Thus what might seem
interminable
to a one-year-old might seem insignificant to a schoolchild.
Bowlby - Separation
As had been expected, the frequency and intensity of the responses typical of children staying in a
-10-
19
residential nursery were much diminished in these children. They cried less and showed fewer outbursts of marked hostility. During the early days especially, siblings constantly sought each other's company, talked and played together. To outsiders they presented a united front, with exclamations such as 'She's not your sister, she's my sister'.
Behaviour at and after Reunion
Inevitably in a situation of this kind the length of time children remain away from home varies. In this study six children were away from twelve to seventeen days; the other four were away for weeks, the periods being seven, ten, twelve, and twenty-one weeks respectively. The ways in which the individual children responded when they returned home differed in many respects; and part of the difference was related to the length of time they had been away, a finding confidently forecast from the results of Robertson's earlier observations.
In this phase of the study two principal lessons learnt from earlier Tavistock studies were applied. The first was to make continuous first-hand observations of how a child responded on first meeting his mother again and during the next few hours. The second was to pay especial attention to a child's response to the visit to his home of an observer he had seen regularly in the nursery. Accordingly, with three research workers available, the following dispositions were made.
One worker, Ilse Westheimer, who had made contact with each of the families before a child went to the nursery, continued contact while the child was away, e. g. by visiting mother in hospital, and was on the spot to make observations when the child was reunited with his parents. Except for one brief visit, she avoided the children while they were in the nursery. In a complementary role, the two observers, Christoph Heinicke and Elizabeth Wolpert, who were responsible for all the observations made on the children in the nursery, took no part in liaising with the families; and they avoided visiting a child at home after he had returned there until a planned visit was made exactly sixteen weeks after his return. 1 (The only exception to this arrangement occurred because Ilse Westheimer was unavailable on one occasion when a child was returning
____________________
1 During the intervening sixteen weeks contact with the home was maintained by Ilse
Westheimer, who also administered doll-play procedures during the sixth and the sixteenth weeks after reunion, and during the equivalent weeks for the control children.
-11-
home, and observation of the return was in this case made by Elizabeth Wolpert. )
In seven cases Ilse Westheimer met mother at the nursery, witnessed the meeting of child and mother, and then drove them home. In three others she met father at the nursery, witnessed the meeting of child and father, and drove the pair home to mother. (In one case they picked mother up on the way, at the hospital in which she had been a patient. )
On meeting mother for the first time after the days or weeks away every one of the ten children showed some degree of detachment. Two seemed not to recognize mother. The other eight turned away or even walked away from her. Most of them either cried or came close to tears; a number alternated between a tearful and an expressionless face.
20
In contrast to these blank, tearful retreats from mother, all but one of the children responded affectionately when they first met father again. Furthermore, five were friendly to Ilse Westheimer as well.
As regards detachment, two findings of earlier studies were clearly confirmed in this one. The first is that detachment is especially characteristic of the way in which a separated child behaves when he meets his mother again, and is much less evident with father; the second is that the duration of a child's detachment from mother correlates highly and significantly with the length of his time away.
In nine cases detachment from mother persisted in some degree throughout almost the first three days of reunion. In five children it was so marked that the mother of each complained, characteristically, that her child treated her as though she were a stranger; none of these children showed any tendency to cling to mother. In the other four, detachment was less pronounced: phases during which they turned away from mother alternated with phases during which they clung to her. Only one child, Elizabeth, who was the oldest and whose separation was among the shortest, was affectionate towards her mother by the end of the first day home. Both Elizabeth and the four who alternated soon showed that they were afraid to be left alone and became far more clinging than they had been before they had gone away.
There is reason to believe that after a very prolonged or repeated separation during the first three years of life detachment can persist indefinitely; the problems to which this gives rise will be discussed in Volume III. After briefer separations
-12-
detachment gives way after a period lasting usually hours or days. It is commonly succeeded by a phase during which a child is markedly ambivalent towards his parents. On the one hand, he is demanding of their presence and cries bitterly if left; on the other, he may become rejecting, hostile, or defiant towards them. Of the ten children studied eight showed a noticeable degree of ambivalence, and in five of them it persisted for not less than twelve weeks. Among determinants of the length of time ambivalence lasts one of the most influential is likely to be the way a mother responds to it.
It will be evident from the descriptions given that when a child returns home after a period away his behaviour presents his parents, especially his mother, with great problems. How a mother responds depends on many factors: for example, the kind of relationship she had with the child before separation and whether she believes that a disturbed and demanding child is better treated with comfort and reassurance or with discipline. A variable to which Westheimer ( 1970) has drawn attention is the way in which a mother's feelings for her child may change in the course of a long separation from him, lasting many weeks or months, during which she does not see him. Warm feelings are apt to cool and family life to become organized on lines that leave no place into which the returning child can fit.
There is abundant evidence that after a child has been away from home in a strange place and in the care of strangers he is liable to be very frightened lest he be taken away again. This was borne in on Robertson during some of his early studies. Children who had been in hospital tended to panic, he found, at the sight of anyone in a white coat or nurse's uniform, and they indicated clearly their fear of being returned to hospital. Several children were apprehensive
21
when Robertson himself visited them at home. They took care to avoid him and, provided they were not in a detached condition, clung close to mother.
In the Heinicke-- Westheimer study one of the two observers who had been present in the nursery visited each child sixteen weeks after his return home. All the children seemed clearly to remember the observer and reacted with strong feeling; all but one made 'a desperate attempt' to avoid the observer. The mothers were much surprised that their child should be so afraid, and affirmed that other strangers who visited the house did not arouse such reactions.
-13-
The case of Josephine, who had been aged two years when she was in the nursery for thirteen days and was now aged two years and four months, illustrates the anxious hostile behaviour seen typically on the occasion of these visits. 1
When CH approached the door of the suburban home, he could hear Josephine making all kinds of excited, joyous noises. As her mother opened the door, however, Josephine at once exclaimed 'No', ran over to the staircase, sat down, ejaculated another 'No', and then picked up the gollywog she had had in the nursery and threw it at the visitor. Mother, observer, and child then went to sit in the garden. Josephine could not sit still, however, and remained excited throughout. She pulled clothes off the line and began to throw them on the grass. Though this seemed deliberately provocative, her mother at first did nothing.
Josephine became more excited, ran about vigorously and repeatedly threw herself in the air and landed on her bottom, but she seemed to ignore any pain she may have inflicted on herself. Later she became aggressive towards her mother, threw herself at her and began to bite, first her mother's arm and then her necklace. Mother was surprised by this behaviour since nothing like it had occurred for some time, and she now restricted it.
Throughout this time Josephine had been afraid of the observer and had assiduously avoided him. When he walked towards her a very worried look came over her face, she cried 'Mummy' and went over to her. Although Josephine continued to react to any approach of the observer by running away, she would try to sneak up to him and to hit him on his back as long as he remained still. Sometimes she ran away and then turned towards him and hit him suddenly. Finally, while the observer sat quietly in one place, Josephine crept close enough to cover him with a small blanket, whereupon she exclaimed 'All gone'. She then uncovered him again.
Mother remarked that the way Josephine had treated the observer was quite different from the way she had treated other strangers, and she expressed surprise that Josephine should so anxiously avoid someone she had not seen for sixteen weeks.
Support for the view that the children were responding in a specially fearful way to the visitor they had known in the nursery comes from a comparison of their reactions with those
____________________
1 The case report is adapted and abridged from that given in Heinicke & Westheimer (
1966). -14-
22
of the matched group of children who had not been away. For the control group, a period of weeks was designated that was treated as the equivalent of the separated children's period of separation, and a succeeding period of weeks was treated as the equivalent of the separated children's period of reunion. During the period equivalent to separation, the control children were visited in their homes by either Christoph Heinicke or Elizabeth Wolpert who administered the same doll-play procedures as they had administered to the children in the nursery. In both samples each child was given either two or three such sessions. In the case of the separated children these were on the third and eleventh days of separation, and, when separation lasted more than three weeks, again a few days before return home. (In the case of all the control children sessions were given on the third, eleventh, and twenty-first days. ) At the end of the sixteenth week of the period equivalent to reunion each of the control children was visited by one of the two workers who had administered the doll-play procedures, just as the separated children were. The response of the control children was quite different from that of the separated children. In every case the control children seemed to recognize the visitor and then approached. 1
At one time it was supposed by critics of our thesis concerning separation that distress seen in a child during a period away from mother, and increased ambivalence and anxiety seen after it, must betoken an unfavourable relationship between child and mother before the event, or reflect perhaps a child's anxiety about his mother's pregnancy or illness. Yet observations of healthy children from thoroughly satisfactory homes,
____________________
1 It was not only at the sixteenth-week visit that the control children behaved differently
towards the observer when compared with the separated children. When the control children were visited in their homes during the period equivalent to separation they treated CH and EW in a far more friendly way than the separated children had done, and nothing resembling panic was seen. It must be remembered, however, that, compared with the separated children, the control children had a very different experience of the observers during the period equivalent to separation. Whereas the separated children were observed six times each week during play in the nursery as well as given two (or three) doll-play sessions, the control children had only the three dollplay sessions. It is possible, therefore, that some part of the difference in the ways in which the two groups of children treated the observers was due to their different experiences of them.
-15-
who are separated from mother for one of many different reasons, show that, whatever contribution other variables may make, when a young child is in a strange place with strange people and with mother absent, protest, despair, and detachment still occur. The only children so far observed in such conditions who appear undisturbed have been those who have never had any figure to whom they can become attached, or who have experienced repeated and prolonged separations and have already become more or less permanently detached. There can be no doubt that a number of variables when combined with absence of mother figure increase the degree of disturbance seen. For example, the more strange the surroundings and the people, or the more painful any medical procedures, the more frightened a child is likely to be and the greater will be his disturbance, both during and after the separation. Again, however, observations of how very differently young children respond to any or all of these conditions when mother is with them make it clear that these conditions of themselves are not sufficient
23
to cause more than transient distress and that, in determining the sequence of protest, despair, and detachment, a key variable is mother's presence or absence.
Conditions mitigating the intensity of responses
Among conditions known to mitigate the intensity of responses of young children separated from mother the two most effective appear to be:
--a familiar companion and/or familiar possessions --mothering care from a substitute mother.
As would be expected, when these two conditions are combined, as commonly happens at home when a child is cared for by a grandmother, disturbance is at a minimum.
Heinicke & Westheimer (see pp. 10 - 11 above) are among several observers who have noted that when a young child is in a residential nursery with a sibling his distress is alleviated, especially during the early days; and Robertson has noted that some comfort is obtained even when the sibling is only two years old and the younger of a pair. Thus the presence of a familiar companion, even when that companion provides a negligible degree of substitute mothering, is found to be a mitigating factor of some significance. Inanimate objects, such as favourite toys and personal clothes, are also known to provide some measure of comfort.
-16-
A second and important mitigating condition is the provision of substitute mothering. How effective this can be in reducing disturbance when given by a woman who is a stranger to the child is not systematically recorded. Much evidence of an unsystematic kind shows, however, that initially a young child is afraid of the stranger and rejects her attempts to mother him. Subsequently, he shows intense conflict behaviour: on the one hand he seeks to be comforted by her, on the other he rejects her as being strange. Only after a period of days or weeks may he become accustomed to the new relationship. In the meantime he continues to yearn for his missing mother figure and on occasion to express anger with her for being absent. (Examples of this sequence are given in Chapter 2 of the first volume. )
The period during which disturbance lasts turns partly on the skill of the foster mother in adapting her behaviour to that of a distressed and, at times, frightened and rejecting child, and partly on the age of the child. In one study (as yet reported only briefly) Yarrow ( 1963) found that every child aged between seven and twelve months was disturbed after being moved from a temporary foster home to a permanent adoptive home. Over this age-span, he found, the 'severity and pervasiveness of disturbance increases with increasing age'.
