Fairbairn make of

Winnicott’s ideas on integration and
primary creativity?

Dr. Sutherland: Oh, I don’t think Fairbairn

got on to that. He got to this stage of
writing about the endopsychic situation
and the central self. I have a feeling that
he kind of died then. Of course, that was
the time when his wife was at her worst,

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and she died of alcoholism in 1952.
Although he had to put up with this for
some time, he was still very attached to
her, so that he was depressed for a long
time after her death. The domestic
upheaval stopped the thrust of his
thinking. I think that he would welcome
a lot of what Winnicott and Guntrip
have done.

Dr. David Scharff: Can you say some more

about the relationship between Fairbairn
as a man, his intellectual development
from boyhood and his interest in
theoretical elaboration?

Dr. Sutherland: Well, I think Fairbairn was

an ordinary child, a thoughtful,
intellectual boy with these somewhat
overintrusive parents controlling his
behavior. Very strong Victorian pressure
to be good and proper. It was very
important in those days, particularly in
Edinburgh society. The class

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consciousness was almost unbelievable,
and you had to conform.

Now, it always seemed to me that

Fairbairn showed his independence in
his attitude to the regular churchgoing
that was imposed upon him. Each
Sunday he had to go twice with his
parents. Now, for a young child a
Calvinistic sermon about an hour long is
hardly an entertainment. Fairbairn made
it into something he found of interest.
He would go and copy down the sermon
from a quite early age. He would pick
out the flaws in the arguments. The one
way he could be himself, assert himself,
was through his intellectual activity. Of
course, that was all right, because his
parents would accept that, you see. That
was quite nice behavior.

Well, at the same time, as he has said,

he was perturbed about the issues of
conscience, guilt, and sexuality that
were mounting up toward adolescence.

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Of course, they were terribly forbidden
activities in that household. I get the
impression that the repressive attitude
between the parents would be pretty
heavy. I’m sure nothing like exciting
sexual orgies were going on. I think that
would be left to Fairbairn’s fantasy.
They were highly controlled people and
preoccupied that this boy mustn’t get
onto the wrong track. He must be
straight and well behaved.

So this forced the intellectual area on

him. He got a lot of encouragement for
that, because he went to this private
school, and in these private schools there
was a good deal of individual attention
compared with the public school system.
When he decided to go into the Church
he found really rather a cunning solution
to his situation, because he was going
into a career where he could really look
at sexuality and things of that kind under
a very respectable cloak because, after
all, it came up in the Bible quite a lot. So

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it gave him a way out. You get the
impression of a boy rather left to
himself, and his intellectual life was his
field for asserting himself. That’s what I
felt.

Dr. David Scharff: You’ve been very

interested in the relationship between his
father’s urinary phobia, Fairbairn’s
rather traumatic exposure to that
symptom in the railway car when his
father had to urinate in front of a number
of women, and the onset of an almost
identical symptom in Fairbairn …

Dr. Sutherland: Identical, yes.

Dr. David Scharff: ... in his middle age.

Dr. Sutherland: Well, in many ways it

brought out Winnicott’s point about the
male and female elements in the growth
of the self. It seems to me increasingly
that a prominent feature of the father’s
role is the symbolic value in asserting
independence of mother. In the infant’s

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world, father is independent. He goes
out to work. He’s not controlled, he’s not
subdued.

Now, Fairbairn’s father, I don’t think,

could have been given much status by
his mother, because she was the
ambitious, socially climbing woman in
some measure. The father had the
typical, rather benign but somewhat
controlling Scottish attitude, “What are
these big ideas you’re getting? You’re
good enough at the level you are, and
you stay there. Going to Oxford and that
sort of thing, what’s all this nonsense?
You don’t even need to go to the
university, and if you do need to go,
Edinburgh is good enough.” The mother
was more expansive. Now, the mother,
therefore, became a very important
figure, because she really was
encouraging the forward movement of
his self into the academic world. She
was his support figure against father.

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Now, when Fairbairn’s wife turned
against him, he was, I think, rather in a
quandary, because his internal objects
vanished when his support figure
vanished. Instead of a supportive mother
figure, he found in her the repressed bad
object, based on his experience of his
father. As he wrote later, what were
repressed were not impulses, but objects.
He wrote in his diary that his father was
a negative figure for him. I don’t think
there was much chatting with each other,
not much in common. But, at the same
time, I think the guilt came back
tremendously about his father—had he
destroyed his father? I think that his
symptom was proof of the resuscitation
of his reserved, stay-at-home,
unambitious father and of the reparation
to father internally, and bringing him
back alive inside himself. He became
like father in order to bring him back.

Well, then he continued with his

work, because the surprising thing is it

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was around this point that his creativity
was just growing, the tremendous
creative urge was just beginning in those
early thirties, and blossomed just at the
end of the 30s. What it brought out for
me was that the successful integration of
the two parents in a constructive
relationship in the self is an extremely
important feature of development.

Dr. David Scharff: Did any of this insight

about the self of Fairbairn reverberate
with thoughts about your own self as
you were writing his biography
Fairbairn’s Journey into the Interior?

Dr. Sutherland: There’s a difference

between Freud’s self-analysis and
analysis of the self. The self-analysis of
the self has a totally different focus than
what went on in the Fleiss
correspondence, I’m sure. I was
surprised by the number of people who
have written to me to say that they
found, by the time they had read the

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book, a considerable amount of
analytical work had gone on in
themselves about themselves. I certainly
felt that in writing it.

I felt that Fairbairn had absolutely

taken possession of me. I got worried
about it. I felt I was living this man night
and day. I really ought to have seen a
good analyst about my writing before,
because I’ve never written much. I don’t
like writing. I much prefer talking. I
wrote the whole thing in 6 months,
which was quite something; for I had
passed my eighty-third birthday.

