Observations on the Relationship between Child and Adult Neurosis
- Author:
McINNES, M.R.C.P.E.
,A study of the relationships between neurosis in in i S- anc* in children necessarily involves the fusion of all those factors which go to the com- position of thf npnrotir- r?if?tntv? Tl-io mflnonm and in children necessarily involves the ors which ot - of the neurotic picture. The influence bi ^redity, of constitution, of biochemical and and -Sical changes arising from somatic causes, be ^sturbance of endocrine function, must all ?nfl n nto account as well as the psychological that^1106 external and internal. It is obvious ^ a brief talk I cannot hope to deal with this a^.e range of considerations; but while selecting of rater neglected aspects of the psychogenesis not be taken as indicating disparagement of the basic factors which I have mentioned. Indeed it is my view that the value of the purely psycho- genic factors can only be properly assessed when they are seen in the setting of a wide psycho- biological concept of the genesis of neurotic states. Having entered this caveat I feel that I may now proceed without fear of distortion to give you a few impressions arising from clinical experience regarding the relationship between child and adult in so far as the development of neurosis is concerned.
In-the?first~place, although one would have
to states for special mention, I want” thought that the work of Freud, on the all-important ake it clear that this present preference should matter of the mother-child relationship, would * Adapted from a talk given at Oxford to Psychiatric Social Service Students. have effectively directed attention not only in theory but in practice to the enlightened manage- ment of the early days and weeks of the infant’s life, there is as yet remarkably little evidence that such a development has taken place to any save the slightest degree. In fact it seems to me that in the management of infants and young children, mothers, nurses, and even doctors have not yet reached the stage where the application of sound principles arising from analytic experience is yet a practicable proposition.
It is often difficult to get accurate information about infant feeding, but in those cases where it can be traced, there is frequently a story of difficulty in getting the infant to suck, impatient handling by mother or nurse, a too early (and often un- justifiable) resort to the bottle, weaning problems and the like. Maternity nurses have a good deal to answer for in this respect, and many doctors just as much; but one looks forward to the time when things will be left more to nature, when the accoucheur and his assistants will attend to the general psychological atmosphere of the birth room, and interfere as little as possible in the establish- ment of a good bond between mother and child. With even the most enlightened and respectful doctors and nurses, however, this emotional bond will not be well established unless the mother herself is in a well poised emotional state. This in turn depends far more on what kind of person she is than upon what she tries to do to or for the baby. This is simply another way of saying that her unconscious emotional atmosphere enwraps the child in a way which influences its behaviour to a profound extent. R. D. Fairbairn (1) emphasizes the primary emotional needs of the child as being the need to be loved and the need to have its own love accepted as being good. The failure to satisfy either of these needs leads to basic insecurity which may later give rise to neurosis or even more profound disorders.
The second prominent impression on looking back collectively so to speak over the histories of neurotic patients, is the surprising extent to which the parents of such patients seem to have failed either to sense or to perceive the love needs of their children. Is this failure of insight a product of the age of scientific materialism ? Have parents become too mechanized preferring to think (if they think at all) that to be loving is to be slushy and sentimental, and that to accept love gladly and freely from their children is to indulge a ten- dency productive of a family of ” cissies ” ? The dominance of intellect in the present age has had as its counterpart a devaluation of the emotional life. Yet there is nothing more devastating than a vapid and sterile agreeableness which is simply the denial of natural emotional responses. No one would advocate a completely uncontrolled display of emotion?there must be some kind of form within which the emotional life can express itself; but this framework should be flexible within the widest limits of social and moral acceptability, and the aim should be to keep i* ? its barest minimum. (In parenthesis one of tl1 penalties of being excessively well mannered 1 that one is liable to develop emotional constipation^’ ?a very prevalent social disease which leads many unpleasant side effects. The thing all others for which the true aristocracy are to D envied is their ability, through long generation of maturing tradition, to be very affectiona without being maudlin on the one hand, and, 0 the other, to be extremely disagreeable with?u. being offensive.) Many people have lost the kna? of being emotionally natural, and the effect of d}1 on children is bound to make for insecurity. the other side of the picture large families are n? uncommon where the parents and children are ? terms of the freest emotional relationship ; roVV are not infrequent, but just because they occu spontaneously they are seldom serious, and a bne engagement clears the air ; demonstrations 0 affection are just as frequent but never forced 0 formal, and consequently never embarrassing Such conditions favour the development of secufl i and poise in the children, and one is often str^cn by the sureness of touch which such people?-ofte. quite unintellectual?display in their persona relationships. <?