Thus, while distress is mitigated both by the presence of a familiar companion and by fostering from a motherly but strange woman, each arrangement has serious limitations.
An Experimental Project
In their study already referred to in the preface, James & Joyce Robertson ( 1971), combining the roles of observers and foster parents, took into their own home four young children who were in need of care while their mothers were in hospital. In doing so they were seeking to
24
discover how young children of previous good experience respond in a separation situation that offers as many ameliorating conditions as are at present known about and possible to arrange, in particular, responsive mothering from a foster mother with whom the child has already become familiar.
For these purposes Mrs Robertson undertook to give each child her full-time care and, in doing so, to adopt so far as she could his mother's own methods of care. Every attention was given to minimizing the strangeness of the situation and to maximizing familiarity. During the month or so prior to the
-17-
separation, the child was introduced to the foster home and to members of the foster family by means of a series of interchange visits between the families. Meanwhile, the foster mother did all she could to learn about the child's stage of development, his likes and dislikes, and his mother's methods of caring for him, in order to maintain during the fostering period as similar a re? gime as possible. On coming into care the child brought with him his own bed and blankets, his familiar toys and a photograph of his mother. Moreover, during the child's time away every effort was made to keep alive within him his image of his missing mother. The foster mother made a point of talking about her and showing the child her photograph. Father was encouraged to visit, daily if possible; and both father and foster mother did all they could to assure the child he would soon return home. In these ways everything possible was done to reduce the impact of change, to accept openly the child's concern over loss of his mother, and to assure him that it would not last longer than necessary.
In the event the Robertsons cared for four children, one at a time, in each case while mother was having a new baby. Ages and days in care are set out below:
Kate 2 years 5 months Thomas 2 years 4 months Lucy 1 year 9 months Jane 1 year 5 months
27 days 10 days 19 days 10 days
All four were first children, had been and were living with both parents, and had not previously been separated from mother, except for an occasional few hours in the care of a familiar person.
The degree of disturbance seen in these children was far less than is seen in less favourable circumstances. Nevertheless each child was perceptibly upset. The form of disturbance in the two older children differed from that seen in the two younger. Although for much of the time Kate and Thomas seemed content with the foster arrangements, both showed plainly that they missed their own mothers. In the brief accounts that follow, derived from Robertson & Robertson ( 1971), particular attention is given to the episodes when the children expressed discontent. There is therefore some danger of the accounts giving an unbalanced picture.
25
Thomas, an active and friendly boy who talked well, settled happily with his foster parents. For most of the time he was
-18-
good-humoured, in friendly contact with his caretakers, and able to enjoy play and activities offered. After two days, however, he began to express both sadness at his parents' absence and also anger about it. He talked much of his mother and sometimes cuddled her photograph. While he seemed to have some grasp of the temporary nature of the separation, as the days passed the situation clearly put increasing strain upon him. On occasion he rejected his foster mother's attentions and indicated that it was his mother's role to look after him: 'Don't cuddle me, my mummy cuddles me. ' At the end of a visit from father, Thomas did his best to prevent his leaving, cried bitterly if briefly after he had gone and insisted that no one else should sit on his father's chair. At the end of his visit on the ninth day father summed up the strain of the situation in four words: 'We've both had enough. '
Although in the Robertsons' opinion Thomas came through the experience better than the other three children, and disturbance after his return home was minimal, he seemed nevertheless to be more aggressive and defiant after it than he had been before. Moreover, when his foster mother visited his home, although he was friendly to her, he was also cautious and throughout made a point of staying close to his mother.
Kate, the other child of nearly two and a half, showed during her first ten days away many of the same features of behaviour as did Thomas. On the one side she ate and slept well, and was cheerful, active, and cooperative with her foster parents. On the other she expressed yearning for her absent parents and occasional anger with them for not taking her home. Owing to mother's obstetric complication, moreover, Kate was away nearly three times as long as Thomas. During the third and fourth weeks her relationship to the foster mother deepened and she seemed to be finding a niche for herself in the foster family. Nevertheless, her yearning for her own mother continued and was 'increasingly intermingled with anger'. Anger, directed at foster mother, was especially strong after Kate's two visits to see mother in hospital.
One other feature of Kate's behaviour during the separation is to be remarked. During the second week she became fearful of getting lost and began to cling. She also cried more easily and at times seemed preoccupied and dreamy. Her query 'What is Kate looking for? ', made on one of these occasions, seems to indicate that her yearning and searching for mother, though continuing active in her, were beginning to undergo repression.
-19-
When eventually Kate returned home she at once greeted her mother and began to rebuild their relationship. By contrast, she completely ignored her foster mother who had looked after her for nearly four weeks, and who was sitting quietly by.
Although Kate settled back in her family with only slight upset, she was noticeably more demanding of her parents' attention. Moreover, her reaction to an episode that occurred two weeks after her return suggested strongly that she was intensely afraid of another separation. Mother was eager to ensure that, when Kate reached five, she would be able to go to a particular school; so mother took her there to be enrolled, over two years in advance. The following night Kate screamed as though with nightmares and in the morning was acutely
26
breathless. When the doctor, who diagnosed bronchial asthma, inquired about stress, mother realized that, during talk at the school the previous day, the head had agreed to 'take' Kate.
Neither of the two younger children had much language capacity and neither could be helped as much as the two older ones to keep the absent mother clearly in mind. Perhaps because of this, each child seemed to transfer attachment from mother to substitute comparatively easily and to find security in the new arrangement. Neither child showed acute upset. Both continued to function well, learnt new skills, and increased their vocabularies. Yet for both children it was evident that all was not well. By her fourth day away Jane had become restless and demanding of attention and gave the impression of 'a child who was under strain and at times bewildered'. Lucy, similarly, had her bad patches and by the nineteenth day away is described as being 'in a highly sensitive state'.
In these little girls explicit yearning for the missing mother and being angry with her occurred only sporadically, and then only in response to specific reminders of her. Jane, for example, on her sixth day of separation noticed the gate of her own garden, opened it and entered, and tried unsuccessfully to open the door of her parents' apartment. Returning, she spoke the word 'Mama' for the first time and also resisted entering the foster home. Jane's relations with her father deteriorated as the separation progressed. At first she played happily when he visited, then she got angry with him and, finally, she seemed pointedly to ignore him, only to cling and cry when he made to leave. Lucy's relations with her father went through much the same sequence. After one visit when he had taken her to a park near their home, she became very
-20-
distressed after his departure; at first she refused to be comforted by her foster mother and subsequently clung tearfully to her and refused to be put down.
On reunion each of these younger children recognized mother immediately and responded pleasurably to her. Unlike the two older children, however, they seemed reluctant to relinquish the foster mother. Lucy in particular had difficulty in weaning herself from her and later showed marked conflict in relation to her. For example, during foster mother's visit three days after returning home Lucy 'oscillated between affection and apprehension, smiling and frowning, clinging to her mother yet crying bitterly when foster mother left'. Like Thomas and Kate, both these younger children were more hostile to mother after the separation than they had been before it (though presumably in each case this could have been due in some degree to the presence of a new baby).
Interpretation of Findings
All these children, then, showed far less distress than occurs when young children are separated from mother in less favourable conditions, yet all four showed unmistakable signs of strain and from time to time that they were aware of missing mother. In the interpretation of these responses there is some difference of opinion. The Robertsons, impressed by the fact that care by a responsive substitute mother in a benign environment holds anxiety at a 'manageable level' and permits 'positive development' to continue, believe that the onset of the deteriorative sequence of protest, despair, and detachment can be prevented. This leads them to the view that the responses shown by children fostered in this way are qualitatively different from those of institutionalized children, and cannot be understood as representing a difference of intensity only. An alternative view, however, is that the sequence of protest,
27
despair, and detachment, although greatly reduced in intensity and curtailed, cannot be regarded as absent. In the two older children, for example, the pattern of response, though at low intensity, showed very plainly most of the elements now known to be typical of how young children respond during and after a brief separation in less cushioned conditions -- yearning and searching for the missing mother, sadness, increasing protest at her absence and growing anger with her for staying away, increased ambivalence on return home, and evident fear of being separated again. Thanks to the precautions taken despair
-21-
was admittedly held at bay and with it detachment, though signs suggestive of the latter were seen in Kate. In the two younger children the pattern of response was less clear, but several typical elements were none the less present. This leads to the conclusion that the differences in response between the fostered children and children removed to an institution are properly regarded as differences of intensity. There are other ways in which the Robertsons contrast their theoretical position with the one I adopt, notably as regards the role of grief and mourning in early childhood. These issues will be discussed in the third volume. Meanwhile it is important to note that, whatever differences there may be between the Robertsons and myself in regard to theory, there are none in practice. For, when the Robertsons come to consider the practical lessons to be derived from their project, they warn that, because these carefully fostered children came through so well, it must not be assumed that the hazards of separation during the early years can be eliminated entirely. On the contrary, they state, their experience has served to reinforce them in the view, which we have long shared, that 'separation is dangerous and whenever possible should be avoided'.
Presence or absence of mother figure: a key variable
From the Robertsons' recent study and the many others now on record two main conclusions can be drawn:
The sequence of intense protest, followed by despair and detachment, which first caught our attention, is due to a combination of factors, of which the kernel is the conjunction strange people, strange events, and an absence of mothering either from mother herself or from a capable substitute.
Because separation from mother figure even in the absence of these other factors still leads to sadness, anger, and subsequent anxiety in children aged two years and over, and to comparable though less differentiated stress responses in younger ones, separation from mother figure is in itself a key variable in determining a child's emotional state and behaviour.
By 'mother figure' is meant that person to whom a child directs his attachment behaviour by preference; and by 'substitute mother' is meant any other person to whom a child is willing temporarily to direct attachment behaviour. Since, however, an individual as he grows older directs attachment behaviour to others besides mother or someone acting as a
-22-
substitute mother, it is convenient to have available terms that are less specifically tied to the child-parent relationship. Among terms used here in a generic way to cover anyone towards whom attachment behaviour is directed are 'attachment figure' and 'support figure'.
'Presence' and 'absence' are relative terms and, unless defined, can give rise to misunderstanding. By presence is meant 'ready accessibility', by absence 'inaccessibility'. The
28
words 'separation' and 'loss' as used in this work imply always that the subject's attachment figure is inaccessible, either temporarily (separation) or permanently (loss). 1
Not only here but elsewhere also, finding suitable language is a problem. For example, how long is a temporary separation? Plainly the answer turns on the subject's age.
Thus what might seem interminable to a one-year-old might seem insignificant to a schoolchild. What might seem interminable to a schoolchild might seem of no great significance to an adult. Another problem, and one that is more difficult, is to know at what point a separation that started as temporary becomes permanent -- or at least becomes conceived by the victim and by others as being so.
Yet a further difficulty turns on the fact that a mother can be physically present but 'emotionally' absent. What this means, of course, is that, although present in body, a mother may be unresponsive to her child's desire for mothering. Such unresponsiveness can be due to many conditions -- depression, rejection, preoccupation with other matters -- but, whatever its cause, so far as her child is concerned she is no better than half-present. Then again a mother can use threats to abandon a child as a means of disciplining him, a tactic that probably has an immeasurably greater pathogenic effect than is yet recognized.