But I was aware of a profound

process going on in myself, and I think
that this is what it was about. It ran in
parallel to Fairbairn’s profound,
essential struggle for the integration of
the self; uniting the male and female
elements that Winnicott later described.
The female element is the establishment
of the base from which you start as a

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person. The male element starts gender
identity. You might say the first identity
is being a person, a secure self; but the
ultimate identity must be a secure
gender self. I think Fairbairn never felt
that he had a secure masculine self. He
describes that. He felt different. He
lacked the ordinary aggressive
boyishness, and I think that’s why, deep
down, there was a deep resentment of
his father for not asserting himself more
in that area.

Self-analysis has acquired a new

significance for me. I always said you
can’t do self-analysis because the
perpetual problem is the
countertransference! But I do think that
people can do a lot of analysis of the self
inside themselves, because once you’ve
got the idea, you can look at it more, you
can use art, you can use literature, you
can use all these things far more readily,
to look at the self. I think something of
that kind was going on with Winnicott

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Looking at Sutherland’s biography of Fairbairn
with publisher Bob Young, outside Fairbairn’s
house in Edinburgh after the Fairbairn centenary,
1989

and Guntrip. They, of course, benefitted

from Fairbairn’s experience, and then
they were able to do some self analysis

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that wasn’t in the analytic culture, but
they brought it into it.

Dr. David Scharff: So in writing this book

and in thinking about it, you found an
aspect of yourself that you had never
found before, which really let you move
on in a new way.

Dr. Sutherland: A very profound influence,

because I was always hopeless at
abstract thinking. I ran away from it, the
way I kind of pushed my father aside.
My mother was the dominant one, not
outrageously so, but she was the
ambitious one for her family. I was the
sixth of eight children, that’s why I can
be bothered with all you lot, that’s why I
enjoy teaching, having been brought up
to be surrounded permanently by people.
That’s when I really feel most at ease.

But I found, as I went on with this

book, I suddenly began to be much more
able to cope with abstract thinking. I had

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At the family country cottage, 1925, from left to
right: Father, Martin, Jimmy, and Jock

reinstituted my father and put that

together with my ambitious mother. Had
I done this, you see, years ago, I might
have been able to write something. It
was a terrible discovery late in life. Still,
there it was. But I’m sure the valuable
lesson I got out of it was bringing the

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parents together in that way. It really
came up rather comically for me. I’ll let
you in on a dreadful secret.

My father was very Scottish. He

loved the Highland traditions and the
Highland regiments. He wasn’t an Army
man, but his ancestors had been in the
Highlanders. He was very fond of the
kilts of the Scottish regiments. Of
course, when you were a boy in
Scotland, you saw kilts all day long
because the soldiers were always there,
you see. As you know, of course, it’s the
only culture in which transvestism is a
national pastime! I found myself,
believe it or not, resuscitating the
wearing of the kilt. I used to wear a kilt
when I was a boy, but not as a man.
Now I got one, and I realized that in my
inner world I thought, “Now, this will
please my father.” It was a definite act to
please him and to bring him back into
my life. That really was quite an
important self experience for me. It

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added to my whole feeling of freedom in
the intellectual world. I felt much freer.

At Gifford, Scotland, 1990

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So I really began to believe in the
self. I thought, “There’s something in
this.” And I went on from there.

Dr. David Scharff: Now, how do you think

that had to do with the particular
formulation of theory that Fairbairn
arrived at?

Dr. Sutherland: Oh, I think that he had

enough of the masculine from many
support figures in childhood, especially
around school. But I think that he was
pressurized all the time from this bad,
controlling mother. I think he was
frightened internally, because when his
own wife turned hostile to his analytic
work, he walled off her objections. He
had made enough contacts to reinforce
his interest and he continued to work.
His dedication to analysis was profound.

He had started as a theological

student. He realized he couldn’t be
helpful to people in this way, but I have
a very strong feeling that analysis was a

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kind of new gospel for him. People must
get to know about this. It was a gospel
that must be spread. It was real
knowledge. It was the good knowledge.
He was a very devoted analyst and he
spent a lot of time talking to societies of
all sorts. He had a very strong feeling for
the social value of analysis. All these
things went into making him the person
he was.

Dr. David Scharff: Right, and a number of

his papers actually were about the social
application of the way of thinking.

Dr. Sutherland: Yes, that’s right. Oh, yes, he

would talk about communism and all
these things, and relate them to analytic
understanding. Analysts were incredibly
naive in their interpretation of complex
social phenomena. Marx was left
completely out, you see. But Fairbairn
wasn’t really foolish about that sort of
thing, as some people said he was from
reading his paper about communism.

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Guntrip, in fact, said he thought it was
silly to reduce communism that way.
Fairbairn felt a bit annoyed about the
criticisms. He wasn’t talking about
political systems. He was talking about
what might happen to the family in those
cultures. That was what he was talking
about, because he was concerned about
the welfare of the family, very
concerned.

Male Questioner: What would you write

about now?

Dr. Sutherland: I want to write a chapter or

a paper concerned with getting the self
properly conceptualized. I want to think
in terms of modern biology, with
systems theory, because if you don’t get
that open systems type of thinking, it’s
very difficult to go forward and see how
the different bits will build up and
realize the necessity of conceiving of the
self as a growing, dynamic process,
needing to be constantly related.

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I think a good concept of the self
would unite the whole psychoanalytic
movement, because that’s what is
lacking. The fights that go on are due to
a lack of an acceptable central concept
of personal development. If we get that,
then I think we’ll go a long way.

Dr. David Scharff: We may have been

diverted from being aware of the self by
the term object-relations theory. You’ve
suggested renaming it self and object-
relations theory.

Dr. Sutherland: Yes, I think object relations

is in danger of becoming a misnomer
and diverting people, because only a self
makes object relations. I think we should
bracket them together, the self and its
object relations, a term that brings in the
essential relatedness. They can’t be
considered apart.

Dr. David Scharff: The self psychology

concept of the self that emphasizes only
its use of objects and is shorn of the

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object’s use of the person is an
imbalance as well.

