The Mentally Ill in Your Caseload

In this talk delivered to social workers, Winnicott brings his understanding of professional psychiatry, with its attempts to treat severe mental illness using a more humane approach, together with his belief in dynamic psychology—the emotional development of the individual derived from the study of psychoanalysis—into a closer connection with one another. He charts a brief outline of psychoanalysis and interprets the psychoses through it. He sees the importance of early environmental factors in mental illness and the possible effects of this on maturation. He comments on depression both normal and psychotic in type, on his theories of personalization, of feeling real, and, through early dependence, the gradual growth of the functioning self. He also gives an empathic view of the role of the social worker in the difficult work of treating acute mental ill health.

Considerations in the Study of Homosexuality

In this essay, Winnicott gives a succinct account of the factors that need consideration when studying homosexuality and bisexuality. He looks at this from the perspective of psychoanalysis and normal child development and its variations, as well as from the societal perspective. His notes suggest a clear wish to attend to this area objectively, without prejudice and fear, at a time of great societal change in attitude towards homosexuality.

The Theory of the Parent-Infant Relationship: Further Remarks

In these further remarks on the parent-infant relationship, on which he and Phyllis Greenacre had given Congress papers, Winnicott endorses Greenacre’s work on maturation and links it to his work on dependence. He notes that babies are helped to face anxiety and avoid moment-by-moment breakdowns by parents providing good environmental conditions. In analysis, a patient may have difficulties that mean he has to be helped to go back and face earlier unbearable anxieties that led to organizing what are now unhelpful defences. Actual clinical breakdowns may have to be lived through analytically to enable regrowth. Winnicott makes these remarks rather than further summarising his paper.

The Development of the Capacity for Concern

This paper given to the Topeka Psychoanalytic Society, Kansas, addresses the development of the child’s capacity for concern. For Winnicott, concern is the opposite of guilt. He elaborates this by describing how the infant fuses the affectionate mother who provides a benign environment with the object-mother who arouses cruder instincts. Learning to manage this and to have a mother who understands and bears it enables the child eventually to recognize a living separate mother who survives his needy attacks and loves him in return. This baby can then begin to take responsibility for himself and his needs (integration of emotional life) and to be concerned for his mother. This is a repeated learning cycle throughout childhood and into adulthood. The mother’s failure to survive may create a failure of concern.

Training for Child Psychiatry

In this contribution to a symposium on the training for child psychiatry—a new specialty in medicine at this time—Winnicott proposes that doctors who have trained in paediatrics and psychoanalysis should also train as child psychiatrists. Becoming an adult psychiatrist who then trains in child psychiatry is not advisable because the trainee doctor will have missed the development of child physical and emotional health during its maturation.

The Aims of Psycho-Analytical Treatment

In this short statement on the aims of psychoanalytic treatment presented to the British Society, Winnicott describes the surface aims of the analyst (keeping and behaving well, alive, and awake, and completing the work of analysis) and the deeper ones. He hopes the patient can use him as a transitional and subjective object; he makes interpretations to show the extent of his understanding and to create an intellectual connection with the patient; he acts to facilitate the pathology of early environmental difficulties and strengthen the ego of the patient. He recognises that nonstandard analyses need modifications of this method and that analysts differ in their abilities in this work. Even in cases of extreme difficulty, the aim is to meet the needs of the patient and verbalise the nascent unconscious where possible.

Envy: A Male Patient Near the End of His Analysis

In this short piece of clinical documentation of a male patient close to the end of his analysis, Winnicott explores the experience of the patient needing to attack and destroy the potency (the ‘good breast’ in Kleinian theory) of Winnicott as his much needed analyst, and the patient’s dependence on him. He adds that Klein’s theory in her recent Geneva Congress paper does not, for him, sufficiently address early maternal failure and its effect on the infant.

Letter to Harry Guntrip

In this letter, Winnicott thanks Guntrip for his book and says that his own earlier review of Fairbairn’s book did not do it justice.

Matti, aet 12½ Years: A Therapeutic Consultation

In this therapeutic consultation with a young child with symptoms of encopresis and antisocial features, Winnicott uses his squiggle technique to diagnose difficulties within the family contributing the child’s behaviour and functioning. The consultation is in Finnish and is assisted by an interpreter.

Letter to Pearl King

In this letter to his colleague Pearl King, Winnicott expresses his personal view that any books chosen for the International Library of Psychoanalysis publications should reflect the given author’s work within clinical psychoanalysis. He suggests that, although any book written by Dr John Bowlby would be popular and profitable, he does not qualify for publication in the International Psycho-Analytical Library on these grounds. Winnicott wants this matter discussed in committee by the Society.