Chapter 15
page 220, paragraph 2, line 10
Scepticism is sometimes expressed about whether a period in hospital or residential nursery has effects in the long term as well as the short.
page 220, paragraph 2, line 10
Scepticism is sometimes expressed about whether a period in hospital or residential nursery has effects in the long term as well as the short.
Bowlby - Separation
162 ), he comes at times near to my own concept of separation anxiety and its exacerbation by threats of abandonment.
What seems to escape Sullivan, however, is that distress and anxiety can be and often are direct consequences of lack of tenderness and of separation per se; and that threats to restrict tenderness would be ineffective were that not so.
While aware that loneliness can be a devastating experience for adolescents and adults.
Sullivan seems unaware that it is even more distressing for infants and young children; indeed, there are passages in which he seems specifically to exclude that that is so: 'Loneliness, as an experience which has been so terrible that it practically baffles clear recall, is a phenomenon ordinarily encountered only in preadolescence and afterwards' (p.
261, my italics).
Reading Sullivan's work one gets the impression that he had never observed young children and that he was only partially aware of the close attachment they form to particular people and of the sense of security that mere proximity to a loved figure brings. The 'need for contact with others, often felt as loneliness', is identified, not with need for a genital or a parent-child relationship, but with gregariousness in animals (p. 370 ); his conviction that 'no action of the infant is consistently and frequently associated with the relief of anxiety' (p. 42 ), which overlooks the relief an infant commonly exhibits when clutching his mother, is a main plank in his theorizing. Because of this, he seems never to have grasped the reality of separation anxiety and, therefore, despite his close attention to the problems to which it gives rise, it remains almost impossible to attribute to him any particular theory of its nature and origin. It is probably for the same reasons that neither grief nor mourning plays any significant part in his system of psychopathology.
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In the theorizing of Phyllis Greenacre ( 1952) separation anxiety, and grief and mourning seem also to be omitted. Instead, experiences during the birth process and the first weeks of postnatal life are advanced as major variables to account for a later differential liability to neurosis (see Chapter 16 of this volume).
Rank's views regarding birth trauma have already been
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referred to. In his early papers Fairbairn, who sees separation anxiety as the mainspring of all psychopathology, follows Rank closely in regard to its origins: Fairbairn's postulate ( 1943) that birth anxiety is 'the prototype of all the separation anxiety which is subsequently experienced' is the counterpart of his postulate that a return-to-womb craving accounts for the child's tie. It should be added, however, that these views are peripheral to Fairbairn's main theoretical position ( Fairbairn 1952), which is in all other respects consistent with the theory of frustrated attachment advanced here. In a late paper ( 1963) in which he gives a synopsis of his views he writes: 'The earliest and original form of anxiety, as experienced by the child, is separation anxiety. '
Others have also founded their psychopathology on the central role of separation anxiety and some have adopted a frustrated attachment theory to account for it. For instance, as long ago as 1935, Suttie, holding the view that the child's attachment to his mother is the result of a primary 'need for company', saw anxiety as 'an expression of apprehension of discomfort at the frustration, or threatened frustration, of this all-important motive'. A year later Hermann ( 1936) expressed an almost identical view. He relates anxiety to the urge to seek and cling to mother: 'Anxiety is basically the feeling of being left on one's own in the face of danger. Its expression is a seeking for help and at the same time a seeking for mother. . . . Anxiety develops in the sense of an urge to cling. . . . '
Odier ( 1948) appears to adopt the same position. Taking Inhibitions, Symptoms and Anxiety as his starting-point, he criticizes Freud's view on the ground that the infant in the second year cannot conceptualize danger. As an alternative he postulates that 'during the second year this affect [i. e. anxiety] indicates that a particular state has become differentiated: the state of subjective insecurity', and concludes, 'originally the cause of the insecurity of the infant is, above all else, the absence of the mother (or her substitute) or separation from her at the time when the infant most needs her care and protection. This state is the basic theory of anxiety as it relates to insecurity' (pp. 44 46 ). In most respects Odier's view is consistent with that advanced in the present work. Where it differs is in his holding that separation anxiety starts only in the second year, a view that may have arisen because its obtrusive exhibition after the first birthday had misled him into supposing that it does not begin until then.
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Winnicott makes no such mistake. Although in several papers (e. g. 1941; 1945; 1955b) he might be thought to favour the Kleinian view that separation anxiety is nothing but depressive anxiety, in his brief contribution 'Anxiety Associated with Insecurity' ( 1952) he takes a line consistent with that favoured here. He refers to 'the well-known observation that the earliest anxiety is related to being insecurely held', and to anxiety that is caused by 'failure in the technique of infant care, as for instance failure to give the continuous live support that
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belongs to mothering'. In his judgement 'it is normal for the infant to feel anxiety if there is a failure of infant care technique'.
This is also the view of William James who many years ago wrote simply: 'The great source of terror in infancy is solitude' ( James 1890).
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Appendix II Psychoanalysis and Evolution Theory
SINCE it is not always realized that the paradigm Freud employed throughout in his metapsychology is pre-Darwinian in its assumptions, it is of interest to consider how that should have been so.
During the latter part of last century two separate debates were being held, the first about the historical reality of evolution and the second about how evolution, should it prove to have occurred, comes about. Not infrequently the adjective 'Darwinian' is used to refer to a belief in the historical reality of evolution. That, of course, is mistaken. Many others besides Charles Darwin advocated the historical reality of evolution, though it is true that none organized and displayed the evidence so cogently as he. Nevertheless the adjective Darwinian should not be applied in a general way to the occurrence of evolution but must be kept strictly for the theory that it has been brought about by a particular biological process, the one Darwin named 'natural selection', which is best described in terms of the differential breeding success, or failure, of naturally occurring variants that transmit their characteristics to their offspring.
Freud was certainly an evolutionist, but there is no evidence that he was ever a Darwinian. No doubt it is largely because a belief in evolution is so often regarded as Darwinian that it is easy to overlook how deeply Freud was committed to a preDarwinian standpoint. In his Autobiographical Study ( 1925) Freud describes how, as a student in the 1870s, 'the theories of Darwin, which were then of topical interest, strongly attracted me' ( SE 20: 8); and we learn from Jones ( 1953) that in his first year at the University of Vienna ( 1872-3) Freud took a course on 'Biology and Darwinism'. Such references, combined with Freud's enthusiasm for evolution in general and his occasional and always favourable references to some others of Darwin's ideas, e. g. the primal horde and the expression of emotions, are deceptive and lead easily to the supposition that Freud adopted Darwin's theory of the evolutionary process, even though he did not always apply it. Such a view, however,
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is incompatible with the historical record, as a reading of Ernest Jones's biography clearly shows (see especially Volume 3, 1957, Chapter 10).
Now that the explanatory powers of the principle of natural selection proposed by Darwin are become firmly established and universally accepted by biologists, it is easy to forget that this was far from the case during the formative years of psychoanalysis. Eiseley ( 1958) has described the scientific climate of the final quarter of last century, by which time belief in the historical reality of evolution was becoming well established whereas ideas on the means by which it is brought about remained in the hottest dispute. In particular, he describes how the
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authoritative yet mistaken criticism of Darwin's theory by Lord Kelvin had given great encouragement to Darwin's critics and to advocates of Lamarckian ideas. 1 So much so, in fact, that in later editions of the Origin Darwin modified his position by incorporating Lamarck's theory of the inheritance of acquired characters into his own theory of evolution by means of natural selection. The to and fro of heated controversy as it reached Freud in Vienna during the 'seventies and 'eighties, mainly through the professor of zoology, Claus, is described by Ritvo ( 1972). In 1909, the centenary year of Darwin's birth, the status of his theory of natural selection was still so doubtful that the celebrations to mark the event were little more than perfunctory. Throughout the first quarter of the present century, indeed, theories of evolution continued to be in 'a state of chaos and confusion' ( De Beer 1963); and it was not until 1942, with the publication of Julian Huxley volume Evolution: The Modern Synthesis, that a definitive account of the theory established during the preceding decade became readily available. It is
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1 De Beer ( 1963) points out that history has treated Lamarck unfairly. As one of the first, in
1809, to advance a systematic theory of the evolution of living species from earlier ones, Lamarck made a substantial contribution; but because his account was eclipsed by Darwin's definitive work it has been forgotten, except perhaps in his native France. By contrast, Lamarck's unproductive ideas regarding the processes whereby evolution has come about -- he attributed it not only to the inheritance of acquired characters but to the powers of a 'tendency to perfection' and of 'an inner feeling of need' -- remain identified with his name. This is because they have been so identified throughout the debate on the nature of the processes causing evolution, a debate that began after the Origin was published (in 1859), continued into the early decades of this century, and is occasionally revived even today.