Dr. Sutherland: Well, I think it is, yes. I

don’t think they’ve got it right. I don’t
think there’s enough biological
foundation there. At least Freud tried to
base psychoanalytic thinking in biology.
But we’ve got to get the right biology.

When you go around psychiatric

departments, especially academic
psychiatric departments, you hear “Oh,
no, we don’t do this mind stuff. We do
biological psychiatry.” I say, “Do you
mean to say—are you saying that the
mind doesn’t belong to biology? Where
are you living?” For me, the mind is the
end point, the absolute cutting edge of
the evolutionary thrust in the biological
sphere. Theirs seems to me the silliest
statement. We’ve got to establish the
right of the mind to be treated
scientifically. We need to apply to the
mind the new thinking by the systems

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theorists. They’re very helpful about the
self-organizing universe and the
relatedness of systems and development.
These are the models, rather than
nineteenth-century science, that we need
now.

Female Questioner: I just wonder whether

you might comment on whether Piaget
has something to give to the formulation
of this biological theory of the
developing self.

Dr. Sutherland: Oh, it’s intensely relevant,

but we’ve got to get it built in right, not
just use it to underwrite cognitive
therapy. We’ve got to get at the
relationship between self development
and cognitive development, because I
think that only a holistic system like the
self can organize knowledge. Difficulties
in learning and using knowledge reflect
splits in the self. The two kinds of IQ,
the conformist and the open-ended one,
are very much a product of the self. The

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self is the integrative body, the structure
that integrates perception, thinking,
feeling, and I think that cognition is
centrally determined by that. So we’ve
got to put what Piaget studied into the
perspective of how learning is governed
by the structural development going on.

Male Questioner: I think Bowlby has

moved along the lines of the conception
of self that you’re talking about in terms
of bringing in Piaget’s sense that
assimilation and accommodation are
part of how we build internal working
models. Although Bowlby certainly
doesn’t talk with the same kind of depth
and poetry about the inner world, his
concepts of internal working models
certainly can accommodate the
conceptions of Fairbairn and Guntrip. I
think that Fairbairn’s view of the
internal world is one of several internal
possibilities; and that we have to
correlate these hypotheses with research
coming from attachment theory, which

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throws light on how the self develops
images of others.

Dr. Sutherland: I don’t underestimate the

work of John Bowlby, but I am nervous
about attachment theory being used as if
this is all that’s needed. To me, what
John Bowlby has done is to show that
without attachment—that is, without the
development of some inner structure
attached to the mother—the self can’t
grow. The value of attachment is that it
sets up the essential precondition for the
further development of the self. Models
of inner objects get built up inside us.
I’m not sure that models is a good word,
because we take bits and pieces from so
many adults, and because it’s really a
fluid, dynamic process.

Attachment theory is a statement of

the evidence for early structures in the
organism, and these we are calling the
self.

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Dr. Jill Scharff: I would like to ask you
about Fairbairn’s idea that introjection
was the first defense, and that the only
motivation for introjection was bad
experience, so that what is taken in is a
bad object. Many people are puzzled by
this emphasis on the bad. If so much is
focused on the introjection of the bad,
where, then, is the good? Is the
unconscious entirely peopled with bad
objects and, if so, is this not a very
frightening prospect for the person?

Dr. Sutherland: There’s no doubt he is

confusing about this issue. But if you
read him carefully, Fairbairn says that
when he talks about internalizing the
bad object, it’s a deliberate act of
incorporating a separate kind of person
who has been frustrating. He’s assuming
that the original self structure has
incorporated the good experience from
mother, not by internalizing an image of
the person, but just taking in all the
things that have happened —the way

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he’s been held and fed. All these
qualities of goodness or nongoodness
have come into the structure of the
central ego there already. So he doesn’t
separate that as requiring the
internalization of a separate object,
although that develops later with the
growth of perceptual capacity.

Better if he had made clearer that

there is an identification with the
mother, so there is an internalization.
Mother’s goodness has become
dissolved inside, permeating the whole
of the structure there with the qualities
she has imbued. So that is there. If she
has been good enough, it gives the self a
feeling of great security that the outer
world is a good place to relate to.

That’s Winnicott’s whole point: if

you get that good feeling coming into
you, then you’re not afraid of the outer
world. You enjoy exploring it. It’s the
necessary basis for all the exploratory

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activity that the child then needs,
because you have no hostile or
frightened feeling of the outer world.
The good mother is built in.

Dr. Jill Scharff: So your point is that the

good mother is taken in, but not as a
defense. It’s taken in as a healthy,
normal mechanism.

Dr. Sutherland: Not as a defense. It’s taken

in and metabolized. Just as food
becomes part of the body structure, the
emotional experiences permeate the
growing content of the structure we’re
calling the self, that becomes the ego.

When the frustration experiences

render the child helpless because the
child can’t control the powerful adult
you then get the frustrating outer adult
being taken inside. As Winnicott would
point out later, the capacity to play is
what forms the foundation that will then
need to manage the bad object. The
infant can think, he can feel, he can

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invent ways of dealing with the bad
object hopefully, you see.
Internalization, as Fairbairn says, is to
try to control the bad object, to manage
it.

But you can see it’s qualitatively a

different kind of relationship and
operation from the nondefensive
internalisation of the good mother in the
centred self. In the case of the bad or
frustrating object, the internalization is
followed by splitting the bad object off
from the good object and getting it away
from the centred self. Even the bad
object is perhaps the wrong word
because, as Fairbairn said, it is both
good and bad at the same time. It has
rejecting and exciting qualities, but it’s
always the frustrating object, the desired
disaster, and it has to be kept in check.

Dr. Jill Scharff: Now, Fairbairn has been

pretty clear on the need to split off an
unacceptable part of experience and

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locate it deep in unconsciousness as a
repressed object that either has rejecting
or exciting aspects. Kernberg, in the
United States, has pointed out how
what’s repressed is both the object, the
part of the ego that is in relation to the
object, and the affects that tire involved
in that cycle.