These and other problems are discussed in later chapters. Meanwhile, the thesis can be phrased more precisely. Whether a child or adult is in a state of security, anxiety, or distress is determined in large part by the accessibility and responsiveness of his principal attachment figure.
____________________
1 The present usage of the word separation should be distinguished from the very different
usage of Mahler ( 1968) who employs it to describe an intrapsychic process which results in 'differentiation of the self from the symbiotic object'. Prior to this development a psychological 'state of undifferentiation, of fusion with mother', termed symbiosis, is postulated.
-23-
There have been, and still are, clinicians and others interested in children who have found it difficult to believe that accessibility or inaccessibility of attachment figure can of itself be a crucial variable in determining whether a child (or an adult for that matter) is happy or distressed. One reason for disbelief is the supposition that, when there is nothing 'objective', namely intrinsically painful or dangerous, for a child or adult to be distressed about or afraid of, any distress or anxiety must be irrational and, if irrational, is to be deemed neurotic. Other reasons derive from a faulty theory of the nature of instinctive behaviour, and especially from failure to distinguish causation from function (see Volume I, Chapters 6 and 8). Others again derive from the many confusions and false value judgements to which the concept of dependency gives rise (see Volume I, Chapter 12). Yet another and different sort of reason may be the sheer inconvenience in practical life of the facts of the case as they seem actually to be in comparison with what things would be like were every normal child to be happy and content with any caretaker whatever -- provided she were kind. If children were only 'reasonable' in this regard, how much easier would life be!
In order to understand how some of the difficulties have arisen it is useful to consider how separation and loss have been treated in the psychoanalytic literature as situations of relevance
29
to personality development and psychopathology. In particular, it is useful to examine the place given to separation in theories of anxiety, and the kinds of explanation that have been proposed to account for its influence. Some of these ideas are traced in the following chapter, and opportunity is taken to compare the standpoint adopted in these volumes with that adopted in more traditional psychoanalytic works.
-24-
30
Chapter 2
The Place of Separation and Loss in Psychopathology
A new pamphlet of mine, Inhibitions, Symptoms and Anxiety, is now being published. It shakes up much that was established and puts things which seemed fixed into a state of flux again. Analysts who above all want peace and certainty will be discontented at having to revise their ideas. But it would be rash to believe that I have now succeeded in finally solving the problem with which the association of anxiety with neurosis confronts us.
SIGMUND FREUD 1
Problem and perspective
From Freud's earliest studies of the aetiology of the neuroses, until the end of his life the twin problems of neurotic anxiety and defence were never far from his mind. Again and again he grappled with them, and on the various tentative solutions he offered rest his successive theoretical formulations. Since Freud's death, moreover, theories of anxiety and defence have continued to be the foundation-stones of psychoanalytic psychopathology; and it is through their espousing differing views on the nature and origins of these conditions that the several distinctive schools of psychoanalysis have come into being.
In Freud's earliest formulations there is no hint that anxiety arises from loss or threat of loss, or that defensive processes are evoked in conditions of intense anxiety. Only little by little, and mainly towards the end of his life, did Freud advance such views and, in so doing, bring his ideas on anxiety and defence into relation with his ideas on mourning which, until then, had been a significant but quite distinct strand in his thinking. A principal result of his new formulation was, as he rightly foresaw, to bring everything 'into a state of flux again'.
Although Freud himself at different periods of his life adopted ____________________
1 Letter to Oskar Pfister, 3 January 1926 (see H. Meng & E. L. Freud 1963).
-25-
a number of radically different theories in regard to anxiety, mourning, and defence, as have the various schools of thought that have grown up subsequently, each theory is based on data obtained by but a single method of inquiry. Data are derived from studying, in the analytic setting, a personality more or less developed and already functioning more or less well; and from these data an attempt is made to reconstruct the phases of personality that have preceded what is now seen. To many the resulting literature is as frustrating as it is stimulating. On the one hand, it is plainly dealing with problems that every sensitive clinician recognizes to be of central consequence for understanding and helping his patients; on the other, it presents a complex web of competing and often inconsistent theorizing without providing methods by which to sort grain from chaff.
What is attempted in these volumes is to approach the classic problems of psychoanalysis prospectively. The primary data are observations of how young children behave in defined situations; in the light of these data an attempt is made to describe certain early phases of
31
personality functioning and, from them, to extrapolate forwards. In particular the aim is to describe certain patterns of response that occur regularly in early childhood and, thence, to trace out how similar patterns of response are to be discerned in the later functioning of the personality. 1
Some of the essential data, as described in the previous chapter, can be summarized as follows. Whenever a young child who has had an opportunity to develop an attachment to a mother figure is separated from her unwillingly he shows distress; and should he also be placed in a strange environment and cared for by a succession of strange people such distress is likely to be intense. The way he behaves follows a typical sequence. At first he protests vigorously and tries by all the means available to him to recover his mother. Later he seems to despair of recovering her but none the less remains preoccupied with her and vigilant for her return. Later still he seems to lose his interest in his mother and to become emotionally detached from her. Nevertheless, provided the period of separation is not too prolonged, a child does not remain detached indefinitely. Sooner or later after being reunited with his mother his attachment to her emerges afresh. Thenceforward, for days or weeks, and sometimes for much longer, he insists on staying
____________________
1 The point of view adopted is described at greater length in the first chapter of Volume I.
-26-
close to her. Furthermore, whenever he suspects he will lose her again he exhibits acute anxiety.
When I came to examine the theoretical problems raised by these observations it was evident that the first step must be to gain a clearer understanding of the bond that ties child to mother. Next, it gradually became apparent that each of the three main phases of the response of a young child to separation is related to one or another of the central issues of psychoanalytic theory. Thus the phase of protest is found to raise the problem of separation anxiety; despair that of grief and mourning; detachment that of defence. The thesis that was then advanced ( Bowlby 1960a) was that the three types of response -separation anxiety, grief and mourning, and defence -- are phases of a single process and that only when they are treated as such is their true significance grasped.
A reading of the psychoanalytic literature shows that, as a rule, separation anxiety, mourning, and defence have been considered piecemeal. The reason for this is the inverted order in which their psychopathological significance was discovered: for it was the last phase that was recognized first, and the first last. Thus the significance of defence, particularly repression, was realized by Freud in the earliest days of his psychoanalytic work and provides the basis of his original theorizing: his first paper on the subject is dated 1894 ( "'The Neuro-psychoses of Defence'", SE 3). 1 His grasp of the roles of grief and of separation anxiety, on the other hand, was at that time still fragmentary. Although he was early alive to the place of mourning in hysteria and melancholia (see note of 1897 to Fliess, SE 14: 240), twenty years were to elapse before, in "'Mourning and Melancholia'" ( 1917a, SE 14), he gave it systematic attention. Similarly in the case of separation anxiety: although in the Three Essays on the Theory of sexuality ( 1905b) he gave it a paragraph ( SE 7: 224 ) and in the Introductory Lectures ( 1917b) three pages ( SE 16: 405 408 ), it is not until 1926 that in his revolutionary late work Inhibitions, Symptoms and Anxiety he accorded it the central place in what was to be his final
32
theory of anxiety. 'Missing someone who is loved and longed for', he there affirms, is 'the key to an understanding of anxiety' ( SE 20: 136 -7). 2
____________________
1 The abbreviation SE denotes the Standard Edition of The Complete Psychological Works of
Sigmund Freud, published in 24 volumes by the Hogarth Press Ltd, London. All quotations
from Freud in the present work are taken from this edition.
2 For an account of the development of Freud's theories of anxiety, see
-27-
The reason for this inverse recognition of the three phases is clear: always in the history of medicine it is the end-result of a pathological sequence that is noted first. Only gradually are the earlier phases identified, and it may be many years before the exact sequence of the whole process is understood. Indeed it was understanding the sequence that baffled Freud longest. Does fence precede anxiety, or anxiety defence? If the response to separation is pain and mourning, how can it also be anxiety? ( SE 20: 108 -9 and 130 -1. ) During the thirty years of his main psychoanalytic explorations, it can now be seen, Freud traversed the sequence backwards, from end-result to initial stage. Not until his seventieth year did he clearly perceive separation and loss as a principal source of the processes to which he had devoted half a lifetime of study. But by then others of his ideas were already firmly established.
By 1926 a substantial corpus of psychoanalytic theory was already being taught. As regards anxiety, castration anxiety and superego anxiety were corner-stones of thought and practice in Vienna and elsewhere; also, Melanie Klein's hypothesis relating anxiety to aggression had recently been formulated and, linked to the concept of the death instinct, was soon to become a key concept in a significant new system. The full weight of Freud's ideas on separation anxiety and its relation to mourning came too late to influence the development of either of these two schools of thought.
Apart from an early reference by Hug-Hellmuth ( 1913) and a brief word by Bernfeld ( 1925), moreover, some years were to pass before the clinical papers drawing attention to the pathogenic significance of separation experiences were published. Some of the earliest, by Levy ( 1937), Bowlby ( 1940; 1944), and Bender & Yarnell ( 1941), presented empirical evidence suggesting an aetiological relationship between certain forms of psychopathic personality and severely disrupted mother--child relationships. At about the same time, Fairbairn ( 1941; 1943) was basing his revised psychopathology on separation anxiety, having been preceded by Suttie ( 1935) and to be followed a few years later by Odier ( 1948); Therese Benedek ( 1946) was describing responses to separation, reunion, and bereavement as observed in adults during the second world war; and Dorothy Burlingham & Anna Freud ( 1942; 1944) were recording their first-hand observations (cited in Chapter 1
____________________
Strachey's introduction to the Standard Edition of Inhibitions, Symptoms and Anxiety ( 1959, SE 20: 77-86); see also Appendix I to this volume.
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33
above) of how young children respond to separation. In addition, studies of a different though related kind, concerned with the effects on infants of being raised without any mother figure, were being conducted by Goldfarb ( 1943 and later) and by Spitz ( 1946).
Nevertheless, despite all this work, separation anxiety has been extremely slow to gain a central place in psychoanalytic theorizing. Indeed Kris, writing as a participant in the Viennese scene, remarked in later years how, when in 1926 Freud advanced his views regarding separation anxiety, 'there was no awareness among analysts . . . to what typical concrete situations this would apply. Nobody realized that the fear of losing the object and the object's love were formulae to be implemented by material which now seems to us self- evident beyond any discussion' ( Kris 1956). He acknowledged that only in the preceding decade had he himself recognized the significance of such fears, and could have added that even when he wrote there were schools of analytic thought that failed to recognize their importance. The long-continued neglect of separation anxiety is well illustrated by an authoritative survey of 'the concept of anxiety in relation to the development of psychoanalysis' ( Zetzel 1955) in which it is not once mentioned; and even in a recent book by Rycroft ( 1968a) it is given scant attention.
In the event, it is clear, some of the ideas Freud advanced in Inhibitions, Symptoms and Anxiety fell on stony ground. This was a pity, since in that book, written at the end of his professional life, he was struggling to free himself of the perspective of his travels -- defence, mourning, separation anxiety -- and instead to view the sequence from his new vantage-point: the priority of separation anxiety. In his concluding pages he sketches out a new route: anxiety is the reaction to the danger of losing the object, the pain of mourning the reaction to the actual loss of object, and defence a mode of dealing with anxiety and pain.