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significant that the turning-point came, during the 1920s, as soon as genetic analysis was applied not only to specimens in a laboratory but to wild populations living and propagating in their natural environment. 1
Once the key dates in the historical development of Freud's psychoanalytic ideas are set beside those of evolutionary theory, the absence in psychoanalysis (as in most other schools of psychology) of a Darwinian perspective ceases to surprise. On the contrary, it is clear that, not only as a young man but on into his middle and later years, Freud would certainly not have been alone among his generation had he been cautious and non-committal in his approach to theories of the evolutionary process, including Darwin's theory of natural selection.
Yet to be non-committal was hardly in Freud's character. Although he never explicitly rejected Darwinian principles, it is evident that his early, deep, and continuing commitment to pre-Darwinian concepts in theoretical biology left no room for them. Nowhere throughout Freud's writings is Darwin's theory of natural selection debated; instead it is passed by as though it had never been proposed ( Jones 1957: 332).
In Chapter 1 of the first volume of this work it is emphasized that the psychical energy model that Freud brought to psychoanalysis came, not from his clinical work with patients, but from ideas he had learnt many years earlier, especially when he was working in the laboratory of
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his admired professor of physiology, Bru? cke. Now these ideas long antedate Darwin's Origin, published in 1859. During the 1840s, Bru? cke had been one of a group of dedicated young scientists, of whom Helmholtz was the leader, who were determined to show that all real causes are symbolized in science by the word 'force'. Since the achievements of the Helmholtz school soon became famous, it was natural that Freud, working under one of their number, should have adopted their assumptions. As Jones ( 1953: 46) points out, the spirit and content of Bru? cke's lectures of the 1870s correspond closely to the words Freud always used to characterize psychoanalysis in its dynamic aspect: '. . . psychoanalysis derives all mental processes (apart from the reception of external stimuli) from the interplay of forces, which assist or inhibit one another, combine with one another, enter into compromises with one another, etc. ' ( Freud 1926b, SE 20: 265).
The limitations of that model for organizing the clinical
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1 For an account of present-day theories of the evolutionary process see Maynard Smith (
1966) and Alland ( 1967). -401-
phenomena to which Freud drew attention are already discussed in the first volume. The point now being emphasized is that the model is not only pre-Darwinian in origin but also remote from the biological concepts introduced by Darwin. For Freud and his colleagues, deep in Helmholtzian assumptions, the Darwinian perspective would, therefore, have been extremely difficult to reach. As Freud grew older, moreover, his increasing commitment to vitalist theories of the kind advocated by Lamarck made reaching it impossible. In his third volume Jones ( 1957) gives half a chapter to Freud's life-long adherence to Lamarckian explanations of the process of evolution, starting with the postulated heritability of acquired characters and progressing to a belief in the powers of a postulated 'inner feeling of need'.
During his early professional years Freud followed his colleagues of the Helmholtzian school in espousing what may now seem a rather nai? ve determinism. But at some time during the years before 1915 his views seem to have undergone radical change, since in 1917 he is expressing the greatest interest in Lamarck's ideas about the effects that an animal's 'inner feeling of need' is thought to have on its structure. During that year, Freud was in a mood of boundless enthusiasm for the whole of Lamarck's work and was in correspondence with Ferenczi and Abraham about an ambitious project to integrate psychoanalysis with Lamarck's theories of evolution. 'Our intention is to base Lamarck's ideas completely on our own theories and to show that the concept of "need", which creates and modifies organs, is nothing else than the power unconscious ideas have over the body . . . in short the "omnipotence of thoughts". Fitness would then be really explained psychoanalytically. . . . ' 1 This amounts, as Jones remarks, to the belief that 'need' enables an animal to bring about changes not only in its environment but in its own body. Moreover, causation is inextricably confused with function. Thus Freud's position in theoretical biology had by that date become wholly at variance with the biology that was about to dominate the twentieth century.
On reflection it becomes clear that Freud's increasingly deep commitment to a Lamarckian perspective, to the exclusion of Darwinian ideas about differential survival rates and the dis-
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1 Extract from Freud's letter to Abraham of November 1917, quoted by Jones ( 1957: 335). Although in his first volume Jones ( 1953: 50) claims that Freud 'never abandoned determinism for teleology', it is plain that that claim cannot be sustained.
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tinction between causation and function, has suffused the whole structure of psychoanalytic thought and theory. 1 With the remainder of biology resting firmly on a developed version of Darwinian principles and psychoanalysis continuing Lamarckian, the gulf between the two has steadily and inevitably grown wider. There are thus only three conceivable outcomes. The first, which is barely imaginable, is for biology to renounce its Darwinian perspective. The second, advocated here, is for psychoanalysis to be recast in terms of modern evolution theory. The third is for the present divorce to continue indefinitely with psychoanalysis remaining permanently beyond the fringe of the scientific world.
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1 Even Hartmann influential book, Ego Psychology and the Problem of Adaptation ( 1939),
was conceived and written before knowledge of modern evolution theory had become disseminated.
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Appendix III Problems of Terminology
EARLY in this volume it is remarked that in discussions of fear and anxiety problems of terminology abound. In Chapters 6, 12, 18, and 20 some of them are discussed. Here we consider some others.
During this century countless efforts have been made to clarify terminology, and a number of writers have proposed specific usages for words in common currency. No solution will satisfy everyone; or at least no solution will do so unless everyone shares a common theory. For as often as not the terms adopted are a reflection of theory.
Danger of Reification
First, it is vital to note that the words 'fear', 'alarm', 'anxiety', and others like them can be used legitimately only with reference to the state of an individual organism. In this work they are used only in their adjectival forms to refer to the way an organism may be appraising a situation, the way it may be behaving, or the way it may be feeling, all of which are closely linked. Conversely, it is never legitimate to refer to 'a fear' or 'an anxiety', as though each were a thing in its own right. The pitfalls into which it is easy to stumble when feelings are reified are discussed in Chapter 7 of the previous volume and in Chapter 20 of this one.
Unfortunately there is a very pronounced tendency not only in common parlance but in psychological, psychiatric, and psychoanalytic literature to reify both fear and anxiety. Thus we find Jersild, whose empirical work is so valuable, not infrequently tabulating the number of fears a sample of children are reported to show -- 'fear of three specifically named groups of animals, such as dogs, horses, cats, received a tally of three' ( Jersild 1943) -- and
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expressing his results as percentages of the total fears counted. Fortunately, however, in others of his tables, his results are expressed as percentages of children who show fear in particular situations; those are the figures drawn upon in this volume.
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In the psychoanalytic tradition it was not until 1926 that Freud treated anxiety as the reaction of an organism to a situation. Prior to that anxiety had been regarded by him as a transformation of libido, and as such was explicitly reified. As Strachey points out in one of his editorial introductions, as late as 1920, Freud added the following in a footnote to the fourth edition of the Three Essays: 'One of the most important results of psycho-analytic research is this discovery that neurotic anxiety arises out of libido, that it is the product of a transformation of it, and that it is thus related to it in the same kind of way as vinegar is to wine' ( SE 7: 224n).
Even today this type of thinking is not dead; and, as I well know, it is very easy to slip into it.
'Anxiety', 'Alarm', 'Fear', 'Phobia'
Because the English word 'anxiety' and its German cousin Angst play such a great part in psychoanalysis and psychiatry let us begin by considering those two.
In this work the usage already adopted for the word anxiety is that it denotes (a) how we feel when our attachment behaviour is activated and we are seeking an attachment figure but without success (Chapter 6), and (b) how we feel when for any reason we are uncertain whether our attachment figure(s) will be available should we want one (Chapter 15). It may be asked, how does that usage fit into other usages and with the etymological origins of the words? There is no lack of authorities to help to answer these questions.
Freud's use of the German term Angst and the difficulties of translation into English to which it gives rise are discussed by Strachey ( 1959; 1962). The usage of the term anxiety by English-speaking psychoanalysts is discussed by Rycroft ( 1968b). And the uses in the fields of psychiatry and psychopathology not only of the English 'anxiety' but of its many relatives in other languages are discussed by Lewis ( 1967), who also examines their etymology. Certain trends in usage, far from consistent, emerge.