Dr. Sutherland: Yes, yes.

Dr. Jill Scharff: What is the place of affect

in the centred ego? Object-relations
theory is quite clear about the affect that
is unconscious. What do you think is the
place of affect in the central ego?

Dr. Sutherland: Well, affect is an innate

property of the organism, of the self. It’s
there from birth, and it’s a sort of global
quality carried by the structure. A living,
feeling organism has this quality. If you
think of it from the evolutionary point of
view, it’s a masterly creation. How can
an organism deal with a multiplicity of
experiences and stimuli coming in and

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how can it be prepared for what’s
painful and deal with each one? Give it a
mechanism whereby anything that is
disturbing the well-being is felt in the
general headquarters as painful.

So affect has always struck me as an

ingenious way of creating a monitoring
system that could deal with all kinds of
stimuli, and could set in motion
internally a reactive mechanism —a cry
of protest, a yell, a “go away” —
specific responses triggered by this
general message of unpleasant affect.

From early on I have not been

convinced that repression is necessary
for this. Splitting does seem to be an
innate property of affect. If there’s a
painful sort of thing inside, the
spontaneous tendency of such a system
is to extrude the painful bit. So that gets
split off. Naturally, what is split off is
the bit of self that’s feeling the affect
and the relationship there. So the whole

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bit of the self system gets split off, not
just the object.

Dr. Jill Scharff: I’ve always thought that

affect at the conscious level had a lot to
do with the infant’s capacity to have an
accepted object. In other words, a good
baby can make its mother wonderful,
whereas a baby with difficulties would
experience the same mother as not such
an acceptable object.

Dr. Sutherland: Well, the affect that comes

into any experience is governed by the
content of what’s going on inside the
organism and the nature of what’s
coming at it. So it’s a combination.

You see, we’ve been so brought up

with nineteenth-century science and
Freud. The whole model for conceiving
personality development was
mechanical engineering. You’re talking
about solid structures all the time with
cybernetic control of negative feedback.
If anything gets out of place, you get it

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back to the same state that it was in.
Whereas, we’re dealing with open,
growing, developing systems with
positive feedback; that is, something is
happening and you create a new bit so
that there’s expansion, growth and
development, and permanent dynamics.

The whole model has changed

completely. Equilibrium, solid structure,
nineteenth-century stuff, that’s only one
area of science. It has no relevance in
living organisms. The second law of
thermodynamics has everything working
toward a steady state. That’s not the case
in living organisms. Living organisms
are negentropic: they are incorporating
food stuff all the time to keep up their
energy system. They’re not dependent
on something that was born in the
system to start with. They’re creating it
all the time, so it’s a permanent dynamic
process.

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We’ve got to think of the self and the
personality as a constant, developing
system, just exactly like the body, taking
in all the time, keeping its structure
going, adding new structures, and
splitting off unwanted bits.

Dr. Jill Scharff: This idea of human

personality and development as part of a
cybernetic system, with other selves in a
family group, in the peer group, in the
society, in the species, seems to me
much richer than the linear perspective
of Freud, even when modified by a
touch of Erikson. What I would like to
ask you now is to comment on
Fairbairn’s view of the linear
development of the oral, anal, phallic,
and oedipal developmental stages, which
he thought were driven not by the
necessary unfolding of a set progression
through the erogenous zones fueled with
instincts, but rather by different
techniques needed for dealing with
objects.

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Dr. Sutherland: Well, I don’t think he
discarded Freud’s biological idea of
libidinal development. There are two
words I think could well be banished —
narcissistic and libidinal — because we
can now give them a more specific
meaning. All we mean by narcissism is
we’ve taken objects inside and we’re
living with them, rather than with outer
people. And the libidinal drive is the
interest toward the real world and the
impulse to relate to it. The organism, as
a potential person, has an insatiable
appetite to encounter and incorporate
other people to build up its own shape,
and so the quality of the relationships
encountered affects the final self. We’re
really in a state of scientific change, of
moving from a linear concept of change
to nonlinear concepts of growth and
development.

I remember in an early day in the

war, when we started those Officer
Selection Boards, and the army officers

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were asking us, “We want you to be able
to predict so and so.” Bion, who had a
great sense of fun, had the answer. An
incredible character, he inspired the
most terrific affection. He was a huge
man, which was a great help in the army,
of course. He had been in the Tank
Corps in the First World War, and he
almost looked like a tank. I felt a little
shriveled wimp beside him, I can tell
you. But I remember, he just looked at
these senior officers, being himself with
enough medals — he had the Legion of
Honor with a Cross. He was
recommended for the Victoria Cross, but
he didn’t get it. He led the first tank
attack in the First World War. But people
come in with till that colored brass on
their chests, and make people like me
feel about this size. But Bion, he could
compete. Well he just looked and said,
“Well, sir, if you will predict the
environment, I’ll have a chance of
predicting how the individual will
behave.”

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Dr. Jill Scharff: Well, I’m not going to
attempt to predict how you’re going to
answer my next question.

Dr. Sutherland: You’re wise not to do that.

Dr. Jill Scharff: Since you didn’t

specifically answer my question about
the stages — oral, anal, and phallic —
I’m guessing that maybe it doesn’t mean
as much to you as do other parts of
Fairbairn’s theory. I, myself, have never
been as taken with, for instance, his
view of the object being kept internally
or being projected externally according
to diagnostic type; and I would be
interested to know if you have much
interest in that or not.

Dr. Sutherland: Well, I think he never

quarrelled with the libidinal stages, but
they were just development phases. As
Erikson put it, they form the pattern for
the psychological disposing of
experience, as it were. I cringe too when
I hear people talking about anality or

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orality, as if they were special forms of
electricity. What Fairbairn didn’t like
about the oral, anal, and phallic stages
idea was that what were modes of
dealing with the internal world were
being given a reified status.