The route finally taken by Freud is also the route followed in this work. Yet, for reasons that emerge more clearly in Chapter 5, the perspective in which the route is viewed is in many respects very different from the perspective adopted by Freud and adopted too by most of his followers. A principal reason for this difference is that, whereas the perspective adopted here is based on a Darwinian-type theory of evolution, that of Freud is not.
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Separation anxiety and other forms of anxiety
The fact that in his later years Freud came to see separation anxiety as the key to the whole problem of neurotic anxiety does not mean that he was right. The term 'anxiety' has been used in very many ways to cover what may well prove to be a range of widely heterogeneous states. The term 'neurotic anxiety' is also ill defined and may also cover a range of heterogeneous states, perhaps of very diverse origin. In this complex scene the place of separation anxiety is still unclear. In particular, it remains uncertain how large a contributor it is to sources of neurosis in comparison with anxieties and fears of different origin.
Eager though every clinician must be to have these matters clarified, the task is outside the compass of this work. No attempt is made to present a general theory of anxiety. Nor is any attempt made to judge how a better understanding of separation anxiety can aid such a project. Those are tasks for the future.
34
What is attempted, instead, is more limited. Young children are upset by even brief separations. Older children are upset by longer ones. Adults are upset whenever a separation is prolonged or permanent, as in bereavement. A pile of clinical reports, moreover, starting with Freud's early studies of hysteria and swelling to increasing volume in recent years, shows that experiences of separation and loss, occurring recently or years before, play a weighty role in the origin of many clinical conditions. These are grounds enough for concentrating attention on our problem.
Study of the problem suggests, indeed, that Freud was probably mistaken in claiming that missing someone who is loved and longed for is the key to an understanding of anxiety. As likely as not there is no single key: fear and anxiety are aroused in situations of many kinds. What seems certain, nevertheless, is that missing someone who is loved and longed for is one of the keys we need, and that the particular form of anxiety to which separation and loss give rise is not only common but leads to great and widespread suffering. That being so, let us grasp the key at hand and see what doors it opens.
A challenge for theory
Once we are aware of the form and sequence of the very intense responses that can result from a separation lasting a few days or longer, we become alert also to the form and sequence of the comparable but far less intense responses that are to be
-30-
seen in young children during the course of everyday living. For example, we notice that in the presence of a responsive mother figure an infant or young child is commonly content; and, once mobile, is likely to explore his world with confidence and courage. In her absence, by contrast, an infant is likely, sooner or later, to become distressed; and he then responds to all sorts of slightly strange and unexpected situations with acute alarm. Furthermore, when his mother figure is departing or cannot be found, he is likely to take action aimed at detaining her or finding her; and he is anxious until he has achieved his goal.
Elemental though these data are, and well known to every perceptive mother, it yet remains true that within this bare catalogue of routine sequences of behaviour there lies a cauldron of controversy. Why should a child be distressed in his mother's absence? What is he afraid of? Why should he be anxious when she is missing and cannot be found? Why is he apprehensive lest she leave him again?
The psychoanalytic literature is strewn with attempts to answer these questions and no fewer than six types of theory can be discerned. Two theories, namely Rank's birth-trauma theory ( 1924) and Freud's signal theory ( 1926a), were developed explicitly to account for the observation that a young child is anxious when his mother leaves him. Another three, namely Freud's earlier theory of transformed libido ( 1905b) and both of Klein's theories, of persecutory and depressive anxiety ( 1934; 1935), had different origins and came only later to be applied to the problem of separation anxiety. All these five theories, however, are distinctly complex since in each case the author rules out of court the idea that absence of mother could, in and of itself, be the real cause of the distress and anxiety seen. Consequently each author either feels constrained to search for a reason of some other kind or else applies a theory developed in another context. Only occasionally has a student of the problem accepted the data at their face value and presented a theory of a sixth type, one that regards the distress and
35
subsequent anxiety as primary responses not reducible to other terms and due simply to the nature of a child's attachment to his mother. Among those who have advanced this view are Suttie ( 1935), Hermann ( 1936), and, with some qualifications, Fairbairn ( 1943; 1963) and Winnicott (e. g. 1952). Half a century earlier, it is interesting to note, William James ( 1890) had recorded his view that 'The great source of terror in infancy is solitude'.
-31-
The very similar generalization made by Freud in 1905, and quoted at the head of the next chapter, shows that he was early aware of the data. Indeed, as Strachey makes apparent in his introduction to the Standard Edition of Inhibitions, Symptoms and Anxiety ( SE 20: 77 - 86 ), from that time onwards the anxiety manifested by a young child when separated from his mother is constantly in Freud's mind and he returns to it repeatedly whenever he makes a further attempt to solve the problem of anxiety. Nevertheless, because the basic postulates from which he began his theorizing biased him in other directions, Freud himself never adopted a theory of the sixth type.
These varied attempts to account for the phenomena of separation anxiety are not only of historical interest but of great practical importance, because each theory gives rise to a different model of personality functioning and psychopathology and, in consequence, to significantly different ways of practising psychotherapy and preventive psychiatry. Because of their continuing and living influence, a detailed review of psychoanalytic theories of separation anxiety is presented in Appendix I. Some of the assumptions on which they rest are evaluated in Chapter 5 in the light of present knowledge of biology and ethology.
Before discussing theory further, however, it is useful to consider additional observations of behaviour during and after separation, starting with the behaviour of human children and proceeding thence to a comparison with the behaviour of young of other species. In all the studies to be described, it must be emphasized, either mother leaves child or child is removed more or less unwillingly from mother. The very different behaviour seen in the reverse situation, in which mother remains in a known place while child explores, is described already in the first volume (Chapter 13) and is the subject of papers by Anderson ( 1972a, b, c) and Rheingold & Eckerman ( 1970). Provided a child initiates the movement himself, in the certain knowledge of where mother can be found, he is not only content but often adventurous. In what follows the word 'separation' always implies that the initiative is taken either by mother or by some third party.
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36
Chapter 3
Behaviour with and without Mother: Humans
Anxiety in children is originally nothing other than an expression of the fact that they are feeling the loss of the person they love.
SIGMUND FREUD ( 1905b)
Naturalistic observations
Chapter I presented data concerning the behaviour of young children when they are away from home and placed for days or weeks either in a residential nursery or in a foster home. Here, by contrast, we are concerned with separation situations of much shorter duration. We begin with separations lasting from a day to a few hours, all requiring a child to be in a strange place with strange people and without substitute mothering.
A number of psychologists have made records of the behaviour of young children when they first enter nursery school or go to a research centre for examination. In so doing the psychologists have, usually without intending it, amassed evidence that to start nursery school much before the third birthday is for most children an undesirably stressful experience. The records, indeed, make it apparent that ignorance of the natural history of attachment behaviour, coupled with a misguided enthusiasm that small children should quickly become independent and 'mature', has resulted in practices that expose children, and their parents, to a great deal of unnecessary anxiety and distress. Nevertheless, for scientific purposes the resulting records have the great advantage that there is no danger that the degree of upset has been exaggerated; indeed the reverse is probably the case.
The first and largest study of this kind seems to have been undertaken by Shirley at the Harvard School of Public Health ( Shirley & Poyntz 1941; Shirley 1942). In this study, 199 children (101 boys and 98 girls) between the ages of two and eight years were observed in the course of an all-day visit to a research centre, during they which were subjected to a variety of
-33-
psychological and medical examinations, interspersed with periods for play, meals, and rest. The children were without mother throughout the day. The authors express the belief that 'the responses of these children to separation from their mothers were fairly typical for children who are cared for predominantly by their mothers during their pre-school period'.
All children visited the centre at six-monthly intervals; and any one child attended over a period of about three years. Age at starting varied: twenty-five paid their first visit at two years, a further twenty-eight at two and a half, and other batches at each half-year of age up to about five. As a result the number of children observed at each age-level varied from twenty- five at the age of two years to a maximum of 127 at the age of five and a half years. Results are given in terms of the percentage of children of each age-level and sex who were upset in
37
each of three situations met with during the day -- leaving mother, play period at centre, and meeting mother at end of day. Published data do not distinguish between the responses of children on their first visit to the centre and those of children who had paid one or more previous visits.
Of the children aged from two to four years, about half 1 are reported as upset on leaving mother at the day's start and half also on meeting mother again at the end of the day. The proportion upset diminishes in the older age-groups, though at the day's end it never falls below 30 per cent in the case of the boys. Even during the free play period with a congenial though strange mother-surrogate the percentage of children upset is substantial, varying from about 40 per cent of the youngest children (two to three years old) to about 20 per cent at four years and 15 per cent of the older ones (five- to seven-year-olds):
. . . emotional upsets during the play period were by no means uncommon. The children manifested their uneasiness in the playroom in a variety of ways in addition to crying and calling for mother. Some merely stood disconsolately killing time; some shifted uneasily from one foot to the other; some peered out the window disappointedly searching for father's familiar car in the stream of traffic. . . . Such children ignored the proffered toys and resisted the play suggestions that were offered.
____________________
1 Because results are expressed in percentages and the N varies for each age-group and sex,
it is not possible to calculate an exact percentage for larger categories of children. -34-
Some sat distracted, aimlessly fiddling with a toy or sifting sand. Of the younger children, half were explicit in expressing a desire for mother; of those between four and a half and six years of age, the proportion asking for mother dropped to about one-quarter.
A number of children who had not expressed upset during the day's proceedings showed it on reunion with mother:
Usually it was the child who had bravely winked back the tears and made a determined effort to surmount his feelings of insecurity earlier in the day that gave way to his pent-up emotion in tears. At the sight of mother his needs for autonomy and independence vanished, and he reverted to the degree of babyishness he had overcome early in the morning.
At each age-level, proportionally fewer girls than boys were overtly upset. Moreover, when girls were upset, the intensity and duration of upset were less than in boys. It is evident that the authors of the study approve the girls for their greater 'maturity' and regret the 'babyishness' of the boys.
The authors note that the three-year-olds tended to be more upset than both the younger children and those older: 'Children of two and two and a half years were little aware of what the day would bring forth; they had little anticipatory dread. ' By three years they were 'more aware of the demands of the day, and more reluctant to leave home'. This was true especially of those who had paid one or two previous visits to the centre. Naturally, both the physical examination and the psychological testing were carried out as kindly as possible. Nevertheless, in mother's absence, so far from becoming used to the six-monthly
38
examinations, the children became more apprehensive about them: 'Familiarity with the situation from one or two previous experiences seemed to make the children grow more apprehensive' and they tended to be more upset when the day began ( Shirley 1942). By contrast, children aged five years and upwards were more likely to settle down, and some are reported to have enjoyed the day.
A study that derives from Shirley's but is confined to a very small part of the area covered by the earlier investigation is described by Heathers ( 1954). Not only is the age-range restricted to the youngest children but the behaviour reported is confined to the way in which they respond to being removed from home to go to a nursery school.
Thirty-one children between the ages of twenty-three and
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thirty-seven months, from middle-class homes and of above average intelligence, were observed during their first five days of starting nursery school. On each of those days each child was called for by a student he had not previously met and taken off to school by car. To meet the researcher's requirements, each 'child's mother was asked to part with him at the door and to let the observer take him out to the car'. Although each mother had attempted to explain to her child what was in store for him, it is very doubtful whether explanation could have conveyed much to such young children. Observed behaviour was checked against a list of eighteen items, which conveys a vivid picture of the kinds of response likely to occur. It runs as follows: When taken from home to car
1. Cries
2. Hides, tries to hide, etc.
3. Resists getting dressed to go
4.