A feature of usage to which all three writers point is that, in technical works, both 'anxiety' and Angst tend to indicate fear the origins of which are not identified. For example, on the final occasion on which he discusses the problem, Freud ( 1926a) remarks that Angst 'has a quality of indefiniteness and lack of object. In precise speech we use the word "fear" [ Furcht]
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rather than "anxiety" [ Angst] if it has found an object' ( SE 20: 165). Rycroft ( 1968b) recommends that anxiety be defined as 'the response to some yet unrecognized factor either in the environment or in the self' and reflects that psychoanalysis is mainly concerned with anxiety evoked by 'the stirrings of unconscious, repressed forces in the self'. Lewis ( 1967) refers to anxiety as an emotional state akin to fear that is experienced when 'there is either no recognizable threat, or the threat is, by reasonable standards, quite out of proportion to the emotion it seemingly evokes'.
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There are a number of difficulties about this type of usage. Thus, it is unclear to whom the situation arousing fear is held to be 'indefinite', or by whom it is 'unrecognized'. Is it the anxious individual himself (as suggested by Freud and Rycroft) or is it the clinician treating him (as in Lewis's formulation)? The answer might be either or both. For, on the one hand, a patient is sometimes aware of what he is afraid of but for some reason does not divulge what he knows; or he may do so and not be believed by the clinician. On the other, a patient may be unaware of what is troubling him, but the clinician may believe, rightly or wrongly, that he can identify it. A further difficulty in this type of usage would arise should either patient or clinician, or both, later come to identify what the patient is afraid of. In that case are we to say that the patient's anxiety is no longer anxiety but fear? And, if so, what is to be done should either or both misidentify what the patient is afraid of? These are not trivial difficulties.
Two other features of the historical usage, in the technical field, of 'anxiety' and Angst to which one or another of these authorities refers are: (a) the words are sometimes used to indicate fear that is considered inappropriately intense for the situation that seems to arouse it; and (b) they are sometimes used to indicate fear of a situation foreseen as more or less likely to occur in the future rather than fear of a situation actually present. Neither criterion is satisfactory, however. In Chapters 9 and 10 it is emphasized how misleading it is to apply notions of reasonableness or appropriateness to fear and fear behaviour. In Chapter 10 it is argued that, more often than not, fear is aroused by situations that are forecast and not actually present, and that the time-scale of the forecast can vary on a continuum from the immediate to the remote future. How far distant in the future does the situation forecast have to be for an individual to be described as feeling anxious rather than
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feeling afraid? Does the future prospect of hell-fire make a believer afraid or anxious?
The convention adopted in this work, which is to use anxiety to refer especially to what is felt when separation is threatened, is, of course, a reflection of the theory advanced. Nevertheless, it remains in keeping with the etymological origins of anxiety (and related words) and also with the way in which Freud came to use the German Angst in his later writings.
According to Lewis ( 1967), the English anxiety and the German Angst have cousins in ancient Greek and Latin with meanings that centre on grief and sadness, a German cousin that in the seventeenth century could also mean longing, as well as two cousins in contemporary English: 'anguish' and 'anger'. Since separation from an attachment figure is accompanied by longing and often also by anger, and loss by anguish and despair, it is entirely appropriate to use the word anxiety to denote what is felt either when an attachment figure cannot be found or when there is no confidence that an attachment figure will be available and responsive when desired. Such usage is compatible also with Freud's thinking when he wrote that 'missing someone who is loved and longed for . . . [is] the key to an understanding of anxiety' ( 1926a, SE 20: 136-7).
The usage of 'alarm' in this work, where it is employed as complementary to anxiety and applied to what is felt when we try to withdraw or escape from a frightening situation, is again in keeping with the word's origins. 'Alarm' derives from sixteenth-century Italian meaning 'to arms! ' and implies, therefore, surprise attack ( Onions 1966).
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Although the usages adopted for both anxiety and alarm are well suited to their origins, it cannot be said that there is any etymological justification for using the word 'fear' in the general-purpose way proposed here. 'Fear' (French peur and German Furcht) has cousins in Old High German and Old Norse with meanings that include ambush and plague ( Onions 1966); as such fear is close to alarm. In defence of using it as a general-purpose term, however, it can perhaps be argued that in modern English fear is very commonly so used.
On the usage of the term 'phobia' there is widespread agreement, though in this work the term is not favoured. Marks ( 1969) discusses its history and defines a phobia 'as a special form of fear which 1. is out of proportion to demands of the situation, 2. cannot be explained or reasoned away, 3. is beyond voluntary control, and 4. leads to avoidance of the feared situation'.
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Rycroft ( 1968b) defines phobia as: 'The symptom of experiencing unnecessary or excessive anxiety in some specific situation or in the presence of some specific object. ' The term always smacks of pathology ( OED). The disadvantages of the term are as follows:
-- it tends to reify fear, as in the title of Marks book Fears and Phobias;
-- a principle criterion in the definition is the unreasonableness of fearing so intensely the situation in question; on this definition fear of the dark or of loud noises or of any other natural clue would qualify as phobic, and thence would become tarred with pathology;
-- when a clinician introduces the concept of phobia in trying to understand what a patient is afraid of, he is focusing attention (i) on a particular aspect of the situation to the neglect of others which may be more important, and (ii) on the escape component of fear behaviour to the neglect of the attachment component (see Chapters 18 and 19) because the meaning of the Greek word phobos centres on flight and escape;
-- when used today by psychoanalysts phobia always implies the result of a particular pathological process, namely that the object or situation is feared 'not on its own account but because it has become a symbol of something else, i. e. because it represents some impulse, wish, internal object, or part of the self which the patient has been unable to face' ( Rycroft 1968b); in Chapters 11, 18, and 19 reasons are given for believing that the processes in question are implicated far too readily.
Once the term phobia is abandoned it becomes easier to consider how the person concerned may have developed so that he has become more frightened and anxious in certain situations than are his fellows.
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Additional Notes Chapter 3
page 56, paragraph 2, line 8
The ways in which young children and their mothers behave in sessions before and after the children start part-time nursery school (at ages ranging from two years eleven months to four years three months) are well described in a recent paper by van Leeuwen & Tuma ( 1972). The authors, using measures derived from attachment theory, report that children who started school at or before the age of three years two months became noticeably more clinging fifteen days after starting than they had been before, and that when mother was absent some showed a marked decrease in their concentration on and enjoyment in play. Three boys who had spent from five to seven months in a previous nursery school, two of them starting at two years eight months and one at two years ten months, were especially disturbed during early weeks at their new school. Reviewing their findings the authors conclude that 'we should approach nursery school entry with much greater caution [than is commonly given to it] and possibly delay it until the child is older'.
Chapter 9
page 140, paragraph 2, line 7
When two or more natural clues are present together, their potential value as indicators of an increased risk of danger would be vastly enhanced were the brain to use the most efficient method of processing the information. Broadbent ( 1973) discusses the various ways in which unreliable or in other respects insufficient items of evidence can be utilized for purposes of decision-making and action. When a number of such items are received together there are two main ways in which they can be processed. One is to process them independently and serially, in which case maximum advantage for decision-making is unlikely to be obtained. Another is for the items to be processed simultaneously. In that case not only is maximum advantage obtained but the effects on decisiontaking, and therefore action, are likely to be dramatically different from those of the first method. In view of the data regarding the striking effects on behaviour of a combination of natural clues to
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an increased risk of danger, it seems probable that combinations are usually processed simultaneously.
Chapter 15
page 220, paragraph 2, line 10
Scepticism is sometimes expressed about whether a period in hospital or residential nursery has effects in the long term as well as the short. In this connection the findings of a recent analysis by Douglas ( 1975) of data collected some years ago in the course of a
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assessed during adolescence, those who had been in hospital before the age of five years, either for longer than a week or on two or more occasions, were found to differ from other children in the following four ways. They were:
-- more likely to have been rated by teachers as troublesome at ages thirteen and fifteen years.
-- more likely, in the case of boys, to have been cautioned by police or sentenced between the ages of eight and seventeen years
-- more likely to have scored low on a reading test
-- more likely, in the case of school-leavers, to have changed jobs four or more times between the ages of fifteen and eighteen years.