Now, the oral pattern, of course,

there’s no question about that. He talked
about that, because the child’s pattern
for psychological taking in is the
physical one. And there’s no doubt that
the foundation of self-security is
physicalized, is very —I think of Ronnie
Laing’s word —corporeal. It’s very
much in the body, physical pleasures,
getting the good. Mother’s goodness
comes in from the way she handles the
baby.

Of course, the omnipotent or the

potency feelings given by the father is a
very direct experience, because the
average father will pick up and lift a
child in a different way from mother.

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The infant must feel a different quality
of power. He’s picked up and thrown
about in a different way, than by mother,
who would be more gentle in lifting and
so on.

So one just has to imagine these

different ways in which the physical
experience could build up to patterns of
relating. Fairbairn had no quarrel with
that sort of thing at all. What he meant
by anal behavior —and the Kleinians go
partly toward this —is an advanced
stage in which psychological reactions
are symbolic. The feces and the
excretory acts are taken symbolically.

Obviously, for him personally, early

on there was conflict about urination and
the parental couple: he was peeing on
them. Well, we all know that that’s a
standard expression amongst kids of real
contempt—“go and pee on them.” So he
was not treating excretion as the object
as well, but as a mode, a symbolic mode

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of treatment of the object, a good way of
getting rid of things.

Dr. Jill Scharff: A way of dealing with the

object, not just a way of getting rid of
instinctual tensions?

Dr. Sutherland: No, no. A way of dealing

with the object all the time.

Dr. Jill Scharff: A way of relating.

Dr. Sutherland: Yes. Melanie was quite

right, you see, when she spoke of infant
terrors coming from projection. When
things were extruded from the self, the
child feels the edge of the cradle has
become a terrifying object because of
what got projected onto it.

Dr. Jill Scharff: Now you’re mentioning

Klein and projection. Fairbairn, of
course, acknowledged that he was
influenced by Klein….

Dr. Sutherland: Oh, he was very much

influenced …

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Dr. Jill Scharff: But I haven’t seen him use
the term projective identification. Do
you know anything about that?

Dr. Sutherland: She had only brought that

term in after he had written his main
papers.

Dr. Jill Scharff: In 1946, wasn’t it, before

his book came out?

Dr. Sutherland: Yes, but he had written his

papers by ’44 or ’45. What’s the third
one called, where we get the internal
structuring, the permanent structuring of
the splits and so on? The endopsychic
situation. She responded to him after
that —and she didn’t say much. Melanie
simply said, “I disagree.” Stop. No
reasons. She didn’t like what he was
saying because he differed, and that
wasn’t done in darkest Melanesia. You
didn’t differ with the boss, you see. But
Fairbairn had that very good intellectual
training. He didn’t just differ, he argued
systematically. Instinctive energies and

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the death instinct —these were
nonconcepts to him. The death instinct is
quite a useful metaphor for somebody
who wants to murder; but, on the other
hand, it is not so good when you take it
on to a wider range of phenomena, like
inner sadomasochistic relationships.
Fairbairn had been trained as a
philosopher, could think, could isolate
principles, could make the challenge,
and ask the vital question “Now, is that a
valid concept?”

Here’s my third confession: I have a

feeling that I avoided the implications of
what Fairbairn was thinking for most of
my life. I didn’t do a lot of thinking
about his work, because I was caught up
in Tavistock, which was so exciting for
me, so different from anything that I had
experienced in Scotland, so different
from anything that he was living, too.
He was also quite fascinated with my
being in the Tavistock. He thought it
was tremendous that he had a friend

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there. You get a certain kind of
relationship with some people such that
you always feel in touch with them, no
matter if you are not seeing them every
day. I had that kind of relationship with
Fairbairn. He would tell me things about
patients and send me his manuscripts.
But I never really devoted myself to
thinking about what he was saying. It
was only when I started to do a self-
analysis that I began to really think
about his ideas on the self and its
subselves. If I had the attitudes and
feelings about thinking then that I have
now, I would be much more informed.

All this is just to say, there’s hope for

us, hope for you all. Start at 70!

Note
[←*] A collage by Jill Savege Scharff from tapes of informal
teaching interviews with Drs. Edward Corrigan and Pearl
Ellen Gordon at the Institute for Contemporary
Psychoanalysis and Drs. David E. Scharff and Jill Savege
Scharff at the Washington School of Psychiatry.

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Epilogue

John Derg Sutherland C.B.E., F.R.C. Psych.,

F.R.C.P.E., Ph.D.
28 April 1905-14 June 1991

Psychoanalyst and psychotherapist, clinical

psychologist and physician

Medical director, Tavistock Clinic, London,

1947-1968
Consultant psychotherapist, Royal Edinburgh
Hospital, 1968-1974

Co-founder, Scottish Institute of Human

Relations, 1970

Jock Sutherland’s engaging personality, his

respect for others, and his firm commitment to

psychoanalysis and its application to

psychotherapy had a profound impact on

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psychiatry in the United States. With
characteristic humor and philosophical integrity,

he persuaded American psychoanalysis to stretch

its ego-psychology orientation to include the

tenets of British object-relations theory.

Beginning in the 1960s and continuing until

1990, he introduced the little known work of his

mentor Ronald Fairbairn to American psychiatry,

psychoanalysis, psychiatric social work, and

nursing during his annual visits as a Visiting

Sloan Professor to the Menninger Clinic, one of

the most prominent American psychiatric training

institutions. His classic (1963) paper, “Object-

Relations Theory and the Conceptual Model of

Psychoanalysis,” given at the clinic and discussed

there by Otto Kernberg, is one indicator of Dr.

Sutherland’s enormous influence on American

psychiatry. Jock’s teaching and consultation at the

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Menninger included organized formal
consultation and participation on the editorial

board of The Bulletin of the Menninger Clinic

and, later, membership on the board of trustees.

