Fourteenth Consultation

The fifteenth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the fourteenth consultation with Gabrielle, 18 March, 1966.

Thirteenth Consultation

The fourteenth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the thirteenth consultation with Gabrielle, 23 November, 1965, and one letter from her parents.

Tenth Consultation

The eleventh chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the tenth consultation with Gabrielle, 23 March, 1965, along with two letters from her mother.

Third Consultation

The fourth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the third consultation with Gabrielle, 10 April, 1964, and four letters from her mother.

Editor’s Foreword

The editor of The Piggle, Ishak Ramzy, describes his experience of meeting and working with Winnicott, and describes the history of the clinical notes on the Piggle.

Environment

In this chapter, Winnicott proposes that, in maturity, the environment is something individuals can contribute to and take responsibility for. Adolescents need the stability of the home and school environment against which to grow and rebel. Latency-age children need to be able to take a stable environment for granted and may suffer if home life breaks down. During pre-latency, children need a safe parental couple and home to work out the aspects of the triangular situation. Winnicott refers to many of the disturbances and disruptions of normal family life and their impact on the growing child, including the disturbing experiences of hospitalisation for small children. Emotional growth with an appropriate and sensitive mothering figure enables the child to adapt and become emotionally integrated. Very early narcissistic states and very early dependence—from which independence may follow—are also described. Regression to an earlier stage of dependence may occur during psychotherapy and may have a healing quality if the intense pain associated with dependence can be tolerated.

Withdrawal and Regression

In this chapter, Winnicott describes two different kinds of experience in the analytic setting: withdrawal and regression. Withdrawal is a protective procedure in which the patient holds a regressed part of the self and cares for it at the expense of external relationships. This situation may be cyclical and difficult to resolve. Regression, however, is a form of true healing for the self that may need this extended space in which to recover and acknowledge helplessness and dependence on the analyst and the setting before resuming more mature and independent responsibilities again. Trust, by the patient of the analyst, is a prerequisite of the regressive state, where the very earliest primary narcissistic phase of life may have to be safely recovered and where the analyst must be experienced as dependable.

Dwelling of Psyche in Body

In this chapter, Winnicott describes the dwelling of the psyche within the body as a process to be achieved. He describes a variety of body experiences and how body and psyche interrelate, and also how external factors impede or assist this relationship. The sources of paranoia are seen by Winnicott as an expectation of persecution by the psyche-soma partnership if things do not go well. In addition, a naïve dependence on all going exactly as needed by the self can lead to vulnerability. The normal position between such extremes depends on sufficient care for the growing self, eventually leading to self-care and independence.

Hypochondriacal Anxiety

In this chapter, Winnicott describes the development of ordinary doubt about the self into an extreme form and the struggle to manage the forces of ‘good’ and ‘evil’ within. Psychosomatic illness is the transferring of unmanageable fantasies into bodily states that then become all-controlling. The original fantasy sources of the difficulties then become unavailable for treatment without analytic intervention.

Development of the Theme of the Inner World

In this chapter, Winnicott addresses the child’s inner world, its paranoid form, its depressive form, and the use of the manic defences to deny inner deadness. He examines the capacity for persecutory or paranoid functioning and its losses for the psyche, the capacity for a depressive richness in the inner world while the depressive mood is held in moderation, and the deployment of manic denial to ward off loss and grief and remain dead inside.