To give a complete account of the effects 0 parental influence on the laying down of has1 emotional trends in children would be impossible but there are three further points worthy of mention^ The first I have already alluded to, namely influence of the unconscious emotional atmospher^j There are a great many parents who behave vve towards their children, but whose efforts in dn direction are brought to nothing because of deep seated disharmony in their own minds. Qul recently I had a mother and a small girl of f0^ brought to me. The child would not or coU. s not sleep upstairs unless the mother came upstalf too. On the face of it there was no obvious causey the mother was sensible, intelligent and orders in her attitude to the child. She was affectiona and considerate too. The father was steads perhaps rather unimaginative. Apart from sleeplessness the little girl showed no other disorde _ The mother gave me an account of two of her <?vV dreams which on analysis revealed an unconsciou hostility to her husband, who was in fact a fat”? figure carrying strong ambivalence for his wd’ With the emergence of this material the chn began to sleep naturally. It is perhaps not t0 great an assumption to say that the child ^ unconsciously influenced by the true situation’ and reacted to it by anxiety at night… Parents need never imagine that by behaving well in front of the children they are therefof shielding them from psychological harm, v the contrary, the damage although not imrneo1’ ately visible may be all the more profound f? being left unhealed at the time. The broken hon1 with overt marital disharmony is of course serion for the emotional poise of the children, but w snK f1106 unconscious hostilities may be more title and prolonged in its effects. What is the echanism whereby unconscious content in the f, rents is communicated to the unconscious of cin ” The Jungians might call it ” parti- Pation mystique” ; whatever its name and Th*6’ it is very real.
1 he second point I wish to mention is perhaps ‘0fe prosaic, and is consequently overlooked in lt ? Present-day welter of analytic theory and practice. haK-Slmply t^le Question ?f the inculcation of good dv ? ^ thought and conduct. Life is j^namic, but it should also have form and order. Wo^6 already alluded to the necessity for a frame- fra Habit is one of the components of that halveVVOr^’ anc* development of good or bad WitV ^ays a Part in formation of the pattern In t ^ movement of life will go on. r luting adult neurotics it is easier to get good With Pe?P’e who have been brought up a sense of order, of appropriateness, of the ness of things, and more difficult with those a? ?Se habits of thought and conduct are shapeless floppy.
to K fashioned training in good habits is not -J-, be despised. It can of course be overdone. q e day when children were obliged to read the ei??d Book on Sunday afternoons while their ers snored on the antimacassars need only be oderately mourned, and yet it is not at all certain at roaming the streets or gaping from the two- g n”les at Hollywood close-ups is a particularly th? . exchange. It should be borne in mind fin ln training children there must always be that anH Maintenance of equilibrium between freedom th 0rder- The two are not incompatible ; indeed jse Mo^ one understands about true order (that re’ i- inner order of the mind) the more one c ‘zes that freedom and inner order are organically rnPlementary. This is the true inwardness of reV ?Vo’ution of Christian democratic forms. The anrf?U-s-way iniplies inner order of mind anH ?P*rtt in conformity with religious experience j lts dogmatic statement. It also paradoxically Plies freedom?freedom from the constantly Curring alternatives of the material world, and freedom for the full development of the gnest spiritual attainments of which man is Pable. (The danger about the present trend e ^ards social planning is that it will become an in lr! itself. Like the inculcation of good habits children, social planning should only be a niponent part of the form in which human . engs can be free to develop themselves; otherwise ,.ls merely a reversion to a more immature and ^archical level of existence.)