Jock’s visits to the Menninger were

anticipated by the staff in the same way
children anticipate the annual arrival of St.
Nick. The gifts he bore were inspiration,
theoretical first aid, and a bottomless
enthusiasm for the kind of work we had
undertaken. Although the influence of
Fairbairn and Winnicott was unmistakable,
he often found the ideas of Melanie Klein
useful. He would occasionally turn to a
young psychiatrist with whom he was
consulting and note with a twinkle in his
eye, “To treat this patient you will need to
enter darkest Melaniesia!”

Glen Gabbard
Director of the C. F. Menninger Memorial
Hospital
Topeka, Kansas

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In addition to his influence on psychiatry
through his impact on psychiatric trainees who

then settled throughout the United States, Jock

Sutherland also made psychoanalysis relevant to

the fields of education, counseling, and

community development.

Jock Sutherland’s breadth of vision, keen

open-mindedness, and inclusive spirit
combined to render him a centrifugal force
in the development and dissemination of
British object-relations theory. He was
committed to and deeply involved in
making analytic understanding available to
the broadest possible spectrum of the
population, and instrumental in encouraging
its disciplined appropriation and adaptation
by human services professionals serving
distressed people in settings well beyond the
consulting room. Having organized his life
work around the conviction that the fabric of
the human psyche is woven from both deep
interior and social experience, Dr.
Sutherland recognized that he shared this

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conviction with the religious community of
church, synagogue, and temple.

Louis Reed
Pastoral counselor,
Jacksonville, Florida

In Britain some months after his death, many

people gathered at a memorial service to

celebrate Jock and let him go.

We are not here simply to make a potpourri

of good memories, to associate around the
name of Sutherland. Jock would have
disapproved of that. “What is the thesis
from which you are operating?” he would
have asked and reminded us, in his
characteristic phrase, that there is nothing so
practical as a good theory.

The Right Reverend Michael Hare Duke

Bishop of St. Andrews

Addresses and readings helped structure the

recollections of the wide company while music

made space for them in a context of Christian

belief and tolerance of ambivalence.

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The service of thanksgiving for John Derg
Sutherland (Jock) took place at St. Mary’s
Cathedral, Edinburgh, in the afternoon of
Friday, October 4, 1991. It was arranged by
the Bishop of St. Andrews, the Right
Reverend Michael Hare Duke (with whom
Jock had worked on several occasions at the
Scottish Institute of Human Relations). It
was a beautiful service, with various
readings and addresses by people who had
worked with Jock, and a cello solo, “The
Swan” by Saint Saens, played by Jock’s
nephew, Dr. Robert Stobie. I had been asked
to speak about Jock’s contribution to
psychoanalysis and the British Psycho-
Analytical Society, which were in
publications and training. Analyzed by
Sylvia Payne, Jock qualified as a
psychoanalyst in 1948, and became a
member of the Society in 1952. In 1954 he
was recognised as a training analyst and in
1956 he was elected to the training
committee that reviewed the 1946
agreement with Anna Freud for parallel
training courses A & B and introduced a
common basic curriculum for all students.
Editor of the International Psychoanalytical

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Library since 1955 where he piloted 28
books to publication, Jock was also
appointed as editor of the International
Journal of Psycho-Analysis in 1960. This
new office gave him a place on the council
and the board of the society, and from that
position he was able to have an important
influence on the affairs of the society.

Pearl King (1992)

British Psychoanalytical Society

For him, the purpose, and the means to that

end, were two distinct but essential
components of every living system —and
that unity entailed giving full consideration
to both purpose and means in every aspect
of life. This could be recognized in all his
endeavours and relationships and that
“double-task,” as I like to refer to it, was
basic in his concept of caring,
psychoanalytic work, institution building,
his group work, leadership roles, and to his
marriage. What I might call his direct,
concerned, but firm, insistence on that
double-task of ensuring full attention to the
unity of purpose and of the means of
achieving it, encouraged others to search

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and explore rather than to occupy more
resistant positions.

Harold Bridger (1992)

Organizational consultant

It was from Jock that I obtained that vision

of a caring society as an infinitely preferable
goal to a controlling, and at times a punitive,
one. If Fairbairn initiated a Copernican
revolution by rescuing the whole person
from the clutches of a somewhat
dehumanised psychoanalysis, it was Jock
Sutherland who completed that revolution
by focusing our attention not just on the
whole person but on “the whole person in
his or her whole environment” —his
exploration of the inner world having led
him back ineluctably to a study of what
went on outside that inner world —of what
went on in the larger society.

Drummond Hunter (1992)

Chairman, Scottish Institute of Human Relations

Jock was deeply concerned about the future

of psychoanalysis, believing that it needed
to broaden its theory to include more
understanding of the development of the

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self. With Fairbairn, he saw the self as an
open system that both moulds and is
moulded by the caretakers. Every child, in
this perspective, has a right to responsive,
loving caretakers and, when these are absent
or deficient, the child reacts with rage and
seeks what it needs, albeit in distorted and
seemingly pathological ways. He showed
great concern for how damaged selves
might be helped through human relatedness
in hospital treatment and in psychotherapy.
He believed that our patients are our greatest
teachers. If we could understand fully what
contributes to the etiology of their problems,
we could make a major contribution to
psychiatry and psychoanalysis. He would
frequently remind us that it was our
obligation to publish and let the world know
about what we are doing and what we are
learning.

Stuart Averill (1992)

Menninger Foundation

In addition to professional journals such as

the British Journal of Medical Psychology (1992)

65:1-4, the International Journal of Psycho-

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Analysis (1992) 73:577-580, both of which he
had formerly edited, and Psychoanalytic

Dialogues (1992) 2(3):277, British daily

newspapers such as The Daily Telegraph

(6/24/91), The Glasgow Herald (6/20/91), The

Guardian (6/21/91), The Independent (6/21/91)

and The Scotsman (6/19/91 and 6/25/91)

newspapers carried obituaries and appreciations:

He was profoundly knowledgeable of the

literature of psychoanalysis and its
applications; firm in his view that good
practice must be grounded in sufficient
theory; and committed to promoting
psychodynamic insights among the caring
professions and into their work beyond the
office and consulting room. He had striking
success in this aim because of a
warmhearted, generous spirit; an
irrepressible sense of humour; a continuing
belief in the potential of others; and a
constant willingness to share what he knew.