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19
residential nursery were much diminished in these children. They cried less and showed fewer outbursts of marked hostility. During the early days especially, siblings constantly sought each other's company, talked and played together. To outsiders they presented a united front, with exclamations such as 'She's not your sister, she's my sister'.
Behaviour at and after Reunion
Inevitably in a situation of this kind the length of time children remain away from home varies. In this study six children were away from twelve to seventeen days; the other four were away for weeks, the periods being seven, ten, twelve, and twenty-one weeks respectively. The ways in which the individual children responded when they returned home differed in many respects; and part of the difference was related to the length of time they had been away, a finding confidently forecast from the results of Robertson's earlier observations.
In this phase of the study two principal lessons learnt from earlier Tavistock studies were applied. The first was to make continuous first-hand observations of how a child responded on first meeting his mother again and during the next few hours. The second was to pay especial attention to a child's response to the visit to his home of an observer he had seen regularly in the nursery. Accordingly, with three research workers available, the following dispositions were made.
One worker, Ilse Westheimer, who had made contact with each of the families before a child went to the nursery, continued contact while the child was away, e. g. by visiting mother in hospital, and was on the spot to make observations when the child was reunited with his parents. Except for one brief visit, she avoided the children while they were in the nursery. In a complementary role, the two observers, Christoph Heinicke and Elizabeth Wolpert, who were responsible for all the observations made on the children in the nursery, took no part in liaising with the families; and they avoided visiting a child at home after he had returned there until a planned visit was made exactly sixteen weeks after his return. 1 (The only exception to this arrangement occurred because Ilse Westheimer was unavailable on one occasion when a child was returning
____________________
1 During the intervening sixteen weeks contact with the home was maintained by Ilse
Westheimer, who also administered doll-play procedures during the sixth and the sixteenth weeks after reunion, and during the equivalent weeks for the control children.
-11-
home, and observation of the return was in this case made by Elizabeth Wolpert. )
In seven cases Ilse Westheimer met mother at the nursery, witnessed the meeting of child and mother, and then drove them home. In three others she met father at the nursery, witnessed the meeting of child and father, and drove the pair home to mother. (In one case they picked mother up on the way, at the hospital in which she had been a patient. )
On meeting mother for the first time after the days or weeks away every one of the ten children showed some degree of detachment. Two seemed not to recognize mother. The other eight turned away or even walked away from her. Most of them either cried or came close to tears; a number alternated between a tearful and an expressionless face.
20
In contrast to these blank, tearful retreats from mother, all but one of the children responded affectionately when they first met father again. Furthermore, five were friendly to Ilse Westheimer as well.
As regards detachment, two findings of earlier studies were clearly confirmed in this one. The first is that detachment is especially characteristic of the way in which a separated child behaves when he meets his mother again, and is much less evident with father; the second is that the duration of a child's detachment from mother correlates highly and significantly with the length of his time away.
In nine cases detachment from mother persisted in some degree throughout almost the first three days of reunion. In five children it was so marked that the mother of each complained, characteristically, that her child treated her as though she were a stranger; none of these children showed any tendency to cling to mother. In the other four, detachment was less pronounced: phases during which they turned away from mother alternated with phases during which they clung to her. Only one child, Elizabeth, who was the oldest and whose separation was among the shortest, was affectionate towards her mother by the end of the first day home. Both Elizabeth and the four who alternated soon showed that they were afraid to be left alone and became far more clinging than they had been before they had gone away.
There is reason to believe that after a very prolonged or repeated separation during the first three years of life detachment can persist indefinitely; the problems to which this gives rise will be discussed in Volume III. After briefer separations
-12-
detachment gives way after a period lasting usually hours or days. It is commonly succeeded by a phase during which a child is markedly ambivalent towards his parents. On the one hand, he is demanding of their presence and cries bitterly if left; on the other, he may become rejecting, hostile, or defiant towards them. Of the ten children studied eight showed a noticeable degree of ambivalence, and in five of them it persisted for not less than twelve weeks. Among determinants of the length of time ambivalence lasts one of the most influential is likely to be the way a mother responds to it.
It will be evident from the descriptions given that when a child returns home after a period away his behaviour presents his parents, especially his mother, with great problems. How a mother responds depends on many factors: for example, the kind of relationship she had with the child before separation and whether she believes that a disturbed and demanding child is better treated with comfort and reassurance or with discipline. A variable to which Westheimer ( 1970) has drawn attention is the way in which a mother's feelings for her child may change in the course of a long separation from him, lasting many weeks or months, during which she does not see him. Warm feelings are apt to cool and family life to become organized on lines that leave no place into which the returning child can fit.
There is abundant evidence that after a child has been away from home in a strange place and in the care of strangers he is liable to be very frightened lest he be taken away again. This was borne in on Robertson during some of his early studies. Children who had been in hospital tended to panic, he found, at the sight of anyone in a white coat or nurse's uniform, and they indicated clearly their fear of being returned to hospital. Several children were apprehensive
21
when Robertson himself visited them at home. They took care to avoid him and, provided they were not in a detached condition, clung close to mother.
In the Heinicke-- Westheimer study one of the two observers who had been present in the nursery visited each child sixteen weeks after his return home. All the children seemed clearly to remember the observer and reacted with strong feeling; all but one made 'a desperate attempt' to avoid the observer. The mothers were much surprised that their child should be so afraid, and affirmed that other strangers who visited the house did not arouse such reactions.
-13-
The case of Josephine, who had been aged two years when she was in the nursery for thirteen days and was now aged two years and four months, illustrates the anxious hostile behaviour seen typically on the occasion of these visits. 1
When CH approached the door of the suburban home, he could hear Josephine making all kinds of excited, joyous noises. As her mother opened the door, however, Josephine at once exclaimed 'No', ran over to the staircase, sat down, ejaculated another 'No', and then picked up the gollywog she had had in the nursery and threw it at the visitor. Mother, observer, and child then went to sit in the garden. Josephine could not sit still, however, and remained excited throughout. She pulled clothes off the line and began to throw them on the grass. Though this seemed deliberately provocative, her mother at first did nothing.
Josephine became more excited, ran about vigorously and repeatedly threw herself in the air and landed on her bottom, but she seemed to ignore any pain she may have inflicted on herself. Later she became aggressive towards her mother, threw herself at her and began to bite, first her mother's arm and then her necklace. Mother was surprised by this behaviour since nothing like it had occurred for some time, and she now restricted it.
Throughout this time Josephine had been afraid of the observer and had assiduously avoided him. When he walked towards her a very worried look came over her face, she cried 'Mummy' and went over to her. Although Josephine continued to react to any approach of the observer by running away, she would try to sneak up to him and to hit him on his back as long as he remained still. Sometimes she ran away and then turned towards him and hit him suddenly. Finally, while the observer sat quietly in one place, Josephine crept close enough to cover him with a small blanket, whereupon she exclaimed 'All gone'. She then uncovered him again.
Mother remarked that the way Josephine had treated the observer was quite different from the way she had treated other strangers, and she expressed surprise that Josephine should so anxiously avoid someone she had not seen for sixteen weeks.
Support for the view that the children were responding in a specially fearful way to the visitor they had known in the nursery comes from a comparison of their reactions with those
____________________
1 The case report is adapted and abridged from that given in Heinicke & Westheimer (
1966). -14-
22
of the matched group of children who had not been away. For the control group, a period of weeks was designated that was treated as the equivalent of the separated children's period of separation, and a succeeding period of weeks was treated as the equivalent of the separated children's period of reunion. During the period equivalent to separation, the control children were visited in their homes by either Christoph Heinicke or Elizabeth Wolpert who administered the same doll-play procedures as they had administered to the children in the nursery. In both samples each child was given either two or three such sessions. In the case of the separated children these were on the third and eleventh days of separation, and, when separation lasted more than three weeks, again a few days before return home. (In the case of all the control children sessions were given on the third, eleventh, and twenty-first days. ) At the end of the sixteenth week of the period equivalent to reunion each of the control children was visited by one of the two workers who had administered the doll-play procedures, just as the separated children were. The response of the control children was quite different from that of the separated children. In every case the control children seemed to recognize the visitor and then approached. 1
At one time it was supposed by critics of our thesis concerning separation that distress seen in a child during a period away from mother, and increased ambivalence and anxiety seen after it, must betoken an unfavourable relationship between child and mother before the event, or reflect perhaps a child's anxiety about his mother's pregnancy or illness. Yet observations of healthy children from thoroughly satisfactory homes,
____________________
1 It was not only at the sixteenth-week visit that the control children behaved differently
towards the observer when compared with the separated children. When the control children were visited in their homes during the period equivalent to separation they treated CH and EW in a far more friendly way than the separated children had done, and nothing resembling panic was seen. It must be remembered, however, that, compared with the separated children, the control children had a very different experience of the observers during the period equivalent to separation. Whereas the separated children were observed six times each week during play in the nursery as well as given two (or three) doll-play sessions, the control children had only the three dollplay sessions. It is possible, therefore, that some part of the difference in the ways in which the two groups of children treated the observers was due to their different experiences of them.
-15-
who are separated from mother for one of many different reasons, show that, whatever contribution other variables may make, when a young child is in a strange place with strange people and with mother absent, protest, despair, and detachment still occur. The only children so far observed in such conditions who appear undisturbed have been those who have never had any figure to whom they can become attached, or who have experienced repeated and prolonged separations and have already become more or less permanently detached. There can be no doubt that a number of variables when combined with absence of mother figure increase the degree of disturbance seen. For example, the more strange the surroundings and the people, or the more painful any medical procedures, the more frightened a child is likely to be and the greater will be his disturbance, both during and after the separation. Again, however, observations of how very differently young children respond to any or all of these conditions when mother is with them make it clear that these conditions of themselves are not sufficient
23
to cause more than transient distress and that, in determining the sequence of protest, despair, and detachment, a key variable is mother's presence or absence.
Conditions mitigating the intensity of responses
Among conditions known to mitigate the intensity of responses of young children separated from mother the two most effective appear to be:
--a familiar companion and/or familiar possessions --mothering care from a substitute mother.
As would be expected, when these two conditions are combined, as commonly happens at home when a child is cared for by a grandmother, disturbance is at a minimum.
Heinicke & Westheimer (see pp. 10 - 11 above) are among several observers who have noted that when a young child is in a residential nursery with a sibling his distress is alleviated, especially during the early days; and Robertson has noted that some comfort is obtained even when the sibling is only two years old and the younger of a pair. Thus the presence of a familiar companion, even when that companion provides a negligible degree of substitute mothering, is found to be a mitigating factor of some significance. Inanimate objects, such as favourite toys and personal clothes, are also known to provide some measure of comfort.
-16-
A second and important mitigating condition is the provision of substitute mothering. How effective this can be in reducing disturbance when given by a woman who is a stranger to the child is not systematically recorded. Much evidence of an unsystematic kind shows, however, that initially a young child is afraid of the stranger and rejects her attempts to mother him. Subsequently, he shows intense conflict behaviour: on the one hand he seeks to be comforted by her, on the other he rejects her as being strange. Only after a period of days or weeks may he become accustomed to the new relationship. In the meantime he continues to yearn for his missing mother figure and on occasion to express anger with her for being absent. (Examples of this sequence are given in Chapter 2 of the first volume. )
The period during which disturbance lasts turns partly on the skill of the foster mother in adapting her behaviour to that of a distressed and, at times, frightened and rejecting child, and partly on the age of the child. In one study (as yet reported only briefly) Yarrow ( 1963) found that every child aged between seven and twelve months was disturbed after being moved from a temporary foster home to a permanent adoptive home. Over this age-span, he found, the 'severity and pervasiveness of disturbance increases with increasing age'.