J here comes a point in the treatment of many eurotics when the usual reductive procedures ave been completed, when explanation has done J tt can, and when persuasion, encouragement nd exhortations to correct adjustment have gone . ar as possible. Not infrequently it is at that Point that the basic trouble becomes appallingly obvious. It can be put quite simply in terms of the neurotic’s question: “Why adjust at all? Is this attempt to achieve a common standard of social behaviour, of morality, of professional or business ability all that there is to strive after ? Is this so- called normality, this prosaic pattern of the ordinary the chief end of all the labour and sweat ? ” One is bound to agree that if it were so, the effort would scarcely be worth while.
Psychotherapy should properly have more than one aim. It should concern itself with the removal of symptoms either directly or by the reduction of the conflicts from which they arise; next, with the establishment of healthy attitudes and habits of thought; but last and most fundamental of all it should concern itself with giving to the patient, or at least in assisting him to find in himself an individ- ual category of values, essentially creative in nature and differing from the ordinary categories of social and moral values in the same way as meaning differs from measurement. Behind all the enormous amount of minor neurosis there is a background of disorder and disintegration which can probably only be adequately stated and fully appreciated in philosophical or religious terms. In psycho- logical terms one could say that the disorder consists of the failure to establish a sufficiently meaningful relationship with the non-material aspects of life. The failure in fact to develop a philosophy or a religion. (This line of thought leads of course to many thorny problems, such as religious education in schools, the boundaries of the psychotherapist’s functions, and many others.) I believe that the essence of the difficulty lies not so much in the absence of a body of religious or philosophical belief, as in the disuse of the function of mind which normally establishes significant relationships with the realities which are con- cretized in such beliefs. Most people are still bemused by the discoveries of science, and have ceased to wonder about that which is still un- discovered and indeed probably undiscoverable. The category of values has become horizontal to the exclusion of the vertical (to use another figure). Herein, lies one of the pitfalls of social service work. It seems to me that social service workers spend so much time finding out all about people, their age, occupation, size of house, husband’s salary, family history, illnesses, etc., that they have no time left for finding their way into them. And yet it is only in so far as they do so that they are able to influence them effectively and permanently. It is only in so far as they can employ a similar category of values (talk the same language) that what they do and say and the way they look and think will become meaningful for their patients. Lawrence Hyde (2) puts the matter as follows : “Although detachment is of the utmost value if you are concerned with fossils or spiral nebulae, when it is exercised in the field of sociology it happens to produce the unfortunate result that it prohibits you from dealing with exactly that type of data which, from the point of view of understanding and controlling life, it is most important that you should handle. It is not that detachment in this field is undesirable, but that if you exercise it rigorously only certain limited aspects of the question can present themselves to your attention. It ensures the reliability of such conclusions as you actually reach, but implies at the same time that they are of a comparatively sterile nature. This circumstance should be obvious enough. Yet the sociologists persistently fail to recognize its significance. They talk instead as if it is only to the detached and scientific eye that the truth about human beings can ever be apparent.” This passage, although perhaps a slight over state- ment of the position, brings out clearly the point which I am trying to make.
Now it seems to me that the ” other ” category of values, i.e. the non-scientific immeasurable category is spiritual and creative in nature, and that the religious function (which I believe to be common to man) is the instrument by which we may be enabled to reach a mutual and meaningful apprecia- tion of these values. If this is true it is little wonder that people who have never had an opportunity to develop the religious function often find them- selves adrift in a world of shifting, impermanent, and shallow values, and for those of tender mind this is an experience which readily leads to insecurity, conflict, disorderly behaviour and neurosis. Jung in his ” Modern man in Search of a Soul” goes so far as to say that among all his patients there has not been one over the age of 35 whose problem in the last resort was not that of finding a religious outlook on life.
This digression has taken us a long way from the question of habit formation, and yet behind it there has been the thought that in so far as the exercise of the religious or integrating function may be made a habit, it is probably the most valuable one which can be bestowed upon any child by those in contact with it. Before leaving this topic, I should make clear that I am using the word religious in its literal sense. Perhaps a better word would be ” integrating” function?thai which relates us to the wholeness of things. In no way do I use the word religious as denoting any particular creed or sectarian belief.