The tendencies to delinquency and unstable employment record are significantly increased for children who experienced a further period in hospital between the ages of five and fifteen. All these differences remain significant when the rather atypical backgrounds of children who are admitted to hospital before the age of five years--e. g. as regards health, large families--are taken into account.
Further findings are, first, that if for any reason a child was insecure at the time of admission to hospital he was particularly likely to have suffered long-term disturbance, and, second, that it was children who on return from hospital were reported by the mothers to have been clinging or to have shown other forms of difficult behaviour who were especially likely later to have been described by the teachers as troublesome.
The findings of this study tend to support the belief expressed earlier, in Chapter 4, that the effects of separations from mother during the early years are cumulative and that the safest dose is therefore a zero dose.
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page 226, paragraph 2, line 5
Moore data do not permit of any conclusions regarding the effects on a child of starting full- time day care during his third year of life, a matter about which there is still controversy. Clinical experience suggests that, whereas there are children who enjoy attending a very small playgroup towards the end of their third year, there are strong reasons for caution about full- time attendance, the more so when it begins soon after the second birthday. The case of Lottie, who started nursery school when she was two years and three months old and attended only two half-days a week (see Chapter 3), illustrates the danger. So also do the findings of van Leeuwen & Tuma ( 1972) referred to in the note to Chapter 3 above (p. 409).
In a recent study of children who spend many hours daily in day care, Blehar ( 1974) has thrown further light on the question. Blehar studied four sub-samples of middle-class children and their mothers by means of Ainsworth's strange situation procedure (see Chapter 3). Children in two of the sub-samples had been attending privately organized day nurseries 1 for between eight and ten hours a day for five days a week during the preceding four months: children in one of these sub-samples had begun attendance at age twenty-six months and were tested at thirty months; children in the other sub-sample had started at age thirty-five months and were tested at thirty-nine months. The other two sub-samples, which acted as controls,
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comprised children of equivalent age and sex who were being cared for in their own homes.
A month prior to testing, the research worker paid a visit to the home of each child during which Caldwell's inventory of home stimulation was completed; this draws mainly on data from firsthand observation of mother-child interaction. Analysis of these data showed no differences in the mean amounts or forms of stimulation received in their homes by the day- care and the homecare children respectively.
Nevertheless, there were clear differences between the children in the two categories of care in respect of their behaviour in Ainsworth's strange situation procedure, the differences being especially noticeable during the episodes when mother was out of the ____________________
1 Blehar describes these as 'four private day nurseries in Baltimore. They followed a traditional nursery school regime and had been recommended as being of high quality, having staffs receptive to research, and serving primarily middle-class families. The child to adult ratio ranged between six and eight to one. ' The nurseries were open from 7:30 a. m. to 5:30 p. m.
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room and those when she returned. During mother's absence children in all four groups explored less than when she was present. The decrease was most marked in the older day-care children and least marked in the comparable group of home-care children. Furthermore, during mother's absence the older day-care children cried far more than did their home-care counterparts (who hardly cried at all) and more even than either group of younger children. When mother returned both younger and older day-care children avoided her to a greater degree than did the home-care children, a form of behaviour that, Blehar points out, has been found in Ainsworth's studies to be characteristic of one-year-olds whose mothers were rated as relatively insensitive, unresponsive, and/or inaccessible during the infant's first year of life (see Chapter 21 of the present volume for details and references).
Behaviour towards the stranger also differed significantly between the day-care and the home- care children. At both ages daycare children avoided the stranger more than did their home- care counterparts. Furthermore, during the course of the test procedure, day-care children tended increasingly to avoid the stranger in contrast to the home-care children who became progressively more accepting of her. Such a finding is utterly at variance with the commonly expressed hope that day care will make a child more adaptable and independent.
Blehar's findings are wholly compatible with the finding from Moore ( 1975) follow-up study, reported above on p. 225, which suggested that those children in his urban sample who had never attended nursery school or playgroup before their fifth birthday might have benefited from doing so. What Blehar's evidence underlines is that, for determining the effects of day care on preschool children, critical variables (in addition to stability and quality of care) are age at starting and hours of attendance.
Chapter 16
p. 239, paragraph 2, line 4
From their definitive review of the evidence Maccoby & Masters ( 1970) also reach the conclusion that anxious attachment is a result not of an excess of parental affection but of the reverse. The same holds for other primates ( Jolly 1972). Yet credence continues to
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be given to the theory of spoiling. For example, in a recent work Anna Freud ( 1972), in considering the origins of intensified separation anxiety in later years, gives weight to an infant's ex-
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perience of a mother who proves unreliable as a stable figure, including actual separations from her. However, she also states her continuing belief that 'excessive gratification in the anaclitic phase' can have similar consequences.
Chapter 18
p. 260, paragraph 3, line 15
Reflection on clinical practice leads to the conclusion that a patient's emotional responses remain puzzling, and are labelled symptoms, only so long as they are seen divorced from the situation that elicited them.
Chapter 21
p. 358, paragraph 4, line 12
A further finding ( Stayton & Ainsworth 1973) is that the more responsive a mother was in dealing with her baby when he cried during the early months of his life the more likely he was to greet her cheerfully when she returned after a short absence.
Very recently Main ( 1973) has carried these studies a step further by following up children who had been observed in the strange situation at the age of twelve months and observing them again in a different but comparable situation nine months later. Of forty children so followed up, twenty-five had been classified as secure at twelve months and fifteen as insecure. 1 When observed again at the age of twenty-one months in a free-play session, the children earlier classified as secure were found to concentrate on an activity both more intensely and for longer periods, and to smile and laugh more frequently, than those earlier classified as insecure. When joined by an adult playmate they were far more likely to approach and play with her. When given Bayley developmental tests they proved more cooperative and achieved a mean score of 111. 2 in comparison with a mean of 96. 1 for the insecure. None of these differences could be attributed to variables such as mother's education, the number of siblings a child had, or his previous experience or inexperience of toys. While the gross behaviour of mothers of the two groups of toddlers did not differ appreciably during the observation session, mothers of the secure toddlers showed more interest in the proceedings, watched the child's activities more closely, and expressed more feeling. Thus
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1 Main's secure infants are those classified in this volume in groups P and Q; her insecure
infants are those classified in groups R, S, and T (see footnote to p. 355 above). -413-
the pattern of child-mother interaction established at twelve months was found to have had considerable stability during the succeeding nine-month period; and the findings strongly support the earlier conclusion that infants whose mothers are sensitive and responsive to them are those who later turn cheerfully to exploration and play. Their willingness to cooperate, their capacity to concentrate, and their good scores on developmental tests at twenty-one
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months bode well for their futures.
Appendix I
page 390, paragraph 1, line 2
In a later work by Anna Freud ( 1972) this theme recurs. Fear of starvation, fear of loneliness, and fear of helplessness are cited, in addition to separation anxiety and fear of annihilation, as 'forms' of anxiety characteristic of the first, or symbiotic, stage in the development of object relations. Unusually intense separation anxiety in later years is attributed to fixation at the symbiotic stage; excessive fear of loss of love may result from parental errors in discipline or from a child's over-sensitive ego during the stage of object constancy. The possible effects of events of later childhood are not discussed.
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References
Abraham K. ( 1913). "'On the Psychogenesis of Agoraphobia in Children. '" In Abraham, Clinical Papers and Essays on Psycho-analysis. London: Hogarth; New York: Basic Books, 1955.
----- ( 1924). "'A Short Study of the Development of the Libido. '" In Abraham, Selected Papers on Psycho-analysis. London: Hogarth, 1927. New edition, London: Hogarth, 1949; New York: Basic Books, 1953.
Ainsworth M. D. S. ( 1972). "'Attachment and Dependency: A Comparison. '" In J. L. Gewirtz (ed. ), Attachment and Dependence. Washington, D. C. : Winston (distributed by Wiley, New
Y ork).
Ainsworth M. D. S. & Bell S. M. ( 1970). "'Attachment, Exploration, and Separation: Illustrated by the Behaviour of One-yearolds in a Strange Situation. '" Child Dev. 41: 49-67.
Ainsworth M. D. S. , Bell S. M. & Stayton D. J. ( 1971). "'Individual Differences in Strange- situation Behaviour of One-year-olds. '" In H. R. Schaffer (ed. ), The Origins of Human Social Relations. London & New York: Academic Press.