Thus, while distress is mitigated both by the presence of a familiar companion and by fostering from a motherly but strange woman, each arrangement has serious limitations.
An Experimental Project
In their study already referred to in the preface, James & Joyce Robertson ( 1971), combining the roles of observers and foster parents, took into their own home four young children who were in need of care while their mothers were in hospital. In doing so they were seeking to
24
discover how young children of previous good experience respond in a separation situation that offers as many ameliorating conditions as are at present known about and possible to arrange, in particular, responsive mothering from a foster mother with whom the child has already become familiar.
For these purposes Mrs Robertson undertook to give each child her full-time care and, in doing so, to adopt so far as she could his mother's own methods of care. Every attention was given to minimizing the strangeness of the situation and to maximizing familiarity. During the month or so prior to the
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separation, the child was introduced to the foster home and to members of the foster family by means of a series of interchange visits between the families. Meanwhile, the foster mother did all she could to learn about the child's stage of development, his likes and dislikes, and his mother's methods of caring for him, in order to maintain during the fostering period as similar a re? gime as possible. On coming into care the child brought with him his own bed and blankets, his familiar toys and a photograph of his mother. Moreover, during the child's time away every effort was made to keep alive within him his image of his missing mother. The foster mother made a point of talking about her and showing the child her photograph. Father was encouraged to visit, daily if possible; and both father and foster mother did all they could to assure the child he would soon return home. In these ways everything possible was done to reduce the impact of change, to accept openly the child's concern over loss of his mother, and to assure him that it would not last longer than necessary.
In the event the Robertsons cared for four children, one at a time, in each case while mother was having a new baby. Ages and days in care are set out below:
Kate 2 years 5 months Thomas 2 years 4 months Lucy 1 year 9 months Jane 1 year 5 months
27 days 10 days 19 days 10 days
All four were first children, had been and were living with both parents, and had not previously been separated from mother, except for an occasional few hours in the care of a familiar person.
The degree of disturbance seen in these children was far less than is seen in less favourable circumstances. Nevertheless each child was perceptibly upset. The form of disturbance in the two older children differed from that seen in the two younger. Although for much of the time Kate and Thomas seemed content with the foster arrangements, both showed plainly that they missed their own mothers. In the brief accounts that follow, derived from Robertson & Robertson ( 1971), particular attention is given to the episodes when the children expressed discontent. There is therefore some danger of the accounts giving an unbalanced picture.
25
Thomas, an active and friendly boy who talked well, settled happily with his foster parents. For most of the time he was
-18-
good-humoured, in friendly contact with his caretakers, and able to enjoy play and activities offered. After two days, however, he began to express both sadness at his parents' absence and also anger about it. He talked much of his mother and sometimes cuddled her photograph. While he seemed to have some grasp of the temporary nature of the separation, as the days passed the situation clearly put increasing strain upon him. On occasion he rejected his foster mother's attentions and indicated that it was his mother's role to look after him: 'Don't cuddle me, my mummy cuddles me. ' At the end of a visit from father, Thomas did his best to prevent his leaving, cried bitterly if briefly after he had gone and insisted that no one else should sit on his father's chair. At the end of his visit on the ninth day father summed up the strain of the situation in four words: 'We've both had enough. '
Although in the Robertsons' opinion Thomas came through the experience better than the other three children, and disturbance after his return home was minimal, he seemed nevertheless to be more aggressive and defiant after it than he had been before. Moreover, when his foster mother visited his home, although he was friendly to her, he was also cautious and throughout made a point of staying close to his mother.
Kate, the other child of nearly two and a half, showed during her first ten days away many of the same features of behaviour as did Thomas. On the one side she ate and slept well, and was cheerful, active, and cooperative with her foster parents. On the other she expressed yearning for her absent parents and occasional anger with them for not taking her home. Owing to mother's obstetric complication, moreover, Kate was away nearly three times as long as Thomas. During the third and fourth weeks her relationship to the foster mother deepened and she seemed to be finding a niche for herself in the foster family. Nevertheless, her yearning for her own mother continued and was 'increasingly intermingled with anger'. Anger, directed at foster mother, was especially strong after Kate's two visits to see mother in hospital.
One other feature of Kate's behaviour during the separation is to be remarked. During the second week she became fearful of getting lost and began to cling. She also cried more easily and at times seemed preoccupied and dreamy. Her query 'What is Kate looking for? ', made on one of these occasions, seems to indicate that her yearning and searching for mother, though continuing active in her, were beginning to undergo repression.
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When eventually Kate returned home she at once greeted her mother and began to rebuild their relationship. By contrast, she completely ignored her foster mother who had looked after her for nearly four weeks, and who was sitting quietly by.
Although Kate settled back in her family with only slight upset, she was noticeably more demanding of her parents' attention. Moreover, her reaction to an episode that occurred two weeks after her return suggested strongly that she was intensely afraid of another separation. Mother was eager to ensure that, when Kate reached five, she would be able to go to a particular school; so mother took her there to be enrolled, over two years in advance. The following night Kate screamed as though with nightmares and in the morning was acutely
26
breathless. When the doctor, who diagnosed bronchial asthma, inquired about stress, mother realized that, during talk at the school the previous day, the head had agreed to 'take' Kate.
Neither of the two younger children had much language capacity and neither could be helped as much as the two older ones to keep the absent mother clearly in mind. Perhaps because of this, each child seemed to transfer attachment from mother to substitute comparatively easily and to find security in the new arrangement. Neither child showed acute upset. Both continued to function well, learnt new skills, and increased their vocabularies. Yet for both children it was evident that all was not well. By her fourth day away Jane had become restless and demanding of attention and gave the impression of 'a child who was under strain and at times bewildered'. Lucy, similarly, had her bad patches and by the nineteenth day away is described as being 'in a highly sensitive state'.
In these little girls explicit yearning for the missing mother and being angry with her occurred only sporadically, and then only in response to specific reminders of her. Jane, for example, on her sixth day of separation noticed the gate of her own garden, opened it and entered, and tried unsuccessfully to open the door of her parents' apartment. Returning, she spoke the word 'Mama' for the first time and also resisted entering the foster home. Jane's relations with her father deteriorated as the separation progressed. At first she played happily when he visited, then she got angry with him and, finally, she seemed pointedly to ignore him, only to cling and cry when he made to leave. Lucy's relations with her father went through much the same sequence. After one visit when he had taken her to a park near their home, she became very
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distressed after his departure; at first she refused to be comforted by her foster mother and subsequently clung tearfully to her and refused to be put down.
On reunion each of these younger children recognized mother immediately and responded pleasurably to her. Unlike the two older children, however, they seemed reluctant to relinquish the foster mother. Lucy in particular had difficulty in weaning herself from her and later showed marked conflict in relation to her. For example, during foster mother's visit three days after returning home Lucy 'oscillated between affection and apprehension, smiling and frowning, clinging to her mother yet crying bitterly when foster mother left'. Like Thomas and Kate, both these younger children were more hostile to mother after the separation than they had been before it (though presumably in each case this could have been due in some degree to the presence of a new baby).
Interpretation of Findings
All these children, then, showed far less distress than occurs when young children are separated from mother in less favourable conditions, yet all four showed unmistakable signs of strain and from time to time that they were aware of missing mother. In the interpretation of these responses there is some difference of opinion. The Robertsons, impressed by the fact that care by a responsive substitute mother in a benign environment holds anxiety at a 'manageable level' and permits 'positive development' to continue, believe that the onset of the deteriorative sequence of protest, despair, and detachment can be prevented. This leads them to the view that the responses shown by children fostered in this way are qualitatively different from those of institutionalized children, and cannot be understood as representing a difference of intensity only. An alternative view, however, is that the sequence of protest,
27
despair, and detachment, although greatly reduced in intensity and curtailed, cannot be regarded as absent. In the two older children, for example, the pattern of response, though at low intensity, showed very plainly most of the elements now known to be typical of how young children respond during and after a brief separation in less cushioned conditions -- yearning and searching for the missing mother, sadness, increasing protest at her absence and growing anger with her for staying away, increased ambivalence on return home, and evident fear of being separated again. Thanks to the precautions taken despair
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was admittedly held at bay and with it detachment, though signs suggestive of the latter were seen in Kate. In the two younger children the pattern of response was less clear, but several typical elements were none the less present. This leads to the conclusion that the differences in response between the fostered children and children removed to an institution are properly regarded as differences of intensity. There are other ways in which the Robertsons contrast their theoretical position with the one I adopt, notably as regards the role of grief and mourning in early childhood. These issues will be discussed in the third volume. Meanwhile it is important to note that, whatever differences there may be between the Robertsons and myself in regard to theory, there are none in practice. For, when the Robertsons come to consider the practical lessons to be derived from their project, they warn that, because these carefully fostered children came through so well, it must not be assumed that the hazards of separation during the early years can be eliminated entirely. On the contrary, they state, their experience has served to reinforce them in the view, which we have long shared, that 'separation is dangerous and whenever possible should be avoided'.
Presence or absence of mother figure: a key variable
From the Robertsons' recent study and the many others now on record two main conclusions can be drawn:
The sequence of intense protest, followed by despair and detachment, which first caught our attention, is due to a combination of factors, of which the kernel is the conjunction strange people, strange events, and an absence of mothering either from mother herself or from a capable substitute.
Because separation from mother figure even in the absence of these other factors still leads to sadness, anger, and subsequent anxiety in children aged two years and over, and to comparable though less differentiated stress responses in younger ones, separation from mother figure is in itself a key variable in determining a child's emotional state and behaviour.
By 'mother figure' is meant that person to whom a child directs his attachment behaviour by preference; and by 'substitute mother' is meant any other person to whom a child is willing temporarily to direct attachment behaviour. Since, however, an individual as he grows older directs attachment behaviour to others besides mother or someone acting as a
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substitute mother, it is convenient to have available terms that are less specifically tied to the child-parent relationship. Among terms used here in a generic way to cover anyone towards whom attachment behaviour is directed are 'attachment figure' and 'support figure'.
'Presence' and 'absence' are relative terms and, unless defined, can give rise to misunderstanding. By presence is meant 'ready accessibility', by absence 'inaccessibility'. The
28
words 'separation' and 'loss' as used in this work imply always that the subject's attachment figure is inaccessible, either temporarily (separation) or permanently (loss). 1
Not only here but elsewhere also, finding suitable language is a problem. For example, how long is a temporary separation? Plainly the answer turns on the subject's age.
Thus what might seem interminable to a one-year-old might seem insignificant to a schoolchild. What might seem interminable to a schoolchild might seem of no great significance to an adult. Another problem, and one that is more difficult, is to know at what point a separation that started as temporary becomes permanent -- or at least becomes conceived by the victim and by others as being so.
Yet a further difficulty turns on the fact that a mother can be physically present but 'emotionally' absent. What this means, of course, is that, although present in body, a mother may be unresponsive to her child's desire for mothering. Such unresponsiveness can be due to many conditions -- depression, rejection, preoccupation with other matters -- but, whatever its cause, so far as her child is concerned she is no better than half-present. Then again a mother can use threats to abandon a child as a means of disciplining him, a tactic that probably has an immeasurably greater pathogenic effect than is yet recognized.