One further impression from clinical experience deserves mention before concluding. It is thai of the great prevalence of devaluation and differentia- tion in neurotics. Sometimes this is a primarj causal factor, as for example, where a child becomes devalued and differentiated from others by loss oi parental love, or by frank rejection. The things which can lead to devaluation are innumerable, complex, and sometimes very subtle ; and at the hands of insensitive parents or teachers children may suffer severe damage in this respect in an imperceptible way. Later, devaluation and differ- entiation are often secondary to the emergence of overt neurotic symptoms and may also of course follow any organic illness particularly if the debility is of long standing. By the time the adult stage of neurosis is reached there is often a fixed sens? of inferiority, of difference from other people whictl is extremely difficult to combat therapeutically’ especially if it has been gradually built up on an ascending series of self convictions. The real remedy for this lies in a greater degree of insight among parents, teachers and all have the care and management of children. With regard to the future of psychiatric worK with neurotics, one cannot get away from the feeling that the main effort is at present misdirected. The enormous amount of time spent on treating neurotics does not produce an adequate result in the social and economic sense. It is true, n may do so in the individual sense, and this must be kept in mind, but sooner or later we shall have to start at the other end. Even child guidance does not go far enough back. What is needed is ? much greater depth of insight spread over a mucn wider number of people. By insight I mean more than learning by rote of what is good or bad bringing up children. I mean the possession of a sense of values of a creative and meaningful kind, in addition to the scale of material values by which we at present mostly live.
The child must come to be honoured not only for what it can do, or can be made to do, but for what it is. How is this kind of insight to t>e achieved and spread in the face of superficiality’ indifference, and frank hostility ? The first requisite is that those who are trying to spread it must have insight themselves. “You cannot do good unless you are good ” it has been said. This means that all doctors, clergymen, psychotherapists, teachers? social workers and everyone whose profession brings them into influential contact with human beings ought ideally to be possessed of greater insight than is common.
To some this kind of insight is a kind of gift* a kind of flair for human beings. To most it comeSr if it comes at all through contact with parents wh? already possess it. Others may acquire it labori” ously by self analysis, or by some form of psych0’ logical analysis provided that it includes the dis- covery of a philosophy; others achieve it by way of religion. The vast majority hardly possess it at all.
We are really very much in the position of having grown so far away from nature that we have to re-learn laboriously how to be natural; on another level it is perhaps equally true that having once fallen from grace we have to climb towards ^ again with much sweat and travail. Work witn neurotics, both children and adults, cannot fa1 to arouse an acute consciousness of the terrible inadequacy of our comprehension of these problems- I am well aware that this paper has only touched upon one or two aspects of the neurotic problem* The great importance of heredity, constitution- endocrine influences, and other biophysical ?r biochemical variations must be given due place- There is also a vast field for the investigation of social and economic conditions as factors in the of^ls of neurosis. Any adequate formulation in J . neurotic problem, either in general or in the ?yidual case must tak6 all of these into account, p * have seemed to emphasize certain purely jchologiad aspects of the situation to the exclu- is n of other equally important considerations, it ^Partly because lack of space makes it impossible , state all the arguments fully, and particularly cjv,Ca1VLSe aspects upon which I have chosen to the6 are those which are often ignored. None p ‘^ss they ought to be tackled by orthodox all s’ who, as far as their understanding a ?Ws> are in a position to give due weight to each tyu eYery influence in the production of neurosis, of neec*ed the spanning type of mind capable c eding in poise all the elements which go to the thi ? 0siton of the neurotic situation. Whether but1S the compass of man is open to question 11 is the goal to strive after. The sectionalism which is still so much in evidence is a hindrance rather than a help to its achievement. The gaps for example between psychiatry and medicine, between medicine and religion, between orthodox psychiatry and the analytic schools, even the gap between one analytic school and another remain to be bridged. Diversity there must be, but it should be diversity related to a central unifying principle. In a larger sense it is this central unifying principle which is longed for and sought after all over the world to-day.
References
(1) W. R. D. Fairbairn: A Revised Psychopathology of . the Psychoses and Psychoneuroses. Int. Journal Psycho-analysis, vol. xxii, pts. 3 and 4. (2) Lawrence Hyde: The Learned Knife, p. 59. Howe, 1928.
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