----- (in press). "'Infant-Mother Attachment and Social Development: Socialization as a Product of Reciprocal Responsiveness to Signals. '" In M. Richards (ed. ), The Integration of a Child into a Social World. Cambridge: Cambridge University Press.
Ainsworth M. D. & Boston M. ( 1952). "'Psychodiagnostic Assessments of a Child after Prolonged Separation in Early Childhood. '" Brit. J. med. Psychol. 25: 169-201.
Ainsworth M. D. S. & Wittig B. A. ( 1969). "'Attachment and Exploratory Behaviour of One- year-olds in a Strange Situation. '" In B. M. Foss (ed. ), Determinants of Infant Behaviour, Vol. 4. London: Methuen.
Alexander F. & French T. M. ( 1946). Psychoanalytic Therapy. New York: Ronald Press.
Alland A. ( 1967). Evolution of Human Behavior. New York: Doubleday; London: Tavistock, 1969.
Anderson J. W. ( 1972a). "'An Empirical Study of the Psychosocial Attachment of Infants to their Mothers. '" Thesis presented for the degree of Ph. D. , University of London.
----- ( 1972b). "'Attachment Behaviour Out of Doors. '" In N. Blurton Jones (ed. ), Ethological Studies of Child Behaviour. Cambridge: Cambridge University Press.
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Anderson J. W. ( 1972c). "'On the Psychological Attachment of Infants to their Mothers. '" J. biosoc. Sci. 4: 197-225.
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Andrews J. W. D. ( 1966). "'Psychotherapy of Phobias. '" Psychol. Bull. 66: 455-80. Anthony S. ( 1940). The Child's Discovery of Death. London: Kegan Paul.
Argles P. & Mackenzie M. ( 1970). "'Crisis Intervention with a Multi-problem Family: A
Case Study. '" J. Child Psychol. Psychiat. 11: 187-95.
Arnold M. B. ( 1960). Emotion and Personality. Vol. 1, Psychological Aspects; Vol. 2,
Neurological and Physiological Aspects. New York: Columbia University Press; London: Cassell, 1961.
Arsenian J.
Reading Sullivan's work one gets the impression that he had never observed young children and that he was only partially aware of the close attachment they form to particular people and of the sense of security that mere proximity to a loved figure brings. The 'need for contact with others, often felt as loneliness', is identified, not with need for a genital or a parent-child relationship, but with gregariousness in animals (p. 370 ); his conviction that 'no action of the infant is consistently and frequently associated with the relief of anxiety' (p. 42 ), which overlooks the relief an infant commonly exhibits when clutching his mother, is a main plank in his theorizing. Because of this, he seems never to have grasped the reality of separation anxiety and, therefore, despite his close attention to the problems to which it gives rise, it remains almost impossible to attribute to him any particular theory of its nature and origin. It is probably for the same reasons that neither grief nor mourning plays any significant part in his system of psychopathology.
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In the theorizing of Phyllis Greenacre ( 1952) separation anxiety, and grief and mourning seem also to be omitted. Instead, experiences during the birth process and the first weeks of postnatal life are advanced as major variables to account for a later differential liability to neurosis (see Chapter 16 of this volume).
Rank's views regarding birth trauma have already been
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referred to. In his early papers Fairbairn, who sees separation anxiety as the mainspring of all psychopathology, follows Rank closely in regard to its origins: Fairbairn's postulate ( 1943) that birth anxiety is 'the prototype of all the separation anxiety which is subsequently experienced' is the counterpart of his postulate that a return-to-womb craving accounts for the child's tie. It should be added, however, that these views are peripheral to Fairbairn's main theoretical position ( Fairbairn 1952), which is in all other respects consistent with the theory of frustrated attachment advanced here. In a late paper ( 1963) in which he gives a synopsis of his views he writes: 'The earliest and original form of anxiety, as experienced by the child, is separation anxiety. '
Others have also founded their psychopathology on the central role of separation anxiety and some have adopted a frustrated attachment theory to account for it. For instance, as long ago as 1935, Suttie, holding the view that the child's attachment to his mother is the result of a primary 'need for company', saw anxiety as 'an expression of apprehension of discomfort at the frustration, or threatened frustration, of this all-important motive'. A year later Hermann ( 1936) expressed an almost identical view. He relates anxiety to the urge to seek and cling to mother: 'Anxiety is basically the feeling of being left on one's own in the face of danger. Its expression is a seeking for help and at the same time a seeking for mother. . . . Anxiety develops in the sense of an urge to cling. . . . '
Odier ( 1948) appears to adopt the same position. Taking Inhibitions, Symptoms and Anxiety as his starting-point, he criticizes Freud's view on the ground that the infant in the second year cannot conceptualize danger. As an alternative he postulates that 'during the second year this affect [i. e. anxiety] indicates that a particular state has become differentiated: the state of subjective insecurity', and concludes, 'originally the cause of the insecurity of the infant is, above all else, the absence of the mother (or her substitute) or separation from her at the time when the infant most needs her care and protection. This state is the basic theory of anxiety as it relates to insecurity' (pp. 44 46 ). In most respects Odier's view is consistent with that advanced in the present work. Where it differs is in his holding that separation anxiety starts only in the second year, a view that may have arisen because its obtrusive exhibition after the first birthday had misled him into supposing that it does not begin until then.
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Winnicott makes no such mistake. Although in several papers (e. g. 1941; 1945; 1955b) he might be thought to favour the Kleinian view that separation anxiety is nothing but depressive anxiety, in his brief contribution 'Anxiety Associated with Insecurity' ( 1952) he takes a line consistent with that favoured here. He refers to 'the well-known observation that the earliest anxiety is related to being insecurely held', and to anxiety that is caused by 'failure in the technique of infant care, as for instance failure to give the continuous live support that
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belongs to mothering'. In his judgement 'it is normal for the infant to feel anxiety if there is a failure of infant care technique'.
This is also the view of William James who many years ago wrote simply: 'The great source of terror in infancy is solitude' ( James 1890).
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Appendix II Psychoanalysis and Evolution Theory
SINCE it is not always realized that the paradigm Freud employed throughout in his metapsychology is pre-Darwinian in its assumptions, it is of interest to consider how that should have been so.
During the latter part of last century two separate debates were being held, the first about the historical reality of evolution and the second about how evolution, should it prove to have occurred, comes about. Not infrequently the adjective 'Darwinian' is used to refer to a belief in the historical reality of evolution. That, of course, is mistaken. Many others besides Charles Darwin advocated the historical reality of evolution, though it is true that none organized and displayed the evidence so cogently as he. Nevertheless the adjective Darwinian should not be applied in a general way to the occurrence of evolution but must be kept strictly for the theory that it has been brought about by a particular biological process, the one Darwin named 'natural selection', which is best described in terms of the differential breeding success, or failure, of naturally occurring variants that transmit their characteristics to their offspring.
Freud was certainly an evolutionist, but there is no evidence that he was ever a Darwinian. No doubt it is largely because a belief in evolution is so often regarded as Darwinian that it is easy to overlook how deeply Freud was committed to a preDarwinian standpoint. In his Autobiographical Study ( 1925) Freud describes how, as a student in the 1870s, 'the theories of Darwin, which were then of topical interest, strongly attracted me' ( SE 20: 8); and we learn from Jones ( 1953) that in his first year at the University of Vienna ( 1872-3) Freud took a course on 'Biology and Darwinism'. Such references, combined with Freud's enthusiasm for evolution in general and his occasional and always favourable references to some others of Darwin's ideas, e. g. the primal horde and the expression of emotions, are deceptive and lead easily to the supposition that Freud adopted Darwin's theory of the evolutionary process, even though he did not always apply it. Such a view, however,
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is incompatible with the historical record, as a reading of Ernest Jones's biography clearly shows (see especially Volume 3, 1957, Chapter 10).