These and other problems are discussed in later chapters. Meanwhile, the thesis can be phrased more precisely. Whether a child or adult is in a state of security, anxiety, or distress is determined in large part by the accessibility and responsiveness of his principal attachment figure.
____________________
1 The present usage of the word separation should be distinguished from the very different
usage of Mahler ( 1968) who employs it to describe an intrapsychic process which results in 'differentiation of the self from the symbiotic object'. Prior to this development a psychological 'state of undifferentiation, of fusion with mother', termed symbiosis, is postulated.
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There have been, and still are, clinicians and others interested in children who have found it difficult to believe that accessibility or inaccessibility of attachment figure can of itself be a crucial variable in determining whether a child (or an adult for that matter) is happy or distressed. One reason for disbelief is the supposition that, when there is nothing 'objective', namely intrinsically painful or dangerous, for a child or adult to be distressed about or afraid of, any distress or anxiety must be irrational and, if irrational, is to be deemed neurotic. Other reasons derive from a faulty theory of the nature of instinctive behaviour, and especially from failure to distinguish causation from function (see Volume I, Chapters 6 and 8). Others again derive from the many confusions and false value judgements to which the concept of dependency gives rise (see Volume I, Chapter 12). Yet another and different sort of reason may be the sheer inconvenience in practical life of the facts of the case as they seem actually to be in comparison with what things would be like were every normal child to be happy and content with any caretaker whatever -- provided she were kind. If children were only 'reasonable' in this regard, how much easier would life be!
In order to understand how some of the difficulties have arisen it is useful to consider how separation and loss have been treated in the psychoanalytic literature as situations of relevance
29
to personality development and psychopathology. In particular, it is useful to examine the place given to separation in theories of anxiety, and the kinds of explanation that have been proposed to account for its influence. Some of these ideas are traced in the following chapter, and opportunity is taken to compare the standpoint adopted in these volumes with that adopted in more traditional psychoanalytic works.
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30
Chapter 2
The Place of Separation and Loss in Psychopathology
A new pamphlet of mine, Inhibitions, Symptoms and Anxiety, is now being published. It shakes up much that was established and puts things which seemed fixed into a state of flux again. Analysts who above all want peace and certainty will be discontented at having to revise their ideas. But it would be rash to believe that I have now succeeded in finally solving the problem with which the association of anxiety with neurosis confronts us.
SIGMUND FREUD 1
Problem and perspective
From Freud's earliest studies of the aetiology of the neuroses, until the end of his life the twin problems of neurotic anxiety and defence were never far from his mind. Again and again he grappled with them, and on the various tentative solutions he offered rest his successive theoretical formulations. Since Freud's death, moreover, theories of anxiety and defence have continued to be the foundation-stones of psychoanalytic psychopathology; and it is through their espousing differing views on the nature and origins of these conditions that the several distinctive schools of psychoanalysis have come into being.
In Freud's earliest formulations there is no hint that anxiety arises from loss or threat of loss, or that defensive processes are evoked in conditions of intense anxiety. Only little by little, and mainly towards the end of his life, did Freud advance such views and, in so doing, bring his ideas on anxiety and defence into relation with his ideas on mourning which, until then, had been a significant but quite distinct strand in his thinking. A principal result of his new formulation was, as he rightly foresaw, to bring everything 'into a state of flux again'.
Although Freud himself at different periods of his life adopted ____________________
1 Letter to Oskar Pfister, 3 January 1926 (see H. Meng & E. L. Freud 1963).
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a number of radically different theories in regard to anxiety, mourning, and defence, as have the various schools of thought that have grown up subsequently, each theory is based on data obtained by but a single method of inquiry. Data are derived from studying, in the analytic setting, a personality more or less developed and already functioning more or less well; and from these data an attempt is made to reconstruct the phases of personality that have preceded what is now seen. To many the resulting literature is as frustrating as it is stimulating. On the one hand, it is plainly dealing with problems that every sensitive clinician recognizes to be of central consequence for understanding and helping his patients; on the other, it presents a complex web of competing and often inconsistent theorizing without providing methods by which to sort grain from chaff.
What is attempted in these volumes is to approach the classic problems of psychoanalysis prospectively. The primary data are observations of how young children behave in defined situations; in the light of these data an attempt is made to describe certain early phases of
31
personality functioning and, from them, to extrapolate forwards. In particular the aim is to describe certain patterns of response that occur regularly in early childhood and, thence, to trace out how similar patterns of response are to be discerned in the later functioning of the personality. 1
Some of the essential data, as described in the previous chapter, can be summarized as follows. Whenever a young child who has had an opportunity to develop an attachment to a mother figure is separated from her unwillingly he shows distress; and should he also be placed in a strange environment and cared for by a succession of strange people such distress is likely to be intense. The way he behaves follows a typical sequence. At first he protests vigorously and tries by all the means available to him to recover his mother. Later he seems to despair of recovering her but none the less remains preoccupied with her and vigilant for her return. Later still he seems to lose his interest in his mother and to become emotionally detached from her. Nevertheless, provided the period of separation is not too prolonged, a child does not remain detached indefinitely. Sooner or later after being reunited with his mother his attachment to her emerges afresh. Thenceforward, for days or weeks, and sometimes for much longer, he insists on staying
____________________
1 The point of view adopted is described at greater length in the first chapter of Volume I.
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close to her. Furthermore, whenever he suspects he will lose her again he exhibits acute anxiety.
When I came to examine the theoretical problems raised by these observations it was evident that the first step must be to gain a clearer understanding of the bond that ties child to mother. Next, it gradually became apparent that each of the three main phases of the response of a young child to separation is related to one or another of the central issues of psychoanalytic theory. Thus the phase of protest is found to raise the problem of separation anxiety; despair that of grief and mourning; detachment that of defence. The thesis that was then advanced ( Bowlby 1960a) was that the three types of response -separation anxiety, grief and mourning, and defence -- are phases of a single process and that only when they are treated as such is their true significance grasped.
A reading of the psychoanalytic literature shows that, as a rule, separation anxiety, mourning, and defence have been considered piecemeal. The reason for this is the inverted order in which their psychopathological significance was discovered: for it was the last phase that was recognized first, and the first last. Thus the significance of defence, particularly repression, was realized by Freud in the earliest days of his psychoanalytic work and provides the basis of his original theorizing: his first paper on the subject is dated 1894 ( "'The Neuro-psychoses of Defence'", SE 3). 1 His grasp of the roles of grief and of separation anxiety, on the other hand, was at that time still fragmentary. Although he was early alive to the place of mourning in hysteria and melancholia (see note of 1897 to Fliess, SE 14: 240), twenty years were to elapse before, in "'Mourning and Melancholia'" ( 1917a, SE 14), he gave it systematic attention. Similarly in the case of separation anxiety: although in the Three Essays on the Theory of sexuality ( 1905b) he gave it a paragraph ( SE 7: 224 ) and in the Introductory Lectures ( 1917b) three pages ( SE 16: 405 408 ), it is not until 1926 that in his revolutionary late work Inhibitions, Symptoms and Anxiety he accorded it the central place in what was to be his final
32
theory of anxiety. 'Missing someone who is loved and longed for', he there affirms, is 'the key to an understanding of anxiety' ( SE 20: 136 -7). 2
____________________
1 The abbreviation SE denotes the Standard Edition of The Complete Psychological Works of
Sigmund Freud, published in 24 volumes by the Hogarth Press Ltd, London. All quotations
from Freud in the present work are taken from this edition.
2 For an account of the development of Freud's theories of anxiety, see
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The reason for this inverse recognition of the three phases is clear: always in the history of medicine it is the end-result of a pathological sequence that is noted first. Only gradually are the earlier phases identified, and it may be many years before the exact sequence of the whole process is understood. Indeed it was understanding the sequence that baffled Freud longest. Does fence precede anxiety, or anxiety defence? If the response to separation is pain and mourning, how can it also be anxiety? ( SE 20: 108 -9 and 130 -1. ) During the thirty years of his main psychoanalytic explorations, it can now be seen, Freud traversed the sequence backwards, from end-result to initial stage. Not until his seventieth year did he clearly perceive separation and loss as a principal source of the processes to which he had devoted half a lifetime of study. But by then others of his ideas were already firmly established.
By 1926 a substantial corpus of psychoanalytic theory was already being taught. As regards anxiety, castration anxiety and superego anxiety were corner-stones of thought and practice in Vienna and elsewhere; also, Melanie Klein's hypothesis relating anxiety to aggression had recently been formulated and, linked to the concept of the death instinct, was soon to become a key concept in a significant new system. The full weight of Freud's ideas on separation anxiety and its relation to mourning came too late to influence the development of either of these two schools of thought.
Apart from an early reference by Hug-Hellmuth ( 1913) and a brief word by Bernfeld ( 1925), moreover, some years were to pass before the clinical papers drawing attention to the pathogenic significance of separation experiences were published. Some of the earliest, by Levy ( 1937), Bowlby ( 1940; 1944), and Bender & Yarnell ( 1941), presented empirical evidence suggesting an aetiological relationship between certain forms of psychopathic personality and severely disrupted mother--child relationships. At about the same time, Fairbairn ( 1941; 1943) was basing his revised psychopathology on separation anxiety, having been preceded by Suttie ( 1935) and to be followed a few years later by Odier ( 1948); Therese Benedek ( 1946) was describing responses to separation, reunion, and bereavement as observed in adults during the second world war; and Dorothy Burlingham & Anna Freud ( 1942; 1944) were recording their first-hand observations (cited in Chapter 1
____________________
Strachey's introduction to the Standard Edition of Inhibitions, Symptoms and Anxiety ( 1959, SE 20: 77-86); see also Appendix I to this volume.
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33
above) of how young children respond to separation. In addition, studies of a different though related kind, concerned with the effects on infants of being raised without any mother figure, were being conducted by Goldfarb ( 1943 and later) and by Spitz ( 1946).
Nevertheless, despite all this work, separation anxiety has been extremely slow to gain a central place in psychoanalytic theorizing. Indeed Kris, writing as a participant in the Viennese scene, remarked in later years how, when in 1926 Freud advanced his views regarding separation anxiety, 'there was no awareness among analysts . . . to what typical concrete situations this would apply. Nobody realized that the fear of losing the object and the object's love were formulae to be implemented by material which now seems to us self- evident beyond any discussion' ( Kris 1956). He acknowledged that only in the preceding decade had he himself recognized the significance of such fears, and could have added that even when he wrote there were schools of analytic thought that failed to recognize their importance. The long-continued neglect of separation anxiety is well illustrated by an authoritative survey of 'the concept of anxiety in relation to the development of psychoanalysis' ( Zetzel 1955) in which it is not once mentioned; and even in a recent book by Rycroft ( 1968a) it is given scant attention.
In the event, it is clear, some of the ideas Freud advanced in Inhibitions, Symptoms and Anxiety fell on stony ground. This was a pity, since in that book, written at the end of his professional life, he was struggling to free himself of the perspective of his travels -- defence, mourning, separation anxiety -- and instead to view the sequence from his new vantage-point: the priority of separation anxiety. In his concluding pages he sketches out a new route: anxiety is the reaction to the danger of losing the object, the pain of mourning the reaction to the actual loss of object, and defence a mode of dealing with anxiety and pain.