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Douglas Haldane, consultant psychiatrist,
Scotland
Eric Trist, formerly director of the Wharton
Business School
British Journal of Medical Psychology (1992) p.
1.

Jock Sutherland was a man of prodigious

energy, filled with interesting and
challenging ideas and eager to communicate
them. A natural teacher, modest to the point
of self-effacement, he possessed the
precious personal qualities of friendliness,
toleration, and good humour…. He will be
missed for his capacity for conceptualization
and for his capacity to adapt his calm but
amazing energies to working at the grass
root level.

Paul O’Farrell
Consultant psychotherapist, Royal Edinburgh
Hospital
International, Journal of Psycho-Analysis (1992)
p. 580.

Jock, as he was affectionately known, was a

psychoanalyst, an editor, a scholar, and an
administrator of rare excellence. For his
work as medical director of the Tavistock
Clinic in London ... he was awarded the
Commander of the British Empire (C. B.

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E.), an honor given to only two other
psychoanalysts, John Bowlby and Anna
Freud. ... In 1989, he published the first
book on the life and work of Fairbairn —
Fairbairn’s Journey into the Interior. He
was an elegant, humane man, infused with a
great sense of humor, joyful, devilish, and
peaceful at the same time.

Edward G. Corrigan
Director, the Institute of Contemporary
Psychotherapy, New York
Psychoanalytic Dialogues (1992) p. 277.

I cannot really recall a time in my life when

Jock Sutherland was not a part of it. I
remember him as an analysand at my
father’s noble consulting rooms at 21
Grosvenor Crescent when I was 4 years
old…. My father’s philosophy of the
workings of the human mind would never
have received the acclaim that it now enjoys
worldwide, but for the almost filial devotion
of Jock Sutherland…. Jock was modest,
almost to the point of self-effacement, but
he was remarkably effective in achieving his
objective of the compassionate cure of those
who suffered from the deep well of mental

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anguish, and in promoting the explanation
of their suffering.

Sir Nicholas Fairbairn

Lawyer, public servant, son of Ronald Fairbairn
The Scotsman 6/25/91

Jock was the youngest of an Edinburgh

family of eight. A studious child, he first
read chemistry and then psychology at
Edinburgh University. There he came under
the influence of Ronald Fairbairn.
Determined to become a psychoanalyst, he
took his medical degree at Edinburgh
University…. With his wartime colleagues,
among whom were Henry Dicks, John
Bowlby, and Wilfred Bion, Sutherland led
the [Tavistock] Clinic into its preeminent
national and international position in
psychoanalytically oriented psychotherapy
and related health endeavours. ... He
devoted himself to furthering the
development of the Scottish Institute [of
Human Relations], using his great skills as
an educator and facilitator, to make
psychodynamic insights available to
doctors, nurses, social workers,
educationalists, voluntary workers, religious

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leaders, and others. “Working is fun,” he
used to say, and with such a dedicated man,
it had to be that, and more than that.

Anton Obholzer
Medical Director, the Tavistock Clinic
The Independent 6/21/91

It is for his personal facilitation that many of us

will remember Jock. In his several visits to the

Washington School of Psychiatry, a national

postgraduate training institution for mental health

professionals, he helped Margaret Rioch found

the A. K. Rice Institute on the Tavistock model

committed to the application of psychoanalysis to

organizational and group relations; he led

workshops on object-relations theory for faculty

and students; and he was the distinguished Frieda

Fromm Reichmann lecturer in 1979. His last and

memorable visit to the Washington School

occurred just a year before his death.

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During this trip he inspired students and
faculty alike with his uncommon
combination of common sense and profound
knowledge. His message then, as it had been
throughout his professional career, was one
learned from his analyst and mentor,
Fairbairn, refined in the cask of his own
experience, and enacted in his work in what
he called “the growth and development
business.” Jock taught us all: “What our
patients want is only to love and to be loved
for themselves.”

Jock loved his colleagues with the tough

practicality of his tender knowledge of the
human spirit. In Topeka, Kansas,
Washington, D.C., and everywhere that he
was known, Jock was unquestionably loved
for himself.

David E. Scharff
Director, Washington School of Psychiatry,
Washington, D.C.

The last word goes to Jock’s wife of 51 years,

Molly, who quotes E. M. Forster on Auden’s

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death: “It is as though the temperature of felt life
has dropped.”

At home with Molly, Edinburgh, 1972

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Credits

Chapter 1 appeared as “Object-Relations Theory

and the Conceptual Model of
Psychoanalysis” (1963). British Journal of
Medical Psychology 36:109-124, and is
reprinted with permission.

Chapter 2 was published as “The British Object

Relations Theorists: The Contributions of
Balint, Winnicott, Fairbairn, Guntrip (1980).
Journal of the American Psychoanalytic
Association 28: 829-860, and is reprinted
with permission.

Chapter 3 was a talk reported by M. Wasserman

and published as “The Contributions of D.
W. Winnicott” (1980). Bulletin of the
Association for Psychoanalytic Medicine
20(l)(Nov.): 18-25, and is reprinted with
permission.

www.theipi.org 1551 www.freepsychotherapybooks.org

Chapter 4 was extracted from an unpublished
paper (1989) spoken at the Fairbairn
Centenary Conference, Scottish Institute of
Human Relations, Edinburgh, and is
reprinted by permission of the Sutherland
literary executor at the Scottish Institute.