Now that the explanatory powers of the principle of natural selection proposed by Darwin are become firmly established and universally accepted by biologists, it is easy to forget that this was far from the case during the formative years of psychoanalysis. Eiseley ( 1958) has described the scientific climate of the final quarter of last century, by which time belief in the historical reality of evolution was becoming well established whereas ideas on the means by which it is brought about remained in the hottest dispute. In particular, he describes how the
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authoritative yet mistaken criticism of Darwin's theory by Lord Kelvin had given great encouragement to Darwin's critics and to advocates of Lamarckian ideas. 1 So much so, in fact, that in later editions of the Origin Darwin modified his position by incorporating Lamarck's theory of the inheritance of acquired characters into his own theory of evolution by means of natural selection. The to and fro of heated controversy as it reached Freud in Vienna during the 'seventies and 'eighties, mainly through the professor of zoology, Claus, is described by Ritvo ( 1972). In 1909, the centenary year of Darwin's birth, the status of his theory of natural selection was still so doubtful that the celebrations to mark the event were little more than perfunctory. Throughout the first quarter of the present century, indeed, theories of evolution continued to be in 'a state of chaos and confusion' ( De Beer 1963); and it was not until 1942, with the publication of Julian Huxley volume Evolution: The Modern Synthesis, that a definitive account of the theory established during the preceding decade became readily available. It is
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1 De Beer ( 1963) points out that history has treated Lamarck unfairly. As one of the first, in
1809, to advance a systematic theory of the evolution of living species from earlier ones, Lamarck made a substantial contribution; but because his account was eclipsed by Darwin's definitive work it has been forgotten, except perhaps in his native France. By contrast, Lamarck's unproductive ideas regarding the processes whereby evolution has come about -- he attributed it not only to the inheritance of acquired characters but to the powers of a 'tendency to perfection' and of 'an inner feeling of need' -- remain identified with his name. This is because they have been so identified throughout the debate on the nature of the processes causing evolution, a debate that began after the Origin was published (in 1859), continued into the early decades of this century, and is occasionally revived even today.
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significant that the turning-point came, during the 1920s, as soon as genetic analysis was applied not only to specimens in a laboratory but to wild populations living and propagating in their natural environment. 1
Once the key dates in the historical development of Freud's psychoanalytic ideas are set beside those of evolutionary theory, the absence in psychoanalysis (as in most other schools of psychology) of a Darwinian perspective ceases to surprise. On the contrary, it is clear that, not only as a young man but on into his middle and later years, Freud would certainly not have been alone among his generation had he been cautious and non-committal in his approach to theories of the evolutionary process, including Darwin's theory of natural selection.
Yet to be non-committal was hardly in Freud's character. Although he never explicitly rejected Darwinian principles, it is evident that his early, deep, and continuing commitment to pre-Darwinian concepts in theoretical biology left no room for them. Nowhere throughout Freud's writings is Darwin's theory of natural selection debated; instead it is passed by as though it had never been proposed ( Jones 1957: 332).
In Chapter 1 of the first volume of this work it is emphasized that the psychical energy model that Freud brought to psychoanalysis came, not from his clinical work with patients, but from ideas he had learnt many years earlier, especially when he was working in the laboratory of
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his admired professor of physiology, Bru? cke. Now these ideas long antedate Darwin's Origin, published in 1859. During the 1840s, Bru? cke had been one of a group of dedicated young scientists, of whom Helmholtz was the leader, who were determined to show that all real causes are symbolized in science by the word 'force'. Since the achievements of the Helmholtz school soon became famous, it was natural that Freud, working under one of their number, should have adopted their assumptions. As Jones ( 1953: 46) points out, the spirit and content of Bru? cke's lectures of the 1870s correspond closely to the words Freud always used to characterize psychoanalysis in its dynamic aspect: '. . . psychoanalysis derives all mental processes (apart from the reception of external stimuli) from the interplay of forces, which assist or inhibit one another, combine with one another, enter into compromises with one another, etc. ' ( Freud 1926b, SE 20: 265).
The limitations of that model for organizing the clinical
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1 For an account of present-day theories of the evolutionary process see Maynard Smith (
1966) and Alland ( 1967). -401-
phenomena to which Freud drew attention are already discussed in the first volume. The point now being emphasized is that the model is not only pre-Darwinian in origin but also remote from the biological concepts introduced by Darwin. For Freud and his colleagues, deep in Helmholtzian assumptions, the Darwinian perspective would, therefore, have been extremely difficult to reach. As Freud grew older, moreover, his increasing commitment to vitalist theories of the kind advocated by Lamarck made reaching it impossible. In his third volume Jones ( 1957) gives half a chapter to Freud's life-long adherence to Lamarckian explanations of the process of evolution, starting with the postulated heritability of acquired characters and progressing to a belief in the powers of a postulated 'inner feeling of need'.
During his early professional years Freud followed his colleagues of the Helmholtzian school in espousing what may now seem a rather nai? ve determinism. But at some time during the years before 1915 his views seem to have undergone radical change, since in 1917 he is expressing the greatest interest in Lamarck's ideas about the effects that an animal's 'inner feeling of need' is thought to have on its structure. During that year, Freud was in a mood of boundless enthusiasm for the whole of Lamarck's work and was in correspondence with Ferenczi and Abraham about an ambitious project to integrate psychoanalysis with Lamarck's theories of evolution. 'Our intention is to base Lamarck's ideas completely on our own theories and to show that the concept of "need", which creates and modifies organs, is nothing else than the power unconscious ideas have over the body . . . in short the "omnipotence of thoughts". Fitness would then be really explained psychoanalytically. . . . ' 1 This amounts, as Jones remarks, to the belief that 'need' enables an animal to bring about changes not only in its environment but in its own body. Moreover, causation is inextricably confused with function. Thus Freud's position in theoretical biology had by that date become wholly at variance with the biology that was about to dominate the twentieth century.
On reflection it becomes clear that Freud's increasingly deep commitment to a Lamarckian perspective, to the exclusion of Darwinian ideas about differential survival rates and the dis-
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1 Extract from Freud's letter to Abraham of November 1917, quoted by Jones ( 1957: 335). Although in his first volume Jones ( 1953: 50) claims that Freud 'never abandoned determinism for teleology', it is plain that that claim cannot be sustained.
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tinction between causation and function, has suffused the whole structure of psychoanalytic thought and theory. 1 With the remainder of biology resting firmly on a developed version of Darwinian principles and psychoanalysis continuing Lamarckian, the gulf between the two has steadily and inevitably grown wider. There are thus only three conceivable outcomes. The first, which is barely imaginable, is for biology to renounce its Darwinian perspective. The second, advocated here, is for psychoanalysis to be recast in terms of modern evolution theory. The third is for the present divorce to continue indefinitely with psychoanalysis remaining permanently beyond the fringe of the scientific world.
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1 Even Hartmann influential book, Ego Psychology and the Problem of Adaptation ( 1939),
was conceived and written before knowledge of modern evolution theory had become disseminated.
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Appendix III Problems of Terminology
EARLY in this volume it is remarked that in discussions of fear and anxiety problems of terminology abound. In Chapters 6, 12, 18, and 20 some of them are discussed. Here we consider some others.
During this century countless efforts have been made to clarify terminology, and a number of writers have proposed specific usages for words in common currency. No solution will satisfy everyone; or at least no solution will do so unless everyone shares a common theory. For as often as not the terms adopted are a reflection of theory.
Danger of Reification
First, it is vital to note that the words 'fear', 'alarm', 'anxiety', and others like them can be used legitimately only with reference to the state of an individual organism. In this work they are used only in their adjectival forms to refer to the way an organism may be appraising a situation, the way it may be behaving, or the way it may be feeling, all of which are closely linked. Conversely, it is never legitimate to refer to 'a fear' or 'an anxiety', as though each were a thing in its own right. The pitfalls into which it is easy to stumble when feelings are reified are discussed in Chapter 7 of the previous volume and in Chapter 20 of this one.
Unfortunately there is a very pronounced tendency not only in common parlance but in psychological, psychiatric, and psychoanalytic literature to reify both fear and anxiety. Thus we find Jersild, whose empirical work is so valuable, not infrequently tabulating the number of fears a sample of children are reported to show -- 'fear of three specifically named groups of animals, such as dogs, horses, cats, received a tally of three' ( Jersild 1943) -- and
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expressing his results as percentages of the total fears counted. Fortunately, however, in others of his tables, his results are expressed as percentages of children who show fear in particular situations; those are the figures drawn upon in this volume.
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In the psychoanalytic tradition it was not until 1926 that Freud treated anxiety as the reaction of an organism to a situation. Prior to that anxiety had been regarded by him as a transformation of libido, and as such was explicitly reified. As Strachey points out in one of his editorial introductions, as late as 1920, Freud added the following in a footnote to the fourth edition of the Three Essays: 'One of the most important results of psycho-analytic research is this discovery that neurotic anxiety arises out of libido, that it is the product of a transformation of it, and that it is thus related to it in the same kind of way as vinegar is to wine' ( SE 7: 224n).