The route finally taken by Freud is also the route followed in this work. Yet, for reasons that emerge more clearly in Chapter 5, the perspective in which the route is viewed is in many respects very different from the perspective adopted by Freud and adopted too by most of his followers. A principal reason for this difference is that, whereas the perspective adopted here is based on a Darwinian-type theory of evolution, that of Freud is not.
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Separation anxiety and other forms of anxiety
The fact that in his later years Freud came to see separation anxiety as the key to the whole problem of neurotic anxiety does not mean that he was right. The term 'anxiety' has been used in very many ways to cover what may well prove to be a range of widely heterogeneous states. The term 'neurotic anxiety' is also ill defined and may also cover a range of heterogeneous states, perhaps of very diverse origin. In this complex scene the place of separation anxiety is still unclear. In particular, it remains uncertain how large a contributor it is to sources of neurosis in comparison with anxieties and fears of different origin.
Eager though every clinician must be to have these matters clarified, the task is outside the compass of this work. No attempt is made to present a general theory of anxiety. Nor is any attempt made to judge how a better understanding of separation anxiety can aid such a project. Those are tasks for the future.
34
What is attempted, instead, is more limited. Young children are upset by even brief separations. Older children are upset by longer ones. Adults are upset whenever a separation is prolonged or permanent, as in bereavement. A pile of clinical reports, moreover, starting with Freud's early studies of hysteria and swelling to increasing volume in recent years, shows that experiences of separation and loss, occurring recently or years before, play a weighty role in the origin of many clinical conditions. These are grounds enough for concentrating attention on our problem.
Study of the problem suggests, indeed, that Freud was probably mistaken in claiming that missing someone who is loved and longed for is the key to an understanding of anxiety. As likely as not there is no single key: fear and anxiety are aroused in situations of many kinds. What seems certain, nevertheless, is that missing someone who is loved and longed for is one of the keys we need, and that the particular form of anxiety to which separation and loss give rise is not only common but leads to great and widespread suffering. That being so, let us grasp the key at hand and see what doors it opens.
A challenge for theory
Once we are aware of the form and sequence of the very intense responses that can result from a separation lasting a few days or longer, we become alert also to the form and sequence of the comparable but far less intense responses that are to be
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seen in young children during the course of everyday living. For example, we notice that in the presence of a responsive mother figure an infant or young child is commonly content; and, once mobile, is likely to explore his world with confidence and courage. In her absence, by contrast, an infant is likely, sooner or later, to become distressed; and he then responds to all sorts of slightly strange and unexpected situations with acute alarm. Furthermore, when his mother figure is departing or cannot be found, he is likely to take action aimed at detaining her or finding her; and he is anxious until he has achieved his goal.
Elemental though these data are, and well known to every perceptive mother, it yet remains true that within this bare catalogue of routine sequences of behaviour there lies a cauldron of controversy. Why should a child be distressed in his mother's absence? What is he afraid of? Why should he be anxious when she is missing and cannot be found? Why is he apprehensive lest she leave him again?
The psychoanalytic literature is strewn with attempts to answer these questions and no fewer than six types of theory can be discerned. Two theories, namely Rank's birth-trauma theory ( 1924) and Freud's signal theory ( 1926a), were developed explicitly to account for the observation that a young child is anxious when his mother leaves him. Another three, namely Freud's earlier theory of transformed libido ( 1905b) and both of Klein's theories, of persecutory and depressive anxiety ( 1934; 1935), had different origins and came only later to be applied to the problem of separation anxiety. All these five theories, however, are distinctly complex since in each case the author rules out of court the idea that absence of mother could, in and of itself, be the real cause of the distress and anxiety seen. Consequently each author either feels constrained to search for a reason of some other kind or else applies a theory developed in another context. Only occasionally has a student of the problem accepted the data at their face value and presented a theory of a sixth type, one that regards the distress and
35
subsequent anxiety as primary responses not reducible to other terms and due simply to the nature of a child's attachment to his mother. Among those who have advanced this view are Suttie ( 1935), Hermann ( 1936), and, with some qualifications, Fairbairn ( 1943; 1963) and Winnicott (e. g. 1952). Half a century earlier, it is interesting to note, William James ( 1890) had recorded his view that 'The great source of terror in infancy is solitude'.
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The very similar generalization made by Freud in 1905, and quoted at the head of the next chapter, shows that he was early aware of the data. Indeed, as Strachey makes apparent in his introduction to the Standard Edition of Inhibitions, Symptoms and Anxiety ( SE 20: 77 - 86 ), from that time onwards the anxiety manifested by a young child when separated from his mother is constantly in Freud's mind and he returns to it repeatedly whenever he makes a further attempt to solve the problem of anxiety. Nevertheless, because the basic postulates from which he began his theorizing biased him in other directions, Freud himself never adopted a theory of the sixth type.
These varied attempts to account for the phenomena of separation anxiety are not only of historical interest but of great practical importance, because each theory gives rise to a different model of personality functioning and psychopathology and, in consequence, to significantly different ways of practising psychotherapy and preventive psychiatry. Because of their continuing and living influence, a detailed review of psychoanalytic theories of separation anxiety is presented in Appendix I. Some of the assumptions on which they rest are evaluated in Chapter 5 in the light of present knowledge of biology and ethology.
Before discussing theory further, however, it is useful to consider additional observations of behaviour during and after separation, starting with the behaviour of human children and proceeding thence to a comparison with the behaviour of young of other species. In all the studies to be described, it must be emphasized, either mother leaves child or child is removed more or less unwillingly from mother. The very different behaviour seen in the reverse situation, in which mother remains in a known place while child explores, is described already in the first volume (Chapter 13) and is the subject of papers by Anderson ( 1972a, b, c) and Rheingold & Eckerman ( 1970). Provided a child initiates the movement himself, in the certain knowledge of where mother can be found, he is not only content but often adventurous. In what follows the word 'separation' always implies that the initiative is taken either by mother or by some third party.
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36
Chapter 3
Behaviour with and without Mother: Humans
Anxiety in children is originally nothing other than an expression of the fact that they are feeling the loss of the person they love.
SIGMUND FREUD ( 1905b)
Naturalistic observations
Chapter I presented data concerning the behaviour of young children when they are away from home and placed for days or weeks either in a residential nursery or in a foster home. Here, by contrast, we are concerned with separation situations of much shorter duration. We begin with separations lasting from a day to a few hours, all requiring a child to be in a strange place with strange people and without substitute mothering.
A number of psychologists have made records of the behaviour of young children when they first enter nursery school or go to a research centre for examination. In so doing the psychologists have, usually without intending it, amassed evidence that to start nursery school much before the third birthday is for most children an undesirably stressful experience. The records, indeed, make it apparent that ignorance of the natural history of attachment behaviour, coupled with a misguided enthusiasm that small children should quickly become independent and 'mature', has resulted in practices that expose children, and their parents, to a great deal of unnecessary anxiety and distress. Nevertheless, for scientific purposes the resulting records have the great advantage that there is no danger that the degree of upset has been exaggerated; indeed the reverse is probably the case.
The first and largest study of this kind seems to have been undertaken by Shirley at the Harvard School of Public Health ( Shirley & Poyntz 1941; Shirley 1942). In this study, 199 children (101 boys and 98 girls) between the ages of two and eight years were observed in the course of an all-day visit to a research centre, during they which were subjected to a variety of
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psychological and medical examinations, interspersed with periods for play, meals, and rest. The children were without mother throughout the day. The authors express the belief that 'the responses of these children to separation from their mothers were fairly typical for children who are cared for predominantly by their mothers during their pre-school period'.
All children visited the centre at six-monthly intervals; and any one child attended over a period of about three years. Age at starting varied: twenty-five paid their first visit at two years, a further twenty-eight at two and a half, and other batches at each half-year of age up to about five. As a result the number of children observed at each age-level varied from twenty- five at the age of two years to a maximum of 127 at the age of five and a half years. Results are given in terms of the percentage of children of each age-level and sex who were upset in
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each of three situations met with during the day -- leaving mother, play period at centre, and meeting mother at end of day. Published data do not distinguish between the responses of children on their first visit to the centre and those of children who had paid one or more previous visits.
Of the children aged from two to four years, about half 1 are reported as upset on leaving mother at the day's start and half also on meeting mother again at the end of the day. The proportion upset diminishes in the older age-groups, though at the day's end it never falls below 30 per cent in the case of the boys. Even during the free play period with a congenial though strange mother-surrogate the percentage of children upset is substantial, varying from about 40 per cent of the youngest children (two to three years old) to about 20 per cent at four years and 15 per cent of the older ones (five- to seven-year-olds):
. . . emotional upsets during the play period were by no means uncommon. The children manifested their uneasiness in the playroom in a variety of ways in addition to crying and calling for mother. Some merely stood disconsolately killing time; some shifted uneasily from one foot to the other; some peered out the window disappointedly searching for father's familiar car in the stream of traffic. . . . Such children ignored the proffered toys and resisted the play suggestions that were offered.
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1 Because results are expressed in percentages and the N varies for each age-group and sex,
it is not possible to calculate an exact percentage for larger categories of children. -34-
Some sat distracted, aimlessly fiddling with a toy or sifting sand. Of the younger children, half were explicit in expressing a desire for mother; of those between four and a half and six years of age, the proportion asking for mother dropped to about one-quarter.
A number of children who had not expressed upset during the day's proceedings showed it on reunion with mother:
Usually it was the child who had bravely winked back the tears and made a determined effort to surmount his feelings of insecurity earlier in the day that gave way to his pent-up emotion in tears. At the sight of mother his needs for autonomy and independence vanished, and he reverted to the degree of babyishness he had overcome early in the morning.
At each age-level, proportionally fewer girls than boys were overtly upset. Moreover, when girls were upset, the intensity and duration of upset were less than in boys. It is evident that the authors of the study approve the girls for their greater 'maturity' and regret the 'babyishness' of the boys.
The authors note that the three-year-olds tended to be more upset than both the younger children and those older: 'Children of two and two and a half years were little aware of what the day would bring forth; they had little anticipatory dread. ' By three years they were 'more aware of the demands of the day, and more reluctant to leave home'. This was true especially of those who had paid one or two previous visits to the centre. Naturally, both the physical examination and the psychological testing were carried out as kindly as possible. Nevertheless, in mother's absence, so far from becoming used to the six-monthly
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examinations, the children became more apprehensive about them: 'Familiarity with the situation from one or two previous experiences seemed to make the children grow more apprehensive' and they tended to be more upset when the day began ( Shirley 1942). By contrast, children aged five years and upwards were more likely to settle down, and some are reported to have enjoyed the day.
A study that derives from Shirley's but is confined to a very small part of the area covered by the earlier investigation is described by Heathers ( 1954). Not only is the age-range restricted to the youngest children but the behaviour reported is confined to the way in which they respond to being removed from home to go to a nursery school.
Thirty-one children between the ages of twenty-three and
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thirty-seven months, from middle-class homes and of above average intelligence, were observed during their first five days of starting nursery school. On each of those days each child was called for by a student he had not previously met and taken off to school by car. To meet the researcher's requirements, each 'child's mother was asked to part with him at the door and to let the observer take him out to the car'. Although each mother had attempted to explain to her child what was in store for him, it is very doubtful whether explanation could have conveyed much to such young children. Observed behaviour was checked against a list of eighteen items, which conveys a vivid picture of the kinds of response likely to occur. It runs as follows: When taken from home to car
1. Cries
2. Hides, tries to hide, etc.
3. Resists getting dressed to go
4.