Chapter 5 was previously published as a co-

authored chapter with H. S. Gill. “The Object
Relations Theory of Personality” (1971). In
Language and Psychodynamic Appraisal ed.
J. D. Sutherland and H. S. Gill. London:
Tavistock Institute of Human Relations, and
is reprinted with permission.

Chapter 6 was previously published as a co-

authored paper with H. S. Gill & H.
Phillipson. “Psychodiagnostic Appraisal in
the Light of Recent Theoretical
Developments” (1967). British Journal of
Medical Psychology 40: 299-315, and is
reprinted with permission.

Chapter 7 was previously published as “Three

Cases of Anxiety and Failure in
Examinations” (1941). British Journal of

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Medical Psychology 19(1): 73-81, and is
reprinted with permission.

Chapter 8 was originally published as “Some

Comments on Dr. Fairbairn’s Paper” (1956).
British Journal for the Philosophy of Science
7 (28) (Feb): 329-337, and is reprinted with
permission.

Chapter 9 was published as “Recent Advances in

the Understanding of Small Groups, Their
Disorders and Treatment” (1965).
Psychotherapy and Psychosomatics 13: 110-
125, and is reprinted with permission.

Chapter 10 was published as a paper co-authored

with H. S. Gill. “The Significance of the
One-Way Vision Screen in Analytic Group
Psychotherapy” (1964). British Journal of
Medical Psychology 37:185-202, and is
reprinted with permission.

Chapter 11 was published as the chapter “Bion

Revisited: Group Dynamics and Group
Psychotherapy” (1985) in Bion and Group
Psychotherapy, ed. M. Pines, pp. 47-86.

www.theipi.org 1553 www.freepsychotherapybooks.org

London: Routledge & Kegan Paul, and is
reprinted with permission.

Chapter 12 was published as a paper co-authored

with I. E. Menzies. “Two Industrial Projects”
(1947). Journal of Social Issues, III (2)
(Spring) pp. 51-58, and is reprinted with
permission.

Chapter 13 was originally an introduction to the

book Towards Community Mental Health,
(1971) edited by J. D. Sutherland. London,
Tavistock, pp. vii-xii, and is reprinted with
permission.

Chapter 14 was originally published as

“Psychoanalysis in the Post-industrial
Society” (1969). International Journal of
Psycho-Analysis 50 (4): 673-682, and is
reprinted with permission.

Chapter 15 was previously published as

“Reflections on the Development of
Counselling Services” (1971). National
Council of Social Services, October, pp. 1-
14, and is reprinted with permission.

www.theipi.org 1554 www.freepsychotherapybooks.org

Chapter 16 was collated from “The Consultant
Psychotherapist in the National Health
Service: His Role and Training” (1968).
British Journal of Psychiatry 114: 509-515,
and is reprinted by permission of the Royal
College of Psychiatrists; “The Place of
Psychotherapy in Community Mental
Health” (1967). Contact, published by the
Scottish Pastoral Association, January pp. 2-
18, and reprinted with permission; “The
Psychotherapeutic Clinic and Community
Psychiatry” (1966). Bulletin of the
Menninger Clinic 30 (6) (Nov): 338-350, and
reprinted with permission.

Chapter 17 was published as “Psychological

Medicine and the National Health Service:
The Need for an Integrated Approach to
Research” (1952). British Journal of Medical
Psychology 25 (2&3): 71-85, and is reprinted
with permission.

Chapter 18 was an unpublished paper, “The

Need for a New Paradigm: Thoughts on My

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Relationship with the Menninger
Foundation, 1964-1987” (1987).

Chapter 19 was a paper, “The Psychodynamic

Image of Man: A Philosophy for the Caring
Professions” (1979). The Malcolm Millar
Lecture of 1979, Aberdeen University. Also
given as the Frieda Fromm-Reichmann
Lecture, Washington School of Psychiatry,
1979, and is reprinted with permission of
both institutions.

Chapter 20 was published as “The Self and

Object Relations: A Challenge to
Psychoanalysis” (1983). Bulletin of the
Menninger Clinic 47(6): 525-541, and is
reprinted with permission.

Chapter 21 will be published as “The

Autonomous Self” (1980). Bulletin of the
Menninger Clinic 57(1): 3-32, and is
reprinted with permission.

Chapter 22 was created by combining an

unpublished paper, “Fairbairn’s Line of
Thought” with part of the final chapter,

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“Fairbairn’s Achievement” from Fairbairn’s
Journey to the Interior, reprinted with
permission of Free Association Books.

Chapter 23 was created by combining two

papers: Sutherland’s part of a three-part
paper co-authored with J. V. Bondurant and
M. W. Fisher, “Gandhi: A Psychoanalytic
Viewpoint” (1971). The American Historical
Review. (October issue) 76(4): 1104-1115,
and “John Buchan’s Sick Heart (1988): Some
psychoanalytic reflections.” Edinburgh
Review Vol. 78-79: 83-101, both reprinted
with permission.

Chapter 24 was edited from transcriptions of

published audiocassettes of an unpublished
talk (1990), “On Becoming and Being a
Person,” presented at the Washington School
of Psychiatry, April 1990, and is used with
permission.

Chapter 25 was collated from transcriptions of

audiocassettes made of informal teaching
interviews with Edward Corrigan and Pearl
Ellen Gordon at The Institute of

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Contemporary Psychotherapy in New York,
1990 (and may be published in the
Contemporary Psychotherapy Review), and
with David E. Scharff and Jill Savege
Scharff at the Washington School of
Psychiatry 1990. Tapes used with permission
from both institutions.

The epilogue is a collation of extracts from

various obituaries in professional journals,
newspaper appreciations, and tributes from
the service of thanksgiving, all furnished by
Molly Sutherland.

Lines from “The Second Coming” are reprinted

with permission of Macmillan Publishing
Company from The Poems of W. B. Yeats: A
New Edition, edited by Richard J. Finneran.
Copyright © 1924 by Macmillan Publishing
Company, renewed 1952 by Bertha Georgie
Yeats.

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