Even today this type of thinking is not dead; and, as I well know, it is very easy to slip into it.
'Anxiety', 'Alarm', 'Fear', 'Phobia'
Because the English word 'anxiety' and its German cousin Angst play such a great part in psychoanalysis and psychiatry let us begin by considering those two.
In this work the usage already adopted for the word anxiety is that it denotes (a) how we feel when our attachment behaviour is activated and we are seeking an attachment figure but without success (Chapter 6), and (b) how we feel when for any reason we are uncertain whether our attachment figure(s) will be available should we want one (Chapter 15). It may be asked, how does that usage fit into other usages and with the etymological origins of the words? There is no lack of authorities to help to answer these questions.
Freud's use of the German term Angst and the difficulties of translation into English to which it gives rise are discussed by Strachey ( 1959; 1962). The usage of the term anxiety by English-speaking psychoanalysts is discussed by Rycroft ( 1968b). And the uses in the fields of psychiatry and psychopathology not only of the English 'anxiety' but of its many relatives in other languages are discussed by Lewis ( 1967), who also examines their etymology. Certain trends in usage, far from consistent, emerge.
A feature of usage to which all three writers point is that, in technical works, both 'anxiety' and Angst tend to indicate fear the origins of which are not identified. For example, on the final occasion on which he discusses the problem, Freud ( 1926a) remarks that Angst 'has a quality of indefiniteness and lack of object. In precise speech we use the word "fear" [ Furcht]
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rather than "anxiety" [ Angst] if it has found an object' ( SE 20: 165). Rycroft ( 1968b) recommends that anxiety be defined as 'the response to some yet unrecognized factor either in the environment or in the self' and reflects that psychoanalysis is mainly concerned with anxiety evoked by 'the stirrings of unconscious, repressed forces in the self'. Lewis ( 1967) refers to anxiety as an emotional state akin to fear that is experienced when 'there is either no recognizable threat, or the threat is, by reasonable standards, quite out of proportion to the emotion it seemingly evokes'.
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There are a number of difficulties about this type of usage. Thus, it is unclear to whom the situation arousing fear is held to be 'indefinite', or by whom it is 'unrecognized'. Is it the anxious individual himself (as suggested by Freud and Rycroft) or is it the clinician treating him (as in Lewis's formulation)? The answer might be either or both. For, on the one hand, a patient is sometimes aware of what he is afraid of but for some reason does not divulge what he knows; or he may do so and not be believed by the clinician. On the other, a patient may be unaware of what is troubling him, but the clinician may believe, rightly or wrongly, that he can identify it. A further difficulty in this type of usage would arise should either patient or clinician, or both, later come to identify what the patient is afraid of. In that case are we to say that the patient's anxiety is no longer anxiety but fear? And, if so, what is to be done should either or both misidentify what the patient is afraid of? These are not trivial difficulties.
Two other features of the historical usage, in the technical field, of 'anxiety' and Angst to which one or another of these authorities refers are: (a) the words are sometimes used to indicate fear that is considered inappropriately intense for the situation that seems to arouse it; and (b) they are sometimes used to indicate fear of a situation foreseen as more or less likely to occur in the future rather than fear of a situation actually present. Neither criterion is satisfactory, however. In Chapters 9 and 10 it is emphasized how misleading it is to apply notions of reasonableness or appropriateness to fear and fear behaviour. In Chapter 10 it is argued that, more often than not, fear is aroused by situations that are forecast and not actually present, and that the time-scale of the forecast can vary on a continuum from the immediate to the remote future. How far distant in the future does the situation forecast have to be for an individual to be described as feeling anxious rather than
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feeling afraid? Does the future prospect of hell-fire make a believer afraid or anxious?
The convention adopted in this work, which is to use anxiety to refer especially to what is felt when separation is threatened, is, of course, a reflection of the theory advanced. Nevertheless, it remains in keeping with the etymological origins of anxiety (and related words) and also with the way in which Freud came to use the German Angst in his later writings.
According to Lewis ( 1967), the English anxiety and the German Angst have cousins in ancient Greek and Latin with meanings that centre on grief and sadness, a German cousin that in the seventeenth century could also mean longing, as well as two cousins in contemporary English: 'anguish' and 'anger'. Since separation from an attachment figure is accompanied by longing and often also by anger, and loss by anguish and despair, it is entirely appropriate to use the word anxiety to denote what is felt either when an attachment figure cannot be found or when there is no confidence that an attachment figure will be available and responsive when desired. Such usage is compatible also with Freud's thinking when he wrote that 'missing someone who is loved and longed for . . . [is] the key to an understanding of anxiety' ( 1926a, SE 20: 136-7).
The usage of 'alarm' in this work, where it is employed as complementary to anxiety and applied to what is felt when we try to withdraw or escape from a frightening situation, is again in keeping with the word's origins. 'Alarm' derives from sixteenth-century Italian meaning 'to arms! ' and implies, therefore, surprise attack ( Onions 1966).
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Although the usages adopted for both anxiety and alarm are well suited to their origins, it cannot be said that there is any etymological justification for using the word 'fear' in the general-purpose way proposed here. 'Fear' (French peur and German Furcht) has cousins in Old High German and Old Norse with meanings that include ambush and plague ( Onions 1966); as such fear is close to alarm. In defence of using it as a general-purpose term, however, it can perhaps be argued that in modern English fear is very commonly so used.
On the usage of the term 'phobia' there is widespread agreement, though in this work the term is not favoured. Marks ( 1969) discusses its history and defines a phobia 'as a special form of fear which 1. is out of proportion to demands of the situation, 2. cannot be explained or reasoned away, 3. is beyond voluntary control, and 4. leads to avoidance of the feared situation'.
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Rycroft ( 1968b) defines phobia as: 'The symptom of experiencing unnecessary or excessive anxiety in some specific situation or in the presence of some specific object. ' The term always smacks of pathology ( OED). The disadvantages of the term are as follows:
-- it tends to reify fear, as in the title of Marks book Fears and Phobias;
-- a principle criterion in the definition is the unreasonableness of fearing so intensely the situation in question; on this definition fear of the dark or of loud noises or of any other natural clue would qualify as phobic, and thence would become tarred with pathology;
-- when a clinician introduces the concept of phobia in trying to understand what a patient is afraid of, he is focusing attention (i) on a particular aspect of the situation to the neglect of others which may be more important, and (ii) on the escape component of fear behaviour to the neglect of the attachment component (see Chapters 18 and 19) because the meaning of the Greek word phobos centres on flight and escape;
-- when used today by psychoanalysts phobia always implies the result of a particular pathological process, namely that the object or situation is feared 'not on its own account but because it has become a symbol of something else, i. e. because it represents some impulse, wish, internal object, or part of the self which the patient has been unable to face' ( Rycroft 1968b); in Chapters 11, 18, and 19 reasons are given for believing that the processes in question are implicated far too readily.
Once the term phobia is abandoned it becomes easier to consider how the person concerned may have developed so that he has become more frightened and anxious in certain situations than are his fellows.
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Additional Notes Chapter 3
page 56, paragraph 2, line 8
The ways in which young children and their mothers behave in sessions before and after the children start part-time nursery school (at ages ranging from two years eleven months to four years three months) are well described in a recent paper by van Leeuwen & Tuma ( 1972). The authors, using measures derived from attachment theory, report that children who started school at or before the age of three years two months became noticeably more clinging fifteen days after starting than they had been before, and that when mother was absent some showed a marked decrease in their concentration on and enjoyment in play. Three boys who had spent from five to seven months in a previous nursery school, two of them starting at two years eight months and one at two years ten months, were especially disturbed during early weeks at their new school. Reviewing their findings the authors conclude that 'we should approach nursery school entry with much greater caution [than is commonly given to it] and possibly delay it until the child is older'.
Chapter 9
page 140, paragraph 2, line 7
When two or more natural clues are present together, their potential value as indicators of an increased risk of danger would be vastly enhanced were the brain to use the most efficient method of processing the information. Broadbent ( 1973) discusses the various ways in which unreliable or in other respects insufficient items of evidence can be utilized for purposes of decision-making and action. When a number of such items are received together there are two main ways in which they can be processed. One is to process them independently and serially, in which case maximum advantage for decision-making is unlikely to be obtained. Another is for the items to be processed simultaneously. In that case not only is maximum advantage obtained but the effects on decisiontaking, and therefore action, are likely to be dramatically different from those of the first method. In view of the data regarding the striking effects on behaviour of a combination of natural clues to
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an increased risk of danger, it seems probable that combinations are usually processed simultaneously.
Chapter 15
page 220, paragraph 2, line 10
Scepticism is sometimes expressed about whether a period in hospital or residential nursery has effects in the long term as well as the short. In this connection the findings of a recent analysis by Douglas ( 1975) of data collected some years ago in the course of a
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assessed during adolescence, those who had been in hospital before the age of five years, either for longer than a week or on two or more occasions, were found to differ from other children in the following four ways. They were:
-- more likely to have been rated by teachers as troublesome at ages thirteen and fifteen years.
-- more likely, in the case of boys, to have been cautioned by police or sentenced between the ages of eight and seventeen years
-- more likely to have scored low on a reading test
-- more likely, in the case of school-leavers, to have changed jobs four or more times between the ages of fifteen and eighteen years.
The tendencies to delinquency and unstable employment record are significantly increased for children who experienced a further period in hospital between the ages of five and fifteen. All these differences remain significant when the rather atypical backgrounds of children who are admitted to hospital before the age of five years--e. g. as regards health, large families--are taken into account.
Further findings are, first, that if for any reason a child was insecure at the time of admission to hospital he was particularly likely to have suffered long-term disturbance, and, second, that it was children who on return from hospital were reported by the mothers to have been clinging or to have shown other forms of difficult behaviour who were especially likely later to have been described by the teachers as troublesome.
The findings of this study tend to support the belief expressed earlier, in Chapter 4, that the effects of separations from mother during the early years are cumulative and that the safest dose is therefore a zero dose.
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page 226, paragraph 2, line 5
Moore data do not permit of any conclusions regarding the effects on a child of starting full- time day care during his third year of life, a matter about which there is still controversy. Clinical experience suggests that, whereas there are children who enjoy attending a very small playgroup towards the end of their third year, there are strong reasons for caution about full- time attendance, the more so when it begins soon after the second birthday. The case of Lottie, who started nursery school when she was two years and three months old and attended only two half-days a week (see Chapter 3), illustrates the danger. So also do the findings of van Leeuwen & Tuma ( 1972) referred to in the note to Chapter 3 above (p. 409).
In a recent study of children who spend many hours daily in day care, Blehar ( 1974) has thrown further light on the question. Blehar studied four sub-samples of middle-class children and their mothers by means of Ainsworth's strange situation procedure (see Chapter 3). Children in two of the sub-samples had been attending privately organized day nurseries 1 for between eight and ten hours a day for five days a week during the preceding four months: children in one of these sub-samples had begun attendance at age twenty-six months and were tested at thirty months; children in the other sub-sample had started at age thirty-five months and were tested at thirty-nine months. The other two sub-samples, which acted as controls,
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comprised children of equivalent age and sex who were being cared for in their own homes.
A month prior to testing, the research worker paid a visit to the home of each child during which Caldwell's inventory of home stimulation was completed; this draws mainly on data from firsthand observation of mother-child interaction. Analysis of these data showed no differences in the mean amounts or forms of stimulation received in their homes by the day- care and the homecare children respectively.
Nevertheless, there were clear differences between the children in the two categories of care in respect of their behaviour in Ainsworth's strange situation procedure, the differences being especially noticeable during the episodes when mother was out of the ____________________
1 Blehar describes these as 'four private day nurseries in Baltimore. They followed a traditional nursery school regime and had been recommended as being of high quality, having staffs receptive to research, and serving primarily middle-class families. The child to adult ratio ranged between six and eight to one. ' The nurseries were open from 7:30 a. m. to 5:30 p. m.
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room and those when she returned. During mother's absence children in all four groups explored less than when she was present. The decrease was most marked in the older day-care children and least marked in the comparable group of home-care children. Furthermore, during mother's absence the older day-care children cried far more than did their home-care counterparts (who hardly cried at all) and more even than either group of younger children. When mother returned both younger and older day-care children avoided her to a greater degree than did the home-care children, a form of behaviour that, Blehar points out, has been found in Ainsworth's studies to be characteristic of one-year-olds whose mothers were rated as relatively insensitive, unresponsive, and/or inaccessible during the infant's first year of life (see Chapter 21 of the present volume for details and references).
Behaviour towards the stranger also differed significantly between the day-care and the home- care children. At both ages daycare children avoided the stranger more than did their home- care counterparts. Furthermore, during the course of the test procedure, day-care children tended increasingly to avoid the stranger in contrast to the home-care children who became progressively more accepting of her. Such a finding is utterly at variance with the commonly expressed hope that day care will make a child more adaptable and independent.
Blehar's findings are wholly compatible with the finding from Moore ( 1975) follow-up study, reported above on p. 225, which suggested that those children in his urban sample who had never attended nursery school or playgroup before their fifth birthday might have benefited from doing so. What Blehar's evidence underlines is that, for determining the effects of day care on preschool children, critical variables (in addition to stability and quality of care) are age at starting and hours of attendance.
Chapter 16
p. 239, paragraph 2, line 4
From their definitive review of the evidence Maccoby & Masters ( 1970) also reach the conclusion that anxious attachment is a result not of an excess of parental affection but of the reverse. The same holds for other primates ( Jolly 1972). Yet credence continues to
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be given to the theory of spoiling. For example, in a recent work Anna Freud ( 1972), in considering the origins of intensified separation anxiety in later years, gives weight to an infant's ex-
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perience of a mother who proves unreliable as a stable figure, including actual separations from her. However, she also states her continuing belief that 'excessive gratification in the anaclitic phase' can have similar consequences.
Chapter 18
p. 260, paragraph 3, line 15
Reflection on clinical practice leads to the conclusion that a patient's emotional responses remain puzzling, and are labelled symptoms, only so long as they are seen divorced from the situation that elicited them.
Chapter 21
p. 358, paragraph 4, line 12
A further finding ( Stayton & Ainsworth 1973) is that the more responsive a mother was in dealing with her baby when he cried during the early months of his life the more likely he was to greet her cheerfully when she returned after a short absence.
Very recently Main ( 1973) has carried these studies a step further by following up children who had been observed in the strange situation at the age of twelve months and observing them again in a different but comparable situation nine months later. Of forty children so followed up, twenty-five had been classified as secure at twelve months and fifteen as insecure. 1 When observed again at the age of twenty-one months in a free-play session, the children earlier classified as secure were found to concentrate on an activity both more intensely and for longer periods, and to smile and laugh more frequently, than those earlier classified as insecure. When joined by an adult playmate they were far more likely to approach and play with her. When given Bayley developmental tests they proved more cooperative and achieved a mean score of 111. 2 in comparison with a mean of 96. 1 for the insecure. None of these differences could be attributed to variables such as mother's education, the number of siblings a child had, or his previous experience or inexperience of toys. While the gross behaviour of mothers of the two groups of toddlers did not differ appreciably during the observation session, mothers of the secure toddlers showed more interest in the proceedings, watched the child's activities more closely, and expressed more feeling. Thus
____________________
1 Main's secure infants are those classified in this volume in groups P and Q; her insecure
infants are those classified in groups R, S, and T (see footnote to p. 355 above). -413-
the pattern of child-mother interaction established at twelve months was found to have had considerable stability during the succeeding nine-month period; and the findings strongly support the earlier conclusion that infants whose mothers are sensitive and responsive to them are those who later turn cheerfully to exploration and play. Their willingness to cooperate, their capacity to concentrate, and their good scores on developmental tests at twenty-one
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months bode well for their futures.
Appendix I
page 390, paragraph 1, line 2
In a later work by Anna Freud ( 1972) this theme recurs. Fear of starvation, fear of loneliness, and fear of helplessness are cited, in addition to separation anxiety and fear of annihilation, as 'forms' of anxiety characteristic of the first, or symbiotic, stage in the development of object relations. Unusually intense separation anxiety in later years is attributed to fixation at the symbiotic stage; excessive fear of loss of love may result from parental errors in discipline or from a child's over-sensitive ego during the stage of object constancy. The possible effects of events of later childhood are not discussed.
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